As monkeypox threat grows, Africa needs more robust health surveillance – Health Policy Watch

Ebola virus disease surveillance at the DRC-Uganda border.

SUFFERING – Preparedness for a pandemic relies on a robust surveillance system to identify health threats – something that is still “rudimentary” in many African countries, says Professor Salim Abdool Karim, a South African infectious disease epidemiologist.

Karim described monkeypox as a health security threat in Africa and said it was important that health services could identify people with recent skin lesions and test them for monkeypox to control the infection.

“It’s critical to make sure the public knows what the monkeypox lesions look like and have the laboratory infrastructure to conduct comprehensive testing,” Karim said health policy monitoring on the sidelines of the EuroScience Open Forum in Leiden, the Netherlands.

Last month, the World Bank approved a $100 million program to strengthen the technical capacity and institutional framework of the Africa Centers for Disease Control (Africa CDC) to “support African countries in preparing for, detecting and responding to.” Disease outbreaks are intensifying and public health emergencies are increasing,” according to the Africa CDC.

laboratory tests

According to Karim, testing for monkeypox is possible in almost every country in the world because it is based on PCR technology, which has been significantly improved during the COVID-19 pandemic.

“The Elements of Surveillance [for pandemic preparedness] are known and most countries in Africa have [them] but they are rudimentary and we have to build them up. It’s about making sure that health services are paying attention to looking for clinical symptoms and signs and looking for patients who might be unusual,” Karim said.

Pandemic preparedness also means having the laboratory testing capacity to identify new organisms and the data analytics and epidemiological capacity to monitor trends to know when things are changing.

The ability to monitor animals is also key to staying ahead of the curve and “not waiting for organisms in animals to jump over to humans,” Karim warned.

Another component of preparedness includes “epidemic intelligence” — the knowledge of what’s going on globally and on the ground in African countries to produce intelligence reports that inform policy and planning.

Countries also need to ensure their health systems have the capacity to deal with epidemics – including adequate hospital beds, ventilators, laboratories and adequate health workers – and have the tools to fight a pandemic, including diagnostics, vaccines and treatments.

misinformation

Communicating public health decisions and the science behind them is a fundamental building block for building public trust and understanding – especially in the age of disinformation and conspiracy theories on social media.

“What disinformation does shifts the narrative and undermines public confidence in government, science and transparency,” said Karim, who was a member of South Africa’s COVID-19 Advisory Committee of Ministers.

At the height of the COVID-19 pandemic, “African governments and scientists weren’t communicating enough, creating an opportunity for disinformation peddlers to gain the upper hand,” Karim said.

“There was no counter-narrative that provided clear explanations to address people’s fears and concerns,” he added.

Monkeypox is endemic in 10 African countries, but it is spreading among the general population and not, as in Europe and the US, among men who have sex with men. But the fight to keep infection rates down could take a hit if stigma in this group of people isn’t adequately addressed, Karim said.

“We must avoid stigmatizing any group for monkeypox as it is a disease that affects everyone. In countries where the virus is spreading in the gay community, recognizing these individuals is key to whether or not the virus can be controlled,” Karim said.

Members of the South African National Defense Force patrol the Bree Street taxi rank in central Johannesburg during the country’s COVID-19 lockdown.

COVID-19 lockdowns

Total lockdowns imposed in countries like Kenya, Nigeria and South Africa may not have been appropriate, Karim said, but there were so many unknowns about COVID-19 at the time.

“If you turn the clock back to February and March 2020, we had very little information about the COVID-19 virus. What we saw and showed on our TV screens every night was developed countries like Italy and New York City in the US were overwhelmed, hospitals were under pressure and people were dying just trying to get a bed or trying to get a ventilator,” Karim said.

“That is the image Africa had to work with at the time. These countries, which have far more resources than ours, have been impacted tremendously and no country, no responsible leader, can look at this and ignore it.”

African countries followed the example of European cities and China, where lockdown measures helped reduce the number of infections and the flow of seriously ill people to hospitals.

“That’s the evidence Africa faced at the time and they had to act in good faith,” he said. “If you look at those decisions now – in hindsight – we have a different understanding of it [diverse ways] where countries in Africa were affected.

“For example, South Africa, Uganda and Zambia have been hit hard, particularly when the Delta variant emerged, leading to many going to hospitals and countries facing a huge clinical burden.

Some countries that have imposed strict lockdowns could have avoided such measures or made them less painful socially and economically if more was known about the transmission and severity of the virus at the time.

“If we look at the impact of the first wave of COVID-19 in many African countries, we could have taken a different route, but that route was not clear at the time. Perhaps that would have meant implementing partial lockdowns, identifying cases, implementing stay-at-home orders in parts of the community, restricting movements, getting as many people as possible to work from home, reducing the flow of people and the Reduce use of public transport,” admitted Karim.

Photo credits: WHO/Matt Taylor, Flickr: IMF Photo/James Oatway.