Variation in SARS-CoV-2 outbreaks across sub-Saharan Africa

Benjamin L. Rice, Akshaya Annapragada, Rachel E. Baker, Marjolein Bruijning, Winfred Dotse-Gborgbortsi, Keitly Mensah, Ian F. Miller, Nkengafac Villyen Motaze, Antso Raherinandrasana, Malavika Rajeev, Julio Rakotonirina, Tanjona Ramiadantsoa, Fidisoa Rasambainarivo, Weiyu Yu, Bryan T. Grenfell, Andrew J. Tatem, C. Jessica E. Metcalf

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (for example, warmer environments1, younger populations2–4) have yet to be framed within a comprehensive analysis. We synthesized factors hypothesized to drive the pace and burden of this pandemic in SSA during the period from 25 February to 20 December 2020, encompassing demographic, comorbidity, climatic, healthcare capacity, intervention efforts and human mobility dimensions. Large diversity in the probable drivers indicates a need for caution in interpreting analyses that aggregate data across low- and middle-income settings. Our simulation shows that climatic variation between SSA population centers has little effect on early outbreak trajectories; however, heterogeneity in connectivity, although rarely considered, is likely an important contributor to variance in the pace of viral spread across SSA. Our synthesis points to the potential benefits of context-specific adaptation of surveillance systems during the ongoing pandemic. In particular, characterizing patterns of severity over age will be a priority in settings with high comorbidity burdens and poor access to care. Understanding the spatial extent of outbreaks warrants emphasis in settings where low connectivity could drive prolonged, asynchronous outbreaks resulting in extended stress to health systems.

Original languageEnglish (US)
Pages (from-to)447-453
Number of pages7
JournalNature Medicine
Issue number3
StatePublished - Mar 2021

All Science Journal Classification (ASJC) codes

  • General Biochemistry, Genetics and Molecular Biology


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