Southern Africa is a region of 345 million people. Although still divided by colonial borders, there is a huge amount of official and unofficial migration, much of it driven by poverty and economic necessity; some of it driven by people fleeing corrupt and increasingly authoritarian governments. That’s why we need a co-ordinated regional response that takes account of these realities. Although the official numbers of Covid-19 infections remain extremely low, the region is very vulnerable. It needs an emergency plan. It doesn’t seem as if one is coming.

In the late twentieth century, in the heyday of dreams for a united and free southern Africa, the Southern African Development Coordination Conference (SADCC) was formed. With the prospect of a free South Africa in sight, it was replaced by the Southern African Development Community (SADC) in 1992. Today SADC has 16 member countries.

The SADCC was initially created to unite against a common threat, apartheid South Africa, and to “lessen economic dependence on South Africa”. That threat ended in 1994, but since then SADC has faced other common challenges, most notably HIV, TB and increasingly, the climate crisis.

Today, however, there is a new regional threat. Covid-19.

In response, together with the African Union, SADC needs to demonstrate unity of policy and purpose. In the face of broken public health systems and populations weakened by hunger and communicable disease, particularly HIV and TB, an uncontrolled Covid-19 outbreak could wreak havoc and set back development, democracy and human rights by decades.

Up to now, Africa has been fortunate that the coronavirus disease appears to have been relatively slow in spreading. The WHO Africa Weekly Bulletin of 9-15 March reported 175 confirmed cases across 29 countries. At the time of writing (18th March) according to the New York Times daily survey and Government updates there were more than 100 confirmed cases in southern Africa:

South Africa: 116

Seychelles: four

Namibia: two

Tanzania: one

DRC: one

Eswatini: one

Zambia: two

But despite this threat, and the window of opportunity SADC has to prepare for it, there seems to be little coordination, with each state doing its own thing at a different time. 

It’s not that there isn’t intergovernmental awareness. On 9 March 2019 SADC health ministers held an extraordinary meeting in Tanzania on the Covid-19 crisis which “urged Member States to put in place National Preparedness and Response Plans as well as contingency and emergency funds to address gaps in prevention, impact mitigation and other interventions.” It also called on SADC members “to mobilise domestic resources, and invest in public health systems to ensure resilience and health security”.

However, with few exceptions, this mobilisation has been largely invisible to millions of vulnerable people and communication to the public has been extremely poor. 

Human rights defenders call for health emergency programme 

As a result, on 16 March 2020 the Southern African Human Rights Defenders Network (SAHRDN), a network that connects human rights defenders across SADC, addressed an urgent memorandum to heads of state, the SADC secretariat and the AU Commission, appealing to members states to Unite, Invest, Prepare, Prevent and Respond!

The letter describes “Africa’s health situation and security” as being “at a crossroads”. It reminds states of the 1999 SADC Protocol on Health and complains that states have taken “individual and uncoordinated policy decisions” despite the fact that:

“SADC borders are porous, making Covid-19 virus a regional public health threat that can unleash a humanitarian catastrophe of immeasurable proportions in the sub-region.

“No country can stand on its own and fight this war,” the letter warns.

As a result, the letter calls for declarations of national disaster (as has now happened in a number of countries), collaboration, preparedness, training of healthcare workers and a SADC health emergency programme.

In particular, it asserts the need for a response based on the right to health, drawing special attention to the rights of migrants (documented and undocumented) and reminding SADC of a 2008 World Health Assembly resolution on the issue of migrant health. 

Lack of coordination across SADC countries 

The SAHRDN letter was necessitated by the fact that there have been vastly differing responses across the region. Although in recent days there has been a scramble of announcements, they have been slow and out of sync with each other.

For example:

• Lesotho introduced an international travel moratorium on 12 March, but has done little more since then.
• In Botswana, President Mokgweetsi Masisi earned praise for a televised address on Botswana TV on 15 March. The next day the government issued new regulations that included travel bans from high-risk countries, mandatory quarantine for Batswana returning from high-risk countries; the “total suspension” of gatherings of more than 50 people; and a recommendation that “funerals are to be brief and last no more than two hours.” However, although the regulations have been widely supported, in a letter to the Minister of Basic Education, the Botswana Teachers Union has criticised the decision not to close schools, calling it a “terrible omission” and calling for the government “to close schools temporarily and make sure that all measures of hygiene in schools are addressed.”
• So far, South Africa is the only country that seems to have developed its capacity to respond. According to the director of its National Institute for Communicable Diseases (NICD), an emergency operations centre was established on the order of the minister of health at the end of January. This was more than a month before the first case on 5 March. Then, on 15 March, President Cyril Ramaphosa declared a state of disaster and introduced a raft of measures affecting almost every area of life.

However, in keeping with the theme of this article, nothing was said about regional coordination. On the issue of the millions of migrants from Southern African countries who live in SA, the speech was silent. As a result, Lawyers for Human Rights in SA has called for a moratorium on all deportations and no discrimination in access to health care services.

• By contrast, in Zimbabwe, the response has been marred by controversy from the start. In early March an outcry erupted over a patient who was reported to have absconded from Wilkins Infectious Disease Hospital in Harare, although he was later reported to be negative. On 2 March Zimbabwe Lawyers for Human Rights (ZLHR) wrote to the government on behalf of doctors threatening legal action to compel the Mnangagwa government to disseminate information. 

The letter pointed out that Zimbabweans were vulnerable because of the country’s close ties with China as well as the millions of Zimbabweans in SA. It complained that even the home page of the Ministry of Health website says nothing. Citing duties arising from the Zimbabwean Constitution it called for the provision of “reliable information to the public” as well as public education on prevention, infection and care.

“In our considered view, nothing short of a sustained serious campaign of public information… will be sufficient for you to discharge your constitutional and legal obligation that is imposed by the right of access to information.”

ZLHR also offered “to distribute any materials using our large countrywide networks.” 

ZLHR received a reply on 9 March setting out steps taken. On the matter of the website it reported that a portal for information had been created, but “the ISP which hosts the Ministry’s website went down and material was lost”.

According to the Zimbabwe opposition shadow Minister of Health, Henry Madzorera, quoted in News Day: “Our health delivery system in terms of human resources is very thin on the ground. Healthcare workers are demotivated and we don’t have the correct protective equipment in the correct places, so if we have a case, it’s going to be a disaster.”

On 14 March, in response to ZLHR and others, the Ministry of Health and Child Care issued a statement with general recommendations but no concrete measures. It was only on 17 March that President Emmerson Mnangagwa addressed the nation on television and declared Covid-19 a national disaster, but (like Botswana) stopped short of closing schools.

• On 14 March Namibian President Geingob held a press conference at the State House suspending travel from Qatar, Ethiopia and Germany for 30 days and calling off the Independence celebrations.
• In Zambia, a statement was issued on 14 March by Health Minister Dr Chitalu Chilufaya, reporting that while, at that stage, Zambia still had no cases, surveillance measures would be strengthened and Covid-19 declared a notifiable disease;  “failure to comply with regulations is an offence”.
• In Eswatini, an activist had commented aptly that “we wait for the sun to set and our government has taken no steps and told us nothing. We are doomed.” However, yesterday the prime minister announced that on the instructions of the king he had declared a State of Emergency for two months. Among other measures, schools and universities have been closed with immediate effect. The king’s birthday celebrations were also cancelled and, it was reported, an undisclosed amount of state money saved from the celebration of the king’s birthday would be diverted to fight the Covid-19.
• Finally, in Malawi, a country with a broken health system and bitter conflict on the legitimacy of the presidency of Peter Mutharika following the Constitutional Court nullification of the presidential election, there appears to be silence. In fact, instead of concentrating resources on this threat, Mutharika seems to be singularly focused on power retention. 

On 17 March he carried out a “de facto coup” when he replaced all the heads of the military with his loyalists. This prompted the SAHRDN to tweet “Ominous signs in Malawi: instead of carrying out law reform and preparing for credible elections, President Mutharika goes for broke, defies court judgments [on reforms and fresh elections] defies parliament [law reform]… detains human rights defenders and fires the army commander”. This determination to retain power at any cost and complete ignoring of the peril posed by Covid-19 in Malawi is a matter of grave international concern. 

No evident plan for scaled up testing 

At the time of writing, SAHRDN had not received a response to its 16 March Memoranda. Attempts to contact the SADC Secretariat were unsuccessful and the SADC website does not even mention Covid-19. In addition, other multilateral agencies including the World Health Organisation and UNAIDS have been most notable by their absence of practical advice or resource mobilisation for the region. This is particularly problematic given the serious dangers of co-infection between HIV, TB and Covid-19.

Although SADC governments will probably defend their responses, what research for this article has shown is that communication, consultation and involvement of civil society is almost non-existent in most countries. Even more worrying is that even where countries have made public statements, in most cases their policies and emergency regulations say nothing about testing or treatment.

Both are serious omissions, particularly given WHO director Tedros Ghebreyesus’ most recent statement:

“You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.

“We have a simple message for all countries: test, test, test.

“Test every suspected case.”

Not announcing a plan for testing suggests that southern African governments are overlooking one of the most important lessons we have learnt so far from responses elsewhere on the globe: scaling up testing, rather than waiting to test people who are sick with Covid-19, is crucial to prevention.

Although none of our governments will admit it, this is an admission that southern African health systems are unequipped to take even some of the initial steps needed to respond – never mind preparedness for the high care that will be required when thousands of people begin to get sick.

While the figures are still low this is something that needs to be addressed urgently. There is a need for an urgent mobilisation of resources to ready health systems; appeals need to be made to the international community, including for debt relief so that the vast sums paid in interest can instead go on health services

Unless this happens soon southern Africa will face the consequences of Covid-19 in the same way the region has felt HIV, TB and Ebola. Once vaccines and treatment are developed the rest of the world will recover.

For the region, however, the damage will be lasting. MC