How did Africa defy the odds with fewer Covid-19 deaths?

When Covid-19 was declared a global pandemic in March 2020, the international community had dire predictions for Africa: the region’s underfunded and poorly equipped health facilities would crumble and millions of people could die.

The UN Economic Commission for Africa said in April 2020up to 3.3-million Africans could lose their lives as a direct result of Covid-19. Five years later, Africa’s recorded Covid-19 death toll stands at just over 175,500, 2.5% of the 7-million global death toll, according to the World Health Organisation (WHO).

“None of the early predictions were steeped in deep science or research about Africa,” said Oyewale Tomori, who chaired Nigeria’s advisory committee on the Covid-19 response.

“We forgot how African scientists dealt with anthrax in Kenya, Ebola in Nigeria, and Marburg and mpox in Rwanda. Though they got international support for Covid, the expertise in these countries is what controlled the outbreaks.”

There have been some concerns about the accuracy of caseloads and death tolls reported by African countries.

The WHO has said African countries conducted fewer tests than those in Europe and the US due to a lack of resources, while a 2022 World Bank study found Kenya underreported Covid-19 deaths.

However, experts said Africa fared better than expected and better than other continents as the grim forecasts failed to recognise Africa’s previous experiences with disease outbreaks, its strict Covid-19 lockdowns and youthful population.

By the time Covid-19 hit, African health experts had experience in border surveillance, contact tracing, social distancing, patient isolation and even in conducting safe funerals, Tomori said.

Mosoka Fallah, director of the Science and Innovation Directorate at the Africa Centres for Disease Control and Prevention (Africa CDC) said preparation and the ability to diagnose cases quickly were key to tackling the outbreak.

Before the region identified its first case in February 2020, Africa CDC had gathered all the region’s health ministers to develop a continent-wide strategy.

When they found only two labs in Africa could test for the virus, Fallah said they sent scientists to SA and Senegal for training instead of sending samples overseas.

“Those in the West were saying Africa did not have the skillset to do diagnostics and samples should be sent to Europe. But we refused and decided to build our capacity in testing,” Fallah said.

When flights stopped heading to Africa, it was difficult to get medical supplies manufactured abroad and the Africa CDC partnered with Ethiopian Airlines and the World Food Programme to move test kits and personal protective equipment (PPE) across the continent, he said.

They also sought assistance from the WHO, philanthropic organisations including the Jack Ma Foundation and a coalition of African business leaders to source and buy scarce vaccines and PPE.

Fallah said Ghana began producing its own PPE to address massive shortages in its clinics.

“It was Africans looking deep within themselves and the coordinated government approach that reversed the dark prediction that there will be so many dead bodies in the streets we would not be able to bury them,” Fallah said.

Moses Orinda, who was head of health programmes for Catholic Relief Services in Kenya during Covid-19, said there were also other factors at play.

“Many African countries had stricter containment measures compared to western nations; we also have larger youthful population, and good community outreach," added Orinda.

African countries imposed some of the world’s strictest lockdowns, controversially resorting at times to police brutality to keep people at home.”

In Kenya, where hundreds of people typically attend funerals, police were deployed to ensure numbers were restricted to up to 15 people and burial ceremonies took place quickly.

In SA, soldiers and police officers patrolled the streets and people’s houses to crack down on social gatherings, the drinking of alcohol and the sale of cigarettes, all of which could land an offender in prison.

Orinda said there was also good public awareness about the virus in rural areas, where villagers reported suspected cases to health authorities.

He said while surveillance at international airports was effective, more resources should have been deployed at a regional level to track and trace suspected cases.

Health experts also pointed to the fact that 70% of sub-Saharan Africa’s people are under the age of 30, meaning they were less susceptible to the virus.

Tomori, who is also a principal researcher on Covid-19 antibodies in Nigeria, said his research found while the virus was spreading, not as many people were getting sick.

He said this was because younger people had better immunity compared to older people.

As many as two-thirds of the African population was largely asymptomatic as studies revealed high levels of immunity despite a lower number of known cases, a study published in the National Library of Medicine paper found.

Though Africa did not succumb to the worst-case scenario during Covid-19, Fallah said African leaders had to do more to strengthen healthcare systems, specially in rural areas, to detect and handle disease outbreaks at the community level. He said this would prevent pockets of disease from developing into epidemics.

Fallah said: “We need to be able to build stronger, accessible primary healthcare centres that have drugs, water and diagnostics so our people can get treatment in their villages without burdening hospitals in cities."”

The Thomson Reuters Foundation is the charitable arm of Thomson Reuters.