Vaccine rollout, food insecurity, and economic recovery take center stage at U.S. Congress Covid-19 update on Africa

At a glance, the three issues in the title appear to be universal. In the U.S. and Africa, vaccine rollout has begun; both have experienced worsening hunger crises – by one estimate, 23 percent of U.S. households experienced food insecurity in 2020, double the number in 2019; and both hope to rid themselves of the Covid-19 pandemic to make way for robust economic recoveries. And both, according to Rep. Karen Bass (D- CA.37), have struggled to equitably distribute resources to their poor.

There are important differences between the North American country and African the continent: The U.S., by one estimate, has secured enough Covid-19 vaccines for nearly twice its population and is administering millions of vaccines daily; its “American Rescue Plan” expands food assistance programs; and its economy is now projected to grow 6.5 percent in 2021 thanks to trillions of dollars in additional stimulus and an accelerating vaccine rollout.

Africa, in contrast, has secured enough vaccines for just “20 percent of its needs,” mainly through the COVAX facility. Instead of being pulled out of poverty – as American stimulus is projected to do – the number of Africans experiencing crisis level food insecurity rose 60 percent and is expected to worsen in 2021. Locusts in East Africa continue to devastate food sources and livelihoods. The African Development bank projects economic growth on the continent to be just 3.4 percent.

Economic Principles

“While victory cannot be claimed yet, African countries should be praised for mounting a concerted response to the Covid-19 pandemic,” said Subcommittee for Africa, Global Health, and Global Human Rights Chair Karen Bass (D-CA.37).

True, some African countries, while laden with debt and lacking the ‘fiscal space’, quickly implemented measures to prevent the spread of Covid-19 and cushion the blow to households and businesses from losses in income as economies ground to a halt –  according to Dr. Donald Kaberuka, Special Envoy for the African Union (AU), in Africa, the informal sector makes up 70 percent of employment and 50 percent of GDP. The AU estimates that Africa has lost out on 360 billion dollars during the pandemic period.

The G20 moratorium on debt repayments until June 2021 was “welcomed” as it gave African countries the space to respond to immediate pandemic challenges, but problems persist: some “multilateral organizations” did not agree to suspend debt payments and commercial lenders were not included in the G20’s moratorium. Public spending increased as government revenues fell, causing budget deficits as well as public debt in some countries to soar.  

Unlike during the financial crisis, when African countries – after strengthening economic policy – had the “economic buffers” to withstand the fall in foreign investment and demand; this time, they confronted the public health and economic crises bereft of reserves.

To ensure African countries can continue to support their citizens and economies, and to ensure adequate resources and capacity for vaccine rollout, the African Union requests that the moratorium on debt repayment be extended at least until the end of 2021. To assist African economies in their recoveries as well as to build resilience to future economic shocks – if Covid-19 variants were to cause another spike in cases – a new IMF allocation of Special Drawing Rights (SDRs) would be especially welcome. As the IMF’s “largest shareholder,” U.S. backing is particularly important. Dr. Kaberuka also suggests SDRs could assist in the purchasing of vaccines.

Public Health plans

Initially, the Covid-19 pandemic sent most of the world scrambling for medical supplies – for personal protective gear (PPE), ventilators, and testing equipment. Some countries also rushed to develop vaccines. The U.S. found it was short on ventilators and testing equipment; France kicked itself for not stockpiling masks as it had done before. Eventually, the U.S. ramped up production of medical supplies and France re-secured medical masks. Africa, in contrast, was largely absent these efforts.

It did not participate in the dash to secure medical resources because it did not, at the time, have the funds available for it. The AU and other African partners eventually secured tests and other medical equipment through an “AU medical supplies platform,” such that by the end of March 2020, all countries were able to test for Covid19. The rapid test and antigen tests have reportedly made it easier to access remote areas on the continent.

As countries were beginning to turn inward and focus on their own populations, some  wealthy northern countries had an idea: that Africa’s youthful population would brush off the health impacts of the Covid-19 virus, therefore negating the need for extra supplies.

Indeed, due to quick public health responses and expertise obtained from addressing previous disease outbreaks – HIV, Ebola, Yellow Fever – the continent has been relatively spared in terms of the number of Covid-19 cases and deaths. Africa has just 3.5 percent of the world’s caseload (4 million) and fewer deaths than anywhere else in the world.

Dr. John N. Nkengasong, Director of the Africa CDC, explained how in Senegal, laboratories and community health systems allowed it to develop a Covid-19 test and successfully prevent the spread of the novel virus; in South Africa, its experience fighting HIV had given it strong contract-tracing networks; in Liberia, Sierra Leone and Guinea, health systems developed in response to Ebola outbreaks in 2014 enabled them to maintain low cases rates. Rep. Ilhan Omar (D-MN.05) – who was born in Somalia – also cited Senegal, Ghana, and Rwanda’s use of “novel technologies” in their pandemic responses.

Dr. Nkengasong, however, pointed out that these metrics may be “the tip of an iceberg”. Though not unique to Africa, some countries’ Covid-19 reporting has been doubtful – Tanzania stopped reporting Covid-19 metrics to the Africa CDC after it had recorded 509 cases. Of greater concern is the spread of asymptomatic cases: 90 percent of Africans recover from Covid-19 infections, meaning they may not have experienced illness and the case was never reported. Because the number of cases is unknown, Dr. Nkengasong argues there is an even greater need to vaccinate Africans as quickly as possible, especially as new variants have pushed African fatality rates above the global average.

The AU also organized the Covid-19 African Vaccine Acquisition Task Team, which has been responsible for vaccines procurement, mainly from the COVAX facility. Like anywhere else in the world, 60 percent of Africans need to be vaccinated in order to eradicate the virus, but the number of vaccines secured comes nowhere close to this.

According to Dr. Kaberuka, there are only a handful of centers “capable of providing vaccines” in Africa: two in South Africa, the Pasteur Institute in Senegal, and one or two in Egypt. The U.S.’ commitment to provide $4 billion in funding to GAVI and COVAX is certainly helpful, but the AU and Africa CDC see support for vaccine manufacturing on the continent as essential. This would require that countries that produce vaccines relax intellectual property rules, which they have been reluctant to do. On a positive note, the African Continental Free Trade Area (ACFTA) is thought to boost the continent’s ability to produce vaccines and other medical equipment.

Some members of Congress recognize the need to support vaccination in Africa, not only to protect the health of Africans but also the rest of the world. “We [the U.S.] have to participate and get vaccines to Africa,” said Rep. Ami Bera (D-CA.7). He and other members of Congress are also concerned that the pandemic has worsened other diseases and health issues in Africa. The UN in October estimated there would be 200,000 excess deaths resulting from a lack of access to healthcare.

The witnesses were equally concerned. Dr. Nkengasong described immunization programs for – HIV, TB, and malaria – as “severely challenged”. As mothers have stopped seeking care out of fear of contracting Covid-19, maternal-child health care has declined. “Women are afraid to go to clinics,” he said. He added that on public health progress as a whole, “This is really going to set us back by so many years if we are not careful”.

Dr. Kaberuka recommends the U.S. increase financing for immunization programs as this would at the very least “protect some of the gains of the last eight years”. He also has ideas for how the U.S. can support the development of sustainable health care systems on the continent.

If domestic health sectors had more robust health financing systems, he argues, they would be less dependent on foreign aid that – as the beginning of the Covid-19 pandemic showed – is at risk of vanishing on a whim. The AU, in partnership with President Paul Kagame of Rwanda, has begun work on increasing domestic resources for health sectors, but African countries need more financing. Moreover, “strong primary health systems,” would better enable countries to manage health crises while providing routine care. The U.S. should then focus its investments on community health workers, technology, and community insurance.

In addition to Covid-19 vaccine access, healthcare infrastructure and effective immunization programs, Rep. Dean Phillips (D-MN.03) in particular was concerned about Africans’ faith in government and the role of disinformation in influencing views on vaccinations. He cited an Afrobarometer report that surveyed five countries in West Africa from October 2020 to January 2021. From the report he read, “3 in 10, or 31 percent of West Africans say they trust their governments just somewhat or a lot to ensure that vaccines are safe. 60 percent of respondents said they were unlikely to receive a vaccination even if the government says it is safe.”

Assuming this is the same report cited, the five countries surveyed were Benin, Liberia, Niger, Senegal and Togo. Dr. Nkengasong’s praise for Senegal and Liberia notwithstanding, the report says, “Mistrust is particularly high in Senegal (83 percent) and Liberia (78 percent), but it’s the majority view in the other three countries as well”. Afrobarometer also found that in Niger, Liberia, and Senegal, “people are far more likely to believe in prayer than in vaccines as an effective treatment against the coronavirus”.

Dr. Kaberuka retorted: “As your colleague Ilhan Omar was saying, this time around, actually, Africa has done much better than many parts of the world. We are doing things right, including built the trust of citizens in their government.” He said he agreed with Rep. Omar that wealthy countries could learn from Africa, that challenges of vaccine hesitancy and disinformation are global, and that some Africans’ responses to the pandemic are not particular to the continent.

Dr. Nkengasong followed, saying the Africa CDC had recently conducted a study – with the London School of Hygiene & Tropical Medicine no less – which covered 15 countries and had a sample size of over 15,000. The study found that faith in vaccines ranges from 60 percent (DRC) to 95 percent (Ethiopia). The study, conducted from August to December 2020 concluded that “(79% average) of respondents in Africa would take a COVID-19 vaccine if it were deemed safe and effective”.  

“Those numbers are much more promising than those I saw in the Afrobarometer survey,” concluded Rep. Phillips.

Food Insecurity

Kip E. Tom, former U.S. Ambassador to the United Nations Agency for Food and Agriculture, was entirely discouraging in his remarks to Congress – except when he mentioned he was a farmer for 45 years prior to his career in public service. Reps. Christopher Wallace (R-NJ.04),Young Kim (R-CA.39), and others questioned Ambassador Tom on food insecurity and the locust crisis in Africa. “Some have suggested that food insecurity will have a larger global impact than Covid-19,” said Rep. Kim.

Ambassador Tom said that the Covid-19 pandemic has indirectly caused 350 million people on the continent to struggle to afford food in part as food prices have risen to a six-year high. High food prices also inhibit the World Food Program to purchase and distribute food aid to the 270 million people it seeks to serve and the 30 million people it works to “keep alive”.

There is apparently a “widening gap” between humanitarian needs and the resources countries have allocated to address them; the WFP may need $5 billion in additional financing. Worse, some agriculture policies are not just ineffective, but also amount, in Ambassador Tom’s view, to “crimes against humanity”. He claimed the European Union’s promotion of its “EU Green Deal” and “Farm to Fork Initiative” in Africa as the EU’s “spreading propaganda”. He blames EU programs for a lack of agricultural advancement on the continent, prolonging the “food crisis in Africa”. He did not comment on any specific U.S. agricultural program.

Not only have African farmers been unable to increase crop yields, they have lacked the capacity to respond to climate change, pests, and other problems. Covid-19 prevention measures have disrupted livelihoods as they have prohibited farmers from accessing their fields. Farmers themselves are reportedly more at risk from contracting the virus because of in-person interactions.

Locusts have caused tens of millions people to become food insecure in Africa. Ambassador Tom recounted how the locusts had originated in South Asia before migrating to Yemen and the Horn of Africa, even reaching Uganda. He says pesticides and digital tracking technologies are needed in order to mitigate the locust’s impact though the problem “is very difficult to address”. If nothing is done, however, the rescue expenses could rise into the billions.

In a moment of serenity, he expressed his approval of FOA-Director Qu Dongyu of China’s work thus far.

He also said food insecurity could lead to increases in “Human trafficking, arms and illicit drug trade, and terrorist activities” – and violence.

Rep. Phillips had earlier shared that a significant number of his constituents were Ethiopian and asked what was being done to support the tens of thousands of refugees and whether they would have access to vaccines. Dr. Kaberuka said that the pandemic would not end if there remained “islands” of unvaccinated people.

He said that while there was an international convention on refugees, there was no such protocol for internally displaced persons (IDPs) for which there many times more in Africa. It is critical that those people also have access to basic materials and services – Financial transfers could help support this population.

Rep. Sara Jacobs (D-CA.53) asked if the Covid-19 pandemic has decreased migration between African countries, in particular from the Sahel to North Africa. Dr. Kaberuka emphasized that most African migration occurs within the continent and that certain countries bear the “burden” of migrants and refugees. He would however expect migration from Africa to Europe to have decreased due to travel restrictions and a less attractive economic environment there. Greater economic integration in Africa could also curb migration flows out of the continent. What’s good for Africa may be good for Europe after all.

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