Since February 2020 when the first case of COVID-19 was reported in Africa, the Africa Centres for Disease Control and Prevention (Africa CDC) has been in overdrive coordinating a continent-wide response. One year since the outbreak, its Director, John Nkengasong, speaks with Africa Renewal’s Kingsley Ighobor about successes and challenges, including the concerted efforts by African leaders to implement a vaccination campaign targeting 60 per cent of Africans. These are excerpts:
COVID-19 was first reported in Africa about a year ago. What has Africa done right? And what have been the major challenges this past year?
First, as we speak, we have now about 3.5 million cases of COVID-19, with close to 90,000 deaths. That is very sobering. When we spoke last year [March 2020], deaths were still in the hundreds. Second, we are witnessing an aggressive second wave of the pandemic. The mortality is increasing. It is taking us only about 25 days to record 20,000 deaths. Last year, during the first wave, it took us several months to record that number.
So, what have we learned so far?
I think the power of coordination, the power of collaboration and the power of leadership across the continent has been very valuable. We are having a very disruptive pandemic, unlike HIV and AIDS that does not stop people from traveling and doesn’t spread that fast. Globally, we have recorded about 100 million cases of COVID-19. It took us 40 years to record 80 million HIV infections.
What is the strategy for dealing with the new wave?
Two things: first, our prevention measures, which include mask wearing all the time and avoiding gathering in large numbers. Like other parts of the world, there's prevention fatigue in Africa, and people are eager to live normal lives. But once you do that, you make it easy for the virus to spread.
I must add that we are concerned about the potential impact of the new variant on vaccine efficacy.
Many cases are disproportionately in a few countries. For example, South Africa accounts for about 40 per cent of cases in Africa. Why is that?
Well, COVID-19 is transmitted from person to person. It’s not as though there's something unique in South Africa; it’s just that if people are mobile and they congregate, they are exposed to the virus. So, we still need to look at demographic factors in a country like South Africa. Are places where people live in clusters more impacted? I don't know. Only science will tell us. A basic concept of epidemiology is who is infected, where did the infection take place and how did it happen?
Last year you said that Africa CDC was providing diagnostic equipment to countries, as well as training laboratory technicians. What impact did these have in countries?
A huge impact. When I spoke to you last year, we were ramping up diagnostic equipment across the continent and training people. Through the PACT initiative (Partnership to Accelerate COVID-19 Testing), we have distributed over 10 million tests across the continent—both the molecular and the antigen tests. All our members states can now conduct their own tests. So remarkable progress has been made, but remarkable challenges still remain.
When are Africans going to be vaccinated?
Morocco, Egypt, Seychelles have started vaccination and vaccines just arrived yesterday [as of 1st February] in South Africa. President Cyril Ramaphosa, in his capacity as Chair of the African Union, helped secure 270 million doses of vaccines. We are working hard through the Africa Medical Supplies Platform to distribute the vaccines. We hope that in the next two weeks or so, we'll start vaccinating our healthcare workers, about three million of them.
We would have hoped to vaccinate the same time as in New York or London or Paris, but that is not the case. It takes logistics to put things together.
So, there is a continental strategy for vaccination; individual countries are not engaging in bilateral arrangements. Is that correct?
A continental strategy is what we call the whole-of-Africa approach, where we have three pillars: One is coordinating vaccine trials on the continent. The second is vaccine acquisition, which has led to the securing of 270 million doses. And the third is the Delivery Alliance that we have just established. The African Vaccine Acquisition Task Team (AVATT) is procuring the vaccines that will complement the COVAX [a WHO and Gavi Vaccine Alliance initiative focused on fair and equitable access to COVID-19 vaccines] mechanism.
Keep in mind that our target is to vaccinate up to 60 per cent of our population. The COVAX mechanism will provide about 27 per cent of the vaccines, so we have a gap right there that the AVATT mechanism will try to fill.
We are developing guidelines on how to roll out vaccinations and countries will contextualize those guidelines according to their needs.
Last year, the International Criminal Police Organization (Interpol) alerted countries about fake vaccines. Is that something that worries you?
We must anticipate everything that human behavior can bring to bear in a crisis and find a way to prevent that. In that light, we have established the Africa Regulatory Taskforce to expedite the authorization process for emergency use of COVID-19 vaccines in Africa. It’s an expert committee.
We are telling countries that, if you have COVID-19 vaccines or if anyone approaches you with a vaccine, send them over. We will take a look and make a pronouncement on it.
How will we know that COVID-19 is over? Is there a threshold to be met?
We have what we call the rate of positivity. If you test X number of people, how many are positive? For example, if I test 20 people and five are positive, then that is already telling you we still have a high positivity rate. So, we are looking at bringing positivity rate down to below 5 per cent. Getting to that point requires a combination of social distancing, mask measures and vaccines.
In Israel, for example, as they increased their vaccination, fewer people are going to the hospital. Once you deny the virus the chance to transmit, it will come to a point that it will be all over. I don’t think we will achieve that level this year; we will probably achieve that mid-2022 to end of that year when vaccination must have happened on a large scale.
What is your position regarding vaccine nationalism?
We need to work cooperatively and in solidarity. If certain parts of the world vaccinated and other parts did not, I don't think it is in anybody's interest. Now that we know which vaccines are working, the vaccines that some developed countries have acquired, at times in excess of what they need, should be brought back so that others can be vaccinated for the common interest.
We all live on the same planet. It’s in nobody's interest if people are behaving in a manner that would delay the elimination of the virus from the world.
Are there issues with affordability, especially for poor countries?
Remember the vaccines from the COVAX mechanism are free. They've been subsidized by donors. The vaccines offered through AVATT will be supported through the African Export-Import Bank [Afrexim] and will require that countries secure some loans or promissory notes to pay for them. Access to those vaccines will not be based on availability of money.
We should also keep in mind that vaccination is not just a health issue, it's an economic issue. If a country doesn't borrow money to vaccinate, its economy will not open up.
The Africa CDC just celebrated its fourth anniversary. What would you say are your top three achievements so far?
I think the top three achievements are, one: the recognition by member states that they have their own public health agency that has strong potential to be a game-changer in the future.
Second, is the level of leadership of the continent. During this COVID-19 crisis, Africa CDC has demonstrated to the leadership, at the level of Heads of State, that they can be a trusted voice. Africa CDC has been fortunate to be called up 13 times to brief the Heads of State. The latest one just happened over the weekend. I think it's unusual to have leaders sit with a public health agency to understand science on the continent and the pandemic, listen carefully to epidemiology, and believe in it.
The third one is the partnerships and networks that Africa CDC is bringing to bear across the continent, through the COVID-19 response mechanism. It is extraordinary. We now know where each other is. Whether you are in Morocco, Tunisia, South Africa, you come to us every Tuesday to discuss the pandemic, discuss resources, network, and share information. We are a very young but very promising institution.
What are your top challenges?
Top challenges are those that face any institution - building capacity. Workforce development is a huge issue. At country level, we have to position ourselves as the public health agency that can work with member states to have competent responders.
Building our own capacity to support 55 members is also challenging. Remember, we are unique in that the US CDC is a national programme, the China CDC is a national programme, the European CDC supports 28 countries, but the Africa CDC, with very limited resources and capacity, supports 55 member states.
What does success look like for you?
For me, success in the future will be defined in three ways. One is that Africa CDC is empowered to be truly a premier public health organization.
Second is that it should really drive the agenda for every country in Africa to have their own national public health institute, that is their own mini-CDC. So that in 10 years from now we can have an Africa CDC in Addis Ababa, plus five regional centers, and every country their own mini-CDC, so that when you have an outbreak, we all move with speed to counter it.
Lastly, we must have workforce development that can bridge the current gap within 10 years. We need 6,000 epidemiologists, yet currently we only have about 1,900 on the continent.
What message would you send to Africans who worry about how much longer the pandemic will last?
We should be resilient. Our forefathers, - the Nelson Mandelas, the Kenneth Kaundas, the Julius Nyereres, the Kwame Nkrumahs - didn't promise us a continent that would be problem-free. They fought to give us independence.
We have to demonstrate our ability to rally around and fight COVID-19. It's difficult for me to imagine that we have to live with this pandemic, in addition to HIV, tuberculosis, malaria, and a rising wave of non-communicable diseases.