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 His rush to reopen came despite alarm from the World Health
Organization (WHO) over an almost total lack of information on the
spread of the virus in the country of 55 million people, which has
one of the region’s weakest healthcare systems.
The shortage of reliable data afflicts many African nations, with
some governments reluctant to acknowledge epidemics or to expose
their crumbling health systems to outside scrutiny. Other nations
simply cannot carry out significant testing because they are so
ravaged by poverty and conflict.
Sharing information is vital to tackling the pandemic in Africa –
both for planning the response and mobilising donor funding - public
health experts say. As things stand, it is impossible to gauge the
full severity of the contagion across the continent.
According to the latest data collated by Reuters, Africa, with a
population of 1.3 billion people, had over 493,000 confirmed cases
and 11,600 deaths. By comparison, Latin America, with roughly half
the population, had 2.9 million cases and 129,900 deaths.
The official numbers make it seem as though the illness has skirted
much of Africa, but the real picture is certain to be worse, with
WHO special envoy Samba Sow warning on May 25 of a possible “silent
epidemic” if testing was not prioritised.
By July 7, 4,200 tests per million people had been carried out
across the continent, according to a Reuters analysis of figures
from the Africa Centres for Disease Control and Prevention (CDC), a
body set up by the African Union in 2017. That compares with
averages of 7,650 in Asia and 74,255 in Europe.
Interviews with dozens of health workers, diplomats and local
officials revealed not just a scarcity of reliable testing in most
countries, but also the lengths some governments have gone to
prevent news of infection rates from emerging, even if that meant
they missed out on donor funding.
“We cannot help a country against its own will,” Michel Yao, head of
emergency operations for the WHO in Africa, told Reuters. “In some
countries, they are having meetings and not inviting us. We are
supposed to be the main technical advisor.” Yao declined to single
out countries, saying the WHO needed to preserve a working
relationship with governments.
For more details, see this graphic:
https://graphics.reuters.com/HEALTH-CORONAVIRUS/
AFRICADATA/dgkplxkmlpb/
TROUBLE IN TANZANIA
Tanzania confirmed its first case of COVID-19 on March 16. The next
day, the government convened a task force to coordinate the
response with international partners including the WHO, foreign
embassies, donors and aid agencies, multiple sources said.
This body never met again with outsiders, two foreign officials
familiar with the situation told Reuters, while government officials
failed to show up to dozens of subsequent coronavirus-related
meetings, they said.
“It’s very clear the government does not want any information about
the state of COVID in the country,” said one aid official, who like
many of those interviewed by Reuters for this story, asked not to be
identified for fear of antagonizing political leaders.
Tanzania’s health minister Ummy Mwalimu and government spokesman did
not respond to phone calls or emailed questions raised by this
article about their handling of the crisis. The spokesman, Hassan
Abbasi, has previously denied withholding information about the
country’s epidemic.
Tanzania has not published nationwide figures since May 8, when it
had recorded 509 cases and 21 deaths. Days earlier, President
Magufuli dismissed testing kits imported from abroad as faulty,
saying on national television that they had also returned positive
results on samples taken from a goat and a pawpaw fruit.
According to three emails seen by Reuters sent between May 8-13, the
WHO believed it had reached an agreement with the government to let
it take part in joint surveillance missions around the country.
However, a WHO spokeswoman said these were all cancelled on the day
they were supposed to start, with no reason given.
Donors have released some $40 million to fund Tanzania’s coronavirus
response, two diplomatic sources involved said. But the country’s
lack of engagement meant it had missed out on “tens of millions of
dollars” more, another official said.
By mid-May, the government decided to ease its lockdown, despite
doctors and diplomats saying the outbreak was far from contained.
The U.S. Embassy warned its citizens on May 13 that hospitals in the
main city Dar es Salaam were “overwhelmed”, an assertion denied at
the time by the Tanzanian government.
Tanzania’s failure to share information about its outbreak has
frustrated its neighbours, who fear that gains won through painful
lockdowns in their own countries could be jeopardized as Tanzanians
cross porous borders.
The WHO organised a call on April 23 with African health ministers
to discuss, among other things, a lack of information sharing, Yao
said. He declined to say who was on the call, and Tanzania did not
respond to requests for comment as to whether its minister
participated.
The United Nations agency cannot compel cooperation and must tread
carefully. When WHO officials expressed concern in late April about
a lack of measures to contain the virus in Burundi, the tiny East
African nation expelled its top representative and three other WHO
experts without explanation on May 12.
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Burundi was one of the first African countries to shut its borders in March,
which seemed to slow the virus’ spread initially. But the country saw an uptick
in suspected cases after rallies were held in the run-up to May 20 general
elections, a health care provider said, speaking on condition of anonymity.
Burundi’s 55-year-old president, Pierre Nkurunziza, died in early June amid
speculation he had come down with COVID-19. The government said in a statement
he had suffered a heart attack. An air ambulance service told Reuters it had
flown his wife, Denise Bucumi, to Kenya on May 21 but declined to confirm
reports in the Kenyan media that she had sought treatment for the coronavirus. A
family spokesman declined to comment.
Burundi's new president, Evariste Ndayishimiye, has promised measures to tackle
the pandemic, including mass testing of people in areas suspected of being
epicentres of the virus.
Another African state to fall out with the WHO was Equatorial Guinea. It hasn’t
shared figures with the U.N. agency since late May, when its government accused
the WHO of inflating the caseload and demanded that it recall its
representative. The WHO blamed a “misunderstanding over data” and denied any
falsification of figures.
Mitoha Ondo'o Ayekaba, Equatorial Guinea’s deputy health minister, did not
respond to repeated requests for comment on the dispute. The Central African
country has continued to provide periodic updates to the Africa CDC, which puts
the number of confirmed cases there at 3,071 with 51 deaths.
SURVEILLANCE GAPS
While some countries won’t share information, others can’t: Their health systems
are too broken to carry out any large-scale testing, surveillance or contact
tracing.
"Even at the best of times, collecting quality data from countries is not easy
because people are stretched thin,” said John Nkengasong, director of the Africa
CDC. “Combine that with an emergency, and it becomes very, very difficult.”
For example, Islamist militants and ethnic militias operate across vast swathes
of Burkina Faso, Niger and Mali, making it impossible for governments there to
establish a nationwide picture of the spread of the illness.
As in other countries, a shortage of kits has led Burkina Faso to largely limit
the number of tests it conducts to contacts of confirmed cases and people
arriving from abroad. This means there is little data on local transmission,
health ministry reports show.
Some countries, like Cameroon and Nigeria, have decentralised testing, but many
others have very little capacity outside their capitals, said Franck Ale, an
epidemiologist with the international aid group Medecins Sans Frontieres
(Doctors Without Borders).
Democratic Republic of Congo, a nation of 85 million that was already battling
Ebola, was quick to suspend international flights and lock down parts of the
capital Kinshasa when the virus hit in mid-March.
However, it took three months before the government was able to process tests
outside Kinshasa, said Steve Ahuka, a member of Congo’s COVID-19 response
committee, citing a lack of laboratories, equipment and personnel. In many
areas, it still takes two weeks to get results, said two doctors.
South Africa, the continent’s most advanced economy, is one of the few to have
rolled out mass testing. But it had a backlog of more than 63,000 unprocessed
specimens as of June 10, because global suppliers were unable to meet its demand
for laboratory kits, according to the health ministry. South Africa’s national
laboratory service declined to disclose the current backlog.
In the absence of comprehensive testing data in other parts of the world,
researchers look to different yardsticks to judge the prevalence of the
coronavirus, including reviewing the number of deaths that exceed the average
for the time of year.
But even that is not possible in most of Africa because data from previous years
is lacking. Only eight countries - Algeria, Cape Verde, Djibouti, Egypt,
Mauritius, Namibia, Seychelles and South Africa - record more than 75% of their
deaths, according to the United Nations. Ethiopia records less than 2%, the
country’s health ministry said.
Without information about how severe an outbreak is and what resources are
available to cope with it, nations risk lifting lockdowns too soon or
maintaining them too long, said Amanda McClelland of the U.S.-based health
policy initiative Resolve to Save Lives.
“The big gap for us is really understanding the severity of the outbreak,” she
said. “Without clarity on data, it is very hard to justify the economic pain
that shutting down countries causes.”
Interactive graphic - Global COVID-19 overview: https://graphics.reuters.com/CHINA-HEALTH-MAP/0100B59S39E/index.html
(Additional reporting by Paul Carsten and Camillus Eboh in Abuja, Hereward
Holland in Calstock, England, Ryan McNeill in London, Giulia Paravicini in Addis
Ababa, and Alexander Winning in Johannesburg; Editing by Alexandra Zavis and
Crispian Balmer)
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