If the coronavirus gains a solid foothold, Africa could quickly replace Europe as the new center of the pandemic. Many African countries lack the infrastructure and personnel needed to fight a deadly outbreak. Warning of “critical gaps in readiness,” the WHO has assured the African Union that it will do its part. It has already ramped up monitoring and evaluation on the continent, but that’s only a first step. The WHO’s regional director for Africa recently warned that covid-19 has “cast a spotlight on the shortcomings in health systems in the African region.”
Despite the recent increase in cases, the actual situation in Africa is probably worse. So far, the number of reported infections in Africa is still low compared with Europe and China. And the situation could change swiftly. Relative to Europe, Africa’s air traffic is quite low, but with large numbers of Chinese workers still traveling between Africa and China — and internal transmission likely in several countries — the risk of spread is substantial. According to a study in the Lancet, Egypt, Algeria and South Africa face the highest risk of importation from China. But the two most populous countries in Africa — Nigeria and Ethiopia — also have a high risk of importation. Africa, of course, is also threatened by importation from Europe. John Nkengasong, director of the Africa Centers for Disease Control and Prevention, warns that early detection and containment are crucial. The WHO reports that only eight countries on the continent are prepared to deal with a major outbreak.
Experts hope that covid-19, like some earlier coronavirus outbreaks, will abate when the weather turns warm and humid, but some of the most populous and vulnerable countries in Africa — notably Ethiopia, Kenya and South Africa — have relatively temperate climates. It is also possible that Africa’s youthful age structure will makes it less vulnerable to an outbreak, but the toll on Africa’s elderly population could still be extremely high.
And even if Africa escapes the worst, the continent could remain vulnerable to pandemics for decades to come. The United Nations projects that sub-Saharan Africa’s population will nearly double by 2050. Africa’s urban population will soar from 548 million in 2018 to 1.49 billion by 2050. Its urban slums, where pathogens can spread swiftly, are among the fastest growing in the world. Chronically underfunded public health systems in Africa are battling a host of health threats, including HIV-AIDS, periodic outbreaks of Ebola and measles and more chronic threats such as malaria and tuberculosis.
In the battle against global contagions, sub-Saharan Africa could prove to be the weak link. Protracted conflicts, escalating terrorism and a rising tide of refugees and displaced people compound the challenge. The Africa Center for Strategic Studies reports that the continent now has more than 25 million forcibly displaced people. That’s a nearly fivefold increase since 2005.
Improving health systems in Africa should be a global priority. What happens in Africa — like what happened in Wuhan, China — will have global implications. African governments must do their part. Corruption, poor governance and a lack of trust in public institutions make containment and prevention difficult. But African governments, particularly those fighting major terrorism threats, require international assistance.
The United States, in particular, should ramp up its support, but the Trump administration has largely shunned Africa up to now. Despite an upsurge of terrorism in the African Sahel, the Defense Department reportedly wants to withdraw some of the 6,000 U.S. military personnel stationed on the continent. The president’s fiscal 2021 budget proposed drastic cutbacks in foreign assistance, including a $3 billion cut in global health funds, much of which would be spent in Africa. The Trump administration even proposed major cuts for the two agencies — the WHO and the U.S. Centers for Disease Control and Prevention — that can help stem the spread of covid-19 in Africa.
The stakes are high for Africa. In making his national disaster declaration, South African President Cyril Ramaphosa said, “Never before in the history of our democracy have we been confronted by such a severe situation.” But the stakes are also high for the world. If the coronavirus isn’t contained there, Africa could be the source of future outbreaks, and any hope that this pandemic will be eradicated anytime soon will likely fade. As demonstrated by earlier outbreaks of HIV/AIDS, Zika and Ebola, what happens in Africa can have a global impact. By strengthening Africa’s health-care systems, we can mitigate the impact of this pandemic, and help ward off future pandemics as well.
This op-ed by Population Institute Senior Fellow Phillip Carter III originally ran on March 18, 2020 in the Washington Post