OMICS A Journal of Integrative Biology

Volume 24, Number 0, 2020

Commentary
ª Mary Ann Liebert, Inc.
DOI: 10.1089/omi.2020.0099

COVID-19 Pandemic and Africa:

From the Situation in Zimbabwe to a Case
for Precision Herbal Medicine

Collet Dandara,1 Kevin Dzobo,2 and Shadreck Chirikure3,4

Abstract
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This opinion commentary on the coronavirus disease 2019 (COVID-19) pandemic brings together observations
from Zimbabwe specifically, and Africa broadly, drawing from the fields of pharmacogenomics, precision
herbal medicine, and responsible innovation so as to respond to the pandemic in ways that are efficient,
critically informed, principled, and responsive to needs in rural and urban communities across Africa. With new
findings suggesting that COVID-19 is a systemic disease, impacting the respiratory system and beyond in some
individuals, we need new molecular targets for therapeutics innovation more than ever. We argue that the
current pandemic will likely strip the limited resources from other diseases such as malaria, human immuno-
deficiency virus (HIV) infection, and among others affecting the African continent. Hence, we need to address
not only COVID-19 but also its broader health care and societal impacts in Africa. Extensive diagnostic testing
to trace and isolate the COVID-19 cases as well as basic income and economic support for those who are unable
to work will be needed. A critically informed and democratic governance that builds on transparency and trust
for the elected leaders is crucial. Finally, the pandemic offers a silver lining for Africa: the prospects to integrate
omics research with long-standing expertise in herbal medicine in Africa, thus accelerating the advances toward
novel molecular therapeutic targets for COVID-19 and precision herbal medicine worldwide.

Keywords: Zimbabwe, COVID-19, SARS-CoV-2, Africa, personalized medicine, precision herbal medicine,
medical tourism

Introduction learned from the pandemic are instructive in that advanced

research, developed infrastructure and economic wealth are

T he COVID-19 pandemic is not only a health crisis, but

it is also a societal catastrophe. The experiences of the
pandemic highlight the complex ways in which long-standing
social injustices and multiple forms of discrimination such
as racism, sexism, and classism in planetary society inter-
sected and combined in a cumulative way, augmenting the
devastating impacts of the pandemic (APM Research Lab,
2020; Springer, 2020). Such intersectionality was apparent
not only in developing countries but also in parts of the
developed world that have long suffered from social fault
lines and historical injustices that became exposed and more
apparent with the pandemic (Eichengreen, 2020). Lessons
necessary but do not necessarily guarantee robust and just
pandemic response.
Critically informed governance that takes into account the
historical and present day social justice issues, wealth in-
equalities, and mutual aid among communities, together with
planetary health and diagnostic testing capacities are crucial
determinants of pandemic outcomes. Against this back-
ground, some but not all resource-rich nations, which com-
bine critical governance with technological capacities, were
able, so far, to respond to the pandemic in robust and re-
sponsible ways (Kuguyo et al., 2020). Rapid large scale
testing, contact tracing, and use of ventilators were some of

1
Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute of
Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
2
Division of Medical Biochemistry, Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape
Town, Cape Town, South Africa.
3
Department of Archaeology, Faculty of Science, University of Cape Town, Cape Town, South Africa.
4
Division of Social Sciences, School of Archaeology, University of Oxford, Oxford, United Kingdom.

1
 2 DANDARA ET AL.
the strategies adopted with great results in Germany, South
Korea, and Singapore.
The same, however, cannot be said about developing
countries in Africa such as Zimbabwe with their perennial
economic and health challenges ( JICA, 2012). Social dis-
tancing through lockdowns appeared to be the major strategy
applied to ‘‘flatten the curve.’’ COVID-19 laid bare the
frailties in Zimbabwe, exemplified by dilapidated health
care infrastructure, shortage of health professionals’ personal
protective equipment (PPE), and much more. Therefore,
although the COVID-19 storm is ravaging the entire world,
African countries such as Zimbabwe are in a different boat
compared with that of China and other advanced economies
(Buffin, 2020; Letzing, 2020).
Africa and Zimbabwe
For multiple and deeply historical reasons, African coun-
tries are mostly poor. They are characterized by failing
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infrastructure, lack of industrialization, high unemploy-
ment, and poverty. As such, the likely impact of COVID-19
on the continent elicited emotional debates between those
who think the continent will be overwhelmed by the pan-
demic versus those who felt Africa will, using its own unique
ways and strengths, successfully manage the coronavirus
pandemic (Bauer, 2020).
In the case of Zimbabwe, COVID-19 arrived against a
background of deteriorating health infrastructure and facili-
ties and a worsening epidemiological profile. Morbidity
and mortality trends showed that the population was still
affected by infectious diseases such as HIV/AIDS, lung
diseases and tuberculosis, diarrheal conditions including
nutritional deficiencies, and noncommunicable diseases such
as diabetes (CDC, 2018; JICA, 2012).
The health system in Zimbabwe’s public sector consists
of four tiers of care:

primary (1331 rural health centers and clinics),

secondary (179 district and missionary hospitals),

tertiary (7 provincial hospitals), and

quaternary (14 central hospitals) ( JICA, 2012).
Citizens and residents in Zimbabwe are supposed to seek
health care along the four tiers starting with the primary level.
However, the public health system has collapsed while pri-
vate health care appears to be on life support at present.
In contrast, Zimbabwe has one of the most admired edu-
cation systems in Africa, which produces a wide range of
skilled professionals including health care professionals, bio-
medical scientists, and skilled humanities and social scientists.
Most of these professionals have emigrated in search of
greener pastures, contributing their skills in other countries.
Such a drastic brain drain has multiple reasons that cumula-
tively do not help in devising effective and principled COVID-
19 pandemic response strategies. The Zimbabwean scientists
in diaspora can (potentially) be mobilized to create a platform,
in contrast, to support public health in Zimbabwe in collabo-
ration with other public health scientists in Africa. This idea is
still one of the future actionable options in many African
countries that experience emigration and a large brain drain.
As things stand, however, Zimbabwe has allowed its health
care system to crumble while at the same time closing
manufacturing industries and becoming an importer of al-
most all its requirements. Not surprisingly, this widened
disparities in the distribution of wealth between the haves and
have-nots. Zimbabwean elites and the privileged can afford,
and often do become subscribers to medical tourism else-
where, for example, in Singapore, India, South Africa, and
China (McCoy, 2020).
The health care system for the majority of the society in
Zimbabwe before the current pandemic was worrisomely
characterized by a dysfunctional infrastructure, lack of health
care equipment including PPEs, shortage of therapeutic drugs,
and overworked and underpaid health care workers. The Zim-
babwean situation broadly resembles that in many African
countries where the closing of nation-state borders has acutely
exposed the necessity of building the local health care infra-
structures that are currently missing in many countries in Africa.
Precision Herbal Medicine Has a Bright Future
in Africa
The economic difficulties experienced by most African
countries such as Zimbabwe meant that what most govern-
ments could do was to impose lockdowns and quarantine,
with minimal or no contact tracing due to lack of resources
and inadequate critical governance. With a lack of invest-
ment in health infrastructure and research and development,
most African countries could not source the much-needed
ventilators and PPEs because the usual sources of these
supplies in the global village, the industrialized countries, are
busy stocking for their own unmet needs. The lack of a
properly functioning modern health care systems, both pri-
vate and public, is augmented by the fact that a large pro-
portion (nearly 80%) of the African population including
Zimbabwe uses traditional herbal medicine for its immediate
health needs (Thomford et al., 2018).
As a new disease, COVID-19 has no known cure or vaccine.
In the developed world, drugs for other related diseases are in
clinical trials for COVID-19. With new findings suggesting
that COVID-19 is a systemic disease, impacting the respiratory
system and beyond in some individuals, we need new mo-
lecular targets for therapeutics innovation more than ever.
There have been recent debates concerning the herbal
preparation in Madagascar, Artemisia afra, which is regu-
larly used throughout Africa to alleviate respiratory disease
symptoms, some of which are shared with COVID-19
(du Toit and van der Kooy, 2019; Mahomoodally, 2013). It is
in this and similar contexts of African herbal medicine that
omics technologies offer prospects to identify the mode of
action of herbal medicines and, thus, can usefully contrib-
ute to the pool of novel molecular targets for therapeutics
innovation for COVID-19. Given the systemic nature of
COVID-19, we will need new treatments against this new
disease over the days, months, years, and decades ahead.
African herbal medicine such as Artemisia afra and the as-
sociated expertise in Africa warrant consideration in clinical
trials and mechanistic omics research now and in the near
future, in much the same way other therapeutic candidates are
currently being evaluated.
Integration of omics sciences and expertise from the field
of pharmacogenomics, the study of gene-by-drug interac-
tions, would help the emergence of the field of precision
herbal medicine in the current fight against COVID-19. For
this, we also need to decolonize the thinking of which
 COVID-19, ZIMBABWE, AND AFRICAN HERBAL MEDICINE
medicines should be studied, by remaining open to a wider
array of potential medicinal sources and recalling that many
of the existing drugs in modern medicine have natural and
herbal medicine origins (Thomford et al., 2018).
Characterizing and evaluating traditional herbal medicines
must be a springboard for rational drug discovery and de-
sign, not to mention a contribution of herbal medicines to
the current responses to COVID-19 and planetary health
(Thomford et al., 2018). Similar to therapeutic drugs being
tested for COVID-19, it is possible that herbal medicines may
succeed or may equally fail, but this needs to be evaluated
scientifically using the tools and knowledge base from pre-
cision herbal medicine and pharmacogenomics in particular.
As herbal medicines are a backbone of poorly resourced
health care systems, African countries should dedicate fund-
ing to public institutions such as universities, and state owned
science councils (e.g., the Scientific and Industrial Research
and Development Centre, SIRDIC, in Zimbabwe), for manu-
facturing to meet local demands of different sectors par-
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ticularly the health sector, tapping on partnerships with
international partners for drug/vaccine manufacturing. In-
stead of competing with rich developed countries, developing
countries should use what gives them a competitive edge
such as precision herbal medicine powered by traditional
and indigenous knowledge and omics systems science.
Commitments for research and development of the precision
herbal medicine value chain have marked potential for drug
discovery, new employment capacities, and the concept of
‘‘one-health’’ in Africa (Thomford et al., 2018).
This approach suggested that herbal medicine could also be
applied for other indigenous knowledge, including revisiting
historical practices that ensured food security through use of
drought-tolerant indigenous grains. These developments need
to be accompanied by some capacity in manufacturing of
general health care accessories and development of diagnos-
tics laboratories.
The COVID-19 pandemic has been a blessing in disguise
for Zimbabwe as some long-neglected hospitals were refur-
bished, investments poured in for the building of new health
care facilities (McCoy, 2020), and improvement in the re-
muneration of health care professionals. It is our hope that
this trend will continue post-COVID-19 pandemic.
Outlook
In terms of how Africans will fare with respect to
COVID-19, it is important to remember that ‘‘.we are in the
same storm, but in different boats.’’ (Buffin, 2020). Africa
is endemic with infectious diseases. We argue that the current
pandemic may potentially strip the limited resources away
from other diseases such as Ebola, malaria, tuberculosis, HIV
infection, and others affecting the African continent (Santoro,
2020). Hence, we need to address not only COVID-19 but
also its broader health care and societal impacts in Africa.
Extensive diagnostic testing to trace and isolate the COVID-
19 cases as well as basic income and economic support for
those who are unable to work will also be needed.
African populations exhibit huge genetic heterogeneity and
diversity, thus, COVID-19 outcomes will not be uniform
across the continent. In the absence of a cure or vaccine for
COVID-19, it is important that African populations continue to
practice social distancing (where possible) and high hygiene,
3
sanitizing whenever possible. Lastly, the COVID-19 pandemic
has seen the coalescence of multidisciplinary teams, with
scientifically generated data, needing effective communica-
tion, thus harnessing opportunities for responsible innovation
drawing from humanities and critical social sciences in na-
tional response committees (Maswime et al., 2020). Let us
keep in mind that pandemic response requires technological
capacity, funding but also critically informed governance that
addresses the historical and current social injustices and fault
lines in society that coproduce the pandemic outcomes.
We remain cautiously optimistic that the COVID-19
pandemic offers a new portal for collective imagination to-
ward an inspired and robust science, technology, and inno-
vation to stimulate Africa to utilize its resources and respond
effectively to the pandemic and other diseases.
Author Disclosure Statement
The authors declare they have no conflicting financial
interests.
Funding Information
No funding was received for this article. However, Collet
Dandara’s research work is supported by the Medical Re-
search Council of South Africa (SAMRC) and the National
Research Foundation (NRF).
References
APM Research Lab. The Color of Coronavirus: COVID-19
Deaths by Race and Ethnicity in the US. American Public
Media, June 10, https://www.apmresearchlab.org/covid/deaths-
by-race Accessed June 28, 2020.
Bauer GK. Beyond the Western gaze-Africa Is a Country.
https://africasacountry.com/2020/05/beyond-the-western-gaze
Accessed June 28, 2020.
Buffin J. In the same storm maybe, but not in the same boat—
who will pay the price for recovery from Covid-19?. https://
www.uclan.ac.uk/research/explore/groups/assets/in-the-same-
storm-maybe-jez-buffin.pdf Accessed June 28, 2020.
CDC 2018. Global Health—Zimbabwe. Centers for Diseases
Control and Prevention. https://www.cdc.gov/globalhealth/
countries/zimbabwe/ Accessed June 28, 2020.
du Toit A, and van der Kooy F. (2019). Artemisia afra, a con-
troversial herbal remedy or a treasure trove of new drugs?
J Ethnopharmacol 244, 112–127.
Eichengreen B. Rage against the pandemic. Project Syndicate,
June 8, https://www.project-syndicate.org/commentary/covid
19-racial-disparities-fuel-usa-protests-by-barry-eichengreen-
2020-06?utm_source=Project+Syndicate+Newsletter&utm_
campaign=36dca8956a-covid_newsletter_11_06_2020&utm_
medium=email&utm_term=0_73bad5b7d8-36dca8956a-1059
90839&mc_cid=36dca8956a&mc_eid=7d6839b074 Accessed
June 28, 2020.
JICA 2012. Data Collection Survey on Health Sector. Country
Report, Republic of Zimbabwe, October 2012, Japan Inter-
national Cooperation Agency, ( JICA). https://openjicareport
.jica.go.jp/pdf/12085205.pdf Accessed June 28, 2020.
Kuguyo O, Kengne AP, and Dandara C. Singapore COVID-19
Pandemic Response as a Successful Model Framework for
Low-Resource Health Care Settings in Africa? OMICS
Epub in advance June 16th. https://www.liebertpub.com/doi/
10.1089/omi.2020.0077 Accessed June 28, 2020.
 4 DANDARA ET AL.

Letzing J. What does COVID-19 still have in store for Africa? Thomford EK, Dzobo K, Chimusa E, et al. (2018). Personalized
https://www.weforum.org/agenda/2020/04/coronavirus-what- herbal medicine? A roadmap for convergence of herbal and
does-covid-19-still-have-in-store-for-africa/ Accessed June precision medicine biomarker innovations. OMICS 22, 375–391.
28, 2020.
Mahomoodally MF. Traditional Medicines in Africa: An Ap- Address correspondence to:
praisal of Ten Potent African Medicinal Plants. Hindawi, Collet Dandara, PhD
2013, http://dx.doi.org/10.1155/2013/617459 Pharmacogenomics and Drug Metabolism
Maswime S, Dandara C, and Sivarasu S. (2020). Coronavirus: Research Group
Never been a more compelling time for African scientists to
Human Genetics Division
work together. The Conversation. https://theconversation.com/
Department of Pathology
coronavirus-never-been-a-more-compelling-time-for-african-
scientists-to-work-together-135849 Accessed June 29, Institute of Infectious Diseases
2020. and Molecular Medicine
McCoy S. Africa’s elite build VIP hospitals for themselves, Faculty of Health Sciences
leaving workers to die. https://www.wsws.org/en/articles/ University of Cape Town
2020/04/08/elit-a08.html Accessed June 28, 2020. Anzio Road, Observatory
Santoro H. COVID-19 Is Stripping Resources From Mosquito Cape Town 7700
Control Programs. That may allow diseases like West Nile South Africa
and dengue fever to spread farther this summer. Future Tense,
June 19, https://slate.com/technology/2020/06/coronavirus- E-mail: collet.dandara@uct.ac.za
Downloaded by 182.1.195.125 from www.liebertpub.com at 10/17/20. For personal use only.

mosquito-vector-control-programs.html Accessed June 28,

2020.
Springer S. (2020). Caring geographies: The COVID-19 inter- Abbreviations Used
regnum and a return to mutual aid. Dialogues in Human COVID-19 ¼ coronavirus disease 2019
Geography 10(2), Epub in advance; DOI: https://journals HIV ¼ human immunodeficiency virus
.sagepub.com/doi/10.1177/2043820620931277 Accessed PPE ¼ personal protective equipment
June 28, 2020.
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