At the beginning of the COVID-19 pandemic it was hoped that the climate of places such as Sub-Saharan Africa and India would be too warm for the virus to thrive, let alone spread, but unfortunately we now know that is not the case.
The total number of confirmed cases of COVID-19 across the African continent is now 5,031,845 with 134,068 reported deaths. These are highly likely to be gross underestimates of the true figures. (1)
Provisional figures from the WHO (World Health Organisation) are predicting up to 10 million cases and 300,000 deaths across the continent although it should be emphasised that these numbers are based on data modelling based on the outbreak in Europe. This, combined with the poor availability of testing in much of Africa, means figures should be treated with caution. (2)
South Africa is the African nation with the highest number of confirmed cases, currently at 1,772,086 with 57,410 deaths. (3)
However, their higher figures may reflect the fact they are better equipped both to identify and test for COVID-19 than many of the other African nations.
Tanzania has still not submitted any data since 29 April 2020 and it seems unlikely any more will be forthcoming despite the death of the president, who had declared the pandemic over citing a miraculous healing from God. Whilst his official cause of death was announced as heart failure there has been widespread speculation that he died from COVID-19. (4) (5)
Factors that Increase Africa’s Vulnerability
Population Demographics
Within Africa’s cities, nearly two thirds of the population live in overcrowded conditions and slums. These provide ideal conditions for the virus to thrive.
A third of the continent’s entire population do not have access to clean water supplies or adequate sanitation.
Average life expectancy is lower, and the infant mortality rate higher, in Africa compared with Europe.
Of the world's 25 poorest countries, 22 are in Africa. (6)
Provision of Healthcare
The African continent as a whole lacks critical care beds and ventilators.
The WHO estimates that there are five intensive care beds per one million people in most African countries. In Europe the average is 4000 beds per million people. Somalia has just four intensive care beds in the capital's only hospital and no ventilators.
Africa has suffered the most in the global competition for badly needed medical equipment but its 54 countries have teamed up to bulk buy items at less prohibitive costs. Whilst some shipments of equipment such as ventilators have arrived, many places continue to have only rudimentary resources.
Background Population Health
Unlike Europe diseases such as malaria, HIV, tuberculosis and polio are prevalent in Africa. There is an ongoing major measles outbreak in many countries with the Democratic Republic of Congo (DRC), Angola, Cameroon, Chad, Nigeria, South Sudan and Sudan particularly affected. Ebola virus disease continues to be problematic in the DRC as new cases continue to emerge. (7) (8)
The prevalence of these diseases causes a two-fold problem. They put the already fragile heath care structures under repeated strain and increase the vulnerability of those already infected with one disease to a new pathogen such as coronavirus.
The one exception is South Africa which already has an extensive programme for monitoring both HIV infection and tuberculosis in cities and remote communities. It has been able to draw on this wealth of experience and quickly mount a similar response to COVID-19.
Political Instability
Against the background of the pandemic, militia groups sympathetic to IS (Islamic State) have been increasing their activities in Somalia, DRC and Mozambique. Ambushings, kidnappings and killings have been on the rise after a period of dormancy.
Concerns are growing that attacks will be extended to neighbouring countries including Uganda, Tanzania and Kenya. IS fighters from Iraq and Syria are being recruited, particularly into the Somalian groups. The extremist group al-Shabaab controls much of Somalia’s rural areas and it is highly unlikely any kind of healthcare will reach the people outside of the capital Mogadishu. (9)
Natural Disasters
An ongoing outbreak of desert locusts is threatening food supplies across East Africa, the Arabian Peninsula and the Indian subcontinent. The outbreak began in June 2019 and continues to cause devastation. Kenya is reporting it as the worst they have had in 70 years.
Swarms the size of approximately 300 football pitches can, in one day, eat the same amount of food as 35,000 people. Locust swarms can cover 90 miles in a day. (10)
A Third Wave in Africa
The WHO has expressed concern over rapidly increasing numbers of COVID-19 infections in many African countries. (11)
South Africa is reporting a sustained increase in cases and Uganda’s cases are increasing each week by more than 130% compared with the previous week. (12) (13)
Matshidiso Moeti, the WHO Regional Director for Africa, has warned that: "It's crucial that we swiftly get vaccines into the arms of Africans at high risk of falling seriously ill and dying of COVID-19." (14)
The third wave may be partially attributable to new coronavirus variants that are both more transmissible and more difficult to identify.
The Delta variant (previously known as the India variant) has been found in at least a dozen countries in Africa.
The Beta variant (originally called the South African variant) is causing high case numbers across southern Africa and has been identified in 20 other African countries.
29 African countries have identified the Alpha variant (previously known as the UK variant.) (15)
In terms of COVID-19 deaths Nigeria and South Africa are reporting significant increases in their numbers.
The Africa Centres for Disease Control monitors 55 countries and reports that 21 of them now have above the global average death rates from COVID-19. (16)
There is widespread variation in how countries record their deaths fuelling concerns that death numbers are likely to be far higher.
Vaccination
The supply of COVID-19 vaccines to Africa has “ground to a halt” according to WHO health officials. (17)
Only 50m doses of vaccines have reached Africa so far for a population across the continent of more than a billion.
Although an initial 600 million doses had been promised to Africa by COVAX (a WHO-backed international agreement whereby richer countries have pledged funding to help low income countries buy the vaccine) the reality is that only a tiny amount has been delivered through the scheme. Supplies of the AZ (AstraZeneca) vaccine were to be manufactured and sent by the Serum Institute of India but, in the face of its own horrific second wave of COVID-19, the Indian government has placed an export ban on all vaccines produced in the country.
COVAX has also found itself competing with rich countries who have been striking their own deals with vaccine manufacturers and using up supplies. (18)
The African Union has struck a deal with Johnson & Johnson for 400 million doses of its single-shot vaccine but the first shipments are not expected until the autumn of 2021. (19)
It is not just supply of vaccine that is impeding the rollout of jabs. Only half of the doses shipped to the continent have been administered so far. (17)
Vaccine hesitancy, fuelled in part by political and media scare-mongering over vaccines, most notably Astra-Zeneca’s, means that supplies that reached some African nations were not used in time.
Malawi destroyed 20,000 doses of the AZ vaccine which had not been administered by their use-by dates. South Sudan destroyed 59,000 doses and handed a further 72,000 back to COVAX. (20)
South Africa Analysis
Although South Africa appears to be the worst hit country on the continent this probably reflects a lack of testing capacity in other countries which is keeping their figures artificially low.
South Africa reported its first case on 5 March 2020 in a man who had returned from Italy. A National State of Disaster was declared on 15 March 2020 which was followed by a nationwide strict lockdown on 26 March 2020. (21)
It is now entering a distinct third wave of infections after two previous ones which peaked in July 2020 and January 2021. (22)
South Africa has benefited from the fact it already had community programmes in place to trace and screen for diseases such as TB and HIV which allowed it to rapidly adapt to COVID-19.
MSF (Médecins Sans Frontières) started combining TB and HIV checks with COVID-19 screening at some of its locations in South Africa. Until now South Africa's TB and HIV programmes have been stand-alone projects but it is hoped that COVID-19 will lead to the integration of the programmes and an increase in resources to run them. (23)
South Africa has a risk-based, five-level approach to lockdown restrictions. Level one restrictions, the lowest level, are currently in place across the country. (24)
The vaccine rollout in the country has been hampered by problems. Initial plans to use the AZ vaccine were cancelled after unfounded fears it would not work against new variants and instead South Africa sold its doses to other African countries.
It then began using the Johnson & Johnson vaccine on 17 February 2021 but then put the programme on-hold over fears the vaccine was linked to blood clots. Vaccination with this vaccine began again in late April 2021.
In late May it began vaccinating with the Pfizer vaccine, the arrival of which had been delayed. At the time of writing just 2.3% of the population have received their first vaccine dose and only 0.8% are fully vaccinated. (25)
The programme is also being hampered by the fact that appointments can only be made online or via mobile phone and many do not have access to either. More than 10% of adults do not possess a mobile phone in South Africa.
The campaign is only being run in English, a language that is only one of the country’s 11 official languages.
Less than half of the country’s over-60s had been able to register to receive the vaccine by 5 June 2021. (26)
Democratic Republic of Congo Analysis
DRC is seeing an exponential rise in COVID-19 cases with the capital Kinshasa the most severely affected.
The United Nation’s health agency has warned the country’s third wave is being fuelled by both the Delta (Indian) and Beta (South African) variants and could be deadlier than either of the previous two waves.
Prof Jean-Marie Kayembe, a member of DRC’s anti-coronavirus taskforce, has warned that the country is the grip of its third wave and that its hospitals and healthcare centres are overwhelmed.
Many of the cases in the capital have been in the comparatively wealthy district of Gombe probably linked to travel.
32 government legislators and aides have died from COVID-19. (27)
Like South Africa, DRC returned 1.3 million doses of the AZ vaccine after determining it would not be able to administer them before they expired in June. DRC had received 1.7 million doses through COVAX but suspended its use following reports about blood clots.
Vaccine hesitancy is high in DRC with less than 60% of the population saying they would be willing to receive a COVID-19 vaccine. By contrast in Ethiopia 94% want to receive the vaccine. (28)
Breaking News: US and UK to Donate Vaccines
On 10 June 2021 U.S. President Joe Biden announced that the US would be donating 500 million doses of the Pfizer vaccine to the world’s lowest income countries.
He promised that: "The United States is providing these half billion doses with no strings attached. Our vaccine donations don't include pressure for favours, or potential concessions. We're doing this to save lives." (29)
UK Prime Minister Boris Johnson has announced that the UK will donate 100 million vaccine doses with at least 30 million sent by the end of 2021. (30)
The G7 countries (USA, UK, Canada, Japan, Germany, France and Italy) are currently meeting in the UK and have announced they want to vaccinate the world by the end of 2022.
It is hoped that they will announce a commitment to provide at least one billion COVID-19 vaccine doses to the rest of the world through a combination of dose sharing and financing vaccine manufacture. (31)
Whilst the wealthier nations roll out their vaccination campaigns - campaigns that will provide a way out of their lockdowns and restrictions - much of the world can only watch. The poor handling of the concerns around the AZ vaccine by both the world's press and many politicians across the globe left several African nations unable to use what precious supplies of the vaccine they had. Unlike the wealthier nations, they do not have the "luxury" of using a different vaccine instead. Whilst the US and UK pledges of vaccines donations are a definite step in the right direction they are just that - a step on what is a very long road to travel before we truly see the whole world vaccinated and everyone safe.
(8) https://www.msf.org/drc-ebola-outbreak-crisis-update
