Soon after the novel coronavirus, SARS-CoV-2 (2019-nCoV), was first identified in
a cluster of patients with pneumonia (Li et al., 2020), in the Chinese city of Wuhan
on 31 December 2019, rapid human to human transmission was anticipated (Hui et al.,
2020). The fast pace of transmission is wreaking havoc and stirring media hype and
public health concern (Ippolito et al., 2020) globally. When the World Health Organization
(WHO) declared the disease, (now officially named COVID-19) a Public Health Emergency
of International Concern (PHEIC) on 31st January 2020 (WHO, 2020a), the Director General
Dr Tedros Ghebreyesus justified the decision by stating that WHOs greatest concern
was the potential for the virus to spread to countries with weaker health systems.
Repeated outbreaks of other preventable emerging and re-emerging infectious diseases
with epidemic potential have taken their toll on the health systems of many African
countries. The devastating 2014–2016 Ebola Virus Epidemic (WHO, 2020b) in West Africa,
demonstrated how ill-prepared the affected countries were to rapidly identify the
infection and halt transmission (WHO, 2020d, Largent, 2016, Hoffman and Silverberg,
2018, Omoleke et al., 2016). Similarly, the smoldering remnants of the 2018–19 Ebola
Virus outbreak in the Democratic Republic of Congo, have demonstrated even for health
services with considerable experience of dealing with a certain emerging pathogen,
geography and sociopolitical instability, can hamper the response (Aruna et al., 2019).
A recent analysis of the spatial and temporal distribution of infectious disease epidemics,
disasters and other potential public health emergencies in the WHO Africa Region highlighted
that 41 African countries (87% of the continent) had at least one epidemic, and 21
countries (45%) had at least one epidemic annually (Talisuna et al., 2020). The top
five causes of epidemics were Cholera, Measles, Viral haemorrhagic diseases, malaria
and meningitis. Seven countries which experienced over 10 events, all had limited
International Health Regulations (IHR) capacities which are now being developed. Most
sub-Saharan African countries are operating at maximum capacity with the huge existing
workload in hospitals and clinics. The WHO’s Joint External Evaluation reports, conducted
since 2016, suggest that the ability to respond to an International Health Regulation
hazard, such as the importation of an infectious disease like COVID-19, requires almost
universal improvement across sub-Saharan Africa (WHO, 2020c).Thus, it is essential
for African countries to take the lead, become proactive and prepare surveillance
systems for the rapid detection of any imported cases of COVID-19, to prevent rapid
spread as seen in China. The question arises, ‘Is Africa prepared and equipped to
deal with yet another outbreak of a highly infectious disease – COVID-19?
The answer to the question is, it is better prepared than ever before. Substantial
progress has been made since the 2014–16 Ebola outbreak (WHO, 2020d), with lessons
learned from previous and ongoing outbreaks, followed by significant investments into
surveillance and preparedness (WHO, 2020d, Largent, 2016, Hoffman and Silverberg,
2018, Omoleke et al., 2016). Africa is now better prepared than ever before. Thus,
African countries have been on heightened alert to detect and isolated any imported
cases of COVID-19. There has been rapid response to the COVID-19 epidemic from Africa’s
public health systems, well before any cases of COVID-19 had been reported from Africa.
This response has been made possible with the re-organization of the WHO including
the creation of the World Health Emergencies Programme; the establishment of the Africa
Centers for Disease Control and Prevention (Africa CDC, 2020) and creation and funding
of consortia such as the ONE-HUMAN-ANIMAL-HEALTH Africa-Europe research, training
and capacity development network (PANDORA-ID-NET)(Pandora-ID-NET, 2020) for tackling
emerging and re-emerging infections with epidemic potential. This ONE-HEALTH network
works effectively and equitably together across all Africa regions, fully engaging
with national disease control authorities and public health institutes, in close liaison
with the Nigeria CDC, Africa CDC and other African and global public health agencies.
Importantly, this consortium has allowed strengthening of communication and establishment
of trust and ‘unity of purpose’ between African governments, Africa CDC, Nigeria CDC
(Nigeria CDC, 2020), local communities and the PANDORA-ID-NET consortium local African
and European public health workers and scientists.
An estimated 2 million Chinese nationals live and work in Africa, and there is increasing
travel in the opposite direction, with people going to China for education, business
and leisure. Prior to the travel restrictions imposed after the COVID-19 outbreak,
there were an average of eight flights a day operated between China and African cities
(Haider et al., 2020a, Haider et al., 2020b). There are ongoing efforts in Africa
to prepare to deal with imported cases or subsequent local outbreaks of COVID-19,
led by the Africa CDC, Nigeria CDC, African Union, PANDORA-ID-NET and other research
and capacity development and training consortia. Many African countries have already
introduced screening of arrivals for COVID-19 at airports, and at some seaports. ‘First
public health emergency responders’ from African countries met in Senegal in early
February 2020 to equip themselves with the latest advances on COVID-19 diagnostics
(Corman et al., 2020), prevention and healthcare knowledge. Over 20 African nations
are now able to test for COVID-19. Several African countries have identified isolation
and quarantine centers and Nigeria, Kenya, Ethiopia, Ivory Coast, Ghana, Uganda and
Botswana have rapidly dealt with suspected cases carrying out laboratory tests, and
in some cases, placing them in quarantine while laboratory tests were performed.
Nigeria was one of the first countries to recognize the risk and start planning the
response for COVID-19. In a massive effort of national coordination, a multi-sectoral
National Coronavirus Preparedness Group was established by Nigeria CDC on January
7, 2020, one week after China first reported the cases and three weeks before WHO
declared the disease to be of international concern. The country has also established
diagnostic capacity for COVID-19 in three laboratories within the country in one month.
Nigeria CDC has established a national team that meets daily to assess the risk coronavirus
poses to the nation and review its response to it. Uganda quarantined more than 100
people who arrived at Entebbe International Airport, some at hospitals in Entebbe
and Kampala, and others were confined in their homes. Zambia has dedicated two medical
facilities in the capital, Lusaka, to quarantine people suspected of having the disease.
They include designating a new 800-bed capacity hospital in Lusaka, funded and built
by China development aid to Zambia. Thermal body scanners have also been set up at
all ports of entry to detect travelers showing symptoms of the virus. Kenya has introduced
mandatory screening at all ports of entry, and established isolation facilities and
a rapid response team to handle suspected cases. South Africa has set up national
and provincial response teams, designated 300 health officials to ports of entry and
begun screening all travelers from China. The Africa CDC has trained numerous participants
from across Africa, including Egypt, on enhancing detection of COVID-19 at points-of-entry
in collaboration with US-CDC, WHO, and the International Civil Aviation Authority
(WHO, 2020e). Two airlines, Kenya Airways and South African Airlines, were also represented
in the training. Additional training and resources have been provided to Egypt and
other at-risk countries for infection prevention and control in healthcare facilities,
medical management of COVID-19, and risk communication and community engagement. The
Africa Union, West African Health Organization (WAHO) and external donors have been
quick to provide support to the Africa CDC. In response to emergency grant calls for
COVID-19, there have been several consortia fielding grant applications for research
and capacity development.
The long anticipated and inevitable and detection of the introduction of SARS-CoV-2
into Africa was announced on 14 February 2020, by the Minister of Health and Population
of Egypt, Dr Hala Zayed, who confirmed the first case of the novel coronavirus disease
COVID-19 in Egypt. The patient was a 33 year old male of foreign origin whose 17 contacts
tested negative but were under home quarantine for 14 days. This has ignited a reflection
on the readiness of the continent to take on the challenge and showcase its new potential.
Following detection of this first case in Africa, the Africa CDC, Nigeria CDC and
other national public health institutes in liaison with the WHO are scaling up preparedness
efforts in the African region, supporting countries to implement recommendations outlined
by the WHO International Health Regulations Emergency Committee. The Emergency Committee
recommended that all countries should be prepared for containment, including active
surveillance, early detection, isolation and case management, contact tracing and
prevention of onward spread of SARS-CoV-2. Thirteen nations with close links with
China, including Nigeria, South Africa, Kenya and the Democratic Republic of the Congo,
have been identified as especially high-risk priority zones for proactive surveillance,
detection and containing the spread of COVID-19. The WHO has sent diagnostic kits
to 29 laboratories in Africa, and reagents and positive controls are being shipped
worldwide by PANDORA-ID-NET partner in Germany, Charité-Universitätsmedizin Berlin
Institute of Virology, to ensure the capacity to screen and test. Some countries in
Africa, including DRC, are also leveraging the capacity they have built up to test
for Ebola, to test for COVID-19. Thus, early detection of cases with implementation
of infection control procedures will remain a priority to control the spread of COVID-19
in Africa.
On 22nd February, 2020 an Emergency Ministerial meeting on COVID-19 was organized
by the African Union and the Africa Centres for Disease Control and Prevention following
which the WHO DG announced several additional measures and plans for supporting the
Africa response to COVID-19 (WHO, 2020g). He appointed Dr John Nkengasong, Director
of the Africa CDC, and Professor Samba Sow, Director-General of the Center for Vaccine
Development in Mali, as special envoys on COVID-19, to provide strategic advice and
high-level political advocacy and engagement in Africa. A WHO Strategic Preparedness
and Response Plan has been developed, with a call for US$675 million to support those
African countries which are most vulnerable. WHO have also shipped over 30,000 sets
of personal protective equipment to several countries in Africa, and 60,000 more sets
are to be shipped to the 19 vulnerable countries in the coming weeks. During the past
month about 11,000 African health workers have been trained using WHO’s online courses
on COVID-19, which are available free of charge in English, French and other languages
at OpenWHO.org.
As of 5th March, 2020, worldwide there were 93,090 laboratory confirmed cases of COVID-19
reported to the WHO. Of these 80,422 cases (with 2,984 deaths) were from China, and
12,668 cases (with 214 deaths) were from 76 countries outside China. From Africa there
have been 5 cases from Algeria, 1 from Nigeria, 1 from Senegal and 2 from Egypt (WHO,
2020f). Given the extent of the outbreak in China, and with a high degree of awareness
of COVID-19 in Africa, and proactive screening on the rise, more COVID-19 cases are
anticipated in Africa. Several lessons have been learnt from the SARS-CoV-2 epidemic,
which is the third lethal human zoonotic coronavirus with epidemic potential to emerge
past 2 decades, the first being SARS-CoV identified in 2002 and second MERS-CoV in
2012 (Hui et al., 2014, McCloskey et al., 2014). Whilst the news and social media
hype has evoked public and political anxieties, it is important to note that COVID-19
appears to have less than 3% mortality rates and is not more serious than outbreaks
of viral respiratory tract infections such as influenza (Ippolito et al., 2020). It
is crucial that other communicable diseases which impact a higher toll and burden
on health services in Africa are not neglected or sidelined by the current hype and
scaremongering of the COVID-19 epidemic.
An important need remains for ensuring long-term sustainability of what is being built.
Africa needs to continue its upward trajectory of activities so as to align public
health resources, scientific expertise and experience, and political commitment so
that any future infectious disease outbreaks can be stopped before they become an
epidemic in Africa. Africa needs more investments into ONE-HEALTH collaborative activities
across the continent in order to meet the challenges of current and future public
health threats (Kock et al., 2020, Petersen et al., 2019, Talisuna et al., 2020, Hui
et al., 2020, Zumla et al., 2016). A whole new young generation of enthusiastic, committed
and dedicated African public health workers, epidemiologists, researchers, healthcare
workers and laboratory personnel have emerged over the past 5 years, and they need
to be supported by security of funding to build their careers and sustain their capabilities
to take forward their research and training portfolios. The future of Africa’s public
health security relies on them. Increased governmental and donor investments are required
to advance locally led, world-class public health work with surveillance, data and
analytics capabilities and further expanding state-of-the-art laboratory capacities
with more trained personnel to sustain capacity to rapidly respond to outbreaks at
their source. A well-planned long-term strategy from the Africa Union will add major
value for consolidating African leadership of public health capacity building, training
and research.
Conflicts of interest
All author declare no other conflicts of interest
Author contributions
Sir Prof Alimuddin Zumla, Dr Nathan Kapata, Dr Chikwe Ihekweazu, Prof Giuseppe Ippolito
and Prof Francine Ntoumi conceptualized the editorial and developed the first draft.
All authors contributed to writing and finalizing the manuscript.