Africa Centres for Disease Control and Prevention’s COVID-19 response: A united, continental strategy

Just over 5 months ago, the first case of COVID-19 (coronavirus) was confirmed in Africa, raising concerns about the continent’s readiness to handle an outbreak. On August 7th, Africa’s case-count crossed one million. What do we know about the response thus far, and what lies ahead? 

The economic impacts of COVID-19 lockdowns and border restrictions have been severe, exacerbating poverty and social impacts. Compared with pre-crisis forecasts, COVID-19 could push 71 million people into extreme poverty in 2020. More than a third of the projected poor will be in Sub-Saharan Africa which is facing its first recession in 25 years.

As African nations ease their lockdown restrictions, health systems are bracing to prevent further spread of COVID-19.  But  limited infrastructure, critical fiscal positions, and insufficient technical capacity are hampering the response efforts.

The consequences of the pandemic will be long lasting, and resources are limited. So regional approaches and resource sharing are more important now than ever. Africa’s leaders have risen to the challenge, breaking down geographical and political barriers that previously prevented rapid response efforts.

A continental strategy

 As the first reports came from China in December 2019, Africa’s Center for Disease Control (Africa CDC)—an African Union (AU) agency launched just three years ago—began preparing for a potential outbreak. As the first case reached Africa in mid-February 2020, African health ministers agreed on an Africa Joint Continental Strategy for COVID-19. Along with the AU COVID-19 Response Fund which was established soon after, the strategy underpinned African leadership in responding to the outbreak from the very beginning.

Leaders also stood united in their global appeal for funding, deferral of debt repayments, and medical procurement assistance. Through the Response Fund, the Africa CDC aims to raise an initial $150 million for immediate needs, and $400 million for the procurement of medical supplies, deployment of rapid responders, and provision of socio-economic support to the most vulnerable populations.

Pooling resources through cross-country collaboration

The continental strategy has demonstrated massive economies of scale in disease prevention and control efforts. An Africa Taskforce for Coronavirus (AFTCOR) was set up to provide technical assistance on case detection and containment. In collaboration with WHO and the West Africa Health Organization (WAHO), AFTCOR helped increase the number of African laboratories with COVID-19 testing capability from two to 43 by mid-March 2020.

Leveraging Africa CDC’s convening power with weekly webinars, some 300 clinicians from across the continent can exchange valuable technical knowledge in real time.

To limit further spread of COVID-19, Africa CDC rolled out the Partnership to Accelerate COVID-19 Testing (PACT): Test, Trace, Treat  to strengthen testing capacity and test at least ten million Africans over the next six months.

Africa CDC also launched the Africa Medical Supplies Platform, in partnership with the African Export-Import Bank, to facilitate country procurement of critical medical and laboratory supplies from certified suppliers.

Expanding and democratizing cutting-edge technologies

Chairperson of the African Union, H. E. President Cyril Ramaphosa, has noted that “success in developing and providing access to a safe vaccine requires an innovative and collaborative approach, with significant local manufacturing in Africa.”  A new Consortium for COVID-19 Vaccine Clinical Trial is focusing on securing sufficient vaccine supplies and removing barriers to vaccine rollout.

Africa CDC is also expanding the continent’s ability to sequence—or to “decode”—the viral genome with unprecedented speed. Genome sequencing is important for tracking mutations of the coronavirus; and identifying the origin of the virus, clusters of cases, and community transmission. Any significant mutation in one part of the world could render vaccines, drugs, or diagnostics developed using data from another part of the world ineffective.

Sophisticated health infrastructure including those for genome sequencing requires large upfront investment outlays and must consistently operate at close to full capacity in order to be cost effective. Rather than setting up facilities in every country, countries can send their samples to a regional lab for genomic sequencing. This allows countries to contribute to, and benefit from, locally relevant assays, therapeutics, and vaccines. This is being facilitated by the Pathogen Genomics Intelligence Institute, which Africa CDC presciently launched in December 2019. This initiative also helps connect research centers conducting genomic sequencing with public health institutes, and  removes potential silos between national initiatives while the continent faces a singular disease threat.

Using these cutting-edge approaches, an African Center of Excellence for Genomics of Infectious Diseases in Nigeria sequenced the first genome of SARS-Cov-2 within 72 hours of receiving the sample . This clearly demonstrates the continent's contribution of crucial data in the global fight against COVID-19, and to the field of genomics.

Challenges ahead

These achievements are remarkable given Africa CDC’s short existence as an institution. But it will continue to face challenges to deliver on its broader mandate beyond the emergency response. These include countries' fragile health systems, limited funding, recurrent disease outbreaks with late detection, and sometimes slow national response measures. 

While more than 80% of member states have done Joint External Evaluations, actions on the resulting recommendations, including development of multi-hazard, multi-sectoral national action plans for health security, funding of such plans, and the conduct of public health simulation exercises at recommended intervals, is very limited. Progress in these areas will be critical to deliver on the longer-term vision of Africa CDC: to act collectively and become self-sufficient in responding to future public health emergencies.

The World Bank is supporting the Africa CDC in its long-term vision, with the Board approving a new project in December 2019. This was indeed timely, just before the COVID-crisis hit. The Bank will continue to help strengthen continental, regional and national infectious disease detection and response systems during COVID-19 and beyond.

When it comes to pandemics, there’s an historic cycle of panic and neglect: efforts have ramped up when there is a serious threat, and then quickly forgotten when the threat subsides . Africa CDC may be the turning point, bringing sustained future investment in pandemic preparedness.