From Unilateral Response to POLICY BRIEF Coordinated Action How Can Mobility Systems in Sub-Saharan Africa Adapt to the Public-Health Challenges of COVID-19? www.migrationpolicy.org JUNE 2021 BY LING SAN LAU, KATE HOOPER, AND MONETTE ZARD mission is a common feature of SARS-CoV-2, reduc- Executive Summary ing the effectiveness of common screening tools such as temperature checks and strategies such as As in almost every part of the world, the COVID-19 symptom-based isolation. pandemic has severely disrupted migration and mobility throughout sub-Saharan Africa. In March and April 2020, many governments in the region While many countries in sub- moved quickly to close their borders and impose Saharan Africa have experience travel restrictions to control the spread of infection, substantially curbing (although not entirely halting) dealing with infectious disease movement. The speed of these actions caught many outbreaks ... COVID-19 forced unawares, with hundreds of thousands of migrants governments to rethink some of their left stranded across the region. Like the large num- public-health strategies. bers of people affected by lockdown measures, those whose livelihoods rely on cross-border trade Instead, governments have relied on a combination or travel face significant economic uncertainty. While of screening, testing, and quarantine requirements some of these restrictions have since been revised or along the migration continuum to try to reduce the phased out in favor of more targeted measures (e.g., risk of cross-border transmission and lay the ground- testing), the emergence of several concerning new work for reopening borders more fully. Introducing variants of SARS-CoV-2 (the virus causing the disease some of these measures (e.g., to administer and COVID-19) has led some governments to reintroduce process COVID-19 tests, or to expand public-health additional travel restrictions. surveillance to track and analyze the spread of COVID-19 and its population impacts) has required While many countries in sub-Saharan Africa have ex- significant resources and support from international perience dealing with infectious disease outbreaks actors such as the Africa Centres for Disease Control (including Ebola, cholera, measles, and yellow fever), and Prevention and the International Organization 1275 K St NW, Suite 800, Washington, DC 20005 COVID-19 forced governments to rethink some of for Migration. But gaps remain. Public-health mea- 202-266-1940 their public-health strategies. For example, rapid sures have been applied unevenly and inconsistent- and widespread transmission has made it difficult ly across the region, reflecting limited capacity and to geographically confine the spread of the disease. weak border management and public-health infra- Further, asymptomatic and presymptomatic trans- structure. An over-reliance on border closures and HOW CAN MOBILITY SYSTEMS IN SUB-SAHARAN AFRICA ADAPT TO THE PUBLIC-HEALTH CHALLENGES OF COVID-19? HOW CAN MOBILITY SYSTEMS IN SUB-SAHARAN AFRICA ADAPT TO THE PUBLIC-HEALTH CHALLENGES OF COVID-19? mobility restrictions as the public-health tools of choice has exacerbated and compounded the eco- 1 Introduction nomic disruption caused by the pandemic, not just The arrival of COVID-19 during the first quarter of in sub-Saharan Africa, but globally. 2020 upended migration and mobility in sub-Sa- haran Africa, as it did around the world. Many Reflecting on the first year of the COVID-19 response governments in the region moved quickly to close in sub-Saharan Africa offers several lessons. Invest- their borders and introduce travel and mobility re- ments in strengthening health systems, surveillance, strictions to try to prevent the spread of SARS-CoV-2 and local capacity are necessary for a robust pub- and give themselves time to fortify their response lic-health response. Public-health and migration to the pandemic.1 By June 2020, nearly all countries actors will need to work together more closely to in Africa had suspended international flights, and ensure that cross-border trade and travel can re- the majority had also closed their land borders (38 start or continue safely, and that response plans countries) and maritime borders (17 countries).2 are informed by the best available evidence and While some migration has continued informally due take into account the needs of migrant and refugee to porous land borders, its volume has fallen sig- populations. Governments also need to coordinate nificantly even within areas of free movement, such closely when planning, introducing, and lifting pub- as the Economic Community of West African States lic-health measures, and where possible, harmonize (ECOWAS). these requirements across countries. Containment measures such as border restrictions can carry sig- While some migration has continued nificant costs for local populations, especially if they are not rolled out thoughtfully and with sufficient informally due to porous land borders, investments in livelihood and social protection sup- its volume has fallen significantly even ports, capacity building, and public and interagency within areas of free movement. communication. Efforts to improve coordination at Since then, governments have invested in pub- the regional level (for example, through the Eco- lic-health measures, such as enhanced hygiene, nomic Community of West African States and the physical distancing, and screening protocols at the East African Community) can help to lay the ground- border and post-arrival quarantine requirements, work for developing common standards, sharing in- which in some cases have replaced border closures formation, and working together to build capacity. or travel restrictions.3 However, the COVID-19 pan- demic has forced governments to reassess their COVID-19 knows no borders, and thus by its very strategies for monitoring and addressing infectious nature, an effective public-health response requires disease outbreaks. For example, the high proportion global and regional coordination. The pandemic has of asymptomatic and presymptomatic transmission challenged public-health infrastructure as never be- has rendered some established public-health tools fore, exposing how out of sync it is with the realities (such as temperature checks) relatively less effective. of migration and mobility. Learning from experienc- es gathered over the last year is key, not just for con- The crisis has also illustrated how public-health re- taining and mitigating the spread of this virus but in sponses can be slow to take the complex realities of order to adequately prepare and respond to future migration in the region into account. For example, public-health emergencies. border closures have come with unintended con- MIGRATION POLICY INSTITUTE | 2 MIGRATION POLICY INSTITUTE | 3 HOW CAN MOBILITY SYSTEMS IN SUB-SAHARAN AFRICA ADAPT TO THE PUBLIC-HEALTH CHALLENGES OF COVID-19? HOW CAN MOBILITY SYSTEMS IN SUB-SAHARAN AFRICA ADAPT TO THE PUBLIC-HEALTH CHALLENGES OF COVID-19? sequences, stranding large numbers of people, im- (such as hand hygiene, travel restrictions, lock- periling the supply of essential goods and services, downs, school closures, the wearing of masks, and and cutting off income for border communities and physical distancing) aim to slow disease spread and prospective migrants. These economic impacts are reduce pressures on health-care systems—that is, to closely linked to public-health impacts, due to the “flatten the curve.”5 According to expert consensus negative effects they can have on a population’s and evidence from past pandemics, including the health, the functioning of health systems, and the 1918 influenza, early government action and rigor- broader pandemic response. Introducing new con- ous mitigation measures are required to slow down tainment and mitigation measures has also required transmission.6 navigating weak border management capacity and often overstretched health-care systems in the Along the migration continuum, governments region, with implications for how quickly such mea- typically use a combination of containment and sures can be rolled out or effectively scaled. mitigation measures to try to prevent the spread of infectious disease. For example, predeparture in- Going forward, the challenge for policymakers lies terventions can include sharing information about in how to adapt mobility systems in the region to the latest travel restrictions and public-health re- effectively reduce the risks of COVID-19 transmission quirements; interventions at the border can include while minimizing the disruption to cross-border health screenings or testing; and post-entry require- trade and movement. Public-health measures will ments can include self-isolation or quarantine mea- need to be tailored to the realities of a region with sures or contact tracing (as will be described in more porous borders, under-resourced health-care and depth in the next section). migration management systems, and limited safety Compared to other coronaviruses that have caused nets for people who lose their livelihoods (especially recent pandemics or pandemic threats, such as the for migrants and all people who work in the informal Severe Acute Respiratory Syndrome (SARS) pandem- sector). This policy brief will explore how govern- ic in 2002–03 and the Middle East Respiratory Syn- ments in the region can navigate these challenges drome (MERS), first detected in 2012,7 SARS-CoV-2 is and the role that the international community can less deadly, on average, but it is