Past, present and future: What should be shaping Africa’s COVID-19 response

Clinic COVID19 Gauteng Health — The World Health Organisation estimates that Africa will need up to 25-million respirators monthly. (Gauteng Health Department)

The World Health Organisation estimates that Africa will need up to 25-million respirators monthly. We must ensure that essential medical supplies such as these reach all of our communities. Now, is the time for the continent to leverage existing HIV services to boost COVID-19 testing, isolation, contact tracing and treatment.

COMMENT

In much of the global COVID-19 conversation, Africa is barely mentioned. But the risks which the COVID-19 crisis brings are greater in Africa than elsewhere – and those risks will be compounded if Africa is marginalised in the global response. Beating COVID-19 in Africa is essential for defeating the virus worldwide. African leadership and global solidarity are both essential to overcoming the COVID-19 crisis on the continent, and Africa’s citizens demand nothing less.

We believe that economic and social determinants of ill-health will be strong predictors of the likelihood of dying from COVID-19.

The greatest risk will be for poor people in poor countries who have a much higher burden of existing illness, and of whom hundreds of millions are malnourished or immunocompromised. While Africa does have vital experience in managing epidemics, it also has largely under-resourced health systems that are still often inaccessible to the poor, and not up to the job of beating COVID-19.

Beating back COVID-19 in Africa is possible, but not under business as usual. We must urgently accelerate access to testing while ensuring the equitable distribution of equipment to protect frontline medical workers. We must treat the sick, while also guaranteeing health systems are adequately funded.

Countries must work to provide large-scale social protection measures and safeguard sustainable economic development to reduce inequality and mitigate COVID-19’s social and economic impacts.

And globally, countries must agree that any COVID-19 vaccine is free for all.

The African Union, through its Africa Centres for Disease Control and Prevention (CDC), is taking a strong lead in the response to the epidemic.

It has created a new initiative as part of the Africa Joint Continental Strategy for COVID-19, the Partnership to Accelerate COVID-19 Testing (Pact), which the Bureau of African Union Heads of State and Governments has fully endorsed.

UNAids is proud to be the first to sign up for this partnership, which aims to close the gap in COVID-19 diagnostics by supporting African countries to rapidly scale up their capacity to test and trace. As we have seen in other regions, this is crucial to reduce the number of infections and deaths. Pact also calls for the establishment of an Africa CDC-led pooled procurement system for diagnostics and other COVID-19 commodities.

The good news is that countries are stepping up. South Africa had conducted more than 300 000 tests, as of the start of May, with Ghana on more than 100 000. They have done so in part by leveraging existing HIV testing infrastructure, and other countries such as Nigeria plan to follow suit. But Africa CDC estimates that the continent needs 10-million tests to respond to the pandemic in the next four months.

But the World Health Organisation says African countries will need 100-million face masks and gloves as well as up to 25-million respirators shipped in monthly to effectively respond to the new coronavirus at a time when the world is scrambling for supplies.

Worldwide, production of test kits and essential medical supplies must be ramped up and their distribution should be globally coordinated to ensure that tests and personal protective equipment get to where they are needed most.

In Africa, that means getting supplies into our high-density townships and to the hands of our frontline medical staff, including community health workers responding to the epidemic. We also need to leverage existing HIV services to boost COVID-19 testing, isolation, contact tracing and treatment capacities.

And African countries need to prioritize investment in essential services. This must include a real commitment to tackle massive corporate tax evasion and ensure that those with the broadest shoulders pay the most tax, including an end to corporate tax exemptions.

Now more than ever, we need global solidarity to fund a multi-billion-dollar response that includes low and middle-income countries not only in Africa but in the rest of the world.

This includes fully funding the United Nations US$2-billion COVID-19 Global Humanitarian Response Plan as well as providing grants to support the abolition of user fees for health services.

This pandemic has shown that it is in everyone’s interest that people who feel unwell should not check their pocket before they seek help. As the struggle to control an aggressive coronavirus rages on, the case to end-user fees in health immediately has become overwhelming.

International financial institutions and private financial actors need to both extend and go beyond the temporary debt suspensions that have recently been announced. Africa’s debt is about 60% of the continent’s gross domestic product, which is completely unsustainable.

We must free governments to invest in the response and to strengthen publicly funded health care provision underscored by the principle that everyone has the right to health. In responding to COVID-19, we must guard against resources being diverted away from other health threats such as HIV, tuberculosis, or malaria, which already take a heavy toll on Africa.

Modelling conducted on behalf of the World Health Organization and UNAids has estimated that if efforts are not made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500 000 extra deaths from Aids-related illnesses, including from tuberculosis, in sub-Saharan Africa in 2020–2021.

There also needs to be prior international agreement that any vaccines and treatments discovered for COVID-19 will be made available to all countries and be free for all. We must not repeat the experience of the HIV epidemic, where medicines remained beyond reach for too long and millions died, while others are still waiting to initiate treatment today.

A strong recovery is key to building resilient societies capable of withstanding the next unexpected event. Given the interconnectedness between health and livelihoods, all countries will need to strengthen social safety nets to enhance resilience. They will need to build more sustainable economies, including decent, well-paid jobs for Africa’s young population and recognition for the undervalued and often unpaid care work carried out by women.

If it has taught us anything, this pandemic has shown how interconnected we are as a global community and that, as the UN Secretary-General, Antonio Guterres, has said, the world is only as strong as its weakest health system. Any global response to COVID-19 that marginalises Africa’s citizens would not only be wrong, it would be self-defeating. Moreover, Africa’s citizens would not stand for it. Even in the exceptional constraints of this pandemic, ordinary Africans have been organising to insist on their rights to healthcare and on their rights to social protection. As Africans, we stand with them in refusing to be sent to the back of the COVID-19 queue.