In addressing the threat of a highly contagious respiratory virus like SARS-CoV-2, there are basic approaches that can slow the spread of the pandemic and eventually end it. This includes testing, quarantining, physical distancing, avoiding large crowds, wearing masks and, when available, widespread uptake of safe and effective vaccines.
Great wealth does not ensure that a nation will successfully implement these strategies.
The United States, the richest nation in the world, has failed to adequately respond to the pandemic, and in doing so has one of the highest Covid-19 death rates in the world – 540 deaths per million people – with total deaths currently standing at 181,000 people. This figure accounts for over 20% of all Covid-19 deaths worldwide.
Contrast the American experience to other countries: South Africa stands at 214 deaths per million people; Norway at 49; New Zealand at 4; and Rwanda at 0.8 deaths per million. What explains the difference?
Francis Fukuyama in Foreign Affairs (July/August 2020) identifies three factors responsible for success: state capacity, social trust, and leadership. He wrote that, “Countries with all three – a competent state apparatus, a government that citizens trust and listen to, and effective leaders – have performed impressively, limiting the damage they have suffered.”
Regime type – whether autocratic or democratic – does not seem to matter, at least not with respect to mounting a successful pandemic response.
Africa came late to Covid-19. In the words of the director of the Africa Centres for Disease Control and Prevention (Africa CDC), John Nkengasong, it was “a delayed pandemic”.
Many feared a looming catastrophe. The World Health Organisation (WHO) Joint External Evaluation (JEE) and the Global Health Security Index (2019) gave Africa’s 54 countries low scores on average for disease detection as well as preparedness and response, notwithstanding some considerable pockets of excellence developed in response to previous outbreaks like HIV and Ebola.
A delayed arrival of Covid-19 gave African governments time to learn from the mistakes of countries with earlier outbreaks. Supported by the WHO and Africa CDC, and fearing their health systems would be overwhelmed, leaders in countries like South Africa mobilised and scaled up fast with universal lockdowns and travel bans to slow the pandemic. Many other countries – not all – emulated South Africa’s response.
That was, of course, just the start. Lockdowns are hard to sustain. What must follow is trusted leaders encouraging citizen engagement in best personal practices; maintaining social distancing, avoiding crowds and adhering to masking, particularly in the vast informal settlements associated with Africa’s cities.
Testing, tracing and isolation tools were introduced, led also by South Africa, which has approximately 652,700 cases out of Africa’s 1.2 million, the latter figure likely a substantial underestimate.
The WHO recommends that the positive test rate be below 10% for testing capacities to be considered sufficient, according to recent reports from Africa CDC and the WHO – yet few AU countries can meet this threshold. The results of local and national testing programmes are critical gauges of the state of the pandemic, and inform leaders and the public as to whether they can relax control measures or whether they need to redouble their efforts.
The ultimate control of the pandemic likely rests with the development and widespread use of safe and effective vaccines. There are several promising vaccines on the horizon. It is critical that Africa begins planning for and building the infrastructure needed for the distribution and administration of the vaccines. Delays will result in countless unnecessary deaths.
What needs to be done? There must be more focus on best practices to:
Build stronger local leadership; drive up community commitment to social distancing; ensure masking and other measures are under personal control; communicate better and build trust; scale up testing, tracing and isolation; prepare for access to vaccines and distribution systems.
Africa must scale up, be bolder and do better. This is vital if we are to ensure every African has access to any future Covid-19 vaccines. DM
Lawrence R Stanberry is Associate Dean for International Programs at the Vagelos College of Physicians and Surgeons, Columbia University.
Wilmot G James is a Senior Research Scholar at the Center for Pandemic Research, Columbia University.
To register for the symposium click on the following link: Meeting the Challenge of COVID-19 in Africa
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