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News from 2020-04-02 / KfW Development Bank

"We are supporting our partners with an emergency coronavirus programme"

KfW healthcare experts and doctors Anna-Maria von Roda and Peter Reff on the effects of the pandemic in developing countries

Ms von Roda, back in early February you described the origins of the coronavirus in a scientific paper. At the time it appeared to be a problem for China. Would you have thought that just a few weeks later we would be looking at a global crisis and that people in Germany would be required to stay at home?

Von Roda: We certainly could not have foreseen the scale of the crisis, especially the fact that it would affect us so severely in Europe. But it was already clear that the virus was highly dangerous. With SARS a few years ago there were also cases in Europe, but people weren't so aware of them. And unfortunately, the current coronavirus is much more easily transmitted. People travel a lot in our globalised world and that has caused this dramatic proliferation.

At the time you wrote that in an advanced health system, it should be possible to identify high-risk sources of infection quickly, isolate them and fight the virus. What went wrong?

Von Roda: From what we see today, it has to be assumed that the Chinese government was too slow to respond. Even though the first case was identified as far back as December, comprehensive measures were only imposed in mid-January, meaning that the virus was able to spread around the city of Wuhan. And for too long the authorities based their response on the process used for SARS and quarantined people with serious symptoms. The insidious thing about coronavirus is, however, that it often takes longer for people with the infection to show severe symptoms. But even if you only experience mild symptoms, you can still transmit the virus and infect other people.

In Germany we currently have the 5th largest number of cases in the world. In some of our less-developed partner countries in Latin America and Africa, official figures make the situation look better. They mostly have fewer than 100 cases. Why is that?

Von Roda: In Latin America it's already starting to look like that is no longer the case. Their numbers are now also increasing fast.

Reff: In Africa, the reported case figures don't reflect the reality of the situation. However, the lack of tests makes it difficult to estimate whether ten times as many or a hundred times as many people are affected. And there often isn't any reliable healthcare data in Africa, which makes it difficult to say much about the mortality rates

However, Welthungerhilfe and other aid organisations fear that there will be a large number of deaths in developing countries because health systems are often very weak.

Von Roda: Unfortunately, many African countries do not have the money to be able to provide an adequate response to a pandemic. There are often national action plans to fight pandemics, but they are underfunded. For people with serious symptoms intensive medical treatment is barely an option as there is a shortage of ventilators. The number of intensive care beds in hospitals is negligible relative to the large populations.

Reff: And there is an extreme shortage of staff who can operate the ventilators. It's recommended that people with moderate symptoms are given additional oxygen via a mask to stop their condition deteriorating further. It would be slightly more feasible to implement that from a staffing perspective, but here again there is a lack of the necessary equipment. The best hope is that medicines soon become available which can alleviate or prevent serious symptoms – and a COVID-19 vaccine, of course. The vaccine can then be added to the ongoing KfW-financed vaccination programme by the global vaccine alliance Gavi in East Africa.

So there is still a hope that with younger populations – over half of the people are often under 20 – it might be possible to cope better with the pandemic?

Reff: Yes, the age demographics are probably the most important factor in reducing the effects of the pandemic in Africa. It is very difficult to assess whether the negative effects of additional factors like malnutrition and other illnesses like TB, HIV and malaria, as Ms von Roda mentioned, will cancel this out. There still just isn't enough of an evidence base around this yet.

Von Roda: Maybe, and we don't yet know this exactly, heat and lots of light will play a role in slowing the spread of the virus – although the number of cases is currently growing fast in Australia where it's warm. We are certain that with normal nutrition, children do not experience such strong symptoms of Covid-19.

Does KfW Development Bank have initiatives to help partner countries fight the pandemic, or are any being planned?

Von Roda: Of course, that is an urgent task. KfW Development Bank has already worked up suggestions for a fast-track aid programme for the Federal Ministry for Economic Cooperation and Development (BMZ). This is about helping countries fight the pandemic and continue supporting the health sector. We want to help East and West African countries prepare their laboratory capacity to handle coronavirus. However, due to the expected economic consequences there will also be increased support for the financial sector, small and medium-sized enterprises and socio-economic stabilisation programmes.

Reff: We are bolting this on to existing programmes. For example, I'm overseeing a project in which we're working with the Bernhard Nocht Institute for Tropical Medicine in Hamburg to help the six countries in the East African Community (EAC) develop an early warning system for epidemics and pandemics. In order to operate mobile laboratories which were delivered to these countries, staff have already been trained on the exact technology that's now being used to diagnose COVID-19. At the same time it was possible to supply a first batch of tests to the National Reference Laboratories of the six EAC countries. We've also been working for several years on behalf of the German Federal Ministry of Education and Research (BMBF) to support research into new diagnostics, medicines and vaccines in Africa. The diagnostic platforms developed through this work are also relevant for COVID-19 tests. However, the global market has been emptied of all COVID-19-related items and aid transports are currently extremely difficult to organise. This makes it all the more important that we provide the healthcare facilities in our partner countries with financial support for all measures that can feasibly and usefully be put in place in the short term and using locally-available resources. Financial support must reach those on the frontline against COVID-19 as quickly as possible – wherever established structures exist, we should use them.

Were healthcare projects a priority for KfW before now and will that change?

Von Roda: As my colleague has said, fighting infectious diseases and pandemics was always a major concern. We have also learned a lot in this area since 2014/2015 from the Ebola crisis in West Africa. We are also continuing our involvement in the fight against HIV and our support for mother and child health. Of course that is not just in Africa, but also in Asia and Central Asia. Finally, it is about strengthening the healthcare systems in partner countries and making them more effective overall in the long term and sustainably.

Reff: Exactly, and we need to be especially aware that disadvantaged and impoverished groups within the population also benefit from improved healthcare systems. Let us hope that after the crisis healthcare budgets will increase in developing countries as well. We are all going to learn from this pandemic. In doing so, we need to listen carefully to the conclusions that our partners draw and the particular areas where they want and need our help.