Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study

Abstract

Background: The novel coronavirus disease 2019 (COVID-19) epidemic has spread from China to 25 countries. Local cycles of transmission have already occurred in 12 countries after case importation. In Africa, Egypt has so far confirmed one case. The management and control of COVID-19 importations heavily rely on a country's health capacity. Here we evaluate the preparedness and vulnerability of African countries against their risk of importation of COVID-19.

Methods: We used data on the volume of air travel departing from airports in the infected provinces in China and directed to Africa to estimate the risk of importation per country. We determined the country's capacity to detect and respond to cases with two indicators: preparedness, using the WHO International Health Regulations Monitoring and Evaluation Framework; and vulnerability, using the Infectious Disease Vulnerability Index. Countries were clustered according to the Chinese regions contributing most to their risk.

Findings: Countries with the highest importation risk (ie, Egypt, Algeria, and South Africa) have moderate to high capacity to respond to outbreaks. Countries at moderate risk (ie, Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya) have variable capacity and high vulnerability. We identified three clusters of countries that share the same exposure to the risk originating from the provinces of Guangdong, Fujian, and the city of Beijing, respectively.

Interpretation: Many countries in Africa are stepping up their preparedness to detect and cope with COVID-19 importations. Resources, intensified surveillance, and capacity building should be urgently prioritised in countries with moderate risk that might be ill-prepared to detect imported cases and to limit onward transmission.

Funding: EU Framework Programme for Research and Innovation Horizon 2020, Agence Nationale de la Recherche.

Figure 1

COVID-19 incidence in China as of Feb 11, 2020, and annual volume of outflow passenger per airport Cumulative incidence was calculated as total number of confirmed cases per province divided by population of the province.

Figure 2

Global distribution of importation risk over human population density, distribution of the SPAR capacity, and IDVI Countries with no estimates of importation risk correspond to situations where the risk of entry was found to be negligible at the time of analysis. The values of MUS (not visible on the maps) are importation risk 4·5 ×  10⁻⁴ , SPAR 65, and IDVI 64. AGO=Angola. BDI=Burundi. BEN=Benin. BFA=Burkina Faso. BWA=Botswana. CAF=Central African Republic. CIV=Côte d’Ivoire. CMR=Cameroon. COD=Democratic Republic of the Congo. COG=Republic of the Congo. COM=Comoros. CPV=Cape Verde. DJI=Djibouti. DZA=Algeria. EGY=Egypt. ERI=Eritrea. ESH=Western Sahara. ETH=Ethiopia. GAB=Gabon. GHA=Ghana. GIN=Guinea. GMB=Gambia. GNB=Guinea-Bissau. GNQ=Equatorial Guinea. IDVI=Infectious Disease Vulnerability Index. KEN=Kenya. LBR=Liberia. LBY=Libya. LSO=Lesotho. MAR=Morocco. MDG=Madagascar. MLI=Mali. MOZ=Mozambique. MRT=Mauritania. MUS=Mauritius. MWI=Malawi. NAM=Namibia. NER=Niger. NGA=Nigeria. RWA=Rwanda. SDN=Sudan. SEN=Senegal. SLE=Sierra Leone. SOM=Somalia. SPAR=State Party Self-Assessment Annual Reporting. SSD=South Sudan. STP=São Tomé and Príncipe. SWZ=eSwatini. TCD=Chad. TGO=Togo. TUN=Tunisia. TZA=Tanzania. UGA=Uganda. ZAF=South Africa. ZMB=Zambia. ZWE=Zimbabwe.

Figure 3

Importation risk as a function of the SPAR capacity and IDVI in Africa Area of circles is proportional to country population. The grey area represents the intervals of SPAR and IDVI values for the Organisation for Economic Co-operation and Development countries. AGO=Angola. BWA=Botswana. CIV=Côte d’Ivoire. CMR=Cameroon. COD=Democratic Republic of the Congo. DZA=Algeria. EGY=Egypt. ETH=Ethiopia. GHA=Ghana. GIN=Guinea. IDVI=Infectious Disease Vulnerability Index. KEN=Kenya. LSO=Lesotho. MAR=Morocco. MDG=Madagascar. MOZ=Mozambique. MUS=Mauritius. NGA=Nigeria. RWA=Rwanda. SDN=Sudan. SEN=Senegal. SPAR=State Party Self-Assessment Annual Reporting. TCD=Chad. TUN=Tunisia. TZA=Tanzania. UGA=Uganda. ZAF=South Africa. ZMB=Zambia. ZWE=Zimbabwe.

Figure 4

Cluster of countries sharing similar risk of importation from specific Chinese provinces Cluster number 1: Algeria, Angola, Chad, Egypt, Ethiopia, Ghana, Guinea, Côte d’Ivoire, Kenya, Mauritius, Morocco, Nigeria, South Africa, Sudan, Tanzania, Uganda, Zambia, and Zimbabwe. Cluster number 2: Cameroon, Democratic Republic of the Congo, Madagascar, Mozambique, Rwanda, Senegal, and Tunisia. Cluster number 3: Botswana and Lesotho. Countries in grey were estimated to have a negligible risk of entry at the time of analysis.