Why Uganda and other African countries have consistently taken extreme and inappropriate Covid interventions
THE LAST WORD | ANDREW M. MWENDA | This week, President Yoweri Museveni addressed the nation on Covid-19. With infection and death rates down, the President did little to open up the country. Most especially; he left schools closed and curfew of 7pm in force. Yet he opened churches and mosques, and markets have been open all this time.
One wonders: if people (including students) can crowd in markets and attend churches, why should they not attend school?
I am not convinced the measures being taken to control Covid are necessary. I believe that Uganda’s failure to open up the country is a product of two interlocking factors both of which reinforce each other.
First is the personality of Museveni, who has an excessive fear of diseases and therefore obsesses a lot about hygiene. In psychology, this state is called hypochondria. Many Ministry of Health officials and other medical personnel are convinced, on the basis of their medical teaching, that this is the right course of action. But I am also inclined to believe some of these public officials know their boss’s psychology. Therefore, they give him solutions that reflect his wishes – it is called confirmation bias. It is easier to convince Museveni about a threat of disease (and even security) than to calm his nerves by telling him things would be okay.
One factor driving this is that the effects of not taking extreme and overt measures to control Covid – likely hospitalisations and deaths – are immediate and deadly and therefore certain. They directly relate to the virus. However, the economic, social and even health consequences of the measures taken (such as economic destitution, teenage pregnancies, death due to malnutrition etc.) come after a lag and are therefore uncertain. Therefore, if a public official advised him against extreme measures, and Covid spread, their advice would be easy to relate to such a disaster and they would in most probability be fired. Thus, given this structure of incentives, it is better to err on the side of caution than take a risk.
The other factor is our tendency in Africa to borrow solutions for every problem from the rich Western world. This is often done without giving due consideration to our own unique circumstances. One does not need to be a keen observer of Africa to see that all too often, our problems are largely (not entirely) local. Even most of the demands to solve them are locally generated. However, when it comes to designing a solution, we often retreat to a theory published in a book, produced at Harvard or Stanford, Cambridge or Oxford, reflecting the experience of the West. The problem of Africa therefore is this mismatch between demands and solutions.
The consequence of these two factors has led us to adopt policies that are extreme and inconsistent with our demographic and healthcare realities.
The corona virus has been devastating to the Western world in large part because of three interrelated factors. First, those countries are old. The median age for most of them is 45-48 years. America is the only rich country with a lower median age at 38. The novel corona virus has been lethal to the elderly. In the first wave, the median age of a person dying of Covid was 76.6 years. The second wave, which was dominated by the Delta variant, saw many people aged 29-50 getting hospitalised but we are yet to get numbers on the deaths rate of people in this demographic group.
In Uganda, the people who are aged 75 years and above constitute only one percent of our population. In the U.S., whose high deaths are consistently cited by Museveni in his televised addresses, the evidence is illuminating. In the state of Ohio, the median age of people dying of covid is 79 years. Less than 10% of the deaths have been of people under 60 years. As per July 13, 2021, only 4% of the Covid death due to the Delta Variant globally was below 45 years. The median age of those dying of Covid reduced from 76.6 to 61 years due to Delta. Again, only about 5% of Uganda’s population is above 61 years. Therefore, Uganda has a very low risk of infection and death from Covid. So it does not make sense for us to take measures as extreme as Italy or Japan whose median age is 48 years.
The second factor increasing death rates in the West is their highly developed medical and healthcare facilities. Many people with chronic diseases such as diabetes, cancer, high blood pressure, etc. remain alive because of availability of, and access to, advanced medical care. Such people were vulnerable to corona because it was novel and shocked their system because of their preexisting conditions.
In Uganda, and all other poor countries, the people and the governments are very poor. Because of this, the healthcare and medical facilities are poorly developed. Hence, people with the aforementioned chronic diseases often die – except among the upper middle class who can afford access to modern medical attention.
These circumstances of poverty and poor health have meant that most of the people above 30 years who are living are only those who are very healthy, have no chronic illnesses (except HIV) and have strong natural immunity.
I have travelled across rural areas of Uganda through the east, north, central and west and hardly find poor people in rural areas who have lost any local member to Covid. On the contrary, most the dead come from upper income families mostly based in towns. Indeed, this is reinforced by the fact that nearly all people who have died of Covid had some chronic disease.
The final factor spreading Covid in the rich world is high levels of urbanisation. Most people in rich countries (up to 90%) live in cities and towns relying largely on crowded public transport where the risks of infection are high. In Uganda most people live in rural areas and those in urban areas walk to work or use boda bodas without crowding. Therefore, policies to control Covid for rich countries cannot be the same as Uganda because of all these differences. No wonder we have lost only 3,132 people in two years compared to USA with 700,000 deaths.
Because we have a very young population, the average age of a teacher in primary school is 25 years, in secondary school is about 32 years. This is the one group that is at the least risk of getting Covid, leave alone being killed by it. This means we should open schools because the risk is low.