In this opinion piece, Prof. Agnes Binagwaho, M.D., MPEd, Ph.D. — vice-chancellor of the University of Global Health Equity in Kigali, Rwanda — and her research associate Kedest Mathewos explain why African countries fared much better than their Western counterparts in the fight against COVID-19.
All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.
In 2019, the Global Health Security Index ranked countries according to their preparedness for pandemics. The United States was identified as the most prepared country, while most African countries were deemed to be least capable of dealing with any new health threat.
Further entrenching this perspective of Africa’s lack of preparedness, Africa as a continent was predicted to have 10 million COVID-19-related deaths.
In the past few months, scientists, global health professionals, and journalists have attempted to explain Africa’s unexpected response to the pandemic. However, these explanations often fail to recognize the reasons behind the prompt response of African countries to the pandemic.
Throughout the past 11 months, we have seen that borders do not prevent the spread of this crisis, be it in health or economic sectors. The pandemic, which originated in Wuhan, China, in December 2019, has now spread to more than 217 countries and territories to date. The economic crisis has not spared any country, with the global economy expected to shrink by 5.3% this year.
In order to provide a concerted response to this global pandemic, African countries leveraged continental and regional collaboration.
As early as February 4 — 10 days before the first case of COVID-19 was detected in Africa — the Africa Centres for Disease Control and Prevention (CDC) established the Africa Task Force for Novel Coronavirus to coordinate the response to the pandemic across the continent.
On February 22, Africa CDC convened an emergency meeting with all 55 ministers of health across the continent to discuss the COVID-19 pandemic and agree on a continent-wide strategy.
This strategy relied on preventing transmission and mitigating community spread to prevent overburdening the already stressed healthcare systems across the continent.
Such continental leadership has provided guidance to member states and ensured a concerted response to the pandemic.
This continental approach was coupled with collaboration at the regional level. A prime example is collaboration within the East African Community (EAC). Given that the prime focus of African countries was to prevent the spread of the virus, the EAC invested in the creation of a Regional Electronic Cargo and Drivers Tracking System to track COVID-19 cases across borders.
Some landlocked countries in this region, such as Rwanda, rely on cross-border travel of trucks to transport essential goods, such as medicine. Therefore, in order to prevent cross-border contamination, this system helps these countries to digitally share the COVID-19 test results of the truck drivers and consequently quarantine and treat those who had the infection.
This not only creates the channel for transparent information sharing but also maximizes the use of the scarce resources needed for testing asymptomatic essential workers who may have had the virus. It also permits us to bring them to treatment earlier, thereby increasing the chance of recovery.
Moreover, under this initiative, the mobile phones of the truck drivers are being used as tracking tools to trace all locations where the drivers made a stop, to ultimately protect communities. Such collaborative systems contribute to the common understanding of the state of the pandemic in the region and give countries a tool to efficiently stop the spread of the pandemic.
While many countries in the Western world failed to implement the known evidence-based interventions immediately, most African countries took this matter seriously to protect their populations.
Lockdowns and border closings were implemented very early after the first few cases were reported, to support the strategy of prevention. As early as March 15, various African countries closed their borders, canceled flights, and imposed strict lockdown measures to prevent the influx of cases.
South Africa implemented one of the strictest lockdowns worldwide on March 27, which contributed to the decrease of the rate of infections from 42 to 4%. We can also take the example of Rwanda, which implemented a lockdown on March 20 — only 6 days after the first case was detected — and banned all nonessential travel within the country.
What was key about Rwanda’s response was its ability to adapt quickly to changes in contextual factors and to arising situations — for instance, prolonging the lockdown in regions with high incidence rate, opening up those with lower case rates, and closing popular crowded markets and relocating the traders to smaller markets in less populous areas.
In addition to the implementation of lockdowns, most African countries quickly adopted other evidence-based prevention interventions, such as hand-washing, mask wearing, and social distancing.
In Rwanda, the government communicated prevention guidelines through social media channels and other traditional media sources, such as the radio, and leveraged community healthcare workers to raise public awareness about the virus and the prevention measures.
Hand-washing stations were provided at public places, and because of the closing of schools, student volunteers were used to encourage people to comply with these guidelines.
This open communication channel and involvement of communities further increased the community’s trust in the public health system — identified as the highest in the world by a Wellcome Trust study — and contributed to the public’s adherence to prevention and response guidelines.
However, simply enforcing the regulations is not sufficient to ensuing adherence. In Rwanda, the government took its theoretical understanding of the social determinants of health into practice.
In a country where the informal sector accounts for 64% of economic output, the lockdown resulted in the disruption of economic activity and hindered people from earning income to support their families.
Protecting economically vulnerable populations
The government used local leaders to identify vulnerable members of communities and provided them with food and financial relief. As of May 19, the government had provided this assistance to 20,000 vulnerable households.
It was also in this move of solidarity that top government leaders had forfeited their April salaries — a move that was rapidly followed by many Rwandans.
Moreover, testing, contact tracing, isolation, and quarantine services, as well as treatment, were all provided for free. We can also see similar examples in other African countries.
For instance, the Federal Housing Corporation in Ethiopia announced a 50% reduction in housing rent due to the COVID-19 pandemic. Some countries provided water and electricity for free to vulnerable citizens and granted tax holidays.
Such measures of support to the vulnerable are key to ensuring that those who cannot afford to adhere to prevention measures on their own have the ability to do so.
Lastly, many African countries adopted innovative technological tools to respond to the COVID-19 pandemic.
In Rwanda, the government used robots to take individuals’ temperature in public spaces and hospitals; drones for mass communication, surveillance, and medicine delivery; and pooled testing to maximize human and financial resources.
Furthermore, various countries are adopting cashless transactions to prevent unnecessary human contact during the exchange of cash.
The COVID-19 has hastened this process in West African countries, with major suppliers, such as MTN Ghana, MTN Nigeria, Vodafone Ghana, and Sonatel Senegal, reducing mobile money transaction fees, and so did MTN Rwanda. Such key innovations from the private sector are supporting the government’s response to the COVID-19 pandemic.
Various publications have provided several other explanations for African countries’ successful response to COVID-19.
Some were driven by a western supremacy mentality that purposefully undermines Africa’s successes using guesses allegedly based on the nature of the virus and the temperature in Africa, as if the climate on the continent was homogenous.
Too many of these claims do not have scientific backing but are rather based on correlations that we all know do not prove causation. Of course, we are not denying that there might be other factors, such as demographic makeup, geographical factors, preexisting antibodies, and others, that could contribute to this low number of cases and deaths. In fact, it is in the interest of all to study them.
However, attributing Africa’s success during the COVID-19 pandemic only to chance, and ignoring the swift and concerted response that many African countries adopted very early in the pandemic contributes to the cultivation of the negative perception of Africa — the expectation that we must fail in all scenarios.
Such arguments simply serve as a bridge between the past and present white supremacist narratives that movements such as Black Lives Matter and commemorative events, such as Black History Month, actively denounce.