COVID-19 Pandemic in the Central African
The COVID-19 pandemic in the Central African Republic was reported in March 2020, with the first case being a 74-year-old traveler returning from Italy on 14 March 2020. The CAR was named one of the least ready countries in the world to face the pandemic. It has only three ventilators to serve up to five million people, and the health sector has been crippled by fighting since 2013. Early on, authorities were worried the virus could “tear through” CAR at “lightning speed” without help. This article follows the CAR experience from 2020 to 2022: milestones (first cases, waves, and vaccine), public health response, obstacles, and international support. Early Outbreak and Restrictions (2020) CAR’s initial COVID-19 instance in mid-March 2020 prompted rapid steps. The government instituted stringent measures in late March, closing its borders to travelers from affected countries (excluding diplomats/NGO personnel) and restricting Bangui’s airport to humanitarian and freight flights. Schools and universities were closed, bars and clubs were closed, and public meetings were limited to 15 persons, as well as a nightly curfew. Confirmed patients were segregated for treatment, and suspected cases were quarantined. In fact, CAR was among the first African countries to make face masks compulsory. Through the World Bank-supported “LONDO” project, thousands of tailors have been mobilized to create cloth masks locally. In just a few monthsthe factory manufactured almost 2.4 million masksed, delivering two masks to each resident for free (see image). COVID-19 Pandemic in the Central African Local tailors in Bangui produce vibrant cloth masks for COVID-19 relief under the World Bank–backed LONDO project. But by mid-2020, despite such attempts, cases were climbing again. In May 2020, CAR recorded its first deaths due to COVID-19 (two patients). Infections increased during the summer, with 961 new cases in May, 2,734 in June, and a total of 4,608 by July 2020. As of the end of 2020, around 4,963 overall cases and 63 deaths** were documented. Testing capacity was limited, and many experts predicted undercounting. UNICEF observed that by late April 2020, just 14 cases had been confirmed, possibly well below the true spread. 2021: Vaccination Starts, Waves Continue In 2021, the focus was on immunization and controlling fresh waves. CAR received 60,000 doses of the AstraZeneca vaccine through the COVAX facility in May 2021 and started its vaccination program on 20 May. But it has been slow to take up, held back by hesitation and logistical constraints. By January 2022, just roughly 9% of the population had been properly immunized. Meanwhile, COVID-19 continued to spread: CAR recorded 7,200 more cases in 2021, for a cumulative total of roughly 12,163, and 38 more deaths (a total of 101). The WHO later projected that the true number of infections by the end of 2021 would have been on the order of 2.1 million (suggesting a significantly greater outbreak) due to underreporting. CAR saw a third wave of COVID-19 in early 2022, spurred by the Omicron variety. Case numbers spiked: In the first week of January 2022 alone, there were around 745 new cases, more than the total for all of December 2021 (674 cases). The official number for the CAR, at the end of 2022, was 15,357 cases and 113 deaths. Importantly, aggressive vaccination campaigns in the period February–July 2022 greatly increased coverage. An integrated polio-COVID immunization campaign helped increase complete vaccination rates to 29% of the population (more than 1.6 million people) from 9% by August 2022. These achievements, together with community outreach to address hesitation, were a major milestone in the CAR response. COVID-19 Pandemic in the Central African Republic: Healthcare Challenges and Humanitarian Context The pandemic highlighted the critical healthcare deficiencies in CAR. In 2020 there was just one dedicated COVID-19 treatment center (14 beds) in the entire country. – There were just 3 ventilators and 1 oxygen concentrator for millions of people nationally. There were barely any isolation facilities. By April 2020, with only 14 confirmed cases, scientists were warning that the CAR may be soon overrun. Ordinary residents experienced suspicion and misinformation, with studies finding many Central Africans doubting whether COVID-19 existed in CAR or believing it was a government ruse. Compliance with measures was variable, especially outside of Bangui. In rebel-held territory (which is around 75% of the territory), health laws were not enforced. The lockdowns hit already vulnerable communities hard economically. Most Central Africans are working for daily salaries and living in poverty; thus, the long curfews and shutdowns impacted food security. As schools stayed shuttered, UNICEF said malnutrition and disrupted education were on the rise by mid-2020. The crisis was exacerbated by displacement from conflict: fighting had led to the internal displacement of roughly 700,000 people, and more than half the population depended on humanitarian assistance. The pandemic hit at a time of ongoing humanitarian crisis. The UN has requested billions of dollars for COVID relief and pre-existing needs. COVID-19 pandemic in the Central African Republic: International assistance and milestones Despite these limitations, the pandemic response in CAR received considerable international backing, and important public health milestones were achieved. Donor pledges were early and forthcoming: by April 2020, the EU had pledged €30 million and the US $3 million in aid. The World Bank granted a $7.5 million fund to offer test kits, PPE, water, and hygiene supplies and boost surveillance. Funding for regional preparedness was provided by the Central African Development Bank ($5M/3 billion CFA francs). NGOs and UN organizations supplied training and supplies. For example, WHO and UNICEF helped set up labs and trained contact tracers in Bangui. Early on, Chinese billionaire Jack Ma donated tens of thousands of masks and test kits to help CAR supplement meager supplies. The “LONDO” project of mask-making is a creative local response with worldwide support. This cash-for-work program educated 18,000 tailors to sew masks to WHO standards. Within months they produced millions of masks, saving families and giving work during lockdown (see figure). COVID-19 Pandemic in the Central African Republic: Vaccination was also a success. CAR, despite a late