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May 4, 2020
Coronavirus Disease 2019 (COVID-19): Impact in Africa
As Congress considers the global impact of COVID-19,
some Members may examine the implications for sub-
Saharan Africa (Africa). Most Africanhealth systems
struggle with low capacity, trailing world averages in per
capita numbers of doctors, ventilators, oxygen cylinders,
and hospitalbeds. Although les sons frompastpandemics
(e.g., recent Ebola outbreaks) led some countries to quickly
ramp up disease surveillance and behavior change
campaigns, overall state capacity tends to be low.
Countries with high rates ofhealth conditions that can
compromise immune systems-such as HIV/AIDS,
tuberculosis, diabetes, and malnutrition-may face
particular challenges in curbing COVID- 19 morbidity and
mortality, notwithstanding Africa's youthfulpopulations.
Measures such as physical distancing and frequent
handwashing may not be viable for those without access to
clean water and sanitation, or living in crowded conditions
such as informal urban settlements, prisons, or camps and
other settings for displaced persons. As of 2019, more than
24 million Africans were displaced byconflicts and
disasters, and Africa hosted 26% of the world's refugees,
according to U.N. figures. Efforts to counter other diseases,
including polio and measles vaccinations and anti-malaria
campaigns, havebeen disrupted due to COVID- 19 control.
The pandemic is severely affecting Africaneconomies.
Global prices for key commodity exports (e.g., oil, natural
gas, and certain minerals) havecratered. Job-rich sectors
such as transportation and tourismare largely suspended.
Informal workers have lost already meagerincomes due to
COVID- 19 controlmeasures. Globaltrade and supply chain
disruptions haveled to rising prices for basic goods. In
April, the International Monetary Fund (IMF) projected that
African economies would contract by 1.6% overall in 2020,
the most severe regionalrecession in decades. The World
Bank has estimated that23 million more Africans may fall
into extreme poverty dueto the pandemic.
The World Food Program(WFP) warned in Marchthat
diminished localpurchasing power, spikes in global food
prices due to export restrictions and speculation, and supply
chain disruptions could cause dire hardships in Africa. Food
insecurity was already extensive as of early 2020, including
in conflict-affected areas of the Sahel and East Africa
(which is also facing locust infestations), andin drought-
afflicted parts of Southern Africa.
African governments have imposed a range ofrestrictions
on population movements and activities. Mosthave banned
large gatherings and closed schools, places of worship,
and/or local markets. Nearly all countries have restricted
international travel and border crossings. Some have
restricted internal travel and/or access to areas with large
caseloads (e.g., Burkina Faso, Niger, Kenya, Democratic
Republic of Congo). Severalhave imposed curfews.
Many African heads of state haveinvoked emergency
powers, including, in a few cases, the authority to is sue
legislative decrees (e.g., Senegal, where parliament
endorsed the move). State security forces have injured or
killed civilians while enforcing lockdowns in some
countries (e.g., Kenya, Nigeria, and Uganda). Control
efforts haveresultedin restricted media access, and some
crackdowns onCOVID-19 fake news have raised
concerns frompres s freedomadvocates (e.g., Ethiopia,
Somalia, Uganda). Residents have reacted violently to
lockdowns or the placement of treatment centers in some
countries (e.g., Niger, C6te d'Jvoire, South Africa). Such
dynamics may deepen the challenge of ensuring compliance
with health measures, and could spur future unrest.
Most African governments have allocated newbudget
resources for their health systems. Senegalis developing an
innovative cheap and rapid COVID-19 test kit. Many
governments have pledged taxrelief and/or targeted
financial or food aid for theirpoorestor most vulnerable
citizens (e.g., Kenya, Rwanda, Senegal, South Africa),
some of which are supported by U.N. agencies, local firms
and civic organizations, and diaspora groups. Some
countries have imposed trade restrictions in response to the
pandemic (e.g., a ban on fuel exports fromAngola).
Governments have also cut top officials' salaries (e.g., in
Kenya, Malawi, Rwanda, South Africa).
Nonetheless, many African governments lack sufficient
domestic resources to import medicalequipment, cushion
localeconomies, andbuild up food stocks. Priorto the
COVID-19 crisis, many African governments were already
reliant on donor aid for budget s upport and/or funding for
infrastructure, health, and educationprojects. African
leaders have appealed for international aid and debt relief to
support health and economic responses to COVID- 19.
Health Aid For more than a decade, about 70% of U.S.
annualbilateral aid for Africa-about $5.3 billion in
FY2019-has supported health programs, primarily focused
on HIV/AIDS (Fig. 1, below). The State Department and
U.S. Agency for International Development (USAID)
administer these funds, and themajority of U.S. global
health as sistance generally. Other federal entities such as
the U.S. Centers for Disease Control and Prevention (CDC)
also support related efforts, as wellas U.S. emergency
responses to globaldisease outbreaks andpandemics.
The United States has committed more than $100
billion over the past 20 years to support public health
on the African continent-by farthe largest donor
nation. [...] And those investments.., have built the
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