May 22, 2020

WINNIE BYANYIMA: We will not defeat Covid-19 without including Africa in global response


Winnie Byanyima, UNAIDS Executive Director

In much of the global Covid-19 conversation, Africa is barely mentioned. But the risks which the respiratory crisis brings are even greater in Africa than elsewhere – and those risks will be compounded if Africa is marginalised in the global response. Beating Covid-19 in Africa, in turn, is essential for beating it worldwide.

African leadership and global solidarity are both essential to overcoming the Covid-19 crisis in Africa, and Africa’s citizens demand nothing less. Economic and social determinants of ill health are strong predictors of the likelihood of dying from Covid-19.

The greatest risk will be for poor people in poor countries who have a much higher burden of existing illness. While Africa has vital experience of managing epidemics, it also has health systems that are largely under-resourced, often inaccessible to the poor, and not up to the job of beating Covid-19.

Beating back Covid-19 in Africa is possible, but not under business-as-usual. We need to accelerate access to testing; ensure equal access to equipment to protect frontline medical workers and treat the sick; ensure that health systems are adequately funded; agree globally that any Covid-19 vaccine is free for all; and ensure that the social and economic impacts of the Covid-19 crisis are mitigated through large-scale social protection measures and sustainable economic development which reduces inequality.

The African Union, through its Africa Centres for Disease Control and Prevention, is taking a strong lead in the response to the epidemic. It has created a new partnership as part of the Africa Joint Continental Strategy for the Covid-19 response, the Partnership to Accelerate Covid-19 Testing (Pact), which has been fully endorsed by the Bureau of African Union Heads of State and Governments.

UNAIDS is proud to be the first to sign up for this partnership, which aims to close the gap in testing by supporting the efforts of African countries to rapidly scale up their capacity to test and trace. As we have seen in other regions of the world, this is crucial to reduce the number of infections and deaths.

PACT also calls for the rapid establishment of an Africa CDC-led system for pool procurement of diagnostics and other Covid-19-related response commodities. The good news is that countries are stepping up: at the beginning of May, South Africa had conducted more than 300,000 tests, with Ghana on more than 100,000.

They have done so in part by leveraging the exiting HIV-testing infrastructure, and other countries such as Nigeria plan to follow suit. But Africa CDC estimates that Africa needs 10 million tests to respond to the pandemic in the next four months.

In addition, the World Health Organisation estimates that 100 million facemasks and gloves, and up to 25 million respirators, will need to be shipped to Africa every month to respond effectively to Covid-19, at a time when there is a global scramble for supplies.

Production of test kits and essential medical supplies must be ramped up and there must be globally coordinated efforts to get the tests and personal protective equipment to the places and people most in need: in Africa that means to our high-density population townships and to frontline medical staff and community health workers.

We also need to leverage existing HIV services to boost Covid-19 testing, isolation, contact tracing and treatment capacities. Now more than ever, African countries need to prioritise investment in essential services.

This must include a real commitment to tackle massive corporate tax evasion and ensure that those with the broadest shoulders pay the most tax, including an end to corporate tax exemptions. Africa needs global solidarity to fund a multi-billion-dollar response that includes low and middle-income countries in Africa and the rest of the world.

This includes fully funding the UN $2b Covid-19 Global Humanitarian Response Plan as well as providing grants to support the abolition of user fees for health services. This pandemic has shown that it is in everyone’s interest that people who feel unwell should not check their pocket before they seek help.

As the struggle to control coronavirus rages on, the case to end-user fees in health immediately has become overwhelming. International financial institutions and private financial actors need to both extend and go beyond the temporary debt suspensions that have recently been announced – Africa’s debt is about 60 per cent of the continent’s gross domestic product which is completely unsustainable.

We must free governments to invest in the response and to strengthen public healthcare provision as a universal right. In responding to Covid-19, we must be on our guard that resources are not diverted from other health threats such as HIV/Aids, tuberculosis or malaria, which are already taking a heavy toll on Africa.

Modelling conducted on behalf of the World Health Organisation and UNAIDS has estimated that if efforts are not made to mitigate and overcome interruptions in health services and supplies during the Covid-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500,000 more deaths from HIV-related illnesses, including from tuberculosis, in sub-Saharan Africa in 2020–2021.

There also needs to be prior international agreement that any vaccines and treatments discovered for Covid-19 will be made available to all countries and be free for all. We must not repeat the experience of the HIV epidemic, where medicines remained beyond reach for too long and millions died. A strong recovery is key to building resilient societies capable of withstanding unexpected event.

Given the interconnectedness between health and livelihoods, countries must strengthen social safety nets to enhance resilience. They should build more sustainable economies, including decent, well-paid jobs for Africa’s young population and recognition for the undervalued and often unpaid care work carried out by women.

If it has taught us anything, this pandemic has shown how interconnected we are as a global community and that, as UN SecretaryGeneral Antonio Guterres has said, the world is only as strong as its weakest health system. Any global response to Covid-19 which marginalises Africa would not only be wrong, but self-defeating too.

Moreover, African citizens cannot stand for it. Even in the exceptional constraints of this pandemic, they have insisted on their rights to healthcare and to social protection. As Africans, we stand with them in refusing to be sent to the back of the Covid-19 queue.


Ms Byanyima, executive director of UNAIDS, co-authored this article with John Nkengasong, director of Africa Centre for Disease Control and Prevention