Dealing with Covid-19

Underestimated Africa

Dr. Alex Awiti about the spread of Covid-19 on the African continent and the maturity of the societies encountered by the virus.

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Dr. Alex O. Awiti is Director of the East Africa Institute at the Aga Khan University in Nairobi, Kenya.

medico: What we’ve observed in the last weeks is that slowly, the centre of the epidemic is shifting away from Europe and countries of the Global North, and that it has now also arrived on the African continent, with South Africa becoming one of the next hotspots of the pandemic. However, overall, the African continent is less affected by the coronavirus pandemic than it was expected before. The total number of Covid-19 cases is in fact much lower than in Europe or North America, despite Africa’s higher population: If I’m not mistaken, Africa currently has about 1.2 billion inhabitants.

What are the reasons for that? Was it the early shutdown, or the experiences with other pandemics like Ebola, the young population, or the lesser degree of global mobility? What can you tell us about this?

The structure of the pandemic in Africa, the epidemiological structure, is very different from what we’ve seen in Europe or what we’re seeing in South or North America.

I think part of the reason certainly is that there is very little connectivity to the rest of the world, especially between Africa and the source points of the disease as we know it, which has been the whole global struggle from Wuhan into Europe into the Middle East and then into Africa. So if we look at the international flight and travel activity, South Africa is one of the biggest hubs on the continent, followed by Eqypt, Algeria and Tunisia, Morocco and then Ethiopia and Kenya; maybe Yaoundé in Cameroon and Kinshasa in the DR Congo are worth mentioning as well. So if we look at the early waves of this pandemic, these were the spots where it went. And now, unfortunately South Africa is flaring up, and Egypt is also pretty high.

The other factor that has contributed to a very slow onset of the disease on the continent is its very youthful population, which I guess in very many circumstances has led to this phenomenon where there’s a very high proportion of Covid-positive people who are asymptomatic and do not present with critical illness or even moderate disease.

I think another point is also that the early steps in lockdown were critical. I think African countries learned the lesson from China, and given the experience with Ebola, there was no government that was taking this lightly because they know what has happened in the past. So for instance when you look at the early actions of president Museveni, president Kagame or Uhuru Kenyatta, you can see that these were very deliberate, methodical early actions. In fact, some people even thought that it was an overreaction, but it was the right reaction at the right time. Of course, the virus is now spreading across communities and more people are being tested, but I think that first, rapid, catastrophic wave did not happen on the continent because of these early actions, and the fact that Africa is not so well knit into the global travel nexus.

For me, it is really interesting to hear that because in German newspapers, a couple of weeks back, you could see big headlines claiming there would be a huge catastrophe in Africa, that everything would break down, and I was wondering whether this narrative also forms part of what Felwine Sarr called Afro-Pessimism – would you agree on that?

I think that sometimes, Africa is underestimated. The resolve, the resilience and the capacity of the people to rally and respond to what is a truly catastrophic pandemic is underestimated. We’ve now seen that governments have taken different paths: the government of Rwanda moved very rapidly and pushed everything online. They have a very intensive and robust digital tracking mechanism where you have to access portal, apply for permission to leave your house and you have to track where you’re going and all of that. You can now shop online and you can do most of your work online. It was very different from Tanzania, whose government basically said: “Look, the disease is there, you can go out there, but take precautions.” Tanzania now is the first East African country to open its schools and universities, and permit social gatherings including churches and funerals. I’ve just been speaking with one of our colleagues from Tanzania, and he said: “Yes, there are hotspots of disease as you’d expect in any other place, but we’re not dropping dead from this pandemic.” So I think in a lot of ways, we just didn’t think that Africa was sufficiently prepared to deal with a pandemic of this scale, but there have indeed been a lot of internal learnings from previous pandemics like Ebola for instance, or the HIV and Aids crisis, so there are a lot of social resources and capabilities that society can mobilise to respond to a disease of this scale.

When you mention the measures taken by Kagame in Rwanda, for instance, who set up mechanisms to shop online, these seem to be targeted at middle class. Do you think that the poor population is at a high risk to be left out by these measures taken by the presidents of African countries?

I don’t think it’s elitist because of the other things that Kagame has done. The internet penetration in Africa is quite considerable, which is something that a lot of people don’t understand. But even just a short text message from the government portal where you receive permission to leave your house is sufficient. You don’t need broadband to send a short message to your nearest grocery. So there is a lot of innovation that is happening in the society that is helping the continent to leapfrog this catastrophe and to still maintain a very credible sense of normality, as far as this can get.

So I would like to go a step into the past and talk about the HIV/Aids crisis where we could observe that some African presidents negated or downplayed the dangers. Now we can observe a development like this in countries like Brazil for example, where thousands of people are at risk of losing their lives because political leaders are negating the dangers that are evident. Are we experiencing a new responsibility for the concerns of the population or is this a transfiguring view? There seems to be a significant difference between Latin America on the one hand and Africa on the other hand, in that the African presidents, as you’ve already explored, are doing a much better job.

This really is an existential challenge and I think part of the reason why governments have reacted the way they have is the level of public knowledge about the fragility of Africa’s health system. The governments have taken the approach that you’re better off preventing an all-out catastrophic surge of the disease, so they have focussed on lockdown measures, trying to minimise the infections to a point where you can actually deal with them given your healthcare infrastructure capacity. So there has been a cautionary dynamic to how African governments have responded. In the very beginning they came out wearing masks and saying “this is a problem”.

In places where there was denial, like Burundi for instance, there has been a serious catastrophe. Nobody knows whether the cardiac complications that the president of Burundi succumbed to can be attributed to Covid, but there is a lot of reliable information out there that senior echelons of the Burundi power structure have been Covid-positive. The president’s wife was hospitalised here in Kenya and has recovered and returned home. So you can see instances where the governments were careless and reckless, and the disease has gone to the heart of the power structure.

I think one of the other things that is also critical is that we haven’t seen the kind of reckless and irresponsible behaviour of African leaders such as what we saw with Yahya Jammeh of the Gambia, who claimed that people could drink some concoction and get cured of Aids. We’ve seen a much more serious African leadership structure that has been very responsive to the pandemic. And I think the African Union has also been at the forefront, saying “This is an important juncture in our lives as a continent, and we need to think about how to protect our populations”.

Talking about the African Union, it is interesting to see these broader questions when it comes to ideas on how to develop health systems on the African continent like debt reduction for example. Can you elaborate a little bit on this issue?

I think what the African Union is trying to figure out is how they can be the trusted broker of ideas and resources on the African continent and how they can help organise Africa’s engagement with the West and other development partners like China, North America and Latin America. I think that cooperative, collaborative approach to solving the problems of a very large and diverse continent is important, so that while the governments can pick and choose the details of the bilateral relationships that they form, the gateway is still one voice. This was established through the Agenda 2063 that sets out the main priorities where the continent should go. It is not perfect, there are still teething problems with the structural and institutional character of the African Union commission for example, but there is a lot of discussion, for instance about how to fund the African Union so that it is able to deliver on its mission. These are very interesting, progressive conversations. And as you know, from your experience in Europe, building a continental structure for collaborative, collegial governance is extremely complicated. National states will still rise and fall prey to the attraction of sovereignty and whatever else it promises, so it’s really work in progress and at this point we can say the African Union is on the right path.

Regarding the development of the vaccine against Covid-19, I think it fits into what you said before, about the emergence of more of a national strategy. Too many countries focus on their own population and think that this will be the solution. The European Union has a somewhat mixed strategy: On the one hand, they continue to finance WHO structures and have even increased the money for the WHO. On the other hand, they have come up with a strategy what one might call “EU first light”, compared to the US. They have tried to finance the European pharmaceutical industry to develop a vaccine against Covid-19 to make sure that European citizens get it first. For us as a human rights and development organisation, seeing that the idea of health as a common good and the question of fair contribution is no longer on the agenda represents a huge problem. Which role could the African Union or African governments play to come up with a different strategy that includes a more Global perspective? Do you think that this situation might be a chance to make a change?

That’s a very good question. I think it speaks to the unfortunate deterioration of global governance at a multilateral level and all of the efforts and the deliberate attempts by, say, the US leadership, to undermine multilateralism. It is a critical question, especially when trying to think about how we as a global collective can deal with a pandemic of this magnitude that is basically ravaging every country, be it rich or poor, old or young, etc., which is truly unprecedented. Thanks to modern biotechnology, we can now really expect the process to go to trial; we now have a trial that has studied itself: in Africa, the UK and in Brazil. And I think this is important because Africa now really has a stake in that vaccine trial conversation. It may not come to Kenya, it may not come to any country across the border from here, but it puts the African population in the conversation as having been part of this bold initial wave of an attempt to find a vaccine. I think this helps to reset the conversation, to highlight that we matter here as well, and that we’re contributing to the mobilisation of scientific evidence on the efficacy of a vaccine. God knows whether we have more than three strings of the Covid-Virus, and I think that the structure of the trial makes it really interesting to be able to figure out whether there will be some specific strings that are really developing and becoming autonomous in the region in terms of their structure and how they affect humans, so I think it is a very important conversation to keep having: how do you balance, in an ethical way, and from a human rights perspective, the fact that we’re all in this together and that any flare up of the virus and any vulnerability to Covid anywhere on the globe basically reverses any gains that we might make? It is not going to be possible to contain one set of population in one corner of the world and say that everybody else is fine, because diseases are spread by human contact. Therefore, I think that in this situation, it is good to think about this as a global health security question, not a sovereign kind of preoccupation of a singular government to keep their population safe – any person unsafe anywhere is a threat to global health security everywhere.

This fits perfectly into the call by more than 100 African intellectuals during the Coronavirus pandemic, from which I would like to quote one passage: “More crucially, it is essential to remember that Africa has sufficient material and human resources to build a shared prosperity on an egalitarian basis and in respect of the dignity of each and every one. The dearth of political will and the extractive practices of external actors can no longer be used as excuse for inaction. We no longer have a choice: we need a radical change in direction. Now is the time!” I don’t remember reading something this progressive and optimistic in the last years coming from a group of intellectuals putting together their ideas and coming up with a statement like this. Could you comment on this?

This is certainly uplifting. I think it recognises both the geopolitical dynamic, but it also places the focus on the African leadership itself, on the political will of local governing organisations and the governing elite. My own perspective has always been that there is one crucial millstone on the neck of the African, to speak in a probabilistic way. This has been the governor’s incapacity and the leadership failure of the continent, the lack of bold, aspirational, ambitious plans to move the country forward, exactly on that trajectory of shared prosperity and egalitarian society, if you think of it as a continuum. And I think that is not the fault of any external actors singularly, but there is some path dependence and a history, that might speak to how we got here. And I think it speaks back to the colonial base and the nature of the processes that led to independence on the African continent. Not a lot of attention was paid to state and organisational capacity development. The first founders of the African states did not have the capacity to run a modern state. They came from very small, unevenly organised societies into this big collective with all the trappings and the structures of a western model of political and governmental organisation, in which they just didn’t understand what they were supposed to do. And you see the early failures of the first leaders of the continent like in Ghana, in Nigeria, and many other west African countries that were embroiled in coup d’états. It only stopped more recently, when the populations got more educated and more activist, asking how we could build shared prosperity and hold local leaders accountable, as well as which ideas offer themselves to galvanise a national vision around to achieve these goals and build the essential social infrastructures, such as health, education and civil liberties. All of these things are critical to building a cohesive, prosperous and egalitarian society. So I think the African rising moment that we’ve all been talking about is a crucial visual conception of an Africa that is now coming of age, whose structures are now beginning to settle. And we talked about the AU that is now providing, in its kind of messy, incomplete way a sense of accountability to local leaders. We’ve seen the AU call out leaders who’ve tried to wrestle power in nondemocratic ways. The Sudan-question has been a very serious take-point. Of course, you see the external forces meddling again, but if the AU had its way, they’re denying the legitimacy of the political structure in Sudan, raising questions about Al-Bashir’s human rights record and all of that. So we’re still in this messy situation, but I think in all of that, the general arch of progress is hopeful.

Interview: Anne Jung
Trenscription: Maja Klostermann

Published: 09. July 2020

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