Gray areas remain on our scientific knowledge of COVID-19 which continues to afflict a significant portion of the world’s population. The acute impact is clear. Risks of infection and deaths are highest in the more disadvantaged and vulnerable sectors of the population in higher income countries. In lower income settings, infection and death rates are not clear. It is possible that death rates are lower, given potential existence of cross-reacting protective antibodies or the overall younger average age of the general population. The economic effects are being felt world-wide, again with the greatest impact in countries without a social safety net. The medium and long-term implications of the pandemic will however most likely be disproportionately felt in lower resource settings, especially in terms of health and the fall out of job losses, loss of education and the disruption of many other health programmes (such as immunizations, tuberculosis, non-communicable disease acre etc).
With several months of hindsight now, that the anticipated health catastrophe in Africa has not yet materialized, although some prominent figures have died from COVID-19, and countries such as South Africa, Kenya and Ethiopia are dealing with a high number of infections. Corruption in the hardest hit countries such as South Africa and Kenya is exposing the ruthlessness of decision makers and their indifference to the health of the general population. Similar corruption may be occurring elsewhere but in more robust societies the impact may be less evident. The current outbreak is therefore still very concerning for Africa, albeit not for the same reasons as in higher income settings. The African CDC rallied early on, lockdowns were instituted early, and therefore Africa may even be considered to have acted more responsibly and in a timelier fashion than other countries. However, the fragility of the economies, health systems and governance structures leave individuals extremely vulnerable. African countries have also not been able to compete on the global market for fair pricing of personal protective equipment, medication and will likely be at the end of the line when it comes to accessing any vaccines.
When this virus began to spread around the world, there was a ‘paternalistic’ claim, which mostly reflects a broader Western perspective unfortunately relayed by some in Africa, that African countries may not recover from this pandemic, as it would impose something like a double penalty to already very broken African health care systems and weak economies. Based on that ‘paternalistic’ analysis, the ‘paternalistic’ solution was also quickly suggested: rich countries should quickly do something to help the very poor African countries who would never be able to manage a pandemic of such magnitude by their own; and many African States did not fail to ask for help right away.
However, by focusing on what we observe rather than on what we believe we know about the African context, we could have foreseen scenarios closer to reality that explained why the situation is less acutely shattering than expected, and should focus on the real health challenges posed by this pandemic for Africa, of which 2 stand out:
The first challenge is the fact that this pandemic is diverting attention from more prevalent and lethal conditions than COVID-19, such as malaria, HIV-AIDS, TB, maternal health and non-communicable diseases, which, combined, lead to many million deaths a year. It is not a question of competition between diseases, but simply of remaining aware of the local health challenges such that responses are adapted adequately in terms of public health policies. African countries should be responsible not to exacerbate spread of the virus within and beyond their borders, but this cannot be the only priority (imposed by the global community) when more or equally pressing other health problems also need urgent attention, to prevent loss of prior gains (e.g, Malaria, HIV, TB) or worsening of already suboptimal baseline outcomes (e.g. NCDs).
The second challenge is how much local African governments should take the human right to health of their own citizens seriously and develop sound and coherent national health care policies that make that human right effective. This pandemic, which has forced many countries to close their borders, has forced us to face the obvious reality, sometimes forgotten, that the fate of the health of each citizen depends first and foremost on their state, and that the national framework remains the place par excellence to make human rights like the right to health effective. The human right to health of each African should also be considered relative to the human right to health of all citizens of all countries. Global stewardship and solidarity is also necessary to permit governments to protect the human right to health of their citizens.
Being aware of the real challenges posed by this pandemic for Africa would prevent African states and governments from making as usual the copy-pasting of outward health strategies and would force them for once to develop sound public health policies that are adapted to African demography and contexts, serve the local needs and really protect the human right to health of African people.
This symposium expects to address these challenges and others as they relate to the protection of health as a human right in Africa.