OPINION | Dr Aslam Dasoo: How SA can restore its failing Covid-19 response

Our lives have been forever changed by this unprecedented natural catastrophe, writes the Progressive Health Forum convenor Dr Aslam Dasoo. “We now owe it to everyone and to those who will follow the best of ourselves to meet this moment.”

A circular issued by the Department of Health earlier this week was hastily withdrawn following pointed queries about its content. The circular sought to create new categories of individuals who may be exempted from the Covid-19 vaccination protocols, such as those needing healthcare, working or studying abroad.

It also included many categories of politicians. This immediately caused an outcry and it is not difficult to see why. When the vaccination drive first began, a list of about two hundred of these same politicians, Cabinet ministers, MECs and other political supernumeraries, were slated to be among the first to receive the shots, ahead even of healthcare personnel. 

This list was approved at the time by the National Coronavirus Command Council, a famously secretive body whose public pronouncements, which ranged from the sinister to the destructive and frequently farcical, but which never deigned to explain its reasoning to a population reeling under the relentless threat of a deadly pathogen. Its peremptory pronouncements were so antithetical to the constitutional order, that many challenges to its behaviour had to be repulsed by lawfare, decree and authoritarian law-fare and authoritarian decree. 

This minor kerfuffle over the circular is an emblematic embarrassment for the Department of Health, which routinely oversees serial, sometimes horrific, disasters in healthcare, but sails serenely on through and beyond the ruin, with those in charge acting as spectators to the damage they cause, leaving loved ones of the victims stunned and healthcare providers frustrated as they battle to save lives put in jeopardy by this miserable managerial practice. 

The national Covid-19 response is a masterclass in this type of mis-governance.

It starts with the lexicon applied to the pandemic. The virus is not an enemy to be vanquished on some battlefield. If we were at war with it, we will have already lost. It is a their capacity to avoid infection that has created a global public health emergency. It needs a commensurate public health response, not militaristic jargon. 

This means diligence in personal protective measures, astute limitations on society's activities when necessary and mass vaccination of the most people in the shortest possible time. Our heroic healthcare personnel are not the front line; they are the last line and our safety net.

Pandemic for the ages 

The Covid-19 pandemic has been sowing terrifying mayhem around the world for one-and-a-half years now - by Wednesday this week surpassing the grim total of four million deaths worldwide. To put that into perspective, these are reported deaths, with excess fatalities, a more accurate reflection, about twice as much on average. At a likely 10 million deaths globally, we're now approaching Spanish Flu pandemic territory, which accounted for anything between 30 and 50 million fatalities over three to four years.

With no certainty that a semblance of pre-pandemic order is likely to eventuate for a long time, perhaps years, this contagion has altered the future expectations of most of humanity. It requires of people to reach deep into their wells of tolerance, resilience and fortitude as they re-order their plans, try to not fall into penury and overcome the shock of losing deeply loved family and friends who, mere days before, loomed large in their lives.

At such times, any modern-era state rightly is expected to rise to the occasion, provide safety, relief and succour without the prevarication and duplicity that characterises most of its activities in normal times; to use empathy and rationality in its actions; to support the people by facilitating their capacity to avoid this virulent pathogen; to protect them from becoming infected through the provision of the most efficacious measure that modern science can provide, vaccines; and to make available to them a responsive, properly-resourced and well-managed healthcare system.

Our state, replete with plentiful wealth, resources and expertise, seems to go out of its way to do quite the opposite, if not deliberately (although it's seldom easy to regard many actions as not being utterly wilful), then through misdirection, mismanagement and a fixed belief in its own invincibility that brooks no criticism and purposefully avoids or prevents independent examination of its activities. 

In short, the state has conjured up an over-weening amalgam of the statutory enablement of government by fiat, mediated by a profusion of committees that thrive on inaccessibility, opacity and questionable motives and enforcement through supercilious, faintly menacing, public proclamations. 

No country for old ways 

President Ramaphosa has performed exceptionally well on the African and international stage in the global response to the pandemic. Regrettably, that performance is not reflected on home soil due to the outsourcing of the response. It doesn't help that he and, by extension, the country is so poorly served by the cack-handedness of his subordinates, many of whom serve through political default rather than choice, by cynical deployment rather than through exceptional talent. 

This is on fulsome display in the C19 response. Many people, anxious about the threat of contagion and cowed by the peremptory and inconsistent enforcement of restrictions are at a loss. The multitudes inured to the disappointment of broken pledges and jaded by the repetitive but ineffective communication, are left to their own devices, forcing them to cast about for something, anything, that can help them make sense of things. 

In the eerie atmosphere of discombobulated messaging and the piteous fear of needing healthcare that is difficult to reach or inaccessible, dying at home has become a signal feature of the pandemic.

This is no way to manage a national response to this catastrophic pestilence and the past 18 months have been an unfortunate series of lurches, stumbles, hits and misses that need not have occurred.

Here's how to engineer a step-change in SA's response to the pandemic. For any effective response to a pandemic to work, there are two vital conditions that have to be met: confidence and trust - neither of which has been cultivated in the consciousness of the people. 

In the milieu of the pandemic, mistrust, resentment, rage and fear abound. The failure to adhere to public health measures is not only a function of the lack of knowledge and information about what the pandemic portends, but also of the perfunctory limitation of the rights and entitlements to which the people are accustomed.

Pandemics are suppressed by the ordinary people, not by governments or health systems. When people fully understand its provenance, transmission and means of protection from it, they develop agency to bring it to an end. 

This has been the experience through the ages, the most recent example of this being during the Ebola outbreaks in West Africa and DRC. It was only when ordinary people and communities understood how to break the crucial links in the chain of transmission, that abatement of the contagion was swift and significant.

Change the guard and restructure the response 

So, with that in mind, here are a few things that are fairly easily and immediately achievable, if there is sufficient political will and bureaucratic gumption.

First, build confidence and trust among the people that they are partners in the response and have a vital role to play. Do not talk down to them, do not blame them for the rise in cases, do not harass them with heavy-handed security, do not deprive them of their sustenance and means without first emphatically putting measures in place that provide them with sustained relief.

Start by centralising the entire response in the Presidency of the Republic, guided by the fulsome authority of the President, consisting of only the most talented and capable ministers, public servants and genuine leaders of society, under the steady direction of an exceptionally well-regarded convenor and with a direct line to the President at all times. 

This is a relatively simple task for the President, for those individuals pretty much pick themselves. That, of course, means dispensing with the secretive and in some instances, patently useless, committees and task teams. They will not be missed and their absence unlamented by most.

Second, to invoke the best scientific guidance, turn the currently ad-hoc Ministerial Advisory Committee into an independent public body forthwith. Its members should be appointed by high level academic and scientific peers and be administered by a relevant department. Its research, deliberations and recommendations should be transparent and publicly accessible at all times.

Any advisories it issues must be in its own name and made public. The government, which retains the right to make final pronouncements on these advisories, must, at all times, publicly disclose any and all the reasons for acting at variance with these advisories.

Third, start planning now for a comprehensive inquiry into the response, at a suitable time, once the emergency phase of the pandemic has passed and the virus has been sufficiently suppressed. This is perhaps the most important thing we can do, since we have entered an age of pandemics and it is not stretching the truth that we may be subjected to another before the end of the decade.

This inquiry must be thoroughgoing, not only to determine any failures or apportion blame, although there will be many instances of that, but, more crucially, to help develop a template and the strategic preparation of the country and the region to respond effectively in future.

Last, a plea to the President. 

Sir, you are presiding over a fractious political and governance situation and your dedication to correcting the many missteps, mishaps and difficulties is deeply appreciated. 

Yours is a lonely and profoundly challenging task, but the people of this country are willing you on in your endeavours, because of the hope you have generated among so many of us.

There is not a moment to lose, Mr President. Our lives have been forever changed by this unprecedented natural catastrophe. We now owe it to everyone and to those who will follow the best of ourselves to meet this moment.

- Dr Aslam Dasoo is the Progressive Health Forum’s convenor

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