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COVID-19 Data Gaps in Africa Unveil the Challenges in the Pandemic’s Response
By Dr. Alessandro Campione
Is it true that Africa was spared by COVID-19, as reported rather sensationally by several Western newspapers? It might well be true if we merely consider the scarce data available on COVID mortality. But it is enough to dive a little deeper under the official figures to uncover a very different, and much bleaker reality.
In order to understand the real impact that COVID-19 has had on the African continent, we first need to ask ourselves if the data available on COVID-19 was gathered in the right quantity and quality. In Africa, there is evidence demonstrating that the answer is no. To correctly record health events such as the spread of a pandemic and its mortality, it is necessary to have a robust and sophisticated health information and surveillance systems. At the very least, countries should be equipped with efficient death registers, which constitute the starting point of every epidemiological analysis. Most African countries are still far behind in this respect.
Therefore, to get a real grip on the situation in Africa, we are only left with considering the total number of deaths, of all deaths, regardless of the cause reported on the certificates. And in this case, the scenario changes considerably. Let’s take a look at what happened in South Africa. The South African government calculated at around 90,000 the number of COVID casualties that took place in the country between January 2020 and January 2022. However, data released for the same period by the South African Medical Research Council (MRC) show nearly 300,000 unexpected deaths. These digits are two-thirds higher than those officially provided by the Ministry of Health. A crisis that has been grossly underestimated.
To visually understand the extent of this crisis, it is sufficient to look at the graph drawn up by the MRC; in red the number of predicted deaths based on historical data, and in black the curve of the actual deaths recorded. The correlation of the black curve with the COVID-19 peaks is striking.
It should be clarified that not all these deaths are the direct result of COVID-19 itself, but they might also be due to issues relating to the overall stress caused on the county’s health system. However, during the lockdowns, South Africa registered a sharp decrease in deaths due to external causes such as road accidents or alcohol consumption. It is thus likely that many of these unexpected deaths are still closely related to COVID.
What’s clear is that South Africa has paid a very high price. And this situation is comparable, if not worse, in most countries in the region. It is therefore misleading to speak of a positive African model from whom to draw inspiration.
Even the lower mortality caused by the Omicron variant, identified in South Africa last November, can be traced back not only to a probable lower severity of the variant but also to the fact that the local population was already experiencing a high level of immunity.
Studies published in December 2021, and thus before Omicron emerged, had recorded that among the South African population over 50, there was already an 80% presence of antibodies against COVID due in large part to pre-exposure. When Omicron appeared, the population was already largely immune. This immunity is not necessarily attributed to the vaccines since less than 30% of South Africans were vaccinated with two doses, but because this country had already been hit hard, as reported by the data from the MRC.
On the vaccine issue, the real problem does not concern the lack of doses, which are already here, as is also evident from the data collected by the African Union.
It is not enough to send vaccines over (sometimes a few weeks before their date of expiry) without also providing, syringes, safety devices for health personnel, machinery to keep them refrigerated, and, most importantly, sufficient funds to conduct widespread awareness-raising campaigns. As a doctor who has been involved in vaccination campaigns in Africa for years, I am aware that huge investments are required to mobilize the Ministries, civil society organizations and the media so that vaccines can reach people scattered around very vast and often remote areas. This commitment, at the moment, seems to be largely insufficient.
It should also be mentioned that, in addition to the loss of human lives, the repeated and severe lockdowns caused by COVID-19 have greatly damaged local economies, also because in Africa, there is almost no social security system providing for economic relief in critical times, nor there is anything comparable to the Next Generation EU plan implemented in Europe.
Help from the international community will thus prove essential and priority should be given to supporting the creation of information systems to conduct proper surveillance and keep track of data concerning mortality and mutation research. Without these, African countries will not be able to effectively monitor the situation and have clear data on which to base adequate responses and prevention campaigns.
And on the variants, they must be monitored to act immediately and find a solution. Certainly, not to isolate countries as soon as a new one is found, as happened with Omicron.
Two years after the onset of the pandemic, it is time to go beyond emergency interventions and start thinking about future prevention. Whilst South Africa may have laboratories where it is possible to sequence new variants, this may not the case in other African countries. COVID-19 has taught us the hard way that the traditional approach to cooperation in Africa, made only of emergency responses, today is no longer enough. Instead, it is necessary to start thinking in terms of preventive health strategies, characterized as much as possible by a One Health approach that takes into close consideration not only the human dimension, but also the animal and environmental one.
It is estimated that about 70% of human infectious diseases affecting Africa are in fact “zoonoses” originating from a spillover effect from the animal kingdom to human beings. Rather than portraying Africa as left untouched by the pandemic, it is important to be vocal on the immediate need to support the cooperation between human health doctors and veterinarians in fields such as research, active surveillance as well as in prevention, and training campaigns. Zoonoses surveillance would not even be particularly complicated to implement in Africa as, in most cases, veterinary laboratories already exist, and could easily be supported to perform the sequencing and monitoring of zoonoses.
Only through these much-needed interventions, African countries will be in the position to act timely and to contain the zoonoses before they expand with the disastrous effects that we are all experiencing. In Africa as in the rest of the world.
Dr. Alessandro Campione is the Programs Director at Jembi Health Systems and a foremost expert in epidemiology and health information systems with over 30 years of experience in Africa and Latin America.