In November 2021, the team led by virologist Sikhulile Moyo (Zimbabwe, 1973), researcher and director of the laboratory of the Botswana-Harvard HIV Institute (BHP)), located in Gaborone, was the first to identify the omicron variant of the coronavirus, together with a Brazilian bioinformatician who works in South Africa. The specialist then believed that the planet had learned a lesson: viruses have no borders. Now he doubts such learning when he sees what the international response was like to the serious health emergency unleashed by mpox—also known as monkeypox—in the Democratic Republic of the Congo.
In the laboratory he directs in the capital of Botswana, he talks about this new virus that worries some African nations and that high-income countries look askance at, but also about how climate change can accelerate the appearance of new epidemics, especially in Africa. Also about how Botswana, a middle-income state, has made significant progress in health. In 2021, for example, it became the first country in the world with a high HIV burden—those in which more than 2% of pregnant women are living with the virus—to eliminate mother-to-child transmission of the AIDS virus.
Sikhulile Moyo in the laboratory he runs in Botswana on September 19. José Ignacio Martínez Rodríguez
Ask. Three years ago this laboratory sequenced the omicron variant of the coronavirus. There was a lot of talk then that many things had to change in Africa to ensure that new epidemics did not catch countries on the continent off guard again. Has it been like this?
Answer. One of the things the world discovered with the omicron variant is that viruses have no passports or borders. They move with the people because we are a global village. We also realized that the effort to control pandemics cannot be that of one country alone. There are now several coalitions, both national and international, working to ensure that in the future we can tackle these types of problems together. Additionally, we have learned how to communicate the existence and dangers of a new virus to communities. Although we scientists do our job, we must be able to make people understand what is happening. People are part of the solution. Finally, I think that African countries are realizing that they can now issue their own diagnoses.
P. However, we have recently seen an outbreak of mpox, the largest known to date in Africa, and it seems that the same problems have been repeated: higher-income countries have withheld vaccines that could have alleviated the situation.
R. What we see is that some lessons that we thought we had learned have come back to us. States like the Democratic Republic of the Congo and Burundi are dealing with an aggressive disease while the rest of the world just watches. One of the things that worries me the most is the selfishness of some countries. In 24 hours they can move from one end of the world to the other. We have seen that there are nations and organizations that have mobilized to bring vaccines and donate materials. It’s not enough, but those are the kind of actions we need.
The effort to control pandemics cannot be that of one country alone
P. Do you think Western nations should get more involved in health emergencies like this new mpox outbreak?
R. The world is a global village, so these types of cases need an international response. If you protect your neighbor, you are protecting yourself. And, in the case of mpox, this is not happening. You don’t act until you see your own house on fire. But I also think that the African continent needs to wake up and be able to produce its own test kits, its own vaccines. It is the only way to stop regretting because no one helps us.
P. In 2021, southern African countries suffered from the omicron variant. Now, the Democratic Republic of the Congo is fighting mpox. In 2022 there was an aggressive Ebola outbreak in Ugandaalthough not as much as that of Sierra Leone in 2014. Furthermore, every so often, countries like Zimbabwe or Zambia deal with serious cases of cholera. Why does it seem that these diseases hit Africa more virulently than the rest of the regions?
R. Africa is more vulnerable for several reasons. Firstly, many of the health systems in African countries remain those of colonial times. Second, here is the largest interface between humans and animals, and more than 70% of these infections we are talking about are zoonotic. Furthermore, prevention systems are still growing. I also have to say that climate change could accentuate some of these problems. And the countries that cause it the most are not exactly the ones that are suffering its most devastating consequences.
Climate change causes animals and humans to come into closer contact and these microorganisms gain adaptability and the ability to infect new hosts.
P. Can climate change cause pandemics or epidemics in Africa?
R. It can amplify diseases and epidemics. It varies temperature and habitats and causes floods that bring with them massive movements of organisms. Climate change causes animals and humans to come into closer contact and these microorganisms gain adaptability and the ability to infect new hosts. Ultimately, it can cause viruses whose main victims are animals to also affect humans. You can see it with mosquitoes that carry malaria; Changes in temperature, for example, allow these bad mosquitoes, so to speak, to displace the good mosquitoes. It also happens with those that transmit dengue, chikungunya and other diseases.
P. There are nations in Africa, like Botswana, that are models in terms of health. For example, in 2021 this country became the first with a high HIV burden to eliminate mother-to-child transmission. How can these achievements be enhanced?
R. Firstly, with committed public policies. The Government here has taken this issue very seriously for the last 25 years or more. A significant number of resources have been allocated to combating HIV. Botswana was the country that, proportionally, had the highest number of people living with the AIDS virus, and was the first nation in Africa to offer free treatment to all its citizens. He did it in 2002. It was a great show of commitment that attracted many collaborators, including this institution. Secondly, Botswana has always been open to working with international organizations in the HIV response. Donors are vital, but allocating a significant amount of your budget to healthcare is even more so.
P. Is it easy for these progress to reach everyone? How do you fight, for example, the stigma that this disease usually carries?
R. Primary care was heavily promoted here to ensure that services reached everyone and all sectors of the population. We must ensure that no one is left behind. Access to healthcare cannot be a thing for the rich, and that is something that Botswana is doing very well. All inhabitants have access to health care for free or at a very low cost. Furthermore, Botswana society has managed to talk about HIV very naturally. Before, some people who were infected felt ashamed, lowered their heads… Now none of that happens anymore.
P. But Botswana does not have three million inhabitants. Is it easier to achieve this progress here than in other countries or even much more populated African cities?
We must ensure that no one is left behind. Access to healthcare cannot be something for the rich, and that is something that Botswana is doing very well.”
R. Not necessarily. It is true that having a small population can be an advantage, but here we have had to face a challenge due to the very low population density—two-thirds of the country’s territory is desert. That makes it difficult for medicine to reach everyone. In terms of means of production, for example, other nations may have many more options.
P. What other diseases are of concern to the Botswana or African population in general today?
R. Now we are focusing on non-communicable diseases such as diabetes, hypertension… That is what worries us now. These are problems that also affect high-income countries. Furthermore, we are facing a growing number of cancer cases.
Welcome, dear readers! Today, we’re diving into a rather eye-opening and slightly troubling conversation about pandemic responses, the state of public health in Africa, and—oh yes—the joys of climate change making our lives even more complicated. Grab your popcorn—or your N95 masks; it’s about to get interesting!
In November 2021, a terrific team led by virologist Sikhulile Moyo from Zimbabwe had a moment that felt a bit like winning the lottery—if the jackpot was an ominous new variant of COVID-19. They were the first folks to identify the Omicron variant, working in tandem with a Brazilian bioinformatician in South Africa, proving once again that science knows no borders—except when it comes to vaccine distribution, of course. Apparently, those borders are more like a series of roadblocks with some countries waving a big stop sign.
Dr. Moyo now seems a bit less optimistic about our collective learning experience. He’s seen how the world’s response to the mpox outbreak—yes, the artist formerly known as monkeypox—is basically reminiscent of a ‘what-not-to-do’ handbook. It’s like when you go to the buffet and someone completely cleans out the dessert table before you get there. Talk about selfish!
In his lab in Botswana, he highlights that, while high-income countries might as well be watching a reality show, African nations are squarely in the middle of a health crisis. They were all too eager to learn from their mistakes with Omicron, but now it seems there’s a selective amnesia regarding other existing health emergencies. Higher-income nations’ reluctance to share vaccines is like watching your neighbor cut down their own trees while yours are still smoldering.
The effort to control pandemics cannot be that of one country alone.
Ask yourself: should wealthier nations be more altruistic? Dr. Moyo has an answer, and it involves a collective response. You can’t just throw a party for yourself and expect others to cheer you on from outside; that’s not how community works, my friends. The idea that if you help your neighbor, you’re ultimately protecting yourself should apply here, too. But right now? It’s more of a ‘you snooze, you lose’ scenario, which is a terrible way to handle a pandemic.
Let’s zoom out a bit and look at why Africa seems to be the punchline for many of these health crises. Dr. Moyo outlines reasons that sound like the plot of a dystopian novel—colonial-era health systems, an interface ripe for zoonotic diseases (that’s fancy talk for viruses that jump from animals to humans), and prevention strategies still in their formative years. And let’s not forget about climate change, which seems to be auditioning for the role of ‘Worst Villain in a Public Health Drama.’
Climate change causes animals and humans to come closer and closer to each other. Spoiler alert: it’s not a love story.
Essentially, the weather’s throwing a rave that nobody RSVP’d to, meaning increased touches between humans and wildlife—and when you combine that with a dash of viral adaptation, boom! You’ve got your next health emergency. And let’s not forget, some bugs (yes, I mean mosquitoes) have turned into first-class carriers of disease. Watch out! If you think buying repellent for summer barbeques suffices, you might want to rethink your strategy.
Now, Botswana takes the spotlight for some solid health achievements. It became the first country with a high HIV burden to eliminate mother-to-child transmission of the virus, proving that good public policy and a little international collaboration can go a long way. But let’s be real: Can these strategies be replicated in other countries with larger and more diverse populations? It’s a trickier game—but it starts with treating health as a right for *everyone*, not just an exclusive club for the wealthy.
Access to healthcare cannot be something only for the rich. That’s what Botswana is nailing.
While Botswana makes strides towards tackling non-communicable diseases, including diabetes and hypertension, it’s pivotal that the rest of the world pays attention. Can you imagine watching a sporting event where one team is consistently injured but no one sends a doctor to help? That’s exactly what’s happening on the global health stage right now. We need to ensure that we’re all in this together, step by grinding step.
So, in summary: viruses don’t respect borders, climate change is the anti-friend we never invited to the party, and it’s time for a wake-up call for both affluent nations and African nations. Together, we can either drown in this chaos or create a world—with borders blurred and compassion in focus. Grab a seat because this show is just getting started.
What strategies can countries like Botswana teach us about effectively addressing public health challenges and improving healthcare access in the face of climate change?
T with adaptable microorganisms, you’ve got a recipe for disaster. Dr. Moyo explains how changing temperatures and habitats can lead to more vector-borne diseases like malaria and dengue, as those pesky mosquitoes find new homes and new hosts to spread viruses.
But it’s not all bleak. Botswana has shown that progress is possible. The country not only tackled its high HIV burden effectively but also eliminated mother-to-child transmission, serving as a beacon of hope for health initiatives in Africa. The key? A government that prioritizes public health, committed funding, and collaboration with international organizations. It exemplifies how effective policies and community outreach can lead to tangible improvements.
However, even with these successes in smaller nations, systemic issues remain. Dr. Moyo emphasizes the importance of ensuring equitable healthcare access, recognizing that many countries have greater challenges in reaching their populations, especially those with larger populations or different geographical landscapes. This reminder of unequal access leads to real-world questions about complacency in dealing with non-communicable diseases, like diabetes and hypertension, which are climbing rapidly across the continent and straining health systems.
So where do we go from here? It’s clear that addressing infectious diseases and the looming threat of climate change will take a united front. As Dr. Moyo puts it, “The effort to control pandemics cannot be that of one country alone.” Wealthier nations need to step up and take a holistic approach to public health that includes global collaboration and investment in healthcare infrastructure, especially in vulnerable regions.
The takeaway is simple: we can either choose to act like the neighbor who looks after their garden (all the while ensuring their own tree doesn’t catch fire) or we can ignore the smoke signals until it’s too late. The choice is ours. Let’s hope that next time, we choose wisely.
