Africa's Unique Vulnerabilities Require a Different Pandemic Approach
Policy Options - Institute for Research on Public Policy
Africa’s fate is precarious in the face of COVID-19. It is the last continent to be affected by COVID-19 following the arrival of the contagion in Egypt and Nigeria in February 2020. Ideally, the late arrival of COVID-19 in Africa could have bought the world’s poorest and politically susceptible continent an advantage. However, a combination of unpreparedness and the severity of COVID-19’s impact left Africa with no such advantage.
When the contagion hit Africa, many countries had already rolled out COVID-19 specific public health response measures. We can classify these measures into four complementary strategies. The first relates to the regulation of social and behavioural conduct. The second are measures for enhanced institutional capacity and treatment or management plans for patients who have contracted COVID-19. The third are those in support of research and development efforts aimed at the discovery of a COVID-19 vaccine, production of pandemic necessities and management of potential turns the pandemic may take. The fourth category are financial and in-kind reliefs targeted at members of the public and businesses to combat the disruptive effects of COVID-19.
An important question is whether these measures are feasible for implementation in Africa in a cut-and-paste manner based off a template from the developed world. This requires us to ponder the viability of a one-size-fits-all approach to public health emergencies. Such an approach ignores the link between socio-economic reality and public health, which determines the viability of these measures. Some assume that average citizens have access to credible information from public health authorities and access to basic amenities like running water, electricity, functional accommodation and public transportation.
However, Sub-Saharan Africa is largely deficient in three core dimensions of the multidimensional poverty index (MPI) – health, education, and standard of living – and also deficient in other specific elements such as nutrition, sanitation, drinking water, electricity and housing. This makes implementation of COVID-19 measures such as physical distancing, hand sanitation, and disinfection of surfaces implausible. Access to basic necessities are important determinants of public health. Continent-wide, the African response to COVID-19 cannot be divorced from its socio-economic reality.
Africa is a heterogeneous continent of 1.2 billion people and 55 countries at different levels of development and diverse economic and human development indicators. As such, it is inaccurate to generalize about the continent, save that all African countries are classified as either least developed or developing. As such, interconnected with socio-economic realities, public health constitutes a core dimension of the vulnerabilities experienced by Africans across all constituent countries, which are only heightened by COVID-19. African countries could not sustain a two-month lockdown without risking political rupture given that over 80 percent of economic activities are driven by the informal sector relying on daily hand-to-month income.
In Africa, most people do not have reliable access to running water, live in crowded spaces (especially the vulnerable urban and suburban slum populations) and are served by decrepit, overcrowded and poorly regulated public transportation. Buying and selling of goods are typically conducted in open-air community markets characterised by intense human traffic, close physical contact and cash payments. Additionally, meagre housing resources and paucity of vital personal identification data make contact-tracing difficult. Despite expanded mobile-phone penetration and internet connectivity in Africa, more than half of mobile phones have non-smart features, compounding deployment of technology for pandemic response.
Unlike other regions, most African countries do not have fiscal flexibility required to support citizens and corporate entities with incentives to cushion COVID-19 socio-economic disruptions. Meagre attempts by a handful of countries were mired in corruption or constrained by a lack of data to identify and reach those in need of such reliefs. At the same time, Africa ranks high on aggressive enforcement of COVID-19 emergency ordinances. Those have resulted in many citizens being subjected to the overzealousness of murderous law enforcement personnel. Draconian law enforcement and legislative power grabs have limited access to legal services, leaving the most vulnerable victimized and their civil liberties freely violated in the name of pandemic.
Many African countries’ institutional capacities in the health sector are weak. Dismal physician-patient-ratios persist, alongside a dearth of local specialist personnel. Additionally, these nations lack the resources necessary to effectively engage in the worldwide scramble for, or domestic production of, COVID-19 supplies such as test kits, ventilators and professional-grade personal protective equipment (PPE). Accordingly, global public health analysts worry that Africa may be overrun by COVID-19.
In a headline-catching remark, Melinda Gates, philanthropist and co-founder of the Bill and Melinda Gates Foundation, was quoted as saying that “[t]he disease is going to bite hard on the continent [with] dead bodies in the streets.” Now at the cusp of a second wave of COVID-19, the lack of accurate data and efficient testing have clouded the true situation in Africa.
Leveraging the continent’s past experiences with infectious diseases and public health emergencies, Africa’s COVID-19 prognosis does not have to be bleak. Across the region, the cliché of necessity being the incubator of innovation is evident. Africans are capitalizing on new technologies, such as 3D-printing and drones, to localize and scale responses to COVID-19. South African inventers have designed an intubation box, which provides an additional layer of protection for ICU medical personnel conducting and monitoring intubation procedures. Nigerian military has been involved in production of ventilators and PPE, using local materials.
In several nations, including Ghana, Nigeria, and Kenya, local fabric and garment industries have been repurposed to mass produce face masks. Ghana is using drones to transport COVID-19 test samples from hinterland areas to cities for analysis. Drawing from experience in fighting Dengue fever and Ebola, a Senegalese laboratory is producing a COVID-19 diagnostic testing kit at the cost of approximately US$1, giving the country the capacity to test every citizen and support other countries. Senegalese innovators are using 3D-printing to produce ventilators at cost of US$60, while imported ventilators cost roughly US$16,000.
As of May 2020, Senegal was believed to have the third best rate of recovery for COVID-19 patients globally and the best in Africa. Despite Madagascar’s gaffe in marketing its Artemisia-based tea as a COVID-19 cure, attention to the potential of Africa’s genetic resources and traditional knowledge in COVID-19-related research and development should not be underestimated.
Yet try as Africa might, it needs international support and solidarity to prevail through the crisis. The capacity to ultimately contain the virus is as strong as the weakest link in pandemic management, which Africa potentially represents. COVID-19 has overwhelmed the world, forcing richer countries to focus inwards on their citizens and economies. The situation is confounded by the culpability spat and mutual suspicion between the United States and China over pandemic mismanagement. This unravels into a huge gap in much needed global leadership.
America’s decision to pull out of the WHO and the organization’s wobbling attempt to raise a meaningful percentage of its target for the COVID-19 Solidarity Intervention Fund is chilling news to Africa. Not only is the continent faced with the reality of rolling back economic progress of the past decades, but its fate remains precarious in the absence of strong international economic and public health solidarity over COVID-19.
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A longer version of this piece can be found in Vulnerable: The Law, Policy and Ethics of COVID-19, edited by Colleen M Flood, Vanessa MacDonnell, Jane Philpott, Sophie Thériault and Sridhar Venkatapuram, out now and available open access from University of Ottawa Press.