Transcript of Dr Agnes Binagwaho’s Remarks

15 May 2020

Reacting to a pandemic or epidemic is the same at national level. At national level it is always an epidemic. What we have learnt since 2014 when Ebola was a threat for the whole of Africa and the whole of the world (the US and Spain were also confronted with this challenge), and what the country is applying now, is that we need to work as one, in solidarity. It is critical that the population participate in the national response. If they do not understand, we will not have them doing the right thing at the right moment. We will have a panic as they will feel neglected, abused or used. We need to provide the population the best the government can do to abide with the guidelines. Now we say lockdown, and everybody stays at home. But we must also consider that around 47% of people in Rwanda live within poverty, they earn their wage on a daily basis, so, after a few days, they will run out of money to feed their family and will have to go out. We need to provide food provisions, and health support to help them feel secure, and be capable of living at home until the situation changes. Secondly, we all know that very few people can afford the test, or quarantine if needed. Therefore, these services have to be free, and this is what the government did.

All countries need to be ready for an outbreak like this. So, we need to have what we call the ‘disease detective’, those who are tracing the contacts ready to be on the frontline when the first case is diagnosed. We already have these in each district, and between outbreaks they are doing another job. So, when the pandemic entered the country, they were immediately on call. We also need to continuously refresh the knowledge of these workers around prevention on a regular basis, knowing who will say what and when. We need to engage the churches, the media, the private sector, the transport sector, the mobile population, youth, and women – to ensure they too are prepared. When the Government of Rwanda knew that China had this problem, we blocked a plane travelling to China. We started screening everyone coming into the country because anyone can be infected in any airport. We had this test ready and the systems prepared to trace all contacts of patients. We also tracked down the respirators we had in the country.

Preparedness is different disease by disease. We had a different response for Ebola than for COVID-19, but Ebola is absolutely deadly and spread by touch. Here, touch is not good, but it is not exactly the same. So, information, participation and a multisectoral approach is critical to pandemic prevention and response. Based on science, and this is the big problem of the world in this case, you can tell me that Europe and the US were prepared. But they were not. This is because they mistrusted science, and the politicians misused information.

What we are doing now, and you will see this more and more, is that there is science behind it. What we call implementation science. You may have all the hard sciences; what is a virus, how you are infected, but if you don’t know how to implement your preparation and your response, you will have what is happening, for example, in the UK and Italy. They did exactly the right things, but too late. Implementation science is the way that we can teach countries, researchers or politicians how to use the right evidence-based interventions at the right time, taking into account the context of time, and how fast an epidemic can spread.

Community Health Workers (CHWs) are the frontline at community level. In many countries they are elected, not nominated. The community recognizes CHWs as their people, so when a CHW says something, the community knows they have the knowledge provided by the ministry of health and the training and education they have, they are trusted by the people. If the pastor says something different than me, they will follow the pastor. And it is the same with the CHWs. It’s therefore important that we give them accurate data, and make sure that they have understood. In my country, Rwanda, they need to know how to read and write, to use a phone and to do a report, and they are trained for six weeks, refreshed every year. They have to talk only about what they know. We need to make sure that we don’t confuse them.

There is something that helped my country do what we do. In my country we don’t have a second amendment, and I don’t want to have it. If, for example, I go and say that vaccines kill, and we have a family who refuse a vaccine quoting my words, I am answerable to the law having put people in danger. And so people must not play with this. All this needs to be explained to CHWs and the entire population. We therefore need a participatory process, which makes sure that, for example, the religious community has the same message for the people as the Minister for Health or the education system so that we are all of the same sense. When we don’t know we say that we don’t know and that there are people out there in the global health community that are searching, and that we will come back soon with an answer when we know.

It is therefore all about honesty, transparency and ensuring that CHWs give the right message to avoid conflicting messages inside the same community. We must not forget the doctors, the nurses, the local leaders; everyone needs to be onboard. When we were preparing to respond to the Ebola crisis, we set up regular meetings between all these constituencies to ensure everyone had the same information and could work together. This means the media, the private sector, the religious community, young people, the association of CHWs, women and more; we need to make sure that they all have the same information and can work together. What scares me is not what is happening in my country, because we are at the other side of the curve and today the 15^th of May, we have not had more than 300 cases. What scares me is what is going to happen in the world when we stop the lockdowns globally. We have the pre and post-COVID time, and we are going to overcome it. But inside the COVID-19 pandemic period, we have the pre-vaccine period and we will have the post-vaccine. During the pre-vaccine period we are very fragile. If life restarts as it does before, and this is my biggest fear, and if the vulnerable stay vulnerable, we will suffer. The world needs to realize that the equity agenda protects us all, and if we do not realize this, we are going to be worse than before this time of COVID-19.

Watch the full video here: https://youtu.be/Zb98eh2GERk?t=1069