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Covid-19Society
Home›Covid-19›One size fits all? Why lockdowns might not be Africa’s best bet.

One size fits all? Why lockdowns might not be Africa’s best bet.

By James Fairhead & Melissa Leach
April 22, 2020
4339
11
africa lockdowns Young people are statistically highly unlikely to get severe symptoms from COVID-19. They make up a much higher proportion of populations in Africaa than Europe, North America or Asia.

If Uganda was 100 people, just two would be over 65. Over two-thirds would be under 25. Are costly lockdowns always the best option?

Young people are statistically highly unlikely to get severe symptoms from COVID-19. They make up a much higher proportion of populations in Africaa than Europe, North America or Asia.

Young people are statistically highly unlikely to get severe symptoms from COVID-19 and make up a much higher proportion of populations in Africa than Europe, North America or Asia. Credit: Rod Waddington

Read all our COVID-19 coverage 

As cases of the coronavirus increased in Wuhan this January, China took the then drastic step of imposing a lockdown. In a country where over 23% of the population is over 55, the government introduced severe restrictions to mitigate the spread of the disease and avoid overwhelming the health system. As the disease spread to other parts of the world, the likes of Japan, Europe and the US – all of which have even older populations than China’s – employed the same strategy.

Many governments in Africa have also imposed lockdowns to deal with the pandemic. Yet these countries have radically different age demographics to those in Asia and Europe. Take two extremes. In Japan, 40% of people are over 55, and 28% are over 65. In Uganda, the equivalent figures are 5% and 2%. In Japan, 13% of the population is made of up children under 14. In Uganda, this figure is 48%.

These different age demographics are very important. Mortality rates for coronavirus start to increase for people aged 55 and higher. Meanwhile, young people are statistically highly unlikely to suffer severe symptoms. This means that in countries with a lower proportion of old people, the relative benefits of lockdown are more limited and are more likely to be outweighed by the downsides.

africa lockdowns Uganda vs Japan age demographics

africa lockdowns Italy vs Congo-Kinshsa age demographics

africa lockdowns UK vs Sierra Leone age demographics

Selected Country Age Profiles. Data from CIA World Factbook. Graphics used with kind permission from indexmundi.

In many countries in Africa, these downsides are particularly significant. Poor countries are much less able to cushion the potentially devastating economic impacts produced by lockdowns. This is if they are feasible in the first place. Effective lockdowns are near impossible in crowded low-income settlements that lack taps and sewers.

Part of the lockdown strategy is also to “protect the health system” by “flattening the curve” and reserving resources for coronavirus cases. This approach not only has more marginal benefits when populations are young and there is a less of a system to protect, but it also diverts attention from addressing health that are dangerous to much of the population, such as malaria, measles and complications in childbirth.

It might be argued that poorer countries with less effective health systems will have a higher burden of underlying health conditions, thus increasing vulnerability to COVID-19. However, the pre-existing health problems most closely related to getting severe symptoms from coronavirus tend to be associated with age. Current evidence from Spain, for example, suggests that people living with HIV are not at increased risk of acquiring COVID-19 or developing severe symptoms. In fact, the opposite may be the case.

This is not to say that there are not susceptible groups in Africa. Though they make up less of overall populations, there are still many older people in African countries. Meanwhile, there may be significant numbers of people who are more vulnerable to COVID-19 due to more widespread diseases of poverty such as TB, though this is not certain.

Nonetheless, the best policies for countries with young populations may not be lockdowns. There may be better ways to save lives such as physically shielding and supporting the most vulnerable while allowing the wider population to gain immunity, whether through a vaccine when it arrives or by virtue of enough people catching and recovering from the virus itself.

Shielding the vulnerable could involve a mix of physical isolation, restrictions on their movement, and focused care, eventually by those who have recovered from the virus. These measures will work best when based on local innovations appropriate to particular social contexts and designed with input from those involved. These could build on practices of respect for the elderly and community organising in many African settings.

Countries – and even regions within them – vary enormously in terms of age profiles, health systems, living conditions, economic resilience, and much more. In some places, including in Africa, lockdowns may be the best policy on balance. In other areas, including even in the likes of Europe and America, there may be more appropriate alternatives to lockdown. It is unlikely, however, that a one-size-fits-all approach serves everyone’s interests equally.

Today, some version of the lockdown has become most countries’ response to the COVID-19 pandemic. In years to come, we may look back on this moment as one in which an ideological practice emanating from older and wealthier countries was misguidedly “copy and pasted” by elites in younger and poorer societies, leading to marginal benefits in tackling the coronavirus but with the effect of increasing poverty and mortality among the poor.

Read a response to this piece: COVID-19 responses in Africa: Ok, one size doesn’t fit all. Now what?


 

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James Fairhead & Melissa Leach

James Fairhead is an environmental and medical anthropologist at the University of Sussex. Melissa Leach is the Director of the Institute of Development Studies, leader of the Pandemic Preparedness in Africa project, and member of the WHO's R & D Blueprint Social Science Expert Group.

11 comments

  1. Peter Awanrin 23 April, 2020 at 20:16

    Hi. I just read one of your article – “One size fits all: …”. I like it for it’s simple logic, but also because it is somewhat similar to what I am working on, entitled – “Africa R.I.P. – signed The US, China and WHO”. In the main, the paper looks at African effort at welcoming the Covid-19, focusing on putting things in place to combat the virus, but when it has already spread. For instance, a little over a month ago, the President of Nigeria announced effort to sources for $7.6 or so from the outside to fight the virus! Funny because the govt has always insisted it has a robust foreign reserve, which would have made sense to start from there – without interest. Then, what does the govt intend to do with the money? Like most African States – to buy medics from CHINA; to PREPARE for the fight against the virus. Note: Not to fight the virus, but to prepare. The role of China, and the United States in the unfolding tragedy is somewhat. Start with the WUHAN connexion. And the fact that Americans are dying in their thousands in peacetime; and Trump’s eyes are not red yet?
    That China is responsible for the present calamity is evident – res ipsa loqutur. The United States is also responsible for a number of reasons, especially its lacklustre attitude thus far. The WHO is the conduit for achieve the liquidation of Africa.
    The paper is controversial; but in the end, what I bet to the best way to STOP this coming doom is recommended – LOCKDOWN – but in a particularly way. Someday, Africa will fall prey to the gimmicks of the Neocolonialists, probably for good, but not through this cheap way.
    For now, thanks, then many more thanks, if may paper is required for assessment.

    P.A. Awanrin
    Benin City, Nigeria.

  2. Grace Atuhaire 23 April, 2020 at 21:39

    I think James could be wrong among all options for countries in Africa lock down, seems to me the most cost effective method. We cannot afford to mask, the lifestyle of People in Uganda is not as adaptive to such changes.
    In societies where most people have not much reasoning of whats best from them. A tough hand as lock down remains the most effective way. We cant be liberal with COVID 19 and survive. My concern is Uganda being landlocked and its neighbouring countries still growing cases, how effective will this lock down be once we open up free but our neighbourhood still affected?
    Im a proud Ugandan myself.

  3. Nke 24 April, 2020 at 18:46

    Disappointed to see a copy and paste approach challenged one hand and herd immunity suggested on the other. Many experts have spoken against this strategy for Covid without a vaccine at hand and countries like Sweden and here the UK have already shown this has many fatalities.

  4. Jennifer 24 April, 2020 at 20:22

    I think these are good points, but the public information needs to be very careful about who COVID impacts lest it makes the wrong people relax. Need to be particularly concerned about those immune-compromised with cancer, who also may not be able to get voluntary but potentially helpful treatments when systems are slammed. Also those with diabetes not more likely to get the virus, but more likely to have serious complications or a worse outcome. Both very prevalent in that region. Yet in our country (USA), young people are relaxing TOO much despite all this shared in the news, then surprised about losing their peers…

  5. Moses Ojirot 24 April, 2020 at 23:12

    Contrary to the article, I think lockdowns are the best option for Africa bcoz they slow down the rate of spread of the virus. This gives govts an opportunity to “improve” their health systems thru acquisition of more testing kits and equipment like ventilators among others. Of course lock-downs come at a cost. In Uganda this has yielded results so far. However, with neighbouring Countries like Kenya, Rwanda, South Sudan who don’t seem to be committed to enforcing lock-downs, Tanzania hasn’t locked down, I am afraid Uganda may just pay the price for being near unserious govts.

  6. Getachew Minas 28 April, 2020 at 13:46

    Lockdown is not fit for poor countries whose people depend on daily labor for survival. As a result the poor people could not save money for the rainy days. As they become unemployed for a day, they definitely starve. COVID19 is a total disaster for these poor people. They have neither unemployment benefit nor pension. With or without COVID, they are damned to suffer. Better to ear & die!

  7. TRIUMPH 1 May, 2020 at 20:55

    Not totally true, lockdown would eventually ease this prostrating covid 19 virus in africa so as to reduce the community transmission but, africa govt i think dont pay unemployed citizens so maybe this virus just want to show the ugliness of corruption in africa

  8. mertens 1 May, 2020 at 20:57

    Not totally true, lockdown would eventually ease this prostrating covid 19 virus in africa so as to reduce the community transmission but, africa govt i think dont pay unemployed citizens so maybe this virus just want to show the ugliness of corruption in africa

  9. SIMON OKELLO 4 May, 2020 at 10:06

    I Think James Is Right, this Lockdown In Africa Is Like you Are In A War But Just Hiding From Your enemy That Will Keep Looking For You. So The Only Solution Is To Let The People Naturally get Immune From The Disease. Tanzania Is Doing Great. Lock Down Is Not The Solution For Corona Virus But being Responsible For The Economy Of Our Country

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