Authors;Uzma Alam, Joanes Atela, Gordon Awandare, Tobias Chirwa

Africa’s response to the COVID-19 pandemic has been hampered by several factors, including lack of adequate evidence on effective approaches for different groups, scientific uncertainties, scarcity of context-relevant data, and the changing nature of the pandemic, most notably the emergence and spread of new variants. These challenges are exacerbated by weak coordination among relevant stakeholders in Africa that, if effective, could enhance sharing of information, improve expertise, and build best practices to manage the pandemic.

For African policy makers dealing with a rapidly evolving crisis, it is imperative to develop and implement the most promising policies in a timely manner. This requires evidence differentiated by its specific context that accounts for the practical realities, experiences and understanding of African stakeholders. Such Africa-led insight into and knowledge of the pandemic has the potential to drive a bottom-up approach to identify priority areas and co-create sustainable and impactful solutions.

The African Union established the African Task Force on Coronavirus (AFTCOR) to support African governments to develop evidence-based responses to COVID-19. To contribute to this effort, the Alliance for Accelerating Excellence in Science in Africa (AESA), in collaboration with AUDA-NEPAD and other partners, conducted a series of priority setting engagements through its African Science, Technology and Innovation Priorities (ASP) programme. These engagements identified 17 priorities for the region’s strategic response to COVID-19 and which supplement the World Health Organization (WHO) roadmap. The priorities were further refined by The Science Standards and Regulatory Technical Working Group (TWG) of the AFTCOR in collaboration with experts from other organizations, resulting in the identification of seven top priority areas where in-depth scientific knowledge is necessary for Africa to effectively respond to the pandemic.

Through funding by the East Africa Research and Innovation Hub of the UK Foreign, Commonwealth & Development Office (UK FCDO’s EARIH), AESA, with support from the Africa Research and Impact Network and other partners, is convening scientists and policy makers to develop strategies to facilitate evidence generation to inform the scientific priorities identified. These “tele-convenings” will focus on targeted, relevant, and context-specific rapid reviews of existing evidence in order for the priority areas to effectively inform COVID-19 policy responses of African governments.

A recent tele-convening focused on understanding the evidence for transmission dynamics and diagnosis of COVID-19, at which stakeholders acknowledged that Africa’s response to the virus has widely been informed by the global narrative of COVID-19 epidemiology and diagnostics. Yet this narrative is not necessarily applicable in its particulars to Africa. Instead, Africa must seek systems and policies that prioritise its marginalised, minority person(s) and is calling for more inclusive management options by:

• Understanding the differentiated nature of COVID-19 to design inclusive management: The global narrative of “flattening the curve” is largely based on the assumption that good data on transmission dynamics, and diagnostics including testing, are available. Moreover, most global COVID-19 containment strategies include lockdowns. But in Africa, certain populations are unable to isolate as widely adopted elsewhere in the world. These people include vulnerable, disabled and critically ill patients. They also include many people who must move about the community for their family’s daily sustenance. Because global guidelines cannot be applied universally in Africa, there is a need to understand the differentiated nature of transmission dynamics and diagnostics across different populations and social groups to develop more inclusive management options. These must encompass detailed understanding of transmission and surveillance, such as asymptomatic versus symptomatic disease, transmission rates, re-infections and age-differentiated risks and care.
• Building R&D capacity in Africa: Equipment, data, information sharing platforms and the capacity to model clinical and socioeconomic scenarios of COVID-19 all require infrastructure. Such infrastructure is limited in Africa; moreover, COVID-19 response management has been weakened by uncertainties around the epidemiology of the virus over time. Therefore, building effective predictive systems is critical to project trends and how they impact and are impacted by management and behavioral priorities.
• Generating multidisciplinary evidence on transmission, surveillance, and diagnostics: Any approach to COVID-19 management must account for all variables, e.g., social, epidemiological, and economic. Currently, focus is on epidemiological evidence with little attention to socio-economic evidence. This complicates surveillance and diagnostics as people struggle to meet their daily needs.
• Developing resource priorities among transmission, surveillance, diagnostics, analytical and other urgent needs: In some cases, managing transmission is most critical, while in others, surveillance and diagnostics are a prerequisite to effective management of the pandemic. In most African countries, testing has continued, albeit in a less targeted manner than in the initial phases of the pandemic. But resources to address transmission and surveillance have deteriorated over time. This highlights the need for evidence to inform prioritisation of resource allocation for transmission, surveillance, and diagnostic efforts. Of course, these resource trade-offs must also account for non-COVID-19 health needs that have already been compromised as resources are diverted to management of the pandemic crisis.

Policy makers are struggling with the above factors as they respond to the emergency nature of the pandemic: most socio-economic and political systems in Africa were and remain unprepared for a crisis of this magnitude. This has meant that the ability to inform policy decisions to manage transmission, diagnostic and surveillance efforts has been limited and too dependent on approaches developed for elsewhere in the world. For example, surveillance through contact tracing has proven to be ineffective in Africa partly due to the shortage of proper communication systems. The result of these shortcomings is that many African populations and communities are excluded from globally adopted COVID-19 management strategies.

A fully inclusive pandemic response can only be achieved by initiatives that promote collaborative partnerships and best practices that are specific to Africa.