Here’s some good news. African nations, who have benefited from America’s years of largesse in global public health are doing an impressive job of managing the coronavirus pandemic, using a disease response infrastructure enabled by U.S. foreign assistance and a play book that America taught. They are also proving to be determined and innovative.
But the fight has just begun, and the United States needs to double-down on helping some of the world’s poorest, because it is what we do – and have always done – as Americans. Moreover, it is in our own self-interest.
Across the African continent, pandemic interventions are being carried out on the platform that the United States helped build to track and treat HIV/AIDS, tuberculosis, malaria, Ebola and other infectious diseases, including more than $85 billion dollars towards the President’s Emergency Plan for AIDS Relief (PEPFAR) which is estimated to have saved 18 million lives.
As a result, there are laboratories, trained microbiologists, supply chain managers and a disease surveillance system operated by tens of thousands of community health workers along with an army of young people and civil society knitting together to support those in need.
Of course, outcomes will be uneven, because leadership is uneven. Mistakes will continue to be made, and disease hot spots will emerge regardless of best practices. But even so, a “shout-out” is merited for our African partners, who are determined to invalidate the worst of predictions.
In February, the philanthropist and Microsoft founder Bill Gates suggested that Africa could see up to 10 million deaths related to COVID-19, pointing to the fragility of healthcare systems and high levels of poverty concentrated in densely populated urban areas. His prediction was echoed by others, including the United Nations Economic Commission for Africa (UNECA).
Gates’ dire modeling felt like déjà vu from the 2014 Ebola epidemic, when experts predicted that Ebola fatalities could reach 1.4 million. In the end, Ebola killed 11,300 people, a devastating loss of life, but much diminished because Africans were not passive actors in determining their own fate.
Ugandan filmmaker Caleb Okereke suggests that such hyper projections risk stripping African countries of their agency and redirecting focus on providing charity rather than supporting existing and well-functioning responses. Okereke further adds that painting with a wide brush a whole continent of 54 countries is simply wrong. I couldn’t agree more.
Today, cases in Africa are climbing towards 100,000 with community spread across the continent’s anchor urban economies including Lagos, Accra, Nairobi, Johannesburg and Addis Ababa, with death tolls at 3,000. As such, Africa is nowhere close to being out of the woods, and there are countries that could face a devastating loss, but the feared exponential growth and the assault on healthcare systems has not arrived.
Some experts point to the continent’s comparative youth, with COVID-19 a disease that largely impacts the elderly. Others speculate that Africa’s climate of heat and humidity reduces the infection rate or point to the prevalence of other diseases like malaria and tuberculosis which could offer some type of immunity.
I would suggest we consider behavior, and the possibility that many African nations are doing better than their counterparts in Europe and the Americas because — like in Asia — they have a long experience in dealing with infectious diseases, and — not unique to the continent — must contend with fragile healthcare systems. These two truths, I believe, have driven the African response.
When the first COVID-19 in Sub-Saharan Africa was confirmed in Nigeria on Feb. 28, protocols from Ebola were reactivated across the continent, with thermal scanners and temperature checks at airports and forms required for entry into the country that list health status, previous places visited and the incoming flight seat assignment.
Upon arrival of the first cases in-country, most African nations enacted stringent policy responses including social distancing, closing borders and mandating nationwide lockdowns. Today, outside of air-cargo, air traffic across the continent remains shut down. This is tough medicine for some of the world’s poorest countries with nearly 90 percent of economic activity in the informal sector.
Quarantining is enforced in most African nations for all confirmed cases, with patients moved to government-designated COVID-19-only hospitals. This protocol is not without controversy, and has led to allegations of human rights abuses, but governments have not backed down — because of their fear of community spread with so many multigenerational households unable to social distance. And there are no exceptions to quarantines, just ask Liberia’s leading opposition leader and its Minister of Information.
African scientists are cultivating their own testing capacities, recognizing that in the global supply chain they cannot compete, nor outbid others. Senegal’s Institute Pasteur de Dakar has developed a COVID-19 testing kit that costs $1 and can deliver results in 10 minutes. In Ghana, a diagnostic start-up out of Ghana Tech Lab has advanced a rapid test that detects COVID-19 antibodies through support to scientists at the Kwame Nkrumah University of Science and Technology and Incas Diagnostics. Both tests are awaiting validation.
On therapeutics, several nations across West and Central Africa have chosen to administer the much-maligned two-drug therapy of hydroxychloroquine (an antimalarial) and Azithromycin (an antibiotic) first tested by Senegalese-born French microbiologist Didier Raoult. With limited medical interventions available, and few ventilators and ICU beds, African nations are sticking with Raoult, offering the drugs to all quarantined patients, symptomatic or asymptomatic.
Despite U.S. studies to the contrary, initial reports out of Senegal are encouraging. And so, the debate on President Trump’s favorite drug therapy plays out in Africa, as he himself has decided to take it as a prophylactic.
Finally, Africa has discovered the power of a collective voice, operating as a block during COVID-19, through the African Union (AU), the Africa Centers for Disease Control and UNECA. Today, the Africa CDC is at the forefront of trying to close Africa’s diagnostic deficit, insisting on access to test kits as some 70 countries have imposed export restrictions on medical equipment.
This month, the Trump administration began opening medical supply chains to Africa, with the White House announcing the shipping of ventilators to several nations. Meanwhile, the U.S. Congress is now considering another urgent supplemental spending bill, COVID-19 4.0, where it is hoped that up to $12 billion dollars will be made available for global COVID-19 response and recovery, including Africa.
It’s nearly impossible to get a bipartisan consensus on anything these days in Washington, but it seems to me that the White House has opened the door, and Congress should jump through it to address the health, economic and food security consequences of the pandemic on the continent.
If history is any guide — and current conduct portends future performance — it will be an investment that will pay huge dividends for Africa and for the American people.
K. Riva Levinson is president and CEO of KRL International LLC, a D.C.-based consultancy that works in the world’s emerging markets, award-winning author of “Choosing the Hero: My Improbable Journey and the Rise of Africa’s First Woman President” (Kiwai Media, June 2016). You can follow her @rivalevinson