Coronavirus Disease 2019 (COVID-19): Impact in Africa

Coronavirus Disease 2019 (COVID-19): Impact in Africa

Updated April 11, 2022
Coronavirus Disease 2019 (COVID-19): Impact in Africa
As of April 2022, most countries in sub-Saharan Africa
measures. Most African economies began to recover in
(“Africa”) had emerged from a fourth COVID-19 wave—
2021, buoyed in some cases by rising commodity prices,
primarily driven by the Omicron variant, first detected in
but growth rates appear unlikely to reverse increases in
Botswana in late 2021—and were reporting relatively low
poverty and debt. The regional outlook remains uncertain.
caseloads. Citing these trends and increased treatment
Vaccination Efforts
capacity in many countries, World Health Organization
Africa has the lowest average vaccination rate of any world
(WHO) officials have expressed optimism that Africa “can
control the pandemic in 2022.”
region (Figure 2). In at least 11 African countries
Officials caution, however,
(including large countries such as Nigeria and the
that low vaccination rates may increase Africans’
Democratic Republic of Congo [DRC]), fewer than 10% of
vulnerability to future surges and could enable new variants
the population had received at least one dose as of mid-
to emerge. Stating that logistical constraints and vaccine
April 2022. Botswana and Rwanda, along with small island
hesitancy—versus raw supply—were now the foremost
states, lead the region in vaccinations, with over 60% of
obstacles to vaccination efforts, Africa Centres for Disease
their populations having received at least one dose.
Control (Africa CDC) Director Dr. John Nkengasong called
for a pause in new vaccine deliveries in February 2022.
Figure 2. Global Vaccination Rates by Region
Overall, Africa has seen fewer confirmed cases and deaths
per capita than other regions. Cases have been concentrated
in a few countries, led by South Africa (Figure 1), where
testing rates have also been higher. Studies suggest that
cases, and to a lesser extent mortality, have been
undercounted in much of Africa; demographic and other
factors may have limited the virus’ toll. Ongoing research
seeks to assess COVID-19 comorbidity with diseases such
as HIV/AIDS, tuberculosis, and malaria.
Figure 1. Total Confirmed Cases and Deaths in Africa

Source: CRS graphic based on WHO COVID-19 Dashboard data.
Notes: Regions follow State Department definitions.
African governments have obtained COVID-19 vaccines
via the multilateral COVAX initiative, direct purchases, and
bilateral donations. The United States is the largest country
donor of vaccines (see below) and has coordinated its
vaccine deliveries with COVAX and the African Union
(AU). The World Bank and Afreximbank, a regional trade
financing institution, have financed AU pooled purchases.
A shortage of vaccine doses was nonetheless a key obstacle
until recently. African countries, on average among the

world’s poorest, generally lack vaccine production capacity
Source: CRS graphic based on WHO COVID-19 Dashboard data.
and were unable to compete with wealthier countries to
procure doses for much of 2021. A temporary vaccine
Impact. COVID-19 has exacerbated health system
export ban in India (a major COVAX supplier), delays in
challenges in many African countries, disrupting routine
donor-pledged deliveries, donations of nearly expired
immunizations, diagnosis and treatment of other diseases,
doses, and global supply chain constraints posed further
maternal and child healthcare, and other health services.
challenges. Several countries (notably South Africa,
The pandemic has intensified food insecurity (especially in
Senegal, and Rwanda) are seeking to manufacture vaccines
areas with conflicts or natural disasters) and prompted long
locally, but intellectual property rights protections and
school closures without virtual options in some countries.
limited capacity have posed challenges. Some vaccine
The initial economic impact in Africa was severe and
production efforts are expected to take years to bear fruit.
pushed tens of millions more people into extreme poverty,
Even as vaccine deliveries have accelerated in 2022, many
according to the World Bank. The pandemic cratered global
African countries face constraints in distributing and
demand and prices for Africa’s oil and mineral exports,
administering shots at a mass scale. Key challenges include
disrupted trade and tourism, stemmed remittances from
ensuring sufficient trained health workers and supplies,
African workers abroad, and prompted local lockdown
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Coronavirus Disease 2019 (COVID-19): Impact in Africa
maintaining vaccines at cold temperatures, and overcoming
counter COVID-19 and mitigate its social and economic
local vaccine hesitancy.
impacts. The Department of Defense and U.S. Centers for
African Government Responses to COVID-19
Disease Control and Prevention (CDC) also have supported
COVID-19 response efforts in Africa. Implementers have
Public Health Responses. Many African governments
leveraged long-running U.S. health programs in Africa;
quickly ramped up COVID-19 surveillance and control
about 75% of U.S. bilateral aid to Africa typically supports
measures in early 2020, drawing on lessons from managing
health activities, primarily focused on HIV/AIDS.
prior outbreaks of other infectious diseases. A few
governments nonetheless minimized or denied the risk of
Vaccines. The United States has donated vaccines from its
COVID-19 at times. Starting in mid-2020, many countries
domestic stocks and purchased doses to give to African
loosened restrictions on travel, schools, and businesses, but
countries. As of mid-April 2022, the United States had
some later re-imposed restrictions during case spikes.
provided over 147 million vaccine doses to 44 African
countries, in coordination with COVAX and the AU. In late
The AU’s Africa CDC, founded in 2015 with U.S. and
2021, USAID launched Global VAX, an effort to accelerate
Chinese support, has expanded African states’ capacity to
global vaccinations, with an initial focus on Africa.
detect and respond to COVID-19. It also helped launch the
nonprofit Africa Medical Supplies Platform and African
The U.S. International Development Finance Corporation
Vaccine Acquisition Trust to support pooled purchases of
(DFC) is helping finance vaccine production by firms in
medical supplies, vaccines, and therapeutics.
South Africa and Senegal. These deals involve “fill-and-
finish” operations, in which vaccine components
Several countries have pursued innovative pandemic
responses. Senegal’s Pasteur
manufactured abroad are compounded and the finished
Institute, for instance, is
vaccines—or, alternately, vaccines fully manufactured
partnering with other institutions to produce an inexpensive
abroad—are then packaged and shipped to recipients. The
rapid COVID-19 test. Rwanda and Ghana have used drones
Administration supports the concept of a temporary waiver
to deliver medical supplies to rural areas, and Rwanda has
of the 1995 World Trade Organization Agreement on
used robots to take patient vital signs in clinics. South
Trade-Related Aspects of Intellectual Property Rights
African cell phone firms supported new telemedicine tools
(TRIPS) for COVID-19 vaccines, in part to facilitate
to reduce COVID-19’s burden on the healthcare system.
production in Africa. (See CRS Insight IN11901,
South African researchers are working to develop their own
Breakthrough on a Potential COVID-19 Intellectual
mRNA vaccine, with WHO backing.
Property Rights Waiver.)
Economic Responses. Limited fiscal resources constrained
many African governments’ capacity to cushion COVID-
Outlook and Issues for Congress
19’s economic shocks through stimulus measures and aid to
The pandemic has adversely affected longstanding U.S.
vulnerable citizens. According to the World Bank, “budget
policy goals in Africa, including efforts to promote health,
support to people and firms” in Africa during the pandemic
food security, poverty alleviation, regional stability,
amounted to less than 3% of regional GDP as of late 2021,
education, and good governance. COVID-19 has
compared to an estimated 17% in advanced economies. The
complicated U.S. aid implementation, military cooperation,
International Monetary Fund (IMF) and G20, among others,
commercial access, and oversight of U.S. programs. China
provided emergency concessional loans and debt service
and Russia, meanwhile, have sought to leverage the
deferments; some African countries also have turned to
pandemic to bolster their influence in Africa.
commercial markets for financing. In part as a result,
African leaders have called for greater equity in access to
sovereign debts have increased across the region,
vaccines and therapeutics, as well as economic aid; in 2021,
heightening debt sustainability concerns. Zambia defaulted
WHO Director Dr. Tedros Ghebreyesus decried “vaccine
on its debt repayments in 2020.
apartheid.” Members of Congress continue to debate the
Governance Challenges. COVID-19 has added to the
level of resources to provide for COVID-19 response and
challenges of states facing political tensions, insurgencies,
vaccination efforts—globally and in Africa—and what the
and other instability. Economic hardships and anger at
trade-offs might be for other U.S. budget, foreign aid, and
state-imposed restrictions have fueled unrest in some
policy priorities. Members may also weigh whether and
countries (e.g., Senegal in 2021), and several governments
how to alter existing U.S. foreign aid programs to address
have cited the pandemic as a pretext to crack down on free
challenges posed by COVID-19, including the pandemic’s
speech and assembly. Ethiopia postponed elections in 2020,
effects on health systems, food security, and poverty.
and infection fears may have lowered turnout in other
A U.S. ban on travel from eight African countries, imposed
elections that proceeded as scheduled (e.g., in Mali and
in late 2021 in response to the Omicron variant, strained
Guinea in 2020). Officials in several countries (including
relations and elicited criticism from some African officials
Cameroon, DRC, Kenya, Uganda, South Africa, and
and observers. The ban was lifted on December 31, 2021.
Zimbabwe) have been accused of corruption or misuse of
Looking ahead at the possibility of new variants emerging,
public health funds intended for COVID-19 response. Top
U.S. policymakers may examine the impact of travel
officials and opposition leaders in several countries have
restrictions on public health and diplomatic goals, including
allegedly died of COVID-19.
where these may conflict.
U.S. Responses
Foreign Assistance. As of late 2021, the State Department
Alexis Arieff, Coordinator, Specialist in African Affairs
and U.S. Agency for International Development (USAID)
Lauren Ploch Blanchard, Specialist in African Affairs
had provided $1.95 billion in aid to 48 African countries to
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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