Social distancing is impossible in much of Africa, and its economic consequences may lead to a famine that is worse than the pandemic. Prevention measures must consider the African context. //

Right now we are facing a choice between more or less drastic measures to slow the spread of COVID-19, a virus which, at time of writing, has yet to claim a life under 10, and claims very few lives under 30, with the risk rising exponentially with age. We are putting in place measures that will lead to malnutrition and starvation for millions of people, and for these horrors, children and especially infants are the most at risk. And very many of those infants are born, and will die, in Africa.

Yet there is little discussion of the consequences for human health of the measures we are taking. Nor is there discussion of how the major differences between Africa and America, Europe and Asia might matter. The World Health Organisation (WHO) website contains no technical guidance on how African governments should approach their considerably different contexts. The advice is the same globally, but the context is not.

Failure to recognise that one size does not fit all could have lethal consequences in this region, maybe even more lethal than those of the virus itself. //

the major components of the recommended public health measures – social distancing and hygiene – are extremely difficult to implement effectively in much of Africa. The net effect of measures that seek to enforce social distancing may thus be to prevent people from working, without actually achieving the distancing that would slow the spread of the virus. If that is true, then we must consider whether we would be better off without them. //

In Africa, it’s questionable whether leaders have a political choice, given intense pressure from an international community that isn’t thinking about the differences of the African context, and a WHO offering no region-specific technical advice.

Leaders need to be given the space to say shocking things, to be upfront about what might go wrong, to change their minds in the face of new evidence, and to pick the lesser of two evils.