Where the pandemic isn’t (yet) the virus: fearing illness and destitution in Lesotho
06 May 2020
Every morning, Google Alerts connects me to news coverage of Lesotho, a small southern African country that I’ve visited regularly since the mid-1990s. Over the past couple of months, the new lexicon of social distancing, lock-down, PCR testing kits and PPE shortages has threaded through the nation’s press, a striking reminder that the coronavirus pandemic is truly global.
Yet, while the language is familiar, in Lesotho (and elsewhere in southern Africa) the pandemic is written about and experienced rather differently than here in the UK. Instead of a broad consensus that lockdown is a necessary sacrifice to protect the vulnerable and ‘flatten the curve’, responses have been contentious. Street vendors and market traders protest the loss of their livelihoods while those who depend on them are anxious about accessing food. In nearby Malawi, healthcare workers are not celebrated as heroes, but stigmatised as dangers to others, facing insults and evicted from their homes. With minimal access to PPE, nurses and doctors have embarked on strike action. And teachers have protested the government’s decision to continue school feeding programmes (aimed at preventing hunger), after schools stopped teaching. A deep fear of the virus itself, and of the immediate consequences of measures taken to address it, are manifesting in protest and discontent, which has been met by heavy-handed police and army responses.
The level of fear the pandemic has evoked in Lesotho and other African countries is suggestive of a serious outbreak. Yet while the UK has officially reported nearly 200,000 cases of Covid-19 and over 30,000 deaths, infection rates across Africa remain relatively low and Lesotho has yet to report a single case. This stark contrast reveals an important characteristic of the pandemic: its harm is not produced by the virus alone, but by the way in which the virus interacts with an unequal and interconnected world.
In part, the anxiety experienced in Lesotho needs to be understood in the context of a region that was devasted by AIDS in the 1990s, and a continent shaken by Ebola in the past decade. But fundamental to current fears is the interlocking of health and economic vulnerabilities that have been exacerbated by four decades of neoliberal policies pushed on African governments by global institutions.
The people of Lesotho will likely be struck by three distinct and devastating waves of coronavirus impact, each shaped by the country’s global relations. The leading edge of the pandemic across many African countries was the sudden downturn in international trade which followed the closure of borders, cessation of flights and collapse of markets in the rich world. Export-led growth strategies foisted on governments by international financial institutions have left African economies highly exposed to global markets. In Kenya, social distancing in Europe meant Mothers’ Day flowers were left to rot and 70,000 workers sent home. In Lesotho, garment factories – the country’s main source of employment since a trade deal with the US – began to close in February, leaving 45,000 without wages. Across the world, as markets for clothing dry up, major brands are failing to honour contracts with producers. Global industries like these extract value from African workers but refuse to bear the associated social costs. Hence, when a crisis strikes in the rich world, thousands of very low-paid individuals are left with rent to pay, no savings and no source of income.
The second wave of coronavirus impact stems from measures taken to shield populations from infection. Restrictions on movement have had dramatic effects in the many countries where labour migration is a common means of survival, again encouraged by neoliberal policy prescriptions. Around 10% of Lesotho’s population is in South Africa at any time, and when the lockdown was announced there on 23rd March, 93,000 Basotho rushed home, swelling the numbers of people without income. Remittances from the 100,000 remaining stranded in South Africa have also dried up, affecting yet more families.
Lesotho itself announced a State of Emergency on 28th March with a lockdown beginning 31st March. Such declarations and lockdowns are among the few responses available to African governments, and have been introduced widely across the continent. Impressive symbolic gestures, they can be instituted without cost to the public purse. Lockdowns are not, however, without cost, and where governments provide no financial support, the costs are borne disproportionately by the poorest in society. The livelihoods of informal sector workers (the majority of the workforce in most African countries) are deemed ‘non-essential’ and rendered illegal, preventing people from earning the money they need for food and other essentials. Meanwhile crowded housing, lack of indoor sanitation and running water make a mockery of instructions to practise social distancing. People who have largely been left aside by global capitalism are now threatened with immediate destitution.
In wealthier parts of the world, lockdowns have had both support and success because they have been accompanied by measures to protect those affected. Few African governments have either the resources or the policy space necessary to manage lockdowns in ways that will save both lives and livelihoods. As with the first wave of impact, international development policy is partly responsible for the harm. State institutions have been weakened by neoliberal ideology that promotes low taxation and the involvement of the market and non-state actors in both policy and service delivery. Growing debt and diminishing tax revenues (exacerbated by Covid-19’s effects on international trade) are further limiting spending power.
In the absence of widespread public support, lockdowns across Africa are being enforced through coercion and also used to serve political ends. Lesotho’s prime minister, struggling to hang onto power, has sent troops onto the streets ostensibly to enforce a lockdown, but in practice to suppress political unrest. His attempt to extend the State of Emergency to 6 months is being resisted. A set of modest socioeconomic support measures to mitigate the economic effects of the pandemic is promised, but has met with scepticism and the government has yet to deliver.
Debate currently rages among experts as to whether the economic costs of lockdowns are justifiable in African settings. Some suggest they are essential and the reason that many African countries appear to be keeping the virus – the third wave of pandemic impact – in check. Others argue that given the low levels of infection, they are risking poor children’s futures and will save few lives. In the press and among grassroots protestors, lockdown is portrayed as an elite concern in which the poor are made to suffer economically in the interests of the health of the rich.
This argument misses several issues. For a start, the distinction made between health and economic impacts is a false one. Economic consequences of lockdown can adversely affect health, provoking mental illness, domestic violence, hunger and malnutrition. And the reason those on low incomes fear the health effects of the virus is partly because ill health is so costly, incurring medical bills, loss of earnings, and potentially high funeral costs. And even if the health effects are largely confined to the elderly, many children’s futures depend on healthy grandparents.
Moreover, if the virus does take hold, in line with countries elsewhere, the poorest in society, living in communities where self-isolation is impossible and even soap is widely unaffordable, are likely to suffer the highest infection and mortality rates. Inequalities shape the impact of the virus as well as the impacts of lockdowns and of economic shocks.
And should the virus begin to escalate, it will be exceptionally hard for cash-starved African health services to cope. Viewed as ‘consumption’ rather than investment, governments have been encouraged to restrict spending on public health. Ironically, at the same time, health sectors have been viewed as investment propositions for the global finance sector. A World Bank-supported public-private partnership between the Ministry of Health and a South African private finance-led consortium replaced Lesotho’s main public hospital. Notoriously, this deal has been absorbing up to half the national health budget, leaving the primary care sector across the country seriously underfunded. And even the new, much improved, facility cannot provide a comprehensive service. Part of the scheme’s excessive cost is due to referrals of more demanding cases to private hospitals in South Africa and even India – a situation that is clearly untenable in the current situation.
Ultimately, it is not lockdowns that discriminatory, but the inability of African governments and unwillingness of global corporations to support the lives and livelihoods of those affected by the pandemic. This is at root a global issue. The coronavirus pandemic is self-evidently global, but the global system it is spreading through is a very unequal one in which economic and political processes favour some nations, weaken others, and interfere with capacity to save lives and livelihoods. This global system uses African people – as labour and markets – to generate profits for corporations and financial returns to investors, but does almost nothing to support the wellbeing of those who are not immediately valuable to it. And global institutions, as well as bilateral aid agencies like DFID, have stood in the way of governments building capacity to deliver effective services and social protection. The rich world – architect and manager of these processes and institutions – is complicit in the full range of impacts of the coronavirus in Africa. To argue that lockdowns are inappropriate for Africa is to assert that saving African lives is too costly; that African lives are worth less than European ones.
The complicity of the rich world places an obligation on governments and international institutions to do whatever is necessary to limit the pandemic’s harm in countries like Lesotho (which is by no means Africa’s poorest country, or the most influenced by neoliberal institutions). Governments must be able to provide the social protection that is needed by those whose jobs, remittances and livelihoods are affected. This means delivering debt relief, scaling up aid, and imposing fewer strictures on spending. And in anticipation of a likely outbreak of the virus, health systems need support with infrastructure, health workers, PPE, and in due course access to treatment and vaccines.
Historically, disaster relief for African countries has been channelled mainly through international agencies and NGOs, which are perceived to have greater capacity to respond to emergencies than governments. The effect has sometimes been to undermine the governments’ capabilities. In the face of Covid-19, many such organisations are restricting operations and some are sending international staff home. It is thus essential to support governments with the funds and freedom to take action. In the UK, we have seen an unprecedented level of government intervention in the economy to ensure it delivers food and healthcare while protecting those who cannot currently earn for themselves. Support is needed for African governments to do likewise.
In the longer term, we must build on the emerging realisation that economies need to serve people and that dramatic intervention is possible, and extend this thinking to the global sphere. Rather than focusing on feeding financial markets or achieving growth for the sake of growth, the global economy must be re-engineered to enable people to fulfil valuable social roles, while sustaining those whose labour isn’t immediately required. Businesses engaged in global trade need to take full responsibility for their workers, and pay adequate taxes to the governments they depend on in order to fund the provision of quality public services. And rich world governments and international institutions must be pressured to ensure this happens.
The coronavirus clearly requires a global response, and it is increasingly evident that pandemics can only be addressed (or prevented) if risks and vulnerabilities are minimised everywhere. This is an important lesson, but mutual interest alone will not stimulate the change that is needed. The current world order drives global inequalities that do not always threaten the rich, but regularly expose vast numbers of people to fear and destitution. Necessary change must be driven by demands for social justice.