Sub-Saharan Africa: We Need to Act Now

撒哈拉以南非洲：我们需要立刻行动起来

 

By Kristalina Georgieva and Abebe Aemro Selassie

克里斯塔利娜·格奥尔基耶娃 阿贝贝·埃姆罗·塞拉西

 

28 July 2021

2021年7月28日

 

Sub-Saharan Africa is in the grips of a third wave of COVID-19 infections that threatens to be even more brutal than the two that came before.

撒哈拉以南非洲正在经历第三波疫情，这波疫情可能比之前的两波更为严重。

 

This is yet more evidence of a dangerous divergence in the global economy. One track for countries with good access to vaccines, where strong recoveries are taking hold. And another for those countries that are still waiting and at risk of falling further behind.

这是全球经济出现危险分化的又一证据。疫苗充足的国家正在经历日趋稳固的经济复苏，而仍在等待疫苗的国家可能会落后得更远。

 

The growth of infections in sub-Saharan Africa is now the fastest in the world, with an explosive trajectory that is outpacing the record set in the second wave. At this pace, this new wave will likely surpass previous peaks in a matter of days – and in some countries, infections are already more than double, or even triple, their January peaks. The latest (delta) variant – reportedly 60 percent more transmissible than earlier variants – has been detected in 14 countries. When the pandemic first hit, quick action by policymakers helped prevent infection rates seen elsewhere around the world. But it pushed already strained local health systems to the breaking point. Only six months after the initial crisis, the region experienced a second wave that swiftly outpaced the scale and speed of the first. Now, another six months on, sub-Saharan Africa faces its third devastating wave. The only way for the region to break free from this vicious pandemic cycle is to swiftly implement a widespread vaccination program.

从全球范围看，撒哈拉以南非洲感染人数的增长速度目前是最快的，病例呈爆发式增长，超过了第二波疫情的创记录水平。按照当前的传播速度，数天之内，新一波疫情就可能超过之前的感染人数峰值——在一些国家，感染病例已经达到今年1月峰值水平的两倍甚至三倍。14个国家已经发现了最新的德尔塔变异病毒株——据报道其比早先的变异病毒株传染性强60%。疫情最初暴发时，政策制定者的迅速行动使撒哈拉以南非洲避免了其他地区出现的高感染率。但当地医疗卫生体系也由此不堪重负。最初的危机暴发之后仅六个月，撒哈拉以南非洲经历了第二波疫情，其规模和速度很快超过了第一波疫情。现在又过了六个月，该地区正受到第三波疫情的严重冲击。撒哈拉以南非洲地区摆脱这种恶性循环的唯一途径就是迅速实施广泛的疫苗接种计划。

 

A still-vulnerable region

撒哈拉以南非洲地区依然脆弱

 

The sheer speed of this third wave highlights the difficulty policymakers in sub‑Saharan Africa face in heading off a crisis once it gets under way. In Namibia, for example, new cases reached the previous January peak within only two weeks, and tripled another two weeks later. For many countries, by the time a new surge is identified, it may already be too late.

第三波疫情传播速度极快，这突出表明，一旦疫情蔓延开来，撒哈拉以南非洲地区的政策制定者击退危机就面临相当大的难度。例如，在纳米比亚，新病例在仅仅两周之内就达到1月份的峰值水平，两周之后则增至三倍。对于许多国家来说，确定发生新一波疫情时，可能已经为时太晚。

 

And the options employed during previous waves may no longer be feasible. The re-imposition of containment measures would likely come at too high an economic and social cost, and is simply unsustainable – and unenforceable – over a prolonged period. Looking back, most sub-Saharan African countries entered the second wave in a more difficult economic position than the first, with shrinking fiscal resources to protect the vulnerable, additional millions thrown into poverty, and depleted household balance sheets. While some countries have taken steps to improve preparedness, unfortunately, very few have had sufficient resources – or time – to strengthen public health systems. And, now, the scale of the current wave is once again threatening to overwhelm local health systems. News reports across the region point to overwhelmed hospitals. The sick are dying while waiting for a bed. Non-emergency surgeries have been canceled to preserve space for COVID-19 patients. And military hospitals have been opened for civilian use. Oxygen has become a key constraint, with supply already failing to keep up with the demand for critically-ill patients. The region’s scarce health workers continue to be at risk.

前两波疫情期间采取的方案可能不再可行。重新实施防疫措施的经济和社会成本可能太高，并且长期来看不可持续、无法执行。回过头看，第二波疫情袭来时，大多数撒哈拉以南非洲国家的经济状况比第一波疫情暴发时要困难得多，保护脆弱群体的财政资源不断减少，又有数百万人陷入贫困，家庭资产负债状况急剧恶化。尽管一些国家已经采取措施提高危机防范能力，但很少有国家拥有充足的资源或充裕的时间来加强公共医疗卫生体系。当前这波疫情规模之大，再次使当地医疗卫生体系不堪重负。该地区的新闻报道普遍显示，各地的医院已经人满为患。病人因等不到床位而面临死亡；为了给新冠病人留出位置，非急救手术被取消；军队医院已向民众开放。氧气成为一个关键的制约因素，其供给已经跟不上危重病人的需求。撒哈拉以南非洲地区稀缺的医护人员继续面临风险。

 

The risks of leaving Africa behind

非洲可能被落在后面

 

The vaccine rollout in sub-Saharan Africa remains the slowest in the world. Less than 1 adult in every hundred is fully vaccinated, compared to an average of over 30 in more advanced economies. This means even most essential frontline workers continue to work unprotected. In this context, some of the world’s more fortunate countries have stockpiled enough vaccines to cover their populations many times over.

撒哈拉以南非洲的疫苗普及速度在全球仍是最缓慢的。每100名成人中还不到1人完全接种了疫苗，而在更为发达的经济体则平均超过30人。接种率如此之低，意味着最关键的一线工作人员仍没有得到有效防护，与此同时，世界上一些更富裕的国家已经储备了足以为本国人口接种多次的疫苗剂量。

 

Without significant, upfront, international assistance – and without an effective region-wide vaccination effort – the near-term future of sub-Saharan Africa will be one of repeated waves of infection, which will exact an ever-increasing toll on the lives and livelihoods of the region’s most vulnerable, while also paralyzing investment, productivity, and growth. In short, without help the region risks being left further and further behind. And the longer the pandemic is left to ravage Africa, the more likely it is that ever more dangerous variants of the disease will emerge. Vaccination is not simply an issue of local lives and livelihoods. It is also a global public good. For every country – everywhere – the most durable vaccine effort is one that covers everyone, in every country. What can be done to speed up the vaccine effort? IMF staff has put forward a global proposal that targets vaccinating at least 40 percent of the total population of all countries by end-2021, and at least 60 percent by the first half of 2022. Africa is expected to receive 30 percent vaccination coverage through COVAX and another 30 percent coverage through the African Vaccine Acquisition Task Team (AVATT), established by the African Union under the leadership of President Cyril Ramaphosa.

如果不先行提供大规模国际援助——不在整个撒哈拉以南非洲地区范围内开展有效的疫苗接种工作，那么该地区近期内将会经历数波疫情，而这将对该地区最脆弱民众的生命和生计带来越来越大的冲击，同时也会导致投资、生产率和经济增长陷入瘫痪。简而言之，如果得不到帮助，撒哈拉以南非洲地区将面临越来越落后的风险。疫情在非洲肆虐时间越长，该地区就越有可能出现更危险的变异毒株。疫苗接种不仅仅是关乎当地生命和生计的问题，同时其也是一项全球公共产品。对于每个国家、世界每个角落，为实现最持久的复苏，需要在全球范围内开展疫苗接种行动，覆盖到每个国家的每一个人。如何能够加快疫苗接种？IMF提出了一项全球建议，目标是到2021年底，所有国家接种疫苗的人口比例至少达到40%，2022年上半年至少达到60%。非洲的疫苗接种需求预计有30%将通过新冠肺炎疫苗实施计划（COVAX）来满足，另有30%将通过非洲联盟成立的非洲疫苗采购工作组（AVATT，西里尔·拉马福萨总统领导）来满足。

 

We see seven key steps to ensure these vaccination targets are met:

为确保实现上述疫苗接种目标，我们认为需要采取七项关键措施：

 

First, it is essential to deliver vaccines to sub‑Saharan Africa as soon as possible. Given that much of the global supply of vaccines for 2021 has already been bought up, many countries will be forced to wait until 2022 to get them. So, the fastest way to get vaccines to sub‑Saharan Africa is for advanced economies to share their stockpiles bilaterally or through multilateral initiatives. COVAX has already received pledges for over half a billion doses. But these need to turn into actual deliveries as soon as possible to make a difference. Indeed, the goal should be to get a quarter of a billion doses to the region by September. Second, vaccine manufacturers should speed up supply to Africa for the rest of this year. Advanced economies with vaccine manufacturing capabilities should encourage their manufacturers to do so, especially when demand at home is falling short of supply. Third, AVATT should be fully financed to ensure coverage of 30 percent of the African Union population. This requires an estimated $2 billion, that would for example allow AVATT to execute its optional contract of 180 million doses with J&J. Fourth, remove cross-border export restrictions on raw materials and finished vaccines. This includes ensuring that the Aspen facility in South Africa – a key supplier to AVATT – is operational at full capacity, and resuming exports from the Serum Institute of India to COVAX. African vaccination plans rely heavily on these two facilities. Fifth, financing of at least $2.5 billion and upfront planning will also be critical to ensure health systems can deliver shots-in-arm promptly as vaccine supply ramps up. Many countries in the region, including eSwatini, Ghana, Kenya, Namibia, and Rwanda, have quickly and effectively administered their limited supplies. These countries, along with others in the region, have had to place their vaccine campaigns on hold as they wait for the arrival of the new supplies that they have recently procured at comparatively high cost or the donated supplies from other countries’ stockpiles. It is these shortages – rather than the ability to administer shots – that has so far been the biggest constraint. But when supply picks up, health systems must be prepared to vaccinate as many people as possible. And this is doable as the experience in many developing countries show – the likes of Seychelles, Mongolia, Bhutan, and Maldives impressively scaled-up vaccinations quickly once their vaccine supplies arrived. Alongside vaccination efforts, countries must also ensure that their public health systems are able to handle an influx of cases. This includes accelerating the acquisition of vital COVID-19 health tools, including therapeutics, oxygen, and personal protective equipment. No matter what the speed of vaccinations, these supplies are needed now to help save lives. This will require urgent grant financing to pre-emptively procure and deliver a minimum package of critical COVID-19 Health Tools to address the rising health and economic costs arising from the surge in cases driven by the delta variant.

第一，必须尽快向撒哈拉以南非洲国家提供疫苗。鉴于2021年全球大部分疫苗供给已被订购完毕，许多国家可能不得不等到2022年。因此，使撒哈拉以南非洲能够尽快获得疫苗的途径是，发达经济体通过双边或多边渠道分享其疫苗储备。COVAX已经收到超过5亿剂的捐赠承诺。但需要尽快落实这些承诺才能真正起到作用。事实上，目标应该是在今年9月之前向撒哈拉以南非洲地区提供2.5亿剂疫苗。第二，在今年剩下的时间里，疫苗生产商应加快向非洲供给疫苗。具备疫苗生产能力的发达经济体应鼓励其生产商这样做，特别是在国内需求不足的情况下更应如此。第三，AVATT应得到充分的资金支持，以确保非洲联盟国家人口的30%获得疫苗接种。这方面的资金需求估计为20亿美元，这些资金将使AVATT能够执行其与强生公司签订的1.8亿剂疫苗的可选合同。第四，应取消对疫苗生产原材料和疫苗制成品的跨境出口限制，包括确保南非的Aspen生产厂（AVATT的主要供应商之一）满负荷运转，并恢复印度血清研究所向COVAX的出口。非洲疫苗接种计划高度依赖这两个生产基地。第五，必须安排至少25亿美元的资金并做出前期规划，以确保医疗卫生体系在疫苗供给增加后能够落实接种工作。该地区的许多国家（包括斯威士兰、加纳、肯尼亚、纳米比亚和卢旺达）已经迅速有效地为人们接种了有效数量的疫苗。这些国家以及该地区其他国家不得不暂时停止接种工作，等待新的疫苗供给。新疫苗要么是它们最近以相对较高成本采购的，要么是其他国家从其库存中捐赠的。到目前为止，最大的制约因素是疫苗供给的短缺，而不是实施接种的能力。但当疫苗供给增加时，医疗卫生体系必须做好准备为尽可能多的人接种疫苗。许多发展中国家的经验表明，这是可以做到的——塞舌尔、蒙古、不丹和马尔代夫等国都在获得疫苗之后迅速扩大了接种工作。在加强疫苗接种的同时，各国还必须确保本国医疗卫生体系能够应付感染病例大幅增加的情况。这包括，加快必要防疫物资的采购，包括治疗用品、氧气和个人防护设备。无论疫苗接种速度如何，现在都需要这些防疫物资来挽救人们的生命。为此，目前迫切需要提供赠款融资，预先采购和发放最低数量的防疫物资，解决德尔塔变异病毒感染病例激增引起的越来越大的健康和经济代价。

 

Finally, the magnitude of the region’s financing needs requires a coordinated effort on the part of the international community. Few countries have the fiscal space to finance this effort on their own, considering the region’s already elevated debt levels and already pressing spending needs. Most of the international community’s financial assistance will need to come in the form of grants or concessional loans. With our colleagues from the World Bank, WHO, WTO, and others, the IMF has formed a special task force to ensure that countries get the resources and vaccines they need.

最后，鉴于撒哈拉以南非洲地区的融资需求规模巨大，国际社会需要采取协调一致的行动。很少有国家具备足够的财政空间来自行解决这些资金需求，因为该地区的债务水平已经很高，并且面临已经十分紧迫的支出需求。国际社会的大部分资金援助将需要以赠款或优惠贷款的形式提供。IMF在与世界银行、世界卫生组织、世界贸易组织和其他机构合作基础上，成立了一个特别工作组，确保非洲国家能获得所需的资源和疫苗。

 

As always, Africa can count on the IMF. We remain deeply committed to all countries in the region. We’ve ramped up our lending to sub‑Saharan Africa – last year it was more than 13 times our annual average – and support to increase our access limits will allow us to scale up our zero-interest lending capacity. And the unprecedented $650 billion new SDR allocation, far and away the largest in the Fund’s history, once approved will make $23 billion available to member countries in sub‑Saharan Africa.

IMF将一如既往地为非洲提供帮助。我们仍坚定地支持该地区的所有国家。我们已经扩大了对撒哈拉以南非洲的贷款——去年，我们向该地区提供的贷款是年均水平的13倍多。提高贷款限额的工作获得了有力支持，这将使我们能够扩大零息贷款能力。6500亿美元的特别提款权新一轮分配将是IMF历史上空前的、规模最大的一次分配，一经批准，将为撒哈拉以南非洲成员国家提供230亿美元的可用资金。

 

Yet the gravity and urgency of the situation requires the global community working together. We all have a stake in this. So, in all countries – advanced and emerging alike – we can reclaim our physical and economic health from the pandemic. And so that sub‑Saharan Africa can resume its path toward a more prosperous future.

当前形势严峻而紧迫，国际社会必须携手努力。这关乎所有各方的利益。只有同舟共济，包括发达经济体和新兴经济体在内的所有国家才能从疫情中恢复经济健康和活力，撒哈拉以南非洲国家也才能继续迈向更加繁荣的未来。