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Eight Covid-19 lessons for – and from – Africa, fro...

Maverick Life

BOOK EXTRACT

Eight Covid-19 lessons for – and from – Africa, from Victor Kgomoeswana’s new book, Africa Bounces Back

Author image: Pan Macmillan SA/Composite: The Reading List

Nearly ten years ago, Victor Kgomoeswana published his landmark book Africa is Open for Business, showcasing the continent as a place of opportunity. If recent headlines are anything to go by, the current African outlook seems dim, but Kgomoeswana’s new book presents case studies from a resilient continent.

As a result of corruption, the deepening infrastructure backlog, including resistance to 4IR developments, and the current global pandemic, it seems Africa is fast running out of time. 

When asked if Africa is still open for business, however, Victor Kgomoeswana says, ‘It depends on your perspective.’

In Africa Bounces Back: Case Studies from a Resilient Continent, Kgomoeswana draws on examples that look at the continent’s response to Covid-19 and where it might leave us; how the shift from globalisation to more nationalist politics could impact the region amidst growing global terror; and the tipping point of the African Continental Free Trade Area implementations.

In this excerpt, the author lays out the realities about Africa that have been exposed by Covid-19 – which, he says, “should be addressed because there will be another outbreak of a similar or greater magnitude”. 

He points out: “Not long before Covid-19, Africa had to deal with Ebola, for example. These lessons should be analysed one at a time”. Read the excerpt below.

***

Covid-19 lessons for – and from – Africa
Technology is no longer a luxury

Affordable data, fast, cheap or free Internet access and a comprehensive digitisation strategy is necessary across the continent. Africa has been too slow to migrate and digitise its organs of state and business for the so-called new normal. We have always thought that we had time to gradually phase in technologies that will make it easier for us to work, teach and conduct meetings from home in periods of extended lockdown. Covid-19 highlighted our tardiness; and the next wave or pandemic should not catch us napping. We should make Internet access and data basic human rights, in policy and in practice.

Poverty and income inequality pose the greatest threat to humanity

Those African countries that enforced a lockdown to contain Covid-19 faced no bigger problem than how to feed, educate and treat the poor among them. It was easier for people with regular monthly incomes, steady inflows of dividends from investments or plentiful reserves to comply with lockdown restrictions than street food vendors or other survivalist entrepreneurs. While the world was in lockdown, a 2020 billionaire report by UBS and PwC, aptly titled ‘Riding the storm: Market turbulence accelerates diverging fortunes’, found that ‘total billionaire wealth reached $10.2 trillion at the end of July 2020, touching a new high after the year’s V-shaped rebound in asset prices’, surpassing the ‘previous peak of $8.9 trillion, reached at the end of 2017’. 10 Compared to 2017, when there were 2,158 billionaires, this report counted 2,189 billionaires. If ever there was a shortage of anecdotal evidence of the rich getting richer and the poor getting poorer, Covid-19 gave us proof.

Health-care across Africa needs urgent attention

Lockdown resulted in other psycho-social complications, especially depression and a hike in domestic violence. This added to what WHO calls the disproportionate burden of disease weighing Africa down. According to WHO, “40% of WHO Member States report to have less than 10 medical doctors per 10 000 population [and] the African Region suffers more than 22% burden of the global burden of disease but has access to only 3% of health workers and less than 1% of the world’s financial resources” (11).

Local expertise is key

One of the professionals cited in the vaccine breakthrough by Pfizer was Zimbabwean Dr Tatenda Shopera, who was quoted as saying he was “so proud not only of being part of Pfizer, but also for being part of the team that delivered this great Christmas present to the world” (12). What if all of Africa’s health-care professionals were encouraged to return to Africa to provide affordable quality health care to fellow Africans? Africa’s disproportionate burden of disease has nothing to do with the inability of African professionals to find solutions to health crises like Covid-19. According to Human Resources for Health, “Approximately 65,000 African-born physicians and 70,000 African-born professional nurses were working overseas in a developed country in the year 2000 … about one fifth of African-born physicians in the world, and about one tenth of African-born professional nurses” (13). Apart from Dr Shopera, M-Net’s Carte Blanche broadcast the “Extraordinary life of Emmanuel Taban”, profiling a South Sudanese-born pulmonologist who made a breakthrough in treating Covid-19 intensive-care unit patients (14). Using therapeutic bronchoscopy, a procedure not encouraged by WHO, Sefako Makgatho Health Sciences University-trained Dr Taban managed to remove patients from life support in two days.

Indigenous knowledge is golden

Africa was expected by some health experts to crumble under the Covid-19 pandemic. Already known for not having strong healthcare systems, it surprised many that the millions projected to die did not perish and the infection rates were very low. When South Africa had exceeded a million cases and was approaching 30,000 deaths in early January 2021, Nigeria only had approximately 90,000 cases and less than 2,000 deaths (compared to the US’s more than 300,000 cases and over 350,000 deaths), and the Democratic Republic of Congo had approximately 18,000 cases and a little over 500 deaths. All this was after the second wave had kicked in (15). Theories about why the incidences of Covid-19 in Africa were low ranged from poor testing systems to falsification of statistics. One article subscribing to the under-reporting or misstatement theory was by Kerry Cullinan. Writing for Health Policy Watch, she notes: “In African countries with less rigorous mortality data, the true extent of Covid-19 deaths may never be known. There is anecdotal evidence that hospitals are filling up in Uganda, as well as reports of delays in tests and poor hospital infection control practices in a country that was once praised as a model for Covid containment. Meanwhile, funerals have increased in places like Somalia.” However, Cullinan concludes that with the “global research community’s scrutiny and measures put into place to track diseases such as cholera, measles and Ebola, it is unlikely that African countries would be able to conceal abnormally high deaths over a long period of time” (16). What these theories overlooked was that many countries employed steaming and various herbal alternatives. These alternatives were labelled as being mythical by many experts, who reasoned that WHO had not approved the use of such methods to treat Covid-19. Madagascar claimed to have found effective treatment in the African wormwood plant (Artemisia afra or annua), but it was dismissed. There is nothing wrong in insisting on WHO approval, but what was puzzling was how African universities and research organisations did not intensify efforts to investigate the efficacy of the plant. This did not stop researchers at Germany’s Max Planck Institute of Colloids and Interfaces, working with colleagues from the Free University of Berlin, from testing whether Artemisia can be used to treat Covid-19. The study, which was yet to be peer reviewed at the time of writing, found that the leaves of Artemisia extract showed antiviral activity after being extracted with pure ethanol or distilled water and that antiviral activity increased considerably when the ethanol extract was combined with coffee (17).

Charity does begin at home

Many Africans first doubted the existence of Covid-19. They were not alone. When many pharmaceutical companies reported breakthroughs, the topic shifted to rich countries hogging the vaccine at the expense of their poorer counterparts. Pfizer, Moderna, Astra-Zeneca and many Russian and Chinese pharmaceutical companies came out with vaccines offering diverse levels of efficacy and storage or transportation requirements. Countries like the US, Mexico and Argentina started administering vaccinations in December 2020. In South Africa, for example, Health Minister Dr Zweli Mkhize announced on 3 January 2021 that Africa’s leading economy was finalising negotiations with pharmaceutical companies. The vaccines were later tested, then the tests were stopped and resumed; but the overall pace of the vaccination was hopelessly slow. Capacity to manufacture the vaccine locally in partnerships with multinational pharmaceutical companies came to the fore, but Africa found itself at the mercy of foreign countries, which were not going to prioritise any other country before taking care of their own. The lesson, in keeping with the call to build local capacity and increase the industrialisation of Africa, is that when the crunch comes everybody looks after themselves. Africa must learn to depend on itself. A better prepared and organised Africa could have taken advantage of Covid-19 to boost its industrialisation and advance the newly enacted African Continental Free Trade Area agreement, starting with manufacturing the bulk of the personal protective equipment (PPE) it needed and pooling health-care resources to ease the burden of treatment.

Debt trap loves crisis

When Covid-19 struck, African countries were already over-indebted. To purchase PPE, sanitisers, ventilators or simply to give Covid-19 grants to Africans in need during the lockdown, African countries turned to multilateral agencies and financiers to borrow. This worsened the continent’s debt-to-GDP ratio (already at more than 100% for states such as Mozambique), high fiscal deficits, the cost of borrowing and the value of many African currencies (18). In spite of being aware of the gloomy future facing Africa, some powerful politicians and big businesses did not flinch before diverting much-needed relief funds and money intended to buy PPE. This was bound to sink Africa further into debt without delivering any benefit to the public; and future generations will have to pay the cost of borrowing without anything tangible to show for it.

Follow the money

The Covid-19 pandemic also highlighted that no story is complete without following the money trail. The vaccine business is big business and Africa is a target, along with the rest of the developing world. While Covid-19 has left Africa impoverished, it has helped to sustain the growth of the vaccine industry. In “Global vaccine market features and trends”, a senior adviser for WHO, Miloud Kaddar, showed in a presentation that fortunes can be made in times of big misfortune. According to Kaddar, emerging markets are a target for pharmaceutical companies. Vaccines comprised 2% to 3% of the global pharmaceutical market in 2010, but it has been growing spectacularly by 10% to 15% annually. The global vaccine market tripled in value from $5 billion in 2000 to almost $24 billion in 2013. With more than 120 products under development, vaccines – the engine of the pharmaceuticals industry – are expected to be worth $100 billion by 2025. That is not the heart of the matter. Emerging markets, where 85% of the world population lived when Kaddar delivered his presentation, accounted for 18% of vaccine sales and carried 93% of the burden of disease (19). Kaddar identifies the following drivers of growth for the global vaccine industry: the importance of communicable diseases and new threats; cost-effectiveness of immunisations (especially if emerging markets are the target); new funding opportunities (including government funding, public-private partnerships and donor funding); new research techniques and manufacturing technologies; increasing demand and larger emerging markets; and higher prices and improved profitability for the industry (courtesy of blockbuster vaccines). DM/ ML

On Wednesday 21 July at 12pm, join Business Maverick’s Ray Mahlaka and author Victor Kgomoeswana for the virtual book launch of Africa Bounces Back. Register here to join the discussion:  https://event.webinarjam.com/register/431/0vnnkuq1

Notes

(10) UBS and PwC, ‘Riding the storm: Market turbulence accelerates diverging fortunes’, 2020, https://www.ubs.com/content/dam/static/noindex/wealth-management/ubs-billionaires-report-2020-spread.pdf.

 (11)   https://www.who.int/data/gho/data/indicators/indicator-details/GHO/medical-doctors-(per-10-000-population).

 (12) G. Dube, ‘Zimbabwean doctor part of team that developed COVID-19 vaccine’, VOA, 17 December 2020, https://www.voazimbabwe.com/a/zimbabwean-doctor-pfizer-happy/5702797.html.

 (13) M.A. Clemens, ‘New data on African health professionals abroad’, Human Resources for Health 6 (1), 2008, https://human-resources-health.biomedcentral.com/articles/10.1186/1478-4491-6-1.

 (14) https://www.youtube.com/watch?v=3aYmoLjuf8Y.

 (15)   https://covid19.who.int/?gclid=CjwKCAiAudD_BRBXEiwAudakXwJMYbSLBaMfF7Ud76jR_HsGQUc-WuRZdgZPtrsWJDgtYTWUcaPkVxoCwA4QAvD_BwE.

 (16) K. Cullinan, ‘COVID-19’s “slow burn”: Africa’s low death rate puzzles researches’, Health Policy Watch, 14 September 2020, https://healthpolicy-watch.news/76831-2/.

(17)   https://www.dw.com/en/germany-scientists-test-artemisia-plant-against-coronavirus/a-53944514.

(18) M. Sallent, ‘External debt complicates Africa’s COVID-19 recovery, debt relief needed’, Africa Renewal, 30 July 2020, https://www.un.org/africarenewal/magazine/july-2020/external-debt-complicates-africas-post-covid-19-recovery-mitigating-efforts.

(19) M. Kadder, ‘Global vaccine market features and trends’, https://www.who.int/influenza_vaccines_plan/resources/session_10_kaddar.pdf. 

Africa Bounces Back: Case Studies from a Resilient Continent by Victor Kgomoeswana is published by Pan Macmillan South Africa (R248).Visit The Reading List for South African book news – including excerpts! – daily.

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