How does Africa fare in responding to COVID-19 pandemic?

  

 There's been multiple interventions and strategies aimed at helping Africa's response to the COVID-19 pandemic. The multitude of support and coordination between Africa's leadership, under the Africa Union Commission, and the global stakeholders including Bill and Melinda Gates Foundation, Mo Ibrahim Foundation, Jack Ma Foundation among others have been positively commended. 

As of August 7, 2020, the continent reported the fist one million confirmed cases of COVID-19 bringing to light the increasing exposure to the diseases by the continent's vulnerable population. 

Whereas the one million cases represent an important measure in Africa's response to the pandemic, it is by far less significant compared to similar numbers in developed countries, such as the United States of America. 

There are those who are of the opinion that Africa's response is too slow because the number of cases coming out of the continent is far less than expected (or predicted) and that there are significant gaps in testing and reporting making it a challenge to fully understand the epidemiology of the disease on the continent. But, isn't that the case in developed countries? 

Comparing the number of cases, positivity rates, death rates, and contribution to global numbers between Africa and the United States show significant difference between the two (see graphs below). 

At the time  Africa reported one million cases, the US reported five million, which is five times more than recorded in Africa. Of course, comparing absolute numbers like this is misleading and hence we need appropriate denomenator to compare. There are more deaths per 1000 cases in the US (163) than in Africa (23). At the same time, more than 22% of COVID-19 related deaths globally originated from the US compared to only 3% in Africa. 

The number of confirmed cases per million, deaths per 1000, and global contributions to the cases and deaths are all much higher in the US than in Africa. So, with these "good" numbers, should Africa continue to receive support from developed countries like the US instead of the US focusing on its domestic cases? The answer is yes. 

There's reported incidence of reagent or testing kits shortages on the continent than it is in the US. In addition, there are reports of unequal access to testing kits in Africa compared to the US. For example, the laboratory-based standard testing kits (RT-PCR) used in Africa for COVID-19 are manufactured by US-based companies of Abbott Laboratories (Illinois, Chicago), Cepheid Technologies (Sunnyvale, California) and Roche Diagnostics (San Francisco, California).  There is no production of any of the standard PCR kits on the continent, exposing the population to export control policies of the United Staes and other developed countries. In addition, Africa is competing with developed countries for the same resources, which are very limited, further exasperating the continent's dependant on foreign players. 

The COVID-19 pandemic has exposed the weak health infrastructure in Africa and that African leaders and health professionals need to rethink their strategies of building resilient health systems strong enough to respond to an emerging pandemic. This can be done with the following consideration:

1) Governments must realign their priorities to focus on health infrastructure development, including the provision of critical units (ICUs), laboratory equipment, infection, prevention and control (IPC), and personal protective equipment (PPEs) to frontline personnel.

2) Solidarity with private sector investments and participation in health care delivery, including private health insurance schemes, and competitive investment incentives to provide quality and affordable healthcare.

3) Human resources skills development and retention schemes to encourage continuous education, mentorship, compensation and to facilitate the exchange of ideas, innovation, research, and technologies.  

4) Local manufacturing of critical pieces of equipment and instruments on the continent. Partnership with global manufacturing and incentivizing them to build local manufacturing sites on the content as well as technology transfer to local experts is encouraged.

5) And lastly, pooling and sharing resources through pooled procurements, harmonization of procurement and regulatory policies as well as working with continental financial institutions, such Africa Development Bank, Africa Export-Import Bank, and ECOBANlK to create sustainable financing options on the continent.   

Changing the paradigm of health system strengthening in this manner will accelerate the continent's shift from a reseource-limited continent to resource-abundant one in order to positively impact on the lives of people in Africa.