Zambia still in middle of serious COVID-19

[By Prof. Kazhila Chinsembu]

Zambia is still in the middle of a serious COVID-19 pandemic, and our national psyche should not be diverted to ill-advised and barren cut-throat political ranting on privatisation.

Several factors have silently conspired to exacerbate the COVID-19 pandemic in Zambia. Failure to halt international travel, coupled with the reluctance to implement lockdown, quarantine, social distancing, and isolation measures, continue to fuel the COVID-19 pandemic in Zambia.

Despite many technical challenges in Zambia, one bright spot is that there seems to be a reliable rescue treatment plan that predictably arrests the progression from mild or moderate COVID-19 to serious or life-threatening illness. This has greatly contributed to the recovery rate of COVID-19 patients in Zambia.

Apart from limited resources in terms of person-power, beds and equipment, Zambia should overcome other logjams associated with real-time analysis of this rapidly evolving pandemic. These additional challenges include inadequate testing capacity, control of cluster transmission, halting asymptomatic community transmission, and lack of precise and accurate mathematical modelling of the pandemic.

As a matter of priority, government should set up a multi-disciplinary, inter-disciplinary and trans-disciplinary advisory group on COVID-19. This advisory group should be broad-based in terms of expertise and it should be independent of the government-controlled Zambia National Public Health Institute. The advisory group should include medical doctors and traditional healers. Other key components of the advisory group should be mathematical modelling, computer-based and smartphone-based applications, disease detectives, and medical geography to track and analyse spatial patterns of COVID-19.

Mathematical models can provide important insights in the understanding of COVID-19 transmission dynamics in Zambia. Mathematical models can help government to devise robust, well-coordinated and effective public health control responses. Suitable mathematical models can help to weight out the impact of current public health control measures in Zambia. As many African countries now desperately queue for candidate vaccines against COVID-19, mathematical models will help Zambian health authorities to explore the potential utility of this anticipated bio-medical intervention. Public health authorities in Zambia should use mathematical models not just to estimate the basic reproductive number but also to estimate the critical vaccination coverage that can control the pandemic.

To contain the COVID-19 pandemic in Zambia, government should employ mathematical modelling to predict the vaccination coverage that is required if there is a vaccine with say 70, 80 or 90 per cent efficacy. It is also important that health authorities in Zambia should now start to think about challenges that will be posed by a frozen liquid vaccine especially in rural areas where clinics lack refrigeration facilities and reliable electricity supply.

As the country anticipates the arrival of a vaccine, we should ensure that there are efficient courier services to rural areas so that we avoid previous scenarios where putative COVID-19 samples were transported on public buses. Although the vaccine may be easily transported with minimal cold chain requirements, government should ensure that there is an efficient delivery strategy and storage infrastructure to support vaccination of all Zambians. A successful COVID-19 vaccination programme will require extra training of health workers in good clinical and laboratory practice. Increased levels of public trust will be needed to achieve high vaccination coverage.

Overall, there is now an urgent need to refashion Zambia’s clinical and scientific landscape. Our country should invest in basic scientific fields that in the short and long-term shall support the new era of COVID-19 vaccine development. We can only go further into the future if we look deeper into the past. Therefore, drawing on the inspiration of the luminary scientist Professor Lameck Goma, Zambia must reinvigorate university teaching and research in important fields such as virology, immunology, genomics and structural biology.

Use of next-generation sequencing and reverse transcriptase polymerase chain reaction should become ubiquitous lab techniques in the fight against COVID-19 in Zambia. We should also monitor community transmission of virus clade B1 and clade A in the country and identify potential immunologic correlates of protection. As a country, we need to develop capacity from viral sequencing to clinical trials. Zambia should strengthen the capacity of key regulators that can monitor the technology, efficacy and safety of investigational and commercial vaccine products that will be brought into the country.

To safeguard public health, a local COVID-19 vaccines regulatory unit should monitor all platforms related to importation and dispensing of COVID-19 vaccines in Zambia. Health authorities in Zambia should resist the temptation to disregard ethics and regulatory protocols.

Due to the severity of the current pandemic, patients may not accept to be assigned to placebo groups. Therefore, other scientifically feasible approaches that allow cogent statistical design and interpretation of clinical trials should be explored. COVID-19 should not subtract from the treatment of other diseases such as HIV/AIDS and malaria in Zambia.

Understandably, numerous challenges still lie ahead, and a COVID-19 vaccine for all Zambians in 2020 remains elusive. Therefore, Zambians should continue to reinforce stringent public health measures such as hand-washing using alcohol-based sanitisers, physical distancing, early detection, self-isolation and face-masking. Our own cassava can be used to locally make ethanol-based sanitisers.

(Professor Kazhila Chinsembu is a full Professor of Molecular Biology and Drug Discovery at the University of Namibia, former lecturer at UNZA, and author of the book Green Medicines)

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