Learning from the best: How five African countries dealt with epidemics

Every day around the world, including in Africa, public health experts work round the clock to fight epidemics.

In many cases, epidemics and pandemics such as Covid-19 exposed flaws in Africa’s public health systems. A recent survey by Resolve to Save Lives shows that major disease outbreaks have exposed tremendous gaps in many countries’ preparedness and response systems, while also offering a ray of hope in countries that have had successful responses. 

“Outbreaks begin and end locally, so community action is crucial to preventing epidemics. Public health officials’ engagement with communities pays off because it builds trust in the health system,” said Amanda McClelland, senior vice-president of Resolve to Save Lives.

The region’s different countries have responded to epidemics with varying levels of success. Here’s a snapshot of how six of them tackled these public health emergencies.
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1. Nigeria

In 2014, West Africa was in the grip of the largest epidemic of Ebola. The epidemic had taken hold in Liberia, Guinea and Sierra Leone. Countries across West Africa were on high alert. 

Nigeria managed to contain the virus in less than three months thanks to a herculean public health response. It recorded its first case on July 20, 2014 and was free from Ebola by October 2, after a total of 20 cases and eight deaths.

Nigeria stopped Ebola from spreading nationally, and potentially regionally, with effective communication, coordinated response activities and dedicated leadership.

“The virus impact was lessened, because of careful planning and swift strategic action. It clearly showed how the trajectory of an epidemic can be fundamentally altered when a country invests in and prioritises preparedness for infectious disease outbreaks and readiness to act when it strikes,” says the report.

2. Nigeria (monkeypox)

Years of preparation by Nigeria health officials ensured that the county was ready to fight the new outbreak, and specifically monkeypox. When monkeypox first reappeared in Nigeria in September 2017, it was contained within a month because of a quick and thorough response.

Teams also ran education campaigns to counter the stigma against infected people that was prevalent throughout the community.

3. Ghana (Marburg)

Ghana contained in less than two months its first outbreak of Marburg virus, which is highly contagious and has a fatality rate as high as 88 per cent.

Stepping up faster disease surveillance, rolling out outbreak control measures, testing, contact-tracing, clinical care, as well as raising public awareness and working with communities to support disease prevention efforts worked well for Ghana.

4. Kenya (anthrax)

Three Kenyans were diagnosed with anthrax on August 15, 2019, in Narok. Through community-based surveillance with the help of residents, this works by connecting communities with the national health and surveillance systems, training them to participate in notification of high-risk diseases.

To gain the trust and participation of local farmers, the government held a traditional community dialogue session.

School teachers were shown how to screen potentially infected children and report any illnesses to public health officers or area volunteers.

From the outreach, the community recognised the risk, prioritised mitigation efforts and took over financing of its own animal vaccinations. In just a month, the situation was brought under control after four human cases and one death, and the community was safer and better prepared than it had been before.

5. Tanzania (rabies)

An outbreak was reported on March 6 this year. A 12-year-old boy showed symptoms consistent with rabies and died.

The doctors’ clinical suspicion of rabies and quick reporting of the case were key to containing the outbreak, as was the team’s early, decisive action to conduct contact tracing and provide prevention to those who needed it. 

Until rabies is eliminated in Tanzania using sustainable and cost-effective strategies such as dog vaccination, the strategic action undertaken by the response team demonstrates how a rabies outbreak can be contained.

Improved systems and skills following deadly epidemics contained Ebola outbreaks in Guinea and Democratic Republic of Congo.

From how the countries responded and contained the epidemics, the report recommends that speed is essential. Well-coordinated action at the local level is also crucial to preventing epidemics, and communities must be fully engaged and frontline workers supported.

“How quickly an outbreak is detected and responded to can mean the difference between an outbreak that is contained and one that spreads unchecked. A start-to-end assessment of timeliness, how quickly a public health system detects and responds to disease threats is an optimal measure of performance,” the report says.

Communities that trust the health system are more likely to report a problem and to work with officials to contain outbreaks. People are more likely to believe in a health system that is equitable and accessible.

“The bottom line is: when countries prepare consistently and act decisively, they can prevent epidemics,” the report says.

Brazil (fellow fever)

While not an African country, like the rest in this list, Brazil was uniquely able to respond to yellow fever, as it had developed scientific expertise on the endemic disease and was a part of developing the yellow fever vaccine in the 1930s, motivated by national risk.

Before 2016, there were relatively few cases of yellow fever in Brazil, with only three confirmed human cases and two deaths. Cases rose to 792 with 274 deaths, a clear indication of a pandemic.

Controlling the outbreak required Brazil to significantly expand immunisation as infections crept toward major cities and because of this outbreak, the country has an integrated public health system that prioritises routine vaccination, including for young children.

The country is one of the largest producers of the yellow fever vaccines in the world. It developed an ambitious vaccination plan.

To stay ahead of further spread of yellow fever, officials expanded vaccination to the entire country, targeting an additional 77 million people.

As it was already one of the major producers of the vaccine, it was able to double its monthly production to eight million doses to support its ambitious goal to vaccinate the entire population.

In conjunction with vaccination, health officials prioritised surveillance of yellow fever outbreaks among animals and case management to reduce deaths among those infected and highly specific testing diagnostics.

By the end of the 2019 yellow fever season, these measures had produced dramatic results: only 85 yellow fever cases and 15 deaths were reported. A disease that had threatened to expand throughout Brazil and across borders had been contained.

Innovations

The challenges posed by the Covid-19 pandemic have accelerated the creation, testing and adoption of digital health solutions in Africa, data from a recent study indicates. Innovators on the continent have responded to the challenges of the pandemic with a wide range of creative inventions.

A survey, “Meeting in the Middle”, conducted by Vodafone, Vodacom, Safaricom and Caribou Digital, reveals that 41 per cent of internet users in Africa regularly use their mobile phones to search for health information.

The report reflects a healthcare sector on the right path of transformation, with opportunities to improve health outcomes at a lower cost, indicating that 75 per cent of African countries have a digital health strategy in place.

With Covid-19, the usage of digital health services and apps has also grown, with Kenya, for instance, having more than 40 telehealth service providers.

Another innovation is MomConnect, a free interactive South African SMS and WhatsApp-based messaging platform that provides pregnant women with carefully curated information throughout the pregnancy stages.

The services are available in 11 of South Africa’s official languages, and enables women to ask questions about their health and the health of their baby and receive immediate feedback from qualified health professionals.

The mVacciNation app, an electronic health record solution that supports vaccination coverage and was developed by Mezzanine, helps users in Mozambique, Tanzania, South Africa and Nigeria deal better with persistent vaccine stockouts, distribution inefficiencies and poor record keeping.

Researchers and universities in many countries developed ventilators and personal protective equipment. In Kenya, firms including Kicotec have re-engineered their processes to produce essential products such as masks and sanitisers.

A nine-year-old Kenyan, Stephen Wamukota, invented a wooden handwashing machine to help curb the spread of the coronavirus. He was honoured by President Uhuru Kenyatta in June this year. Using a foot pedal to operate the machine without touching surfaces reduces the risk of infection.
Another team of 15 medical and engineering students at Kenya’s Kenyatta University made the country's first homegrown ventilator to help treat patients severely affected by the coronavirus. This happened as the number of people who needed the services had increased.

A 20-year-old engineering student in Nigeria came up with portable ventilators to help people with respiratory problems.

Kenya converted existing factories to produce face masks, with a production target of tens of millions. Other African countries quickly followed, those with stronger manufacturing capabilities coming out on top.

Rwanda has used locally assembled drones to increase awareness through in-flight public broadcasts, and robots to screen and monitor Covid-19 patients, while in Ghana, Zipline drones were used to deliver samples to testing sites.

When Covid-19 hit, schools were closed, affecting over 300 million learners, data from the World Health Organisation shows. This offered an opportunity for many countries, including Kenya, South Africa, Egypt and Morocco, to launch e-learning platforms for learning to continue.