Years of political and economic decay in countries like Zimbabwe promise COVID-19 devastation
By Paul Friesen and Chipo Dendere
While the total number of COVID-19 cases around the globe has reached one million, the majority of African countries have only reported a handful of cases —about 0.3% of the global total. The low report rate is actually worrisome because publicly available figures reflect not only incidence but testing ability and presume government transparency.
Sub-Saharan Africa may ultimately be among the hardest-hit regions of the world. Poor economic and political conditions combined with authoritarian governance have created the ideal conditions for a heartbreaking degree of devastation in countries like Zimbabwe.
One reason for the low case count across Sub-Saharan Africa is fewer international travelers compared to other world regions, insulating the region from the early stages of the pandemic. According to the World Bank, air travel to Sub-Saharan African countries represented just 1.5% of the world's total passenger air travel in 2018.
Tests are in scarce supply in most countries, particularly poorer countries with less developed medical systems. Burundi, which is currently reporting 0 cases of COVID-19, has also reported 0 tests to date. South Africa, the country with by far the highest number of reported cases, typically accounts for more than one-third of Africa's total air passenger travel—but also has the most robust testing capabilities.
Zimbabwe's current official case total is nine, with one death after just over 300 tests. But many observers are deeply skeptical that these numbers reflect reality and more likely, the government is either inadequately prepared for mass testing or willfully suppressing information. Public awareness campaigns have been limited, particularly in rural areas, and misinformation is exacerbated by the proliferation of fake news on social media.
Like the United States, Zimbabwe has not initiated a critical and timely response to monitoring, screening, and testing at-risk persons. Health experts have shown that in hardest-hit Italy and the United States, the virus spread silently for weeks due to delays in testing. In such scenarios, containment becomes increasingly unlikely.
Not enough attention is being paid to the probable devastating effects of the virus on poorer countries with ill-prepared governments. This situation is most evident in Zimbabwe, where experts are bracing for over half the population getting infected and more than a quarter of a million deaths.
One has only to look a decade back when deteriorating economic conditions and a weak healthcare infrastructure primed Zimbabwe for a series of deadly cholera outbreaks. In 2008, nearly 100,000 poor urbanites were infected by cholera, and over 4,000 died from the disease. This episode serves as a preview for how COVID-19 will impact Zimbabwe. However, the health infrastructure has deteriorated even further since then. Just days ago, health professionals went on strike, citing government unpreparedness for COVID-19. In the absence of extensive interventions, COVID-19 is likely to spread much wider and faster than previous viral outbreaks.
Furthermore, authoritarian regimes are more likely to control the flow of information to maintain an illusion of control. Government spokespersons have issued veiled threats on social media for anyone who claims to have witnessed a coronavirus case. Meanwhile, community member reports of pneumonia-like illness suggest the virus is rapidly spreading. Few Zimbabweans believe their government is being forthright about the pandemic.
Crowded living and working spaces are not conducive to social distancing or quarantining, and high population density in urban areas will accelerate the diffusion of the virus. High-density and slum areas in large cities such as Johannesburg, Kinshasa, Lagos, Nairobi, and Harare are powder-kegs. The Alexandra suburb of Johannesburg, for example, has a population density of 386,000 people per square mile. In these areas, containment will not be possible.
Making matters worse is the lack of clean water and sanitation. More than half of Africans must go outside of their compound to access water, and about a third go outside to use a toilet or latrine, according to Afrobarometer data. In Zimbabwe, water shortages are a severe problem. The majority of urban households are dependent on public water pumps that hundreds of others use and touch every day.
Zimbabwe's weak economy, food shortages, and lack of social safety nets will compound and exacerbate the looming health crisis. Estimates suggest that 86% of working-age Africans make ends meet in the informal sector, and virtually none of these workers can work from home. The choice between eating and social distancing is no choice at all.
If mass infections become a reality for countries like Zimbabwe, crucial health interventions, and the ability to save the lives of critically ill patients will be virtually nonexistent. The director of CDC Africa has raised serious concerns over the conditions of most African countries' health systems. To be adequately prepared for mass infections, African governments will need to spend tens of billions of dollars. Currently, it is estimated that there are only one to two intensive-care hospital beds per 100,000 Africans. (By contrast, in the US, that number is one to three thousand.) Ventilators, which may provide life-saving treatment, are nonexistent in countries such as Zimbabwe or Mali at one ventilator per million residents.
While the relative youthfulness of Zimbabwe's population may help to reduce the number of serious cases, the high prevalence of individuals living with immunocompromised conditions like HIV or tuberculosis puts a worryingly high proportion of the population at high-risk. There is also serious concern that transmission rates will accelerate as temperatures begin to cool across Southern Africa in the coming months.
There are no massive stimulus packages to be discussed for Zimbabweans, as the country is already heavily indebted to the IMF. Any social safety nets such as social security have been shredded by rampant inflation over the past year. The inflation-driven economic downturn has resulted in an estimated 90% of the population living in severe poverty. The average citizen cannot afford protective gear such as masks and hand sanitizers, which seem exorbitantly expensive at $5 and $2, respectively.
The Zimbabwean government has recently recognized the seriousness of the situation by ordering a 21-day lockdown starting on March 30. Like other authoritarian-leaning regimes (e.g., Uganda), clearing the street with military personnel is the only meaningful action to be taken by a government that cannot provide social safety nets and lacks the capacity for large-scale health interventions. While the coercive power of the state may momentarily slow the virus, keeping millions of poor people at home for three weeks will likely be ineffective in the long run. The move risks mass starvation, and will likely lead to a spike in violence.
Finance Minister Mthuli Ncube is sounding the alarm within Zimbabwe's government by pushing for a $2.1 billion fund to fight COVID-19. Sadly, the government is requesting that citizens and other "well-wishers donate the majority of the funds." Requesting that citizens fund their own emergency response strikes a deep irony in a country where corrupt leaders have stolen upwards of $15 billion from diamond mining operations over the past two decades.
We are encouraged by a recent effort led by leaders of France, Italy, Ethiopia, and South Africa to mobilize an emergency aid relief package from G-20 countries to African nations. Nevertheless, given that millions are likely to be infected across the continent and outbreaks anywhere in the world are a threat to all, a stronger response is still needed. We urge leaders and international organizations to immediately deploy resources to track and test potential COVID-19 cases, while also preparing for mass humanitarian and healthcare assistance.
Paul Friesen is a PhD candidate in political science at the University of Notre Dame and a PhD Fellow at the Kellogg Institute for International Studies focusing on regimes, parties, and elections in southern Africa.
Dr. Chipo Dendere is an Assistant Professor of Political Science in the Africana Studies Department at Wellesley College.