On 11 March 2020, just months after the SARS-CoV-2 coronavirus was first identified in China, the World Health Organization declared Covid-19 to be a public health emergency of international concern. Over the next two years Covid-19 would go on to infect nearly half a billion people, killing over 6 million around the world. Governments introduced strict lockdowns with stay-at-home orders that shut down the global economy. Now, most of the world is opening up. The Conversation Africa spoke to public health experts based in Kenya, Nigeria and South Africa to get their take on the biggest lessons so far. The themes that recur are about breaking down boundaries: sharing, communicating, and valuing people equally.
Catherine Kyobutungi, Kenya: After the first few cases were confirmed, most countries followed a similar script. This involved lockdowns, social distancing and hand hygiene. A few months later, differences started emerging between countries. There are countries like Uganda and Rwanda that took a more public health approach, focusing on trying to stop infection at all costs. And those, like Kenya, that took a more economic approach, focusing on minimising the effect of lockdowns. Of course Tanzania was in a league of its own when it stopped all public health measures that were recommended at the time.
Once differences emerged, they were quite stark and often led to misunderstandings between countries. For instance, while Uganda and Rwanda were testing all arrivals at their land borders (mostly truck drivers), for several weeks, Kenya and Tanzania were not.
These differences are a symptom of a larger issue: the near absence of a harmonised regional pandemic response. This was a global pandemic. But countries crafted individual responses – even in situations where a regional approach would have been more appropriate.
Michelle Groome, South Africa The Covid-19 pandemic has highlighted the importance of providing up-to-date data as well as national and global data sharing. When SARS-CoV-2 first appeared, we did not have a lot of data on which to base clinical and public health decisions. This led to fear, uncertainty and decisions which could not initially be driven by science. As the pandemic unfolded, more and more data became available and this made decision-making easier, with reliable scientific data to back up these decisions.
I think there is still room for improvement when it comes to critically assessing public health measures and their benefit in real-time. Some measures introduced early on in the pandemic, for example temperature screening, did not prove to be effective in detecting infections, yet are still being used as part of the response.
Global nature of the pandemic
Catherine Kyobutungi, Kenya The global power system was unshakable in the midst of a once-in-a-lifetime pandemic. Countries retreated inwards and even when they had an upper hand over the pandemic within their borders, they were unwilling to look outwards and address the pandemic from a global perspective.
In spite of intense pressure from civil society, many rich countries rebuffed all requests for temporary intellectual property waivers and voluntary technology transfer that would unlock vaccine manufacturing in more facilities and regions of the world. Rather than decisively address vaccine supply issues that would have enabled everyone to be vaccinated quickly, those rich countries were more concerned about maintaining the status quo –- about who has power, who has influence, who donates, who receives, who is benevolent and who is the recipient of benevolence.
The fact that two years into the pandemic, the North-South disparities and unequal power structures in global health are still intact is a huge cause for concern. This unequal system has failed to adequately deal with the current pandemic and will struggle to deal with future pandemics and other global challenges like climate change.
Michelle Groome, South Africa The benefits of global data sharing became evident through this pandemic. A good example of this was the early data on severity of the omicron variant that South Africa provided towards the end of 2021. This was one of the busiest times of my life, as we battled a fourth wave of infections in South Africa while fielding innumerable questions from across the globe on how the omicron wave was unfolding in our country. Our scientists were able to actively engage with the WHO, public health institutions in many countries and international media outlets, which enabled data to be shared quickly and assisted with the omicron response in other countries. Lack of data sharing can really hamper the ability to provide robust data for action.
Catherine Kyobutungi, Kenya Public health communication failed. Even in the face of an assault of misinformation and disinformation, government communicators stuck to old methods of communicating health messages. As a result, misinformation took hold and it became difficult to convince the public about why certain measures were important and what everyone needed to do.
The sudden avalanche of all sorts of information created an environment where complex concepts and knowledge that have traditionally been the preserve of academics and other experts became common place and hence open for gross misinterpretation. Public health communicators failed to adequately respond to this challenge.
They also failed to adequately communicate simple information like where people could get tested, vaccinated and report vaccine side effects. Many people who were willing to be vaccinated had to hunt for information on where to get the jab. It just shows how much more we need to do as a community of public health practitioners to communicate effectively now and in future.
Michelle Groome, South Africa The Covid-19 pandemic has also underscored the need for transparency – on an international and local level, and in dealing with academics, health professionals and the public. Scientific terminology and outputs are no longer restricted to scientists and academics, but are readily available to the general public. However, misinformation and conspiracy theories about Covid-19 can end up dominating.
As scientists we need to ensure that data is shared in a way that is easily understandable, that epidemiological terms are correctly interpreted and that the rationale behind public health decisions is clarified. Lack of transparency and misinformation have led to lack of public trust in government decisions and non-acceptance of public health interventions. Scientists, health professionals and politicians also need to acknowledge uncertainty when this exists and quickly address any misconceptions in order to ensure credibility and trust.
Catherine Kyobutungi, Kenya Countries acted fast and most African countries relied on WHO guidance. This is guidance produced by large teams of experts. Since African countries do not always have such a wide range of experts, they relied on very good guidance and then used their own experts to adapt and refine it.
Doyin Odubanjo, Nigeria The health workforce in Nigeria, and indeed Africa, has to be seen as critical to national development. Better strategies for retaining them must be implemented. There must be better welfare packages for health workers. Even countries with better health workforce to population ratios were readily overwhelmed and will now replenish or strengthen their health systems by drawing on the undervalued workforce of places like Africa. We must guide against this.
Catherine Kyobutungi, Executive Director, African Population and Health Research Center; Doyin Odubanjo, Executive Secretary, Nigerian Academy of Science, and Michelle J. Groome, Head of the Division of Public Health Surveillance and Response, National Institute for Communicable Diseases