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Africa and Global Health Security: Asking the Right Questions

May 11, 2021
by Uzma Alam

The first confirmed case of COVID-19 in Africa was reported in February 2020. More than a year later, in early April 2021, Africa was reporting 4.28 million infections and 114,000 deaths, with South Africa accounting for approximately 40% of the reported cases. Overall, Africa is currently contributing about 3.2% of the global COVID-19 burden. These statistics run counter to initial predictions of how COVID-19 would unfold on the continent, owing to several factors such as weak health systems, densely populated informal settlements and high concentrations of marginalized communities, including approximately 14.5 million forcibly displaced persons and 6.3 million refugees and asylum seekers.

However, it is important to remember that some models did more closely predict the realities on the ground. For example, Achoki et al., 2020 provided the first prevalence, incidence and mortality estimates across Africa using a context specific covariate model. Some newer studies point toward the demographic pyramid and trained immunity among other factors having contributed to a low COVID-19 caseload in Africa.

Questioning why Africa has had a lower COVID-19 caseload than the rest of the world conveys racist undertones implying that it would be the normative for more Africans to be infected and/or dying from COVID-19. But if we ask the right questions, there are valuable global health lessons to be learned from Africa’s response to the COVID-19 pandemic.

Pandemic responses are intrinsically complex and do not occur in a vacuum, but are instead mirrored in experience and environment, i.e. context matters. During the HIV/AIDS pandemic, Africa learned that highly effective health interventions fail when local context is unrecognized. Ebola taught us community engagement underpinned by trust is a key enabler of an equitable disease outbreak response – lessons that have come into play during COVID-19. For example, the African Sex Workers Alliance activated mutual aid funds and produced safe sex work guidelines in response to COVID-19 measures.

The COVID-19 pandemic has also highlighted the importance of recognizing political determinants of health, from which the world can borrow a lesson or two from Africa. It is evident to many that political failures muddled the COVID-19 response in the U.S. and U.K., driving up case numbers. Most African governments, in contrast, acted swiftly taking a multi-sectorial approach and implementing national government coordination. For example, as much as a month before the first reported case of COVID-19 in Africa, the Ivory Coast implemented enhanced surveillance at ports of entry, closely followed by other African nations. Prompt, proactive and precautionary responses are more effective than wait-and-see strategies.

African leadership also has not actively dismantled its public health infrastructure, as some Western countries have done through funding reductions and poor policy decisions, allowing the continent to be better prepared to tackle the pandemic. Politically driven decisions to cut U.S. funding for public health programs have resulted in a pivot away from evidence-based decision-making along with implementation of policies and practices that have exacerbated pre-existing vulnerabilities and societal imbalances by race, ethnicity, immigration status and income, among other factors. There is clear indications that poor health outcomes among Black people and communities of color in the U.S. during the COVID-19 pandemic are closely linked to systemic racism.

While the U.S. Centers for Disease Control and Prevention (CDC) struggled to present a coordinated response to the COVID-19 pandemic early on in the crisis, Africa’s CDC, a much younger agency, moved quickly and efficiently. Africa’s CDC activated its emergency operations centre months before the first cases of COVID-19 were reported on the continent. Furthermore, Africa mobilized a Joint Continental Strategy for COVID-19 that was implemented at the individual country level, in contrast to the fractured state-level response in the U.S. This strategy focused on contact tracing among other public health responses. Again, in contrast, Western countries during the early phase of the pandemic failed at contract tracing, with statistics indicating that the U.K. failed to reach 1 in 8 people who tested positive for COVID-19.

Lastly, Africa – via its pan-African organizations, health ministries, academics and public health professionals – relied on data. This led to decisions being made based on scientific evidence and informed policy. It also allowed for cost-effective choices in resource-poor settings. A great example of this is The African Science, Technology & Innovation Priority Setting Programme (ASP), which engaged African stakeholders and political leaders to identify the top priorities for responding to COVID-19 and which options offered the highest return on investment. Specifically, a month after the first case of COVID-19 was reported in Africa, the ASP released a research and development priority list identifying 17 areas of focus for Africa’s COVID-19 response, supplementing the global response road map issued by the World Health Organization. Today, these priorities inform not only Africa’s research priorities, but also those of low-middle-income countries around the world.

Evidence-based decision-making, not politics, saves lives.

Uzma Alam, M.P.H. ’13

By leading responses based on scientific evidence and sound public health approaches, and by understanding that it’s not a zero-sum game between saving lives and saving the economies, Africa has shown what is possible when it comes to global health security. Evidence-based decision-making, not politics, saves lives.

Uzma Alam, M.P.H. ’13, is senior program officer for the DELTAS Africa program of the Alliance for Accelerating Excellence in Science in Africa and a researcher at the Africa Institute for Health Policy.

This commentary is part of a series produced by Yale School of Public Health highlighting important issues related to COVID-19 and public health.

Submitted by Colin Poitras on May 11, 2021