It may be one of the most-vaccinated countries on earth, but the Seychelles has seen an explosion in cases – and the imposition of crippling new lockdown restrictions – since rolling out the Covid-19 jab. As the rest of the continent races to follow its lead, with Burundi and Tanzania receiving their first shipments in recent days, investigative reporter Sonia Elijah asks what lessons, if any, can be learned from the Seychelles’ apparent vaccine failure.

The foiled attack on World Health Organization-critic Andry Rajoelina has raised concerns over foreign interference in Madagascar. By Jerome Armstrong in Zanzibar.

Ex-World Health Organization (WHO) scientist Dr David Bell, and historian Toby Green, on why Africa needs to stop following Western policies and learn from its own experience.

Medical colonialism is back. After two decades of increasing life expectancy across Africa, the last year has seen control of the continent’s public health goals return to distant global institutions more reminiscent of the European imperialist era.

Despite low Covid-19 mortality across most of the continent, African societies and economies have been subjected to one externally promoted and mis-directed public health response after another – even though, in contrast to countries in the West, Covid-19 is a minor disease among many others that must be weighed in the balance of public health.

What has driven these catastrophic responses? Wealthy donors and global health bodies have advocated policies leading to the destruction of day-labourers’ livelihoods through lockdowns, the removal of children’s education through school closures, and an obsessive focus on Covid-19.

This is reversing years of effort in reducing mortality from malaria, tuberculosis (TB) and HIV-Aids.

Now, their new target is a vaccine passport.

Aviation agencies on the continent have already been talking up the possibility of introducing them by the end of 2022, while in Morocco a vaccine passport has been created, allowing vaccinated people to break the curfew and travel abroad without restrictions. Though the Africa Centres for Disease Control has said that vaccine passports are currently inappropriate on the continent, pressure appears to be growing to roll out this response.

This is not a private digital health record – but a Pass. A Pass provided by others, to enable access to basic freedoms.

Pushed by a small but very wealthy group of corporations and individuals who stand to gain greatly from management of pharmaceuticals, this technology can monitor the travel and freedom of movement of ordinary people.

All of this on the basis of a disease that barely rates on most African countries’ mortality statistics.

Mass vaccination is not medically justified in Africa. Much of the population is already immune. A February study of blood donors in South Africa found antibody levels of 63 per cent in Eastern Cape province, 46 per cent in Free State, 52 per cent in KwaZulu-Natal, and 32 per cent in Northern Cape. Further north, high rates of immunity have been shown in Malawi, Kenya and Nigeria.

And even if antibody rates weren't so high, more than 50 per cent of people in sub-Saharan Africa are under 19 years, an age at which Covid-19 is nearly always mild and mortality exceedingly rare.

Less than one per cent of the population is over 75 years, above which most mortality occurs elsewhere.

The vulnerable minority of Africans can be protected without vaccinating the majority.

But even if mass vaccination was medically justified in Africa, there are plenty of other downsides to a vaccine passport.

In the first place, this will clearly be discriminatory.

Reports are showing high levels of vaccine hesitancy on the continent, especially among poorer populations.

Discriminating between those who have and have not been vaccinated will target those who have already suffered disproportionately from the catastrophic economic impacts of lockdowns.

Perhaps even more significantly, using data to identify between different 'groups' is something that has been misused in the past – and could be again in the future.

In Apartheid South Africa, the ‘Pass Laws’ were used to determine who could and could not enter certain areas and participate in certain activities. In Nazi Germany, so-called ‘punch cards’ supplied by the American company IBM were vital in collating data on ethnicity and in ‘processing’ Jews, who were ultimately sent to the death camps.

In post-colonial Africa, too, such misuse of identity passes has been known, with passports used to identify – and thus easily butcher – Tutsis in Rwanda in 1994 and Igbos in Nigeria in the 1960s.

Vaccine passports may seem harmless, but history shows that they could be a ticket to discrimination, marginalisation and even genocide.

The UK’s proposed vaccine passports, which are currently being trialed at sporting events like the UEFA Euro 2020s, Wimbledon and Ascot horse races, have ‘special categories’ with the option to record people’s ‘racial and ethnic origins’. These functions may not currently be active, but it doesn’t take much imagination to realise how such information could be used to discriminate against people if activated in the future.

Putting race aside, vaccine passports are especially dangerous in a continent like Africa, where mass vaccination against Covid-19 is unnecessary and, in fact, enormously counter-productive, distracting from the management of other more deadly diseases.

The WHO may have sided with wealthy donors who profit from mass vaccination and vaccine passport technologies, implying that without mass global vaccination the whole world is at risk – but in doing so it is sacrificing African health needs for those of the richer world.

Every nurse vaccinating young Africans against Covid-19, is one less nurse inoculating against real child killers.

This is a tragedy on many levels. Agencies tasked with ensuring equality of humanity – and with human rights – should be stepping in to support the people whose freedoms and health have been under assault for over a year, not those who profit from this misery while entertaining each other among Swiss mountains and lakes. 

Dr David Bell is a public health physician and former medical officer and scientist at the World Health Organization (WHO). Toby Green is a Professor of African History at King’s College, London, and author of The Covid Consensus: The New Politics of Global Inequality.

He may have been ridiculed in the West for rejecting lockdowns and encouraging prayer-a-thons. But as ex-World Health Organization scientist Dr David Bell explains, Tanzania's late president John Magufuli is not seen as a pariah by many in the scientific community – he’s seen as a life-saver.

If you read the BBC website, you probably think Tanzania’s late president was either a rebel, a ‘Covid denier’ or just plain stupid.

In reality, he was none of these.

President Magufuli was actually a highly educated scientist with a PhD in chemistry, who probably saved thousands of lives by refusing to embrace lockdowns and other knee-jerk reactions foisted on the people in much of Africa and the West. 

Magufuli’s decision not to lock down was consistent with the evidence-based pandemic guidelines released by the World Health Organization (WHO) in 2019.

He rightly predicted that Covid-19 mortality in Africa would be very low compared to other major killers like malaria, tuberculous (TB) and HIV-Aids, and followed good public health principles in prioritising these higher burden diseases that particularly afflict the young, while telling Tanzanians not to panic.

He also prioritised keeping the economy growing, which is in the long term the most effective way of improving life-expectancy and health. In short, he acted as you would expect a well-trained scientist and rational public health expert to act in the Tanzanian context. 

Throughout the Covid-19 pandemic, the media has demanded longer and harder lockdowns, as if they were normal – or helpful.

But they rarely point out that no pandemic plan recommended mass business closures and restrictions on religious freedom, travel, or normal societal function before 2020, because removing these is expected to cause greater harm, and impinges greatly on fundamental human rights.

We never implemented any of these measures during the SARS, MERS or swine flu outbreaks of recent years. People attended places of worship, caught packed buses and trains, the young went clubbing and danced and sang and kissed.

The same was true for Tanzanians during this pandemic too.

And rightly so. 

Most Tanzanians are young and not obese, and so are at very low risk from Covid-19.

President Magufuli received a lot of bad press for telling his countrymen to go to church at the start of the pandemic to ‘pray’ Covid away.

But mass gatherings would not be expected to put the vast majority of the Tanzanian population at significant risk.

Tens of thousands of sports fans went to stadiums in Florida and Texas recently, and there was no noted uptick in cases afterwards.

Of course, protecting the vulnerable from harm is important in any epidemic, and it’s difficult to say whether the mass prayer-a-thons were a good idea from a purely transmission standpoint, as they may have increased risk to older people early on in Tanzania’s outbreak.

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Building so-called ‘herd immunity’ in young people rapidly through such gatherings would however be expected to exert a protective effect, if the vulnerable are well protected until such transmission-suppressing immunity is achieved.

The policy overall was probably far better for public health than strict lockdowns, which led to the first recessions in a quarter of a century in many African countries, as well as a reduction in treatment for major killers like malaria, tuberculous (TB) and HIV-Aids.  

The virus that leads to Covid-19, SARS-CoV-2, is likely to become endemic, and as herd immunity is reached through natural infection or through vaccination, severe disease and death will become increasingly uncommon.

Multiple studies have shown very limited impact of stricter lockdowns on Covid-19 mortality.

Therefore, one would expect Tanzania, like Sweden, Croatia, Belarus and other ‘non-lockdown’ countries, to have similar overall Covid-19 deaths and epidemic trajectories as comparable lockdown countries in the end. 

The vehement criticism of President Magufuli in the media is therefore disappointing and highly ignorant. It does appear that Western journalists find it easier to smear leaders in African countries than European leaders. Sweden's leaders, for instance, have never been labelled 'Covid deniers'.

This is not new, but perhaps shows how much hypocrisy and prejudice persist in Western society.

Tanzania appears to have done better from a health point of view than most other low-income countries through this last year. While millions of Africans have been thrown into hunger and poverty, Tanzania has seen GDP rise throughout 2020.

Falls in GDP and general impoverishment are associated with increases in all-cause mortality.

This is particularly the case in sub-Saharan Africa, where food security is often a real problem and control of endemic diseases such as malaria, tuberculosis and HIV-Aids is fragile.

It is therefore highly likely that, in maintaining a well-functioning economy, he and his government were responsible for greatly reducing mortality. UNICEF estimate almost a quarter of a million additional child deaths in South Asia in 2020 due to the responses to Covid-19 there.

It is likely that similar tolls will be seen in sub-Saharan Africa but we would expect that Tanzania will now be relatively protected from this. 

Let us hope, for Tanzanians’ sake, that this continues with his successor.

Western media may have had a good laugh at President Magufuli – and Tanzanians in general – for thinking they could ‘pray’ away a virus.

But, rhetoric aside, by refusing to lockdown, and by refusing to divert health resources away from malaria and TB to test people with no symptoms for a virus with a very low fatality rate, Magufuli was following an orthodox pandemic response. 

He was also orthodox in his approach to human rights. Religious freedom was considered an important human right by most Western journalists only 18 months ago, and fear should not change fundamental human rights. 

Honest journalists should acknowledge the benefits of Magufuli’s approach, however much it may contradict their current preferred world view.

Ridiculing religious observances that fall outside their experience, and denigrating public health science that they clearly don’t understand, is not good journalism.

It just highlights how ignorant they are. 

EXPERT OPINION: Global public health experts Dr David Bell and Muhammad Usman Khan ask whether millions of young Africans need to be vaccinated – and for whose benefit?

Child mortality will almost certainly rise across sub-Saharan Africa this year.

The singular focus on Covid-19 has resulted in an interruption to all other healthcare – as well as growing levels of malnutrition, thanks to lockdown-induced job losses and poverty. 

The World Health Organization (WHO) was at pains to reassure children in developed countries of Father Christmas's immunity to the virus in December, so as not to ruin their year.

Meanwhile, little focus has been given to African children, increasing numbers of whom have been orphaned by HIV/Aids and tuberculosis during the pandemic. 

Sadly, the global health community that, in the past, prioritised HIV/Aids, tuberculosis (TB) and the big child killer, malaria, appears to consider avoidable deaths from such illnesses an acceptable cost in their attempt to reduce transmission of SARS-COV-2.

This paradox is especially true in Africa, where more than 50 per cent of the population is under the age of 19, and additional factors such as the climate, low levels of obesity and other comorbidities, may have left most Africans effectively protected from Covid-19.  

In spite of this, influential organisations in global health are calling for restrictive measures to continue until a Covid-19 vaccine is available and all are vaccinated – sometime in the coming years.  

With wealthy countries and private philanthropy planning to divert large donations to this cause, and a global alliance under the COVAX umbrella gearing up to lead it, there is an urgent need to examine whether this is of benefit to Africa.  

The virus, SARS-COV-2, was initially feared to be highly lethal and capable of killing up to one in 20 infected people.

The initial mortality rates for northern Italy’s elderly looked frightening when transferred to the entire population of the African continent.  

Governments, corralled by the WHO, narrowed their focus on dealing with what was initially presented as an existential threat to medical infrastructure around the world.

But as more data poured in, it became clear that the challenge the virus presented, although serious, was not the global catastrophe previously feared.

Yet seemingly undeterred by emerging data – the infection fatality rate is now estimated at 0.23 per cent, and far lower for those under 65 years of age – global health institutions and governments continue to allocate hefty resources and a blinkered focus on the pandemic with undiminished urgency.  

Half of the billion-plus people in sub-Saharan Africa are under 19 years of age, and we know that most infections in children are barely symptomatic.

Regardless, a climate of fear is being sustained with the media still whipping up fear of a looming ‘catastrophe’ for African countries.  

When most European nations locked down their populations, copying the highly restrictive measures employed in China, the WHO advocated similar measures across Africa.  

This ran contrary to its own prior evidence-based pandemic guidance and with seemingly little regard for the high vulnerabilities to pre-existing epidemics, such as malaria, TB and HIV/Aids, as well as the limited capacity of these populations to absorb income loss.  

The catastrophe currently unfolding in Africa is not due to the coronavirus.

Despite months of community spread in crowded cities, recorded Covid-19 mortality was under 70,000 across the entire continent by January 1, 2021.

If we exclude the Mediterranean countries and South Africa with their differing demographics and high comorbidities, just 13,031 people died of Covid-19 in the rest of the continent in 2020 – that’s approximately one death for every 80,000 people.  

As the figure shows, Covid-19 would likely have gone unnoticed in Africa if we had not been testing for it.

The virus has dominated the policies of donors and international organisations on an unprecedented scale, and while African countries may be easing internally, the focus externally remains on Covid-19, and a vaccine whose roll-out in these populations would defy all previous public health norms.  

This catastrophe goes far beyond health alone.

A generation of children’s schooling has been interrupted. Children from poor and rural families will likely never recover.

Even more alarmingly, girls and young women have been pushed back into the trap of early marriage and poverty.   

Without any serious pushback from its staff, the World Health Organization and wealthy philanthropic foundations have advocated for policies that impoverish, restrict and reduce healthcare access, abandoning previous recommendations advising against such measures.

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In a new form of post-colonial oppression, the rich world, via video meetings on Zoom, have introduced policies that are leading to impoverishment in Africa. 

The rise of large private philanthropies, who arguably dominate the current global public health agenda, has undoubtedly brought great benefits in terms of almost unlimited funding, new ideas and enthusiasm, though this may not always be fully aligned with local priorities.  

Vaccines are a perfect example of this.  

In recent months, the world has been focused on the development and trials of vaccines for SARS-COV-2, in the hope that they will allow a return to normality.  

This had led to a poorly considered campaign of mass immunization being promoted, despite the current lack of evidence that the vaccines have a transmission-blocking effect.

If vaccines don’t stop onward transmission, and just lessen symptoms, it essentially means we will not be vaccinating children for their own health, but in order to protect a small cohort of elderly citizens. 

And given the very low impact of Covid-19 on younger people, and thus on the vast majority of Africans, one has to question why a vaccine for Covid-19 should take precedent over investment in mosquito nets for malaria, for instance.

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A Covid-19 vaccination programme will inevitably reduce the amount of money and manpower to prevent far worse diseases that African children face.

Foreign aid from increasingly cash-strapped donor countries is already being sought for the COVAX mechanism in the name of global equity, while local health staff, logistics and expertise will be drawn from other pressing areas to help vaccinate against Covid-19. 

To justify this approach, some pressure groups are claiming that people in sub-Saharan Africa need to be vaccinated in order to reduce the risks for those living elsewhere.

If we believe the SARS-COV-2 virus can and should be eradicated globally, but we recognise that diverting resources for this programme will cost lives, then we need to acknowledge that the children who are no longer benefiting from other health interventions, are dying for the benefit of mostly elderly and chronically sick people in far wealthier nations, who wish to reduce their own Covid-19 risk.  

This may not be ‘wrong’, if the benefit to Africans can be shown to outweigh the costs.

But clearly, if this is not demonstrated, then the equity argument behind COVAX and the universal Covid-19 vaccination programme becomes unsustainable.

Those of us in the global health community need to pause, question and think for ourselves.

By any normal measure, we are catastrophically failing the people we were entrusted to serve.

The current approach appears to be causing net harm, and African health is at risk of being crushed under a model designed by and for others.  

Covid-19 is a chance to reset, but not through the deaths of children and the impoverishment of tens of millions.

Fixing this will take humility and self-awareness.  

To build a better future, we first need to avoid doing more harm. Let’s hope, collectively, we have the courage and moral decency to undo the mess we have created.

Then we must support the people of these countries in continuing the broad improvements in health care upon which they, with admirable support from both public and private sectors, had previously embarked.  

 

Dr David Bell is a clinical and public health physician with a PhD in population health. He was Director of the Global Health Technologies at Intellectual Ventures Global Good Fund in the USA, Programme Head for Malaria and Acute Febrile Disease at FIND in Geneva, Switzerland, and coordinating malaria diagnostics strategy with the World Health Organization. 

Muhammad Usman Khan is a health policy analyst. Usman has consulted and worked in advisory roles for multiple governments and NGOs.

Almost 10 per cent of Africa’s economy relies on the tourism industry, which was shuttered by Covid-19. But, as travel editor and TV tourism expert Jill Starley-Grainger reports, for the millions employed by the safari industry, there is confidence that the good times – and the tourists – will return. 

In a typical year, thousands of tourists visit Africa to spot lions, zebras and elephants – and to lounge on the continent’s white-sand beaches.

It’s a vitally important industry that employs 25 million people directly or indirectly, including a large number in well-paying jobs, such as rangers and guides.

But Africa’s safari industry has been particularly badly hit by the coronavirus pandemic, with the impact devastating businesses, communities and conservation efforts alike.

Africa as a whole has suffered a 57 per cent loss in international arrivals due to the pandemic, according to the United Nations World Tourism Organization, and safari business are particularly reliant on an international clientele, most of whom have been unable to travel to Africa since March.

This has led to a significant reduction in customers and the temporary – and potentially permanent – closure of many companies reliant on safari tourism.

A recent survey by SafariBookings.com found that safari tour operators have seen bookings decrease by three quarters or more over the last four months, compared to the same time last year.

And many have received no customers or bookings at all.

The human cost:

Travel operator Aardvark Safaris,, which works with lodges throughout Africa, has seen the devastating human impact of this sudden loss of tourists.

‘We support over 1,000 camps and lodges throughout sub-Saharan Africa,’ said co-owner Alice Gully.

‘And they are all looking at a year with limited or no income. Not only does this affect jobs, but it affects the dependants on these employees.

In Kenya, for example, seven million people are employed in tourism - a third of the country’s workforce - and they each have approximately seven dependants.’

In Botswana, Desert & Delta Safaris managed to maintain all of its staff, albeit on reduced incomes, said Andrew Flat, Desert & Delta Safaris’ marketing manager.

‘High-value, low-volume destinations like Botswana have faced incalculable losses. Botswana is roughly the size of France, but with a population of just over two million people, and around 40 per cent of the country consists of protected parks and reserves.’

With so few visitors to such a vast region, even a small dip in numbers can have devastating consequences for communities.

Some safari businesses have managed to fare a little better, such as Go Places Africa DMC.

It arranges safaris in Kenya, Uganda, Tanzania, Rwanda and Ethiopia, and has managed to maintain all staff.

'Management and directors took salary cuts to make sure that we were able to pay our staff without any cuts as they rely on their salaries for their livelihood, and some of them are the main bread earners in their families. We also set up internet services for our staff in their homes to ensure regular communication virtually with them as well as with our clients.’

In South Africa, meanwhile, hotels across the country have had virtually no income since March.

Royal Malewane was effectively closed for five months with zero revenue,’ said Ross Bowers, marketing manager of the luxury lodge in South Africa’s Greater Kruger National Park.

'The pandemic has been devastating for our industry, for our staff and for their many dependents. Government support for the industry has been extremely limited, but we fought hard to keep everyone employed.

He added: ‘Since we reopened, we have had very limited local business. We need international visitors to return as soon as possible. Recovery for the safari industry will be extremely slow, but we are optimistic that safaris, nature and wildlife will be highly sought after post-Covid experiences.’

Conservation crisis:

Covid-19’s economic impact is significant for conservation, too, with some reporting an increase in poaching activity.

‘With no game drives, there are fewer eyes on the ground to watch out for poachers,’ said Gully of Aardvark Safaris.

This is a real concern throughout the industry, added Luke Bailes, founder and executive chairman of Singita, which has 15 luxury eco-lodges in Rwanda, Tanzania, Zimbabwe and South Africa.

‘If ecotourism stops funding the conservation work of non-profit conservation partners, the likelihood of illegal hunting and poaching increases,’ explained the Anglo-Kenyan businessman, whose family have been involved in the Kenyan safari industry since the 1920s.

'Laid-off workers could turn to poaching to make ends meet, and if anti-poaching efforts are not maintained, traffickers have easier access to the animals and will simply stockpile until they can transport to their end markets.’

Some governments have taken heed of the impact on their wildlife and landscapes, and have put plans in place to try to increase protection in some areas.

In South Africa, the government, conservation organisations and local communities recently announced a plan to create protection areas to safeguard rhinos from poachers.

But the funds available for this are limited, and until international visitors return in significant numbers, it’s likely that both the landscapes and the animals that conservation projects help will suffer.

Future bookings:

While some African countries have recently started allowing international visitors, more openings are planned in the coming months.

This has helped a little for 2020, but since much of Europe and North America – the two major markets for Africa’s wildlife experiences – are still in various forms of lockdown, most safari businesses are pinning their hopes on 2021.

Roar Africa, a luxury specialist operating in 13 countries in southern and eastern Africa, has seen a massive profit hit this year, but does have some bookings for next year.

‘We had over 300 trips booked for 2020, and have had to move 80 per cent of them,’ said Deborah Calmeyer, Roar Africa’s CEO and founder.

‘With the recent reopening of Kenya and Rwanda, we have seen more enquiries for travel to these destinations, but we have a long way to go to get to pre-Covid levels of tourism.’

‘We have seen a marked increase in enquiries since restrictions began to lift,’ noted Toby Pheasant, founder of Bonamy Travel, which operates in 15 countries in Africa.

‘There has been an increase of 320 per cent [in enquiries]. But while we would normally expect to convert between 60 and 70 per cent of these, [the number that result in sales] is significantly lower than we would expect, at around 10 per cent.’

It seems many customers are dreaming and planning, but still worried about the pandemic and travel restrictions, so less inclined to make a booking.

But some of the people who missed out on their 2020 safari trip are securing bookings early for next year.

African Bush Camps, which runs 15 luxury camps in Botswana, Zambia and Zimbabwe, has recently seen a noticeable increase in reservations, particularly for 2021, said its CEO and founder, Beks Ndlovu.

‘Bookings were up 400 per cent in mid-August for 2021 in comparison to 2019 bookings.’

This increase is no doubt helped by the company’s new policy of a 100 per cent refundable deposit – a clever strategy to ensure guests know they won’t be out of pocket if the crisis affects their travel plans.

South African tour operator Unearth Experience has seen a similar trend in forward bookings for its safari trips, which it arranges to destinations throughout Africa.

‘The majority of our clientele impacted by Covid-19 restrictions have opted to postpone their travel plans versus cancelling their trips.

This has allowed us to have a strong forward book for 2021,’ said Rory James Loader, managing director.

Nobody knows how the pandemic will play out, but many safari businesses are doing their best to prepare, and there are hope that many will be able to adapt to ensure the future of the industry.

‘Africa is tough, its people and wildlife are resilient,’ opined Flatt of Desert & Delta Safaris.

‘The silver lining is that we are still here, ready and waiting to welcome guests back to our lodges, and ready to prove that, post-pandemic, nothing beats the social distancing a Botswana safari offers.’

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