African health practitioners should own the narrative of the coronavirus pandemic and take advantage of Africa's experience of other outbreaks of disease in order to mount a tailored response, says the writer in a guest column for AllAfrica.
It has been close to three months now since the first case of COVID-19 was confirmed in Africa. The infection curves are today much flatter than those seen in France, Italy or the United States. Contrary to what is happening elsewhere, and in contrast to what was predicted for us, the epidemic has not exploded, health systems are not overwhelmed and mortality is much lower than expected.
This is no reason to declare victory, but is rather a heads-up to prepare for a long-distance run.
To survive this marathon, doctors, researchers and others responding to the pandemic across Africa must take ownership of the narrative of the fight against COVID-19 and provide hard evidence to remove emotions and promote a rational response to the pandemic.
Let's not allow panic, or a fanatical desire to protect our exceptional continent, to take over. Instead we need to prepare to offer cost-effective and efficient responses tailored to local conditions.
Reanchoring the debate in local communities
On March 18, Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, called on Africa to "wake up" and face the pandemic. A succession of alarmist speeches about Africa's level of preparedness followed in the international media. But in a continent consisting of 54 states, each at a very different level of preparedness, the COVID-19 response in Africa cannot be judged as if it is a single territory.
The new virus has claimed – and will undoubtedly continue to claim – casualties in our countries, but paradoxically our health systems – so often referred to as fragile – could end up being quite resilient in addressing this crisis.
Most of our health workers have completed their medical studies, and then practised the art of healing, in resource-deprived settings. They have learned and developed know-how that is unfamiliar to their peers elsewhere.
For example, basic preventive strategies are nothing new in our communities. During an epidemic of Lassa fever - a regular occurrence in West Africa - physical distancing and isolation rules are the norm. We also know from experience that the right information – shared rather than imposed on people – will break the chain of infection more quickly.
Here's the thing: there is no monopoly of knowledge! Our healthcare systems are certainly short of intensive-care units and beds, as well as respirators. They certainly cannot claim sufficient numbers of qualified nursing staff to care for patients who will need oxygen. But we have developed resilience, skills and knowledge through our experience gained in managing other emergencies and epidemics.
While we acknowledge our fragility, it also presents opportunities for innovation. Our healthcare systems are aware of their limits and conscious of the levels of capacity, but in the face of an emergency such as COVID-19, we can increase our capacity response and perform a better triage. We have learned from unfortunate experiences that we cannot save everyone.
Working with people
An important point to keep in mind is the imperative to work with people. It is not just a question of designing and implementing a response, through self-protective habits, for the middle and urban classes. Everyone in society needs to be part of the debate and action at every stage, be it prevention, preparedness or care, and decisions must be made jointly.
The issue of lockdowns should be tackled through this collective and community-based approach. The restrictive measures put in place early on by our states have enabled us to slow down the spread of the pandemic and to better prepare ourselves. Yet these measures will not prevent the spread of infection, particularly in our densely-populated neighbourhoods or family backyards. In addition, the measures will have a very heavy economic and social impact on people who subsist on minimal daily earnings.
The collective approach has to be changed in order to enable our fellow citizens to survive and to ensure that everyone follows basic preventive measures: regular handwashing, good respiratory hygiene and respect for physical distance, as well as the wearing of masks. People must be assisted by making sure that the means to follow these measures are available and usable.
In Côte d'Ivoire, for example, Médecins Sans Frontières teams have arranged for cloth masks to be manufactured locally and distributed to local people. "I protect you, you protect me" is the principle, because we must encourage local solidarity in response to the pandemic.
Sharing information and raising awareness is key to fighting an epidemic. For the population, it's a right, and for us, as medical doctors and researchers, it's a duty. A relationship of trust with our fellow citizens has to be restored. This means we have a duty to be transparent about what we are doing, especially in an environment in which fake news circulates quickly.
We vaccinated populations in a preventive way, and we have participated in clinical trials on treatments and vaccines before COVID-19, and hopefully we will keep on doing it afterwards, since such initiatives protect populations from diseases such as measles, meningitis or Ebola.
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For the record, the MenAfriVac vaccine, to protect against meningitis A, was introduced in West Africa in 2009 after several years of clinical trials. Mass vaccination campaigns have been carried out in the past 10 years and there has been no meningitis A outbreak in the region since. Some of our readers might be too young to remember this, but most of them have actually benefitted.
Let's speak directly with the population to avoid any mistrust. Let's encourage global solidarity to address any discrimination, particularly when it comes to access to treatment and vaccines, should they become available. We must do all we can to ensure that the large majority of people reach the finishing line of this long-distance run.
Dr Chibuzo Okonta is president of Médecins Sans Frontières (MSF) West and Central Africa. Originally from Nigeria, he joined MSF in 2005 and has worked with MSF's emergency medical teams across the region. MSF is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, pandemics, natural disasters and exclusion from healthcare. The NGO today runs medical activities in over 70 countries in the world, including in 13 countries in West and Central Africa.
