We cannot afford another India to prevent a catastrophic third wave of COVID-19 in Africa, look at data to drive the response

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By Amanda McClelland and Dr. Richard Mihigo

Although the light at the end of the COVID-19 pandemic tunnel is visible in certain parts of the world, it remains dim across much of Africa. Vaccine availability ranges from severely lacking to nonexistent even for priority groups such as health care workers. COVID-19 surges in places such as India, where the dominance of new, more dangerous variants has had devastating consequences, are cause for concern in many countries in Africa.
It is likely that cases have been underestimated across much of Africa since the start of the pandemic, contributing to a dangerous global myth that the continent has escaped the most devastating effects from the virus. Limitations on testing capacity and surveillance make it difficult for governments to properly track the virus, although countries have made great strides in testing capacity. In the past six months, tests per 10,000 people have doubled.
More than one year into the pandemic, we are contending with the threat of the virus itself and the threats associated with pandemic fatigue. To combat the latter, governments must be smart about balancing the use of public health measures to stop the spread of COVID-19 with the impact these measures have on lives and livelihoods.
A group of organizations including Resolve to Save Lives, an initiative of Vital Strategies, and the World Health Organisation formed a public-private partnership* to compile and analyze data to provide African Union Member States insight into the direct and indirect effects of COVID-19 in Africa, including the acceptability, impact and effectiveness of public health measures to combat COVID-19. The Partnership for Evidence-Based Response to COVID-19 recently released its third report based on data compiled in February 2021 from more than 24,000 surveys, data from social and news media and trend analysis with the previous report. The findings speak to a real and immediate need for us, as part of the global community, to increase support to country leadership as they work to prevent further spread of COVID-19 in Africa, lest another, deadlier wave sweep across the continent.
Here’s what we learned from our recent survey:
COVID-19 has become more prevalent across Member States, although this varies from country to country. The percentage of respondents reporting they or someone in their household had COVID-19 more than doubled from our previous survey fielded in August 2020: from 3 percent to 7 percent in February 2021. And people may not be seeking care for potential COVID-19 symptoms; more than 20 percent of respondents that reported missing health care services said they did not seek care despite experiencing symptoms which may overlap with COVID-19.
There has been significant disruption to health service delivery since the start of the pandemic. Among respondents that reported they or someone in their household required a health care visit, almost one in four (23 percent) reported missing or skipping services since November 2020, and 43 percent reported difficulty obtaining medication in the same timeframe.
Income loss and food insecurity continue to increase, particularly among the most vulnerable. More than three quarters of all respondents (77 percent) reported losing some or all of their income since the start of the pandemic. More than 80 percent of respondents reported challenges accessing food in the previous week, an increase of 8 percentage points since August 2020. Lower-income households reported higher rates of complete income loss and barriers to accessing food.
Overall, respondents reported high adherence to individual measures to prevent COVID-19, particularly face mask use an encouraging finding, because masks are low-cost and high-impact. However, adherence to measures restricting social gatherings and mobility decreased between August 2020 and February 2021 in most Member States surveyed, in line with governments loosening public health measures.
What can we do now to prevent another India?
Africa needs more vaccines as quickly as possible, and the global community must step up to increase production, ensure equitable allocation and rapidly share technology and expertise with Member States to allow long-term regional production. That said, vaccination is not a panacea; Member States should take urgent steps to increase capacity to detect, test, sequence and trace cases and new variants to mount effective COVID-19 responses and implement targeted public health measures.
With vaccine rollout proceeding slowly, targeting public health measures to the areas most affected by COVID-19 will be vital to ensuring continued adherence in the coming months and years. Continued emphasis on individual measures mask-wearing, hand-washing and maintaining physical distance will be necessary for keeping transmission low while economies remain open. Focused public health measures will maximize adherence for the long haul, while minimizing their secondary burdens allowing governments to prevent surges before they start and limit the need for the most restrictive measures.
Transparency in decision-making and community engagement are key to convincing people to adhere to public health measures and receive the vaccine if offered. Respondents who were satisfied with their government were more likely to report adhering to public health restrictions and express interest in vaccination (for the latter, 71 percent versus 50 percent). With this in mind, the slow vaccine rollout across Africa offers the opportunity for governments to craft targeted information campaigns. Health literacy will be the vaccination against misinformation.
Relief for high-risk populations will offset at least some of the crushing indirect burdens cascading from the pandemic such as income loss, food insecurity and access to essential health services. Such burdens were more likely to be experienced by lower-income households, who were simultaneously less likely to receive government support. Only 13 percent of respondents reported receiving any government support in the past month; within this number, a higher percentage was from higher-income households, which indicates that the communities in most need are, dismayingly, receiving the least support. Governments must use evidence-based and targeted strategies to identify and offer relief to their most vulnerable populations.
This relief also applies to essential health services. COVID-19 threatens to undo decades-long progress in strengthening health systems and improving access to care and treatment. Fear of catching COVID-19, health facility disruptions or closures and affordability were the top three reasons for missing care. To mitigate these factors, governments must prioritize vaccinating and otherwise protecting health care workers, as well as strategically communicate to the public that seeking care at health facilities is safe.
With the slow vaccine rollout and the threat of new variants, the African continent remains vulnerable to COVID-19. The global community must step up for vaccine manufacturing. Governments must be vigilant in their continued fight against the disease and use data to find the balance between public health measures and the indirect burdens they pose. We all the global community, as well as country leadership have the responsibility to protect our people in times of crisis. With targeted campaigns, community engagement and support for their country’s people, governments have the capacity to save lives.

Amanda McClelland is Senior Vice President of the Prevent Epidemics and Dr. Richard Mihigo is Immunization and vaccine development coordinator at WHO
*Resolve to Save Lives and the World Health Organisation partnered with Africa Centres for Disease Control and Prevention, the World Economic Forum, UK Public Health Rapid Response Team, the London School of Hygiene and Tropical Medicine, the National Academies of Sciences, Engineering, and Medicine, and market research firms Ipsos and Novetta Mission Analytics to produce the PERC report.