COVID-19 as a big lesson to reform Africa’s health sector


With African Union kicking off its summit here in its headquarters Addis Ababa, COVID-19 is expected to be high on the agenda in addition to the long lists of socio-economic and political issues. The pandemic that is caused by the tiny virus has implied that the continent has a tall order to reform its health sector.

COVID-19 has opened up the status of Africa’s health sector and nations’ capability to cope with pandemics like COVID. It has been a couple of years since the World Health Organization declared COVID-19 as a global pandemic. The outbreak rocked the whole world pushing nations into uncharted territories with unprecedented socio-economic impact. At the heart of hard-hit continents, Africa is the one.

Despite nations coming up with preventive and coping measures, Africa has been going through tumultuous times due to the pandemic and COVID-induced ramifications. The pandemic has significantly tested Africa’s entire health sector. With poor health facilities, the continent lags behind in COVID testing and vaccine administrations as it heavily relies on foreign aid for COVID kits and vaccine doses. It even finds it hard to supply its population with simple face masks. This in fact makes vaccine equality challenging .

Despite its complex impacts on the socio-economic wellbeing of the nations, COVID can be taken as a testing opportunity to the continent’s readiness for future pandemics. The COVID-19 outbreak has even resulted in human casualties in the most developed nations that have well-built health infrastructure.

The pandemic killed millions of people and destroyed economies and livelihoods. It literally turned the table on the world; no nation has escaped this unfortunate reality. From east to west, from north to south, nations in the world have been facing unimaginable repercussions due to the tiny yet disastrous virus.

With the discoveries of vaccines, nations in the world have started breathing a sigh of relief though the world is yet to feel the worst impact of the pandemic due to the complex nature of the viral disease. Still, the world continues losing a significant population due to the virus.

For Africa, the pandemic has far-reaching implications in terms of the continent’s health sector.

Poor health infrastructure, insufficient research, and laboratory activities coupled with other socio-economic and political problems have made the prevention and treatment of COVID a daunting task. Despite these gruesome realities, there have been concerted and collective efforts by countries and health organizations in terms of research and clinical trials.

Over the last 20 years, African researchers have conducted many clinical trials to international standards and have taken into account complex contextual issues. Despite heavy reliance on foreign support, there have been some initiatives to conduct clinical trials for vaccines and treatments in Africa.

Dr. Borna Nyaoke is Senior Clinical Project Manager and Medical Manager at Drugs for Neglected Diseases initiative – Africa Regional Office. She said that a number of African countries were reliant on getting the Covid-19 vaccines through COVAX. The idea behind the initiative was to pool resources to ensure that all countries received a fair supply of effective vaccines. But wealthier nations have generated deals with manufacturers guaranteeing themselves a supply; meaning COVAX struggles to obtain enough doses.

Speaking of the challenges facing Africa in terms of testing and vaccine applications, limited funding has also played a crucial role since people have to pay for COVID-19 tests out. This reduces the numbers screened as most people are already struggling to meet basic needs. Mass vaccination drives are also not taking off effectively or are stopping due to operational costs, including cold-chain logistics and travel costs and payment for vaccinators and supervisors, as well as a looming shortage of syringes and other crucial commodities, she added.

“Healthcare systems in Africa suffer from neglect and underfunding. We need to train and build the capacity of more health workers, increase budgetary allocation to health, and advocate for political support and commitment of our healthcare systems.”

Again, despite the huge burden the pandemic brought, Africa has relatively seen fewer COVID cases and deaths. She argued that Africa may have been spared the worst of the pandemic with relatively low numbers of COVID-19 cases reported thus far, contrary to earlier predictions of ‘dead bodies lining the streets of Africa’. Unfortunately, due to our weak healthcare systems and resources being diverted in the last two years to COVID-19; diseases such as HIV, TB, and malaria that result in serious morbidities and mortalities in sub-Saharan Africa every year have re-emerged as serious concerns despite all the work that have gone into them for a number of years, she underlined.

Africa may have a harder time coping with pandemics such as COVID-19 due to; numerous informal settlements within its cities resulting in crowding that makes physical distancing difficult. Across the continent, there is also limited access to safe water, undernourishment, poorly funded health systems, and underlying health conditions like TB and HIV/AIDS making the people in the continent more susceptible to this pandemic, she noted.

Addressing the question of clinical trials, she argued that at the beginning of the pandemic there were less than five clinical trials being conducted on COVID-19 in Africa, these being in South Africa and Egypt. Currently, there are over 500 COVID-19 clinical trials in Africa registered on WHO’s International Clinical Trials Registry Platform (ICTRP) portal. This includes the ANTICOV clinical trial coordinated by DNDi that is being conducted across 19 sites in 13 African countries to find treatments for mild to moderate COVID-19 before it progresses into severe disease. “Data is slowly trickling in and there is hope that we will soon have evidence that is home-grown and specific to our people.”

“To ensure Africa’s readiness for future pandemics we need to invest in research and development, manufacturing, health, and technology capacity. As African countries build infrastructure, they must also ensure that those in charge of it have public trust and are held to account.”

While indicating the possible remedies, the expert said that planning is also quite important, countries with National Vaccine Deployment Plans have fared better e.g. Ethiopia, which has used 80 percent of its available vaccines, used a reverse logistics system to bring back vaccine doses from areas where they were underutilized, and redistributing them to areas with higher demand, thereby avoiding the expiry of precious doses.

The testing capacity of Africa was by far very low compared to elsewhere in the world because of lack of resources and infrastructure, lack of reference laboratories, and poor health-seeking behavior. The vaccination rates were very low and many people are hesitant to take the vaccine including the health professionals. The main challenges are lack of adequate vaccination rollout as it solely relies on aid, but the cultural values also remain the main obstacles for the proper coverage, said Dr. Mezgebu Silamsaw Asres, an Internist and Assistant Professor of Internal Medicine at the University of Gondar Hospital and the main investigator of the ANTICOV clinical trial at the University of Gondar site.

The capacity of conducting clinical trials in Africa is in general limited. However, there is an increased effort to conduct clinical trials; and activities are underway to expanding at different sites throughout Africa. Several institutions, including the University of Gondar, are part of the ANTICOV consortium in conducting one of the biggest clinical trials in Africa; he argued adding that despite many challenges it is being conducted successfully at many sites, which indirectly increases the capacity building, experience, and research culture. These days clinical trial centers are being established at the local institutions, one of which is a center at the University of Gondar, he added.

A large proportion of health care is dependent on foreign aid. This is true, making it difficult to be self-sufficient. Such over-reliance on aid is not helping Africa. Hence, countries should look for alternative sources of financing the health care. “The COVID pandemic has also shown us that the continent still has the capacity to become self-sufficient, starting manufacturing such products including the face mask from locally available resources.”

The COVID-19 pandemic is a threat to the globe in general and will be a potential threat to the Sub-Saharan countries.

“Readiness for the occurrences of pandemics should be planned ahead which is not the case in Africa. During this pandemic, most health experts and the World Health Organization were warning Africa because of the poor health system, slow vaccination coverage and poor ICU set up which will have major consequences.”

COVID-19 is a disease that is difficult to control because it has multiple transmission methods in the handling of money, where there is no access to technologies and overcrowded transportation, and busy market places. Gathering in the religious and other gatherings continued despite the pandemic.

He also said that there should be improved coordination across the globe with good leadership of the health care system, improving the financial capacity of the health system; especially an emergency preparedness and response system should be established. In addition, research and development should be strengthened, and adequate resources should be allocated in the field.

The February 6/2022

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