In the developed world, we’ve become accustomed over the last 18 months to practicing simple measures like masking, social distancing, frequent handwashing, and quarantine and isolation when necessary. That was especially crucial before vaccines became available, when experts recommended a “Swiss cheese” approach to virus mitigation, providing various layers to prevent COVID-19 transmission.

In Africa, those steps are arguably more important—since only 2.5% of the continent’s population of 1.2 billion has been vaccinated. But, a new study suggests that many of these techniques are basically impossible, due to living conditions defined by poverty, such as a lack of running water and toilet facilities, overcrowding, and homes with only single rooms. The authors propose that the influx of vaccines, currently being hoarded by developed countries, is urgent. And, in the long term, the world needs to work together on more coordinated public health responses.

The University of Bristol study considers several non-pharmacological public health interventions (NPIs)—those steps to prevent infection that don’t involve drugs or treatment—using household data from past years for all of Africa’s 54 countries. The study produced some alarming figures (though not the availability of masks). It found that 718 million Africans live in households with 6 or more individuals, many of which are not multi-room homes; and, about 283 million live in households where 3 or more people sleep in the same room. These conditions make it impossible to stay physically distanced. Coauthor Tim Brewer, an infectious disease physician and epidemiologist at UCLA, says that, using the standard definition of “close contact”—as 15 minutes of contact between people within 6 feet over a 24-hour period—in these African homes, “that’s likely happening every single day.”

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