NOVEL CORONAVIRUS (COVID-19) PANDEMIC AND AFRICA AN OVERVIEW

Benjamin Afrifa

Unquestionably, the world is dealing with a planetary disaster. The virulent force of COVID-19 pandemic continues unabated. The physical and psychological impact of COVID-19 has been heart-breaking with multiple deaths, acute hospitalizations and the economic impact that is yet to be assessed. The onslaught of the virus caught governments off-guard. The virological threat has exposed the hitherto fissures in public health systems worldwide. Many have been overwhelmed by the human and mental devastation the virus is leaving in its path. The massive scale and the sheer unpredictability make it challenging for governments to respond. In just a short period, governments instituted aggressive, unprecedented measures to protect their citizens and slow the spread of the pandemic. Many governments have relaxed longstanding laws to free up resources. Others have made massive investments in vaccine research. Health experts have predicted a longer recovery period before human and economic activity revert to some sense of normalcy.

COVID-19 and Africa’s Response

Many Africans are perversely relieved that COVID-19 did not originate on the continent. Nevertheless, Africa recorded a cumulative total of 25,832 and 1,242 deaths on April 22, 2020, the (www.afro.who.int/health; www.africanarguments.org). lowest for every region of the world. Experts are concerned that should Africa become the next epicenter of the pandemic, it could buckle the already impoverished regional public health systems. With just over 17 percent of the world’s population, Africa carries approximately 25 percent of the global burden of diseases. The immense disease burden and frail health systems are embedded in a broader context of poverty, underdevelopment, poor sanitation, inadequate water supply, poor and inadequate housing, conflict and weak or ill-managed government health institutions and programs.  Unfortunately, any continental containment and mitigating strategies, in the short- and long-term, could be hindered by these complex, interrelated development challenges.

The saying that “the kids without umbrellas must run faster than others in a heavy rain” aptly characterizes Africa’s respond to the virus; countries are bootstrapping their responses to the pandemic with limited testing; contact-tracing, travel restrictions and partial lockdowns. Ghana reportedly allocated $100 million for its aggressive containment and mitigation strategy andinaugurated the COVID-19 National Trust Fund. The Africa Centers of Disease Control (Africa CDC), which serves 31 of 54 countries linked up with the World Health Organization (WHO) and its regional counterparts in Europe, the United States of America and Asia for coordinated prevention protocols. Despite these unprecedented, aggressive measures, Africa has unique challenges as it responds to COVID-19 pandemic.

The crisis management experience of the leaders became tested and a few performed exceptionally well even while strapped for resources. Ghana’s Nana Addo-Dankwa Akuffo-Addo, Mackie Sall of Senegal, Cyril Ramaphosa of South Africa and Abiy Ahmed of Ethiopia gained recognition for their efforts. These leaders exemplified vital crisis response leadership qualities, deliberate calm – the ability to detach from fraught situation and think clearly about how to navigate the crisis and bounded optimism or confidence combined with realism. Early in the crisis these leaders earned credibility and adoration by displaying excessive confidence despite obviously difficult conditions.

The Realities and Challenges of COVID-19 Response in Africa

The fragile public health systems were partly caused by the neoliberal worldview encapsulated in the perceived failed IMF and World Bank’s Structural Adjustment Facilities (SAFs) imposed on African countries in the 1980s and the 1990s. The draconian budgetary cuts to health expenditures further undermined the already weakened capacities of hospitals, health departments, agencies, programs, etc. In short, the pandemic outbreak, its fallout, and the current challenges have laid bare the brokenness of neoliberalism. In the face of a global pandemic, the impact of such cuts is now painfully obvious and African countries are disastrously unprepared to respond.

First, epidemiologists unanimously agree that the single most important component of any national COVID-19 containment and mitigation plan is early and frequent mass testing, contact tracing and isolation of suspected cases. After reported weeks of inaction and downplaying the reality of the pandemic, testing is inadequate in many African countries due mainly due to inadequate testing supplies. The donation of test kits and related supplies from the Jack Ma Foundation and Alibaba Foundation to the Africa CDC for distribution to African countries helped to alleviate the testing challenge. Nevertheless, the testing situation remains a major challenge.

Second, many African countries lack medical equipment and related supplies to treat symptomatic COVID-19 patients. Ventilators are critical to treating potential respiratory failure of COVID-19 patients. For example, the Africa CDC estimated that the per capita for ventilators for Mali is 1:1 million people. Mali reportedly has about 20 ventilators for the entire population of 10 million. Kenya reportedly has 550 intensive care unit beds for its 50 million citizens. Ghana recently readied 200 intensive unit beds for potential symptomatic COVID-19 cases. Even South Africa, which is the most medically prepared country in African, has about 7,000 intensive-care unit beds and an estimated 3,000 ventilators for its 60 million people. Liberia reportedly has 3 ventilators in private hospitals for its 5 million citizens. Libya has closed 20 percent of hospitals. Its heath infrastructure has only 6% capacity providing health services for its 7.2 million people; mainly due to the protracted civil conflict that destroyed many hospitals. Tragically, the WHO reported that there is less than 5,000 ICU beds in 43 African countries, or 5 ICU beds per one million people while functional ventilators in public health systems in 41 African countries is less than 2,000. ((www.afro.who.int/health)

Third, the perennial shortage of healthcare personnel in Africa remains a challenge. According to a recent WHO estimate, the current workforce in Africa would need to be scaled up by at least 140% to attain international health development targets. The deficit is intense. There is simply not enough human capacity to absorb, deploy and efficiently use the substantial additional funds that are considered necessary to improve health in Africa. The ratio of healthcare workers to the population is the lowest worldwide. For instance, 46 out of 47 African countries have significantly less than 2.28 physicians or nurses per 1,000 people, which is widely regarded as the minimum threshold required to deliver basic health services. Given Africa’s nearly 24% of the world’s disease burden, 3% of its healthcare workforce and 1% of its financial resources for healthcare, Africa is starring into an abyss with the onslaught of COVID-19 outbreak.

Fourth, implementing social distancing measures has been difficult. Epidemiologists state that in the absence of diagnostic testing supplies, the next logical measure to contain COVID-19 spread is social distancing. However, due to poor and crowded housing in urban centers in major African cities and rural areas, authorities are facing difficulties enforcing social distancing orders and lockdowns. For instance, with the highest African COVID-19 cases of 1.5 million, South Africa is facing challenges in enforcing social distancing orders due to crowded conditions in townships such as Kroo Bay (Freetown, Sierra Leone); Kibera, Makuru Kwa, Mathare, Korogocho, Kiambiu, Kangemi (Niarobi, Kenya); Ezbet-el-Haggana (Cairo, Egypt); Alexandra (Guateng, South Africa); Kayelitsha (Cape Town, South Africa); Soweto (Johannesburg, South Africa); Nima, Agbogbloshie, Fadama, Jamestown (Accra, Ghana); Cazenga (Luanda, Angola); Ajegunle, Shomolu, Makoko (Lagos, Nigeria); Kennedy Road (Durban, South Africa); Clara Town, West Point (Monrovia, Liberia), etc. (www.africarankings.com).  

However, the counterargument is that the coping mechanisms of Africans have been sharpened over the years as the continent has handled past epidemics, pandemics, coup d’etats, civil wars, famine, post-election violence, etc. Thus, African countries have a lot to teach the world about how to survive global threats.

Africa’s Exceptionalism

Despite these challenges, Africa, nevertheless, has certain comparative advantages:

First, United Nations estimates that the continent has an average age of 20 years old, making Africa the youngest continent. It’s been observed that children and young adults rarely get infected with COVID-19 relative to older people, or those with weak or compromised immune systems.  Comparatively, the median age in Italy is 47 years, 37 years in China and 38 years in the United States. However, Dr. Tedros Adhanam Ghebreyesus, the Director-General of the World Health Organization (WHO), at the recent G20 Summit on COVID-19 in Saudi Arabia, warned young people in a tweet that “they are not invincible. The virus could put you in hospital for weeks, or even kill you.”

Second, in a study on climate and COVID-19, the authors found that warmer weather and areas with higher humidity levels have positive impact in reducing the exponential spread of COVID-19. However, Dr. Nkengasong, Director of Africa CDC, debunked this assertion by stating that there are outbreaks of COVID-19 countries in the tropics like Thailand.

Third, Africa has approximately 24 percent of global disease burden. As a result, the continent unfortunately has the dubious experience in fighting deadly infectious diseases such as SARS and Ebola. The experience in responding to past infectious disease outbreaks may have provided legacy knowledge and experience that may prove beneficial in fighting COVID-19.

Lastly, a recent study to examine the efficacy of the Bacillus Calmette-Guerin (BCG) vaccine as treatment for COVID-19 infection, a group of U.S. biomedical scientists tested the hypothesis that the incidence of COVID-19 is less severe in countries that have universal and long-standing national policies on BCG vaccination than countries without BCG policies. The BCG administration was adopted to inoculate babies against tuberculosis infection. In the unpublished study, the researchers found that countries, such as the Netherlands, Italy and the United States, without universal policies of BCG vaccination have been severely affected compared to countries with universal and long-standing BCG policies such as African countries. This may be considered advantageous for African countries as they respond to the pandemic.

Africa’s in Global Response Efforts to COVID-19 In an extremely illuminating interview, the Ethiopian Prime Minister, Dr. Abiy Ahmed opined that “there is a major flaw in the global strategy to dealing with the novel coronavirus pandemic. While the advanced economies have launched a panoply of unprecedented responses, including economic relief to their citizens, all efforts would be unsustainable and counterproductive if global efforts ignore the effect of the pandemic in Africa. Obviously, as the United States, Italy, Germany, France and the United Kingdom and other advanced economies continue to grapple with COVID-19, Africa has so far been left out to fight the outbreak alone. Given the effects of globalization and its impact, any momentary victory by the advanced economies in

controlling the virus at the national levels, coupled with travel bans and border closures, may give a semblance of accomplishment. However, in our connected and globalized world, any effort to tackle the pandemic must be global in scope. The G-20 and WHO must provide collective leadership for a coordinated global response. The launching of, for instance, the COVID-19 Relief Fund by the World Bank and the IMF, is appropriate and will help prevent the collapse of health systems and economies in Africa. The U.S. leadership is required to resuscitate the defunded Global Health Security Agenda (GHSA) established in 2014. The GHSA was built to enhance national capacities to prevent, detect, and respond to infectious disease threats (whether from an accidental, natural, or intentional causes). Over 30 countries, along with international organizations including the World Health Organization (WHO) joined the effort. The need for such a global initiative to combat infectious disease is painfully obvious today, with COVID-19. Hopefully, the United States will assert a leadership position and revive the GHSA to prepare for a global response to future pandemics.

This is an unprecedented and difficult time that will test Africans. When we do get through it, maybe like past infectious disease outbreaks such as influenza, HIV/AIDS, ZIKA, MERS, malaria and recently, Ebola, it will cause us to reexamine what has caused and continues to cause differential treatment of certain countries and regions of the world as well as the fractional division we have in our countries. The virus is an equal opportunity infector.  It would be better if we saw ourselves that way: much more alike than different.

In an op-ed in AfricanArguments, former presidents Olusegun Obasanjo of Nigeria and Ellen Johnson-Sirleaf or Liberia and Jonathan Oppenheimer of The Brenthurst Foundation noted that “we might be experiencing a temporary discontinuation of global integration, prompting us to think carefully about the world we live in and how we limit the spread of negative shocks. The virus may have disrupted global supply chains, prompted (temporary) border closures, and led some to question aspects of globalization. But the crisis demonstrates the limits of isolated national responses; its resolution will demand unprecedented levels of international scientific and other collaboration. Putting people, not politics, first will ensure the conditions for continued prosperity post-COVID-19.”

The Way Forward

Even though Africa is facing a daunting challenge, the current pandemic presents an opportunity for African governments to make system-wide short-term and long-term investments to reform the public health systems with the goal of improving the living standards and quality of life of all citizens. Dominic Muntanga, a Zimbabwean friend recently put it aptly, COVID-19 has “not only exposed our vulnerability that had hitherto been concealed by propaganda-induced belief that we are ready and have everything under control. … [Zororo’s death] shook everyone out of the denial that COVID-19 is a real threat and not just God’s punishment. At the end of this ordeal, we will all know a lot about ourselves as a country, especially the inefficiencies and inequities in our health system. …it will also provide a deep reflection on what kind of nation we want to be. I hope it becomes a turning point for Zimbabwe. Though we face a serious challenge, we have a unique opportunity to use this time to build a better nation, starting with our individual selves. If we take that challenge, we can emerge from this pandemic as a stronger nation.” This sentiment expressed by Dominic Muntanga is shared by many Africans and non-Africans.     

When Africa emerges from the COVID-19 pandemic, it should be with a reformed public health system that is prepared for future pandemics. The requires investments in African health systems in the form of a Marshall Plan for Healthcare in areas such as i) investment in data-science tools to track infectious disease spread and predict the direction of pandemic’ ii) providing funding for frontline medical supplies, hospitals and community health centers; iii) expanding health care workers’ access to the tools they need, including respirator masks; iv) providing funding to expand laboratory capacity and response efforts to develop vaccines, treatments and diagnostics to bolster stockpile supplies and conduct pandemic forecasting; developing a home health diagnostic monitoring app for infectious diseases; v) providing funding for comprehensive field testing systems, and vi) ensuring continued access to critical medications and the avoidance of supply-chain disruptions.

It should be noted that African health systems will not look normal until three things happen. First, the need to figure out whether the distribution of COVID-19 looks like an iceberg. If we’re only seeing one-seventh of the actual disease because we’re not testing enough, we will be in a world of hurt. Second, the need for a treatment that works, a vaccine or antiviral. And third, maybe most important, the need to see large numbers of frontline personnel such as nurses, doctors, policemen, firemen, and teachers who have had the disease are immune. We must have them tested to know they are no longer infectious. There should also be a system that identifies them; either a concert wristband or a card with their photograph and stamp on it. Once that occurs, parents can be comfortable sending their children back to school, because parents would know the teacher is not infectious. I don’t want to pretend that going through this exercise will lead directly to this improved situation. But it will hopefully prepare Africa to face future pandemics.

Conclusion

Undeniably, the public health sectors of a post COVID-19 Africa will not be the same. As a result of this COVID-19 crisis and our collective response to it, we might be seeing what healthcare can look like once this crisis has passed. It will leave providers and health care consumers with different ideas of what are possible in a transformed and consumer-centric healthcare industry. Simply, and at great risk of sensationalizing the milestone, the end of the COVID-19 coronavirus crisis would mark the beginning of a new day in African healthcare.

Today, despite the temptation to hunker down and isolate, we need to continue to reform and push for openness and competitiveness. We must act locally, but we need to keep thinking globally. This moment challenges all of us. We will do everything possible to ensure that the private sector and government collaborate and cooperate on behalf of the African people.

The author, Benjamin Afrifa (PhD) writes from New York