Despite African countries being wholly unprepared for the Covid-19 pandemic, their swift, early and innovative responses meant they were able to ward off an initial rapid spread of the virus. This is according to a new study of Covid-19 responses in South Africa, Egypt, Ethiopia, Nigeria and Kenya conducted by Columbia University’s Institute for Social and Economic Research and Policy.
Nonetheless, the study found that the resulting economic hardship and impending waves of infection mean the countries will have to re-strategise constantly and swiftly — even with a vaccine in hand. To contribute to this undertaking, the university has launched an initiative which will take innovations which worked in one African country and tailor it to suit another’s needs. In addition, it is on a mission to develop “new ways of solving big problems” — immediately.
The study and initiative — the African Pandemic Response Innovation Working Group — are both led by Dr Wilmot James. He is a senior research scholar and interim chair of the Center for Pandemic Research at the Institute for Social and Economic Research and Policy. He served as a Member of Parliament in South Africa between 2009 and 2017.
The study paints a picture of how five of Africa’s biggest economic and cultural hubs have responded to Covid-19 in the first year of the pandemic and how it should change strategy to strike a balance between protecting health as well as the economy.
The study states that Africa was expected to “become the next epicentre of the disease” because of its public health vulnerabilities — yet, a year into the pandemic, it still has the world’s lowest rate of Covid-19 infection. In March 2020, an Imperial College Covid-19 Response Team report concluded that Africa would see more than 1 billion infections and 2.4 million deaths.
At present, the continent contributes just 3% of global cases, according to the study. Its population makes up 17% of the world’s total. While testing capacity is woefully inadequate, test positivity rates and test per case ratios imply that the virus is not as widespread among African states.
Why might this be?
The study argues that quick and pre-emptive public health responses in all five countries were key to slowing transmission and lessening the burden on the continent’s healthcare systems. It says that a contributing factor to this was that public health leaders in all five countries knew the weak state of their healthcare systems. All five states had been evaluated as unprepared to handle a health emergency. None had systems specifically designed to deal with a pandemic. In 2019, the World Health Organisation deemed all five to have a weak ability to rapidly respond and communicate risk when faced with a disease outbreak. At least two other evaluations had found the same.
“With no ready-purposed pandemic response machinery at hand, countries created new structures and instruments as the need arose,” write the study’s authors.
Aided by existing public trust and leadership, all five countries implemented stringent measures before Covid-19 had even arrived within their borders. They ordered people to stay at home, closed borders and encouraged mask-wearing, washing of hands and physical distancing. The Partnership for Evidence-Based Covid-19 Response found that support for and adherence to these measures were relatively high in all five states studied.
They established advisory committees, such as South Africa’s Ministerial Advisory Committee on Covid-19, and launched information campaigns even before the virus arrived within their borders. Kenya, Nigeria and South Africa set up direct communications systems with frontline health workers.
The study argues that: “In contrast to many other countries and regions battling Covid-19, Africa has adopted a multilateral approach to pandemic response”.
Led by the African Union’s Africa Centres for Disease Control and Prevention, the continent was able to pool resources and expertise to scale up testing, contact tracing, surveillance and infection control in health facilities. Within the first two months, the continent went from two laboratories equipped to test for Covid-19 to having testing capacity in all 55 states. In addition, a host of new pandemic financial facilities have been established to help African countries in particular in the future.
Nevertheless, all five have suffered severe economic costs as a result of these interventions and still saw major outbreaks of the disease. The continent is expected to go into recession for the first time in 25 years after its economy contracted an estimated 3.4% or 5.2% in 2020.
The study points out that South Africa’s lockdown was more severe and longer than the four other countries studied. In addition, business confidence has not begun to recover in South Africa as in its four counterparts. International borrowing and financial aid had an immediately positive impact on Kenya and Ethiopia. However, this impact is less evident in South Africa, Egypt and Nigeria. All five have focused on helping small and medium and micro enterprises, providing stimulus packages and cutting interest rates.
The pandemic exacerbated pre-existing challenges in the healthcare system, such as healthcare worker shortages. Frontline workers, in particular, were at elevated risk because of a severe lack of personal protective equipment. Because of a lack of trust in government, it was left to the health workers to disseminate correct information about Covid-19 to citizens, the study argues. Ethiopia, South Africa, Kenya and Nigeria relied on established networks of thousands of community healthcare workers to communicate the threat of Covid-19. Essential health services were disrupted as clinics closed and medicines stocked out.
The study found that despite initial success, these issues have weakened the countries’ ability to respond to future outbreaks. The study points out that the pandemic continues to evolve on the continent and that constant restrategising is needed to take into account these strengths, weaknesses and new innovations. The roll-out of vaccines is still to come and economic recovery a long way off. Governance and systems will need to be rehabilitated and regional integration patched up.
This is where the African Pandemic Response Innovation Working Group comes in.
James explains that while doing the study, they encountered a number of innovations developed on the spot with limited resources in Ethiopia, Egypt, Nigeria, Kenya and South Africa.
“We want to harvest those systematically for applications and develop best practice elsewhere,” he explains. “We want to identify those innovations, harvest them and then replicate them across the continent. Then we want to cultivate new, genuinely new, ways of solving big problems. The focus is on innovation — it’s not a pure university effort at all. It’s to use the knowledge that’s generated to solve some real-world problems around pandemic response.”
The pandemic requires that research be done swiftly. “This is not a once-off affair,” explains James.
“So, we see we are in the middle of the second wave and we have vaccines coming. That will change the response requirements. It’s very clear that no country can afford to have a full lockdown and with testing you can have targeted lockdowns that are regional and local. And with the vaccine, the strategy has to change again.
“So, you have to be really smart and quick with this thing which means you need quick turn-around times in research and quick interventions. The pandemic is not going to wait for anybody. There’s a real need for being swift, rapid and fleet-footed in terms of the research and interventions and those things will really turn around until there’s herd immunity.”
The Working Group will focus on three key areas of intervention at a regional level — technology, systems reforms and “brain power”.
The challenges African countries face are upscaling testing and making sure vaccine acquisition and distribution is tailored to the need, explains James. “There are some logistical problems with vaccines — getting the vaccine to the right places is one thing, then vaccinating the population is another thing. Those all require solutions. That’s what we’re looking at in terms of the challenge looking ahead. The task that we have is to solve some of those problems and contribute it.”
Another example is to create an “infrastructure backbone” to generate the data needed for proper surveillance of disease. James explains that South Africa is the only African country to calculate the number of excess deaths linked to Covid-19: “We want to solve that problem. It sounds quite simple, but it’s actually quite difficult to do when it comes to data to support public health interventions for pandemic response.”
So far, the Working Group has partnered with Schmidt Futures and Resolve to Save Lives. Schmidt Futures is a philanthropic initiative founded by former CEO of Google Eric Schmidt to provide financial support for projects with a “public purpose”. Resolve to Save Lives provides funding to support health initiatives around the world.
The group is looking to partner with African institutions across the continent before it launches in a few months’ time. “Our interventions are African, principally, and we clearly want to work with people on the ground… There’s a lot of expertise in Africa. There are pockets of excellence everywhere and we’d really like to draw on that and build on it,” he says. The group will also foster links with regional branches of the Africa CDC as well as governments.
The work on setting up this global group starts now, with the aim of getting up and running within a few months, says James. “I feel privileged to be able to do this, from the basis of where I sit. Also to work very closely with my colleagues, particularly my South African colleagues, in taking this forward and it’s very exciting. We have some real, massive problems to solve in terms of the pandemic so that’s really the value of what it is that we are trying to do.” DM/MC
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