By Bhavi Mandalia

Today’s data confirm the worst forecasts: Covid-19 is expanding relentlessly in the African continent, which has already accumulated more than one million cases registered in 47 countries and more than 20,000 deaths. In recent months there has been an exponential increase. Half of these cases (almost 560,000) correspond to South Africa, the epicenter of the pandemic on the continent and the fifth country in the world with the highest number of infected. It is followed far behind by countries such as Nigeria (46,577), Ghana (41,003), Algeria (35,214) and Kenya (26,928). Data up to the time of this publication.

In a previous article we argued with hope that resilience and African experience in epidemic management could be your best asset. However, the shortage of diagnostic tests and insufficient medical resources and health personnel appear to be undermining the success of Africa’s fight against the pandemic.

Shortage of tests and diagnostic capacity

The relatively low number of coronavirus cases in Africa a few months ago had raised hopes that some countries would manage to rid themselves of the worst of the pandemic. In the end it was only a matter of time. Not even the most developed country knows for sure the total number of people infected with SARS-CoV-2. We only know the status of those who have been tested. This means that the count of confirmed cases depends on the number of tests a country performs. Rates of people tested (per 1,000 people) range from 148 in Iceland to 0.76 in India. In South Africa, as of May 3, 2020, the testing rate was 4.5. Without evidence there is no data.

If we look at the number of PCRs per country It is observed that there are places where the number of confirmed cases is high in relation to the number of tests performed. This suggests that the number of tests is insufficient to adequately monitor the pandemic. In these places, the number of real infected can be much higher than confirmed. Many of the African countries are in that category today. For example, the Republic of the Congo, Nigeria, Senegal, Mali, Ivory Coast, and Togo. Last April Chikwe Ihekweazu, head of Nigeria’s Center for Disease Control (CDC), made a desperate call on Twitter for PCR testing in his country.

Against this background, the African Union launched an initiative called PACT (Partnership to Accelerate Testing in Africa) in which it undertook to supply, within a period of six months, 90 million diagnostic kits among member countries. Still, they may not be enough to stem the tide of COVID-19 on a continent with a population of 1.3 billion people. In fact, even with PACT resources, it is estimated that 25 million tests would still be missing for the continent to match the diagnostic capacity of many European countries.

In addition to PACT, the African scientific community is drawing on its international collaborations to increase its capabilities. Thanks to that diagnostic laboratories have already been set up in Uganda, Senegal and Ghana. However, WHO has doubts about the effectiveness of such tests, which do not always conform to international standards.

Although there is variability between African countries, in global terms only half of the population has access to primary care, and their health systems function at half their capacity. Among the challenges they face to increase its diagnostic capacity would be the installation of reference laboratories, the increase in health personnel and the self-supply of medical supplies.

In addition, due to the pandemic, international cooperation has been undermined. Countries like the United States are limiting access to medical supplies. The European Union has also urged member countries to limit the export of EPIS and possible drugs against covid-19. In April, John Nkengasong, director of the African Centers for Disease Control and Prevention in Addis Ababa, wrote in Nature about how African countries are being excluded from the global market for diagnostic tests.

Collateral effects of covid-19 in Africa

To the impact of confinement in education, health systems, food security and the economy, is added the collateral effects that the coronavirus pandemic is having on health programs aimed at other diseases: tuberculosis, malaria and AIDS end every year with the lives of millions of people.

The Global Fund presented data from the first wave of the pandemic showing that 85% of HIV programs had been interrupted, 78% of those for tuberculosis and 73% for malaria. WHO warns that these disturbances mainly affect the campaigns for the provision of mosquito nets and access to antimalarials. Epidemiological models predict twice the number of malaria cases in sub-Saharan Africa in the coming years. This would take us back 20 years in the fight against the disease.

Our project, financed by the CSIC’s covid-19 fund and carried out in collaboration with institutions in Burkina Faso and Equatorial Guinea, aims to shed light on this question. On the one hand, contribute to the diagnosis of covid-19 by performing rapid serology tests and PCR tests. On the other, to estimate the incidence rates of malaria before and after the pandemic.

Africa has to be part of the solution

Africa has extensive experience in managing health emergencies. There is a multilateral action (Africa Joint Continental Strategy for COVID-19 OUTBREAK) that coordinates efforts of African Union agencies and member countries, WHO and other partners, for surveillance, prevention and control.

However, Africa will also need funding to pay for vaccines and possible treatments, and to increase the number of local clinical trials. Despite the fact that the continent has the highest burden of disease worldwide – a quarter -, it only accounts for 2% of global clinical trials. Community clinical trial, driven by African Scientific Academy (AAS), aims to close this gap in clinical research.

A step forward in this regard is the participation of South Africa in the Oxford / AstraZeneca vaccine clinical trial. But to ensure access to the future vaccine, Africa has to be an integral part of clinical research against covid-19. Not just as mere subject’s research, but leading it. In the words of the writer, politician, feminist and anti-globalization activist Aminata Traore: “We are overflowing with potential and I rebel against the nature of the system and its ability to destroy hope in Africa.”

Elena Gómez Díaz is a Ramon y Cajal Researcher. Leader of a research group on epigenomics in malaria, López-Neyra Institute of Parasitology and Biomedicine (IPBLN-CSIC).

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