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.
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. 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.
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.
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.
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.”