Depuis l’apparition officielle du Sars-Cov-2 sur le continent le 14 février 2020, le nombre de contaminations et de morts dues à la pandémie semble largement contenu, malgré une résurgence dans certains pays ces dernières semaines.
Les chiffres ne laissent jusque-là pas de place au doute. 2,32 millions de contaminations, 55 265 morts. Dix mois après le premier cas officiellement déclaré en Égypte, le continent africain ne totalise que 3,4 % des contaminations au coronavirus alors qu’il représente 17 % de la population mondiale. La réalité de la propagation du virus est sans doute nettement plus importante, surtout dans les pays disposant de capacités de dépistage limitées. Il n’empêche, la plupart des pays africains ont dès le début de la pandémie réussi à prévenir ou à contenir la transmission communautaire généralisée, déjouant par la même les prédictions les plus alarmistes.
À l’Organisation mondiale de la santé (OMS), on se veut pourtant très vigilant. « Le virus continue de circuler et la plupart des gens restent sensibles », a déclaré depuis Genève, Tedros Adhanom Ghebreyesus, directeur général de l’organisation, le 10 décembre dernier, à l’ouverture du troisième Forum Galien Afrique, qui se tenait à Dakar, la capitale sénégalaise. Selon lui, le continent africain est « à une période charnière » dans la gestion de la pandémie mondiale. « Ces dernières semaines, nous avons constaté une augmentation inquiétante du nombre de cas et de décès », a alerté le chef de l’agence sanitaire mondiale.
Une situation contrastée
De fait, depuis début octobre, la circulation du virus a repris et la courbe est repartie à la hausse. Toujours de façon inégale. Les pays d’Afrique australe et d’Afrique du Nord se partagent le plus grand nombre de cas. Soit sept pays totalisant environ 81 % des contaminations, dont l’Afrique du Sud (27 %) qui reste le pays le plus touché. Pour la seule journée de mercredi 9 décembre, Pretoria a enregistré 6 709 nouveaux cas ainsi que 135 morts. Le nombre de nouvelles contaminations est en forte hausse depuis le début du mois, laissant présager une deuxième vague, notamment au sud du pays, dans la région du Cap, mais également dans le Sud-Est et la région de Pretoria et Johannesburg. Contrairement à la première vaque, ce sont surtout les adolescents qui sont touchés, principalement les 15-19 ans. Pour l’instant, il n’est pas question d’un nouveau confinement, mais les autorités appellent chacun à être responsable durant les fêtes de Noël.
L’Afrique de l’Ouest, qui avait jusque-là enregistré peu de malades, est elle aussi confrontée à un rebond des nouvelles contaminations : +45 % en moyenne entre le 30 novembre et le 6 décembre. Avec des hausses records par endroits : +194 % au Burkina Faso – qui est passé de 2 856 cas le 30 novembre à 3 212 cas le 6 décembre -, +79 % pour le Nigeria. Dans son rapport hebdomadaire, le centre nigérian de contrôle des maladies (NCDC) indique d’ailleurs que le nombre de personnes testées positives sur cette période est passé de 3,9 % à 6 % alors que le nombre de tests pratiqués a diminué par rapport à la semaine précédente. Même écho au Sénégal ou l’on craint « une deuxième vague ». Selon Abdoulaye Diouf Sarr, le ministre de la Santé, le pays est passé de dix nouvelles contaminations par jour il y a un mois à 101 quotidiennes le 10 décembre dernier. Pas de mesures restrictives annoncées pour le moment, mais une « tolérance zéro » pour le port du masque.
Les systèmes de santé à l’épreuve de la pandémie
Au Sénégal comme ailleurs, pas question d’exposer à nouveau les systèmes de santé déjà fragilisés. En dépit d’une réponse rapide des autorités sanitaires dès le début de la pandémie en mars dernier, les services essentiels ont été mis à rude épreuve. Vaccination, lutte contre le paludisme, santé reproductive… tous les secteurs ont pâti de la pandémie.
Une étude préliminaire de l’OMS menée dans quatorze pays révèle une chute importante de la prestation dans cinq services de santé essentiels – entre janvier et septembre 2020 – par rapport aux deux années précédentes.
Des campagnes d’immunisation contre la rougeole, la tuberculose, la fièvre jaune, la polio et d’autres maladies ont été repoussées dans au moins quinze pays africains. L’introduction de nouveaux vaccins a été suspendue et plusieurs pays ont enregistré des ruptures de stocks de vaccins. Quant à la santé des femmes, elle s’est considérablement dégradée. Au Nigeria, par exemple, il y a eu 310 morts maternelles dans les structures sanitaires en août 2020, soit près du double par rapport à août 2019.
De son côté, l’Onusida s’inquiète des menaces qui pèsent sur l’avancée de la lutte contre le VIH. En Afrique du Sud, l’expérience accumulée dans le combat contre le sida a pu aider à contenir la pandémie de coronavirus. Mais les chercheurs sont inquiets : le confinement strict mis en place au début de l’année, puis les mesures progressivement relâchées, ont ralenti les objectifs de dépistage et de traitement. Les organisations tentent désormais de rattraper le retard.
Un accès difficile au vaccin
La course au vaccin est lancée. Et elle s’annonce semée d’obstacles pour le continent. Le premier est d’ordre financier. Sur les 47 pays de la région Afrique de l’OMS, « seulement près du quart disposent de plans adéquats pour les ressources et le financement », regrette l’agence onusienne qui entend vacciner « 3 % des Africains d’ici mars 2021 et 20 % d’ici la fin de l’année prochaine ».
Pour y parvenir, le continent attend beaucoup de l’initiative Covax, lancée par l’OMS et Gavi (l’alliance du vaccin) pour assurer une disponibilité mondiale des vaccins. Objectif du partenariat : se procurer deux milliards de doses qui seront ensuite données aux pays membres à faibles revenus et vendus à prix préférentiel à ceux à revenu modérés.
Le Rwanda espère ainsi être l’un des premiers pays africains à obtenir le vaccin contre le Covid-19. C’est ce qu’à déclaré le ministre de la Santé Daniel Ngamije dans une interview à la chaîne de télévision nationale ce dimanche. Selon lui, les premières doses pourraient arriver dans le pays aux alentours de mars 2021.
Pour l’instant, seules 600 millions de doses ont été réservées auprès de neuf laboratoires, et on estime qu’il manque encore 3,8 milliards d’euros pour obtenir les 1,4 milliards restantes. Covax et l’OMS comptent sur la générosité internationale pour mobiliser cette somme. Malheureusement, celle-ci tarde à se concrétiser.
Bien au contraire. Les contrats bilatéraux passés directement avec les laboratoires priment sur les belles paroles. À ce stade, les pays les plus riches représentant 14 % de la population mondiale ont mis la main sur 53 % des doses de vaccins promises à court terme. Et qu’importe si l’Afrique du Sud et le Kenya participent à plusieurs essais cliniques, cela ne leur garantit aucun accès préférentiel aux doses.
Reste ensuite à relever les défis logistiques. La plupart des vaccins actuellement développés nécessitent d’être conservés à -70 degrés, ce qui constitue un véritable frein pour les pays ne possédant pas les infrastructures nécessaires. À quoi il faut ajouter le scepticisme des populations.
La méfiance des populations
Lors d’une enquête, menée par des chercheurs de l’IRD dans quatre pays africains (Cameroun, Sénégal, Bénin et Burkina Faso), six à sept personnes interrogées sur dix affirmaient qu’elles n’accepteraient pas le vaccin si on le leur proposait. Alice Desclaux est anthropologue à l’IRD à Dakar et a participé à cette étude. Selon elle, les raisons avancées pour ce refus sont multiples.
En Afrique du Sud, une étude Ipsos révèle que moins des deux tiers des Sud-Africains seraient prêts à accepter le vaccin s’il était disponible, principalement à cause de la peur d’effets secondaires. Quelques manifestations ont d’ailleurs eu lieu contre l’annonce des premiers essais cliniques, en juin dernier. Et plus récemment, le chef de la Cour suprême, connu pour ses convictions chrétiennes, a même affirmé dans une prière que les vaccins était « l’œuvre du diable ». De quoi fragiliser un peu plus la confiance des populations.
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