On March 11, the World Health Organization (WHO) declared COVID-19, the disease caused by a coronavirus that is new to human beings, a pandemic. A day later, Kenya confirmed its first case, alongside other African countries like Sudan, Ghana, Gabon and Guinea. More than anything, the declaration is a call to multilateral action that shocks individual states into moving resources towards the management of the new disease. It says: “This is unusual, and we need to work together to get it under control.” The myth of Africa evading COVID-19 has been dispelled, and as the region braces for the imminent storm, it is important to stop and take stock of the lessons from other countries.
I should declare at this point that I am not a doctor nor am I a healthcare professional. What follows is a political analysis of a public health situation, because the decisions that underpin how states will respond to the crisis are fundamentally political. What resources get diverted and where, what messages get crafted or disseminated, which countries get banned and which do not – these are all political decisions undertaken by policymakers. Thus for African nations, it is crucial to distil the political lessons of the outbreak from elsewhere in order to avoid repeating mistakes and to build from the knowledge.
The first and most important lesson that COVID-19 has reminded the world of is that diseases do not respect class or borders. By March 13, Canadian Prime Minister Justin Trudeau was in self-isolation, as a cautionary measure after his wife caught the virus. The Australian home affairs minister, Peter Dutton, meanwhile, is under quarantine in hospital after contracting the virus. With outbreaks of diseases like cholera or tuberculosis, there is often a subliminal connection to poverty, perhaps because these diseases are overtly connected to access to facilities like clean water and uncrowded housing, which poor people in poor countries simply do not have. But the coronavirus that causes COVID-19 is affecting people from all classes, and in fact, wealthier people are more vulnerable because so far the disease has been closely connected to travel and airports. Everyone is vulnerable to this disease and whatever measures are proposed must not focus on one segment of the society at the expense of the other – making soap and clean water widely available is just as important as restricting price gouging on hand sanitizer.
More broadly, countries like Kenya have demonstrated a stark double standard in dealing with visitors from Europe as they have with visitors from China. Yet the vast majority of more than 200 cases reported in Africa so far have come from European countries. There are certainly practical reasons for this hesitation. Tourism is Kenya’s biggest export for example, and visitors from Italy specifically and Europe more broadly comprise a large part of that market. If this travel pattern is broken, Kenya’s economy will certainly buckle. I, too, was initially reluctant to support a flight ban because I believed that with 60 countries affected at the time, it would be bolting the stable door after the horse had escaped. Plus the thousands of jobs that the sector creates would be significantly affected.
But there’s a difference between shutting down borders to keep people out and asking people to stay put during an emergency. Asking people to stay in place helps affected countries to contain the disease within their borders and protects poor countries with weak health systems. With the reluctance of countries like the United States and the United Kingdom to take necessary measures to do just that, African countries cannot afford to hesitate on this issue. The human race has never lived through this disease before, so suspending flights for a few weeks while we figure out what the best response will be is a short-term cost that might protect us from a long-term catastrophe.
Secondly, and tied to this, COVID-19 has really brought home how racist presumptions about Africa underpin many of the political discourses on health and disease. Numerous international outlets like CNN and AFP have carried headlines asking why Africa has not dealt with an outbreak yet, grasping at explanations predicated on poverty or innate biological resistance – both of which rest on racist assumptions about Africa and Africans. But it does not take a genius to realise that a disease so intimately connected to human contact and travel would reach Africa last, as the continent is significantly disconnected from international travel routes. A viral video showing every flight in the world within a 72 hour period emphasises this point – in Africa, there is a surge towards Europe in the morning, and again at night, plus one or two flights towards Asia and across Southern Africa, but for the most part, the continent remains in the dark.
For African governments, what this means in practical terms is we have a headstart in terms of managing the pace of the outbreak. Epidemiologists suggest that the progress of the disease follows a definable growth curve, and that the countries that have had the best success at managing the outbreak are those who stop it early. Most importantly, the countries that have done the best job of managing the outbreak are not in Europe or North America – they are in Asia. Hong Kong, Taiwan, Singapore and after a rough start, South Korea have given the world a template. Test many, test often, control public movements – these key steps are integral to preventing an outbreak from spiralling out of control.
Third, and perhaps most significantly, the COVID-19 outbreak has reminded us that public health is about communities and societies, and is a collective responsibility. The individual measures that experts are recommending we all take – wash hands, practice social distancing, avoid sick people – may seem small, but the fact that they are cumulatively altering the trajectory of the disease in countries where they are implemented. Epidemiologists warn that the major risk for countries is not just that individuals will get sick, but that so many people will get sick at the same time that even the best hospitals will struggle to cope. This is what is happening in Italy. And while the death rate for younger people amongst the cases that have been counted remains low, it goes up to 14.8 percent for the elderly, and people with pre-existing immune deficiencies. This suggests that even if Africa’s young population survives the worst of the pandemic, the survivors may pass on the illness to their elders and the millions on the continent living with HIV/AIDS. We are social creatures, and we have to survive this pandemic together.
Overall, this illness is a painful reminder of why we have governments in the first place. We have governments to protect the most vulnerable from the worst outcomes particularly during times of crisis. We enter societies in order to exit a state of chaos, and to have a source for mutual aid and support in times of upheaval. And it doesn’t matter how good your personal hygiene is if your government is unwilling to take the necessary policy measures to protect everyone in your society. Many of the crucial things that must happen to address this outbreak that can only happen at the society level. The challenge on governments in Africa and beyond is to remember these fundamentals of politics.