Out Of Africa: South Africa’s Covid-19 Response Ignores The Rest Of The Continent

By: Steven Friedman

In global Covid-19 statistics, South Africa is in Africa. In the minds of the government, its scientific advisors and much of the national debate, it is in Western Europe or North America.

Infection rates in South Africa are slowing. Much of the official and unofficial comment, while it warns that new outbreaks are a constant danger, seems to assume that the worst is behind the country and that it is now possible to begin evaluating how well it has done in dealing with the disease. Business lobbies, cheered on by the media, keep pressing for the end to all restrictions as thought the pandemic is over. This is strange – at the time of writing, there are still almost 2 000 new cases a day, which, in many other countries, would be seen as a major outbreak. But the relief at a significant drop in cases is nevertheless great enough to prompt the government to declare success because the number of people lost to Covid-19 is low ‘by international standards’. Its advisors agree.

The ministers who make these statements never say which international standards they have in mind. But a quick look at world trends makes these claims puzzling. South Africa’s official Covid-19 death toll is around 15 000 which is exponentially higher than the toll for all of East Asia combined. (The Medical Research Council estimates that the actual number of deaths may be three times that. But other countries may be under-estimating their Covid-19 death rates by a similar margin so it is best to compare official rates).  Even in India, whose soaring case numbers and death tolls break all records, the official death rate as a percentage of population is lower than South Africa’s. But the claim that the country is doing well becomes even more puzzling when its record is compared to that of the rest of Africa: currently, South Africa has reported as many case and deaths as all other African countries combined.

It is common to assume that numbers for the rest of the continent are low only because, since Africa is always thought to be awash in incompetence, deaths and cases are simply not reported. But, while it is easy to see how case numbers could be much higher than claimed because there is less testing, a huge increase in hospital admissions and mass deaths would surely have been noticed. Some international media have produced evidence that deaths in some African countries are unreported, but the sheer size of South Africa’s case and death load compared to the rest of the continent means that so many unreported deaths would have needed to occur if other countries were doing worse, that someone would surely have noticed. The chair of the council advising the South African government on Covid-19, Salim Abdool Karim, has acknowledged that the death rate in the rest of the continent is low. Given this, it seems safe to assume that South Africa is doing worse than any other country on the continent. Even if other countries are so poor at reporting fatalities that it is, say, third worst, this would hardly be ‘doing well’.

So, is the government claim simply a fiction? Is it guilty of spreading ‘fake news’? This seems unlikely if only because it knows that the figures in other countries are readily available and that false claims would be quickly discovered. The answer is surely that South Africa is doing well, but only compared to the countries which matter to government ministers, officials, and advisors: those of Western Europe and North America. If we look at official cases (and not at the probably more accurate measure which compares the number of people who have died since March with similar figures for previous years), South Africa is doing better than the United States, Britain, Italy and Spain. It is certainly true that the health system here was never placed under the sort of pressure those countries faced (although thousands of health workers have been infected). It is also significant that these claims have not been challenged by media, citizens’ groups or the ever loud social media chorus. This suggests that the government has ‘got away’ with insisting that the country is doing well because the national debate also sees only the rich countries of the West as important measures of how well this country is doing.

It was, for example, common at the start of the pandemic for advisors and politicians to warn that South Africa should avoid ending up like Italy or Britain. Perhaps more telling is that, when Africa’s experience is mentioned at all (and it is usually not mentioned), it is spoken of as a mystery, much as colonisers- or would-be – colonisers might have spoken of it. In an interview with Nature, Karim acknowledged that death rates were low in Africa but added: ‘I don’t have the answer… At the moment, it’s an enigma. The reason will reveal itself in due course’. In an interview with the BBC he confessed to being ‘all at sea’ as he tried to make sense of this.

While the confession that he doesn’t know is refreshingly unusual for South African members of his profession, this does not suggest any deep study of the issue. The comment could easily have been made by any of the European and American pundits who insisted that the ‘dark continent’ would be engulfed in Covid-19 deaths and are now forced to puzzle at why they have thus far been wrong. Nor does he – or anyone else in the South African debate – suggest that it might be worth talking to colleagues in these countries to find out what is afoot: neither, of course, would someone in Europe or America who commented on the issue. Karim is used here simply as an example: his views are typical of mainstream thinking. It is also worth recalling that about the only time the South African debate showed any interest in Covid-19 elsewhere in the continent was shortly after the first case was reported here, when there were demands on social media that the borders be closed to prevent Africans bringing the disease here: in reality, of course, it was brought by a South African returning from a European holiday.

It is not only Africa which officials, scientists and most advisors ignore. They mention East Asian countries which have succeeded in controlling the virus, such as South Korea and Vietnam, only to claim that, after initially being praised for their success, they are experiencing fresh outbreaks (which implies that they aren’t that much better than us after all). This ignores the fact that, even after the new outbreaks, Vietnam’s total number of cases for the year is lower than that for a single day in this country ( even now, when numbers are said to be low) and that South Korea’s case number is around 3% of  South Africa’s: the two have experienced less than 400 deaths combined, around 2% of this country’s. The Indian state of Kerala is never mentioned at all despite the fact that its social and economic profile is closer to most South Africans’ and that, despite a ‘surge’, its cases are less than 10% this country’s and its death toll is, adjusted for population size, only 4% of South Africa’s. So, blindness to the rest of Africa is simply part of a wider tendency to regard Western Europe and North America as the centre of the universe. But refusal to take Africa seriously is, of course, far more of a problem since South Africa is an African country.

This bias has shaped South Africa’s Covid-19 strategy. From the outset, the government and its advisors have assumed that a severe outbreak here was inevitable. So, their goal was not to stop the virus in its tracks but to ensure that the health system could cope. This sounds reasonable until we recall that there is no cure for Covid-19 and so, even if the system was entirely ready, this did not necessarily mean that more people would recover because they received treatment. Even if we assume, as is likely, that using the system did help some people to recover, we can safely assume that stopping many people falling ill would have been better for the populace’s health than making sure that every sick person who needed a hospital bed got one. So why put such emphasis on the health system rather than the health of the people? Because that is what America and many Western European countries did.

One probable reason why countries like the USA and Britain are doing far worse than Rwanda or Kerala is that these countries (like Italy, for example), focus on curative medicine, which treats people who are already ill. But they are far less good at – or interested in – public health measures which aim to stop people getting ill in the first place. Curative medicine is obviously not a huge help if there is no cure and so fighting Covid-19 was easier for countries used to using public health measures to prevent the spread of viruses. South Korea, Vietnam and Kerala have experienced epidemics repeatedly, as have some African countries. This is why they have so far been better able to cope than countries with state-of-the-art curative health systems. South Africa emphasised getting people into hospital because that is what was done in the countries which its politicians and scientists take seriously.

The government’s failure to work with people living in poverty may also be a product of its fixation with the rich West. If you believe that the rich countries are the standards by which you should be measured, townships and shack settlements and those who live in them don’t match up. Either they must be forced to fit in with approaches based on the experiences of the rich countries or they must be left to their own devices. This makes it inevitable that there will be high case numbers in those areas because, around the globe, trust between citizens and governments has usually been the key to fighting Covid-19. Trust is clearly not possible when most citizens are told, in effect, that they are not up to the task.

There is nothing new about this fixation with Europe and America at the expense of Africa. Since the negotiations of the 1990s, South African debates over constitutional arrangements or electoral systems focus on richer countries (including Australia and Canada) and rarely on Asia, let alone Africa. In most news coverage and public discussion of events beyond this country’s borders, Africa is always at most an afterthought. There is little interest in current developments in Nigeria, Kenya or Ghana – and none at all in learning from them. This is particularly striking this year since South Africa’s President is also chair of the African Union.

But it is particularly interesting at the moment because, for some years, the government, if not the country, has insisted that it is moving away from the Europe-North America preoccupation: this is what its membership of the BRICS alliance is meant to be about. It could, of course, be argued that besides BRICS’s other drawbacks (none of the other countries are currently run by governments which share the values proclaimed by South Africa’s constitution), it is a move away from Africa because no other African country is a member. But it is meant to signal that South Africa takes seriously countries other than the one which once colonised it physically and the one which still colonises it culturally.

The response to Covid-19 suggests that the turn to BRICS may be a shift in economic strategy but that it has made no difference at all to the elite’s view of the world which is as firmly fixated on the ‘developed’ countries of the West as it ever was. It is a fixation which may explain why the country which claims the most sophisticated health system on the continent is also the one with most Covid-19 cases and deaths.

Prof Steven 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.