ANALYSIS | Before it’s too late for Africa

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Long before the Corona Virus Disease 2019 (COVID-19) arrived in Africa via Egypt in mid February 2020, everyone knew its emergence on the continent was a matter of when and not if…

 

A health professional conducts a Covid-19 test in Johannesburg. Despite having one of the continent’s best public health systems, South Africa has fewer than 1,000 intensive care unit (ICU) beds for its 56 million people. Photograph: Marco Longari/AFP via Getty Images

 

Having first emerged in China’s central city of Wuhan in late 2019, the 2019 novel coronavirus later named COVID-19 by the World Health Organisation (WHO), has wrecked a devastating havoc on Chinese lives and economy; infecting over 81,000 people and killing over 3,000, as at April 6. The disease had quickly spread to neighboring Asian countries, Europe and North America before the highly contagious virus eventually hit Africa.

The global number of COVID-19 cases and deaths stood at over 1,300,000 and over 73,000 deaths, respectively, as at April 6. Europe (with Italy and Spain being the worst hit) and later United States of America replaced China as the epicenters of the disease. With over 347,000 cases and over 10,000 deaths, as at April 6, the United States of America has since surpassed China, Italy and Spain in terms of number of cases of COVID-19. USA’s number of cases is almost equal to the combined number of cases in Spain, Italy and China: over 349,000.

One can better appreciate the magnitude of the serious dangers that lie ahead by looking at the consequences of COVID-19 on countries such as Italy, Spain and the United States. Despite having some of the most effective and efficient health systems as well as advanced mechanism of epidemic preparedness in the world, these countries are but buckling under the strain of the outbreak.

 

Africa and COVID-19

Although Africa still accounts for a mere over 9000 cases (0.25% of global cases) and over 400 deaths (0.6% of global deaths) from the COVID-19 pandemic, this is not in any way a cause for laxity – the unavoidable enormity of COVID-19’s effect on African lives and economy might not have been seen yet! Except urgent, collective and drastic preventive and containment measures of immense proportions are taken by the entire continent, the 9000 cases and over 400 deaths resulting from COVID-19, as at April 6, might after all just seem like a child’s play.

Africa might still be experiencing the dawn of the disease thus the continent is a long way from its sunset.

Much as the continent has made a significant inroad in responding to COVID-19, thanks to the combined efforts of the Africa Centres for Disease Control (Africa CDC), governments of individual countries, and the WHO, amongst others, much more is still left to be done – as far as mitigating the potentially disastrous consequences of unhindered spread of COVID-19 across the continent is concerned.  A lot more preventive and containment measures are still desired to guarantee the safety of the continent’s over 1.2 billion inhabitants.

Granted, Africa CDC, the specialized technical institution of the AU established to strengthen the capacity of Member States’ public health institutions to detect, prevent, control and respond quickly and effectively to disease threats, has been quite proactive in responding to the COVID-19 threat in Africa. The CDC had convened an emergency meeting of African health ministers on February 22 where they agreed on a continental strategy for the COVID-19 outbreak.

The CDC had also built the capacity of Member States to test for COVID-19 and trained African health personnel on infection prevention, surveillance, airport screening, risk communication as well as clinical management of cases. It had also since activated an emergency operations center (EOC) which provides regular updates on the continental COVID-19 situation including new cases, recoveries, deaths as well as efforts of AU and its Member States in responding to the pandemic.

 

A weak preparedness mechanism

Africa has one of the weakest health systems in the world and as a result the weakest epidemic preparedness and response mechanism. This is the basis for the high-level of anxiety about the potentially disastrous consequences of a full blown and unimpeded outbreak of COVID-19 in Africa, where until very recently, only two out of 55 countries – South Africa and Senegal – had the capacity to even test for the virus.

Even now that almost all African countries have the capacity to test for the disease, access to COVID-19 testing remains a sort of luxury; one that is inaccessible to majority of the population due to lack of testing equipment, manpower, and consumables such as reagents. This is why some are of the opinion that the low figures of people testing positive for COVID-19 in countries such as Nigeria, Africa’s most populous nation cum its biggest economy, is not a result of low numbers of infections, rather, due to low capacity of the country to test more people.

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As well as electricity and medical oxygen, ventilators or rather breathing machines are crucial for the clinical management of respiratory failures resulting from acute COVID-19 cases in Intensive Care Units (ICUs); however, ventilators are grossly in short supply across all African countries. Countries like the USA boast as high as 34.7 critical care beds or rather ICUs per 100,000 persons while Germany and Italy, 29.2 and 12.5, respectively; yet, these developed countries are struggling to contain the pandemic. African countries like Uganda boast a trivial 0.1 ICU beds per 100,000 persons.

If these developed countries would struggle the contain a full-blown outbreak of COVID-19, even as they continue to procure thousands of ventilators, one can only imagine what will happen if Africa’s outbreak become full-blown. One country that demonstrates Africa’s seeming ill preparedness to combat the virus is conflict-ridden Central African Republic (CAR). Whereas Nigeria with over 200 million people has only 500 ventilators, CAR, whose population is 5 million – out of which 2 million people are already in need of health assistance – boasts only 3 ventilators. Shocking! Isn’t it?

 

A slow, uncoordinated response

European countries and the United States had adopted a ‘wait and see’ attitude towards COVID-19 while it ravaged China. Instead of ensuring cooperation and coordination with his counterparts in Europe, President Donald Trump of the USA initially dismissed the virus as a “Chinese virus”. Like Europe and the USA, Africa’s initial response to COVID-19 was slow, haphazard and uncoordinated – despite the fragile health systems prevailing across most African countries and the relatively slow pace with which the pandemic arrived on the continent.

African countries waited until the first case of COVID-19 was confirmed in Egypt mid-February, before they began to actively put in place even then, largely country-specific measures for preventing and containing the outbreak of the disease on the continent. Although the last to be hit by the virus, African countries remained sitting ducks as COVID-19 ravaged China and later Europe; it was not until the actuality of COVID-19’s viciousness and zero respect for land, sea and air borders became a reality that vigorous preventive and containment measures began.

Afterwards, measures to prevent, detect, and respond to COVID-19 such as closure of air space to flights from China and other COVID-19-affected countries; suspension of mass gatherings; strict surveillance such as screening at points-of-entry; social distancing; total lockdowns as well as effective risk communication across AU Member States, were slow to come. And when they eventually came, they were done in such a haphazard and arbitrary manners that their effectiveness in preventing the importation and transmission of COVID-19 was compromised.

It was over a week after the first COVID-19 case in Africa was confirmed in Egypt that the CDC convened an emergency meeting of African health ministers which agreed “to prepare for and potentially respond to COVID-19 importation to Africa.” The CDC also announced efforts to establish the Africa Taskforce for Novel Coronavirus (AFTCOR), as a continental platform for the coordination of efforts to combat COVID-19. However, we have not seen similar meetings of Africa’s ministers of transport or aviation, finance or a similar meeting of Africa’s key private sector actors, all of whom are integral in Africa’s effort to combat COVID-19.

Perhaps, this was responsible for the haphazard manner in which African countries suspended flights operations with COVID-19-affected countries and eventually all international and local flights operations. Bearing in mind the fact that almost all the early COVID-19 cases in Africa were imported from outside of the continent, one can confidently say, a speedier and unified approach to the closure of Africa’s air and sea borders, would have prevented most, if not all the imported cases.

Whereas other African countries were a bit more responsive in suspending flights to and from China, Ethiopian Airlines – Africa’s major carrier whose main hub in Addis Ababa is the gateway to the continent – continued its flight operations with China, until things began to get out of hand. This was a clear case of a preventive failure resulting from lack of coordination and cooperation in responding to COVID-19 by African countries. Relatedly, looking at Africa’s private sector’s response to the pandemic, what is obvious is that the continent’s billionaires are largely contributing to the COVID-19 response efforts in their respective countries, only.

For example, despite being home to one of the highest numbers of African billionaires, Nigerian billionaires’ donations to the COVID-19 campaign had largely been to efforts to stem the tide in Nigeria, alone. Even Africa’s richest man and leader of the Coalition Against Coronavirus (COCAVID), an alliance of Nigerian private sector leaders in support of the country’s efforts against COVID-19, Aliko Dangote’s donation was to Nigeria only – and not Africa as a whole. No African businessman is more qualified to lead African business community’s charge against COVID-19 as Dangote is – Being its richest son, one with investments all over the continent!

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Similarly, South Africa’s richest families, the Rupert, Oppenheimer and Motsepe families, had each donated $57 million to the South African government to cushion the effects of economic hardship caused by COVID-19 on small businesses and employees. A notable exception is Nigerian billionaire businessman Tony Elumelu, whose USD14 million donation through the United Bank for Africa, was to Nigeria and 19 other African countries. If billionaires from Africa’s economic giants such as Nigeria, South Africa and Egypt are only supporting their national governments in the fight against COVID-19, what happens to poor and war-ridden countries like CAR, South Sudan and Somalia? With COVID-19, no one is safe until everyone is safe!

So far, like the Ethiopian Prime Minister Abiy Ahmed has said, what we have seen are largely country-specific measures to respond to the pandemic. African countries’ health systems are mostly fragile while multitudes of families living on border communities, moving freely across borders. This explains why as a continent, Africa’s approach to combating COVID-19 must be collective, collective and collective!

It was not until March 26, when COVID-19 had since found its way into all but a few of the 55 AU Member States, that the Bureau of the Assembly of the African Union Heads of State and Government under President Cyril Ramaphosa of South Arica cum Chairperson of the African Union, held a teleconference. At the teleconference, Ramaphosa emphasized the need for a “continental coordinated response” and the establishment of the African Union COVID-19 Response Fund into which each Member State pledged the sum of $12.5 million and an additional $4.5million to the Africa CDC.

On April 3, the Bureau held a second teleconference where they announced the establishment of a continental ministerial coordination committees on health, finance and transport to support the AU’s comprehensive continental strategy for COVID-19. The heads of state underscored the need to “speak with one voice on Africa’s priorities”. Even if belated, the recent high-level collective approach to the campaign against COVID-19, is a laudable one. However, it is one thing for the heads of state to convene and pledge to commit resources to the campaign and entirely another for them to make good on the pledge.

Considering the potentially disastrous consequences of the COVID-19 crisis – which has been described as the biggest global crisis since World War II  – what Africa needs is a heads of state-level taskforce on COVID-19, whose membership should also include, the AU Commission, Africa CDC, the WHO, AfDB, the Regional Economic Communities (RECs) and Africa’s private sector. That way, collective action, coordination, and resource mobilization would be speedier and more effective. If fully operationalized, the AU COVID-19 Fund and its ministerial committees might be the perfect answer to the pandemic.

 

Socioeconomic cost of COVID-19 to Africa

Since its emergence in China late 2019, COVID-19 has continued to wreak  havoc on the global economy including that of African countries, whose projected economic growth for 2020 is being severely hampered. The pandemic has sent stocks and commodity prices tumbling, led to a decline in the value of national currencies as well crashed oil prices to their lowest level in two decades. Africa’s biggest oil exporters namely Algeria, Libya, Nigeria, Angola, Gabon and Equatorial Guinea, have begun to feel the economic brunt of the pandemic.

The fall in oil prices and lockdowns of cities and towns across the continent means  up to half of Africa’s jobs may be lost, according to the UN Development Programme (UNDP). Consequently, the International Monetary Fund (IMF) and World Bank are calling on financial creditors to provide poor countries with debt relief.  The IMF and World Bank have both launched emergency schemes offering grants and loans to their member countries, with a particular focus on developing countries, so as to cushion the socioeconomic effects of the pandemic on the world’s poorest people, a huge chunk of which reside on the African continent.

According to the Brookings Institution, economic disruptions resulting from COVID-19 will lower sub-Saharan Africa’s GDP growth in 2020 by between 1.5 percent and 2.5 percent, down from the 3.6 percent pre-COVID-19 projections, and consequently, push countries into economic recession. Besides, the United Nations Economic Commission for Africa (ECA) has warned that Africa’s losses in export earnings might be over $100 billion, inclusive of $65 billion for oil-producing countries.

The near complete shutdown of economic activities means many formal sector workers have already been made to either take pay cuts or even go on unpaid leave. While many of those earning daily wages and unskilled workers in the informal sector have totally lost their sources of livelihood.  Consequently, governments across the continent must, despite the prevailing economic constraints, come up with far-reaching palliative measures to ease up the sufferings of low-income earners.

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The success of the ongoing lockdowns meant to keep people at home will, to a large extent, be determined by the effectiveness of the social safety nets. Notably, many African countries have already began to introduce palliative measures such as providing conditional cash transfers to the poor, reduction in value-added and corporation taxes as well as offering waivers on utility bills, to cushion the effects of these fallout.

Experts believe the Africa Continental Free Trade Agreement (AfCFTA) might offer Africa a window of opportunity to evolve a homegrown continental response to the socioeconomic costs of COVID-19 – against simply waiting for external support in mitigating the economic effects of the pandemic. This can be achieved by speeding up of the implementation of the AfCFTA, under which trade is set to commence July 1. Actions such as dismantling current tariffs and all non-tariff barriers on goods and services within Africa as well as reducing the time it takes to cross borders, it is said, would generate $134 billion per year or 4.5% of Africa’s GDP.

 

Before it’s too late

Africa has almost always relied on the support of the international community in crisis situations like this; this time around, its ‘saviors’ are themselves fighting the same war. What this means is the continent must look inward and develop African solution to what, this time around, is obviously a global problem. And that is only possible if African countries are able to work together for their common good and by extension the good of the global community. The time for complacency is now over!

Like UN Secretary-General António Guterres said, “Only by coming together will the world be able to face down the COVID-19 pandemic and its shattering consequences…we are only as strong as the weakest health systems.” For Africans, more than ever before, this is time to imbibe the spirit and teachings of Ubuntu. Indeed in a highly communal society such as Africa’s, where hundreds of millions of people either live together in rural extended families where they share everything – from pit latrines to eating bowls – or dwell in cramped urban informal settlements with poor access to clean water and sanitary facilities, the idea of social distancing might be difficult to practice!

Consequently, Africa must ensure COVID-19 doesn’t get to the millions of low-income Africans living in rural communal homes, urban slums and even more critically, the 27 million refugees and IDPs residing in camps dotted all over the continent. For, when it does, the continent will have neither the healthcare infrastructure nor the medical manpower and financial resources to confront the disastrous consequences of such a full blown outbreak. Like the Ethiopian-born Director-General of the World Health Organization Tedros Adhanom Ghebreyesus, has said: “The best advice for Africa is to prepare for the worst and prepare today.”

To achieve this, countries must begin by ensuring effective risk communication to make people aware of COVID-19’s symptoms and dangers as well as the need for collective social responsibility through self-isolation when such symptoms are noticed. Commendably, CDC is launching an innovative mass awareness campaign on COVID-19, using indigenous African languages and targeting semi-urban and rural populations across Africa, as a means to counter disbelief, disinformation and misinformation, so as to catalyse collective citizens’ action and solidarity as well as combat stigmatization.

Very importantly, AU countries must ramp up their grossly limited mass testing capacity through innovations like drive-thru testing points, mobile testing, and self-testing. They must also ensure the availability and accessibility of personal protective equipment (PPEs) such as face masks for health workers and other citizens as well. Countries must also massively deploy technologies in surveillance and tracking of the movement of potentially infected persons so as to break the chains of local transmission for the virus.

Scientists say only aggressive preventive and containment measures such as regular hand washing, use of PPEs such as face masks, self-isolation, restrictions on movements and mass gatherings, as well as physical distancing will prevent a full blown outbreak of COVID-19 in Africa. This measures will only work if they are implemented with ruthless efficiency through aggressive engagement with people at grassroots leveraging community-based traditional and religious structures. In summary, Africa’s approach to containing COVID-19 must be about prevention, prevention, and prevention as well as containment, containment and containment!

Although some believe the still relatively low numbers of COVID-19 cases and deaths in Africa is due to its tropical climatic conditions, others see the low numbers as but a calm before the storm! The best time for Africa to prepare for COVID-19 was 3 months ago, the second best time is NOW! The continent must learn from the mistakes of Europe and the USA , by developing a comprehensive, collective and well-coordinated plan of action – one that will ensure COVID-19’s chain of transmission is broken for good and consequently, avert a potentially disastrous tragedy, before it is too late to do so.

 

 

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