Today is day 125 of the lockdown. By last night South Africa had 459,761 confirmed Covid-19 cases and probably at least a million more that haven’t been diagnosed. We have 7,257 recorded deaths, but statistics on excess deaths calculated by the SA Medical Research Council show that the unusual loss of life is actually far greater; according to the MRC “by the second week of July, there were 59% more deaths from natural causes than would have been expected based on historical data”.
Thankfully there have been 287,313 recoveries.
South Africa now has the fifth-biggest epidemic in the world, a status which —except for the US — is occupied solely by members of the BRICS club (Brazil, Russia, India, China and SA).
In addition, we have unquantified hunger, unmeasured mental illness, and growing social and political instability.
Unrest is in the air. So is repression.
It didn’t need to be like this.
South Africa started preparing for Covid-19 weeks before the first confirmed case on 5 March. We had an early warning and political and scientific leadership; world-class scientists and institutions, like the National Institute for Communicable Disease (NICD) and the National Health Laboratory Services (NHLS); we had strong civil society organisations, like the Treatment Action Campaign, that are blooded in community mobilisation around health. We had the experience of being at the epicentre of the Aids and TB epidemics. We had a media keen to play a role in getting essential information to people who needed it.
How did we get to where we are now from what appeared to be a good start? What went wrong? Below are seven things Maverick Citizen thinks went wrong — and what needs to be done to fix them:
1. Survival of the science that fits
The government says its Covid-19 response is “based on science”, and it is — mostly. After the repudiation of scientists by Thabo Mbeki in the early days of the Aids epidemic, we all breathed a sigh of relief that from the beginning President Ramphosa and Health Minister, Zweli Mkhize bound themselves to “the science”. However, between the banks of a policy based on denialist conspiracy theories and a policy that truly and without discrimination “follows the science” there is a wide river.
Unfortunately, our government’s approach is best described by what Alex Stevens, writing in the journal Nature, calls “survival of the ideas that fit”.
I witnessed the start of this slide from 23 March 2020. On that day a consultation to prepare for Covid-19 was organised by the Medical Research Council between the Minister of Health and about 50 of the country’s most eminent infectious disease specialists and medical scientists and researchers.
On that day there were 402 reported confirmed infections and no deaths.
Halfway through the constructive meeting Prof Olive Shisana, the president’s social policy adviser, disclosed to the meeting that the government was “considering the possibility” of a lockdown. She offered to circulate a document for discussion and invited comment on it. What she did not disclose was that a lockdown would be announced by the president that same evening.
A robust discussion followed and, while there was consensus on the need for a lockdown, the advice that was given was that for a lockdown to achieve its objective of drastically cutting infections (‘flattening the curve’ became the overly simplistic explanation) it would require immediate and simultaneous scale-up of a complementary testing and tracing strategy; as well as immediate measures to mitigate the effects of the lockdown on the poor and most vulnerable.
From the school of very hard knocks, we now know that none of this had been considered or planned for.
The NHLS was a mess (testing actually dropped in the first days after the lockdown). As a court has recently confirmed, plans were not even in place for such critical interventions as the continuation of the National School Nutrition Programme (NSNP) in one form or another.
As a result, the University of the Witwatersrand’s Professor Shabir Madhi’s unfortunate prediction that an explosion of community transmission would follow the lockdown has proved correct.
Yet Madhi and other scientists’ worry was contrary to the assessment made on 13 April 2020 by the Ministerial Advisory Committee Chairperson, Prof Salim Abdool Karim, at a public presentation broadcast live that “our epidemic trajectory is unique… no other country has been able to reach a stage where you get that kind of plateau” as a result of the lockdown (see here at minute 8.17). Unfortunately, this opinion proved to be ‘the science that fits’ and so, for a while the notion that we had flattened the curve, became the official narrative.
Since then, the science has continued to be followed — when it fits. But when MAC advisories don’t fit, such as on 100% taxi occupation, the re-opening of church congregations, school reopenings and further restricting (rather than totally prohibiting) alcohol sales, they are not followed. According to Professor Karim (writing in an email to concerned colleagues), this is because:
“When the NDoH says that they are “listening to scientists”, this does not mean “listening to the MAC” as there are many scientists providing solicited and unsolicited advice and guidance to the NDoH.”
Selectively following science inevitably creates glaring contradictions, which some in government would have us believe are not contradictions; but whether we believe it or not they have contributed to breaking a trust and a national common purpose that was (briefly) evident for a few weeks in late March and April.
Follow the science. When it is not possible to follow the science, explain publicly and honestly why and then do everything to mitigate the consequences.
2. Not ensuring transparency and accountability
At the outset of Covid-19 we were grateful for the updates sent out nightly without fail by Dr Lwazi Manzi, the spokesperson of the Minister of Health: they tell us the number of cases, number of tests, number of deaths and number of recoveries. We were grateful because, during the Aids epidemic activists battled for a year to get the president to permit the release of statistics on Aids-related deaths — so it signalled a welcome intent to be open.
But it was not to be.
In a Maverick Citizen editorial on 7 April, I wrote that: “much more needs to be done to provide the vital statistics that allow us to be informed about our response. Paradoxically, while there is a lot of noise and media briefings, there is not that much hard information; what comes out on the sacoronavirus website is an increasing bald, minimal and not independently verified set of health statistics.
… Asking these questions is not imposing a burden on the government because this is all information that the president should be being supplied with on a daily basis anyway; information that is indicative of the state of our response. But without this information being shared — as legally required — it is hard for we, the people, to assess our progress, because this is by all accounts our response.”
Little has changed since then.
Obey the law. Define a basket of essential information and share it with the public. This information should include in an accessible form: All stats on district, sub-district and town level. Number of beds, ventilators and oxygen units available and how many are taken up. Recoveries at every level. It should also provide important socio-economic data such as facts and figures on measures taken to ensure access to food, water and PPE.
3. Communicating and consulting over broken telephones
President Cyril Ramaphosa puts a premium on consultation. That is not just an honourable attribute, it is a constitutional requirement. We know he consults with big business. But the president also repeatedly refers to his consultations with civil society.
However, many activists on the front lines of civil society ask themselves who the president is referring to. “Not us”, they say. This is largely because the institutions and organisations via which the president and ministers communicate are broken. From outside it looks as if they have been reduced to tender markets and travel clubs.
The National Economic Development and Labour Council (NEDLAC) is one example. The South African National Aids Council (SANAC) is another. Both of these organisations have formed special forums and Rapid Response Teams for Covid-19. The SANAC Civil Society Forum allegedly spent R3,5-million on a “nerve centre” in a Pretoria hotel, but no one knows what nerve system it was at the centre of.
The deliberations of these bodies may be important, but there appears to be very little evidence of any onward communication of their discussions and decisions; their minutes should be public and accessible. There also appears to be little soliciting of ideas and information from outside their inner circles.
If only the form but not the substance of consultation takes place, it means that in reality the president and the government are not taking society along with them; the reasoning and rationale for difficult decisions are not subject to meaningful scrutiny and debate. It is consultations with the most quiescent, those with a vested interest in staying in the inner circle, sweetheart NGOs.
It means leaving most people behind.
Find ways to consult with all stakeholders. Make minutes and costs of every meeting public. Yes, meaningful consultation requires time and effort, but it will always be less costly than conflict, litigation and policing preventable ‘unrest’.
4. Trusting the business elites and not understanding the dynamics of own society and economy
There is another problem with selective consultation. It means that you do not fully understand the society around you or tap into the panoply of its resources and ideas. You see society through the eyes of the elite that you are consulting with. Yet that same society will look very different through the eyes of an informal trader.
From the beginning big business was drawn very closely into the Covid-19 response, leading to the setting up of Business for South Africa (BSA). BSA has shown a willingness to engage, including from time to time with civil society. Its efforts are commendable and there has been deployment of significant financial and human resources to assist the response.
However, by contrast, from the beginning it looked as if the informal business sector was being left out of planning, despite the fact that the nearly five million informal workers constitute nearly 30% of the workforce. Although not necessarily in traditional trade unions, these workers are organised with representatives and structures that can be consulted. The cost of not understanding the centrality of this sector in the economy was evident as food systems collapsed when informal food retailers were initially not included in the list of essential services in the first weeks of the lockdown. The good news is that since then activists in the informal sector report that informal workers have “been made more visible by covid because of their vulnerability, creating new opportunities for change and recognition”. Evidence that good can come from bad.
If NEDLAC, as a statutory forum for organised stakeholder consultation and negotiations, is to provide real value for social dialogue it must be urgently transformed to include informal workers, unemployed people’s organisations and genuine representatives of civil society.
5. Believing a broken and corrupted state could effectively channel relief to the poor
The less said about this the better.
By not meaningfully engaging the whole nation, by not levelling with people on the real challenges he faces as president of a corrupted party whose immoral cadres are deployed throughout the state apparatus, President Ramaphosa left the Covid-19 response reliant on a broken and bastardised state.
By the time he cried corruption in his address to the nation on 23 July the milk was spilt.
Instead, Ramaphosa should have used day one of the lockdown to call on citizens to demand maximum accountability and maximum transparency at every level of government — to watch like hawks.
The result of relying on unworthy public officials is evident in the final implosion of the Eastern Cape health system, renewed allegations of massive corruption in the Gauteng health department, now embroiled in yet another scandal costly to the lives of the most vulnerable and the failure to invest in school infrastructure that would make public schools safe for learning in the era of Covid-19.
At the beginning of 2020 Archbishop Thabo Makgoba called for this year to be made the “year of the Orange jumpsuit”. His call was echoed by civil society. But other than the handful of arrests made in the VBS bank matter we are still waiting. Is it any surprise therefore that there is a belief that corruption pays and Covid-19 is just another convenient cash-cow?
6. Not engaging with communities
South Africa’s power of resistance, be it against apartheid or Aids or corruption, has always lain in poor and working-class communities. This law has revealed itself again as a result of Covid-19. Across South Africa, we have seen the formation of Community Action Networks (CANs) and many other hybrid and exciting forms of organisational response to the crisis (see here, here, here, here for some examples).
However, there is little evidence of meaningful engagements with or support for these structures by either municipal government or business. The Solidarity Fund, for example, is only now looking at a framework on how to address the needs of communities. Yet this has been the actual coal-face of Covid-19 prevention and care.
After the experience of Aids, it is unforgivable that the National Command Council’s focus on a medical response (necessary, but insufficient) has been at the cost of a community mobilisation. Reflecting on this a recent comment in the Lancet had the following to say:
“Based on lessons learned from HIV and Ebola on the importance of working together with communities, it is time for policymakers to shift to a less patriarchal approach and engage with, rather than shield, communities so that communities have agency and voice in developing the response. A two-way dialogue with formal and informal leaders is an evidence-based approach to addressing fear, misinformation, and contextualising the response for those at risk of severe outcomes.”
In June the government formed a second Ministerial Advisory Committee, this time on Social Change. This MAC is made up mainly of community, trade union and faith-based leaders. Although it lacks any experts in health communication and behaviour change it is vital that its recommendations are made public, not ignored and that they come to form the backbone of our response. It is also overdue for the government to develop a massive communication strategy that focuses on people’s risk, agency and power against Covid-19. Finally, to aid behaviour change in communities deprived of basic services by corruption and mismanagement we must be vigilant to ensure that the R5 billion allocated by Treasury to municipalities is not stolen.
7. Not understanding or protecting all human rights and the Constitution
From the start, President Ramaphosa has emphasized the importance of “saving lives” and the human right to health. Saving lives was the justification he used for unleashing an economic meltdown. Since then the lockdown is repeatedly defended for having “bought us time to prepare the health system.”
On the surface this seems noble. To save tens of thousands of lives we were prepared to disrupt a whole economy: the welcome message seemed to be that lives, not money, counts.
However, this betrayed a one-dimensional understanding of the right to health by the president and his advisers.
Health is not like Covid-19. It cannot be isolated in a test tube from its social and economic determinants. Health is wholly dependent on other rights, such as food, social security and employment.
Although lockdown restrictions were introduced in many countries and recommended by the WHO the fact that our society was not ready or willing to balance them with an equal effort to protect other related rights led to a mass deprivation; the desperation it caused has ultimately fueled community transmission by disabling the autonomy of millions of people to follow public health advice by feeding and protect their families.
One result, as explained last week in a lecture by former Constitutional Court Justice Edwin Cameron (at minute 12): “is that we have re-enacted many of the mistakes of Aids … in the overall approach to a catastrophic health disaster”. Cameron said that Aids taught us that “those who are most vulnerable socially and structurally are the worst affected (and we’ve seen that again)” and that “strong-arm tactics are the wrong approach to a public health disaster ”.
According to Cameron “respecting people’s rights and conserving public health and containing contagion are not opposite goals, they are goals that mesh together”.
This is the antidote to any inclination in the coming weeks to respond to the unstable broth of public anger and public hunger with further police action a-la-Zimbabwe. Truth be told, the lockdown is to all intents and purposes over but the need for assisting people to voluntarily implement and abide by effective public health measures has never been greater.
And on the subject of respecting rights… Now is not the time for an austerity budget. It is the time for scaling up investments in health, education and food. This will prove the best prevention strategy for Covid-19 as well as future pandemics.
We do not accept the argument that there is no money. We can find the resources within and without ourselves. In the words of Italian writer Paolo Giordano, whose book, How Contagion Works: Science, Awareness and Contagion in Times of Global Crisis has become a bestseller: “In the time of contagion the lack of solidarity is first and foremost the lack of imagination.”
Imagination, Solidarity and Self-Belief
Regrettably, some of us may have shielded President Ramaphosa from a full and frank assessment of his government’s performance until now. We were, perhaps, justifiably afraid of undermining a national effort which required unity and a focus on strengths of his leadership rather than weaknesses of his ministers.
But now is the time for frank talk.
South Africa is at a crossroads. All of the strengths we have as a society, which could and should have been mobilised against Covid-19 still exist. There is still an enormous reservoir of solidarity, resources and ideas. We can still save lives, rebuild livelihoods, push back Covid-19 and birth a better society.
The politicians may have betrayed the people, but in this moment of danger, the people do still have a Constitution that requires accountability, openness and a focus on the realisation of rights. People in South Africa must make that Constitution work. The people owe the politicians nothing. They owe the people everything. They must dance now to the people’s tune.
To protect lives and realise rights requires the medicines prescribed in this article; it requires honest people to mobilise communities, take control and make the people’s voices, values and demands felt. DM/MC
Mark Heywood is the Editor of Maverick Citizen