In an assessment released on Oct 14, 2021, WHO stated that only one in seven COVID-19 infections in Africa are being detected, highlighting the need to expand testing capabilities. At the time of this assessment, about 4 billion COVID-19 tests have been conducted globally, of which only about 73 million were carried out in Africa—a small fraction of the continent's 1·3 billion people.
In Nigeria, Africa's most populous country of 200 million people, only about 3 million tests have been carried out since the beginning of the pandemic. By contrast, the USA, which has about one-third of Africa's population, has administered more than 550 million tests. The UK, with less than 10% of the population of Africa, has administered over 280 million tests.
“More testing means rapid isolation, less transmission, and more lives saved through targeted action”, said Matshidiso Moeti, WHO Regional Director for Africa.
Considering PCR assays cannot be easily rolled out in most settings across Africa, experts including Dr Ngozi Erondu (Georgetown University's O’Neill Institute) described antigen rapid diagnostic tests (RDTs) as a major means of closing Africa's wide COVID-19 testing gap and getting ahead of the pandemic.
“RDTs are the only way to have accessible, reliable, and affordable widespread testing for COVID-19. RDTs help communities to get on top of COVID-19 by providing more data for local decision making”, Erondu said.
Erondu also noted that with increased use of RDTs, African countries could minimise the economic consequences of lockdowns, movement restrictions, and other measures to control community transmission. RDTs can enable local health authorities to make decisions based on the current situation. People who work in public-facing positions, such as doctors, nurses, and hospitality workers, would have more assurance because there would be more testing available to them, she added.
RDTs are not new in Africa. They have allowed expanded access to HIV and malaria testing. For COVID-19, Africa CDC Director John Nkengasong told The Lancet Microbe that RDTs are performing well enough in Africa to justify their expansion to testing international travellers, although WHO is not yet recommending RDTs for international travellers, who are still required to incur the usually high cost of PCR assays.
Thierno Balde, WHO Regional Office for Africa's Regional COVID-19 Deputy Incident Manager, confirmed this decision of the organisation, and told The Lancet Microbe that, instead, test kits should be used for monitoring the spread of the disease in areas where cases have already been detected using a PCR test.
In addition to the major gap in testing, Africa has also vaccinated a low proportion of its population. About 90% of high income-countries have fully vaccinated at least 10% of their population against COVID-19, with some countries having achieved much higher rates of vaccination. Conversely, only 15 African countries have achieved 10% vaccination coverage, most of which have quite small populations and 40% are small islands developing states. “There is still a long way to go to reach the WHO target of fully vaccinating 40% of the population by the end of the year. Shipments are increasing but opaque delivery plans are still the number one nuisance that hold Africa back”, said Richard Mihigo, WHO Regional Office for Africa's Immunization and Vaccines Development Programme Coordinator.
In Senegal, the Government said it is striving to ensure that as many citizens as possible receive the available vaccine doses while it continues to ask for more doses through COVAX, donations, and other sources. “We are trying to vaccinate as many people as possible. We are conducting sensitisation and awareness campaigns in districts to explain how important it is to be vaccinated. Regarding our strategy about vaccination, we try to organise vaccination campaigns as close to the population as possible,” Dr Aly Ngon Tambdou, Deputy Chief Medical Officer at Senegal's Dakar West African Health Region, told The Lancet Microbe.
WHO and Africa CDC are increasingly encouraging other African countries to adopt Senegal's approach and similar ones that aim to bring vaccines closer to the people while also expanding access to testing to provide a clearer picture of the status of the pandemic across the continent, quickly vaccinate as many people as possible, and make it possible for targeted interventions to be implemented.
In spite of the challenges, Moeti noted that countries across the continent are identifying and addressing the difficulties and are deploying relevant local solutions and ideas to successfully respond to the COVID-19 pandemic.
For WHO's assessment see https://www.afro.who.int/news/six-seven-covid-19-infections-go-undetected-africa