The coronavirus pandemic is one of the worst peacetime crises in a century, wreaking economic havoc that could dwarf the Great Depression. Without an integrated global response, all countries, including the United States, are flying blind, ignorant of the ways in which the virus could mutate, possibly become more lethal, and boomerang around the world.
As countries in the Northern Hemisphere begin to ease stay-at-home orders, it’s important to consider that countries in the Southern Hemisphere are in the early stages of the pandemic. If COVID-19 has taught us anything, it is that no country is safe as long as the virus lurks anywhere in the world.
We recently published an action plan for a global response, focusing on Sub-Saharan Africa. The bottom line: We must engage now to respond to the humanitarian need, to limit the spread and genetic drift of the coronavirus, and to protect the incredible gains — and lives saved — that the world has achieved through broader global health investments.
One of the gravest concerns is a hidden, asymptomatic spread of COVID-19 among Africa’s youth population, where the median age is 19.7 (compared to 38.3 in the United States and 43.1 in Europe). The immune pressure caused by widespread infections could lead to mutations in the virus and, potentially, more virulent and deadly second and third waves of the pandemic.
It has happened before. It is believed that the two subsequent waves of the 1918-19 influenza pandemic — which killed at least 50 million people — were the result of mutations of the virus from the first, less deadly wave.
So far, in much of Africa, the virus seems to be spreading relatively slowly. But with the cooler, drier seasons approaching, Sub-Saharan Africa could also see a surge of infections and, potentially, deaths due to the suppressed immune systems common in communities suffering from malnutrition and higher infection rates of HIV, tuberculosis, and malaria. High population density and cultural norms will make social distancing difficult, if not impossible.
Yet, there is good reason to be hopeful. African leadership and ingenuity combined with massive and highly successful global health investments from the United States and others have created strong community-based health systems in many countries that have proved effective in combating Ebola, cholera, yellow fever, and other infections. In fact, South Africa has already mobilized 28,000 people to test and trace COVID-19. Plus, the machines used to test for drug-resistant tuberculosis and HIV are already being used for this virus.
Many African leaders were also quick to close borders and lockdown countries, and there has been strong leadership by heads of state to work together through the African Union and regional structures.
Yet we believe several key policy priorities will be essential in combating the spread and genetic drift of the virus.
African countries need sufficient supplies and resources. As a starting point, this means tests and personal protective equipment for health and community workers to safely conduct tests and care for patients. Oxygen is inexpensive, and it is also life-saving. Isolation units, hospital and intensive care beds, and ventilators are in short supply, and several countries have fewer than 10 ventilators.
International partners should provide commodities and resources and support domestic production to ensure sufficient supplies, as several African countries scale up the production of tests, PPE, oxygen, and low-cost ventilators. During the Ebola crisis, militaries from several countries rapidly built fully equipped field hospitals. They should do it again to prevent existing medical facilities from being overwhelmed during a surge of COVID-19 hospitalizations.
Data and artificial intelligence can and should be used to predict where infections are most likely to spread and disease to progress. It can also be used to alert those who have been exposed and provide summary reports at the local, national, and global levels while protecting privacy. That data will help countries respond more effectively and also help the world prepare what comes next.
Key to all of this is a comprehensive international effort: only a global response can defeat a global pandemic. With its unique capabilities and reach across the developing world, the World Health Organization is essential and must be supported. And all international and multilateral organizations and donor countries must step up and coordinate to ensure an effective global response.
The good news is that on the American front, voters clearly understand the importance of investing overseas with a new poll finding that 4 in 5 Americans believe “assistance to other countries with weaker health systems . . . makes America safer.”
If we act now, we can support countries in sub-Saharan Africa to stem the tide of infections and study the viral dynamics so that they, and the rest of the world, can be prepared for whatever course COVID-19 takes.
Throughout history, we have faced down threats at home and abroad by coming together as a human family. We believe we can emerge from this crisis, stronger, healthier, and more resilient.
Dr. Mark Dybul is a professor at Georgetown University Medical Center and the Joep Lange Chair at the University of Amsterdam. He was the head of the Global Fund to Fight AIDS, Tuberculosis and Malaria and of the US President’s Emergency Plan for AIDS Relief. Dr. Peter Piot is director of the London School of Hygiene & Tropical Medicine and Handa Professor. He was the founding head of UNAIDS.