The people are an asset, not a problem

By: Steven Friedman

THIS country would have far fewer Covid-19 infections if the government had seen most of its people as a partner, not a problem.

South Africa may be an economic giant in Africa but its fight against Covid-19 has not distinguished itself. Its infection rate is by a long way the highest on the continent and is rising rapidly. While the government is proud of the fact that the death rate thus far is low by international standards, it is still the highest on the continent. The government – and the scientists who advise it – insist that high infection and fatality rates were inevitable, even though other countries, including some on the continent, were able to avoid them.

Covid-19 has shown that ability to protect citizens from a pandemic does not necessarily depend on wealth: some rich countries have battled to contain the virus while more than a few poorer states have succeeded. One very clear reason is that there is no cure for Covid-19. Health systems in rich countries are built on curative medicine – curing people who are ill. These countries are not necessarily equipped for effective preventative medicine, which tries to ensure that people do not fall ill in the first place. Curative medicine relies on technical medical skill and money – preventative medicine relies on public health measures which usually work only if citizens can be persuaded to co-operate with the authorities. And curative medicine is obviously not that effective when there is no cure, which is why the United States has battled to contain the disease while some African and Asian countries have succeeded. It is also one reason why this country’s response has fallen short.

Ignoring an Asset  

From the outset, South Africa’ reaction to Covid-19 assumed that the technical skills in the health system would be the key to fighting the disease.

When the government imposed a lockdown in March, citizens were told that the purpose was not to stop large numbers of infections (since these were supposed to be inevitable). It was, rather, to ‘buy time’ to ready the health system for a drastic rise in patient numbers. But this made sense only if hospitals were able to cure patients which, since there is no cure, is not at all obvious. Months into the pandemic, we still don’t know how many people who contracted the disease have recovered because they were treated in a hospital. This means that it is at least possible in theory that getting the hospitals ready did not save a single life. (It seems likely that lives were saved but it is certainly possible that the numbers are not high). This stress on medical facilities rather than stopping the virus in its tracks also assumed that only a small number of people who fell ill with Covid-19 would be unable to recover: at this stage, only around 1,5% of people who contracted the disease have lost their lives. But there is evidence now that at least some people who contract Covid-19 suffer permanent organ damage even if they recover.

Given these realities, it isn’t at all clear that readying the health system made nearly as much sense as South Africans were told. The reason why the government seems to have opted for this approach immediately is that those who govern South Africa and influence its public opinion assume that technical skills and money – curative medicine- are what is needed to fight an epidemic, even when there is no cure. This may partly explain why its Covid strategy showed no interest in forming a partnership with citizens to fight the disease.

When the lockdown was announced, President Cyril Ramaphosa stressed that the government had consulted stakeholders on its Covid strategy. But this did not mean that it was seeking a partnership with the people. Only business and faith-based organisations seem to have been included. In the latter case, the only purpose was to secure co-operation in not holding religious services, so only business seems to have been regarded as an important stakeholder. Nor is it clear whether the government was seeking a partnership with businesses or merely wanted to ensure that they would accept the need to close down most of the economy.

Noticeably absent was any attempt to reach out to citizens to find ways of working with them to stem the virus. Organisations with roots in the society who could have been mobilised to work with government officials to find ways of enabling people to protect themselves –from faith organisations through school governing bodies to activist organisations – were clearly not considered to be stakeholders worthy of consultation. And so, a huge opportunity to stem the spread of Covid-19 was lost. This did not matter much in the well-off suburbs were people had no problem protecting themselves but was extremely costly in townships and shack settlements where what is easy for the affluent is often very hard.

To some, the idea that a partnership between the government and citizens’ organisations could achieve anything is foolish. In this view, only governments have the resources and the power to make things happen and they should simply get on with doing this. Citizens’ groups are narrowly focussed on sections of the society – only governments can tackle problems which affect everyone. An example of the flaws in this thinking is the recent history of social grants. When the constitutional lawyer Zola Skweyiya took over the national department of Social Development, his core aim was to extend social grants, which were then reaching only a fraction of the people entitled to them, to everyone who qualified. He did not develop a grand government plan for extending grants. Instead, he told his officials to make contact with citizens’ organisations or individuals with networks such as school principals and pastors, and to ask them to encourage anyone they encountered who qualified for a grant to apply for one. The result was a mushrooming of grants which gave millions a tool to deal better with poverty.

There is no difference in principle between encouraging people to apply for a grant and urging them to protect themselves from a disease. Asking people to apply for money seems easier than asking them to find spaces in overcrowded townships where infected people can isolate or to locate hand-washing facilities in public places and encourage people to use them or to ensure that everyone wears a mask. But it could be argued that people are likely to be more open to protecting themselves (as well as others) than to helping others apply for a grant. If Skweyiya’s model had been followed in response to Covid-19, we may well have witnessed not only a much more effective effort to stem it but an exciting grassroots campaign for health and safety.

Recently, the government has made concessions to the idea that citizen mobilisation is important. Social development minister Lindiwe Zulu claimed she was working with grassroots organisations to distribute government Covid grants and President Cyril Ramaphosa has welcomed the emergence of citizens’ groups who encourage people to fight the virus. But neither have said who these organisations are. It seems unlikely that they are strong or effective because not only are infections rising at an alarming rate but much of the money committed to people in need has not reached them. This may be partly explained by the fact that the role of citizen’s organisations has never been a core government concern – it is usually mentioned in passing, if at all, before discussion moves to something considered more important.

The Limits of Science 

Why has the government ignored one its most important assets in the fight against Covid-19?

From the time the virus arrived in South Africa, the government, like some of its counterparts elsewhere, has insisted repeatedly that it is ‘following the science’ – that it is guided by the insights of medical scientists. This sounds attractive because it suggests that hard evidence, not prejudice, is informing decisions. It is particularly attractive in this country because, almost two decades ago, many lives were lost because the government ignored the scientific evidence on HIV and AIDS. But there is a crucial difference between AIDS and Covid-19. When AIDS arrived here, scientists knew how it worked and how to treat it. Covid-19 is very new and so there is no agreement among scientists on how it works and no treatment. It has, therefore, never been clear what ‘follow the science’ means in South Africa’s fight against Covid-19. What is clear is that it does not mean an effective way of curbing infections.

‘Follow the science’ also suggests a particular attitude to the task of government – one which assumes that it is about ‘science’ and technical knowledge. But, while this can be very useful (when the science is clear), governing is also about relations with citizens. Governments can enjoy the best scientific advice which tells them what they need to do. But citizens will always frustrate what it thinks it needs to do if they are not convinced that it will meet their needs, and so effective governments need to find ways of convincing citizens to accept what they plan. This may mean changing their plans when citizens insist that it needs changing. And, as the social grants example shows, governments can sometimes only do what they want to do if they persuade citizens to help them to do it. So, ‘follow the science’ can be anything but attractive. It can signal that governments do not understand how important it is to work with and to listen to citizens.

A second reason stems from deeply rooted attitudes in the government and among the society’s elite more generally about people living in poverty. From the outset, the government’s strategy assumed that it needed to control people in townships, not work with them. Ironically, some of the regulations which upset people in the suburbs are designed to control those in the townships. A ban on tobacco sales was explained by a government minister as a way of preventing people in townships sharing cigarettes, a rule preventing the sale of cooked food was explained as a means of curbing sales on township street corners, a prohibition on exercising after 9am as a means of ensuring that people did not loiter in streets, something which does not generally happen in suburbs where cars are the favoured means of transport. If we add to this the deployment of over 70 000 troops to reinforce the lockdown, and incidents which show that the soldiers sometimes used heavy-handed tactics to bully people into obeying, the message is clear: in the view of the government, people in townships would spread the virus unless they were controlled.

If the majority of citizens are seen as a problem, not an asset, there is little point in inviting them and the organisations which are in touch with them to co-operate in curbing the spread of Covid-19. The way in which the government responded to people at the grassroots suggests that the failure to reach out to them was not an oversight – it seems likely that the government never seriously considered doing this because to do it would have meant treating a problem as if it were capable of becoming a solution.

We will, of course, never know whether a partnership between the government and organisations in touch with people at the grassroots would have halted the spread of Covid-19. What we do know is that the government’s alternative, which relied on controlling people, did not work. Commanding people – and relying on technical advice rather than strong links with citizens – is often seen as the hard-headed, practical, way of addressing problems and working with citizens as a luxury. South Africa’s Covid-19 experience may well show that it is a highly impractical approach since it simply does not work. In a sense, the choice was between relying on democracy or on a scientific elite. Had the government chosen democracy, South Africa might well be a much healthier and happier place.

Prof Steve Friedman is a lecture at the University of Johannesburg. He writes for DDP in his personal capacity and his views do not represent those of the organization.