Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda.

Most African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload.

The contribution of the Medical Education Partnership Initiative to Africa's renewal.

African countries gained independence from colonialism five decades ago with high expectations. Initial positive achievements were not sustained, however, and the continent slumped on many fronts. Medical schools were not spared: Many declined, became inward looking, and suffered from massive migration of health professionals to richer countries, commonly known as "brain drain." For more than a decade, however, Africa has been experiencing a renewal, backed by a more accountable African Union and a strong global movement for equity and social justice. The Medical Education Partnership Initiative (MEPI), a $130-million, 5-year award to 13 African medical schools by the U.S. government, arrived at an opportune time and is poised to contribute to Africa's transformation, provided that it continues to focus on capacity building, locally relevant research, retention, sustainability, and strengthening of health systems. MEPI also needs to distill and share its many successes with country governments and join existing regional and global health workforce institutions to reach African leaders at all levels. MEPI will represent another legacy of support to Africa, similar to the taming of the HIV pandemic but on a bigger scale of catalyzing the creation of a new generation of transformative African leaders.