guest column:Wilmot James/Lewis Rubin Thompson THE economic impacts of COVID-19 for Africa are expected to cause the first recession on the continent in 25 years, threatening to undo years of economic progress. Governments interventions to combat the virus have been effective from a public health perspective, but they are not economically sustainable. When Egypt reported the first African case of COVID-19, many expected the continent to become the next epicentre of the disease. However, swift and pre-emptive action by Africa’s leaders largely managed to prevent outbreaks on a scale seen in countries such as Italy, the United Kingdom and the United States. Unfortunately, these measures have led to severe social and economic consequences for the African continent, threatening to undo years of hard-won progress. Without innovative and sustainable recovery efforts, Africa faces an uncertain future. This column draws on the findings of a report authored by a team of researchers at Columbia University and the Brenthurst Foundation. The report identifies common successes and challenges in response to COVID-19 in five African economic and cultural hubs — Egypt, Ethiopia, Kenya, Nigeria and South Africa; it also outlines optimal pathways for economic recovery and bolstering future epidemic preparedness in the five countries and Africa as a whole. The report’s findings were presented on January 12 at the Futures Forum on Preparedness, a two-day event focused on global health security hosted by the philanthropic organisation Schmidt Futures. Africa’s swift and multilateral response to the pandemic contributed largely to its initial success in controlling the spread of the virus, though some countries such as South Africa experienced significant outbreaks. After the first African case of COVID-19 was reported in Egypt, leaders of most African countries quickly implemented pre-emptive public health campaigns and containment measures such as suspending international flights and screening incoming travellers for symptoms of COVID-19. The Africa CDC, modelled after its US counterpart and aided by multilateral institutions including the Africa Development Bank and the WHO, helped ensure access to accurate information and co-ordinated public health responses across the continent. One of the greatest casualties of the COVID-19 pandemic has been public trust. Public health initiatives such as mask-wearing mandates, lockdowns and vaccination campaigns cannot function effectively when citizens do not trust the government institutions imposing them. On the African continent, disinformation and conspiracy theories, most often spread through social media, have led to a deterioration of confidence in information coming from governments. As COVID-19 vaccines become available, widespread vaccine acceptance hesitancy threatens to undermine vaccination efforts across the continent. Limited testing capacity is another pressing issue for Africa, making it difficult to assess the full extent of COVID-19’s spread across the continent. This has forced