COVID-19 exerted diverse pressures of unimaginable proportions on lives and livelihoods, especially among vulnerable populations across the world. As the global economy was struggling, socio-economic inequities deepened, thrusting many vulnerable populations further down the poverty line. But the situation was even worse in developing countries like Nigeria where economic challenges are rife even in ordinary times. So, how did vulnerable populations survive the stark devastation of the COVID-19 pandemic and its management in the most populous country in Africa?
The findings we share in this article emanate from the rapid assessment component of arguably one of the most ambitious research projects undertaken on COVID-19 in West Africa. The research project “Rectifying the Effects of COVID-19 on Vulnerable populations in West Africa: a Research-action (RECOVER)” ran from November 2020 to February 2024. The project was an initiative of the West African Network of Emerging Leaders in Health Policy and Systems (WANEL) and implemented by a consortium of five implementing partners. RECOVER was funded by IDRC and enjoyed technical support from the Institute of Tropical Medicine, Antwerp.
The research project aimed to reduce the knowledge gap about the multi-level impact of collateral effects of COVID-19 on vulnerable populations in West Africa and develop evidence-based strategies to respond to future epidemics. Recently, a “wrap-up” RECOVER workshop was held in Accra (Jan 18-19), among others, to advance a people-centred, multisectoral policy framework that can mitigate the collateral effects that arise from future pandemics in West Africa. Here we will focus on Nigeria.
COVID’s direct and collateral impact on vulnerable populations in Nigeria
In West Africa, the first case of COVID-19 was reported in Nigeria on the 27th of February 2020. It involved an Italian expatriate who had returned from Milan to Lagos. Within months, the rate of infection soared to unimaginable levels unleashing also unprecedented challenges on vulnerable populations.
Before going into some of these, let’s first provide a few relevant definitions:
Vulnerable populations include but are not limited to: “people experiencing homelessness, people living in overcrowded housing, collective sites and slums, migrant workers, refugees, people with disabilities and chronic illnesses, people living in closed facilities, and people living in poverty and extreme poverty”. A more exhaustive list – in a country like Nigeria – would also encompass women, older persons, adolescents, children, and youth, especially girls and persons with mental health conditions.
The direct effects of pandemics on individuals can be contrasted with the collateral effects that result from interventions tailored to respond to the pandemic. Here, the direct impact refers to the immediate and primary health consequences of the virus on individuals who contract it. These effects can vary widely and may include respiratory symptoms, fever, fatigue, cognitive issues and even death. On the contrary, collateral effects (also known as indirect, secondary, or incidental effects) are the broader consequences (social, economic, psychological, etc) that result from the governmental and public health responses to the pandemic such as curfews, lockdowns, and other public health measures. More in particular, the “collateral effect” refers here to the unintentional or incidental effects of an action or an intervention. In the context of outbreaks, collateral effects are changes of health system components and the broader social health determinants, that can be attributed to the outbreaks themselves (first level collateral effects) or the interventions or policies to respond to them (second level collateral effects), and further, the effects of interventions and policies that seek to mitigate the second level collateral effects (third level collateral effects).
Collateral effects resulting from governmental or public health measures often bring about economic hardships on the vulnerable as many of them see their jobs lost, with the related loss of income. As the pandemic was raging in Nigeria, instituted control measures such as curfews, lockdowns, and other stringent containment approaches exacerbated (already dire) economic conditions further, plunging the vulnerable into abject poverty. They also struggled with a lack of food and other necessities of life, and in many cases their health suffered, including mental health issues like depression, stress, anxiety, fear, etc. In addition, the preventive measures taken against the pandemic led to the emergence of more vulnerable populations as previously non-vulnerable people became vulnerable due to limited access to basic life necessities such as food and funds. People living with chronic illnesses (like HIV/AIDS) suffered most as chronic ill-health often intersects with other social identities like gender, unemployment, and socio-economic status. The incarcerated equally bore the brunt of the collateral effects of COVID-19 as they lived in fear of being infected because of the prison service’s inability to ensure physical distancing in some of the congested prison facilities. Women were inequitably affected because of their unique biophysiological needs and roles as caregivers at home and in most healthcare facilities. Many other vulnerable persons suffered a mix of interconnected collateral effects like job losses, food insecurity, school dropout, gender-based violence, and mental health disorders.
Coping strategies
Nonetheless, some vulnerable persons managed to adapt to these harsh collateral effects of COVID-19 by adjusting their behaviour and lifestyle. These coping strategies included increased commitment to exercising (including using online programmes or videos); nurturing of social relationships through talking with friends and family and engaging in more family-oriented activities; promotion of (better) spiritual health through a reliance on prayers, religious services, and use of faith-based community support (eg: palliatives distributed by religious organizations). More time was also spent watching television and engaging in other screen time activities including social media use. On a more negative note, the pandemic also saw changes in eating habits, with both overeating and undereating becoming more common, leading to a wide range of malnutrition among others.
In addition, most vulnerable people also relied on government social interventions and charity for survival as the pandemic led to scarcity and hikes in the prices of common goods that the vulnerable could not afford (anymore). And although in general the pandemic negatively impacted businesses, a few of the vulnerable coped by starting alternative businesses like face mask production and online sales.
In summary, COVID-19 alongside the (too) rigid preventive measures in place had a variable impact on the vulnerable in Nigeria. The application of a mix of the abovementioned socio-behavioural lifestyle modifications helped a good number of vulnerable people to cope with the most devastating effects of the pandemic. These coping strategies had mixed effects on their health and wellbeing, both positive and negative ones. There is a need to ensure that the vulnerable who were worst hit by the pandemic are supported to recover and continue to thrive in the post-pandemic period – in Nigeria and elsewhere.