Covid-19 Response in Liberia
Coronavirus COVID-19 pandemic

COVID-19 in West Africa: “Let’s prepare for a long-distance run”

This op-ed was originally published in Punch, Nigeria, on 15 May 2020.

Dr Chibuzo Okonta is president of Médecins Sans Frontières (MSF) West Africa. Originally from Nigeria, he joined MSF in 2005 and has worked with MSF’s emergency medical teams across the region. Here, he calls on practitioners from the African continent to own the narrative of the current COVID-19 pandemic and take advantage of Africa’s experience of outbreaks in order to mount a tailored response.

It has been close to three months now since the first case of COVID-19 was confirmed in Africa. The infection curves are today much flatter than those seen in France, Italy or the United States. Contrary to what is happening elsewhere, and in contrast to what was predicted for us, the epidemic has not exploded, health systems are not overwhelmed, and mortality is much lower than expected.

This is no reason to declare victory, but rather is a heads-up to prepare for a long-distance run.

To survive this marathon, doctors, researchers and all others engaged in the response to the pandemic across Africa must take ownership of the narrative of the fight against COVID-19 and provide hard evidence to rationalise – and remove emotions from – the ongoing debate. Let’s not allow panic, or the fanaticism of protecting our exceptional continent, to take over. Instead we need to prepare to offer cost-effective and efficient responses tailored to local conditions.

Dr Chibuzo Okonta, president MSF West Africa “The epidemic across Africa has not exploded, health systems are not overwhelmed, and mortality is much lower than expected. This is no reason to declare victory, but rather is a heads-up to prepare for a long-distance run.”
Chibuzo Okonta

Re-anchoring the debate in local communities

On 18 March, Dr Tedros Adhanom Ghebreyesus, the director general of the World Health Organization (WHO), called on Africa to “wake up” and face the pandemic. A succession of alarmist speeches about Africa's level of preparedness followed in the international media. Yet, the COVID-19 response in Africa cannot be reduced to a single territory; after all, Africa consists of 54 states, each at a very different level of preparedness.
 
The new virus has claimed – and will undoubtedly continue to claim – casualties in our countries, but paradoxically our health systems – so often referred to as fragile – could end up being quite resilient in addressing this crisis. Most of our health workers did their medical studies, and then practised the art of healing, in resource-deprived settings. They have learned and developed know-how that is unfamiliar to their peers elsewhere.

For example, basic preventive strategies are nothing new in our communities. During an epidemic of Lassa fever (a regular occurrence in West Africa), physical distancing and isolation rules are the norm. We also know from experience that the right information – encouraged, rather than imposed, on people – will break the chain of infection quicker.

Our healthcare systems are certainly short of intensive care units and beds, as well as respirators... But we have developed resilience, skills and knowledge through our experience gained in managing emergencies and epidemics. Dr Chibuzo Okonta, president MSF West Africa

Here is the thing: there is no monopoly of knowledge! Our healthcare systems are certainly short of intensive care units and beds, as well as respirators. They certainly cannot claim sufficient numbers of qualified nursing staff to care for patients who will need oxygen. But we have developed resilience, skills and knowledge through our experience gained in managing emergencies and epidemics.

While we acknowledge our fragility, it presents more opportunities for innovation. Our healthcare systems are aware of their limits and conscious of local capacities, but in the face of such an emergency, we can increase our capacity response and perform a better triage. We have learned from unfortunate experiences that we cannot save everyone.

Centre de Traitement des Épidémies de Nongo, à Conakry

Working with people

One important thing to keep in mind is the imperative to work with people. They need to be part of the debate and the action at every stage, be it prevention, preparedness or care. It is not just a question of designing and implementing a response, through self-protective habits, for the middle and urban classes. Decisions must be made jointly.

The issue of lockdown should be tackled through this collective and community based approach. The restrictive measures put in place early on by our states have enabled us to slow down the spread of the pandemic and to better prepare ourselves. Yet, these measures will not prevent the spread of infection, particularly in our densely populated neighbourhoods or family backyards. On top of that, the measures will have a very heavy economic and social impact on people who subsist on minimal daily earnings.
 
The collective approach has to be changed, in order to enable our fellow citizens to survive and to ensure that everyone follows basic preventive measures: regular handwashing, good respiratory hygiene and respect for physical distance, as well as the wearing of masks.

People must be assisted by making sure that the means to follow these measures are available and usable. In Côte d'Ivoire, for example, MSF teams have arranged for cloth masks to be manufactured locally and distributed to local people. “I protect you, you protect me” – because, yes, we must also encourage local solidarity in response to the pandemic.

One important thing to keep in mind is the imperative to work with people... It is not just a question of designing and implementing a response... Decisions must be made jointly. Dr Chibuzo Okonta, president MSF West Africa

Sharing information and raising awareness is key to fighting an epidemic. For the population, it’s a right, and for us, as medical doctors and researchers, it’s a duty. A relationship of trust with our fellow citizens has to be restored. This means we have a duty of transparency about what we are doing, especially here, seeing the speed at which fake news circulates.

Yes, we do vaccinate populations in a preventive way. Yes, we do participate in clinical trials on treatments and vaccines. We did so before COVID-19 and we will keep on doing it afterwards – I hope – as this is a successful public health measure to protect people from diseases such as measles, meningitis or Ebola.

For the record, the MenAfriVac vaccine, to protect against meningitis A, was introduced in 2009 after several years of clinical trials. Mass vaccination campaigns have been carried out in the past 10 years and there has been no meningitis A outbreak in the region since. Some of our readers might be too young to remember this, but most of them have actually benefited.  

Let’s speak directly with people to avoid any mistrust. Let’s encourage global solidarity to address any discrimination, particularly when it comes to access to treatment and vaccines, should they become available. It is more than necessary to allow a large majority of people to reach the finishing line of this long-distance run.

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