While the U.S. and Europe battle to slow the spread of the novel coronavirus, I can’t help but think about how Africa will cope when it becomes the next epicenter. Based on the three-month-old data that we have about the virus and its spread, guidelines on prevention, containment and mitigation have been set by the World Health Organization (WHO). So far, several African governments have adopted the U.S. and European approach that is centered on lockdowns, social distancing and frequent hand washing with soap and water. Though these are evidence-based recommendations, it is simply not practical for most of sub-Saharan Africa.
As of April 5, there were nearly 1.3 million patients with COVID-19, and there have been about 69,000 deaths. In Africa, 51 out of the 54 countries have recorded cases totaling more than 9,000 with 437 deaths. These low numbers are partly due to the limited testing capacity. The countries that have recorded the highest numbers of COVID-19 cases happen to be doing the highest number of tests. For example, as of April 4, South Africa has tested about 57,000 people and recorded more than 1,600 confirmed cases — the highest so far. There is still a window of opportunity for African governments to implement “Afrocentric” solutions in the battle against this pandemic.
There are several strengths going for Africa in the fight against COVID-19. First, the Ebola experience in West and Central Africa has helped develop capacity in disease surveillance, laboratory diagnostics and contact tracing. The Democratic Republic of Congo and Nigeria are in the middle of battling more deadly epidemics like Ebola and Lassa fever, respectively.
Second, Africa has the youngest population in the world, with a median age of 19.7 years. This puts it in a favorable position in lessening the number of people who could die or require hospitalization from the disease.
The strategy of hand washing, and social distancing adopted by many African governments assumes that most of the populace have running water and live in spacious neighborhoods. However, according to a United Nation’s report, nearly half of the 700 million people in sub-Saharan Africa live in “water scarce” environments. Similarly, over half of sub-Saharan Africa’s urban dwellers live in slums. How then can the 2.5 million slum dwellers in Nairobi, Kenya, practice “social distancing?” It is clear that these preventive recommendations won’t work for a vast majority of sub-Saharan Africa. In Nigeria, nearly half of the population live on less than $1.25 a day. How will these people buy hand sanitizers that cost around $5-$10, or stay indoors without the opportunity to make a living? Your guess is as good as mine. Lockdowns simply won’t be sustainable. This is why I am advocating for adaptable solutions that account for the weak health-care systems and the socioeconomic realities in Africa.
There are some examples of this adaptation that could be potentially scaled. For example, Ondo state in Nigeria contracted a local ethanol factory to mass-produce hand sanitizers to distribute in the state. The Bill & Melinda Gates Foundation and the U.K. government contracted a British biotech company that is presently developing COVID-19 tests that will cost only $1. There have been donations of tens of thousands of test kits by Chinese business magnate Jack Ma.
Given the evolving evidence on the efficacy of wearing masks, it could serve as an alternative solution for slum dwellers since social distancing isn’t possible. The medium of public health messaging is key to the fight. While it is important for Health Ministers and presidents to address citizens, without partnering key religious and traditional rulers, government messages may be less effective. Examples abound of religious leaders alleging the potential vaccine candidates as harmful or directly causing the disease.
Finally, in a weak health-care system, procuring ventilators is an uphill task. Rather, exploring low-cost technologies may be the right way to go. Rice University and Canada’s Metri Technologies developed a ventilation unit that can be built for about $300. This design is open source and can be used by anyone in the world.
There are no easy solutions, but what is certain is that adopting Western-style solutions is a recipe for failure. Therefore, before the next epicenter of the pandemic shifts to Africa, adaptable solutions must be speedily implemented to save lives.