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Africa's pandemic handling helped by intra-country learning and effective leadership

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African countries have contained the pandemic relatively well, according to Africa Health 2021 speaker Dr Alex Coutinho, while Delta and vaccinations remain challenges.

In an Africa Health 2021 interview with Omnia Health Insights, Dr. Alex Coutinho, former Executive Director for Partners in Health in Rwanda, revealed how Africa has tackled infectious diseases threats during the pandemic, and what the future holds for the continent.

What have been the biggest successes and challenges from your perspective in Africa’s handling of the pandemic? How can African countries learn from these going forward?

In comparison to other continents, such as the United States, Europe and South America, Africa has been spared from relatively worse COVID-19 related infections and deaths.

This is partly due to the WHO and Africa CDC mobilising many African countries. COVID-19 has been prioritised on the political agenda, enforcing early prevention measures such as lockdowns and masking mandates.

Social media and other communication technologies have been leveraged to spread information. However, that's also led to misinformation. Nevertheless, it's also been very successful in mobilising people.

Challenges were experienced in the following areas: the availability of good healthcare infrastructure in regions with rising cases, the arrival of the Delta variant, and vaccination.

The target of vaccinating at least half of Africa by the end of the year is not going to be met. Some countries are still at 1 percent. Vaccine doses are unavailable and there is a lack of funding to purchase what is available, while some vaccines require technological means to be transported, received, and distributed.

In Africa, inter-country learning and good leadership, particularly from Africa CDC in mobilising vaccines, have been fostered. We have watched and learned from countries such as the US, Brazil, India, and the United Arab Emirates, which has almost 80 percent of its population vaccinated, resume normalcy.

We have also witnessed countries like Vietnam and Thailand, which initially did not have a serious epidemic, encounter huge epidemics.

Africa has benefited, in a sense, by learning from other countries. This needs to be encouraged as the big challenge remains in understanding how do we continue to generate demand for vaccines?

And by doing so, how do we continue to sustain prevention against COVID-19 through precautionary measures? COVID-19 has consumed the health systems of many African countries, derailing and worsening treatment of other health conditions. How do countries juggle COVID-19 with HIV, TB, Malaria, and maternal-child health?

How effective have official communications been across the continent, in areas such as mask-wearing and social distancing for example?

From a Ugandan perspective, three initiatives have been very effective. Schools have been closed and religious gatherings have been banned, as these are key areas where large populations gather. The third has been mandating a curfew to limit population movement at night.

These are strictly enforced, impacting social distancing which has been reduced. Mask-wearing varies, depending on the policy of the region. One of the biggest advantages for Uganda and Africa, excluding South Africa in winter, and this is my hypothesis, is that a lot of our daily activities are outdoors.

This is perhaps a benefit of not being a society that is trapped in large office buildings. The economy is driven by informal activities. People spend most of their time outdoors, returning home late at night to rest.

The risk of contracting COVID-19 is far less outdoors due to natural ventilation. Therefore we can potentially move other activities outdoors.

 

Millions of people in Africa have grown up with malaria. How will the vaccine breakthrough be life-changing, and how will accessibility be possible?

The malaria vaccine can be life-changing for those it protects. However like any other vaccine, it is not perfect, having 30 percent efficacy. It is a breakthrough; however, as it marks the beginning of striving to eradicate and eliminate malaria.

This is the very first vaccine against a parasitic disease and was five decades in the making. We still have a long way to go. The first steps are to manufacture this vaccine and make it affordable.

The deadliest parasite causing malaria is Plasmodium falciparum, prevalent in Africa. It is crucial to communicate the reason behind it being an African vaccine primarily.

According to the WHO, the African Region continues to carry a disproportionately high share of the global malaria burden. In 2019, the region was home to 94 percent of all malaria cases and deaths.

Prescribed for children, it is key to communicate to parents that the vaccine does not guarantee 100 percent immunity. It is crucial to implement preventative methods such as using bed nets.  

However, I want to emphasise its success, being the first in a series of successes. Vaccines that are 95 percent efficacious, go through a long process to attain that high efficacy.

The pandemic caused disruption to child and maternal health services across Africa - how can this be prevented in the future? 

When you have lockdowns, the population is suspicious of healthcare facilities, because they think if they go there, they might get COVID-19. 

Maternal child health services have been provided mainly by the public sector. There haven't been many provisions for the general population by the private sector.

The private sector needs to work with the government to subsidise services. We need to look at new models, which break away from public facilities. In Uganda, pharmacies are emerging as major providers of services for urban populations.

Between 40- 50 percent of Africa is urbanised, therefore there is a need to rethink how we can better provide these services.

Pre COVID-19, facilities, and services available for Maternal and Child health were insufficient, and when faced by a pandemic, the resources become more deficient.  

We need to look at empowering community healthcare workers. Philips has a pilot in Kenya, where they provide community healthcare workers with a series of tools.

They can conduct ultrasounds on pregnant women in their homes and transfer the data to a specialist for analysis, followed by delivering the results to the patient. COVID has compelled us to innovate; however, change needs to be supported by national governments, ministries of health, and policymakers.

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