As had been feared and expected, Africa was not spared from the “novel coronavirus” pandemic. The rapid spread of COVID-19 on the continent is a matter of grave concern. If the very first confirmed cases were linked to European clusters – the “patient zero” in sub-Saharan Africa was an Italian citizen traveling to Nigeria from Milan – what frightens now is the activation of local chains of transmission further worsening the prospects for a widespread diffusion of the virus and threatening to put a strain on African management and response capacities.
In this respect, the health systems’ fragilities, on a continent where the number of acute care beds are dramatically scarce – less than 1,000 in South Africa, one of the best health systems in Africa – are major sources of concern, looking at the prevention, diagnosis and control needs in emergency situations. Over the last weeks, efforts made by the African governments to enhance their capacity are encouraging, though. At the outbreak of the epidemic in the world, only two health centres, in Senegal and South Africa, were adequately equipped to conduct tests and diagnose cases of coronavirus: the continent’s capacity has been strengthened rapidly and the number of countries “ready” has been boosted to 43, thanks to the support of the World Health Organisation. According to Matshidiso Moeti, Regional Director for Africa, WHO’s main goal was to “prioritize strengthening the capacities for countries to investigate alerts, treat patients in isolation facilities and improve infection, ensure prevention and control in health facilities and in communities” to prevent the COVID-19 spread to Africa. To this aim, the Africa Center for Disease Control and Prevention (CDC) and the African Union established a continental task force – Africa Task Force for Novel Coronavirus (AFCOR) – led by Morocco, South Africa, Senegal, Nigeria and Kenya, to oversee the progress made in broadening African response capacity to the epidemic and provide the help and technical support needed to deal with possible clusters of infections. The initiative was based on five pillars: surveillance (screenings and controls on entry into countries); infection prevention and control in healthcare facilities; clinical management of persons with severe infection; laboratory diagnosis; risk communication and community engagement.
Africa under lockdown, too
“The best advice for Africa is to prepare for the worst and prepare today”. A few weeks ago, WHO general director, the Ethiopian Tedros Adhanom Ghebreyesus’s statement stressed that real numbers of positive cases could be much higher than official figures, warning African states against the risks of a worrying development in the spread of the pandemic on the continent. The adoption of restrictive measures by a growing number of governments reflected these concerns. The initial suspensions of flights to China – Ethiopian Airlines was one of the only airlines to keep providing regular connections to Chinese cities – has been followed by the adoption of restrictions and precautionary measures – from reinforced health checks to compulsory quarantines or bans on entry – for travellers coming from the most affected areas in the world, such as Italy. Ultimately, the growing number of cases on the continent persuaded the political authorities of African states to adopt lockdown regulations along the lines of the European measures. The Senegalese head of state, Macky Sall, was among the first to order the closing of schools and universities and the cancellation of the main religious events in the country, while in South Africa Cyril Ramaphosa declared a national state of disaster, announcing strict measures to contain the spread of COVID-19. Many other states have followed their example. Paul Kagame’s Rwanda, for instance, decided the total closure of the country, except for essential and emergency services.
The economic impact of the global health crisis
Sub-Saharan Africa is entering its third post-2000 economic stage. Besides the human costs, the coronavirus pandemic will mark an economic earthquake for the region as much as it is doing across the globe. For Africa, it comes at a particular time and opens a new chapter that must be understood in relation to those immediately preceding it.
Between 2000 and 2014, sub-Saharan economies had gone through a rather comprehensive period of surprising dynamism and impressive achievements. Sustained by renewed international interest in the region, growth rates, trade increases and foreign investments broke record after record, turning sub-Saharan Africa from a laggard to a high-growth area. Macroeconomic management and indicators also generally appeared sounder than had previously often been the case.
Yet this landscape changed in the five years between 2015 and 2019. Many countries, particularly oil producers, were badly affected by a widespread decline in international commodity prices. Others were better positioned to cope with or even benefit from the new circumstances, and kept piling up remarkable rates of economic expansion. Africa’s economic trajectories thus became more diverse, ranging from fast-growing economies to cases of low growth or stagnation. This was also a time when many state budgets began to suffer, with a rising number of nations swelling their debt burden.
The coronavirus will likely hit Africa hard. The effects of the economic shock will condition African states’ performances for years to come. If phase one (2000-2014) was a stage of economic ascent, phase two (2015-2019) was a moderation and mixed scenario, phase three is bound to be a socially disrupting and economically halting time, beginning in 2020 with an unpredictable duration.
In March, the UN Economic Commission for Africa estimated a loss of Africa’s GDP growth for 2020 from 3.2% to 1.8%, due to the disruption of global supply chains, demand shocks (in sectors as energy, tourism, remittances), the slowdown in investment flows and the loss of jobs, supply side shortages and inflation pressures. In a more recent analysis of the state of sub-Saharan economies, the World Bank foresees the first recession for the region in 25 years, with growth expected to slow down to -5.1% and output losses between 37 billion and 79 billion dollars for 2020. The deteriorating fiscal position will likely lead to unsustainable debt growth and welfare losses, with destabilising effects. According to ECA, the demand shocks and the decline in commodities prices could cause losses for almost 65 billion dollars for oil-exporting countries in Africa: from 2016 to 2018, fuels accounted for 7.4% of Africa’s GDP, with almost 166 billion dollars of yearly export revenues. The impact of the COVID-19 pandemic on the fuels sector could lead to export revenues falling to 101 billion dollars. The most affected countries would be Angola, in which oil accounts for 89% of total export, with a share of 30% of GDP; Nigeria, where a COVID-19 crisis could reduce total exports of crude oil by between 14 billion and 19 billion dollars compared to predicted export for 2020; South Africa, which despite better production diversity exports 9 billion dollars worth of fuels.
The effects of the production shutdown and the decline in Chinese demand pose a severe threat to sub-Saharan economies. Particularly, some figures show how deep China-Africa connections are: there are at least 200,000 Chinese workers in Africa, and almost 80,000 African students in China, 5,000 in the Hubei province. China isAfrica’slargest commercial partner: the trade volume in 2018 was 204 billion dollars. Sixty-four percent of African exports to China (99 billion dollars) concern fuels and mining resources. The main supply markets on the continent are South Africa (gold, diamonds, manganese) and Angola (oil exports filled 10% of Chinese needs in 2018), jointly accounting for 53% of Chinese imports from Africa, followed by Congo (oil), Democratic Republic of Congo (cobalt ores), Zambia (copper). Imports from Africa grew 38% between 2017 and 2018. Moreover, in 2017 Chinese direct investments stocks in Africa were worth about 43 billion dollars: still behind France, Netherlands, United States and the United Kingdom, but constantly growing from 2013. In the infrastructure sector, China has established itself as the main state investor in Africa, with an 11.5 billion dollar average of funds invested yearly between 2012 and 2016, 15% of the total infrastructure investments, mostly in East Africa to support Xi jinping’s Belt and Road Initiative (BRI). Some examples of strategic infrastructures financed by China in the region are the Addis Ababa-Djibouti railway, connecting the Ethiopian capital to Djibouti, on the Red Sea, and the Nairobi-Mombasa railway in Kenya. Lastly, McKinsey’s findings suggest that more than 10,000 Chinese-owned firms operate in Africa, across many sectors: a third involved in manufacturing activities, a quarter in services and a fifth each in trade and construction. According to an Overseas Development Institute (ODI) report, Kenya will likely be the African country most vulnerable to the effects of the pandemic on China’s economy, as it is one of the most exposed to China in terms of trade connections, investments and airline services, and one of the least well placed to address the impact of the crisis over the next months.
Beyond economic and financial risk factors, two further elements should be taken into consideration concerning the coronavirus spread in sub-Saharan Africa. First, the fact that the disease is particularly prevalent and severe in older people, while the case-fatality rates are nearly irrelevant for young people and children. On a continent where the median age of the population is under 20, the impact of the pandemic could be after all be lower than elsewhere. It is understood, however, that pressures on fragile health systems, characterized by the lowest physicians’ density in the world – 1 doctor per 5,000 inhabitants on average –, an average health expenditure of about 5% of GDP and several comorbidities weakening immune systems, could prove unsustainable. Second, some sort of resilience related to the diffusion of endemic diseases such as malaria, dengue, Lassa fever, and the incidence of severe epidemics territorially circumscribed such as Ebola, that affected West Africa (Liberia, Sierra Leone and Guinea) in 2013-2014 and north-eastern Democratic Republic of Congo more recently, with lethality rates around 50%. The experience in management of serious health emergencies throughout the continent could provide African states with an essential asset in terms of expertise in control and response to the emergency: in this respect, the response capacity should be built on existing structures, while communities should be engaged to stop the spread of the disease and adapt containment measures to local conditions and cultural specificities.