Cape Town — In the latest WHO update on the novel coronavirus, the speed at which COVID-19 is spreading was a major concern for Dr Matshidiso Moeti, World Health Organization Regional Director for Africa (WHO Afro).
"We have countries like South Africa, Algeria and Cameroon which now account for half of confirmed cases," Moeti said. "The rise in cases in Algeria and Cameroon were of particular import, along with those in Burkina Faso and the Democratic Republic of Congo, due to the high fatality rate."
She was joined by Dr Simon Missiri, Regional Director for Africa for the International Federation of Red Cross and Red Crescent Societies (IFRC), Elsie Kwanza, Head of Africa at the World Economic Forum (WEF), and Dr Michel Yao, Emergency Operations Manager at WHO Afro.
Spread and Safety Measures
The rapid rise of infections in Niger, Cameroon, Guinea and Cote d'Ivoire underlie the importance of implementing safeguards for public health like testing, contact tracing and effective quarantine. "We recognise that testing has become a challenge because of the availability of test kits," Moeti said.
According to Moeti, one safeguard that may have the most trouble being implemented effectively was social distancing. "We have observed in some African countries that it's very difficult to enforce when people are living in very crowded conditions." However, Moeti maintained that the implementation of safeguards must still be applied despite difficulty. "We need to try and engage people at a grassroots level so that they understand the risk and how they may best protect themselves, their families and society at large."
Several points of progress were welcomed by the WHO Afro leader, who said efforts from the government of Ethiopia, the World Food Programme and the African Union saw the distribution of supplies like personal protective equipment for healthcare workers, as well as test kits, some of which were donated by China's Jack Ma Foundation.
"We understand that the impact in Africa will be very severe," Moeti said. "We still have 14 African countries that reported fewer than 20 cases and I'd very much like to encourage that we seize this opportunity to learn from countries with more advanced forms of the pandemic."
'Climbing the Curve'
Dr Simon Missiri believes more attention needs to be paid to the continent's increasing rate of infection. "We are watching Africa climbing the curve and so far it has not been in the headlines of the world media, but I think it's our job to make it a focus of attention. This pandemic will not be won over the world if it's not won in Africa."
Missiri said the continent's fight against the disease is exacerbated by factors like weak health systems and endemic diseases. "This disaster just adds to that, so there is a lot of cause for concern," he said.
However, Africa may be uniquely prepared for the outbreak compared to other parts of the world, according to the IFRC's Africa director. "The African community is better prepared in the sense that they know how to manage hardship, having developed mechanisms over generations to deal with circumstances like this," Missiri said, adding that it would be important for organisations like the IFRC, WEF and WHO to build on that and provide support, not only to the viral threat but with the consequences that will follow it.
Working in an auxiliary capacity to governments, the IFRC liaises with various departments of health in close coordination with the WHO. "African communities can count on roughly 1.4 million volunteers across 12,000 branches, and these are the people that speak the local languages," he said.
The IFRC's initial phase of efforts was dedicated to health messaging by combating misinformation, rumours and fake news about the virus. "We learnt many lessons in other disease work - ebola and so on- but now it's time to move to the response," Missiri said.
The economic impact of COVID-19 on Africa
"According to the World Bank, it now looks increasingly likely that Africa will face its first recession in 25 years and, accordingly, the World Bank and the International Monetary Fund (IMF) are supporting the call by finance ministers to in Africa and their governments for a debt servicing standstill," said WEF's Head of Africa Elsie Kwanza.
This, she said, is essential to free up revenue which already suffered due to the pandemic. "The loss of export markets, tourism-related revenues and the shock in the drop of oil prices are really important to free up space in governments' budgets so that more can be allocated to health budgets to get ahead of the health challenge," said Kwanza.
"Unfortunately we're seeing the economic squeeze of people not being able to work - over 80% are employed in the informal sector." Kanza said about lockdowns, curfews and border restrictions. She cited a recent study by American management and consulting firm McKinsey & Company which estimated that one-third of Africans are likely to lose their jobs due to the outbreak.
Africa is also seeing the impact and disruption of food value chains and supply chains, aside from the logistics and the fact that farmers are unable to plant or sell produce, the combination of shuttered restaurants and businesses and a drop in consumer expenditure factor into making a potential food supply crisis a cause for concern, she said.
"Last month we (the WEF) launched the COVID Action Platform to support the WHO in terms of fostering global cooperation." Over 1,000 partners from businesses, governments and international organisations have signed up for the initiative assisting with 25 current projects with another 15 in development.
"Here we are enabling coordination on the health front, repurposing automotive factories in South Africa to produce ventilators. We're seeing repurposing of garment factories in Kenya to produce protective equipment and the development of means for direct cash transfers in vulnerable communities in South Africa, Kenya and South Sudan. These are important to keep micro-businesses afloat," Kwanza said.
Following U.S. President's Trump's decision to rescind funding to the WHO, what is the organisation's budget for fighting COVID-19 in Africa for 2020 and what impact does President Trump's decision have on that programme?
Moeti: "With regard to the budget for the COVID response by WHO, it's about U.S.$300 million. In the African region, we have 47 countries and each of the countries 's offices have developed a plan of how to work with local governments. Our regional office team will oversee this and will need U.S.$300 million for the next six months … The potential impact of this decision will be quite significant on areas such as polio eradication - we were on a path to eradicate polio from the continent, the U.S. was one of the biggest supporters of that as well as other programmes that dealt with communicable diseases like HIV and malaria. We are very much hoping this decision will be rethought because the U.S. is an important partner."
Based on South Africa's response to the COVID-19 outbreak, do you think that the country made smart decisions in its handling of the crisis, and what can other African countries learn from this?
Moeti: "South Africa has the largest number of cases on the continent. The government took strong action as soon as they understood that community spread was occurring. Of course, we had been working with them and they already had a preparedness platform in place as we observed the pandemic unfold in Asia and then in Europe. They put in place public health measures - case identification, testing. South Africa was one of the earliest countries with the capacity to test for COVID-19. They also did well with contact tracing and adopted physical distancing measures relatively early on like closing schools and closing public and sporting events. The curve is bending, this is what we can cautiously understand is happening in South Africa. Of course the context is extremely challenging, South Africa is one of the most inequitable societies in the world, so we have places where social distancing is feasible and others where it is extremely difficult. We need to continue to monitor the situation."
How would you explain the relatively slow pace of infections in a lot of African countries like Kenya? Is there any indication that this could be linked to the Bacille Calmette-Guérin (BCG) vaccine that's quite common in many African countries? Also, has the lockdown imposed in South Africa had a positive impact on the rate of transmissions?
Moeti: "We do not have the evidence that clearly indicates that BCG makes a difference. I think this is being studied by some scientists. There has been a lot of speculation about whether the temperature in Africa makes a difference. We've seen in some west African countries where the virus has spread rapidly at the community level, these are places where the environment is very hot so we need to continue to try and understand. The virus came to Africa later than it did to other regions and some measures had already been put in place. We think some of the early alert screenings made a difference. The challenges now are confronting the shortages of test kits and key items to scale up and decentralise these interventions.
Should the WHO and WEF play a role in preventing rich nations from monopolising COVID-19 treatments and medications?
Kwanza: "It's good to build on lessons of the past. Coming after the ebola epidemic, among others, in Davos during 2017, WEF facilitated the launch of a coalition for epidemic preparedness innovations which essentially was fostering cooperation and collaboration among different stakeholders to develop vaccines against epidemics. WEF aims to bring on as many partners as we can so that we can maintain an equitable approach - it's all about solidarity. We're in this together. It does not make sense to support just one part of the world and not the other as we're all vulnerable."
Missiri: "When you have the whole world affected one way or another, with different degrees of severity, the instinct of politicians is to protect their own people. Our organisation is based on solidarity. The only way to deal with it is with strength of solidarity. We're all tested during these times of crisis."
Moeti: "We would encourage African countries to participate in finding a vaccine by participating in clinical trials. This is important in that the continent can contribute to the science and research of finding a vaccine. Secondly, I can only say the WHO is very much part of these coalitions that Ms. Kanza mentioned. There is also a role of advocacy which the WHO carries out at a global level. Our Director-General, for example, addresses the G7 countries, the G20 countries. These are fora in which people can make the correct decisions. I also think at the community level that citizens themselves can influence the decisions of their countries if they're aware of the potential for some of these commodities to be made available by actions of their countries. We need to continue to strive for this global solidarity even in the context of the geopolitical situations the world finds itself in today.
Before COVID-19, international focus was on climate change, environmental protection and sustainability. It may be too soon to discuss it but what measures will be taken after the pandemic?
Moeti: "I think it is a good reminder that our response with COVID-19 needs to be contextualised according to other important global issues. At the WHO, we understand at a pragmatic level that countries are providing essential healthcare for other diseases otherwise we will see an even greater impact of this pandemic. So we need to be aware of environmental impacts and take into account some basic ways of disposing of waste, for example. At the United Nations level, there is a strategy document being developed which will take into account all these other very important aspects of life on the planet."
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Given poverty in Africa how realistic is social distancing and how long are asymptomatic carriers contagious?
Moeti: "It is important that social distancing is applied in a way that's contextualised to the reality of people but it also needs to be supported and enabled. For example when people go shopping, in an African setting, the markets where we buy our food , it's very difficult to keep people apart. In an informal setting like that, if you're a person running a stall, you're not going to be reminding your potential clients to stay away from each other because you might disadvantage yourself in terms of what you're going to earn for that particular day. This is why additional protections need to be considered like masks when going out to do shopping while minimising distance. It is also important to mention hygiene and making sure people have access to sanitiser, to running water, to soap if they are unable to distance themselves within homes.
How long can African states economically maintain lockdown measures before people start rebelling against them?
Moeti: " I think this is an important question which is why it's important to put mitigation measures in place from the very beginning so that the impact on people and their livelihoods are considered. There are a number of parameters that need to be taken into account, like the evolution of new cases and how the virus is spreading and if the measures are starting to have an impact. The WHO will release a strategy document about this in the next couple of days and will enable countries to figure out how to program and analyse whether safeguard measures can be lowered or not. It's also important to remember that's not a matter of all or none. For example, in South Africa, the measures were introduced progressively.
Epidemiologist Professor Salim Abdool Karim expects the peak of the pandemic to only reach South Africa in September. He also said the exponential spread of the disease is unavoidable throughout the continent. Does this match the WHO's forecasts for Africa?
Moeti: "I saw Professor Abdool Karim's presentation though I wasn't able to follow all of it and we're asking for our office to send an analysis on what impact these measures will have on different countries. At the WHO we have carried out projections to chart the evolution of the epidemic. If current safety measures are not effective, I do not think we have an idea of how long it will take for really effective measures to bring a change to the situation. I'll ask Michel to come in on this."
Michel Yao: "It's quite a difficult estimation to make. We have to be cautious because there are many factors that need to be taken into account including geographical access to some areas so the disease may or may never reach some remote rural areas. We need to emphasise public health measures to ensure estimates remain accurate."
