Averting worse COVID-19 outcomes in Africa has been attributable in part to early lockdowns, “absolutely no opposing forces between the politics and public health” and solidarity between countries in executing a pandemic control strategy, the leader of the Africa Centres for Disease Control and Prevention said, but vaccine inequities could create “a moral catastrophe.”
John Nkengasong, a Cameroonian virologist, told a Brookings Institution webinar Friday that there are valuable lessons to be learned from Africa’s coronavirus response when preparing for the next pandemic.
As of today, Johns Hopkins reported 27,832,979 confirmed cases of COVID-19 in the United States and 490,875 deaths, with a population of nearly 331 million. The Africa CDC reported 3,783,214 cases and 99,840 deaths, with a population on the continent of more than 1.3 billion.
The first known case of COVID-19 in Africa was detected Feb. 14, 2020, involving a Chinese national at Cairo International Airport in Egypt. Current hot spots include South Africa, which was the first place the highly infectious variant B.
A week after the continent’s first COVID case, all ministers of health met in Addis Ababa for an African Union session to coordinate the Joint Continental Strategy for COVID Response. The leaders “saw the threat and took it seriously,” Nkengasong said.
“Beyond leadership is the cooperation and coordination across the continent. I’ve never seen in any efforts in this manner the African countries coordinating the efforts to the Africa CDC,” he added. “…They brought coordination, cooperation, collaboration, and communication.”
Public health experts across the continent meet ever Tuesday afternoon “to discuss the pandemic and chart a way forward and adjust our strategy.”
With challenges in some countries of political instability and a lack of healthcare infrastructure, many predicted a healthcare catastrophe in 2020 as the novel coronavirus took root in Africa. Nkengasong said the most dire predictions have been averted by swift, strict lockdowns in some nations — “severe measures that had serious consequences on the economy, but you have to blunt the spread of the virus” — and a culture in which “public health was allowed to guide the response” instead of politicians directing public health experts. Partnerships with the private sector were also cultivated to expand access to diagnostic and treatment necessities through the African Medical Supply Platform.
“Then we launched the Partnership to Accelerate COVID Testing, which at that time in May, only 300,000 tests had been conducted on the continent… we scaled that up very quickly,” Nkengasong said. “We set aside a target of 20 million within two or three months. And we achieved and exceeded that target because of the different partnerships that came together.”
The Africa CDC was founded in 2017, and Nkengasong said that at the time he called for “a new public health order” on the continent including strengthening public health agencies with the understanding that “diseases are an economic threat, a health threat, and a security threat,” strengthening “local manufacturing of diagnostics, vaccines, and treatment,” and building a robust healthcare workforce equipped to respond to a pandemic. Of the current “north-south tension” over equitable COVID vaccine access, he noted it’s “all because Africa doesn’t produce vaccines.”
“It is unacceptable that a continent of 1.2 billion, aspiring to be 2.4 billion in 30 years, will not produce its own vaccines for its own health security or diagnostics,” he said. “I think that is completely unacceptable.”
And crucially, he added, “we have to be able to begin to finance our own health threats, first of all, before we look outside of the continent — without that, we will continue to be very, very vulnerable.”
Nkengasong said that Africa’s 2001 Abuja Declaration in which countries pledged to spend 15 percent of their annual budgets on health “has to start and has to start now — because we cannot mortgage the health security of our continent outside of the continent, and we cannot allow external politics, the elections that happen in political capitals of Western countries, begin to determine our health security.”
On equitable vaccine distribution and ensuring that the underprivileged and most vulnerable do not get shuffled to the back of the line, the Africa CDC chief warned that if there isn’t action to “recalibrate” the definition of vaccine equity “then we are moving toward a moral catastrophe.”
“I was a young HIV-AIDS public health expert in 1996, when AIDS drugs were available. We saw death rates decreasing drastically in the West,” he said. “But in Africa, it would take us 10 years, between 1996 and 2006, before we saw our deaths decreasing. And between 1996 and 2006, 12 million Africans died needlessly. As a public health expert, when I look at that, I look at that with horror. And if we didn’t learn moral lessons from that, then I think that we are preparing ourselves for a similar moral catastrophe, which the next generation will ask the questions.”
“…The same scenario we are going through now happened in 2009 during the H1N1 pandemic. And vaccines were on mortgage, and they only became available to the developing world when the pandemic was over in the developed world.”
While global collaboration has been “strong” in the identification and sharing of sequences for the novel coronavirus along with rapid vaccine development, Nkengasong cautioned that countries “have to recognize that a threat anywhere in the world with a disease that’s spread as fast as this will be a threat everywhere, no matter much you fold inward and protect yourself with vaccinating your people — we are now seeing how this virus is evolving and mutating.”
Africa has secured more than 300 million vaccine doses and the goal is to vaccinate 60 percent of the continent, with about 35 percent of the population vaccinated before December.
“We will go to war with what we have. What we have is our health systems, what we have is our people,” Nkengasong said. “But we count on the resilience of our people, of Africans, who have fought these viruses over and over and over — the HIV, the malarias, the Ebolas — that we’ll be able to deliver these vaccines in a timely fashion.”
HIV kills more than 500,000 Africans a year. Over the next 30 years, over 4 million Africans could die every year from antimicrobial resistance. Nkengasong said he fears “COVID is going to aggravate” these along with the killers tuberculosis and malaria.
“We see the light at the end of the tunnel because of the COVID vaccines,” he said. “But I always caution that we should recognize that our only failure in this fight against COVID-19 will be the failure for us to admit some of our own failures… we just have to make sure innovation keeps growing and we keep sharing.”