This moment in the Covid-19 pandemic is marked by its contrasts: whilst some countries emerge from restrictive public health measures and consider how to ‘live with Covid’, others continue to struggle with the health impacts of new variants. There is widespread agreement that Covid-19 has been, and continues to be, an economic, social and political crisis as well as a health crisis, and that preparedness for the future is critical – yet an important debate is taking off about what such preparedness should mean.
A recent article by the Pandemic Preparedness Project, led by Hayley MacGregor and Melissa Leach contributes some lesser-heard African perspectives to this debate. Examining concepts and practices of epidemic preparedness and response in African settings across 2020, the research shows that pre-emptive government measures to contain the spread of Covid-19 throughout 2020 often compounded pre-existing vulnerabilities. Under such circumstances, both the pandemic AND responses to it have intensified precarity, both as a state of chronic insecurity and a political process of exclusion that disproportionately worsens living conditions for those at the margins.
Covid-19 response in Africa
After the West African Ebola outbreak 2014-16, there was an increased focus on pandemic ‘preparedness’ across the continent. This was reflected in the creation of the African Centres for Disease Control and Prevention (ACDC) in 2016 and renewed ‘preparedness’ plans. Our team began research in January 2019 in Sierra Leone and Uganda, examining local people’s perspectives on disease outbreaks in the context of wider responses to threats to health and life, what we termed ‘preparedness from below’. This focus swiveled to prioritise Covid-19 as it began to spread across the world early in 2020. At the time, cases were high across Europe and Asia, but African numbers were still very low.
In March 2020, as cases rose, WHO advised a move from readiness to response. Amongst fear about the spread of the disease and its effect, African states started to implement response measures similar to those seen in Asia and Europe. As 2020 progressed, African experiences were varied, but in most settings, deaths were lower than expected – a so-called ‘African paradox’ likely to have multiple causes. Yet though the rate remained generally low, the picture in 2020 was not wholly positive. The effects of prevention measures on those living with pre-existing precarities and without formal social protection, were devasting. New waves of disease in 2021 also further complicated the picture.
Focus on Sierra Leone
The first known cases of Covid-19 in Sierra Leone arrived in late March 2020, but the country had been preparing from late January. Measures were enacted by the epidemic preparedness and response governance structure which had been strengthened with external investment after Ebola. An early speech by the president emphasized the importance of national response and heavily referred to Ebola with little differentiation of the differences. During regular briefings over TV and radio there was little nuance in the communications about the age specific risk factors.
Our field research in several villages moved to focus on Covid-19 and highlight local perspectives to the response. Villagers were initially scared of the virus. Yet as cases remained low, they became increasingly resentful of a government response that was impacting heavily on their livelihoods. District lockdowns, market closures and interrupted trade meant rising food prices and that villagers couldn’t get to their closest market centres. In the height of the hunger season, Covid-19 ranked low, if at all among people’s concerns. With few cases around, people often ignored hand-washing and mask-wearing measures. Local traders moved collectively to re-open markets, ahead of government authorities themselves relaxing the rules as they became unsustainable.
Focus on Uganda
The Covid-19 warning came at a time of ongoing concern about yellow fever, typhoid and Ebola. The country gained international attention for the authoritarian response, where local defence units enforced strict lockdown measures. Deaths remained low even months after the first cases. In July 2020, the government stopped broadcasting primarily Covid-19 awareness messages, yet measures such as a curfew remained in place until late 2020.
In our field research village, Covid-19 was not experiences as a disease, but instead as a set of government restrictions enforced by a military presence. Suffering from restrictions exceeded any suffering from the disease. People took issue with restrictions on funerals and were distressed that the government would close places of worship, a source of comfort. The authorities beat people in order to disperse them and prevent congregation in the market. People crossing the river border to work their fields in the DRC were beaten and fined, and livelihood difficulties increased due to lack of access to markets, fields and accustomed places for access to river water. In August 2020, other priorities arose, such as severe floods that destroyed crops, hunger, and the resurfaced Ebola in DRC.
Lessons for future pandemic responses
Whilst we have explored these issues in two African countries with relatively low numbers of Covid-19 cases and deaths, at least during 2020, our findings and analysis have broader significance. Proactive and forceful responses, geared to dealing with a short-term emergency, are the logical follow-on from dominant approaches to preparedness planning. Yet the impacts of such responses have been acute and damaging in societies facing the ‘slow emergencies’ of challenges such as austerity and deepening inequalities.
The research findings advance the concept of “intersecting precarities”. This was vividly illustrated in the two rural districts in Sierra Leone and Uganda, where measures to contain viral spread compounded pre-existing uncertainties in health, livelihoods, and citizen–state relations. Yet villagers did not just accept, but actively negotiated these intersections as they sought to sustain their lives and livelihoods, including through mutuality and collective action.
Having the pre-existing capabilities, forms of collective organization, and experiences in dealing with everyday uncertainties to do so, is key to what our research identifies as “preparedness from below.” As the concept of precarity highlights, wider structural conditions and political economies often undermine these capabilities, leaving people in perpetual states of insecurity.
Looking to the future, there is the possibility that the experience of Covid-19 might concretize a top-down vision of preparedness. However, there is also an opportunity to foreground the actions, adaptation and mobilisation of ordinary people, albeit with appreciation of the constraints placed on such action. Local ‘resilience’ is often hindered by resource constraints. The new ‘community readiness and resilience’ unit established within the Health Emergencies Unit at the WHO suggests that appreciation of local experiences, priorities and responses is receiving greater attention.
In this light, epidemic preparedness and response cannot simply involve attempts to foresee and control risk of disease, through standardized, largely technical processes delivered in a short time-frame. Rather, it requires appreciation of preparedness and response as linked processes. Processes of interacting time-frames, long and short, of deeper structural conditions, and of multiple uncertainties and how people interpret and respond to them, amidst everyday precarities.