Observations and contribution of the Mandela Institute
“The crisis is not just about health. It is economic and social, especially for the weakest among us. We will see if our societies are still capable of solidarity. Economic globalization exists, just like that of communication. We have not yet started that of solidarity. The coronavirus occupies our minds, but I have not heard anyone recall that a child dies of malaria every 3 minutes in the world, while a treatment costs 70 cents. Or that a woman dies every two minutes from childbirth. If this crisis could make us open our eyes … “, Pr. Philippe Douste-Brazy, Former French Minister and Former Deputy Secretary General of the United Nations and Special Advisor to the Secretary General of the United Nations in charge of innovative sources of financing for development.
Africa is in a permanent epidemic and health crisis (smallpox, measles, cholera, Polio, HIV-AIDS, Ebola, Lassa, malaria …). The Covid-19 is unfortunately just one more epidemic. The African is constantly experiencing a health emergency and the fight to overcome diseases and epidemics. So why such a sudden fear of African and world leaders over the fate of Africa? The coronavirus crisis once again sheds light on the dependencies of Africa, which has never thought of the world in strategic terms. The absence of forward thinking weighs heavily on crisis management.
The analysis of the geopolitical impact of the Covid-19 can be summed up as follows: the Asian resistance with the control of epidemiological parameters and the Western collapse with decisional and medical muddle hide weakly the African weakness in the management of coronavirus. The predictions of millions of deaths in Africa due to the coronavirus pandemic (UN Secretary General on France 24, Director General of the WHO in February, several Western journalists and experts) pose serious ethical and prospective questions: Is this a fear mongering strategy? Is this a confidential information available to them? Or is it a question of a serious matter: was the Covid-19 intended to stop the demographic surge of Africa of which the Westerners were alarmed for a long time? How else can we understand that we are worried about the only continent less affected by the virus! The resulting fear and anxiety or panic raises the problem of perception between the reality and health crisis.
The Mandela Institute noticed that certain measures taken in the West have been replicated in certain African countries indiscriminately when the socio-economic realities are not the same. To effectively manage the pandemic, we must promote African decisions with intelligent and differential measures between the cities and the countryside, between the capital and the provinces. The lockdown of the country with the closing of the borders is a good solution; but the lockdown of the populations is impossible because it will not be respected by the daily workers and the farmers who live from day to day by their strength and daily wages. Therefore, we should rather consider a zonal lockdown than an individual one (unless it is accompanied by social assistance measures and food distribution).
We can beat this disease if African governments can understand that Covid-19 is much more than a pandemic, but above all, a geopolitical struggle, that exposes the weaknesses of countries and people. It is time to prove that the political, economic, social, and health crises have taught us a lot and made us the most resilient people. Africa has no right to lose this war whose battles are fought elsewhere.
The Mandela Institute works with African governments by providing them with strategic advice and scientific expertise. Our mission is to prepare leaders of today and tomorrow to put in place post-Covid-19 scenarios because the world will change and so will Africa. It’s he who is the most visionary and strategic who will reign. Our contribution aims to support the competent authorities in taking intelligent and logical measures. To govern is to plan, but also to decide. Given the circumstances, to govern is to decide quickly.
I. Summary of advices for taken actions or actions to be taken
The top priority is to protect people’s health and safety from the coronavirus. The authorities must take all smart measures to prevent the weakness of our health care system from sliding into collapse.
– Governments should make decisions to incorporate chloroquine into the treatment regimen to treat Covid-19. We will come back to its benefit / risk ration and its Hydroxychloroquine / Azithromycin combination.
– It is necessary to suspend any vaccination campaign up to 6 months after the end of the epidemic to avoid mutation and resistance of the virus linked to its interactions with vaccine antibodies. Some vaccines used in Africa are useless, ineffective and dangerous. We must prevent Africans from becoming guinea pigs or mice for the testing of Covid-19 vaccines.
– Reorganize the health care system with the concentration of medical and human resources in referral hospitals to receive patients and treat Covid-19.
– Consider public health as a question of national security with the creation of a Health Security Agency within the National Defense or Security Council to coordinate with authority a national response to the epidemic. We will propose the evolution of its health security watch missions once this pandemic is over.
– Take smart, logical, and applicable hygienic and health security measures to avoid the risk of starving vulnerable populations; we will provide more details later.
– The combination of zonal lockdown measures (city, town, district, villages or other epicenters of infected people) and the wearing of masks made of cloth is very effective in limiting the spread of the virus.
– Set up disinfection tunnels (Turkish system or Algerian smart system) for populations entering and leaving neighborhoods and public places such as markets with temperature tests and barrier actions. This makes it possible to adapt to the various African socio-economic contexts, which make difficult the general lockdown.
– Apply the principle of prudence and control for all medical materials purchased or offered (test kits, masks, and disinfectants) and humanitarian personnel (profiling and continuous surveillance). It is a precautionary principle: it is better to prevent than to cure because free help does not exist. It is well applied by Nigeria, which refuses international aids and prefers to count on national solidarity against the coronavirus. Thus, it protects itself from all the consequences these aids hide in terms of health and finance (debt service).
– It is possible to transform sports equipment (stadiums) into a field or quarantine hospital to compensate for the lack of places in medical structures. Military engineering battalions can be used.
– Promote the national production of cloth masks (washable and disinfectable) to distribute to populations and leave medical masks to health professionals to avoid shortages.
The virus does not spread by its self. It is disseminated by individuals. We therefore have the responsibility to think about zonal lockdown and generalized testing in outbreak epicenters to ensure the protection of all. These smart measures (localized lockdown and testing) will prevent the “community spread” phase from turning into “national spread”.
II. Update on Covid-19 in Africa
The global comparison clearly shows that Africa has largely been untouched by the epidemic so far. To keep this advantage, we must ban all trials for Covid-19 vaccines and drugs while being careful about a rapid development of Covid-19, which may become catastrophic due to weak health care systems. The future of Africa is at stake now. Of the 65,000 people who have already lost their lives during this pandemic as of April 5, 2020, only 424 are in Africa.
Several far-fetched and false ideas have been propagated that Africa seems to be spared from the assaults of the virus based on a certain incapacity of the virus to resist the African climate (beyond 27°C) and a supposed immunity of Africans. It’s wrong to distract people from the basics: the relentless fight against the virus.
Until February, Africa had only two laboratories capable of diagnosing Covid-19, one in Senegal, the other in South Africa. But the situation has changed; there are now fifty on the continent.
The majority of African countries have weak health care systems and will be unable to cope with an explosion of patients. The lack of screening kits and protective equipment for caregivers, the lack of oxygen therapy equipment and resuscitation beds complicate the health equation with populations that are immunologically weakened by previous epidemics. Medical supplies and equipment may be insufficient to cope with a possible health and humanitarian disaster. The health care system will have to be restructured around the reference hospitals, concentrating the human and medical resources available there.
In addition to health measures for emergency treatment and testing, the decisions taken generally took the form of public health measures centered on social distancing and the generalization of barrier actions to help break the chain of transmission of the disease; closing borders and shutting down non-essential services with the consequences of slowing production.
The first screening tests and masks were aids from the Chinese billionaire Jack Ma with for each country 20,000 screening kits, 100,000 masks as well as protective suits for medical use. We will have to think about having strategic stocks.
All of the first cases of Covid-19 in the 51 affected countries were of external origin.
Of the 54 countries, 24 have no casualties and 3 are still unaffected by the epidemic as of April 5, 2020.
The number of cases recorded (8842 on more than 1.3 billion inhabitants) is infinitesimal compared to those of Asia, Europe, and America, which are in hundreds of thousands of positive cases. All continents are affected by Covid-19. But it is on the African continent that the worst is predicted by calling the virus “a time bomb”. Western experts believe that the international mobilization is needed to help finances of African countries, which are at the risk of experiencing “millions upon millions of contaminations and deaths”. This information should prompt Africans to think about the conspiracy theory and flood social media networks with contradictory and questioning messages: “So, let’s summarize this story. In December, the Chinese eat pangolin and then fall ill with Covid-19. They then contaminate Europeans and Americans. In the end, we decide to vaccinate all Africans”.
The number of deaths (424) is even more derisory and these are grouped for the most part in 3 North African countries (292 total for Algeria, Morocco, and Egypt), which are in contact with European tourists. The Lassa hemorrhagic fever epidemic in Nigeria has a death rate of 23% when that of the coronavirus is around 4% without anyone being upset.
Africans have regularly used chloroquine and its derivatives for decades to combat malaria, especially in wetlands. This malaria drug before its resistant mutation is effective today against the coronavirus.
The hypothesis that the low spread and progression of the virus currently observed on the continent is linked to the resistance of bodies stuffed with anti-malarial substances may be plausible and deserves to be confirmed or invalidated by epidemiological and medical studies. With regard to Africa’s record, faced with Covid-19, we can even formulate a profound postulate: besides the fact that the African population is young and robust and went through serious epidemiological tests in a hostile environment, the observed low spread and progression wouldn’t it also reflect the combined result of the regular consumption of aromatic and medicinal plants for self-medication but also chloroquine and its derivatives to fight malaria. These are avenues for future scientific research and political decisions.
African doctors are well equipped to prescribe and administer chloroquine and other associated drugs because they are well aware of contraindications, adverse effects and the dangerousness of drug combinations. The use of medicinal plants is strongly recommended with precautions of use.
The regular objections carried out on television by medical authorities (many of whom are “sponsored” by pharmaceutical companies) against chloroquine and its derivatives become suspicious. We have never seen so many experts point out the dangers of a product that has crossed more than half a century of history, bringing much good than harm to the inhabitants of tropical zones. These same luminaries were strangely silent on the danger of vaccines administered on a large scale to Africans against measles, smallpox and other diseases whose negative effects on the sexuality of men and maternity of women are legion. Nor do they say a word against the on-going wild clinical trials in some countries under the guise of humanitarian action.
Some countries, NGOs, Foundations, and International Organizations, instead of worrying about the state of health of their people who are seriously affected by the epidemic, they are alarmed about Africa and worried about how many people may die and how many regimes may fall. It is a mind blowing to predict an implosion of Africa due to the Covid-19; if there is no hidden agenda! One thing is certain: if not managed well, this crisis could become an economic, social, and political tsunami. All bets are open for those who love “Africa without Africans”. They theorize that the weak state is unable to cope with a Covid-19 pandemic. The battle of Western powers to afford Chinese masks at low blows is nothing compared to the war that awaits Africa. The good news is that, probably at the end of the pandemic, the birth of the Federation of Africa will surely accelerate with all the shocks of health, economy, security, and political crises.
Trends and trajectories, developed in the West by foundations and charities, estimate that the Covid-19 should reach more than 50 million people across sub-Saharan Africa. We must prepare for the worst because these aid workers and world experts are not angels.
About 20 African governments have called on European expertise for advice on coronavirus crisis response systems. These experts have even integrated the crisis management structures in certain countries. It is understandable why certain taken measures are not adapted to the African context because they do not reflect the exercise of sovereignty and cultural representation. These are the experts who advise vaccinating Africans.
The current level of the epidemic crisis does not force African countries to give in to pressure from pharmaceutical groups to accept clinical and vaccine trials for Covid-19. It is time to prioritize the health of the people rather than the large sums of money that will certainly end up in Western banks. Recall that measles vaccines have caused partial impotence in men and some kind of infertility in women over the age of 40.
From what is said in the media and other sources of information, Africa is a traditional testing ground for the most controversial vaccines (e.g. Ebola DRC vaccine, etc.). This is very well documented and widely known today. In the Covid-19 pandemic, a successful vaccine could not normally be available in 12 or 18 months. One wonders therefore why such agitation and the global precipitation on a vaccine which has not yet followed, unless proof to the contrary, all the necessary scientific protocols. A basic precautionary system recommends saying no to the Covid-19 vaccine in Africa. It is the fundamental responsibility of the State. If not, it breaks the basic pact: the citizens recognize the authority of the State, and in exchange, the latter provides them with a certain number of services, first and foremost, the guarantee of health security. This ultimate protection of our freedoms and rights is non-negotiable. The opposite act is a betrayal against the people.
The Central Africa (6 CEMAC member countries), Ghana and Nigeria have rejected all proposals to experiment with the Covid-19 vaccine and have refused with dignity that their populations be guinea pigs because effects and risks of vaccination are unknown.
The survival of the regimes of some twenty African countries is subject to the effectiveness of health, social, and political measures taken for the public interest, which will prevent attempts to destabilize through a possible social explosion.
III. State of scientific and medical knowledge
The Coronavirus – COVID-19
Coronaviruses are a very large family of viruses (with a crown, hence its name), very widespread in birds and mammals with the possibility of human-to-human transmission. They have been known since 1965: virus 229E (1965), OC43 (1967), SARS (2003) NL63 & HKU1 (2004), MERS-corona (2012 in Saudi Arabia) and COVID-19 in Wuhan in China. They are the third leading cause of viral respiratory infection in the world. The Covid-19 mortality rate remains low: 1 to 5%. Poor management of affected patients can increase this rate up to 10%, which is significantly low compared to Ebora (80% of deaths).
There are around twenty viruses associated with respiratory infections: Adenovirus, Bocavirus, Enterovirus, Influenza A & B, H1N1, H3N2, Coronavirus… They are different from hemorrhagic fevers: Ebola, Typhus, Cholera, and Plague.
The coronavirus is not a living organism, but a protein molecule covered with a protective layer of lipids (fats) which breaks down by itself when it is absorbed by the cells of the ocular, nasal or oral mucous membranes. It changes their genetic code (mutation) by converting them into multiplier and aggressive cells. To exist, the virus is forced to parasitize the cells of the sick body in order to reproduce. The disintegration time depends on the temperature, humidity, and the type of material in which it is found. These are fragile viruses whose protective grease is broken by any soap or detergent with the rubbing action of more than 20 minutes.
While the real cause of the transmission of an animal virus to humans (zoonosis) is still unclear, its origin is attributed to a market in Wuhan. The trade of wild animals for food and the practice of traditional Chinese medicine is to blame. The response to Covid-19 should be based on experience from previous SARS 2003, H1N1 2009, MERS 2015 epidemics.
The Covid-19 pandemic is worrying because of its rapid spread, contamination, and mortality. It struck with an unprecedented ferocity. Symptoms vary from a moderate to severe infection of the respiratory tract accompanied by cough, fever, loss of taste, and difficulty breathing. At a very advanced stage, the virus causes respiratory failure, septic shock or failure of several organs that must be treated with a strict biotherapy protocol.
Chloroquine, an effective treatment for Covid-19
Chloroquine has been a well-known drug in Africa since 1949, easy to produce and at low cost. Africans are used to chloroquine. As a result, Africa has far fewer deaths than other continents at the moment. Its treatment (based on hydroxychloroquine, derived from chloroquine) lowers the viral load of Covid-19. Chloroquine is one of the best (benefit – risk) avenues available to treat Covid-19 with very minimal side effects.
Chloroquine is synthesized on the model of a natural molecule extracted from a plant found everywhere in Africa: quinine.
This molecule was used against malaria (malaria) and was abandoned because Plasmodium (microorganism responsible for malaria) became resistant to this molecule.
Not all anti-malarial drugs (Plaquinil, Amodiaquine, Mefloquine, Primaquine) are from the same family because they do not have the same basic molecular structure.
Chloroquine is given to Europeans traveling in Africa. This does not cause them any side effects. It is given to healthy people and there is no problem. In what name would this drug cause a problem for sick people? It is a nonsense and a controversy linked to the big money.
Chloroquine does not endanger the lives of patients; on the contrary, it can save them. So, the logic dictates using it in the absence of an effective scientifically proven treatment. It has been advocated and successfully used for healing by the team of Professor Didier Raoult of the IHU in Marseille.
Five studies have shown that the coronavirus is sensitive to chloroquine, whose viral culture models have been known for a long time. We know it was an effective antiviral. Its use to heal Covid-19 is a matter of time for everyone to accept the evidence. A new study by the IHU Méditerranée Infection, led by Prof. Didier Raoult, recommends a dual therapy combining hydroxychloroquine and a pulmonary antibiotic. Its effects are confirmed by the results observed on a cohort of 500 patients in New York State and 80 patients in Marseille.
In some cases hydroxychloroquine is combined with other drugs:
– The combination of Hydroxychloroquine / Azithromycin (antibiotic) is the most used for Covid-19. Treatment: chloroquine: Plaquenil 200 mg (3 times / day for 10 days) combined with Azithromycin 250 mg twice a day on the first day and then once a day for five days (precise protocol to be followed). Both drugs have been used for a long time. Effective and cheap drugs to recommend from the start of the disease.
– The combination of Hydroxychloroquine/Lapinavir/Ritonavir is recommended and can be prescribed, dispensed and administered under the responsibility of a doctor to patients affected by Covid-19.
The Moroccan government has taken a courageous decision to overcome pressure from pharmaceutical group experts by purchasing all stocks of Plaquenil (one of the trade names for Chloroquine) from the Sanofi plant in Casablanca to treat patients with Covid-19. It is a strategic decision because public health is a matter of national security. Besides that, Professor Didier Raoult judges “immoral” not to administer chloroquine to patients of Covid-19.
APIVIRINE, an African phytomedicine effective against the coronavirus
The contribution of traditional medicine against coronavirus is manifested in the exemplary cooperation of the Burkinabé and Beninese governments to scientifically and medically promote the antiretroviral, APIVIRINE by Dr. Valentin Agon, which has given satisfactory results in the treatment of Covid-19 with twenty subjects affected.
“Some confirmed Covid-19 patients have successfully used APIVIRINE during their illness. They immediately obtained an improvement in their state of health ranging from the rapid improvement of symptoms to the negation of the coronavirus screening test after treatment”, said in a press release dated March 26, 2020, the Ministry of Higher education, scientific research, and innovation in Burkina Faso.
The ministry has appointed a team of scientists for a clinical trial to validate the scientific and medical protocol. African countries should seize this opportunity to join the Benin-Burkinabé initiative to develop APIVIRINE and traditional medicine with aromatic and pharmacological plants with medicinal and antiviral properties.
This coronavirus epidemic that affects all of Africa is a collective opportunity to put the package on traditional medicine. The pooling of research and intervention resources, either at the regional or continental level, is the only response towards future pandemics. The African Union can bring together experienced researchers in this field around Prof. Raphael Eklu-Natay, Author of the Dictionary of Medicinal Plants of Africa; Prof. Rokia Sanogo, Head of the Pharmaceutical Sciences Department of the Department of Traditional Medicine (DMT) of the National Institute of Research in Public Health (INRSP) and Director of the Laboratory “Spaces, Societies, Cultures, and Health” of the IRIS WEB DUBOIS Institute of Mali; Dr. Valentin Agon, Owner and General Manager of Api-Benin, which produces medicines phyto, including APIVIRINE and CEO of Api-Pharma in Benin; Dr. Jérôme Fagla Medegan, Inventor of CD4 (a glycoprotein molecule) allowing the immune system to come out of its annihilation in the face of HIV to fight the disease; Dr. Eric Gbodossou, Director of PROMETRA International (Promotion of traditional African medicine) in Senegal; Dr. Charles HOPSON, OrthoMolecular Doctor and patron of Doctor Hopson Pharma Labs in Cameroon and Longevity Labs USA, and Dr. Daniel Biakou, Managing Director of BDA PHARMA. They all offer the use of plant extracts, which come from the rich heritage of our traditional ancestral medicine. These plants were used to overcome smallpox, sickle cell anemia, and the viral flu viruses. Plant extracts can strengthen the immune system to the point where it can act as a barrier to the coronavirus. We lose nothing by using the means at our disposal, the plants that our ancestors used for self-medication and which we can successfully adapt to current standards of modern medicine. The Mandela Institute, the African Cultural Institute (ICA), and the School of Advanced Studies in Public Health (EHESP), Mali, will organize the second edition of the International Conference on African Traditional Medicine in 2021, the first edition of which was organized in April 2019 in Bordeaux by the ICA.
The financial stakes are enormous for the vaccine and the screening tests. This is ensured by the primacy of the patent over this viral virus and delays the announcement of a vaccine or drug against Covid-19.
– The virus has been known since 2003;
– The vaccine / antidote was successfully tested in 2004 by the Pasteur Institute in Paris, a European patent No. EP 1 694 829 B1 on the “New strain of coronavirus and its applications” was filed in 2004 by the Pasteur Institute on conclusive results whose tests were successfully carried out in 2003 on mice;
– The virus was in scientific manipulation (genetic mutation) from the P4 laboratory in Wuhan in China (home of the epidemic);
– The virus lives 20 days in the sick subject, unlike the 14 days that are mediated by the media;
– Chloroquine is more effective and better indicated for relieving, treating or even curing the sick;
– The vaccine is almost available from the improved measles vaccine.
In short, we are faced with a simple strategic choice:
- Concentrate the research effort on already existing molecules including APIVIRINE and chloroquine, already available in Africa with known effects.
- Wait for results of foreign research on new molecules for new drugs that will cost more and for which we do not know anything about their side effects.
IV. Smart and differential measures of hygiene and health security
To govern is to decide the smart way. All of the first cases of Covid-19 in all African countries are of external origin from the continent. So, if we had made sovereign decisions to close the air borders, our populations would have been spared from the epidemic. The lack of responsiveness of public authorities, certainly linked to the absence of a health surveillance structure, has sometimes led to hesitant, useless, and ineffective decisions to contain the virus, which is spreading at a very rapid rate.
Certain measures applied in Europe have been partially or totally taken up by African countries without questioning their applicability in a septic environment. These are barrier and lockdown actions to combat the spread of the virus. You should wash your hands regularly, cough or sneeze into the elbow, use single-use tissues that you throw away after use, avoid greeting each other by shaking hands, stop kissing, and stay home. In the absence of measures adapted to the African cultural and socio-economic context, accompanying measures will be necessary in order to help the populations to respect these instructions.
How to implement lockdown measures for populations mainly confined to an informal economy, which obliges them to travel daily to provide basic needs for living? In these conditions, how do you solve the equation of the choice between dying by illness (health risk) and by hunger? In view of lockdown as the only option to fight effectively against the virus, it must be targeted according to the infected areas and backed by measures more suited to local socio-economic and cultural realities. Territorialization of the disease is essential in Africa.
Zonal lockdown and separation of populations
It is practically impossible to lockdown a hungry population struggling for survival. We are proposing zonal lockdown for epicenters of epidemics because general lockdown risks provoking popular riots and the destabilization of fragile countries.
Smart lockdown of the population is a policy that is less focused on restrictions, prohibitions, and criminalization. It is based on mutual trust, awareness of the danger, and the freedom granted to each citizen to take responsibility (social distancing, fortification of immune defenses, and other social smart ways).
The African cultural and sociological context of community life is incompatible with isolation and individualism, which are focal elements of measures of containment, social distancing and quarantine. What about street children and refugee or displaced person camps with precarious and appalling living conditions?
Strict lockdown measures are not easy to manage due to the poor resources of the populations and the State. We have observed that curfew measures to curb the spread of the coronavirus result in police brutality. Balancing health risk and public liberties is difficult to apply to the compulsory lockdown of people who live day by day. There is no point in making decisions that will not be respected.
The logic of the decision to contain the population is purely administrative to prevent the disease, not to fight it. This strategy of approaching the epidemic, widely practiced in the West with generalized lockdown, is not adapted to the socio-economic structures of Africa. It was necessary to opt for a medical approach with zonal lockdown for territories affected by the virus. These are intermediate solutions to limit traffic in cities: closing of interurban stations, places of worship and bars, zonal curfew, filtering dams, disinfection tunnel, etc. but no complete containment.
As soon as Covid-19 spread in the West, it was necessary to make the decision, not to lockdown populations, but to lockdown the country with the suspension of all international flights for an indefinite period of time and the interruption of the issuance of visas. If the coronavirus is circulating with people, closing the borders gives meaning to the precautionary measures taken, otherwise they are completely meaningless. Only the return flights of foreigners and nationals should be possible under strict sanitary conditions.
In several countries, certain areas are not affected by lockdown, namely the medical professions, food stores, banks, administrations, and transport must function. It will be necessary to examine the possibilities of opening up markets in certain territories (cities, provinces, localities, villages) not affected by the epidemic.
Why are we arguing for zonal lockdown? It’s a matter of logic and common sense. Can farmers be concerned by a lockdown? This is obviously impossible, even in the event the Covid-19 pandemic gets worse. The African population is overwhelmingly rural, therefore agricultural. And African agriculture is dependent on the rainy seasons. The rains will not wait until the fight against the pandemic ends to fall! Pandemic or not, rural people sometimes have to go to fetch water and look for food and firewood in the fields. Some city dwellers are experiencing the same situation, adding to the fact that they have to survive through daily activities in the informal sector. All these are reasons of survival, which justify that the general or total lockdown is impossible to enforce. For effective measures, it is necessary to take into account the realities and specificities of each country, cities, and countryside.
The clear separation of the populations (sick subjects, contaminated subjects, subjects in contact with the sick, healthy subjects) is a serious option to stop the spread of the virus through the exclusion of positive patients from society and the quarantine of mild cases combined with the identification and tracking of individuals who have been in with positive patients.
Certain specific cultural and social traits (impossible social distancing, precedence of the collective over the individual, friendliness, social pressure, promiscuity) and religious practice justify taking into account a psychology of acceptability of the measures and explain their successes or failures.
The country that is totally locked down may probably have to face a second and then a third wave of contamination, while the country with high-risk zonal lockdowns would have acquired group immunity and would be protected.
In medicine, we have an impartial judge who is the death rate. The results (6/4/2020) of two different strategies deserve to be highlighted to enlighten the authorities:
1 – Lockdown or no lockdown.
It is interesting to note that two countries which have not locked down their populations have the number of deaths per million inhabitants that is much better compared to countries which have issued lockdown decrees:
|South Korea: 4 deaths / million inhabitants
||France: 124 deaths / million inhabitants
|Sweden: 40 deaths / million inhabitants||Italy: 263 deaths / million inhabitants|
|France is affected more than 30 times than South Korea and 3 times than Sweden|
2 – “Mask for all” or “no mask for all”
On the 20th day of the epidemic, the number of contaminations requires a choice between:
|Masks for all||No masks for all|
|Singapore: 490 cases
||France: 13,000 cases
|South Korea: 7,000 cases||Italy: 19,000 cases|
The combination of “No lockdown / masks for all” strategies seems to be effective in combating the spread of the virus.
The Government of Benin has responded to the threat by putting in place adequate sanitary cordon, self-isolation, hygiene, and social distancing measures. If within a self-lockdown, there is a case in a neighborhood and the patient has been self-locked down with his/her family or with many people, all those concerned will be put in quarantine. This is the principle of zoning that we’re proposing.
In a fragile economic and social context with poor populations that are unable to obtain disposable tissues, disinfectant gels, masks, the difficulties in applying barrier actions are complicated by the problem of access to clean water for handwashing. We recommend the use of ordinary soap, accessible to many, which is also effective in dissolving the fat layer from the virus.
Some countries do not have the means to provide social support for total lockdown, which is not required due to low numbers of positive cases. On the other hand, it was necessary to smartly limit gatherings and conduct an awareness campaign on the personal benefit from respecting barrier actions with a simple slogan “Between life and death, you may choose. But, please choose for yourself, not for others”!
Accompanying support for differential quarantine measures
Balancing health risk and socio-economic risks requires support with immediate economic, fiscal, and social measures.
Successful lockdown involves the distribution of food, hygiene and cooking products, the cessation of payment of rents, water and electricity bills for vulnerable populations.
Social measures to relieve poor people and economic measures to support national activity must be thought of, taken and applied in conjunction with lockdown measures.
In some areas, where individual measures are adopted, emergency social and food aid must be put in place to relieve the poorest populations. The priority should be given to workers, the informal workers, and the unemployed people who manage to feed their families on a daily basis.
The set of social and economic measures taken by the Governments of Mauritania, Gabon, and Senegal to overcome the health crisis can serve as an example for other countries.
A crisis management approach, adapted to African realities, should reinforce preventive measures taken by States such as closing borders, limiting the movement of people living in epicenters of the epidemic, social support for fragile and poor people, raising public awareness of the importance of barrier actions and the seriousness of the situation, quarantining detected cases, increasing the detection of cases, etc.
What we decide today will define tomorrow. It seems essential to us to underline the effort of certain African Presidents to forge a national alliance which transcends partisan considerations in order to mobilize their respective nations against the pandemic. The economic and social measures taken by the various governments mitigate the impact of social fragility. Faced with the pandemic, the decisions taken now will soon arise as realities of governance focused on/or not focused on the well-being of populations. It’s a time for a rule-based leadership and actions that leave no one behind. These rules benefit everyone to avoid the quest for an alternative.
V. Health is not a marketing product
Health is not a marketing product. It is an eminently national security issue. We thank the African governments which refused the proposals for vaccines which were proposed to them to strengthen the immune system of vaccinated people, in order to resist various diseases.
In 1960, Africa had 280 million inhabitants. Today, it has 1.3 billion. By 2050, its population could reach 2.4 billion, and 4 billion by 2100. Demography is one of the essential elements of the power of a country. This is the one and only reason why everyone wants to vaccinate Africans or worse, to experiment with drugs and vaccines without protocol and whose effects are not yet known.
The coronavirus crisis has awakened the African genius:
- The rapid adaptation of medicines (StopCoronavirus, APIVIRINE, CD4) from traditional medicine to cure Covid-19. This titanic work was the work of various researchers: Dr. Charles Hopson (Cameroon), Dr. Valentin Agon and Dr. Jérôme Fagla Medegan (Benin), whose authorities in their countries of origin follow their research with a particular attention.
- Meanwhile, young Algerian engineers from the City of Batna invented a smart disinfection tunnel to help healthcare workers and members of the civil protection team to protect themselves from the coronavirus. Algerian authorities strongly support the installation of disinfection modules at the entrance to health care facilities and fire stations.
- The Covid-19 Collective of Moroccan Engineers in Tangier has put its skills and knowledge to the manufacture, production and distribution of medical masks to participate in the fight against the coronavirus. The Moroccan authorities support this innovative initiative and manufacturers are ready for mass production of their masks.
These laudable initiatives should continue after the crisis, under the national, regional or continental flag to prepare for the challenges of an uncertain future.
The battle against the coronavirus is now focused on finding drugs or vaccines for the coronavirus in African territory. This will make the traditional African medicine a tool for geopolitical influence should China use masks as a geostrategic weapon. The conventional medicine treats while the traditional medicine heals. This well-maintained holistic healing benefit will be an instrument of power. It is possible to embark on this path quickly, because we have the:
– gray matter that is available and can be mobilized at any time by removing it from the scientific fallow;
– raw material that is available everywhere with very diverse medicinal, aromatic and pharmacological plants.
There remains the political will to provide the financial and technical means to carry out basic research and produce medicines according to African standards and protocols.
We must take the health problem with the African prism to preserve:
– our overwhelmingly young population,
– our resilience, because the change of virus depends on the populations and the environment,
– our capacity for immune responses which are different according to the people,
– our nutritional benefit which protects against the virus.
The lasting response to epidemics can be organized around the SuperNova Institute, created by African doctors from the Naval Health School in France and chaired by Dr. Olga Ndamba, whose aim is research, promotion, public health expertise and advice. The Institute aims to become an African Public Health Agency to pilot research and health security on the continent in order to limit the risks and test the effectiveness of medicines.
We again urge African countries to suspend all vaccination and medical testing for a period of 6 months to clarify this case of prevention and treatment of the coronavirus, the dangers of which are unknown. To embark on this criminal path is a betrayal against one’s own people.
VI. Public communication and transmission of information adapted to the African context
In the context of the epidemic, prevention and awareness campaigns are among the essential tools to contain the crisis. There is an urgent need to establish an effective community communication program (via radio and television, social media, other local transmission channels, etc.) in national and local languages.
To better respect the rules of hygiene and health security recommended by medical and governmental authorities, it will be necessary to adapt the communication and information to the African populations:
– In messages aimed at sensibilizing the population about preventive measures against the virus, let’s use ordinary soap which costs less. In principle, any soap kills microorganisms (due to its surface-active structure). We must break the television image which presents the practice of handwashing with liquid soaps with hydroalcoholic solutions and which makes people believe that coronavirus is a disease of the rich.
– Carefully recommend the use of foods and fruits containing antioxidant molecules (garlic, ginger, lemon, onion, turmeric, tomato, carrot, vegetable) as well as grandmother pharmacological recipes with antiviral properties (herbs, Aloe vera, Ndole, etc.) to strengthen the immunity of the human body in the fight against viruses.
– The transmission of information must also be imbued with the psychology of populations. “To understand the psychology of a population affected by an epidemic”, the historian Jean Delumeau carefully reconstructed, in “The Fear in the West”, published in 1978, the social effects of plague and cholera pandemics (rumors, denial, searching for culprits), which are found today with the coronavirus:
- “The denial of the authorities”, in order not to panic the population, interrupt economic activities and see the reality of the danger, weighs on the decision-making processes. While it is possible to take good measures at the beginning of the epidemic to lockdown the country and not the population, African countries have copied the measures taken in the West when the socio-economic context is not the same.
- “The carelessness of the population“, which refuses to believe the unthinkable. The psychological state of being a candidate in danger of the virus gives way to fear which sometimes translates into rumors. Covid-19 is perceived by a part of the population as a virus imported by the western and local elites. So, it’s a disease of the wealthy for the urban and a disease of the urban for the rural.
- “The panic” because contagion forces us to give in to malicious psychosis and to a planetary panic that is skillfully orchestrated. The virus first affected the elites in Africa then spread in working-class neighborhoods where problems of access to care are as worrying as risks of rapid spread.
- “The lockdown” punctuates the lives of individuals who are quarantined. It is seen as oppression and asphyxiation of the vital informal economy.
- “Social distancing” requires precautions to avoid contamination. People look at each other like earthenware dogs in the streets, markets or supermarkets.
- “Rejecting the sick” increases loneliness and isolation. As soon as you cough, people quickly run away. The fear does more damage than Covid-19 itself, an unknown virus without a vaccine. The field hospital which was being set up to receive Covid-19 patients in the locality of Yopougon (Abidjan – Ivory Cost) was vandalized, ransacked, and burned by young people on the pretext of being in danger. This requires that communication in relation to the management of the pandemic be adapted to the local and sociological context of the different populations to avoid any misunderstanding.
- “The abandonment of funeral rites” confirms the brutal ruptures of daily and social routines of a society. We mourn the dead on social networks that have become places of collective cemeteries.
- “Heroes and others” distinguish humans and classify them into a coward or heroic category: Professor Didier Raoult and his team from the Hospital-University Institute (IHU) Méditerranée Infection de la Timone, in Marseille, are rigorous people, recognized worldwide and now adulated by the whole world for having found a way to cure Covid-19: the chloroquine. However, politicians are in the wrong sheets because they are unable to assume their responsibility for protecting populations and the discontent rises up a notch every day.
- “The search for culprits” is fused with conspiracy theories and the divine anger found on social networks. “We must bet more on bullshit than on conspiracy” (Prime Minister Michel Rocard).
The epidemic is there, and given the decisions taken and the state of the health systems of our countries, we are not ready. It is important to keep in mind that the global health of the population and to adopt measures to avoid the spread of the virus. Despite the various deadly health crises, the reality of the risks is not ingrained in the minds of African populations. This is a challenge to be taken up in decision-making by the public authorities. Africans thank Covid-19 for having almost restored social justice: leaders, rich, and poor alike are afraid of dying from the epidemic which mostly threatens the traveling high society, unaccustomed to the failure of the health system and the ordeal of hospitals in their country. The powerful, who fly to seek treatment for a cold in Europe, are locked down in the country by the closure of foreign borders, of which the unlucky ones are hospitalized in hospitals for the dying. They think nothing can happen to them when no one can hope today to be out of the reach of a virus that has proven to be deadly. Let us hope that they may realize, like members of other nations that the best national investment is to build dignified and modern schools and hospitals.
The problem with Covid-19 is that there are not enough scientific answers about the epidemic, which leaves room for rumors, uncertainty and confusion. The political decision must be based on scientific recommendations. However, the time of scientific production is lagging behind the rapid time of the epidemic. Political decision with barrier and lockdown measures applies on the individuals’ behavior not on the disease as such, hence the discrepancy between political, epidemiological, medical and social reaction logics. The best strategy to respond to the epidemic must focus on prevention and treatment at the same time: barrier, administrative and social measures, protection of caregivers, massive tests, medical treatment of patients at the onset of symptoms, etc. It is up to scientists, epidemiologists, doctors, virologists, and infectiologists, to be on the front line and to advise politicians on the decisions to be taken and not the reverse.
Economist Prof. Esther Duflo, 2019 Nobel Prize winner in economics, calls on countries to open the floodgates of public spending to limit the economic ravages of the coronavirus pandemic, saying that there is absolutely nothing to “worry about the bill” in the face of the health crisis. The economist, a specialist in poverty, encourages the G20 countries to support the less developed countries, less armed in the face of the epidemic, and points out the uncertainties on the “way out of the crisis”, in particular on the strength of the recovery of the consumption, a factor that will determine “the final scale of the economic disaster”. She minimized worries about the public debt to finance development because long-term profits outweigh deficits. Investment is often a useful expense. It is time for African countries to refuse the dictate of international financial institutions to regain the quintessential Keynesian spirit that advocates state interventionism in the social and economic sectors. Resources must be injected to stimulate the economy by financing the economic, health and education systems and supporting poor households. The legitimacy of national industrial policies must be recognized.
In order to live, other people need an imaginary enemy while Africans need friends to survive. It is no longer possible to dominate the world in the current context of strong geopolitical competitions. Everyone must play their part of influence and whoever refuses will disappear. The time of entertainment of the populations by the policy of public amusement and the permanent diversion of the political leaders will definitely be ended with the coronavirus Covid-19. We must reflect on the post-crisis by calling for proposals from citizens and national intellectuals.
The feeling of devastation from the Covid-19 pandemic will change the way we see and think about the world. Africa has suffered unreserved raids, slavery, colonization, and globalization. It must prepare for geopolitical changes to continue to exist as a People. This requires the foresight and clairvoyance of governments and pan-African strategists to overcome the crisis with the people and face the challenges of stability and security. Governance ingenuity will be tested by mastering the systemic crisis and adapting to the new post-coronavirus order. Resilience will create new opportunities, while fragility will open up dangerous horizons.
The major challenge for African leaders is to manage the upheavals of the systemic crisis while thinking about the future. Failure could seriously undermine their authority and open up prospects for destabilizing contestation. They should take forward-looking measures to:
– Mitigate the socio-economic effects of the health crisis through daring national production policies
– Rethink the legitimacy of the State, the aim of which is to provide for the basic needs of the population: security, order, justice, and socio-economic well-being with a responsibility to protect the people in all areas of life. Inclusive governance is the best balance between power and legitimacy to maintain the national social contract.
– Consolidate the African resilience to infectious diseases by encouraging traditional medicine
– Allow the State, regions, and cities to prepare to protect their population against epidemics by strategic stocks of medical equipment.
-Make the African traditional medicine a tool of geopolitical influence (instead of being hit, and without reaction, with vaccines that are sometimes or often harmful) through basic and applied research and pharmacological industries.
The health verdict augurs well for changes in governance. This epidemic which forces to reset the planetary ways of functioning is a chance which allows Africa to update itself. The African Union has, as too often, been politically “absent subscribers” in this crisis. At the end of this pandemic, African countries must take stock of the management of the health crisis and take steps to lift Africa out of dependence in all its forms. Vulnerability lessons will need to be learned quickly to prevent such a strategic surprise from happening again on the continent. When the health crisis is over, it will be necessary to revisit the initial analyzes in order to ensure their relevance, to draw the necessary lessons, and to modify what should be the governance, national and continental, or even the administrative organization and socio-political functioning of countries in the face of repeated epidemics on the continent. Now is the time to assert a sense of state, of national interest, and of the long term, which requires listening more to national and pan-African experts.
Thus, in Africa, there is a risk that the health crisis may turn into a real social revolt, which may cause an economic crisis and generate a destabilizing political crisis in certain countries. Let’s be prepared for the crisis system! It’s all about good or bad management of the epidemic to protect/not protect yourself from geopolitical earthquakes. General Mac Arthur explained that “The Lost Battles can be summed up in two words: too late”. In terms of responsibility, one must be a strategist so as not to regret today’s decisions tomorrow.
Paris, the 6th of April 2020
Dr. Paul Kananura
President of the Mandela Institute