*3.1.3 Improved methods/technologies for surveillance, identification and containment*

Innovations are required in testing, contact tracing, treatments, vaccines, policies for opening up since no single system can capture all parameters of the pandemic, multiple, complementary surveillance systems should be implemented [78].

Testing - for diagnosis and clinical management or for surveillance and outbreak control - is critical but countries such as Ethiopia are facing a daunting task because of limited facilities, testing kits, reagents etc. The case reports are likely to be an underestimate as, by mid-March, Ethiopia has carried out only about 11,000 tests/10 for every 100,000 people compared to, for example, about 280 for South Africa, 2,000 for Australia and 1,560 for the United States [42]. Ethiopia has, thus, a long way to go to reach testing levels recommended by WHO. There are indications that global solidarity has faltered as market restrictions are being imposed by a number of countries [32]. Ethiopia, as for other African countries, should plan for its own quality assurance of diagnostic tests, drugs, and vaccines production, including antibody and nano-technology based testing [79, 80]. These could be along the lines of the Africa CDC initiative of Partnership to Accelerate COVID-19 Testing (PACT) and the Ethiopian Food and Drug Authority (EFDA) Digital Health Activity (DHA) system. It should also explore the potentials of pooled testing in the Ethiopian context [42, 81].

For contact tracing, Ethiopia should bolster its relatively strong community level services by mobilizing health extension workers (HEW), health development army (HDA), model families etc. [65, 82] using tested epidemic models and experiences in other settings [77, 83]. It could enhance this by using digital technology, 'coronavirus apps' – with due attention to privacy and other pitfalls [84, 85] not only for contact tracing but also for testing, isolation and physical/social distancing [86]. Overall, control of the pandemic will require action at the individual, community, and population levels as recent data show that asymptomatic cases could play a major role in transmission.

Evidence shows that strict implementation of physical distancing, optimum use of face masks, respirators, and eye protection in public and health-care settings provide, in spite of some contextual challenges, high levels of protection against transmission [26, 87]. A systematic review and meta-analysis [88]. Mobility/lockdown restrictions could have variable results depending on areas – high for retail and recreational areas and transit stations but could be challenged by lockdown fatigue or the practicalities of daily living [89].

The development of safe and effective vaccine, including the potential use of vaccines for other diseases such as BCG and polio, is a priority [12, 14]. In terms of personal protection equipment (PPE) for care providers in particular, treatments – which seem to be a long shot, country specific guideline should be developed as well as strengthen inter-African collaboration policies for opening up etc. [87]. Access pool and to categorize Covid-19 vaccines as 'global good' and GAVI's Covax Advance Market Commitment and other initiatives, the temptation to prioritize producer countries will be high. As often seen, the potential of selfish gain trumping over collective good is high [39].

Vaccine hesitancy has, to date, been low in Ethiopia [90], but measures should be taken to ward off the global trend of vaccine hesitancy and politicization [73, 91]. Measures should also be taken to strengthen the vaccine delivery system as whether new or already in use, is only as effective as the system that provides it.

#### *3.1.4 Optimal use of all the limited available resources*

Ethiopia's health care system, already highly limited, will be extremely strained by the response to the pandemic [65]. As in other LIC, there are already signs that essential services such as immunizations, reproductive health etc. could be sidelined for various reasons with dire consequences [15, 22, 92, 93].

There are also indications that the pandemic could affect pregnancy outcomes and, in general, exacerbate social inequalities in health [94]. Therefore, ensuring access to basic support water, sanitation, and hygiene to most vulnerable ones is important [15, 56, 95–98]. The system should also improve quality of care including improved supply chain, adopt improved technology for delivery of health care for new therapies and roll out vaccines as soon as they become available including mitigating potential hesitancies based on already mounting misinformation [99, 100].

#### *3.1.5 Forging partnerships at all levels*

COVID-19 is menacing the whole of humanity and so the whole of humanity must fight back. Individual country responses are not going to be enough [9]. As Bill Gates put it some 3 years ago, 'What the world needs – and what our safety, if not survival, demands – is a coordinated global approach. Specifically, we need better tools, an early detection system, and a global response system' [101]. UN agencies at all levels (local, national, continental and international) and across all disciplines and sectors, WHO in particular, should lead in forging partnerships.

All stakeholders in Africa, the AU and CDC Africa in particular, should contribute towards a unified continent-wide anti-COVID-19 Strategy [10]**.**
