Covid-19 response failed in Africa

Lancet report says `hidden pandemic’ kept infection figures low

| ANDRE VAN WYK | The global response to the Covid-19 epidemic has been nothing short of a massive failure, according to a study by The Lancet; the world’s highest-impact general medical journal.

The peer-reviewed journal explains that millions of deaths may have been preventable but the failure of rationality, transparency, norms of public health practice, operational coordination, and international solidarity all contributed to the spread of COVID-19.

It says there result is additional cost lying in the reversal of progress towards sustainable development in multiple countries.

Meanwhile, spread of the virus within sub-Saharan Africa was compounded by what the study described as a “hidden epidemic”.

According to Lancet, when the Covid-19 outbreak started to show its presence in Africa, concerns were raised by governments and global authorities that conditions of poverty, urban crowding, and fragmented health-care systems would accelerate the spread of the virus. It was also found that the numbers of reported cases and deaths were relatively low compared to estimates that those statistics should have been 100 times higher.

This, according to The Lancet, was “the hidden epidemic”. The continent experienced multiple waves of infections, according to several surveys. However, the continent’s low overall case load was attributed to the fact that most cases went unreported.

One study in Zambia found that one in 92 actual infections were reported with similar findings being confirmed in the Democratic Republic of Congo, Malawi and Kenya. Thus, it was suggested 80% of the populations had already been infected with Covid-19 before the emergence of the omicron variant.

Furthermore, in October, 2021, the WHO confirmed that six in seven Covid-19 cases in seven Covid-19 infections went undetected in Africa. “With limited testing, we’re still flying blind in far too many communities in Africa. Most tests are carried out on people with symptoms, but much of the transmission is driven by asymptomatic people, so what we see could just be the tip of the iceberg,” Dr. Matshidiso Moeti, WHO Regional Director for Africa, said at the time.

Africa’s battle against Covid-19 a watermark for global response?

In the initial stages of the pandemic, Ethiopia’s Prime Minister Abiy Ahmed had issued a warning on the future of the pandemic, saying: “If Covid-19 is not beaten in Africa it will return to haunt us all.” Then the June 2020 study by the Organisation for Economic Co-operation and Development (OECD) found that five countries accounted for 56% of cases across the continent. These were South Africa (19%), Egypt (15.5%), Algeria (9%), Morocco (7%) and Nigeria (6%). At the time, Africa had over 200,000 confirmed cases of Covid-19 with 5,600 deaths reported. The greatest challenge recognised was the continent’s lack of accessibility to medical supplies, most notably, Covid-19 test kits.

Lab testing in Africa

The need for testing facilities in Africa became more and more urgent as the pandemic wore on; only two African nations had Covid-19 testing facilities at the start of 2020, according to the WHO. The global health body moved to support joint ventures like the ACT-Accelerator, Pandemic Supply Chain Network (PSCN) and UN COVID-19 Supply Chain Task Force to bolster the continent’s preparedness against the virus. As a result, lab testing capability in African nations rose dramatically over six months.

The WHO called for a more proactive community testing effort when vaccines were less accessible during the earlier waves of the pandemic. Estimates showed that between 65% and 85% of Covid-19 infections in Africa generated few or no symptoms. As a result, most Africans infected with the disease did not seek out treatment in local health facilities.

Did the COVAX Initiative fail Africa?

COVAX, a global drive that sought to bring about equitable vaccine access to lower middle-income countries (LMIC), was found to have been “chronically short of vaccine supplies for LMICs” by The Lancet report. It claims that COVAX failed in its mandate to deliver on its targets and timelines because vaccine-producing companies made contracts directly with the governments that paid the highest prices, rather than with COVAX, which insisted on lower prices for low-income countries.

As a result, African countries were constantly the last in line to receive new vaccine supply shipments. The Lancet found that, as of January, 2022, the percentage of fully vaccinated individuals in the European Union totalled 71% while the U.S. figure stood at 63%. Meanwhile, only 10% of Africans were fully vaccinated with some nations like Nigeria having figures as low as 2%.

The impact on sustainable development

The continent’s strides towards achieving sustainable development goals (SDGs) set out by the United Nations (UN) were severely hampered due to the Covid-19 outbreak. In 2015, the UN rolled out an update of its millennium goals, among which were 17 SDGs. These included finding means to tackle everything from poverty, hunger, health and gender equality to environmental sustainability.

“Covid-19 has set us back. It has had a negative effect on the SDGs. Progress that had been made was reversed or damaged. Covid-19 also came at a time when our economy was greatly challenged with very low growth and limited wealth distribution, so it made South Africa one of the most unequal nations in the world,” said Mamokgethi Phakeng, Professor of Mathematics Education and Vice Chancellor of the University of Cape Town.

The impact on other health crises was also highlighted, most notably cancer, HIV and tuberculosis, Phakeng added. She went on to say that the long-term impact on these issues will not be apparent for many years.

The pandemic also impacted SDG four (Quality Education) and SDG eight (Decent Work and Economic Growth), as school and workplace closures affected people with no internet access. In remote areas it has been a challenge to get children back into schools and in universities; first-year intakes are coming in on the back of two years of remote learning.

 African economies set back by Covid-19

The Covid-19 Pandemic had a critical effect on the global economy with recession lasting from February to April in 2020. The Lancet report found that countries heavily dependent on tourism and travel – as many across Africa are – suffered extreme losses of national output, and their economies have not yet recovered.

According to the African Development Bank, the Covid-19 pandemic’s impact on the continent’s multiple economies was heightened by the low vaccination rate. By the end of March 2022, only 15.3 percent of the continent’s population was fully vaccinated. While this was attributed to severe constraints in supply-and-demand, improvement in vaccinations rates was identified as being paramount in quickening the pace of economic recovery.

The AfDB went on to determine that  Africa’s fiscal deficit is projected to narrow to 4.0 percent of GDP in 2022, from 5.1 percent in 2021, reflecting scaling-down of Covid-19-related interventions. The economic body wrote in its ‘Africa’s Economic and Outlook’ report: “A policy mix to speed up vaccine access and rollout, address debt vulnerabilities (through reconfigured and enhanced global mechanisms) and climate change effects, and support vulnerable households and firms remains critical to boosting the post-Covid-19 economic recovery.”

Lessons for the future

According to the Lancet report, some of the most pertinent preparations governments and nations can make with regard to future pandemics include the following:

• Improved primary health care and universal access to health care for all as a precondition for effective health systems and public health.
• Investment in supporting scientists to present evidence more effectively to decision makers, and in supporting decision makers in their understanding of how to interpret evidence and implement science-based recommendations and policies.
• Global coordination and standardisation of data collection, data quality, monitoring, and reporting, to ensure the disaggregation of data by relevant factors (e.g. gender, age, race, and ethnicity).
• Universal adoption of updated medical, scientific, and public health training and airborne infectious disease exposure standards that reflect the paradigm shift towards more accurate definitions of transmission routes for respiratory infectious disease, and the most effective mitigation strategies for each one, including enhanced building ventilation and air filtration.