Chief Covid-19 response coordinator in the office of the President and Cabinet Agnes Mahomva

Zim doing well in Covid-19 fight — Mahomva. . . complacency the main challenge in the battle

ZIMBABWE of late has seen an upsurge in new Covid-19 infections and deaths that forced the government to implement a hard lockdown last week. 

The Daily News on Sunday Chief Writer Mugove Tafirenyika on Friday spoke to the country’s chief Covid-19 response coordinator in the office of the President and Cabinet Agnes Mahomva on the country’s coronavirus fight. Below are the excerpts.

Q: What are the major challenges we are facing as a country regarding the Covid-19 situation?

A: Globally most countries including Zimbabwe, are facing a number of Covid-19 response challenges.

The good news is that here in Zimbabwe, the government in collaboration with communities and many different sectors and stakeholders (public and private) is implementing and continuously looking for innovative strategies to address some of these challenges.

It is, however, important for me to first acknowledge the amazing hard work that most of the teams on the ground have done and continue to do under very difficult circumstances.

Remember this is a very new disease. A disease that currently has no known cure and has claimed many lives. A disease that we are constantly learning about in view of the fact that the virus that causes this disease is continuously mutating into new variants that require different response approaches from those that were originally planned.

Coming on to the specific challenges that we are facing as a country, complacency is the number one challenge. Individuals and communities at large continue to ignore Covid-19 prevention measures. We all need to comply with all the recommended Covid-19 prevention measures if we want to end this pandemic.

The good news is that we know these measures — avoiding gatherings, social distancing, washing our hands with soap and running water and wearing face masks properly just to mention a few.

Low risk perception at individual level is contributing to limited adherence to recommended prevention measures. An unacceptably large percent of individuals in our population seem to think that this disease will infect someone else and that they will not be infected. Unfortunately, this is not the case. We are all at risk especially now as the third wave rages on.

“Fake news” and misinformation on Covid-19 continues to fuel poor adherence to recommended preventative measures. This is a big challenge. A lot of work is currently going into multimedia information campaigns to counter this.

The disruption of the global supply chain mostly due to lockdowns resulted in acute shortages of PPE and testing consumables at the start of the pandemic. This has since improved, but has not gone away completely.

Today the global supply challenge is mainly seen in the unequitable supply and distribution of Covid-19 vaccines.

Developing countries especially in the Africa region, Zimbabwe included, are struggling to access vaccines and other Covid-19 commodities. The country has, however, managed the global supply challenge by stepping up local production of some Covid-19 commodities such as PPE, hand sanitisers and laboratory testing consumables in line with the country’s self-sufficiency strategy.

A key challenge the country faced at the beginning of the pandemic is a struggling    economy, which to be fair, had begun to grow and is in fact continuing to grow following a raft of comprehensive system wide reforms before Covid-19. The economic challenge has contributed to very difficult prioritisation issues in addressing some specific Covid-19 response gaps.

Limited Human Resource for the required and intense surveillance work of Covid-19 Rapid Response Teams and Case management teams especially those needed in the High Dependency Units (HDUs) and Intensive Care Units (ICUs) is a key gap.

Limited laboratory testing capacity (HR and equipment) to diagnose and carry out genomic sequencing for new variants has greatly improved since the start of the pandemic. PCR testing which was initially only done i

n Harare has been decentralised to all 52 districts. A lot more work is, however, still required to strengthen all testing facilities and to roll out genomic sequencing.

Porous borders and limited quarantine facilities have made it difficult to prevent and contain imported cases, especially cases from places where the highly transmissible Beta and Delta variants originated from.

At the beginning of the pandemic the country only had two central hospitals designated for the management of Covid-19 cases. Additional health facilities have since been upgraded and designated to manage Covid-19 cases in each and every one of our 10 provinces.

A lot more is, however, still needed as infrastructure and equipment upgrades in some of the facilities is required and is fortunately in progress. The negative impact of Covid-19 response measures on the delivery of other essential health services is another challenge.

Health institutions (both public and private) are rightfully prioritising Covid-19 cases, but unfortunately they sometimes end up paying little attention to other critical and essential health services.  This challenge was clearly documented in a December 2020 survey by the National Covid-19 Experts Advisory Committee.

A lot of work has and is being done to address this gap. For example, the HIV teams on the ground are now providing more than one month supply of ARVs to ensure that ART clients do not have their supply of ARVs disrupted due to lockdowns.

Finally, the difficult balance between public health and social measures is a big challenge. We need to manage the disease yet we also need to make sure that livelihoods and the economy are protected.

As we do this balancing act, it is very important to continuously remind ourselves that, if we do not contain this pandemic once and for all, there will be no economy to talk about.

Q: How many hospitals have been designated to admit Covid-19 patients in the country?

A: When we started, the national preparedness and response in March 2020, we only had the two main national infectious diseases hospitals (Wilkins and Thorngroove) designated for management of Covid-19 cases.

The initial lockdown bought us time to upgrade and designate additional health institutions for the management of Covid-19 in all 10 provinces. Government also roped in several private institutions for this purpose. According to our ministry of Health and Child Care, we now have a total of about 100 health facilities that have been designated to manage Covid-19 cases throughout the country.

Most of them are managing moderate cases since very few cases have been severe enough to require High Dependency Unit (HDU) or Intensive Care Unit (ICU) management.

Q: How many beds are there for the patients countrywide?

A: The 100 facilities have a total Covid-19 bed capacity of about 1 728.

Q: Do we have enough oxygen to cater for the maximum number of patients we can admit?

A: Currently, the country is managing reasonably well. More work is in progress especially on improving oxygen infrastructure such as oxygen piping and tanks at all designated Covid-19 facilities.

Recent assessment by our hospital engineers in close collaboration with some partners and the doctors who manage the Covid-19 patients at these facilities is guiding this work.

Note, however, that generally no country has reported having enough oxygen for Covid-19 cases. 

This is because the situation on the ground keeps changing. What we planned for and had during the second wave is very different from what we need during this third wave.

Continuous assessments and adjustment of existing plans are, therefore, taking place all the time. This disease has taught us to be nimble, strategic and innovative.

Q: How many ventilators do we have as a country to cater for a worst-case scenario when the number of cases needing hospitalisation increases?

A:  Whilst ventilators are important, they are required for a very few cases since most cases (over 80 percent) are mild to moderate.

In other words, a large percentage of people who contract Covid-19 do not require hospitalisation or ventilation.

The most important thing for most Covid-19 cases is, therefore, non-mechanical support, especially provision of oxygen. It is, therefore, important to put more resources into first making sure that people do not get the disease and second into making sure that those who do get the disease, get the support they need early so that they do not end up severely ill and requiring hospitalisation.

Remember the capacity required for a severely ill case goes beyond a bed and a ventilator. It includes the required specialised health teams led by anaesthetists.

In other words, the total number of ventilators alone is not the most important thing at all. It can in fact be very misleading and provide a false sense of security.

We have vaccinated just over
800 000 people against a target of about 10 million to reach herd immunity.

Q: Is this a result of hesitancy or unavailability of vaccines?

A: Our vaccination programme is moving reasonably well considering the general challenges most global and regional vaccine programmes are facing that also affect us.

Some hesitancy did play a part at the beginning of the programme mostly due to fake news and vaccine misinformation.

This has improved as government is continuously addressing this challenge. The issue of limited availability of doses from the manufacturers is a challenge that most countries, especially in the Africa region, are facing. Advocacy by the African Union and the WHO to get this challenge addressed is ongoing.

Q: What do you think needs to be done to overcome vaccine hesitancy?

A: Sharing of correct information that addresses some of the vaccine myths and misinformation circulating on social media helps to address this issue. 

Note, however, that hesitancy is actually not as big a problem as it was when the vaccine programme roll-out started here in Zimbabwe.

A survey by a team of global scientist (PERC) in August 2020 showed that about 61 percent of Zimbabweans planned to get vaccinated. 

The country has since had a very successful “get vaccinated” campaign which is still running. 

This has probably raised that percentage to a much higher level as evidenced by the large numbers turning out to get vaccinated — Zimbabweans are not hesitating at all. They are in fact coming out in their numbers to get vaccinated.

Q: There are concerns over the use of politicians for vaccine awareness owing to alleged mistrust. What other options are there?

A: Awareness campaigns must be done by everyone as long as the information shared is factual. Community leaders, church leaders are some of the people who can provide vaccine awareness as they have a large following.

Q: Is the country facing challenges in procuring vaccines? What are they?

A: This is not an issue for Zimbabwe alone. Remember the whole world is procuring vaccines from the same few manufacturers. There are, therefore, bound to be some delays in vaccine delivery.

To address this challenge, the government was very strategic from the very start by setting aside domestic resources to the tune of US$100 million for procurement of vaccines and immediately placed orders ahead of a number of countries that are only starting their procurement processes now.

Q: Do you think the target to reach herd immunity by the end of the year is still achievable given the current slow uptake?

A: We continue to be guided by this ambitious target. It is important that we do so for the health of the country. We need that herd immunity especially in view of the complacency we continue to observe in our communities.

Note, however, that how we reach this target will not only be determined by uptake as you rightfully indicated. It will also be determined by availability of doses from the manufacturers. The good news is that according to the “Our World in Data” daily publications of global vaccine coverage, Zimbabwe is leading in vaccination coverage on the Africa continent. 

The county, therefore, continues to push forward since the aim is not about leading everyone on the continent, but about reaching every eligible citizen for herd immunity within the shortest possible time.