While the United States is often celebrated as a global leader in health expertise, it currently leads the world in COVID-19 infections and deaths. African countries, often considered under-resourced and underprepared, have proven far more successful in responding to the global pandemic. The Center for Health Security at Johns Hopkins School of Public Health and the Nuclear Threat Initiative created a 2019 Global Health Security Index^[i] ranking 195 countries in terms of preparedness for infectious disease outbreaks. The United States and United Kingdom were rated as the two countries best prepared for a global pandemic and most sub-Saharan Africa countries were ranked at the bottom, below the average score of 40.2. Yet, as of February 23, 2021, out of the total 112,073,782^[ii] worldwide confirmed positive coronavirus cases, the U.S. is leading with a staggering 28,256,160. The U.K. has 4,146,734 confirmed cases (in the top 4 countries infected). On February 22, the U.S. reached the grim milestone of 500,000 COVID-19 related deaths^[iii]. The incidence rate in the U.S.^[iv] is 8,432 cases per 100,000 people, while in the UK^[v] it is 6,059 per 100,000 people. In comparison, the incidence rate in Senegal is 199 per 100,000 people, while Rwanda’s incidence rate is 142 per 100,000 people.

These numbers expose the fallacy of the Global Health Security Index’s assessment and the assumption that global health expertise is centered in Western countries and institutions, ready and able to come to the rescue of less prepared countries^[vi].

Here are three lessons that can be learned about community responses to epidemics and pandemics from countries at the bottom of the index. 

One: The Important Role of Community Health Workers

Sub-Saharan Africa is well known for its mobilization of community health workers^[vii]. As a front-line defense against diseases like malaria^[viii] and Ebola^[ix], community health workers are able to triage and sometimes treat cases, freeing up space in clinics and hospitals for more severe cases. These workers go door-to-door and view people in their communities holistically – understanding their financial burdens, issues with transportation, and kin structure – making community health workers uniquely suited to understanding factors associated with health care seeking and treatment delay and in-home care.

Mobilizing and sustaining community health workers in the U.S. could enable community support to those caring for the ill in their homes while under quarantine. In the United States, many people cannot afford health care and frequently put off doctor or hospital visits. There are many communities throughout the U.S. without access to hospitals (hospital deserts). Currently, hospitals in the United States are forced to handle every COVID-19 case whether it is mild or severe, which drains resources.  

Two: Multimorbid Focus for Care

It is becoming clearer that people with cardiovascular disease, diabetes, and hypertension are at greater risk of developing severe symptoms if also infected with COVID-19^[x]. Integrating medical responses to account for rising noncommunicable diseases (NCDs) alongside communicable diseases is becoming a global necessity.

Sub-Saharan Africa is an area of the world experiencing some of the fastest rising rates of NCDs commonly found in Western countries^[xi],[xii]. The region has been working toward comprehensive care models capable of treating both communicable and noncommunicable diseases in tandem.  Integrating medical responses to accommodate both disease types is critical for care. 

Three: Expanding Testing 

Sub-Saharan Africa knows how to both create and carry out rapid virus and antibody testing. The Pasteur Institute in Senegal^[xiii],[xiv] is developing a rapid COVID-19 test that can be self-administered with near immediate results interpretable by the person, no doctor necessary^[xv]. Rwanda has engaged in aggressive testing and tracing to keep the spread of the virus contained^[xvi]. Eliminating the need for central testing infrastructure means that individuals can know within minutes whether or not they are positive. Currently, some U.S. doctors are stopping testing due to low reimbursement costs.^[xvii] One year out from the first positive COVID-19 test in the U.S., experts agree that testing in the country is barely adequate^[xviii]. The U.S. government has previously blocked funding to provide more robust testing^[xix].

Global health has been overly focused on what wealthy Western nations bring to Africa and has mostly ignored what can be learned from Africa. The U.S. government and media have been too quick to dismiss African responses to COVID-19 as luck or due to biological differences rather than recognizing the strengths of African health systems^[xx]. As the U.S. continues to blunder through responses to the novel coronavirus, perhaps it is time to consider the lessons Africa has learned and how they offer a better holistic approach to managing pandemics, understanding disease, and creating healthy environments. 

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Emma Nelson Bunkley is a Ph.D. candidate in Medical Anthropology at the University of Arizona. She studies Senegalese women’s experiences with metabolic illness. 

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^[i]2019 Global Health Security Indexhttps://www.ghsindex.org/wp-content/uploads/2019/10/2019-Global-Health-Security-Index.pdf(accessed on March 27, 2020)

^[ii]Johns Hopkins University and Medicine. Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html (accessed on February 23, 2021)

^[iii]February 22, 2021 NYTimes: U.S. counts 500,000 Covid-related deaths. https://www.nytimes.com/2021/02/22/us/us-covid-deaths-half-a-million.html (accessed February 23, 2021)

^[iv]Centers for Disease Control and Prevention. COVID Data Tracker https://covid.cdc.gov/covid-data-tracker/#cases_casesper100k (accessed on February 23, 2021)

^[v]Statista: Incidence of coronavirus (COVID-19) cases in Europe as of February 14, 2021, by country  https://www.statista.com/statistics/1110187/coronavirus-incidence-europe-by-country/ (February 23, 2021)

^[vi]March 26, 2020 The Lancet: Covid-19 gives the lie to global health expertise Sarah L. Dalglish https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930739-X (accessed on March 27, 2020)

^[vii]January 2007. World Health Organization: Community health workers: What do we know about them?https://www.who.int/hrh/documents/community_health_workers.pdf (accessed on April 13, 2020)

^[viii]July/August 2017. United States Agency for International Development: Senegal has a Plan to Prevent Malaria When the Rainy Season Hits and Mosquitoes Multiply.  https://www.usaid.gov/news-information/frontlines/july-august-2017/senegal-has-plan-prevent-malaria-when-rainy (accessed July 26, 2020)

^[ix]March 10, 2020. World Health Organization Africa: Ebola Community Health Workers Trained for the Future. https://www.afro.who.int/news/ebola-community-health-workers-trained-future (accessed July 26, 2020).

^[x]Coronavirus Threatens Americans with Underlying Conditions https://www.nytimes.com/2020/03/12/health/coronavirus-midlife-conditions.html (accessed on March 27, 2020)

^[xi]de-Graft Aikins, A., et al. 2010.    Tackling Africa’s chronic disease burden: from the local to the global. Global Health 6:5.

^[xii]World Health Organization. Noncommunicable diseases: the slow motion disaster. https://www.who.int/publications/10-year-review/ncd/en/ (accessed on July 26, 2020)

^[xiii]June 2, 2020 New York Times: Coronavirus Infects Famed Research Lab Workin on At-home Test. https://www.nytimes.com/2020/06/02/world/africa/coronavirus-test-lab.html (accessed July 26, 2020)

^[xiv]Mologic. Mologic CE Marks professional-use rapid diagnostic test for COVID-19 and begins manufacture. https://mologic.co.uk/mologic-ce-marks-professional-use-rapid-diagnostic-test-for-covid-19-and-begins-manufacture/ (accessed on July 26, 2020)

^[xv]March 17, 2020 Washington Post: A 10-Minute coronavirus test for $1? Researchers in Senegal say it’s coming https://www.washingtonpost.com/world/africa/a-10-minute-coronavirus-test-for-1-researchers-in-senegal-say-its-coming/2020/03/17/43f82cb6-67ab-11ea-b199-3a9799c54512_story.html (accessed on March 27, 2020)

^[xvi]July 15, 2020. NPR: Why Rwanda is Doing Better than Ohio When it Comes to Controlling COVID-19 https://www.npr.org/sections/goatsandsoda/2020/07/15/889802561/a-covid-19-success-story-in-rwanda-free-testing-robot-caregivers (accessed on September 22, 2020)

^[xvii]February 3, 2021. The New York Times: Some doctors, burned by low reimbursements, have stopped testing for the virus.https://www.nytimes.com/2021/02/03/world/some-doctors-burned-by-low-reimbursements-have-stopped-testing-for-the-virus.html (accessed on February 8, 2021)

^[xviii]January 20, 2021. National Geographic: How good is COVID-19 testing in the US right now? https://www.nationalgeographic.com/science/2021/01/how-good-is-covid-testing-in-the-us-one-year-after-first-positive-case/ (accessed February 8, 2020)

^[xix]July 18, 2020. The New York Times: Trump Administration Aims to Block New Funding for Coronaviurs Testing and Tracing https://www.nytimes.com/2020/07/18/world/coronavirus-news.html (accessed July 26, 2020)

^[xx]September 10, 2020 The Overwhelming Racism of COVID Coverage. https://medium.com/indica/the-overwhelming-racism-of-covid-coverage-78e37e4ce6e8 (accessed September 24, 2020)