We will not defeat COVID-19 without including Africa in the global response

25 May 2020

This article was first published on 19 May 2020 here

In much of the global COVID-19 conversation, Africa is barely mentioned. But the risks which the COVID-19 crisis brings are even greater in Africa than elsewhere – and those risks will be compounded if Africa is marginalized in the global response. Beating COVID-19 in Africa, in turn, is essential for beating it worldwide. African leadership and global solidarity are both essential to overcoming the COVID-19 crisis in Africa, and Africa’s citizens demand nothing less. 

Economic and social determinants of ill-health are strong predictors of the likelihood of dying from COVID-19. The greatest risk will be for poor people in poor countries who have a much higher burden of existing illness, and of whom hundreds of millions are malnourished or immunocompromised. While Africa does have vital experience of managing epidemics, it also has health systems which are largely under-resourced and which are still often inaccessible to the poor, and not up to the job of beating COVID-19.

Beating back COVID-19 in Africa is possible, but not under business as usual. We need urgently to accelerate access to testing; ensure equal access to equipment to protect frontline medical workers and treat the sick; ensure that health systems are adequately funded; agree globally that any COVID-19 vaccine is free for all; and ensure that the social and economic impacts of the COVID-19 crisis are mitigated through large-scale social protection measures and sustainable economic development which reduces inequality.

The African Union, through its Africa Centres for Disease Control and Prevention, is taking a strong lead in the response to the epidemic. It has created a new partnership as part of the Africa Joint Continental Strategy for the COVID-19 response, the Partnership to Accelerate COVID-19 Testing (PACT), which has been fully endorsed  by the Bureau of African Union Heads of State and Governments.  UNAIDS is proud to be the first to sign up for this partnership, which aims to close the gap in testing by supporting the efforts of African countries to rapidly scale up their capacity to test and trace. As we have seen in other regions of the world this is crucial to reduce the number of infections and deaths. PACT also calls for the rapid establishment of an Africa CDC-led system for pool procurement of diagnostics and other COVID-19-related response commodities.

The good news is that countries are stepping up: at the beginning of May, South Africa had conducted more than 300,000 tests, with Ghana on more than 100,000. They have done so in part by leveraging the exiting HIV testing infrastructure, and other countries such as Nigeria plan to follow suit. But Africa CDC estimates that Africa needs 10 million tests to respond to the pandemic in the next four months. In addition, the World Health Organization estimates that 100 million face masks and gloves, and up to 25 million respirators, will need to be shipped to African countries every month to respond effectively to COVID-19, at a time when there is a global scramble for supplies.

Worldwide, production of test kits and essential medical supplies must be ramped up and there must be globally coordinated efforts to get the tests and personal protective equipment to the places and people most in need: in Africa that means to our high-density population townships and to our frontline medical staff and community health workers responding to the epidemic. We also need to leverage existing HIV services to boost COVID-19 testing, isolation, contact tracing and treatment capacities.

Now more than ever, African countries need to prioritize investment in essential services. This must include a real commitment to tackle massive corporate tax evasion and ensure that those with the broadest shoulders pay the most tax, including an end to corporate tax exemptions. Now more than ever, also, we need global solidarity to fund a multi-billion-dollar response that includes low and middle-income countries in Africa and the rest of the world. This includes fully funding the United Nations US$2 billion COVID-19 Global Humanitarian Response Plan as well as providing grants to support the abolition of user fees for health services. This pandemic has shown that it is in everyone’s interest that people who feel unwell should not check their pocket before they seek help. As the struggle to control an aggressive coronavirus rages on, the case to end-user fees in health immediately has become overwhelming. International financial institutions and private financial actors need to both extend and go beyond the temporary debt suspensions that have recently been announced - Africa’s debt is about 60% of the continent’s gross domestic product which is completely unsustainable. We must free governments to invest in the response and to strengthen publicly funded health care provision underscored by the principle that everyone has the right to health. In responding to COVID-19, we must be on our guard that resources are not diverted away from other health threats such as the HIV epidemic, tuberculosis, or malaria, which are already taking a heavy toll on Africa.

Modelling conducted on behalf of the World Health Organization and UNAIDS has estimated that if efforts are not made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500000 extra deaths from AIDS-related illnesses, including from tuberculosis, in sub-Saharan Africa in 2020–2021. 

There also needs to be prior international agreement that any vaccines and treatments discovered for COVID-19 will be made available to all countries and be free for all. We must not repeat the experience of the HIV epidemic, where medicines remained beyond reach for too long and millions died, while others are still waiting to initiate treatment today.

A strong recovery is key to building the resilient societies capable of withstanding the next unexpected event. Given the interconnectedness between health and livelihoods, all countries will need to strengthen social safety nets to enhance resilience. They will need too to build more sustainable economies, including decent, well-paid jobs for Africa’s young population and recognition for the undervalued and often unpaid care work carried out by women.

If it has taught us anything, this pandemic has shown how interconnected we are as a global community and that, as the UN Secretary-General, Antonio Guterres, has said, the world is only as strong as its weakest health system. Any global response to COVID-19 which marginalizes Africa’s citizens would not only be wrong, it would be self-defeating. Moreover, Africa’s citizens would not stand for it. Even in the exceptional constraints of this pandemic, ordinary Africans have been organizing to insist on their rights to healthcare and on their rights to social protection. As Africans, we stand with them in refusing to be sent to the back of the COVID-19 queue.

Winnie Byanyima, Executive Director of UNAIDS

John Nkengasong, Director of Africa Center for Disease Control and Prevention