Managing Health and Economic Priorities as the COVID-19 Pandemic Spreads in Africa

The coronavirus is placing severe strains on Africa’s health, economic, and security sectors. Mitigation and suppression efforts will require a comprehensive government response built on clear communications and public trust.

As COVID-19 spreads in Africa, the effects could be devastating—even for a continent accustomed to battling infectious disease. COVID-19 endangers African lives and African economies, and efforts to control the disease will themselves come with an enormous economic and social price. In South Africa, President Cyril Ramaphosa said the pandemic has become a “national disaster.” Never before, he said, “in the history of our democracy have we been confronted by such a severe situation.”

 What Does COVID Mean for Africa?

The regional chief of the World Health Organization (WHO) has said that Africa is experiencing an “extremely rapid evolution” of numbers of COVID-19 cases. As the virus has followed its slingshot path around the world, countries elsewhere have seen surging numbers overwhelm local health systems, offering ominous examples for those that are later in this global sequence.

In the fight against the novel coronavirus, Africa does have certain advantages. Demographics are on its side. The median age of Africa is under 20 years—less than half that of Italy—and international data shows that risk of serious medical complications and death from COVID-19 rises significantly with age. Additionally, Africa has experience confronting infectious diseases, including the Ebola epidemic in West Africa in 2014-2016. Many African countries have made improvements in health security since that outbreak, including the establishment of the Africa Centres for Disease Control and Prevention. Finally, there is an unresolved scientific debate as to whether warm weather will inhibit spread of the virus. The pandemic, however, could overwhelm those advantages, and Africa’s health, economic, and security sectors will be at the frontlines of this fight.

Health Sector

Researchers take a sample swab at C.H. Rennie Hospital in Kakata, Liberia. (Photo: World Bank/Dominic Chavez)

The health challenges of COVID-19 for the continent are daunting, with a serious potential loss of life in Africa either directly or indirectly related to the COVID-19 virus:

• Africa’s health systems are weak, and its health workforce already overtaxed. A 2016 Rand study concluded that of the 25 countries most vulnerable to infectious disease, 22 are in Africa (the other three are Afghanistan, Yemen, and Haiti). Health workers have been particularly at risk for COVID-19. Reportedly, over 3,300 Chinese health workers were infected by mid-February. During the Ebola outbreak (a disease with a much higher fatality rate), 8 percent of Liberia’s doctors, nurses, and midwives perished. Africa already has fewer health professionals per capita than most regions of the world, making any impact on the health sector more resounding. Further, in other regions, including some wealthy countries, the virus has reached crisis proportions, as testing capacity, intensive care unit (ICU) space and personnel, ventilators, and personal protective equipment have been stretched past the breaking point. All of these are scarcer in Africa. South Africa, for example, reportedly has fewer than 1,000 ICU beds. Malawi has 25.
• Africa is already confronting multiple health challenges, including HIV/AIDS and tuberculosis, meaning millions of people may be immunocompromised and more at risk of serious complications from this respiratory virus. Additionally, high rates of malaria in some countries may both make people more vulnerable to infection and may confuse diagnoses since high fever can be a symptom of both malaria and COVID-19.
• The emergence of a new disease can have a devastating and lasting impact on already fragile health systems. In West Africa, an estimated 10,600 people died of HIV/AIDS, TB, and malaria during the Ebola epidemic as a result of the strain it caused to the health system. Moreover, maternal and child health declined significantly and still had not recovered well after the end of the epidemic. More recently, while resources were focused on halting the Ebola outbreak in the eastern Democratic Republic of the Congo, a measles outbreak has continued to rage in the country.

Economic Sector

When the novel coronavirus outbreak first began in Wuhan, China, its possible economic impact on Africa, through Sino-African trade and tourism ties, was immediately apparent. As the disease has transformed into a pandemic, however, its adverse economic impacts have also become globalized.

The tools that countries have adopted to try to mitigate the spread of the disease—closing borders, cutting off flights, shuttering schools and universities, encouraging or requiring physical separation or sheltering in place, and ordering the closure of businesses and even entire industries—all exact a high economic cost. For Africa’s oil and other commodity exporters, plummeting prices add to the distress.

The economic impact of COVID-19 in Africa may now be considered through three lenses: the Chinese, the global, and the national:

• The impact of China’s shutdown affected Africa before the first case of the coronavirus reached its shores. The outbreak disrupted supply chains and affected infrastructure investments, African commodity exports, and African imports that provided stock for small businesses. The decline in the Chinese tourist trade and the loss of income for African airlines also hit hard. Even if China’s economy begins to bounce back, the early effects of the outbreak are already making themselves felt in empty African ports and emptying store shelves.
• Estimates for the global impact of the virus depend upon several variables, including the length of time it takes the United States and Europe to “flatten the curve” enough to greatly reduce new infections and end their lockdowns (and maintain that status) and the degree to which the virus takes hold elsewhere, including in Africa. Global GDP growth could fall by one-half of a percentage point or could even contract for the year under some scenarios. Foreign direct investment has already diverted from emerging markets to perceived safer harbors in bond markets at the expense of African development opportunities.
• In Africa, COVID-19 is striking just as East Africa reels from a locust invasion, West Africa battles a rising violent extremist threat, and Southern Africa is still suffering the effects of drought and cyclone. Furthermore, oil prices have plunged as Saudi Arabia and Russia duel in the global marketplace, hammering Nigeria, Angola, and other African producers. Recognizing the threat of COVID-19, many African countries have sought to close borders and otherwise made economic sacrifices to try to prevent transmission. Nonetheless, economic side effects are already making themselves felt. The South African rand, for instance, hit a record low against the U.S. dollar.

The cumulative impact of these economic body blows has to be measured in the context in which one in three Africans live below the global poverty line. Those who live on the economic margins are most vulnerable to lockdowns and other measures instituted to prevent transmission. Basic food security becomes an immediate concern.

Security Sector

A member of MONUSCO practicing measures to avoid the spread of COVID-19. (Photo: MONUSCO/Michael Ali)

COVID-19 is also intersecting with security institutions and political processes on the continent:

• Leadership. COVID-19 has already infected senior officials in multiple countries. This growing list includes several ministers in Burkina Faso (as well as the U.S. Ambassador there). Nigerian President Muhammadu Buhari’s chief of staff, Abba Kyari, has also been infected. In Africa, as other regions, many senior leaders fall into high risk groups for the virus on the basis of age.
• Elections. For countries with elections scheduled in the coming months, COVID-19 may disrupt registration, campaigns, and other activities and may prompt electoral commissions or incumbents seeking to extend their tenures to postpone elections.
• Security Forces. African security forces (like security forces everywhere) are themselves vulnerable to COVID-19. The close conditions under which many military members live and work do not permit social distancing. Further, security threats such as Boko Haram have not ceased their attacks on military and civilian targets. Finally, countries in many parts of the world are turning to military forces to assist in the crisis, whether to construct emergency medical shelters, engage in cleanup operations, distribute food or supplies, or enforce curfews, quarantines, and lockdowns. Enforcing lockdowns, in turn, increases the chances that COVID-19 containment efforts will spark social resentment, resistance, and violence. Indeed, there have already been clashes between police and populaces.
• Peacekeeping. COVID-19 is already affecting peacekeepers. In early March, the United Nations asked a number of European and Asian countries to delay rotations of their forces due to outbreaks at home. As the virus has spread, there are almost no contributing countries who are untouched. Furthermore, peacekeeping missions in the field are also likely to be affected. Maintaining full force capacity will require close cooperation between the UN and national leaders. UN peacekeepers may be able to assist with communications and preparedness in their mission areas. However, further spread of the virus will probably constrain operations and the displaced populations whom peacekeepers protect are highly vulnerable themselves.

Confronting COVID-19 in Africa

The direct and indirect human costs of this pandemic for Africa will rise. COVID-19 may well contribute to more deaths through indirect effects (overtaxed health systems, the loss of health workers to illness, reduced incomes, and perhaps social unrest) than from COVID-19 itself. Africa, like the rest of the world, cannot avoid many of these costs, but it can try to avert the worst effects. There is no exact playbook for this situation. However, here are some lessons learned thus far:

Mitigation and Suppression

The two primary tools against COVID-19 are mitigation and suppression. Mitigation seeks to slow the spread to reduce the demand on the health system and protect those at highest risk. Suppression uses lockdowns or other restrictions to try to reverse the growth of the epidemic. The Africa CDC, drawing on a modeling study by Imperial College in the United Kingdom, reports that a combination of mitigation measures could cut the number of deaths from the disease in half. These include:

• Case isolation (where confirmed cases are isolated from others)
• Home quarantine (where those who have been exposed and may be infected remain at home for 14 days to prevent infecting others)
• Social distancing, especially for those who are over 70 years old and others who are most vulnerable

The study also shows, however, that in order to reverse the rising numbers, broader suppression or lockdown measures are needed, including closing schools and universities, prohibiting gatherings, and “social distancing the entire population.”

Trust and Government Leadership

Bobi Wine recording a song to sensitize listeners to the threat of COVID-19. (Photo: screen capture)

Governance is crucial to public health. Governments from the local to the national must work together to address the growing COVID-19 threat. Countries, as detailed in the medical journal The Lancet, should activate National Response Management protocols if they have not already done so and should initiate risk-based strategies that will depend upon where a country stands in terms of the stage of the outbreak. In the earliest phases, with few-to-no confirmed cases and little community transmission, contact tracing and testing patients with acute respiratory infections are vital steps. In 2014, Nigeria successfully averted a disaster when it aggressively pursued tracing after the introduction of Ebola.

Most of Africa is still in this early stage with COVID-19. However, as African countries move into more advanced stages, protecting health care workers will take on even greater importance as demand and risk both rise. Maintaining the shutdown of physical contact and economic interaction while meeting the basic needs of those sheltering in place becomes of paramount importance in these phases. This is where military forces may be able to provide assistance through managing logistics for food and water access and using other skills honed in emergency preparedness training.

Maintaining public trust during the course of this pandemic will be essential. Governments should communicate rather than simply compel. Strategic communications are a crucial element for public health. The Ebola epidemic in West Africa ended ultimately because of behavior change under very difficult circumstances. This required community input, local interlocutors, and communication. Government officials must set good examples in terms of social distancing, self-quarantine when needed, and candor.

A Comprehensive Approach

Beyond active health measures, governments will also have to address the coronavirus comprehensively.

In its guidance, the African Union has said, “Limiting transmission and minimizing harm from COVID-19 will require an all-of-government approach. Social unrest could result from healthcare facilities having insufficient capacity, stock-outs of essential food, medications, or other supplies, and resistance to social distancing policies that limit work, school, cultural events, and/or religious practice. … All government agencies will need to be involved in implementing COVID-19 response activities, including, for example, finance, justice, trade, agriculture, education, and finance.”

Today’s crisis underscores the importance of integrating health security into national security strategies.

International assistance will also be needed, but may be slower in coming and less plentiful than the unmet need as Africa could find itself the last epicenter of the disease.  While tests, therapeutic drugs, and vaccines will probably all be developed with rapid speed, relatively speaking, they may still take months to develop and more time still to distribute.

Economic Stabilization

Border security is important but so is cross-border trade and international cooperation. Those factors will have to be balanced. Entire sectors, such as aviation and tourism, will be hit especially hard. Countries will have to rewrite budgets and re-allocate resources to adjust to these new realities. Economic effects of a lockdown will be felt most by those who have least. Accordingly, resources will need to be directed to those communities that are in need.

Individual Responsibility

Individuals in every country should take the steps recommended by the WHO, Africa CDC, U.S. CDC, and others to avoid infection and helping protect those most at risk:

• Wash your hands frequently. Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water.
• Maintain social distancing. Maintain at least 1 meter distance between yourself and anyone who is coughing or sneezing.
• Avoid touching your eyes, nose, and mouth.
• Practice respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.
• If you have fever, cough and difficulty breathing, seek medical care early.
• Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority.
• Many countries have restricted the size of gatherings to limit the spread of the disease.

Individuals can also fight misinformation, which can be deadly.  Africa Check, Africa Fact Check, and the Africa CDC are all good sources to consult.

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