- Interview by
- Sa’eed Husaini
Since February 14, when Africa’s first case of COVID-19 was recorded in Egypt, the number of confirmed cases across the continent has risen to roughly 130,000 and caused 3,800 deaths. Though tragic, these numbers pale in comparison to the pandemic’s devastation in Western Europe and the United States. New York City alone has suffered well over five times the number of deaths as Africa’s fifty-four countries. And while experts point out that the true scale of infections in Africa has likely been concealed by insufficient testing, a recent World Health Organization (WHO) analysis also suggests that the virus is spreading more slowly on the continent than elsewhere.
Observers have offered a variety of explanations for this comparably low level of COVID spread: the continent’s relatively young population; governments’ decision to implement lockdowns earlier than their Western counterparts; and countries’ innovative responses to the crisis, such as Ethiopia’s door-to-door survey that recorded the symptoms and travel history of each of the 5 million residents of its capital city, Addis Ababa.
Despite these glimmers of hope, experts caution that it is still too early to say how the pandemic will play out in individual countries, much less in Africa as a whole. While many African nations have experience responding to acute public health crises like the deadly 2014 Ebola outbreak, many of the continent’s public health systems are wracked by wider vulnerabilities and inequities. Neoliberal economic adjustment programs in the 1980s and early 1990s, followed by decades of austerity measures and underinvestment in public health, left much of the continent’s health systems in crisis long before COVID-19 arrived. Nor has Africa been left unscathed by the economic fallout of the pandemic. Many of its economies, dependant on commodity exports like oil and coffee beans, are now facing the possibility of fiscal, currency, and debt crises, prompting many governments to begin easing lockdowns even as infection numbers grow.
The COVID-19 pandemic thus reveals not only the sources of resilience and innovation often overlooked by a world accustomed to expecting failure and crisis in Africa, but also the continent’s continued economic and health vulnerabilities brought about by its history of unequal engagement with the wider world. As Simukai Chigudu argues in his new book, The Political Life of an Epidemic: Cholera, Crisis and Citizenship in Zimbabwe, health care crises in Africa have always been deeply political in nature, whether in terms of the structural conditions that caused outbreaks or the deep-seated inequalities that drive their disproportionate effects.
Jacobin contributor Sa’eed Husaini recently spoke with Chigudu about the causes, effects, and trajectory of the coronavirus in Africa.
Has a dominant narrative emerged about how the African continent is likely to be affected by the COVID crisis?
For the historian of medicine Charles Rosenberg, epidemics have a “dramaturgical character.” What he meant is that epidemics are rendered intelligible as social phenomena through stories or narratives that follow a familiar pattern.
The COVID-19 “outbreak narrative” begins in the wet markets of Wuhan. From here, the drama intensifies as the virus spreads through the circuits of global modernity — economy, trade, finance, and tourism — becoming an international security threat as well as a parable about the dangers of our interconnected world. The narrative, of course, is never fully coherent. It elicits contradictory reactions about the obsolescence and tenacity of borders, the threat and benevolence of strangers, the failures and redemptive potential of medical science. But this is part of the outbreak narrative’s potency in setting the terms of social dialogue and political debate.
Africa, in the COVID-19 outbreak narrative, has been placed as the virus’s final frontier where, we are assured, it will yield untold damage. Numerous headlines by journalists, policymakers, and scientists alike have warned that the virus is a “ticking time bomb” on a continent “woefully ill-equipped to deal with COVID-19.” Legitimate concerns about weak health systems (the product of decades of austerity), densely populated urban centers, and a history of devastating epidemics mingle with racist ideas about the primordial nature of African poverty and about the inability of African peoples and governments to respond with ingenuity to a crisis. Contrasting the horror of COVID-19 in the Global North with its presumed trajectory in Africa offers an important yet ignored political question about how and why the suffering induced by communicable diseases is treated as unthinkable in one place and inevitable in another.
Do you have a sense of the likely trajectory that the pandemic will take in Africa? To what extent can we generalize about it?
The sweeping statements about Africa in the outbreak narrative might touch on some important truths, but they are ultimately unhelpful and even misleading. For a start, “Africa” is not a terribly illuminating category of analysis given the diversity of the continent across demographic, geographic, economic, and epidemiological parameters. The continent is made up of fifty-four different nation states with different public health systems, institutional capacities, and limitations.
Having said that, it is clear that the COVID-19 data patterns in Africa as a whole, in terms of prevalence, incidence, and mortality, do not match the figures we are seeing in the rest of the world, particularly in Europe and North America. Speculation about this trend is running rampant, and some analysts in the West have cited a peculiar alchemy of Africa’s youth, heat, and proclivity for witchcraft — okay, the last point is facetious — as possible explanations for the slow penetration of COVID-19.
It seems to me that the most plausible explanation is that many African governments have implemented an array of disease control measures, declaring states of emergency and halting international travel when hardly any cases of COVID-19 had been detected. In parts of East and West Africa, public health infrastructures, protocols, and personnel that were mobilized to respond to Ebola have been adapted and repurposed to respond to the coronavirus.
It is encouraging to look for a good news story in this pandemic and to hold on to the hope that the pandemic will not be as devastating in Africa as elsewhere in the world. But I think it is still too early to tell. Many health systems in Africa suffer from profound structural fragilities, such as fragmented services, shortages and maldistribution of health care workers, and inadequate access to much-needed drugs and equipment. These problems might only be compounded by the global disruption to supply chains of biomedical equipment.
I wanted to bring your book into the mix. Through examining Zimbabwe’s 2008–9 cholera epidemic, you point to the sociopolitical origins and afterlives of outbreaks. In the case of Zimbabwe, what major legacies from the past (infrastructural, ideological, etc.) appear to be shaping how the public health system is responding to the pandemic?
My book is a study of the sociopolitical causes and consequences of Zimbabwe’s catastrophic cholera outbreak of 2008–9. The outbreak began in August 2008 in the high-density suburbs of Harare’s metropolitan area. The disease quickly spread into peri-urban and rural areas before crossing the country’s borders into South Africa, Botswana, Zambia, and Mozambique. Over the course of ten months, cholera infected nearly one hundred thousand people, claimed over four thousand lives, and has been deemed the most extensive cholera outbreak in African history.
In the book, I show how the outbreak resulted from a combination of long-term and short-term factors. Long-term factors included the siting of the water-supply system in the same water catchment zone as the sewage system, the poor maintenance of the water reticulation system since it was first established under colonial rule, and the misalignment of water provision to population needs. These conspired with shorter-term events, notably the country’s economic crisis, to precipitate the collapse of Harare’s hydraulic infrastructure.
On top of the collapse of the water supply was a collapse of the health care delivery system, itself a consequence of Zimbabwe’s political-economic meltdown. The health system failures were compounded by dramatic changes in livelihoods for much of the population, brought about by economic meltdown. Homelessness, squalor, and infrastructural damage in the townships, in combination with fuel and currency shortages, engendered and augmented widespread, critical food shortages that, in turn, triggered a sharp rise in acute malnutrition. Acute malnutrition and hunger made the population more susceptible to cholera, especially the poor and vulnerable, and exacerbated its pathological effects in those affected. By 2008–9, the overlapping crises of the collapsed health system, the multilevel failure of the water reticulation system, and the grinding political economy of daily life converged to create a perfect storm for a ruinous cholera outbreak.
I think Tony Barnett and Alan Whiteside put it best when they wrote of HIV/AIDS: “The conditions that facilitate rapid spread of an infectious disease are also, by and large, those that make it hard for societies to respond — and ensure that the impact will be severe.” In the years since the 2008–9 cholera outbreak, the Zimbabwean government has implemented crucial measures to manage recurrences of the disease. In particular, the Ministry of Health has formulated a comprehensive and sophisticated detection and control plan for epidemic disease.
However, this strategy is, by its very nature, reactive. It is designed to address outbreaks when they occur, not to prevent them in the first place. Many of the underlying structural conditions that caused the cholera outbreak to be such a calamity — poor sanitation, food insecurity, overcrowded housing — remain intact. The political risk posed by COVID-19 is that we will see another potentially catastrophic outbreak further weakening the country’s bureaucracies, with the humanitarian responses ultimately filling in the gaps. In other words, that there will be no accountability for the crisis, and no structural change will take place.
How does the current global health response compare to humanitarian institutions’ response to previous outbreaks in Africa?
The “global health industrial complex” is a multibillion-dollar enterprise. It is driven both by a growing recognition of the interconnectedness of the world’s population and the threats and opportunities these present, such as fears that deadly infectious diseases like Ebola or swine flu can rapidly spread around the globe; the ostensible threat of bioterrorism; a desire to reduce global inequalities in health; an aim to promote economic development; and the political and economic interests of donor countries and organizations. The global health industrial complex has immense power to shape international responses to epidemics and the public health agendas in Africa.
In the twenty-first century, the language of “emergencies” in Africa has gained increasing purchase amid international concerns about security, conflict, and the spread of disease. This is frequently linked to moral agendas and discourses of human rights in the West. The logic of emergency channels vast resources into short-term, high-impact, visible interventions that tend to target specific pathogens or disease. Thus, responses to previous outbreaks in Africa can broadly be characterized as top-down, often reflecting concerns and political imperatives of actors far removed from local communities, and fragmented. The drive to address public health challenges as “emergencies” undermines a broad-based commitment to public health equity, including providing universal health coverage and addressing the social determinants of health.
It remains to be seen if responses to COVID-19 will perpetuate this model, but the unprecedented speed with which this pandemic has spread across the globe suggests there will be continuity in emergency thinking rather than change.
The pandemic has also triggered a global economic shock. What do you make of calls for debt relief as the economic impact of the crisis begins to hit Africa?
This is not my area of expertise, so I will limit myself to reinforcing a message that progressives around the world have been delivering. If, as Vasudha Chhotray writes, “Disasters are key political moments in the life of a society,” which bear new possibilities for actors to transcend the past, elide preexisting social inequalities, and reinvent the social contract, then the shock of COVID-19 invites us to imagine a new global economic orthodoxy.
At the moment, the public health impact of the pandemic in Africa is uncertain, but the response to it is already narrowing the continent’s limited fiscal space. In the UK, where I live, economic policy experimentation is underway as new redistribution mechanisms are put in place to address the acute economic insecurity of the moment. But this economic insecurity is not new — it has been accelerated and amplified by the pandemic.
It seems to me that rethinking redistributive politics at national and global scales is now imaginable and even imperative. The old neoliberal consensus has been complicit in the making of this crisis and has ensured its impact will be severe. I think now we need political coalescence to reconfigure international financial institutions for the benefit of ordinary people. Debt relief in Africa could well be an important aspect of that strategy. I would like to see it as part of a wider, more global effort to tackle the economic insecurity of our times.