COVID-19 in Africa: insights from our 23 April WHO media briefing 

This week’s WHO briefing took place at 13:15 Geneva time with the below speakers.

In today’s COVID-19 in Africa briefing, topics ranged from personal protective equipment (PPE) and emergency food aid to the virus’s knock-on effects on vaccination programmes for malaria.

Tackling the outbreak across the continent
Dr Matshidiso Moeti, the World Health Organization’s Regional Director for Africa, prefaced the briefing with some general remarks about the progress of the COVID-19 response across the continent.

She said that Africa had seen more than 25,000 confirmed cases with more than 1,200 deaths. South Africa remained the worst affected nation and people there were “beginning to see the bending of their curve”. Counterbalancing this positive news, however, were “concerning developments in West Africa”.

That said, the ongoing approach advised by the World Health Organization (WHO) for all nations remains the same: identifying cases, contact tracing, employing physical distancing where possible and employing hygiene measures such as the washing of hands.

With the start of World Immunization Week Friday, Dr Moeti reminded listeners that Africa remains the global epicentre for malaria, recording more than 90% of global fatalities, with some 360,000 deaths in 2019 alone.

Without adequate vaccination, malaria deaths could double on 2018 levels, reaching their highest levels since 2000. At present, an estimated quarter of African are under-immunised. Countries will need to rapidly “scale up” immunisation and care programmes once the worst of COVID-19 passes.

Organising preparedness

Dr Sani Aliyu, Nigeria’s National Coordinator of the COVID-19 Presidential Task Force, stressed that the challenge went further than minimising and healing coronavirus infections. “We know that is a major health concern but the impact goes way beyond the health sector,” he said.

In Nigeria, as in many other nations, the challenge has been organising the response. “It has been a difficult road when it comes to national coordination,” he said. “If we fail to bring everyone on board, then the consequences will be quite severe.”

The solution in Lagos has been to set up a Presidential Task Force composed of nine different agencies. The focus had been on trying to understand the pandemic, finalising an action plan and supporting the Nigerian Centre for Disease Control, as well as working with the UN to streamline aid funding.

The cities of Lagos, Abuja and Kano, all early centres for COVID-19 cases, had been shut down, with state governors elsewhere in the country given the power to enact measures.

Dr Aliyu said the country has been “trying to harmonise all our needs across the board” and “adopt an all-society” approach, but pointed to the problems of lockdown in a country where, day to day, lots of people depend on leaving the house in order to make the money they need to live.

To ease the threat of food shortages, the government had released 70,000 megatons of grain from the national reserves, and distributed 100 trucks of rice across the country, along with approving conditional cash transfers.

But he admitted that “Nigeria is a large country and this is probably going to be a drop in the ocean compared to what is needed”.

Dr Chikwe Ihekweazu, Director General of the Nigeria Centre for Disease Control, was frank about the difficulties of developing coronavirus testing “starting from zero”. However, he said the coordination efforts of the WHO and the Africa Centre for Disease Control and Prevention had much improved since the Ebola outbreak, and had been a brilliant help. “The collaboration across the continent has been incredible,” he said. “We have relied heavily on regional collaboration because we are all learning about this together.”

Dr Ihekweazu said Nigeria had 873 confirmed cases at present, and in a nation of 200 million people – including some of the globe’s most densely populated areas – the chances of a significant outbreak remained considerable. He had recently returned from a tour of nine states and was reassured by efforts being made but had also seen the challenges faced.

“In a way we are running against time,” he said. “We are under pressure from the population to return to some semblance of normal life, because people need to make a living.” Balancing this will mean that “very difficult decisions” will need to be made in the next week.

“We have to work with what we have,” said Dr Ihekweazu. “We wish we had more laboratories... care facilities and ventilators, but we simply don’t, and the supply chains for these are fragmented at the moment.”

“This is a long haul for Nigeria,” he added. “It’s going to be a marathon as we face this disease in the complex context of our beautiful country.”

Confirmed deaths, testing capacities

Ruth Maclean of the New York Times queried reports of confirmed deaths in Kano and of testing availability in the northern Nigerian city.

“Kano is in lockdown,” said Dr Aliyu, “so we don’t have a true baseline when it comes to number of deaths.” However, if it a “true increase” has occurred, the culprit might not be only COVID-19 but also the closure of outpatient clinics, and the difficulties of seeking medical help under lockdown.

Regarding testing, Dr Aliyu said a single lab had been closed as a precaution after a couple of members of staff testing positive for the virus. The decision was taken to disinfect the lab and provide extra training to staff before reopening in 3 to 4 days.

Aanu Adeoye, a journalist at South Africa’s Mail and Guardian, questioned Nigeria’s low testing capacity of 10,000 compared with the South African and Ghanaian totals of 130,000 and 70,000 respectively. What was Nigeria doing to ramp up testing?

“We have to work with what we have,” replied Dr Ihekweazu. South Africa was a country already blessed with “excellent facilities”, but Nigeria did not at present have the same luxury. “In the middle of a crisis there is not the time to build up infrastructure that takes 20-30 years to build.”

He admitted that Nigeria had been “slow to start” with its testing, “but those who understand molecular diagnostics know it’s not an easy thing to do.” Dr Ihekweazu stressed the work would progress carefully, to ensure it's done correctly.

Libby George, Reuters’ senior correspondent in Lagos, asked what impact the US decision to suspend funding would have on Africa.

“The funding for the WHO is so important,” stressed Dr Ihekweazu. “Lives are saved because of the work that they do.” Countries in Nigeria’s position “don’t have the luxury” of building up the requisite infrastructure and knowledge – especially in the midst of a pandemic – and the organization has provided crucial support in those areas.

He reminded listeners that a prolonged outbreak in Africa could spell danger for the rest of the world. “If the funding to the WHO is affected in the way it may be, there will be a huge price for humanity to pay – not just on this side of the world.”

Tackling equipment shortages
George also asked about the quantities of ventilators and PPE in Nigeria, and what was being done to boost them.

Dr Aliyu said that, before the pandemic, Nigeria only had about 350 ventilators, most in the private sector. Around 100 more had been bought since, with provisions made for at least 10 ICU beds across each other 37 states.

Rather than equipment, the “major limitation” and the real area of ongoing concern would be in the training of specialized healthcare workers, such as anaesthetists. “It’s impossible to train healthcare workers in this short time.”

New solutions
Paul Adeopoju of the Lancet asked whether any solutions unique to Africa had emerged in tackling the virus so far.

“One of the unique features of African society is how people are connected and organised,” said Dr Moeti. She said the WHO was working on the transmission of public health messages from technical English into local styles of communication, and had sent out a call to local innovators to help correct the flow of misinformation.

Equally, she had seen Africa’s clothing industry step up in the making of masks, to enable people to protect themselves when physical distancing wasn’t always possible, such as at local markets.

Chioma Ezenwafor asked how soon Africa could begin to prepare for the post-COVID-19 era – and, given that “every storm leaves debris”, how could a lasting crisis be prevented?

Dr Aliyu said that, regrettably, “the post-COVID era will be very different to how it was before the pandemic, especially with regard to social interactions”. He said that Nigerians had already changed how they functioned as a community and a society, but that after the pandemic, there was “going to be a lot more work”.

On the plus side, African nations had the opportunity to learn from other regions around the world who were slightly ahead of them in working out how to successfully deal with COVID-19.

“We don’t really have the luxury of not paying attention,” added Dr Ihekweazu. “Every improvement, every intervention has to 1) help us solve short-term problems and 2) build for a better tomorrow.”

He said Nigeria was “building people, building institutions” but also “building to last”.