COVID-19 Pandemic Preparedness and Response in West Africa: An Anthropological Lens

The almost devouring union of a catastrophic world where an exceptional consensus has been reached on the fear that now devours us is the rhythm of daily life. Didn’t the American novelist Kurt Vonnegut say that in the world in which we live “paranoia is an act of faith” (Exley 2020)? And what if governing by affect was his perfect and parallel answer (Lordon 2016)? The end of the pandemic and the hour of assessment will tell us whether reason or fear have conditioned the decisions of our rulers.  

Rebalancing: all lives have the same value

Whatever one may claim, this pandemic is banally generating what happened elsewhere in Africa during the Ebola epidemic: social inequalities in health, pharmaceutical shortage generated by austerity policies (Abramowitz 2016), denial and blame, contradictory injunctions in public health, undignified burials (Le Marcis 2015), academic delay, travel bans for Africans, isolation of countries that have caused the penalization of their entire economic sector: tourism, agriculture, markets. The reference to the Ebola epidemic as regards African popular reactions during this painful and worrying period largely echoes current experiences. The same scenarios force us to think symmetrically about the pandemic upheavals in different societies. The last African experience is also the tragedy of hundreds of traditional healers, volunteer nurses and conventional medicine practitioners who passed away while rescuing their folks amidst indifference (O’Dempsey 2017). Global health is also the making of lives that are not equally valuable. Today, the terrifying reality of Western caregivers falling from exhaustion and infection, has caught up with us. The incorporation of the African experience would at last bear witness to an epistemic justice and an ethic of life (De Sousa Santos 2016) that could characterize the relationship between Africa, Europe and the East. Meanwhile, will the COVID-19 pandemic find Africa better prepared?

The COVID-19 pandemic in West Africa

Background

As of April 28, 2020, fifty-two African countries have reported COVID-19 cases, with an increase of 41.6% over the previous week, according to the Africa CDC epidemiological bulletin. As expected, South Africa and Algeria, the continent’s gateways and countries with close relations with China, were the first to report cases, while West Africa has seen cases imported from Europe: France, Spain and Italy. The countries have only recently acquired diagnostic capacities for COVID-19; at the beginning only South Africa and Senegal had them. However, reported cases are concentrated in large cities such as Bobo and Ouagadougou in Burkina Faso, or Niamey in Niger. It may be linked to the diagnostic capacity of large cities and may underestimate the true scale of the epidemic at the national level. My ten years of experience as an anthropologist investigating previous epidemics by diseases, such as meningitis or Ebola in West Africa in the area of the social history of infections and public health strategies, has shown that only half of the countries who followed meningitis surveillance reported data, and that the majority of suspected cases never received laboratory testing (Thiongane, Graham, and Broutin 2017; Thiongane 2012). Also in remote settings, daily testing and samples need transportation that could take weeks before reaching a laboratory that could confirm the disease etiology. The data reports from war zones like Democratic Republic of Congo, South Sudan and other countries with weak health system are irregular, while low income countries like Burkina Faso have inherited their capacity building in reporting regularly reliable data from previous programs of surveillance for epidemic diseases (like meningitis).  

The measures and elicited reactions

Several African countries reacted to put the social life of their citizens on hold by closing borders, suspending flights, closing markets, ordering curfews, closing schools, banning gatherings, quarantining cities. Everywhere media that convey prevention messages and work on risk perceptions have flourished: institutional messages, popular songs, murals, technical reports, journalistic commentaries, digitalized religious sermons.  

Therapeutic hesitancy between transnational hope and anticipation of vaccine refusal

In Senegal, travel restrictions and especially the curfew announced overnight have caused surprise and anger to the people in Dakar. Many workers have walked tens kilometers to reach their home with public transport coming to a sudden halt. After a classic cycle of shame, blame and conspiracy theories, popular and religious measures to keep people away from misfortune were introduced. Magical thinking gave way to the measure of danger and a clearer perception of risk. Senegal recorded a first death from COVID-19, on March, 31, 2020, in the person of Pape Diouf, former president of the Olympique de Marseille, one of the most prestigious football clubs in France. After his death, several people became conscious of the reality and seriousness of the epidemic.  

The controversies over hydroxychloroquine, some weeks ago, swept through the public arena, raising transnational hopes and provoking rushes into drug stores. The shortage of local production of Plaquenil, a few months earlier, was seen as a heresy by leaders of civil society claiming immediate pharmaceutical sovereignty. In Burkina Faso, clinical studies combining hydroxychloroquine with and without azithromycin have begun at the Nanoro Health Centre situated at 100km from Ouagadougou. On the other hand, mistrust of vaccines continues to grow. The same rumors that have been spread by previous vaccinations against other diseases are coming back. Messages of early refusal of COVID-19 vaccination among Africans have been circulating since the beginning of the pandemic in Africa.  

Many were looking after a vaccine coming from Europe that would be inoculated into the population. Africans would still be used as guinea pigs. Echoes of clinical trials in progress or to come, mainly that of the BCG vaccine, and the clumsy and disdainful comment of a physician of the hospital of Cochin on the lack of resources in Africa, set fire into the powder keg.  Since the COVID-19 pandemic, part of the Senegalese population has been watching and warning against vaccine trials that would use Africans as subjects. Warning videos of the African diaspora in the United States have been widely circulated on social networks as well as other actors affiliated with revivalist churches. The French doctor’s comment triggered controversy and reinforced these representations, forcing the presidency of Burkina Faso to issue a formal denial of participation in a COVID-19 vaccine trial on its territory.  

Vaccination is a technique that triggers the strongest conspiracy mentality. Moreover, rumors about vaccination have often been associated with the lack of knowledge of the populations and their ignorance, thus disqualifying their expertise. Resistance to vaccination is long-standing. It dates back to the period of the great colonial conquests (Anderson 2007; Löwy and Rodhain 2001). Recently, it has been fuelled by experiments lacking transparency and ethics, such as the one on the Trovan by Pfizer in Nigeria (Renne 2006). In 2011, the story that the assassination of Bin Laden was made under the cover of a vaccination campaign, organized by the CIA, near his residence at Abbottabad in Pakistan, appeared as the paroxysmal and parabolic model of this instrumentalization of vaccination (Larson 2012), which remains imprinted in popular belief. There are also vaccine trials where detailed information has not been provided and which fueled lack of confidence, or where resistance may be linked to negative perceptions of disease, as in the case of Ebola (Kummervold et al. 2017).  

More than COVID-19, growing inequality and hunger could lead governments to reconsider the hard line of the virologist model

The situation in Africa could be increasingly worrying, as malnutrition, HIV, tuberculosis and insecurity could be a fertile breeding ground for the spread of the virus, especially as co-morbidities, particularly chronic diseases, seem to be a major risk factor. Even if epidemic diseases are the daily lot of countries (cholera, Ebola, meningitis, Lassa, yellow fever), health services could be over-invested. COVID-19 transmissions have ceased to be imported and are now localized in the most countries on the continent. If they are not maintained, more drastic containment measures could ignite the powder keg and trigger more dangerous revolts against the fragile stability of several states. Indeed, more than epidemics, economic vulnerability and structural problems are the primary risk factors for African governments. Drastic hygienic measures without contextualization (most of the African economic sector is based on informal work) and without proportionality to the extent of the danger, can destabilize the region. The political, cultural, economic and health contexts of West African countries impose serious limitations compared to the containment model of rich countries.  

Some direct consequences of virological measures in West Africa

With unprecedented haste, Senegal has closed its schools and universities, suspended flights to several countries, drastically reduced activities at Blaise Diagne International Airport, and reduced market opening times while multiplying preventive measures. To cushion the economic shock, the President of the Republic took a first loan from the World Bank so as to relieve the poorest households and the taxed economic sector. Other governments followed his example.  

However, these series of measures could be more cosmetic than anything else. The children are left behind, hanging around in the streets, the talibés, young people attending Koranic schools and begging for alms for food are more exposed than ever, since no measures have been planned for them. Teachers had not received any instructions from their Ministry, the pupils in examination classes were attending classes organized as reality TV shows while the others were dropping out of school.  

The effectiveness of pandemic governance in Senegal is therefore seriously questionable. A note from the Forecasting and Strategy Analysis Centre of the French Ministry of Foreign Affairs, full of oversimplified reflections on the management of the pandemic by African countries, sets Senegal up as a model, which remains to be demonstrated for those most concerned. Social network chat rooms were set ablaze when police in working-class neighborhoods intercepted and took several young people aside, scenes of violence were reported, filmed and distributed on different platforms. The authoritarian discourse borrowed by the President as he multiplied his speeches on television, reinforced police coercion. Decisions on lockdowns and curfews have divided the population in its opinions. Some believe that the Senegalese have not understood the danger of the virus or what the concept of curfew means, and believe that the state has the right to do so. Others stressed that they found police repression unacceptable.  

Authoritarian temptations on the pretext of the pandemic are proliferating elsewhere: unbearable police violence in the wake of curfews or states of emergency, imprisonment of journalists or activists, electoral hold ups. Imminent danger has often been a pretext for allowing the extension of state and police power in times of epidemics. Authoritarian regimes seem to benefit from this on the continent, and more and more violence against the civilian population is reported.  

In Niger, in early March, an alert given on social networks by a journalist from the Alternative Association Espace Citoyen, Kaka Touda Mamane Goni about suspicion of cases of COVID-19 in Niamey hospital resulted in repression. He was arrested by the police and imprisoned for four days for “disseminating data likely to disturb public order”. Journalists and civil society actors were imprisoned during a demonstration denouncing the embezzlement of public funds on March 15, and people were killed when a fire broke out in the city market at the time of the intervention of the police. The repression used the ban issued the day before the demonstration, which gathered more than 1,000 people. Journalists denounced the Nigerien President’s torpedoing of the rule of law, arguing that the coronavirus allowed several abuses that needed to be questioned, especially in the area of press freedom. Following the President’s decision to quarantine towns and ban religious gatherings, including prayers at the mosque, clashes were unleashed by young people in southern Niger in Mirriah, in the Zinder region, and in Maradi. Tires were burned and the youths came down chanting that they were hungry. The social discontent in Niger, could be unleashed in other countries, also concerning decisions to hinder circulation and the closure of food and drink shops, such as bars from which several families draw their daily income, without the government announcing any counterpart. The fear in countries such as Niger and Burkina Faso is for the reactivation of food riots if draconian measures persist. Lockdown will not be sustainable or tolerable for long.  

In Guinea, flights have been suspended, the curfew has been extended. The majority of Ebola-traumatized populations could respect health measures. The country inherits a series of measures, devices and community engineering that could cushion the harsh effects of an epidemic crossed with a dangerous political situation. Populations carefully follow instructions to wear hand-made masks, even by children. Meanwhile, more than one thousand cases have been reported and it is unclear to what extent the country will be able to benefit from the lessons learned during the Ebola outbreak. Several Infection control and treatment centres (CTPI) built at the end of the outbreak were not being used in 2018, equipment such as health centre generators lacked maintenance, and the country lost many health workers in the Ebola outbreak. The majority of Ebola-traumatized populations could respect health measures. The country inherits a series of measures, devices and community engineering that could cushion the harsh effects of an epidemic crossed with a dangerous political situation. Indeed, taking advantage of the diversion of international attention to the pandemic, the 81 years incumbent president organized a constitutional referendum that the African Union had asked him to postpone to avoid undermining the credibility of the electoral register. This forced electoral passage, despite the boycott of the opposition and a low turnout, resulted into civil unrests and deaths, burning tension in cities and neighborhoods where opposition to the ruling regime is strong.    

A game of balance between threat and real disease and strategies of everyday survival

How can the fear of a threat articulated with the experience of the misery of endemic infectious diseases be prevented, diagnosed and treated in the best possible way? The director of Nigeria’s Centre for disease control, Chikwe Ihekweakzu, confided in an interview that global health also means going beyond the concentration of resources in the hands of powerful countries that suffer the least from infectious diseases, and managing to reconcile the fight against the Lassa epidemic that has caused 600 cases in Nigeria with preparation against a COVID-19 epidemic. How can we resolve this tension imposed by the shift and injunction of this globalized health to the service of anticipation and preparation for that of local health, where disease is an ordinary event and the perception of risk obeys complex cognitive and cultural treatments? It is to this game of balance that COVID-19 invites African governments for the immediate future. In past decades, low and middle-income countries have had little or no influence over the global politics of public health, which are now a matter of global failing and need to be immediately re-balanced.  

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Oumy Thiongane, a member of APAD office (Association for the anthropology of social change and Development), is a Research associate at Dalhousie University and has been an anthropologist specializing in epidemics for the past 10 years. She has conducted her research in several African countries (Benin, Burkina Faso, Cote d’Ivoire, Guinea, Niger, Senegal).

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Works Cited

Abramowitz, Sharon Alane. 2016. “Humanitarian morals and money: health sector financing and the prelude to the Liberian Ebola epidemic”. Critical African Studies 8 (3): 1‑16. https://doi.org/10.1080/21681392.2016.1221735.

Anderson, Warwick. 2007. “Immunization and hygiene in the colonial Philippines”. Journal of the History of Medicine and Allied Sciences 62 (1): 1–20.

De Sousa Santos, Bonaventura. 2016. Epistemologies of the South. Justice Againt Epistemicide. 2^nd edition. London & New York: Routledge.

Exley, Frederick. 2020. À la merci du désir. Arles: Monsieur Toussaint Louverture.

Kummervold, Per Egil, William S. Schulz, Elizabeth Smout, Luis Fernandez-Luque, and Heidi J. Larson. 2017. “Controversial Ebola Vaccine Trials in Ghana: A Thematic Analysis of Critiques and Rebuttals in Digital News”. BMC Public Health 17 (1): 642. https://doi.org/10.1186/s12889-017-4618-8.

Larson, Heidi. 2012. “The CIA’s Fake Vaccination Drive Has Damaged the Battle against Polio”. The Guardian (May 27, 2012) https://www.theguardian.com/commentisfree/2012/may/27/cia-fake-vaccination-polio.

Le Marcis, Frédéric. 2015. “‘Traiter les corps comme des fagots’ Production sociale de l’indifférence en contexte Ebola (Guinée)”. Anthropologie & Santé. Revue internationale francophone d’anthropologie de la santé 11 https://doi.org/10.4000/anthropologiesante.1907. Lordon, Frédéric. 2016. Les Affects de la politique. Paris: Seuil.

Löwy, Ilana, et François Rodhain. 2001. Virus, moustiques et modernité: la fièvre jaune au Brésil, entre science et politique. Éditions des Archives contemporaines. http://www.rehseis.univ-paris-diderot.fr/IMG/pdf/Ilana_Lowy-2.pdf.

O’Dempsey. 2017. “Dr Khan: une vie”. In Michiel Hofman & Sokhieng (eds) Au La politique de la peur. Renaissance du Livre & Médecins Sans Frontières, 237‑49.

Renne, Elisha. 2006. “Perspectives on polio and immunization in Northern Nigeria”. Social science & medicine 63 (7): 1857–1869.

Thiongane, Oumy. 2012. “La méningite «prise en grippe»?. Ethnographie d’une décision au Comité National de Gestion Épidémique du Niger”. Anthropologie et santé. Revue internationale francophone d’anthropologie de la santé 4 https://doi.org/10.4000/anthropologiesante.910.

Thiongane, Oumy, Janice Graham, et Hélène Broutin. 2017. “Lueurs et leurres de la santé globale. À propos de MenAfriVac®, un vaccin ‘africain’ contre la méningite”. Anthropologie & développement 46‑47: 213‑34. https://doi.org/10.4000/anthropodev.607.