African scientists and health officials are taking on coronavirus by adapting technology and systems developed to fight diseases such as tuberculosis and polio, an effort they hope will help compensate for the continent’s lack of critical care infrastructure.
“Technically, Africa is not better prepared,” said Christian Happi, director of the African Center of Excellence for Genomics of Infectious Diseases at Redeemer’s University in Nigeria. “But in terms of understanding diseases and combating outbreaks with limited resources, Africa is much better prepared because they deal with outbreak on a permanent basis.”
Mr Happi is one of Africa’s leading scientists. He helped sequence the Ebola and coronavirus genomes and last year deployed a test for Lassa fever using Crispr gene-editing technology at his state of the art laboratory in rural Nigeria. The deadly disease killed 161 Nigerians between January 1 and March 15.
Now he is using the same technology to develop a rapid diagnostic test for coronavirus. “We want to take that same approach for SARS-CoV-2,” he said, adding that the test will find the RNA of the virus — the cellular information that would identify whether it is Covid-19 — and deliver a positive or negative result in about 30 minutes.
Key materials needed to produce the test including reagents are not available in Africa and will be slow to be delivered amid the global shutdown, he said, but the first prototype is expected to be ready in a “few weeks”.
Across the continent, government officials and other scientists are drawing on similar experiences to develop coronavirus solutions, despite weak health infrastructure and a severe shortage of life-saving equipment.
South Africa has increased Covid-19 testing using a network of over 200 public laboratories that was developed in response to past HIV and tuberculosis outbreaks. It has conducted over 70,000 tests so far.
Meanwhile, WHO Africa has said it will use a data collection system originally set up to battle polio to track infections. Avadar, as the system is known, uses a network of roughly 6,000 community members from traditional healers to village chiefs across 11 countries who can report symptomatic patients to WHO via their mobile phones.
Since its first application to track polio the system has also been used to hunt tuberculosis and Lassa fever. WHO maintains periodic contact with the community members in the network and sends explanatory videos when new diseases arise, helping officials to spot potential outbreaks early.
“Things we never used to notice before they became an epidemic, we now see the ones turn into twos into tens and we can respond faster,” said Godwin Akpan, a technical officer who works on data collection initiatives and polio eradication at WHO Africa.
This week the system will start to send messages to its network of informants asking “have you seen someone with a cough, or difficulty breathing” or displaying other Covid-19 symptoms, said Mr Akpan. “We just push it from the server on to their mobile at a very grassroots level.”
In west Africa, countries are deploying skills and surveillance techniques developed during the 2014-15 Ebola outbreak, which infected at least 28,000 people and killed more than 11,000, mainly in Guinea, Liberia and Sierra Leone. Nigeria was praised for its success in containing the outbreak.
“I think the Ebola experience has really prepared Nigeria in a way because it means we have good alert systems,” said Dr Sani Aliyu, national co-ordinator for the country’s presidential task force on Covid-19.
Dr Aliyu said Nigeria is working to adapt its network of roughly 400 rapid TB testing machines to test for coronavirus and that teams deployed to trace Lassa fever will now investigate Covid-19 cases too.
But contact tracing still needed to be improved, he said, adding that the country had conducted only a few thousand tests by April 9.
“Three thousand tests in a population of 200m is really nothing,” he said. “I think if we were testing properly and really doing proper contact tracing, our numbers would be a lot higher, [and] that could reflect the rest of the continent as well.”
The pandemic is in its early stages in Africa but is so far following a similar trajectory to Europe. Nigeria had reported 343 confirmed cases as of Tuesday morning and the continent had recorded just over 15,000 confirmed cases.
“If we do have a bad spate of Covid like what’s happening in Europe . . . there will be problems because our infrastructure is really not prepared,” Dr Aliyu said. “The health system is not strong enough to withstand a major shock.”
That is one way most African governments have not learnt from past outbreaks, said Mr Happi. Few have invested seriously in permanent healthcare infrastructure. “The unfortunate thing is I’m just a laboratory and a team working with me . . . we can’t prepare for the whole country.”