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Africa’s Race Against COVID-19

With governments in Europe and the US fighting desperate national battles of their own against COVID-19, the continent may seem a remote concern. But if there is one thing the pandemic has taught us, it is that we are all connected in a world of shared risks.

LONDON – There are now worrying signs that the COVID-19 virus has taken root in Sub-Saharan Africa, the world’s poorest region. The window of opportunity to prevent a humanitarian catastrophe is still ajar, but keeping it open will take decisive national action and international cooperation.

Until recently, the low number of reported cases in Africa was fueling complacency. Perhaps higher temperature was limiting COVID-19 transmission rates. In a region with more children (who are less susceptible) and fewer elderly people than elsewhere, some experts conjectured that demography was offering some protection as well.

But the time for complacency is over. The Director General of the World Health Organization, Tedros Adhanom Ghebreyesus, former health minister of Ethiopia, has urged Africa to wake up to the COVID-19 threat. Governments and aid donors are now preparing for the worst, belatedly responding to a coronavirus trajectory bearing the hallmarks of Europe’s experience: a small initial caseload that then grows exponentially.

Sub-Saharan Africa currently has 1,305 confirmed cases of the COVID-19 coronavirus – less than 1% of the world total. Just 11 countries have more than 20 confirmed cases. Europe alone reported over 4,000 new cases in the 24 hours before I wrote this commentary.

But these headline figures obscure the scale of the pandemic threat. With few countries equipped to test for COVID-19, reported cases may represent the tip of an iceberg – and the numbers are growing fast. While most early cases were “imported” by visitors arriving from Europe, several countries – including South Africa, Senegal, Kenya, Liberia and the Democratic Republic of Congo – are now reporting community transmission.

Many African governments are now acting with greater resolve than some European governments. Countries like Senegal and Nigeria are testing and tracking cases. Airports are being closed either fully, or to visitors from countries with high numbers of reported cases. Public gatherings and funerals have been prohibited in Ghana. Schools have been closed in several countries. Social distancing is being encouraged.

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But Africa’s governments and communities cannot contain this pandemic alone. Even with multi-billion-dollar cash injections, some of the world’s strongest health systems are buckling under the coronavirus strain. With roughly one-third of hospitalized patients requiring intensive care, COVID-19 is overwhelming hospitals, health workers, and medical infrastructure, especially supplies of personal protective equipment and medical oxygen. Witness the crisis in Italy’s Lombardy region and the United Kingdom’s National Health Service.

If prevention and containment fail and COVID-19 spreads, Africa’s health systems will be unable to withstand the burden. Chronic underinvestment and a deficit of more than three million health workers has left countries unable to meet even the most basic health-care needs, let alone respond to COVID-19.

No region is further from universal health coverage. Half the population has no access to modern health services. Public health spending averages just $16 per person – far short of the $86 per person needed to finance basic health provision. There are just seven hospital beds and one doctor for every 10,000 people (Italy has over 34 beds and 40 doctors).

Consider medical oxygen, a vital part of the treatment regime for COVID-19 patients suffering from the acute respiratory distress accompanying viral pneumonia. It is sometimes forgotten that Africa already has a pneumonia epidemic that kills over 400,000 children each year. As the Australian pediatric consultant Hamish Graham has shown, many of these deaths could be averted through antibiotics and medical oxygen. The problem is that medical oxygen is seldom available.

While health systems are on the front line of the fight against COVID-19, the pandemic poses far wider threats. Weak demand in China has already hit commodity prices. Recession in Europe and falling oil prices will hurt the region’s major economies. African growth forecasts are being revised downward, with potentially devastating consequences for poverty.

Millions of children’s education will be disrupted as schools close. The most disadvantaged could be forced by poverty into labor markets or, in the case of adolescent girls, early marriage.

In contrast to the situation in 2008, public debt and limited access to international credit markets constrain governments’ ability to increase spending on safety nets, health, and economic infrastructure. That backdrop, added to the sheer scale of the coronavirus threat, makes international cooperation more critical than ever.

Unfortunately, responses to date have been half-hearted. To its credit, the World Bank has put in place a package of fast-track financing that will help strengthen health systems. But the money is flowing too slowly. It is now urgent that the Bank’s finance is converted into public-health preparedness for the diagnosis, treatment, and containment of COVID-19.

Real preparedness will require ruthless prioritization. Apart from early promotion of social distancing, countries in East Asia that have contained the pandemic more successfully have used large-scale testing to isolate carriers, trace contacts, and break chains of transmission. Africa must follow that example. Without more testing, an outbreak could go undetected until it’s too late. That’s why the effort by the United Kingdom’s Department for International Development and the government of Senegal to develop a rapid diagnostic test is so important.

The next few weeks are critical. Working with African health ministries, the WHO is well placed to support the development of front-line plans for COVID-19 containment, including the finances needed for testing and diagnostic equipment, medical supplies, and protective clothing. There is a ready-made vehicle for supporting these plans. Yet donors have still failed to fund fully the WHO’s $675 million emergency appeal launched in January.

Fiscal support is the second line of defense. Africa urgently needs commitments from the International Monetary Fund to inject liquidity. Current emergency credit lines – around $10 billion for all low-income countries – are just too small. Apart from providing a fiscal helicopter, both the IMF and the World Bank should be working together to support the health, education, and safety-net investment that will be so critical to recovery.

Africa may seem a remote concern for policymakers in the rich world. But if there is one thing coronavirus has taught us, it is that pandemic viral threats don’t respect borders. This is not a disease that can be beaten in our own backyards. It must be beaten globally, or it will not be beaten at all. And now we must beat it in Africa.

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