The COVID-19 pandemic has required rapid new efforts to manage the disease globally. Within a few months, Cabo Verde has significantly strengthened local capacity to quickly and effectively diagnose COVID-19 through an accessible and effective laboratory system.
At the start of the pandemic and relying on WHO’s technical guidance, the country’s leadership recognized the importance of detecting SARS-CoV-2 through polymerase chain reaction (PCR) method. As Cabo Verde is an archipelago, the government opted for the development and strengthening of decentralized testing and rapid investment in human resources and equipment to improve the capacity of local laboratories for diagnosing COVID-19.
These efforts leverage on the country’s response to previous epidemics. Cabo Verde experienced the first dengue epidemic during the last quarter of 2009. With the support of WHO, it obtained equipment for reverse transcription polymerase chain reaction (RT-PCR). During the Zika epidemic in 2016, with support from WHO and its collaborating centre, the Pasteur Institute in Dakar (IPD), the Ministry of Health (MoH) set up a virology laboratory. In this context, eight laboratory technicians were recruited and trained, and four of these were specifically trained for the virology laboratory to perform RT-PCR tests for the diagnosis of Zika.
As the threat of rapid spread of COVID-19 was looming in March 2020, the country with the support of WHO, acted quickly to develop laboratory capabilities for diagnosing SARS-CoV-2 through RT-PCR tests in Cabo Verde. WHO supported the training of a technician in the diagnosis of SARS-CoV-2 in partnership with the IPD and with financial support from the West African Health Organization.
At the same time, WHO financed the purchase of PCR equipment to reinforce the capacity of the laboratory in Santiago Island and to open a laboratory in St. Vicente island, the second most populated island. Additionally, WHO assisted the government in securing funds to cover five months of the technicians’ remuneration to ensure uninterrupted provision of testing services in Santiago and St. Vicente islands. IPD and the WHO Regional Office for Africa also provided the required technical assistance.
Based on the needs assessment and in consultation with the government, WHO acquired and delivered to the virology laboratories in Santiago, St. Vicente, and in Sal island 2000 units of rapid antigen tests, consumables for the automatic extractor, Viral Transport Medium, and reagents. With the reinforcement of the laboratory capacity, up to 800 samples per day can be processed by the three laboratories by January 2021. The virology laboratories were integrated into the COVID-19 platform for laboratory professionals in the WHO African and Eastern Mediterranean regions. Furthermore, Cabo Verde put in place an external quality assurance programme to monitor the country’s capacity to correctly test for SARS-CoV-2.
Maintaining high quality of tests was a priority for Cabo Verde. Responding to the request of the government, WHO contracted an international consultant to provide technical assistance to elaborate a manual for the transportation of biological samples from Cabo Verde. In partnership with the MoH, WHO organized a three-days biosafety training for technicians on COVID-19 management. Under WHO’s guidance, national health professionals were trained on triple packaging for transporting samples, on emergency procedures for containing spills in laboratories, on elaborating procedures to align the interpretation of results with reference laboratories responding to the pandemic, and on supporting the validation of results of positive cases with follow-up (2nd and 3rd samples from the same patient). Finally, WHO consultant provided support regarding COVID-19 laboratory protocols and the comparison of testing results among the different diagnostic kits available in the country.
The office of UNICEF in Cabo Verde also contributed to SARS-CoV-2 testing capacity with the procurement of Gene-Xpert cartridges tests for SARS-CoV-2. In addition, The Global Fund also provided financial support, to purchase PCR tests and to contribute to overall efforts on laboratory strengthening.
The process of increasing local diagnostic capacity has not been without challenges. As many flights to Cabo Verde were cancelled and due to bureaucratic obstacles, there were delays in the procurement of Gene-Xpert as well as in receiving equipment, consumables and tests. There was also a lack of sentinel sites for influenza surveillance. Ongoing challenges include ensuring sufficient and qualified human resources and capacity for integration into the network of genome sequencing laboratories for COVID-19 and emerging pathogens, which are vital for the diagnosis and understanding of the spread and control of the pandemic.
In spite of an extremely challenging year, Cabo Verde has increased and fortified its local capacity for successfully diagnosing SARS-CoV-2 by PCR in a very short period of time thus reinforcing its health emergency preparedness and response. Currently, thanks to the country’s actions, 5 of the 9 islands of the archipelago have access to quick, PCR tests. The remaining 4 islands are getting the benefit of a quick referral system where samples are analyzed in the closest available laboratory, covering by this way the needs of the entire country.
Photo caption: Identifying cyrotubes for sample separation and subsequent packaging and conservation, Praia, Santiago Island, Cabo Verde, 2020.
Photo credit: WHO
