Most developed African countries suffered worst during pandemic, study suggests

Thomas Hornall
Wed, 15 September 2021

The most developed African countries were the hardest hit by Covid, the study suggests (Hugh Macknight/PA) (PA Archive)

Countries in Africa rated as being better prepared for a pandemic were the worst hit by Covid-19, a study has suggested.

Nations in the World Health Organisation’s (WHO) Africa Region assessed as having more resilient health systems and the least vulnerable to infectious disease had higher mortality rates and higher levels of restrictions imposed, the findings indicated.

Predictors of higher death rates included large urban populations, stronger pre-pandemic international travel links, and a higher prevalence of HIV among the 42 nations evaluated.


The research, led by the University of Edinburgh and the WHO African Region body, offers “compelling results which challenge accepted views of epidemic preparedness and resilience in Africa”, study authors say.

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Findings show South Africa had the highest mortality rate during the first wave between May and August last year, at 33.3 deaths recorded per 100,000 people.

Cape Verde and Eswatini, commonly known as Swaziland, had the next highest rates at 17.5 and 8.6 deaths per 100,000, respectively.

Uganda recorded the lowest mortality rate at 0.26 deaths recorded per 100,000, in the first wave.

South Africa also had the highest death rate during the second wave between December and February at 55.4 per 100,000, while Mauritius had the lowest, with no reported deaths.

Second wave mortality rates could be predicted from the first wave, the study said, although deaths were higher during the second.

Researchers from the NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA),an African-led programme at the University of Edinburgh, said the pandemic had highlighted “unanticipated vulnerabilities to infectious disease in Africa that should be taken into account in future pandemic preparedness planning.”

Our results show that we should not equate high levels of preparedness and resilience with low vulnerability

Professor Mark Woolhouse

Professor Mark Woolhouse, who co-led the study, said: “Our study shows very clearly that multiple factors influence the extent to which African countries are affected by Covid-19.

“These findings challenge our understanding of vulnerability to pandemics.

“Our results show that we should not equate high levels of preparedness and resilience with low vulnerability.

“That seemingly well-prepared, resilient countries have fared worst during the pandemic is not only true in Africa, the result is consistent with a global trend that more developed countries have often been particularly hard hit by Covid-19.”

Dr Matshidiso Moeti, WHO Regional Director for Africa, added: “The early models which predicted how Covid-19 would lead to a massive number of cases in Africa were largely the work of institutions not from our continent.

“This collaboration between researchers in Africa and Europe underlines the importance of anchoring analysis on Africa’s epidemics firmly here.”

Researchers say deaths were higher during the second wave compared to the first. Some 675 deaths were reported on the second-wave peak on January 18, compared with 323 during the initial wave peak on August 5 last year.

Potential under-reporting was accounted for in the analysis, the study added.