Keeping Covid-19 at bay
John Nkengasong (PhD) is director of the Africa Center for Disease Control and Prevention (Africa CDC). Prior to his current position, he served as the acting deputy principal director of the Center for Global Health, United States Center for Disease Control and Prevention (US CDC), and Chief of the International Laboratory Branch, Division of Global HIV and TB., US CDC. He received his Master’s in Tropical Biomedical Science at the Institute of Tropical Medicine in Antwerp, Belgium, and another Master’s Degree in Medical and Pharmaceutical Sciences at the University Of Brussels School Of Medicine and a Doctorate in Medical Sciences (Virology) from the University of Brussels, Belgium. From 1993 to 1995, he was Chief of the Virology and the WHO Collaborating Center on HIV diagnostics, at the Department of Microbiology, Institute of Tropical Medicine, and Antwerp, Belgium. He joined the US CDC in 1995 as Chief of the Virology Laboratory, US CDC Abidjan, Ivory Coast. He has received numerous awards for his work including: the US Secretary of Health and Human Services Award for excellence in Public Health Protection Research, the Sheppard Award, the US Director’s Recognitions Award and, most recently, the William Watson Medal of Excellence, the highest recognition awarded by CDC, for outstanding contributions and leadership in advancing global laboratory services and programs to support the President’s Emergency Plan for AIDS Relief. He serves on several international advisory boards including the Coalition for Epidemic Preparedness Initiative – CEPI and the International AIDS Vaccine Initiative (IAVI) among others. He has authored over 200 peer-reviewed articles in international journals and published numerous book chapters. Birhanu Fikade of The Reporter sat down with Nkengasong in his office at the African Union headquarters to discuss the efforts and readiness towards preventing Coronavirus (Covid-19) not to reach Africa. Excerpts:
The Reporter: Before we talk about coronavirus, tell us what Africa CDC has been doing in the past two years?
John Nkengasong (PhD): Africa CDC was officially launched in Addis Ababa by the heads of state on January 31, 2018, during the annual summit of the AU. It was during the devastating Ebola outbreak that occurred in West Africa where in Sierra Leon, Liberia and Guinea some 11,000 people died. The heads of state took a very important decision to accelerate the implementation of the African Center for Disease Control what we commonly call the Africa CDC. In doing that, they have also established five regional centers. The centers are in Nigeria for Western Africa, in Gabon for Central Africa, in Zambia for Southern Africa, in Egypt for Northern Africa, and in Kenya for Eastern Africa That is the whole set up of the Africa CDC. It’s a continent-wide public heath institution. Its mandate is to ensure that the continent is safeguarded against any diseases not just infectious diseases but non-communicable diseases that might be newly emerging or existing ones and endemic diseases.
In the last two years many diseases have occurred including Covid-19. What is Africa doing in regards to fending off such infectious diseases that would have a devastating impact to the continent?
We should always applaud the vision, wisdom and the political innovation of the heads of state of Africa. We find ourselves in a very interesting period. These diseases are emerging and continue to change their patterns because of several reasons. One of which is because of the growing population of the continent. It’s very exploding. During the independence, we were some 300 million in the entire continent, from Egypt to South Africa and from Liberia to Somalia. But today we are a 1.2 billion people and we are projected to be 2.4 billion people by the year 2050. With this increase in population size, we are encroaching to areas that were previously restricted for farming, for food, for housing, for infrastructure and others. We are exposing ourselves for an ecosystem that was not reachable. We are getting viruses from animals. Remember that 70 percent of our viruses come from animals. The changing dynamics of the ecosystem is also a breeding ground for emerging diseases. As population expands, people constantly tend to move to places.
For instance, Ethiopian Airlines flies to China five or six flights a night. Emirates flies to all countries in Africa, Turkish Airlines as well. Hence, the movements of people inside the continent has increased because of the ease of travelling. Increase in population and increase in movements also help for the rapid movements of pathogens. That’s important. With such state of changes, you might begin to see a shift in movement from rural areas to urban places. Because of that we are having many slums in big cities. We have those in Kenya or in Ethiopia. Lastly, we are witnessing impacts of climate change. It is there for real. It’s affecting us. It is also important to state that conflicts in Africa are also driving factors for the spread of diseases. These are some of the factors lending to the emerging diseases and outbreaks.
Let’s talk about Covid-19. How is Africa prepared to deal with the disease?
As of February 18, 2020, we had one case of Covid-19 reported in Egypt. Thus far, the continent has not reported any cases and that is good. But we are watching what’s happening in China. Large number people have been infected and thousands have died. More than 25 countries have reported cases of Covid-19. The great fortune we have was that since December 2019, we had the chance to prepare the continent. We have prepared the continent aggressively in several areas. One is that we are doing diagnostics. We have spread diagnostics to over 16 countries and last week additional 20 countries will have diagnostics dispatched. We are about to have a stock of 10,000 tests for Covid-19 at the Africa CDC and we can easily dispatch that to any country that might have cases of Covid-19. We are working with airports and airlines. We have provided trainings. Our goal is that by the end of this month, we will achieve laboratory preparedness, enhanced airports screenings, infection control and risk communication. We have at least prepared ourselves with the basics and will be able to quickly identify the virus and respond to the virus.
If I remember correctly one of the factors that helped Ebola to quickly spread in those countries and forced thousands to die was because of lack of well-prepared laboratories, diagnostics systems or clinical readiness. How well is Africa prepared to withstand Covid-19?
We can only be as prepared as the overall health systems in the continent. I think one major thing we learned from the Ebola outbreak in West Africa is that it has created an awareness for preparedness. It was for the first time that we saw a disease that was known since 1976, can suddenly find itself into a different population settings. This time it evolved in urban settings and came out to devastate and overwhelm the health systems available. Countries began to take it seriously. If you remember, the WHO had established what they call a Joint External Evaluation Tool which has been utilized to review the status of each country and to evaluate their preparedness. That has given us a common tool to look at ourselves in an objective manner. People from outside will come and check your preparedness and infrastructural status. After that, there was a massive increase in providing supportive resources what we call the global health security. It’s a global initiative launched to support countries to strengthen their health systems. I think there are progresses since the Ebola outbreak. But that is not enough. We have to be very deliberate in mobilizing resources to strengthen the health systems that are required for the health security in the continent. That discussion still has to happen.
The likes of President Uhuru Kenyatta of Kenya have openly expressed fears and called for precautionary measures to be considered for Covid-19. The President requested Ethiopian Airlines to suspend flights to China fearing that the virus might easily arrive to Africa which lacks every capacity to withstand the outbreak. If heads of state are echoing such concerns, what does it mean and what confidence we will have in our health systems?
I think in dealing with an outbreak of this nature, we have to realize a couple of things. The first is the science behind it. You have to apply science to drive all actions not just reactions. Secondly, we don’t have to shy away to actively fight misinformation. Thirdly, we should spread facts not fear. If we do these three things, then we will be better prepared psychologically to deal with the situation rightly. Having said that, there are instruments and we, as the whole world, have signed into what we call the international health regulation and WHO provides an overall guidance in this picture. The overall guidance includes non-restriction of trade, movement of people and airlines. This is important. I can submit a hypothesis that it’s not stopping airlines from flying to China from Africa that keeps off Chinese coming to Africa. If I am Chinese, there are easy ways to come to Africa in several routes. I might go to Moscow take a flight to Istanbul and another flight to Dubai then fly here. That becomes even more complicated for you to control. But if you keep flying and you are transparent then you know who is coming then you can better control and monitor. But if I came from Wuhan through Moscow by some airlines to arrive to Africa it makes it difficult to truly monitor and control. The only way to avoid conspiracy is to be transparent. Keep flying but strictly follow and apply international regulations. The solution for Africa’s ability to respond rapidly depends on how quickly it detects and take rapid actions. We might not have the ability to construct a 2000-bed hospital in less than a week. But we have the ability to rapidly detect and respond. All our systems are at the highest alert in the continent. That gives us an encouragement.
You mentioned about airports’ screenings system, trainings provided and equipment installed. But how are they regulated and checked and crosschecked frequently than their reporting procedures?
They are checked and regulated very often. I will give you an example; Addis Ababa because of the traffic volume that goes out to China and comes in from China. Together with Ethiopia’s acting Minister of Health, a Minister represented from the Office of the Prime Minister, with a WHO representative to Ethiopia and with the director general of the Ethiopian Public Health Institute, we have examined and went through all the airport facilities. I was very pleased by what I saw. The isolation hospital they have set up away from the airport is also essential for unforeseen circumstances. Whether that enables you to pick up some suspects at the airport or not doesn’t a guarantee since the virus has an incubation period of two weeks. The infected person might arrive today at the airport and when screened, might not have any symptoms yet. But what we are saying is that at least we have a system to screen and monitor persons arriving at the airport. If you don’t have any symptoms, we have your records and will know where they go. We will continue to monitor them until 14 days are passed. We are doing everything we can. But we can’t be absolutely certain that we can control everything. If one infected passenger skips, there is a possibility of having an outbreak. We are trying to pick any suspected cases as much as possible.
The procedures and standards applied in Addis Ababa and in its airport should be different and rigorous when compared to other cities in Africa as it is a diplomatic hub. Hence, do you think such extra measures need to be put in place here?
I can assure you that the Ethiopian Public Health Institute is standing at its highest alert. Ethiopia is an important country and the biggest hub in Africa and the third diplomatic city after New York and Geneva and we are aware of the challenges. You can trust that we are not asleep and working with the Public Health Institute closely. We are providing maximum support. The WHO is also supporting them. It’s our responsibility to ensure and protect the health security of not just diplomats but whoever is in Addis Ababa. If it happens here then it will easily get into the continent.
What was the screening like during the recent AU heads of state summit?
We were at a maximum alert and we were screening everybody including the heads of state. They were screened. We are working quietly. In science, the most effective way to control diseases is not to alarm the public. It’s like the military. If you pour the military in the streets of Addis Ababa, you might maintain security but you will certainly create fear. What we are doing is that we keep tracking you before you know it. Disease detection is not that far different from the military system. You track the enemy before it knows that.
China is reporting declining trends of Covid-19 infections. What does that mean for Africa?
It is a very good news for Africa and the rest of the world. If the diseases is getting closer to be controlled in China, the chances Covid-19 reaching Africa might get lesser. We also have to face the fact that we don’t have a cure for the virus. We might not have a vaccine for the coming 12 months or further. It takes time to develop a vaccine. The only thing we have is supportive care. That’s the tricky part for Africa. Once we are hit the way China is hit, we might have the ability to provide that supportive care. China showed how capable it is and it ability to withstand the outbreak. It quickly built a hospital, provided life support cares and essentials which we lack. It is a very good news that new cases are declining. The best way to fight a disease is to fight it at the source.