Covid-19

CORONAVIRUS

Africa pins its hopes on a youthful population to mitigate the devastation of Covid-19 

A member of the Nigerian army performs a temperature check on a visitor at the entrance of the Nigerian Army Hospital in the Yaba area of Lagos, Nigeria, on Friday, Feb. 28, 2020. Nigerian health authorities said theyre tracing everyone whos been in contact with an Italian man who tested positive for the coronavirus, the first such case in sub-Saharan Africa. Photographer: George Osodi/Bloomberg via Getty Images

Covid-19 remains a plague of mystery, and its likely course in Africa is still one of the bigger secrets it is concealing. So far, the continent has not been hit by huge numbers of infections or deaths and it’s not clear why. Is there some reason why Africa will continue to escape the worst of the pandemic? Or is Covid-19 lying low for some reason, before raging across the continent? 

The economic impact on Africa, of Covid-19 itself and even more so, of government lockdowns to curb human contact and therefore transmission of the virus, is likely to be very large. The World Bank has estimated that Africa will go into a recession for the first time in 25 years this year – with a 5% contraction of the continental economy. 

President Cyril Ramaphosa, as African Union chairperson, is leading a continental campaign to persuade the international community to provide about $100-billion to Africa to help it fight Covid-19 directly and deal with the economic fallout. How much he will get is uncertain. 

Politically, Covid-19 is also having an impact, likely destabilising fragile parts of the continent. Fifteen African countries are due to hold elections in 2020. Some governments are postponing their polls, others are ploughing ahead and in both cases many are arousing suspicions that they have chosen the option which will help them win. And in northern Mozambique, and the Sahel, violent jihadist extremists seem to be taking advantage of the coronavirus distraction to intensify their campaigns. 

To return to the medical impact, two months after the first case of infection was discovered on the continent, in Egypt on 15 February 2020, its trajectory in Africa remains uncertain. The continent has registered under 15,000 infections, only about 1% of the global total. But will it stay that way?

“Many fear that with its high levels of poverty, weak health systems and crowded urban areas, the virus could be particularly devastating,” the Africa Centre for Strategic Studies (ACSS) writes in its report Mapping Risk Factors for the Spread of COVID-19 in Africa. “Others hope that with its warmer climate, youthful population and experience fighting infectious disease, that Africa will be able to avoid the worst of the pandemic.”

Another hope is that Africa could be enjoying unintended protection from the century-old Bacillus Calmette-Guerin (BCG) childhood vaccination against tuberculosis (TB) – like Covid-19, a respiratory disease. In March 2020, scientists from the New York Institute of Technology, published a paper which suggested that the lower impact of the disease in some countries of the world could partially be explained by the compulsory childhood BCG vaccination policies in those countries. Significantly, compulsory childhood BCG vaccinations are national policy throughout Africa (and most of the developing world) though how effectively they have been implemented is uncertain. 

Other scientists have cautioned that this sort of broad study needs to be verified with actual clinical trials of the impact of BCG on Covid-19, several of which are underway. 

And then, perhaps inevitably, there are those, like Burundi’s President Pierre Nkurunziza, who believes his devout country is being spared the worst ravages of Covid-19 by divine providence. 

So far, the Covid-19 infection rate has been much higher in African countries like South Africa, Egypt, Morocco and Algeria with the greatest airlinks to the world, through which they imported the virus, mainly from China, Europe or the US. The ACSS suggests that numbers have been high in these countries also because of their relatively urbanised populations and more effective health systems which have enabled them to trace infections better than others. 

But it predicts that as the disease becomes rooted on the continent and local community transmissions increase, it will shift its focus to other countries. It ranks the most vulnerable countries in order as South Sudan, DRC, Nigeria, Sudan, Cameroon, Egypt, Ethiopia, Central African Republic, Somalia and Chad when nine risk factors are combined. These are: international exposure; quality of public health system; density of urban areas; total population in urban areas; population age; government transparency (i.e. readiness to put out good, honest information about the virus); press freedom (i.e. capacity to transmit good, honest information about the virus); conflict magnitude; and proportion of displaced persons.

The African nation least at risk is the Atlantic Ocean island state of Sao Tome and Principe (which registered its first infection last week), followed by Seychelles, Mauritius, Cape Verde, Benin, Namibia, Botswana, Malawi, Gambia and Sierra Leone. South Africa ranks slightly only better than average, as the 28th most vulnerable state out of 54.

“African countries face varying levels of risk that will require adapting a diversified set of response strategies to the coronavirus. The most vulnerable countries may not be those with the earliest onset,” the ACSS report says.

The latest casualty figures, published by the Africa Centre for Disease Control in Addis Ababa on 13 April 2020 show the initial trend still largely continuing. Overall infections total 18,333, with 961 deaths and 4,352 recoveries.

Egypt has now overtaken South Africa, with 2,673 infections and 196 deaths; South Africa is second with 2,605 infections and 48 deaths; Morocco has 2,283 infections and 130 deaths; and Algeria has 2,268 infections and 348 deaths.

At the other end of the spectrum, among those countries which the ACSS believes are at highest risk of contagion in the longer run, figures are still fairly low, so some increase is becoming evident.  

South Sudan is registering only 4 infections with no deaths; DRC, 287 infections and 23 deaths; Nigeria, 442 infections and 13 deaths; Sudan, 32 infections and five deaths; Cameroon, 855 infections and 17 deaths; Ethiopia, 92 infections and three deaths; CAR, 12 infections and no deaths; and Somalia, 80 infections and five deaths.

Burundi may no longer be sure it enjoys divine protection as it has recorded only five infections, but its first death. 

Lesotho and the Indian Ocean island archipelago of Comoros remain the only African countries which have so far registered no infections.

However, Dr John Nkengasong, director of the Africa Centre for Disease Control and Prevention (Africa CDC) noted this week that the African infection rate had doubled in a week. He also noted Africa’s fatality rate (deaths as % of infections), is about 6% –  quite high by global standards.

And Dr Matshadiso Moeti, head of the WHO’s Africa region, expressed concern that the virus was continuing to spread within countries and that some West African states were seeing a rapid rise. She mentioned Niger, Guinea, Cote d’Ivoire and Cameroon.

The ACSS report says that apart from South Africa and the north African countries where infection numbers have been high, the report also believes “Kenya, Nigeria, Ethiopia, Uganda, Tanzania, and Zimbabwe are countries that exhibit relatively high risk factor scores for rapid increases in initial transmission as well, though they have not seen the high levels of reported cases. This may reflect relatively effective efforts to contain the spread of the virus — or lagged reporting of cases. Accordingly, these countries will be important to watch.”

The ACSS report says that during the next phase of the pandemic in Africa, one should keep an eye on countries with high composite vulnerabilities, including weaker health systems, denser urban populations, more conflict, larger displaced populations, greater mistrust in government and more closed communications channels.

Apart from South Sudan, DRC, Sudan, Cameroon, CAR, Somalia, and Chad at the top of the list, other countries in the Sahel and Great Lakes are at high risk for severe outbreaks because, even though they don’t have large over urban populations, they do have very densely populated cities and towns. The report notes that in South Sudan, for instance, inhabited areas average 8,730 people per square kilometre. “Urban layouts and architectures in these locations are similar to the compacted towns of Spain and Italy, where the virus has hit Europe the hardest to date.

“Built-up areas across much of Africa have higher population densities than those in Europe and the United States. Influenza transmission rates in India have been found to increase above a population density of 282 people per square kilometre. The density of many built-up areas in Africa is over five times this threshold.”

The ACSS also believes that, apart from population density of urban areas, another important risk factor for spreading Covid-19 is the total number of people living in urban areas in a country.

And it says Africa’s megacities: Lagos, Cairo, Kinshasa and Johannesburg, all have peak population densities greater than New York City’s 56,000 people per square kilometre, where Covid-19 has been rampant. “Cairo’s peak population density (175,000/km2) easily tops the density of Wuhan, China (106,300/km2), where the novel coronavirus originated.”

“Stay-at-home orders will be particularly difficult to maintain in African cities where many residents lack adequate shelter, sanitation and the monetary means to stock up on supplies and to stop work.”

Many Africans are pinning their hopes on Africa’s youthfulness. The report notes that about 80% of Covid-19 fatalities in the world so far have been among people over the age of 60. 

“With 70% of Africa’s population under the age of 30, Africa’s youth bulge may be a buffer against the most devastating human costs of the disease on the continent.

“The benefits of a more youthful population, however, will need to be balanced against other underlying health factors facing many African populations such as malaria, malnutrition, tuberculosis and HIV/Aids.”

The report also notes that African countries with relatively older populations, such as the Seychelles, Cape Verde, Mauritius and Tunisia may suffer more deaths than one might expect from their low rank on most other risk factors.  

How is Africa responding to the crisis? “With confirmed cases in Africa rising at a rate of approximately 25% per day, time is of the essence if Africa is to avoid the worst effects of the pandemic,” the ACSS says. “Slowing the exponential expansion of the virus will rely on identifying the primary transmissions routes within each country and disrupting these.”

African countries have each responded to Covid-19 in their own way. Most have implemented lockdown measures of varying severity to keep their citizens apart and avoid transmission of the highly-contagious Covid-19 disease. WHO Africa director Rebecca Moeti has singled out South Africa for “bending the curve” of infections with the exceptionally strong measures it adopted, first declaring a State of National Disaster on 13 March 2020 and then a total lockdown on 26 March, cancelling all domestic and international scheduled flights, closing schools and businesses, and confining all but essential workers to their homes for three weeks. These measures were then extended for another two weeks. 

South Africa has also led the continent in the scale of its testing which on 16 April reached 95,060 and was expanding through an aggressive campaign of community screening of citizens. The South African government revealed this week that by flattening the curve of new infections – now at to 2,605 – it had delayed the peak of the pandemic to September 2020, giving the country more time to prepare. 

Continentally, the response has been led mainly by the Africa Centre for Disease Control and Prevention in Addis Ababa, which has focussed its attention on helping the countries least prepared, in equipment and training, to tackle the virus. 

In February 2020, it began training African countries in how to test for Covid-19 when there were only two countries which could do it – South Africa and Senegal. Now, as the Africa CDC director John Nkengasong said this week that there was testing across almost all countries. But there were huge shortfalls, he added, with South Africa having done over 95,000 tests while Ethiopia had done less than 5,000 and Nigeria, with a population of 200-million, only about 6,000. 

Tebogo Job Mokgoro, premier of the North West,, left, speaks during an event to distribute personal protective equipment (PPE) at a taxi rank in Rustenburg, South Africa on Tuesday, April 7, 2020. South Africa is mid-way through a three-week national lockdown and has sealed off its borders in a bid to stop the spread of the coronavirus, which has infected 1,749 people so far and claimed the lives of 13. Photographer: Waldo Swiegers/Bloomberg via Getty Images

The centre is also buying or receiving donations of test kits. Over the next week and a half, it would roll out more than one million new test kits to all countries.

He said the centre is buying test kits from Germany, but it has also received a million test kits, 500 ventilators and much more equipment from the Chinese philanthropist Jack Ma. 

This week, the Africa CDC launched a new campaign, the Partnership to Accelerate Covid-19 Testing (PACT) to help AU member states step up their tracing and testing of people for infection. 

And it would launch an initiative with UNAids to train community workers to help trace suspected cases in the Africans countries which were being hardest hit. Nkengasong said there were four things Africa had to do if it wanted to have “a fighting chance” of defeating Covid-19. They were to scale up testing and tracing; to protect health workers as much as possible, as it would be a disaster if Africa started losing them to Covid-19 when it already had an acute shortage of them; to ensure there was a strong community response as this was the only way to have effective contact tracing; and to ensure a constant supply of the necessary commodities, the equipment to fight the virus. 

He said his organisation was also building a genomic sequencing network, using reference labs around the continent to analyse the full genome of the virus to understand the pattern of how Covid-19 was circulating in African states. “So we can trace that to the source of the outbreak and use that to sharpen our response strategies.”

Nkengasong said a few clinical trials of possible Covid-19 treatments had so far been registered in Africa. These include the WHO’s international Solidarity trial of four drugs which South Africa was participating in and will include testing of chloroquine and hydroxychloroquine, Remdesivir, lopinavir/ritonavir and lopinavir/ritonavir with interferon beta-1a. Nigeria has also registered a test and so has Egypt for a natural honey treatment.

The Africa CDC was also mapping the medical equipment shortage across the continent. He said, for example, South Africa had the highest number of ventilators, about 1,500, which are used to treat critically-ill Covid-19 patients, while 10 African countries had none. The centre was arranging to ship some of the 500 ventilators donated by Jack Ma to these and other countries with low numbers and also to link them to neighbouring countries which had ventilators.

South African companies had started to produce low-cost ventilator machines. Nkengasong said it was a very good sign to see local manufacturing on the continent.

Egypt had the highest number of clinical care beds, with about 10,300, while six countries had none. 

“As we continue to receive equipment, these are some of the gaps we will continue to fill as the pandemic evolves.” 

Nkengasong said AU leaders had specifically asked his centre to pay attention to especially vulnerable populations, such as refugees and fragile states, such as South Sudan. South Sudan was getting its share of the equipment donated by Jack Ma. Its testing for Covid-19 was now being done in Kenya, but he hoped it would develop its own capacity. Nkengasong said the Africa CDC was developing guidelines for addressing refugee communities “as we truly don’t want Covid-19 to seed into such vulnerable populations”.

Economic impact 

Whatever the medical impact of Covid-19 on Africa will be, the economic impact is likely to be large – the combined effect of huge global trade disruptions – especially of Africa’s commodities exports – as well as postponements of inward investments and interruptions to remittances. 

The International Monetary Fund (IMF) forecasted that the global economy would shrink by about 3%, with the Euro zone taking a huge hit of -7,5%, the US -5,9% and advanced economies as a whole -6,1%. Former head of the UN Economic Commission for Africa (UNECA), Carlos Lopes says the ILO is projecting 200 million jobs to be at risk while UNECA has estimated that 20 million of those lost jobs will be lost in Africa. 

UNCTAD is estimating a 40% foreign direct investment contraction, and the WTO is worried about a fall between 13% and 32% of world trade. 

The IMF has estimated Sub-Saharan economies would on average shrink 1.6%, with the two largest economies suffering much bigger contractions, of 5.8% for South Africa and 3.4% for Nigeria. The World Bank’s  forecast is even gloomier. 

“African countries are likely to be hit particularly hard,” said Hafez Ghanem, World Bank Vice President for Africa. The bank forecasts Sub-Saharan Africa’s overall economy shrinking at least 2,1% and possibly as much as 5.1% in 2020 – its first recession in 25 years – after 2.4% growth in 2019. And this would translate into contractions of 15 to 20% in the first quarter in some countries, Marius Oosthuizen of Gordon Institute of Business Science told Washington’s Centre for Strategic and International Studies this week.

He noted that Africa had felt the economic impact even before Covid-19 arrived on the continent when manufacturing collapsed in China – where the coronavirus began – creating a large knock-on effect on the exports of African commodities.

And on top of this, the collapse of the oil price had put oil producing nations, like Angola and Nigeria, under severe strain. This loss of revenue was aggravating Africa’s ability to respond to the health crisis – coming on top of a large debt burden which was about 40% to 50% of GDP in one third of the continent’s countries. 

Compared to rich countries in the OECD which were spending up to 8% of GDP to stimulate their economies, African countries had so far spent only 0.8% of GDP.

And this is even before calculating the direct economic costs of addressing the pandemic, he said. If the pandemic really takes off in Africa, as many fear, that would create “a perfect storm” as the imported macroeconomic problems would be aggravated by microeconomic ills. Most African countries were about 60% dependent on the informal sector, which required day to day, face to face trading. So most African countries would be harder hit by lockdowns. Oosthuizen said it was likely to take African countries two to three years to return to their normal economic growth. 

Economic response

Carlos Lopes writes in the Africa Report, that while others are debating whether the world is now going into a shorter recession or a longer depression, “African countries will most likely find themselves in the depression category unless some major effort is made to rescue their precarious economies”. 

A mechanical ventilator sits by a bed at the Aga Khan University Hospital in Nairobi, Kenya, on Thursday, April 9, 2020. Kenyan President Uhuru Kenyatta banned all road, rail and air travel in and out of the capital, Nairobi, and three other regions at the coast that are the epicenter of the Covid-19 outbreak in the nation. Photographer: Patrick Meinhardt/Bloomberg via Getty Images

Oosthuizen said given their huge shortfall of revenues to reboot their economies, GIBS had roughly estimated that African countries would require at least $300-billion in financial assistance from the international community. But since the world was facing its own financial constraints, only a small part of this demand was likely to be met. 

The African Union has appealed to the international community for a $100-billion package and AU chairperson Ramaphosa has despatched a team of special envoys to try to raise the money. Though a large number, this pales by comparison with the $3-trillion which rich countries are spending to reboot their economies. 

The focus of the AU appeal is for debt relief, including a temporary suspension on interest payments for loans from international financial institutions such as the IMF, World Bank and African Development Bank and from individual creditor countries. 

This week, at a virtual G20 finance ministers meeting, the representatives of the world’s richest countries agreed to freeze poor nations’ debt obligations, responding in part to a joint appeal from nearly 20 European and African leaders – including Ramaphosa – made a joint appeal for a massive international effort to boost Africa’s Covid-19 response, saying that “only a global victory that fully includes Africa can bring this pandemic to an end.”

The finance ministers of the G20 countries, which includes the US, China, India, Germany, the UK and France, pledged to immediately put on hold poor countries’ obligations to service debt they owe, freeing up revenue for them to tackle the Covid-19 pandemic. 

French Finance Minister Bruno Le Maire said 76 countries were eligible for the moratorium on repaying interest on loans, including about 40 in Sub-Saharan Africa. Debt payments worth $20-billion will be suspended, including $8-billion owed to private creditors and $12-billion owed to other countries, he told AP.

An additional $12-billion in debt payments to multilateral institutions like the World Bank are also under consideration for a debt freeze. The freeze on debt repayments will last through the end of 2020 and could be extended.

“This is a powerful, fast-acting initiative that will do much to safeguard the lives and livelihoods of millions of the most vulnerable people,” said World Bank Group President David Malpass and IMF Managing Director Kristalina Georgieva in a joint statement.

The World Bank Group had said before it would be deploying up to $160-billion in financial support over the next 15 months to help all poorer countries fight the pandemic. Politically, the pandemic is also having an impact in Africa, most obviously on leadership ability because of some leaders, like King Mswati of eSwatini, President Mokgweetsi Masisi of Botswana and many ministers or senior officials especially in West African countries having been infected or gone into isolation because they feared they might have been, as Judd Devermont, head of the Africa programme at the Centre for Strategic and International Studies (CSIS) in Washington, said at a webinar this week. 

Some 15 elections are scheduled for African countries in 2020 and the virus has either caused them to be postponed – as Ethiopia – or in other cases, such as Malawi, they are going ahead, even though many fear that they will not truly reflect the political will of the people because so many will stay away from the polling stations. Devermont, said it was clear some of the leaders either postponing or resisting postponement of elections were using the pretext of Covid-19 to cling onto power. Others were democratically consulting with their opponents before doing so.

Others, one could add, are using the fact that their political opponents are locked down or otherwise distracted, to push through political measures that would otherwise be blocked. There is some suggestion, for example, that Ramaphosa and his feisty finance minister, Tito Mboweni might be using the opportunity to push through radical reforms such as slashing the public service wage bill and maybe even liquidating SAA. 

Jakkie Cilliers, chairperson of the Institute for Security Studies (ISS) in Pretoria, told the webinar the pandemic would tend to make Africa’s democracies more democratic and its authoritarian states and pseudo-democracies more autocratic. He said that Ethiopia was postponing elections for justifiable reasons, while Guinea and Mali were more likely doing so to suit the leaders of those countries. 

Some leaders like South Africa’s Ramaphosa and Ghana’s Nana Akufo-Addo, who had taken strong early action to combat Covid-19 would come out of the crisis stronger, while others, like Zambia’s Edgar Lungu and Egypt’s Abdel-Fatah el Sisi, and Tanzania’s John Magufulu who were struggling to show leadership, would not, Cilliers said.

But generally, the pandemic – though depending on how it panned out –  could set the scene for greater political volatility in Africa. There had already been significant mass protests in Sudan, South Sudan, South Africa, Zimbabwe and Ethiopia. The big dilemma for political leaders would be how to respond if the pandemic accelerated as traditional lockdown strategies could not possibly work in economies dominated by the informal sector, with people crowded in informal settlements or even slums. 

And he said the virus would also be destabilising because it would hamper the efforts of the many UN peacekeeping missions in Africa – in Sudan, South Sudan, DRC, Mali, CAR, Western Sahara and Somalia – to do their work, such as doing troop rotations, in the face of lockdown and travel restrictions.

The UN, which was already struggling to find enough money for peacekeeping operations, could find its resources even more severely constrained in the global economic fallout from the pandemic.   

Other commentators have noted that while the pandemic seems to have put terrorism on hold in some parts of the world, in the Sahel and in northern Mozambique, violent extremists seem instead to be exploiting the distraction of security forces to intensify attacks. 

Cilliers also said he believed Covid-19 would accelerate Africa’s tilt towards China, which had launched a major campaign to help the continent cope with the crisis. DM 

 

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