Preparing For The Next Pandemic In Africa: Some Lessons From Covid-19
The Covid-19 virus as of March 2021 has infected more than 100 million people globally and more than 2.4 million have died from the disease. However, it is likely that this number will be far higher. With a global average mortality of about 2%, the tragedy is incalculable . The pandemic has brought prosperous nations and well-run healthcare systems to their knees. Even in economically powerful nations like the U.S., tension between maintaining social freedoms and engaging in collective efforts in defense against the virus has led to the establishment of stringent preventive measures such as hand washing with soap and water, physical distancing, and wearing of mask , just to name but these. Looking at it from the point of view of preventive measures such as immunization, there have been controversies regarding the acceptance of vaccines in most African countries with lots of mixed feelings being reported here and there . But what if the “first” SARS from 2003 re-emerges again with its 8% mortality? Or the MERS epidemic from 2012 with its 34% mortality? These two viruses are still out there in their respective animal hosts, and there are many millions of other animal viruses with the potential to jump from their host species to humans . The world was not well prepared for Covid-19 . Even wealthy countries have shown their poor levels of preparedness. However, the differences between the rich and poor, those who are privileged versus those who are vulnerable have raised the challenges of an equitable global pandemic response. The points listed below are not meant to be exhaustive but are simply some of the long-term interventions that may be required to enable a better response to the next epidemic.
Better epidemiology data
Surely the age of “precision public health” is here with the emergence of Covid 19. After the MERS epidemic in 2012, this concept was highlighted as a possible key to bring about a systematic monitoring of infectious disease. The existing data systems of the public health system are inadequate for epidemic interventions. Government data systems should embrace precision public health (It is essentially about delivering the right intervention at the right time, every time to the right population), including incorporating more modern methods of mapping diseases through, for example; tracking on GIS systems in real time, integrating laboratory diagnosis with disease presentation and severity, integrating unique patient numbers with numbers of staff to assist them, migration of people, and many more. African governments should fast-track a national electronic health record system that captures everyone and their health-seeking behaviours and diagnoses. The important “single patient identifier system” will proof to be exceptionally useful within the Covid-19 epidemic response. Such systems allow for a greater ability to know who is being infected, where they are and how best to allocate human and infrastructural resources . They would also allow for a better view on treatment interventions and determining which work better than others and why. The data systems should integrate clinical features with basic science so that the clinical results can be integrated with data sets from the molecular surveillance teams. This is the future of epidemic control; having real-time and integrated data systems. Covid-19 has shown that viruses spread very quickly across borders. Therefore, data systems need to be trans-national and shared with all to reduce its spread and improve patient outcomes across the continent.
The role of diagnostic and molecular surveillance cannot be underestimated in times like this. The next pandemic may again develop in a far-off country or in any African country. Nobody knows where or when it could happen. Irrespective of the role of fully funded surveillance systems, the academic community is critical to detect both minor and major disease outbreaks and assist with guiding interventions. This requires a full training system for budding surveillance officers and leadership skills in epidemiology, infectious diseases and monitoring and evaluation of interventions. It has also given guidance on whether certain vaccines will work. This molecular surveillance capacity is a specialised one that takes decades to be fully established and capacitated .
Equipped laboratory services
Before the coming of Covid 19, only few laboratories in many African countries were equipped with appropriate technologies and sophisticated equipment for the rapid diagnosis of epidemics. Covid-19 has revealed the importance of decades of investment in disciplines, such as virology, microbiology, immunology, anatomical pathology and hematology. Pathologists have played a critical role in guiding our national response to patient care. Therefore, it is critical to invest in the required disciplines and set up the required diagnostic capacity and have a team of experts trained and ready to respond to such outbreaks. Existing national laboratory services need to be strengthened. The Covid-19 crisis has shown the importance of investing in diverse pathology technology platforms that can test millions of people for a novel pathogen. Most African countries need to look at building increased human and technological capacity to expand testing capabilities, and to become more self-sufficient in the production of testing systems that can be used immediately at the onset of an outbreak. Countries will need to develop a comprehensive pandemic preparedness strategic plan that is updated every year, and which guides a strategy for laboratory testing .
The distribution of Covid-19 vaccines to the entire population is one of the largest logistics exercises ever attempted because of the large population that needs to be served on a daily basis  The difficulties of getting the vaccines to those who need them are significant, particularly when certain vaccines require up to -70°C storage. It is unclear if many African countries even have sufficient storage capacity for a -70°C vaccine in major towns and cities, let alone in the remote clinics around African countries that will administer such vaccines. This requires a comprehensive rethink of our primary healthcare vaccine systems and processes and redesign them for Covid-19 vaccine effort and future pandemics.
Coordinating major sectors better
It is often said that public and private sectors should work together. That’s true, but pandemic responses need to be more empowered and there needs to be a review of the levels of coordination that have occurred, even within government. It is notable that even government departments operating under the same leadership system vary significantly in their responses. There are major groupings in society which span the public and private sectors that need to be looked at as opportunities for better interventions. Sectors such as schooling, the more diverse post-schooling education and training institutions, the military, police, unions and industry should be regulated to work together during pandemics, with common protocols and common interventions. The civilian health system is often very much sidelined from the military health system. But in an emergency of this scale, there should be improved coordination when it comes to clinical care and vaccinations .
The Covid-19 pandemic has demonstrated deep inequities globally, with wealthy countries mopping up supplies of essential materials such as PPE, ventilators, oxygen, and more recently, vaccines. Some African countries such as South Africa have the opportunity to work even more actively with other countries to ensure a more equitable distribution of essential medical support .
This epidemic has demonstrated the porous nature of national boundaries. Viruses have no respect for such artificial lines on maps, and there are major transmission modes both within and between countries. This offers opportunities for regional cooperation on both biological interventions and humanitarian needs. Vaccine nationalism is highly destructive, and even well-meaning initiatives such as the Covax mechanism have their limitations as wealthy countries will inevitably buy up early supplies using commercial pressures. Africa has the opportunity to put in place alliances across the region for pandemic control and vaccine procurement. These can be improved for the regional purchasing of treatments as they become available .
As we begin to come out from this pandemic, we need to recognise that we are underprepared as a continent for future epidemics. It is suggested that the African continent learn from this pandemic as soon as possible and put in place a formal review mechanism perhaps high-level presidential panels to define a long-term pandemic strategy to better prepare us for the future.
- Tim Tucker (February 2021). Lessons for the future: Here is how South Africa can prepare for the next pandemic. https://www.dailymaverick.co.za/article/2021-02-09-lessons-for-the-future-here-is-how-south-africa-can-prepare-for-the-next-pandemic/
- Preparing for the next pandemic. Nat Med 27, 357 (2021). https://doi.org/10.1038/s41591-021-01291-z.
- Tony Blair (5th May 2021). The World Was Not Prepared for Covid-19. We Should Learn the Lessons and Change.
- John Nkengasang (2021). Building a new public health order for Africa—and a new approach to financing it. https://www.brookings.edu/essay/support-for-public-health-preparing-for-the-next-pandemic/.
- Kapata N., Ihekweazu C., Ntoumi F et al. Is Africa prepared for tackling the COVID-19 (SARS-CoV-2) epidemic. Lessons from past outbreaks, ongoing pan-African public health efforts, and implications for the future. Int J Infect Dis. 2020; 93: 233-236.