The year 2020 can be described as the quintessential annus horribilis, the horrible year. The year began normally but by February, reports emerging from Wuhan province in China indicated that the world was facing an existential threat. The novel coronavirus which became known as Covid-19 broke out.
Soon it became evident that this was nothing like the Swine flu of 2009 caused by the H1N1 virus which killed about 200,000 people or even the Asian flu of 1957-1958 caused by the H2N2 virus which killed about one million people. Covid-19 was going to be more like the Spanish flu. That flu came in two waves, starting in 1918 and ending in 1920. The number of infected is staggering — as many as 500 million, with estimates of 50 million deaths worldwide, according to the US Centre for Disease Control. Isolation and quarantines were used to slow down transmission.
The Covid-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work. The economic and social disruption caused by the pandemic is devastating: one and a three-quarter million have died, 80.5 million have been infected, tens of millions of people are at risk of falling into extreme poverty, while the number of undernourished people, currently estimated at nearly 690 million, could increase by up to 132 million by the end of the year. Commendably, The Gambia Government, like many other governments in the sub-region, attempted to mitigate the hardship by giving out rounds of food and cash relief to citizens and businesses like this very medium.
The pandemic has decimated jobs and placed millions of livelihoods at risk. As breadwinners lose jobs, fall ill and die, the food security and nutrition of millions of women and men are under threat, with those in low-income countries like The Gambia, particularly rural farmers, being hardest hit.
Covid-19 has also laid bare the fragility of our public health system. Nineteen years ago, African governments made an historic pledge to allocate at least 15% of their annual budgets to the health sector. This vow became known as the Abuja Declaration. As Covid-19 spread and wreaked havoc across the world, the question asked was: What became of it?
Covid-19 has lifted the lid on the acute shortage of critical and lifesaving equipment such as ventilators and intensive care beds in Africa. According to the World Health Organisation in mid-April, there were just 2,000 ventilators across 41 African countries and 5,000 intensive care beds across 43. Ten countries did not have any ventilators at all. And, to make matters worse, Africa has a paltry number of medical personnel trained to operate them.
The dire shortage of medical capacity has put a spotlight on the poor state of public health systems in Africa and the distance yet to be travelled to ensure that health care is affordable and accessible to all persons. A report by the Mo Ibrahim Foundation showed that only ten African countries provide free and universal healthcare. An Afrobarometer report found that even before Covid-19, more than half of all people on the continent could not access necessary medical care at least once a year.
At the heart of our continent’s fragile health systems is the perennial failure by governments to prioritise health and allocate it adequate resources. The Abuja Declaration sought to correct this by securing a commitment of at least 15% of national budget for the health sector. But this target has proven elusive for many countries. In 2011, ten years after the declaration, 27 African countries had increased the proportion of their expenditure allocated to health. However, only two countries – Rwanda and South Africa – had reached the 15% target. Seven had actually reduced their health budgets as a proportion of their national budgets.
By 2016, the situation had deteriorated. 19 African countries were spending less on health as a percentage of their public spending than in the early 2000s. According to the WHO report, prioritising health on the continent has no direct relationship to a country’s wealth. It found that several countries with high per capita income – such as Algeria, Botswana, Equatorial Guinea, Gabon, Mauritius, Seychelles and South Africa – do not systematically spend more of their budgets on health.
Meanwhile, some lower income countries – such as The Gambia, and Malawi – have in fact surpassed the 15% Abuja target for several years. Yet our public health system is nowhere near satisfactory not to talk about being excellent. Therefore we must go back to the drawing board and see how we better protect the health, livelihoods and food security of all people, and ensure that our ‘new normal’ is a better one.
As we say goodbye to the annus horribilis of Covid-19 and the orange Satan that is Donald Trump, we pray to the Great God of nations to usher in 2021, an annus mirabilis, a wonderful year, a year of hope, of recovery and decency.