A year ago, Africa trembled with fear. Apocalyptic predictions emanating from the most prestigious research centers and official health organizations alerted a kind of pandemic holocaust to come. “The Covid-19 pandemic is going to leave millions of deaths in the streets of African cities.” This was the evil omen, the leaf of the scythe, which was about to make a poorly endowed continent face this sorrow. However, they were wrong. The Covid-19 arrived, yes, and some countries such as South Africa, Egypt or Morocco were hit with intensity, but in general it was not the hecatomb that was announced.

First, the figures. With about four million cases in a year and something over 100,000 deaths, Africa represents 3.3% of global contagion and 3.8% of the deceased, figures well below the proportional weight of the continent’s population in the globe. The experts agree that these numbers are not real and that the underdiagnosis, more accentuated than in other continents, hides a greater circulation of the virus. In fact, initial studies of seroprevalence in countries such as Kenya, Mozambique, Nigeria or Senegal point towards much greater contagion rates.

This means that the virus managed to circumvent the rapid reaction of the closure of borders and sanitary controls from African countries and circulated more than it might seem. However, this did not generate an explosion of respiratory infections or an increase in mortality of unknown origin that points in the direction of the new Coronavirus. With some exceptions, such as – South Africa or the Maghreb, COVID-19 has not represented a greater threat than many of the diseases and epidemics facing Africa each year, such as malaria, HIV, measles or children’s diarrhea.

No consensus

Scientists still disagree on a single theory that explains the reasons for this anomaly: crossed immunities from increased population exposure to other coronaviruses, cousins of the SARS-CoV-2, more active immune systems from parasitic infections, greater youth of the African population, the weather linked to a greater life outside the houses, or even genetics. All these explanations have been put on the table, none are conclusive, and all could be a part of the solution of the enigma.

Previous experience in all types of epidemics allowed the continent to show a greater reaction when compared to other regions. The public health machinery was greased. In the words of Dr. Chibuzo Okonta, president of Doctors Without Borders in West Africa, “Our health systems, often described as fragile, could paradoxically be more resilient in managing a shock like this. Most of our health professionals have practiced the art of healing endemic diseases in settings with limited resources. This has made them develop reflexes unknown in other places.”

Due to the lower connectivity of the continent and the rapid closure of borders, the virus entered Africa later than other continents, providing a critical time for different governments, in coordination with the WHO and the African Centers for Disease Control (CDC), to get ready. Except for notable exceptions, such as the denialist Tanzania – its president, John Magufuli, who died on March 17 of heart problems, according to the country’s vice president – practically all countries adopted drastic measures, which went from partial confinement to curfews, through limits on mobility, and the suspension of all school activities, markets and even religious ceremonies.

Economy and health

This was the first big debate. How to manage the impact on daily economic activity? The income of many households depends on the informal sector, that of daily trading. Limiting people from exiting their homes implied cutting off the main livelihood of the population. Aware of this, the countries modulated their response based on their profile. Those with more authoritarian regimes had no problem displaying their coercive muscle, while the more democratic systems wavered and offered greater flexibility. In general, the confinements were loosened earlier than in the rest of the world due to this African peculiarity.

However, by mid-summer, the virus had already found its way into every corner of the continent and – as Africa had been increasing its diagnostic capacity – the numbers began to grow. At the end of July, the pandemic reached its first peak in the continent and the shadow of the dark omens grew thicker and darker than ever. New error. The intensity of the pandemic declined again in the autumn as Europe fully entered its second wave.

African public health systems, the weakest in the world, were subjected to enormous stress due to the indirect impact of COVID-19. Those who have suffered the most and continue to suffer are the most vulnerable, notably those displaced by conflict, refugees and children. The loss of family income and mobility problems, as well as the closure of schools, represent a serious risk of an increase in child malnutrition in 2021 – as warned by the WHO, the World Food Program, Unicef and the Agency of the United Nations for Food last July, while the suspension of vaccination campaigns raises fears of outbreaks of other diseases. The efforts of the governments to respond to the pandemic meant diverting resources and personnel, which weakened other essential health services.

Similarly, the economic shock has been tremendous. In fact, Africa is experiencing its first recession in 25 years, according to a report by the United Nations Economic Commission for Africa (UNECA) which estimates production losses at $99 billion dollars. The slowdown in the world’s economic activity caused a drop in demand for raw materials, especially oil, and a consequent drop in prices on international markets. Since Africa is highly dependent on these exports, the bump started there.

Despite the good growth rate of the last two decades, most governments have a limited capacity for budgetary response, in many cases due to the fact that they allocate up to half of their income to pay the external debt that has built this growth. A perfect vicious circle that prevented a greater support from the State to the most vulnerable populations that began to denounce the coup.

South African variant and vaccines

But the virus still held some surprises. The appearance of new variants, one of them baptized with the name of “South African” due to its discovery in this country, caught Africa in the middle of the second wave that, once again, occurred late compared to the rest of the world and reached its zenith in January this year. By then, the world was already in the beginning of the largest vaccination campaign in history, and the first signs that the poorest continent was going to suffer the consequences of its low importance in the concert of nations was already a reality.

At the end of December 2020, the first vaccinations occurred in the United States and some European countries, which in January were already in full swing. Africa lagged behind because fierce competition from wealthy nations for sufficient stocks to vaccinate their populations narrowed the margins of the market, and because many African states did not have the financial resources to obtain sufficient doses. “It is not realistic to suggest that we are going to reach 60% of the immunized population in a year,” the percentage considered minimum to achieve herd immunity, said Phiona-Atuhewbe – head of Introduction of New Vaccines at WHO Africa – in mid-February. “It would take 12,000 million dollars, which we do not have,” she added.

With the aim that no country would be left out of vaccination, the Covax initiative emerged, championed by the WHO, the GAVI Vaccine Alliance and Unicef, among others. The idea is to distribute about 2 billion doses this year among low and middle-income countries. Although some African nations turned to the free market in search of supplies, all joined this initiative, which officially started on February 24, with the arrival of the first 600,000 doses in Ghana. Then it would be the turn of Ivory Coast and Nigeria, reaching 23 countries in mid-March, trying to ensure that, at least, health personnel and the population at risk were immunized.

Failure

“It is a moral problem,” said John Nkengasong, director of the African CDC, “it will be terrible to see this distrust between the North and the South regarding a common good such as vaccines.” The United Nations estimates that only 20% of Africans will be vaccinated by the end of this year. The director general of the WHO himself, the Ethiopian, Tedros Adhanom Ghebreyesus, raised the tone to denounce the hoarding of vaccines by rich countries. “The world is on the brink of a catastrophic moral failure with respect to equitable distribution of vaccines,” he said in February, “the price of this failure will be paid in lives and livelihoods in the world’s poorest countries.” Covax's own supply was threatened by bilateral agreements between Northern countries and pharmaceutical companies.

“Most manufacturers have prioritized regulatory approval in rich countries, where profits are higher, rather than submitting full records to the WHO. This could delay Covax deliveries and create exactly the scenario it was trying to avoid, a chaotic market, an uncoordinated response and continued social and economic disruption,” said Ghebreyesus in a speech to the WHO executive board.

The nightmare of the coronavirus pandemic is not yet done and its economic, political and social consequences, such as an increase in poverty, instability or even gender violence, will last for several years, experts agree. Unequal access to vaccines, which was already evident in the first quarter of 2021, and the consolidation of projects such as the vaccine passport that the European Union has in mind, could further slowdown Africa’s recovery. The continent is today, a year after the start of the pandemic, far from the apocalyptic predictions of those initial studies, but it cannot be said that Africa has emerged unscathed. Covid-19 is still biting fiercely and the way out of the well is long and full of vicissitudes.

See the Spanish article África burla el apocalipsis pero sufre el impacto