The first case of Covid 19 was diagnosed in Wuhan (China) on December 1, 2019. By January, the epidemic had spread to Southeast Asia, America and Europe, and on January 11, WHO Director-General Dr. Tedros Adhanom Ghebreyesus proclaimed the Covid 19 pandemic. The African continent was affected on 14 February with a first confirmed case in Egypt and Nigeria.

As of 19 May, throughout the African continent, there were officially 88.172 Covid-19 infections and 2. 834 deaths; the north and west of the continent are by far the most affected but, at this stage, we are far below the figures of infection and deaths reported by the health authorities of Western Europe, the USA and the USSR; indeed one feared a hecatomb in Africa given the fragility of its health systems and of the economy of a majority of its States; these low figures are therefore fortunately surprising.

Certainly, the epidemic started later and the peak may not yet have been reached; there is probably also an underestimation of the number of cases and deaths. In addition, demographics are globally different in Africa, where the population is younger and less dense than in Western Europe, for example. Above all, there are no rest homes in Africa for the elderly, who are particularly vulnerable to Covid-19. As we know, African elders still have the good fortune to grow old in the family cocoon.

But these explanations are not enough. We must look for elements of response, especially in the fact that Africa is familiar with epidemics. In Europe there are also epidemics, but they are quickly forgotten. However, several African countries knew that, in the strategy to be adopted to combat an epidemic, anticipation is a decisive element. Almost each Member State of the African Union (AU) therefore developed its own strategy for preparing for and responding to the epidemic and implemented it early, when the first cases of infections were imported. In addition to the isolation and treatment of confirmed cases, the main strategy was based on the forced and abrupt confinement of the population in most major cities[1] with a ban on internal travel and border closures; curfews were introduced in some countries and law enforcement agencies, including the military, strictly enforced all these measures, sometimes in a very brutal manner[2]. Information about the epidemic was widely disseminated with the help of singers, football players and other celebrities.

With their meagre means, the AU Member States have accompanied these measures with a social component to cover somewhat the basic needs of the mostly precarious populations living in the informal economy and unable to remain confined to their homes without the risk of starvation.

Finally, the tracing of cases and contacts with the isolation of suspect or positive cases was slowly implemented according to the means (tests…) that were available.

The response to the epidemic in the Member States was supervised and supported by various stakeholders, including in Africa:

  • CDC Africa (Africa Centres for Disease control and Prevention); this is a young AU institution created in January 2016 to support the health services of its 55 member states in their efforts to detect, prevent and control health threats. Its headquarters is in Addis Ababa (Ethiopia); it has 5 regional collaboration centres covering the entire continent and is supported in particular by the CDC Atlanta of the USA and the CDC of China.
  • the WHO Regional Office for Africa in Brazzaville.
  • the WAHO (West African Health Organization), an organization known since its intervention from 2013 to 2016 in the management of the regional Ebola epidemic.

Under the impetus of CDC Africa, the diagnostic capacity of 50 national laboratories was upgraded in less than a month; the famous Pasteur Institute of Dakar was solicited as one of the training sites. In addition, dozens of health officers from different AU member states were trained in public health risk communication, enhanced surveillance, prevention and control of infection. A taskforce called AFTCOR (Africa Taskforce for the Novel Coronavirus) was set up to coordinate the preparation and response of member states and to organize a platform for health ministers from across the continent to develop and support a Covid-19 Continental Strategy.

Hundreds of thousands of laboratory test kits were distributed throughout Africa by CDC Africa, WHO, CDC USA, the Chinese government and the Jack Ma, Bill & Melinda Gates and Alibaba Foundations, to name just a few major donors. In addition, CDC Africa made guides available to member states, including a case tracing guide. The European Union contributed to these different reactions with its Team Europe, which brings together the European Commission, the European Council, the European Investment Bank and the European Bank for Reconstruction and Development; 3.25 billion euros were allocated to Africa, including 2.06 billion euros for sub-Saharan Africa and 1.19 billion euros for the neighboring countries (North Africa) that were particularly hard hit.

What can be said at this time about the treatment of Covid-19 in Africa?

First of all, it is obvious that at this stage there is no treatment that has proven its effectiveness against Covid-19, either curative or preventive.

The President of Madagascar, Mr. Andry Rajoelina, has promoted CVO (Covid-19 Organics), a decoction based on plants including Artemisia, from which artemisinin, a molecule used for more than twenty years in the treatment of malaria, is extracted; an injectable form of CVO is also in preparation. Dr Jérôme Munyangi, a young Congolese researcher working in Antananarivo, has been asked by Congolese President Félix Tshisekedi himself to conduct a clinical trial on CVO in the DRC. Neither the ECOWAS nor the WHO recommends it at this stage; moreover, there is a fear of increasing the malaria parasite’s resistance to artemisinin. Nevertheless, CVO is already included in the treatment protocols of several AU member states.

Clinical trials of other treatments are well under way and an international coalition of medical research institutes has been formed under the auspices of the WHO to conduct two large clinical trials entitled ‘SOLIDARITY’ and ‘DISCOVERY’ on six potentially active molecules; the Pasteur Institute of Dakar is part of this coalition, whose results are now awaited.

Among these six molecules, there are drugs already known as antiretrovirals used against Ebola and as antimalarial and antirheumatic drugs (like chloroquine and hydroxychloroquine). Many African and European countries have developed treatment regimens including chloroquine and hydroxychloroquine in high doses but serious toxic effects have occurred, mostly cardiac, especially in combination with azithromycin, but            also renal, hepatic, neurological… Therefore, CDC Africa, the CDC USA, the WHO and the EMA (European Medicines Agency) have recommended waiting for the results of the two major clinical trials in progress and using chloroquine or hydroxychloroquine only in exceptional cases, in well-equipped intensive care units that can react quickly in case of serious complications. It must be said that the more than 80 clinical trials used to recommend the prescription of chloroquine and hydroxychloroquine in cases of Covid 19 infection have not been carried out with a rigorous methodology (in vitro tests, animal tests, no control group, small number of patients, no definition of the stage at which the drug is administered, no peer review…) But the high expectations and criteria of conscience do not easily accommodate the delays imposed by a quality clinical trial; the economic stakes also weigh in the balance.

Moreover, the epidemic has adverse collateral effects in terms of the quality and availability of drugs, diagnostic tests and medical equipment. These problems are likely to cause significant morbidity and mortality without being directly attributable to Covid-19 (“Covid 19 collateral damage”). Some of these problems include the following:

– cuts in the supply of essential drugs not related to the Covid-19 outbreak due to slower international transport and a reorientation of production chains by the producers;

– Problems related to export licenses for certain equipment; as we have seen with masks f.i., unscrupulous exporters manage to slip through the cracks.

– the placing on the market in sub-Saharan Africa of falsified and/or substandard medicines following an irrational demand from the public and health personnel and the focus of regulatory authorities on the fight against the pandemic at the expense of quality control; falsified chloroquine has recently been placed on the market in the DRC and Cameroon; the WHO regularly publishes alerts concerning criminality linked to falsified medical products placed on the market.

– Decreased accessibility of health facilities due to home confinement and fear of contracting Covid-19 (on the part of patients and staff).

The same applies to the delicate issue of diagnostic tests. There is a plethora of tests of different types and quality; falsified and sub-standard tests are also circulating on the market. For some tests, the cold chain has to be guaranteed, which is not obvious in some latitudes.

All this obviously argues for the strengthening of control mechanisms in Africa even at national and regional level, and for the development of African production of medicines, small medical and laboratory equipment; the process has certainly begun, but it will require major resources and international collaboration in the future.

Conclusion

The final word goes to a hundred or so African intellectuals who have just made a prophetic appeal to African leaders:  “…Africa has a head start in managing large-scale health crises…we must strive to rethink the foundations of our common destiny based on our specific historical and social context and the resources at our disposal…We must…be seized by the real urgency, which is to reform public policies, to make them work for the benefit of African populations and in line with African priorities…The best way to do this is to rely on ideas that are adapted to the realities of the continent. Achieving the second wave of our political independence will depend on our political creativity as well as our ability to take charge of our common destiny…Pan-Africanism also needs a new lease of life. It must be reconciled with its original inspiration after decades of inadequacies. If progress in continental integration has been slow, it is largely due to an orientation inspired by the orthodoxy of market liberalism. The challenge for Africa is nothing less than the restoration of its intellectual freedom and its capacity to create – without which no sovereignty is conceivable. It is a matter of breaking with the outsourcing of our sovereign prerogatives, of reconnecting with local configurations, of breaking with sterile imitation, of adapting science, technology and research to our context, of building institutions on the basis of our specificities and resources, of adopting an inclusive governance framework and endogenous development, of creating value in Africa in order to reduce our systemic dependence.“

AEFJN[3] can only applaud this pathetic appeal and hope for a progressive control of the epidemic in Africa through local know-how, active solidarity among AU member states and among all countries of the world facing the same deadly challenge. AEFJN aligns itself with the positions of CDC Africa and will monitor the situation closely.

Christian Roberti

AEFJN

[1] In Kinshasa, only the Gombe neighbourhood in the centre was officially confined, not the working-class neighbourhoods where the population spontaneously confined itself as best it could.

[2] [2] Some authoritarian regimes have taken advantage of the situation to increase repression and further limit freedoms.

[3] Africa Europe Faith and Justice Network.