Thursday 14 May 2020

The Global Frontline

Catastrophe averted… or coming?

Despite numerous challenges, including the negligence of world leaders, Africa has so far kept the coronavirus at bay. But many experts fear that worse is still to come

By Giles Whittell

The stories from Kano are what keep Dr Chinwe Ochu awake at night. First there were reports of 600 unexplained deaths in one week last month. Gravediggers were said to be stacking coffins on top of each other to get them buried.

Then local officials admitted that Covid-19 was the cause, but, despite this, testing stopped. Asked why, they said the local test centre had run out of reagents, and this was true – but they had also run out of testers. They too were infected.

Kano is 1,000 kilometres north of Lagos, where tropical Nigeria blends into the Sahel. There and throughout Africa’s most populous country, coronavirus infection numbers are ticking up and Ochu is watching them anxiously. She leads prevention programmes for Nigeria’s Centres for Disease Control and says with cool understatement: “Kano is one of the places we’re really worried about. No one is confident around this disease, but we’re getting the right system to contain it.”

There is a theory – a hope – that sub-Saharan Africa may escape the worst ravages of this pandemic because of its young population, early lockdowns and relatively few direct links with the megacities of the northern hemisphere.

Staff from Shining Hope for Communities (SHOFCO) measure a woman’s temperature, as the NGO installs hand-washing stations at a slum in Nairobi, Kenya

“The catastrophe has not happened,” La Liberation said in a recent headline, and that may not be as premature as it sounds. There is good evidence from testing in South Africa, Ghana and elsewhere to suggest that, whatever happens next, the region’s responses have already been far more effective than those of Europe, North America and now South America – where Brazil reported 900 deaths on Tuesday alone.

But if Kano loses control of its outbreak, nowhere in Africa is immune. If Brazil is Africa’s near future, a continental-scale tragedy looms.

This month, the World Health Organisation released modelling suggesting that undetected cases are rife across Africa and 190,000 people could die in the first year of the pandemic if containment measures fail. In that event, only a globally coordinated response could prevent disaster, not least because most of the necessary medicines and equipment are made outside Africa. That sort of response would require global leadership – and there is none in sight.

Instead, there is a void. Gayle Smith, chief executive of the ONE Campaign and former head of the US Agency for International Development, told a Tortoise ThinkIn on Tuesday that she finds herself staring at “the single most dramatic lack of global leadership” of her lifetime.

Secondary school students wash their hands before returning home. The Rwandan Government decided to send back all students from boarding schools after the first case of Covid-19

This is partly a euphemism for Trump, but it’s more than that. Since roughly 2016, the G7 and G20 groupings have become sideshows next to the nationalist posturing of their more powerful members. Since the appearance of Covid-19, national pride and pique have taken precedence over cooperation, even when obvious mutual interests are in play.

On 4 May, when Boris Johnson hosted a donor conference to fund Covid vaccine and drug development, Russia, China and the US stayed away. The next day, the US vetoed a UN Security Council resolution on the pandemic because it alluded to the WHO, which President Trump has accused of attaching too much credence to Chinese Covid-19 statistics.

For the past 70 years, American leadership has been essential for the kind of international cooperation required to beat this virus. Under present management, the US seems bent on sabotaging it instead.

Dr David Nabarro, a former senior WHO official, might be considered parti pris in this peculiar debate. Even so, his words at this week’s Tortoise event – at which he was also a participant – ring in the ears. One country failed to take the virus seriously for five crucial weeks and is now the world’s virus factory, he said. A global public health system proven to work against Ebola is now being paralysed by a small number of people for domestic reasons. “The people of the world should be going completely crazy with anger”.

That isn’t happening yet. All along the coronavirus frontline, governments have more immediate worries than the global leadership vacuum. Brazil is not alone in South America in facing spiralling infection rates. Ecuador and Peru do too. In India, total infections have climbed past 75,000 despite a long and stringent lockdown that is being cautiously lifted despite the colossal risk in a population of 1.4 billion.

In Tanzania, President John Magufuli has refused to close markets, mosques or churches and appears to be in denial about the spread of the virus – but he is the exception. Elsewhere in sub-Saharan Africa, people may ask why they need global leadership when their own are rising to the challenge.

South Africa imposed a stringent lockdown before recording a single Covid-19 death. Its president, Cyril Ramaphosa, and health minister, Zweli Mkhize, have been praised for uniting the country behind clear rules, strictly enforced. Mkhize has also mobilised an army of 28,000 community health workers who – so far – have prevented outbreaks on the scale that would have overwhelmed the healthcare system.

Members of the South African National Defence Force (SANDF) and Gauteng Traffic Police set up a roadblock in Alexandra, Johannesburg

Ghana has deployed a testing system – of asymptomatic as well as symptomatic subjects – that has tracked the spread of the disease more effectively than most European countries. Its confirmed Covid-19 death toll stands at 22 in a population of 30 million. Kate Dooley of the Tony Blair Institute says Nigeria’s CDC deserves credit for keeping the virus at bay despite the Kano outbreak, and Aya Chebbi, the African Union’s first special envoy on youth, says she’s proud of the union’s leadership during the pandemic even though she has criticised it in the past as a “club of old men”.

It certainly is that. The average age of Africa’s leaders is 64. The average age of its people is 20. Their youth is almost certainly a major factor in their resistance to the virus, but the AU has played a role. Chebbi says that it’s the only intergovernmental organisation with a “joint continental strategy” for Africa – and it is hard to point to another.

In these circumstances, isn’t it condescending to say the continent needs global leadership? The answer is no, says Dooley, and she gives three reasons besides Africa’s need for medical supplies made elsewhere. First, the economic impact of the pandemic won’t respect national borders and could quickly overwhelm national and AU resources. Second, “the cliche is true – global problems need global solutions”. In particular, when a vaccine comes, only a world body can make sure everyone who needs it gets it. And third, world bodies have a role in helping national leaders establish priorities – especially when much about this virus remains a mystery.

What goes unsaid here is important: Africa needs global leadership, not maverick leaders elsewhere dismissing Covid-19 as a hoax or minimising the threat it poses.

Gonzaga Yiga, a community chairperson in Kampala, Uganda, speaks through a loudhailer every morning and evening – to encourage people to curb the spread of Covid-19

Many epidemiologists believe Africa is at a moment of acute risk right now. Coronavirus infection could peak as soon as this month or as late as September. Either way, says Dr Carl Pearson of the London School of Hygiene and Tropical Medicine, “it looks like an oncoming wave” that has been a little slower than expected in arriving. “It could be grim.”

As the wave approaches, the global systems built to fight Ebola are in pieces. In principle, Nabarro says, every UN member state should be supporting the WHO as the lead agency against Covid-19 across the developing world. In practice, the US is in the process of defunding the WHO while failing to control multiple outbreaks of its own.

“The catastrophe has not happened.” The world must hope that Liberation headline was on the money. If not, this crisis has barely begun.

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