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.

Scenes from lockdown in South Africa. Credit: The Conversation

The inversion of African health priorities

The past two years of sub-Saharan health policy has centred on reducing healthcare access, reducing services for pregnant women and children, and promotion of malnutrition. Childhood vaccination has been reduced, while reversing progress on malaria has brought tens of thousands of additional child deaths. A broad policy of school closures, enforced unemployment and increased national debt will reduce the ability of future generations to recover. A new disregard for human rights has reversed progress on girls’ education and child marriage, ensuring higher birth rates and gender inequality.

These policies, externally driven and reminiscent of a previous era when Europeans disrupted and pillaged African society, are based around management of Covid-19. This emphasis on a single disease would make sense if the virus itself was devastating society. But it isn’t, certainly not in Africa, where it has killed at about a fifth the rate of malaria, and a tenth that of HIV and AIDS.

So what happened? Has healthcare been stolen? As a resident of the West, I try to make sense from afar. And the problem seems, inescapably, here.

The corporate colonization of global health

Global health policy was led almost solely by the World Health Organization (WHO) through post-War decolonization to the late 1990s, based on its broad definition of health: ‘Physical, mental and societal health, not just the absence of disease.’ Related UN organizations such as UNICEF, private charities and NGOs provided on-ground support, and government aid was largely bilateral.

Something changed 20 years ago. Private foundations rapidly increased their influence on health policy through political influence and sheer financial clout. The Bill and Melinda Gates Foundation (BMGF) soon became one of WHO’s largest funders at over $300 million per year, disrupting its former sole dependence on country-based funding. The Clinton Foundation funnelled young Western public health graduates into the offices of African ministries of health, whilst a bevy of NGOs grew off increasing aid budgets. While increasing private funding improved many health metrics, it also radically tilted power over policy towards private interests from a for-profit world that shared little common background with those whose health was at stake.

Private money also helped spawn specialist agencies including Unitaid, Gavi and CEPI, as ‘global public-private partnerships’ dedicated to increasing the use of health commodities; vaccines, drugs and diagnostics. Uninhibited by WHO’s theoretical restrictions on industry partnering, these institutions have ignored conflicts of interest by providing the companies making these commodities with a seat at the table setting rules for their own markets. The private club where these wealthy corporations meet – the Switzerland-based World Economic Forum (WEF) – took this further, partnering directly with the UN on policy development.

Even with the best intentions, a shift towards a top-down, technology-based approach to global health was inevitable. Wealthy entrepreneurs from a technology background, lacking experience in community-based public health, tend to think of technology when looking for answers. The corporate partners of Gavi and CEPI have a responsibility to their shareholders to maximize profits. That is how capitalism works. In contrast, there is little profit to be made in training community health workers and improving nutrition. The stage was set.

Covid-19 finds its role

By March 2020 it was clear that the newly-emerged coronavirus causing Covid-19 was overwhelmingly targeting old, overweight, and chronically sick people. A scourge for Western nursing homes, but not sub-Saharan Africa, where over 50% of people are below 19 years of age – teenagers and children. Ignoring such realities, existing evidence-based pandemic guidelines, and the fragile nature of African health, they deliberately stoked fear to support the transfer of new ‘lockdown’ policies from Chinese cities and northern Italian towns to the people of the African continent. Amidst the growing economic and health system destruction, the aerosolized virus spread essentially unhindered through Africa’s densely-packed cities and towns, causing relatively little mortality.

Emerging evidence of the growing disaster, however, has not staid the hands pushing this new one-size-fits-all public health. As vaccines became available, the focus has pivoted to insistence that all the world be vaccinated – ignoring the highly focused nature of severe disease risk and a century of knowledge on natural immunity.

WHO has essentially proclaimed that African children should be vaccinated to protect old, obese Western adults, under the patently false slogan of ‘No one is safe, until everyone is safe’. Ignoring continued transmission amongst vaccinated people and fading efficacy, the clear nonsense of this unfocused policy continues unabated. Africa CDC estimates such a mass vaccination programme will cost up to $10 billion – WHO estimates the whole world currently spends just $3 billion per year on malaria.

An opportunity to decolonize, again

The wheel appears to have turned back over a century. Like ‘omnipotent moral busybodies’, Pfizer, BMGF, the WEF and their adherents now mirror the colonial administrations and companies of the 1800s, dictating policy for the ‘good’ of distant peoples, and doing extremely well for themselves in the process. Their proclamation of the new religion of ‘Build back better’ and ‘Vaccine equity’ (not health equity) recall similar justifications for the pillaging of a century ago.

Western corporations and rich software entrepreneurs are not going to ‘save’ Africa’s people. The WHO, Gavi, CEPI and their courtiers have declared their allegiance. Their staff no longer have the backs of the market sellers, farmers, mothers, infants, girls, and communities seeking equality, health and prosperity in sub-Saharan Africa.

If public health policy in African countries is to prioritize the people of Africa, then African expertise will have to form it free of the webs of neo-colonial intent. The disaster these distant health tyrants have wrought is becoming so stark that it should provoke an urgency to reverse course, now.