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Minggu, 11 April 2021

COVID-19 success story for Rwanda is a wake-up call for wealthy West - ABC News

Sabin Nsanzimana won't forget the night of March 13 last year, when the first COVID case was confirmed in Rwanda.

"My team had called to cross-check and confirm the first case," she says.

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The physician and clinical epidemiologist is the deputy general of the Rwanda Biomedical Centre, which is leading the country's response to COVID.

"Although we'd been testing other diseases like Ebola virus disease in our lab, coronavirus was different because of the amount of panic and communication across the world," Dr Nsanzimana says.

"We had to retest that particular sample three times just to be sure."

But with that one case, the central African nation went into lockdown, and has repeatedly since.

An African COVID success

Rwanda stands out internationally, including amongst other African nations, as a remarkable COVID success story. It has 314 deaths at last count.

In December, the tally was just a third of that, but the holiday season saw cases spike briefly.

Compare this with the more than half a million deaths in the US — a country where nearly every aspect of the pandemic has been politicised — from mask wearing to managing lockdowns.

Why has one of the world's poorer nations succeeded — a nation blighted by the history of a brutal genocide — when wealthy nations have fumbled and failed to save lives, or fuelled coronavirus conspiracies?

"The Western sense of democracy has totally failed, and COVID is the proof of that," says Agnus Binagwaho, Rwanda's former health minister.

"Politics is a killing weapon.

"Democracy should be people-centred, not egocentric."

Health first, and economics will follow

Last year, every Rwandan diagnosed as COVID-positive was taken to a treatment centre for monitoring.

"That has helped to keep the number of deaths at the lowest levels," Dr Nsanzimana says.

Last year, more than 3,500 health workers in hospitals and aged care were infected in Victoria alone.

Only two health workers have been infected in Rwanda, according to Dr Nsanzimana.

The deployment of eight robots has also played a small, albeit novel, role in the nation's effort to control the virus and protect health workers.

Five white, humanoid-like robots with arms, camera and screen
To much fanfare, Rwanda put a handful of robots to work in treatment centres to prevent infection of health workers. (

Getty Images: Cyril Ndegeya/Xinhua

)

The robots help measure various vital signs of infected patients, serve them food and clean hospitals.

"We still have these robots at the airport checking temperature, and if people are wearing masks," Dr Nsanzimana says.

A health system destroyed by genocide

Dr Nsanzimana says trust in the advice of authorities and scientists has been a significant factor in containing the virus.

But Rwanda is a country where trust was completely destroyed.

In 1994, the Rwandan genocide saw tensions escalate between the majority Hutu and the minority Tutsi populations.

Hutus turned on Tutsis with machetes.

Up to 1 million people were slaughtered in just 100 days.

Many survivors still bear the scars of machetes on their necks.

Former leader of the Rwandan Patriotic Front, Paul Kagame, has been president of Rwanda since 2000, and served as vice-president after the genocide.

He's been praised for bringing stability to the country and for his development record, but some describe him as a "benevolent dictator", concerned about the serious suppression of dissenting views.

Rwanda's approach to its pandemic strategy has also attracted significant criticism from groups like Human Rights Watch, who have condemned the government's "authoritarian tactics to enforce public health measures".

Rebuilding trust through health care

Dr Binagwaho helped rebuild the health system from scratch whilst serving in Mr Kagame's ministry until 2016.

Her goal was to take health services to the people, for the people, by the people.

Health workers are elected by local communities across the country, and the trust they engender has been key to Rwanda's successful management of the pandemic.

"Those community health workers are so crucial," says Dr Binagwaho, now founding vice-chancellor of the University of Global Health Equity.

Rwanda's childhood vaccination rates are near universal, infant mortality has fallen, and life expectancy has increased.

In Australia, the failure to contain the major outbreak in Victoria was partly due to an under-resourced and overly centralised public health system after decades of budget cuts.

Rwanda has a more distributed health system with some parallels to the "local health district" model successfully used in New South Wales to help curb outbreaks.

Its community-based teams perform COVID tests, help with contact tracing and support those infected — services which are free for Rwandans.

Dr Nsanzimana says rapid communication of the latest data and science, and solidarity amongst health workers, has been key in Rwanda.

"Maybe for bigger countries that have very complex health systems and structures, that could be a challenge."

Acting fast

As early as January last year, nearly two months before the World Health Organization officially declared a pandemic, Rwanda stopped a plane destined for China.

Other countries failed to act as nimbly, and the virus was allowed to spread unhindered.

"If a country as serious as China says be careful — it was on their website; the magnitude of the problem, the speed of the problem, and the spread of the virus," Dr Binagwaho says.

"We took action because with the level of travel and having tourists coming here, we were at risk.

"The world had enough information to act according to science."

Rwanda has a relatively young and mobile population and shares borders with Tanzania, Burundi, the Democratic Republic of Congo, and Uganda.

A young African woman wearing a yellow face mask collects grass
Rwanda has a young and mobile population, with a high rate of poverty.(

Getty Images: Simon Wohlfahrt

)

Truck drivers have spread coronavirus in the East African region, and Rwanda has worked with its neighbours to mitigate the risks.

"It's not an easy task," Dr Nsanzimana says.

"You have to build mobile labs at the borders that give results without people waiting for many days.

"We're [now] giving results within six to nine hours."

At the start of the pandemic, only one lab and six people in the entire country were trained to perform PCR tests.

From running 200 tests per day in March last year, they are now able to do more than 10,000 tests in a day.

Dr Nsanzimana says the recent deployment of rapid antigen COVID tests — which are as fast and portable as pregnancy tests — will make a difference too. 

Does lockdown mean people starve?

An estimated 55 per cent of Rwandans live in poverty, though reported figures vary.

When their government enforced lockdowns, people were at real risk of hunger if they weren't allowed to leave their homes to shop for food or work.

In many Western countries, public health has been pitted against the economy, fuelling heated debates over lockdown strategies.

This hasn't been the case in Rwanda, Dr Nsanzimana says.

"That is the principle we had from the beginning from our leadership."

Village leaders were asked to identify people in their communities most at risk, and they received government funding to provide supplies.

"That means the worst thing that can happen to you is to die," Dr Binagwaho says.

"The second thing is to be sick.

"Being a little bit more poor because you save your life, it's really not so dramatic.

"It has been proven that [in] countries that didn't take care of their vulnerable … you are not going to respect the lockdown to save people who are richer than you."

Like Australia, the Rwandan government put in place financial protections, including freezing bank loans and stopping evictions of tenants by landlords.

"If you want people to comply and to protect themselves, their family, their communities and the entire nation, you need to provide for the basic care," Dr Binagwaho says.

A community-based health insurance scheme also covers most Rwandans.

"That's how with less money, we are less rich than our neighbours in Tanzania and Kenya, we have better results with managing COVID-19," she says.

Why Western vaccine nationalism might undermine successes

But even with such impressive results, the only way out of this pandemic is to ensure global access to vaccinations.

As nations compete to shore up supplies and get needles into arms, vaccine nationalism is rearing its head and delaying access to Africans.

Under the COVAX initiative, Rwanda received its first shipments of nearly 350,000 doses of the AstraZeneca-Oxford vaccine at the start of March.

Within nine days, about a quarter of a million people had been vaccinated.

Army helicopters were deployed to get doses to their remotest communities, Dr Binagwaho says.

People most at risk of infection or death have been prioritised, but it remains to be seen when, or if, Rwanda will receive enough vaccinations to cover its whole population.

Africans are often recruited by pharmaceutical companies to be human guinea pigs in drug trials — as they were for the Oxford/AstraZeneca COVID-19 vaccine — but too often this doesn't translate into timely access to any resulting medications.

Dr Binagwaho believes the citizens of Western nations, whose taxes contributed to the development of COVID vaccines, will also lose out unless vaccines are distributed widely, and equitably.

"It's a global effort, it's not just big pharma, it's your taxes, your money, and to be protected … people across the world should be vaccinated, so we make progress to herd immunity."

Dr Nsanzimana points to Africa's success in manufacturing anti-retroviral drugs for HIV treatment, and wants to see local manufacturing of COVID vaccines too.

"It's something that should be prioritised in an African context," he says.

"It's a win-win situation, because the enemy is common.

"Preventing [the virus] from coming to you or preventing it [spreading] from you to others is the best way we can end this situation globally."

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2021-04-11 19:00:00Z
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