How ingenuity, experience and decisive leadership helped to manage coronavirus in Africa

Four months into the Covid-19 pandemic, global predictions of the disease’s impact on Africa persisted in grim forecasts of total catastrophe.

A Yale School of Medicine study published in May 2020, explained that despite Africa’s low incidence of infection in the first quarter of the pandemic, the continent would likely “experience catastrophic levels of COVID-19.” The study also predicted 16.3 million cases in Africa by June 30 th , 2020. As of mid-October 2020, when this article was written, the continent had recorded nearly 1.6 million cases out of a population of 1.3 billion with approximately 34,000 deaths.

Without minimizing the thousands of tragic deaths that have occurred, or overlooking possible inadequacies in data collection, what could explain the stark contrast between the predictions of total doom and the actual outcomes of the pandemic in Africa?

In order to properly understand the factors that have contributed to Africa’s relatively positive performance during the COVID-19 pandemic, it helps to be cautious about the default images and language traditionally employed to report news on the continent.

If viewed through the lenses of a continent infamous for its failing public systems and governance, desperately poor populace, and filthy crowded slums, it is challenging to imagine anything short of utter disaster during a pandemic that demands social distancing, pristinely sanitized areas, and expensive Personal Protective Equipment (PPE).

Unsurprisingly, several international journalists reporting on the issue seem completely dumbfounded and in perpetual anticipation of an African COVID catastrophe, resorting to the same tired narratives of the continent’s failings even with evidence to the contrary.

Eight months on, however, across Africa, we observe some of the lowest infection rates, highest testing rates, and impressive recovery rates of the pandemic.

The research on Covid-19’s management in Africa surfaces three likely factors contributing to Africa’s outcomes so far: ingenuity, experience, and decisive leadership. This article will examine these concepts in action in three African countries; Ghana, Rwanda, and South Africa to grasp Africa’s mitigation of COVID-19’s effects. Ingenuity Contrary to the diseased and lifeless bodies we were primed to imagine, the prevailing images of COVID-19 in Africa have largely been those of innovation. In Ghana for instance, the Veronica Bucket, a simple handwashing mechanism invented by Ghanaian biological scientist, Veronica Bekoe, has become synonymous with COVID-19 prevention. Designed with a tab at the bottom, the bucket enables public handwashing under running water, replacing handwashing in bowls of standing water. Simple mechanisms like the Veronica Bucket though irrelevant in most of the western world where clean running water is standard are genius innovations in certain part of the continent, where running water is a luxury.

Beyond nifty hand washing buckets, advanced scientific and technological innovation helped African leaders navigate the pandemic on African terrain. In Ghana, with the first two diagnosed cases of COVID- 19 announced on March 12 th , 2020, it was obvious that widespread testing would be a primary tenant of any strategy to contain the virus. However, with Polymerase Chain Reaction (PCR) machines initially limited to only two of Ghana’s leading medical research facilities - The Noguchi Memorial Institute for Medical Research (NMIMR) and, Kumasi Center of Collaborative Research (KCCR) – scaling testing efforts would be critical.

Scientists at Noguchi acted swiftly and intuitively to the challenge, by-passing the usual bureaucracy needed to obtain approvals and instituted pooled sampling, which immediately and drastically increased the country’s testing capacity. Of the 415,000 tests conducted across the continent in April of 2020, Ghana was responsible for a sixth of these tests! Today Ghana has conducted over half a million tests, encouraged Rapid Testing Kit innovation by student scientists, and established nine specialized testing centers backed by government funding and support from the regional Word Health Organization (WHO).

Pooled sampling worked particularly well in Ghana and was later adopted in Rwanda and across the continent because of the virus’ relatively low prevalence rate on the continent.

In pooled testing, samples are tested in groups and only retested individually if the virus is detected in the pool. This rapidly scales testing, while saving on testing reagent costs. Boosting testing capacity in African countries helped identify infection hot spots and guided governments in their lockdown advisories.

Once the virus began to spread past the continent’s largest cities into more remote areas, public health leadership looked to more avant-garde technological innovation to work around the nuanced complexities of pandemic management in Africa.

In Rwanda and Ghana this involved a partnership with California-based company, Zipline, using already functioning drones as medical transport to cart samples from remote areas to specialized testing centers; effectively circumventing the African infrastructural inadequacies that were predicted to exacerbate the prevalence of the disease.

In Rwanda, medical drones were use multi-purposely. Not only did they transport testing samples, but they also served to promote and police social distancing protocols. Medical drones with megaphones would castigate mask-less Rwandans in public or demand social distancing be respected when restrictions were flaunted. As the most densely populated African country, Rwanda paid particular attention to implementing social distancing protocols even enlisting six robots as health workers, donated by the United Nations Development Program (UNDP).

Having learned from the disastrous effects of the pandemic on health workers across the globe (in May, totaling over 90,000 causalities), the robots were tasked with mass temperature screening, patient status monitoring, and keeping medical records of infected patients, eliminating unnecessary contact between human health workers and COVID-19 patients.

According to the Rwandan Ministry of ICT, robots would also alert health workers when patient abnormalities were detected and educate patients and health workers on safety protocols related to the pandemic.

African ingenuity during the COVID-19 pandemic was multi-sectoral, leveraging technical innovation, technology, and entrepreneurship to chart a path to survival. When faced with a scarce global supply of PPE, the Ghanaian government funded Small and Medium Enterprises (SMEs) to manufacture these supplies. Seamstresses and tailors were trained to properly make cloth facemasks, and pharmaceutical and liquor companies were immediately challenged to ramp up production of alcohol-based sanitizers.

Within weeks, 34 newly registered companies produced massive quantities of sanitizers for every-day use at affordable prices – a far cry from the alarming rates of hoarding of basic supplies that occurred rampantly in the west. Even Ghanaian fashion got on board, with matching African print masks made to compliment national attire. If masks became a political statement representing an encroachment on civil rights in certain parts of the world, in Ghana, masks became a fashion accessory required to make a health-conscious statement in turbulent times.

Experience

Initial predictions of total devastation across Africa by the pandemic were informed by the continent’s well- researched infrastructural inadequacies, fragile health systems, and economic challenges.

What predictive models failed to account for in their algorithms was the positive impact that Africa’s experience could have.

Precisely because of the challenges the continent has faced for decades, Africa has been forced to learn and rapidly innovate in areas that are but a distant memory to the developed world. Part of the slowness to action exhibited by leaders in the developed world may be explained by their complete lack of recent reference points.

The often-cited Spanish Flu as a reference for the USA’s management of the pandemic for instance, happened over a century ago and even their more recent HIV pandemic in the 1970s, half a century later.

In Africa, crisis management is the norm, and we understand that a pandemic must be urgently contained. West Africa experienced the Ebola pandemic a mere four years ago, so the health protocols instituted at our ports of entry were easily re-instated at first report of COVID-19.

This may also explain how Rwanda was already massively testing for COVID-19 in January when debates about whether Covid was a hoax or not were still rampant in the United States. Though Rwanda didn’t discover its first Covid-19 case till March 21 st , it had already employed a multi- sectoral response team to tackle it on arrival. Unsurprisingly, as of October 22 nd , according to the Rwandan Biomedical Center and after over half a million conducted tests, Rwanda had recorded only 5,017 cases and still registers only 34 COVID-19-related deaths.

Africa has pried from its struggle, innovation, and wisdom, clear in its management of Covid-19. South Africa’s playbook for containing the Corona virus, is rooted in the country’s decades-long battle with HIV/AIDs. Home to the largest number of HIV patients on the continent, and with a fairly recent past mired with prominent HIV deniers, a lack of access to Anti-Retroviral drugs (ARVs), and 300,000 lost souls, the government swiftly and strictly implemented a total lockdown within the first three weeks of detecting the first case, before a single Covid-19 related death had occurred, and despite an ongoing economic recession.

South Africa’s experience with HIV/AIDS established more than just a cautious COVID-19 containment strategy. Managing HIV/AIDs and its twin ailment, TB, required strong public health protocols and systems that could easily be redeployed in the fight against COVID-19.

Particularly because disease prevention protocols for both TB and COVID-19 are similar given common means of transmission via exhaled infected droplets, using PPE and social distancing measures was already familiar to the population and easily reintroduced. However, many South Africans, afraid of being stigmatized after testing positive for COVID-19, would rather not test at all, a trait that lingered on from HIV/AIDs stigmatization.

There was also the persistent myth that the virus infects only rich people, given the disease’s prevalence among the middle and upper classes – people who were internationally mobile and may have initially imported the virus to the continent after visiting countries in Europe and Asia. Public education through community outreach has been crucial as a result.

Through a comprehensive network of former HIV/AIDS community outreach workers and using the ‘Find, Treat, and Prevent’ strategy, South Africa tackled COVID-19 head on, myths and all!

Despite early action to combat the virus, the South African government has received mixed local reviews on the severity and length of its lockdown. While swift action likely slowed down the rate of infection at the beginning, a lot of that mitigation is being undone with recent reopening. Meanwhile, the severe economic woes of marginalized and informal workers, who have lost their livelihoods as a result of lockdown restrictions, may be viewed as more brutal punishment than a positive Covid-19 test.

These are certainly difficult times to be in leadership, but Africa seems to be appropriately leveraging its past struggles to navigate this unknown terrain.

Decisive Leadership Indeed, managing Covid-19 has been a great test in leadership across the globe. It has been refreshing to repeatedly observe decisive leadership make a difference in Africa despite the scarcity of resources available. The South African president, Cyril Ramaphosa, was internationally applauded for his discernment and proactive decision to lockdown South Africa early on in March. Similarly, Paul Kagame of Rwanda, despite the country’s head start in containing the virus and low rates of casualty, continued to urge his citizens’ vigilance focusing efforts on keeping the economy running despite the distractions of the pandemic and critiques on his leadership style.

In an interview with Dr. Anthony Nsiah-Asare, Presidential Advisor on Health in Ghana, he stressed the importance of President Nana Akuffo-Addo’s decisive leadership during the crisis. As early as February 2020, the President instituted and chaired a multidisciplinary task force to prepare for and manage the pandemic before any cases had been detected in the country. The task force included epidemiologists, virologists, medical doctors, and a cross section of representatives from government ministries. At the onset of the pandemic, a strong government partnership with the Ghanaian scientific community emerged, driving a science-backed pandemic management strategy.

Coordinated by Dr. Asamoah Baah, a former Deputy Director General of the WHO, the task-force emerged with six thematic objectives, which ranged from building the country’s health and surveillance capability to economically supporting the most vulnerable sectors of the population during the pandemic.

As a result of the task-force’s work, and in addition to containing the virus’ spread, systemic challenges in the country’s health system are being addressed, including building tech-operated health surveillance systems to tackle future pandemics and developing consistent and advanced management of chronic diseases to avoid high incidence of co-morbidities in future health crises.

In a country known for its hospitality and sociable culture, the President had to emphasize the importance of social distancing in the fight against the Coronavirus, making it a point to model social distancing behavior and protocols needed in the new normal. Beginning at the country’s Independence Day celebrations on 6 th March, 2020 President Nana Akufo-Addo offered no handshakes to foreign and local dignitaries and observed social distance, reiterating in his speech that the Corona virus was real and needed to be managed with a united front. Following that initial speech, President Nana Akuffo Addo has delivered 18 national Presidential addresses to the people of Ghana, earning him the term of endearment - “Fellow Ghanaians” - the greeting he begins all his public speeches with.

Using the influence of his podium, the Ghanaian president encouraged, incented, and warned Ghanaians to adhere to health protocols. Mask wearing was mandated at a national level and major cities including the nation’s capital, Accra, were completely locked down for several weeks.

Religious services, funerals, weddings, and all mass gatherings were completely banned for months and gradually reopened in phases with capacity limitations when infection rates had subsided. In Ghana today, schools still remain closed and with lockdown restrictions gradually relaxing, another committee has been tasked with the strategic management of reopening schools in phases, when the science indicates that it is safe. When the government reopened the airport on September 1 st , 2020 after being closed since March 17th , it did so by instituting stringent travel policies, which included certified proof that a PCR COVID-19 test had been taken 72 hours prior to arriving in the county and mandatory testing at the airport. Managing the crisis hasn’t gone without hiccups – the pricy tests demanded for reentry into the country are quite unpopular especially after previous tests were conducted on the government’s dime. Keeping Ghanaians from religious services and asking working parents to homeschool their kids, were all expectedly hard pills to swallow. But decisive leadership has prevailed in murky times and so has the hardiness, cooperation, and industrious nature of Ghanaians. With continued cooperation, Ghanaian leadership remains cautiously optimistic about their ability to contain the virus. Unsurprisingly, managing a pandemic during an election year has increased tensions between Ghana’s primary political parties – the ruling NPP and opposing NDC. Though the sparring teams haven’t always agreed on what the right decisions are to protect and serve the country’s citizens during the pandemic, we haven’t seen the same disintegration in civil discourse over scientific fact as has happened elsewhere. Both parties have managed to collaborate on pandemic relief efforts (through a bi-partisan body set to manage fundraising efforts) and public messaging on health protocols; both stressing the virus’ indiscriminate lethality.

Understanding the factors and nuances that have delivered Africa’s outcomes in the COVID-19 pandemic, so far, is complex and perhaps a little premature. “We are not out of the woods yet,” Dr. Anthony Nsiah-Asare cautions. Indeed, part of the challenge African nations face while gradually relaxing lockdown restrictions is the tendency for their citizens to completely throw caution to the wind and possibly face another wave. Leading through a pandemic is a fragile balancing act anywhere in the world but in Africa, it’s a tight rope act of epic proportions – a small misstep could lead to a tragic plunge – suddenly amplifying the voices of critics whose predicted apocalypse would have finally arrived.

Notwithstanding Africa’s numerous challenges, several African countries have taken commendable steps to curb the spread of COVID-19 – we need to own and tell our stories boldly. Especially during a year christened with a sharp global rise in social justice consciousness, including protests against police brutality and failed governance in parts of our continent, it is imperative to record the good news and celebrate each victory.

Most importantly, in a world always too eager to highlight Africa’s struggles and dismiss our accolades, it is telling that during a pandemic that continues to perplex the world’s most influential players, African solutions for the continent will always work best.