Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com
Last week I promised to talk about the pros and cons of lockdowns. That is not going to happen as there is too much else to report. The presidential election in the United States was last Tuesday. We had to wait until Saturday for the result to be definitively called. Democrat Joe Biden was clearly the winner. It remains to be seen what additional damage Trump and his Republican confederacy will do over the next few weeks. The Andrew Marr Show on the BBC on Sunday mornings does a review of the British papers. This brought to our attention the headline in the Ayrshire Daily News, a small regional Scottish paper. It was: “South Ayrshire golf club owner loses 2020 presidential election”.1
The blog is published on 11 November, Armistice Day. It is the day we remember those killed in armed conflicts around the world. This year it is particularly poignant, as the Second World War ended 75 years ago. There are still veterans who, in the absence Covid-19, would have joined a shrinking band of fellow servicemen to mark the event. Next year there will be fewer. Two years ago, I trudged through snow to the service at the cenotaph in Waterloo. It was the Centenary of the end of the First World War. It was particularly moving for me; my father ran away from school aged 15 and joined up. He survived the trenches with minor wounds and lived to 90.
Today humankind is engaged in numerous battles for survival. Covid-19 is the immediate one, with the vaccine news and ‘The Biden-Harris plan to beat COVID-19’.2 At the same time, the urgent challenges of climate change and environmental degradation remain. Covid-19 is a zoonotic disease, spread from animals to humans. The news of an outbreak of a mutated Covid-19 transmitted on mink farms in Denmark is extremely concerning. According to the World Health Organisation “Since June 2020 214 human cases have been identified in Denmark with SARS-CoV-2 variants associated with farmed mink.”3 The WHO suggests the mink were infected by humans, and acted as a reservoir before re-infecting humans with a mutated version. The Danish response is to cull. Seventeen million animals will be slaughtered. The only reason these animals are farmed is for their fur. Unbelievable!
As of 11th November, there have been 51,480,441 globally.4 The cumulative case data from the Johns Hopkins website show that in the ‘millionaires’ category the USA is highest, with 10.25 million cases, the greatest number of which were recorded on 10th November, at 136,325. India follows with 8.6 million; Brazil at 5.6; in both rates of increase have fallen. France at 1.8 million, Spain at 1.31 million have seen rapid but erratic rises in cases. The UK remains in 8th place with 1,237,192 cases. South Africa’s 740,254 cases seems to have stabilised with a low number of daily cases.
Please look at the Economist’s excellent data tracker, especially the graphs showing excess death.5
So, what can we learn from the data? The rate of increase in most countries is slowing. Globally there has been a slight decrease. This indicates either prevention measures are working or there is a point of saturation of susceptible people. We will stop looking at cumulative cases, it is simply a tally and does not have enough information to understand the dynamics of the disease. We need to start looking at the economic effects and ‘collateral’ damage and how to address it.
Guest: The Africa Experience by Richard Morrow6
As COVID-19 spread across the world there was concern around Africa’s preparedness and capacity to manage a health crisis of such magnitude. With its densely populated cities, limited healthcare resources and expertise, and an economic landscape highly susceptible to external shocks, many believed COVID-19 would have a catastrophic impact on the continent. It was therefore never a question of if COVID-19 would impact Africa, rather, how big the impact would be.
When evaluating the impact today, the results are mixed. The number of deaths—currently 43,421 at the time of writing—is far below those seen elsewhere and as projected in epidemiological forecasts. While there is no definitive answer, many have attributed the continent’s low death count to its demographic makeup, climate, and previous experience with health crises.7
The economic situation paints a different picture, however. The continent’s economy is set to shrink by 3% in 2020, with commodity-dependent countries expected to experience an average economic contraction of 4.6%. The impact of this contraction will be a drop in real per capita income of 5.3% across the continent, and an economic recession for the first time in a quarter of a century.8
Africa’s experience with COVID-19 ultimately serves as a watershed moment in how the continent, its governments and institutions prepare for future crises. This comes as COVID-19 has highlighted many fragilities: from weak fiscal reserves and a lack of economic diversification, to fragile supply chains and strained healthcare facilities. A return to ‘business as usual’ is not an option – there must be reform.
As COVID-19 has illustrated, crises can occur at short notice and have cascading effects across the world. African governments and policymakers therefore need to be aware of the continent’s shortcomings in the face of COVID-19 and understand how they can better prepare. Planning for the future is more important than ever.
While much can be gleaned from the responses to COVID-19 elsewhere in the world, it is important to promote strategies and solutions which are tailored for Africa, by Africa. This will require strong commitment from individual governments as well as collaboration at a bilateral and multilateral level. In seeking to strengthen resilience and mitigate the threat of future crises, African governments need to act upon five key lessons from the recent COVID-19 crisis.
1. Preparation is paramount. The COVID-19 pandemic is first and foremost a crisis of vision and planning. The first, and perhaps most important lesson, is to be prepared for the next crisis, whatever it may be. Governments can ensure greater preparedness by developing appropriate risk management systems, establishing a dedicated fund which can only be utilised during a government-declared crisis, and investing in future-proofing initiatives.
2. Context matters when confronting crises. Lockdowns have become a commonly used measure by governments to contain the spread of COVID-19. But while the lockdowns are designed to contain the spread of COVID-19 and save lives, in Africa they have had an adverse effect on the economic livelihoods of citizens. Context is therefore key. Understanding both the crisis itself and the makeup of a country’s society and the nuances which underscore it are important. When addressing a crisis, governments need to triage to determine the most vulnerable, create tailored strategies which limit disruption to the status quo, and, using data, monitor constantly and adapt accordingly.
3. Robust economies will help weather the storm. The economic ramifications of COVID-19 on Africa have proven devastating. Those economies which are reliant on commodities and tourism have been particularly hard-hit. While no economy can survive a crisis unscathed, governments can take appropriate measures to ensure the economic effects of a crisis are greatly diminished. This should see governments double-down on diversification efforts, promote domestic manufacturing, and support private sector growth.
4. Collaboration is key. When COVID-19 first grabbed headlines, there was a call for Africa to “act collectively, and fast”.9 This was predicated on the fear the continent’s poor healthcare infrastructure would collapse under the strain of COVID-19, and everything should be done to ensure adequate capacity. While the COVID-19 pandemic has spurred collaboration on the continent, more can be done to improve co-operation and ensure future crises are confronted collectively and more effectively. Governments should strengthen regional blocs and actors, supplement internal shortcomings with domestic, regional, and international support, and catalyse implementation of integration frameworks and plans.
5. Leadership in times of crisis. The primary responsibility of any government is to serve its people this is especially true during a crisis. It is fitting that the final lesson is concerned with leadership. During a crisis, exemplary leadership is required to steer a country through the hardship. When confronted with a crisis, governments must ensure they look beyond party politics and prioritise the country, ensure actions such as spending and procurement are transparent, and regularly engage the public to instil confidence and assuage fears.
The news came on Monday 9th November that there is, finally, a promising vaccine.10 It has been developed by US-based pharmaceutical company Pfizer Inc. and BioNTech SE, a German biotechnology company. According to an article in the Wall Street Journal it proved to be more than 90% effective in the first 94 subjects infected by the coronavirus. Data are still being collected and while encouraging they are incomplete. Pfizer will ask health regulators for permission to sell the vaccine before the end of November if it is proven to be safe. The earliest there will be safety data is in the middle of November. This will be followed by an extensive review by US health regulators. Once this is completed, and assuming all goes well, production and distribution will begin. So far there have been no serious safety issues, among the nearly 44,000 subjects in the US and other countries.
Issues to look out for are: how long the protection lasts; how effective it is among the target population; how the vaccine can be stored, distributed and delivered; and cost. It is, however, very encouraging news.
‘“The most important message is that you can make a vaccine against this critter,” said Prof. John Bell, from the University of Oxford who led Oxford in reaching its Covid-19 vaccine deal with British drugmaker AstraZeneca PLC. Bell predicted Oxford and AstraZeneca “won’t be far behind” in releasing their trial results, they are expected within weeks.’11
On Tuesday the Daily Telegraph reported Brazil suspended clinical trials for China’s coronavirus vaccine after a participant died. This was being developed by Instituto Butantan, a research centre in Sao Paulo in partnership with Sinovac, a private Chinese firm. The companies say the death of a study volunteer was not linked to ongoing trials.12
The events of the last two days, while encouraging, are also a harbinger of the potential political and economic battles. The Brazilian President
“supported the Oxford-AstraZeneca vaccine, pledging in August to set aside 1.9 billion Brazilian real (£267.5 million) to purchase and produce those doses when they become available. …. In October, he announced that Brazil would not buy the Sinovac vaccine just one day after health minister Eduardo Pazuello said the Chinese firm’s vaccine would be included in the national immunisation programme”.13
Outside of Brazil, Sinovac is also being trialed in Turkey and Indonesia. China is enthusiastic to be vaccine developer, they want to win points following the cover-up of the pandemic in the early stage. It is just speculation: I wonder if this announcement would have had any impact on the US election if it had been released a week earlier?
The Biden-Harris Plan
What delight to find this document within days of the Biden victory. It is significant for many reasons: equally billing for Biden and Harris; short and inclusive; and clear. The opening statement is:
“The American people deserve an urgent, robust, and professional response to the growing public health and economic crisis caused by the coronavirus (COVID-19) outbreak. … the federal government must act swiftly and aggressively to help protect and support our families, small businesses, first responders, and caregivers essential to help us face this challenge, those who are most vulnerable to health and economic impacts, and our broader communities – not to blame others or bail out corporations.”
It sets out three things the administration will always do:
- Listen to science
- Ensure public health decisions are informed by public health professionals
- Promote trust, transparency, common purpose, and accountability in our government
The seven-point plan is:
- Ensure all Americans have access to regular, reliable, and free testing.
- Fix personal protective equipment (PPE) problems for good.
- Provide clear, consistent, evidence-based guidance for how communities should navigate the pandemic – and resources for schools, small businesses, and families to make it through.
- Plan for the effective, equitable distribution of treatments and vaccines — because development isn’t enough if they aren’t effectively distributed.
- Protect older Americans and others at high risk.
- Rebuild and expand defenses to predict, prevent, and mitigate pandemic threats, including those coming from China.14
- Implement mask mandates nationwide by working with governors and mayors and by asking the American people to do what they do best: step up in a time of crisis.
This is a fantastic statement, of course the devil will be in the detail. Health is a state responsibility (as in the UK with the devolved administrations), so there will need to be activity at this level. There were two very striking actions. The first is setting up a
‘U.S. Public Health Jobs Corps to mobilize at least 100,000 Americans across the country with support from trusted local organizations in communities most at risk to perform culturally competent approaches to contact tracing and protecting at-risk populations.’15
The second is the statement that the administration will
“immediately restore our relationship with the World Health Organization, which — while not perfect — is essential to coordinating a global response during a pandemic. … and expand the number of CDC’s deployed disease detectives so we have eyes and ears on the ground, including rebuilding the office in Beijing.’
What a week, two bits of excellent news. We can welcome the US back to the rational world, although we should be aware that millions voted for Trump and the Republicans. It seems there will be a vaccine available sooner than we dreamed possible. My final thought is that this does not mean we are out of the woods, now we need to look at the consequences, unemployment, poverty, hunger and despair that this epidemic has brought.
Well worth looking at brilliant graphics and common sense: https://tomaspueyo.medium.com/coronavirus-the-swiss-cheese-strategy-d6332b5939de
Thank you for reading, reposting and providing comments. What I write is public domain so please share, forward and disseminate. My contact is: firstname.lastname@example.org
- Johns Hopkins University – https://coronavirus.jhu.edu/map.html
- Richard Morrow is Machel-Mandela Fellow at The Brenthurst Foundation, a Johannesburg-based think tank.
- Bamba Gaye, et al., ‘Socio-demographic and epidemiological consideration of Africa’s COVID-19 response: what is the possible pandemic course?’, Nature Medicine, Vol 26, pp. 996-1008, July 2020 and Connie Celum et al ‘Covid-19, Ebola, and HIV – Leveraging Lessons to Maximise Impact’, The New England Journal of Medicine, October 2020
- Albert G. Zeufack, et al ‘Africa’s Pulse – An Analysis of Issues Shaping Africa’s Economic Future: Charting the Road to Recovery’, Vol 22, World Bank: Washington D.C., October 2020
- John Nkengasong and Wessam Mankoula, ‘Looming threat of COVID-19 infection in Africa: act collectively, and fast’, The Lancet, Vol 395, March 2020
- Jared S Hopkins. ‘Pfizer’s Covid-19 Vaccine Proves 90% Effective in Latest Trials: Drugmaker and partner BioNTech could seek FDA authorisation by end of November. Wall Street Journal 9th November 2020
- Sophia Yan, ‘China’s Sinovac coronavirus vaccine trial suspended in Brazil after participant dies’, 10 November 2020 http://www.telegraph.co.uk/news/2020/11/10/china-sinovac-vaccine-trial-suspended-brazil-participant-dies
- I personally think it would have been better to not specifically mention China but reopening the office in Beijing is really welcome.