• 2025.09.19 ｜

  Policy Recommendation

  ｜

  No.35

  SDGs Collaborative Research Unit

Recommendations for infectious disease control in sub-Saharan Africa

The SDGs Collaborative Research Unit at the Institute for Future Initiatives (IFI) at the University of Tokyo issues policy recommendations based on a three-year research project titled “Exploring Resilience and Practical Knowledge to Overcome Downside Risks: Grassroots Voices in Africa during the COVID-19 Crisis” from December 2021 to November 2024.

This research project aimed to classify and assess the real and perceived risks associated with both COVID-19 and government responses to the pandemic in sub-Saharan Africa. It also elucidated the people’s resilience in overcoming these risks by using their practical wisdom.

Research countries included the Democratic Republic of Congo, Ethiopia, Kenya, South Africa, Tanzania, Uganda, and Zimbabwe. We collected “grassroots voices” during the COVID-19 pandemic through field research in collaboration with local research institutions and online communication tools, and dynamically clarified how people overcame risks over time.

In particular, this research makes a significant contribution by revealing that governments’ potential politicization of COVID-19 prevention measures and people’s distrust of the government could hinder the effectiveness of their policies. Several countries faced criticism that politicians used government prevention measures to garner votes and favor the governing party in elections. Such biased policies decrease people’s trust in government and can harm preventive measures and vaccine dissemination. While rapid implementation of these measures is vital in preventing pandemics, policymakers should carefully consider them from the perspective of protecting vulnerable populations and guaranteeing human rights.

On the other hand, our survey revealed that people’s perceptions of the government and its policies are complex and multifaceted, often depending on the passage of time and the outcome of the policy. Moreover, ordinary people, in pursuit of survival, improvised creative activities to maintain their livelihoods while maneuvering the containment measures. It is also essential to understand the sources of people’s resilience in times of hardship and to empower them with public assistance during regular times.

Based on the survey results from the seven countries, we identified four overall findings.

1. Risk perception of COVID-19 was low. The impact of economic shocks caused by government policies was perceived as more serious. Therefore, a risk trade-off occurred.
2. Politicization of containment policies was observed, and the limited spread of the pandemic in Africa, compared to initial fears, affected people’s perception of the “success” of the policies and led to a high evaluation of the government.
3. The effect of misinformation on vaccination behavior was revealed. Moreover, belief in misinformation is affected by trust in religious and scientific authorities, and medical professionals. Additionally, trust in these experts is affected by religious beliefs.
4. The reality of coping strategies to overcome difficulties was portrayed. Thereby, the importance of informal networks in African countries as a root of resilience was depicted.

Based on the results of the survey, we propose four recommendations to the international community, in particular, UN and international organizations implementing aid policies for Africa, and government aid agencies of various countries, to prepare for future outbreaks of infectious diseases.

The survey suggests the need to achieve an appropriate balance between infectious disease countermeasures and maintaining economic activity. Alternatively, the simultaneous and rapid implementation of both countermeasures. So as to avoid a risk trade-off in which policies aimed at protecting people’s lives through disease control increase other risks, such as hunger and the other infectious diseases, due to restrictions on economic activity. In particular, in areas where vulnerable populations are exposed to various risks even in peace and stable times, it is necessary to understand the connections between risks and implement policies accordingly.

We note that the politicization of pandemics or the high evaluation of the government resulting from infectious disease control can lead to a crisis of democracy. Experts warn that people’s acceptance of strong government power during a pandemic can cause a crisis of democracy. In our research, we found significant politicization of anti-pandemic policies in Uganda and Kenya, where elections occurred during the pandemic. People reported short-term problems and corruption related to strict lockdowns. However, over time, people became more willing to accept severe policies and allowed the government to have more power. Awareness of the future risks associated with this trend is necessary.

Any public health communication strategy must consider the religious context of the target population, and a targeted communication strategy is necessary to address and correct misinformation by collaborating with key persons such as trusted traditional leaders, based on an understanding of the local history and culture.

Since all of the countries showed that the roots of resilience lie in informal networks, we advocate the need for aid that supports these networks in times of peace and stability. Aid from international organizations tends to be oriented toward formalizing the informal sector in the Global South. However, given that informal networks are key to resilience when the world as a whole is in crisis and neither aid nor public assistance can reach them, it is important to support the formation and maintenance of informal networks that promote mutual support among people.