Little wonder countries on the continent rushed to follow the lead of rich nations such as Italy and Spain that were visibly struggling to cope with pandemic. Many closed borders, shut businesses and locked down citizens. Among the firmest responses was Uganda’s, where public transport was suspended, schools shut down, shops closed, curfews imposed and big gatherings banned. Kampala has conducted more than 350,000 tests, according to official data. After doom-laden warnings of 68,000 fatalities from the virus if there were failure to act, there have been 44 confirmed coronavirus deaths in this east African nation of 43m.

Such actions won praise from global health bodies. Yet were blunt lockdowns really the right approach in Africa? A growing body of doctors, economists and scientists fear these measures will have disastrous consequences. These experts warn of financial carnage, spiralling epidemics of other diseases, the intensification of gender and wealth inequalities and the battle against poverty being set back by decades. They point to Africa’s youth, with a median age of 18 years compared with 41 years in Europe, and few people in the highest-risk older categories — which may help explain why a continent of 1.3bn people has seen fewer confirmed virus deaths than the UK. Almost one in five Britons is aged 65 or over; in Africa, it is fewer than one in 50. Yet the impact of shutting down countries will be far worse than in wealthier developed nations.

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David Bell, a malaria specialist who has worked with both Bill Gates and the WHO, is among those concerned that we may be witnessing catastrophe unfolding on the continent. “It seems global health authorities did not think through the collateral damage, yet we knew by March the age-related fatality levels of this virus. If you looked at Italy or China, it was old people who were dying. In developing nations, many people live day to day, so even short disruption can be devastating to lives, while there are already large epidemics of malaria, tuberculosis and HiV that will only get worse if you reduce access and healthcare for a few months.”

Take Uganda, where borders remain closed, the curfew is still in place, and half the citizens are under 16 years old. On the plus side, there is thought to have been a fall in traffic fatalities as people stayed at home. But a new study by Bell and five other researchers indicates restrictive measures led to plummeting detection of new HiV and malaria cases, along with treatment of highly-infectious tuberculosis, while maternal mortality instantly surged from 92 deaths in January to 167 fatalities in March. “The fear is more people will die from other conditions,” said Agnes Kiragga, head of statistics at the Infectious Diseases Institute, Kampala, and co-author of the paper. “This has been a learning curve. Governments in Africa must consider not just Covid but other diseases that are more dangerous in a young population.”

One medic said the nation’s health budget had been depleted in three months, storing up problems. Another told me of children missing critical immunisations and a surge in suicides amid economic downturn so fierce the BBC recently showed a school teacher who lost her job selling maize on the street. “I had to look for a way of surviving,” said Harriet Agasiu. “I was eating my savings, which I finished.” There is little safety net in such places. Many people also live in crowded conditions lacking basic services that make social distancing impossible. And in countries such as Angola, Kenya and Uganda, people have been killed by security officials enforcing lockdown and others beaten and shot, exposing how thugs in uniform may be more dangerous than the disease.

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Malawi was among the handful of African countries that did not impose such rigid measures after its pandemic response became ensnared in electoral politics. Human rights activists, fearing the government was using the virus to wriggle out of a re-run presidential contest, won a court battle to stop lockdown on the basis there was not sufficient provision to stop poor people going hungry. Even big campaign rallies went ahead, although schools and later bars were shut down. Predictive modelling warned that inaction would lead to 16 million infections, 483,000 hospitalisations and 50,000 fatalities in this southern African nation of 19m people — yet there have been just 176 confirmed deaths to date.

There has been limited testing in Malawi, while doctors admit significant numbers of deaths may be going unrecorded, especially in rural areas. Yet there have been few coronavirus patients in their hospital emergency units. “We’ve not seen a lot of cases and the reasons remain unknown,” said Marah Chibwana, a member of the Viral Immunology Research Group at Malawi Liverpool Wellcome Trust Clinical Research Programme. She has just completed a study in Blantyre that found one in eight health workers has had Covid-19, highlighting this discrepancy between predicted and actual reported deaths. “It is a mystery that despite not going into a lockdown, we have experienced a low number of fatalities.”

The youth of citizenry must be a factor. But, as Chibwana says, another theory under investigation is that previous exposure to coronaviruses, such as those responsible for common colds, might have built up immunity to Covid-19. One leading South African virologist says he cannot think of any other reason to explain the numbers of completely asymptomatic people seen on the continent. If this is correct, it would mean the very conditions expected to fuel huge fatalities — cramped homes, crowded urban areas and communal washing spaces — may in fact help to protect poorer places in developing nations. Although who knows what lies ahead with this unpredictable new virus?

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Some countries are now tweaking their approach to focus more on testing and surveillance, having seen the disadvantages of lockdown. Lynda Iroulo, a Nigerian research fellow at the German Institute of Global and Area Studies, points to a spike in crime during lockdown in Lagos. “African nations made the mistake of mimicking Western measures without considering local conditions. In Western nations lockdowns were more feasible because the infrastructure is there and social welfare is available. But in most African nations lockdowns were flouted in search of money and sustenance. This is not surprising — it is a difficult challenge to overcome because the pandemic only exacerbated existing problems within nations. So the lockdown did more harm than good.”

A series of studies is starting to show the collateral damage in a continent where countries and families are being pushed to the brink, and where more than eight in ten people are self-employed, many surviving on marginal incomes as street vendors or day labourers. The UN forecast that Africa could have 30 million more people in poverty. A study by the International Growth Centre spoke of “staggering” implications with 9.1% of the population descending into extreme poverty as savings are drained, with two-thirds of this due to lockdown. ‘The context is very different to Europe because people become food deprived,” said co-author Matthieu Teachout, who fears the crisis could set poverty rates back two decades.

Then there is the wider health impact. One US charity predicts 2.3m child deaths due to disruption of services in the pandemic’s first year. Births in Zimbabwe’s health clinics have fallen more than one-fifth — which, according to a study in the Lancet, if replicated across the developing world might lead to 12,200 more maternal deaths, since women are more likely to die in childbirth from complications if not in a medical setting. A WHO analysis projects an extra 200,000 fatalities from TB this year, while the organisation also warns that the blocking of access to anti-retroviral therapies could lead to half a million extra deaths from AIDS-related illnesses.

The Lancet paper in May came from researchers at the John Hopkins Bloomberg School of Public Health, who were instantly concerned by the possible side-effects of the pandemic. It showed the results of modelling maternal and under-5 deaths resulting from disruption of health systems and decreased food access. The best scenario resulted in 253,500 additional child deaths over six months in 118 low- and middle-income countries; the worst led to 1,157,000 extra child fatalities and 56,700 more maternal deaths. “The scenarios were based on assumptions, not empirical data,” said lead author Timothy Roberton. “However, since May we’ve seen various data from different countries, and lots of anecdotal reports, that suggest our original scenarios might not be far off the mark — including the higher scenario.”

Malaria, the main cause of death in sub-Saharan Africa, is another concern. To put this in perspective, Angola has seen 126 coronavirus deaths compared with 2,500 fatalities from this parasitic disease in just the first quarter of 2020. One study warned that suspending the distribution of insecticide-treated bed nets and a big drop in the use of drugs across Africa could lead to mortality rates not seen for two decades. Another paper in Nature Medicine by researchers at Imperial College, London, predicts a doubling of malarial deaths this year: “In Nigeria alone, reducing case management for six months and delaying long-lasting insecticidal net campaigns could result in 81,000 additional deaths.” The tragedy behind such horrifying data, as co-author Thomas Churcher pointed out to me, is that we know how to control malaria though prevention and quick treatment.

This discussion over lockdown in Africa is a microcosm of the wider global debate over how to balance the handling of a deadly new disease with wider health, commercial and social issues. But it is multiplied many times over since coronavirus fatality rates are so much lower than in developed nations while the impact so much more profound. “Lockdowns are the wrong policy not just for Africa, but for almost all low income countries,” said Charles Robertson, global chief economist at Renaissance Capital and author of a book on Africa’s renaissance. I fear he is right. The more you look at the data, the harder it is to avoid the conclusions that the instant panicked response on the continent was a mistake — and one that may have the most hideous long-term consequences.

But Professor Didier Raoult is not an ordinary microbiologist — as he would be the first to tell you. He is an iconoclast and an enemy of the French medical establishment. He has long white hair and a pointed white beard, which makes him look like a fictional wizard — perhaps more of a querulous Gandalf than a genial Dumbledore.

In the last two months, Raoult, 68, has become both famous and infamous. He has, he says, discovered a “game-changing”, cheap, off-the-shelf cure for Covid-19 — namely hydroxychloroquine, a common treatment for malaria.

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His claims created a pandemic of controversy and conspiracy theories on both sides of the Atlantic. They have brought angry rebuttals from the medical establishment in France and beyond.

In the last few days, the Raoult game-changer appears to have fallen to bits. An extensive series of tests in American veteran hospitals concluded that, if anything, hydroxychloroquine increased the death rate among acute sufferers from Covid-19. A US state health agency warned that the two drug combination used by the professor could be “toxic”.

*

Didier Raoult is no quack. He is an eminent scientist with a long track-record of brilliant, original research, including his groundbreaking work on giant viruses (or ‘giruses’).

Some of his claims and methods have long been disputed. He is a climate change sceptic. He originally dismissed the Covid pandemic as a “crazy” fuss over the “death of three Chinese”.  He rejects the standard, systematic methods of medical research — such as the use of control groups and placebos — as the plodding obsession of “bureaucrats” and “mathematicians”.

So if not a charlatan, is he a genius? President Emmanuel Macron visited him a few days ago in his medical institute in Marseille and declared him to be a “very great scientist”. Professor Raoult agrees. Many of his colleagues, though acknowledging his brilliance, believe that Raoult lost the plot some years ago.

They point to the fact that he has put his name to 3,062 research papers, including more than 30 since the beginning of this year — way beyond what most scientists claim in a lifetime. “How can anyone believe that a scientist can really take part in work leading to one publication a week?” asks the biologist and investigative writer, Nicolas Chevassus-au-Louis.

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Nonetheless, Raoult has become in recent weeks a scientific super-hero for the young — the subject of memes and running anti-establishment jokes on French social media. He has also become an inspiration for the political Right on both sides of the Atlantic.

In France, the cautious official response to his ideas was used as a stick to beat the Emmanuel Macron and Edouard Philippe government for its allegedly “over-centralised” and “bureaucratic” response to the pandemic.

In America, the Marseille professor’s sweeping claims were taken up by Donald Trump and the alt-Right as proof that other approaches to Covid-19 — such as social and economic lockdowns and careful research — were the product of ‘Left-wing’ rather than ‘can-do’ thinking.

Raoult is also a favourite of conspiracy theorists. Official dismissals, or qualifications, of his claims are seized upon as proof that the pharmaceutical industry and its political lackeys are trying to bury a cheap, easy solution to the Covid-19 crisis. In other words, Big Pharma wants to make Big Bucks from Covid-19. Possibly they invented it.

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Raoult’s claims — first posted by him not in a scientific journal but on YouTube in February — have not been dismissed out of hand by fellow scientists. Many other research programmes, 18 in France alone, are looking at the possible beneficial effects of hydroxychloroquine in treating Covid-19.

However, colleagues, and rivals, point out that the two sets of results published last month by Raoult and his Institut Hospitalo-universitaire Méditerranée Infection fall far below the usual standards of medical or scientific proof.

The first results, published on 20 March, covered only 30 patients and omitted one who died and three others who were admitted to intensive care. A second, published seven days later, covered 80 patients, of which 65 (or 81%), it was claimed, “got better and left hospital within five days”.

Critics pointed out that patients had been carefully selected and included some who exhibited few symptoms of Covid-19 or no symptoms at all. The eminent French geneticist Axel Kahn commented:

“Very interesting. Data from 600,000 cases shows that 85% are benign and 15% are severe, including 5% who need intensive care. Those are the same figures we find in the 80 people treated at IHU Marseille.”

In other words, the evidence of Raoult’s own study suggests that the effect of Hydroxychloroquine is…zero.

*

So who is Didier Raoult?

He was born in 1952 in Dakar in Senegal, still then a French colony. His father was an army doctor and his mother was a nurse.

As a teenager, he was a poor student who only just passed his baccalaureate after leaving school early to study at home. He took the ill-considered, literary ‘option L’ of the ‘bac’ rather than mathematical or scientific ‘option S’ — the shame of all shames for a French medical family.

The young Raoult spent several chaotic (or formative) years back-packing and working on merchant ships before his father dragooned him into medical school in Marseilles. He once told the city’s newspaper, Le Provençal:  “All the doctors that I knew here wanted to be the best in Marseilles. I wanted to be champion of the world, based in Marseilles.”

Arguably, he succeeded. In 2003, in collaboration with the geneticist, Jean-Michel Claverie, he made a breakthrough in the study of giant viruses — viruses as large as bacteria — which contain many genes not found in other forms of life. His work in the 1980s on rickettsia (a category of bacteria), had already won him international recognition

Claverie recalled: “We worked together. We published many fine things together. Then we fell out in a big way. Now we’re rivals but I still have enormous respect for him as a scientist.”

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Raoult, who insisted on remaining in Marseilles, became an outspoken critic of the Paris medical establishment, which he regards as plodding, uptight and bureaucratic. He has become a hero to a rebellious city which loves to boost the claims of its one literary success (Marcel Pagnol) and its many footballing geniuses (from Eric Cantona to Zinedine Zidane).

Didier Raoult is, in fact, a kind of medical-scientific Eric Cantona. His behaviour, and appearance, have become increasingly unconventional. Asked why he wears his hair long and a pointy beard, he replied: “Because it pisses them off.”

“Them” is, without a doubt, the Paris medical and scientific world.

His obsession with the glacial progress of traditional medical research — the use of control groups, placebos, peer reviews — may largely explain his decision to stake his reputation on hydroxychloroquine. Raoult argues that, faced with a deadly new disease, medicine and science have no right to cling to their cautious, academic behaviour patterns.

In an op-ed article for Le Monde last month, he referred to the ‘parachute paradigm’ — a jokey concept invented by two young British scientists in 2003 as a challenge to traditional medical research. (Briefly: to test the effectiveness of a new kind of parachute, researchers ask 100 people to jump out of an aeroplane. 50 of them wear parachutes; 50 wear empty backpacks.)

Raoult argues that promising off-the-shelf drugs should be extensively used in a medical crisis, like Ebola or Covid-19, not tested endlessly in parachute paradigm studies in which placebos are given to very sick people. “It is time,” he wrote in Le Monde, “for doctors to reclaim their place alongside philosophers and people with a humanist or religious cast of mind and get rid of all the mathematicians and weather-forecasters who have invaded our field.”

He hints in the same article that the traditional caution of researchers is influenced by the lobbying of Big Pharma. Other researchers react furiously to such claims. They point to the terrible history of thalidomide, the drug which caused foetal deformations in the 1950s and 1960s, and more recently to Mediator, a proprietary drug sold as a slimming cure in France, which has been blamed for hundreds of deaths. The first moral duty of doctors, they say, is “not to make things worse”.

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Raoult administers hydroxychloroquine in combination with a pulmonary antibiotic called azithromycine. Anxious to try his miracle cure, queues of people have formed outside his institute. Local politicians have spoken about him in almost apocalyptic terms as a great scientist and a great Frenchman.

Renaud Muselier, centre-Right President of the Provence-Cote d’Azur Region, himself a doctor and former student of Raoult, said: “He’s a genius. He is inspired by the idea of the greatness of France — the liberty of expression, liberty of thought. His vision is very Gaullist.”

Others complain that Raoult, with his wild claims, has single-handledly destroyed confidence in the French government and French medical establishment and their handling of the Covid crisis.

“Raoul smashed national unity by taking up such a rebellious point of view,” one senior member of Macron’s La République En Marche (LREM) party said. “It was a great exploit. Single-handedly, he discredited everything that politicians and scientists were saying.”

That may be a little over the top. The French have less reason than the British or Americans to criticise their government’s performance but they do have some cause for complaint and they are congenitally quick to complain.

*

The person who is likely to emerge with the most discredit from the chloroquine craze is Didier Raoult. He risks being seen not as Dumbledore or as Gandalf, but as the Wizard of Oz.

Of the 18 independent French tests of the drug, none has yet found any significant effect on patients suffering from Covid-19. The US veterans’ hospital tests, the largest so far, published this week, found that there were slightly more deaths amongst patients who took the drug than those who did not.

Professor Raoult has yet to comment. He is perhaps looking for a parachute.

Warning signs have been there in recent months. Crises in Venezuela, Nigeria, Yemen, and South Sudan made headlines for different reasons; but each has led to malaria cases spiking. The emergence of drug-resistant malaria in Southeast Asia triggered concerns of a possible worldwide health security risk if it crosses to Africa. Finally, this month the UN cautioned that funding for proven mosquito nets, quick diagnosis and drugs has plateaued, falling short of what’s needed globally. Why isn’t this bigger news? Because malaria is an ongoing epidemic, a constant killer often accepted as if it were a common cold. Moreover its 445,000 casualties are mainly politically underserved pregnant women and children in Sub-Saharan Africa. Unlike other disasters it’s the silent tsunami going under the radar. Yet with 6 out of 10 of the most affected countries being Commonwealth nations, their heads of government have an opportunity when they meet in London next April to change all of that.

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Introduction to this Under-reported series.

Summary guide to all under-reported articles in this series.