Remarks by WHO Regional Director for Africa, Dr Matshidiso Moeti [by video conference]
Good afternoon Honourable Ministers and dear colleagues in Geneva.
I would like, on behalf of my team here in the Regional Office, to thank you very much for the opportunity to share with you the status of the COVID-19 outbreak in the WHO African Region.
Starting off, I would really like to very warmly acknowledge and thank you for the close relations, the solidarity and the support of Nordic countries for countries in Africa in a range of areas, and particularly as far as this is concerned.
Going directly to the situation: we observe that the epidemic is evolving very rapidly in the WHO African Region now.
A month ago, it was only Algeria that was reporting confirmed cases. A couple of weeks later, we had five countries reporting a total of about 50 cases a day. This week, we are up to 39 countries and around 300 new cases a day – admittedly, concentrated in a few countries.
South Africa is the worst affected country in the Region, with over 1000 confirmed cases, followed by Algeria, Burkina Faso, Nigeria and Senegal.
What we notice, is that out of the 47 countries in the African Region, in about half, we have fewer than 10 confirmed cases. At the same time, we realize this may be an underestimate because of limited contact tracing and testing.
There is in place in the Region, a network of surveillance of influenza, on which we base some of the observations and surveillance in the Region. We don’t actually believe that large numbers of African people are infected and dying of this virus. But we recognize the limitations in access to testing and diagnostic capacity, which we have rapidly built in the Region. We have not at the country-level been able to have an aggressive case finding strategy of testing widely to detect, for example, people who are infected but asymptomatic.
Our impression is of some degree of an estimation of the number cases in the Region: a large number of countries, half of our countries, with essentially imported cases, mainly coming from some of the worst-affected European countries, and several countries now with local transmission, community transmission, and these are South Africa, Senegal, Burkina Faso, Cameroon and Nigeria.
The measures that have been put in place, need to be adapted of course to the African context.
We realize as well that the demographics in our Region are different from the countries where this pandemic started. We have a younger population, which may give us some sense of comfort. However, we have several issues that may make more people, and particularly younger people, more vulnerable to this infection.
As you know, we have the world’s worst situation as far as HIV infection is concerned. Even if many people have access to treatment, there is still a significant proportion of those who need treatment who are not on antiretroviral drugs. They may be more vulnerable to infection and to serious illness than has been the case in more developed regions.
We have still a significant proportion of young children with malnutrition, including severe malnutrition. We need to be aware that this may cause more severe illness among children, since they would be immune-compromised. So, we need to take into account these factors as we anticipate the pattern of illness, especially serious illness, that we might see as more and more people in the African Region become infected.
So, turning now to what countries are trying to do:
First of all, we have worked very much to promote, and support countries put in place basic public health measures, to limit the spread of this virus, meaning trying to identify cases, trying to isolate those cases, trace their contacts and ensure that those too are isolated to limit the spread to other people.
There is also work ongoing to inform the general public about prevention measures for themselves including basic hygiene, handwashing, the use of sanitizers, and also social distancing, to the extent that it is feasible in some of the contexts in African settings where people live very closely together. You don’t necessarily have a bedroom for everybody in the house and in lower socioeconomic groups, people live in crowded conditions where such measures are going to be a real challenge.
We are observing widespread implementation by governments of closure and lockdown type measures. So, they started off first, by limiting flights and prohibiting from what they considered to be severely-affected areas. Now, many countries have essentially stopped passenger transportation getting into their territories. They have also instituted land border closures, so between African countries, the movement of people and goods is becoming more and more difficult. A few countries have instituted limitation of movement of people outside. I think South Africa is the latest country to announce such measures, which started at midnight today.
Many countries have put in place school closures, sometimes for indefinite periods. So, there are concerns and efforts to limit interaction between people, limit gatherings of people, and minimize transmission. We observe that they need to be equally accompanied by very strong public health measures and sometimes there are gaps in capacities in countries to put these in place. This is an area where we are working to support them.
We have seen quite significant progress in some components but not in others. For example, early in February there were only two countries with the capacity to diagnose this virus. Now, we have 43 countries that can do that. So, we have reduced the need to send specimens internationally for diagnosis.
We do recognize that there are significant gaps in infection prevention and control, including in the availability of personal protective equipment in our countries. This is in common with the global problem in the market.
There are really severe gaps in case management capacity, so how to manage people, particularly those who are going to be severely ill and require critical care (ICU, ventilation, oxygen). These are areas where there are significant gaps and needs for support in our countries.
In addition, we need to address gaps in capacity: health workers, people who are able to provide support for the COVID-19 cases and very importantly for continuation of provision of basic services, like immunization for children, safe deliveries for women, continuing treatment for people with HIV, TB and malaria, and provision of treatment for people with chronic conditions, which are increasing in our countries.
We realize that putting in place some of the measures may be difficult in our countries. We have understood the importance of working, for example, with the water sector, to ensure that water is available for people in areas where it is not easy to get access to taps inside your house where you can keep washing your hands, for example. We are working with social scientists, to find ways to adapt some of these measures, which are meant to limit contact and interaction between people to limit the spread.
Turning now, to planning and what countries are proposing to do and some of the resources they might need in order to implement these plans:
So far 43 countries in the African Region have developed COVID-19 contingency and response plans and submitted them to the WHO global platform, that has been put in place, to link these plans to resources. The total cost of these plans is around 300 million US dollars.
We recognize that the focus initially was very much on public health interventions, and we are working with our UN partners to define some of the other sectoral interventions that would be needed, first to support the public health actions and secondly, to mitigate against some of the impacts, both of the outbreak and also of some of the measures that are being putting in place.
As you know, we have a high proportion of people who are not in formal employment and are making their living day-to-day working in the informal sector. We have large numbers of displaced people, refugees, very vulnerable households who will need particular support and care in order not to be thrown into catastrophic situations by the epidemic.
As far as longer-term considerations are concerned, we have worked with countries on preparedness to face up to outbreaks. Thirty countries have developed national plans on International Health Regulations capacity-building in the Region. We are linking this very much with the work we are doing supporting countries on health system strengthening, so that we have a way of planning for health development that takes into account the needs to deal with outbreaks, including this work on COVID-19.
So, I would like to conclude by saying we are working with the UN at regional and country levels, to define what different UN agencies have to do to contribute this effort, including on impact mitigation. We work very much with UNICEF, with UNHCR, and with OCHA, and the World Food Programme particularly around issues of logistics, procurement and how to move goods and supplies around now in the face of closures of borders and transportation.
In closing, we have more detailed information that we can share with you. This is the situation in the Region and we are prepared to do our best to support the countries to put in place response plans that can be implemented.
Thank you very much.