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Interview: Responding to the COVID-19 pandemic in Africa

In this interview conducted on May 2, 2020, AFENET Director Dr Simon Antara and Head of Programmes Dr Herbert Kazoora discuss the COVID-19 pandemic from an Africa perspective with London based Ugandan Journalist Florence Naluyimba Blondel. We listened in during the recording of the interview and we bring you a transcription of the same verbatim:

1. What is AFENET?

Dr Antara: The African Field Epidemiology Network (AFENET) is a networking and service alliance of field epidemiology training programs in sub-Saharan Africa. We work very closely with Ministries of Health and Agriculture, Universities, CDC and other partners to develop capacity in field epidemiology for countries in the sub-region. The skills from field epidemiology training are critical in the response to many public health challenges including responding to public health emergencies such as COVID-19. Our member programs provide tiered and tailored training all the way up to master’s level. Graduates of these trainings constitute the AFENET Corps of Disease Detectives (ACoDD). This is a well-trained, trans-disciplinary team that can be rapidly mobilized and promptly deployed to respond to public health emergencies across the continent. We are present in 31 countries and still counting. AFENET is a critical component of the emergency response infrastructure in Africa. We have our headquarters right here in Kampala.

2. How is AFENET contributing to the continental response to COVID-19?

Dr Kazoora: We have been working with ministries of health on the continent for the last 15 years and we have been building capacities for disease surveillance, outbreak investigations, and response. Our member field epidemiology training programs [FETPs] are embedded within the ministries of health and our trainees do their field work and activities within their ministries of health. We provide a service-based kind of training. So, during the preparedness phase when Africa had not yet recorded any case our programs were already involved working with the ministries of Health. Graduate field epidemiologists, Field Epidemiology Training Program staff; the faculty of those programs were involved in developing national response and preparedness plans in each of the countries where we are. The field epidemiologists were also involved in developing the protocols and tools for COVID-19 surveillance, investigation and response. They were involved in training and orienting health workers on COVID-19. They were also at points of entry. Initially before governments closed airports, we had people travelling across the world and we knew this was the only route through which COVID-19 could enter Africa. So immediately with support from member programs, we deployed field epidemiologists at points of entry at airports and they were doing the screening of travelers at that point detecting suspected cases, and investigating them. This was done until COVID-19 came home.

But before that we were also supporting risk communication and community engagement, working with our programs we were able to produce some Information Education and Communication materials, helping with adapting IEC materials and using those to sensitize the communities about the disease. Eventually when the cases started coming into the continent, we activated what we call the AFENET Corps Disease Detectives. This is a corp of graduate field epidemiologists of FETPs. It is a mechanism through which we mobilise and deploy graduates of FETPs in real time and these are not subjected to a lot of bureaucracies in terms of getting clearances for them. We maintain an active database of them from which we are able to mobilise and deploy. So, when we started getting cases, of course we stepped up the point of entry screening of all travelers. And as you know for countries like Uganda the first case was picked at the airport and our graduates where involved in that and the screening of travelers in all countries where we are on the continent. These teams were integrated into the national response structures and they were actively involved in all case investigations. For, every case detected through various surveillance systems, our field epidemiologists deployed through ACoDD were involved in that particular case. And what happens with case investigation, epidemiologist gather additional information on the case, or identifying some of the risk factors which could include history of travel, contact with an infected person and so on. So, they gathered information and through that process they were also able to support the listing of contacts and continue to do that even during this period. Individuals that came into contact with the confirmed case are listed and then we go into the next phase, which is contact tracing or contact following. So, the field epidemiologists out there are still involved in contact tracing which means they are following up on all the contacts for 14 days for every case and this period is what we call the incubation period. For now, we know that from the time someone is exposed and when they start showing signs is about 14 days. We have also been facilitating linkages between surveillance and case management. All the contacts that begin showing signs and symptoms are linked up with the case management teams of the ministries of health. And those case management teams come along with their laboratory teams to collect samples and isolate those suspected cases.

We have also been involved with the Africa CDC. We knew that this disease would come to Africa so we collaborated with them to build additional capacities in member countries. And these capacities involved conducting rapid trainings for public health workers in the areas of laboratory diagnostics. Initially, we had two laboratories in Dakar Senegal and South Africa. But as we speak now from those interventions and support by partners, countries can now test COVID-19. We also trained people on point of entry surveillance, risk communication, infection prevention and control, but also secured and distributed supplies like the PPEs that are in high demand. We played a critical role in mobilizing those, procuring them, and distributing them with the Africa CDC.

AFENET Director: Dr Simon Antara

3. Why is it that Africa is recording a relatively lower number of cases? 

Dr Antara: Several factors may account for the relatively low numbers of cases reported in Africa. COVID-19 arrived in Africa relatively late and that provided a window of opportunity for the continent to prepare and respond. Generally, both the political and health leadership in the continent have shown great commitment in the fight against COVID-19. Of course, the level of commitment varies from country to country but generally, a great deal of attention has been given to the pandemic.

Indeed, when the epidemic started in China, it was a question of when not if the disease will get to Africa. This consciousness of the risk and vulnerability in the continent moved the leadership into action to prepare and ramp up the capacity to respond.  Many countries imposed travel restrictions and ultimately closed their borders. Heightened surveillance, isolation of cases contact tracing and quarantining and lockdowns were imposed to ensure physical distancing in the quest to interrupt transmission of the disease. In mid-February, the Africa Union Commission organized a meeting of African Ministers of Health to deliberate on the pandemic and chart a common path to deal with it.

The Africa CDC and WHO AFRO have been particularly proactive in mobilizing resource, developing technical guideline, building capacity in various areas and distributing logistics to countries to ramp up capacity for response.

The relatively late arrival of COVID-19 coupled with the measures taken by many countries in the continent cannot be ignored in discussing the factors contributing to the low numbers reported.

The level of testing may also be playing a role in the numbers that we are seeing. Yes, it must be acknowledged that the capacity to test has improved greatly in the continent.  By close of January, only two countries, South Africa and Senegal had capacity to test for COVID-19. By the close of February most countries had developed the capacity to test. However, I must quickly add that the testing capacity in the continent is still sub-optimal with wide variations across countries. It is likely that when we reached optimal capacity of testing, we will have more cases reported. I have heard some people try to use the testing capacity as the only reason to explain the low numbers. To accept that the low numbers are only due to the low testing capacity will be to ignore all the interventions and all the continental efforts at preventing the spread of the disease.

The role of temperature in the transmission dynamics of COVID-19 is being investigated. One of such studies has reported that a 1degree Celsius rise in local temperature reduces transmission rate by 13%. More studies need to be done to clearly define the role of temperature and other weather conditions in all this. Possibly, the high temperatures in Africa might be contributing to the low numbers.

That said, I must say that there is no room for complacency. We have not arrived yet, indeed with many countries reporting community transmission, the problem is growing and Africa must continue to implement the needed measures until we are out of the woods.

4. If Africa is not helped now by the West before COVID gets out of hand, are we likely to face the same problem of a delayed response to the HIV pandemic on the continent? 

Dr Antara: It cannot be overemphasized that the amount of resources required to mount a formidable and sustained response to COVID-19 is huge. Indeed, a large amount of resources is required to mitigate the health, economic and social cost of the pandemic and many developing countries may not be able to meet the resource needs. Whatever the challenge, it is incumbent on the leadership in the continent to mobilize these resources. These resources may come from the West, East or even within Africa. They may come from private individuals, corporate bodies, foundations, etc. We have seen many innovative approaches by leaders towards resource mobilization. We have seen the repurposing of manufacturing to meet local needs. May I add that any helping hand extended for this response, is not an act of charity, it is an act of responsibility to safeguard our collective survival. If any country is left behind in the fight against COVID-19, a vicious cycle will be created whereby we have repeated outbreaks across the globe. How can I be certain of this? Our interconnectedness guarantees that.

AFENET Ag Head of Programmes: Dr Herbert Kazoora

5. What role can regional blocks like IGAD, ECOWAS, EAC, and SADC play in the COVID-19 response? 

Dr Kazoora: Regional bodies play a critical role especially in developing regional response strategies on the continent. For example, within the East African Community they have developed and disseminated a regional response plan on what countries should do to control the spread of this pandemic. Much as we have lockdowns, we still have travel across borders. You have cross border movement bringing in goods especially for landlocked countries like Uganda. So, there are these protocols that have been developed on how to sustain the movement of goods and services. We have issues of truck drivers; how do you ensure that those coming from a country that has more cases than another are monitored and tracked right from the country of origin. So, standards and protocols are being developed and all these require strong collaboration among countries. And these can be facilitated by these regional bodies. These bodies can also help with resource mobilization. The East African Community has of recent procured mobile laboratories and these laboratories can be moved from one point to another to do the testing. We think that these labs which are going to be distributed among the member states will be able to increase the number of tests but also address the issue of cross border testing of truck drivers for example. Currently we have samples picked off drivers and sent to a central laboratory like the Uganda Virus Research Institute and then results come in later. But having a mobile equipped lab that has been provided by the EAC is going to bridge that gap and reduce the time between testing and when we know who is positive and who is not positive and through this reduce transmission. They have also supported procurement for equipment, supplies, and distributed those to member countries. So, they do play a critical role.

Dr Antara: there comes a time when interdependence is of a higher value than independence. I believe that the COVID 19 pandemic is one of such situations. In the fight against infectious diseases, concerted effort is required. As we always say, diseases do not require passports nor visas to move from one country to another. Having regional blocks come together to fight these pandemics is very critical and I think these regional bodies have been up to the task on this issue. When we talk about IGAD, the Heads of State and Governments had a video conference somewhere in March and they passed very useful resolutions that would not only be of benefit to the COVID-19 response, but for other pestilences beyond COVID-19. For example, they passed the resolution on establishing the IGAD Emergency Fund to not only address COVID-19 but even other pandemics that may come up. They passed a resolution to mobilise support for the economies in the member countries. They also passed a resolution to support countries that are much more vulnerable. These are very useful. I know that after the heads of state discussions, the ministers of finance and the ministers of health also had discussions to see how they can bring the resolutions to work. In ECOWAS, the same thing is happening. In fact, ECOWAS has the West African Health Organisation as its health agency. And they have been mobilizing resources such as laboratory test kits, personal protective equipment, they have defined a regional strategy and have done many other things. So yes, these regional bodies have played a critical role in the response to COVID-19 and I think it is something that they need to continue. I am particularly happy about the measures put up by IGAD and other regional bodies that are not only looking at COVID-19 but at any other emergencies that may come up.

 6. What are we foreseeing in the post COVID-19 era if and when this is over?

Dr Antara: There are efforts from the global sub regional level and many organisations are working on preparing countries for any such emergencies. In fact, COVID-19 is not going to be the last one. The approach to emergency preparedness in Africa is another issue for discussion. There is a lot of effort towards this and all that we need to do is to learn the lessons from COVID-19 emergency preparedness and response. The World Bank Group has estimated that to have an acceptable level of emergency preparedness and be able to respond effectively, a country needs to invest 0.5 to 1.5 US dollars per person per year in emergency preparedness. I think this is doable but countries have not been able to do that. We are more concerned about responding to emergencies than preparing for them. Our response to emergencies is as good as our preparedness. If we are not well prepared, our response will not be good. So I believe that countries are going to learn from this and will invest more in emergency preparedness. 

Dr Kazoora: Life after COVID-19 is not going to be the same. Science is going to inform whatever decisions are made. We are likely to change the way we do things. We are not going to continue mixing up as before until we fully understand the transmission dynamics of the disease and the control measures. We are going to try and maintain social distancing as much as possible. The issues of hand hygiene. We have to ensure that we are adhering to sneezing and coughing etiquette. If we adhere to these, we will be able limit transmission on the African Continent and keep cases to a manageable level that will not over stretch our health systems.

7. Are African scientists making any contributions to vaccine and medicine development?

Dr Antara: African scientists are not left out in this fight. They are involved not only in vaccine development and trials but also in the trials of possible medications that can cure COVID-19. I know that African scientists have been involved in doing clinical trials on hydroxychloroquine and azithromycin to determine their effectiveness in the treatment of COVID-19. For vaccines, there is a way these trials are carried out. They are supposed to be tested in various populations and our scientists are not left out of that.

Dr Kazoora: I have leant of a one-dollar test that is being developed in Senegal. If that comes on board, the cost of testing is going to be low. We will have more people tested and we will be able to know the magnitude that we are really dealing with.

8. Aren’t health care workers afraid under the given circumstances?

Dr Antara: This is our calling. There are times journalists  have to report in war zones and they do so. But this is of course done with all the precautions to ensure that they are protected. As medical people we have had to work with these situations over and over. If you are in the hospital you don’t know the kind of people that are coming. You have to attend to patients. COVID 19 has come and there must be people to work to see to it that we bring it under control. If we are all afraid of it, it is going to consume all of us. What we have to ensure is that every one of our detectives that is out there to respond to this pandemic has what it takes to protect themselves. And with that we are bold enough to go forward. It is possible and we already have a few people -not our detectives- but medical workers that are infected. But that is not going to scare us because that is our calling. It is for us to work to ensure that we bring this under control.

9. Would you advise any President to relax their lockdowns and open up their economies?

Dr Antara: The decision to lift any lockdown should be based on the science of it. And I was particularly excited when I heard the president of Uganda saying that the decision that will be made will be based on science and will not be something that will just be imposed. What we can say is that let every country look at what the data they have tell them based on science. If we make evidence-based decisions, we are not likely to have terrible consequences from those decisions. But if we make decisions just because we want to make them, we are going to have challenges.

END/ Transcript by Kakaire Ayub Kirunda.