Africa’s response to

the COVID-19 pandemic:

A summary of country reports
January 2020 to December 2021
Africaʼs response to
the COVID-19 pandemic: A
summary of country reports
January 2020 to December 2021

WORLD HEALTH ORGANIZATION

EMERGENCY PREPAREDNESS AND RESPONSE CLUSTER
BRAZZAVILLE – 2022
Africa’s response to the COVID-19 pandemic: A summary of country reports — January 2020 to December 2021

ISBN: 978-929023480-7
© WHO Regional Office for Africa 2022
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Designed in Brazzaville, Republic of Congo

Contents

Acknowledgments VI
Introduction 1
Objective 3
Results: COVID-19 Response by pillar 4

1. Coordination, Planning, Financing and Monitoring 4

2. Risk Communication and Community Engagement (RCCE) 5

3. Surveillance, Outbreak Investigation and Calibration of Public Health Measures 7

4. Points of Entry (POE), International Travel and Transport, and Mass Gatherings 9

5. Laboratories and Diagnostics 10

6. Infection Prevention and Control (IPC) and Protection of the Health Workforce 12

7. Case Management, Clinical Operations and Therapeutics 13

8. Operational Support, Logistics, and Supply Chains 15

9. Strengthening Essential Health Services and Systems 16

10. Vaccination 18

11. Research, Innovation and Evidence 19

Discussion 20
COVID-19: A New Global Health Challenge 20
Africa’s Experience: A Different Epidemiological Picture 21
Strengths in the Africa Country COVID-19 Response 23
Research, Innovation and Production Capacity in Africa 24
Risk Communication and Community Engagement in Pandemic Control 24
The Socio-Economic Effect of Health Emergencies 25
Health Systems Strengthening Approaches to Managing COVID-19 26
and Improving Overall Health Outcomes

Lessons Learnt 26
Recommendations 27
References 28

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | III
List of Figures and Tables

Figure 1: COVID-19 Cases by WHO Regions (Nov 29th 2021) 1

Figure 2: Surveillance and Public Health Measures in Africa 7
Figure 3: COVID-19 Laboratory and Diagnostics Response in African Countries 10
Figure 4: COVID-19 Case Management and Clinical Operations 14
Figure 5: Persons fully vaccinated per 100 18
Figure 6: Vaccination vs immunized population as at Dec 31, 2021 22
Figure 7: Age demographic pyramid in Africa and Europe 23

Table 1: Characteristics of COVID-19, Influenza H1N1 and Ebola Virus 21

Table 2:  Regional COVID-19 Cases and Mortality 21

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | IV
Foreword

COVID-19 Pandemic presented an unprecedented health emergency,

starting in 2019 in Wuhan China, and spreading to the whole world by
2020. It has caused over 5 million deaths within 2 years. WHO is
leading efforts to contain the disease through various recommended
measures implemented. The WHO AFRO regional office has support-
ed countries by sourcing and distributing PPEs, strengthening lab
testing capacity, giving technical support through staff and technical
experts supporting coordination activities across various response
pillars and in COVID-19 guideline development.

Africa learned lessons on the COVID-19 response from the other re-
gions which reported COVID-19 cases earlier. The countries’ response
was based on country-specific COVID-19 response plans. However,
there were strengths and weaknesses in the implementation of these
plans. This report aims to showcase the WHO AFRO Region country
responses to COVID-19, WHO AFRO and WHO Country Office support
to countries; highlighting best practices and challenges to:

– Document best practices to form a starting point for health

emergency response planning to contain any other pandemics
or health emergencies
– Provide evidence to promote learning across countries, within the region, and globally to improve
COVID-19 and other health emergency response
– Illuminate areas where there were gaps in COVID-19 response to build capacity in these areas,
not only for emergency response but also for routine health services
– Highlight key lessons learnt in the COVID-19 response across the WHO AFRO countries
– Give recommendations to improve COVID-19 response

WHO is committed to continued support to the AFRO region countries to ensure a coordinated,
efficient response to the COVID-19 pandemic.

Dr Abdou Salam Gueye

Regional Emergency Director
WHO Regional Office for Africa

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 |V
Acknowledgments

This report would not have been possible without the ove rall le ade rship of Abdou Salam Gue ye and the
inputs of country-specific incident management teams (IMSTs), Ministry of Health officials, WHO country offices in
all 47 countries of the WHO African Region, public health emergency operation centres (PHEOC) together with
those at the regional hubs (Kenya and Senegal) and the regional office, who have provided coordination
and supportive role in bringing the information together. Specifically, Thierno Balde (IMST chair) together with
Miriam Nanyunja and Bailo Amadou Diallo (heads of the Nairobi and Dakar hubs respectively) are specifically
recognized for their coordination and support roles. The technical teams involved were led by Humphrey Karamagi
(Team Lead for the Data, Analytics and Knowledge Management unit) with Benson Droti (Team Lead for the Health
Information Systems unit). Additional colleagues that contributed to the report were from: the Emergency
Preparedness and Response cluster: Tamayi Mlanda, Boniface Otieno Oyugi; the UHC Life Course cluster: Hillary
Kipruto, Asamani James Avoka; and from the office of the Assistant Regional Director: Solyana Kidane, Aminata
Binetou-Wahebine Seydi, Serge Bataliack. The technical team also included independent experts: Janette Karimi
from the Ministry of Health Kenya, Silimane Ngoma based in Burkina Faso.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | VI
Introduction

SARS-CoV-2, the virus that causes COVID-19, was declared a public health emergency of international concern on 30 Janu-
ary 2020 and a pandemic on 11 March 2020. It was first detected in Wuhan, China in November 2019. Most countries were
on high alert and surveillance was heightened at airports and other points of entry.

The principal mode by which people are infected with SARS-CoV-2 is through exposure to respiratory fluids carrying the
infectious virus. Exposure occurs in three principal ways: (1) inhalation of very fine respiratory droplets and aerosol par-
ticles; (2) deposition of respiratory droplets and particles on exposed mucous membranes in the mouth, nose, or eye
by direct splashes and sprays; and (3) touching mucous membranes with hands that have been soiled either directly by
virus-containing respiratory fluids or indirectly by touching surfaces with the virus on them1.

As at 29 November 2021, COVID-19 has caused 259,502,031 infections and 5,183,003 deaths; an average case fatality
rate of 2%2.

Figure 1: COVID-19 Cases by WHO Regions (Nov 29th 2021)

Source: World Health Organization

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 |1
Introduction

The World Health Organization developed the Strategic Preparedness and Response Plan (SRP)
to guide countries on COVID-19 response and prevention. This was focused across 11 pillars, specifically:

1. Coordination, Planning, Financing and Monitoring

2. Risk
 Communication and Community Engagement (RCCE)

3. Surveillance,
 Outbreak Investigation and Calibration of Public Health Measures

4. Points
 of Entry (POE), International Travel and Transport, and Mass Gatherings

5. Laboratories and Diagnostics

6. Infection Prevention and Control (IPC) and Protection of the Health Workforce

7. Case
 Management, Clinical Operations and Therapeutics

8. Operational Support, Logistics, and Supply Chains

9. Strengthening Essential Health Services and Systems

10. Vaccination

11. Research, Innovation and Evidence

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 |2
Objective

This report aims to assess the preparedness and response of the countries in the WHO African region against the SRP
guide as reported by the WHO AFRO Countries. The specific objectives are to:

Summarize the overall response of African countries to the COVID-19 pandemic

across the different pillars, sequentially from the start of the pandemic
(period of January 2020 to December 2021)

Highlight specific country responses and highlight

best practices and / or innovations

Discuss lessons learnt from the COVID-19 pandemic response

Give recommendations for strengthening health emergency response

The 47 countries in the WHO African region responses were compiled using Situation Reports (sitreps) sent to the WHO
Regional Office for Africa (AFRO), based on their COVID-19 response across each pillar. A minimum of two reports were
randomly selected per month to assess the major activities against the SRP summarized per pillar and by quarter from
January 2020 to December 2021.

The Country Summary was then compiled into Microsoft Excel to enable an analysis of the overall response by pillar
across all AFRO countries, examining similarities and differences in the COVID-19 prevention and control measures enact-
ed across countries, progress made in building capacity for containment of the pandemic, innovations and best practices.
The information collected was based on the availability and content of country situation reports. Some country sitreps
did not contain any qualitative data to assess pillar response.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 |3
Results: COVID-19 Response by pillar

1. Coordination, Planning, Financing and Monitoring

Ribbon-cutting ceremony held for the construction of the second phase of the PHEOC in Juba, South Sudan – WHO South Sudan

Country Response

Coordination, planning, financing and monitoring pillars were central to managing all the other pillars. Most countries
activated a joint national COVID-19 task force comprising high-level multi-agency/ministerial officials to guide a coordi-
nated response. This was the case in Botswana, Eritrea, Ghana, Guinea-Bissau, Kenya, Liberia, Malawi, Mauritius,
Namibia, Rwanda, Seychelles, Sierra Leone, South Sudan, Uganda, Tanzania, Zambia and Zimbabwe. A Public
Health Emergency Operations Centre (PHEOC) was activated to coordinate the day-to-day COVID-19 response activities
in each country. The PHEOCs coordinated the development of a costed National COVID-19 Response Plan with technical
support from WHO. PHEOCs were initially established at the national level, but later decentralised with increasing cases
at the sub-national levels. These decentralised structures were established at different time points within countries. Leso-
tho and Nigeria established national and regional PHEOCs at the same time in Q1 2020, whereas sub-national PHEOCs
came into play in Q2 2020 in Guinea-Bissau. In Botswana, public health specialists were deployed to the sub-national
units to help guide coordination of response activities in Q4 2020. Kenya trained sub-national teams and supported the
formation of the sub-national unit PHEOCs in Q4 2020.

Most of the countries in the region reallocated their development budgets to the health sector to fund the COVID-19
prevention and control strategy, which included all pillar activities outlined above. Furthermore, majority of countries
received World Bank and other donor support to meet the financial gap in the COVID-19 response plan, for vaccine fi-
nancing and to support economic mitigation measures to cushion citizens against the effects of lockdown, including
loss of income due to orders to remain at home. Mauritius launched an online platform for people to order supplies for
home delivery. Stringent price controls on essential food (rice, cereals, pulses and pasta) and hygiene commodities like
baby and adult diapers, sanitary towels and washing products were enforced to counteract abuses by sellers. Financial

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 |4
Results: COVID-19 Response by pillar

support was provided by the government to employees of the private sector and the informal sector, through the Wages
Assistance Scheme and the Self-Employed Assistance Scheme respectively, during the curfew order. Gambia introduced
a COVID-19 emergency response nationwide food relief package. In South Africa, around 400 million Rands was allocat-
ed by the government for the Social Relief of Distress (SRD) grant to vulnerable households. Ghana developed a package
for vulnerable persons affected by COVID-19 in designated regions (Ashanti and Greater Accra), and exempted funds were
drawn from the provident fund or personal pension schemes from income tax. Sierra Leone implemented the Quick
Action Economic Response Programme (QAERP) to mitigate the shocks associated with COVID-19, aimed at providing
safety nets to the most vulnerable through cash transfers and food assistance, supporting labour-based public works
and ensuring price stability of essential commodities3. Kenya implemented a 10% tax relief for individuals and corporate
entities, and reduced value-added tax and bank lending rates.

WHO Support

WHO guidance was key in coordinating the COVID-19 response across all countries in the region. The development of the
Strategic Response Plan for the WHO African Region guided countries in the development of their country-specific costed
response plans. The WHO Country Offices coordinated partners to establish national and regional Incident Management
Teams (IMTs) in countries to support governments mount effective COVID-19 response. The WHO country teams provided
technical support to form the PHEOCs even before cases were reported in countries. WHO further supported PHEOCs to
strengthen coordination of all COVID-19 response activities through staff supporting various pillar teams. WHO continues
to support countries to hold Intra Action Review (IAR) meetings to assess COVID-19 response plan progress, successes and
challenges in view of adopting more effective and efficient response mechanisms to contain the pandemic. WHO teams
also led in resource mobilisation and provided countries with catalytic support to fund the pandemic response.

2. Risk Communication and Community Engagement (RCCE)

Country Response

RCCE activities targeted messaging on measures to prevent the spread of COVID-19, including mask-wearing, staying at
home, social distancing and hand-washing. From Q1 2021, the messaging included creating awareness and promoting
COVID-19 vaccine uptake. RCCE activities were initiated from the start of the pandemic, with messages disseminated
through mass media (e.g., television and radio in different languages, mass SMS messaging and billboards), public ad-
dress systems in communities, and messaging through community leaders, religious leaders and trained community
health workers. Call centres were set up in all countries to respond to questions on COVID-19, address rumours and mis-
information, and provide answers to frequently asked questions. IEC materials on COVID-19 prevention measures, symp-
toms, case management, and later vaccination, were produced and disseminated to the public through community and
health facility mechanisms.

Countries used innovative methods to reach specific communities. The Rwanda National Police used drones to spread
awareness messages to remote and densely populated neighborhoods. Ghana used robust RCCE mechanisms focusing
on all gatekeepers, such as Queen mothers (women leaders selected from the royal family of each town/village with
socio-political influence) and businessmen, to promote prevention and control mechanisms. Ghana Health Services en-
tered an agreement with Ghana Premier and Division One Soccer Leagues to utilize their platforms for the propagation of
risk communication messaging on COVID-19, including using COVID-19 branded sportswear, screens in stadia to display
COVID-19-related messages and show COVID-19-related adverts during matches. Community health workers were used
in many countries for COVID-19 prevention messaging. For instance, the Central African Republic trained 600 social
protection agents for door-to-door sensitisation on COVID-19 in Q2 2020. In Chad, community relays were deployed to
promote community messaging. Benin carried out awareness campaigns in high-traffic areas using health brigades. In

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 |5
Results: COVID-19 Response by pillar

South Sudan, COVID-19 messages were disseminated by Blue Bicycle Messengers comprising of youths with bicycles
– each mounted with a megaphone, amplifier, battery and USB drive. They broadcasted recorded messages while also
collecting feedback from communities.

Blue Bicycle Messengers in South Sudan broadcasting recorded messages and collecting feedback from communities – UNDP South Sudan, Kymberly Bays
Source: https://unric.org/en/blue-messenger-bicycles-bring-lifesaving-information-to-south-sudan/

Despite the continuous efforts, many countries highlighted the challenges of non-adherence to COVID-19 prevention
guidelines. For example, Sierra Leone reported inconsistent adherence to COVID-19 prevention measures (use of face
masks and physical distancing) by the majority of the population. In Kenya, laxity in observing public health measures
on COVID-19, particularly during political events and in public transport (overloading) and markets has been observed
across the country. In Uganda, complacency in observing COVID-19 protocols was noted after the 2021 Presidential and
Parliamentary elections.

In Ethiopia, there was low adherence by the public to COVID-19 prevention measures. Lack of adequate resources at
sub-national levels in Zimbabwe affected community engagement activities in the hardest-to-reach areas in the districts;
the country also faced challenges with communities such as Marange sect members who refused to wear masks.

The RCCE messaging was tailored to country contexts and seasons. During holidays in 2020, messages were targeted
at observing IPC protocols throughout the festivities. For example, Senegal trained and communicated on IPC mea-
sures during the Maouloud Islamic holiday in October. Cameroon ran the ‘Christmas without COVID-19’ campaign. Chad
disseminated messaging on vigilance about COVID-19 in the run-up to end-of-year celebrations. Messages on infection
prevention in schools were prepared in advance of school re-opening in 2021. Messages to encourage COVID-19 vaccine
uptake were developed and disseminated before the vaccines reached countries. Benin developed a communication
and social mobilisation strategy for the introduction of the vaccine in Q4 2020. As vaccination began in Q2 2021, a docu-
mentary film was aired on the benefits of vaccination against COVID-19, featuring testimonies from influencers and local
authorities. A Rumor Management Committee was also set up at the community level to manage the infodemic.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 |6
Results: COVID-19 Response by pillar

WHO Support

WHO supported all countries in the region by providing technical support in the development of RCCE messages, IEC
materials, and RCCE plans and strategies. Financial support was given for the translation of the messages into local lan-
guages, as well as printing, disseminating and distributing IEC materials. Additionally, WHO supported the airing of mass
media messages through radio and television.

3. Surveillance, Outbreak Investigation and Calibration of Public Health Measures

Country Response

Most countries reported their first cases of COVID-19 between March and April 2020. The first country in the WHO Afri-
can region to report a case was Nigeria on 28 February 2020, and the last to report was Lesotho on 12 May 2020. Most
countries have faced three waves of COVID-19, with the first wave peaking between June and August 2020. The second
wave peak was observed between December 2020 and February 2021. The third wave was experienced between July and
August 2021. A few countries, such as Angola, Congo, and Kenya, experienced a fourth wave in September 2021. These
countries had faced an earlier third wave in March/April 2021. The emerging patterns across most African countries, across
the 11 aforementioned pillars are summarised below.

Figure 2: Surveillance and Public Health Measures in Africa

Regional Rapid Ongoing IDSR 3 Continued Continued

2020 response teams
established
2020 training from
Q2 2020
2021 emphasis on
prevention
2021 emphasis on
prevention
Q1 Q3 Q1 measures and Q3 measures and
Widespread
social distancing social distancing
environmental
during the 3rd
disinfection
wave due to
Easing of Delta Variant
lockdown /
restriction
measures
Jan–Mar Jul–Sep Jan–Mar Jul–Sep

Surveillance Apr–Jun Regional Rapid Oct–Dec Most countries Apr–Jun Scale up of Oct–Dec
heightened at Response Teams implemented vaccination as
airports and decentralised full school vaccines
points of entry re-opening become more
between Q4 2020 available
National Rapid
and Q1 2021
Response Teams
established Vaccination
begun in most
Most countries in 2020 2020 countries in 2021 2021
lockdown from
March 2020
Q2 Q4 March 2021 Q2 Q4

Surveillance was intensified with POE screening of all passengers arriving from high-risk countries in Q1 of 2020 before the
first cases were reported in Africa. For most countries, once the first case was reported, call centres were established for
reporting suspected cases (alerts) and to give information on where to seek testing and/or treatment services. For most
countries, more than 90% of the alerts were investigated, such as Ethiopia, South Sudan, Uganda and Zimbabwe.

Rapid response teams (RRTs) were immediately established at the national level to respond to alerts, test, isolate con-
firmed cases and carry out contact tracing and monitoring. In Q1 and Q2 2020, most RRTs at the national level were
also sent to the districts to support surveillance and response. By the end of Q2 2020, most countries had established
sub-national RRTs, as more COVID-19 cases were recorded in the districts. This was the case in Burundi, Congo, and
Nigeria. Malawi trained regional RRTs in Q3 2020. Kenya transitioned contact-tracing functions to Nairobi Metropolitan
Services and other counties in Q3 2020. Testing for COVID-19 cases remained mostly among suspected cases, internation-

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 |7
Results: COVID-19 Response by pillar

al travelers and those presenting to health facilities for the management of other conditions. Community-based testing
approaches were used in hotspot areas from Q2 2020, as with the Central African Republic for example, where agents,
district medical officers and contact follow-up agents were trained on community-based surveillance. Ethiopia launched
the enhanced ComBAT strategy with a focus on community-based approaches and mass testing. Burkina Faso deployed
civil society volunteers to conduct COVID-19 community-based contact tracing. Gambia Tourism Security Unit patrol
teams began patrols within the tourism development areas to enforce COVID-19 restrictions. Community-based surveil-
lance was also strengthened to increase awareness and testing rates in the Gambia. However, community testing was
not sustained throughout the review period due to inadequate funding to cater for testing reagents and logistics costs.

The third edition of the Integrated Disease Surveillance and Response (IDSR 3) manual was adopted in 2020 and many
countries trained staff on the IDSR 3, including COVID-19, with WHO Country Office (WCO) support. In Q2 2020, Ghana and
Malawi conducted regional Training of Trainers (ToT) on IDSR 3 Technical Guidelines, and Zambia trained Districts health
teams and health care workers on IDSR. In Q3 2020, Tanzania rolled out IDSR 3 guidelines in the Dodoma region, and
Botswana recruited surveillance officers to support the response in the districts and trained them on IDSR core modules.
In Q4 2020, Namibia conducted regional IDSR, Sierra Leone rolled out IDSR 3 technical guidelines to all 16 districts, and
Uganda validated and adopted IDSR 3 guidelines and training modules. Togo conducted IDSR training in Q2 2021, while
Burundi did so in Q4 2021.

Public Health Measures

Many countries implemented lockdown policies and procedures, which entailed: restriction of internal movements into
or out of endemic zones within the country; restriction of travel in or out of the country; restriction of public transport;
working from home except for essential services staff; banning public gatherings; restricting social gathering numbers;
and use of curfew hours to restrict social gatherings at night. These were imposed at different levels in all countries within
a few days of reporting the first COVID-19 case. Schools were closed and hospitality industry operations were restricted
with the closure of restaurants and service industries like salons and gyms.

COVID-19 prevention messages encouraging social distancing measures, wearing of masks, and handwashing and hy-
giene practices were widely disseminated. Some countries passed laws to penalize failure to wear a mask and non-adher-
ence to social distancing protocols. These measures were compiled as part of the indicators to measure the stringency of
COVID-19 prevention measures, i.e., the stringency index4. The stringency index was highest in all African countries when
the first cases were reported from March to May 2020 but gradually reduced as restrictions were lifted from June/July to
September 2020. This coincided with the first wave of COVID-19 in most African countries due to community spread.

Travel limitations within the countries were relaxed in Q2 2020 but re-enacted in some areas with the first wave surge. Re-
strictions were relaxed in the hospitality industry with the requirement to maintain social distancing and other prevention
measures still in place. Phased re-opening of schools for some countries started in Q3 2020 for students sitting national
level examinations only, as in Kenya, Malawi, Uganda, Zambia and Zimbabwe. For most countries, the full re-opening
of schools was done between the first and third quarters of 2021 with school IPC guidelines issued. Examples include
Eritrea in Q2, Gambia in Q1, Ghana in Q1, Kenya in Q3, Seychelles in Q1 and Sierra Leone in Q3 of 2021. This also
coincided with the third wave of COVID-19 seen between June and August 2021.

WHO Support

WHO Country Offices supported countries financially and technically to scale up surveillance capacity, including support-
ing consultants in surveillance and data management activities, training of RRTs and contact tracers, and the deployment
of surge teams in different states as needed to support the case investigation and initial response. WCOs supported sur-
veillance for influenza-like illness (ILI) and severe acute respiratory infection (SARI) and acute respiratory infection (ARI).

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 |8
Results: COVID-19 Response by pillar

Countries were also supported to conduct IDSR 3 training and mass testing in hotspot areas. Benin WHO Country Office
supported Benin with two data managers focused on surveillance data management, trained central level data managers
on the GO surveillance platform and mobilized 34 tablets for the collection and transfer of data from hospital structures.

Nigeria WCO supported the implementation of the hotspot strategy, including the generation of information products.
The RRTs in Congo Brazzaville and Pointe-Noire were trained by WHO technical officers. In Sierra Leone, WHO provided
technical support in planning and conducted first-surge mass testing for two months in health facilities and communities.
WHO also provided technical support during the training on electronic case-based reporting for ten sentinel sites in West-
ern Area Urban Sierra Leone. WHO supported South Sudan to conduct the first seroprevalence survey, and supported
testing conducted through ILI/SARI/ARI surveillance. Uganda WCO supported health facilities to establish surveillance
committees to enhance surveillance work at the health facility level. WHO Country Offices also provided technical and
financial support for determining appropriate containment measures, developing and printing the guidelines in addition
to information, education and communication (IEC) materials, and disseminating messaging on the same.

4. Points of Entry (POE), International Travel and Transport, and Mass Gatherings

Passenger screening at Maya Maya international airport, Brazzaville, Republic of Congo – WHO, D. Elombat

Country Response

Surveillance was intensified at points of entry, with thermal machines installed for temperature screening and passenger
screening forms filled by all incoming travelers with details of their travel and destination data. POE staff were trained on
screening, testing and contact-tracing measures. Countries closed their airports to commercial flights within days of con-
firmation of the first COVID-19 case, only allowing for cargo flights. Some African countries closed their borders before the
first case was reported, e.g., Angola, Botswana, Burkina Faso, Burundi, Equatorial Guinea, Gabon, Guinea-Bissau,
Malawi, Mali, São Tomé and Príncipe, Sierra Leone. Returnees to most countries were subjected to mandatory quar-
antine for 14 days. Initially, this was institutional quarantine in Q2 2020, but as the cases increased, this transitioned to
home-based self-quarantine in Q3 2020. In Rwanda, surveillance teams used bracelet-enabled trackers to enforce travel
restrictions for inbound travelers required to be on home-based quarantine. Most of the African countries opened their
airports between July and November 2020, as observed in Cameroon, Mauritius and Sierra Leone in July; Burkina
Faso, Côte d’Ivoire, DRC, Kenya, Nigeria, Rwanda and Seychelles in August; Cabo Verde and the Gambia in October;
Botswana and South Africa in November 2020. With the re-opening of flights and land borders, guidelines were issued

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 |9
Results: COVID-19 Response by pillar

requiring all incoming travelers to have a negative Polymerase Chain Reaction (PCR) test done within 48 to 72 hours of
travel, and have a repeat PCR test on arrival. Incoming travelers were required to quarantine for 14 days if COVID-19 posi-
tive, but this was mostly home-based.

WHO Support

WHO provided technical and financial support in developing standard operating procedures (SOPs) for use at POEs,
trained POE staff on COVID-19 preparedness and response and developed travel advisory guidelines for re-opening land
borders and airports. WHO country also worked with countries to foster cross border collaboration on land POEs for
example WCO Sierra Leone provided technical and financial support during the international cross border meeting be-
tween Sierra Leone and Liberia to agree on the implementation of cross border guidelines and also provided technical
support during the POE review meeting for all 8 border districts.

5. Laboratories and Diagnostics

Country Response
Figure 3: COVID-19 Laboratory and Diagnostics Response in African Countries

Scale up of Lab Continued lab Delta Variant Omicron Variant

2020 capacity using
GeneXpert
2020 capacity
expansion
2021 detected in Africa
2021 detected in
South Africa
Q1 Machines Q3 and external Q1 Q3
Quality Assurance
for COVID-19 labs

Jan–Mar Jul–Sep Jan–Mar Jul–Sep

Limited Labs Apr–Jun Begun external Oct–Dec Increase in Apr–Jun Continued Oct–Dec
with PCR Quality Assurance genomic Increase in
capacitv (1–3) for COVID-19 sequencing COVID 19
per country testing labs capacity testing capacity
and training
Trainings on Increase in
COVID-19 COVID19
testing begun Antigen Rapid
Tests capacity
2020 2020 2021 2021
Q2 Q4 Q2 Q4

Most countries initially had one or two laboratories with the capacity to test for COVID-19. These were either the national
public health laboratory or the national medical research or virology laboratory. Some countries, such as Namibia and
Lesotho, could not initially conduct COVID-19 PCR testing and tested the first samples outside the country. Laboratory
testing capacity was scaled up in Q2 2020 through hiring and training of laboratory personnel, procurement of reagents
and testing kits for public health facilities, and inclusion of private health facilities in the COVID-19 PCR lab testing network.

Countries like Comoros, Gabon, Ghana, Kenya, Liberia, Madagascar and Nigeria, with support from WHO and other
partners, further expanded their laboratory capacity for COVID-19 testing by using and scaling up GeneXpert testing5 in
Q2 and Q3 2020. By Q3 2021, Ghana had 23 facilities providing testing for COVID-19 using GeneXpert across all 16 regions.
Rapid antigen tests were introduced in most countries in Q1 and Q2 of 2021, e.g., Comoros, Equatorial Guinea, Na-
mibia, Rwanda, Seychelles and Sierra Leone. Acquisition of mobile laboratories expanded testing capacity to include
community mass testing in Burundi, Kenya, Liberia, Mali, Rwanda, South Sudan and Togo in hotspot areas.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 10
Results: COVID-19 Response by pillar

Most countries conducted External Quality Assurance (EQA) for COVID-19 testing labs in Q3 and Q4 of 2020, including
Botswana, Eritrea, Ghana, South Sudan, Uganda and Zimbabwe, with support from the WHO Country Office. EQA
provided a system for objectively checking the laboratories’ performance using an external agency or facility6 to assess
the quality of tests and results and give assurance that the laboratory can produce reliable results while identifying areas
that require corrective actions to ensure this. The EQA assessments were followed up with support supervision and men-
torship to address gaps noted in the assessment.

Genomic surveillance capacity was available in some African countries in Q1 and Q2 2020, including Botswana, Kenya,
Malawi, Senegal, South Africa and Uganda. WHO supported countries to build their genomic sequencing capacity
through the development of guidelines for genomic sequencing, training of laboratory technologists and procurement of
reagents. Capacity for genomic sequencing was built in other countries like Gabon, Niger and Togo in Q1 and Q2 2021.

Daniel Baah is a data analyst at the Veterinary Services Directorate in Accra, part of which has been repurposed to provide COVID-19 testing services –
WHO / Blink Media, Nana Kofi Acquah

WHO Support

WHO played a major role in building laboratory capacity in many African countries by hiring laboratory technicians and
training lab personnel on COVID-19 testing, biosafety and IPC measures. WHO also provided equipment and reagents for
testing to increase testing capacity, as well as coordinating the EQA in most African countries to ensure reliable COVID-19
results.

Examples of WHO support to countries include Lesotho where WHO installed COVID-19 testing machines and orientated
the laboratory team in the use of the machines in preparation for cases. WHO in Sierra Leone recruited and trained 30
laboratory personnel who were deployed in the airport and other strategic sites to scale up COVID-19 testing capacity. In
Ghana, WHO donated 9,000 GeneXpert cartridges for the operationalization of GeneXpert testing sites. Moreover, WHO
supported Eswatini to expand its capacity for genomic testing.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 11
Results: COVID-19 Response by pillar

6. Infection Prevention and Control (IPC) and Protection of the Health Workforce

Country Response

Infection, prevention and control were targeted toward the general population and health care workers. IPC guidelines
and protocols, such as donning and doffing protocols were developed during Q2 2020 to guide IPC measures for health
care workers at the health facility level. For example, Nigeria developed Guidelines for the Rational Use of Personal Pro-
tective Equipment (PPE) in the care of COVID-19 cases. IPC training for health care workers began in Q2 2020 and contin-
ued throughout the year to ensure compliance. This was conducted majorly through virtual training in Q1 and Q2 2020 for
IPC trainers of trainers, which was then cascaded to health care workers in the health facilities. Follow-up IPC assessments
having mostly taken place in Q2 2020 were conducted to assess compliance to IPC protocols at health facilities using the
WHO IPC scorecard tool.

Seychelles prioritised health care worker safety through infection prevention and control. In Q1 2020, the country de-
veloped a case management and IPC preparedness checklist and carried out IPC assessments in all health care facilities.
From Q2 2020, supervisory visits were conducted using the WHO IPC Scorecard and the quarterly IPC practice audit tool
to support the practice of IPC protocols. Additionally, the country began an assessment of Health Care Worker (HCW)
COVID-19 exposure and infections using the WHO risk assessment tools in Q4 2020. The report was finalised and shared in
Q1 2021, and the findings were used to inform the guidance for minimizing and managing COVID-19 risks for health care
workers which were finalised in Q3 2021. Seychelles also developed the IPC Strategic Framework 2021-2025. In 2021, IPC
training materials were updated to include guidance on IPC when giving COVID-19 vaccines, management of biomedical
waste from immunisation and disinfection of vaccination sites.

IPC guidelines for the general public were also developed by countries. For instance, Tanzania developed guidelines on
the rational use of PPE; Lesotho developed interim guidelines on the use of non-medical masks in public places; Ethio-
pia developed a community-based strategic activity plan to enhance IPC/water, sanitation and hygiene (WASH); Nigeria
produced guidelines on IPC safety at National Youth Service Camps, and Namibia issued guidelines on COVID-19 expo-
sure in public and work environments to the general public in Q3 2020.

A worker produces face masks at the Kitui Textile Industry, Kenya – AFP / Getty Images, Luis Tato

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 12
Results: COVID-19 Response by pillar

At the beginning of the COVID-19 pandemic, there were global shortages in the availability of face masks and other PPE
due to lockdown measures limiting exports from China, increased demand globally with the high number of COVID-19
cases outside Africa7 and long customs clearance processes. Most countries instituted the requirement to wear masks in
public, which necessitated countries to begin local manufacture of face masks using locally available materials to sup-
plement the PPE donations from various partners and foundations. The Central African Republic, Eswatini, Gambia,
Ghana, Kenya, Nigeria, Rwanda and Uganda are some examples of countries that began local manufacture of reusable
cloth masks in Q2 2020 and later moved to produce disposable masks from Q2 and Q3 2020. Ghana, for example, began
production of face masks at highly subsidized prices and produced a million quality-assured face masks, with 11th-grade
students and teachers across the country benefitting from them. At the same time, countries began local production of
alcohol-based hand rubs. By Q1 2021, most African countries had PPEs readily available to the general public at affordable
prices.

WHO Support

WHO provided technical and financial support for the development and printing of IPC guidelines and protocols. Further-
more, WHO supported the development of IPC training materials for health workers that were delivered virtually as well as
during physical regional training. WHO supported Eswatini to develop the IPC action plan and Zimbabwe to finalize and
print the reviewed PPE policy. In Eritrea, WHO provided training and training materials, videos, and interim guidelines to
national and sub-national health facilities to build IPC capacity. In Ghana, WHO AFRO supported weekly virtual IPC train-
ing, and received financial and technical support provided to the Greater Accra Regional Health Directorate for IPC train-
ing. WCO Namibia supported the introduction of two online interactive courses to provide guidance for the management
of ill travelers and the management of COVID-19 cases or outbreaks on boats and ships. WHO AFRO and Country Offices
also led support efforts to countries by providing and distributing PPEs, e.g., Benin, Eswatini, Gabon, Lesotho, Liberia,
Nigeria, Senegal and South Sudan.

7. Case Management, Clinical Operations and Therapeutics

Country Response
Figure 4: COVID-19 Case Management and Clinical Operations

Increase in Continued Continued Continued

2020 number of
isolation and
2020 training and
support
2021 training and
support
2021 training and
support
Q1 treatment Q3 supervision Q1 supervision Q3 supervision
facilities National
Increasing
COVID-19 case
ventilators
management
and oxygen
guidelines
capacity
finalised and
HCWs trained
Jan–Mar Jul–Sep Jan–Mar Jul–Sep

Isolation and Apr–Jun Countries Oct–Dec Countries revised Apr–Jun Continued Oct–Dec
treatment established COVID-19 Case training and
facilities regional Management support
identified and treatment Guidelines as supervision
prepared centres needed
COVID-19 Clinical
Focus on
case management
increasing
protocols
oxygen
developed and 2020 availability 2020 2021 2021
HCWs trained
Q2 Q4 Q2 Q4

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 13
Results: COVID-19 Response by pillar

Countries adopted the WHO case management guidelines and finalised country-specific case management guidelines
and SOPs within Q1 and Q2 2020. There were regular updates to the case management guidelines in line with emerging
evidence and guidance from the WHO. National referral hospitals or university teaching hospitals were identified as the
first isolation and management units in Q1 and Q2 2020. Countries worked towards establishing regional isolation and
treatment centres in Q2 2020. By Q3 2020, most countries had established regional treatment centres, e.g., by Q3 2020,
Eritrea had established COVID-19 isolation treatment centres in all Zobas, in addition to the two in Asmara; Burkina Faso
decentralised the management of COVID-19 to other hospitals; Chad designated Farcha Provincial Hospital and provin-
cial hospitals as COVID-19 treatment centres. Senegal set up treatment centres in each region in Q4 2020 and Comoros
set up mobile medical teams for home follow-up of positive cases in Q1 2021.

The biggest challenge to COVID-19 management was the availability of COVID-19 intensive care unit (ICU) beds, due to
insufficient ventilators and oxygen to manage severe and critical COVID-19 cases. Countries like Rwanda started the pro-
duction of ventilators to meet this gap. Most countries allocated more funds to the health sector to build capacity for ICU
beds and increase oxygen capacity. In Q1 2020, Eswatini expanded oxygen supply through the installation of a generation
plant at The Luke Commission. WHO supported Uganda in Q1 2020 to quantify oxygen requirements and related delivery
accessories’ need for inclusion in the application to the Global Fund to Fight AIDS, Tuberculosis and Malaria for funds ded-
icated to the COVID-19 response. In South Sudan, an oxygen plant including 240 filled oxygen cylinders was constructed
and handed over to the MOH in Q3 2020. 30 units of oxygen concentrators were distributed to various health facilities in
Tanzania in Q3 2020.

Solar powered oxygen concentrator systems are delivered by WHO to Hanaano Hospital in Galmudug state, Somalia – WHO, Ismail Taxta

WHO Support

WHO was key in supporting countries to increase their capacity to manage COVID-19 cases. This included supporting the
development and updating of national guidelines on the management of COVID-19, training healthcare workers on IPC
and case management across all the countries and providing follow-up supportive supervision to healthcare workers.
WHO also supported equipping of the COVID-19 case management centres, for example, WCO Tanzania distributed oxy-
gen concentrators, ventilators and other critical supplies for COVID-19 case management. In some countries like Eswati-
ni, WHO supported the recruitment of staff to support COVID-19 case management.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 14
Results: COVID-19 Response by pillar

8. Operational Support, Logistics, and Supply Chains

Boosting Sierra Leone’s COVID-19 response and disease surveillance with laboratory commodities – WHO Sierra Leone

Country Response

Several countries experienced shortage of PPEs and essential equipment especially in Q1 and Q2 2020 when COVID-19
was first reported in African countries. The shortage was attributed to high global demand for PPEs, travel restrictions,
lockdowns and country-specific challenges, which limited importation at the beginning of the pandemic. In many coun-
tries, the available PPEs were deployed to all POEs facilities, national lab networks and hospitals. Several independent
initiations and interactions were undertaken to tackle this issue, including donations and re-distribution of materials
where they are most needed. For instance, donations from Jack Ma and the China Government included COVID-19 test
kits, PPEs like masks, face shields, gloves, sanitisers and equipment like ventilators, respirators with accessories, and ox-
ygen generators to Botswana, Guinea-Bissau, Guinea, Gambia, Mauritius, Chad, Namibia, and Tanzania. WHO and
UN agencies’ support was also critical with examples of WHO, WFP, WHO, UNDP and UNICEF providing Guinea-Bissau
and Zimbabwe support for telephone and internet connectivity, transport and fleet management including fuel in Q 2
of 2020. Moreover, Uganda, Tanzania, Congo, Nigeria, Gabon, Guinea, Burkina Faso, Lesotho, South Sudan, Benin,
Comoros, Madagascar and Togo, Senegal, South Sudan received hand wash, sanitisers and donations of PPEs, masks,
gloves from WHO, WFP and UNICEF. In addition to PPEs, Senegal received 30 ventilators from the WHO office. Private or-
ganizations in-country also contributed to the COVID-19 response through donating PPEs directly or through contribution
to existing COVID-19 funds.

By Q2 and Q3 of 2020, most African countries had made strides toward organizing and strengthening procurement mech-
anisms to acquire COVID-19 PPEs and other required materials. Governments were able to quantify their COVID-19 needs,
procure and distribute these commodities to the peripheral facilities. Seychelles logistics pillar developed tools to proj-
ect required PPE in Q2 of 2020 with the support of the World Customs Organization (WCO). This enabled centralized
COVID-19 supplies ordering through government procurement in Q3 2020. Liberia in Q2 2020 equipped and reinforced
the national security stock of drugs, medical equipment and PPE. Malawi prepared and submitted their procurement
plan for Covid-19 to WB for support in Q3 2020. In Q2 2020, Benin activated the Logistics Sub-Committee, which in-return
established the COVID-19 stocks status and carried out the needs quantification for 6 months (June-Nov 2020). By Q4
2021, data on COVID-19 stock status in Benin was available at all levels, enabling real-time adjustment of orders. Burundi
instituted a functional emergency purchasing platform in Q2 2020 hence enabling an efficient supply of drugs, personal

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 15
Results: COVID-19 Response by pillar

protective equipment, reagents and consumables to the districts. In Q1 2021, South Sudan finalized the Procurement
plan of over 14 million PPE valued at USD 5 million and submitted it to the South Sudan Humanitarian Fund. In Q1 2021,
Comoros strengthened customs collections, transport, warehousing and inventory management for COVID-19 supplies.
Equatorial Guinea carried out training for transfer of skills for logistical management of the storage warehouse of drugs
and medical materials in Q2 2021.

WHO Support

WHO gave logistical support to all 47 countries. WHO worked with Eswatini, Ethiopia, Gambia, Kenya, Lesotho, Ni-
geria and South Sudan to develop distribution plans and providing vehicles to distribute COVID-19 supplies and charted
a special aircraft in Comoros to move teams and equipment to Mwali Island to support the COVID-19 response. Uganda
WCO supported the procurement of laboratory supplies through the Uganda Virus Research Institute (UVRI) procurement
channel and gave technical support for the quantification of oxygen and related delivery accessories for inclusion in the
Global Fund application for COVID-19 response. WHO provided technical support to enable countries to develop and
strengthen their emergency supply needs quantification, procurement and distribution as outlined in the other sections.

9. Strengthening Essential Health Services and Systems

Country Response

With the reporting of COVID-19 cases, health services were disrupted due to fear of SARS-CoV-2 infection while in health
facilities. Disruption was also caused by the implementation of lockdown travel restrictions. A decrease in utilisation of
health services was observed and WHO guided to ensure continuity of essential health services (CEHS) while still tackling
the pandemic. As part of the response, African countries established mechanisms to ensure no or minimal disruption of
essential health services. Eritrea reinforced messages on the continuity of immunisation services at health facilities in
all Zobas. Community outreach activities on immunisation were emphasised and an android application was designed
for use by CHWs and schools to promote continuity of services. As a result of the focus on continued child immunisation,
routine immunisation coverage in Eritrea in 2020 was 14% higher than in 2019 despite COVID-198. Eswatini conducted a
measles-rubella catch-up campaign with coverage of more than 80%. Eswatini guidelines on CEHS were disseminated,
and HCWs were sensitised. Ethiopia received USD 50,000 funds from WHO (as catalytic support) to regions and districts
to support the continuity of essential child health services with immunisation as the entry point. The country disseminat-
ed messages to encourage community continuity of immunisation services. Programme coordinators from the Oromia
region were trained on CEHS and conducted vaccination drives. Oral Polio vaccination campaigns were integrated with
WASH activities and mobile health and nutrition teams were assigned to cover woredas. Liberia’s MOH also received cat-
alytic funding of USD 50,000 from WHO AFRO to strengthen the continuity of essential health services, including adapting
the CEHS guidelines, in addition to monitoring and evaluation (M&E). Benin conducted a mass vaccination campaign
against meningitis in different communities in Atacora Department. Madagascar ensured the continuation of routine
vaccination at basic health centres, ensuring the availability of all antigens.

Nigeria’s Centre for Disease Control released guidelines for the management of pregnant women and nursing mothers in
the context of COVID-19. The Hard-to-Reach team provided life-saving health services to children and women in remote
and security-challenged areas. Ghana developed guidelines on the continuity of essential Reproductive, Maternal, New-
born, Child and Adolescent Health (RMNCAH) services and established specialised COVID-19 management centres to
allow for CEHS in other facilities. Uganda also received USD 50,000 from WHO to fund the continuity of essential health
care services and developed and disseminated guidelines on the continuity of essential health services with an emphasis
on performance tracking and response to any disruption of services.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 16
Results: COVID-19 Response by pillar

Continuity of essential services for other health programmes was also prioritised. Equatorial Guinea developed the
HIV/TB/Hepatitis Strategic Plan 2021-2025. Gabon conducted an evaluation of the impact of COVID-19 on the continuity
of essential health services, reviewed the performance of the National Tuberculosis Control Programme and developed
the Tuberculosis National Strategic Plan 2021-2025. Zimbabwe conducted the community action cycle for malaria in
the context of COVID-19 and reviewed the implementation of the trachoma programme in the era of COVID-19. Eswatini
decentralised non-communicable disease services to primary health care facilities to serve the greater population. South
Sudan launched a National Action Plan for Health Security to strengthen its capacity to prevent, detect and respond to
public health emergencies. Burundi identified and adopted various activities critical to ensuring service continuity, and
validated a service continuity budget of USD 9,142,162.

Case Management Pillar trainers from WHO, CDC and Ministry of Health and Social Services – WHO Namibia

WHO Support

WHO AFRO office supported all AFRO countries in the monitoring of essential health services to quickly detect disruptions
and develop appropriate mitigation measures9. Additionally, WHO supported frontline health services capacity assess-
ment in the context of COVID-19 to assess the COVID-19 case management capacity in health facilities, and also to assess
the continuity of essential health services from primary care facilities to referral facilities. Frontline health services capac-
ity assessments have been conducted in Burundi, Cameroon, Chad, Congo, Ghana, Kenya, Mali, Namibia, Nigeria,
Rwanda, Senegal, Zambia, Zimbabwe and Seychelles. The results have informed the countries on areas for improve-
ment to increase capacity to manage COVID-19 cases, while still ensuring continuity of the essential health services.

WHO AFRO provided catalytic funding to several African countries to ensure continuity of essential health services. These
included countries like Ethiopia, Ghana, Liberia and Uganda. WHO Country Offices were also instrumental in providing
technical support for the development of guidelines on CEHS in several countries, such as Eswatini, Ghana and Kenya.
WHO also continued support for routine and catch-up immunisation services in several countries.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 17
Results: COVID-19 Response by pillar

10. Vaccination

Country Response

COVID-19 vaccines were introduced in Q1 2021, one year after the pandemic began in Africa; however, uptake has been
low, with 6.8% of the population having received at least one dose of the vaccine, and only 4.45% being fully vaccinated
by Q3 2021. As of now, Seychelles has the highest proportion of its population vaccinated (79%). It also has the smallest
population among the AFRO countries. The Democratic Republic of Congo (DRC) has the lowest proportion of the
population vaccinated (0%). The low vaccination uptake in DRC has been attributed to safety concerns and a lack of
perception of COVID-19 as a threat, especially among those who do not know someone who has been infected or died
from COVID-19. Those in conflict-affected areas also consider insecurity to be a greater threat than COVID-19. As a result,
despite having received more than 1.7 million doses of AstraZeneca vaccines, more than 1.3 have been redistributed to
other countries with higher vaccine uptake10. Eritrea has not yet started vaccinating its citizens. Figure 2 below shows the
percentage of the fully vaccinated target population per country.

Figure 5: Persons fully vaccinated per 100

79
80
72
70

60

50
43
40 38

30 27
23 23 23 22
20 19
14 14
12 11 11
9 9 9 9 8
10 7 7 6 6
5 5 4 4
3 3 3 3 2 2 2 2 2 2 2 2 2
1 1 0 0 0 0
0
Le re
Ca aur lles
Bo Ver s
tsw de
So Les ana
h ho
a
m a
Zi wa s
ua Ma bab ni
ria ita e
ui a
Al nea
za mi a
m bia

m e

pu a
ib c
ne i
Ga gal
Cô K bon
Lib bia
Libria
Co ya
An go
n ui a

Si e d' nya

Za one
Ma bia
hi i
Gh pia
Ca Be a
m nin
Ug oon
N da

rk za a
aF a
o
Gu th sc li

-B an
th Ch u
o d
ru o
Er ndi
ea
of ig r

in Su ar
Se out

Et law

ic N ige
bo itiu

Es oro

Dj bli
Re ne
Rw fric

to ur w

Ga iqu
Co and

l G ni

Mo Na geri

ca G gol

an

Bu Tan eri
in ni

Bu ng
a
So ag Ma
as

eC a
m ti

ra oi

itr
n

iss
ea d
an
e
ut ot

o
M he

t e
er Iv

er

a
A

b
yc

d
Se

Ma
u

of
fri

ic
bl
lA

bl
Eq

pu

pu
ra

Re
nt

Re
d
Ce

ite

tic
Un

ra
oc
m
De

Source: https://ourworldindata.org/grapher/covid-vaccination-doses-per-capita (Accessed Nov 29th 2021)

Preparation for vaccination began in Q4 2020 in most countries, with support to develop national deployment and vacci-
nation plans. RCCE messaging was developed to promote vaccine uptake in all countries. Most African countries kicked off
their COVID-19 vaccination in March 2021. Some countries began earlier like Mauritius in January 2021 and Zimbabwe
on 22 February with Sinopharm BBIBP-CorV. Vaccine uptake was been slower than expected at first due to low vaccine
availability in the countries in Q1 and Q2 2021. Vaccine stocks later increased through donations and country procure-
ment, but uptake remains low for countries in the WHO African region with less than 10% of the population being fully
vaccinated2.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 18
Results: COVID-19 Response by pillar

WHO Support

WHO gave technical support to most AFRO countries in the development of country vaccine and deployment plans. More-
over, WHO supported country applications for the COVAX facility, as well as planning and the training of health workers for
vaccine roll-out. To review the vaccine and deployment plan, WCO gave technical and financial support to hold vaccine
Intra Action Review meetings to assess implementation success, gaps and challenges in COVID-19 vaccine rollout, and
develop improved deployment plans. WHO Country offices continue to support countries in the development and dis-
semination of messaging to promote vaccine uptake.

11. Research, Innovation and Evidence

Country Response

Most African countries conducted research activities to understand the community knowledge, attitude and practices
(KAPs) towards COVID-19. These aimed to generate evidence to inform guidance and strategic direction for COVID-19
prevention and management. In Q1 of 2020 Ghana, in collaboration with WHO conducted surveys on face mask use in
hotspots districts in the Greater Accra region. In Tanzania, WHO supported the MOH Zanzibar Health Research Institute
(ZAHRI) in conducting a survey to assess how compliance with public health measures interrupted the transmission of
COVID-19 in Q2 2020. In Q3 of 2020, Nigeria conducted a perception survey on the threat of COVID-19 and efficacy of
recommended protective behaviours. In Q4 2020, Eritrea conducted a nationwide mid-line KAP Survey. The results were
used to revise the RCCE strategy in Q1 2021. Botswana conducted surveys to gauge public perceptions around vacci-
nations in Quarter 1 of 2021. South Sudan in Q2 2021 conducted a rapid KAPS study targeting concerns like cultural
beliefs, behavioural patterns, and identifying knowledge gaps. Kenya also conducted several nationwide community KAP
surveys from Q3 2020, to understand community response and compliance to COVID-19 containment measures, as well
as its effect on the community. Burkina Faso in Q4 2021 conducted a socio-anthropological survey, to understand the
causes of reducing compliance to the COVID-19 IPC measures which informed the review of the risk communication strat-
egy. Seroprevalence surveys were carried out in various countries including Zimbabwe, Zambia, Uganda, Togo, South
Sudan, South Africa. Sierra Leone, Senegal, Nigeria. Mozambique, Mauritania, Mali, Malawi, Madagascar, Kenya,
Guinea-Bissau, Guinea, Ghana, Gabon, Ethiopia, Democratic Republic of the Congo, Côte d’Ivoire, Congo, Central
African Republic, Cameroon, Cabo Verde and Angola. The outcomes of some of the KAP surveys, and seroprevalence
surveys highlighted in country SITREP reports can be found in the WHO COVID-19 Knowledge hub (https://aho.afro.who.
int/covid-hub/mu) and tracker (https://serotracker.com/en/Explore).

Few clinical trials were reported from the WHO AFRO countries, an example being a clinical trial on the preventive role of
“COVID Organics” in Congo in Q2 2020. COVID Organics is herbal remedy made from sweet wormwood (Artemisia annua)
and various other plants, developed by Madagascar’s state-owned Malagasy Institute of Applied Research, aimed at pre-
venting COVID-19.

WHO Support

WHO supported Guinea, Burkina Faso and Tanzania, Ghana carry out the aforementioned research on COVID-19 relat-
ed topics. Further, WHO Supported Eswatini in conducting a study on HCW infection in Q1 2020, and Benin to participate
in the symposium on resilience mechanisms to health shocks in developing countries which took place in Q4 2020 : In Q1
2021, WHO supported Nigeria to develop of action brief on “Quality essential health services and COVID-19- Lessons from
Nigeria” in collaboration with the Quality team in headquarters and AFRO for publication in Global Learning Laboratory
for quality universal health coverage.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 19
Discussion

COVID-19 testing in Rwanda – WHO Rwanda

COVID-19: A New Global Health Challenge

COVID-19 brought with it an unprecedented health crisis, the response to which required learning from past epidemic and
pandemic experiences and quickly generating new evidence to guide containment approaches. The measures applied
in emergency responses to COVID-19 were based on lessons learnt from previous epidemics such as that caused by the
Ebola virus (EBOV) and pandemics like the one due to the H1N1 Influenza A virus. The Ebola virus - causing Ebola Virus
Disease (EVD), a haemorrhagic fever – is transmitted through contact with body fluids, including blood, sweat, saliva,
vomit, diarrhea, urine, breast milk and semen infected by the virus. The virus is spread during the final symptomatic stage
of the disease11. Asymptomatic carriers of EBOV, who do not become ill after physical contact with EVD patients, play a
very limited role in the EVD outbreak. Invaded viruses are often quickly wiped out by efficient immune responses, leading
to a low viral load and a short-lived inflammatory reaction that disappears in two to three days without subsequent tissue
and organ injury. It is commonly believed that an asymptomatic carrier is not infectious12. The case fatality rate for Ebola
Virus has ranged in various outbreaks from 25 to 90%. The influenza virus is also transmitted through respiratory droplets.
It however has a lower-case fatality rate (0.026%) compared to 2% from COVID-1913. H1N1 has a short incubation period
(one to seven days). Infected patients can transmit the H1N1 virus from one day before symptoms appear up to seven
days after symptoms appear.

Although the case fatality rate for COVID-19 is much lower than that of the Ebola Virus, COVID-19 has caused more deaths
than all the Ebola Virus outbreaks combined. This is due to the mode of transmission: inhalation of air carrying the small-
est very fine droplets and aerosol particles that contain the infectious virus. The risk of transmission is greatest with-
in three to six feet of an infectious source where the concentration of these very fine droplets and particles is greatest.
Additionally, COVID-19 asymptomatic and pre-symptomatic patients also transmit the disease and are therefore more
likely to expose others unknowingly during the incubation period. COVID-19 has also caused more deaths than Ebola and
H1N1 Influenza because of a higher reproduction rate (2.5-3.2) as compared to Ebola Virus (1.5-2.5) and H1N1 Influenza
Virus (1.46-1.48). The reproduction number (R0) describes how many additional cases of a disease each infected person
will cause during their infectious period. The numbers exist within a range because they depend on a variety of factors
that vary from situation to situation and case fatality rate. The characteristics of the three viruses are summarised in
Table 11, 14, 15, 16, 17, 18, 19 .

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 20
Discussion

Table 1: Characteristics of COVID-19, Influenza H1N1 and Ebola Virus

COVID-19 Influenza H1N1 Ebola 2014 Ebola 2018

Categorisation Pandemic Pandemic Endemic Endemic
Year of outbreak 2019–ongoing March 2009–June 2010 2014 August 2018 –
June 2020
Country of origin China Mexico Guinea Democratic Republic
of Congo
Mode of transmission Respiratory droplets Respiratory droplets Contact with infected body fluids
Incubation period 5–6 days, with a range 2 days, with a range 8–10 days after exposure,
of 1–14 days of 1–7 days with a range of 2–21 days
Timing of transmission Symptomatic and asymptom- 1 day before symptoms to 7 Only symptomatic patients
atic transmit virus days after onset of symptoms majorly transmit virus
Reproduction Number (Ro) 2.5–3.2 1.46-1.48 1.51–2.53 1.03
No. of reported cases 261,926,144* 60,800,000 estimated 2.0 3481
No. of reported deaths 5,220,328* 12,469 estimated 11,310 2299
Case fatality rate 2% 0.01–0.03% 39.5% 66%
Susceptible population Elderly (>58), hypertensive, Children, Elderly > 65, Any person in Any person in
diabetic, obese pregnant women, chronic close contact with close contact with
disease patients symptomatic patient symptomatic patient

Note: Numbers reported as at November 29th 2021

Africa’s Experience: A Different Epidemiological Picture

COVID-19 started in China, but quickly spread to all countries by May 2020. The first COVID-19 wave in Africa peaked be-
tween June and August 2020 and was driven by community spread of the imported cases. The second wave peak was ex-
perienced between December 2020 and February 2021 and was driven by re-opening of airports in many African countries
from July to November 2020. Partial re-opening of schools, travel and low compliance to social distancing regulations
during the December holiday season may all have contributed to an upsurge of cases. The third wave was experienced in
June/August 2021 and was attributed to entry of the Delta variant into Africa20. A few countries experienced a fourth wave
in September 2021, e.g. Angola, Congo, Kenya. These countries had experienced an earlier third wave in March/April
2021. Notably, the African experience of COVID-19 was different from that of the rest of the world. Africa showed the lowest
number of cumulative cases as compared to all continents.

Table 2: Regional COVID-19 Cases and Mortality

Global Region Cumulative cases Cumulative deaths Case fatality rate

(for reported cases)
Asia 81,988,286 1,212,093 1.5
Europe 73,113,205 1,409,485 1.9
Europe 73,113,205 1,409,485 1.9
North America 58,784,038 1,189,970 2.0
South America 38,954,587 1,181,199 3.0
Africa 8,718,947 223,365 2.6
Oceania (includes Australia) 366,360 4,201 1.1
Global 261,926,144 5,220,328 2.0

Note: Numbers reported as at 29 November 2021

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 21
Discussion

WHO estimates that only 14.2% of the COVID-19 cases are reported in Africa. This is because COVID-19 detection in the
region has focused on testing those presenting in health facilities, in addition to arriving and departing travelers, leading
to large-scale under-reporting. This is particularly salient in light of the high percentage of asymptomatic cases on the
continent.

This would mean that the number of people infected from the onset of the pandemic to November 2021 would be 61.2
million, against the reported 8.7 million cases. This may also mean that deaths are under-reported as well. However, there
have been no reports of excess hospitalisation and widespread deaths at the community level in Africa. Several other the-
ories have been advanced to explain the low number of COVID-19 cases and mortality in Africa21. One is that the severity
of disease in this region has generally been mild with many cases being asymptomatic or with mild to moderate disease.
This may be due to higher immunity developed due to exposure to other endemic coronaviruses and therefore develop-
ment of partial cross-immunity to the SARS-CoV-2. Modelled estimates from recent studies indicated that seroprevalence
of COVID-19 antibodies in Africa (51.1%) is high and has been increasing as the cases have increased. The highest sero-
prevalence estimate in the world is in South East Asia at 68.4%.

Figure 6: Vaccination vs immunized population as at Dec 31, 2021

Source: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00233-9/fulltext

The demographic make-up of Africa also favours mild disease. Age above 58 years is the single largest risk factor for severe
COVID-19 illness and mortality. The age distribution in Africa is mostly made up of children and youth (0-35 years) who
are less susceptible to COVID-19, explaining why majority of the cases on the continent are asymptomatic or mild. The
elderly population in Africa also live in rural areas, whereas most cases in Africa were highest in urban areas/cities where
the population is mostly the youth. Chronic diseases like hypertension and diabetes – also risk factors for COVID-19 mor-
bidity – are less prevalent in Africa.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 22
Discussion

Figure 7: Age demographic pyramid in Africa and Europe

Source: https://www.populationpyramid.net/

The swift and rapid response to the pandemic prevention and control discussed below cannot go unmentioned and also
would explain the lower case and mortality numbers.

Strengths in the Africa Country COVID-19 Response

African countries mounted timely, appropriate containment measures – even with limited resources. The greatest strength
lay in activating multi-agency/ministerial National Emergency Response Committees/teams, which were constituted to
provide policy directions on response efforts towards the COVID-19 outbreak, often chaired by the Head of State. The
multi-agency approach ensured coordination of all relevant stakeholders key to the COVID-19 response. The implementa-
tion of strategic decisions was coordinated by the PHEOCs, which were devolved to sub-national units. WHO AFRO coun-
tries had developed COVID-19 preparedness and response plans prior to reporting of the first case, having learnt lessons
from the rest of the world on the critical nature of early containment measures.

COVID-19 containment measures in African countries were implemented in a timely manner, with airports being shut
before or within days of reporting the first COVID-19 case. Lockdowns were instituted in most cases with stay-at-home
campaigns running. Countries in the region were able to mobilise their communities to follow these directives, hence
accounting for the low number of cases in Q1 and Q2 of 2020. The re-opening of airports and easing of travel restrictions
in countries towards the end of Q2 2020 came with the first wave of COVID-19, occurring between June and August 2020.

Risk communication and community messaging was robust with messages created, approved and translated into multi-
ple languages. The RCCE messaging was disseminated using multi-pronged approaches such as through television and
radio campaigns, use of social media, use of community and social media influencers, posters and the printing of IEC ma-
terials. The consistent messaging was effective in ensuring all citizens and residents were reached, even those in the rural
areas. However, there was also a high prevalence of the infodemic phenomenon which contributed to non-compliance
to COVID-19 containment measures.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 23
Discussion

Research, Innovation and Production Capacity in Africa

Most of the documented research carried out with regard to the COVID-19 pandemic were KAP surveys to understand
community behaviour and response to the pandemic. Seroprevalence surveys were carried out to assess the prevalence
of community infection in a set-up of low infectivity rates compared to the global picture. These were useful to inform
improvement of COVID-19 control mechanisms. However, more clinical studies should be encouraged to also gauge any
differences in management and patient outcomes. This calls for strengthening of health information systems including
electronic medical record systems to more readily avail data for research and knowledge management.

There is great untapped capacity to produce health products and technologies, which was utilised in the COVID-19 re-
sponse as African countries sought innovative local solutions to the challenges presented by the pandemic. To scale up
laboratory capacity for COVID-19 testing, most countries made use of GeneXpert machines that were already available,
were more affordable than other screening methods, required less personnel and specialisation to operate, and had a
faster turnaround time. This enabled speedier diagnosis and management of the disease. To enable adherence to IPC
protocols, countries began manufacturing cloth masks, which were cheaper to produce and reusable, thus making them
sustainable for the general public. Although cloth masks were proven to be less effective in containing the transmission
and spread of COVID-19 as compared to surgical masks, they still slowed disease transmission. Countries also started
mass production of surgical masks and hand sanitizers at a much lower cost than the imported options.

Case management capacity was scaled up rapidly with the designation of the first isolation and treatment centres. Tem-
porary isolation and treatment centres in schools or tents in open fields were set up and permanent treatment centres
were also constructed. Moreover, existing health facilities were equipped with ventilators. Oxygen plants were built and
the use of oxygen concentrators was scaled up to support ICU care for severe and critical COVID-19 cases. Countries like
Rwanda led in innovation and technology use in Africa by utilising machines for patient examination and record-keeping,
as well as manufacturing their own ventilation machines.

Risk Communication and Community Engagement in Pandemic Control

As countries responded to the COVID-19 pandemic with containment and IPC measures, the biggest hurdle has been
compliance to these measures over time. This includes social distancing measures, wearing of masks and washing hands.
Compliance was highest in the first two quarters of 2020, but reduced over time with the lifting of restriction measures.
WHO has described “pandemic fatigue” as the demotivation to follow recommended protective behaviors, emerging grad-
ually over time and affected by a number of emotions, experiences and perceptions. This demotivation is part of a com-
plex interplay of individual and contextual factors that affect protective behaviors22. Examples of reasons for this emerging
in Africa include: perceived lower risk of COVID-19 with easing of lockdown restrictions; misinformation on COVID-19 caus-
es and effects; the negative social and economic impact of COVID-19 restrictions, among others23. A 15-country study in
African countries showed that many respondents continued to socialize as before COVID-19, despite public health advice
to the contrary. Only a minority reported that they reduced the frequency with which they host guests in their home or
gather in large groups to socialize since the outbreak began. Predictably, the countries reporting the lowest observation
of protective measures are also those where more people feel that the threat from the virus is being exaggerated – e.g.,
DRC, Nigeria, Niger and Sudan24. This could explain the second COVID-19 wave in Africa, which was largely attributed to
airports re-opening to international travel, but also coincided with the December holidays where there is increased travel
from urban to rural areas. This likely contributed to faster spread of the Delta variant in the second wave.

The notable vaccine uptake hesitancy among the African population is also due to similar individual and socio-cultural
contextual factors that contributed to pandemic fatigue. Vaccine hesitancy has been driven by a lack of trust in COVID-19
vaccines, which is higher in those who trust rumours and conspiracy theories. Likelihood of vaccine uptake was also found
to be lower in those who did not perceive themselves to be at risk of getting the disease. These individuals likely did not
personally know anyone who had tested positive. Others did not trust the vaccine’s safety24.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 24
Discussion

The Socio-Economic Effect of Health Emergencies

Despite the ban on international travel and local movement restrictions, complete lockdown measures could not be
sustained due to significant socio-economic losses associated with the economic slowdowns that ensued. Where full
lockdowns were implemented, the public was required to stay home and the knock-on effects resulted in loss of income
across many industries, more so to those working in the informal sector and earning daily wages. The hospitality indus-
try was largely impacted due to initial closure of hotels and, even after they were allowed to open, they still operated at
sub-optimal capacity due to restrictions on travel and social gatherings. This resulted in the loss of jobs and of income.
A study done in Kenyan informal settlements showed that 86% of those interviewed experienced partial or full loss of
income, and 74% reported eating less or skipping meals due to having too little money for food25. This means that though
stringent controls may reduce COVID-19 transmission, they are not sustainable in the long term as majority of the AFRO
region countries did not have adequate finances to cushion the population against economic losses. The benefits of con-
tainment measures must be weighed against socio-economic impact of the same.

Health Systems Strengthening Approaches to Managing COVID-19

and Improving Overall Health Outcomes
COVID-19 is a communicable respiratory disease but those with the highest risk of severe illness and death are the el-
derly, those with chronic diseases like diabetes, hypertension, chronic respiratory disease, obesity and immunosuppres-
sion. COVID-19 therefore blurred the line between communicable and non-communicable diseases programming, and
highlighted the need for health systems strengthening in order to cater for all disease conditions and emergencies. The
COVID-19 pandemic also exposed weaknesses in the health system in terms of emergency response. The need for ICU
care increased with rising cases of severe and critical COVID-19. The availability of ICU beds, ventilators and oxygen at the
bedside was limited in many African countries. Governments therefore put financing into the health sector to strengthen
critical care by investing in ventilators, piped oxygen, along with improving referral, M&E and surveillance systems. This
has not only benefitted COVID-19 patients but also all other patients needing critical care.

A strong commodity supply chain system is key to ensuring a responsive health system. At the beginning of the pandemic,
most African countries were not able to quantify their COVID-19 supplies needs. Mechanisms for the procurement, storage
and distribution of commodities were not well established with reliance on donations. However with time, counties were
capacity built to be able to quantify their needs for the COVID-19 response and put in place mechanisms to ease procure-
ment and supply given the urgency of the situation.

There was a notable decline in the community utilisation of outpatient health care services as countries reported their first
COVID-19 cases26. This was mainly attributed to fear of nosocomial COVID-19 infection. Lockdown measures also limited
travel and access to health facilities. The decline in access to, and utilisation of, health services was noted early in the
response and measures put in place to monitor and implement timely response to ensure continuity of essential health
services. Therefore, the pandemic threatened to negate gains made across all health programmes and reverse or slow the
progress towards attaining the Sustainable Development Goals (SDG) 2030 targets. Development and dissemination of
guidelines to ensure CEHS was key in ensuring that, despite dealing with a pandemic, the health system remained resil-
ient to cater for other disease conditions.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 25
Lessons Learnt

1. Global connectivity through air travel has increased the chances of disease spread
across countries and continents at a rapid pace.

2. Each disease presents different characteristics that may require new strategies for
control, containment and prevention, while still leveraging lessons learnt from
previous outbreaks. It is therefore critical to document and use lessons to mount
a rapid emergency response. At the same time, agility to rapidly learn about the
virus and therefore understand approaches to containing it is required.

3. African countries have sufficient capacity and have responded swiftly and
appropriately to the COVID-19 pandemic, even with limited resources. The activation
of a multi-sectoral/-agency response enabled coordination of all available resources
towards the COVID-19 response, with the health sector coordinating alongside other
ministries/agencies. Owing to this, African countries were able to gather public
support and compliance to the international and local travel restrictions
and lockdown measures. The countries were able to reach most of their population
with multi-pronged RCCE messaging.

4. Gaps and challenges in the COVID-19 response were evident with limitations in
robust sustained surveillance mechanisms, low COVID-19 testing capacity, weak
emergency response supply chain systems, and untapped research opportunities on
COVID-19 response and case management. To build resilient health systems, these
gaps need to be addressed.

5. Countries have local capacity for innovation and manufacturing. Countries

developed country-appropriate solutions, for example the production of cloth
masks, expansion of laboratory testing using available GeneXpert machines and
working with community influencers to disseminate RCCE messages and promote
behaviour change.

6. Countries had inadequate emergency response funding to fund the COVID-19

response plan and also implement economic mitigation measures to cushion
citizens against loss of income due to the restriction measures.

7. The community’s perception of the risk of COVID-19 infection and death, and
willingness to take self-responsibility to contain the spread of the disease is key in
containing pandemics and uptake of vaccines. Widespread infodemic also resulted
in lowered compliance to restriction measures and low vaccine uptake. Continuous,
multi-pronged RCCE messaging is necessary to reinforce containment measures
throughout the pandemic and ensure that pandemic fatigue does not affect
protective behaviours too severely.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 26
Recommendations

1. Disease outbreak in one country should be of international concern as the risk of

spread to all other countries is high, especially for diseases spread by respiratory
route. Therefore, irrespective of the country of origin, there a coordinated global
response is recommended to contain the disease, develop treatment modalities
and produce vaccines for all.

2. Country responses to COVID-19 showcased the potential for home-grown solutions

to global challenges that meet the local population’s needs. African countries are
advised to maximise their potential to manufacture in the health sector for scalable
and sustainable COVID-19 emergency response and for health system strengthening.
This is through countries developing policies and funding to encourage innovation
and manufacturing.

3. Governments must have emergency preparedness plans and resources,

not only to fund emergencies, but also to address any resultant economic shocks.
Financial reserves need to be built to enable self-sustaining economic relief
mechanisms as necessary.

4. Study and understanding of the socio-cultural dynamics of each community is

recommended in order to create effective RCCE mechanisms. This includes the
most effective communication mechanisms with widest reach and knowledge
of community influencers to increase community acceptance and trust of RCCE
messaging. Measures that allow people to live their lives as they know it while
minimising risk should be employed, with the community as part of the decision-
making to avoid pandemic fatigue.

5. Measures to ensure continuity of health services should be prioritised at the

beginning of any pandemic to avoid excess mortality in other disease areas due to
lack of essential health services.

Africa’s response to the COVID-19 pandemic: A summary of country reports – January 2020 to December 2021 | 27
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