Picture by Maria Oswalt on Unsplash.

“Jeez mom,” said my 11 year old last night, “2020 has been hectic. First we had the bush fires, then corona, and now these protests.” I pointed out that corona is still very much with us, especially in Cape Town as we enter the peak at the same time as easing a lockdown that has incurred more hardship than the virus. Well at least until now. In the next three months that is likely to change. Cape Town is on course to becoming one of the hardest hit cities in the world, the epicentre of the African pandemic.

As the world’s press turns it full attention to events unfolding in the US where people of all races protest against continued structural exclusion of people of African descent, so Africa falls off the radar again – a mirror on a global scale of what has happened to people of and from this continent for centuries.

Example of materials developed by KTU.

Last week we ran out of reagent for tests, and while we wait anxiously for imported stocks to arrive, we have had to limit testing to those health workers on the front line, people already in hospital battling to breathe and those at greatest risk of death and severe illness. And this in one of the most well-resourced cities in the region’s most resourced country.

I run the Knowledge Translation Unit (KTU) at the University of Cape Town which develops health worker guidance for low- and middle-income countries, including South Africa, Nigeria, Ethiopia and Brazil. This week we drafted guidance on how to manage the pandemic with no testing, or extremely limited testing, sentencing people to what we know will be repeated episodes of empiric isolation and quarantine until such time as a vaccine arrives.

We debate how to balance this against the epidemic of TB, at what point to test for TB, and when to test for both. Assuming you have the tests. TB case detection is already plummeting across the continent, and resources earmarked for TB including GeneXpert machines and precious N95 masks have been commandeered for COVID. Next week we write the guidance on what to substitute for the PPE when it runs out, how to reuse masks and how best to choose candidates for what oxygen the continent has access to. These shortages are not unique to Africa, but the extent of them and their chronicity will surely be.

The Sustainable Development Goal’s promise to leave no-one behind rings hollow for Africa. In the short term we need reagent, test kits, PPE, oxygen, morphine, debt relief and humanitarian aid for the millions of people who have slipped below the poverty line in the last three months. I find that I cannot dismiss my cynicism that when the vaccine arrives, we will be last in the queue, dismissed as younger and less obese than the rest of the world.

Ultimately, and urgently, we need to be included in the global community and agenda. I hope very much that America’s tipping point has come. I grieve because I understand that the world’s has not, and that Africa will be left behind.

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Prof Lara Fairall is a clinician scientist and founding head of the KTU. She is an expert in the design and conduct of pragmatic trials in less developed country primary care settings and had led 9 trials involving 82 745 patients from 225 clinics across 13 districts in South Africa and Brazil to investigate how to improve the quality of primary care for priority conditions including HIV/AIDS, tuberculosis, NCDs and mental health. She has published over 50 peer-reviewed publications, including, in The Lancet, the only randomised trial of non-physician initiated antiretroviral treatment. She has led the development of educational interventions to improve the quality of primary care in South Africa and spearheaded the partnership with the BMJ to spread PACK to other LMICs. She is currently the co-Principal Investigator of a NIMH-funded trial to improve the quality of mental health care for people on lifelong antiretroviral treatment and an Executive Member of the NIHR Global Health Research Unit at Kings’ College London on Health System Strengthening in sub-Saharan Africa.