Africa: Global Health Expertise in the Time of Coronavirus


Debating Ideas is a new section that aims to reflect the values and editorial ethos of the African Arguments book series, publishing engaged, often radical, scholarship, original and activist writing from within the African continent and beyond. It will offer debates and engagements, contexts and controversies, and reviews and responses flowing from the African Arguments books.

'Nobody knows anything' the Hollywood screenwriter William Goldman once proclaimed-illuminating his own industry to the unspoken taboo and uncomfortable truth that expertise is in the eye of the beholder.

This is the closest analogy we find to the global Covid-19 pandemic and how it is dealing with notions of expertise. Among the myriad of things this pandemic is bringing to light is how we must re-evaluate the old tropes of scientific expertise - particularly in global health. The novel coronavirus is a precursor to disastrous days ahead as governments and populations make decisions in order to prevent thousands of potential deaths and buffer societies to the economic dominoes that are currently falling one by one.

Speaking at the government's daily coronavirus briefing on the 26 March, the UK's deputy Chief Medical Officer, Jenny Harries, when asked why the UK was not following the WHO's recommendations for combatting the pandemic virus, said 'We need to realise that the clue with the WHO is in its title - it's a WorldHealth Organization. And it is addressing all countries across the world, with entirely different health infrastructures ... . We have an extremely well-developed public health system in this country.'

Suggesting that the WHO's recommendations were, essentially, for 'other' countries, and the fact that the UK's developed country status and healthcare exceptionalism makes it immune to pressures of following public health measures from other experts. Ignoring a global pool of expertise that has already shown to be effective in saving lives, not just for this pandemic, but previous epidemics over the years.

One common thread to each national response is decision-making based on the available evidence wherever they may find it. The WHO, often the easy target of chagrin when global health events of this magnitude hit, has largely risen to the challenge, ensuring that the lessons learnt from one country are at least available for the next country to learn from, and hopefully avoid untold numbers of cases and deaths. Their daily press briefings since the start of the outbreak have been a masterclass in public health communications messaging -being technically exact and using precise urgent language. This is a unique role only the WHO can fulfil.

Countries that once prided themselves as being cathedrals to scientific expertise have been shown to struggle to stem the tide of the virus transmission. At the time of writing, the UK and US stand above other countries in not only their unique approaches to responding to the virus, but also in cases and resulting deaths from the virus.

Global health expertise in the 'Global North' has always been an abundant commodity that was exported - writ large - to the rest of the world, to those 'other' countries. Global decisions get made in Geneva, Seattle, Washington DC, and London by global health actors whose financial resources arguably outmatch local expertise. (Spoiler alert: I too am guilty of this.)

A recent New York Times (NYT) opinion piece has called for a 'brain trust' of the developed world to focus on a coronavirus strategy for the developing world. A brain trust of the same think tanks, news media, universities and non-governmental organizations that have shaped the unbalanced global health debate up until this point. The NYT article largely ignores, either knowingly or unintentionally, the work that has already gone on within African borders. In February, only Senegal and South Africa had the capacity to test for the virus.By the middle of March that number was already at 40 countries. Due, in large part to the Africa CDC and WHO.

This false dichotomy in global health expertise is nothing new. But this pandemic is putting it in a spotlight, and makes it impossible to ignore. This has been a recurring trend, with the 'decolonise global health' movement among others. And no doubt the discussion will continue. What is needed now is a way to re-orientate what we traditionally considered global health expertise and institutionalise this reorientation. Expertise cannot be a black box that is untouched from scrutiny.

Recently, researchers writing in The Lancethave recommended that, to combat the pandemic, the UK will need to implement a national programme of community health workersfor the Covid-19 response. A distinctly 'Global South' approach, citing how expertise in a coordinated community workforce can provide effective health and social care support at scale can be gleaned from Brazil, Pakistan, Ethiopia, and other nations. If there was ever a time to be more community minded, it is now.

There are many more lessons to be learnt from a truly global pool of expertise. As the British Prime Minister was telling its elderly population not to worry and not to go on cruises! Uganda, for example, had already implemented airport screening for incoming travellers a month earlier- all in the absence of detected cases within its borders. Videos of handwashing stations at bus stations in Rwanda have gone viral.

The lessons are there to be learnt from other countries for those willing to learn them. In a post-Covid-19 world, this will change, for no other reason than it needs to. The virus is also a precursor for a new world to emerge on the other side.

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