In an African pandemic it is more productive to consider lockdowns after using other non-medical measures first, especially in countries with high levels of poverty and corruption, says Prof. Nicholas Ngepah, a Professor of Economics at the University of Johannesburg in South Africa.
"Looking at the socio-economic conditions of African countries, we can see reasons for this," he says.
"What has happened during COVID-19 is that people get locked down by strict regulations. But the majority don't have the nutrition, basic economic opportunities and infrastructure to cope. It becomes almost impossible for a poor person to keep the rules of the lockdown.
"The rules are very strict, but people will contravene them. They will be willing to fight with public order policing to get their livelihoods going."
This is the experience in South Africa and many other African countries, he says. The poorest are most conflicted with lockdown regulations.
Ngepah's research titled "What lessons Africa can learn from the social determinants of COVID-19 spread, to better prepare for current and future pandemics on the continent?" is published in a special issue of African Development Review.
The study is based on data from 53 African countries including South Africa. The first recorded case in each country to 4 January 2021 was included.
The latest pandemic
"The rich and the middle class would appear to comply well with lockdowns. But this is because they are able to rush to the shops and empty them. Poor people cannot empty shops because they don't have money.
"Rich people have resources to keep going, so their desperate actions only show much later. With poor people, their desperation shows immediately, because they have no reserves to fall back on."
"When a large part of your population is on the wrong end of inequality, it follows that many will not trust state machinery.
"If in good times, the state was not taking care of poor people, and now in bad times it comes along with very strict rules… it doesn't work. The poor need good services, support and infrastructure before pandemics hit."
The desperation during a pandemic lockdown has implications, he says. Governance and political stability are affected.
"It's intuitive. If you are constrained without an alternative means of survival, you will end up revolting."
Another reason the poor are unlikely to obey strict lockdowns is corruption.
With high levels of corruption, impoverished workers feel they are asked to pay for the corruption of the rich in government, he says.
In South Africa, COVID-19 is the latest arrival in a long line of challenges. The country has pandemic levels of inequality, poverty, corruption, unemployment, and HIV/AIDS.
Poverty and spread
Quality policymaking is crucial in dealing with current and future pandemics, he says.
"In my view, the need to better take care of the poor has not been driven home in many policymakers' minds yet, despite the COVID-19 pandemic," says Ngepah.
"Economic deprivation by itself has a positive relationship with the spread of disease and mortality.
"In good times, poverty reduction policies should be taken seriously. Because poverty directly influences how successful stringency measures will be.
"Poverty also influences to what extent sanitation services will limit the spread of the disease.
"It also directly influences the rate of internal population dynamics, or internal migration. This is where the rural poor flee to the cities for economic opportunities—and create dense, very poor neighborhoods," he says.
In South Africa, the "townships" that receive these people often do not have adequate water, power or sanitation services.
To slow the spread of the COVID-19 and future pandemics, African policymakers and governments need use social and economic measures available to them. These non-medical interventions can be very effective, he says.
Public capacity for testing
Firstly, enhance public health capacity for effective, swift testing for the pandemic disease so that cases are isolated early enough to deal with. This will limit spread and mortality.
Economic health of the most constrained
Secondly, before thinking about stringent lockdowns, first check the economic health of your population. Make sure that the basic capacities are in place, for them to be able to cope during the period of lockdown, he says.
"For a country with high levels of inequality like South Africa, you can't just wake up in the morning, declare lockdown and send soldiers and police to try and enforce it, without checking first how the more deprived people are living. Especially in South Africa where we know that more than half the population is living below the poverty line."
Managing international borders
Thirdly, managing the international border swiftly is most important to limiting spread.
"Managing the border is about being able to foresee a problem and act before the pandemic spreads into communities. You need to close borders early, while quarantine measures will still work. This gives you breathing space to deal with internal issues before lockdown. It also creates time for the poor to prepare as best as they can with the very constrained resources they have.
"For example, before lockdown you would already put safety nets in place to say this is how we will cater for the poor during that time. As opposed to what's happening here, where the poor are crying," he says.
Quality services where most need is
Then in the medium and longer term, management of internal population dynamics is crucial. This can limit the growth of extremely poorneighborhoods which are ideal for the spread of any pandemic.
If poor people have services, jobs and good infrastructure where they are, the motivation to move into a disadvantaged area closer to a big city is lower.
"It is about pro-poor infrastructure and decentralization. It isn't just about bringing key public services into poor neighborhoods. It is also about moving and redistributing government services so that they are closer to the majority of those who are most in need of them."
As an example, currently a district police headquarters may be in a well-to-do suburb, with a badly resourced satellite station in a township. Ngepah suggests doing the opposite.
Put the well-resourced police headquarters in the township, where the majority who need it, are close by. The rich and middle class can go online or drive 30 minutes in their cars because physical proximity is often not a barrier for them, he says.
Sanitation infrastructure and services
Sanitation is probably the most important non-medical aspect of infrastructure before and during a pandemic, says Ngepah.
"On one hand, it is about habits. Most people learned about proper washing of hands during the pandemic. During good times, the government should prioritize this as something important. This pandemic came, but it is not the first communicable disease outbreak that we have had," says Ngepah.
The second aspect of sanitation is the infrastructure.
"Don't say wash hands and give all the lessons about handwashing when the tap is not flowing, when there are no services relating to sanitation."
The actual role of alcohol in the pandemic
In South Africa, debates have raged about the role of alcohol and social interaction in spreading COVID-19. But Ngepah says that managing internal population dynamics is more important than the issue of alcohol itself. This is because internal migration creates impoverished neighborhoods with bad or no services.
"If you ban alcohol, without checking the role of alcohol in the whole equation, you might not be getting the right result. Before you ban alcohol, check what the channel of transmission is. The channel of transmission of the corona virus pandemic is the socializing with alcohol, rather than alcohol by itself.
"When we are talking about spread, the real question is, how does alcohol spread the disease? My view, which is not proven in this study, but it is in line with other research, is that your social interaction route is important.
"Because we are trying to balance restraining COVID with the health of the economy and job losses. So we have to look at private alcohol consumption versus social alcohol consumption, before making decisions," he says.
Support to small businesses, relaxation of labor laws
Most economies have seen job losses and rising unemployment during the pandemic. Small businesses, which have much lower reserves than large ones, have been hard hit in South Africa.
"Liquidity support to small business is paramount as a first measure to keep them afloat and prevent job losses," says Ngepah.
"At the same time, in the context of high unemployment, we should be less stringent with small businesses when it comes to labor laws. Because small businesses usually have very thin margins. And if they have to employ more people, we have to have some trade-offs.
"Before COVID-19, the government had been trying to pilot a program to assist. They intervene by giving some resources to companies in exchange for skills development on the job. These are the things government should be thinking about to ease the burden of the wage bill in small enterprises in South Africa," he says.
The most efficient way of managing pandemics is to get a handle on economic deprivation, he adds. Especially for a national or city government with the majority living in poverty,
Ngepah concludes, "Take care of the poor all the time, so they are well placed to obey you when you put rules in place. If this is done in normal times, then we will stress less during pandemics.
"In the military, they say that those who stress in times of peace to prepare themselves, will bleed less in times of war."
More information: Nicholas Ngepah, What lessons can Africa learn from the social determinants of COVID‐19 spread, to better prepare for the current and future pandemics in the continent?, African Development Review (2021). DOI: 10.1111/1467-8268.12530
Provided by University of Johannesburg