'A hidden pandemic': lockdown fatigue and lack of vaccine put Africa at risk of Covid surge

While there is cautious optimism that the coronavirus pandemic is nearing a close in the UK, the worst chapter may be only “just beginning” in Africa, where case numbers are ticking upwards in some countries and vaccination campaigns have barely begun. 

According to Dr Ayoade Alakija, co-chair of the Africa Union Vaccine Delivery Alliance, a lack of testing has masked the true scale of the outbreak of the continent’s “hidden pandemic”.

Dr Alakija warned the region is still “flying blind” as it teeters on the edge of a surge of cases, triggered by the emergence of highly infectious new variants, lockdown fatigue and limited vaccine supplies.  

“Not only are we not out of the woods – this pandemic is not nearly over – but I think in Africa you could almost say it is just beginning,” Dr Alakija told The Telegraph. 

When Covid first emerged many predicted that Africa would be devastated. With little testing, the virus would rip unchecked through the continent’s slums and refugee camps. A lack of ventilators and sophisticated medical equipment would mean people would die in the hundreds of thousands, cemeteries would be full. 

But to date, the virus does not appear to have taken hold in the same way it has done in other parts of the world: between February and December 2020, Africa accounted for just 3.4 per cent of Covid cases globally and 3.6 per cent of deaths. 

Dr John Nkengasong, the head of Africa’s Centre for Disease Control, told the Telegraph last October that early doomsday scenarios had been based on a “shallow understanding of the continent”.

However, Africa has not been immune to the virus. According to a paper in the Lancet  published this week the region’s first wave was relatively small, followed by a bigger peak in December and January. The highly infectious variant first detected in Kent, B.1.1.7, took hold in northern Africa while the southern tip of the continent was hit by the resistant B.1.351 variant which emerged in South Africa. 

Many African nations locked down early on in the pandemic – even when they only had a handful of cases. But by the second wave lockdown fatigue had set in. Economic necessity meant that many countries were forced to open up again and a lack of social safety net mean citizens had little choice but to go back to work. Social distancing and mask wearing have also been less adhered to. 

There are concerns that cases are now rising in the east. 

“A decline in the pandemic’s trajectory since January has now plateaued, and we are concerned about increasing numbers of cases in a few countries,” Dr Richard Mihigo, of the World Health Organization’s Africa office, told a press conference on Thursday (see chart below). 

Kenya and Ethiopia are among the worst hit, with a 66 and 28 per cent rise in cases in the last week respectively. In Kenya, cases have risen from around 250 a day at the beginning of March to over 1,000 this week (see chart below). Its doctors’ union said on Tuesday that the country’s intensive care units were full.

And while the continent’s testing capacity may have grown since the beginning of the pandemic, it is still patchy. The Lancet study showed that at the peak of the second wave only a third – 36 per cent of countries – had adequate testing capacity.

Since the virus was first detected in Africa in February 2020, only 39.8 million tests have been carried out in a population of 1.2 billion – compared to 114 million in the UK, home to just 66 million people. 

In a commentary accompanying the Lancet paper three African researchers say that the true picture of the pandemic is “limited by incomplete data for surveillance, testing and reporting of Covid-19 cases… It is possible that the toll of Covid-19 on African countries could be higher than reported here”. 

Dr Alakija agreed: “We don’t know what's happening in Africa, we’re flying blind. You can say that Africa’s numbers haven’t been huge, and it doesn’t look like health systems have been overwhelmed and we haven’t seen so many deaths – but is that true?” 

She added that while health systems have not been overwhelmed with Covid-19 patients like South America, this is paradoxically because the region has a “way more functional health systems than we do here”.

“So the reason you know people are dying is because people are going to hospitals. But over here, that is not what pertains. Cases don’t go up because you’re not testing; there are limited hospitalisations because of how few people have access to hospital care.

“Africa has a hidden pandemic,” she said.

The Lancet paper shows that nine countries accounted for 82 per cent of cases last year – these countries are not connected geographically and range from South Africa to Morocco in the north, Kenya in the east and Nigeria in the west. 

Identifying the coronavirus pandemic has been complicated by widespread misdiagnosis of cases – symptoms such as fever are similar to those triggered by diseases including malaria – while a popular narrative of Covid-19 a “disease of the outside” has persisted. 

It has also been seen as a disease of the elite, taking out many of Africa's ageing officials. Malawi declared a state of emergency after two government ministers died in the same week, Burundi’s president also reportedly succumbed to the disease and last week, Tanzanian president John Magufuli – who repeatedly denied the existence of the disease – was also said to have been killed by the virus.

On top of this is the uneven vaccine supply. According to the WHO, just 7.7 million vaccine doses have been administered, mainly to high-risk population groups, across a continent home to 1.2 billion people.

So far 32 countries have started administering jabs, which have been secured via a combination of bilateral deals with companies and countries including China and Russia, and the WHO-led Covax scheme, which has delivered 16 million doses to 28 African nations. 

“The only game changer right now is vaccinations… but we just don’t have the supply,” said Dr Alakija. She urged countries further along in their immunisation campaigns to share doses and for the global community to issue limited intellectual property waivers. 

Delays not only allow the virus to spread – costing lives and allowing new coronavirus variants the space to emerge –  but have “humongous” ripple effects on social issues like girls' education and the economy, Dr Alakija added. The World Bank estimates that $13.8 billion is lost by Africa for every month delay in vaccination. 

“I cannot be optimistic about it, we have a very rough year ahead of us… because we don't yet have the tools at our disposal to fight this virus in Africa,” said Dr Alakija. 

“There's been a lot of pain, both in health and economics. And until we vaccinate our population, we cannot recover.”

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