Amidst a global pandemic that continues to wreak havoc across the globe, Dr Grant Murewanhema has stepped up as a much needed leading voice on Covid19 in Zimbabwe. Currently one of the key administrators of the National Covid19 Group, a Facebook Group of now over ninety thousand and counting Zimbabweans that he created together with some colleagues in order to spread accurate information and dispel the several falsehoods, rumours, myths and misconceptions around COVID19, Dr Grant is determined to play his part in curbing the spread of COVID-19, reducing the morbidity and mortality associated with the disease, and reducing its impact on the population, particularly among vulnerable populations. As the battle against Covid19 rages on, with a current third wave that’s not letting up and with vaccination still very much a contentious issue, we check in with Dr Grant to get to the bottom of some of our most burning questions.
Infectious diseases are a huge area of concern to me, having seen the devastating effects of malaria, TB, HIV, cholera, dysentery and other problems that we have encountered in Zimbabwe and beyond such as the Ebola viral disease outbreaks. I am trained in Epidemiology and Public Health, and a big focus of my training was Infectious Diseases Epidemiology. Naturally, with the pre-existing interest in Infectious Diseases, when COVID-19 came, it just tickled my interest, but more so the rate of spread of COVID-19 and the extent to which it ravaged countries such as Italy and Spain in the first wave made me commit voluntarily to being a voice to raise awareness and prevention. The infodemic was scaring, and I said to myself, there are many non-scientific and non-medical voices peddling a lot of falsehoods, rumours, myths and misconceptions, and as a public health specialist I must add in my voice to spread accurate and verified information, and play my part in making sure that we curb the spread of COVID-19, reduce the morbidity and mortality associated with this disease, and reduce its impact on the population, particularly among vulnerable populations.
All this is entirely voluntary. It is at that time that I also joined forces with the likes of Dr Brighton Chireka and Professor Edward Kunonga, to make sure that we spread correct information, counter the infodemic, and dispel the several rumours, myths and misconceptions around COVID-19. Naturally when vaccines came, we added our voices to that too, to make sure we proactively deal with vaccine hesitancy, and improve vaccine confidence and uptake in our population.
Yes, we are unfortunately in a third wave of the COVID-19 pandemic, which is harsh, and spreading across the world at an alarming rate, and terribly affecting African countries, especially when compared to the previous waves. The major driver of the wave has been the emergence of mutant variants, which spread more easily and cause more remarkable clinical disease, not sparing any age group. The delta variant is a case in point. This has been worsened by increasing human mobility after previous lockdowns, as relaxations across the world gradually become relaxed. Governments have also become more reluctant to impose stiffer restrictions on people, as it becomes evident that these lockdowns also have several negative socioeconomic consequences. The population had become tired, people want return of lives to normalcy, they have to find ways of sustenance, especially in countries such as Zimbabwe, where people live from hand-to-mouth. Over time, in any pandemic or large-scale outbreak, people become fatigued and more complacent to prevention measures. We need to continue reinforcing prevention messages daily, even if the people become saturated, as the goal is to save lives, and ensure that socioeconomic activities return to acceptable levels of normalcy.
Look, vaccine hesitancy is not a new phenomenon altogether; in fact, it’s widely described in literature and has accompanied the introduction of almost all vaccines. It’s driven by several rumours, myths, misconceptions, mistrust, lack of accurate knowledge/information, and many other concerns. For example, you know how much social media influencers, religious leaders and other different antivaxxers have spoken negatively about the vaccines, and unfortunately because of social media, the rate of spread of information is tremendous, and as public health stakeholders, we have not been ahead of this. The speed with which the vaccines were developed, given that historically vaccines have taken years to develop, and some problems that have afflicted the human race for decades such as the HIV epidemic still do not have effective vaccines as yet, and the introduction of new types of vaccines (mRNA such as the Pfizer) have all served to propagate vaccine hesitancy. We acquired Chinese vaccines early on when they were not yet authorised by the WHO for emergency use, and their safety and effectiveness data were not widely available. The mistrust for our Chinese counterparts and their motivation for donating vaccines to us obviously came into play as well. Of course, the other problem is the mistrust for the government in a hostile political environment. Public health stakeholders and the government failed to adequately address concerns of specific groups of people, such as women of reproductive age, including breastfeeding and pregnant mothers, people living with HIV and AIDS, and those with other chronic conditions such as asthma, diabetes mellitus and hypertension.
People should understand what vaccines do. Vaccines can reduce new infections yes, but more importantly, we aim to reduce symptomatic disease, including moderate, severe and critical disease, reduce hospitalisations, deaths from COVID-19 and long-term consequences of the disease; and reduce the strain on our public healthcare systems. So yes, indeed it’s not surprising that vaccinated people will catch the virus, and some will even die, but overall, when you look at the whole picture, the odds of bad outcomes and severe disease will be markedly reduced among the vaccinated, and this applies to the Sinovac and Sinopharm vaccines. Evidence from countries that have widely used these vaccines including the United Arab Emirates and Chile, where huge proportions of the population are now vaccinated, prove beyond reasonable doubt the effectiveness of these Chinese-made vaccines in reducing severe disease, hospitalisation and death, and both have greater than 50% effectiveness at reducing new infections, which is remarkable. The influenza vaccines, which are administered annually in some populations where the disease kills several thousands of people per year, are much less effective than that. And the influenza viruses undergo periodic antigenic shifts and drifts, necessating repeated vaccination with adjusted vaccines for the evolving strains.
When the WHO authorised the first vaccines in December 2020, their messages were centred on putting in place adequate mechanisms to ensure equitable distribution of vaccines. Remember richer countries had already invested in research and production of these vaccines, and had huge claims to the vaccines, so nationalisation wouldn’t be surprising. African countries, and other low-medium countries, must have put in place their own mechanisms to ensure earlier access to the vaccines, and unfortunately a number were not part of the COVAX arrangements. I applaud the Zimbabwean government for swiftly looking to the East, finding alternative sources of vaccines to protect our population. However, Zimbabwe, and other African countries, must continue putting in place mechanisms to deal with inequitable distribution of vaccines, making sure that the vulnerable groups in the populations are prioritised, and invest adequately in science and research to make sure that we can also develop our own vaccines, or buy patents to make generic vaccines, otherwise we will continue lagging behind.
We must vaccinate, vaccinate and vaccinate until we attain levels sufficient enough for herd immunity.
Therefore, we must continue investing in procuring more vaccines, dealing with vaccine hesitancy adequately and make sure we have vaccines in people’s arms rather than in refrigerators. The battle with COVID-19 is likely to be a protracted one, especially with the emergence of variants of concern. We must be ahead; we must prepare our public healthcare systems for the unknown, and make sure we are prepared to deal with the worst, and this calls for investment in manufacturing and infrastructural development. We need more proactive approaches than the reactive approaches we have adopted so far. We have to learn to live with COVID-19, putting in place mechanisms that allow socioeconomic activities to return to normal, allow schools and colleges to open, allow people to continue getting essential health services, whilst protecting people from dying from COVID-19. It’s always going to be a struggle between survival from COVID-19 and survival from poverty, and we have to protect the population from both. It’s a lot of work, and its work that requires commitment and investment at various levels, including the government and the citizens, and requires amazing political commitment that must start now.
For now, we have to continue abiding by infection prevention and control protocols. Prevention is our best tool; we have no capacity to deal with large scale outbreaks and it’s easy for our fragile health sector to become overwhelmed. Whilst the government has shown a reluctance to imposing tougher measures, it’s up to us to act responsibly and break the chains of COVID-19 transmissions. Let’s continue masking up, washing our hands, practising physical distancing, avoiding unnecessary gatherings, isolating if we have been diagnosed with COVID-19 and making sure our close contacts are appropriately quarantined in our homes. The responsibility is on us to break this current devastating outbreak. Let’s however remain hopeful, lets care for each other in ways we can, and let’s protect our communities.
I grew up and went to primary school in a rural area, a place where very few make it. I was doing well during my primary school years and I always wanted to do something that would somehow help the community. I knew there were people called doctors, but I never saw a doctor until I finished primary school, and even through most of my high school which I attended in Highfields. Because of that I always wanted to be, and always dreamt of being that doctor who would help and serve in the community, where such people didn’t exist. Thats why I eventually ventured into Medicine.
Thank you. Choosing an area of specialisation is a choice based on personal passion and experiences. Highlights of my life include growing up in a rural community, where women catered for families most of the time as their husbands worked in cities. At clinics I always saw more women and children seeking treatment services though at that time I didn’t know why, but I said to myself if I become a doctor then I must become one for the women. After finishing my compulsory government rotations about 10 years ago I went to work in an HIV Care and Treatment Programme, and the disparities became even clearer to me, that more women than men were affected by the HIV epidemic, or were rather seeking treatment services. More women came forth seeking advice and treatment for reproductive health concerns, and my interest grew further. I joined an HIV prevention research programme that focuses on finding solutions to reduce HIV infections among women, and worked on studies on the dapivirine ring, which has just been licensed for HIV prevention in Zimbabwe. I worked with several renowned gynaecologists, and spent three years offering care and treatment services to women only. It became obvious that the focus of my career would be on finding solutions for women’s reproductive health concerns, hence I chose to specialise in Obstetrics and Gynaecology. Yes, I am a clinician, but the major focus of my career is on finding interventions and solutions for women at population level rather than at individual level. My main clinical interest is on what we call Minimal Access Surgery in Gynaecology.
By: Chido Kakora