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A teachable moment about African innovation: how the continent is trying to combat COVID-19

| October 30, 2020 | 0 Comments

BY MIKE BRUTON

There is no doubt that the COVID-19 epidemic is a catastrophe for humankind.

In April 2020, the president of Madagascar, Andry Rajoelina, publicly promoted home remedies, such as drinking ginger and lemon tea, for treating COVID-19. He also announced the launch of a new herbal potion that he believes can prevent and cure the disease.

The drug, called COVID-Organics (CVO), which was developed by the Malagasy Institute of Applied Research (IMRA) in Antananarivo, contains extracts from Artemisia annua (sweet wormwood) – a plant that has proven efficacy against malaria but, as yet, no proven effect on COVID-19. Furthermore, Rajoelina issued a presidential decree that made it mandatory for CVO to be administered to all children returning to school in April 2020. The president also announced that CVO will be distributed ‘free of charge to our most vulnerable compatriots and sold at very low prices to others. All profits will be donated to IMRA to finance scientific research.’

Rajoelina’s announcement was met with considerable scepticism internationally. This is not the first time that bogus cures have been touted in Africa. In Nigeria, in the 1990s, Jeremiah Abalaka, a surgeon with fringe training in immunology, startled the world with a fake HIV cure claim. More recently, fake cure claims were circulated during the Ebola and SARS epidemics.

While medicinal remedies derived from indigenous knowledge have been widely and successfully applied in Africa for some ailments, there is no known cure for COVID-19 based on them.

Yet this is not to say that Africa’s contributions should be ignored.

Dr Moses Alobo, programme manager for Grand Challenges Africa, African Academy of Sciences,1 has spearheaded an extensive survey of hundreds of the continent’s scientists to identify COVID-19-related research priorities across a range of disciplines. He says:

The African Academy of Sciences recognised there was an urgent need to help scientists, researchers and practitioners on the continent in pharmaceutical and non-pharmaceutical mitigation efforts. We need to provide guidance and resources that will help address COVID-19 by shifting the focus to specific needs that may be unique to the African continent… We had respondents [to the survey] from the biomedical sciences, clinical and epidemiological research, social sciences, policy making and management sciences, among others. In total, 56 countries globally took part [in the survey] – 39 of those were African countries.

Some lessons from Ebola apply

When the Ebola outbreak erupted in West Africa in 2013, the world wasn’t looking – and by the time the virus was detected, it had been circulating for months. African countries are particularly vulnerable to such epidemics as the continent accounts for only 1% of global health expenditure, yet it carries 23% of the disease burden, according to the United Nations Economic Commission for Africa (UNECA).2 Furthermore, there is a chronic lack of medical facilities and staff, as the continent only has 1.8 beds per 1 000 people, says UNECA.

However, many experts believe that the policies that have been adopted in Western countries to flatten the curve of COVID-19 infections – including self-isolation, working from home, lockdown and social distancing – will not work in densely populated cities and informal settlements in Africa: Lagos has a human population density of 209 people per hectare compared to New York’s 25. Social distancing is also not practical on crowded public transport systems, such as Lagos’s Bus Rapid Transit system and danfos (minibus taxis), which are used by 67% of all commuters. Working from home is impractical for the 68% of Lagosians, and hundreds of millions of other Africans who earn their living from face-to-face informal trading in street markets, and there is concern that forced isolation will drive many of them below the poverty line. Consequently, Nigerian authorities decided to ease the lockdown restrictions early on 4 May 2020 in Lagos and Abuja.

Even regular handwashing is not practical for many urbanites in Africa, as it is estimated that only 56% of the urban population of sub-Saharan Africa has access to piped water and many have to spend 30 minutes or longer sourcing it. How can you wash your hands regularly in Lagos when you have to buy water by the bucket?

The measures taken in Mauritius, Nigeria, Kenya and Ghana

In March 2020, Mauritius implemented novel procedures to reduce congestion in supermarkets, by allowing only 30 minutes for each shopping visit and allocating specific days for shopping depending on the initial letter in your surname: A to F shop on Mondays and Thursdays, G to N on Tuesdays and Fridays, and O to Z on Wednesdays and Saturdays.

The commissioner for health in Lagos, Akin Abayomi, has stated that extensive preparations have been made for the coronavirus outbreak based on Nigeria’s experience of dealing with Ebola (which was named after a river in the Congo). One of the key lessons learned was the need to build systems during ‘peace time’ that could be used during outbreaks, including rapid response teams in all 36 states, efficient interstate communication systems, well-trained technical staff and properly equipped national reference laboratories that have primers specific for each new virus. Emphasis has also been placed on developing emergency operations centres in 22 states, and on issuing public health advisories to all Nigerians.

Kenya and Ghana have also learned from the Ebola, SARS and MERS outbreaks and put emergency measures in place. Ghana has repurposed Ebola treatment centres and mobilised 35 000 military and police personnel to enforce isolation. Its health officials recognise that coronavirus is much more infectious than Ebola, as it can be transmitted in air droplets like the common cold. The novel coronavirus can also be transmitted during the incubation period before the infected person develops a fever, which means that temperature screening needs to be combined with rigid individual screening of high-risk people.

The ‘benefits’ of COVID-19

The extreme severity of the COVID-19 outbreak (over 534 000 people around the world had died of the disease by 6 July 2020) has ironically resulted in two consequences that are beneficial to the natural environment, and in doing so, have finally made the world realise that the illegal wildlife trade is not just an environmental issue, but also a serious public health issue.

In early February 2020, the Chinese government issued a temporary ban on wildlife trade to curb the spread of the virus, and on 24 February 2020, it banned the consumption and sale of bushmeat at wet markets.

The temporary ban has closed about 20 000 captive breeding enterprises involving 54 species – including snakes, ostriches, guinea fowls, peacocks, civets, porcupines, bats, monkeys and other species from Africa – that are all allowed to be traded domestically in China. However, the ban excludes products that are used in traditional medicine, such as sea cucumbers, abalone, sea horses and rhino horn.

The COVID-19 outbreak has also revealed the full scale of the Chinese bushmeat industry. The legal global wildlife trade is estimated to be worth about US$300 billion and the illegal trade between US$7 billion and US$23 billion annually. At least 5 500 different species are traded, and wildlife breeding in China alone is estimated to be worth US$74 billion and involve 14 million people. Economists are inclined to oppose bans because they tend to drive legal trade underground. Moreover, legal trade often has no ability to crowd out illegal activity, as an illegal product is always cheaper to procure. Instead, in a corrupt world, it can create laundering opportunities for illegal supply chains. Improving regulations alone is also not the answer, as every improvement in regulation requires more law enforcement capacity, technology and manpower, which most countries do not have.

The second benefit started in early March 2020, when China reported the lowest levels of air pollution by carbon dioxide, carbon monoxide and nitrogen dioxide in years, in areas where economic and industrial activity had been impacted by travel bans imposed by the government. This soon became a worldwide trend.

Predicting pandemics

Researchers constantly investigate the likelihood of another zoonotic disease pandemic. In 2015, Bill Gates predicted the same. Some of the most widely recognised and widely feared diseases started off in other species – including salmonella, influenza, ticks, cattle, badgers, sheep, goats, antelope and deer, chimpanzees, bats, palm civet cats and raccoon dogs, dromedary camels, domesticated birds and pigs, and possibly pangolins, which, says the International Union for Conservation of Nature, are ‘the most illegally traded mammal in the world’ and are prized for their meat and the claimed medicinal properties of their scales. The World Health Organisation (WHO) states that zoonoses account for not only 60% of diseases found in humans, but represent 75% of all emerging infectious diseases.

The international concern now is that if bushmeat markets in China and elsewhere are not completely banned, another even more harmful zoonotic virus could infect humans, with even more devastating impacts.

Alternatives to bushmeat hunting

While global bans on the bushmeat trade are being considered, an innovative alternative is also being tried in Africa – the development of livelihoods that provide alternative sources of employment and protein at the community level, thereby addressing the problem at its source. These interventions reset past behaviours rather than create new ones, and include activities such as beekeeping, fish farming, mini-livestock rearing (including cane rats, rabbits and guinea pigs) and caterpillar farming.

These projects have been most successful in Ghana, the Democratic Republic of the Congo (DRC), Cameroon, Liberia and Burundi. In many of the projects, the conditions for participation include an agreement by participants to reduce or cease the hunting and sale of bushmeat.

COVID entrepreneurs

As always, when a crisis strikes, there are entrepreneurs who take the gap and answer society’s needs. Senzo Jiyane, 32, of Johannesburg, a construction worker, runs a small factory that produces hand sanitiser. His sales, which have increased thirteen-fold since the outbreak, mainly go to small businesses, hospitals and municipalities. But, sadly, it will be small-scale entrepreneurs and ‘gig’ workers with insecure or casual employment who are most vulnerable to COVID-19 – not only due to a loss of income, but also in terms of their exposure to the virus. They are typically on the frontline of dealing with the public and, in the case of delivery drivers and rideshare hosts, may make direct contact with infected people during the pandemic. Furthermore, their lack of sick pay or medical aid support might lead many to continue working even if they are infected, rather than to self-isolate.

Impact of Gavi

Gavi is a globally collaborative vaccine alliance launched by Bill and Melinda Gates. The alliance enables almost half of the world’s children to have access to ongoing immunisation programmes, avoiding future deaths resulting from a range of preventable diseases including measles, yellow fever, polio, meningitis, pneumonia and diarrhoea. The alliance also has tremendous power to negotiate vaccines at prices that are affordable for the poorest countries, and to remove the commercial risks that previously kept manufacturers from serving them.

Gavi, which is active in 37 African countries, is now gearing up to distribute COVID-19 vaccines throughout the continent when they become available. According to Dr Marthe Essengue, regional head of Gavi in Francophone Africa: ‘All people in the world need to be protected by vaccines – not only those who can pay. This is about saving lives.’

Emerging African innovations

Belinda Shaw, founder and CEO of Cape BioPharm, is using biotechnology to manufacture COVID-19 proteins in plants. These proteins, called antigens, are used in rapid diagnostic test kits that detect antibodies against the virus in a person’s blood, indicating whether they have been exposed to the virus. If a person has COVID-19 antibodies in their blood, they will bind with the antigens in the test kit and trigger a positive response.

But test kits and potential vaccines cannot be rolled out en masse as yet, as Cape BioPharm is struggling to secure a reliable supply of positive serum (blood from COVID-19-positive people) to test the kits, and it lacks the advanced facility required to obtain a compliance certificate to make the vaccines and therapeutics. Shaw says:

Africa has always been at the end of the queue when it comes to receiving vaccines and therapeutics. It’s enough now. We have the capability, we have the expertise, we have incredibly clever people, to be able to ensure the security of our own supply of pharmaceuticals. The business of having to import all this stuff should be, hopefully, almost a thing of the past.

Dr WHO

Dr Matshidiso Moeti is the WHO’s regional director for Africa and spokesperson on the COVID-19 crisis.

Throughout the COVID-19 outbreak, Moeti has been the voice of Africa to the world, in her weekly briefings from Brazzaville in the DRC, where the regional headquarters of the WHO is located. Her main role is to coordinate public health responses in collaboration with leaders and ministries throughout the continent, and to persuade them to make very difficult decisions.

She gained valuable experience in the fight against Ebola, and says, ‘When there was an Ebola outbreak, it was an African problem. This is a global problem. Some of the challenges relate to the fact that those countries from whom you would be expecting help, are themselves struggling.’ Furthermore, she adds, the draconian travel restrictions imposed by many African countries have meant that WHO experts and supplies cannot not reach the places where they are most needed.

African robots fighting COVID-19

Intensive care frontline workers at Tygerberg Hospital in Cape Town can thank a robot named Quinton for reducing their risk of COVID-19 infection. Quinton does the ward rounds of infected people under the remote control of physicians who are at risk of infection, or who are convalescing at home after being infected. Charmaine Lambert, head of co-working space WorkInProgress, an Absa Innovation Lab, states: ‘Robotic process automation can take over manual, repetitive tasks – freeing people up to tackle more important and nonautomatable tasks.’

In Netcare hospitals in Johannesburg, Xenex pulsed ultraviolet (UV) robots and Yanex pulsed-xenon UV robots have been deployed to use high doses of UV light to decontaminate wards, personal protective equipment and medical supplies. In May 2020, Rwanda deployed four humanoid robots to screen body temperatures and monitor the status of patients in coronavirus treatment centres, to minimise human-to-human contact.

A police robot has been deployed to patrol areas of Tunisia’s capital, Tunis, to ensure that people are observing the coronavirus lockdown. If the robot spies anyone walking in the deserted streets, it approaches them and asks why they are out. They must then show their ID and other papers to the robot’s camera, so that the officers controlling it can check them. The four-wheeled robots, called PGuards, which were designed and built in Tunisia by Enova Robots, have a thermal-imaging camera and LiDAR (light detection and ranging) technology, which works like radar but uses light instead of radio waves.

Singers spread the message

Ugandan pop star Bobi Wine has spent his career singing about social injustice. Now the 37-year-old singer –who has his eye on the presidency – is leading a star-studded galaxy of African musicians and politicians who compose and perform songs about COVID-19, including soccer star and president of Liberia, George Weah, and singers and songwriters from Senegal, Gabon, Nigeria, the DRC, South Africa and Ghana. ‘Sensitise the masses to sanitise, keep a social distance and quarantine,’ sings Wine, whose hit soon passed a million clicks on YouTube.

Wine has also launched a collective call to action, #DontGoViral, and has invited content creators of every musical genre ‘and creatives from all over the world’ to share their work on #ShareInformation. He argues that in this time of crisis, humanity needs artists and cultural entrepreneurs to bring people together.

In Cape Town, an electronic group founded by David Scott in 2011, The Kiffness, embraced the challenges of the COVID19 lockdown and parodied several well-known songs with lyrics related to the pandemic. They included ‘Quaranqueen’ (‘Dancing Queen/I’ve lost track of time and my life’), ‘Yesterday’ (‘Yesterday, COVID-19 seemed so far away/now it looks as though it’s here to stay’), ‘Lockdown Rhapsody’ (‘This is the real life/this isn’t fantasy/caught in a lockdown, no escape from the quarantine’) as well as ‘The Sound of Sirens’ (‘Sound of Silence’) and ‘Sweet Corona’ (‘Sweet Caroline’).

What’s the take-away?

Despite our superior intellect and advanced technologies, an invisible and simple but highly effective virus has brought human civilisation to its knees, and we are scrambling to pick up the pieces. This should remind us that we are the misfit in nature, not the other species, and that the biosphere has been in the habit of rejecting misfits for millions of years. It is a selfcorrecting system that favours the fittest.

But maybe there is a glimmer of hope. In this information age, our unprecedented interconnectivity, our ‘intellectual superorganism’ comprising the community of human brains and the internet of things – combined with advances in artificial intelligence, telemedicine, quantum computing, 5G wireless technology, 3D printing, nanotechnology, biotechnology and many other fields – may equip us to do something that we have never done before on this scale: call a truce on wars and other conflicts and work together as a species in a fight against a common enemy. But this will only work if we acknowledge our humble place in nature. Perhaps our greatest arrogance is that we keep saying that we must ‘save the planet’. How can we save the planet when we don’t know how to fit into its processes ourselves?

Professor Mike Bruton obtained his PhD degree from Rhodes University. Through Mike Bruton Imagineering, he plans to use his knowledge to guide and provide services in the fields of science centre development, aquatic research management and imagineering. For more information, visit: www.mikebruton.co.za. To read a list of references applicable to this article, please go to: www.ieducation.co.za or www.isasa.org

Category: Spring 2020

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