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Urgent investments for an effective response to COVID-19 in Africa

By Abiodun Awosusi
on March 25, 2020

The World Health Organization (WHO) declared COVID-19 a pandemic on March 11. The novel coronavirus (SARS-CoV-2) has now spread to more than 170 countries and regions with over 400,000 confirmed COVID-19 cases and more than 19,000 deaths. Over 100,000 people have so far recovered. Although Europe is the current  epicenter of the pandemic with potential escalation in the United States, there is now also a rapid increase in the number of cases in Africa.  I believe African leaders and public health agencies have a narrow window of opportunity for an effective response to COVID-19 hinged on trust and timely investments. In this piece, I propose three ways.

In an October 2019 article, I recommended urgent investments in health security particularly for the Africa Centers for Disease Control and Prevention and National Public Health Institutes (NPHI). With a decade of experience in clinical medicine and global health including use of epidemiological and economic modelling tools in resource-limited settings, I believe it is time to rapidly scale up the response at subnational, national and continental levels, leveraging useful lessons from other countries particularly China, Singapore and South Korea.

Africa is not alone in the fight against COVID-19. There is a growing global response to the pandemic. The Coalition for Epidemic Preparedness Innovations (CEPI) is leading the development of vaccines while the Bill and Melinda Gates Foundation, Wellcome and Mastercard have launched a Therapeutics Accelerator. The Rockefeller Foundation, Jack Ma Foundation and Bloomberg Philanthropies have announced key investments to support response efforts in low- and middle-income countries. The World Bank Group and the International Monetary Fund are deploying an array of financial instruments to support countries, businesses, and health systems in need. As it could take several months before treatments and vaccines become widely available, we must approach our response with a sense of urgency, solidarity and calmness.

Smooth implementation of public health measures and deployment of economic and financial tools hinges on trust. Trust is key to prevention, containment and mitigation of COVID-19 spread particularly in fragile contexts. Trust is crucial for citizens’ compliance with government directives and productive public- private partnerships to combat the virus. It is also required for regional and global cooperation for an effective response as we implement these urgent priorities.

Scale up institutional response and financing

The Africa Centers for Disease Control and Prevention (Africa CDC) responded early to the outbreak with the formation of the Africa Task Force for Coronavirus and activation of the emergency operations centre. In collaboration with WHO, it has trained staff from over 40 countries on coronavirus surveillance, case management, infection prevention and control (IPC), and risk communication to curtail the spread of the virus on the continent.  The institution also continues to adapt emerging lessons from other countries that have contained the virus to the African context. Various NPHI have also activated their emergency operation centres.

Although it is hard to predict the full trajectory of COVID-19 in Africa, scaling up current response and coordination efforts with the African Union, WHO and partners (domestic and international) will be crucial in ensuring countries have adequate resources, medical supplies and equipment to limit the spread of the virus across the continent. The United Nations Economic Commission for Africa estimates an effective response to COVID-19 requires up to $10.6 billion in health spending alone. African leaders need to urgently devote ample resources for the national and continental response efforts alongside fiscal and monetary measures.  Debt relief is also an important intervention in the current circumstances. Investing now will save lives and livelihoods and limit the socioeconomic impact of the outbreak. While the emergency funding is crucial to manage this crisis, we must also begin to explore financing sources for future outbreaks including (but not limited to) pooled funding, earmarked taxes for epidemic preparedness and epidemic risk insurance.

Engage communities on relevant channels  

Open, transparent and consistent communication is key to building trust. This harnesses apt understanding of appropriate communication channels and messaging tools to provide accurate information. Radio is the principal information channel in Africa: more than 80% of households have radio sets. WhatsApp is the most popular messaging platform among internet users on the continent. Curtailing the coronavirus outbreak requires targeted messaging in local languages through traditional and contemporary channels. This will also require effective engagement with trusted informal institutions, mainly religious, traditional and community leaders to facilitate information dissemination and compliance with government directives. Effective mobilization also includes entertainment stars and celebrities who can be channels of information to the populace.

Although the continent is rapidly urbanizing, 60% of the population in sub-Saharan Africa still live in rural areas with limited access to the internet and social media. In densely populated urban areas which could be hotspots for virus transmission, many households live in informal settlements or slums. Leaders and response teams must deliver context-specific messages to promote good hygiene practices, social distancing and compliance with other recommended public health measures across all communities via radio, TV stations and social media. Measures must be taken to quickly dispel rumors and misinformation. Ongoing mobilization will lay the foundation for community system strengthening – a key pillar for reduction of disease burden and improvement in wellbeing.

Intensify testing and invest in healthcare infrastructure  

The 2014/16 Ebola epidemic in West Africa underscored the immense value of building strong health systems to save lives, reduce disease burden and limit socioeconomic damage caused by disease outbreaks. The ongoing coronavirus pandemic shows that a strong but complacent health system is as vulnerable as a weak health system. As the outbreak evolves, urgent health system investments require multi-stakeholder collaboration platforms and tools with full participation of public, private and philanthropic partners as well as citizens. These investments pale in comparison to the health and socioeconomic costs of the pandemic if urgent action is not taken now.

While NPHIs coordinate the response through emergency operation centres, there is a need to intensify testing to identify cases, clusters and hotspots as well as speed up contact tracing and social distancing to limit transmission of the virus. We must protect and support frontline health workers – potentially with a volunteers corps – as cases present at health facilities. Continuous, equitable access to diagnostics, medical supplies and equipment is crucial. Local production should be encouraged and accelerated where it is possible. Technology-enabled supply chain enterprises can support the public health response in efficient distribution of medical supplies. Accredited telehealth providers can help ease the surge of enquiries on public health agencies. The spatial mapping of public health facilities in 50 African countries and islands with any complementary mapping of private facilities is useful to support national and continental planning and potential investment in additional hospital infrastructure and isolation centres. We need all hands on deck to win this battle against COVID-19.

African leaders must be ready to take bold data-driven, context-specific decisions to halt the transmission of the virus and flatten the curve – with useful lessons from Asian countries. The support of the international community at this crucial moment is vital. The WHO Regional Director for Africa, Dr. Matshidiso Moeti, said “we can still change the course of this pandemic. Governments must draw on ALL of their resources and capabilities and strengthen their response.’’ A trust-based whole-of-society, continent-wide response to COVID-19 will save lives and livelihoods, boost citizens’ confidence in national and international institutions, and build a solid foundation for recovery and continental integration. There is no time to waste.

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Paul Okediji says:

This is very insightful. Community engagement is one of the key interventions required across many of the LMICs in sub-Saharan Africa. The need to ensure community awareness of simple disease prevention habits has never been more important.

Also, while EOCs have become crucial in the response against the COVID-19 pandemic, there is a need to also ensure that we don’t remain in the emergency mode. Governments and private sector organizations need to work synergistically together to strengthen the health system and avoid building parallel systems that are unsustainable.

Oluwafemi Akinwunmi says:

Really nice pan-African approach to Covid-19 pandemic. It is time to prepare for the next outbreak!

Femi Adebola says:

Brilliant piece! The continent still battles with data issues. There is a need for African leaders to urgently invest in data infrastructure and fix data quality, if we must progress.