Coronavirus: Why lockdowns may not be the answer in Africa

Many African countries have introduced lockdowns in order to halt the spread of coronavirus, but, as Alex de Waal and Paul Richards argue, ordinary people have to be involved in choosing the solutions that will work for them.

Countries on the continent have learned much from tackling epidemics such as HIV and Ebola that should be put to good use as they face the impact of Covid-19.

The most important lesson is that communities must be at the forefront of responding.

This is not a pious mantra but fact of life.

First, infectious disease outbreaks unfold differently in different communities, according to social conditions that only local people can know.

Second, no control measures, for example lockdowns, can be imposed without the consent of the people affected. It is only when local people are fully involved in planning and implementing epidemic control measures, that they can work.

Public health officials developed a useful guide during the Aids epidemic: “Know your epidemic, know your response, and act on its politics.”

It is useful to think of Covid-19 not as a single global pandemic, but as a simultaneous outbreak of innumerable local epidemics, each one slightly different.

The basic transmission mechanisms of the virus are the same everywhere. But the speed and pattern of spread varies from place to place.

A densely populated township will have a different trajectory to a middle-class suburb or a village. The epidemic will spread differently again in refugee camps and among nomadic peoples.

Africa’s disease burden is different

In each case, the key factors are social behaviours such as greetings, mingling among the generations, hand washing, or maintaining physical distance.

Experts can build their models based on assumptions and averages, but only communities can know what these mean for their particular circumstances.

Africa has a burden of diseases different to other continents.

There are good reasons to fear that Covid-19 will be particularly dangerous to tens of millions of people with tuberculosis or whose immune systems are compromised by HIV.

Little is known about what infection with the coronavirus means for people who have malaria or are malnourished.

On the other hand, Africa’s population is young.

One reason given for Italy’s high mortality rates has been that it has a large proportion of elderly people – 23% of the population is over the age of 65 – who are most at risk should they contract the disease.

By contrast, less than 2% of Africa’s population is over 65. For this reason alone, the virus’ mortality rate may be lower on the continent.

It is clear that each African country will have to design its own response, suitable for its own need.

Why governments need to talk to the people

Governments do not have the data and models for precise expert prediction, and will not get them quickly enough.

But there is a better method, tried and tested: talking with the communities. Doctors and epidemiologists can provide the medical facts, communities can provide the contextual details and knowledge of what has worked for them in the past.

China, Europe and North America all adopted much the same epidemic control policy: lockdown.

African governments followed suit, but in general lockdowns may be simply unworkable in the continent. Only a few African countries, such as Rwanda and South Africa, have the capacity to administer a centralised strategy.

For people living from day to day, reliant on earning cash in the market to buy food, a few days’ lockdown is the difference between poverty and starvation.

For people already suffering hardship because of unemployment, drought or a swarm of locusts, social welfare is provided by relatives. If a lockdown cuts these social ties, adversity becomes destitution.

Lockdowns also threaten to interrupt supply chains of essential drugs to treat TB, HIV and other diseases.

If any form of lockdown is to work, emergency assistance measures are needed.

The lockdown which didn’t work

These include aid to those who have lost either their jobs or the money they received from family in Europe and America to keep food and fuel supply chains open.

Some countries, for example Uganda and Rwanda, are distributing free food. Ghana has announced free electricity, water and a tax holiday. But African governments simply do not have the funds to sustain these kinds of measures without international aid.