Remarks by WHO Regional Director for Africa, Dr Matshidiso Moeti, delivered in Nairobi, Kenya on 2 March 2020.
Note: Similar remarks were delivered by the Director of Programme Management, Dr Joseph Caboré on the Regional Director's behalf at the partnership meeting in Dakar, Senegal, on the same day.
Honourable Minister for Health of Kenya,
Your Excellency African Union Commissioner of Social Affairs, Ms Amira Elfadil Mohammed Elfadil,
United Nations Resident Coordinator,
Regional directors and heads of partner agencies,
Dear partners and colleagues:
Good morning!
I am pleased to welcome you to this meeting and I thank you for accepting my invitation at short notice.
It is now even more timely that we meet to coordinate and collectively plan our efforts. Coronavirus, or COVID-19, is spreading very fast in all continents. So far, over 85 000 people have been infected, including more than 3000 deaths. We now have confirmed cases in the WHO African Region, in Algeria and Nigeria. This is very concerning because we know the health systems in African countries will face challenges in responding to this outbreak.
We initially assessed the regional threat of coronavirus based on the extent of direct travel and trade between African countries and China and based on country capacities to implement the International Health Regulations. The cases in Algeria and Nigeria are both linked to Milan, Italy, and so we have revised our prioritization approach. All countries in the Region now need to be in a heightened state of readiness to be able to detect, rapidly respond and contain any possible threat.
The COVID-19 outbreak stretches our already stretched systems to prevent, detect and respond to infectious disease epidemics and health emergencies. Every year, the WHO African Region experiences over 100 acute health events, such as outbreaks, disasters and humanitarian crises. In the Democratic Republic of the Congo, we have ongoing outbreaks of Ebola and measles. The measles outbreak is devastating and has resulted in more cases and deaths so far than COVID-19. Children are by far the most affected, and this could have been prevented with strong routine immunization.
We are working with the DRC not only to contain these outbreaks, but at the same time to strengthen health systems, particularly at the district level, to achieve universal health coverage. This is a priority for the President of the country. Last week, I met with the Minister of Health and he urged us, as health partners, to provide guidance and support practical approaches to make a real difference. We cannot wait for nice documents to be fully and officially endorsed. We need immediate action to save lives. Let this be a guiding reflection in our discussions during this meeting.
Already, we are seeing the results of our collective work in countries.
A few weeks ago, only two countries had laboratory testing capacity. Now we have 29 countries with capacities to test for COVID-19 and in the coming weeks close to 40 countries will have this capacity.
Thirty-one of the 47 countries in the WHO African Region have reported 298 suspected COVID-19 cases. Every suspected case has been investigated. Of these, 293 were ruled out because they either did not meet the case definition or tested negative and the results are pending for five cases. This progress was possible because of your support.
This is a new virus whose origins and characteristics are still under investigation. WHO is constantly analysing data as we receive it and working closely with global experts on a range of topics. WHO is proposing specific studies to better understand transmission, risk factors, and source of the infection. Some of these studies are already underway.
But the continued increase in the number of cases and the number of affected countries over the last few days are clearly of concern. WHO epidemiologists have been monitoring developments continuously. They have now increased our assessment of the risk of spread and the risk of impact of COVID-19 at global level has been raised from high to very high.
Every country must be ready for its first case, its first cluster, the first evidence of community transmission and for dealing with sustained community transmission. And every country must be preparing for all those scenarios at the same time.
We are calling on all countries to invest urgently in preparedness for the arrival of cases, and to prioritize the protection of health workers, individuals at risk and to communicate better the risks of transmission to their people.
At present there is no proven vaccine on therapeutic intervention. About 20 candidate vaccines are under investigation as well as several therapeutics. Results will be available in a couple of weeks. The main stay of current clinical management is:
- Triage and early recognition,
- Implementation of immediate strict infection prevention and control interventions,
- Early diagnosis and alert of public health authorities,
- Supportive and intensive care interventions for severe acute respiratory infections, or SARI,
- Therapy for co-infections,
- Prevention of complications,
- Quality care and ethics, and
- Clinical research for new products such as vaccines and drugs.
This requires new partners, in areas ranging from research to scaling interventions.
Many of our Member States are asking for guidance for nontraditional intervention measures such as quarantine. Whereas isolation separates people who are ill or infected to prevent the spread of disease, quarantine goes further to restrict the activities and/or separate those who who may have been exposed to an infectious agent or disease.
We have experience in setting up isolation facilities in the context of viral haemorrhagic diseases such as Ebola. However, COVID-19 presents new challenges that we must address.
Quarantine is included within the legal framework of the International Health Regulations (2005), specifically: Article 30-Travellers under public health observation, Article 31-Health measures relating to entry of travellers and Article 32-Treatment of travellers.
In a few days, WHO will issue interim guidance for quarantine for Member States to consider whether to implement such measures in the context of COVID-19; and to propose minimum standards (e.g. for infection prevention and control), if quarantine is implemented.
The interim guidance is informed by current knowledge of the COVID-19 outbreak and other respiratory pathogens, including SARS, MERS and influenza. WHO will continue to update these recommendations as new information becomes available.
The other major concern for our Member States is whether African countries should repatriate African students in the affected areas. This should be assessed on a case-by-case basis considering: the circumstances of the students; and whether their continued stay in the affected areas affects their health and social and economic well-being.
For countries that decide to repatriate their students, WHO has issued interim guidance, considering:
- measures before embarkation, onboard the aircraft and upon arrival,
- how to quarantine, should this be an option,
- how to ensure the health and well-being of those involved in the repatriation, and
- measures to bolster national preparedness capacities to prevent the further spread or importation of COVID-19 before, during, and after repatriation.
In closing, we have an opportunity today, to coordinate our efforts, to reduce duplications, and make the most of the scarce resources we have.
We have observed that investments made for Ebola preparedness are yielding some benefits for COVID-19. Last month, we conducted a readiness assessment with countries, which showed that capacities have improved in coordination, screening at points of entry, surveillance and logistics. We need to invest more to sustain these gains while addressing the identified gaps.
I encourage all of us to continue to mobilize resources to facilitate preparedness in our Member States. We should all advocate for increased investment in epidemic preparedness from domestic resources, in addition to supplementing with necessary external support, to safeguard health security in the Region and globally.
I look forward to a very productive meeting, with concrete decisions to enhance our partnerships in supporting our Member States.
I thank you for your attention.