A volunteer receives a shot

Health & Medicine

Demographics, preparedness may explain Africa's low COVID-19 fatality rates

BBC Africa reporter Andrew Harding speculates on the reasons why Africa's overall COVID-19 fatality rates have been so low compared to the rest of the world.

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Volunteer Thabisle Khlatshwayo, who received her first shot for a COVID-19 vaccine trial, is tested before receiving her second shot at a vaccine trial facility set at Soweto's Chris Sani Baragwanath Hospital outside Johannesburg, South Africa, Monday, Nov. 30, 2020. Over 2,000 South African volunteers are part of AstraZeneca's experimental coronavirus vaccine trial.

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Jerome Delay/AP

Africa is home to 17% of the world's population, but the continent accounts for only 3.5% of the world's reported COVID-19 deaths. Even with the knowledge that there may be some underreporting, epidemiologists are still puzzled by what they are seeing.

“I've been trying to follow and to understand this right from the start,” says Andrew Harding, BBC Africa reporter. “A few months ago, I was talking to some of the…senior prominent scientists here, the sort of Dr. Fauci equivalents here in South Africa, professor Salim Karim and others, who are saying, ‘These numbers still don't quite make sense to us.’ I think there are lots of reasons why Africa has done relatively well so far. But the scientists were saying some of these figures still don't add up. And there was lots of speculation about why.”

Africa is a continent that is “used to diseases, used to viruses and used to really grim death tolls,” Harding adds, so people were worried that COVID-19 could also take a devastating toll on citizens. But so far, that hasn't happened.

"[A]cross vast amounts of this continent, they seem to be having a much easier time. And the scientists I was talking to here were scratching their heads and wondering [why].”

Andrew Harding, reporter, BBC Africa

“It has, to some extent, in South Africa, and in some of the northern countries, but across vast amounts of this continent, they seem to be having a much easier time,” Harding explains. “And the scientists I was talking to here were scratching their heads and wondering [why].”

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The concern, Harding says, is that in poorer parts of the continent “really no one has a clue about how prevalent the virus has become because, simply, no one is doing the test. You pick a war-torn country like the Central African Republic and they're just doing basically a few hundred tests, rather than the tens of thousands, or millions, that need to be done.”

There are some key things that make Africa different from other regions, Harding notes. Africa is not connected by travel to the rest of the world in quite the same way as Europe and elsewhere. Those who come into African countries by air tend to be wealthier people who might be better informed and more easily able to distance themselves from the rest of the population. And to some degree, African still has an “outdoor culture,” Harding adds. A lot of people still live in rural areas, and the virus doesn’t spread as easily outdoors.

Demographics no doubt also play a role, Harding notes. The average age of the population on the African continent is between 19 and 21, compared with Europe and America, where the average age is the early 40s. There are also fewer people in their 70s and 80s, who tend to be the ones most likely to die from COVID-19. The virus seemed to be slow to arrive in Africa, and African governments by and large responded quickly and aggressively to the pandemic with lockdowns, “out of a sense of acute vulnerability,” Harding says.

"[Africa] had a bit of extra time, if you like, to get their act in gear, and they'd done a good job with that. But even then, the scientists I was talking to here were saying, ‘We still are not sure that that explains everything. Maybe there are other factors involved.’"

Andrew Harding

“So they had a bit of extra time, if you like, to get their act in gear, and they'd done a good job with that,” he says. “But even then, the scientists I was talking to here were saying, ‘We still are not sure that that explains everything. Maybe there are other factors involved.’ And that's where it gets a lot more complicated and, frankly, a lot less clear, because the science is still in its early stages.”

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Researchers are running studies to see whether the population might have some degree of prior immunity, due perhaps to exposure to other coronaviruses in the past or to receiving other types of inoculations, such as BCG (tuberculosis) and MMR — even perhaps anti-malarial medication. There is some evidence to suggest that these inoculations “may give your immune system a boost, or at least get it rehearsing more effectively for what comes next,” Harding says.

“So all these theories are now being tested very aggressively in the United States and in Africa and around the world, as scientists still, I think, are trying to understand what on earth is going on here,” he adds.

This article is based on an interview by Aynsley O’Neill that aired on Living on Earth from PRX.

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