Dr Kenneth Staley is USAID Global Malaria Coordinator and COVID-19 Task Force Leader. In a telephonic conference, African journalists including from The Ethiopian Herald had the opportunity to discuss with him regarding the activities of USAID in the continent. Excerpts:
Question: When the pandemic is over or at least gets under control, what do you think the lasting legacy or learned experience would be for African nations like Ethiopia who remain vulnerable to the virus pandemic?
Dr Staley: I would say that there are two lessons, and I think they really are applicable to the world. First, from an Ethiopian perspective, the community health worker system that you have developed over the last 20 years has been truly remarkable and is a model for other nations across the continent. There are so many good news or stories about the way in which those community health workers have been able to revolutionize the delivery of care across Ethiopia, and I think they will continue to play an integral role in the response to COVID.
I think the lesson that the world should take and every nation should take, is that transparency in the face of public health crises is absolutely critical. Without transparency, people can’t help. Without transparency, we don’t know how to respond. And without transparency, people will ultimately lose their lives. And so I applaud efforts across the continent to try to be transparent with their health data and to try to share that broadly across borders and throughout the world.
Question: Tell us about the activities of USAID in Africa?
Dr Staley: Through the American people’s generosity and our government’s action, we continue to demonstrate global leadership in partnering with you across the continent of Africa in the face of the COVID-19 pandemic. To date, we have committed more than 1 billion USD to benefit the global COVID response and we want to assure everyone that will continue to ensure that funding and scientific efforts on this front will remain a central and coordinated part of the USGs response.
Since the outbreak began, the Department of State and USAID have provided almost 400 million USD throughout Africa, and that’s devoted to emergency health, humanitarian, economic, and development assistance specifically aimed at helping governments, international organizations, and NGOs fight the COVID-19 pandemic.
We know that the funding provided would save lives in partnership with the efforts of each of the countries in the continent by improving public health education, protecting healthcare facilities, and increasing laboratories, disease surveillance, and rapid-response capacity.
Question: How does redirecting resources to COVID-19 affected the fight against malaria? Can you quantify this impact somehow?
Dr Staley: I think the first important point here is that we, as the President’s Malaria Initiative and the United States Government and all of our partners, whether it be the Global Fund or the Gates Foundation or others, have focused with our country partners on actually ensuring that we continue our services on malaria. So, the first point is really that were trying to ensure that all of our services are maintained during this time.
The second point I would make is actually that as with many other crises, the challenges we see are very similar. So first of all, we see effects with our supply chains. We need to spend more time and think more about how we can get active pharmaceutical ingredients, for example, all the way to making sure that our medicines can reach the last mile.
Then the third point in terms of quantifying impact, we’ve seen about a 25 to 30 per cent increase in our costs across supply chains, delivery of care, and delivery of interventions in villages across the areas where we work. To put a price tag on it, our estimated increased costs at the moment are about 120 million USD.
The last thing I’ll mention is that I think the malaria community globally has worked very hard to think through how we can learn lessons from past experiences, like Ebola, to shift the way in which we deliver care during this time. And so I think the malaria coordinators in each country, as well as international partners, are going to great lengths to think through how we can adapt our delivery of care in the COVID-19 environment.
Question: How much funding is the U.S. providing specifically for COVID testing in Africa? Do you agree that current testing levels are failing to reveal the true extent of the outbreak in sub-Saharan Africa?
Dr Staley: First, what I would say is I’ll need to come back to you with the specific amount that’s been spent on testing and reagents, but the broader point I think is that testing and surveillance is a critical part of disease response. And as you’ve seen really across the world as people have responded, there’s been a shortage of the ability to use rapid diagnostic tests in a fast way to diagnose the spread of the illness.
I think as the world ramps up its production of these commodities, you will see a better and more effective way of monitoring the spread of the disease. So I think in essence, all of us want to be able to do better with comprehensive testing and treatment over time.
I think that from a USAID perspective and a United States Government perspective, we look at the infrastructure we’ve built in partnership with countries, whether that’s through PEPFAR (President’s Emergency Plan for AIDS Relief) or the President’s Malaria Initiative or our work on TB, that has existing laboratory infrastructure that will allow us to ramp testing very quickly once commodities are available.
Question: What are the difficult questions you’ve faced from African officials in recent days as you try to assure them that the Trump administration cares about the wellbeing of black people anywhere, or about democratic backsliding?
Dr Staley: I think U.S. values are really universal values. And I think that we’ve tried throughout our time in relationship with countries across Africa to demonstrate the need for sustained focus on democracy and human rights.
And within the United States, I think we continue to focus on that and think through the ways we can become an even more perfect union. And I think our own internal debates hopefully allow people to know that open and free expression is a critical part of building a better society.
Question: What is the USAID vision on Portuguese-speaking countries? Are there new projects for these countries, i.e., Angola, Cape Verde, Equatorial Guinea, Guinea-Bissau, Mozambique, Sao Tome and Principe?
Dr Staley: I think as with other efforts across the continent, I think Portuguese-speaking nations are a critical part of our efforts to help African people. So let me provide a couple of examples that are COVID-specific.
In Angola, we’ve provided about a half-million dollars to assist in limiting community transmissions, helping to identify patients early, and help to isolate them and provide care, and then finally, to communicate critical health information to the Angolan people.
In Mozambique, we’ve contributed about 7 million USD to date, and that assistance is focused on risk communication and community engagement, including mass media prevention messages. We’re also focused on water and sanitation, and the prevention of controlled infections in health facilities in Mozambique. Finally in Mozambique, we’re also helping to fund the training of healthcare workers in case management and ensuring health facilities are prepared to respond to the outbreak.
Question: Some African states in the East African region have come up with different approaches in regards to the response to the pandemic. This has led to a regional miscoordination in terms of the response. How does this shape the U.S. Government’s interventions?
Dr Staley: I think across the globe as we think about the way in which we respond to disease, as we’ve all learned, diseases don’t respond to orders. And so it’s critical for us to have transparency of health reporting and cooperation across borders, to discuss ways in which to mitigate the spread of disease. I think those principles apply whether its malaria or HIV or COVID-19. And in the case of this disease, we’ve seen with tragic consequences some of the challenges when there is not transparency.
Question: How do you see the responses from African nations so far regarding the coronavirus?
Dr Staley: I think in many ways we’ve been encouraged by the way in which governments have leaned forward to try to learn from the experiences of other nations as they have battled COVID-19. I think one of the challenges all of us have is that we don’t know as much about the disease as we would like to.
And you can see in the weeks and months that COVID has spread around the world, the approach actually that many countries have taken has been slightly different, but the learnings that have come from all of that have actually shaped our approaches pretty dramatically.
So whether it’s thinking about the way in which we can protect some of our most vulnerable populations, to what kinds of commodities we’re thinking about to be able to provide immediately for relief, to how we’re thinking about planning for a future response that may involve a therapeutic, I’ve been encouraged actually by the collaboration across governments and through organizations like GAVI, and by collaboration with the Global Fund especially, whose pivoted very quickly.
I think I would only say that governments have an ability to continually learn and adapt, and I think that will be the hallmark of success as we move forward.
Question: What’s your assessment of Africa’s health systems compared to other regions?
Dr Staley: I think if we look at the progress of the African health systems over the last 20 years, it’s been absolutely incredible. So childhood mortality has been reduced by almost 50 per cent. At the same time, there’s been a 30 per cent growth in population across the continent. Maternal-child health has improved dramatically. Treatment of HIV/AIDS has been revolutionized in Africa as well as around the world. And so, it’s a really incredible story.
I think if you look at the health systems generally of most countries, they tend to improve as economic growth spurs development across multiple sectors. And so when I think about the ways in which the health system broadly will improve over time, I think it’s very much tied to the ability to have economic growth and dynamism in a society.
When I think about that challenges that are going to occur as a result of this outbreak, I think about it in two ways. First, I think about it in the provision of existing services that may be disrupted. So just like in the United States where people have chronic conditions and maybe weren’t seeing docs as much, there are people who may not seek out a health facility when their child has a fever.
The second thing that I think about is actually the stress that’s being put on the system generally, so whether that’s a supply chain that’s being asked to try and deliver more medicines or more therapeutics at the same time that there may be less people available or less resources to do it.
I see that whether it’s actually the amount of healthcare workers in a particular facility. So what I see is a need to ensure that there is not a setback as a result of this disease outbreak, to ensure that we continue to deliver the kind of care that we have in the past, and to adapt as necessary.
I think to make that happen there are a couple of things I would emphasize. Earlier on I spoke about a novel effort in Nigeria to team up with Airtel. There are so many ways in which the new modes of communication can help us have better awareness of challenges, and respond more effectively, both for health and for supply chains. I think that’s critical.
The second thing I would say is that I think in every country that we’ve seen respond to this, it’s been a whole of society approach, and so I think non-traditional means for thinking about supply chains or delivery of care in the home are worth considering.
The Ethiopian Herald Sunday Edition 14 /2020
BY MEHARI BEYENE
