Are we winning? Yes and no!

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

I finished my quarantine in my Waterloo apartment a week ago. I had three days confined in an airport hotel and then 11 more in Waterloo. The government was efficient at checking up on me. Every day I got an automated email with a weblink, and had to complete a form online. There were at least two phone calls and one visit from a private investigator, who had been repurposed as a quarantine inspector, complete with stab proof vest. He came to the door of the apartment, but said he was not allowed to enter it – which somewhat defeats the objective of checking.

The whole of the post-hotel quarantine depends on the honesty of individuals entering Canada. The press has reported, with outrage, of people flying to American airports and crossing the border by road, thus avoiding some of the more intrusive processes. I must be honest and say it was not too bad, though the current lockdown is wearing. Friends made sure I was well supplied with the essentials (food and wine), and so my incarceration went by reasonably quickly. But then I have a large apartment with a great view. I am privileged and I recognise it.

My overarching impression in Ontario is of a province on its knees, and an overwhelming weariness with the whole process. The smiles are becoming fixed, that is when you can see them because people wear masks outside. The problem is the lack of clarity and consistency. As I understand the situation, rules are enforced at the local level. Where I am, it is enforced by Region of Waterloo Public Health. They work closely with Public Health Ontario, the relevant section of the provincial government, which sets policy, and at the national level, with the Federal Ministry of Health. The lockdown is tight; people should only leave their homes for essential reasons, socialising is not allowed, and currently schools are closed. This last regulation has, as in Europe, had an extremely detrimental effect on children and their parents.

A large part of the problem is the Provincial Government, run by the Progressive Conservative Party of Ontario under the leadership of Doug Ford. The world over, conservative governments have reduced public health expenditures and services, and Ontario is no exception. Indeed, Ford was forced into a humiliating climb down when he attempted to announce that the provincial police would enforce his regulations,1 only to have various forces announce the next day that they would not be doing this.2 The numbers in the province are coming down slowly. There is a decent website3 giving data for the province. The citizenry needs clear guidance and, above all, to know the nightmare will end soon, but this is lacking.

The little mall across the road has a security officer at a desk at each entrance. Their task: to ask each customer if they have any Covid symptoms as they enter. It would take a pretty stupid individual to admit to having signs of Covid. I suppose it is important to be seen to be doing something, and this has certainly created employment. Interestingly most of the security officers seem to be recent immigrants from Southeast Asian countries. That probably indicates that these are minimum wage jobs.
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Vaccination: the way ahead

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

This is being written as I quarantine in my Waterloo apartment. Getting here was surprisingly easy, despite a great deal of bureaucracy. The story began in December 2019 when I travelled from Waterloo to the UK for a year’s sabbatical. I planned a busy year, with visiting fellowships at two German and a British University, and visiting status with two English Universities. It was set to be a full, productive, and fun year. And then Covid-19 arrived, and everything was put on hold. I did not leave Norwich for over a year but making a trip to Canada was increasingly urgent. Travel was not easy, cheap or pleasant.

The first step was getting permission to leave the UK. International travel was not allowed until 17th May, unless the traveller has good reason. There is, of course, a government website. The “Declaration for International Travel” has a drop-down menu of about 10 reasons, from ‘Work’ to ‘Other reasonable excuse – please specify’. I dutifully completed and printed it. No one asked to see it at any point. There were no flights for my preferred route (Norwich, Amsterdam, Toronto) so I booked from Heathrow. There is extensive guidance on travelling to Canada on the Canadian government website. Only four airports accept international flights: Calgary, Montreal, Toronto, and Vancouver. At the moment, there is no recognition in the terms of travel and restrictions of vaccine status. I am fully vaccinated and have a flimsy little record card to prove it. I made photocopies for officials. No one asked or showed an interest.

To enter Canada (and various other countries) a traveller has to have a negative Covid test within three days of boarding. In the UK, private laboratories produce a “Fit to Travel Certificate for SARS CoV-2/Covid-19 Testing”. At a price of course. Also required is an arrival form to allow border officials to track you.

“Speed up your arrival process in Canada and spend less time with border and public health officers. Use ArriveCAN1 to provide mandatory travel information… Help … keep Canadians safe and healthy.”

The aircraft, a Boeing 787 Dreamliner, seats about 250 people. I booked myself in the premium economy section for more room. What a waste of money, there were only 19 passengers! There was a full complement of very bored cabin crew and consequently we had excellent service and some interesting conversations. Clearly, they had time to check the passenger list, halfway through the journey they began addressing me as Professor!

On arrival getting through the Canadian formalities was straightforward. The test is a nasal swab. There was no interest in my vaccination status – but there were a few comments on Canada’s failure to roll out a vaccine. Mind you I was on an empty plane; the next scheduled flight from Manila had 350 passengers. The government requires you to pay for three days’ quarantine in a hotel. My choice was a bog-standard business hotel, where the confinement included three meals brought to the door in large brown paper packets. I understand Pavlov’s dogs better now. Within 24 hours I recognized the rustle from the moment the delivery person exited the lift. There was nothing to get excited about on the menu though.

At Heathrow I bought a couple of bottles of duty-free wine and when I checked into the hotel, I asked for a third. The clerk said that he was glad I asked before he checked me in. He is not allowed to send alcohol to the quarantine rooms! There was no corkscrew in the room and the desk said they had none so here are some tips.
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New Decade! New Life?

The 1st January 2020 marks the start of a new decade as well as a New Year. I am aware that some purists (or pedants) think that the decade does not actually officially start until 1st January 2021, I am not part of that group. This is it! A new decade!

The next year will be interesting, I need to adapt my lifestyle. The first order of business will be getting used to living full time in Norwich. At the moment I have absolutely no travel planned for the next calendar year. As I am on sabbatical I don’t have to think about teaching but I am ‘on the books’ to the end of 2021. What should I do? This will become clearer in the next few months.

I returned to the UK on the 23rd December, just ahead of Christmas. My last few weeks in Waterloo were crammed with wrapping up the term and students and seeing and saying goodbye to friends. I also had to pack up the apartment for rental. Fortunately, I had help. The estate agent who is handling it for me, Dave McIntyre, is hopeful it can be let furnished. This means crockery, cutlery, furniture, linen and books were left out, but could be packed away if necessary. Dave is the chap who sold me the place originally and who will take care of the sale in due course. He is not just an estate agent but a decent and trustworthy person.

I did not write about this in my last post (not enough room), but at the end of November I went, with my friend Dana, to the event Dining with the Dead! This was held at the Kitchener Museum which had a themed exhibition on the afterlife. The way it was advertised was as a

“one of a kind dining experience! To coincide with the Exhibition at THEMUSEUM, we’re hosting Psychic Medium Kerrilynn Shellhorn (who) will utilize her strong connection to the other side to bring messages from lost loved ones while you dine on a delicious 3 course dinner.”

The food was excellent and the service great. The séance was, well, medium. There were about 35 diners. Only a few were given messages from the departed. I was not convinced but will chalk it up as an interesting experience.

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The end is nigh

It is many years since I included a ‘round robin’ in with Christmas cards and this, lazily, also constitutes my blog post for December. There is a good reason this year. I have significant news and don’t want to leave people out, or have to write it in all the cards I send.

You may recall in January 2014 I joined the Balsillie School in Waterloo, Ontario as a full time member of faculty. It is complicated appointment. My salary is paid by Wilfrid Laurier University, but I work at the Balsillie School of International Affairs. Here I was, according to my letter of appointment, employed to teach two courses per year, and carry out the other responsibilities of a senior academic, including researching, writing and publishing.

About two years ago the University unilaterally, and with very little consultation, decided to change the conditions of service. They were, of course, made less favourable for academics. Of particular concern was the doubling of our teaching commitment. I came here because I had not, in 30 years as an academic, taught (two years of teaching one course at the University of Natal on Southern African Development in 1984 and 1985 had receded to a distant memory). I wanted to see what it would be like to work with and teach MA and PhD students. The idea of supervising a thesis from start to finish was intriguing, and I am happy to report that I did manage to do that with one student.

This new demand regarding teaching made staying in Waterloo problematic in the long term. I neither had courses prepared, nor much guidance on what to do. In addition to more teaching being mandatory my academic cohort was assured, when we signed up in 2012 and 2013, there would be research money available to us, without too many hoops to leap through. This promise evaporated like the dew in the Kalahari in January, although it was not entirely the fault of the university but rather the shocking behaviour of one of the other ‘partners’. In addition to this moving the goalposts, a part of the university bureaucracy was irrational to me. I have every intention of writing about this in due course.

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The Misty Murky Mornings

I had not been in Waterloo for long when I was at a meeting on a very foggy day. I looked out of the window and declaimed:

“Season of mists and mellow fruitfulness,
Close bosom-friend of the maturing sun;
Conspiring with him how to load and bless
With fruit the vines that round the thatch-eves run”

This is from John Keats’ poem To Autumn, published in 1820. Everyone looked at me blankly. Doesn’t everyone know the romantic poets? Evidently not! My mind is a bin of snatches of poems and quotes. I can’t always quote them entirely accurately, but I do generally have something appropriate.

There is so much going on around the world that it is hard to know where to start. Britain remains on the edge of a cliff as the Brexit process continues to falter and stutter. So far Theresa May lost three crucial votes and was replaced by Boris Johnson. At the weekend, on 19th September, in an exceptional Saturday sitting, he lost the first vote seeking approval for his ‘deal’. I am not sure that anyone knows what is going to happen. I hoped that by the time I posted my monthly blog, things might be clearer. This does not seem to be the case, and the only credible way forward is to take the decision back to the country, either in a general election or a second referendum.

My sources of information are BBC World News and the occasional dip into the Canadian Broadcasting Service. Canada had an election for the Federal Government on the 21st September. The main parties were the Liberals, led by Justin Trudeau, the governing party going into the election; the Conservatives, led by Andrew Sheer, an oleaginous individual; the New Democrat Party (NDP), whose leader is a Sikh complete with turban (which he could not wear as a public servant in secular Quebec); and the Greens, lead by a faintly desperate looking woman. There is also Bloc Québécois (BQ) which advocates for Quebec nationalism and sovereignty. They are not a force outside Quebec. Interestingly, like the DUP in the British Parliament, they had 10 seats before the vote, but 34 after the polls closed. Finally there is the small The People’s Party of Canada, a splinter group similar to The Brexit Party in the UK.

I watched the results come in. The process was amazing as the CBC had excellent hi-tech coverage down to individual polling stations. This meant they were able to call results before all the constituency polls had been counted – although they did warn that these were preliminary tallies. The final outcome was 157 seats for the Liberals, 121 for the Conservatives, 32 for the Bloc, 24 for the NDP, three for the Greens and one Independent. Ironically the Conservatives got the most votes at 34.4%; Liberals’ at 33.1%; The New Democrats took 15.9% of the vote, followed by the Bloc at 7.7%, the Greens at 6.5% and the People’s Party at 1.6%. Of course there are more tiny parties, but none should be taken very seriously. It is clear that there will be a minority or coalition government. No bad thing in my opinion. Equally the green vote did not translate into seats!

Around the world from Lebanon to Chile, Barcelona to Hong Kong, people are taking to the streets to protest against governments. Unfortunately these events frequently turn violent, but it should be noted that, at the time of writing, there have been few deaths. This is very striking and suggests restraint on the part of everyone, authorities and protestors alike. The reasons for the increase in protests range from climate change (which is having an insidious but serious impact) to unemployment to global anomie. This is, to my mind, the key concept. As originally developed by Émile Durkheim it is

“a social condition in which there is a disintegration or disappearance of the norms and values that were previously common to the society”

We have to respond to this upheaval, and not with repression.

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Heat and Humidity

The Canadian summer has been hot and humid. I have never enjoyed humidity and so wonder why I managed to do summers in South Africa and Canada. The UN held a Climate Summit in September and there is increasing recognition of the environmental crisis we are facing. Earlier, in mid-September, the running news bar on the BBC was that the bird population has fallen precipitously in North America. In Waterloo there was a climate strike day on the 27th and people marched from the Universities to the town square. There were thousands of participants and I was proud to be among them.

Another running news bar on the BBC has been that ‘flight shaming’ means the growth in airline travel is expected to fall. Looking back more than 40 years I was so excited to take my first flight. I got a ride from Mbabane to Johannesburg, and boarded a flight to Heathrow to go to University. At 19, this was the first time I had been on a plane. I have a record of all the flights I took on a computer file, it is a bit scary.

Today when I board a plane I feel somewhat guilty. It is my intention to drastically reduce the amount of air travel and increase the amount of train travel. From Norwich to London is two hours by rail, and from there it is easy to get to Brussels or Paris. Plans for 2020 including going to Ireland (Norwich, London, Fishguard and the ferry to Dublin), and, perhaps, Amsterdam (Norwich, Harwich and ferry to Rotterdam). The possibilities are numerous.

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Frying in Norfolk

Anyone who denies climate change, and more specifically, global warming, is seriously wrong. At the end of August we had record temperatures in Norwich. Fortunately it cooled down in the evenings so sleeping has not been too difficult. However, this summer the rowan tree in the front garden died from a mixture of disease and heat stress. Ailsa has been using the water from the rain butts to keep some of her favourite plants alive, but it is an uphill battle. It presents a dismal picture and I really wonder what the next 10 to 20 years will hold. I am increasingly aware of my contribution to this crisis, particularly through flying, but I do not consider myself to be a flamboyant consumer of other things.

Having said that, I have to begin this blog by reflecting on my travelling over the past month. My final class in Waterloo was on 30th July. I had to complete the marking and submit the marks by 8th August. I was able to do this, and almost all of the students should have been pleased with the outcome. The temperatures and humidity gradually rose in Waterloo, and I was glad to be heading for Norwich. I did not realise how hot Norwich was going to be.

I travelled over on Sunday 11th August, flying via Amsterdam. Toronto to Amsterdam is not all that long, just 7½ hours. This is not long enough to take a sleeping pill, so I sat and watched the film ‘Red Joan’. This was about a British woman who became a Soviet spy in the 1940s and 50s. Oddly I was reading a book called ‘And Is There Honey Still For Tea?’, by Peter Murphy, set in the same time period and covering the same topics. It is hard to believe how much skullduggery there was going on then. I guess it is still happening, with electronic surveillance playing an ever-increasing role.

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Sunshine and students

There are three semesters at the Balsillie School, and across Canada. The Autumn term starts in September and ends just before Christmas; the Winter term is from January to April; and we are completing the Spring term which lasts from May to July. The terms are longer than in the UK and Europe at 12 weeks.

I taught two courses in the Spring and will teach two in the Autumn. Next calendar year (January 2020 to December 2020), I am on sabbatical and am very much looking forward to this. This is the first time I have been in Waterloo for the Spring term, and while it might have begun as spring it ended as summer – which is the one term we do not have. My word it was hot and humid for weeks at a time. Fortunately there were occasional thunderstorms that roiled across the region and brought some relief.

It has been very hot across much of Europe as well. We have a friend who has been in hospital in Norwich for some weeks now. The Norfolk and Norwich Hospital was opened in 2001. It was built on a greenfield site near the University, which means that UEA is able to offer medical degrees which was not the case when I was a student. It replaced a Victorian establishment in the centre of the city.

The new hospital is ‘state of the art’, except that there is no air-conditioning! This is OK for 10 months of the year. When there is a heatwave, as there was in July, it means that everyone from the consultants to the patients really suffers. It is miserable and sadly I don’t think there is any way that AC can be retrofitted into the building. The other major problem is that the hospital is not easy for the public to get to. It is an expensive and inconvenient bus journey, while those who drive have to pay car parking charges.

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Hotting up in June

This posting is being written over a long weekend in Canada. It will only be posted on the website in early July. The reason is that I am one of the contributing authors to a paper being published in the journal Health Affairs and the article was released on Monday. That means we could put a link up, but not until 4 PM Eastern time on 1st July. Eastern time refers, of course, to the time in New York and Washington, not Moscow. The writing was led by Steven Forsythe, someone I have known for many years, and who did his Ph.D. at the Liverpool School of Tropical Medicine. Apart from him there are another seven named co-authors. The title is Twenty Years Of Antiretroviral Therapy For People Living With HIV: Global Costs, Health Achievements, Economic Benefits. It will go on the reading list for my students.

The other activity I have been extensively engaged in over the past couple of weeks is editing The African Journal of AIDS Research. I am the Editor-in-Chief. This means that I read every article that gets through the review process to approve it for publication. We are now getting about 260 articles submitted every year, we only publish 40 (and these I read), and so there is quite a lot of work involved. On the other hand it is does give me a forum to express views in editorials, should I wish, and keeps me up to date on current writing. Hopefully the last issue of 2019 will comprise papers presented at the International AIDS Economics Network meeting just ahead of the International AIDS Conference in 2018. To some extent this will be a ‘development’ issue as some of the authors have not published before. Steven is one of the two guest editors for the issue.

I am teaching two courses this term and am increasingly aware of the importance of equity in health. It is quite clear that, in the near future, a number of countries will not be able to afford to have their citizens on antiretroviral therapy. Donors are paying for it and may step back. This will raise a series of moral questions and it will be deeply interesting and concerning to see how they are addressed. My belief is that donor agencies will agree to continue funding people who are on treatment, but they probably won’t initiate new patients.

The big news from Waterloo is that the light rail service is finally in operation. This means that there are spanking new two-car trains running from a mall to the north of Waterloo to one to the south of Kitchener. I find it quite telling that the endpoints are shopping emporia. The train has been free of charge for the first 10 days of operation, giving the local citizens the opportunity to try it. In general I believe large infrastructure projects are critical for long term development, although it may not seem so at the time.

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Pollen and polling

In my blog, posted at the end of March, I described the surgery I underwent in Durban. I also talked about going out a couple of times, with friends, to a really delightful little bakery/pizza restaurant in the neighbourhood. It does not even have a liquor licence; and this does tend to mean the evening is cheaper as one takes one’s own wine. Among those friends was Jurgen Brauninger and his family. I wrote in that blog:

‘On a personal level it is interesting to see my cohort, friends and colleagues ageing into their 60s, for the most part with grace and dignity. It is however a shock to us all – but, as I said to one friend, ‘it is better than the alternative’.’

Within two weeks of these dinners we learned, out of the blue, that Jurgen was not well. He was suffering from pancreatic and liver cancer, and was having difficulty in eating. After various consultations he was scheduled for urgent surgery to ease pressure on his duodenum. While this was not a cure, it was expected to improve the quality of his life. The surgery was carried out on 26 April (by the same surgeon who did my hernia); Jurgen did not recover and died on 6 May.

I want to pay tribute to a dear friend and colleague, a talented musician, but above all a devoted family man. I know Tania, Hannah and Brigitte will be torn apart by grief. Sitting in Canada I have felt very distant, but no less sad. I wish I had deep and meaningful forethoughts about this but I don’t, I just know I will miss him enormously. Andrew Marvell’s lines “But at my back I always hear, Time’s wingéd chariot hurrying near”, were not written about death; they do seem very apt though.

The Brauningers lived a few houses up the road from us in Manor Gardens. Their children were similar ages to Rowan and Douglas. We celebrated many milestones together; Brigitte did the most amazing Easter lunches for the university crowd and others. The families went away together for a number of short holidays in the province. Everyone enjoying each other’s company, even braaing under umbrellas during a heavy rainstorm. Their home was an original ‘wood and iron’ house, this is one of the first Durban houses and relatively few are left standing. Jurgen, I and Ullie, one of his friends, purchased the house next door when it came on the market, in order to preserve it and the jungle of a garden for a little bit longer. Jurgen and Brigitte had just moved a few kilometers to a more modern house and were planning their retirement when this devastating event occurred. This has been a deeply sad time.

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