Updated December 22, 2021
Coronavirus Disease 2019 (COVID-19): Impact in Africa
In December 2021, the World Health Organization (WHO)
Vaccine Distribution and Access
warned of a “fourth wave” of COVID-19 cases across much
African countries have obtained far fewer COVID-19
of Africa, notably in southern Africa. This followed South
vaccine doses per capita than other world regions (see
Africa’s genomic identification and notification to
Figure 2) due to limited financial resources to obtain doses,
international health authorities of the new “Omicron”
delays in donor-pledged deliveries, mass procurement of
variant, first detected in Botswana. Public fatigue with
vaccines by wealthier countries, and supply chain
infection control measures, the Delta variant, and low
constraints. In addition, India, a major source of vaccine
vaccination rates helped drive earlier waves of cases in
production for developing countries, restricted vaccine
many African countries in 2021. Omicron’s rapid spread
exports for much of 2021 to meet domestic demand.
prompted countries around the world (including the United
Vaccine supplies have increased in recent months, but
States) to restrict travel from southern Africa, which
logistical challenges, shortages of syringes and other
African leaders decried as punitive and discriminatory.
commodities, and donations of nearly expired doses have
hindered vaccinations. Some African countries also have
Overall, confirmed cases and deaths in sub-Saharan Africa
faced significant vaccine hesitancy. In addition to the
(hereafter, “Africa”) have been lower than in other world
humanitarian toll of the virus in Africa, some experts assess
regions and concentrated in a few countries, with the
that the scale of unmet needs in the region may facilitate
majority in South Africa (Figure 1). As access to testing
virus mutations.
has been low in many countries, some health experts posit
that actual caseloads and mortality may be higher.
Among African countries with over a million people,
Figure 1. Total Confirmed Cases and Deaths in Africa
Botswana (47%), Lesotho (29%), Rwanda (28%), and
South Africa (26%) had fully vaccinated the largest share of
their populations as of mid-December, according to WHO
data. At the other end of the spectrum, fewer than 1% were
fully vaccinated in Burundi, the Democratic Republic of
Congo (DRC), and Chad, and fewer than 2% in Africa’s
largest country, Nigeria. Eritrea has not released data.
Figure 2. Global Vaccination Rates by Region

Source: CRS graphic based on WHO COVID-19 Dashboard data.
Impact. The pandemic has exacerbated health system
challenges in many African countries, infecting health
workers and disrupting routine health services, such as

childhood immunizations and malaria and tuberculosis
Source: CRS graphic based on WHO COVID-19 Dashboard data.
treatment. Some infection prevention measures have been
Notes: Regions follow State Department definitions (with the
difficult to implement in areas such as crowded urban
addition of the United States to Western Hemisphere).
settlements, prisons, and humanitarian settings. Still, many
countries’ quick initial responses, youthful populations, and
African governments have secured COVID-19 vaccine
doses via the multilateral COVAX initiative, direct
other factors may have averted worse scenarios to date.
purchases, and bilateral donations. The United States has
The pandemic’s economic impact in Africa has been
donated the largest number of doses to African countries of
severe. It initially caused a drop in global demand and
any government, followed by China. The World Bank and
prices for African natural resource exports (especially oil
Afreximbank (a regional trade financing institution) have
and some minerals), disrupted trade and tourism, stemmed
financed pooled purchases by the African Union (AU).
remittances from African workers abroad, and prompted
In late 2021, amid ongoing challenges with vaccine supply
local lockdown measures. Some African economies began
chains, COVAX reduced its COVID-19 vaccine provision
to rebound in 2021, but the region is recovering more
target for Africa for 2021 from 600 million doses to 470
slowly than others due, in part, to African governments’
million. In November, the AU and COVAX assailed “the
limited stimulus resources. The effects of increased
majority” of vaccine donations to Africa to date as having
poverty, food insecurity, and school closures (often without
virtual options) are likely to endure.
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Coronavirus Disease 2019 (COVID-19): Impact in Africa
been “ad hoc, provided with little notice and short shelf
support for international financial institutions, which have
lives,” significantly complicating vaccination efforts.
provided billions of dollars in emergency lending to African
African Government Responses to COVID-19
countries in response to COVID-19. The Departments of
State and Defense, and the U.S. Centers for Disease Control
Public Health Responses. The AU’s Africa Centres for
and Prevention, also have supported COVID-19 responses
Disease Control and Prevention (Africa CDC, founded in
in Africa. More broadly, some 75% of U.S. nonemergency
2015 with U.S. and Chinese support) has helped build
African countries’
bilateral aid for Africa generally supports health programs,
capacity to detect and respond to
primarily focused on countering HIV/AIDS.
COVID-19. The Africa CDC also helped launch the
nonprofit Africa Medical Supplies Platform and African
Vaccines. The United States has donated vaccines from its
Vaccine Acquisition Trust (AVAT) to support pooled
domestic stocks and purchased additional doses to donate to
purchases of medical supplies and vaccines.
African countries, in coordination with COVAX and the
AU. As of mid-December 2021, the United States had
Many African governments quickly ramped up COVID-19
provided over 97.7 million vaccine doses to 43 African
surveillance and control measures in early 2020, drawing
countries. In October 2021, the Administration stated that it
on lessons from managing other disease outbreaks. Many
would enable the AU to procure 33 million Moderna
countries began to loosen restrictions on travel, schools, and
vaccine doses by deferring U.S. delivery.
businesses in mid-2020, but some later reimposed them (in
several cases repeatedly) in response to case spikes.
The Administration has committed to support vaccine
manufacturing in Africa, although intellectual property
Several countries have pursued innovative pandemic
rights protections and limited local manufacturing capacity
responses. Senegalese institutions, for instance, developed
have hindered progress. The U.S. International
an inexpensive rapid COVID-19 test kit. Rwanda and
Development Finance Corporation (DFC) is helping finance
Ghana are using drones to deliver medical supplies to rural
vaccine production by firms in South Africa and Senegal.
areas, and Rwanda has used robots to take patient vital
These deals involve “fill-and-finish” operations, in which
signs in clinics. South African cell phone firms supported
vaccine components manufactured abroad are compounded
the creation of a telemedicine system. South African
and the finished vaccines—or, alternately, vaccines fully
researchers are now working to develop their own vaccine,
manufactured abroad—are then packaged and shipped to
backed by the South African government and donors.
recipients. The Administration supports the concept of a
Economic Responses. Most African governments
temporary waiver of the 1995 World Trade Organization
reallocated budget resources, instituted economic stimulus
Agreement on Trade-Related Aspects of Intellectual
measures, and/or provided targeted aid to vulnerable
Property Rights (TRIPS) for COVID-19 vaccines, in part to
citizens in response to the pandemic. The International
facilitate production in Africa. (See CRS In Focus IF11858,
Monetary Fund (IMF) and G20 creditor nations, among
Potential WTO TRIPS Waiver and COVID-19.)
others, supported these actions through concessional loans
Outlook and Issues for Congress
and debt service deferments. This aided health and stimulus
The pandemic has adversely affected long-standing U.S.
measures but raised debt sustainability concerns. At least 12
policy goals in Africa, including support for health and food
African countries reportedly have debt totaling more than
security, poverty alleviation, regional stability, trade,
70% of their respective GDP, raising sustainability
democracy, and good governance. COVID-19 also has
concerns. Zambia defaulted on its debt repayments in 2020.
complicated U.S. aid programs, military cooperation,
Governance Implications. Economic hardships and anger
commercial access, and oversight of U.S. programs. China
at restrictions fueled unrest in some countries in 2021 (e.g.,
and Russia, meanwhile, have sought to leverage the
Senegal) and arguably provided a pretext for crackdowns
pandemic to bolster their influence in Africa. The U.S.
by some states. Ethiopia postponed elections in 2020, while
decision in November 2021 to single out eight African
infection fears may have lowered turnout in others that
countries for a travel ban in response to the Omicron variant
proceeded as scheduled. The pandemic has imposed new
arguably strained diplomatic relations, although other
challenges on governments already facing political
countries imposed similar restrictions.
tensions, insurgencies, and other threats. Some African
African leaders have called for greater equity in access to
leaders have invoked emergency powers to respond to
vaccines and therapeutics, as well as economic aid; WHO
COVID-19, and state security forces in some countries have
Director Dr. Tedros Ghebreyesus has decried “vaccine
been accused of human rights abuses while enforcing
apartheid.” Some Members of Congress argue that more
lockdown measures. Officials in multiple countries (e.g.,
can be done to support vaccine donations and local
Cameroon, DRC, Kenya, Uganda, South Africa, and
production, including technology transfers. Others seek to
Zimbabwe) have been accused of corruption and misuse of
focus U.S. efforts on domestic pandemic challenges and/or
public health funds. Top state and opposition leaders in
note that the United States has donated more vaccine doses
several countries have reportedly died of COVID-19.
than any other country. Some Members may wish to assess
U.S. Responses
the efficacy and scope of U.S. vaccine donations, and other
Foreign Assistance. The U.S. Agency for International
U.S. efforts to counter the pandemic, including in the
Development (USAID) has allocated over $1.57 billion in
context of appropriations or other legislative proposals.
COVID-19-focused aid for Africa, in addition to vaccine
and ventilator donations. USAID also has invested in health
Alexis Arieff, Coordinator, Specialist in African Affairs
system strengthening in support of vaccine administration
Lauren Ploch Blanchard, Specialist in African Affairs
and other capacities. The above figure does not include U.S.
Nicolas Cook, Specialist in African Affairs
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Coronavirus Disease 2019 (COVID-19): Impact in Africa

IF11532
Tomás F. Husted, Analyst in African Affairs


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https://crsreports.congress.gov | IF11532 · VERSION 11 · UPDATED

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