World Health Organisation director-general Tedros Adhanom Ghebreyesus. Picture: AFP/PIERRE ALBOUY
World Health Organisation director-general Tedros Adhanom Ghebreyesus. Picture: AFP/PIERRE ALBOUY

Paris — The first detected case of coronavirus in Africa highlights the vulnerability of the world’s poorest continent to outbreaks of contagious diseases.

Much of Africa struggles with conflicts, poor health infrastructure, crowded cities with inadequate sanitation, rickety governance, and porous borders — all of which provide excellent opportunities for the microbe to spread, experts say.

Last weekend, World Health Organisation (WHO) chief Tedros Adhanom Ghebreyesus pleaded with AU states “to come together to be more aggressive in attacking” the virus. “Our biggest concern continues to be the potential for Covid-19 to spread in countries with weaker health systems.” 

The first case south of the Sahara was announced on Friday in Nigeria’s mega-city of Lagos. Two previous cases in Africa were detected in Egypt and Algeria.

A 2016 analysis by the Rand Corporation, a US think-tank, found that of the 25 countries in the world that are most vulnerable to infectious outbreaks, 22 are in Africa — the others are Afghanistan, Yemen and Haiti. Heading its list were Somalia, the Central African Republic, Chad, South Sudan, Mauritania and Angola.

Nigeria reported the first coronavirus case in sub-Saharan Africa on 28 February 2020 after an Italian citizen returned to the country from Milan earlier this week with the virus. Two of 12 South Africans who were working on board an American-owned cruise ship, the Princess Diamond, were diagnosed with the coronavirus in Japan. The World Health Organisation has warned that African health systems are ill-equipped to respond should the virus spread on the continent.

The report put the finger on a “disease hot-spot belt” extending on a line of countries, running across the southern rim of the Sahara through the Sahel to the Horn of Africa, many of which are struggling with conflicts.

“Were a communicable disease to emerge within this chain of countries, it could easily spread across borders in all directions, abetted by high, overall vulnerability and a string of weak national health systems along the way,” the report warned.

“Though we have seen modern diseases rapidly transmitted all over the world through interconnected travel, it is these vulnerable states with porous borders and weak or conflict-affected neighbours that face the greatest risks and potential health challenges.”

Weak health systems

Past epidemics in Africa — from malaria and HIV to drug-resistant TB and Ebola — have already triggered loud warnings about the continent’s problems in healthcare.

They range from public awareness and disease screening to lack of doctors, nurses, drugs and hospital beds — and the heightened risks for people already weak from malnourishment or a damaged immune system.

According to the World Bank, per capita health expenditure in Sub-Saharan Africa in 2016 was just $78 (about R1,200), compared to $1,026 on average in the rest of the world. The highest was $9,351 in North America, followed by $3,846 in the EU.

Trudie Lang, director of the Global Health Network at Oxford University, said a major concern was that the virus, despite its relatively low mortality rate, could “overwhelm healthcare provision” in African countries. This would have a cascade effect, affecting care for Africa’s many other health problems, she told Britain’s Science Media Centre.

There is “real fear that health systems become swamped and unable to manage their ongoing healthcare, thereby presenting an even greater threat than the virus”, she said.

In a study of anti-coronavirus preparedness in Africa on February 19, The Lancet medical journal said that, overall, countries had strengthened their shield. Implemented measures include temperature screening at ports of entry, recommendations to avoid travel to China, and improved health information provided to health professionals and the public.

But some countries “remain ill-equipped,” notably on surveillance and rapid identification of suspected cases, patient isolation and contact tracing, it said.

South of the Sahara, only SA won high marks for preparedness, while Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana and Kenya would all need support, it said.

In early February, just SA and Senegal among sub-Saharan countries had existing lab facilities to test people for the coronavirus, although the WHO thereafter supplied equipment to some 40 countries.

The Africa Centres for Disease Control and Prevention, a co-ordination body set up by the AU, established an anti-coronavirus task force on February 5. Its main task is to provide African countries with training on lab diagnosis, surveillance, screening, and safe transportation of suspected cases.

AFP