"No one is safe, unless everyone is safe"

John Amuasi is an expert on neglected tropical diseases and director of the ARNTD (African Research Network On Neglected Tropical Diseases) in Kumasi, Ghana. Impulse editor Beate Reinhold spoke with him in April 2021 about the consequences of the pandemic – for the people of Africa and for his work.

How does the pandemic affect people in Africa and which are the most vulnerable groups?

John Amuasi: Those suffering the most are the poor in overcrowded suburbs. Many of the infections and deaths occurring there go unnoticed because the poor are less visible and don’t have a voice. Recent seroprevalence studies in African cities provide the evidence. In Zambia for instance, fewer than 5,000 cases had been officially reported as at July 2020. However, a study revealed about 454,000 SARS-CoV-2 infections in the six participating districts between March and July 2020. Another study in South Africa revealed higher seroprevalence in workers with lower socioeconomic status. Generally, the African continent has a youthful population but is bedeviled by high unemployment. Restrictions such as lockdowns saw the already weak economies further plumb downwards with the poor being the most affected. 

How do governments and health services manage the pandemic? 

Of course, this varies widely. Some countries like Ghana are more active in contact tracing and declaring numbers of cases and so end up having a lower mortality rate than Burkina Faso, for example. There are countries which are hardly declaring cases,  presumably due to lower testing capacity. With better organization and transparency with numbers of cases, Ghana was the first country in the world to receive vaccines via the WHO-coordinated COVAX program.

How do African researchers cope with Covid-related restrictions on their practical work?

In the beginning this was very challenging. A lot of very important research had to be put on hold for a while due to closure of universities and research institutions and travel restrictions, putting many studies in jeopardy as recruitment ceased. Meanwhile, most research work is back on track. Procurement of consumables for research from abroad also became more difficult, but this has since improved as well. 

With a fast-moving pandemic, no one is safe, unless everyone is safe. COVAX initiative

Which main differences in coping with the pandemic between the Global South and the Global North do you notice?

The stricter and longer lockdowns in the Global North caused many Africans living in Europe and North America to come to their home countries. However, several of the relief packages, particularly government support to institutions, business and individuals  organized in countries of the Global North could not be matched in the Global South. There is a severe strain on individuals due to loss of livelihood. In addition: By March 2021 only about 1.7% of the African population have received at least one dose of a COVID-19 vaccine – which is significantly lower compared to 26.3% in the U.S. and 12.3% in the Europe. This is due to lower purchasing power and more importantly, political interventions: some vaccine-producing countries limited the export in order to focus first on catering for their own people. However, the COVAX initiative's warning should really be heeded: With a fast-moving pandemic, no one is safe, unless everyone is safe. 

This article is part of our Impulse 2021 issue with the title "Don't let us stop you!" (in German). It is about the challenges of the Corona pandemic, but above all about looking ahead.

What is needed most in research and healthcare? 

We need a better linkage between healthcare delivery systems and clinical research systems to provide knowledge which would immediately inform treatment policy as well as prevention and control policies. In the field of research, genome sequencing is central to developing appropriate disease response. With the rapid mutation of the virus as identified in other parts of the world, early detection and the identification of circulating strains is crucial. Most of the research laboratories in Africa are not well equipped to conduct genome sequencing. 

How is the awareness of Neglected Tropical Diseases these days?

NTDs affect the poorest of the poor who are less visible and don’t have a voice – hence their neglect. However, despite COVID-19, NTDs have maintained visibility thanks to the continued efforts of key stakeholders. On January 28, 2021 the WHO launched the new NTD roadmap virtually and this gathered a lot of attention globally. Our network was well-represented and I was part of a panel discussing how partnerships have catalyzed success in the fight against NTDs together with the WHO Director of NTDs, Dr. Mwele Malecela – herself an ARNTD member.

Did the ARNTD activities change, and in which way? 

Many of our members who are researchers had their work slowed down or on hold. But the good thing is that many of them also applied their research skills and networks to supporting the fight against the pandemic in their various countries. Quite a few are even playing leading roles, including case management and leading SARS-CoV-2 research projects and test laboratories.

We are concerned that funding for NTD research will be lowered. John Amuasi

What are the effects of the pandemic on NTD research?

Research on NTDs slowed down and in the medium term we are very concerned that funding for NTD research and interventions will be lowered since funds are being diverted to new and emerging infections such as SARS-CoV-2. This risks reversing some of the gains made towards control and elimination of NTDs. Examples are the Guinea worm disease which is near eradication and Trachoma infection which has witnessed a reduction of about 91% of the total number of people at risk from 2002 to 2019. 

What support would you like to see? 

African NTD researchers have always been perhaps just as neglected as the diseases themselves. The agenda for NTD research and interventions has traditionally been set without the involvement of African NTD researchers. This is changing thanks to efforts of supporters like, for example, the Volkswagen Foundation, Taskforce for Global Health, USAID and the UK Foreign, Commonwealth and Development Office. But much more is needed by way of sustained funding for networks like the ARNTD. It is vital to secure the visibility of and cooperation with and among African NTD researchers and to support the building of human and physical capacity (including laboratories) for research in the life and social sciences. This is the only way to gain further knowledge towards the control or elimination of such diseases. The globally set targets launched by the WHO in January 2021 provide us with an excellent orientation concerning the need to support networks like the ARNTD now more than ever. 

The final question refers to the concept of "One Health": Is this the key to the much needed progress in global health efforts?

I happen to co-chair the Lancet One Health Commission, so this issue is very dear to me. One Health recognizes the fundamental interconnection between humans and animals within the environment – natural and built) – which we share. With this in mind, a One Health approach not only refers to health directly, but to almost every major global activity. It is ultimately what will guarantee a healthy sustainable future for life on earth.

Together against NTDs

Having already been involved in this field since 2005 in the framework of its Africa Initiative, in 2008 the foundation joined forces with four other European foundations to set up a program for research into neglected tropical diseases (NTDs). 30 postdoctoral fellowships were awarded and more than 60 PhD and master's students received allocations. Since the end of the program, the foundation consortium has been supporting the ARNTD network so that expertise can be further expanded and interlinked.