In all the best-case scenarios where countries succeed in dramatically decreasing transmission rates of Covid-19, testing has been shown as the single most important tool in the fight against the deadly virus. Despite contributions from Chinese billionaire Jack Ma and sustained efforts from a variety of continental bodies, Africa has a severe lack of testing kits.
Rather than a lack of funds or political will, Africa’s shortfall is triggered by richer nations outcompeting the developing world for critical equipment, says John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC).
“The companies that produce the tests are finding it very difficult to meet global demand because of the competition that exists in the form of Western countries buying all the tests. We’ve learned that when the world is challenged with access to limited commodities then global solidarity collapses,” he says.
Test, test, test
As the African Union’s specialised agency for strengthening the response of member states to infectious diseases, Africa CDC has been instrumental in coordinating the fight against the virus on the continent. Shortly after the first African case was announced in Egypt on 14 February, the institution procured testing kits from a company in Berlin and had them shipped to Senegal.
Despite distribution of thousands more across the African continent since that initial shipment, access to the crucial equipment varies wildly from country to country and breaks down among economic lines. South Africa, which currently has the most cases in Africa, has conducted more than 150,000 tests for a population of 58m whereas Nigeria has conducted around 10,000 for a population of over 200m.
While the African Union said that it planned to distribute one million tests from late April, Nkengasong estimates that Africa requires a further 15m over the next three months. This seems ambitious given the competition surrounding the equipment.
The softly-spoken Cameroonian with more than 20 years’ experience at the US Centres for Disease Control and Prevention warns that Africa must learn from its reliance on “trickle-down technology” from more developed nations.
“Lesson one is that because of our dependency on the diagnostic technologies from the West, we are in a very vulnerable position with respect to the health situation,” he says.
“That has to change almost immediately. We need diagnostic companies on the continent which can manufacture these tests like Singapore, Thailand and others. It is not that difficult. The gene sequences are known. Yet there is not one company on the continent which produces diagnostics.”
The greater concern in the long-term fight against Covid-19 is access to vaccines. While scientists are not yet sure whether recovered patients will develop long-lasting immunity to the virus, it is generally accepted that vaccines will play a pivotal role in returning the world to normal. Numerous companies are working on vaccines around the world; none of them are in Africa.
Africa’s unequal access to testing kits may serve as a grim warning for when a vaccine is finally produced. Failure to secure the preventative measure would cause untold economic and social disruption, with African nations foreseeably forced to continue lockdowns well past those of richer nations.
“What we have observed for diagnostics should give us a sense of how access to vaccines may look like and that concerns me,” says Nkengasong.
“We as Africans have to stand up and make sure our voice is heard. We are in a world of 7bn people and Africa is a continent of 1.3bn people. If there are vaccines in the next 15 to 18 months, Africa should be a factor in that and we should not have to wait for a trickle-down effort.”
Nkengasong hopes that global health institutions like the Norway-based Coalition for Epidemic Preparedness Innovations (CEPI) will “play the role they are designed for” and champion the equitable distribution of a vaccine once it has been created.
However, recent events cast doubt on global cooperation. President Donald Trump’s withdrawal of US funding to the World Health Organisation (WHO) over accusations that it was too lenient with China during the initial outbreak of the virus has damaged the multilateral response to Covid-19.
Some European countries are also beginning to take a more critical stance towards China, believing that the government lied about the true scale of the crisis.
Overseeing the health response of the world’s poorest continent, Nkengasong is well aware of the dangers of retreating to isolationism.
“We are in for a global crisis, a global war against this virus,” he says. “This is the time to focus on the enemy. The enemy here is coronavirus. What we ought to do is express global solidarity.”
Africa has responded in a unique manner, formulating a response at the continental level, he says. Eight days after the first reported case in Africa, the head of the African Union Commission summoned all health ministers to an emergency meeting in Addis Ababa where they agreed on the joint strategy of coordination, collaboration and communication.
Many African governments acted quickly to shut down borders and implement lockdowns. Some countries, like Niger and Lesotho, had implemented a lockdown even before any cases were confirmed, which stood in stark contrast to other responses around the world.
“African leaders have not underestimated the enemy,” Nkengasong says. “We must recognise that this is a deadly virus. Countries which have underestimated the virus will pay the price.”
Nevertheless, Africa has around 25,000 cases at time of writing and the increases show no signs of stopping.
It remains to be seen whether Africa will be spared the devastation witnessed in Europe and North America as a result of the extraordinary measures put in place. The fact that there is only around six months of Covid-19 data makes any conclusive judgements difficult.
Indeed, it is unclear why West Africa and North Africa seem to be worse hit then East Africa, Central Africa and Southern Africa (excluding South Africa). Such questions will need to be answered by conclusive studies when the pandemic is over, Nkengasong says.
One thing that can be determined is the importance of best practice. By combining Africa’s most rigorous testing and tracing regime with a total lockdown, South Africa has managed to reduce the daily growth of cases from 31% to just 5% at the time of writing.
This example of “flattening the curve” should be mirrored across the continent, he says.
Yet if Africa’s efforts to stop the virus from spreading are not successful, the continent will be in real danger. Africa’s relatively undeveloped health systems are unable to cope with a dramatic increase in cases. Ten African countries are without even a single ventilator which can make the difference between life and death for severely affected patients.
This begs the question of where Africa will secure equipment which is in such high global demand.
“I’ll be honest with you, we have very few ventilators,” Nkengasong says.