Another pandemic, another crisis?

By Steven Robins

Professor Steven Robins has published on a wide range of topics, including the politics of land, development, urban studies, citizenship and governance, and truth and reconciliation. More recently he has been writing on the global climate crisis as well as Covid-19 and the political implications of humanitarian aid. His most recent book is Letters of Stone: From Nazi Germany to South Africa (Penguin Random House, 2016). He is employed as a Professor in the Department of Sociology and Social Anthropology at the University of Stellenbosch. He is a member of the board of the Institute of African Alternatives (IFAA).

In striking contrast to Covid-19, the “slow violence” of global health crises such as AIDS, TB, malaria, climate change and malnutrition are left to silently kill in the shadows – without significant disruptions to the global economy, 24/7 media attention and overriding international concern. Could this be because they are seen to be “ordinary suffering” and outcomes of structural violence that unfolds slowly? Why are some crises taken more seriously than others, and how did the Coronavirus come to crowd out these other catastrophes in our midst?

In February 2009, following the devastating 2008 financial crisis, President Obama’s White House chief of staff, Rahm Emanuel, publicly stated, “You never want a serious crisis to go to waste.” According to Will Wilkinson, a researcher at the libertarian Cato Institute, this statement revealed the Obama Administration’s strategic plans: “Not about to waste his opportunity, Obama’s going big. A cap and trade carbon permit system, a fundamental overhaul of American health care, and huge new subsidies for ‘green’ technology are just a few of the big‐ticket items the president wants to nail down before his window of crisis closes.”

Naomi Klein uses terms such as “shock doctrine” and “disaster capitalism” to refer to the ways in which governments and corporations exploit crises for profit and political gain. Clearly, crises are open to many possibilities.

We live in a world where we are bombarded by crises all the time – hurricanes, floods, droughts, nuclear disasters, wars, health disasters, climate change and countless other catastrophes. We are currently in the midst of yet another global crisis, one that has led many writers, activists, scholars and media commentators to speculate on what lies beyond it. For some, the Covid-19 crisis offers the possibility of helping to bring about the end of neoliberal capitalism and usher in a global New Green Deal, while for others it threatens a global economic depression and the spectre of authoritarian populism, possibly fascism.

But even beyond these speculations, what is extraordinary about the Covid-19 crisis is the scale of the response to the virus, namely the global spread of a standardised lockdown approach. By introducing lockdown in almost every country, the global economy was disrupted as never before. Why did Covid-19 alarm governments everywhere, whereas other global health crises such as AIDS, TB, malaria, and malnutrition have been left to silently kill in the shadows, without the same kind of international concern and media attention? Why are some crises taken more seriously than others?

As Rob Nixon has observed, writers, journalists and activists often face difficulties and dilemmas in drawing attention to crises that are not spectacular, but are instead about “ordinary suffering” and structural violence that unfold slowly, and without much public and media attention and visibility.[1] Examples of this include the long-term health consequences of human disasters such as the Chernobyl and Fukushima Daiichi nuclear meltdowns, the Bhopal gas explosion, HIV/AIDS, TB, climate change, and countless other forms of “slow violence” that do not conform to graphic imagery of instant media spectacles.

While the spectacular explosions at Chernobyl, Fukushima and Bhopal initially drew international television crews, this media attention was short-lived as international journalists and NGOs quickly redeployed to other crises elsewhere. Similarly, the “slow dyings” from diseases such as HIV and TB do not draw the same kind of media and public attention as the dramatic imagery of trucks being used as temporary mortuaries during the Covid-19 crisis in New York City. Yet, in early June 2020, at a time when the United States had over 100,000 Covid-19 deaths, television news migrated from Covid-19 hospital wards to the burning streets and mass protests that followed the police murder in Minnesota of an African American man, George Floyd. Mass media attention proves to be hyper-transient.

As we live through the spectacular high-speed Covid-19 crisis, we seem to have lost sight of other crises taking place in various parts of the world. So, how did Coronavirus come to crowd out so many of these other catastrophes in our midst? Closer to home, what made the Covid-19 crisis so different to another pandemic that hit our country’s shores at the turn of the new millennium – HIV/AIDS?

The Covid-19 crisis had economists predicting an unprecedented global economic meltdown. Given the statistics and predictions, it seemed self-evident that this crisis would dominate the international news and our daily lives everywhere. Looking back, the Coronavirus had already been recognised as a global health threat in early January 2020, when it began to spread from the “wet markets” of Wunan city in Hubei Province, China, to the rest of the world.

It was the television images of overwhelmed hospitals and Covid-19 corpses in makeshift mortuaries in Northern Italy, London and New York that provided the most frighteningly graphic evidence of the devastation this virus could cause, even for well-resourced hospitals in the global North. It was also the modelling by scientists that convinced political leaders and governments to introduce extreme forms of lockdown that involved the unprecedented closing down of economies and societies throughout the world.

The speed with which the virus spread through casual contact, along with the expanding media coverage of the disease, provoked considerable fear and panic in countries that were unprepared for such an epidemic. The World Health Organization (WHO) declared Covid-19 a pandemic and recommended a “suppression strategy” (“lockdown”) involving the suppression of all transmission for 12 to 18 months until a vaccine became available. The WHO also noted that a second option would be a “mitigation strategy” that would aim to control the epidemic until populations developed “herd immunity” but this would come with a very high health burden.[2]

By March 2020, it was the “lockdown” model that was rapidly implemented almost everywhere. Lockdown became the default global health response even though, prior to the Covid-19 outbreak, it had not been part of global pandemic prevention and containment planning.[3] In an extremely short space of time, variations of the Chinese lockdown model were implemented on a global scale even though it was known that this would bring the global economy to its knees. How did this response come about with such speed and resolve in contrast to global responses to other diseases and crises, including the global climate crisis?

Anthony Stavrianakis and Laurence Anne Tessier [4] provide a blow-by-blow account of how “lockdown” became the default Coronavirus response in most countries. They describe how the modelling work of Neil Ferguson and his team at Imperial College London provided the scientific justification for lockdown measures. It was the scale of Ferguson’s predictions of Covid-19 deaths in the UK, US and Europe that influenced political leaders to opt for such measures.

Stavrianakis and Tessier tell us that on 14 February, during an interview on Channel 4 News (UK), Ferguson had stated that his models indicated that 400,000 people could die in the UK from Covid-19 unless extreme “suppression” (i.e. lockdown) measures were introduced. Four days after Ferguson presented his findings to French president Emmanuel Macron on 12 March, France implemented a general lockdown (“confinement”). On 15 March, the White House received Ferguson’s report, and his predictions of an estimated 2 million deaths in the US without a lockdown was the catalyst for the US policy response, including the acceptance of Ferguson’s recommendation that schools be closed and that gatherings of more than 10 be avoided. On 16 March, Ferguson met UK Prime Minister Boris Johnson, and on 23 March the UK announced a stay at home order and closed schools. The Chinese model of a blanket shutdown of the city of Wunan and the province of Hubei had rapidly become international “best practice”, even though, as Stavrianakis and Tessier have argued, it was based on flimsy scientific evidence.

Carlo Caduff, who has done extensive research on past pandemics, claims that governments in powerful countries used panic and fear about death to justify lockdown measures, which were sometimes driven by “authoritarian impulses” rather than reliable scientific data. He suggests that Covid-19 responses departed dramatically from previous pandemics partly due to the “political visibility of the deaths” as well as “the fear of death in powerful societies eager to repress the inescapable reality of death”.[5] Caduff also observes that there have been no equivalent responses to worldwide fatalities caused by preventable and treatable “Third World diseases” – each year there are 1.3 million TB deaths, 770,000 deaths due to HIV infections, and 435,000 malaria deaths. Neither have there been such extreme responses to the between 300,000 to 500,000 people who die from seasonal viruses every year, or the millions who died in influenza pandemics in 1957 (1-2 million) and 1968 (2-4 million). So, why did Covid-19 elicit such measures?

Caduff attributes the exceptional response to a number of factors, including “the speed of infection, the clinical picture of the disease and the impact on demographically older populations causing massive compression of morbidity and mortality that is overwhelming weak healthcare systems with no excess and low surge capacity”.[6] According to Caduff, the Covid-19 health disasters that played out in the United States, the UK and Europe, in overwhelmed hospitals and elder-care homes, were largely a result of neoliberal policies that led to the “systematic divestments in public health and medical care that have created fragile systems unable to cope with the crisis”.[7] Caduff also suggests that rather than using reliable scientific data and pandemic preparedness strategies that had been developed over the past 15 years, governments justified draconian lockdown measures by means of a “politics of fear”. As Caduff concludes, “Loose science, lack of data, speculative evidence, strong opinions, misinformation, exaggerated mortality rates, the 24/7 news media attention and the rapid spread of dramatic stories on social media have led to poor political choices and major public anxiety.”[8]

Caduff and other critics have asked how the Covid-19 crisis came to be singled out for such an exceptional and unprecedented global health response, whereas there have not been similar responses to other treatable diseases such as AIDS, malaria and TB. They also ask why the modellers, such as Ferguson, did not factor in “externalities” such as the devastating economic and health consequences of lockdown measures, especially in poorer countries in the global South where AIDS, malaria, TB, food insecurity, chronic poverty and malnutrition are so widespread. To address these questions, we will now turn to the cases of HIV/AIDS and Covid-19 in South Africa, where the Ramaphosa administration has been widely praised for taking the Coronavirus  crisis seriously from the start.

AIDS and Covid-19: A case of competing crises?

 There are of course many differences between the Covid-19 and HIV/AIDS pandemics in South Africa. For instance, in contrast to the scientific and epidemiological uncertainty surrounding Covid-19, by the late 1990s there was a global consensus regarding the science and treatment of HIV/AIDS. Yet, soon after former President Thabo Mbeki assumed office in 1999, he began flirting with AIDS dissident science, and insisted that AIDS in Africa was a “disease of poverty” caused by malnutrition and compromised immune systems. He also claimed that a profiteering global pharmaceutical industry was using Africans as guinea pigs to test and market their toxic antiretroviral drugs. AIDS activists and health professionals responded to President Mbeki’s dissident position by mobilising around a life and death struggle for treatment. In the course of these struggles, activists not only challenged President Mbeki’s position, but also legally challenged the global pharmaceutical industry and the TRIPS intellectual property regime in order to clear the way for the production of cheaper generic drugs in countries of the global South such as India, South Africa and Brazil. But the biggest challenge in the late 1990s and early 2000s was to convince the government and citizens that AIDS was indeed a “national health crisis”.

Together with health professionals, NGOs and the media, the Treatment Action Campaign (TAC) was exceptionally successful in bringing the pandemic into public visibility and defining it as a national crisis. The TAC was founded in Cape Town in 1998 by Zackie Achmat at a time when there was still a veil of silence about the disease due to a range of factors relating to taboo, stigma, fear, denial and shame. Activists not only had to challenge AIDS dissidents, but also a range of alternative explanations of the causes of HIV ranging from dissident science to witchcraft beliefs. As the anthropologist Leslie Bank has noted, the shame and stigma of HIV also meant that families of the deceased often tried to cover up the causes of the deaths.

It was only through mass mobilisation in virtually every space of South African society that activists ultimately succeeded in getting the wider public to accept the basics of AIDS science, to test for HIV, and to take the treatment when testing HIV-positive. In April 2003, following global and international pressure, President Mbeki’s Cabinet eventually decided to provide antiretroviral therapy in the public health system. Once treatment became available, the disease began to vanish from media visibility and public discourse. It appeared that it was now no longer necessary for people living with AIDS to mobilise – they simply visited their physicians, clinics and hospitals for checkups and to get their drug supplies. The “slow dyings” from HIV were thereby rendered invisible to the wider public.

In 2014, activist Mark Heywood publicly denounced AIDS complacency amongst government and donors by observing that, on every World AIDS Day on 1 December, there are political speeches and media coverage of the pandemic, but these annual ritualised expressions of public concern are typically followed by silence and denial about an epidemic that has continued to devastate South Africa. In 2018 UNAIDS revealed the following statistics for South Africa: 7.7 million people were living with AIDS; 240,000 new HIV infections; and 71,000 AIDS-related deaths. Although the crisis was clearly far from over, it appeared that the “slow dyings” of people living with HIV meant that this pandemic was no longer seen to be a national crisis. Moreover, with treatment now available, it was widely assumed that AIDS was simply another chronic, manageable disease, much like diabetes, hypertension, obesity and TB.

When it comes to TB in South Africa, the situation is equally grim – in 2018 an estimated 301,000 South Africans became ill with TB and 63,000 people died from the disease.[9] Even though TB deaths in 2017 were four times greater than the 21,022 murders between April 2018 and March 2019, and South Africa has the fifth highest burden of TB in the world, this disease has become normalised and is not seen as a national crisis. The same could be said of gender-based violence, chronic poverty, inequality, malnutrition, poor access to housing, water and sanitation, massive unemployment and so on. Why are these not also seen to be national crises? Could this be attributed to the “unspectacular”, slow-moving nature of these diseases?

In the midst of the Covid-19 crisis, top South African scientists such as Professors Glenda Gray and Shabir Mahdi warned government that the lockdown measures were causing “collateral damage” in relation to other health conditions whereby many citizens were not coming to clinics and hospitals for vaccinations and TB and HIV treatment. Professor Gray caused a political storm when she claimed that malnutrition was becoming a problem in the country because of the lockdown and the exclusive focus on responding to the Covid-19 crisis. So, how can we better understand how this concept of “crisis” works in public, political and academic discourses?

In her 2013 book Anti-Crisis[10], Janet Roitman analyses the concept of “crisis” in social science theory and writing. Drawing on the work of the German historian Reinhart Kosellek (1988), she examines how crises come to be “defined as turning points in history” and how this shapes decisions and judgements about the past, the present and the future. Crisis moments, according to Roitman, are also “instances when normativity is laid bare,” and this makes it possible to inaugurate new redemptive and utopian historical times.[11] Roitman illustrates this with former President Barack Obama’s famous speech about a new hopeful future in the aftermath of the 2008 economic crisis. In this speech, Obama not only made judgments about the ethical failure of those bankers responsible for creating the “false value” and “toxic” housing bonds of the “bubble economy”, but he also used this financial crisis to envision a new world that would be profoundly different from the past.

Many commentators on Covid-19 have viewed this crisis as a portal to the devastation of capitalism[12], as well as a potential “historical turning point” that could usher in the end of neoliberalism.[13] Closer to home, in April 2020, during the Covid-19 crisis, President Ramaphosa identified the pandemic as a “turning point” in South Africa. In a televised speech to the nation, Ramaphosa told South Africans that this was a totally unprecedented crisis and that the country would never be the same again. He envisaged a new economy would emerge from the ashes of Covid-19, and announced the country’s largest ever rescue package of R500 billion. What this speech also seemed to acknowledge was the need for “radical economic transformation” to address what Covid-19 had laid bare – the extreme racialised inequalities, massive structural unemployment, chronic poverty, inequality and hunger. Although all of this was already known, it was the Covid-19 crisis that made Ramaphosa’s revelatory critique of the existing order possible, along with his articulation of an ethical demand and moral task for creating a fundamentally different society in the face of the devastating consequences of the disease. Whether or not that will happen is another story entirely. Meanwhile, for those living in violent and precarious conditions – the poor, marginalized, unemployed and those living in war zones and shantytowns  – “chronic crisis” is lived as an enduring everyday reality with no end in sight; for them crisis is endemic rather than episodic.[14]

While we live in a world of multiple, ongoing crises, during the first half of 2020 the world seemed focused on one crisis only – Covid-19. Then, towards the end of May 2020, came the explosion of rage across the US in response to the video of the brutal police murder of George Floyd in Minneapolis. The response to Floyd’s cold-blooded murder, one of a litany of similar “lynchings” of black men and women by police, brought to the surface centuries of racialised violence experienced by African Americans – on slave plantations, in prisons and on the streets.

The media reporting of the protests following the “spectacular violence” of the murder of George Floyd seemed to temporarily displace and render invisible the “slow violence” of racial capitalism and its economic and health disparities that have produced disproportionate deaths of black American and Latino citizens from Covid-19. Yet, studies have revealed how racialised poverty has contributed towards the comorbidities of high blood pressure, diabetes and obesity that have rendered black lives more vulnerable to Covid-19. Moreover, black and Latino Americans are also disproportionally represented as “essential workers”, even as they are treated as disposable by the neoliberal logic of the capitalist society they live in.

When Covid-19 is over, we may well return to the question of how it was possible that Covid-19 came to obscure the devastation caused by a multiplicity of other ongoing crises of “slow violence” that typically do not make it onto television news. We may also want to reflect on how AIDS in South Africa morphed from being recognised as a national health crisis, to a chronic manageable disease characterised by “slow dyings” and “ordinary suffering.” In the spirit of Rahm Emanuel’s call not to let a serious crisis go to waste, we need to ensure that the global Covid-19 crisis becomes a catalyst for systemic economic and public health transformations to address the consequences of everyday health disparities that are typically not televised.

While many on the Left hope the Covid-19 crisis could be a catalyst for a shift from fossil fuel-driven neoliberal capitalism to a more environmentally sustainable and socially just future, at the same time right-wing and authoritarian governments everywhere are also determined not to let this crisis go to waste. With the outbreak of Coronavirus, countries such as China extended their mass surveillance systems and introduced new forms of state control over its citizens, while Hungary’s Prime Minister Orban used the crisis to further restrict freedom of expression and postpone elections. Similarly, President Trump invoked an economic “emergency” arising from the Covid-19 crisis to dismantle federal regulations designed to protect workers, consumers, investors and the environment.[15] In the name of “unburdening the economy”, he signed an executive order allowing agencies to waive 50-year-old environmental laws to accelerate federal approvals of pipelines, highways and other infrastructure projects. Crises can clearly be used and abused for many purposes – in the name of corporate profits, “disaster capitalism” and authoritarian rule, or to promote progressive change and social justice. It is all up for grabs.

ENDNOTES

[1] R. Nixon, (2011), Slow Violence and the Environmentalism of the Poor, (Cambridge, Mass: Harvard University Press); N. Shepherd, (2019), “Making Sense of ‘Day Zero’: Slow Catastrophes, Anthropocene Futures, and the Story of Cape Town’s Water Crisis,” Water 11(9), 1744; available at https://doi.org/10.3390/w11091744

[2] A. Stavrianakis and L. Anne Tessier, (2020), “Go Suppress Yourself – A Chronicle”, May 20, in Dispatches from the Pandemic, available at http://somatosphere.net/2020/go-suppress-yourself.html/

[3] See C. Caduff, (2020). “What Went Wrong: Corona and the World after the Full Stop,” available at https://www.academia.edu/42829792/What_Went_Wrong_Corona_and_the_World_after_the_Full_Stop

[4] Op.Cit. “Go Suppress Yourself”.

[5] Ibid., p 9.

[6] Ibid., pp p. 6-7.

[7] Ibid.

[8] Ibid.

[9] World Health Organisation. (2019). “Global Tuberculosis Control. Geneva, available at www.who.int/tb/publications/global_report/en/

[10] Janet Roitman, (2013). Anti-Crisis. (Durham, North Carolina: Duke University Press).

[11] Ibid. pp 3-6.

[12] Arundhati Roy (2020). “The Pandemic is a Portal,” Financial Times, available at https://www.ft.com/content/10d8f5e8-74eb-11ea-95fe-fcd274e920ca?What&fbclid=IwAR2qC9QnHcOrV-0bl_1XQIjwerN1msMlR0XmxVdGG7jQTC-jzW1EWm_a3j4

[13] R. Bregman. (nd). “The neoliberal era is ending. What comes next?” The Correspondent, available ay https://thecorrespondent.com/466/the-neoliberal-era-is-ending-what-comes-next/61655148676-a00ee89a

[14] H. Vigh. “Crisis and Chronicity: Anthropological Perspectives on Continuous Conflict and Decline.” Ethnos, Vol. 73:1, March 2008 (pp.5-24).

[15] https://www.washingtonpost.com/climate-environment/citing-an-economic-emergency-trump-directs-agencies-across-government-to-waive-federal-regulations/2020/06/05/6a23546c-a0fc-11ea-b5c9-570a91917d8d_story.html?fbclid=IwAR27ibwuKEC-_iJcmKZ9K0rirucIx7AQNo0lMnQn5x7lvjIipMzMusAST18

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