Table 2. Biomedical, Sociocultural and economic challenges of outbreak control.

CATEGORY	Type of challenge encountered	Consequences on both preparedness and response to COVID-19 pandemic
Biomedical	Limited capacity for epidemiological techniques such as mathematical modeling to guide the decision making in response to the outbreak, particularly in localised settings.	•    Insufficient scientific references to guide the response to the outbreak.
	Insufficient medical infrastructure including laboratory technology, (Example: RT-PCR testing labs)/medical capacity such as ICU services, mechanical ventilators.	•    Inability/reduced capacity to perform the required tests locally •    Delays in availability of test results •    Reduced patient safety that may result in life losses due to unavailability of required medical procedures.
	Shortage of medical supplies and PPE (priority given to COVID-19 medical and research activities)	•    Increased risk of infections among health care workers •    Interruption/delay of non-COVID-19 related research activities.
	Insufficient testing capacity	•    Inability to attain the testing level needed for adequate disease surveillance and control. •    Delayed testing that may result in increased disease spread due to late detection of COVID-19 cases.
	Shortage of medical/research and clinical laboratory personnel and space	•    Overworked medical personnel •    Focused medical attention to COVID-19 delaying non-essential medical services during the pandemic such as the recommended regular medical check-ups and non-life-threatening interventions. •    Interruption or delay of non-COVID-19 related medical/research activities (Example: minor/elective surgeries).
	Lack of local biotech capacity to conduct advanced biomedical research studies such as transmissibility of SARS-CoV-2 in the African climate conditions, antibody-based therapy, or vaccine and treatment research in the African population.	•    Relying on responses from countries that have the capacity to create solutions. •    Unavailability of accurate information relevant to the local context that is important for development of adequate preventive measures.
Sociocultural	Interruption of school programs and unavailability of remote education technology	•    Delays in completion of school programs
	Structure of the markets, social aspect of the population and the culture	•    Difficulties to practice social distancing in the communities
	Science is misunderstood, misinformation about the consequences of the safety recommendations (Some interventions being termed harmful or unethical among some communities. Ex: some have suggested that wearing a mask is detrimental to health due to carbon dioxide poisoning 103, misleading myths and numerous faith-related rumors whereby some religious leaders have spread wrong information that they are able to cure COVID-19 104.)	•    Mistrust of health care systems •    Failure to comply with safety procedures
Economic	Insufficient funds	•    Limited procurement capacity, •    Difficulty to expand existing services or scale up to new available technology.
	Borders closure and reduced frequency of international trade	•    Delay of transport of essential materials that are initially imported (Example shortage of infant vaccines, anesthesia used for minor surgeries or dentistry). •    Increased cost for medical supplies and imported food items •    Unavailability of needed materials locally
	Interrupted supply chain due to market scarcity/ priority given to non- African countries	•    Incapacity to obtain suppliers for the African market even when there are available funds. •    Shortage of frequently used reagents that need to be imported.
	Poor infrastructure, poverty, informal housing and high population density	•    Increased risk to get the infection due to unavailability of essential sanitary services •    Nearly impossible to comply with social distancing •    Hardly able to implement safety measures
	Reduced job security due to lockdown measures	•    Increased unemployment during COVID-19 pandemic •    Loss of income for most of the families who depend on casual labor, informal market that have been severely affected by the lockdown.
	Lockdown resulting in reduced movements between cities, unavailability of public transportation and discontinued non-essential work activities including stopping work for researchers working on non COVID-19 projects	•    Interruption of pre-existing programs (Ex: HIV prevention programs such as PrEP, ART treatment, TB programs, cancer, maternal health care or non-life- threatening surgeries), •    Ironically, the emergence of a new virus has prevented virologists to go to the lab!
	Lack of income due to discontinued earning activities, inability to buy food leading to starvation	•    Countries unplanned mobilization of emergency fund to feed poor families. •    Early ease of the lockdown that may result in new infections •    Re-opening work activities to avoid hunger related deaths.