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Africa/Global: Pandemic Mobilization amid High Vulnerability

AfricaFocus Bulletin
April 27, 2020 (2020-04-27)
(Reposted from sources cited below)

Editor's Note

At a continental level as well as in almost all African countries, African institutions mobilized quickly in response to the pandemic. In most countries, the pandemic response so far has been encouraging in terms of buying time by flattening the curve, although implementation of lockdowns has been marred by human rights abuses by security forces and insufficient funding for support to those already economically vulnerable to loss of income. A minority of countries, including Tanzania, Burundi, Cameroon, and Madagascar, seem to be emulating the denial and delay pattern previously followed by the United States and the United Kingdom.

With continued high vulnerability due to poverty and lack of resources, a rapid expansion of the virus could still come at any time. And, in economic terms, the continent faces the double whammy of the impact of its own shutdowns and of the global recession from which it is already experiencing massive consequences.

This AfricaFocus Bulletin contains two sections. At the end you will find substantial excerpts from a new report (released April 17) from the UN Economic Commission for Africa (UNECA) on Covid-19 in Africa, with analyses of the impact on both lives and economies, including projections and policy proposals. The full report is available at and at

Just below you will also find a wide selection of links to articles that your editor has found useful. The amount of information coming out is overwhelming, and this set of links is both highly selective and incomplete. Most of the links are listed with no commentary from the editor and no details about title or date if those details are obvious from in the URL itself. But given limited time and space, I decided to include more links for readers to choose rather than additional descriptions or commentary.

Also strongly recommended for a longer read is The Continent, the new weekly newsletter from South Africa´s Mail and Guardian, which includes including critical articles on government strategies and reporting from journalists around the continent. The first two issues can be downloaded at It is available by email or WhatsApp.

For previous AfricaFocus Bulletins on health and related issues, visit

++++++++++++++++++++++end editor's note+++++++++++++++++

Highly respected African public health officials, all with extensive international experience, are leading both the global and the African pandemic response. Pictured above are Dr. Tedros Adhanom Ghebreyesus, director general of the World Health Organization (WHO), from Ethiopia; Botswana-born Dr. Matshidiso Moeti, who directs the WHO regional office from Brazzaville; and Cameroon-born Dr. John Nkengasong, director of the Africa CDC in Addis Ababa.

Global Overview

One of the best overviews of the pandemic and the issues of strategies to respond that I have found, comparing many country responses, but not African countries as yet, which is both well-researched and well-written, is the series by Thomas Pueyo on Medium – March 19; – April 20; – April 23

And a similar overview from ProPublica - April 18

These two articles from April 22 provide an overview of the wider crisis in the developing world and in Africa specifically.

And this provides another continent-wide overview

In addition, given the widespread accusations against China and the WHO by the Trump administration and others, this detailed account of the timeline of their interaction is a useful corrective:

General Update Links on Covid-19 in Africa

For statistics, two of the best regularly updated global sites now allow a filter to look at African countries: and (go to link, click on countries, then on Africa tab).

Africa statistics can also be found here:

Financial Times charts are interesting, and are now open-access, but to date have little on African countries:

Other sites with a variety of updated information are and (note: use this instead of, which is often hard to reach).

Alternate projections from McKinsey & Company (less detailed than those from UNECA excerpted below) – April 2020

The Debate in South Africa – April 20

“Why we need governments to keep us apart” – April 21

President Cyril Ramaphosa, April 21 - April 22

Around the Continent - Kenya, April 17 - April 17

Life inside the lockdown, April 18 - April 20 – April 20 Roundup on security forces, April 21 – Somali community in London – April 21 - April 22 - April 23 - April 24

COVID-19 in Africa: Protecting Lives and Economies

Report released on April 17, 2020

Excerpts below. Full report available at and at

Summary messages

People: Anywhere between 300,000 and 3.3 million African people could lose their lives as a direct result of COVID-19, depending on the intervention measures taken to stop the spread.

Africa is particularly susceptible because 56 per cent of the urban population is concentrated in overcrowded and poorly serviced slum dwellings (excluding North Africa) and only 34 per cent of the households have access to basic hand washing facilities. In all, 71 per cent of Africa’s workforce is informally employed, and most of those cannot work from home. Close to 40 per cent of children under 5 years of age in Africa are undernourished. Of all the continents Africa has the highest prevalence of certain underlying conditions, like tuberculosis and HIV/AIDS. With lower ratios of hospital beds and health professionals to its population than other regions, high dependency on imports for its medicinal and pharmaceutical products, weak legal identity systems for direct benefit transfers, and weak economies that are unable to sustain health and lockdown costs, the continent is vulnerable.

Prosperity: The impact on African economies could be the slowing of growth to 1.8 per cent in the best case scenario or a contraction of 2.6 per cent in the worst case. This has the potential to push 27 million people into extreme poverty.

Even if the spread of COVID-19 is suppressed in Africa its economic damage will be unavoidable. The price of oil, which accounts for 40 per cent of Africa’s exports, has halved, and major African exports such as textiles and fresh-cut flowers have crashed. Tourism – which accounts for up to 38 per cent of the gross domestic product (GDP) of some African countries – has effectively halted, as has the airline industry that supports it. Collapsed businesses may never recover. Without a rapid response, Governments risk losing control and facing unrest.

To protect and build towards our shared prosperity at least $100 billion is needed to immediately resource a health and social safety net response. Another $100 billion is critical for economic emergency stimulus, including a debt standstill, the financing of a special purpose vehicle for commercial debt obligations, and provision of extra liquidity for the private sector.

Partnerships: African economies are interconnected: our response must bring us together as one. The development finance institutions must at this time play an unprecedented counter-cyclical role to protect the private sector and save jobs.

We must keep trade flowing, particularly in essential medical supplies and staple foods, by fighting the urge to impose export bans. Intellectual property on medical supplies, novel testing kits and vaccines must be shared to help the continent’s private sector take its part in our response.

The level of assistance that is required is unprecedented. Innovative financing facilities are needed, including a complete temporary debt standstill, enhanced access to emergency funding facilities, and the provision of liquidity lines to the private sector in Africa. We must “build back better”, by ensuring that there is an abiding climate consciousness in the rebuilding and by leveraging the digital economy. And we must be firm and clear on good governance to safeguard African health systems, ensure proper use of emergency funds, hold African businesses from collapse and reduce worker lay-offs.

1. People

Susceptibility – sensitivity to spread and impact

Nearly 600 million people (43.5 per cent of Africa’s total population) live in urban areas, of which 56 per cent (excluding North Africa) live in slums. Slums are susceptible to the spread of infectious diseases owing to population density, overcrowding, high population mobility, quarantine enforcement difficulties and poor access to health care. Surveillance, monitoring, containment and mitigation interventions pose acute challenges for the control of infectious disease outbreaks in slums.

The main transmission mechanism for COVID-19 is respiratory droplets, against which regular hand washing is the best regular control. Basic hand-washing access in Africa is limited, with 36 per cent of the population having no access to household handwashing facilities, and a further 30 per cent having only limited access.

The impact on levels of mortality and hospitalization of COVID-19 are highly related to age and underlying conditions, according to data emerging from hard-hit regions. Cardiovascular disease, respiratory disease, kidney disease, and immunocompromised conditions, including HIV/AIDS and tuberculosis, prove particularly dangerous. While Africa has a relatively favourable demographic profile (nearly 60 per cent of the population below the age of 25), the high prevalence of HIV/AIDS in southern regions and levels of chronic respiratory and kidney diseases in certain countries, tuberculosis and malnutrition are cause for concern.

Vulnerability – critical fragilities in Africa’s response

The health systems of countries in Africa are weaker than those elsewhere in the world, with lower ratios of hospital beds, ICUs and health professionals to its population. Africa has on average 1.8 hospital beds per 1,000 people, compared to 5.98 in France. Of the 25 countries estimated by Rand to be most vulnerable to infectious disease, 22 are in Africa.

Africa is critically dependent on imported medicinal and pharmaceutical products. Every single African country is a net importer of these. With 1.8 average hospital beds per 1,000 people, hospital beds capacity across Africa is weak products and as much as 94 per cent of Africa’s total stock of pharmaceuticals are imported. At least 71 countries have now imposed limitations or outright bans on exports of certain COVID-19 essential supplies, putting access to these supplies in Africa in a perilous position. Africa’s weaker economies will struggle, however, to sustain health and absorb costs related to lockdowns. Simultaneous economic shocks will exacerbate Africa’s compromised capacity for action.

Lives – morbidity risks

How African countries respond to the COVID-19 crisis in the coming weeks will affect the trajectory of national epidemics across the continent. The Imperial College COVID-19 response team has combined data on age-specific contact patterns and COVID-19 severity to project the health impact of the pandemic in African countries. The project compares predicted mortality impacts in the absence of interventions or spontaneous physical distancing with what might be achieved with policies aimed at mitigating or suppressing transmission.

Scenario A is the worst case scenario characterized by no interventions. Under this scenario the model predicts 1,222.3 million infections, 22.5 million hospitalizations and 3.3 million deaths in Africa this year. Mitigation strategies targeted at social distancing significantly reduce the burden on health systems and number of deaths. Under the best case scenario (D), the model predicts just 122.8 million infections, 2.3 million hospitalizations and 0.3 million deaths.

If a suppression strategy is implemented early (at 0.2 deaths per 100,000 populations per week) and sustained, then 3 million lives could be saved while if it is initiated when death numbers are higher (1.6 deaths per 100,000 population per week) then 1.8 million lives could be saved: urgency is critical.

As with the Ebola crisis, COVID-19 will also impose spillover costs on Africa’s existing health challenges as resources are redirected and spread even thinner. During West Africa’s Ebola crisis, the number of women giving birth in hospitals and health clinics dropped by 30 percent and the maternal mortality rate increased 75 percent. COVID-19 is already limiting access to sexual and reproductive health and increasing gender-based violence.

Focus on emergency health costs Fighting COVID-19 requires the rapid mobilization of emergency health-care and social safety net spending. We estimate the cost of emergency medical supplies and personnel needed to respond to the COVID-19 crisis, based on the four scenarios in table 1.1 (of the preceding subsection).

In a best-case scenario, with suppression and intense early physical distancing interventions, $44 billion would be required for testing, personal protective equipment, and to treat all those requiring hospitalization and intensive care treatment across Africa (scenario D). If COVID-19 were left to spread unmitigated, the COVID-19 medical supply gap across Africa would reach approximately $446 billion (scenario A), and Africa would be completely unable to afford to treat even a fraction of all those in need.

Healthcare demand in Africa can only be kept within manageable levels through the rapid adoption of public health measures (including testing and isolation of cases and wider social distancing measures) to suppress transmission.

The largest share of projected medical supply costs is accounted for by personal protective equipment (PPE) reflecting a significant scale effect. This highlights the importance of getting basic healthcare right. Ensuring sufficient supplies of PPE has even been a challenge in more advanced economies such as the UK, USA and Italy.

A crucial challenge for the continent is the very low ratio of medical personnel per 10,000 patients as well as weak health systems. The cost of the total health-care response (gap) is therefore likely to be much higher than the figures depicted in table 2.1 and figure 2.1, which are limited to medical equipment and exclude costs for medical staff. Medical equipment such as ventilators and oxygen concentrators are important, but without trained personnel in sufficient numbers, they will be less useful.

Care must be taken over non-COVID-19-related health issues. The experience of Ebola in west Africa suggested that funding and resources are likely to be diverted away from other areas, including sexual and reproductive health. This disproportionately affects pregnant women, lactating mothers, girls, and women in general as well as those facing existing health threats.

2. Prosperity

COVID-19 is a significant headwind for growth in Africa. The uncertainty around the virus and the consequent policy actions, such as physical distancing and lockdowns, have led to a decline

in demand for African products due to a sharp decline in global manufacturing activities, compounded by a decline in economic activity on the continent as the labour force remains at home to combat the virus.

Against this backdrop, we estimate that, in a best- case scenario, Africa’s average GDP growth will fall 1.4 percentage points, from 3.2 per cent to 1.8 per cent. In the worst-case scenario, Africa’s economy could contract by up to 2.6 per cent in 2020.

Poverty impact – socioeconomic damage

We estimate that between 5 million and 29 million people will be pushed below the extreme poverty line of $1.90 per day owing to the impact of COVID-19, compared to the baseline 2020 African growth scenario. Vulnerable households affected by COVID-19 face an increased probability of moving into transient poverty by 17.1 per cent, a 4.2 per cent increased probability of staying in poverty for a decade or longer, and a fall in the probability of moving out of poverty by 5.9 per cent. Increased poverty levels will also exacerbate existing income inequalities.

For low-income households, which already spend an average of 36 per cent of their income on health care-related expenses, access to health care will become increasingly unaffordable in the wake of COVID-19, leading to an increase in the number of households falling below the poverty line.

Annual formal job creation (currently 3.7 million) is forecast to drop by 1.4 to 5.8 per cent, compared with the baseline 2020 African growth scenario. An increase in informal and vulnerable employment is expected (more than 60 per cent of men, and nearly 75 per cent of women are informally employed in Africa) and an increase in out-of- pocket expenditure by poor and vulnerable households.

The 2008 financial crisis increased vulnerable employment by 10 per cent. The more systemic shock of COVID-19 is expected to increase vulnerable employment considerably more than this, with the International Labour Organization (ILO) anticipating 19 million job losses in Africa as workers face full or partial workplace closures.

Fiscal risk – Africa’s limited space to respond

Focus on falling tax revenues Africa remains the region with the lowest tax-to- GDP ratio. At an estimated 13.4 per cent in 2018, its tax-to-GDP ratio was lower than that of Asia (14 per cent), Europe (25 per cent) and Latin America (18 per cent).

On the whole, average tax revenues on the continent consistently decreased by 2.8 percentage points from 16.2 per cent of GDP in 2014 to 13.4 per cent of GDP in 2018. Commodity exporters have in particular been under pressure since the 2014 commodity price shock.

Notwithstanding increased government efforts on domestic resource mobilization, several Africa countries (oil exporters and non-oil exporters alike), in recent years have adopted policies such as tax holidays that were aimed at attracting foreign direct investments. Consequently, tax buoyancy in Africa has been less than 1, with output and incomes growing much faster than tax revenues. Ethiopia, Gabon, Ghana and Kenya are examples of countries that have export processing zones or special economic zone agreements with foreign countries that grant tax reductions.

Focus on largest taxpayers hit hard

Income tax is an important source of tax revenue for African countries, contributing over 40 per cent of total tax revenue for the lower-middle- income countries and middle-income countries.

Both personal income tax and corporate income tax are larger for the more diversified economies like Kenya, Morocco and South Africa.

In Egypt, Kenya, Morocco and South Africa, national carriers such as Egypt Air, Kenya Airways, Air Maroc and South African Airways are registered under the large taxpayers office. As at February 2020, regional carriers that cancelled flights to China included RwandAir, Kenya Airways, Air Madagascar and Air Mauritius. The subsequent losses were heavy, estimated at $29 billion globally and $400 million for African carriers. More precisely, for instance, it was estimated that Kenya Airways lost over $8 million monthly as a result of suspending flights to China. Most airlines have currently suspended flights to over 50 per cent of their destinations.

Countries that are tourist destinations such as Côte d’Ivoire, Egypt, Kenya, Morocco and South Africa have also come under severe pressure as travel restrictions are imposed. As an example, following the imposition of travel restrictions from the northern part of Italy by the Government of Kenya, the country is currently experiencing holiday booking cancellations to Malindi, a popular destination for Italian tourists on the country’s coast. It is anticipated that this will lead to closure of hotels and subsequently to job losses

As borders close as part of the COVID-19 policy response, governments can expect a drastic reduction in revenue collection. Local governments will also face a decline in own-source revenues as well as national transfers, which account for 70–80 per cent of their finances. Consequently, the financial capacity of African national and local governments to respond to the COVID-19 crisis is acutely impaired.

Focus on debt and borrowing

While developed countries have injected trillions of dollars into COVID-19 health, social safety net and economic stimulus responses, Africa severely lacks the fiscal space to react similarly. Africa is fiscally hamstrung by four critical challenges: 1. High debt-to- GDP levels; 2. High fiscal deficits; 3. High costs of borrowing; 4. Depreciation of many African currencies against the euro and the dollar.

Over 50 per cent of African countries recorded fiscal deficits above 3 per cent in 2019. Similarly, some 22 African countries had debt-to-GDP ratios above the African average of 61 per cent, breaching the 60 per cent level of debt-to GDP-ratios, a threshold that has been defined as uncomfortable even for the more advanced economies with larger debt-carrying ca- pacities such as South Africa. The increase in spending was a result of development financing needs, in particular, investment in infrastructure. Consequently, fiscal policy has come under pressure, with very little or no fiscal space to deal with crisis situations under normal circumstances.

Traditionally, countries may turn to the bond markets to seek funds for stimulus programmes, but high borrowing costs hamper the ability of countries to do so. Compared to developed economies and emerging economies in Asia, the costs of borrowing in Africa are extremely high, with many countries seeing yields in excess of 10 per cent on a 10-year sovereign bond. Raising additional funding becomes very challenging and might further exacerbate debt burdens for many highly leveraged countries.

Another challenge for bond issuance lies in the denomination of many African sovereign bonds. Most African bonds are issued in dollars or in euros, meaning that issuers have also to be wary of exchange rate risk, especially if the home currency depreciates against the issuance currency. Since January 2020, almost all major African currencies have depreciated in value against the dollar and the euro. As the crisis continues, investors and businesses will continue to gravitate towards cash, potentially strengthening the dollar and euro further, making debt servicing even more challenging in the coming months.

It is clear that Africa does not have the fiscal flexibility or space to deal with the shocks from the COVID-19 pandemic, even though fiscal responses are critically needed to prevent economic collapse.

Focus on financing Africa’s response

Taking cognizance of the fiscal situation in Africa, considerable support will be needed for Africa’s health and social safety net response and emergency economic stimulus. Based on the virtual Ministers of Finance meeting hosted by ECA in March 2020, the following suggestions are made for financing Africa’s response:

1. Secure a $100 billion African health and social safety net fund:

• For the most vulnerable, including feeding for out of school children and unemployment support

• To procure through WHO and CDC Africa the materials needed to save lives, share and promote research, provide vaccines, manufacture health equipment and share emergency services

2. Secure $100 billion for Africa’s economic stimulus:

• Prioritize its investment into climate conscious and digitalization projects

• Ensure that stimulus supports African businesses through allowing for the suspension of leasing, debt and other repayments

• Support airlines and the future of tourism through temporary tax waivers and encouraging banks to renegotiate loans

• Grant tax breaks to forestall the collapse of firms that keep jobs, maintain activity and that can earn export revenues in the recovery

3. Complete temporary debt standstill for two years for all African countries, low and middle income included. Many countries, especially in Africa, have lost market access because of the COVID-19 pandemic, and must also confront the consequences of the pandemic which include substantial losses in major revenue sources. These pressures have made debt service unsustainable for most.

4. Double access to the IMF Emergency Financing Facility and raise IMF special drawing rights allocations to provide additional liquidity, particularly for the procurement of basic commodities, food, fuel and other essential commodities, and also to provide liquidity to the financial sector, private sector, corporates and in particular small and medium-sized enterprises over the next two–three years. This could in part also serve as a bridge special purpose vehicle for commercial debt servicing.

5. Accelerate disbursement of budget support through fast disbursement facilities, including the Crisis Response Window, the Global Pandemic Window and reprogramming of regular programmes at the World Bank Group and similar measures from the European Union and other Group of 20 members.

Countries in return pledge to build and strengthen systems to fight corruption and to enhance predictability, transparency and accountability of flows so that finance ministers can plan effectively and civil society stakeholders can help to track fund flows to ensure that these reach those most in need expeditiously.

Focus on governance

African Governments must ensure the proper use of any COVID-19 financial assistance, debt forgiveness or borrowing. The young people of Africa will not forgive the misappropriation of COVID-19 emergency funds. Citizens and all stakeholders, including development partners working with Africa to strengthen COVID-19 responses, will be better assured if financial flows and debt forgiveness or forbearance measures go through strong institutional processes. This must be balanced against speed, to ensure a rapid response to urgent needs.

Finally, with 2020 having been designated by the African Union as the year when it would achieve its initiative of Silencing the Guns, governments must take care to protect against the ravages of unemployment and the disenfranchisement of their young people brought on by the economic impact of COVID-19. Mass unemployment is a fertile breeding ground for civil unrest.

Indirect shock – ripple effects

As the severity of COVID-19 emerged in February and March 2020, commodity prices plummented for more than 67 per cent of African exports. The price of petroleum oils, which account for 40 per cent of African exports and about 7.4 per cent of total GDP in Africa, crashed more than 50 per cent to their lowest levels since 2003. Metal prices are down 20 per cent on December-end values, the FAO food price index lost 5 per cent in that period, while cotton – as proxy for textiles – fell 26 per cent. The exception is gold, an investment safe haven, which is up by 5 per cent.

The crashing of oil prices has considerable fiscal and exchange rate implications for Africa’s many fuel-oriented economies. We estimate a $65 billion loss to fuel revenues, at a minimium, for 2020. Large gold exporters, such as Ghana, South Africa and Guinea, which account for 20 per cent, 17 per cent and 9 per cent of Africa’s gold exports, respectively, will experience a small compensatory benefit from the rise in the price of gold.

Also problematic has been the shift in the COVID-19 epicentre from China, which accounts for 11 per cent of African exports and 16 per cent of imports, to Europe, which accounts for 33 per cent of African exports and 32 per cent of imports, further disrupting the continent’s global trade value chains.

[detailed sections follow on trade in textiles, coffee and cocoa, tourism, and flowers, as well as on remittances, the specific situation of women.]

3. Partnerships

[not included in these excerts]

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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