Containment

Africa's United Front

Galvanized by experience of past diseases, Africa’s leaders acted swiftly to contain the spread of Covid-19. There are lessons for the rest of the world.

The Pasteur Institute in Dakar in Senegal has been designated by the African Union as one of the two reference centres on the continent for the detection of Covid-19.Seyllou/AFP via Getty Images

As Covid-19 spread from Chi­na to Asia and into Europe, it pro­vid­ed Africa with the one thing they need­ed most – time. The first case to be report­ed on the con­ti­nent was in Egypt on Feb­ru­ary 14, and it sparked an instant polit­i­cal response. Just one week lat­er all Africa’s health min­is­ters had gath­ered to coor­di­nate their actions, lead­ing to the launch of the Africa Joint Con­ti­nen­tal Strat­e­gy for Covid-19. Tough­ened by the expe­ri­ence of deal­ing with dis­eases such as Ebo­la, Las­sa fever, TB and HIV AIDS, the min­is­ters need­ed no con­vinc­ing of the need to act. Coun­tries with zero cas­es began enhanced sur­veil­lance, bor­der checks and lock­downs.

The Africa Centres for Disease Control and Prevention (ACDC), established in 2017 in the wake of the Ebola outbreak, launched the pan- Africa response, anchored around the four Cs: cooperation, coordination, collaboration and communication.

The Africa Cen­tres for Dis­ease Con­trol and Pre­ven­tion (ACDC), estab­lished in 2017 in the wake of the Ebo­la out­break, launched the pan- Africa response, anchored around the four Cs: coop­er­a­tion, coor­di­na­tion, col­lab­o­ra­tion and com­mu­ni­ca­tion. Com­mu­ni­ty work­ers were quick­ly mar­shalled to go into rur­al com­mu­ni­ties and unplanned urban set­tle­ments to look for pos­si­ble cas­es and iso­late them. “We get local peo­ple who have been well-trained and know their area and can get to those who are real­ly vul­ner­a­ble,” says Dr. Ahmed Ogwell Ouma, deputy direc­tor of the ACDC. “We are try­ing to pro­tect not just the old and the ones with comor­bid­i­ty but also chil­dren, par­tic­u­lar­ly under five, who in Africa are vul­ner­a­ble due to weak­ened immune sys­tems.”

ACT HARD AND FAST

Africa has sev­er­al points in its favor that have bought the con­ti­nent time. Most trav­el is rel­a­tive­ly local, espe­cial­ly south of the Sahara. Dis­ease spread through inter­na­tion­al trav­el nodes has large­ly been avoid­ed. Around 60 per­cent of the continent’s pop­u­la­tion lives in rel­a­tive­ly iso­lat­ed rur­al com­mu­ni­ties, and the medi­an age across Africa is just 20. Like else­where, it is antic­i­pat­ed the young will be more resilient. Final­ly, unlike Europe, dis­ease con­tain­ment is noth­ing new in Africa, which means cit­i­zens under­stand the need to shut down hard and fast. By the first week of May, ACDC fig­ures showed 50,000 cas­es and 1,800 deaths across the con­ti­nent.


Testing for Covid-19

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"When Covid-19 was first reported in China there were no laboratories able to test for it in Africa. Just three months later, 52 countries were able to carry out tests across many, many laboratories in each and every country." – Dr. Ahmed Ogwell Ouma

Dr. Ouma acknowl­edges that Africa’s response suf­fers wor­ry­ing vul­ner­a­bil­i­ties. “We are very can­did about them, espe­cial­ly to our­selves because if we do not address them, we are in trou­ble,” he says. Africa’s health­care sys­tems are not equipped to deal with the acute symp­toms of Covid-19. With no local capac­i­ty, sourc­ing ven­ti­la­tors and test­ing equip­ment on the world mar­ket has been a chal­lenge. The ACDC is set­ting and mon­i­tor­ing qual­i­ty stan­dards for domes­ti­cal­ly pro­duced PPE equip­ment while also nego­ti­at­ing with over­seas sources. Anoth­er chal­lenge has been build­ing clin­i­cal exper­tise when med­ical experts are restrict­ed to online train­ing rather than face-to-face tuition. Lab­o­ra­to­ry test­ing is one area where Africa has wit­nessed remark­able suc­cess. “When Covid-19 was first report­ed in Chi­na there were no lab­o­ra­to­ries able to test for it in Africa. Just three months lat­er, 52 coun­tries were able to car­ry out tests across many, many lab­o­ra­to­ries in each and every coun­try. From zero to 52 in three months is impres­sive,” says Dr. Ouma. Respons­es across Africa have not always been con­sis­tent.

Disease containment is nothing new in Africa, which means citizens understand the need to shut down hard and fast.

South Africa saw ear­ly suc­cess with con­tain­ment. With its dense­ly pop­u­lat­ed town­ships and cities, it drew on its past expe­ri­ence with tuber­cu­lo­sis and HIV to com­bat the virus. It used its army of 28,000 com­mu­ni­ty work­ers to imple­ment mass screen­ing by call­ing on cit­i­zens to present them­selves for test­ing and then trac­ing their con­tacts. It also imple­ment­ed one of the tough­est lock­downs glob­al­ly before it had reg­is­tered a sin­gle case. Kenya closed its bars and clubs when it had only 50 cas­es, while Ugan­da was sim­i­lar­ly quick off the mark. Tan­za­nia, on the oth­er hand, has had less suc­cess and ques­tions are being asked about the effi­ca­cy of its ear­ly response. Unlike most oth­er African states, it failed to imple­ment ear­ly con­trols.

We have learned to never waste an outbreak. We picked up big lessons from Ebola and now Covid-19 and we are going to package them together, so we are even better prepared for the next outbreak.

Dr. Ahmed Ogwell Ouma
Deputy director of the ACDC

COMMUNICATION IS ESSENTIAL

Africa has learned from Ebo­la that risk com­mu­ni­ca­tion is crit­i­cal to the pan­dem­ic response. In Ghana, for exam­ple, health min­is­ters feared that any­one suf­fer­ing Covid-19 symp­toms would be reluc­tant to present to health work­ers for quar­an­tine, as iso­la­tion cen­ters were asso­ci­at­ed with death dur­ing the Ebo­la out­break. “We need­ed to com­mu­ni­cate right from the begin­ning the rea­sons we are doing quar­an­tine and iso­la­tion, so peo­ple were not afraid,” says Pro­fes­sor Kojo Ansah Koram, epi­demi­ol­o­gist and for­mer direc­tor of the Noguchi Memo­r­i­al Research Insti­tute in Ghana. “We got those iso­lat­ed very ear­ly on to come to a min­istry press con­fer­ence to explain the rea­sons why they went in, telling peo­ple ‘I had symp­toms and they took care of me and I am back and recov­ered’.” While Covid-19 always posed an extreme threat to African states with weak­ened pri­ma­ry care sys­tems, their expe­ri­ence with past dis­eases and their approach to pan- nation­al coop­er­a­tion meant they launched a remark­ably effec­tive ear­ly con­tain­ment of the virus. “We have learned to nev­er waste an out­break,” says Dr. Ouma. “We picked up big lessons from Ebo­la and now Covid-19 and we are going to pack­age them togeth­er, so we are even bet­ter pre­pared for the next out­break.”

CALL TO IMPACT
1 When it comes to the availability of medical and protective equipment in a pandemic, often each country has to fend for itself. Local production is key to protecting citizens when global procurement networks become unreliable. 2 The public's fear has to be harnessed in the correct way. Citizens should be scared enough to take precautions, but not feel any hesitation about coming forward if they exhibit symptoms. 3 Lessons from previous outbreaks, speed and pannational cooperation to achieve effective early containment of the virus are key to winning the fight against the Covid-19 pandemic.
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