An interview with Augustin Augier, Managing Director of ALIMA.
ALIMA, the NGO of which you are the Director General, is particularly active in West and Central Africa. What is the state of the Covid-19 pandemic in the countries of the region and how can we respond effectively when we know that containment is difficult and that health infrastructures are insufficient?
Augustin Augier : The epidemic is now present in all West and Central African countries and is progressing at different rates depending on the country. To date, there have been more than 20,000 cases and the virus is now present outside the capitals of most countries. However, it is very difficult to have a clear vision of the epidemic dynamics given the specific and differentiating factors in these countries.
On the one hand, certain characteristics allow us to be reasonably optimistic: demography; the possibility of a decrease in the virulence of transmission with the increase in temperature and humidity; the lower population density, particularly in rural areas; the introduction of social distancing measures earlier in the epidemic. Without any certainty, all this could explain why the rate of transmission observed since the first confirmation of cases is lower than in the rest of the world. There are also some very specific features, such as the very low proportion of severe cases and deaths in some countries such as Senegal, which cannot be explained at this time.
But this optimism must be tempered very strongly. On the one hand because epidemiological surveillance data are particularly fragile in these countries due to the very low testing capacity and much lower use of health services. Finally, it should be remembered that although the disease affects older people, who are less numerous in sub-Saharan Africa due to a much lower life expectancy, the fact remains that, as demonstrated by Pasteur’s study published on 21 April, all age groups are affected by severe cases requiring hospitalisation. Admittedly less for the 20 to 30 year olds (0.5% of cases) but this gradually rises to 2.8% for the 50 to 60 year olds. These age groups will also be affected in the most fragile countries. In France, they die very little because hospital capacities have been able to monitor and take care of them properly. But what will it be like in countries with 20 to 30 times fewer hospital beds per inhabitant and only a few dozen (or even fewer) resuscitation beds for populations of several tens of millions of inhabitants? According to the WHO, there are on average 5 resuscitation beds per million inhabitants in sub-Saharan Africa compared to 4000 in Europe!
In total we do not know what the evolution of this epidemic will be in the most fragile countries, particularly in West and Central Africa, but we can reasonably think that it will be difficult to measure the dynamics, the mortality (people often die at home) and that even if the incidence will be lower, or in any case slower to rise, mortality will probably affect several hundred thousand people as predicted by the WHO.
In such a complex humanitarian intervention context, what is ALIMA doing concretely in the field at the moment and how do you think you can increase your capacities ?
ALIMA is focusing on two pillars: first, strengthening infection prevention and control measures in the 400 health structures it supports (including some 30 hospitals). This involves reviewing the patient circuit to isolate suspected cases and reduce the risk of nosocomial infections, reinforcing the training of health personnel and equipping them with adequate protective equipment to better protect them.
Second pillar: supporting the Ministries of Health to open beds dedicated to the management of Covid-19 cases. In at least 6 countries ALIMA will create a total of 1000 hospital beds, with oxygen and adapted medical care. Due to a lack of personnel and equipment, it will be difficult to significantly increase the resuscitation capacity, so we have decided to focus on the 80% of severe cases hospitalized that do not require resuscitation but for which an adapted hospitalization can make the difference.
This represents an enormous and unprecedented mobilization of ALIMA’s 2,000 employees in the field. A major recruitment campaign has been launched to recruit more than 100 expatriate managers, including non-medical staff, to support the healthcare teams.
What synergies do you think are possible and desirable with the public services in these countries and between NGOs?
In any epidemic there are two main lines of work: reducing transmission and reducing mortality. On the first axis, total containment, a measure that seems to be the most effective so far, does not seem to be appropriate in the most fragile countries, or at least neighbourhoods. NGOs and public services need to concentrate financial support policies, through the distribution of cash, to facilitate social distancing measures. Good coordination between state and non-state actors should make it possible to target the most affected populations and neighbourhoods and to implement this type of programme on a significant scale.
Africa is fortunately lagging behind the pandemic in Europe and the United States. Do you think this time is really being used to prepare for the spread of the virus and is the mobilization of actors and capacities up to scratch?
Unfortunately, the general mobilisation seems to be largely insufficient. When we see that the first Covid-19 global humanitarian response plan, more akin to a refinancing plan of the United Nations agencies, only totalled $2 billion, we realize that the scope of the task was largely underestimated. A review is underway, and let us hope that this time it will be up to the task.
Fortunately, however, we can sense a strong mobilization of all societies in the field. Generally speaking, I would tend to say that in this crisis, the humanitarian response is significantly below needs and is lagging far behind local responses.
How can humanitarian organizations, particularly in France, get experts and freight to the African countries most at risk?
This is one of the major problems facing all humanitarian actors. The closure of commercial aviation has significantly reduced the deployment capacities of humanitarian actors. Beyond the reflection that this should induce on the need to rethink our model by further strengthening localization, including humanitarian leadership, this poses immediate problems. Solutions are being deployed, notably with the establishment of a global air system for humanitarians piloted by WFP/UNHAS, but how long does it take! Rarely has there been so much time to prepare for and contain the epidemic, but with great frustration, the implementation of these solutions has been slow. Individually, everyone seems to agree on the need for this “health airlift”, which has been planned in the global HRP since the end of March, and yet for the moment no serious solution is in place. The task is certainly difficult, but when we see the imaginative efforts and quick decisions made by the most developed countries to protect themselves in an unprecedented way against this virus, it is hard to accept that it will take more than five weeks to set up a few dozen regional aircraft, with priority being given to the most fragile countries, most of which are openly asking for this solution. Fortunately, between now and then, French NGOs are coordinating among themselves, under the impetus of the directors of operations of Solidarités International and Première Urgence International, to find solutions with the Crisis and Support Centre and the European Commission. But the solutions proposed are still largely insufficient.
Do you want to add a word in conclusion?
Beyond the urgently needed humanitarian effort, this crisis reveals, once again, some of the absurdities of the inequalities of our contemporary world. For example, when we look at the issue of protective equipment for healthcare personnel and tests, we see that there is no mechanism to prevent the richest countries from building up stocks for several months when entire countries only have a few tens of thousands of them. National egoism is not new, but it is surprising to see that we are not even trying to build fairer distribution mechanisms, based on needs and not on means, for these essential items in times of crisis, even though we know that, beyond the humanitarian imperative, allowing the virus to circulate on an entire continent is the certainty that it will return elsewhere. Solidarity is above all a moral imperative, but let us hope that this crisis will help some people understand that, in the face of their national egoism, it is also a health imperative.
A graduate of a business school, Augustin Augier began his professional career in M&A consulting and then at the National Assembly in a parliamentary group. In 2005, he spent three years in project coordination functions in conflict areas with an international medical NGO. In 2009, he was one of the founding members of ALIMA, of which he is currently the Managing Director.