Covid-19: the spectre of an Africa unprepared for health crises


31 March 2020

On March 29, 2020, African Center for Disease Control (CDC) had reported a total of 4,282 cases, 134 deaths, and 302 recoveries from Covid-19. 46 out of 54 countries have been affected since the first case reported on the continent in Egypt on February 15. Africa is almost closed by Covid-19 and the situation is almost similar to the first month of invasion of the pandemic in Europe. But this is far from a similar development: sub-Saharan Africa has the worst health system on the planet, and is therefore ill-equipped to handle this crisis.

More than a week ago, the WHO Director General also warned about the risks of an eventual disaster in Africa if nothing serious was done. Governments met this with staggering carelessness. A few days later, we have begun border closures, total flight ban, market closings, schools, universities, churches, and other gathering places, social distancing measures, awareness raising...it's a real race against the clock with heavy media pressure on governments in Africa. Isn't it too late? 

North Africa remains the epicenter of Covid-19 crisis on the continent

The first case of Covid-19 in Africa was in North Africa, in Egypt. In this region, 4 countries alone hold almost 50% of the cases on the continent: 1,716 cases, 98 deaths, 211 recoveries. Of those, the most are in Egypt (576 total cases, 36 deaths, 121 recoveries), but there is also a heavy impact in Algeria (454 cases, 29 deaths, 77 recoveries), Morocco (402 cases, 25 deaths, 12 recoveries), and Tunisia (278 cases, 8 deaths, 1 recovery). However, Libya has seen only 3 cases. The insecurity and chaos that led to a degree of isolation for Libya may have spared it from Covid-19. But we can't be so sure - it may also be linked to weaknesses in their tracking system. 

Local contaminations cause concern in Sub-Saharan Africa 

Most of the first reported cases in Africa were "imported" by visitors arriving from Europe. Since few days, several countries have been reporting cases of community transmission. From now on, it is almost impossible in some countries of Sub-Saharan Africa to accurately track transmissions. In Togo, for example, 28 official cases were reported on March 29, and 400 cases of contact with infected people. The hotel reserved for quarantine is already overwhelmed and the government recommends home quarantine. 

Moreover, the figures for Africa mask the magnitude of the threat posed by the pandemic. Few countries are equipped to test Covid-19 - the cases reported could only be the tip of the iceberg - and the numbers are constantly increasing. We are beginning to see the exponential character of the disease here in Africa. Many African governments are now acting with great determination. Senegal and Nigeria, in particular, are carrying out screening tests and following up on cases. Airports are either completely closed or closed to visitors from high-risk countries around the world. Public gatherings and funerals have been banned. Schools have been closed in several countries, social distancing is encouraged, the closure of certain cities has begun in Togo, and other countries are considering general confinement: South Africa (1170 cases), Botswana (no cases yet), Senegal (130 cases), Niger (10 cases), and Burkina-Faso (207 cases). 

The misfortune of countries run by corrupt governments and dependent on the rest of the world  

The poor countries of Africa are very dependent on the outside world. Trade with China in 2019 shows a figure of $208.7 billion. But the balance is to the advantage of China, which exports $113.2 billion in consumer goods to Africa while the African countries combined only export $95.5 billion worth of goods, mostly raw materials. How long will Africans be able to stay confined to their homes without rice, food and other basic necessities imported from China, Europe and the USA?  

Sub-Saharan Africa does not have the medical equipment necessary to withstand a serious health crisis like what we see in Asia, Italy and USA. Public investments intended for the health sector are low and are subject to constant diversion. Statistics estimate that there are only 7 hospital beds and 1 doctor per 10,000 people in Africa, where Italy has more than 34 beds and 40 doctors per 10,000 people. According to UNICEF, 1 child in Africa dies of pneumonia every 39 seconds. According to Australian pediatric consultant Hamish Graham, a large part of these deaths (800,000 children under the age of 5 in 2018) could be prevented by antibiotics and medical oxygen. The problem is that medical oxygen cylinders and breathing machines are rarely available. A coronavirus epidemic in Africa on the level of that in Europe would therefore be a huge disaster.

In February 2005, after ruling Togo for 38 years, then-President Gnassingbé Eyadema died during his evacuation on a medical flight to Israel for treatment. 15 years later, his son, the successor to the presidency, has no desire to improve the country's health infrastructure. No public infrastructure in Togo has a medical scanner. It's almost the same scenario across the continent. To make life easier for themselves, the rulers use public funds to relieve themselves in modern hospitals in Europe, Israel and the United States. 

Very few African countries have drawn up a clear and well-designed strategy for a plan to manage this Covid-19 pandemic crisis, be it on the social, health or economic levels. Some governments communicate poorly and act nonchalantly. There is a crisis of trust with their people, since corruption and bad governance are still realities. In Côte d'Ivoire, scandals of discrimination in who is made to comply with the quarantine protocol and who can move freely have led to a public outcry. By exerting their influence and power, some people have been exempted from the quarantine protocol at Abidjan airport as soon as the first precautionary measures were announced in the country.

With all these factors, if the virus hits Africa as badly as is feared, African communities and governments cannot alone avoid a worse humanitarian catastrophe.  

The need to coordinate efforts against a humanitarian disaster in Africa 

Globalization has been a determining factor in the rapid spread of Covid-19 across the planet. We are in a context where a Chinese makes a living in Paris, an American develops his business in Abidjan, a Lebanese manages his restaurant in Cotonou, Apple and Huawei find the raw materials of their technologies in DRC, the Beninese live on Thai rice etc . In this context, we cannot hope to contain Covid-19 in an individual way, even at the state level. A global coordinated effort can help Africa to avoid the worst.

UN Secretary General Antonio Guterres warns that Africa must prepare for millions of Covid-19 deaths. The slow reaction of African governments against the disease could justify these fears being expressed by the UN and WHO.  

The disease comes in a particularly difficult context where, many African countries are already languishing under the weight of heavy public debts and complicated access to international credit markets. Despite their faulty health infrastructure, countries like the DRC are unfortunately emerging from another health crisis: Ebola. There is a real need to help the continent by:  

  • Raising an emergency fund for Covid-19 in Africa. Money is the nerve of war. If China has quickly succeeded in mobilizing technology, human resources and all energies against the pandemic, it is partly thanks to the availability of financial resources.  The World Bank has approved an accelerated funding envelope that will help strengthen health systems. But the implementation of this aid is too slow, as are the emergency funds for Covid of the African Union and other announcements of goodwill. Without a way to make this funding immediate, it risks being a kind of doctor after death. 
     
  • Technical support for the implementation of emergent strategy, adapted to the reality of African needs and capacity. Until now, the preventive measures applied in Africa are based on classic protocols copied from the rest of the world. Social realities in Africa may require additional measures. Many Africans are not in the habit of going to the doctor at the first signs of illness. Even if Africa has a demography that has more children (apparently less likely to contract the disease) and fewer elderly people than elsewhere, experts do not exclude the possibility of mutation of the virus. What are the appropriate measures to manage this scenario? 
     
  • The need for protocol to protect against the embezzlement of funds intended for the fight against Covid-19. Africa needs cash to act quickly against Covid-19. Unfortunately, the opportunists of misfortune are legion in this continent. It is not poor for lack of potential but above all for the poverty of the minds of those who govern. There is no shortage of opportunities to plunder the continent's resources. In Togo, in the DRC, several political figures are implicated in scandals of embezzlement intended to fight crises like malaria and Ebola. For these unscrupulous people, Covid-19 could be a juicy way to fill their pockets at the expense of saving human lives. It would be sad to go into debt again in Africa, or to gather subsidies which will only serve to enrich the same people. Any donor should impose a transparency mechanism in the management of funds. 
     
  • Support and finance African scientific research and traditional medicine. African research gives hope with successful treatments and clinical trials on Apivirine developed by a scientist from Benin, Prof. Valentin Agon. This drug has already successfully treated dozens of Covid-19 patients of mixed origin: Africa and Europe. Apivirine is an antiretroviral with all international certifications. The governments and scientists of Burkina-Faso and Benin are currently coordinating efforts for extensive clinical trials. This initiative deserves all the necessary support and should be preserved from the clashes of interests between the big world pharmaceutical companies. There are several initiatives in Africa that can help address an effective response to this health crisis.
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