I am very grateful to the editors of Africa for inviting me to comment on the thoughtful reviews by Abigail Neely and Matthew Hannah of The Covid Consensus. One problem throughout the SARS-CoV-2 pandemic has been a lack of opportunity for engaged critical response and, above all, dialogue; so, this kind of space is important.
This was a book written at great speed during the events of 2020. As I was on research leave, I was able to work fast. The main text was drafted in four weeks (to 3 December 2020), and then revised extensively during several proofing stages through to mid-February 2021. Inevitably, the book is not fully formed.
So, although I did try to make references to Foucault’s biopower framework, which Hannah alludes to (in mentions of Giorgio Agamben’s work on the pandemic), I certainly did not develop these ideas fully. Since publication, I have become aware of other elements that I certainly would have included had I had more time for research. I had not known, for instance, that very short lockdowns had been trialled in Sierra Leone and Liberia during the Ebola epidemic in 2014, a policy criticized at the time by Médecins sans Frontières and which subsequent research deemed ineffective. Indeed, I have been accumulating much new material ever since this book went to press.
Nevertheless, almost two years into the pandemic, this is a reasonable moment to consider this book’s analysis and its ongoing applicability. While the data may have changed and while, as Neely points out, the question of the vaccine has become central policy-wise, the book’s focus remains relevant: on the one hand, as Hannah notes, through its critique of the absence of social science perspectives in policy responses; and, on the other, through its questioning of the impacts of the lockdown policy model.
The two reviews offer contrasting perspectives. Hannah’s is more supportive of my critique of the Covid policy response and how this has produced enormous increases in inequality and collateral health harms. Neely, meanwhile, is less willing to follow this critique, suggesting that the world that emerged at the start of the pandemic offered hope for challenging future inequalities through care for the vulnerable and as seen in the global uprisings following the George Floyd murder.
One element unites both reviews. Despite the venue for this discussion – Africa – neither has much to say about the continent. This surprised me, but on reflection it may mirror the response to the pandemic, which I argue in the book has been very nationalistic. Certainly, on my reading anyway, Neely’s pivot to US President Biden’s stimulus package as a counterargument to the book’s critique of lockdowns does little to engage with its thematic of global inequality.
So, what does evidence from Africa suggest, one year on? Does it support the top-down lockdown model promoted by the WHO, which The Covid Consensus criticizes? The evidence is even clearer now than when the book was first published. In December, I wrote:
At the time of writing (December 12), data shows that Covid-19 has killed around 225,000 people on the African continent in almost two years, whereas roughly 9 million people die in Africa every year. 172,500 of these deaths have occurred in just 6 countries: South Africa, Morocco, Tunisia, Libya, Egypt and Algeria. Thus, the total recorded Covid-deaths in the rest of the continent are less than 55,000.
Many claim these figures are a large underestimate. The Stanford University Professor of Medicine John Ioannides has estimated that they represent between 30% and 80% of the true figure, that is, roughly half the true total. But let us be more drastic, and say the true figure is four times that recorded – or roughly 200,000 deaths in the rest of the continent. How can it be the case that this level of mortality has had all the destructive effects that are noted?Footnote 1
The evidence on these effects is stark: more than 40 million additional people in Africa in extreme poverty by late 2021 when compared with 2019. Some 4.5 million children removed permanently from education in Uganda alone. The last twenty years of development gains wiped out, according to Ayoade Alakija, co-chair of the African Vaccine Delivery Alliance. Huge increases in child marriage, especially in Nigeria. And a situation where, according to the International Labour Organization, 40 per cent of domestic workers, street vendors and waste pickers are still earning less than 75 per cent of their pre-Covid earnings. Meanwhile, as Hannah notes in his review, austerity programmes to pay for Covid indebtedness will have alarming consequences for future public health measures.
And all this to treat a disease that, as the mortality figures discussed above show, is less severe in Africa than existing endemic diseases on the continent. Since the book came out, I have conducted interviews for Collateral Global that confirm this analysis. Colleagues from Angola and Ghana have stated that SARS-CoV-2 is just one endemic disease among many, less severe than existing endemic diseases, a point that has been confirmed in articles from Angolan and Mozambican doctors.Footnote 2 And yet the medical and socio-economic infrastructure of the continent has been undermined by a lockdown policy that, as noted above, had been contra-indicated following the response to Ebola in 2014.
Nonetheless, Neely holds that the first months of the pandemic response held out great hope since ‘a new attention to the central tenet of public health – to care for and protect the vulnerable – offered new possibilities for thinking about how we live together and how we support one another in this world’. From my perspective, this seems to hinge on what is meant by the terms ‘care’ and ‘vulnerable’. Caring for the vulnerable is a noble ideal, but as the data above demonstrates, in practice vast numbers of additional people in poor countries have been rendered vulnerable – deprived permanently of education and livelihoods and made food insecure, while gendered inequalities and gender-based violence have soared. In a context where, as I point out in the book, the WHO itself estimates that 45 per cent of child deaths under five years are caused by malnutrition, the health impacts of this policy response are catastrophic: as a December UNICEF report put it, children around the world face the biggest crisis in the organization’s history.Footnote 3
To turn, briefly, to Western countries, subsequent data has shown that the lockdown policy response did not care for many of the vulnerable in wealthy societies either. A December Collateral Global report found that 40 per cent of Covid mortalities in Western nations took place in care homes.Footnote 4 Thus the lockdown response did not care well for those most at risk from Covid; meanwhile, as referrals for severe mental health crises among young people have increased by as much as 77 per cent in the UK and Spain, it also enormously increased the vulnerable population in Western nations.
I would argue, in sum, that a policy idealizing care for the vulnerable, which does not protect the most vulnerable and renders hundreds of millions of other people newly vulnerable, while making US billionaires alone US$2 trillion richer in less than two years, cannot be deemed either progressive or successful.
Neely notes that the politicization of the Covid debate has pivoted to the vaccine question, pointing to an ‘overlap between the rise of white nationalist movements and anti-mask and anti-vax movements’. And yet, as the impacts of the lockdown measures on poverty, inequality and civil rights emerge, the political reality has become more complex. Certainly, these movements mentioned by Neely are being weaponized by some far-right groups. Yet many of the unvaccinated in the UK and in cities such as Los Angeles and New York are from minority communities. Many left-wing critics in the West oppose vaccine mandates, from Giorgio Agamben and Massimo Cacciari to Laurent Mucchielli, Max Blumenthal and Black Lives Matter New York. The article I wrote with the Italian socialist writer Thomas Fazi for UnHerd was translated on critical/hard left platforms in France, Italy and Spain and was the subject of a feature in the Norwegian left daily Klassekampen.Footnote 5 Meanwhile, a left-oriented Covid-critical network has grown in the Netherlands.
This is fast-moving ideological terrain. The comfortable ideological certainties of the early Covid days no longer hold. They never did, because it was clear from the outset that the world’s richest people would become far richer, the world’s poorest far poorer. And this is precisely what has happened. To me and to an increasing number on the critical left, that is not a progressive response – and it has also created a public health catastrophe.
This was the origin of the articulation I tried to develop, on the hoof, in The Covid Consensus, and it will guide the next edition of the book, which Thomas Fazi and I will be preparing over the coming months.
