Statement – COVID-19: Multisectoral measures should be evidence-based

Statement by Dr Matshidiso Moeti, WHO Regional Director, African Region

19 March 2020, Brazzaville, the  Republic of the Congo

Members of the diplomatic corps in Denmark,

WHO Regional Director for Europe, Dr Hans Kluge,

WHO Regional Director for the Western Pacific, Dr Takeshi Kasai,

Dear colleagues,

Good morning.

I appreciate the opportunity to share some reflections and observations from the African Region. First of all, I would like to say that the European Union is one of Africa’s best supporters in our work on development and there is a strong relationship between the European Union and African Union, including quite significant levels of financial resources and technical support to development in different sectors. So I find this an opportunity to emphasize those strong links between Europe and Africa that go back many years, and I am sure will continue in the future, in this discussion of the global pandemic, having been invited by Dr Kluge.

I can only echo the comments of my colleagues on the importance of global solidarity in our collective efforts to address this pandemic.  The fact that we are seeing signs of it (solidarity), and as WHO see it as our duty to acknowledge it and promote it where it is happening.

As far as the African Region is concerned, about six weeks ago, two months ago, we were observing that there were not many cases of coronavirus in the Region. So about 8 days ago we only had 5 African countries with cases. Today, we have 28 African countries that have reported cases. So in the last two weeks we have had an exponential geographical spread of this virus in the African Region. We now have over 300 confirmed cases and four deaths. Compared to what is happening in Asia, and what is happening in Europe, this looks like very little, but we are concerned about the speed with which it has occurred and the socio-economic context in which it is happening, and the ability of our health systems to deal with this problem.

We have local transmission in only four countries in the African Region - Algeria, South Africa, Burkina Faso, and Senegal, and all of these have arisen out of travel from European countries. Initially we were very concerned about the link between China and African countries, it is one of Africa’s top economic partners, but the majority of cases here have been sporadic importations mainly from Italy, France, Germany, Spain, Switzerland, the United Kingdom and the USA. This again demonstrates the strong links between African and European countries.

We have carried out a baseline risk assessment of the readiness of our countries, understanding that the starting point is relatively weak health systems, and that includes weak preparedness to address and operate in public health emergencies in general.

We are very encouraged in the investment by governments and the international community in this work. For example, a month and a half ago we only had two countries and two laboratories that could confirm diagnosis of this virus. Now we have  41 countries that are able to do this through work that has been done by governments and with the  support of WHO and Africa’s CDC.

Countries have built their capacity for surveillance, point of entry screening, and working on areas including contract tracing. Where we have the greatest challenges is in the areas of infection prevention and control and case management. This relates to the paucity of capacity for critical care in the majority of African countries in the public sector and also in the private sector.

And we observe that South Africa, which has one of the most well-developed health systems in the Region, both in the public and private sector, already acknowledges that it will be challenging to deal with the number of cases that are projected to occur with the rapid geographic spread of COVID-19.

We also have a demographic that we believe needs particular consideration. We  have the elderly who are at greatest risk, and a high prevalence of HIV among young adults. We have to understand what this means for the vulnerability among our populations. We have very high levels of malnutrition among children under 5 in African countries. Does this also constitute a population sub-group that is more at risk than we have observed in other regions? This is what we need to be monitoring  as we see the situation evolve in our countries.

We have worked very hard with our countries to develop national plans, so 40 African countries have defined what they would like to do and we are now logging these on the international platform for financing from the international community.

What we have to contend with, according to the particularities of our Region, is that social distancing in some contexts in Africa may be quite a challenge.  In low-income settings, in urban slums, it may be quite difficult for a person to lock themselves away in a room, because there are simply not enough rooms in the home. So we will need to think differently about how to achieve containment within this context. In many of our settings, we do not have access to water in the home, so if we are asking people to wash their hands frequently we will need large volumes of sanitizers to be made available in homes to achieve some of these interventions.

We would like to learn from the experience of countries in Asia, such as China, in terms of active case-finding. As a public health community we need to be innovating in terms of what kind of testing can be carried out for people who are asymptomatic in the types of settings we have in Africa.

I would like to conclude by saying that we are strongly recommending to our governments that the types of measures that are being taken of a multisectoral nature be based on evidence. We look to contain and isolate the virus and not people, and certainly not countries. We have observed a raft of measures that are being put in place that are going to have an impact on the movement of people and of supplies and goods, including those that are essential for this response.

What we would like to see and promote is a dialogue between the Regions, between the European partners of Africa and between our political leaders, so that the strategies that are being put in place are mutually supportive and synergistic for control in all 3 regions.

I would like to conclude by thanking the European Union Member States and the European Union for the generosity in response to WHO’s global call for resource allocation. We stand to benefit from that in our Region and I echo Dr Kluge in saying that we will do the best we can to manage and use the resources well and get the best results.

Thank you very much.