The Unknown Impact of COVID-19 in Africa

            As the United States struggles to dig itself out of the tremendous economic and social hole created by the COVID-19 virus, there are those who look at Africa and say the nations of the continent have done far better than America or other developed countries in coping with this disease.  One of my Facebook colleagues posted a comparison of Africa with the United Kingdom.  He said the entire continent of 1.3 billion people has fewer COVID deaths than the UK with 65 million people.  On paper, that is true, but in reality, we have no idea how hard COVID has hit African countries.

The McKinsey consulting firm estimated early on that while about 1% of worldwide infections were in Africa, the continent is the least able to access aid for those most in need. Testing lags far behind that in Asia or the West, suggesting that the epidemic likely had spread further than the official figures suggested.  As in the United States, the number of recorded cases probably was expected to rise significantly as more testing equipment was made available.  As we know, Africa has numerous concerns about the accuracy of social measurements and the efficiency of social programing, despite improvements made on the continent due to experience with HIV-AIDS, TB and Ebola.

            On March 17 of this year, Rep. Karen Bass convened a House Subcommittee on Africa, Global Health, Global Human Rights and International Organizations hearing on COVID in Africa with very credible witnesses.  One of them, John N. Nkengasong, Director of the Africa Centres for Disease Control and Prevention, said Africa lacks health statistics to provide and maintain accurate information.  For example, Tanzania stopped providing such information at a certain point.  Perhaps such information, if taken seriously by the Tanzanian government, might have motivated a better response to COVID prior to the death of then-President John Magufuli, and he isn’t the only African leader to die of this virus.  President Pierre Nkurunziza of Burundi succumbed to the virus before him.  Other African officials also have died from the COVID virus.  If African leaders, who have the all the resources of their governments at their disposal, are dying from this virus, can you imagine what the fate of average citizens, especially in rural, medically underserved areas, must be?

COVID is believed to impact mostly older populations and those in densely-packed urban areas.  Mostly young Africa, whose population is still largely rural (although becoming increasingly urban) has some natural advantage in coping with the virus.  However, according to one of the world's leading source of high-quality data on what Africans are thinking - Afrobarometer polling - before the pandemic about one in five African faced a frequent lack of needed health-care services, including almost two-thirds of the poorest citizens.  A 2016 report by the think-tank the RAND Corporation on the most vulnerable countries to infection outbreaks in the world, said 22 out of 25 countries are on the African continent.  Unfortunately, this situation is not believed to have markedly improved since then.

Health experts have noted that African states host a large immunocompromised population.  Roughly 70 percent of the world’s HIV-positive population live in Africa, many of whom were not receiving adequate treatment prior to the pandemic.  Africa hosts the highest global rate of tuberculosis (TB) infection – approximately 417,000 people died of TB in Africa in 2016 alone, according to the World Health Organization – and are uniquely vulnerable to COVID-19 given its respiratory impact. 

Much of the problem is due to a lack of capacity among African countries on monitoring disease outbreaks and providing health care broadly.  It also is true that African governments, such as those run by the two late presidents of Tanzania and Burundi, refuse to provide useful health information so they won’t be thought to have neglected the health sector in their countries.  In African countries, public facilities typically provide more than two-thirds of the medical care, with private nonprofit (mostly charitable) institutions providing the remaining approximately one-third.

Developing countries in Africa provide services at three levels: primary care at basic clinics and dispensaries, a secondary level of district hospitals and a tertiary level of referral and specialty hospitals. Would it surprise you to know that less than 25% of recurrent government expenditures go to primary care, according to a World Health Organization study?  It isn’t that African governments don’t spend on health care; rather, it is the decisions on where to spend on health care that are critical in safeguarding the health of their citizens.

Another issue hampering effective medical care in Africa is the lack of faith African citizens have in their governments.  As African governments ramped up efforts to fight COVID-19 in 2020, it was expected that they would encounter opposition from citizens who either didn’t trust what their government recommended for disease avoidance or preferred not to follow their directives.  This was the case often encountered during the Ebola crisis. "We don't understand what this Ebola is; we can bury the bodies of our people ourselves," said one villager, quoted by the CBS Evening News on May 24, 2019 in a look back at the Ebola outbreak.

On April 2 of last year, the Wall Street Journal reported violent incidents across the continent as governments attempted to enforce efforts to prevent or minimize the spread of the virus.  “In South Africa, three people were killed as police attacked crowds with whips and rubber bullets for defying the lockdown to prevent the spread of the coronavirus. Five more were killed in Kenya, including a 13-year-old boy hit by a stray bullet fired by police enforcing a stay-at-home order in Nairobi. In Uganda, soldiers shot and injured two people for riding on a motorbike during a curfew,” the newspaper reported.

Live animal markets are commonplace throughout Asia and Africa and feature crowded conditions and the intimate mixing of multiple species, including humans. This too plays a key role in how a killer pathogen could emerge and spread between species.  Another risk is bush meat hunting, butchering and consumption, which is particularly widespread in sub-Saharan Africa. These activities, as they threaten animal species and irrevocably change ecosystems, also bring people and wild animals together. Bush meat consumption, perhaps particularly bat meat consumption, is a clear and primary path for zoonotic disease transmission.  It should be remembered that when the Ebola crisis abated in West Africa, it didn’t disappear completely; it remains a zoonotic threat that could reappear at any time, as it did in the Democratic Republic of the Congo last year.

Furthermore, traditional practices, such as those surrounding family burial preparations, led to the spread of Ebola in West Africa.  African government warnings about handling bodies infected with Ebola went unheeded, especially by rural residents.  In Liberia and Sierra Leone, where burial rites are reinforced by several secret societies, some mourners bathe in or anoint others with rinse water from the washing of corpses. Some socially prominent members of these secret societies have been known to sleep near a highly infectious corpse for several nights, believing that doing so allows the transfer of powers.

Finally, we must take into consideration the willingness of Africans to allow for the closure of churches, mosques and informal religious gatherings.  Houses of worship in the United States for the most part willingly shut down services in person early on in the pandemic, relying to the extent possible on video outreach, although some churches increasingly defied stay-at-home orders or limits on the numbers of gatherers.  Pew Research Center reports that in the United States, the percentage of people who attend weekly services is approximately 36%, while in many African nations, the weekly worship percentage is much higher: Nigeria (89%), Uganda (82%) and Egypt (62%.).  Protests broke out in Senegal in late March 2020 when mosque gatherings were banned.  Even if organized churches cooperated in closing in-person services or otherwise enabling social distancing, what was the likelihood that non-traditional worship in groups would follow suit?

            In the House subcommittee hearing in March, Dr. Donald Kaberuka, the AU Special Envoy on COVID, said measures to address the COVID outbreak in Africa have had seriously adverse social and economic impacts.  “While the levels of infections were relatively modest, the measures taken to control the pandemic have taken a heavy toll; from prolonged lockdowns, disruption to international, regional and national traffic; closure of businesses, large and small. One has to bear in mind that 70% of employment and 50% of GDP is in the informal sector. In the context of societies, with limited social safety nets and welfare – the impact on families, households and business has been drastic. The channels of transmission of the economic impact have been via reduced exports, lower economic activity, at a time when economic buffers were weaker. As a result, deficits have become wider and social conditions deteriorated and many African countries have seen their first recession in 30 years,” Kaberuka said.

            So while we’d like to believe that COVID has not hit Africa as hard as some estimate, it likely has hit much harder than others want to believe.  Those of us who want Africa to survive this virus and recover completely, must not only call for developed nations to contribute to the health of Africa’s people (and by extension to the health of the rest of the world), but we also must urge African leaders to put aside their pride and reveal the genuine data on the course of the virus so help can be applied effectively.