Africa faces a potential human and economic catastrophe because of its particular vulnerabilities to the new coronavirus. In recent days, confirmed COVID-19 cases have surged to nearly 11,000 across the continent, although due to lack of testing, the exact total is suspected to be much higher. While some countries, lenders and organizations have stepped up to ease the economic burden of the pandemic, as a community physician with more than 30 years of experience in epidemiology, public health, social protection and international development, I am concerned that the pandemic will settle in Africa, especially amongst the poor and hard to reach. The impact could go well beyond containment of the virus to a total disruption of our economies with severe consequences on social protection, particularly for women and children. Interventions must be urgent and context-specific, with an initial focus on containment and then on recovery and sustainable investments in public health and social protection.
In sub-Saharan Africa, community health is already underfunded by an estimated $2 billion every year, according to the U.S. Agency for International Development. Ultimately, the real battles in every pandemic are fought at the local level where community health workers are often the first point of contact. This is especially true in Africa, where people tend to live close together in urban areas or several kilometers away from the nearest health facility in rural areas.
Equal access to personal protective equipment (PPE) is an immediate critical need. Lack of PPE was partly to blame for the deaths of more than 500 health care workers in Guinea, Liberia, Nigeria and Sierra Leone during the Ebola epidemic in West Africa. Dr. Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), called the lack of PPE an urgent threat that can only be solved with international cooperation and solidarity. “When health workers are at risk, we are all at risk,” he said during a March 27 press briefing. “Health workers in low- and middle-income countries deserve the same protection as those in the wealthiest countries.”
In early March, the WHO warned of severe and mounting disruption to the global supply of PPE caused by rising demand, panic buying, hoarding and misuse. As a result, supplies delivery is delayed and market manipulation is extensive, with stocks frequently sold to the highest bidder. Few African countries can compete in such a market.
It is also difficult for African countries to compete against more developed nations when it comes to health worker salaries. The U.S. Department of State appealed to foreign health care workers to apply for a U.S. visa on March 26. The United States has 25 doctors for every 10,000 people, compared to four in Nigeria, two in Kenya and one in the Democratic Republic of the Congo, according to the WHO. Now is when African countries need their health professionals the most, especially when we have already lost so many to more lucrative and stable jobs abroad and when we are likely to lose more to COVID-19 infection.
While we do not yet know exactly how the COVID-19 pandemic will play out in Africa, we have some indications. The continent’s population is relatively young, but many have weak immune systems associated with tuberculosis, HIV/AIDS, malaria, diarrheal diseases and malnutrition, as well as the evolving menace of noncommunicable diseases such as diabetes. Compounding these vulnerabilities are fragile primary health care systems that could easily become overwhelmed. During the Ebola epidemic in West Africa, more people died of malaria, tuberculosis, HIV/AIDS and maternal complications than those who succumbed to the disease itself because people either could not get care or feared seeking it.
While widespread testing, social distancing and hand washing help stem the spread of COVID-19, there is no one-size-fits-all solution. Many Africans lack access to running water, preventing them from frequent hand washing. Those who rely on daily pay for food security cannot practice social distancing for long periods.
Bloomberg Economics estimates that the pandemic will cost the world $2.7 trillion, but this figure does not take into account the projected losses in Africa due to unavailable data. Without international mobilization to address our public health and social protection needs, the continent faces a dire future — one that threatens to keep COVID-19 and other emerging viruses circulating throughout the world. The international community must ensure equal access to PPE, support health workers and mitigate the impact on the poor and vulnerable by providing a long-term COVID-19 rescue and recovery fund. The time for this solidarity is now. As we have all seen, every day — and every hour — counts.
Dr. Lola Dare is a community physician and president of the African-led social enterprise, Centre for Health Sciences Training, Research and Development (CHESTRAD) Global. CHESTRAD Global is part of the Primary Health Care Strategy Group, a global coalition of civil society health advocates convened by PAI.