When COVID-19 began spreading globally, predictions for Africa were grim. Many models anticipated widespread transmission, overwhelmed health systems and substantial loss of life. Yet as the pandemic unfolded, the experience in several African countries did not follow the trajectory many had expected. Hospitals were not overwhelmed to the extent predicted, and reported COVID-19 mortality remained considerably lower than anticipated in many settings.

African researchers set out to understand why. Their work would help challenge some of the assumptions being made about the continent and demonstrate something fundamental for global health: understanding an epidemic in Africa requires evidence generated from African populations and contexts.

The challenge

The unexpectedly low number of reported COVID-19 deaths across much of Africa generated considerable international debate. One explanation was that the apparent difference did not reflect a genuinely different experience of the pandemic. Instead, weak surveillance systems, limited testing and unrecorded deaths were suggested as reasons why the true burden of COVID-19 might have been substantially underestimated.

These were important questions, but without sufficient locally generated evidence, there was a risk that assumptions would become accepted explanations. What was needed was rigorous epidemiological research capable of examining what was actually happening within African populations, including patterns of infection, disease and mortality.

For African scientists, this was also about who generates the evidence used to explain African health experiences. Researchers working within these settings were well placed to investigate the questions emerging from their own populations and contribute African evidence and perspectives to a scientific conversation that had largely been shaped elsewhere.

The response

Researchers from the KEMRI-Wellcome Trust Research Programme in Kenya, part of the Initiative to Develop African Research Leaders (IDeAL) consortium under DELTAS Africa, contributed evidence that offered a different interpretation of Africa’s experience of the pandemic.

Drawing on emerging epidemiological evidence, the researchers challenged the idea that lower reported COVID-19 mortality in Africa could be explained primarily by low levels of infection or widespread failure to identify COVID-19 deaths. Their analysis pointed instead to an important distinction between infection and severe disease: populations could experience substantial exposure to SARS-CoV-2 without experiencing the levels of symptomatic and severe COVID-19 observed elsewhere.

Published in The Lancet Infectious Diseases, their work argued that populations in some African settings may have had reduced susceptibility to symptomatic COVID-19. This shifted attention towards understanding the biological, demographic, environmental and epidemiological factors that could explain why infection produced different patterns of disease across populations.

Crucially, the researchers were not simply responding to an international scientific debate. They were helping shape it, bringing evidence generated from African populations into conversations about one of the defining global health emergencies of the century.

The impact

The research helped reframe the scientific discussion about COVID-19 in Africa, moving the conversation beyond explanations centred predominantly on weak surveillance, undetected transmission and hidden mortality. It demonstrated that Africa’s pandemic experience needed to be investigated on its own epidemiological evidence rather than interpreted solely through assumptions derived from experiences elsewhere.

This contribution also illustrates the wider value of DELTAS Africa’s investment in developing African research leadership. Through IDeAL and the research environment around it, African scientists have been able to generate, analyse and communicate evidence on questions of immediate importance to the continent while contributing to international scientific knowledge. The significance extends beyond COVID-19. Future epidemics will bring new uncertainties, new models and new assumptions. This experience shows why African research leadership, strong institutions and locally generated evidence must be part of the global response from the beginning. When African researchers have the capacity and platforms to investigate the questions affecting their populations, they do more than fill gaps in global knowledge. They help determine how those questions are asked, how the evidence is interpreted and, ultimately, how the world understands health and disease in Africa.