“May Allah protect all of you,” a colleague from Guinea-Bissau wrote recently, as the number of US fatalities from coronavirus continued to move upward, on track to approach 100,000 by the end of May. We’ve been receiving similar messages by WhatsApp and email as our West African colleagues watch the news in disbelief.
Their countries are in some ways ahead of the game – to a large part due to their experience of surviving the Ebola crisis of 2014-2016 and the community health networks that have been developed.
With a rise in populism and associated patterns of scapegoating, response to any crisis in the United States tends to default towards denial, deflection, blame-shifting, and foot-dragging, rather than the proactive, collective response necessary for resilience that is so much more evident in West Africa. Governments in much of the region have responded swiftly and urgently to curb COVID-19, with the memory of the Ebola outbreak still strong.
In a world where democracies, including the United States, have, according to the Fragile States Index, been growing increasingly divided since the 2008 financial crisis, social capital (networks of collaborative relationships and reserves of implicit trust within and between groups that enable society to thrive) is in diminishing supply, notwithstanding the wealth of financial and human capital at our disposal. With declining confidence in shared institutions, and a fragmentation of our media consumption and social interactions along cultural and partisan lines, it has become difficult as a society to take collective action to face common challenges.
If resilience means the ability to bounce back from shocks and adapt to change, then different types of shocks require different types of capital: financial capital, political capital, natural capital, human capital, moral capital, and/or social capital. When an earthquake hits, countries with infrastructure, building codes, and well-resourced and coordinated emergency management agencies do well. When violence breaks out, countries with professional, representative, and legitimate security services do well. When a sharp economic downturn occurs, countries with strong financial institutions and a robust social safety net do well.
For most crises, it comes down to money and expertise. But a pandemic is different, at least at the beginning. Even more than stimulus checks or ventilators, resilience to a pandemic requires strong social capital for collective action, where millions of individual women, men, and children are willing and able to make the small or large personal sacrifices necessary to stop the disease before it spreads.
“For most crises, it comes down to money and expertise. But a pandemic is different.”
If West Africa is going to avoid catastrophe, embracing the lessons learned from the Ebola epidemic and leveraging strong social capital is their best bet. Other countries – including the United States and others that perhaps fare better on our annual Fragile States index – could learn from their experience.
The pandemic is especially gripping for residents of the three West African countries – Guinea, Sierra Leone, and Liberia – that are still recovering from the Ebola crisis of 2014-2016. Although Guinea has reported only 11 fatalities, Sierra Leone 19, and Liberia 20 as of 12 May, officials we spoke with in a series of interviews said that people are still taking COVID-19 very seriously. The governments encourage the wearing of locally made face masks and people have placed water points and hand sanitisers in front of their private residences and businesses for others to use as they walk by – this is in addition to handwashing stations set up by the government. In Guinea, the city of Conakry is sealed off from the rest of the country. To enable people to stay home from work, the government is providing three months of free electricity and water to residents. In these countries where health systems are already fragile, slowing the spread has been the top priority; if the disease does start to spread, the humanitarian impact could be devastating.
“If West Africa is going to avoid catastrophe, embracing the lessons learned from the Ebola epidemic and leveraging strong social capital is their best bet.”
Not that it has been smooth going for West Africa. With very few COVID-19 fatalities reported so far in the 15 countries that make up the Economic Community of West African States, or ECOWAS (417 as of 12 May, according to the Africa CDC, compared to over 80,000 in the United States), some people are unable or unwilling to take the necessary precautions. Colleagues in the region have reported that in countries like Togo, where there is political tension, some people are suspicious of the motives behind curfews and lockdowns. Others believe the disease only affects the wealthy elites who travel. And for far too many, especially the poor, sheltering at home and constant handwashing is a luxury they cannot afford.
In late March, for example, police deployed water cannons to disperse a group of traditionalists in Accra who contravened the partial lockdown to perform libation rituals on the beach intended to rid the land of COVID-19. Curfews have been imposed in Côte d’Ivoire, Senegal, Togo, Nigeria, and elsewhere, with some reported cases of violence, and at least one sexual assault perpetrated by a soldier.
When the coronavirus pandemic first emerged, regional governments took swift action to slow the spread of the virus. Contact tracing was the first step in this effort; by 2 March, three days after Nigeria confirmed the country’s first coronavirus case, 58 people who had been in contact with that patient had been identified and quarantined.
West African nations were also quick to put in place social distancing measures. In Togo, two weeks after the first case of the virus was confirmed on 6 March, schools were closed. Since then, travel between major cities has been curtailed and a state of health emergency was declared. In Ghana, on 16 March, two days after their first confirmed case, schools were closed, public events were ended and entry into the country was barred to those who had been in a country with over 200 cases in the previous 14 days.
As a sign of how receptive the population has been to these measures, even many of Ghana’s small-scale gold miners – with whom the government has had a challenging relationship in recent years – have ceased operations to avoid congregating people in close quarters. And, in Nigeria, as a colleague reported in an email, instead of shaking hands, people “hail from a distance, with ‘Na COVID-19 oo, no vex!’”
In the United States, aside from the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which was critical to easing the economic impact of the shutdown for small businesses and citizens, the public response has been highly uneven, including mass protests in some states and a general lack of coordination and consistency overall. By contrast, West African countries have been very proactive. The same day Côte d’Ivoire announced social distancing measures, it also announced that the diagnosis and treatment of all suspected and confirmed COVID-19 cases would be totally free. At the end of March, the country announced that travel between Abidjan – its economic heart and where most of the country’s cases of COVID-19 were detected – and the rest of the country would be banned in an effort to slow the spread of the disease.
Several countries also used the time they had bought through early prevention to prepare their health systems to care for coronavirus patients. Nigeria, for example, created specialised clinics and areas separate from the regular health facilities to treat COVID-19 patients, allowing the health system to continue operating in a manner approaching normality without getting overwhelmed.
While countries like Italy, Iran, Spain, Turkey, and the United States have seen extremely rapid growth in the number of cases, many countries in West Africa have seen a trajectory lower and flatter than virtually any Western country. Many factors may play into this. Younger populations in West Africa may be more naturally resilient. Additionally, there are likely limitations in the available data, given uneven testing capabilities in poorer, more rural communities. However, the lack of reports of overwhelmed health systems as in Italy or New York City do suggest the trend lines are real.
None of us know where this is going next, in West Africa or in the United States. As a Senegalese colleague wrote in an email, “May God protect us all.”
What we do know is that resilience to a pandemic like COVID-19 requires strategic leadership, coordination, and consistent messaging. Resilience is stronger when, as in West Africa, people know their neighbours, respect their elders, and maintain civil society, faith-based, and community-based organisations committed to advocating for the vulnerable and raising awareness and solidarity. All of which are goals to keep in mind if those of us in the United States and elsewhere wish to be better positioned to respond to a healthcare crisis the next time around.