Despite data showing the coronavirus is widespread across Africa, Covid-19 hospitalization and death rates seem to be relatively low across the continent, Stephanie Nolen writes for the New York Times—leading some experts to question whether the African Union's current push to increase Covid-19 vaccination rates is the best use of health resources.

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How Covid-19 has impacted Africa

In the early days of the pandemic, there was concern that the coronavirus would decimate Africa, particularly in countries with weak health systems. However, in many areas of the continent, particularly in West and Central Africa, the coronavirus has had "comparatively minimal impact," Nolen writes—even as data shows that the virus has spread widely.

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According to studies that tested blood samples, around two-thirds of the population in most sub-Saharan countries have antibodies against the coronavirus. These antibodies are largely from infection rather than vaccination, since only 14% of the African population has received any kind of Covid-19 vaccine.

Similarly, a new analysis from the World Health Organization, which has not yet been peer reviewed, examined surveys across the continent and found that 65% of Africans had been infected by the coronavirus by the third quarter of 2021—much higher than infection rates in other parts of the world.

In addition, despite the prevalence of the coronavirus across the continent, many African countries have reported relatively low Covid-19 hospitalization and death rates. For example, research from Njala University has found that 78% of Sierra Leone's 8 million people have antibodies against the coronavirus, but only 125 deaths from Covid-19 have been reported since the beginning of the pandemic.

Why are Africa's Covid-19 death rates so low?

Some have speculated that Africans' lower median age, and therefore better relative health, as well as high temperatures, outdoor lifestyles, and low population density have kept death rates low.

Other researchers suggest that Africa's low Covid-19 death rates overall may be due to limited or nonexistent surveillance and registration systems in many countries. According to a recent survey by the United Nations Economic Commission for Africa, official registration systems often only capture one in three deaths since many people die at home instead of hospitals.

South Africa is the only sub-Saharan country that reliably tracks the number of deaths among its population, and excess mortality data shows that between May 2020 and September 2021, around 250,000 more people died from natural causes than was predicted for that time period, likely due to Covid-19. 

The Economist, which has been tracking excess deaths throughout the pandemic, has found excess death rates similar to South Africa's across the continent as a whole. Sondre Solstad, who runs the Africa model, said there have been between 1 million and 2.9 million excess deaths on the continent throughout the pandemic.

"It would be beautiful if Africans were spared, but they aren't," he said.

Separately, Lawrence Mwananyanda, an epidemiologist from Boston University and a special adviser to the president of Zambia, agreed, saying that Covid-19 death rates in Zambia were likely similar to those in South Africa, but had gone unreported due to a "much weaker registration system," Nolen writes.

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"If that is happening in South Africa, why should it be different here?" Mwananyanda said. In fact, a research team he led found that 87% of bodies in hospital morgues during Zambia's delta surge had Covid-19. "The morgue was full. Nothing else is different—what is different is that we just have very poor data," he said.

However, other scientists who have been tracking the pandemic on the ground in Africa disagree, saying that hundreds of thousands or millions of Covid-19 deaths would not have gone unnoticed even if they weren't officially reported.

"A death in Africa never goes unrecorded, as much as we are poor at record-keeping," said Abdhalah Ziraba, an epidemiologist at the African Population and Health Research Center in Kenya. "There is a funeral, an announcement: A burial is never done within a week because it is a big event. For someone sitting in New York hypothesizing that they were unrecorded—well, we may not have the accurate numbers, but the perception is palpable. In the media, in your social circle, you know if there are deaths."

Austin Demby, an epidemiologist and Sierra Leone's health minister, agreed. "We haven't had overflowing hospitals," he said. "We haven't. There is no evidence that excess deaths are occurring."

Is Covid-19 vaccination the best use of resources in Africa?

According to Nolen, the African Union has made it a goal to vaccinate 70% of Africans against Covid-19 by the end of 2022, but some health experts are now questioning whether doing so would be the best use of resources, particularly since other pathogens, such as malaria, remain a larger problem for many countries.

"Is [getting 70% of the African population vaccinated against Covid-19] the most important thing to carry out in countries where there are much bigger problems with malaria, with polio, with measles, with cholera, with meningitis, with malnutrition? Is this what we want to spend our resources on in those countries?" asked John Johnson, a vaccination advisor for Doctors Without Borders. "Because at this point, it's not for those people: It's to try to prevent new variants."

Instead of a broad immunization campaign, Johnson suggested that a more targeted campaign that focuses on protecting those who are most vulnerable would be a better use of resources in many African countries.

However, other experts warned that the coronavirus is still unpredictable and scaling back vaccination efforts in sub-Saharan African countries "could yet lead to tragedy," Nolen writes.

According to Prabhat Jha, who heads the Centre for Global Health Research in Toronto, if a new variant that is infectious as omicron and more lethal than delta emerges, many Africans will be vulnerable to severe illness and death unless vaccination rates increase significantly.

"We should really avoid the hubris that all Africa is safe [from Covid-19]," Jha said. (Nolen, New York Times, 3/23)