A third wave of Covid-19 infections is well underway in Africa driven by the Delta variant, which is up to 60 per cent more transmissible than the Alpha variant. Cases are spiking across the continent, with the weekly average number of deaths doubling in the past month alone. This flood of new infections – the third-wave peak is expected to be higher than the first and second waves – poses a serious threat to the continent’s vulnerable health systems. With vaccination rates in Africa the lowest in the world (only 2.6 per cent of the population has received at least one dose and only 44 per cent of those inoculated have received their full course), most of the population remains at risk of contracting and passing on the highly infectious Delta variant.
This means that African policymakers cannot rely exclusively on vaccines to protect their populations from the third wave and are once more faced with the complexities of balancing lives and livelihoods.
An analysis of lockdown measures implemented globally during the initial wave of the pandemic points to their efficacy in slowing transmission.[1] The assessment indicates that the most effective non-pharmaceutical public-health measures in this approach are curfews and restrictions on places where people can gather; examples include the closure of shops, restaurants and schools, limiting gatherings of people and implementation of work from home policies. Countries such as South Africa and Uganda have recently imposed similar national restrictions.
The least-effective measures include policies to disinfect surfaces in public places and social distancing on public transport (possibly due to heightened public-risk awareness associated with commuting). Conversely, the most-effective public-health measures noted are some of the most invasive and economically severe too. Closing markets, businesses and schools, and limiting gatherings to the virtual world, constrain economic activity and are especially damaging or, altogether devastating, for people in lower-income households.
Estimates by the African Development Bank indicate that about 30 million Africans were pushed into extreme poverty in 2020 as a result of Covid-19, while 39 million could fall into extreme poverty this year. Those with low education rates, minimal assets and job insecurity (informal, temporary) are most affected. Considering this third wave, the economic impact on these communities could be even more dire than estimated.
While restrictive lockdowns might be effective in higher-income countries with stronger safety nets, they are much more likely to cost lives in lower-income nations because of higher poverty rates and reliance on informal sectors for work. This is why countries need to go back to the drawing board and learn from local experiences when it comes to the effectiveness of previous public-health measures as well as the associated impact on livelihoods in order to implement policies that are tailored to local contexts rather than taking sweeping measures nationwide.
Less-invasive measures, including government support for vulnerable populations and enhanced risk-communication strategies, have proven effective especially in the right settings. Policymakers must also factor in the likelihood of non-compliance because measures that restrict economic activity but do not reduce transmission are most harmful.
Policymakers should note that new variants could reduce the impact of certain public-health measures (as well as vaccine efficacy and therapeutics). Given this, the priority of governments must be to curb transmission and prevent new emerging variants that threaten to prolong the pandemic and economic hardship. To do so, policies must be implemented quickly based on lessons learned during the past year in terms of what works best in local contexts, thereby maximising compliance and minimising economic impact to save lives and livelihoods.
[1] https://www.nature.com/articles/s41562-020-01009-0