Pandemic preparedness, demographics and climate have helped Africa limit the COVID-19 pandemic better than many of the more medically and technologically advanced regions around the world. But as winter has settled in, case counts have risen across the continent and concerns are growing over vaccine availability.
“The second wave is here,” John N. Nkengasong, the head of the Africa Centers for Disease Control and Prevention (Africa CDC), warned in mid-December.
Africa had slightly more than 2.8 million cases as of Jan. 3, according to the Africa CDC. In comparison, as of Dec. 29, there were more than 25 million cases in Europe and 34 million in the Americas.
Travel and tourism, along with the cooler winter weather, are potential contributors to the spike. African tourism has substantially decreased during the pandemic but travel policies vary within the region. Though borders remain closed in some countries, such as Algeria, others have allowed tourism with some restrictions, such as Botswana and Congo, including flights with COVID-testing protocols and mandatory quarantines.
South Africa in particular has seen its case numbers explode. On Dec. 27, the WHO reported that South Africa saw a weekly increase of 82,434 cases, by far the most of any African country.
The rising case counts increase concerns that Africa will be left vulnerable as richer countries snap up available vaccines.
On Jan. 3, Moderna disclosed that it would not be distributing its vaccine in South Africa, further raising concerns that a “vaccine apartheid” was emerging between more affluent Western countries and countries in the Global South.
“It will be extremely terrible to see” rich countries receiving vaccines while African countries go without, Africa CDC director John Nkengasong said recently, adding that Africa might not see vaccines until after the second quarter of 2021.
Nkengasong called it a “moral issue” and urged ethical and fair distribution to avoid “this North-South distrust in respect to vaccines, which is a common good.”
Preparedness and planning in developing vaccine introduction plans and creating the infrastructure to support mass vaccination will be critical when the vaccine rollout begins.
Matshidiso Moeti, the WHO Regional Director for Africa, said in a Nov. 26 press briefing that of the 40 African countries from which data on vaccine readiness was obtained, “so far, the average readiness score is 33 per cent, which is well below the desired benchmark of 80 per cent.”
However, she noted Africa’s experience in dealing with disease outbreaks in the past, saying, “Luckily, in many African countries, we are familiar with preparing to organize vaccination campaigns.” There are WHO representatives in all 47 countries of the WHO Africa region working with authorities, health agencies and communities in developing and implementing vaccine delivery strategies.
Moeti also touched on the rapid mobilization of vaccine pre-orders by wealthy countries. “We (the WHO) have promised Africa’s ministers of health to do all that we can to ensure countries in the region are not left behind in the race to deploy vaccines (…) There are also key logistical and financing gaps, where international solidarity will be imperative.”
In conjunction with Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and other partner organizations, the WHO is working to support equitable access to supplies through the COVAX Facility, a mechanism for pooled procurement and equitable distribution of COVID-19 vaccines that 64 higher income countries have joined. Once vaccines are licensed and approved, COVAX aims to allocate enough doses to be administered to an initial 20 per cent of the African population.
The continent’s exposure to past outbreaks, like the Ebola Virus Disease (EVD), and its experience in outbreak management may have primed its initial response to COVID-19. An article published in Developing World Bioethics noted that the EVD outbreak hastened public health responses to COVID-19 in sub-Saharan Africa and ultimately improved surveillance capacity.
The response to COVID-19, the article states, “…has been led by governments of the affected countries. External support has been limited to technical assistance from WHO and Africa Centre for Diseases Control, a regional entity that was absent during the 2014 EVD outbreak, gifts from philanthropists and in-country re-allocation of funds and technical support from partners.”
Some countries imposed rigid protocols before the pandemic even arrived to preventatively address the potential for spread. Lesotho imposed a strict, nation-wide lockdown prior to any cases of COVID-19 in the country. Following the earliest cases in Rwanda, the country closed its airport and imposed a lockdown. Within a matter of a few days, Rwanda shifted to an essentially cashless economy, providing incentives and waiving fees to promote cashless transactions.
One of the most well-recognized protective factors contributing to Africa’s low case counts and fatality rates is the continent’s relatively young population. Only about three per cent of Africans are over the age of 65, among the most susceptible groups to COVID-19 and its complications. Compare this to the Canadian demographic, in which 17.5 per cent of the population is older than 65.
The 20- to 40-year-old group has accounted for the majority of African COVID-19 cases. Younger individuals tend to be of overall better health and are more likely to fight off the virus.
In stark contrast to North America, old age homes are also uncommon, with older adults tending to live in rural settings. Furthermore, there is a tendency for people to move back to their rural roots once retired from work in urban centres. Rural life is more amenable to public health measures such as social distancing, helping contain the number of cases.
Perhaps surprisingly, however, it is Africa’s community health systems that have had the most success in tackling COVID-19. While Africa may be less financially advantaged in the healthcare sector, communities have shown resilience in adapting existing structures. A marked example of Africa’s adaptability is the pivoting of their polio prevention program to enable visits to villages and educate the public about COVID-19.
Community healthcare workers continue to provide essential services, including contact tracing, testing, education and dissemination of supplies. These workers are often the first and sometimes only source of health information. And research has proven the public’s acceptance of pandemic-led measures. A survey by the Partnership for Evidence-Based COVID-19 Response (PERC) in 18 African Union states showed that 85 per cent of respondents reported wearing a face mask in public in the previous seven days and approximately 60 per cent said they avoided religious gatherings.
Countries have also reacted to the rising case counts with local efforts. Rwanda, for example, has enhanced infection control measures in prisons after three outbreaks in the capital, Kigali, and the southern and eastern provinces.
Ultimately, the coming weeks will be pivotal for Africa’s COVID-19 response and for determining whether cases will stabilize or continue to rise.