Fighting COVID-19 in The Gambia: Efforts, Challenges, and way Forward

Society for the Study of Women’s Health (SSWH), Old Yundum, The Gambia Department of Nursing Science, Ahmadu Bello University, Zaria, Nigeria Faculty of Pharmaceutical Sciences, Ahmadu Bello University Zaria, Nigeria Department of Global Health and Development, London School of Hygiene and Tropical Medicine, England, UK Faculty of Pharmaceutical Sciences, University of Port Hartcourt, Port Hartcourt, Nigeria


DEAR EDITOR,
On March 11, 2020, the novel coronavirus disease  was declared a pandemic of global magnitude. Since then, nations have instituted response measures to curtail the rapid spread and propagation of the virus. This Letter to the Editor provides a brief assessment of the measures and challenges facing The Gambia's COVID-19 response and suggests some policy and practical recommendations that can be used by policymakers and implementers to address the COVID-19 situation in The Gambia. It is based on a narrative review of existing literature on the COVID-19 response in The Gambia, as well as on the authors' opinion as researchers supporting the COVID-19 response efforts in The Gambia.

COVID-19 RESPONSE MEASURES IN THE GAMBIA
The first case of COVID-19 in The Gambia was confirmed on March 17, 2020 [1], which was immediately followed by the government declaring a state of public emergency on March 27, 2020, with the closure of schools, non-essential shops, places of worship and workplaces. Since then, the number of cases risen to over 4,469 with a total of 139 deaths as of February 17, 2021 [2]. In April 2020, the Ministry of Health, The Gambia Red Cross Society and International Organization for Migration (IOM) partnered with other national stakeholders to launch a COVID-19 sensitization campaign to reduce person-to-person transmission. Using trained volunteers, guidance and information to the public on COVID-19 modes of transmission, common signs and symptoms and prevention methods were provided. Restriction measures including physical distancing requirements, closure of land borders and airspaces, and suspension of public gatherings were also implemented [3,4]. Testing facilities were also established at tactical locations, primarily in the western urban areas, with initial efforts centered on the identification of imported cases, tracing and isolation of their contacts, especially among travelers from Europe and bordering countries. As the epidemic evolved, individuals were urged to present for testing if symptomatic or following known contact with infected persons. As per WHO guidelines, all identified cases were quarantined in designated facilities regardless of symptoms until considered non-infectious. During the early part of the outbreak (April -July, 2020), contacts were traced and quarantined in hotels, after which self-isolation at home was recommended. A COVID-19 Preparedness and Response Project, which aims to help prevent, detect, and respond to the threat posed by COVID-19 and strengthen the national system for public health preparedness, was also launched by the government with financial support from World Bank. A COVAX vaccination rollout was launched on March 10, 2021. This followed the arrival of 36,000 doses of Oxford Astra-Zeneca vaccines under the COVAX facility and the first consignment of the vaccine prioritized for healthcare workers, people with a chronic condition, and those aged 65 years and above to minimize the severity of the condition if they become exposed to the virus. These efforts initiated by The Gambia government and its development partners may have contributed to the relatively low number of COVID-19 cases in the early days of the epidemic. However, there is mild and intense wave of COVID-19 in The Gambia [5], and more deaths have been reported [6].

CHALLENGES FACING THE GAMBIA'S COVID-19 RESPONSE
A major challenge facing The Gambia's COVID-19 response is the declining level of trust in the handling of the COVID-19 situation by the government [7]. Inadequate enforcement and supervision of the ban on public gatherings have also made many individuals disregard the restriction measures on religious gatherings and other public events.

Fighting COVID-19 in The Gambia
The Open Public Health Journal, 2021, Volume 14 493 Currently, places of worship are indiscriminately filled with people, and music festivals with local and international artists and mass political campaigns are all too common [8]. As part of the state of public emergency, schools were also closed. But this measure has been relaxed nationwide, prompting COVID-19 infections among students at a private school. The lifting of the international travel bans, especially from high-risk countries, has also resulted in the importation of the new COVID-19 variant that was first found in Britain, which could have been prevented if the bans were not relaxed rather prematurely. In addition, although the rollout of COVID-19 vaccines has begun, challenges such as misconceptions around COVID-19 vaccines, lack of robust electronic database to track vaccinated persons, limited vaccination points and staffing shortage can also significantly affect the planning and efficiency of the COVID-19 vaccine rollout in The Gambia.

ADDRESSING THE COVID-19 SITUATION IN THE GAMBIA
To mitigate the spread of COVID-19 in The Gambia, there is an urgent need for strict enforcement of the bans on public gatherings and international travels, especially from high-risk countries. Continuous sensitization of individuals to be responsible for their health by practicing physical distancing, sanitation and hygiene measures is also needed. Ensuring trust in the information about COVID-19 and confidence in national COVID-19 response efforts is also another way of mitigating the spread of the coronavirus disease in The Gambia. The experiences from the 2014 Ebola epidemic in West Africa, for example, showed that the misperceptions about the response strategies led to mistrust and poor acceptance among people and communities, which resulted in the escalation of the epidemic and contributed to the high mortality recorded in Guinea, Liberia and Sierra Leone [9]. Drawing from the Ebola Virus Disease response in Guinea, Liberia, and Sierra Leone lessons, policymakers and implementers in The Gambia should engage communities in the decision-making processes related to COVID-19. Community enlightenment campaigns that target politicians, musicians and religious leaders who are largely responsible for organizing religious and other social gatherings are also considered important.

CONCLUSION
To mitigate the challenges of Covid-19 vaccine rollout in The Gambia, there is also an urgent need to develop a robust digital system and strengthen the national health management information system (HMIS) to effectively track vaccinated persons, in addition to running vaccination centers in multiple locations and recruiting and training more medical and allied health professionals to ensure mass vaccination campaign and universal coverage.

AUTHORS' CONTRIBUTIONS
Mat Lowe and Don Eliseo Lucero-Prisno III conceived the manuscript. Mat Lowe, Fatou Kineh Ceesay and Shuaibu Saidu Musa wrote the draft manuscript and collected data and literature. Mat Lowe, Fatou Kineh Ceesay, Edikan Friday Akpan and Abimbola Amos edited the draft manuscript and wrote the final manuscript. All the authors read and approved the final manuscript.