How prepared is Africa should the swine influenza hit?

It is possible that by the time you finish reading this piece, the current data reported about suspected or confirmed cases of the swine flu may be old. So much information is filtering through; we have to constantly change our understanding of the level of threat posed by the current swine influenza. Consequently I have had to change the focus of my postings; the last one thrown out after the World Health Organization (WHO) raised the pandemic threat level to phase 4 defined as “sustained human to human transmission”. Furthermore a statement from the WHO Director General’s office states that focus should be on "mitigating" measures as "containment is not feasible".
Browsing through the maps and alerts as they are updated, I notice African countries been spared at least for now. In as much as I have some relief, I have serious concerns about how well prepared these countries are, should the disease reach the continent or were this to progress to a global pandemic level.
Africa, especially sub Saharan Africa is predominantly lagging behind in key indices of socio economic and human development. Lack of trained medical personnel, poor access to water, poor sanitation, poor health infrastructure and delivery systems are but just a few of the parameters that make the health capacities of these countries very precarious. In seemingly normal or more appropriately usual circumstances, the predominant infectious diseases like Malaria, Tuberculosis, and HIV/AIDS are constantly taking their toll on the population – in some cases dessimating entire communities and regions – and death from some commonly preventable diseases contribute to the low life expectancy. Without NGO’s and foreign government aid, most departments of health could not function or adequately address the health care needs of the respective countries.
It is thus important that African countries, in addition to maintaining membership of the World Health Organization be signatories to other international organizations and regimens for Disease control. One such regimen is the International Health Regulations (IHR). http://www.who.int/en/
Due to some events prior to but more importantly shortly after the SARS threat, the IHR in its current form (IHR 2005) was put in place as a regimen to “prevent, protect against, control and provide a public health response to the international spread of disease” in 2005 taking effect in 2007 in all member countries. It required member states to have minimum core public health capacities including notification of WHO of events constituting health emergencies of international concern. The three top priorities for member states were to establish functioning national IHR focal points, adhere to reporting requirements and verification of public health events and assess and strengthen national capacities. Decision instruments for assessment and reporting of unusual cases of influenza, among other diseases were established.
Having established that the current swine influenza is of the type A/H1N1 genetic strain, we now know that (at the time of writing this) it has been reported in all continents except Africa. Direct air transportation between Mexico and African countries is not as common it is with the rest of the world which is evident in the current pattern of spread. But the rate of current intercontinental travel means there is no safe zone on teh planet. How well African countries deal with the potential spread is dependent upon several factors; awareness by the general population of symptoms and seeking immediate medical care; adequate diagnostic tools for confirmation of the current swine influenza strain; availability of medication for treatment of possible mild cases as has been done in some of the countries reporing cases now; availability of vaccines for at risk individuals. It is not clear how much public awareness campaigns have been done to influence individuals to seek help as soon as they experience symptoms. Mass media outlets are not sufficiently available and accessible to most people, especially in rural Africa, so how public awareness campaigns affect immediate behaviour change in the present circumstance is uncertain. There is also a significant lack of health care facilities in most countries; and of those available, lack of equipment and personnel means numerous cases going undiagnosed and unattended to. At the time of writing, enquiries have already been sent to various agencies requesting data on African countries with regard to the minimum core public health capacities as outlined in the IHR. Furthermore it would be important to know which countries have activated systems for disease surveillance both within the resident population and at points of entry - land, air and sea - in the current situation.
While waiting for those responses, A report by IRIN news services titled “EAST AFRICA: Swine flu scare prompts surveillance scale-up” that I read this afternoon provides some clue( http://www.irinnews.org/Report.aspx?ReportId=84144). It clearly shows an overall lack of preparedness on the part of East African countries. If we were to go by their rankings in human development as well as health indices over the years the same would be the case for most of the other African countries.
It probably is too late, but the question now is what can be done? More importantly what can international agencies and well equipped foreign governments with established systems in place offer by way of mitigating the effects should it reach Africa or become a global pandemic? Should African countries be allowed to ride out this health hurricane and thereafter learn to develop systems efficient at dealing with situations like these? Should they be tasked with the responsibilty of stretching their resources in an already critical global economic situation? So many more questions, but let us know what you think.