Four Years Since COVID-19 Day Zero: A Time to Evaluate Past and Future Pandemic Control Policies and Practices in Sub-Saharan Africa?

Abstract

Four years after the first case of COVID-19, the world is still determining how best to prevent and control the long-term effects of SARS-CoV-2 infection. Non-pharmaceutical interventions (NPIs) were employed at the start of the pandemic as the only available options, prior to effective vaccines and antiviral agents. The World Health Organization recommended dual vaccination for 70% worldwide as the threshold for a return to “normal” community life. Immunization rates needed to increase in all global regions, irrespective of socioeconomic status, necessitating more equitable access. During the pandemic, wealthier countries hoarded vaccine supplies even when their citizens were immunized. This highlights the already enormous difficulties in healthcare provision faced by low-income sub-Saharan African countries, which remain at risk as industrialized nations have progressed to a post-pandemic era. Thus, in addition to redoubling vaccination efforts public health policymakers should consider ongoing and future use of NPIs. In this narrative account, we advocate that various NPI practices should not be shelved; rather, more research is needed to evaluate their impact in parallel with booster vaccination. This especially applies to so-called “long COVID”. Lessons learned from implementing best practices in resource-limited settings should be incorporated into preparedness guidelines for future infectious disease outbreaks.

Keywords:

• sub-Saharan Africa
• COVID-19
• health inequality
• non-pharmaceutical interventions
• pandemic
• vaccination

Approval Statement

The authors confirm that this article does not need institutional approval to be published.

Acknowledgments

We are grateful to the following individuals for useful discussion or feedback during preparation of this manuscript: Professor Sir Tumani Corrah, Africa Research Excellence Fund, MRC@LSHTM, Fajara, The Gambia; Professor C. Wendy Spearman; University of Cape Town, South Africa; Professor Salim Abdool Karim, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

SDT-R is supported by the Wellcome Trust Institutional Strategic Support Fund (grant number 105603/Z/14/Z) awarded to Imperial College London.