Originally published on Addis Standard, April 9, 2020: https://addisstandard.com/in-depth-analysis-what-should-be-africas-strategy-to-counter-covid19-a-strategy-for-containment/
Super sense of urgency: clarity, clarity and clarity of strategy
Addis Abeba, April 09/2020 – The current Covid-19 pandemic, like most of its kind, poses two closely interlinked challenges. They can be summarized as the demands for urgent actions needed to contain the outbreak; and the requirement to work on long-term strategic issues including investments directed towards social and economic recovery, and peace and security. The last part— peace and security that is intrinsically tangled with governance, the nature and the role of state, the popular and performance legitimacy and capability required by governments, is a subject deserving detailed analysis with urgency and perhaps in another piece.
The urgent response: marshaling all resources
The immediate response to a pandemic is aimed at saving lives. The African Union (AU) Bureau of Assembly rightly underscores that the Covid-19 situation ‘could explode in an even more catastrophic way than has been seen [in pandemics] thus far in Africa’. The aim of urgent measures to contain it should be the prevention of local transmission leading to a lower infection and death rate; reduced levels of illness and hospitalization; maintenance of social stability; and mitigation of the adverse impact of the pandemic on the livelihoods of the poor.
In such a life-and-death issue the authorities’ response cannot be delayed, even though the climate of urgency deflects the leadership’s attention, and claims resources that otherwise would be directed to long-term strategic action. This is the first set of problem.
Covid-19 is especially widespread and severe. Families are its first victims; but lockdowns and travel bans seem likely to destroy national economies and that economic impact is a hammer-blow that could lose Africa all the economic advances it has made of late. The third serious impact is its disastrous effect on the livelihood of families and communities and the drain on community assets and family savings that it represents. Fourth is the strain on the states’ future capacity for delivery. All the advances toward the social goals of the Sustainable/Millennium Development Goals (S/MDGs) will also be wiped out. This is especially true of the health sector which, failing continuous huge investments (which require a resilient economy), may be irreparably damaged. During states of emergency and societal lockdowns, law enforcement agencies and army resources will also be overstretched, while treasuries will lack replenishment in the absence of normal revenue generation. What is more, aggressive prevention in poor governance contexts works only with the exercise of state control of means of violence and administrative powers and may require postponement of elections that are the source of legitimacy to govern. Since the armed forces have a superior capacity for rapid deployment, African states will need to rely on their military assets in the response to the Covid-19 pandemic. Countries may declare state of emergency, border closures, travel bans, lockdowns and curfews. It may require nationalizing some resources either to utilize them for the fight against Covid-19, or to save strategic companies from total collapse in the absence of revenues. Given the history of African armed forces and the abuses by predatory politics, if and when state of emergency is declaredand armed forces are deployed, mechanisms for deliberative governance and accountability must be set up to ensure strict oversight and respect of human rights within the legally permissible derogation.
It is often said that where there is accountability and a free press, famines are rare. Now, similarly, where there is accountability the incidence of Covid-19 could be minimized. The present situation throws a spotlight on the quality of leadership and governance. Already, as a consequence of the pandemic elections are being deferred, hence transitions to legitimate governance stalled. With the economy at a standstill there will be greater demands for improved public service delivery. As always during pandemics and crises, the legitimacy of government and leaders and of the state itself will be tested and possibly would diminish, while if past experience is any guide pandemics also encourage a certain kind of predatory politics. Incumbent office-bearers may use the pandemic as a pretext to extend their term of office – if only by months – while others may use it to wreak havoc by stoking public fears and attributing any failure to respond to the incompetence of the government in place. All these issues form part of the first set of problems involved in immediate action on the outbreak.
The urgent responses necessary to save lives at the same time undermine strategic actions directed to building resilient economies and institutional capabilities. In this context leaders may apply the capacity framework proposed in the AU Common Africa Position (AU-CAP), which remains relevant for responses to Covid-19. The first line of strategic capability is to predict the number of infections using scientific modelling. The second refers to prevent by carrying out early interventions by applying WHO guidelines, including social distancing, frequent washing and, where possible and necessary, wearing masks. Clearly, not all infections can be prevented but the response needs to involve tracing, testing, and treating those suspected of carrying the virus. The last, fourth strategic capability is the ability to adapt to new local, national and global realities of life during and after the pandemic. Adaptation requires resilience in employing community assets by way of sharing resources, encouraging traditional structures of support, exploiting advantageous socio-cultural traits, fostering the informal economy and seeking social innovation. Ensuring readiness of the food, water, and energy (fuel) stocks is an aspect of adaptive capabilities. These strategic interventions require the same, or similar, efforts and resources as are diverted directly to fight Covid-19. Together they form the second set of problems.
Prevention of virus spread
All countries are vulnerable to the disastrous impact of the pandemic but some more so than others, depending on their socio-economic development, the determination in action shown by their leadership, and the propensity and skills of political and social leaders in mobilising communities.
Covid-19 will spread through Africa at a rate varying with geographical connectedness, mobility levels and frequency of travel. Shortages of fresh water, gaps between supply and demand for energy, and a widening income gap with associated social unrest may increase the vulnerabilities of communities to religious promptings. The death rate will also depend on disease incidence, considering co-morbidity and other concurrent factors. In Africa, it is the community level of prevention that is the primary arena of intervention; in this regard the response must be tailored within a particular community context.
African governments can readily institute prevention measures such as social distancing and frequent hand washing because granted all their limitations, such initiatives demand only extra effort of which all individuals, even the poorest, are capable to some extent. However, Africa has no capacity to conduct tests in sufficient numbers to monitor the total infected population. Testing alone has no impact unless those infected are isolated and – when necessary – treated; moreover, Africa’s capacity to hospitalize all or most victims of the pandemic is all but non-existent. Germany, with a population of 80 million, is conducting more than half a million tests a week while Ethiopia, with a population of more than 100 million, can test fewer than 500 per day. At the time of writing New York, with a population of 20 million, has 4 000 ventilators but needs 30 000 more if it is effectively to hospitalize all its expected Covid-19 patients. Even so it is facing a serious shortage. One can only imagine what will happen in Ethiopia, which has fewer than 400 ventilators. Furthermore,
African states must somehow acquire the necessary testing kits and technology but until they do, the silent progression of Covid-19 will continue, with a count of the sick and the dead as the only real way of determining the level of infection.
Hence until Africa mobilizes its resources and those of its potential partners, the only way to fight Covid-19 is by employing aggressive prevention programs. It is almost impossible in crisis situations to meet the both the urgent and the strategic demands, especially when the legitimacy of many governments can be called into question. In light of these challenges, the key to the success of Africa’s fight against the virus is the determination of its leaders, the mobilization of an entire society, and a campaign of mass communication.
Political determination: time, energy and leadership vision
To quote economist Paul Romer, a crisis is a terrible thing to waste. This offers opportunity to exhibit leadership. For the urgent and the strategic actions each to succeed, Covid-19 itself has to be identified as the primary foe. Secularizing the pandemic will prevent further transmission only for a short time but the real deal – rooting out the pandemic by aggressive prevention measures – will hinge on strict implementation of social (perhaps more aptly, physical) distancing, and aggressive tracing and quarantining of those who may be infected. When resources permit, large-scale testing, quick treatment and hospitalization constitute the main preventive measures.
The first and foremost factor for success in stopping the spread of the virus is the political determination of leaders (i.e: their will to mitigate the pandemic and to allocate adequate time, finance and energy to doing so). Political leadership must be exercised with determination. Epidemiologically- not ideologically-based solutions are the keys to success. It is science, not politics, that will take us farthest.
The narrative now flooding the media is (justifiably) negative. A surge in infections awaits and the scale of the pandemic to be deduced from some models is almost too intimidating to contemplate. Mathematical models are merely instruments to help evaluate and prepare interventions but if they are accurately based on past experience of comparable situations, they are the best estimates available. Too many infections arising too fast, with substantial death rates, will overwhelm the continent’s capacity for testing and medication. Against that background, governments need to prepare for all possible scenarios, including nightmarish ones; in Africa, overreaction and over-preparedness rarely occur and it is preferable to over-prepare and ‘waste’ resources than face the possibility of an almost unimaginable death toll.
The continent’s political leaders require foresight to grasp what is likely to happen in Africa in relation to this brutal pandemic (learning from the other parts of the world hit by Covid-19 is one way to go about it) and they need an unprecedented sense of urgency. The disease will only reveal itself in numbers of hospital admissions or deaths. If the US, Italy and Spain, with relatively high standards of testing and hospitalization systems and generally better health care, can be hit so hard by the pandemic, leaders in Africa, with its more limited health care systems, must employ some seriously imaginative thinking on what their countries may look like over the next few weeks and months. It will be the sense of urgency and resolve shown by the political leadership that will determine its ability and willingness to foresee the looming societal dangers and eventually define the continent’s success in its fight against the virus, by demonstrating how far the damage can be mitigated. Clarity of direction and purpose and mobilization of society can result only from determined and energetic leadership.
Marshaling a whole of society
The fight against the Covid-19 pandemic will not succeed unless the virus is fought tooth and nail by society in its entirety. Africa lacks the testing kits, technology, drones and Artificial Intelligence to trace effectively, but is has pervasive community social networks that could be easily mobilized and repurposed for tracing Covid-19 infections even in remote areas and difficult geography.
Through very early to make a conclusive judgment and delay by the government to act, UK’s response to the virus seems to show some encouraging results. It has marshaled its national resources including the mobilization close to 4000 intensive-care hospital, in short time, and the re-purposing of some unlikely institutions such as the brilliant engineers Formula One racing teams which used to working against the clock, were hanging around with nothing to do because the races were cancelled. Formula One race engineers are now built ventilators.
As a mechanism for instilling a sense of cooperation, governments need to take an whole of society approach in which state and non-state actors, particularly religious leaders, traditional elders, tribal chiefs and the youth, together with private sector interests, are co-opted into active participation in the battle. Such an approach will ensure community commitment and take into consideration peculiar localized circumstances, proximity to local authorities and the mobilization of local resources and community assets. Mobilized societies, inclusive of religious leaders, traditional elders and community associations, young people, women’s groups and parents, can help reduce the risk of exposure. Many African countries have traditional chiefs and self-help associations; Ethiopia, for example, has close to 500,000 Iddir (traditional neighborhood funeral associations) and Iqub (credit clubs). Traditional elders and religious leaders generally command immense respect from their communities and similarly, political leaders exercise significant influence over their supporters. Professionals (in all sectors although mainly health, media and technology) may also be brought into play to contribute their particular expertise, while the mobilization of resources should focus on local private sector interests, including chambers of commerce. Such a holistic approach will encourage private interests to deploy skills in building, transportation, mask manufacture, food aid and other kinds of assistance. Moreover, adaptation to the new post-Covid-19 economy will require significant lateral and innovative thinking, which can come only from the private sector and the communities themselves. Mobile transfer of money, for example, and door-to-door social support and service, come primarily from the private sector, while community assets help in adaptation to a crisis-mode economy.
Re-purposing and redeploying community assets
The battlegrounds in the war on Covid-19 are at the level of families and communities. Ultimately, aggressive prevention is best implemented locally and even more, at neighborhood and household levels. Lacking artificial intelligence (AI) and other sophisticated technologies for tracing infection, African governments need to re-purpose and deploy the existing early warning systems that were intended to handle famine, floods and locusts. Given sufficient determination on the part of the authorities, existing mechanisms and assets (such as health and agricultural extension programs, safety net schemes, early warning systems, town halls, universities, churches and mosques) can be quickly incorporated into a national program. Safety net systems designed to offer social protection for the needy could be extended to offer essential assistance to the poorest; several African countries already have safety net structures in place for times of drought and flooding, together with social protection systems and microfinancing institutions to support the poor. For example, until recently, Ethiopia had a Productive Safety Net Program that supported more than seven million people in need of social support; furthermore, Ethiopia’s health extension program has 40 000 on its payroll and the agriculture service extension has over 60 000 development agents. Long standing food storage and fuel stock need to be refilled and ready for distribution when needed.
To mitigate the impacts of Covid-19 on the livelihood of those affected by lockdown and social distancing, safety nets, social protection systems and microfinancing institutions all need to be repurposed. The last of these, together with traditional neighborhood associations and religious organizations, could also be used to help alleviate the social and physiological burdens of those affected. Early warning systems developed for drought and flooding could be temporarily adjusted for service in tracing potential infections, as could the functioning Famine Early Warning System that many African countries, Ethiopia included, use as a predictive and responsive mechanism during periods of drought that might lead to famine. In addition, early warning systems such as those of the Intergovernmental Authority on Development (IGAD) could assist in cross-border cooperation and tap into community assets that could help build the resilience of border communities in the implementation of a cross-border response to the spread of the virus. Those early warning systems, plus health and agricultural extension programs, could easily be redeployed for use in prevention campaigning and tracing and treating Covid-19 patients.
Quite aside from the notional efficacy of such programs, only harnessing community assets and fostering local solidarity can deliver a suitably rapid means not only of ameliorating the disastrous impact of self-isolation on livelihoods but also of controlling outbreaks of disease through tracing and isolation.
Mass communication programs
Aggressive prevention of Covid-19 relies heavily on mass communication. Provided they are honest and transparent, mass communications constitute the first tool in the battle against such pandemics and the first virtue of a leadership sincerely determined to fight Covid-19 is honesty and transparency in providing information. Clear communication of effective prevention strategies tailored to the realities of local populations can be shared through various platforms, including traditional media (print, mainstream TV and radio) and new methods organized remotely through social media, telegrams, WhatsApp and other virtual platforms. In pandemics of such severity, panic is an ever-present danger and the distribution of ‘fake news’ and counter-factual information can be a major source of public disquiet.
The battle against Covid-19 pandemic in Africa will be fought mainly by Africans but should not be a lonely battle for self-preservation. The G20 group of leading industrial countries has already pointedly noted ‘the serious risks posed to all countries, particularly developing and least developed countries, and notably in Africa and small island states, where health systems and economies may be less able to cope with the challenge, as well as the particular risk faced by refugees and displaced persons. We consider that consolidating Africa’s health defense is a key for the resilience of global health. We will strengthen capacity building and technical assistance, especially to at-risk communities. We stand ready to mobilize development and humanitarian financing.’
Development partners including the UN, EU, the US and China might consider helping Africa in three specific ways. First, since testing is an insurmountable challenge for African countries acting alone, those countries should try to provide testing resources as quickly as possible (given their own domestic demands). Secondly, they should provide finance to resuscitate, re-purpose, and improve the operation of existing African mechanisms, such as national safety nets, early warning systems and microfinance. And lastly, those development partners need to work with the AU, its Regional Economic Communities and member states to help in the eventual economic recovery of Africa, once the present crisis hopefully is only a memory. AS