Opening remarks by WHO Regional Director for Africa, Dr Matshidiso Moeti
Honourable Ministers,
Distinguished officials,
Dear colleagues,
A very good afternoon to you and thank you so much for joining us during this very unprecedented period. I know, and I see, that some of you are joining us from home, I myself am at my house.
You really are at the frontlines and leading edge and are demonstrating your leadership – for which I thank you and congratulate you – in addressing and tackling this very challenging situation.
I’d also through you, like to thank the Heads of State, because they themselves have been very proactive and have reacted strongly in putting in place some measures, including multisectoral, high-level task forces to advise them and to monitor and ensure the implementation of the different measures that have been put in place, central of which, is the work you are leading in public health in order to contain the outbreak.
We are all aware of the gravity of the COVID-19 situation at the global level and in our Region, and we are seeing community transmission of this virus, after it arrived later in our Region than in some other places that are now very severely affected. We have seen it expand exponentially, particularly including in some of the countries that are participating in this meeting today.
We have witnessed how countries, who have more resources and stronger health systems than in our Region, are being overwhelmed and the potential that is there for collapsing of their economies. So, at the global level this is having a very profound effect and we are expecting that we will also have very serious situations in our Region.
The purpose of the work that you are doing, which we are supporting, and the purpose of our discussion today, is to see how we can continue to work together to prevent the worst that could happen on the African continent for the people, and also for the economies of the Region.
This pandemic is significantly affecting African lives and livelihoods, and so we need to accelerate our actions.
Virtually every country in the WHO African Region has reported cases and there are now more than 15 000 confirmed cases and 700 people have died of this disease. We are now seeing reported, almost 500 new cases every day.
We observe that cases are starting to spread beyond capital cities, where the virus normally enters from international travel, and there is a need to scale-up preparedness even before the virus arrives in certain districts, and also the response actions beyond major cities into the hinterland of the countries, and linked to this is the need therefore to repurpose some of the staff in the ministries and in the UN agencies as well, to support public health measures beyond capital cities, where ever they are needed.
We are advising those countries who have not had country-wide spread to position already the capacities beyond the capital cities to improve preparedness and be in a better position to contain what may happen.
In some countries, capacity for testing is expanding to provincial laboratories in the public and private sector, and we see this also as an important step to understanding where the virus is, so that it can be contained.
We of course realize that global supply shortages of essential products, like laboratory test kits, are hampering the ability to do this. For example, the GeneXpert technique, linked to the work that you have been doing on tuberculosis. The machines are present beyond the capitals, but we have not been able to access up to now, the cartridges in sufficient numbers, to enable testing at the subnational level to take place.
We are working very hard to expand the availability of critical supplies for testing and we congratulate those countries who have managed to make this happen. This is a very important part of implementing the public health measures to try to contain the outbreak.
At the country level, as far as these essential supplies are concerned – not only test kits and diagnostic equipment, but also personal protective equipment for health workers – our priority is to work with you to continue to estimate the needs and to map the supplies that are coming. We realise that many partners are trying to assist.
At the global level, we are working with UNICEF and the World Food Programme, and with other partners, to do a pooled procurement, so that we are not competing with each other, because the international market to access these items is very difficult at the moment.
We also understand as far as testing is concerned, the need for clarification around the use of rapid diagnostic tests – specifically which ones to use, and when and how to interpret the results for your action – our teams in WHO are working on this. There was guidance recently issued on this, and I’m expecting that our teams at country level have made you aware of this. We are continuing at the global level, to analyse and assess rapid diagnostic tests, so that we can best advise you how to take advantage of and use them.
We are very much encouraging intensified and robust public health measures – the usual measures that you started implementing as soon as this threat arrived in your countries. These are identifying cases through testing and ensuring every suspected case should be isolated or quarantined, even if they have not been tested as is sometimes the situation now that we have these challenges in testing capacity. This would require having places arranged at the national and local levels, and a system so that when clinical signs or symptoms suggest COVID-19, patients are immediately isolated until this can be confirmed. I think this is important for limiting the spread.
Contact tracing is also a priority intervention, even in countries with extensive spread, particularly also in countries where numbers continue to be low.
Contacts should practice physical distancing, either through self-isolation or being quarantined. We encourage monitoring of contacts to ensure adherence to these instructions, as well as quality assurance of the contact tracing. For example, spot checks with contacts, can be very useful to monitor how contact tracing is going.
I’m saying this because we emphasize that identifying cases, testing them, identifying contacts and isolating them are really central interventions that we need to continue at every stage of this outbreak, and it sometimes needs the investment in follow-up capacity, in the people who will go out there and carry out these functions – even in the context of some of the physical distancing measures that have also been put in place in countries.
We also need to look at the data, to understand and analyse the pandemic and also the response and its impacts. The geographic information system technologies that we have used for polio could be very useful if repurposed to help with contact tracing and to better understand trends and key issues of the response. This technology is already available. We are encouraging our WHO representatives to make it available to you for use if it will be helpful in tracing contacts.
I’d just like to emphasize data sharing in line with the International Health Regulations, which is another important area for our collective work in the Region and globally. In some settings, the absence of data is creating a situation where we are unable to advise on what is happening in countries. I’d like to clarify that the data we are requesting be shared with our country teams, should not be shared with names, which can be replaced with unique identifiers, so that we do not know whose case this is, but we are able to assist in analysing the data and helping to guide the interventions.
In addition to the core public health response measures, other essential health services need to be sustained – like immunisation services for children, safe deliveries for mothers, and treatment of diseases like HIV, TB, malaria and indeed, treatment of priority acute diseases to ensure that we do not have an unfortunate, unforeseen impact of increases in other diseases and increased mortality because capacity is very challenged and responding to this outbreak of COVID-19.
Our country and regional teams can support you in ensuring communities continue to have access to these essential services. We recognize that service delivery has to be adapted to the measures of physical distancing that are being put in place. This is a challenge that requires our innovation and our thinking together. We have a team that is developing guidance on how to work in this way, and we will soon share some of these suggestions with you.
In terms of support from WHO and other partners, we would like to point out that some of the measures that have been put in place in countries in order to minimise the transmission of the virus, including international transmission, make it necessary for us to negotiate for humanitarian corridors. Despite the border closures and prohibition of flights, we sometimes need to fly in experts to support the work, and very much the supplies and equipment that are needed to support your responses.
Here we would like to appeal for your help, and I would like to really thank the Ministers who have helped us so far in some countries when we have needed to land airplanes, to bring in supplies or to bring in people. This is a vital part of the work we are going to do together, and I’m asking that we continue to monitor the situation and when needed to get the permissions by the Ministers of Transport under the instructions of Heads of State to allow these flights to land. We will make sure that our landing people and supplies do not aggravate the situation, in terms of minimising the contact with local people and ensuring they are not bringing in the virus through this support.
We are aware in some countries there are challenges around coordinating the partners, and we offer that our WHO country leaders are there to support you in doing this – in knowing who is doing what, in mapping the various actors, in helping to convene them so that you are able to be sure that all the support that is being given, is being done in the most efficient way possible.
I’d like further to thank you for having developed response plans under the strategic response plan that WHO has developed at the global level. We have now uploaded all these plans on the international platform and are following-up to see that they are being funded.
Several partners have indicated that they are making funds available through this platform, including the World Bank, which has made available quite a significant amount of money. For those countries that are eligible, I’d like to point out that at a meeting I attended a short while ago with the Director-General and my fellow regional directors, we were informed that the uptake of the funding is very little compared to the amount they are offering. You will perhaps be aware that they offered to provide 12 billion dollars at the global level through various mechanisms and they are finding that very little of this money has been requested and is being accessed by countries so far. So, we would like to encourage those countries have eligibility, to explore how you can access this money, which is going to support the work you are going to be doing, honourable ministers.
In addition, for example, the Global Fund if offering 5% of their grants and Gavi 10% of their health system strengthening grants to be re-allocated for use in response to the COVID-19 outbreak. I’m certain that my colleagues have informed you and would like to encourage using those funds.
At the same time, I would also like to say that WHO is coordinating some clinical trials of therapeutics, and also working with partners who are working on the discovery of vaccines. We would like very much to encourage our countries in the Region to join the solidarity series of trials that WHO is coordinating, so that we take a scientific and ethical approach to testing therapies that are going to be used in response to this outbreak. This is very important to make sure that the therapies that are discovered are appropriate for African populations and to make sure that we approach the use of therapies in a scientific and ethical manner.
Finally, we have observed the measures, sometimes called lockdowns, that some countries have imposed to slow down the spread of the virus through physical distancing. We know that some countries are starting to consider, after some weeks, loosening and transitioning out of these measures. WHO has issued guidance on some of the factors that need to be taken into account in transitioning out of these measures and we encourage that they be looked at as you are contemplating this.
We find it very important that communities be fully engaged and empowered to take the self-protection and prevention-of-transmission measures, which we know are a challenge in some African settings – where residential areas may be overcrowded and physical distancing is a challenge, or shopping areas make it very difficult for people. So, we consider that dialogue with communities, informing them through their own networks, and at the grassroots level is very important to carry out.
The public health and medical services need to be in place at all levels, and we are ready to support you, together with partners in the UN, to make sure that this continues to be the case.
We would like to work with you to minimize risks in settings in the public and other essential settings of transmission of the virus.
Once local transmission is controlled, we need to have, in transitioning out, systems to manage the importation and re-importation risks, which we have seen in some countries in Asia, for example.
In closing, I would like to thank you once again for your leadership, for the work that you are doing, and for our learning from your interventions at country level. I assure you that my team and I are committed to supporting you, working through our WHO representatives and their teams in countries.
I would like to ask that where you consider it relevant it might be useful to get permission for the WRs to attend some of the high-level sessions to coordinate the response in countries and perhaps to benefit from their advice. I know they are working very closely with the resident coordinators, who have been asked to lead the work of the UN on this and we think it would be helpful sometimes if they were able to advise directly. Of course, I know that you are working very closely on a day-to-day basis with them.
I look very much forward to our discussion, and how we can resolve any problems that you are having, and how we can learn from each other in addressing this very difficult problem.
Thank you very much.