FEATURE: Complacency and lack of trust amidst surge in Covid: Is Liberia out of the woods?

James S. Shilue*

The frightening news of Coronavirus surge around Africa is claiming the attention of global health authority. The most recent John Hopkins statistics recorded 4,913,066cases with 131,728 deaths in Africa. “The threat of a third wave in Africa is real and rising”, said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Our priority is clear – it’s crucial that we swiftly get vaccines into the arms of Africans at high risk of falling seriously ill and dying of COVID-19.”

In Liberia, there is still the usual laisser-faire disposition to the pandemic. On the 16th of March, the first case of coronavirus was confirmed in Liberia. As of May 28, 2021, health authority in Liberia had reported 2183 cases of COVID-19 with Montserrado County recording the highest cases. COVID-19 infections are increasing in Liberia, with 10 new infections reported on average each day. That is 38% of the peak, the highest daily average reported on July 3, 2021.

Liberia is one of many developing countries in Africa experiencing rapid epidemiological transition, which involves dealing with both communicable and non-communicable diseases at the same time. Decades of corruption, deep-rooted mistrust of government, weak public services and patriarchal practices contribute to the rapid spread of epidemic and much more needs to be done to bridge communication gap between government and citizens, if the current surge should be mitigated. Assertive national political leadership and citizens’ trust are essential in the fight against the pandemic.

The increase in the number of Coronavirus cases around Africa is not only worrisome for Liberia, a country that relies on ‘international partners’ for everything, but also brings the competence and creative capacity of those who manage Liberia’s health sector to public glee. Liberia’s health care system is confronted with several challenges including inadequate human resource capacity, limited availability of essential genuine medical equipment and pharmaceutical products, inadequate infrastructure, and a poorly motivated workforce with limited training, all of which have exposed the system’s fragility and vulnerability. As a result, severe medical conditions require emergency evacuation outside Liberia for adequate treatment. This means that only those who can afford the cost can make it. If the current surge continues, most medical facilities in Liberia could eventually become overwhelmed and covid patients will run the risk of dying because of the lack of oxygen and proper treatment.

While health seeking behaviour is influenced by several factors, one can cautiously assert that in Liberia some of the critical determinants for health seeking behaviour are the level of competence in health authority, literacy, poverty, socio-economic condition, level of trust in national leadership, cultural beliefs and the organisation of the health care system. These factors and challenges need to be given urgent attention, if Liberia wants to mitigate the surge, which has already permeated the country.

The World Health Organization said test positivity had risen in 14 African countries over the last seven days, with eight reporting a surge of over 30 percent in new cases. There are reports of a new variant in several African countries, including Kenya, Morocco, Algeria, South Africa, Botswana, Angola, DR Congo, Nigeria, Uganda, Zambia and Zimbabwe bathing with the pandemic. BBC recently reported that in Nigeria, scientists have also identified a new variant of the virus, although there is currently no evidence to indicate it is contributing to increased transmission.

In its Security Advisory # 18, The United Nations Department of Security and Safety acknowledged that Liberia is witnessing a spike in confirmed Covid-19 cases. The release noted that “the trajectory of these new cases is an indication of active chains of COVID-19 transmission in the country with an average of 6-7 cases per day especially in Montserrado County. So far, the UN has recorded five (5) active cases with over 30 high risk contacts over the past two weeks.” Meanwhile, ordinary people out there are not aware of the surge and the ramification is not difficult to predict for a poverty stricken population with little or no trust in government. At the geopolitical level, this crisis cries out for leadership, solidarity, transparency, trust and cooperation. This is no time for obfuscation or politicization because the tone set by leaders at the national and local level matters in the strategy to contain the surge.

WHO has classified the situation as a “variant of global concern” with possible increased transmissibility yet, rather than escalating anti covid measures adopted at the onset of the pandemic, in Liberia we are rather seeing de-escalation and lack of compliance. Supermarkets, schools, churches, mosques, business and entertainment places, transport industry, even hospitals are not stringently enforcing the coronavirus protocols. People are resorting to hugging, shaking hands and not observing social distancing. Liberia like most African countries survived the first wave but complacency could be playing out in the face of a more lethal variant.

Despite the euphoria of ‘vaccine nationalism’ worldwide, Liberia received a total shipment of 123,000 AstraZeneca vaccines, via the COVAX initiative, a partnership between CEPI, Gavi, UNICEF and WHO.  The news of the arrival of vaccine brought much hope but it took several weeks before the government launch its vaccination campaign. Protracted delays in the formulation of a comprehensive plan only fuelled mistrust and birth various conspiracy theories. Like the unproven Madagascar herbal Covid remedy that arrived in the country without any announcement and distribution plan, people have begun to think that the AstraZeneca was yet another hoax along the same trajectory.

Also, there has been widespread suspicion surrounding the vaccine efficacy, exacerbated by reports of blood clots among AstraZeneca recipients in several European countries. However, even before the vaccine safety concerns came about, an Afro barometer survey found hesitancy and mistrust surrounding Covid inoculation in Liberia was among the highest in the region, with just one in three respondents saying they would volunteer to be vaccinated. The survey attributes the high hesitancy to low confidence in the government, with 78 per cent of respondents in Liberia stating they didn’t trust the government to ensure the safety of the vaccine before offering it to citizens. During the Ebola epidemic, one study underscored the correlation between economic hardship, decision making and health care preference. Respondents who experienced hardships during the epidemic expressed less trust in government than those who did not, suggesting the possibility of a vicious cycle between distrust, non-compliance, hardships and further distrust. Today, the pandemic has raptured livelihood activities all-round Liberia with unemployment skyrocketing. Moreover, the costs of basic communities are beyond the reach of the poor, hence trust level is very low.

In Africa, a continental of 1.3 billion people, only 31 million have received at least one dose, said Dr. Moeti of WHO. Seven million are fully vaccinated. Amidst doubts, growing public suspicion, and poor publicity, on April 01, 2021, Health Minister Dr. Wilhelmina Jallah finally rolled out the Astrazeneca vaccine. So far, Liberia has administered at least 56,144 doses of COVID vaccines. Assuming every person needs 2 doses, that’s enough to have vaccinated about 0.6% of the country’s population. Although the emergence of new COVID-19 variants is common, the news of the current variant with higher speed of transmission or potentially increased pathogenicity requires the government and health authoritiesto embark on massive awareness and confidence building measure. For example, the three branches of government should mandate their members to publicly take the vaccine. The same should be done in other public and private sectors. Leaders should set example.

Moreover, there is a need to investigate the issue of time interval between the first and the second vaccine. Study done in the U.K shows that a single standard dose of vaccine provided 76% protection overall against symptomatic covid-19 in the first 90 days after vaccination with protection not falling in this time frame. It is not clear; however, how long protection might last with a single dose. The study found vaccine efficacy reached 82.4% after a second dose in those with a dosing interval of 12 weeks or more (95% confidence interval 62.7% to 91.7%). If the two doses were given less than six weeks apart the efficacy was only 54.9% (CI 32.7% to 69.7%).

Already with dysfunctional health care facilities, experts warned that an infectious disease outbreak can catalyse further health issues in any country as the public loses trust in the healthcare system. Indeed, the likelihood of more people turning to unorthodox means of treating sicknesses will increase, if the surge continues.  Health authorities need to not wait until medical facilities are overwhelmed. Also, there is a need to commence discussions on what needs to be done with the surge in covid cases, especially for people who have taken one dose and waiting for 12 weeks to take the other. Presently, there is no information when the second dose will be donated to the country and this leaves room for speculations and in the extreme case, radical decision that could potentially do more harm than good. Hence, there is no time for self-glorification but to embark on aggressive community awareness involving CSOs and local community members through rigorous enforcement of public health measures, including imposing fines and revoking business licenses for would-be violators, while at the same time reminding people to comply with public health protocol.

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