50 Middle East & Africa The EconomistMarch 28th 2020
21tious diseases may prove useful. Roughly
one in three deaths in Africa every year is
from an infectious or parasitic disease,
compared with one in 50 in Europe. Recent
Ebola outbreaks, across west Africa in
2014-16 and in eastern Congo in 2018-20,
have taught policymakers vital lessons.
People who have dealt with Ebola, such
as David Nabarro, a special envoy for co-
vid-19 to the World Health Organisation,
say it is essential to win over communities.
One sign of success in Sierra Leone was
when Ebola became known in the Menda
language as “bonda wote”, literally “family
turn round”—a sign that people were
changing behaviour. “I am absolutely con-
vinced that African countries can get on
top of this quicker than European coun-
tries,” says Dr Nabarro.
Experts also urge vigilance. “We are vet-
erans of outbreaks,” says Monica Musen-
ero, a Ugandan epidemiologist. The coun-
try has contained regular flare-ups of
diseases such as Ebola and Marburg virus.
Whereas Ebola always “announces itself”,
covid-19 spreads quickly and quietly, she
says. As doctors find cases of the new virus,
they may be only “catching the tail”.
That is the worry across Africa, where
outbreaks could rapidly overwhelm health
systems. Sub-Saharan Africa has about one
doctor for every 5,000 people, compared
with one per 300 in Europe. Data are
patchy, but the average American hospital
may have more intensive-care beds than
most African countries. Kenya has 130;
Uganda 55; and Malawi about 25. In Zimba-
bwe there are probably even fewer in the
public system, and doctors and nurses are
on strike. Ventilators are scarce: Mali and
Mozambique may have one per 1m people.
Given the lack of capacity, the disease
could be “horrific”, says Tom Frieden, a for-
mer head of the Centres for Disease Control
and Prevention in America.
The underlying health of Africans may
not help either. Doctors do not know if the
more than 25m Africans infected with hiv
are at greater risk from covid-19. Some
speculate that anti-retroviral drugs may
help fight the new virus, though early stud-
ies suggest otherwise. Even if this were the
case, notes Denis Chopera, a Durban-based
virologist, only about 60% of South Afri-
cans with hivregularly take their pills.
The burden on health-care systems
from covid-19 could impede treatment of
other diseases. Studies of the Ebola out-
break in west Africa suggest that about as
many people died because they could not
get treatment for malaria, hiv and tubercu-
losis as from Ebola itself. Others died from
being unable to give birth safely. Suppress-
ing outbreaks of Lassa fever in Nigeria and
measles in Congo could be hampered by
the diversion of resources to covid-19.
Governments may also have a hard time
convincing their citizens to take the newvirus seriously. Fake news is one reason.
Dodgy cures and conspiracy theories are
spreading on WhatsApp groups, which
typically have more members in Africa
than elsewhere. In Congo the virus is seen
as a “mzungu” (white person) disease. Some
Ethiopians see their country as blessed and
therefore protected. More than a quarter of
Nigerians say they are immune, most com-
monly because they are “a child of God”.
Religion may be doing more to spread
the disease than stop it. Senegal was slow
to stop pilgrims from travelling to the holy
city of Touba, despite an outbreak. A Chris-
tian gathering in South Africa has been
linked to another outbreak. Thousands
still attend megachurches in Nigeria. Al-
though many pastors and imams are
spreading the gospel of handwashing, oth-
ers are talking nonsense. Orthodox Chris-
tians in Ethiopia have promoted quack
“cures” involving garlic, lemon and ginger.
Prices of these foodstuffs have risen by
more than 200%, and fights have broken
out in markets over them.
Many African leaders have been swift to
ban religious meetings. Some churches are
streaming services online. But this is not
the case in Tanzania, where President John
Magufuli has refused to close churches,
saying: “That’s where there is true healing.
Corona is the devil and it cannot survive inthe body of Jesus.”
African governments face practical as
well as spiritual obstacles. The state’s abili-
ty to enforce social distancing and lock-
downs is questionable in cities, where two
in every five Africans live. More than half of
city-dwellers are in crowded slums (see
map). In Alexandra, a slum in Johannes-
burg, there are more than 9,000 house-
holds per square km, compared with fewer
than 700 in neighbouring Sandton, a posh
suburb. In Kampala 71% of households
sleep in a single room. Frequent hand-
washing with soap is difficult. In Makoko, a
huge slum in Lagos, less than 20% of
households have piped water. Conditions
in refugee camps are often worse.
Persuading slum-dwellers to stay in
one-room shacks with many relatives will
be tougher than getting people in New York
or London to stay on the sofa watching Net-
flix. And few can work from home. Six in
ten Ugandan workers are either self-em-
ployed or help out in a family business. If
people do not work they do not eat, says
Steven Agaba, who lives in a poor part of
Kampala, Uganda’s capital. He gestures at a
man selling fruit from a tarpaulin spread
across the muddy ground. “It will not be
the coronavirus to kill us, but the hunger.”
It may also send the poor back to their vil-
lages, further spreading the disease.
The precariousness of everyday life
means that the economic effects of co-
vid-19 in African countries will be both co-
lossal and different from the rich world.
The welfare of a billion people depends on
how governments balance saving lives
from the virus while minimising economic
damage in a continent where more than
400m people live on the equivalent of less
than $1.90 a day. It is not at all clear how this
Gordian knot can be untied.
The hit to economies was already appar-
ent even before the first case of covid-19
was reported in Africa. More than 80% of
its exports go to the rest of the world, the
highest share of any big region save Aus-
tralasia. About half of these are raw mater-
ials. As commodity prices have plunged, so
have forecasts for growth and tax receipts.
Other industries have been hammered
too. Tourism, which employs more than 1m
people in each of Kenya, Tanzania, Ethio-
pia and South Africa, has collapsed. In Ken-
ya and Ethiopia, both exporters of flowers,
bulbs are being fed to cows and roses are
rotting in heaps. Manufacturing is strick-
en. Orders have dried up for clothes export-
ers in Ethiopia, Ghana and Lesotho.
Trade is at a trickle. Dozens of scheduled
ships are either not turning up at Mombasa
port, in Kenya, or arriving partly empty. Re-
mittances could soon dry up—a disaster for
the 13 African countries where that money
is worth more than 5% of gdp. (In Lesotho
remittances equate to 23%.) The overall ef-
fect is “more serious than 2008”, says Al-Selected
townshipsSebokengKatlehongAlexandraTembisaGauteng provinceGautengprovinceJohannesburgPretoriaPopulation density, 2020
People per km2Crowded houses
South AfricaSources: Fraym; Worldpop1 >10,000Soweto20 kmRising fast
Africa, confirmed cases of covid-19
Selected countries, to March 25thSource: Johns Hopkins CSSE700
600
500
400
300
200
100
0
February MarchEgypt
Burkina FasoGhanaSenegalSouth Africa2020