Anasthasia Shilov, Illustrations Editor

In the midst of a dangerous third wave of the coronavirus pandemic, Yale professors are discussing what African nations can teach the United States about effectively stopping the spread of COVID-19.

Professor of Economics Ahmed Mushfiq Mobarak and Program and Communications Manager of the Yale Research Initiative on Innovation and Scale Rifaiyat Mahbub penned an op-ed earlier this month contrasting how the United States and African nations like Senegal and Rwanda are handling COVID-19 outbreaks. The authors wrote that African leaders have largely inspired civic duty, implemented aggressive lockdown measures, enforced action plans rooted in scientific evidence and facilitated public trust, such measures lacking in the United States. The article was published in CNN on Nov. 3.

“Epidemiologists had expected weak health systems in Africa to crumble under the weight of Covid-19,” Mobarak and Mahbub wrote. “Africa as a continent appears to have handled the pandemic more effectively than the U.S. has.”

The authors note that eight months into the pandemic, Africa, with its population of over 1.3 billion, has reported only 1.8 million positive tests. Meanwhile, in the United States, a country with a population of nearly 330 million, COVID-19 cases have soared above 11 million as the country enters its highest wave of infections.

Though the authors wrote that a lack of testing in nations like Senegal and Rwanda may contribute to the relatively low reports of positive cases, the quality of leadership in these nations has also played a large role in effective responses to COVID-19.

Mobarak met with the President of Ghana Nana Akufo-Addo and Vice President of Nigeria Yemi Osinbajo in a recent webinar to discuss policy responses to the pandemic. Mobarak said that the “clear, level headed” manner in which the President of Ghana addressed the issue of COVID-19 and the thoughtful, “genuinely curious” questions from the Vice President about the most effective COVID-19 response strategies illustrated effective leadership. Mobarak said this was in stark contrast to the “very confused messaging” coming from the United States federal government. 

“I was quite impressed with leadership in Africa, especially relative to leadership in the United States,” Mobarak said in an interview with the News 

In the article, Mobarak and Mahbub said that President Macky Sall of Senegal self-quarantined even after testing negative for SARS-CoV-2 simply because he was exposed. They cited this as another instance of how African leaders have led by example to inspire collective behavioral change among their citizens.

Mobarak told the News that decentralized governments or governments with multiple decision makers such as the U.S. are more likely to implement weak, ineffective responses to COVID-19. He said that whether in a pandemic or times of war, quick and decisive actions from centralized government institutions are necessary to produce successful results.

He used an analogy of finance to describe this concept. Just as with risky, high-return investments, single-decision maker environments have the potential to be perilous if the decision making power of leaders remains unchecked and poor decisions are made. But they can also be high reward if effective public health policies are implemented without redundant bureaucratic hurdles that delay and dilute these measures. 

“In the interest of collective public health, there’s more of a reason for us to be much more directive with our policies as opposed to leaving it up to each individual and what they want to do, because each person’s behavior is affecting everybody else’s outcome,” Mobarak said.

Associate Professor of Epidemiology Luke Davis said that Mobarak’s article illustrates general truths about the public health response of African nations. Davis noted that many of these countries have enforced intense mandates, requiring physical distancing, restrictions on population movement and mask wearing. In some cases, these governments can impose penalties such as arrests for non-adherence, while similar policies would not be acceptable in the United States.  

Davis also echoed Mobarak’s points that part of the success of African nations in quelling the spread of COVID-19 is a result of how leaders, such as those in Senegal and Rwanda, have prioritized the advice of public health officials and evidence-based actions to control outbreaks. He also noted that some of the low COVID-19 mortality rates in African nations might be explained by a history of foreign investment in African health systems to respond to health emergencies like a pandemic.

“This reflects extremely competent public health leadership that has emerged from decades of investment in health systems to respond to HIV and other diseases, much of which has been funded by the US and multilateral agencies from outside Africa,” Davis wrote in an email to the News.  

Assistant Professor of Political Science Kate Baldwin said that regardless of whether a nation’s governmental institutions are decentralized or centralized, a democracy or an autocracy, it is the citizens’ trust in public health institutions and government that matters most during a pandemic. 

She said that people are more likely to follow suggestions or mandates to wear masks, increase hand washing, refrain from large public gatherings and make other small sacrifices if they have faith in public health agencies and the government.

“What matters is people’s trust in government,” Baldwin said. “Once you control for the fact that some of the initial outbreaks were in Europe or countries that tend to score more highly democratic on our measures of democracy, it doesn’t seem that the type of government institution in place matters.” 

Baldwin also said that in places like Senegal and Rwanda, many people’s work and other activities were already held outside or in well-ventilated areas. Additionally, the population structure is different in these nations compared to the U.S, with fewer individuals over the age of 70 — the age group most at risk of adverse consequences from COVID-19 infection. She said that these factors may have influenced lower mortality and case rates of the disease in African nations.

Department Chair of Epidemiology Albert Ko said that Mobarak and Mahbub’s article also poses important points about the global health issue of paternalism — when policies created by higher income countries like the United States are considered superior to policies of lower- or middle-income countries.

Ko explained that wealthier nations like the United States should be receptive to potential solutions to public health crises like COVID-19, regardless of which nations propose them. 

“Paternalism inhibits us from thinking outside of the box,” Ko said. “We are not the owners, in the first world, of those answers … paternalism precludes us from learning from others.” 

Davis added that the health budgets of many African countries are heavily subsidized by international partners. However, the success of countries like Senegal and Rwanda in tackling the COVID-19 pandemic may help to counterbalance the effects of paternalist thinking, he said.

According to the New York Times database, more than 246,000 people in the United States have died from COVID-19.

Sydney Gray | sydney.gray@yale.edu