Beyond COVID-19: Diseases that Plague Africa

Amanda Betag,¹Research Fellow, African Political Economy Lab
abetag@africacfsp.org

COVID-19 has affected nations worldwide, and Africa has been no exception. However, the focus cannot be removed from other diseases that continue to plague millions of African citizens. Prevention and treatment programs for malaria, tuberculosis (TB), and HIV/AIDS have been severely affected due to the increased attention on fighting the pandemic, leaving these diseases the ability to run rampant. This article reviews recent research that estimates the total impact of the reduction in programs targeted at these other diseases.

Introduction

COVID-19 has been rapidly growing across Africa, becoming the biggest concern for the continent. However, there are still other diseases that plague Africa. COVID-19 has the potential to impede the treatment of other diseases by shifting resources away to focus on the pandemic, especially in low-income countries where resources are already limited. This article discusses the need for countries to continue to treat diseases other than COVID-19 present in the area. Most notably, malaria, tuberculosis (TB), and HIV/AIDS torment most African countries and create huge economic burdens in terms of foregone economic growth for these countries.

Malaria

According to the 2019 World Malaria Report, there were an estimated 228 million cases of malaria worldwide, with 93 percent, or 213 million, of these cases occurring in Africa in 2018.² This report also documented an estimated 405,000 deaths from malaria globally, with 94 percent of deaths occurring in Africa.³ Those who are at the greatest risk of dying from malaria are children under the age of five, who accounted for 67 percent of all malaria deaths worldwide.⁴

With COVID-19 as the primary focus of most countries’ health services, these figures are expected to increase significantly. The World Health Organization (WHO) analyzed nine scenarios which investigated the extent of the malaria epidemic’s disruption on a country’s health services. In the worst-case scenario, there would be no insecticide-treated net (ITN) campaigns and both continuous ITN distributions and access to effective antimalarial treatment were reduced by 75 percent. Depending on the scenario, the WHO estimates an additional 15 to 46 million additional cases of malaria in sub-Saharan Africa with an additional 50,000 to 318,000 deaths.⁵ Moreover, 70 percent of these deaths would be among children under the age of five.⁶ The complete estimates from this report are summarized below in Table 1.⁷

Table 1: Estimated Excess Cases and Deaths from Malaria in sub-Saharan Africa

Scenario	Excess Cases	Excess Deaths
Scenario 1	15,303,942	25,241
Scenario 2	17,574,789	29,081
Scenario 3	18,802,981	31,148
Scenario 4	8,857,461	101,460
Scenario 5	17,883,653	210,971
Scenario 6	27,059,774	328,748
Scenario 7	25,233,210	134,487
Scenario 8	35,809,832	253,724
Scenario 9	46,358,814	382,145

Source: World Health Organization (WHO), The. “The potential impact of health service disruptions on the burden of malaria: a modelling analysis for countries in sub-Saharan Africa.” World Health Organization, April 23, 2020.

It is also important to note that some countries would be more affected than others. For instance, not all countries are scheduled to have ITN campaigns, which typically occur every three years. Therefore, only countries that were due for ITN campaigns in 2020 would be affected by their cancellation. Additionally, the seasonality of malaria is different in every country, with peaks occurring at various times depending on the country or region. For example, malaria cases peak in February in Zambia, but do not peak until September in Niger. Therefore, countries that experience peaks during the height of COVID-19 will be at greater risk of higher cases and deaths from malaria. According to the WHO’s analysis, the countries expected to experience the greatest percentage increases in deaths from malaria under the worst-case scenario include Angola, Côte d’Ivoire, Gabon, Gambia, Ghana, Guinea-Bissau, Kenya, Liberia, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Togo, Uganda, the United Republic of Tanzania, Zambia, and Zimbabwe, all of which are predicted to have a 100 percent or greater increase in deaths in this scenario.⁸

Tuberculosis

In Africa, 2.5 million people were infected with tuberculosis (TB), accounting for a quarter of new TB cases worldwide, and an estimated 417,000 people died from the disease in 2016.⁹ Additionally, over 25 percent of TB deaths occur in Africa.¹⁰ Figure 1 depicts the estimated TB incidence rates in 2018 across the world and shows that many of the countries with the highest incidence rates are in sub-Saharan Africa.¹¹

Figure 1: Estimated TB Incidence Rates, 2018

An analysis by the Stop TB Partnership, which aims to make tuberculosis a high priority on the global political agenda, investigated how COVID-19 would affect the treatment of TB in high-burden countries, many of which are in Africa, by focusing on two possible scenarios. Under the best-case scenario, there would be a two-month lockdown with a two-month recovery, and, under the worst-case scenario, there would be a three-month lockdown with a ten-month recovery. Under these scenarios, they estimate a 3.1 to 10.7 percent increase in cases and a 4 to 16 percent increase in deaths from 2020 to 2025.¹² In other words, there would be an estimated 1.8 to 6.3 million additional cases and 340,000 to 1.4 million additional deaths from TB worldwide.¹³ Since 25 percent of all new TB cases originate in Africa and 25 percent of TB deaths occur in Africa, this analysis would imply roughly 450,000 to 1.6 million additional cases and 85,000 to 350,000 additional deaths in Africa alone.¹⁴ Lastly, the Stop TB Partnership estimated the amount of additional cases and deaths for every month of lockdown and for every month of recovery. These results, after taking 25 percent of the total estimated number of cases in deaths in Africa into account, are summarized below in Table 2.¹⁵

Table 2: Estimated Excess Cases and Deaths from TB in sub-Saharan Africa

Scenario

Excess Cases

Excess Deaths

For every month of

lockdown

152,100

31,525

For every month of

restoration

105,100

20,800

Source: Stop TB Partnership. “The potential impact of the COVID-19 response on tuberculosis in high-burden countries: a modelling analysis.” Stop TB Partnership, July 13, 2020.

There is also the question of whether COVID-19, through the physical distancing measures taken, could actually improve the TB situation in Africa. Furceri et al. (2020), a group of researchers from the International Monetary Fund (IMF), evaluated this situation by creating a model based on data from three of the most high-burden countries in the world; China, India, and South Africa. They concluded that any potential benefit from physical distancing would likely decrease TB incidence far more than it would decrease TB deaths.¹⁶They also concluded that any benefit, if present at all, would likely be outweighed by the disruption in health services.¹⁷ Therefore, although the figures presented by the Stop TB Partnership may be an overestimate since it did not factor in the potential benefits of social distancing, it is nonetheless likely that TB cases and deaths will remain high due to health service disruptions. Both these papers agree that it is crucial to maintain and strengthen TB-related health services during and after the COVID-19 pandemic.

HIV/AIDS

As of 2016, HIV/AIDS is the second leading cause of death for people in Africa.¹⁸ Africa is also the most affected continent in the world, with 25.7 million people living with HIV in 2018.¹⁹ HIV is most pronounced in Eastern and Southern Africa, followed by Central and Western Africa. Africa also accounts for almost two thirds of the global total of new HIV infections.²⁰ With the prevalence of HIV in Africa, COVID-19 poses a great threat to the treatment of HIV/AIDS and could cost many more people their lives.

One analysis funded by the Bill & Melinda Gates Foundation estimated the potential effects of COVID-19 on HIV by estimating the relative change in HIV incidence and mortality from six-month disruptions in different prevention programs, HIV testing, and treatment and care. They used five different mathematical models for disruptions of 20, 50, and 100 percent over a one-year period. Additionally, they estimated the excess HIV-related deaths over a one-year period due to a six-month disruption in a number of sub-Saharan African countries, different African regions, and for sub-Saharan Africa as a whole using the same five models. They found that, in sub-Saharan Africa, a 20 percent disruption could lead to between 92,299 and 150,000 excess deaths, a 50 percent disruption could lead to between 229,023 and 420,000 excess deaths, and a 100 percent disruption could lead to between 461,682 and 956,600 excess deaths.²¹ Furthermore, they showed that Eastern and Southern Africa would be hit much harder than Western and Central Africa. For example, for a 50 percent disruption in services, Eastern and Southern Africa is estimated to have an excess of 186,000 to 320,000 deaths compared to Western and Central Africa, which is predicted to have an excess of 32,134 to 100,800 deaths.²² These estimates, as well as further estimates for the different regions of Africa, are summarized in Table 3.²³

Table 3: Estimated Excess Deaths from HIV in sub-Saharan Africa

Scenario	Excess Deaths in sub-Saharan Africa	Excess Deaths in Eastern and Southern Africa	Excess Deaths in Western and Central Africa
20% Disruption	92,299 – 150,000	77,000 – 110,000	12,950 – 40,000
50% Disruption	229,023 – 420,000	186,000 – 320,000	32,134 – 100,800
100% Disruption	461,682 – 956,600	351,000 – 700,600	64,778 – 256,000

Source: Britta L Jewell, Edinah Mudimu, John Stover, Debra ten Brink, Andrew N Phillips, Jennifer A Smith, Rowan Martin-Hughes, Yu Teng, Rob Glaubius, Severin Guy Mahiane, Loveleen Bansi-Matharu, Isaac Taramusi, Newton Chagoma, Michelle Morrison, Meg Doherty, Kimberly Marsh, Anna Bershteyn, Timothy B Hallett, and Sherrie L Kelly. “Potential effects of disruption to HIV programs in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models.” The Lancet, August 6, 2020.

Effect on Economic Growth

All of the analyses in this paper lead to one conclusion: if health services are discontinued during and/or after the COVID-19 pandemic, there will be many lives lost. Not only this, but lacking health services would also have detrimental effects on the economies of many African countries, especially sub-Saharan Africa.

Over the years, sub-Saharan Africa has seen immense growth, but this is set to change in the coming year.²⁴ In fact, sub-Saharan Africa is expected to see its first recession in 25 years due to COVID-19.²⁵ Although most of the decrease in growth is expected to be due to the pandemic, the increase in malaria, TB, and HIV/AIDS would also likely decrease economic growth in a similar manner that COVID-19 has done. For example, an increase in the incidence and deaths from malaria, TB, and HIV/AIDS is expected to decrease growth through lower worker productivity, reduced labor supply, decreased resources going towards things such as education and public investments, decreased tourism, and decreased savings at the societal level, according to a number of studies.²⁶ The reduction in growth can also be forecasted from the known relationship between health and economic growth. Many studies show that good health and investing in a healthier population is essential for growth and that diseases that plague many countries are responsible for a significant amount of foregone growth.²⁷ Therefore, there is extensive evidence showing that the increase in malaria, TB, and/or HIV/AIDS would further hamper economic growth in Africa.

Conclusion

It is not only necessary for the sake of saving lives, but continuing prevention programs and treatment for malaria, TB, and HIV/AIDS is also vital for Africa’s economic growth. It is easy to lose sight of these diseases while the world is facing a pandemic, but doing so will have catastrophic consequences that will be seen for many years to come. It is worth directing the available resources today towards these services to prevent even further costs in the future.

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