COVID-19 lessons from Africa for the world

Hayley Andersen, The Independent

The arrival of COVID-19 vaccines has fuelled hopes that the pandemic will be brought under control in 2021. Yet, as daily cases surge around the world, governments still need to reduce the spread of infections.

The World Health Organisation says that to stop the chain of transmission, countries need an effective “test, trace and isolate” strategy, with deliberate testing to identify positive cases, tracing all contacts of positive cases and isolating those who are infected, as well as quarantining their contacts.

The UK has struggled to implement a successful contact-tracing strategy throughout the pandemic, significantly impacting the country’s ability to control the spread of the virus. Since its inception in May, the contact-tracing system – a combination of app and central test-and-trace teams – has failed to warn over 723,000 contacts of possible exposure and the need to quarantine, nor has it provided sufficient incentives for individuals to do so, conceivably implicating millions of cases.

The central system reaches on average just 60 per cent of contacts, well below the 80 per cent needed to be effective, and has been hindered by testing delays. Meanwhile, local public health teams, which were given authority to trace outbreaks in settings such as schools and care homes, consistently reach over 95 per cent of contacts, prompting calls for the government to ditch the national mobile service in favour of locally-run person-to-person regimes.

The Tony Blair Institute (TBI) has analysed what African countries got right. Unlike the UK, many nations were prepared and acted fast. Countries like Senegal, South Africa and Nigeria were already familiar with best practices for contact tracing, having recently responded to other communicable disease outbreaks. Our analysis of the Oxford COVID-19 Government Response Tracker data suggests that a majority of Sub-Saharan African countries introduced a contact-tracing policy within two days of their first cases or earlier.

African systems used manual, person-to-person outreach. Senegal set up manual contact-tracing teams led by local staff back in March, which helped flatten its initial curve in early July. This approach is supported by research from the UK’s Centre for the Mathematical Modelling of Infectious Diseases which found that, despite the global trend toward digital contact-tracing apps, an app-based strategy reduced COVID-19 transmission by 44 per cent (based on the assumption that 53 per cent of the population uses the app), while manual contact-tracing strategy reduced transmission by 61 per cent. African countries with particularly effective contact tracing strategies have often used both, especially as cases surge and resources become constrained, but person-to-person tracing is critical to chasing down the chain of transmission.

African countries’ contact tracing also relies on community health workers and volunteers, who can develop the trust necessary to persuade people to share personal information about their health, where they have been and their contacts. In March, South Africa dispatched nearly 30,000 community health workers to undertake manual door-to-door screening, testing and tracing in the most vulnerable areas, later augmenting this with a smartphone app. Although South Africa accounts for over 50 per cent of total confirmed cases in Sub-Saharan Africa, experts say this helped curb early exponential growth, enabling its health system, though strained, to cope and reducing the overall burden of disease.

Contact tracing can also be more effective when designed with central expertise but implemented locally. After finding that state-level execution was hindering tracing efforts, Nigeria’s Lagos State handed implementation to local government and ward levels, leading to faster tracing and an increase in case detection.

Supervision of quarantined contacts, another key feature of many African countries’ tracing programmes, stops contacts violating quarantine and inadvertently infecting others if they become positive. Nigeria’s procedures say high risk contacts (who had direct physical contact with a positive or probable case) must self-isolate at home or quarantine at a state-designated facility for 14 days where they are monitored by a health team which reviews daily temperature logs and conducts at least three physical visits. Contacts who had no direct contact with a confirmed case self-isolate at home for 14 days, supervised via phone calls.

The pandemic is not over. Without effective tracing strategies, including incentives for traced individuals to isolate, financial or otherwise, combined with frequent and mass testing, governments will struggle to control the spread of infections.

As cases surge around the world, there is still time for the UK – and other countries in the global north – to learn lessons from Africa, especially as they seek to loosen restrictions on movement and safely reopen their economies.