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Ghana in COVID-19 Pandemic – one year on

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More than a year has passed since the COVID-19 virus first emerged in Wuhan, China. Since then it has spread rapidly across the world, thrusting nations, communities and families into a pandemic that has yet to end. To date, we are discovering new strains of the virus that are much more infectious. Notably, the strain first identified in the United Kingdom, followed by the South African, Nigerian, Brazilian and possibly, even German and Japanese strains. More and different strains of the virus are likely to emerge as the scientific community focuses its attention on how the virus is mutating as viruses do, and how well COVID-19 in particular, is adapting to our bodies and the environment, in ways and speed the world has not seen before.

Ghana in West Africa, with a population of about 30 million has a young population with median age of about 21.5 years. Considered a middle-income country by the World Bank before the pandemic, it is fast becoming a West African hub for international travel and business, enjoying close political, economic, as well as social ties with the United States of America, the United Kingdom and the European Union. China is its second largest trading partner, after the US. As an anglophone country, it remains within the western sphere of influence in terms of economics, politics, military, mass and social media, education, language, culture and religion (a predominantly Christian country with a Muslim minority). All these factors account for the way the pandemic has entered and spread in the country, and the responses of the government and its people.

Being part of the African Union, Ghana’s response to the pandemic is also shaped by its multilateral ties and cooperation with the rest of the continent. Ghana like most countries in Africa, is burdened by high foreign debts, under-investment of infrastructure including, the public health system and ‘robbed’ for centuries, of its economic gains due to unequal and unfair trade and loan agreements with other countries, primarily China, Europe and the USA. Such disparities in geo-political, national, social, and economic realities have given rise to vast differences in the way COVID-19 has emerged and spread in Ghana, as well as the responses of its government and people.

Urbanization creates conducive conditions for the transmission of infectious diseases, such as COVID-19, due to high population density in cities. Moreover, improved transportation and increased mobility of humans, goods and services, aid the spread of COVID-19, given that it is predominantly transmitted from human to human, from surfaces to human and even airborne, which makes large, vast and crowded urban, metropolitan areas susceptible to its spread. Thus, the rapidity of the spread of COVID-19 is closely connected to the speed, density, and intensity of human activities, movement, and interaction. Similarly, globalization is a vector of the disease due to an exponential increase in cross-border travel and air traffic, Ghana included.

The first COVID-19 positive cases in Ghana were officially reported in early March 2020. They were Ghanaians and foreigners arriving from Europe and Nigeria by air. Even though Ghana and Africa have had the benefits of hindsight, having observed how COVID-19 sent China and Asia, as well as Europe reeling, the detection of positive cases on Ghanaian soil still took the government by surprise. The government eventually closed its air, sea and land borders on 22nd March 2020 and a three-week lock-down from 30 March to 20 April was imposed on major cities like the Greater Accra Region where the capital is, as well as Kumasi, its second largest commercial city,

Following the lock-down, schools were closed, church and social gatherings including, funerals were banned while testing for the virus and contact tracing of positive cases were carried out. Specific hospitals and testing centers were designated for COVID-19 and the local media began to report daily, the number of confirmed cases, recoveries, and deaths. Many migrant workers returned to their home villages from cities because of job losses and homelessness. The sudden and prolonged closure of commercial activities had taken a toll on migrant workers and the working class in urban centers. The government temporarily provided free meals to certain vulnerable groups, such as the ‘Kayaye/Kayayo’ i.e. women porters who depend on public markets for their livelihood, but the reach was limited and fraught with problems including, corruption.

By 1 September 2020, the country’s air borders were opened but land and sea borders remain closed until today. As the country’s first line of defense against importation of the virus, the fourteen-day mandatory quarantine of in-bound travelers is replaced by self-paid, mandatory anti-gen tests (USD 150/- per test for non-ECOSWAS nationals and USD 50/- for ECOWAS nationals) at the Kotoka International Airport. To date, the country’s President has made twenty-three national addresses on policies and measures taken. Since mid-January 2021, schools and universities have reopened, along with some relaxation of social restrictions.

With the advantage of hindsight by observing and comparing the different government approaches in tackling the pandemic, Ghana seems to navigate its way through, without huge upheavals or disasters. Despite the country’s relatively free press, it is however, difficult to ascertain how COVID-19 related data is collected or produced, controlled, and interpreted, as well as how accurately it is conveyed to the public. There are many factors that prevent the authorities from consistently and adequately publishing COVID-19 related statistics in a timely manner including, the lack of infrastructure, resources, and technology that industrialized and developed economies take for granted. Additionally, changes in COVID-19 test and trace regimes and classification of ‘recoveries’/ ‘active cases/deaths’ also have implications on the statistics presented. Published figures do not take into account, unreported, undiagnosed or asymptomatic cases, as well as unreported and undiagnosed deaths, which are common in the vast rural areas.

Further, the backlog in testing and delays of test results that could go up to two weeks mean that government statistics may not reflect the reality. Moreover, as a vast country with under-developed infrastructures, the efficacy and thoroughness of contact tracing remains limited. There is growing concern of many more ‘asymptomatic cases’, which official statistics do not capture. Henceforth, the ‘silent spread’ of the disease in local communities may be more prevalent than known. While testing and treatment may be free for Ghanaians who seek help in public hospitals, which have limited capacities, private clinics and hospitals that provide COVID-19 tests charge from USD 40 to 120 per test, with the most expensive tests delivering results within 24 hours.

On the other hand, the government has invested considerably in its messaging to the public about the pandemic and its response. Nevertheless, confusion and misinformation continue to spread, mainly through the social media, which the majority has access to because smart phones are so popularized, they transcend urban-rural and class divides. Until effective treatment and cures are found, and vaccines effective against the various strains of the virus become available to the majority in Ghana, no one is truly safe; especially given its under-funded, under-equipped and fragile public health system. Besides COVID-19, Ghana still has a high rate of HIV/AIDS infection, and sporadic outbreaks of diseases like H5N1, Lassa Fever and lately, Meningitis. Not to mention the ongoing malaise of malaria, cholera, typhoid, yellow fever, as well as hepatitis among its population. COVID-19 is just an addition to the already long list of public health threats that people in Ghana must live with.

After the initial shock and panic in early 2020, partisan politics eventually caught up with the ‘pandemic narrative’. Leaders from the two major political parties, the New Patriotic Party (NPP) and the National Democratic Congress (NDC), as well as state dignitaries and officials began to spin conflicting and even contentious narratives about the virus, its origin, dangers, cures, vaccines, and other implications to bolster their political agendas and popular support. In other words, after headlining COVID-19 in the mass media for several weeks, the issue has become politicized, at the expense of public health.

The ruling elite has been systematically managing public’s perception of the pandemic to augment their political interests, minimize the damage to its economy and to capitalize on the situation. Consequently, the increasing number of COVID-19 cases ‘plateaued’ before last December’s Presidential and General Elections and social restrictions were eased ahead of the polls. The incumbent National Patriotic Party won the elections by a narrow margin despite ongoing legal challenge by the opposition, the National Democratic Congress, on grounds of electoral fraud and irregularities.

As a liberal democracy, it is impossible for the government to adopt authoritarian measures to curb the pandemic because it is politically, socio-culturally, technologically, and logistically untenable. Economically, given that most of its people work in the informal sector and rely on daily wages, strict regulatory measures immediately put Ghana in a conundrum. Should it curb the COVID-19 pandemic or the poverty pandemic that can lead to malnutrition, starvation, pauperization and increased criminality? This is a political choice with profound implications.

Ghana’s economy is largely agricultural and heavily reliant on export of primary and natural resources. In addition, its level of ICT advancement and literacy differ markedly from developed economies and between the urban and the rural. This partially explains the difference in people’s understanding and consciousness about the pandemic. All these affect how local communities react to social distancing, restriction measures and their trust in the public healthcare system. Moreover, fear of stigma and discrimination, which cuts across socio-economic classes, educational background, and professions has led to people’s reluctance to be tested despite exhibiting symptoms including, members of the parliament, which in turn affects the efficacy of tracing. Even though measures like social distancing, wearing of masks and hand washing are mandated in public, commercial and official premises, its implementation and monitoring are uneven despite stern warnings and threats of fine and imprisonment. And where law enforcement is involved, particularly during the initial period of the outbreak, there were numerous reports of police and military abuse. Inadequate information and misinformation also made it difficult for the public to abide by the rules.

One year on, people in Ghana are experiencing ‘COVID-19 fatigue’. Hand-washing stations (known locally as ‘Veronica Buckets’) placed in and around small and medium-sized enterprises, are gradually disappearing. Less and less people are wearing masks in the streets. As restrictions on social gatherings like church services, funerals, parties, dining-in and meetings relaxed, there is a growing sense that life has returned to ‘normal’, that is, until this January when the country sees spikes in positive cases and deaths again. With the 23rd national address of the President, Ghana has officially entered the second and more virulent wave of the pandemic. At the point of writing, test and treatment centers are full, hospitals are inundated by COVID-19 cases, leading to lack of beds and even oxygen supply, as in the case of a well-known hospital. Stringent social restrictions are back but institutions of education remain open, despite the call of the National Teachers’ Union to close schools due to inadequate PPEs (masks, hand sanitizers, running water, etc.), with increasing number of students and teachers infected across the country. The government has confirmed that the first batch of a limited supply of vaccines will arrive in March. However, as a developing country struggling with a fragile public health system and inadequate infrastructural development for decades, the impact of such a limited scale of vaccination, which is contingent on the ‘who, how, where and when’, coupled with people’s general hesitation to be inoculated, remains unclear.

Key barriers in tackling the pandemic for Ghana are popular skepticism about the disease, fear of stigma and discrimination, distrust of the government and the under-funded public health system. COVID-19’s arrival in Ghana was initially greeted with skepticism and denial, partly due to the lack of information and over-reliance on western media, which was slow in reporting about the pandemic until it broke out in the US, UK and across Europe. Besides, fake news like ‘Black people and Africans are naturally immune to the disease’, ‘Bleach can cure COVID-19 virus’, ‘it is a Chinese disease because Chinese eat bats and wild animals’, and ‘wearing masks do not protect us’, abound. It was only after COVID-19 was declared a pandemic by the WHO that the government began to intervene, and public education was rolled out, mainly through mass and social media. Whilst fear of the disease sent panic to COVID-19 hotspots like the capital city of Accra initially, misinformation and poorly conceived protective and preventive measures by individuals and businesses persist until today. It is particularly problematic that people were bombarded with news that could not be fact-checked but widely accessible through social media.

Furthermore, due to the bi-partisan characteristics of Ghanaian politics, COVID-19 as a public health issue became a point of contention and contestation between the ruling party and the opposition. This inevitably gives rise to conflicting public messaging, which causes even more confusion and skepticism among the public. Aggravated by people’s longstanding distrust in their political leaders and officials, regarded as self-serving and concerned only about their financial and political interests, the government’s effectiveness in tackling the pandemic is further compromised. Such popular distrust of the system is compounded by decades of under-investment and under-development of Ghana’s public health system, which also leads to the proliferation of profiteering clinics and hospitals. A functioning and effective healthcare system must have an adequate number of professional and well-trained healthcare workers, well-maintained infrastructures that are regularly upgraded, and a responsible administration that is not corrupt. Moreover, Ghana's universal health coverage is compromised by the fact that the largest and best-equipped medical facilities are in the two largest cities, Accra and Kumasi. The lack of medical facilities in smaller towns and rural areas where, according to The World Bank, 43.94 % of the population lives in 2018, means that these people has little or no access to adequate medical facilities and care.

The people’s lack of confidence and trust in the country’s healthcare system also leads to fear in seeking help or treatment during the pandemic. People’s avoidance of hospitals and clinics particularly in the rural areas, for fear of COVID-19 infection complicates and aggravates the already poor health conditions among the poor and the vulnerable. The poor and the working class tend to resort to self-medication by purchasing drugs over the counter or relying on traditional medicine and indigenous medical practices as the only option for the majority who cannot afford private healthcare. Moreover, the lack of trust and confidence in the government’s capacity and will to tackle the disease head-on is manifested in the fear and unwillingness of frontline medical workers to remain in their post to treat COVID-19 patients. To date, several high-profile medical professionals, including doctors, have died of COVID-19. The government had to promise additional ‘pay-outs’ like tax rebates and wage supplements to stop doctors and nurses from resigning. This, however, did not prevent illegal practices within the health system like illegal sale of personal protective equipment (PPE) by hospital staff for personal profit. Not to mention, various forms of opportunism that capitalize on people’s ignorance, such as scamming.

With the increasing disparity between the rich and the poor in Ghana, as a result of neo-liberal globalization; detection and treatment of COVID-19 is skewed against the poor, working class and marginalized communities, such as daily-wage or casual labor, urban slums and squatter areas, migrant workers (domestic and foreign/documented and undocumented), as well as refugees. Even before COVID-19, the economic disparity between Ghana’s urban centers and its vast rural areas was widening; as seen in the uneven provision of healthcare, education, infrastructural and economic development. The pandemic is aggravating the divide. For instance, many more people are tested and traced in the big cities where more facilities are available and accessible.

While social distancing and protective measures may be easier enforced (but not always followed) in middle-class or affluent communities, and in government and high-end commercial premises, thereby forming a ‘bubble’ where foreigners and the well-to-do can afford to cocoon themselves from infection or if they are infected, have better access to medical care, such protection is unaffordable for the working class. For the latter’s survival, they still travel in crowded public buses, shop in local markets where social distancing is impossible, and work and live in congested areas, like shanty towns and urban slums. These areas with poor hygiene and sanitation, must also contend with regular flooding during the rainy season, frequent fires that razed neighborhoods to the ground during the dry season, and the ongoing lack of running water. For social distancing and personal hygiene to be properly practiced, there must be constant access to clean, running water; functioning and well-maintained toilets, not to mention, general healthy living conditions. For a developing economy like Ghana where the gap between the rich and the poor is wide and widening, the people are more concerned about the ensuing ‘pandemic of poverty’ than the pandemic itself. Hence, before changing people’s behavior, the country’s medical infrastructure must first improve and strengthen, as well as its economic, environmental, and living conditions. Furthermore, public health awareness should be incorporated into Ghana’s everyday life.

The COVID-19 pandemic has deeply impacted the socio-cultural fabric of the Ghanaian society and the people’s psyche. Funerals are central to Ghanaians’ social, cultural, and spiritual lives. These are huge and lively gatherings held over the weekends, attended by extended families from across the country and even around the world. They are mournful and at the same time, joyous; with lots of dancing, drinking and communal sharing of food. During the funeral ban, (currently relaxed to no more than 25 in attendance), many bereaved families chose not to claim the bodies of the deceased from the morgues and deferring the funerals, which in turn, led to other problems like congestion in the morgues. Similarly, long church services (currently reduced to 2-hours by law) on Sundays for the majority of the population and Friday prayers in the mosques for the Muslim minority, are an integral part of everyday life, so much so that some ‘home-grown’ or independent churches held gatherings illegally, leading to arrests of erring pastors.

Even with the wearing of masks, there are several dimensions peculiar to Ghana that countries in the Global North do not have to reckon with. Firstly, the cost of disposable masks can be unaffordable for the working-class or daily waged workers who must make stark economic choices. In addition, there are the risks of getting masks that do not meet medical standards or fake hand-sanitizers. Since these masks are extremely uncomfortable to wear in the hot, sweltering heat, many people resort to cloth-masks and face shields (without nose masks) that are of little protection.

Furthermore, with schools closed for nearly a year, there is concern that students are not only losing out in their education, their mental health is also at stake. The repercussions of COVID-19 on the education and health of our younger generations are yet to be fully understood. Moreover, the country has yet to discuss the phenomena of ‘Long COVID’ whereby those who have recovered from the illness continue to suffer from long-term side effects.

Internationally, the ongoing US-China rivalry and tension amidst a pandemic, has also significant impact on Ghana. The most apparent being rising racism against Chinese or Asian-looking persons in Africa since Trump has labelled COVID-19 as a ‘Chinese virus’ and the pandemic as a ‘Kung-flu’. Such racist rhetoric is uncritically taken over by social media in Ghana, which has accentuated racism against Asian-looking people who are assumed to be ‘Chinese’, with all the implied stereotypes and racialized discourses. Similarly, African migrants and traders in Guangzhou, China, have reported blatant racism against them by police, hotel owners and landlords due to the pandemic, which had instigated diplomatic protests by several African countries including, Ghana. Both Ghana/Africa and China/Asia have experienced stigmatization, racism, and xenophobia, as a result of disease outbreaks, such as EBOLA and COVID-19. What lessons can we learn to prevent racism, bigotry, and discrimination from escalating? Racist and discriminatory policies and measures articulated through border controls, trade restrictions and in the case of COVID-19 pandemic, regulatory measures that are undemocratically imposed upon the population, can lead to tensions between countries, as well as conflict between peoples.

One year-on, national and international media has shifted its focus from race-based discourses to vaccines and its uneven distribution between the Global North and the Global South. Ghana benefits in no small measure from US aid, not only financially but also in infrastructural support and trade, which ranges from oil exploration to agriculture, as well as political and military cooperation. Similarly, Ghana receives substantial aid and loan from China, before and during the pandemic; ranging from infrastructure (roads, bridges, dams and harbor ports), extractive industries (gold, natural gas, bauxite), trade and investment in agriculture, light manufacturing industries, food production, medical supplies including, COVID-19 test kits and PPE. The ongoing Sino-US rivalry for economic domination has worked largely in favor of developing countries like Ghana, especially in development cooperation, aid, and loans. ‘Pandemic Diplomacy’ is a new and opportunistic form of ‘soft power’ that superpowers leverage vis-à-vis countries in Africa.

On the other hand, the devastating impact of the pandemic on the world’s economy, notwithstanding the American and Chinese ones, has already resulted in deep global recession. The World Bank has projected negative economic growth for all countries in 2021. This will undermine and de-stabilize Third World economies, especially those most reliant on US and China for trade, commerce, investment, loans, and aid. Ghana is bound to feel the economic fall-out of COVID-19 pandemic, if not already. And Third World economies, like Ghana may take far longer to recover economically than developed and industrialized economies.

Due to the pandemic, some industries will collapse and be replaced by new types of industries e.g. bio-chemicals, genetic engineering, pharmaceuticals, ICT/AI. The ‘new normal’ shall see a much more digitized world system with new economic engines that meet demands for an ecologically balanced world. Consequently, disparities in economic and technological development between the Global North and South, will continue to widen in the post-pandemic era.

COVID-19 is the world’s rude awakening, after centuries of extractive and excessive consumerism and materialism. Ghana stands on the juggernaut of either continuing its current path towards neo-liberal economic growth or radically change its development priorities away from namely, unchecked urbanization at the expense of the countryside; depletion of its natural resources; destruction of its ecology in favor of export revenue; reliance on export of cash crops at the expense of its food security and farmers; and last but not least, endemic corruption in the system.

While COVID-19 has divided us by forcing us into quarantine, self-isolation, social distancing, and reduced mobility, it has also brought us closer together by making us keenly aware through the spread of the disease, our inter-connectedness. The virus does not distinguish between class, race, gender, sexual orientations, age, nationality, religion, political affiliations, professions, or social and economic statuses. However, its impact differs markedly along class lines, and between the Global North and the Global South.

The COVID-19 virus, which has hit Ghana hard, will remain with us in the world of ‘new normal’. The experience of the US, UK, Brazil, and India, which are currently the worst-hit countries, has shown that populist and protectionist nationalism are counter-productive and exacerbates the spread of the virus. What can Ghana learn from these countries in order not to repeat their mistakes? It is crucial that the Ghanaian government adopt strategies that are specific and relevant to Ghana’s context and do not uncritically borrow approaches from other countries. Given that contexts and conditions are so vastly different from one country to another, particularly in the case of public health, specific protective behavior in developed countries may not be applicable to developing countries.

Intra-African cooperation remains key for Ghana to effectively fight against the COVID-19 pandemic. Whilst looking to the US, UK and Europe for options, the best buffer against the spread of such a disease lie in a well-protected continent, especially where national borders are porous and movements of people within the country, as well as between countries cannot be effectively monitored or controlled. Preparedness against future epidemics requires consistent and long-term state investment to avoid even greater financial loss and loss of lives, not to mention problems like political instability and collapse of the economy.

Without a healthy population and thereby, a productive workforce, the economic and social development of a country is bound to be stunted. Ultimately, changing our awareness and behavior to improve public health is our civic responsibility as global citizens. By keeping oneself safe is to keep others safe, thereby breaking the circuit of disease transmission. Vaccination is not the ‘magic pill’ for Ghana due to its limited scale with all the logistical challenges. Preventive measures and behavior, more than treatment and cures are the viable options to see us through the pandemic.

Agnes Khoo-Dzisi teaches International Relations, Africa-Asia Relations, Gender and Development, and Migration in Ghana. Her PhD. at the University of Manchester, U.K., was on the role of women in the democratization movements of South Korea and Taiwan. Having worked internationally in local and regional NGOs, Agnes has taught in Bangladesh and the UK before calling Ghana her home. She co-founded in 2006, a community-based social enterprise in rural Ghana that provides education and employment to women and youth. Originally from Singapore but a Dutch citizen, she is a migrant woman whose existence straddles Asia, Europe and Africa, which gives her an unique vantage point about the world.