When COVID-19 hit the country in mid-April, Tanzanian President John Magufuli called for three days of national prayer to seek God’s protection from the scourge. Barely a month later, he claimed victory over the disease and invited tourists to return to the East African nation.
His rush to reopen came despite alarm from the WHO over an almost total lack of information on the spread of the virus in the country of 55 million people, which has one of the region’s weakest healthcare systems.
The shortage of reliable data afflicts many African nations, with some governments reluctant to acknowledge epidemics or to expose their crumbling healthcare systems to outside scrutiny. Other nations simply cannot carry out significant testing because they are so ravaged by poverty and conflict.
Illustration: Tania Chou
Sharing information is vital to tackling the pandemic in Africa — both for planning the response and mobilizing donor funding — public health experts say. As things stand, it is impossible to gauge the full severity of COVID-19 across the continent.
According to the latest data, Africa, with a population of 1.3 billion people, had over 493,000 confirmed COVID-19 cases and 11,600 deaths. By comparison, Latin America, with roughly half the population, had 2.9 million cases and 129,900 deaths.
The official numbers make it seem as though the pandemic has skirted much of Africa, but the real picture is certain to be worse, with WHO special envoy Samba Sow warning on May 25 of a possible “silent epidemic” if testing was not prioritized.
By early July, 4,200 tests per million people had been carried out across the continent, according to Africa Centres for Disease Control and Prevention (CDC) data. That compares with averages of 7,650 in Asia and 74,255 in Europe.
Interviews with dozens of healthcare workers, diplomats and local officials revealed not just a scarcity of reliable testing in most countries, but also the lengths to which some governments have gone to prevent news of infection rates from emerging, even if that meant they missed out on donor funding.
“We cannot help a country against its own will. In some countries, they are having meetings and not inviting us. We are supposed to be the main technical adviser,” WHO program manager for emergency response in Africa Michael Yao said.
Yao declined to single out countries, saying the WHO needed to preserve a working relationship with governments.
Tanzania confirmed its first case of COVID-19 on March 16. On the next day, the government convened a task force to coordinate the response with international partners including the WHO, foreign embassies, donors and aid agencies, multiple sources said.
This body never met again with outsiders, two foreign officials familiar with the situation said, adding that government officials failed to show up to dozens of subsequent COVID-19-related meetings.
“It’s very clear the government does not want any information about the state of COVID in the country,” said one aid official, who asked not to be identified for fear of antagonizing political leaders.
Tanzanian Minister of Health Ummy Mwalimu did not respond to phone calls or e-mailed questions about his nation’s handling of the crisis, while Tanzanian government spokesman Hassan Abbasi has previously denied withholding information about the country’s epidemic.
Tanzania has not published nationwide figures since May 8, when it had recorded 509 cases and 21 deaths. Days earlier, Magufuli dismissed testing kits imported from abroad as faulty, saying on national television that the kits had also returned positive results on samples taken from a goat and a pawpaw fruit.
According to three e-mails sent between May 8 and May 13, the WHO believed it had reached an agreement with the Tanzanian government to let it take part in joint surveillance missions around the country. However, a WHO spokeswoman said these were all canceled on the day they were supposed to start, with no reason given.
Donors have released US$40 million to fund Tanzania’s COVID-19 response, two diplomatic sources involved said. The country’s lack of engagement meant it had missed out on “tens of millions of dollars” more, another official said.
By mid-May, the government decided to ease its lockdown, despite doctors and diplomats saying the outbreak was far from contained. The US embassy in Tanzania warned US citizens on May 13 that hospitals in Dar es Salaam, the country’s largest city, were “overwhelmed,” an assertion denied at the time by the Tanzanian government.
Tanzania’s failure to share information about its outbreak has frustrated its neighbors who fear that gains won through painful lockdowns in their own countries could be jeopardized as Tanzanians cross porous borders.
The WHO organized a call on April 23 with African health ministers to discuss, among other things, a lack of information sharing, Yao said.
He declined to say who was on the call, and Tanzania did not respond to requests for comment as to whether its minister participated.
The UN agency cannot compel cooperation and must tread carefully. When WHO officials expressed concern in late April about a lack of measures to contain COVID-19 in Burundi, the East African nation on May 12 expelled its top representative and three other WHO experts without explanation.
Burundi was one of the first African nations to shut its borders in March, which initially seemed to slow the spread of COVID-19. However, the country saw an uptick in suspected cases after rallies were held in the run-up to its May 20 general elections, a healthcare provider said, speaking on condition of anonymity.
After losing in the election, former Burundian president Pierre Nkurunziza died in early June amid speculation that he had come down with COVID-19. The government said in a statement that he had suffered a heart attack.
Meanwhile, an air ambulance service said it had flown his wife, Denise Bucumi, to Kenya on May 21, but declined to confirm reports in the Kenyan media that she had sought treatment for COVID-19. A family spokesperson declined to comment.
Burundian President Evariste Ndayishimiye has promised measures to tackle the pandemic, including mass testing of people in areas suspected of being epicenters of the outbreak.
Another African nation to fall out with the WHO was Equatorial Guinea. It has not shared figures with the UN agency since May, when its government accused the WHO of inflating its caseload and demanded that it recall its representative. The WHO blamed a “misunderstanding over data” and denied any falsification of figures.
Equatoguinean Deputy Minister of Health Mitoha Ondo’o Ayekaba did not respond to repeated requests for comment on the dispute.
The country has continued to provide periodic updates to the CDC, which puts the number of confirmed cases there at 3,071 with 51 deaths.
While some countries are not willing to share information, others cannot: Their health systems are too broken to carry out any large-scale testing, surveillance or contact tracing.
“Even at the best of times, collecting quality data from countries is not easy because people are stretched thin. Combine that with an emergency, and it becomes very, very difficult,” African CDC director John Nkengasong said.
For example, militants operate across vast swathes of Burkina Faso, Niger and Mali, making it impossible for governments there to establish a nationwide picture of the spread of COVID-19.
As in other countries, a shortage of kits has led Burkina Faso to largely limit the number of tests it conducts to contacts of confirmed cases and people arriving from abroad. This means that there is little data on local transmission, Burkinabe Ministry of Health reports show.
Some countries, like Cameroon and Nigeria, have decentralized testing, but many others have very little capacity outside their capitals, said Franck Ale, an epidemiologist with the international aid group Doctors Without Borders.
The Democratic Republic of the Congo (DR Congo), a nation of 85 million that was already battling Ebola, was quick to suspend international flights and lock down parts of its capital, Kinshasa, when COVID-19 hit in mid-March.
However, it took three months before the Congolese government was able to process tests outside Kinshasa, said Steve Ahuka, a professor at the University of Kinshasa who is a member of the DR Congo’s COVID-19 response committee, citing a lack of laboratories, equipment and personnel. In many areas, it still takes two weeks to get results, Ahuka said.
South Africa, the continent’s most advanced economy, is one of the few to have rolled out mass testing. However, as of June 10, it had a backlog of more than 63,000 unprocessed tests, because global suppliers were unable to meet its demand for laboratory kits, according to the South African Ministry of Health. Its national laboratory service declined to disclose the current backlog.
In the absence of comprehensive testing data in other parts of the world, researchers look to different yardsticks to judge the prevalence of COVID-19, including reviewing the number of deaths that exceed the average for the time of year.
However, even that is not possible in most of Africa because data from previous years are lacking. Only eight countries — Algeria, Cape Verde, Djibouti, Egypt, Mauritius, Namibia, the Seychelles and South Africa — record more than 75 percent of their deaths, according to the UN. Ethiopia records less than 2 percent of its deaths, the Ethiopian Ministry of Health said.
Without information about how severe an outbreak is and what resources are available to cope with it, nations risk lifting lockdowns too soon or maintaining them too long, said Amanda McClelland, senior vice president of US-based non-governmental organization Resolve to Save Lives.
“The big gap for us is really understanding the severity of the outbreak. Without clarity on data, it is very hard to justify the economic pain that shutting down countries causes,” McClelland added.
Additional reporting by Paul Carsten, Camillus Eboh, Hereward Holland, Ryan McNeill, Giulia Paravicini and Alexander Winning
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