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3 years of COVID-19: Africa has made progress but challenges remain

Dr Thierno Balde

Dr Thierno Balde

Soon, the world will mark three years since the first case of COVID-19 was documented.

In the African region, the pandemic exposed some of the gaps in the healthcare system and disrupted health services despite the continent recording some of the lowest cases compared to Europe and America. With countries starting to move away from the acute stage of the pandemic, how prepared is Africa for this shift?

The Observer spoke to Dr Thierno Balde, the incident manager for COVID-19 at the World Health Organisation (WHO) Regional Office for Africa.

How would you describe the current situation of COVID-19 in Africa?

We can say the COVID-19 pandemic on the continent is currently under control. Despite the previous increases in cases documented, over the past three weeks, we have seen a continuous decline in numbers. 

The region also continues to witness fewer hospitalisations, ICU admissions, and low numbers of deaths. For several months now, we have not recorded a case of any country in the region being in resurgence. A country is usually considered to be in resurgence when a 20 per cent increase in cases is reported for at least two consecutive weeks.

We have a number of countries on alert that we are closely monitoring at the moment based on the increase in cases that they have registered. In terms of the overall case numbers, since the pandemic started, in Africa we have recorded 12.4 million cases, including over 250,000 deaths.

We have also documented 11.6 million (93 per cent) recoveries. Across the region, countries have improved their surveillance and laboratory capacities, which has enabled them to detect any surges in a timely manner and institute targeted response measures to contain cases. 

However, with the holiday season approaching, the likelihood of cases going up again is high as more people travel across countries and regions. We need to ensure that countries have effective control measures in place to deal with any surges.

There is no doubt that the pandemic exposed the weakness of the health sector in almost all countries in Africa. Even Uganda where authorities have previously managed Ebola outbreaks before could not cope. How can countries prepare better for the future?

One of the key actions that African countries need in order to prepare better for the next pandemic is to build strong health systems. Systems that will enable us to detect and respond to outbreaks in a timely manner, while at the same time ensuring adequate response mechanisms to deal with the problem. 

This is critical in a continent like Africa which experiences several disease outbreaks every year. Therefore, a strong surveillance system, backed by adequate investment in the health sector, especially human resource capacities, infrastructure, and access to adequate medical tools such as vaccines and test kits will get the continent on the right path to manage future health emergencies.

Most countries are still performing poorly when it comes to vaccination and it is clear they will not reach the 70 per cent vaccination target by the end of 2022. What challenges does the vaccination drive face since the problem does not seem to be with the availability of the vaccines?

While the continent has not achieved the target of vaccinating 70 per cent of the population, there are varying degrees of progress that we see in many countries. Currently, Mauritius, Seychelles, and Liberia have already hit or surpassed that 70 per cent target. We are expecting Rwanda to hit the 70 per cent target soon, based on the numbers we are seeing at the moment.

So far, 28 per cent of the population have completed their vaccination series - meaning they are fully vaccinated. But there are also a number of other countries where vaccination rates have progressed well into the 40 per cent to 69 per cent coverage for fully vaccinated individuals. 

Unfortunately, we still have a few countries where coverage remains below 10 per cent because they are either dealing with humanitarian emergencies or other outbreaks which have impacted COVID-19 vaccination campaigns. In recent months, the WHO Africa regional office is supporting countries to ramp up these numbers by deploying teams to different countries and undertaking social anthropological research to understand and address barriers to vaccination.

The focus now is to increase vaccination among the most vulnerable groups, which includes health workers, older populations, and people with comorbidities. There are also plans to integrate COVID-19 vaccination into routine health programmes. This is one of the strategies we are exploring as countries transition away from the acute stage of the pandemic.

COVID-19 vaccination in Uganda

We have also seen a problem of misinformation about vaccines, especially on social media. Is there a way WHO is helping to deal with it? 

There are cases of misinformation about vaccines out there and not just on COVID-19 vaccines. With social media, it is easy for individuals to spread and share information, including some that may not be accurate. Cases of anti-vaccine groups pushing conspiracy theories and false information about vaccines have also been well documented not just in Africa, but globally.

This, on many fronts, has affected vaccine confidence and hampered public health responses to the pandemic. However, WHO has established strategies to tackle misinformation through different platforms by providing evidence-backed information to the public.

Together with a number of partners, WHO also launched the Africa Infodemic Response Alliance (AIRA), which is made up of fact-checkers with expertise in data, behavioural science, epidemiology, research, and digital health. They have been critical in countering cases of online disinformation around the COVID -19 pandemic and other health emergencies on the continent by providing accurate information that is backed by science.

WHO has been talking about the COVID-19 transition. Could you explain more about this? What does it entail exactly?

As we move away from the acute stage of the pandemic, we need to ensure that the health systems are resilient enough to deal with any health emergencies or threats that we may have to deal with post-COVID-19. This is in terms of preparedness and access to medical and public health tools and systems.

Without having a concrete guide, we will find ourselves dealing with the same challenges we have had to deal with the last three years.  At the WHO African region, we have come up with a framework to guide this transition phase. It focuses on ways we can maintain and consolidate the current response capacity but also how we can harness the power of science, research and innovation, and digital technologies. The framework also centres primary health care as a key cornerstone for building a resilient health system that can effectively address future health emergencies and disease outbreaks.

Funding remains a major challenge for countries. Even before the pandemic, many countries did not have the resources to fund their healthcare. Funding for testing, PPE oxygen, and other medical supplies is not adequate to this day. Does the transition plan cover how to address funding gaps? If yes, how?

WHO is looking at engaging and mobilizing donors to have additional funds which help countries to transition effectively from the pandemic to a situation where health systems can manage appropriately other similar public health emergencies.

It is almost three years since the start of the pandemic, can we say we are about to see an end to it as the WHO director-general stated recently?

While cases are declining, we cannot yet say the pandemic is over yet. We continue to see the virus spreading and more sub-variants are also emerge. Furthermore, vaccination figures in the African region are still not where we would like them to be.

Improving vaccination coverage will be one of our key priorities for 2023. We also need to continue investing in good surveillance systems in order to detect cases early enough and provide the necessary prevention tools.

Africa: COVID-19 at A glance: (as at December 13)

• 12.4 million COVID-19 cases recorded

• 11.6 million recoveries

• 257,312 deaths

• 84.5 million COVID tests conducted in the WHO African

• 28% of the people in Africa are fully vaccinated and 34% have received at least one dose

• 15% have received booster doses

• Mauritius Seychelles and Liberia only countries in Africa to achieve 70% vaccination target.

• 42% of healthcare workers fully vaccinated in 29 countries 

editor@observer.ug

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