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Boosting diagnostic capacities for COVID-19 across Africa

Germany enables reference laboratories in East and West Africa to perform the much-needed diagnostic tests

Molecular biologists from the Bernhard Nocht Institute holding a training on testing for the novel Corona Virus for the EAC in February 2020 in Arusha, Tanzania

As the pandemic spreads across the continent, German advisors are racing against time in order to re-enforce reference laboratories in West and East Africa to test for the virus. There is a need for training, test kits, PCR machines - all currently in short supply. Capacities developed in the wake of the Ebola outbreak are now being put to the test.

Earlier this month, Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization (WHO), called on African countries to ‘wake up' to the Corona Virus threat. The message was also directed at Africa's laboratories. In January 2020, when the novel Corona Virus was first detected outside of China, only three laboratories in the whole of sub-Saharan Africa had the capacity to test for it: one in Senegal and one in South Africa, both supported by WHO, and one in Ghana which collaborates closely with Prof Drosten's virology department at the Charité in Berlin.

Although the situation has since improved, laboratory expertise and equipment are still far from sufficient to enable an adequate response to the new pandemic. This is why existing German development cooperation projects are rallying to support their partner countries.

Two KfW-supported projects charged with strengthening laboratory capacities in the East African Community (EAC) and the Economic Community of West African States (ECOWAS) regions, respectively, and a Ghana-based German expert for the Centre for Migration and Development (CIM), now focus on enabling their counterparts to perform the diagnostic tests much needed for their countries' COVID-19 responses.

Participants taking part on a workshop on COVID19 laboratory diagnosis with the Institut Pasteur de Dakar in February 2020

Supporting laboratories in West Africa

Training laboratory experts in preparing, conducting and interpreting tests is one of the most important ways in which German development cooperation can currently assist countries across Africa in responding to the pandemic, says Dr Olivier Manigart, Senior Team Leader of the Proalab project "Strengthening epidemiological services and health systems in the ECOWAS region" at the West African Health Organization (WAHO).

Manigart and his team are based at the WAHO office in Burkina Faso, the West African nation which has become the worst affected by the novel Corona Virus in the region so far. Since July 2018 the Proalab project has been working with the "Department of Public Health and Research" to strengthen the capacities of 11 regional reference laboratories around West Africa, providing them with the necessary equipment and training the staff to ensure that they provide reliable results when it comes to detecting infectious disease outbreaks.

Through this work, a network of reference laboratories with trained laboratory experts was already in place when the new virus started to spread. Together with Senegal's Pasteur Institute, WAHO with the support of the project team organised a three-day training workshop for 24 laboratory experts from 18 countries in late February on COVID19 diagnosis. ‘All of the participants received a kit with 100 tests, swabs for sampling and viral transport medium to take back to their countries' says Manigart.


Training on the inactivation of SARS-2-CoV inside the glovebox

Separately, in Ghana, the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR) - a joint venture between the Ghanaian Kwame Nkrumah University of Science and Technology in Kumasi, the Ghanaian Ministry of Health and the German Bernhard Nocht Institute of Tropical Medicine in Hamburg- was able to begin testing for the novel Corona Virus the moment the first cases arrived the country.

Since then, a continuous flow of samples has come to KCCR and the Centre is contributing significantly to the strength of the Ghana Health Service and Ghanaian Ministry of Health, says Dr Tabea Binger. Seconded by CIM, she is a virologist and expert in biosafety and security who works closely with Prof Drosten's virology department at the Charité, where four of KCCR's virologists were trained.

Supporting laboratories in East Africa

In East Africa, since 2017 KfW, on behalf of the German government, has been providing funds for the establishment of a network of mobile laboratories as an important new element for an early outbreak warning system in the EAC. When the novel Corona Virus began spreading outside of China, two molecular biologists from the Bernhard Nocht Institute based at the EAC headquarters in Arusha, Tanzania and working on the project, Dr Muna Affara and Dr Florian Gehre , reacted swiftly, organizing a similar training on testing for the novel Corona Virus for the EAC in February 2020. Six laboratory experts, one from each EAC member country's national reference laboratory, took part in a 2-week training course.

‘All the participants took part in our earlier trainings where they learned how to train other laboratory experts in their countries in whichever specific methods for infectious disease detection they learn from us', says Dr Gehre. ‘They have already applied this learning for Ebola and Dengue fever outbreaks. This is just one more epidemic - we've retrained them specifically to conduct novel Corona tests,' he adds.


Providing the necessary equipment

Sample collection kit distributed to hospitals for safe sample collection and transport in Ghana

The most reliable tests for the novel Corona Virus require a PCR (polymerase chain reaction) machine, which detects a selected part of RNA or DNA of specific pathogens, such as the novel Corona Virus. The KfW project is providing 18 PCR machines for mobile laboratories to EAC countries and they are expected to be in place by mid-April 2020.

These machines are ‘open systems', explains Dr Affara, meaning that they can be used for a variety of diagnostic tests, including for the novel Corona virus and for other disease outbreaks. ‘A PCR machine is a bit like an oven, you can cook a number of different dishes in the same place.'

‘This has been the most timely and best targeted intervention one could imagine,' notes Dr Peter Reff, Senior Medical Expert at KfW head office. ‘However, scaling up is extremely challenging as, for example, PCR machines and test kits are not available on the market due to massive global demand.'

For many providers, Africa is currently last on the list

The challenge to provide adequate test kits for novel Corona Virus diagnostics has been a struggle all over the world, German development experts in Africa agree. In East Africa, KfW is supplying each of the six countries in the EAC with 1000 test, says Dr Affara, adding that additional funds for 24.000 tests and 6 PCR machines, one for each EAC country, have just been deployed in order to substantially increase the provisions for the coming months.

In West Africa, WAHO has used KfW funds to distribute test kits. ‘Last week, we bought 36,000 tests - that's not so much in our circumstances,' explained Dr Manigart, adding that his team is currently working on procuring 50,000 more. Yet, given the global shortage and the fact that in Africa the outbreak is only just starting for many providers, ‘Africa is last on the list,' he added.

Lessons learned from the Ebola virus outbreak

Despite the challenges, Dr Manigart who worked in The Gambia during the 2014-2016 West African Ebola outbreak, says that there has been much improvement in crisis preparedness and management in the region since then - particularly in the areas of communication, surveillance and coordinated medical responses.
The improved networks and communication systems also help German cooperation work have quicker impact, he says, describing how, for example, such a network recently helped tackle the problem of a lack of epidemiologists in Burkina Faso. ‘We have a database of people who were already trained so we were able to link up those qualified with the relevant health bodies', he adds.

‘This is definitely an opportunity to demonstrate that we can provide quick financial contributions to relevant projects,' says Dr Manigart. ‘We are happy and grateful to the German government that, despite the difficult situation in Germany, they were able to react quickly to the emergency situation. ‘

More help is needed

Despite this, enormous challenges remain. ‘Although we are only at the beginning of the pandemic crisis we already face serious shortages for crucial consumables and equipment, be it viral transport medium, swabs or secondary containers for a safe transport of samples', says Dr Binger in Ghana.

Other challenges are as basic as the principle of ‘social distancing' currently being practiced across many countries around the world. ‘In many countries in Africa, one of main problems is that you cannot ask people to stay at home more than two to three days,' says Dr Manigart. ‘They have to work in order to ensure they have a meal in the evening.'

‘I am sure that in many African countries there's a huge reservoir of infection that is not detected,' says Dr Gehre. And this cannot be changed with tests that require PCR machines. ‘A rapid test - similar to an HIV or malaria test - would be so important for Africa.'

Inna Lazareva, March 2020


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