The Lancet   |  November 11, 2021

Ngozi Erondu is senior research fellow at the Chatham House Centre for Global Health Security (London, UK). She points out that there was always likely to be a sizeable number of missed cases of COVID-19 in Africa. “Many African countries have weak surveillance systems”, said Erondu. “There are challenges in detecting known diseases like meningitis; a new disease that has non-specific febrile symptoms is going to be even more difficult to pick up.” At the start of 2020, Africa contained two laboratories capable of undertaking RT-PCR testing. Capacity has since improved, but it is almost entirely restricted to the cities. More than half of sub-Saharan Africans live in rural settings.

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