Countries in East Africa are among those with the highest prevalence of HIV in the world and with the highest numbers of HIV positive persons. Mobile populations, among them are truck drivers, play a significant role in the spread of both COVID-19 and HIV pandemics. The East African Community partners comprises six countries: Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda. Those countries currently have 3.6 million people living with HIV, 250 000 people with tuberculosis; almost 24 million people were treated for malaria in 2018 (latest data available), according to the Global Fund to fight AIDS, Tuberculosis, and malaria data explorer. In total, the Global Fund made $4.5 billion available for grants for the 2017-2019 cycle.
Among those countries, only Kenya and Tanzania have access to the Indian Ocean. The other four countries are landlocked and rely on the ports of Mombasa in Kenya and Dar es Salaam in Tanzania and an army of truck drivers to carry cargo that includes food, medication, and health commodities. Updated and reliable data on truck drivers in the region is hard to find. Kenyan media reported that, on an ordinary day, 2 000 truck drivers cross the Kenya–Uganda borders through the two main towns of Malaba and Busia. An older study published by the United Nations University with data from 2013 estimated that the total truck fleet in Kenya, Tanzania, and Rwanda were 17 066, 12 356, and 444 respectively. Each truck had, on average, 2.5 passengers: the driver, an assistant, and sometimes a mechanic or support staff member. These numbers give an idea of the significance of truck drivers and their crew in the economy of the region.
As for their risk in terms of contracting HIV, truck drivers are at a higher risk of contracting COVID-19 because they are highly mobile, and often have multiple contacts along the transport corridor, particularly at the weighbridges, restaurants, and hotels. According to the National Aids Control Council in charge of HIV policy in Kenya, border counties in Kenya are among those with the highest rates of new HIV infections.
Diverse COVID-19 responses in the six countries
Preventive measures in all six countries of the East African Community included the closure of schools in March and the promotion of frequent hand washing, physical distancing, and working from home when possible to prevent the spread of COVID-19. East African Community countries have all closed their airports to passenger traffic during March and April. Uganda, Rwanda, South Sudan, and later Kenya also closed land borders to passengers, but kept them open for cargo. Some countries added more preventive measures. Kenya, Uganda, Rwanda, and South Sudan closed places of worship, restaurants, bars, and imposed a curfew. In addition, Kenya restricted movements into and out of the five counties with the highest number of COVID-19 positive cases. Rwanda and Uganda enforced a stricter lockdown, where residents were allowed outside their houses only if necessary. The government banned public transport and later private transport in Uganda. Burundi and Tanzania did not set up a curfew, or other restrictions of movements inside the country. Places of worship remained open in Tanzania. In Burundi, football competitions were not suspended; presidential, parliamentary, and local elections took place on 20 May.
This variety of preventive measures contributed to varying levels of infections and fatalities by 30 May. According to the East African Community website, Burundi, Rwanda, and Uganda had the lowest number of COVID-19 positive cases at 63, 359, and 413, respectively. No one had died of COVID-19 in Uganda, while one person died in Burundi and Rwanda. In contrast, the number of Covid-19 positive cases and fatalities in Kenya were 1 745 and 62, respectively. In South Sudan, authorities reported 994 cases and ten deaths. Tanzania reported 509 positive cases and 21 deaths. Note that the government officials in Burundi and Tanzania do not update COVID-19 statistics as frequently as in Kenya or Uganda.
Truck drivers in the eye of the Covid-19 trans-border storm
Since the end of April, authorities in Kenya, Rwanda, and Uganda started pointing to truck drivers as a potential source of COVID-19 infections. Newspapers labeled truck drivers “super-spreaders” of the COVID-19 disease.
The different countries’ approaches to the COVID-19 pandemic created diplomatic tensions in the East African Community. While Tanzania decided against daily updates of COVID-19 cases and fatalities, Kenya held daily briefings and announced the citizenship of those who tested positive. Rwanda used to publish not only the citizenships of those who tested positive but also the country where the infected had traveled from. While Tanzania was saying little about the extent of the epidemic within the country, its neighbors were announcing the number of Tanzanian truck drivers who tested positive in neighboring countries.
East African Community countries then decided to adopt a common COVID-19 response. They published a statement on 19 April with several decisions including the decision to refrain from publishing the citizenship of foreign truck drivers who tested positive. Truck drivers now have to follow specific routes and stop only at designated stops. In Rwanda, police/customs officers escort truck drivers from the point of entry at the border to the final destination in the country and back to the border to prevent their interaction with the local population. Other truck drivers transship their cargo at warehouses built in the border areas. In Kenya, truck drivers have to be in possession of a COVID-19 certificate issued only if the holder has tested negative valid only for 14 days while driving through the country. According to the Kenya’s Ministry of Health, entry is only allowed to truck drivers who test negative at the border points and who hold those certificates. In Uganda, as most of the new infections are among foreign truck drivers, President Yoweri Museveni decided that foreign truck drivers who tested positive at the border would not be included in Uganda’s tally. Instead, Uganda requested that their countries of origin add them to their tallies. Thus, the number of COVID-19 cases in Uganda dropped by half from 260 to 145 on 28 May 2020.
Nevertheless, the implementation of the agreement is not without its problems. Due to the COVID-19 testing requirement and truck drivers’ displeasure about the conditions of its implementation, a 50 km snarl-up occurred at the Malaba border between Uganda and Kenya in the last week of May.
Omar, a truck driver who asked that we only use his first name, covers the Dar-es-Salaam-Kigali route linking the port city of Tanzania to the Capital of Rwanda. He usually stops at the border of Rusumo between Rwanda and Tanzania. Omar stated that “a lot has changed” with COVID-19. Before starting a trip from Rwanda, he has to be tested, and only if the test result is negative, can he start the journey. After coming back from Tanzania, he is tested again and can go home only if his test results are negative. He said, “when you want to go home, you have to be isolated for at least seven days, and two tests are done: on day one and day six; if both results are negative, you get discharged on day seven.” He explained that if the test is positive, the government of Rwanda pays for subsequent treatment. All this lengthens his time away from home.
Omar and his fellow truck drivers may soon see an improvement in their working conditions. The East African Community Ministers of Health, Transport and East African Affairs adopted a Regional Electronic Cargo and Drivers Tracking System on 29 May. The system links laboratories, a command center at the Secretariat of East African Community, drivers, and crew members through an app on their cellphones. Drivers and crew who test negative at State-approved laboratories will receive a COVID-19 certificate that will be uploaded on the system and will be available to other “stakeholders” at testing points on the trucking corridors. Thus, drivers/crew will not be subjected to additional testing if they have a certificate on the system. The certificate will be valid for 14 days. The implementation of this cargo tracking systems requires a few steps.
Firstly, the East African Community states will need to designate accredited health facilities (clinic/laboratory/health center/hospital) to test/screen truck drivers and crew for COVID-19. The countries will also provide designated areas where truck drivers can spend the night and access refreshments. The designated areas will have some basic amenities like safe parking space, clean and well-maintained rest stops that are about 100-150 kilometers apart. They will be equipped with handwashing, sanitary and shower facilities, cooking and food areas, and access to clean, refilling drinking water.
To succeed, the Regional Electronic Cargo and Drivers Tracking System will need the cooperation of truck companies or individual owners in the use of the platform, including the provision of information about drivers and crew, and the approved journey with starting and stopping times. The Secretariat will set up a command center for live monitoring of the tracking system that will enable information sharing and decision making.
The Global Fund finances part of the COVID-19 response
On 4 March 2020, the Global Fund allowed countries to use up to 5% of their savings from current grants to fight COVID-19. These funds can pay for personal protective equipment, laboratory services, health care workers, and other items as recommended by the World Health Organization. Aidspan has described these flexibilities earlier. Four of these East African countries used the flexibilities to support their COVID-19 response. Kenya requested $5.9 million, Rwanda requested $5.5 million, Tanzania requested $6.2 million, and Uganda requested $4.4 million.
As new information indicates that COVID-19 may be around for many more months, or even years, it is clear, says the World Bank that “regional coordination, cooperation, and integration are key to Africa’s future.”