There’s an interesting pattern that emerges from the coverage of how different countries have performed in their Covid-19 response: it is greatly influenced by their experience of previous disease outbreaks:
West Africa, Uganda and DRC had Ebola
But the worst-hit areas – Europe and the US – have a collective narrative that has been shaped by the flu, a much more humdrum disease, with a vaccine. Could this be to blame for a laxer response in parts of both, with great costs?
This is about a society’s readiness to take a threat seriously and make sacrifices while there is still time, more than just health authorities and others learning from the last outbreak, although that’s important too.
There’s also a temporal aspect – memories fade, but Nipah, SARS, MERS, Ebola etc are recent enough that health systems (formal/informal) and social norms are still highly activated in the policy and social consciousness – like a societal immune response. In contrast, Spanish Flu, which caused havoc in Europe after World War One, has since faded from the collective memory – society has lost its antibodies.
This could also help explain another oddity. The pre-Covid global ranking of pandemic preparedness bears no resemblance to countries’ actual performance. In that index, the US ranks first in preparedness, so either the measures they use are inadequate or politics and other factors (such as memory of previous disease responses) play a much much greater role than the index allows for.
The Index claims it ‘provides a comprehensive assessment of countries’ health security and considers the broader context for biological risks within each country, including a country’s geopolitical considerations and health system and whether it has tested its capacities to contain outbreaks.’ I presume there is some serious rethinking going on about how it measures these things.
There is a global element to this process – the WHO tries to learn lessons and spread them around. According to a recent piece in The New Humanitarian, ‘The 1995 outbreak of Ebola haemorrhagic fever in the Democratic Republic of Congo prompted the World Health Organisation to create global intelligence and response networks that became instrumental when rumours of a “fatal flu” arose in China in late 2002.’ But if this runs up against a different national experience, it seems likely to founder.
Obviously, these are massive generalizations and raise lots of questions:
How has the fact that we know how to prevent the spread of HIV affected the South African and other heavily HIV-affected countries’ responses? Has it made countries with wider ARV availability more complacent than those with higher death tolls?
History is not destiny: Brazil under Lula might well have taken a different path than under Bolsonaro; Kerala under a different health minister might well have done things differently.
In Europe, some countries (Germany) have done much better than others (UK).
I keep coming back to that wonderful quote from Marx about the interaction between history and human agency:
‘Men make their own history, but they do not make it as they please; they do not make it under self-selected circumstances, but under circumstances existing already, given and transmitted from the past. The tradition of all dead generations weighs like a nightmare on the brains of the living.’
And there were some dogs that didn’t bark – Zika doesn’t seem to have helped Brazil much. Why not?
One hopeful final thought, does this mean flu will be replaced by Covid in our collective memory, so next time we’ll do better?
When I asked Melissa Parker about this, she pointed out ‘The dark side to responding needs to be foregrounded too … in Uganda Museveni is clearly using COVID-19 to further political power. Superficially, it looks as if he is acting responsibly and able to do so because he is able to capitalize on recent experiences and memories of Ebola, but in practice the brutal imposition of lockdown is creating hunger, and people are afraid of attending health services. Will we see what we saw in Sierra Leone – that more people end up dying of malaria, maternal deaths etc than ever die from COVID-19?’
Thanks to Anna Marriott for her suggestions on this post