Covid-19: How South Africa differs from the rest of the continent

Deaths have been massively underestimated in Africa

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South Africa’s excess death estimates, by the Medical Research Council, are based on much better systems than most countries in the world.

Among African states, South Africa is often singled out as the mysterious exception because, according to official estimates, we have fared much worse through the Covid-19 pandemic than most of the continent. But is this true? Almost certainly not.

At least one commentator has used the official statistics to claim that the SA government’s response has been worse than much of the continent. While there is much to criticise about the government response, there is one primary reason why Covid deaths appear higher in South Africa than most of the continent: we have better systems for measuring them.

There has also been speculation that Africans outside South Africa, for various reasons, have been less susceptible to Covid infection or death. Scepticism is warranted. A similar view was held about India. Before the delta wave sowed havoc in India, overwhelming cremation sites and hospitals, and devastating communities, there was some wild speculation about why India was being hit relatively mildly. That began to crumble when antibody surveys showed that official case counts were missing a huge number of infections. But it took the overflowing of morgues to make it clear to all that there was no Indian exceptionalism.

There are two sources for the number of deaths in South Africa: the official Covid death toll published daily by the health department, and the excess deaths estimated weekly by the Medical Research Council. Of these, the latter is by far the most useful. Both of these reports depend on vital statistics systems that are poorly developed in much of the rest of the continent.

As far as we can tell, on the African continent, only Egypt, Tunisia and South Africa monitor excess deaths (the island of Mauritius appears to as well, and so does the archipelago of Seychelles, but its population is less than 100,000). Without reasonably accurate excess deaths statistics, it’s extremely hard, perhaps impossible, to make measurable comparisons of how hard countries have been hit by Covid.

The fact that you don’t measure something doesn’t mean it hasn’t happened. Officially, fewer than 240,000 people in Africa have died of Covid at the time of writing. This number is almost certainly exceeded just in South Africa, and across the continent it is probably millions. If better vital statistics were kept, we’d be able to better assess the performance of African governments and perhaps see clearly the urgency of distributing vaccines across the continent.

Below is a table showing official Covid deaths and estimates of excess deaths from a selection of countries. The data is sourced from The Economist. The excess death estimates for most of the African countries amount to an educated guess. By contrast, in South Africa, the weekly excess death estimate is for the most part based on an actual count of recorded deaths. The rises in excess deaths have closely matched the Covid waves, and are nearly three times greater than the official Covid death toll.

It’s implausible, for example, that Lesotho’s excess death rate per 100,000 people is only about 140 while the Free State’s is over 550 and the Eastern Cape’s is well over 700.

Country Official
Covid deaths
Per 100,000 Estimated
excess deaths
Per 100,000
United States 851,730 256 1,200,000 355
Brazil 621,478 290 720,000 335
India 486,451 35 4,750,000 315
Russia 315,495 216 1,100,000 770
Peru 203,464 610 215,000 640
Britain 152,197 223 155,000 230
Indonesia 144,174 52 695,000 245
Italy 141,391 234 190,000 315
South Africa 93,451 156 255,000 420
Tunisia 25,803 216 33,000 275
Ethiopia 7,162 6 170,000 143
Kenya 5,499 10 87,000 161
Zimbabwe 5,258 35 40,000 265
Namibia 3,821 148 10,500 400
Nigeria 3,110 2 184,000 87
Botswana 2,534 106 8,400 375
Mozambique 2,132 7 53,000 165
Eswatini 1,363 116 4,200 335
Ghana 1,343 4 36,800 114
Madagascar 1,169 4 20,400 73
Lesotho 687 32 3,005 141
Mauritius 240 19 170 13

The data is from The Economist (18 January 2022). Excess deaths are the middle of the (often very wide) ranges. If you are using a PC, placing your mouse over the excess death figures shows the range.

For most countries, the official deaths are a considerable underestimate. For most African countries the excess death estimates are an educated guess, and are implausible in some cases. As The Economist states: “Outside Europe and the Americas, few places release data about excess deaths. No such information exists for large swathes of Africa and Asia, where some countries only issue death certificates for a small fraction of people.”

But South Africa does have reliable excess death data. The fact that South Africa has the third highest excess death rate in this table should be taken with a pinch of salt; other sub-Saharan African countries may well be as bad or worse.

The Covid pandemic has shown the urgent need to improve the collection of vital statistics across the continent.

The view that Africa is exceptional provides an excuse for the slow vaccine rollout in most countries. The invisibility of the pandemic’s likely devastating effects reduces pressure on wealthy governments that have done too little to distribute vaccines, as well as on African governments indifferent to their populations.

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TOPICS:  Covid-19

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