Africa has yet to experience worst of pandemic — Report

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COVID-19 mortality in Africa has been significantly lower than elsewhere, but the worst is yet to come and will set the continent back several years, finds a report by the Institute of Security Studies of SA, the Gordon Institute of Business Science, and the University of Denver.

While it took 98 days for Africa to reach the first 100 000 cases, it took only 18 days for that number to double and the rate continues to accelerate.

Updated forecasts on the potential impact of COVID-19 on Africa were released on 23 July. Compared to pre-COVID-19 projections, Africa’s economy will be between $349bn and $643bn smaller in 2030. ‘COVID-19 is set to undo several years of development progress in Africa,’ says lead author Jakkie Cilliers.

He warns that instability will increase as government revenues decline in tandem with other effects such as the accelerated impact of climate change in regions like the Sahel.

The report finds that, in a best-case scenario, GDP per capita will recover to 2019 levels in 2024. In the worst case, Africa will only return to 2019 levels in 2030.

As such, beyond being a health pandemic, COVID-19 is set to create a generational set-back for development in Africa. The analysis shows that COVID-19 will further constrain the continent’s progress towards attaining the 2030 Sustainable Development Goals.

Efforts to provide additional social grants in several African countries to mitigate the pandemic’s impact will only marginally reduce extreme poverty and income inequality in the short term.

Relative to the pre-COVID-19 forecast, 14m additional Africans will be extremely poor in 2020. In 2030, 38m to 70m more people would be classified as extremely poor. This translates to poverty rates of 35% to 37% of Africa’s total population. Instead of a pre-COVID-19 tally of 570m extremely poor Africans by 2030, that number could increase to 640m.

The pandemic is expected to significantly reduce government revenue and health expenditure, pushing many countries towards a debt crisis. In the worst case, more people will have died from the impact of reduced health expenditure and hunger by 2030 than from COVID-19.

The report calls for a concerted international effort to assist the continent. African leaders need to speed up implementation of measures such as the African Continental Trade Agreement that could unlock more rapid development. The success of Africa’s recovery also depends on addressing longstanding deficits in water and sanitation infrastructure and improving the underlying structural drivers of economic growth, such as education, governance and public-private partnerships

The report presents three scenarios on the impact of COVID-19 in Africa using economic growth forecasts, mortality and efforts to ameliorate impact through social grants. Likely effects are examined on per capita income, poverty and the attainment of selected Sustainable Development Goals targets. Africa’s development trajectory has suffered a severe setback, with extreme poverty rising in all the scenarios. The pandemic threatens Africa in several ways, and the report provides policy recommendations to reduce vulnerability and strengthen resilience.

Community transmission is now accelerating in most countries. The pandemic is spreading particularly rapidly in South Africa, which has the largest number of cases, although most deaths in Africa attributable to COVID-19 have occurred in Egypt. While the veracity of testing and case data in Africa is questionable, the impact of the pandemic is uneven. Other highly affected countries include Algeria, Morocco, Nigeria and Ghana. 

While it took 98 days for Africa to reach the first 100 000 cases, it took only 18 days for that number to double and the rate continues to accelerate. For much of Africa, it seems likely that the larger infection and mortality impact of COVID-19 is still to come. 

Early efforts to contain the spread through travel restrictions, lockdowns and market closures have played an important role in constraining rates of infection in many countries, but have taken a heavy social and economic toll. Some countries, such as Tanzania, have taken limited measures against the virus and in April stopped updating public information relating to the pandemic. 

The impact of the pandemic has been described by the UN as ‘the greatest test that we have faced since the formation of the United Nations’, and by the International Monetary Fund (IMF) as ‘the worst economic fallout since the Great Depression’. 

The UN Development Programme expects the decline in the Human Development Index in 2020 to erase all progress made in human development worldwide over the past six years. Globally more than US$8 trillion has been committed to fighting the associated health, economic and other effects – an amount several times larger than the combined GDP of Africa. 

Lockdowns, testing and tracing 

At first blush Africa appeared to many to be particularly susceptible to COVID-19, due to the continent’s crowded informal urban settlements and the challenges these pose to the implementation of measures such as social distancing. 

In addition, many African countries have relatively low levels of access to safe water, generally considered the first line of defence against COVID-19. They also have high levels of undernourishment, poorly funded health systems and underlying health conditions such as tuberculosis and HIV/AIDS. The average percentage of the population in Africa with improved water access was 78% in 2019, compared to the average for the rest of the world of 96%. In Africa, only Mauritius, Algeria, Egypt, Tunisia, Cape Verde, Botswana, Seychelles, and São Tomé and Príncipe are above the average for the rest of the world. 

Furthermore, countries in sub-Saharan Africa generally spend significantly less on health as a percentage of GDP compared to all other regions globally, except South Asia. Many African countries adopted public health and mitigation measures taken by states that were more advanced in their response to the pandemic, such as China, and generally reacted rapidly despite limited resources and capacity. Countries closed their borders and some embarked on a comprehensive lockdown strategy, accompanied by contact tracing to map transmission clusters and isolate people suspected of being infected. 

A number of countries, such as Uganda and South Africa, rapidly established expert panels to guide their pandemic response. Others, such as Ghana, decided against a full lockdown, opting instead for a partial one, backed by vigorous contact tracing and monitoring. Rwanda disinfected and decongested its food markets and provided sanitary facilities along key rural-urban public transport corridors, while Senegal established mobile teams that targeted their response to where the disease was reported. 

The intention was to flatten the rate at which COVID-19 infections increase, buy time for public officials to improve the capacity of health systems, and improve their readiness to deal with the anticipated full impact of the pandemic. The continent was able to benefit from the experiences gained from previous diseases such as Chikungunya. Some 41 African countries have experienced at least one epidemic, such as the Ebola epidemics of 2014–16 in West Africa and 2018-2020 in the Democratic Republic of the Congo (DRC), and recurrent Lassa fever epidemics in Nigeria. 

While some countries such as New Zealand have been able to reduce infection rates through a comprehensive set of interventions, some of these measures are difficult to implement effectively in much of Africa. This is due to low state capacity, widespread poverty, high levels of informality and the absence of adequate social safety nets on the continent. 

Flattening the COVID-19 infection curve therefore might avert the collapse of a national health system but potentially have far-reaching impacts on the economy and livelihoods. In addition, with fewer hospital beds, physicians and intensive care facilities per million people than other regions, most African health systems will be unable to cope once infection rates accelerate, as is expected to happen in the latter half of 2020. 

New medicines will help in responding to COVID-19.

In mid-June the use of the well-known and relatively inexpensive steroid dexamethasone was hailed as the first major breakthrough in the treatment of patients who are severely ill with the coronavirus. 

Dexamethasone is claimed to reduce deaths by one third in severely affected patients in need of ventilation and by one fifth in patients receiving oxygen only, but there was no benefit among patients who do not require respiratory support. Other medical treatments will inevitably follow with important impacts on the mortality forecasts referred to in this and other reports. Without effective medicine or a vaccine that can be manufactured and rolled out on a massive scale, COVID-19 will affect Africa for some time to come. 

Countries such as Sweden, with much more health capacity than African states, experimented with
an alternative approach. It opted not to institute a lockdown and allow for the development of herd immunity instead, but is now moderating its policies.  Herd immunity would probably require that up to 80% of the total population becomes infected. There would be large health, economic, social and political uncertainties on the path to that level of immunity – bearing in mind that at current methods and levels of testing most countries are below infection rates of 10%. 

The potential health, economic, social and political impact of infection rates of 30%, 50% or 70% of a total population are currently unknown and a lot depends on the symptoms and severity with which people are affected. Our current limited insight and data about why the pandemic is spreading so unevenly in Africa may result in an outcome where COVID-19 settles into an endemic equilibrium, as is the case with seasonal flu. 

Key Findings

COVID-19 is set to undo several years of development progress in Africa.

Compared to the pre-COVID-19 forecast, Africa’s economy will be between US$349 billion and US$643 billion smaller in 2030.

In a best case scenario, GDP per capita will recover to 2019 levels in 2024. In the worst case, Africa will only return to 2019 levels in 2030.

Efforts to roll out additional social grants in several African countries to mitigate the impact of the pandemic will marginally reduce extreme poverty and income inequality in the short term.

Relative to the pre-COVID-19 forecast, 14 million additional Africans will be extremely poor in 2020.

Recommendations

African countries should:

Continue to act proactively in responding and adapting to new information and strategies to tackle COVID-19

Efficiently manage existing resources to contain COVID-19 and other structural challenges

Increase transparency and practice more responsible borrowing

Grow their tax base and improve tax collection systems

Take advantage of the opportunity to accelerate digitisation of their economies to improve resilience, productivity and ability to reap the bene ts of the 4th industrial revolution.

Re-engineer sectors like health and WASH to better cater to the needs of people in rural and urban areas.

The African Union should:

Call for better procurement systems and action plans for African countries to acquire health equipment amidst high global demand and competition

In 2030, an additional 38 to 70 million more people would be classified as extremely poor. This translates to poverty rates of 35% to 37% of Africa’s total population.

COVID-19 is set to further constrain Africa’s progress towards attaining the 2030 Sustainable Development Goals.

The pandemic is expected to significantly reduce government revenue and health expenditure, and undermine debt sustainability in several African countries. In the worst case, more people will have died from the impact of reduced health expenditure and hunger by 2030 than from COVID-19.

Advocate for debt moratoriums and relief for African countries

Spearhead the implementation of the African Continental Free Trade Agreement as a means to unlock economic diversification and more rapid growth

Promote an African response framework and medical research partnerships for COVID-19, and lead on disease and public health surveillance on the continent.

International development partners, lenders and civil society should:

Provide debt relief and insist on full transparency on all loans

Support the provision of healthcare and basic infrastructure

Assist Africa’s response to COVID-19 through continued nancing and capacity building in key sectors like health

Draw attention to human rights issues to keep governments accountable in their response to COVID-19.

 

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