SARS-CoV-2 (yellow), isolated from a patient, emerging from the surface of cells (blue/pink) cultured in the lab.Credit: NIAID-Rocky Mountain Laboratories, NIH
“They say never waste a crisis. Every crisis has an opportunity,” said Salim Abdool Karim, the director for AIDS programme of Research in South Africa (CAPRISA) at a virtual lecture: A new public order in the 21st Century, at the Africa Centre for Disease Control (CDC). According to Karim and his peers, the COVID-19 pandemic could be the opportunity that Africa uses to spur innovation and use of locally available materials which would make way for future tech-based economies for the continent.
Through developing COVID-19 testing kits, disinfectants, and PPE from local materials and more universities creating or strengthening innovation ecosystems, institutions have increased their capacities with genome sequencing at regional laboratories. A WHO report published last October noted the development of more than 120 health technology innovations that were piloted and adopted in Africa, targeting different areas of the COVID-19 response. These include innovations from surveillance, contact tracing, community engagement, treatment, laboratory systems and infection, prevention and control.
The report noted at least 57.8% of the technologies in Africa were ICT-driven, 25% based on 3D printing and 10.9% were robotics. From ICT-based innovations, self-diagnostic tools, contact tracing apps, mobile health information tools, Solar-powered automatic handwashing tools, mobile applications that build on Africa’s rapidly growing connectivity, the list is still growing.
“Before the pandemic, it was very difficult to buy anything made in Africa. China and India were making the PPE and diagnostics, but now many African countries are manufacturing them,” said John Nkengasong, the head of Africa Centres for Disease Control (CDC).
A challenge and opportunity for innovation
“COVID-19 is an opportunity to drive innovation, ingenuity and entrepreneurship in life-saving health technologies,” said Matshidiso Moeti, WHO Regional Director for Africa. For many countries in Africa adopting home-grown technologies was a priority since lockdowns forced them to look inward. The African Medical Supplies Platform (AMSP) described as the ‘Amazon’ for procuring health commodities, and the African Union’s African Vaccine Acquisition Trust (AVATT) platform which pools resources for vaccine procurement, are some of the pandemic innovations. “Every day I go to these platforms and am amazed at how they have united the continent through the procurement of health commodities. These are game-changers which give me a lot of joy,” Nkengasong told Nature Africa.
The Rwanda Biomedical Center (RBC) data dashboard has enabled user-friendly data utilisation for several key decisions for COVID-19. According to RBC head Sabin Nsanzimana, this impressed international colleagues at one of the seminars for experience sharing hosted by the Commonwealth Medical Association. Rwanda also moved its health workforce from an office-based practice to being field-based, enabling the treatment of mild COVID-19 infected patients. The active participation in ‘Operation save your neighbour,’ a home-based care model, which enables doctors to attend to COVID-19 patients in their community, ensured a quick response and community caregiving. It also created a new friendship for all the healthcare services within the same community, says Nsanzimana.
With limited capacity and resources, many African countries have adopted a ‘pooling strategy’ for testing for COVID-19. Pooling is a testing method wherein swabs from specimens from multiple subjects are combined into a pool and screened with a single test. If the pool tests positive, then new samples from the collected specimens are individually tested, while if the pool tests negative, the subjects are classified as negative. Pooling can substantially expand COVID-19 testing capacity and throughput, without requiring additional resources.
Existing COVID-19 research infrastructure to the rescue
Two young African researchers on a mission in the laboratory.Credit: Victor Okhumale/Alamy Stock Photo
Various universities have also stepped up their innovation ecosystems, allowing students and staff to come up with ideas, systems or devices that they can test and scale for use against COVID-19. In Sudan, media reports show that medical students are using a tele-medicine programme to both treat community members with mild COVID-19 in their homes and educate their communities about the pandemic. The Sudanese medical students joined the community medical response teams (CMRT) established earlier this year by US-based Sudanese physician, Nada Fadul, an infectious disease physician at University of Nebraska, and Reem Ahmed from Emory University.
In Kenya, students at Kenyatta University have come up with a prototype ventilator, testing kits, face masks and PPE that are manufactured locally. In Uganda, Makerere University students and staff have also developed ventilators and test kits. Research publications have increased from 992 papers in 2019 to 1,301 in 2020 – the highest output in a single year.
Local vaccine production
A more ambitious goal in Africa is to develop its own vaccines, therapeutics and diagnostics. The continent imports 99% of the vaccines it uses. “The gap is so big that our heads of state have stepped in and told us we must change the narrative,” said Ahmed Ogwell Ouma, deputy director of the Africa CDC. The regional body has set targets to see that vaccine manufacturing on the continent rises to 60% of what is needed by 2030.
Already, South Africa, Egypt, Morocco, Senegal, Rwanda, Algeria and others, have set up pipelines for vaccines manufacturing. “Africa needs to generate its own knowledge and manufacture its own vaccines. If we do not do that we shall always be at the back of the queue,” Karim said.
“If we do all this, the way we fight the next pandemic will be very different,” Nkengasong added.
The COVID-19 pandemic has compelled African countries to increasingly rely on the region’s local science ecosystem. When the COVID-19 pandemic hit Nigeria, Africa’s most populous country’s early response largely leant on experience and capacities acquired during previous Ebola and Lassa fever outbreaks. Beyond the government-led response, existing COVID-19 relevant research infrastructure has also been integrated into the country’s plan.
Near the city of Lagos, the African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), a research facility that focuses on infectious diseases, has been contributing genomic sequences to provide Nigeria’s public health agencies with information regarding the variants in circulation.
In May 2021, Nature Africa reported that a combination of genomic and epidemiologic approaches can improve public health response to serious emerging infectious diseases. Since the publication of the sequence from Nigeria’s first case of COVID-19 to reporting other strains and variants, including the Delta variant, ACEGID has been playing an active role as a member of the network of laboratories in Africa with capacities for genomic sequencing.
Genomic sequencing is not the only COVID-19 response, as the local research landscape provides evidence to counter the efforts of anti-vaxxers — addressing vaccine misinformation and persuading Ghanaians and other Africans to receive vaccines in Ghana.
Christian Owoo, Ghana’s National COVID-19 Case Management Coordinator for Severe and Critical Diseases, revealed that after vaccination began in Ghana, it became clear that the majority of COVID-19 patients that require critical care were those yet to be vaccinated.
“Sharing this knowledge is important in African countries. Research and sharing of knowledge are going to be a massive part of reducing vaccine hesitancy; working collaboratively with other African countries and making sure that this evidence is put out there to encourage an efficient distribution of vaccines,” Owoo said.
The situation is similar in DRC where Jean-Jacques Muyembe Tamfum leads the country’s COVID-19 response and leading the National Institute for Biomedical Research. DRC had to return more than a million doses of expired COVID-19 vaccines because of vaccine hesitancy. With the Delta variant driving the surge in the number of cases and hospitalizations, Tamfum said more citizens are now asking for vaccines.
