The Covid-19 Response in Africa

It’s easy to lose track of the number of articles in Western publications predicting imminent Covid-19 doom across the African continent. It’s equally easy to conclude that foreign news desks would love another reason to write the typical “Africa struggling” narrative. Of course, that’s not what they’re really hoping for, but that can be hard to remember among the general gloom of the reporting of the continent’s preparedness and capability to deal with a crisis like this.

Yet for all the fearmongering, the African continent’s healthcare systems and responses are coping better than expected. It is instead in the economic and social domain that Covid-19 will have its most damaging and lasting effects. In recovering from a crisis of this magnitude, African and  more developed nations alike will require strong state intervention to recover. The UK government should prioritise support in this area in their international development expenditure as they lay the groundwork for the post-Covid-19 recovery, even as they cope with the immediate healthcare threat.

The realities of why the spread of the disease has been so much slower and more contained across the bulk of the continent are prosaic, but varied. Firstly, Africa, particularly south of the Sahara, is significantly less well connected with the rest of the world than all other continents are. The countries that are the exceptions, where the virus is prevalent in large numbers, are Morocco, Egypt and Algeria, incidentally also the countries with significantly better connectivity to one of the current viral epicentres: Europe. Within each country, the high proportion of people (around 60%) living in rural areas, in villages with low population densities and fewer connections to the cities where the virus is generally concentrated, acts as a protective buffer. Secondly, the median African age of 20 years may make the continent as a whole less susceptible to a widespread outbreak than Europe, where the median age is more than double that.

Thirdly, this continent has also been at the forefront of epidemic preparedness investment in the past 20 years. This preparedness is, by virtue of the more varied and dangerous pathogen threats, significantly better designed by comparison to, say, the UK’s pandemic preparedness exercise, which modelled an influenza outbreak, a viral pathogen for which we already know and understand the treatment protocols and possible vaccines and cures.

Finally, the lessons from past epidemics have been learned here; you shut down early and you shut down hard. In Kenya, where Lauren is currently based, bars and restaurants were shut down in the same week they were in the UK, when Kenya had less than 50 cases and the UK already had 6,000. The borders were closed not long after, and all new arrivals into the country had to undertake mandatory government monitored quarantine at dedicated premises (some hotels, some hostels), meaning contact tracing has been possible and successful from the outset. Almost all cases reported now are from patients who were already being monitored because they had been quarantined, or were discovered as a result of contact tracing. Lockdowns were similarly swift in Uganda and South Africa.

There are instances of police brutality in enforcing these lockdowns, and these were as avoidable as they are tragic. But they are also, for the most part, the exception and not the rule. There are also cases of poor government handling of quarantine facilities, and there are rumours that statistics are false and cases and deaths under reported. Yet for the most part, government communications have been clear, and in Kenya ministers and the private sector are working well together on the national response. Public hotlines have not been overwhelmed, and the public health system is not exhibiting signs of the number of Covid-19 cases presenting at hospitals outstripping the official statistics released by the government on a daily basis. Though there are countries that are notable exceptions to this, by and large the continental response has not been the public health disaster that was predicted.

However, it is the socio-economic impact this pandemic will have that looks likely to have a far nastier and more durable impact than the virus itself. Nations are terrified of the aftermath of locking their countries down against the virus. Last month, at the very beginning of this outbreak in Kenya, Nick received a message from a Kenyan taxi driver who provided a regular service when he lived in Nairobi. The driver wrote with alarm that his daily revenue had fallen from about KSh 1,500 (about £11.50) to KSh 200 in three days – what was he to do? His was an experience being felt all over Kenya and Africa as economies closed shop.

Gains in poverty reduction are at risk, especially in countries exhibiting high levels of informal or self-employment where there is already too little protection for many against loss of income and scant social safety net. High reliance on agricultural employment may be an asset for rural areas and food security – particularly given high food demand in export markets – but could equally be a threat if the supply of agricultural inputs dries up or food prices drop. Globally, supply chains are strained and Africa’s exports of primary commodities and products such as flowers are suffering. Couple this with the inevitable wholesale shift in the tourism industry worldwide, which employs so many in both the formal and informal economies of this continent, and poverty looks set to rise in the coming years.

With approximately 80% of the world’s children out of school, twin challenges around access to remote learning, and ensuring children return to school when the crisis has passed present themselves. Gaps in education have lasting effects on poverty and equality. Lessons from the 2013-2016 Ebola outbreak tell us that many children, particularly those from low-income families, do not go back to school after prolonged absence.

Governments starved of resources will have less to invest in infrastructure, widening the existing infrastructure gap still further. After significant capital flight from emerging markets, banks will be warier of investing in large infrastructure projects to make up for the public sector shortfall, and over-leveraged developing nations will be wary of taking on yet more debt. Governments will also have less capacity to tackle endemic challenges such as corruption, even though, as the Ebola response tells us, corruption is likely to increase during instability.

If the shutdown is prolonged then public order, currently under control, will fray, requiring a measured response from what we know are often weak or heavy-handed police and security services. In already fragile countries, Somalia or Mali for example, the potential exists for extremism to rise as a product of hardship and marginalisation.

For the UK and donor governments everywhere a vital first step is to sustain aid budgets. Our own as well as developing countries’ interests will be served by assisting in the resumption of trade and the maintenance of international security. Second, in the urgency of bolstering healthcare and government budgets, the wide array of priorities being addressed pre-Covid-19 must not be neglected. Corruption must still be fought, access to education remains as important as ever, and climate change is still the largest long term threat to global stability.

Finally, ASI’s experience in Sierra Leone during the Ebola outbreak, in Iraq and Afghanistan in periods of political unrest, and in Kenya and Zimbabwe following post-election violence, has shown that embedding advice at the top levels of government in a time of crisis can be pivotal. A third priority should therefore be to supply expertise to the Covid-19 response units being set up across all of Africa from Nigeria to Ethiopia. Supporting these units leads to the establishment and delivery of key sector priorities, aids in decision-making, and communicates progress to the public. Having advisory expertise on hand is proven to make such initiatives more effective.

States that better plan and coordinate their responses will be better prepared to achieve economic and social recovery when the crisis is over, and it is in the UK’s national interest to support this global recovery both financially and organisationally.

By Nick Haslam, Head of Programme Partnerships at Adam Smith International and Lauren McEvatt, MD of Morpeth Consulting and Advisor at Adam Smith International

Nick Haslam & Lauren McEvatt