The Fear of COVID-19 in Africa

“Africa has to prepare for the worst”

 

It is almost done. The Democratic Republic of Congo (DRC) has had no new Ebola infection for more than 42 days. With this, the second worst epidemic in the history of the virus is close to be over. What is missing is the official declaration by the World Health Organization (WHO) that is likely due by mid-April.

However, thanking the many committed local and international health care staff, who has helped preventing a regional and global emergency, may go unheard. While Ebola is ending in Eastern Congo, the capital Kinshasa in Western Congo, a city of 12 million people, is preparing for the COVID-19 pandemic as is the rest of the African continent. Its consequences could be much worse than Ebola in Congo or in West Africa in 2014-16.

„Africa has to prepare for the worst,” said WHO Director-General Tedros Adhanom a few days ago. African countries do not have health systems as in Europe, Asia or the United States. Many observers fear that the number of victims could reach hundreds of thousands. The health crisis could also be followed by a political crisis, an “African Spring”, however with a lot of sorrow and bitterness.

 

A “victory” over Ebola, but not a “success”

 

It is a “victory” over Ebola, but not a “success”. With almost two years, the crisis took too long and cost the lives of more than 2,250 people. Different from West Africa in 2014-16, insecurity was the reason in the DRC why the epidemic could not be controlled for a long time.  Many rebel groups remain active in the country because the Congolese government fails to impose its security monopoly. A number of these groups targeted health workers and prevented them from stopping the spread of Ebola. It has to be fully assessed yet, but the Congolese military, and even more so the UN peacekeeping mission MONUSCO, can most likely claim the “victory” over Ebola for their courageous counter strategy since the beginning of the year that helped fighting back rebels and protecting health teams.

If it was for insecurity that caused the spread of Ebola in the DRC, it is the feeble health systems that are a problem to fighting coronavirus. They explain why Africa has to shiver in the face of the COVID-19 pandemic. In Kinshasa, a city of 12 million inhabitants, less than ten hospitals have been identified by the government for treating coronavirus patients. One of the best, the “Hôpital du Cinquantenaire”, can only treat up to 150 patients a day, according to its own information.

 

COVID-19 reaches Kinshasa

 

Three weeks ago on Tuesday March 10, the DRC’s Secretary of Health declared the first coronavirus case in the country. A Congolese citizen, who got infected in France, had brought the virus to Kinshasa. Today, the country officially has more than 150 confirmed cases and 18 deaths. The WHO believes the number on the entire continent is much higher as countries lack the capacity to test.

The large majority of cases is concentrated in Kinshasa, apparently in the very ranks of the government whose members often travel to Europe. The Secretary of the Economy got infected, her brother died, so did a presidential advisor and other decision makers. Experts fear that they could have passed on the virus to employees and their housekeeping personnel who then take the virus from Kinshasa’s rich districts to the poor neighborhoods, the “quartiers“, where millions of Congolese live door to door. The virus has also flared up in other parts of the DRC, in the provinces Ituri, Kwilu and North Kivu, and in Bukavu, a city in South Kivu province. However, the epicenter is Kinshasa.

Like other African heads of state, the DRC’s President Félix Tshisekedi quickly took action. He suspended domestic and international flights. He closed restaurants, churches and other places of public life. He built a committee to coordinate the crisis management, and he declared the “state of emergency”.

 

No advantage: “draconian measures”

 

However, the presumed advantages that autocratic systems are said to have over Western democracies in declaring “draconian measures” fall short as the examples of Kinshasa and other African countries show. On the one hand, bad governments often lack the support of the population who doesn’t follow their rules and regulations. On the other hand, weak institutions lack the capacity to impose their actions. Following the announcement, life continued almost unchanged in Kinshasa. People continued to use public transport unrestrictedly, crammed into mini-buses or rode on the back of motorbikes with three people.

The crisis management showed weaknesses, too. Instead of suspending public transport completely, the city government only reduced the number of passengers. Up to 20 people could still use bigger buses, up to 16 their smaller versions. A week ago, the crisis management reached a first peak: On Thursday evening March 26, the Governor of Kinshasa surprisingly declared a complete lock-down over the course of three weeks that was to begin only 24 hours later, on Saturday.

 

A lock-down in Kinshasa

 

The idea was an intermittent schedule: It should begin with four days of lock-down. Nobody, except security officials, civil servants and health workers, would have been allowed outside. Even grocery shopping would have been forbidden. After four days, the lock-down would have been lifted for two days, so people could shop and refresh their stocks at home. After that, another four days of lock-down would follow, and so on.

Kinshasa was on the brink of chaos. On Friday, people flocked to markets in their thousands, trying to quickly buy some water and food. Many people borrowed money if they hadn’t yet received their salaries. Food prices skyrocketed. Destitute people who live on one dollar or less a day and represent the large majority of the population, did not know how to get by over four days. Pressure on the city mounted. On Friday afternoon, authorities quashed the lock-down – which in general is a valid measure to take, but which needs to be better prepared and with more time.

“People were angry,” said one observer. “They first borrowed money to then buy groceries for prices that had risen drastically. And in the evening, the lock-down was postponed. I believe the next time people will not accept such a measure.”

Discussions followed in the days after. A week later, on Thursday April 2, the city government announced once again a lock-down that starts on April 6 and will last for two weeks. This time, it will only include Kinshasa’s most important and richest district, Gombe. The government also amended the list of people who can go to work during the lock-down.

In our globalized world, Africa’s ruling classes and population follow just as much as everyone what happens outside their territory. These days, the Congolese follow on WhatsApp and YouTube how security officials in Kenya, South Africa and Nigeria impose their “draconian measures” with sticks and tear gas. In many cases, the information about restrictions has not reached the population. Another problem is the lack of education among a large number of people who miss the gravity of the disease or believe “fake news” that are rife on Africa’s social media.

 

Political Consequences for the Entire Continent

 

All this is an explosive mix that might transform the health crisis into a political one with grave consequences for many African countries. If COVID-19 causes a high number of victims, leads to violence, destroys economies and leads to even higher unemployment, many people will blame governments who have neglected building their countries for years, in particular robust health systems, which lie at the heart of the crisis. A lock-down that prevents people from working might be just enough. Germany has “short-time working” (Kurzarbeit). African countries do not. The last means against hunger is violence. Sudan is the most recent example which shows that growing fuel and food prices are enough to lead to political upheaval.

Besides the political consequences, many other things are at stake. If COVID-19 does not get controlled in Africa, the crisis will remain, without a vaccine, over months a risk for the world’s leading economies with all the possible consequences, even if the crisis has been tackled by then in Europe, China and America.

“And in a situation like that, where the virus can be transmitted unrestrictedly, the risk of mutations also grows. And if there is a mutation, all the money that is currently being invested in a vaccine, may be lost,” said UN Secretary General, António Guterres, a few days ago on French television.

 

Who is responsible?

 

A few days ago, Ethiopia’s Prime Minister and Nobel Peace Prize winner, Abiy Ahmed, called on the G20 to provide 150 billion USD in emergency funding for Africa’s health systems. The G20 was holding a meeting and finally pledged 5 trillion USD as a stimulus for the global economy suffering from the pandemic. In an Op-Ed for the Financial Times, Abiy Ahmed renewed his claim, this time adding debt relief for African countries and upholding national development aid budgets that leading economies had already pledged. “This is where true humanity and solidarity must be demonstrated,” he ended his article. The Nobel laureate, however, did not mention that African governments also have a responsibility.

 

Supporting Africa’s health systems: With Strings attached

 

At this moment, priority is to prevent a humanitarian catastrophe in Africa. However, the billions of dollar in development cooperation that are expectable and will follow the relief to rebuild Africa’s health systems – and that many other African heads of state besides Abiy Ahmed have already called for  – must not come for free this time. It should encompass conditions, rules and mandatory reporting, which include sanctions if African governments do not fulfill their duties. African governments can then prove how willing they are to reform their countries and how important the well-being of their population really is to them. If put in practice and invested well, the aid for Africa’s health systems will strengthen their economies in the long run, their population will become healthier. Robust health systems as a foundation of robust economies? The ‘G20 Compact with Africa’ initiative and its country partnerships offer an existing framework.