Botswana health officials say they are waiting for equipment from China. It might be a while before they get it, if it does arrive. COVID-19 has exposed the country to global politics and the reality of its small stature in this new dog-eat-dog world of global medical supplies, writes TSHIRELETSO MOTLOGELWA.
It is rough out there. Forget the preaching of the leading economies of the world for the last three decades that such a thing as an “international community” exists. In action they are proving that such a thing is an urban myth. Ask German Chancellor Angela Merkel. Late March the German Chancellor experienced a problem when a consignment of about 200 000 protective masks destined for Berlin were reportedly intercepted by the United States in Thailand, snatched and sent to America where Trump’s battle with the new flu was heating up.
The Germans later called the expedition an act of “piracy.” Countries who run the world are now coming out clean about their interests. Trump says the company that manufactured the masks, 3M, is an American one, albeit doing so in China. Merkel encountered Trump once again when the American rabble rouser reportedly sought to offer a German vaccine company an offer they could not refuse. According to German newspaper Die Welt, Trump approached the German company, CureVac, “large sums of money”, some say around a billion dollars, for exclusive access to any COVID-19 vaccine that the company could concoct. Trump sought to have the vaccine, if it was ever created, to be exclusively for the US. German parliamentarians were left fuming.
It is rough out there. i even rougher if you a Third World country, as the Western boys like to say. You have never been more Third World than now. The advent of Covid-19 and its complete stick up of countries’ health systems has upended the façade of global cooperation upon which the entire edifice of global unity has been stacked. Ask the Barbados Minister of Health, Lieutenant Colonel Jeffry Bostic. Two months ago, he was sitting in his office expecting a consignment of about 20 ventilators from a good Samaritan in the United States to arrive on the island so he could beef up his readiness for the time the pandemic began to put healthy citizens into beds, as it sure would eventually. It turns out the United States had other ideas. The consignment was hijacked by Donald Trump’s boys offering five times the price and rerouted to American health authorities. It is rough out there.
But it is not just for the former colonies, the fight is just as rough for the former colonisers themselves. All major manufacturing centres of the world, from Europe to Australia, have banned the export of medical equipment. Third World countries, who all through these years have been told to dismantle their manufacturing ambitions since the world economies can supply everything they need, are now left in the lurch. In China, where all manufacturing seems to be concentrated, it is said there is a queue for everything from medical masks to ventilators, and that the queue is not based on first come first served but it is based on who has what financial, political and geo-political power.
Which brings us to Botswana. There is a leaked wish list by the Ministry of Health in which – at least according to the records – the government is seeking assistance from embassies in the country to source, among others, about 1000 ventilators, 1000 hospital beds, 200 ICU mattresses, 1100 cardiac tables, 1000 invasive monitors and 8 000 infrared thermometers. That letter seems to have been drafted in early April, which would indicate that it is the exact period when the ministry finally commenced its full process to procure equipment, at least the major medical equipment they project they will need.
Ventilators are central to COVID-19 intervention at the sharp end of infections when people start to get sick. According to medical experts, the availability of a ventilator is the difference between life and death. “Ventilators provide temporary ventilatory support or respiratory assistance to patients who cannot breathe on their own or who require assistance to maintain adequate ventilation because of illness, trauma, congenital defects, or drugs (e.g. anaesthetics),” the World Health Organisation website advises. As countries around the world experienced the pandemic in that east to westerly direction, ventilator demand also stretched in that direction, from China through Italy and then slowly to Germany, United Kingdom, United States but now that demand is flowing downwards to the southern hemisphere, the late destination in the COVID-19 spread.
The WHO Africa Regional Office has revealed that the worst case scenario for Africa is that the continent would have 29 million to 44 million infections, leading to between 83 000 and 190 000 people deaths. This was a prediction the disease fighting global body conducted on the continent, covering 47 countries with a population of one billion people. Dr Matshidiso Moeti says Africa should prepare for a permanent presence of the disease. “COVID-19 could become a fixture in our lives for the next several years unless a proactive approach is taken by many governments in the region. We need to test, trace, isolate and treat”, she urged in a recent report. That means ventilators would be needed at the very peak of infections and then permanently for running infections as the continent proceeds into a post-pandemic level phase.
At the peak, therefore, WHO says, there would be an estimated 3.6 million to 5.5 million COVID-19 hospitalisations, 82 000 to 167 000 of which would be severe cases requiring oxygen and 52 000 to 107 000 critical cases requiring breathing support. “Such a huge number of patients in hospitals would severely strain the health capacities of countries,” adds the WHO Africa Region. At the most, therefore, there is at least 100 000 needed across the continent. Botswana itself has no more than 150 ventilators, according to sources at the Ministry of Health. However, its infection rate has crept low at 35 infections in a country of 2.2 million people. But the country has been under lockdown and the most challenging phase is approaching as it slowly releases restrictions. The question, therefore, is what level of infections do Botswana experts project would be the peak of the infection, the so-called tip plateau of the curve? Already health ministry insiders behind the scenes are said to be concerned that perhaps government over-estimated the infection.
Dr Christopher Samuel, a Gaborone-based medical doctor who has been following the Coronavirus, says statistics reveal generally that of the infected cases, 20 percent will ultimately need hospital care. Out of the hospitalised, 5 percent will eventually need ventilators. Half of those who end up on ventilators often end up dying. The Ministry of Health says they are working with some company in Hong Kong, among others, to procure a variety of medical equipment. However, the major hurdle with ventilators may be the price. The price of one ventilator is said to vary between 8 000 dollars to 60 000 dollars, depending on the specifications.
But forget the price. The biggest problem for small countries like Botswana is the lack of power while competing with more powerful Western countries for limited equipment supplies. The New York Times reports that African and Latin American countries have found themselves reduced to the backwaters of global supply chains with Western countries monopolising supply. Meanwhile, the same countries have largely stopped the export of medical equipment. “Developing nations in Latin America and Africa cannot find enough materials and equipment to test for Coronavirus partly because the United States and Europe are outspending them.
As the United States and European Union countries compete to acquire scarce medical equipment to combat the Coronavirus, another troubling divide is also emerging, with poorer countries losing out to wealthier ones in the global scrum for masks and testing materials. Scientists in Africa and Latin America have been told by manufacturers that orders for vital testing kits cannot be filled for months because the supply chain is in upheaval and almost everything they produce is going to America or Europe. All countries report steep price increases, from testing kits to masks,” reports Jane Bradley of the New York Times last month.
The shortage of equipment has also brought forward an opportunity for major countries to harness the crisis for diplomatic influence. A week ago, the United States delivered 1000 ventilators to South Africa with another 1000 set for Nigeria. It is no accident that President Donald Trump made it his objective to personally call Nigerian President Mohammed Buhari and offer the ventilators. And neither is it an accident that he also provided South Africa with the same offer. Both countries are the biggest economies and regional powers with immense influence in the continent with SA President Cyril Ramaphosa currently chairing the AU. Had Trump been looking for the neediest African countries, he would have skipped the southern economic superpower, which itself is projecting that it will produce 10 000 locally manufactured ventilators. Trump is buying geopolitical influence. He is coming late though. China, his most fervent of competitors has been all over Africa providing COVID-19 support. COVID-19 diplomacy is well underway and is a serious dynamic in world politics. In short the money is not useful any more. It is rough out there.