Q&A with UNAIDS Country Director Savina Ammassari
Savina Ammassari has been the UNAIDS Country Director for Cameroon since 2018. Before that, she worked for UNAIDS in India, Myanmar and Cambodia as a Strategic Information Adviser. She has supported initiatives promoting sustainable development, equity and human rights in more than 20 countries.
Because she has lived and worked in so many countries and speaks many languages, she considers herself quick to adapt, but COVID-19 has definitely tested her.
Savina, did you feel like COVID-19 was a tsunami coming your way?
Yes, indeed, I saw the tsunami coming. I’d followed the COVID-19 outbreak in China, the rapidly unfolding epidemic in Italy, my home country, which already has claimed more than 24 000 lives. I was acutely aware that many countries in sub-Saharan Africa, including Cameroon, would be ill-prepared to address the devastating health and economic impacts of COVID-19, where fragile health systems and chronic poverty represent significant challenges for government, community and United Nations system responses to the pandemic.
The realities of the crisis enveloping the world were starkly brought home to me when my brother-in-law, working as a surgeon in Brescia, the epicentre of the Italian epidemic, developed severe COVID-19 symptoms, leading to bilateral pneumonia. Fortunately, he was ventilated and received experimental treatments. His life has been saved. But I know this will not be the case for everyone, especially in countries with weaker health-care systems.
Cameroon is now the COVID-19 epicentre in western and central Africa. The first cases were detected at the airport of the capital, Yaoundé. Additional cases were soon recorded in Douala, the largest city of the country. Despite early measures taken by the Government to isolate initial cases, testing and contact tracing, community transmission has taken hold. Limited access to testing services makes it difficult to know the extent of transmission.
The Cameroon response has faced significant constraints, not least the capacity to scale up testing and expand contact tracing and the provision of intensive care unit/ventilation support for the seriously ill, as well as adequate personal protective equipment for medical staff. The rapid implementation of community education programmes, emphasizing hand hygiene and social distancing, is an ongoing challenge, especially in poor, often overcrowded, urban areas.
How did Cameroon prepare? In Cameroon, there initially was a sense of optimism that, somehow, Africa, unlike other regions, would manage to avoid the catastrophic consequences of the pandemic. There was little awareness that Cameroon was most likely just a matter of a few weeks behind.
Today, Cameroon is the most affected country in the region and second in sub-Saharan Africa, with a quickly rising rate of infections. The scarcity of test kits obviously hides the real number of infections. Counting individual infections, recoveries and fatalities does not provide the real picture. UNAIDS advocated for a modelling of the epidemic in order to enable quantification of health-care needs and procurement.
As the first COVID-19 cases were detected in Yaoundé, a small number of health-sector officials gathered with the Minister of Health to discuss and plan epidemic containment and impact mitigation measures. I was one of the United Nations officials requested to be part of the group, given UNAIDS’ experience in epidemic management. I underscored the need to build on existing systems and make use of the community-driven efforts of the national AIDS response. I advocated for frontloading investments in communication and community mobilization to prevent COVID-19 infections, using a multisectoral approach.
The multisectoral response fell into place through the direct involvement of the United Nations Resident Coordinator (UNRC) with my support. I facilitated the UNRC’s efforts to connect the Minister of Health with development partners in weekly teleconference calls. Partners were ready to assist but lacked information on the most immediate needs.
UNAIDS has supported the Ministry of Health to model the COVID-19 epidemic to better understand and quantify needs. This has been done through teleconferencing, with the participation of various technical and financial partners. It has helped with the prioritization of needs and the quantification and costing of urgently required supplies and equipment. Partners were ready to support this effort, but required not only a modelled, costed national COVID-19 response plan but also a well-articulated procurement schedule based on the plan. UNAIDS has also successfully advocated for the establishment of a strategic information working group to analyse more in-depth data from surveillance, model the epidemic, and monitor and evaluate the COVID-19 response.
Communicating is indeed key. But how do you deal with things as basic as the lack of running water in many sub-Saharan African countries, making handwashing difficult. How are people coping with this and other measures, such as physical distancing?
This is indeed a major challenge in Cameroon as there is a lack of consistent water supply in many urban and rural communities. The use of hand sanitizers is not an affordable option for most people and locally produced product is not necessarily quality assured and safe for use.
Similarly, physical distancing and self-isolation are remote, often unrealistic options for communities where large numbers of people, as a rule, share common spaces in their home and community environments. The government has put in place a series of strict measures to contain the spread of COVID-19 (closing schools and educational or training institutions, banning gatherings of all kinds, imposing the use of face masks on public transport), although a comprehensive lockdown has not been promulgated to date. There are legitimate concerns on how a full lockdown could affect the majority of people, as more than 80% of the population work in the informal sector and live hand-to-mouth. Yet, from a public health perspective, lockdowns are a must. Balancing concerns is a major challenge.
Savina, you have never shied away from challenges. Would you say this is the biggest challenge you have faced, and why?
Yes, this crisis is unprecedented, unpredictable. I’m concerned at how the COVID-19 pandemic will affect not only our staff and their dependents but also people living with HIV, who need to continue accessing antiretroviral therapy and services, and people who are already stigmatized, vulnerable and socially and economically marginalized.
We have already witnessed a worrisome rise in stigma and discrimination against members of key populations in Cameroon and are making sure that the UNCT and partners keep human rights issues high on the agenda.
Our work is already challenging in normal times as Cameroon is facing enormous development and humanitarian hurdles. Already, Cameroon’s humanitarian crises on three fronts are not getting enough international attention. It’s the least funded humanitarian crisis worldwide. The COVID-19 epidemic multiplies these challenges several times over.
UNAIDS is mobilizing communities and networks in COVID-19 prevention work and making sure that civil society is adequately consulted and involved in the national response to the new virus.
How do you unwind in the evening? How do you recharge your batteries?
I’m afraid I don’t give enough time to relaxing, as I work around the clock, which isn’t good. Perhaps one of the challenges of COVID-19 is to take up new interests outside of work, that can be sustained and enjoyable well into the future.
What are the lessons learned? Will you do things differently from now on?
I’ve learned once again that unity makes force. In unpreceded emergencies like the current one, where no one has the answer or a magic bullet, everyone’s competence and experience is needed. Connecting people, bringing in resources, getting a transparent exchange—all this is paying off. It requires strong leadership and a cohesive team effort.
