• AFRICA
• HEALTH
• COVID-19

Avoiding the nightmare

After the coronavirus shuts down Western economies, Africa’s governments face stark health and financial choices

Despite the lower numbers of people infected by the coronavirus in the region, Chikwe Ihekweazu, head of the Nigeria Centre for Disease Control, warns of the need for rapid action now. Huge effort must go into stopping transmission of the coronavirus, or Covid-19, before it picks up speed.

He draws a comparison with conditions in Italy, where the virus quickly outpaced measures to control it. Ihekweazu, who helped lead Nigeria's successful efforts to control the spread of Ebola in 2014 by running an effective contact-tracing system, was on a mission last month by the World Health Organisation to Wuhan to shape strategy elsewhere (AC Vol 56 No 13, 'Lack of focus' on Ebola). 

Liberian doctor James Moses Soka, together with researchers Julia Spencer and Peter Piot, call on countries to 'strengthen their core capacities to prevent, detect and respond to outbreaks'. Arkebe Oqubay, senior advisor to Ethiopia's Prime Minister Abiy Ahmed, warns the effects of the coronavirus in Africa could be 'catastrophic'. 

A big concern is the information gap. On available data, the rate of the spread of the virus in Africa is lagging well behind the rate in East Asia, the Middle East, Europe and North America. But many of the statistics are suspect.  

Although the Egyptian authorities have reported fewer than 200 cases, Isaac Bogoch, a specialist in infectious diseases working with local professionals, wrote in the peer-reviewed Lancet Infectious Diseases journal that the numbers could be around 6,000, perhaps three times that amount. Police in Cairo have arrested several people for disputing the official figures.

Other countries, such as Ghana, Kenya, Nigeria and South Africa have had a more open approach to information about the outbreak, quickly imposing pre-emptive restrictions on travel and mass gatherings. In many countries, schools, colleges, churches and mosques have been closed. Bars, restaurants and hotels are putting up their shutters and tourists from China, Europe and the United States are being barred.

Stretched
But the reality of life in the region's crowded cities complicates the imposition of a 'social distancing regime'. Public health systems are already stressed because of widespread cuts in public spending. That will stretch their capacity to test and provide quarantine facilities. 

At least 40 African countries now have testing facilities, a sharp increase from January when only South Africa and Senegal were so equipped. Yet there will have to be a boost to import testing kits. 

Nigeria, one of the better equipped countries, has 200 staff and five laboratories to run tests in a population of 200 million. That could be mitigated by the work of Nnaemeka Ndodo, a bioengineer who is developing a new test system to produce results within ten minutes at a cost of a dollar each. Working with Britain's Mologic and the Institut Pasteur research foundation, the new system could be on the market within three months and hugely boost the region's response. 

Like many other countries in the region, Nigeria battles with malaria and rampant yellow fever. It has just vaccinated hundreds of thousands of people in the Niger Delta against yellow fever. A fresh outbreak of lassa fever has killed over 130 people in the south-west and beyond. Ndodo has taken time from his work on other epidemics to focus on the new tests. 

Containing all that and keeping the coronavirus at bay will take a massive infusion of resources. If Italy with 41 doctors per 10,000 people is desperately over-stretched, African states – where the best case is an average of two doctors for 10,000 in the cities – face an epic struggle if Covid-19 takes hold. 

Lessons from the Ebola epidemic, such as the importance of community mobilisation and adapting measures to local conditions and cultural norms, are vital, says Arkebe. Countries will have to reorganise administrations, and do more than just put more people and money in health ministries. Governments will have to set up task forces to streamline decision-making and mobilise resources. 

Ethiopia, says Arkebe, set up a task force to organise facilities before any cases had been reported. Other countries are following suit. 

The WHO in Geneva, whose Ethiopian director-general Tedros Adhanom Ghebreyesus has become the face of the international system's response, can extrapolate from infection patterns in Asia and Europe although differing climatic and social conditions limit the value of those models (AC Vol 57 No 24, New faces, old tactics).

The UN's Economic Commission for Africa reckons the continent's average GDP growth rate will fall to 1.8% this year from 3.2%. That still looks optimistic. NKC African Economics expects South African exports to contract by 10% in 2020, compared to predictions in January of a 0.3% contraction. 

Unlike North America and Europe, few African countries can make tax concessions and sharp cuts in interest rates to prop up failing businesses. The South African Reserve Bank was expected to cut rates to a five-year low of 5.75%. Ghana cut its rates on 18 March. 

Currencies have also been hit – the South African rand and Zambian kwacha recording 5% and 3% losses against the dollar – which will deter governments from going to the bond market. Weaker currencies will raise the cost of servicing dollar debts, despite historically low interest rates. 

China's fortunes will dictate the severity of the economic hit. Although it is expected to avoid recession, China's growth rate is forecast to fall to 4.5% from 6%. That means far less demand for Africa's raw materials and commodities.  

The ECA reckons Nigeria could see a $19 billion hit, largely from falling oil revenues.

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