COVID-19: A mammoth task for Africa’s public health agencies

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Coronavirus testing at Aga Khan Hospital, Nairobi Kenya.Credit: Patrick Meinhardt/Bloomberg via Getty Images

Launched in July 2017, the work of the Africa Centres for Disease Control and Prevention (Africa CDC) started with battling the Ebola virus disease, Lassa fever and other disease outbreaks in more than 15 African countries. However, its greatest test so far is supporting and directing the continent’s response to the COVID-19 pandemic.

Africa CDC director, John Nkengasong said: “COVID-19 is the biggest test ever for us,” Nkengasong said. “When the pandemic hit, it was not regional, it was spread all over the continent and we had to stretch ourselves.”

As the Africa Union’s (AU) specialized technical institution, the agency supports member states’ public health initiatives in addition to strengthening the capacity of public health institutions to “detect, prevent, control and respond quickly and effectively to disease threats”1. It led to efforts for sourcing face masks, protective gear, and other essentials. Another area of coordination is the sharing of molecular testing capabilities between countries, including testing reagents.

Beyond these actions, the agency has been actively involved in guiding and assisting African countries with COVID-19 vaccination through initiatives such as the African Vaccine Acquisition Task Team (AVATT), and the Africa Medical Supplies Platform. The centre provides guidance on vaccine efficacy and safety, while helping track the spread of variants through a genomic surveillance network that leverages sequencing capabilities available in some African countries to support other nations that lack such capabilities.

The Nigeria-based Africa Centre of Excellence for Genomics of Infectious Disease (ACEGID), led by Christian Happi, is one of the centers involved in helping other countries with genomic surveillance. Its published sequences have been instrumental in providing a better understanding of the spread of the virus across Nigeria.

“We’ve provided evidence to show that the strains are here and are spreading via community transmission,” he told Nature Africa. He added that the insights provided on the pandemic from research into genomic surveillance should bolster African governments’ decisions to support both epidemiologic response and sequencing efforts.

Praise for public health institutions

The World Health Organisation (WHO) has also expressed satisfaction with the conduct of Africa CDC and other public health institutions on the continent. “They've done a very good job,” Matshidiso Moeti, director of the WHO Regional Office in Africa, told Nature Africa.

Moeti noted that beyond the central coordination and guidance being provided by the WHO and Africa CDC, several national public health agencies had responded well, including the Nigeria Centre for Disease Control (NCDC)2. “They have managed to expand their capacity not only at the federal level, but down to the state level, and moving to the local level,” Moeti said.

Moeti noted that even though several of the continent’s public health institutes are relatively new, they have built a lot of capacity extremely quickly in surveillance, diagnostics, tracking, tracing and anticipation, and preventive action. Nkengasong told Nature Africa that while the Africa CDC has sufficient power, its ability to act depends on the willingness of member states to cooperate.

Going forward

Oyewale Tomori, a professor of virology and chairman of Nigeria’s Ministerial Expert Advisory Committee on COVID-19, described the pandemic as an eye-opening experience for African countries. It requires prioritisation and improvement of capabilities to respond to outbreaks without having to rely on foreign governments for assistance. This entails funding and strengthening the continent’s public health agencies, he says, adding “our leaders would have learned the need to be proactive in ensuring Africa is not at the mercy of the rest of the world again,” he told Nature Africa.

Happi also conceded that there are still avenues for African countries to do more in the area of genomic surveillance, including ensuring the labs conducting the sequencing have regular and easy access to samples and their systems are automated. “Automation is the only way for us to generate robust data. We already have the sequencers, but automation will make the system more robust,” Happi said.

Nkengasong described the COVID-19 pandemic as a transformative moment for Africa CDC. “With the political support that we have across the continent at the highest level, Africa CDC is poised to play a very strong role to enable the continent to fight endemic diseases including HIV/AIDS, tuberculosis and malaria,” he told Nature Africa. He noted that the centre’s efforts will complement those of the World Health Organization, especially the global health body’s regional offices in Africa.

Moeti said that health agencies on the continent now have reasons and platforms to continue to build their international health regulation capacities as part of their public health system.

“There is a need to invest a lot more in all these institutions. As WHO, we coordinated joint external evaluations of the International Health Regulations capacities of virtually all of our countries, and all these countries have a plan where they've identified what needs to be invested in order to fill gaps. We are advocating strongly for domestic resources and international support to be made available to support these health agencies,” she said.

For Happi, the next frontier in Africa is the early detection and preemption of future diseases. “We are proposing establishing and developing early warning systems for early detection and preemption of pandemics. That's what we should all work toward.”

doi: https://doi.org/10.1038/d44148-021-00046-9


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