Following in China’s footsteps, almost all nations around the world have imposed lockdowns to contain the coronavirus. Africa too, is no exception. However, a careful analysis of the move shows that it may not be the best solution for the continent. Age demographics mean that the cons outweigh the pros in the cash-strapped region.
In China, 23% of the population is over 55. Similarly, in Japan, 40% of the population are over 55. The story in Africa, is however different. Take for example Uganda, where just 5% of the population are over 55. This is very similar to most other nations in Africa. Age demographics are critical to combating the coronavirus, as studies have consistently shown that the mortality rate starts to increase for people aged 55 and higher.
Statistically, young people are highly unlikely to suffer severe symptoms. Yes, they can and will catch COVID-19, but the mortality rate is far lower (0.8% of COVID-19 patients between 18-44 died in New York as of May 13 compared to 6.5% of patients between 65-74). So for nations where older people make up less of the population, the health benefits of a lockdown are more limited. The downsides outweigh the pros, which can lead to long-term effects in African nations.
Why It Matters
The downsides in developed nations aren’t as significant as they are in Africa. While Italy, Spain, the UK and the US can all afford to cushion the devastating economic impacts with bailouts and loan waivers, poorer African nations cannot as they simply don’t have the financial muscle of their western counterparts. In cash-strapped nations like Malawi and Zimbabwe, without work, there is almost no chance of food on the table. It is almost impossible to shut off the economy without risking genuine hunger and a huge increase in poverty and all that entails, meaning people have little choice but to continue working. So, people living in these economies have less incentive to stay at home
Another major challenge is enforcing social distancing. Even in big cities like Lagos, Nairobi and Mogadishu, a large percentage of the population live in crowded low-income slums. They lack proper sewage and water systems, making simple things like handwashing impossible. People are often cramped with 10-15 members of their family, or strangers. This has already played out in Dharvi in Mumbai, where 1,327 (as of May 18) have been infected. Dharvi is Asia’s largest slum, and one of the most densely populated areas in the world, with 700,000 people packed into 2.1 square kilometers.
Africa’s inadequate health systems are also a cause for concern. While western nations have imposed lockdowns to “flatten the curve” and “protect the health system”, such slogans have little meaning in Africa. According to the World Bank, sub-Saharan African nations spend on average 5.17% of their GDP on healthcare, as compared to 9.89% by the rest of the world. As a result, these nations are nowhere near capable of dealing with a pandemic. Uganda, for example, has only 55 intensive care beds for a population of 43 million. Since there is less of a system to protect, forcing people to stay at home comes with marginal advantages. Lockdowns also divert attention from other health problems in the region, such as malaria, ebola and HIV.
It might be argued that poorer countries with less effective health systems will have a higher burden of underlying health conditions, thus increasing vulnerability to COVID-19. However, the pre-existing health problems most closely related to getting severe symptoms from coronavirus tend to be associated with age. Current evidence from Spain, for example, suggests that people living with HIV are not at increased risk of acquiring COVID-19 or developing severe symptoms. In fact, the opposite may be the case.
Planning for the Local Context
The one size fits all approach to COVID-19 is clearly not working. With such a young population, the best policy to combat the coronavirus may not be a full lockdown. To save lives, African nations need a different approach, one where their social context is taken into account. Since young people are more immune to the virus, a herd immunity approach may be more appropriate.
At the same time, it is important to shield the most vulnerable. This can be accomplished by a mix of forced isolation, restricted movement and focused care. Aggressive policies and acting early, as Rwanda did also make a huge difference in bringing down the numbers. These measures will work best when based on local innovations appropriate to particular social contexts and designed with input from those involved. These could build on practices of respect for the elderly and community organising in many African settings.
Age demographics vary not just in countries, but also regions within them. Health systems, economic conditions and immunity are also varying. Thus, a standardised approach is far from the best solution. By getting people back to work, most nations can at least avoid some of the severe economic shocks faced by other nations. Right now, the United Nations predicts economic losses could exceed £180 billion in developing nations. That money is not coming back, no matter how many loan waivers, emergency loans and investments are made. The economic hit of the coronavirus could wipe out all the economic gains made in the last decade, setting Africa and the world back.
In years to come, we may look back on this moment as one in which an ideological practice emanating from older and wealthier countries was misguidedly “copy and pasted” by elites in younger and poorer societies, leading to marginal benefits in tackling the coronavirus but with the effect of increasing poverty and mortality among the poor.