South Africa, the country with the most resources in Africa, has two suspected cases of swine flu, but does not have adequate supplies of the antiviral drugs known to be effective in treating the rapidly spreading disease that has so far claimed more than 150 lives in Mexico, according to an expert.
"I know for a fact we haven't stockpiled. If you don't have a national stockpile, that's it – you're not going to get the drugs in time," said Ed Rybicki, a virologist who teaches at the University of Cape Town.
In the absence of a vaccine for swine flu, antiviral medicines such as oseltamivir (Tamiflu) and zanamivir (Relenza) have been used to treat the disease.
Dr Lucille Blumberg, of the South African National Institute for Communicable Diseases, confirmed on 29 April that two suspected cases of swine flu were being investigated. South Africa is a major transit hub for the continent and a destination of migrants.
The World Health Organization (WHO) has allocated a Phase 4 alert level to the flu, which is two steps away from the pandemic phase but signals the need for response and mitigation efforts.
|I know for a fact we haven't stockpiled. If you don't have a national stockpile, that's it – you're not going to get the drugs in time|
Dorothy Mwangu, a spokeswoman for Roche, the global pharmaceutical company that manufactures Tamiflu, confirmed that the South African government had a stockpile of the drug and said the company also kept its own reserve of drugs to handle seasonal flu outbreaks at country level, but could not comment on the specific quantities on hand in South Africa.
The company had set aside key ingredients of the drug, but it would take time to respond to any sudden major upsurges in demand. She said the country's best bet was to maintain an adequate stockpile.
Neighbours such as Namibia have pinned their hopes on South Africa to meet their drug requirements, should there be an outbreak. Mozambique's national deputy director of health, Leonardo Antonio Chavane, said his country did not have the antiviral drugs. "We use what we have."
Tamiflu is sold at a discounted price to developing countries, and a box of 75 pills retails for about US$24 in South Africa. The government had not responded to queries on the quantity of antiviral drugs stockpiled at the time this story went online.
Rybicki, who is working on a flu vaccine, said if swine flu hit Africa it might be nearly unstoppable because the continent's poor surveillance capacity, higher disease burden than more developed regions, and lack of drugs were a deadly combination.
"I think picking it up - outside of sophisticated centres - all over the world is going to be difficult," he said. "Surveillance at airports is almost nil - I reckon you can count the number of thermal scanners in South Africa on one hand."
Screening a problem
Screening for the disease in Africa would mean locating it in a population that already suffered from many fever-producing ailments, like malaria, and could result in higher mortality rates, Rybicki said.
Developed countries often have standing orders with pharmaceutical companies for vital drugs, so developing countries like those in southern Africa may be out of luck when placing emergency orders for medicines in high demand.
Swine flu is a respiratory disease in pigs, caused by type A influenza viruses. According to the US Centers for Disease Control and Prevention, people do not normally get swine flu, however, "swine flu viruses have been reported to spread from person-to-person, but in the past this transmission was limited and not sustained beyond three people."
Here is how some southern African countries have responded so far:
- Zimbabwean economist Innocent Makwiramiti said there was "zero preparedness" for an outbreak. The country is still recovering from one of the biggest ever cholera outbreaks, which claimed thousands of lives. "There is no money to stock hospitals with drugs and it would be a miracle for the government to mobilize funds needed to combat swine flu that, as it were, seems far away."
- Frank Mwenifumbo, Malawi's deputy minister of agriculture and food security, told IRIN that medical teams, including veterinary officials, had been deployed at all entry points to ensure that the human strain of the virus associated with pigs did not spread into the country.
- Zambia is placing a renewed emphasis on epidemiological surveillance throughout the country, while working with the WHO and other organizations to obtain drugs and set up the logistics to cope with a swine flu epidemic, according to local media reports.
- There is concern whether Angola, which has a fragile health infrastructure and a poor track record of responding to recent outbreaks of cholera, rabies and polio, would be able to handle an outbreak. The government has announced that it was "taking measures".
- Botswana's Ministry of Health has advised people who travelled to any of the affected countries or have had contact with any person affected by swine flu and developed a combination of symptoms to report to the nearest health facility.
- Swaziland, which lacks capacity, will be assisted by the WHO country office to help monitor flu cases.