Explaining why Africa had much lower COVID-19 fatalities per million than Europe and North America

This letter aims to explain the observed difference between COVID-19 fatalities in Europe or America, and Africa. At present (January 23, 2023) the cumulative number of COVID-19 fatalities per million people has been 3,080 in South America, 2,709 in Europe, and 2,608 in North America. In particular, the United States and the United Kingdom had 3,265 and 3,203 respectively. With much fewer opportunities to practice social distancing, or hygiene, and much more limited access to health care, Africa only had 180 fatalities per million. The much better performances of Africa have been ascribed to the positive effects of reduced hygiene, increased biome diversity, lack of masking mandates and restrictions, better access to antivirals, a younger population, and lower vaccination rates, which all may have contributed to the much better performances of Africa compared to Europe and North America against COVID-19.