Three Principles to Guide Africa’s COVID-19 Response

Government leaders in Africa are being inundated with rapidly changing information about the spread of COVID-19 in their countries and about recommendations on how to respond. The fluidity of the situation—combined with the dire consequences of an uncontrolled outbreak—make it critical for leaders to put a cohesive strategy in place today to battle the pandemic.

That strategy must be guided by three principles. First, governments must take a comprehensive approach. This means focusing not only on health care challenges but also on managing the economic and broad societal challenges that will arise, such as the security of the supply of food, basic commodities, and energy. Second, it must be adaptive, with governments able to respond as more is learned about the virus and as conditions on the ground change. In particular, governments must be prepared to quickly take mitigation measures if current aggressive containment measures are insufficient. Third, there must be a relentless focus on an implementation that is effective.

Those principles should inform plans to take fast action in several areas in the days ahead. Governments will need to immediately bolster the health care response, protect the economy, and safeguard social stability, including by ensuring that food and other supplies keep moving. At the same time, they will need to rapidly deploy key bodies for a powerful pandemic response to support effective policy, execution, and decision making. They must also work collaboratively with community leaders and players in the private sector.

Three Principles for the Response

The COVID-19 pandemic has already swamped the health systems of many developed countries and delivered a major blow to their economies. In Africa, some unique factors will determine the impact of the outbreak. Given that the disease appears to be more deadly in older patients, African countries are somewhat buffered by their younger populations. However, the continent also has large numbers of immunocompromised and malnourished people, as well as relatively weak health care systems. As a result, the pandemic could be even more deadly in Africa than elsewhere.

On the basis of our work supporting COVID-19 responses around the world, our broad range of support for governments in Africa, and our experience assisting in managing the 2014 Ebola outbreak, we believe an effective response to COVID-19 must be based on three principles, which can be characterized as follows.

Comprehensive. The COVID-19 outbreak will have significant impact on multiple systems in Africa. Health care systems, already strained by the high incidence of such conditions as HIV and tuberculosis in some countries, will be potentially overwhelmed by an influx of critically ill patients. Economies in the region will also be hit, especially by declines in tourism, oil prices, and foreign investment. A disruption in the production and delivery of supplies is just one of many possible societal challenges that may arise. And governments may have difficulty deploying pandemic response interventions—including support for individuals and small businesses—because of a lack of financial resources and insufficient underlying infrastructure for implementation.

Governments will need to develop strategies that focus on supporting health care, the economy, food, and supply security—an objective made more difficult by the fact that actions in one area can hinder performance in another. Social-distancing measures, for example, may help slow transmission of the virus but may exacerbate shocks to the economy and difficulty in gaining access to food and other essentials. The goal should be to calibrate strategies to ensure balance among all three objectives.

Adaptive. Government responses must allow for adjustments and course corrections. In particular, they will need to simultaneously drive containment while preparing to also deploy mitigation measures in case containment is insufficient. And government leaders must be ready to adapt their strategies as more is learned about the virus and as specifics of the outbreak in Africa emerge.

Consider current containment efforts. A number of African countries have taken aggressive action to contain the pandemic, including confinement measures and the closure of frontiers. However, so far the only countries to successfully contain the virus have been in Asia. (See the exhibit.) Those nations developed highly sophisticated epidemic response capabilities in the wake of the SARS and MERS outbreaks and have directed significant resources toward aggressive COVID-19 testing, screening, and surveillance. South Korea, for example, ramped up widespread testing quickly, conducting 14,000 tests per day by March 24 of this year. And Singapore rolled out screening at major checkpoints, allowing the country to quarantine 90% of all COVID-19 cases within two and a half weeks of the onset of the outbreak.

African countries, however, will find it difficult to replicate those measures because of two factors: the lead time required to build sufficient capacity to execute them and the unique challenges of implementing social distancing in Africa as a result of different housing, work, and population movement patterns. As a result, even as they pursue strong containment efforts, African governments must simultaneously develop and prepare to carry out aggressive mitigation measures. 

At the same time, governments must be prepared to make adjustments as more information becomes known about COVID-19, its impacts, and the efficacy of tools to fight it. Right now, government leaders must keep in mind four primary unknowns:

• How do various nonpharmaceutical interventions impact the spread of the virus? Little information exists about the impact of the complete-shutdown strategy employed by several Asian countries, and it is not entirely clear how well different combinations of approaches reduce the spread of the virus. Similarly, not much is known about how effective and feasible these approaches are likely to be in different contexts within Africa. Measures that work in cities, for example, may not be directly transferrable to rural areas. More evidence is likely to emerge in the weeks ahead, particularly with regard to the effectiveness of containment efforts in Africa.
• How will the spread of the virus vary under different temperature and humidity conditions? Coronaviruses exhibit varying degrees of seasonality. However, given that the novel coronavirus is spreading rapidly in Australia, where average temperatures are roughly 25° to 30° F above those in Hubei, China, there is reason to believe that the virus is not particularly sensitive to variations in temperature and humidity. Still, it is too early to tell if—or how—the climate in Africa will impact the spread of the virus there.
• What treatment options will arise, and when will they become available? Perhaps most impactful—and uncertain—is the outlook for COVID-19 treatments. To date, no therapeutic approach has been shown conclusively to be effective. The global community is working rapidly to test existing treatments first, to test treatments already in clinical trials next, and then to discover and develop new treatments specifically targeted at COVID-19. Early promising anecdotal results for two existing treatments have given researchers hope. More will likely be known in the coming weeks: China alone, for example, is conducting more than 350 ongoing studies related to several molecules, and the WHO has kicked off a clinical trial comparing promising therapies.
• What diagnostic options will arise, and when will they become available? Testing is critical to control the spread of COVID-19, and different test types have rapidly proliferated. As of late March this year, more than 200 test platforms were available, including recently launched rapid tests that can give results in just ten minutes. Governments must monitor the changing testing landscape and match the right test type to particular use cases, including diagnosis of patients in hospitals, primary care centers, and field clinics. A cheap and easy-to-use test that could be deployed very widely in Africa could be transformational for the response strategy, potentially allowing mass-scale testing and more targeted isolation.

There is also, of course, a major question about timing for a vaccine. Given the long lead time for development, however, governments should not factor the availability of a vaccine into their strategy for the next 12 months.

Effective. Developing the right strategy is important—but it is not enough. Effective implementation of the response is perhaps the most critical factor in determining how Africa will be impacted by COVID-19 in the months to come. Critically, effective implementation requires decision making and execution across multiple government ministries and agencies, such as the ministries of health, finance, agriculture, and the interior.

Given the resource and infrastructure limitations in Africa, a key element of effective implementation will be speed. The experience of countries during the 2014 Ebola outbreak underscores this lesson. Some countries—including Mali, Nigeria, and Senegal—had relatively few cases and a compressed outbreak period thanks to rapid and effective implementation of such measures as public education, testing, and containment.

Three Areas for Action Today

As African leaders navigate through these first days and weeks of the response in their country, they should take action in three areas.

First, they should take some fast, no-regrets moves to address the challenges to their nation’s health care system, economy, and food supply:

• Health. Governments should create or bolster existing emergency operations centers (EOCs) to operationalize government decisions, rapidly deploy resources, and monitor the fast-changing situation on the ground. EOCs also need the capability to model and integrate information about future health system capacity, which can be used to inform decisions in partnership with other relevant bodies, such as government executive task forces. Governments should procure key supplies, particularly personal protective equipment, such as masks and gowns. And they should prepare the health care system for a large influx of COVID-19 patients by scaling up such capabilities as triage systems, oxygen treatment, and innovative care models—including the remote monitoring of patients who have mild symptoms and are recovering at home.
• Economy. At the macro level, governments must develop financial policies to maintain liquidity and labor policies to mitigate unemployment. At the business level, they must support such hard-hit sectors as tourism and commodity production by providing tax relief and credit lines. And at the individual level, governments should prevent price gouging and initiate direct and indirect transfers of funds both to unemployed workers and to those who are losing wages in the informal economy.
• Food and Supply Security. The COVID-19 outbreak could exacerbate existing food security challenges in some parts of Africa. Governments must monitor and regulate food prices to ensure affordability, support access to agricultural inputs, and facilitate trade, particularly within the continent. They must also keep distribution networks open within their borders, including the last-mile delivery of food supplies. And they must ensure food access for vulnerable populations at the local level, including finding alternative ways to provide food for students who normally eat some meals at school but who are now kept at home to comply with social-distancing measures. In parallel, governments must also reinforce capabilities to provide other supplies and essentials.

Second, governments need to rapidly deploy key enablers for a powerful pandemic response to support effective policy, execution, and decision making. These enablers should include the following:

• A government executive task force to set overall, cross-sector direction and policy
• EOCs to coordinate and execute day-to-day responses
• An integrated decision support hub to support operational and strategic decision making with robust analytics in coordination with other groups

Third, governments must actively engage with community leaders and the private sector. Community leaders should be integrated into the response effort immediately because they can help with communication and support in local communities and because they can ensure that the response doesn’t fail due to lack of community trust. Governments should also identify the critical activities and objectives that require private-sector support. This can include the delivery of health care services, the repurposing of manufacturing and logistics capacity to aid in the response, mass communication, and the distribution of food and other essentials.

COVID-19 presents an unprecedented challenge to governments around the world. In Africa, leaders must cut through the noise created by the frenzied news cycles and rapidly evolving situation to develop a strategy that is comprehensive, adaptive, and implemented effectively.