Liberia: Essentials for an Effective National COVID-19 Response

The Ministry of Health has declared a National Health Emergency, outlining a host of measures to support efforts to curb the spread of the Coronavirus. Eventually, these efforts will avert a possible existential threat to our country. We are witnessing how COVID-19 is ravaging nations, especially western countries with advanced healthcare infrastructure and ample financial resources. It is confusing how COVID-19 is spreading out of control in these countries, in spite of the financial resources and technologies at their disposal.

One lesson we have learned, so far, is that delay in setting up an early precautionary response was the biggest mistake made by most of these countries. We cannot afford to repeat such mistakes in Liberia because the consequences will be immense. Without the requisite public health infrastructure and the national resources to sustain a prolong containment, our best recourse is to 'nib the Coronavirus in the bud.'

I support the government of Liberia in declaring a national health emergency. Hopefully, this will make it possible to harness the basic means and measures to maximize the effectiveness of the national response. This declaration should also awaken national consciousness and inspire all Liberians to realize that we are getting ready for an imminent attack. Obviously, the measures being recommended would usher a wide range of inconveniences, including challenge to our very livelihoods.

For this reason, the government should not advance these measures without considering the corresponding interventions to protect the livelihoods of its citizens. The extent to which citizens will adhere to these measures will greatly depend on the extent to which their livelihoods are affected. We know this from our experiences during the years of war - when people are hungry, they get angry and will overcome any obstacles in order to secure their daily bread. Also, it is very important that state actors, especially security personnel and public officials, realize that we are not in a State of Emergency. In short, the Constitution of Liberia is in full force, and civil liberties are thus guaranteed. It is no secret that COVID-19 is yet another poignant test of our democracy. How, then, can the government deliver an effective national response, yet still guarantee the civil liberties of its citizen under the Constitution?

An effective national COVID-19 response strategy should have at least three dimensions:

POLITICAL DIMENSION

Declaration of a health emergency does not imply a suspension of the Constitution, in part or whole. Unlike health emergency, the Executive must work together with the Legislature to declare a State of Emergency. The Judiciary is still working to ensure equality and justice for all. Those who violate our laws must face the full force of the law. The current declaration prohibiting gathering of more than 10 people needs to address application to the assembly of the Legislature (with either 30 or 73 legislators gathering). Also, how does this apply to our crowded prison facilities across the country?

The Executive must foster strong collaboration with the other two branches and conjointly determine the appropriate course of actions, consistent with guidance from relevant international health agencies. This duty also includes broad-based consultations with relevant national stakeholders to engender "ownership and buy in" that will promote public adherence to the measures being put in place. For example, it is important that religious groups understand that the ban on public gatherings is not a crackdown on religion, but a safeguard for the lives of worshippers. More importantly, there must be equity in the application of these measures, without fear or favor. The government needs to pay attention to allegations of partiality in enforcing the ban on worship groupings and compliance with screening protocols at entry points such as the RIA. Let this not be business as usual. We know of previous declarations that were either dead on arrival because of lack of political will to enforce; or were violated by the very authorities that formulated them.

ECONOMIC DIMENSION

The heavy toll the Coronavirus has taken on the global economy is overwhelming... global economies seem to be sinking from meltdown to shut down! The importance of the informal sector in the Liberian economy cannot be overemphasized. Micro and small businesses have been the cornerstone for employment creation in the economy, often masking our labor force statistics, unfortunately. How many Liberians live on "daily hustle," surviving from "hand to mouth?" Sooner than later, the government would need to take actions regarding the overcrowded markets in Red Light, Duala, Waterside, etc.

This will have huge impact on the livelihoods of thousands of families: street sellers, cook shop owners, barbershop owners, taxis drivers, kekeh drivers, market women, store owners, wholesalers, retailers, farmers, civil servants, etc. This will cripple household incomes, greatly undermining ordinary people's ability to survive. What plans does the government have in place to bring financial relief to families that would face stress as a result of the imposition of these restrictions? Government has to allocate national resources to address this potential crisis. Also, there is a need to look into opportunities to work with the private sector, as well as work with other humanitarian organizations to plan how to deal with the unintended negative consequences of the national COVID-19 response strategy.

HEALTHCARE DIMENSION

Eventually, the management of the COVID-19 crisis will rest on the healthcare system. The inadequacies in our healthcare system are open secrets: weak infrastructure; stock out of essential medicines and supplies; limited frontline health workers; questionable capacity of facilities to care for the sick; lack of logistics for referrals, lack or disrepair of medical equipment, etc. Without the industry to manufacture needed supplies and equipment, where will we seek help? Even those who usually help us (the United States, for example) are themselves experiencing shortages of unusual scale.

The concern is not about whether or not we have trained infectious disease experts; the question is what capabilities do we have to quarantine, test, hospitalize and treat an acute caseload of hundreds of patients? Sadly, some people are in denial, speculating with various conspiracy theories - that the government is just trying to get donor money. Others are arguing that Coronavirus is not as dangerous as Ebola virus; yet some people have a false belief that Africans are too strong for the Coronavirus. This is a dangerous cocktail that could catalyze an impending national health calamity.

Liberia cannot afford for COVID-19 to reach a crisis proportion; we are not prepared for this pandemic, today or tomorrow; and we will not be prepared in the foreseeable future. Educating the public to practice social distancing, and adhere to safe hygiene practices, including regular washing are essential to prevent the infamous "epi-curve" which always proves difficult to flatten. Health authorities must continue to gather data to generate evidence that will inform current and future decisions in health policy and programs.

In view of this, the government must take decisive actions to avert an escalation of the disease. We must equally invest in the political and economic dimensions of our response. This requires that all three branches of the government must be in this together to help us navigate these trouble waters. All Liberians must realize that our individual and national health and safety are at risk. However, the government must not rely on heavy-handed tactics of force and threats to violate civil liberties. We must design a COVID-19 response strategy that is rooted in evidence, nationally envisioned and locally driven - that was how we defeated Ebola. We can do that again; God bless Liberia!

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