Prof. Salim S. Abdool Karim, is a South African clinical infectious diseases epidemiologist widely celebrated for scientific and leadership contributions in AIDS and COVID-19. He is Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA). He is a member of the Science Council of the World Health Organisation (WHO) and the WHO TB-HIV Task Force.  He is the Chair of the WHO’s Strategic and Technical Advisory Committee on HIV and Hepatitis. He is a Member of the Africa Task Force for Coronavirus, the African Union Commission on COVID-19 and the Lancet Commission on COVID-19. He talked to New Vision about Africa’s and Uganda’s COVID-19 response

How do you assess Africa’s response to COVID-19 especially East Africa countries?

The outstanding feature that has characterized Africa’s response has been the quick decision making that led to a very early response in much of southern and eastern Africa. We saw the closing of borders, lockdowns, reduction of movements and then, slowly easing those restrictions as the virus spread was reduced. There were also a mixed set of reactions in some countries where the responses were poor like in Tanzania and Burundi. Elsewhere, it has been well developed. We have seen how countries have been proactive in ensuring oxygen supply, adequate health systems that information dissemination. So, we have seen the good and the bad in the last 2 years.

Any area of concern?

The greatest right now is that we have not been successful in ensuring an adequate supply of vaccines. This is just part of a global inequity where rich countries have secured most of the vaccines leaving too little available for Africa. We’ve got to do better; to find a way to ensure we can secure vaccines, we challenge global vaccine inequity and, ultimately, lay the foundation to make vaccines in Africa. We are actually doing that through the African Centre for Disease Control.

How do you rate East African countries?

I think overall East African countries have generally not had as bad a pandemic impact as we have seen in other countries like Brazil or India. We have seen how these countries have been devastated by the delta and the gamma viruses respectively. Both spread quite rapidly and put pressure on the hospitals, oxygen supplies and the whole infrastructure. Supplies ran short and we saw the devastation. We have not seen that kind of pressure in East Africa. There have been just small short periods of COVID-19 surges but not long-lived. Coping has generally been better; we are not sure why the pandemic has not been as worse as was predicted. But there are many things we do not fully understand about this virus.

That said, I think East Africa has done reasonably well overall. I look at the overall trends in each of the waves, the cases and how they came down quite rapidly. We have seen nice long periods of low transmission in the countries of eastern Africa. So that is good because it means that we are not seeing too many outbreaks. It also all means that some of our social and public health measures are working. They are keeping the virus at bay.

What could we have been done better?

There are many things. One of them is we needed much stronger links with the African CDC. We needed to be able to drop upon the entire continent response to ensure that each country is well aligned. You can’t sort out COVID-19 in a piecemeal fashion. You have to have a well-coordinated approach. This is a pandemic that affects everyone and the only way you deal with it is you cooperate with every country so that we don’t end up with pockets where interventions are working and pockets where it is not working. So, for me that is where we will need to do better the next time. We created the opportunity for both scientists and public health officials to interact with each other on an ongoing basis so that each is aware of how the others are thinking about the COVID-19 response so we get better sanity and better response.

What successes do we need to learn from each other?

There are 3 key lessons we can take from the way the pandemic has impacted southern and eastern Africa. The first has been the importance of good leadership and trust in government. Where the public has had a higher level of trust in government, we have generally seen a better response. There, we have seen people follow the rules, whether it is social distancing or mask-wearing. We have seen more compliance and less impact of the epidemic.

The second is how very difficult it is to secure essential commodities for the response during the pandemic. Back in April last year, we just couldn’t get diagnostic tests. The few that were available were bought by the rich countries. And so, when we tried to buy - because we buy small quantities, we were not successful. So, it became important to pull our resources and increase buying power and that was done in the African CDC’s combined purchasing platform. CDC took orders from several countries and put them together so that we could place one big order as a block. Buying in bulk also got us better prices. That was a big lesson that if we cooperated and pulled our resources, we would be stronger than trying to do this alone and competing against one another.

And then finally the 3^rd for me is the importance of being prepared. You really cannot go into a pandemic like this without ensuring that you have a well-developed capacity in laboratory, surveillance, medicines referral system, isolation systems etc. And to ensure that you know what is going on, the data you have must be accurate because your scientific decision making requires evidence.

What African challenges where exposed by the COVID-19 pandemic which need urgent attention?

So many. I think for one, we had very little understanding of the mental health impact of the pandemic. The isolation, the anxiety and the trauma of the many deaths that were occurring. And to deal with all that has created a whole lot of challenges in terms of mental health that we are going to be dealing with for quite a long time. We are also dealing with other challenges like the way our inequity was exposed. For example, if you lived in an urban setting or in a school that was able to transition quickly to online teaching, then those who had internet access, those who lived in homes where internet linkage was available and data access was available, they continued with their school learning. However, in many of our schools and communities in Africa, internet is not cheap or readily available. So, in those settings, kids are falling behind. And as a result, we have a situation of them and us, we have a situation of those who are benefiting from data and those who are losing out because of data. So, this distinction between the haves and have nots has really become much more sharply defined in the COVID-19 pandemic.

So, what other lessons can we make from the COVID-19 response that can make us ready for another pandemic?

One is the importance of good leadership and the importance of trusting government. But I will just add two things: the first is when dealing with a new disease that you do not know very well, you really need your scientists to help you in those critical times of very high uncertainty. It is not like they know something miraculous about the future, no, they don’t. But they just have better knowledge and understanding of viruses and highly infectious diseases. So they can provide sound advice to guide policy action. You really need to have a good relationship and nexus between scientists and the government, because the government is going to need scientists for advice and the scientists need government for support.

Is there anything else you want to tell Ugandans?

Sure. I will just end on a note that none of us knows what is going to happen next. But using some of the basic elements of science, we can map out the likely scenarios in the future. And if I was a betting man, I would put my money on the fact that Africa is going to present an enormous challenge to the world, especially eastern Africa because there has been a low vaccine coverage of below 5%. So, as we think about the future of this virus, we can expect a bigger challenge in terms of waves of infection. We should prepare for that should by ensuring that we focus on combination prevention. There is no one solution that fixes this problem. We need a combination; that is vaccines, public health measures, ensuring that we communicate and encouraging behavioural change to minimize the risk of infection.