The Fight Against Coronavirus Disease in Ghana and Evidence-Based Medicine – Dr Omane Boamah

Last night (21st April 2020), the Government of Ghana projected fifteen-thousand (15,000) deaths from coronavirus. I believe it is based on evidence. It is a projection, not a certainty! This projection assumes 10% of Ghanaians are likely to test positive for the virus before infections peak.

“We expect that about 10% of the population may be infected and out of the 10% of the population 80% may not show signs or symptoms at all and 5% of them will be very ill, that is the projection,” according to Dr Anthony Nsiah Asare, Presidential Advisor on Health.

https://www.myjoyonline.com/news/national/government-projects-15000-coronavirus-deaths-in-ghana/

These scary statistics call for a concerted effort and an all hands on deck approach to Ghana’s fight against COVID-19. So far, I commend stakeholders for the contributions, support, encouragement and efforts at combating this deadly virus.

Needless to say, Ghana’s response was late in coming, and release of funds by Government initially was a paltry GHC2.5 million before it was later ramped up. Whiles Government was waiting to release funds, the virus was moving. Hence, this scary projection of 15,000 deaths.

But we cannot fight over spilled milk – we must all continue to be involved and be partners. To be engaging participants, we also need data. Credible data. Hence there is every need for Government to accept in good faith concerns about discrepancies in its COVID-19 data.

Such concerns from the celebrated Professor Agyeman Badu Akosa, a seasoned Pathologist and former Director-General of the Ghana Health Service (GHS) and many others including my good self are all geared towards our common good – to heal our land of Coronavirus disease in good time. Evidence is key to our collective objective.

The ‘Evidence-Based Medicine Movement’ in the early 1990s began advocating increasing use of direct evidence in medical practice. Currently, thanks to the Archie Cochrane inspired, “Cochrane Reviews” robust evidence is used in health and medicine. Therefore, we must all be interested in relying on credible data which lends itself to reliable and robust evidence. The World Health Organisation, itself, needs credible date from countries to plan for today and for the future.

Additionally, Davies (1999), notes that evidence-informed policy making is the integration of experience, judgement and expertise with the best available external evidence… This view suggests that evidence-based policymaking in general and in particular health is certainly not based on the extreme case of relying solely on evidence but must necessarily reflect the a delicate balance between evidence, values, beliefs, norms and interests.

Therefore, factors such as social values (which are determined by concepts such as belief systems, motivations) and power of interest groups based on ideology, politics and power are vital to the final decision/policy.

Indeed, Friedrich Nietzsche the celebrated German philosopher, cultural critic, composer and poet, posits, “All things are subject to interpretation. Whichever interpretation prevails at a given time is a function of power and not truth.” Therefore, in order to limit the influence of power on the truth, we need credible and clean data – not data that contains duplicates among others.

Several models have been explored in evidence-based medicine or health policymaking. They include the:
¬ Engineering Model;
¬ Enlightenment Model;
¬ Elective Affinity Model;
¬ ‘Two Communities’ Model;
¬ ‘Linkage and Exchange’ Model; and
¬ Strategic Model.

For the sake of relevance and brevity, I will focus on the Strategic Model to explain why Ghanaians must be assured and not be talked down by Government in the ongoing discussion and debate about the discrepancies in the COVID-19 data in Ghana.

The Strategic Model views evidence as ammunition which is used to support predetermined positions or to delay or obstruct politically uncomfortable decisions. Weiss (1979, p.173) explained this strategy and history is replete with examples from HIV/AIDS management in Uganda to the search for Weapons of Mass Destruction in Iraq by the President Bush administration.

Hence Ghanaian decision-makers must come to the table with candour, humility and detailed explanations to convince the public that yes, you must continue trusting the Ghana Health Service COVID-19 figures because of a, b, c, d… factors. If possible support these factors with timelines and with figures.

Such figures should include names of all the centres which conducted the tests with their corresponding figures attached, when the testing centres ramped up operations, any additional equipment deployed and functioning, any more human resource added among others. If need be – I hope not – independent verification should be allowed.

Conclusion

The discussion around credible COVID-19 data is healthy, and it must not degenerate. Professor Agyeman Badu Akosa, and many others who have raised concerns must be seen to be helping the process towards healing our land of Coronavirus disease in good time.

We must heal the land in good time because the projections are scary. We cannot afford the loss of 15,000 Ghanaians lives.

Dr Edward Kofi Omane Boamah
MD & MSc. Health Policy Planning and Financing
Former Minister for Communication.