The world is slowly recovering from the ravaging effects of COVID-19 which lasted close to three years before the World Health Organisation (WHO) announced that it was no longer a Public Health Emergency of International Concern (PHEIC). According to WHO data, globally, as of 2 August 2023, an estimated 6,953,743 COVID-19 deaths and 768,983,095 confirmed cases of COVID-19 had been reported to WHO.
By Michael Gwarisa
While the risk of COVID-19 has subsided, and the rest of the world seems to be moving forward, Africa is experiencing a new wave of infections and in some cases, for diseases the continent had eliminated several decades ago. Though some of these illnesses are vaccine-preventable and curable, the disruption of health services during the COVID-19 period resulted in several diseases being relegated, while the focus was given to treating and managing COVID-19.
Barely 12 months after the African continent was declared indigenous wild poliovirus-free, the virus resurfaced in a township in Lilongwe, Malawi, a country in the Southern Part of the African continent. On 20 September 2022, Uganda declared an Ebola disease outbreak caused by the Sudan Ebola virus species, after the confirmation of a case in Mubende district in the central part of the country. In Zimbabwe, a Measles Outbreak raged across the country’s 10 provinces in 2022, killing approximately 750 children, according to data released by Amnesty International Zimbabwe.
At the 2023 the Africa Centre for Disease Control’s annual International Conference on Public Health in Africa (CPHIA) to be held in Zambia from 27-30 November 2023 in Lusaka, Zambia, Epidemiology, Diagnostics and Clinical Management of Emerging and Re-emerging High Consequence Infectious Diseases (HCID) is one of the nine tracks to be discussed at the conference.
Speaking in a virtual interview with HealthTimes, Dr. Thomas Nyirenda, a Public Health Physician and Medical Researcher who is also billed to speak at the CPHIA 2023, said while attention should be given to novel and emerging infectious diseases, Africa should not ignore existing infections, whose burden is already weighing down the continent’s capacity to deal with diseases.
Re-emerging disease and NTDs on the African Continent
Dr Nyirenda said the continent is also still ravaged by what he termed the “Big Three” diseases namely Tuberculosis (TB), HIV, and Malaria.
“I would call them re-emerging because they are just endemic diseases, meaning they are always with us. These are diseases that have ravaged the continent for many decades and some kind of look like they are not going to be a problem anymore, and then they resurface. I don’t want to mislead people that they are new diseases and then we have to forget about the old ones. The picture just shows an up-and-down fluctuation trend.
“For TB, we have 10 million new cases in the world and for that disease, 25 percent of the global numbers come from Africa. That’s about 2.5 Million cases come from Africa, and most of the deaths that we record out of TB are also from Africa. Coming to HIV, of the 34 Million HIV cases that WHO tells us exist in the world, 70 percent of those cases are from Africa and 95 percent of the deaths around HIV are also from African HIV patients,” said Dr Nyirenda.
In terms of Malaria, he said about 250 Million cases of Malaria are recorded globally and 95 percent of those cases and 95 percent of the deaths also come from the same continent.
“Over and above these, we also have what are called other Neglected infections, these include sleeping sickness, Bilharzia, Snake Bites, Diahoreas, and many others. These are also a problem. The world says they see 600 Million of these diseases around the world every year and 14 percent are found here in Africa.”
Debunking the Myth of Emerging Diseases
While the general belief is that the infectious diseases devastating the world today are new, Dr Nyirenda says these old diseases presenting themselves as new threats.
“Then we have what we mistakenly call emerging diseases because these diseases have been with us already, so they mingle with the diseases that I have talked about.
“We have Ebola, which we have to be always on the lookout for, then we have the other haemorrhagic virus diseases that are cousins to Ebola like Marburg, Chikungunya and luck enough, Yellow Fever, although it is in that category, is not really a problem, but in some parts of Africa, people still experience Yellow Fever and bleed from everywhere and they also die. Those are mistakenly called emerging disease but they have been always with us.”
He also cautioned on the link between Climate Change and epidemics which he says could have a devastating effect on the continent’s healthcare if it goes unchecked
“You may have heard recently that some countries like Malawi and parts of Mozambique, because of flooding and Cyclones, they also have had an emergence of Cholera epidemics. Large numbers of cases and large numbers of deaths were recorded. That is my rational. We need to call these diseases endemic diseases and not emerging diseases,” said Dr Nyirenda.
Antimicrobial Resistance on African Continent
The bigger the diseases burden on the African Continent, the greater the demand for treatment and medications to treat the diseases. However, the unabated use of Antibiotics to treat certain conditions threaten to derail Africa’s progress.
“Indeed AMR is our next threat on the continent,” said Dr Nyirenda, “Other people can argue that we have effective drugs against HIV or against TB, Malaria or NTDs but what we are seeing now is that we have this AMR, meaning that the health prescribers do their best according to how they are trained to prescribe the medicines, but we are seeing that when the patients are given the treatment, the medications don’t get cured, they don’t kill those bacteria they don’t kill those viruses.
“Globally, close to 1 Million, that is 700,000 or more people die because of this AMR and the figures in Africa where they have been collected show a rate of 24 cases per 100,000 patients treated will have failed their treatment.”
While the blame may lie on the prescribers or patients who self-medicate, Dr Nyirenda said there is also a growing problem of poor quality, substandard and fake Antibiotics and drugs circulating on continent and Medicines Regulatory authorities should move swiftly to curb the mal-practice.
He said there is need to dig deep into the reasons behind the rise in AMR on the continent and the CPHIA conference should discuss at length this subject of AMR. He also said Africa needs to do more work to get hospital and population data to ascertain the actual burden of AMR in Africa.
The state of Disease Surveillance and Control in Africa
To curb the growing burden of remerging diseases and new threats to Africa’s healthcare such as AMR and Climate change, Dr Nyirenda said structural challenges were retarding Africa’s disease tracking and surveillance capacity.
“Diseases surveillance is something that many countries practice, although not effectively because of challenges at that level. Many countries will have departments that is looking at surveillance of ongoing infections and those that are re-emerging. We have also support from the African CDC supporting regional centres to strengthen them in this aspect and the WHO African region also works with all the countries, and in each of the country, they will be an officer specifically assigned for issues of surveillance to work with the ministries of health and partners affectivity in countries.
“The surveillance weaknesses on the African continent however are the structural support issues that when you go from one country to another, the diseases surveillance network starts to change in terms of strength and shape because of economic challenges and that they are also emerging priorities that overshadow what the diseases control programs are doing. For example when we had COVID-19, everything stopped, other diseases suffered because the focus was on COVID-19,” he said adding that post COVID-19, there is need to reassess how well the continent is doing since capacity has suffered a setback and there is need to see how best to regain the continent’s diseases surveillance capacity.
Artificial Intelligence and diseases Surveillance and control in Africa
Dr. Nyirenda said even though Africa has its own challenges regarding disease surveillance and control, the continent was on track but just needs the right support in terms of resources, commitment and also in using Morden technologies and Artificial Intelligence (AI).
“We need to start thinking about how we can deploy AI in our health systems and not keep data on paper files but go electronic. Even when our health workers in the villages and rural areas are picking up these diseases, they can report them through an Application or mobile phone to the Ministries of Health and then ministries can respond accordingly. We need to start thinking strongly on how to use AI.”
He added that AI was not as sophisticated and threatening as it sounds and the healthcare sector on the continent should not shy away from moving with the times.
“AI is not rocket science. It is machine learning and if you look closely, it is already happening. We have disease control programs that are monitoring treatment on patients that have been given drugs and there are now in the community. This is being done through the SMS platform. They know that the patient has now opened the pill and the chip sends a message to the server and the health facility knows that the patient has taken the drug and if notm they will take action. AI is already happening but needs to be expanded. It should not be a project but should be country programs,” Said Dr Nyirenda.
He said Africa has already started and embraced the AI evolution but just needs good investment so as to have usable good technologies, and effective technologies that suit Africa’s investment level and level of advancements that can help address the health challenges. He also called on African countries to speed up the adoption of Telemedicine to enable the treatment of diseases expeditiously at community level without the patient having to travel long distances to get care.
He concluded by saying there is no way Africa can win the fight against re-emerging and existing disease as long as the continent is divided.
“The best way for the African continent to coordinate will be to first of all for policy makers and leaders to strengthen the Africa CDC. Once that has happened, we will have firstly the leadership that countries require. For all 55 states, we really need good leadership for connected and collaborative surveillance. Without good leadership, other countries will be doing what they think is important or feasible to them.
“The second step is then to create this network very strongly so that there is quick sharing of information. This is what we learnt from COVID-19. If there wasn’t so much threat that created the network that we require, we would be at the same level where we said we have never done it so how are we going to do it. Now we know that it is possible to diagnose diseases overnight, send data to central point and get publicised on Television the next morning. We should do the same for Cholera and all other epidemics that are in our midst. That connectivity is required. With a strengthened Africa CDC, you can start now strengthen these connection roots.”
Once that is done, Dr Nyirenda said there needs to be collaboration on what effective response should be taken. He also said there is need to strengthen the genomic sequencing at continental level as well as share epidemiological data on the continent in order to address the growing disease burden on the continent.