Earlier this year, before COVID-19 gained ground in Nigeria, another deadly disease endemic to West Africa ravaged households and communities. Lassa fever, an acute viral haemorrhagic illness where infection usually comes from exposure to contaminated food or household items, has killed close to 200 people across the West African nation so far this year. So far, COVID-19 has killed 249 people to date in Nigeria, Africa’s most populated country.
Dr. Adaeze Oreh calls Lassa fever a disease of “poverty and hygiene”. She has been watching with alarm the effects COVID-19 is having on healthcare in West Africa – especially to tropical diseases like Lassa fever endemic to this part of the world.
A family physician, Oreh works for Nigeria’s Federal Ministry of Health. As COVID-19 numbers began to rise in Nigeria, she says attention shifted from combating the Lassa fever outbreak.
Africa has so far reported relatively low COVID-19 death tolls and cases compared to Europe or the US. Many nations acted early and quickly, putting resources in places to deal with expected numbers or measures to curb the spread, including closing borders and stay-at-home orders. In Ghana, this has included the government paying for all water bills – hand washing has widely been touted as an effective measure to curb the spread.
“Not making care available to people who have chronic health conditions like HIV during a pandemic only makes them further susceptible.”
But many of these nations already deal with poorly funded and overburdened healthcare systems. On average, there is only one doctor for every 5,000 people in sub-Saharan Africa. The World Health Organization (WHO) recommends one doctor per 600 people. The WHO points to primarily low-income countries in Africa lacking the resources they need to invest in healthcare, and so having to rely on external funding, which then brings in restrictions on how they develop their policies.
The outbreak has meant health services both from governments and donors working in West Africa have had to scale back on service like immunization programs. Meanwhile, patients are less likely to attain care for non-COVID illnesses, either because the services are not available, or due to patients’ fears around catching the virus.
Dr. Oreh has received firsthand calls from people whose family members desperately need treatments for non-COVID illnesses, but couldn’t or wouldn’t attain care from Nigeria’s skeletal and overburdened health services.
“A lot of those people died, that’s another unfortunate adverse effect from this laser-like focus on just COVID-19,” she says. “Not making care available to people who have chronic health conditions like HIV during a pandemic only makes them further susceptible.”
Indeed, across West Africa immunizations programs for many of these preventable conditions are already on hold, putting children and other vulnerable demographics more at risk of life-threatening diseases.
‘Don’t lose focus’
A significant concern across Africa is resources diverted from campaigns to eradicate malaria. In 2018, an estimated 228 million cases of malaria occurred worldwide – 93% of those were in Africa. Also, in 2018, an estimated 405 000 people died from malaria globally; again, the vast majority were in Africa. Children under five are most at risk; in 2018, they accounted for 67% of all malaria deaths worldwide.
Recent efforts to combat malaria- funded mainly by international donors – including supplying insecticide-treated nets for people to sleep under, antimalarial drugs and in the past year a vaccination was introduced for children in a handful of African nations. While rates of malaria have declined globally between 2010 and 2018, from 2014 to 2018, the rate of change slowed dramatically. There is recent history to show what other health crises can do to hamper these efforts.
The 2014-2015 West African Ebola outbreak in Guinea, Liberia and Sierra Leone led to a massive increase in malaria-related illness and deaths; reports estimate this increase in malaria deaths in these countries greatly exceeded the number of deaths from Ebola.
“A struggling health system might see a drop in immunization rates as it responds to COVID-19.”
COVID-19 has already led to disruptions in the supply chains of essential malaria supplies including nets, rapid diagnostic tests and antimalarial medicines—resulting from lockdowns and export bans.
An analysis by the WHO suggests that in a worst-case scenario, the number of malaria deaths in 2020 in sub-Saharan Africa could double from their 2018 numbers—exceeding 700,000 this year alone.
Dr. Matshidiso Moeti, WHO Regional Director for Africa, has urged all countries “to not lose focus on their gains made in health as they adapt to tackle this new threat.”
Global health organization PATH is also expressing concern about COVID-19’s effects on other healthcare initiatives: for example, Liberia’s plans for a nationwide typhoid vaccination campaign, which have been paused in the face of the coronavirus pandemic.
“A struggling health system might see a drop in immunization rates as it responds to COVID-19. Later, the community is even more vulnerable to a surge in measles, typhoid, and other vaccine-preventable illnesses,” Deborah Atherly of PATH’s Center for Vaccine Innovation and Access says.
Meningitis in Ghana
And don’t think these fears about possible COVID-19 knock-on effects are purely theoretical. On the ground, health workers are already seeing fatalities from other diseases that might have been caught in time if not for coronavirus.
Earlier this year, a deadly outbreak of Cerebrospinal Meningitis (CSM) disease killed at least 48 people in north Ghana, there were more deaths from CSM in this area of Ghana, than COVID-19 across the nation. Commentators say the outbreak was ignored because coronavirus sucked up all the oxygen from the local health infrastructure, while Ghanaian officials blamed the high death toll of the outbreak on late reporting of cases to health facilities because the symptoms were so similar to COVID-19, which unlike CSM can be treated at home.
“You can not talk about [CSM] because COVID is the top of the day.”
A development worker in Ghana’s north, Jeremiah Seidu, of the Jaksally Development Organization has seen the effects of COVID-19 in rural communities in Ghana’s north; he says without a doubt, attention and resources that would go to the CSM outbreak, have been diverted.
“You can not talk about [CSM] because COVID is the top of the day,” says Seidu.
Meanwhile, people dealing with other health conditions are so terrified to leave their homes that they are going without medication and other care. It’s a lose-lose situation. “People are just coiling back,” he says.
So what’s the long-term solution?
Much has been said about African elites being able to leave their nations to seek healthcare from Asia or Europe before this pandemic, and in doing so neglecting investment in the hospitals and clinics, they are tasked with resourcing. With border closures, COVID-19 has put a halt to this. Some commentators have said this pandemic should be a wake-up call for governments to fix their systems, and increase their spending on healthcare.
This is a realization Ghana’s president Nana Akufo-Addo seems to have come to. In a televised address to the nation in April he said COVID-19 “exposed the deficiencies of our healthcare system, because of years of under-investment and neglect” so pledged to build more hospitals, and new testing laboratories as well as infectious disease control centres, a decision he said was reaffirmed by Ghana’s CSM outbreak. He said the nation especially needed to focus on other chronic diseases.
“It is my hope and expectation that this expanded and empowered public health system will be the most enduring legacy of the pandemic,” he said.
“You who are wearing the shoe, feel where it pinches. Nobody else can feel that pinch.”
This is exactly what Dr. Oreh wants to see. She says African nations will never be able to wage the simultaneous health campaigns they need to wage as long as they are mostly reliant upon outside funding from international health organizations or donors, where funding comes with conditions. If governments across the continent put sustainable resources in place they will be able to better focus on these killer diseases – including developing vaccinations, she adds.
Not doing so, will continue to see these diseases endemic to this part of the world, put on a back burner when other, global issues come to wreak their havoc, and will divert global attention and financing to find cures, as is the case with COVID-19.
“If we build our research capacities and start building our own financing mechanisms, then we can prioritize these diseases that affect us and not depend on international funding,” Oreh says.
“You who are wearing the shoe, feel where it pinches. Nobody else can feel that pinch.”