The challenges of tackling Covid-19 in Africa

Interview with Dr John N. Nkengasong, Director of Africa Centres for Disease Control and Prevention about the current situation with the spread of COVID-19 across Africa, about the main risks, challenges and lessons learnt from the HIV/AIDS pandemic and Ebola epidemic.

John NkengasongDr John Nkengasong was appointed first Director of Africa CDC in November 2016. He is a leading virologist with nearly 30 years of work experience in public health. Prior to his appointment with Africa CDC, he was Associate Director of Laboratory Science and Chief of the International Laboratory Branch at the Division of Global HIV/AIDS, Center for Global Health at the United States Centres for Disease Control and Prevention. Earlier in his career (1993 to 1995), Dr Nkengasong worked for the WHO as Chief of Virology at the Collaborating Centre on HIV Diagnostics at the Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium and later joined US CDC in 1995 as Chief of the Virology Laboratory in Abidjan, Cote d’Ivoire.


Could you explain the role, mandate and functions of the Africa Centres for Disease Control and Prevention (Africa CDC)? When was it founded and where is its HQ?

Africa CDC was founded on the 31 January 2017, however in July 2013 in Abuja during the Special Summit for HIV, TB and Malaria, the Heads of States and Government identified a need for Africa to have a public health institution dealing with African issues. . The core mandate of the Africa CDC is to safe guard the health of Africans by supporting Member States, through their National Public Health Institutions or similar organisations, by building the necessary capacity and capability to adequately respond to public health emergencies and events.


Data governance in emergency contexts in Africa is historically difficult. What is the current status of COVID-19 across Africa?

As of 25 April 2020, Africa has had more than 30,000 cases with fewer than 1,500 deaths reported. Currently three Member States (Comoros, Lesotho and Western Sahrawi) have no reported cases. Africa CDC has a responsibility to ensure that Member States can effectively respond to emergencies based on data-driven interventions and programmes. Therefore, Africa CDC supports Member States with the capacity it needs to make data-driven informed decisions.


Why has the pandemic been slower to reach the African continent in comparison to other global regions? Previous coronaviruses (SARS-1, MERS) had limited transmissions in Africa.

This is an important question and most likely requires the necessary research to adequately assess the transmissibility of all the coronaviruses on the continent. There has been limited research and testing of the other coronaviruses and therefore hard to estimate the true burden of coronaviruses on the continent. The first case of COVID-19 was reported in mid-February in Egypt, by the 22 February the ministers of health held an emergency meeting for a continental strategy to respond to the pandemic. The continent has been quick to respond by imposing travel restrictions from the affected countries and strengthening public health measures.


About 43% of the African population – 587 million people – live in urban areas. What does the risk profile look like for urban vs rural areas of Africa in terms of susceptibility to COVID-19?

There is a concern in the urban areas, especially the more vulnerable communities that are in informal settlements, public transport usage and overcrowded spaces where physical distancing may be a challenge. Therefore, Member States would need to invest more on protecting these populations. Access to healthcare in rural areas can also pose a challenge not just for COVID-19 but other health issues, especially during some mitigation measures. This highlights the need for universal health coverage on the continent to ensure that public health officials can better support the population.


Are there lessons learnt from the HIV/AIDS pandemic and Ebola epidemic that African countries could draw on at this time to inform their response to the COVID-19 pandemic?

Yes, definitely. There is the need to strengthen community engagement and ensure that community leaders and religious groups are equipped with the right and accurate information about COVID-19. This will help curb mis-information and rumours that occur in the communities.


Any effective preparedness and response strategy for COVID-19 requires a committed political will: what is the situation in Africa?

The continent has had a strong political commitment in responding to the pandemic. At a continental level the Bureau of the African Union Heads of State and Government chaired by President Cyril Ramaphosa, president of the Republic of South Africa, has committed to reversing the possible crisis of COVID-19 on the continent. The countries have also pledged funds to the African Union COVID-19 Response Fund and Africa CDC to support the response.


Commitment of financial resources from partners and donors before a crisis hits Africa will help anticipate demand and address supply chain management, mapping, and stockpiling of COVID-19 response needs. Are you optimistic?

Under the leadership of the African Union chairperson, President Cyril Ramaphosa, an African Union Special Envoys of the African Union was established to mobilise international support for Africa’s efforts to address the economic challenges African countries will face as a result of the COVID-19 pandemic. Further, we have a number of donors such as the Jack Ma Foundation supporting in kind with supplies for the testing in the African continent. There is a lot of optimism about the response with already 44.5 million dollars pledged towards the fund and Africa CDC.


The European Union has been repeatedly accused of not having been sufficiently prepared to deal with the pandemic. What is Africa doing at intergovernmental level?

On the 22nd of February 2020, the ministers of health of the African Union Member States held an emergency meeting where they developed a comprehensive response strategy as a continent. The strategy was later approved and adopted by the Bureau of the African Union Heads of State and Government during its special meeting on the 26 March 2020, as the overarching framework for Africa’s COVID-19 preparedness and response. The strategy aims to enhance coordination, collaboration, cooperation and communication on COVID-19 by Member States and partners. It focuses on six major technical areas and has guided Africa CDC in its support to Member States on the outbreak. The technical areas are laboratory and subtyping, surveillance and enhanced port of entry screening, infection prevention and control, clinical case management, risk communication, and supply chain management.


The concrete possibility that time and resources may be diverted to the pandemic at the expense of other health problems must be considered. The risk is that the new emergency absorbs resources destined for other disease conditions. A recent example was the Ebola epidemic in Africa. What do you think?

It is important for countries to ensure other programmes remain unaffected during the pandemic. This would weaken the public health system even further, causing a huge burden on the health care system during and after the pandemic. Programmes for HIV and TB treatment should ensure that patients continue to get their treatment and pregnant women have access to healthcare to maintain reduction of maternal and child mortalities. These are important for Member States to achieve the sustainable development goals.


Social media can, and should, support public health responses both in preparedness and controlling the outbreak by teaming up with governments in providing consistent, simple, and clear messages. However, the outbreak of fake news has also spread to Africa…

Social media is a powerful tool that can measure whether the public health message is being transcribed effectively to the communities. A reduction of mentions of COVID-19 in social media could highlight the need for a more proactive and agile public health presence on social media to combat the spread of fake news.


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