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‘People Are Scared’: U.S. Officials in Africa Fight a Resurgent COVID-19

As a new variant of the coronavirus spreads across southern Africa, U.S. aid officials are worried about health care—and a lack of guidance from Washington.

By Amy Mackinnon, a national security and intelligence reporter at Foreign Policy., and Robbie Gramer, a diplomacy and national security reporter at Foreign Policy.
A morgue attendant at the Pretoria branch of the South African funeral and burial services company Avbob stands next to the body of a patient who died from COVID-19-related illnesses as a coffin is brought along ahead of his burial on Jan. 22.
A morgue attendant at the Pretoria branch of the South African funeral and burial services company Avbob stands next to the body of a patient who died from COVID-19-related illnesses as a coffin is brought along ahead of his burial on Jan. 22. Marco Longari/AFP via Getty Images

Aid officials posted at U.S. embassies across southern Africa are raising dire warnings to Washington about the rapid spread of COVID-19 in the region, asking for urgent guidance from senior aid officials amid a surge in cases thought to be driven by the hypercontagious South African variant and strained health care systems. 

Internal memos and emails sent late January and obtained by Foreign Policy detail how U.S. Agency for International Development (USAID) missions in southern Africa are grappling with low morale and staff shortages due to illness and that at least three USAID members of staff in the region have died from COVID-19 as well as several staff members from local partner organizations. 

“A significant portion of our work day right now is spent checking up on sick colleagues (we have a work buddy system) and feeding information on their health situation to our [executive office] to share with the Embassy,” one email said, describing the situation in Mozambique, where there have been at least 38 confirmed COVID-19 cases among mission staff.

The internal communications reflect how rapidly the virus is spreading in the developing world and presents an urgent challenge to the Biden administration and USAID Administrator-designate Samantha Power, who is awaiting confirmation by the Senate. 

One official in the region noted that there had been some improved communications about the rollout of the COVID-19 vaccines to U.S. officials overseas since the change in administration. A cable sent to all missions on Wednesday and seen by Foreign Policy gave the first detailed rundown of how vaccines would be distributed. A message from the acting undersecretary of state for management and director-general of the foreign service acknowledged that there had been some confusion but promised greater transparency going forward. 

In a statement to Foreign Policy, a spokesperson for the U.S. State Department said: “Protecting and promoting the health and safety of the Department’s workforce is among our top priorities.”

“In distributing allotments of COVID-19 vaccines to our personnel, we review available public health data on case counts, dosage requirements, first response and treatment capacity, case counts among our workforce at a facility or posting, and the logistics of vaccine distribution to most effectively protect our personnel while minimizing risk to supply,” the spokesperson added.

Some officials in the region have floated requests for a new round of so-called “authorized departures,” allowing U.S. officials posted abroad who fear for their health and safety the option of returning to the United States. One memo describes how an official in the region opted to take home leave to ensure their family could get out before they ran out of test kits.

The State Department first greenlighted plans to evacuate most of its diplomatic personnel and their families from China in late January 2020 as the virus began rapidly spreading across China. In March, as the pandemic picked up pace worldwide, State Department and USAID officials at embassies around the world who were at higher risk from COVID-19 were allowed to temporarily leave their posts. But in the final months of the Trump administration, despite rapidly rising case numbers, U.S. officials posted in sub-Saharan Africa said they hadn’t heard any further guidance about when—or whether—they may be permitted to leave their posts. 

In South Africa, one of the hardest-hit countries on the continent by the pandemic, a mutated and more transmissible variant of the virus emerged less than two months ago, leading to a massive spike in both the number of cases and deaths. That variant has now spread widely to at least 30 other countries—including the United States. 

Experts and humanitarian workers fear that even as high-income countries in the developed world get a handle on cases and begin distributing vaccines, poorer and developing countries in Africa will be left behind.

“Allowing the majority of the world’s population to go unvaccinated will not only perpetuate needless illness and deaths and the pain of ongoing lockdowns, but also spawn new virus mutations as COVID-19 continues to spread among unprotected populations,” the chief of the World Health Organization, Tedros Adhanom Ghebreyesus, warned in an op-ed for Foreign Policy on Tuesday. “Unchecked spread can result in the emergence of more contagious variants, leading to a steep rise in cases. It is a vicious cycle.”

Data from the Africa Centres for Disease Control and Prevention released on Tuesday shows that the African continent has tracked more than 3.6 million COVID-19 cases and some 91,500 deaths. That number is expected to increase further in the coming weeks. 

Internal USAID communications reveal increasing concern about the ability of local health care systems to provide sufficient care in the event that staff become critically ill. 

“People are scared, they’ve got kids, they’re at home, and they don’t know what happens if they get sick when many of these countries don’t have great health care systems,” said a USAID official in the region. 

Last month, then-U.S. Ambassador to South Africa Lana Marks announced that she had spent 10 days in an intensive care unit after developing COVID-19 in late December. Marks, a luxury handbag designer and Trump political appointee, drew fire from embassy staff last March when she returned to the country and did not self-isolate after attending an event at the former president’s Mar-a-Lago resort despite some attendees later testing positive for COVID-19. 

South Africa has a highly developed health care system, but in poorer countries in the region embassies are relying on medical evacuation to deal with severe cases. One official in the region said medical evacuations have been taking 48 to 72 hours, adding, “In terms of COVID, that could be a death sentence.”

Speaking on background, the State Department spokesperson said: “The Department has a medical evacuation program in place for employees and their family members under the embassy health unit medical program. The Bureau of Medical Services’ (MED) providers work through regional medical evacuation centers and Washington, D.C. to arrange medical transport when required.”

They added that MED had successfully carried out 38 medical evacuations by air ambulance worldwide and that less urgent evacuations had been carried out by scheduled air carriers.

According to an internal USAID memo, patients in Eswatini, which borders South Africa, were dying due to a lack of oxygen supplies. “The Health team lead was searching high and low for ways to help get some O2, and they may have sorted some solutions, I am not sure of the latest, but their system is struggling,” the memo said. 

Officials in the region described a lack of clear communication from agency chiefs about vaccine availability and safety procedures. In internal emails seen by Foreign Policy, the regional medical officer advising U.S. missions in South Africa appeared to downplay the importance of masks, writing, “Masks are exciting, colorful and currently mandated in public areas but the most important measure that we can take to keep ourselves and our colleagues healthy from disease during any pandemic/epidemic is to keep our hands clean.” That email was sent July 29, almost four months after the U.S. Centers for Disease Control and Prevention advised Americans to wear masks in public spaces. 

Amy Mackinnon is a national security and intelligence reporter at Foreign Policy. Twitter: @ak_mack

Robbie Gramer is a diplomacy and national security reporter at Foreign Policy. Twitter: @RobbieGramer