Africa's Response Research Articles

Global climate disruption and regional climate shelters after the Toba supereruption

The Toba eruption ∼74,000 y ago was the largest volcanic eruption since the start of the Pleistocene and represents an important test case for understanding the effects of large explosive eruptions on climate and ecosystems. However, the magnitude and repercussions of climatic changes driven by the eruption are strongly debated. High-resolution paleoclimate and archaeological records from Africa find little evidence for the disruption of climate or human activity in the wake of the eruption in contrast with a controversial link with a bottleneck in human evolution and climate model simulations predicting strong volcanic cooling for up to a decade after a Toba-scale eruption. Here, we use a large ensemble of high-resolution Community Earth System Model (CESM1.3) simulations to reconcile climate model predictions with paleoclimate records, accounting for uncertainties in the magnitude of Toba sulfur emissions with high and low emission scenarios. We find a near-zero probability of annual mean surface temperature anomalies exceeding 4 °C in most of Africa in contrast with near 100% probabilities of cooling this severe in Asia and North America for the high sulfur emission case. The likelihood of strong decreases in precipitation is low in most of Africa. Therefore, even Toba sulfur release at the upper range of plausible estimates remains consistent with the muted response in Africa indicated by paleoclimate proxies. Our results provide a probabilistic view of the uneven patterns of volcanic climate disruption during a crucial interval in human evolution, with implications for understanding the range of environmental impacts from past and future supereruptions.

Intra Action Review of the COVID-19 Pandemic Response in Africa: Best Practices, Challenges, and Perspectives for the Future

Background: The COVID-19 pandemic has continued to spread throughout the globe and in all African countries with major public health and economic impacts. Methods: We have conducted a detailed synthesis of intra-action review (IAR) reports from 18 countries in the World Health Organization (WHO) African Region, which were available as of March 2021. We conducted a thematic analysis across ten preparedness and response domains, namely, governance, leadership and coordination; planning and monitoring; risk communication and community engagement; surveillance, rapid response and case investigation; infection prevention and control; case management; screening and monitoring at points of entry; national laboratory system; logistics and supply chain management; and maintaining essential health services during the COVID-19 pandemic. Findings: The COVID-19 pandemic response in African countries has relied on many existing response systems such as laboratory systems, surveillance systems for previous outbreaks of highly infectious diseases, and a logistics management information system. These best practices were backed by strong political will. The key challenges included low public confidence in governments, inadequate adherence to infection prevention and control measures, shortages of personal protective equipment, inadequate laboratory capacity, inadequate contact tracing, poor supply chain and logistics management systems, and lack of training of key personnel at national and sub-national levels. Interpretation: These findings suggest that African countries’ response to the COVID-19 pandemic was prompt and may have contributed to the lower cases and deaths in the region compared to countries in other regions. The IARs demonstrate that many technical areas still require immediate improvement to guide decisions in subsequent waves or future outbreaks. Funding Information: World Health Organization Regional Office for Africa. Declaration of Interests: We declare no competing interests.

Africa's preparedness towards COVID-19 vaccines: Demand and acceptability challenges.

To date, the response to coronavirus disease (COVID-19) in many African countries has been quick, forward-looking and adjustable in spite of the continent's limited resources. These responses were triggered by the continuous increase in cases and deaths, which have necessitated speedy development of an effective vaccine. It is anticipated that African governments and public health officials will show more transparency, and provide evidence-based strategies to support COVID-19 vaccines and design equitable as well as effective vaccine delivery plans for the populace. To this end, this review analysed Africa's preparedness and response towards COVID-19 vaccines, potential demand, acceptability and distribution challenges related to the management of the virus. The review takes stock of context-specific vaccine preparedness; the demand for vaccine and associated challenges; as well as vaccine accessibility and its distribution. The review offers insightful approaches and strategies by which African countries can maximize benefits from the COVID-19 vaccines to overcome the virus. These include the pursuance of vaccines that may help confer immunity or protection against the virus in the light of contextual circumstances of specific African countries, including sociocultural and economic issues among other factors.

Simple rules and self-organisation: A complex systems' perspective on South Africa's COVID-19 response.

No abstract available.

Applying lessons learnt from Ebola for effective COVID-19 response in Africa

The Ebola virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission via direct contact with blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials contaminated with these fluids. In December 2019, a novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) emerged in Wuhan, China, attracting the notice of regional authorities and rapidly drawing global attention. In less than 4 months, COVID-19 spread through almost all countries and regions. The COVID-19 pandemic is wreaking havoc on the world economy, in addition to creating the current global public health crisis. According to the World Health Organization (WHO), 28,616 cases of Ebola were detected, and 11,310 people died during the outbreak in Guinea, Liberia and Sierra Leone. As of 17th December 2020, COVID-19 has killed 1,658,062 people, and positive cases have topped 74 million globally. Africa has suffered several outbreaks of Ebola Virus Disease (EVD); learning from the past is a good way to prepare for the future. We hope to highlight some of the lessons learnt from Africa’s response to previous epidemics that can help in the fight against the ravaging coronavirus pandemic.
 Keywords: Ebola, COVID-19, WHO, transmission, global 
 
 French Title: Appliquer les leçons tirées d'Ebola pour une réponse efficace au COVID-19 en Afrique
 Le virus Ebola est transmis aux humains par des animaux sauvages et se propage dans la population humaine par transmission interhumaine par contact direct avec du sang, des sécrétions, des organes ou d'autres fluides corporels de personnes infectées, et avec des surfaces et des matériaux contaminés par ces fluides. En décembre 2019, une nouvelle maladie à coronavirus (COVID-19) causée par le syndrome respiratoire aigu sévère-coronavirus-2 (SRAS-COV-2) est apparue à Wuhan, en Chine, attirant l'attention des autoritésrégionales et attirant rapidement l'attention mondiale. En moins de 4 mois, le COVID-19 s'est propagé dans presque tous les pays et régions. La pandémie de COVID-19 fait des ravages sur l'économie mondiale, en plus de créer la crise mondiale actuelle de santé publique. Selon l'Organisation mondiale de la santé (OMS), 28616 cas d'Ebola ont été détectés et 11310 personnes sont décédées au cours de l'épidémie en Guinée, au Libéria et en Sierra Leone. Au 17 décembre 2020, le COVID-19 avait tué 1658062 personnes et les cas positifs dépassaient 74 million dans le monde. L'Afrique a souffert de plusieurs flambées de maladie à virus Ebola (MVE); apprendre du passé est un bon moyen de préparer l'avenir. Nous espérons mettre en évidence certaines des leçons tirées de la réponse de l’Afrique aux épidémies précédentes qui peuvent aider à lutter contre la pandémie ravageuse de coronavirus.
 Mots clés: Ebola, COVID-19, OMS, transmission, mondial

The Challenges of COVID-19 Pandemic and South Africa's Response

The Challenges of COVID-19 Pandemic and South Africa's Response

Preparedness and response of a tertiary hospital to the COVID-19 pandemic in Nigeria: challenges, opportunities and lessons.

Africa was the last continent to be affected by the COVID-19 pandemic. Much of the discourse on Africa's response captured in scientific journals revolves around nations, public health agencies and organizations, but little is documented about how individual healthcare facilities have fared. This article reports the challenges faced in a tertiary hospital in Nigeria, including space constraints, diagnostic challenges, shortages in personal protective equipment and health worker infections. The opportunities and strengths that aided the response are also highlighted. The lessons learned will be useful to similar facilities. More information about health facility response at various levels is needed to comprehensively assess Africa's response to the pandemic.

COVID-19: Learning from the HIV/AIDS pandemic response in Africa.

About 74.9 million persons were infected during the human immunodeficiency virus/acquired immunodeficiency syndrome HIV/AIDS global pandemic with nearly half of them succumbing to the disease. In 2018 alone, Africa recorded over 400,000 AIDS‐related deaths which is more than half of the global total. This reflects years of inequality in the global pandemic response. Also, the international response to AIDS in the early years was very slow, with a global programme only developed 6 years into the pandemic. Many African countries still lack pandemic preparedness plans to handle a global pandemic. Thus, this paper highlights the important lessons that can be learnt from the response to the AIDS pandemic and recommends how they can be applied during the coronavirus disease 2019 (COVID‐19) pandemic. Some of the important lessons include: HIV reversed the previous success recorded in health systems of developing countries; the antiretroviral drug development process was prolonged and required long term commitment; and primary healthcare was crucial in preventing and controlling the disease. These lessons can be utilised in the fight against COVID‐19 pandemic. It is recommended that: there should be solidarity among the nations of the world to fight COVID‐19; health authorities should be proactive in curbing misinformation; and interventions should prioritise human rights and focus on vulnerable communities. HIV treatment services should not be discontinued as it is still an ongoing pandemic. A balance needs to be achieved in combating both pandemics as discontinuation of HIV treatment during the coronavirus pandemic could result in more than 500,000 deaths.

Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda.

ABSTRACTMost African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload.

Towards 90-90-90 Target: COVID-19 and HIV Response in Africa

As cases of the novel coronavirus disease (COVID-19) continue to rise, so are the concerns of the effects this pandemic could have on people living with HIV. In response to the pandemic, measures have been put in place by African governments to limit the spread of the virus. We examine the impact of these measures on ensuring progress towards the HIV advocacy of '90-90-90' by 2020, i.e., 90% of all people living with HIV will know their status, 90% of people diagnosed will receive sustained antiretroviral therapy (ART), and 90% of people receiving ART will have viral suppression all by the end of 2020.

Equity in Adaptation: A Systematic Global Review

Climate change disproportionately affects marginalized groups in society. Growing evidence suggests that adaptation responses without equity considerations may worsen inequality and increase vulnerability. Using data from a systematic review of peer-reviewed empirical research on adaptation responses to climate change (n=1682), we present a large-n assessment of how social equity is integrated into adaptation across regions, sectors, and social groups. Roughly 60% of peer-reviewed literature on adaptation responses addressed social equity by documenting how historically marginalized groups were involved in planning, or targeted in implementation. Responses in Africa and those focusing on poverty reduction most frequently integrated social equity. Equity was less likely to be addressed in adaptation responses in Europe, Australasia, and North America, and in the urban sector. Income-based inequity was more frequently considered than gender, age, or Indigenous status. Ethnic and racial minorities, migrants, and people with disabilities were rarely considered. Renewed and rigorous attention to equity in adaptation research, policy, planning and implementation is needed to fill key gaps in knowledge and to ensure a more fair and just adaptation process and outcome.

The Impact of the Evolving Human Immunodeficiency Virus Response on the Epidemiology of Tuberculosis in South African Children and Adolescents.

Few studies have evaluated tuberculosis control in children and adolescents. We used routine tuberculosis surveillance data to quantify age- and human immunodeficiency virus (HIV)-stratified trends over time and investigate the relationship between tuberculosis, HIV, age, and sex. All children and adolescents (0-19 years) routinely treated for drug-susceptible tuberculosis in South Africa and recorded in a de-duplicated national electronic tuberculosis treatment register (2004-2016) were included. Age- and HIV-stratified tuberculosis case notification rates (CNRs) were calculated in four age bands: 0-4, 5-9, 10-14, and 15-19 years. The association between HIV infection, age, and sex in children and adolescents with tuberculosis was evaluated using multivariable logistic regression. Of 719 400 children and adolescents included, 339 112 (47%) were 0-4 year olds. The overall tuberculosis CNR for 0-19 year olds declined by 54% between 2009 and 2016 (incidence rate ratio [IRR] = 0.46; 95% confidence interval [CI], .45-.47). Trends varied by age and HIV, with the smallest reductions (2013-2016) in HIV-positive 0-4 year olds (IRR = 0.90; 95% CI, .85-.95) and both HIV-positive (IRR = .84; 95% CI, .80-.88) and HIV-negative (IRR = 0.89; 95% CI, .86-.92) 15-19 year olds. Compared with 0- to 4-year-old males, odds of HIV coinfection among 15-19 year olds were nearly twice as high in females (adjusted odds ratio [aOR] = 2.49; 95% CI, 2.38-2.60) than in males (aOR = 1.35; 95% CI, 1.29-1.42). South Africa's national response to the HIV epidemic has made a substantial contribution to the observed declining trends in tuberculosis CNRs in children and adolescents. The slow decline of tuberculosis CNRs in adolescents and young HIV-positive children is concerning. Understanding how tuberculosis affects children and adolescents beyond conventional age bands and by sex can inform targeted tuberculosis control strategies.

Systems dynamics approach for modelling South Africa's response to COVID-19: A "what if" scenario.

Background: Many countries in the world are still struggling to control COVID-19 pandemic. As of April 28, 2020, South Africa reported the highest number of COVID-19 cases in Sub- Sahara Africa. The country took aggressive steps to control the spread of the virus including setting a national command team for COVID-19 and putting the country on a complete lockdown for more than 100 days. Evidence across most countries has shown that, it is vital to monitor the progression of pandemics and assess the effects of various public health measures, such as lockdowns. Countries need to have scientific tools to assist in monitoring and assessing the effectiveness of mitigation interventions. The objective of this study was thus to assess the extent to which a systems dynamics model can forecast COVID-19 infections in South Africa and be a useful tool in evaluating government interventions to manage the epidemic through ‘what if’ simulations.Design and Methods: This study presents a systems dynamics model (SD) of the COVID-19 infection in South Africa, as one of such tools. The development of the SD model in this study is grounded in design science research which fundamentally builds on prior research of modelling complex systems.Results: The SD model satisfactorily replicates the general trend of COVID-19 infections and recovery for South Africa within the first 100 days of the pandemic. The model further confirms that the decision to lockdown the country was a right one, otherwise the country’s health capacity would have been overwhelmed. Going forward, the model predicts that the level of infection in the country will peak towards the last quarter of 2020, and thereafter start to decline.Conclusions: Ultimately, the model structure and simulations suggest that a systems dynamics model can be a useful tool in monitoring, predicting and testing interventions to manage COVID-19 with an acceptable margin of error. Moreover, the model can be developed further to include more variables as more facts on the COVID-19 emerge.Significance for public healthThe paper offers a nuance in the realm of uncertainty through prediction of infectious diseases, which could assist national authorities in decision making through a multidisciplinary approach of systems dynamics.

Systems dynamics approach for modelling South Africa's response to COVID-19: A "what if" scenario.

Background: Many countries in the world are still struggling to control COVID-19 pandemic. As of April 28, 2020, South Africa reported the highest number of COVID-19 cases in Sub- Sahara Africa. The country took aggressive steps to control the spread of the virus including setting a national command team for COVID-19 and putting the country on a complete lockdown for more than 100 days. Evidence across most countries has shown that, it is vital to monitor the progression of pandemics and assess the effects of various public health measures, such as lockdowns. Countries need to have scientific tools to assist in monitoring and assessing the effectiveness of mitigation interventions. The objective of this study was thus to assess the extent to which a systems dynamics model can forecast COVID-19 infections in South Africa and be a useful tool in evaluating government interventions to manage the epidemic through 'what if' simulations. Design and Methods: This study presents a systems dynamics model (SD) of the COVID-19 infection in South Africa, as one of such tools. The development of the SD model in this study is grounded in design science research which fundamentally builds on prior research of modelling complex systems. Results: The SD model satisfactorily replicates the general trend of COVID-19 infections and recovery for South Africa within the first 100 days of the pandemic. The model further confirms that the decision to lockdown the country was a right one, otherwise the country's health capacity would have been overwhelmed. Going forward, the model predicts that the level of infection in the country will peak towards the last quarter of 2020, and thereafter start to decline. Conclusions: Ultimately, the model structure and simulations suggest that a systems dynamics model can be a useful tool in monitoring, predicting and testing interventions to manage COVID-19 with an acceptable margin of error. Moreover, the model can be developed further to include more variables as more facts on the COVID-19 emerge.

Urban health nexus with coronavirus disease 2019 (COVID-19) preparedness and response in Africa: Rapid scoping review of the early evidence.

Introduction:Severe acute respiratory syndrome coronavirus 2 also called coronavirus disease 2019 was first reported in the African continent on 14 February 2020 in Egypt. As at 18 December 2020, the continent reported 2,449,754 confirmed cases, 57,817 deaths and 2,073,214 recoveries. Urban cities in Africa have particularly suffered the brunt of coronavirus disease 2019 coupled with criticisms that the response strategies have largely been a ‘one-size-fits-all’ approach. This article reviewed early evidence on urban health nexus with coronavirus disease 2019 preparedness and response in Africa.Methods:A rapid scoping review of empirical and grey literature was done using data sources such as ScienceDirect, GoogleScholar, PubMed, HINARI and official websites of World Health Organization and Africa Centres for Disease Control and Prevention. A total of 26 full articles (empirical studies, reviews and commentaries) were synthesised and analysed qualitatively based on predefined inclusion criteria on publication relevance and quality.Results:Over 70% of the 26 articles reported on coronavirus disease 2019 response strategies across Africa; 27% of the articles reported on preparedness towards coronavirus disease 2019, while 38% reported on urbanisation nexus with coronavirus disease 2019; 40% of the publications were full-text empirical studies, while the remaining 60% were either commentaries, reviews or editorials. It was found that urban cities remain epicentres of coronavirus disease 2019 in Africa. Even though some successes have been recorded in Africa regarding coronavirus disease 2019 fight, the continent’s response strategies were largely found to be a ‘one-size-fits-all’ approach. Consequently, adoption of ‘Western elitist’ mitigating measures for coronavirus disease 2019 containment resulted in excesses and spillover effects on individuals, families and economies in Africa.Conclusion:Africa needs to increase commitment to health systems strengthening through context-specific interventions and prioritisation of pandemic preparedness over response. Likewise, improved economic resilience and proper urban planning will help African countries to respond better to future public health emergencies, as coronavirus disease 2019 cases continue to surge on the continent.

Monetary Policy Interdependency in Fisher Effect: A Comparative Evidence

Abstract In this paper, we examine the ability of Fisher effect to describe the subjective behaviour of monetary policy responses for nations constrained by global factors. We developed and estimated a simple DSGE model for appraising the consequence of an integrated financial market predictor on national monetary policy response in Africa’s largest economies – Nigeria and South Africa. The paper integrated the theoretical intuition of the famous Fisher effect on the New Keynesian DSGE model with global predictors to describe national monetary policy response as it influence domestic financial variables and macroeconomic fundamentals. Simulations show that the existence of global factors threatens the abilities of national monetary policy to predict financial variables and macroeconomic fundamentals in their economies.

Context and Rationale for the Thought Pieces on COVID-19 Response in Africa

Context and Rationale for the Thought Pieces on COVID-19 Response in Africa

Key population of HIV should not be forgotten in Africa's COVID-19 response: Nigeria as a case study

Key population of HIV should not be forgotten in Africa's COVID-19 response: Nigeria as a case study

The Effect of COVID-19 On Presidential Language

Coronavirus COVID-19 has its effect on all the aspects of life. The research is oriented towards exploring to what extent COVID-19 affects the presidential language, and whether this effect leads to the use of indirect speech in the presidents’ speeches about COVID-19 instead of talking directly about such unprecedented crisis. Three presidents’ speeches are chosen arbitrarily since the effect of COVID-19 overcomes all countries equally: President Trump’s Speech on Coronavirus Pandemic on March 11, 2020, speech by M. Emmanuel Macron, President of France, on the COVID-19 coronavirus on 16 March 2020, president Cyril Ramaphosa: South Africa's response to Coronavirus COVID-19 pandemic on 23 Apr 2020. By adopting Searle’s speech acts (1969), the researcher makes a comparison by the qualitative and quantitative analysis leaving the readers to decide to what extent COVID-19 has indelible mark on the presidential language.

African Pentecostalism and the 1918 influenza pandemic: The supernatural amid the fearful and implications for the COVID-19 pandemic

Infectious outbreaks that lead to epidemics and pandemics are dreaded because of the adverse health, economic, and social effects. The 1918 pandemic caused by the H1N1 influenza virus killed about 40 million people worldwide. Like the case of COVID-19, the pandemic of 1918 kept Christians, as well as people of other faiths, from worshipping together. However, African indigenous Pentecostal movements and groups emerged in various parts of the continent around the same time. This period was the time of huge Pneumatic experience and spiritual awakening. Pentecostals devoted themselves to building their faith and praying ceaselessly during that time, and this has become the foundation of the doctrine and theological instruction of most African-initiated churches (AICs). Because there have been no studies that consider the 1918 flu pandemic and Pentecostal response in Africa, this study was undertaken. The time of the 1918 pandemic appeared to be a good opportunity for spiritual awakening. Intense prayer prevailed during those times, and teaching and exposition about prayer formed the core of the theology of most AICs. Pandemics often bring devastation but could also be an opportunity for spiritual awakening through prayer, love in action, social justice, compassion, and care.