In March 2021, the opposition candidate running for the presidency of the Republic of Congo never learned how many people voted for him. On the day of the election, 61-year-old Guy-Brice Parfait Kolélas died aboard a medical transport to France. He had been diagnosed with coronavirus.
Kolélas is one of at least three high-profile African politicians who have died of coronavirus, which also claimed the lives of Abba Kyari, chief of staff to the president of Nigeria, and Jackson Mphikwa Mthembu, a cabinet minister in South Africa. It is widely believed that several other politicians were victims of COVID, although their deaths have been attributed to other causes. State tallies of coronavirus deaths and case numbers in African states are famous for their uncertainty, and, in some cases, for their deliberate obfuscation.
“We have countries in Africa that, as early as May 2020, decided they would no longer report COVID numbers,” says Lawrence Were, an assistant professor of health sciences at Sargent and of global health at the School of Public Health. “The leadership of some countries felt that it was not in their best interests to acknowledge that there were cases of COVID, so you know, if you don’t measure it, it doesn’t exist.”
Were points out that when China, Europe, and the US went into lockdown mode, African countries followed suit. While that did help to contain the virus, African countries couldn’t match those more developed countries’ moves to fund recovery efforts.
This, Were says, highlights the need of healthcare systems in Africa that have the capacity and means to collect and analyze granular data to respond to pandemics. He and a group of pan-African researchers are trying to make that data accessible to all in hopes of slowing the virus’ deadly spread.
Data-Driven Solutions
Were is a lead researcher on the COVID-19 in Africa Data Science Initiative, a team that includes Tom Achoki of the Africa Institute for Health Policy. The group is aggregating as much information as possible about the spread of COVID in Africa and modeling its trajectory, hoping to better understand the economic impact and the capacity of country-level healthcare systems to respond to the pandemic over time. With help from Data Clinic, the pro bono data and tech arm of the financial sciences company Two Sigma, the initiative has developed a dashboard that tracks COVID’s toll on a continent that is poorly prepared to deal with it. The team hopes that the dashboard, which is available in English, Swahili, Arabic, French, and Portuguese, will advance the work of other researchers, and will help local health officials and relief agencies implement necessary protocols, including mask mandates and lockdowns, and eventually, clinical solutions such as vaccines and therapeutics rollouts.
According to Achoki, the dashboard has already been used by the authors of at least 14 key research papers. “Researchers like those can help us develop our models,” he says. And, Were adds, “As we further develop the dashboard, we are hoping to have African governments use the dashboard to create data-driven scenarios that will show how long it is going to take for increased vaccinations to lead to herd immunity.”
History Repeats
Were’s research is driven by more than academic interests. “For me, this comes from a health systems point of view, it comes from a historical point of view, and it also comes from a personal point of view,” he says. “I grew up in Kenya and I saw firsthand the destruction caused by HIV. I saw my schoolteachers get sick and die, and my relatives get sick and die. I don’t want to see that history repeat itself.”
More recently, Were was the lead researcher on a study of health insurance enrollment among HIV positive women in Kenya. When COVID-19 arrived in Africa, he feared that it, like HIV, would overwhelm the continent’s relatively fragile health systems. Now, he says, those fears have played out in several ways, starting with a lack of available testing. What testing was available revealed the disturbing fact that 70 percent of people who tested positive were asymptomatic. “Those people were out there interacting with others,” says Were, “and they had no idea that they were carrying the virus.”
Worse, many of those who did know they carried the virus had little choice but to be out there. Were points out that when China, Europe, and the US went into lockdown mode, African countries followed suit. While that did help to contain the virus, African countries couldn’t match those more developed countries’ moves to fund recovery efforts. “They didn’t have resources to provide unemployment,” says Were. “People had to go back to work. When that happened, we began to see the numbers in Africa going up.”
The problems were compounded by a widespread lack of medical care. “Only the super rich in society get into the few ICU beds that are available,” he says. “And now we are seeing the same thing with vaccines.”
Overcoming Vaccine Inequity
In the United States and Europe, the surprisingly rapid development and rollout of COVID-19 vaccines was made possible by many billions of dollars of public funding, along with strategic partnering of governments and pharmaceutical companies. By late March, according to the New York Times, wealthy and middle-income countries had received about 90 percent of the nearly 400 million vaccines delivered so far, and roughly three-quarters of vaccines had gone to only 10 countries. Africa, with 17 percent of the world’s population, had administered roughly 2 percent of the vaccine doses given globally.
“When we look at what’s going on with vaccinations outside the US and Europe, we see that a lot of the world is depending on those countries to sell them vaccines or donate vaccines,” says Were. “If you don’t have the money to buy vaccines from pharmaceutical companies, and if no one is donating vaccines, you are in kind of a waiting game.”
“It’s a health systems issue,” says Were. “It’s a supply issue on one hand, but also the countries that have been able to get vaccines have not been able to distribute them. Part of that is adverse events from vaccines and the misinformation that stems from that.” Achoki adds that “this has made the vaccine rollout in Africa challenging, hindering efforts to fast-track the process with an eye on herd immunity.”
“We know what public health tools can be used to dampen the spread, but really the only way that we will get to the other side, where we can manage with COVID in our everyday lives, is going to involve vaccines.” —Lawrence Were
Axios, for example, reported that one month after the first shipment of vaccines arrived in the Democratic Republic of Congo, they were still sitting in a warehouse in Kinshasa. And in much of Africa, vaccine distribution is complicated by the need to keep vaccines at super low temperatures until shortly before they are administered. All of which adds up to low expectations for Africa’s vaccine rollout.
“The Africa CDC hopes to get 60 percent of the continent vaccinated by the end of next year,” says Were. “Some countries expect that at best they will have vaccinated one-third of the population by mid-2023.”
Even those modest expectations may have to be adjusted downward. More transmissible and more deadly variants of the virus are already blamed for recent increases in the numbers of cases and deaths. In August, the Africa CDC warned that of the 55 countries they monitor, 23 were reporting fatality rates above the current global average of 2.1 percent.
Were expects, and hopes, that the vaccine rollout information presented on the dashboard will help health officials. Specifically, the dashboard is being designed to identify gaps in vaccine rollout and various health systems levers—including financing, delivery systems, and the healthcare workforce—that can be engaged to optimize and fast-track vaccinations.
“We now have a good understanding of how COVID is spread,” says Were. “We know what public health tools can be used to dampen the spread, but really the only way that we will get to the other side, where we can manage with COVID in our everyday lives, is going to involve vaccines. And I think the greatest contribution of this work is going to be around vaccines.”
Until vaccines become available, he says, the most compelling reason for hope is the African people themselves.
“Africans are very resilient,” he says. “It’s encouraging to see people trying to make things work despite the limitations. It’s good to see people trying to innovate and to carry on with life as close to normal as possible.”