The ongoing global COVID-19 outbreak has revealed how strikingly unprepared the world is for a pandemic. A governance crisis is unfolding alongside the pandemic as health officials around the world compete for access to scarce medical supplies. As the governments of African countries seek to avoid catastrophic outcomes, we point to a recent Lancet analysis by a prominent team of global health policy experts from the O’Neill Institute, Chatham House and other institutions.
As of the beginning of May, Africa had recorded over 52,000 COVID-19 cases with more than 2,000 deaths. Although this appears to be small relative to the global burden, the sad truth is that it is the tip of the iceberg. This is because of the low testing capacity of most African countries. According to the Africa Center for Disease Control, testing capacity ranges from 10 tests per 100,000 people in Ethiopia to 280 per 100,000 in South Africa. These pale in comparison to the rate of testing in Western countries such as the United States, New Zealand and even Lithuania.
With nationalism rising in the face of COVID-19, Africa is being relegated to the sidelines in acquiring much-needed diagnostics, as countries with the technology have restricted exports and preferentially sell to wealthier buyers. This is a recurrent malady. During the AIDS pandemic, lifesaving diagnostics and drugs got to many African countries only long after they were available in Europe and North America.
The generous donation of test kits and personal protective equipment by the Jack Ma Foundation to all 54 African countries has given a boost to national efforts at COVID-19 control. But given the limited availability of polymerase chain reaction (PCR)–based testing, the anticipated development of a $1 test kit by Senegalese researchers and their partners in the United Kingdom is quite commendable. This may just be what Africa needs in its race to scale up testing. Such tests, however, may have reliability concerns. Before they become widely accepted, validation by the World Health Organization (WHO) or Africa CDC is necessary.
African countries may also need to adopt the use of drones for faster transport of COVID-19 samples, as recently demonstrated in Ghana.
Beyond limited testing, the bigger problem is the fact that health care facilities currently have grossly inadequate capability to cater for the anticipated number of cases. The poor state of isolation facilities in several African countries discourages symptomatic patients from accessing care. Because of our communal lifestyle, the home-based care reportedly effective in parts of Italy may be useful in rural African communities.
Much has been said about the need to increase the number of ventilators and intensive care beds as part of efforts to cope with the complications of COVID-19. There has always been a critical shortage of intensive care staff and facilities in sub-Saharan Africa. As efforts are made to expand capacity where possible, it should be realized that manpower availability is also essential as the equipment do not self-operate.
In the wake of surging global demand for personal protective equipment, widespread shortages have been reported. African countries need to find innovative local technology to manufacture face masks, shields, gloves, gowns, etc. South Africa, Kenya, Zimbabwe and Morocco are leading the way in this regard.
While measures such as social distancing, frequent handwashing, and self-isolation are proven control measures worldwide, they work best for those in the upper and middle classes of African society. Those with fewer resources often cannot maintain safe physical distancing in crowded households. Nor can they wash frequently without access to running water. Creative solutions like the “Veronica bucket” are now commonplace in front of shops and offices. Such innovations must be encouraged.
With ongoing trials of different drugs and candidate vaccines worldwide, there is a need to expand such programs on the African continent beyond the SOLIDARITY drug trial in South Africa. The rest of Africa needs to rise and join global efforts in search of a cure. But, if and when effective therapies or vaccines become available, will African countries be able to afford them?
Governments should protect their citizens. However, the ethical principle of fairness must be applied. No single community, country or continent should bear the full brunt of global shortages. Although difficult decisions in resource allocation are inevitable, it is unethical for African countries to have considerably less access and harder choices than others.
Thus, Africa needs to remain awake to the realities of COVID-19, because the usual Western donors are now grappling with their national challenges. The lessons learned from our response to malaria, tuberculosis, and HIV should now be put to good use.
International collaborative efforts, such as the COVID-19 Clinical Research Coalition and the Partnership to Accelerate COVID-19 Testing (PACT), are commendable. The former brings together scientists, physicians, funders and policy makers to accelerate COVID-19 research in resource-poor settings. The latter has an ambitious aim to perform 10 million tests across Africa in the next four months.
In the end, while the COVID-19 pandemic rages on, Africa must take its destiny into its own hands because, as rightly echoed by the Lancet analysis, “Every life has an equal worth.”