By Ben Taylor

Prayers answered?
In the four months that have passed since the last issue of Tanzanian Affairs, Tanzania has defeated the Coronavirus. There have been no new infections and no deaths reported since early May – the only country in the world for which this is the case. President Magufuli has declared victory.

The President had previously called for the country to use the power of prayer against the virus, saying that the virus “could not survive in the body of Jesus”. He called for three days of national prayer and said God would protect Tanzanians against the virus.

So, did it work? Is this why Tanzania has reported no new cases?
It would be easier to answer the question – and indeed to report on the state of the outbreak in Tanzania more generally – if the government had released any new data since early May. It has not done so. On the website of the African Centres for Disease Control and the reports of the World Health Organisation, the number of positive cases in Tanzania has remained firmly stuck at 510 since May.

In a speech on May 3rd the President accused unnamed “imperialist foreign powers” of sabotaging the national response by providing ineffective testing kits or buying off laboratory employees. He said he had sent dummy samples from a pawpaw and goat for testing, with some producing positive results. Heads rolled at the national health laboratory. In the same speech, the president also suggested international media organisations – the BBC was not named, but the implication was clear – have been deliberately spreading scare stories to undermine Tanzania while ignoring the extent of the outbreak in their home countries. He called this “another form of warfare”. Reforms were instituted at the national laboratory, together with a promise that once testing facilities were working properly, regular reports on case numbers would resume. This has not happened.

Nor, however, has there been any compelling evidence to disprove the government’s claims. Hospitals have not been overwhelmed with huge numbers of patients – whether of COVID-19 or indeed of “pneumonia”. It could be possible to cover up or disguise a few hundred – or even a few thousand – COVID-19 cases, but not the 150,000-200,000 deaths suggested by the London School of Hygiene and Tropical Medicine’s epidemiological modelling for Tanzania, assuming an uncontrolled outbreak. That model projected that most of the fatalities would occur in July and August. It has clearly – and thankfully – not come to pass.

The result is two narratives on the state of the outbreak in Tanzania that exist entirely independently of each other. On the one hand, there are no new cases and victory has been declared. The absence of undeniable evidence to the contrary means that the national media has almost entirely bought in to this view, or lacks the basis on which to question it. Life has returned, for most, to something a lot like normal, and the public has largely moved on.

At the same time, it has been very easy for the international media to paint the President as dangerously naïve and misguided, and to foretell devastating consequences for the country.

The true situation may bear little relation to either picture. Indeed, looking beyond Tanzania, scientists are intrigued by the limited impact of the virus across much of Africa. In an article in early August, the journal Science looked at the numbers and found evidence of infection rates in several countries well above official case counts, but with very few people reporting symptoms.

For example, a study by the Kenya Medical Research Institute (KMRI) Wellcome Trust Research Programme in June and July found that one in twenty Kenyans had COVID-19 antibodies – an indication of past infection. This would put the outbreak in Kenya on the scale of anything seen in Europe. And yet, at the time of the research, Kenyan hospitals were not reporting large numbers of patients and the official death toll stood at 100.

Similar studies in Mozambique and Malawi have reached similar conclusions. In the Malawian case, comparing findings with mortality ratios for COVID-19 elsewhere, researchers estimated that the reported number of deaths in Blantyre at the time, 17, was eight times lower than expected.

The discrepancy is unlikely to be solely due to lower testing numbers, otherwise overall mortality rates would be increasing, which does not appear to have happened. It could have more to do with the very low age profiles of African populations – the median age in Kenya is 20, in Spain it is 45. It could be that Africans have some form of genetic advantage, though higher fatality rates among ethnic minorities in western countries suggest otherwise. Or it could be that regular exposure to parasites like Malaria and to a range of COVID-like viruses has helped prime people’s immune system to respond effectively.

This all raises the question of whether the continent should try for “herd immunity” – letting the virus run its course to allow the population to become immune, perhaps while shielding the most vulnerable. But Glenda Gray, president of the South African Medical Research Council, says it could be dangerous to base COVID-19 policies on antibodies. It’s not clear whether antibodies actually confer immunity, and if so, how long it lasts, she notes.

The herd immunity strategy arguably (and charitably) reflects the path that Tanzania has effectively taken. It may yet work. And yet, with no data being released, we have no way of knowing.