Remarks by WHO Regional Director for Africa, Dr Matshidiso Moeti
Thank you so much for inviting me to speak, it is an absolute honour.
Professor Puleng LenkaBula, Principal and Vice Chancellor of the University of South Africa, my sincere congratulations for making history as the first woman, and the first black woman to occupy that position,
Mr Nkosinathi Biko, son of Steve Biko, Founder and Executive Trustee of the Steve Biko Foundation,
Dr Ntsiki Biko, my warm greetings and congratulations for the recognition by Rhodes University of your years of activism and community service to improve the lives of fellow South Africans; I understand that the celebration of your 75th birthday in May simply gave you more energy and drive to continue serving.
I recognize other members of the Biko Family watching this event,
Members of the University Council and the Board of Trustees of the Steve Biko Foundation,
Members of the National Executive and the Diplomatic Corps,
Representatives of national, provincial and local departments,
Members of civil society, Judiciary, religious, and political organizations,
Institutions of higher learning,
Members of the media,
Ladies and gentlemen: Molweni, dumelang, good evening!
I am truly grateful and delighted to deliver the 21st Annual Memorial Lecture on the 44th anniversary of the murder of Bantu Stephen Biko – I’m humbled to join such an illustrious group of previous speakers.
This lecture coincides with what would have been Steve Biko’s 75th birthday, in December this year.
I want to appreciate the Steve Biko family and the Foundation for all their work to reduce inequality, and to promote democracy and values-based development.
In particular, I thank Mr Nkosinathi Biko for the invitation to speak, and for recognizing that COVID-19 is a devastating example that illustrates the need to be aware of, to acknowledge, and to redress deep-rooted, structural injustices, in Africa and in the world.
That’s why the I’ve chosen to share some reflections on the pandemic as the opportunity to push for equity, justice and self-reliance.
During this global crisis, the principles that Steve Biko embodied in his dialogue with South Africa and with the world, which guided his actions, have once again proven to be central to action across all countries, on the pandemic and going beyond, towards sustainable development.
Many of us, in South Africa, across the continent, and worldwide, have links to Steve Biko – we are connected to him as a person, to the work that he did, to his philosophy and to his enduring message.
My own links started in my teens: I remember conversations with my late aunt, who was at medical school with Steve – and being enthralled and inspired on hearing about the ideas and helping black people help themselves, the translation into action in setting-up medical clinics, improving access to health care, and changing people’s lives – demonstrating self-belief and agency.
I was inspired and convinced that these actions were starting a momentum that would help to right the many wrongs that millions of black people experienced, living in apartheid South Africa, and beyond.
Fifty years on from the Conference on the Development of the African Community, which called for the promotion of Black Consciousness, the pandemic has shone a spotlight on enduring challenges of inequity and injustice.
There are links between what happened in that faraway past and what is happening in the world today. Understanding and honouring the reality of the past is important to solving challenges now and creating a future moving at a different speed towards the betterment of the condition of African people.
Looking back in history, the effects of slavery, colonialism, racism and imbalances in the international economic order are evident in all spheres of life and development today, including in health.
They are dramatically highlighted by the COVID-19 pandemic.
In countries and societies affected by white settler colonialism (including slavery) black and indigenous people are among those at greatest risk of injustice.
The global Black Lives Matter movement – which gained such visibility following the murder of George Floyd by a policeman just as the pandemic was gaining speed – has brought these injustices out vividly into the open once more.
Foundations of injustice were laid during colonialism, across the African continent and in other parts of the world. In the South African apartheid project, they were legislated assiduously, meticulously and elaborately into the fabric of daily life; their impact endures today in all spheres of social and economic development.
For example, we know that education provides a critical foundation for development, the grounding on which much of economic and social well-being including health, is built.
Millions of black South African children were denied fair-access to education, including through how public resources were inequitably invested between racial groups. On a personal note, this was one of the reasons my parents decided to leave South Africa and move to Botswana.
At age 12, crossing the border at the start of each school term, in search of a better education in Swaziland, had become a recurrent and fierce battle with security and other officials.
Black workers were extensively limited in their labour market participation, largely relegated to low-skilled, low-paid and often dangerous jobs.
27 years post-apartheid, equity has improved in some aspects of life, including in access to education and essential services and utilities.
Yet today, South Africa remains one of the world’s most unequal societies.
Two out of five black African women and two out of three young people under 25 are jobless.
Access to quality education still depends largely on where a child is born, how wealthy their family is, and the colour of their skin.
The violence witnessed a few months ago, the worst the country has seen since 1994, had the combined impact of COVID19-related hardship building on deep poverty and lost hope as the perfect backdrop for the lighting of the flame.
The riots slowed down the decline of the third COVID-19 wave in a closing of that circle of relationships.
Other countries in Africa and elsewhere, have seen similar experiences – again, long-standing inequalities and poverty deepened by the pandemic, leading to riots in countries like Colombia, Tunisia, Nigeria, Senegal and others.
The United Nations General Assembly after five years of debate, apparently, recently established a Permanent Forum of People of African Descent to combat systemic racism that descendants of victims of slavery and colonialism continue to experience. This is a long overdue and positive step forward that must bring concrete results going beyond addressing violence (as happened to George Floyd), and address the presisting structural and legislated injustices in many parts of the world, that have driven the skewed impacts of the pandemic on different population and ethnic groups.
Last year about 17 African countries celebrated sixty years of independence. Overall, the scorecards show much more needs to be done, including more practical emphasis on bridging inequity gaps and bringing hope for a better future to a burgeoning youthful population, which needs a serious, data-based factoring-in of the impact of the pandemic into action going forward.
Inequities in African countries span urban-rural divides, sex, age and ethnicity, and are reflected in access to jobs, education, health care and other basics. They drive the desperation that sees African youth drowning in efforts to cross the Mediterranean Sea.
Here is where we have to hark back to the core message of Black Consciousness – self-worth and self-belief, taking our destiny into our own hands, demonstrating agency in improving the lives of the people.
A critical step is generating enough financial resources to make progress on socio-economic development and poverty reduction, including health and preparedness for the next pandemic, which enables citizens to be supported – more than has been the case for COVID-19.
So, increasing revenue, including through taxes, will be central to this.
In 2015, South Africa’s former President Mbeki, led an international high-level panel that found that more than 50 billion dollars is lost each year from Africa – through illicit financial flows, including under-taxation and mis-invoicing of international companies in the extractive sector. Thus, capital flight of money that is illegally earned, transferred or used.
Five years later, UNCTAD – the United Nations Conference on Trade and Development’s estimate has increased this figure from 50 to 88 billion. To put this in perspective, aid from foreign governments to African countries has stayed at 30 billion dollars each year for the past decade. Foreign direct investment is predicted to drop from 45 billion to between 25 and 35 billion, recovering in 2022.
Imagine the difference that could be made if 88 billion dollars every year – instead of going into foreign bank accounts – was used to improve education and health, reduce poverty and assist the population in the next emergency. All this would have a knock-on impact for productivity, economic output, and contribute to closing Africa’s 200 billion dollar a year gap towards attaining the Sustainable Development Goals.
What’s more, we would see a needed shift in the balance of power between the global north and south, with African countries using their resources to determine their priorities and grow their societies and economies.
This, rather than relying on aid, on which governments spend huge amounts of time and energy, and which does contribute, but also sometimes distorts prioritization, and which leads to ways of working that perpetuate colonialism, including in the mindsets and agency of African people and institutions.
I remember 20 years ago, when I was working on the HIV epidemic and Africa was lagging sorely behind in access to treatment with millions of deaths every year. My colleagues and I spent a year supporting the preparation of a Heads of State Summit in Abuja on HIV, TB and malaria. My expectation as I invested all those hours of work, was that at the Summit I would hear Heads of State declaring with determination and clarity what they were going to do to save the lives of their citizens.
Mr Koffi Annan announced the launch of the Global Fund and from that moment the statements were all about needing money, needing help, please help us. In exhaustion, in exasperation, in absolute disappointment, I actually left the Conference and went to sleep in my hotel room, exhausted after days of working. So that was a citizen not seeing the expectation of Heads of State and Leaders demonstrating agency.
For COVID-19 there has been a unique movement of leaders who have recognized their role and their agency and mobilized their networks.
The African Union has championed a continental strategy that has established a platform that is actively sourcing vaccine supplies in the face of huge challenges, for example.
This kind of coordinated, pan-African approach is unprecedented and indicative of the what can be achieved when countries work together.
For the African Renaissance to take hold, governments need to confront and accept challenges, and to take action and monitor progress in tackling them.
Governments and people need to act with agency – deciding rather than accepting their fate. As individuals we need to regain control of how we see ourselves, and what we believe about ourselves – this is Steve Biko’s message that the Foundation reminds us of in its communication and its actions.
Institutions and systems should be capacitated, accountable and transparent.
Countries should work together across the patchwork of borders established by former colonial powers, for example, to harmonize strong tax regimes towards implementing the African Continental Free Trade Agreement.
Countries should also engage actively in global mechanisms to develop tax regimes for multinational corporations that make some of the greatest profits from our continent.
What is needed, is a marathon, and not a sprint.
COVID-19 has reinforced the need for global solutions and for international solidarity. It has shown the world that viruses do not respect national borders, nor barriers of class, wealth or race.
People from all walks of life have succumbed to COVID-19.
We have lost Dr Nchaupe Mokoape, a leader of the Black Consciousness Movement, Mr Richard Maponya, who defied apartheid restrictions to build his business empire, Ms Zindzi Mandela, the South African Ambassador to Denmark, and many others across the continent and the world.
We have all lost people we look up to and love.
Frontline health workers, the people keeping us safe – thousands have died carrying out their duties, others have faced stigma from people who are afraid of the virus. Health workers have been on the frontlines for so long, and many are totally burnt out.
Globally, there have been around 220 million cases of COVID-19 and five million lives sadly have been lost.
Although the pandemic is having huge social and economic impacts in Africa, this crisis did not unfold on the continent in the catastrophic way as several models initially projected.
However, a UNDP model and analysis predicts economic impacts will last longer, with GDP losses lasting into 2030 and even 2050, depending on government capacity and the structure of the economy. Detrimental impacts on health and education will follow.
Some of the models projecting COVID-19 cases and deaths were based on external assumptions about the continent – pointing to a need for African-led research driven by people who understand African societies and systems.
So far Africa accounts for only around 4% of global cases and deaths, despite being home to 16% of the world’s population. More than a third of all cases and deaths reported in the continent, have been in just one country, South Africa.
Africa’s most internationally-connected country, with the highest score in the GINI coefficient that measures income inequality, has been the hotspot of the continental pandemic.
Across the continent the initial impacts were not severe, with South Africa at times accounting for up to 50% of the daily cases in Africa.
Some underestimation of cases on the continent does need to be acknowledged, due in large part to limited testing and fewer resources for the response than major global economies.
But the experience of responding to past severe and widespread outbreaks was also a positive, with many countries quickly recognizing the threat posed by COVID-19 and taking action.
In countries such as the United States of America, the United Kingdom and Sweden – studies show systematically higher risks of severe illness and death among migrants and ethnic minorities.
This risk stems from systematic disadvantages in access to housing, education, employment and health care, as well as opportunities to access healthy food and even to exercise. Without these basics, people are more prone to conditions like diabetes, hypertension and heart disease that put them at higher risk of severe illness and death due to COVID-19.
Across Africa, COVID-19 has highlighted failures to invest in health systems. Early on in the pandemic there was a lot of concern expressed about ventilator shortages. In the recent third wave – the worst one yet – scores of COVID-19 patients died in intensive care units, because oxygen supplies ran out.
The pandemic has also disrupted access to other essential services like care for pregnant women and children, treatment of HIV, and management of chronic diseases. Millions of people are not getting the care that they need.
As WHO, we have worked with countries to plug gaps but there is still much more to do. We advocate constantly that lessons must be learned from severe epidemics of diseases like Ebola and cholera, and now definitely from COVID-19.
Once the disturbing images fade of mass burials and health workers in protective suits, once the drama of an outbreak is over, investments in building resilient health systems and societies should take off, to be better prepared for the next threat.
But so far, international financing has been available to respond to emergencies rather than prepare for them, and governments have not picked up the slack.
So, there is a continuous cycle of weak health systems, being more vulnerable to outbreaks, leading to heavier tolls on people and economies.
Many of the broader social and economic impacts and effects of COVID-19 in African countries, have largely being ignored by the international media.
Livelihoods have been devastated, and the most vulnerable and marginalized – low-income households and those working in the informal sector, women and children – are among those who have suffered the consequences the most.
In South Africa, black women are disproportionately represented – they are often heads of households, with families relying on them to survive.
Globally, millions of school-aged children will not return after the closures last year. Some estimates suggest that this has reversed gains made over 20 years.
Essential workers have risked their lives for a pay cheque, and some have risked impoverishment if they are not able to work.
As WHO we have urged adherence to personal preventive measures – physical distancing, frequent hand hygiene and wearing masks – but the reality is that for millions of poor people around the world, the choice can be between buying masks and sanitizer, and putting food on the table.
National investments are critical for people to have access to essentials like water, sanitation and education, to be able protect their health. Governments should be accountable for enabling citizens to play their role.
The gap between the rich and the poor will grow, the longer the underlying, fundamental issues of inequality in access to basic services, and the pervasiveness of racism and sexism go unaddressed.
In Africa, almost 80% of COVID-19 cases and deaths, have been reported in just 10 countries.
But analyses suggest that even if African countries didn’t experience severe direct health impacts during the pandemic, they are at greater risk of changing patterns due to COVID-19 in trade, people abroad sending money home, foreign investment and aid.
Countries with low levels of productivity and government capacities, and less resilient health systems, will be the worst-affected.
The economic downturn is expected to compound difficulties in access to clean water, sanitation, food and income, leading to more infectious diseases.
While children under-five are at low risk of COVID-19 illness and death, they are the most at risk of death due to the indirect impacts of the pandemic.
Overall there is a diverse picture of effects across rural and urban communities, across different age groups, genders, income levels and ethnicities. Trade patterns, economic structures and government capacities do matter.
To address these issues, continental and regional integration and collaboration can help to define solutions – so countries need to work together.
In the short term, collaboration is needed to get populations vaccinated quickly.
The World Bank has estimated that every month of delay in rolling out COVID-19 vaccines in Africa, costs almost 14 billion dollars in lost GDP.
As WHO, we have repeatedly called for vaccine access, equity and international solidarity, acknowledging now that this has failed spectacularly, beyond ad hoc instances of kindness, charity and donations.
Worldwide over five billion COVID-19 vaccine doses have been administered, yet in Africa only 150 million doses have been received.
Countries that have locked up global vaccine supplies, have left the whole world, including themselves, vulnerable to COVID-19 virus variants and to the risk of further mutations that will keep this pandemic situation going on and on.
Potentially making this situation much worse by creating additional delays in access, some high-income countries are now promoting booster shots and expanding vaccination to low-risk groups, like young children. This concern to protect and save every life, should not be at the expense of highly vulnerable groups that are still exposed in low-income countries, particularly in Africa.
But to the extent that African countries remain reliant on other parts of the world for essential commodities, they remain vulnerable to global systems that perpetuate inequities.
During the pandemic, governments in African countries have faced huge barriers in securing the supplies needed for the response – empty shelves, inflated prices, and some producing countries that hoarded and banned exports.
This led to the creation of multilateral platforms, like the Access to COVID-19 Tools Accelerator and the COVAX Facility, that have contributed and have enormous potential to save lives.
But there have also been shortcomings.
These global platforms set goals assuming that low- and middle-income countries wouldn’t progress as fast as the rich world.
The catch cry of “solidarity”, verbalized loudly, has been a challenge to translate into action and progress at an equal pace. The risk analysis clearly underestimated nationalism.
Manufacturing was concentrated among a handful of suppliers and there have been immense logistical challenges in transporting supplies.
All of this has led to a loud call to scale-up local production in Africa and to enhance self-reliance.
This builds on long-term continental strategies, and some successes in Ethiopia and a few other countries.
Several efforts have faltered over the years due to challenges in creating a market, pricing and competition from multinational producers – this is the background that still needs to be confronted.
What’s different this time, is that there is a strong political push from the highest levels of government to carry through intentions and statements into actual action.
With the political drive of the African Union, and the combined work of leaders and governments, partnering with high-income countries, small pharmaceutical companies and multinational partners, South Africa has announced the establishment of an messenger RNA hub. This hub will transfer the technology and know-how needed to manufacture mRNA vaccines locally and in other countries. It is worth noting though that the large pharmaceutical companies are yet to come to this party.
Expanding this work beyond COVID-19 vaccines will be critical for the sustainability of the South African hub. MRNA technology has the potential to benefit other priority diseases in Africa, like malaria, TB and even HIV.
This is a game changing moment and a clear expression of determination to act.
Manufacturing of other medical products should also be explored, for example, Africa is the biggest global consumer of antiretrovirals for people living with HIV, but it still imports them.
The local production agenda provides tremendous opportunities for African experts and entrepreneurs, both at home and abroad, to play a leading role in creating transformative change on the continent.
A pan-African approach is needed for local manufacturing to be sustainable, for the continent to come together as 1.2 billion people, to be competitive in the global arena.
This is an opportunity for African leaders to exercise their agency, in the spirit of Steve Biko, and to mobilize and incentivize people, including the diaspora, to participate in leading this change.
African researchers are deploying their capacities to the agendas of international funders. With the engagement and investment of governments they could pursue innovations and knowledge of more direct relevance to their homelands.
This investment could create an enabling environment and a market for great, cost-effective innovations, to elevate homegrown solutions to the world stage.
A few years ago, as WHO in Africa, we launched an inaugural health Innovation Challenge, and 2400 experts, many of them young and from the continent, shared their bright ideas. We were able to connect the top innovators with funders and opportunities to scale-up their innovations in countries across the continent.
For me, this experience reaffirmed that there are so many people with good, sometimes ground-breaking ideas. More needs to be done to connect them with the opportunities to succeed. Together, we should recognize, support and celebrate African excellence. Governments have a responsibility to create an enabling environment.
On many fronts COVID-19 has created momentum, now collective action is needed to make the most of this opportunity to build a fairer, more equitable world.
More needs to be done to recognize and address the powers at play and to call out unfairness and injustice.
More needs to be done too, to make Governments accountable to the citizens they serve.
Epidemics start and end in communities, and so they must be engaged and enabled to play their roles. They know the challenges and are well-positioned to drive the solutions.
For this to happen, a two-way dialogue between governments and communities needs to be strengthened. Ways of listening to people must be improved.
So, a compact is needed. Individuals need to know and believe and have the capacity to play their part, but they also need to trust their government, and ensure it is enabled, honest and committed to playing its part.
Some suggestions for a way forward:
COVID-19 will not be the last threat to our collective humanity. But it should be a wake-up call to transform our systems and societies.
Together, it is our responsibility to seize this moment, to build a world where our connectedness and shared fate drive solidarity demonstrated in action by States and people, including big business, guided by equity, justice and self-reliance.
As a priority, we need a connected world and a communal spirit. Connection between people is deeply rooted in African culture. In South Africa, some of the places I feel safest are in the townships where my aunts are well known – despite being warned that these are among the most dangerous places. In these communities, human connections are surviving against the erosions of hardships and urbanization, and yes, brutal levels of crime and violence. Connections between people are the basis for solidarity and mutually supportive action. They need to be strengthened, to improve people’s lives.
Biko and the students of the Black Consciousness Movement were leaders in this. Steve Biko was on this earth for 30 short years, yet his words, ideas and actions have left a tremendous legacy.
Young people, Africa’s majority, have the passion, the drive and the quick-wittedness to persevere and to change the status quo.
It is in all of our interests to harness this demographic dividend of bright, young, productive populations, to support them and to push them up.
We should make sure that our future leaders have a fighting chance by investing more in education – ensuring that a girl from the poorest, most remote village or urban slum has her chance to go to, and stay in, school, and to learn in a space that is safe and equipped with skilled, motivated teachers.
In wealthy countries, health-care systems are powered by nurses, doctors and specialists from the continent. In other fields too, like engineering and technology, opportunities are lost for Africans with the education, knowledge and skills to drive social and economic development in their home lands.
A systemic approach is needed to mobilize these individuals, to transform the brain drain into a resource, leveraging the drive, knowledge, experience and connections of the diaspora. This starts with creating jobs and investment opportunities, incentivizing their return.
Rather than imposing economic and social solutions devised by external players, countries need to raise and amplify African approaches to influence and shape global decisions and actions.
When countries come together in multilateral discourse, long lists of challenges and solutions are often presented that skirt structural power dynamics.
Greater transparency and accountability are needed to unmask power relations between private sector entities and governments at the global level.
An awakening is needed, and African countries have to play a role, to put pressure on those hoarding power.
Within the United Nations system, global discussions are dominated by a few countries. African countries should band together to have a stronger voice.
Multilateral agencies can do much more to help countries in the global south to navigate and influence these issues.
Initiatives like the COVAX Facility are glimmers of hope born out of COVID-19 that reinforce a new system founded on solidarity and fairness. Even though there have been huge difficulties and there is much to improve, these platforms lay the foundations for a more equitable regional and international regime.
Overall, there is a need for the stronger influence of an enlightened Africa.
So, in closing, it is within our collective grasp to mitigate the long-term ravages that will permeate from the COVID-19 pandemic: starting by learning the lessons this crisis is teaching us.
COVID-19 will not be the last nor the worst threat to our humanity, but it has catapulted ideas of equity, justice and self-reliance to the front of people’s minds. This should be leveraged for sustainable, holistic development.
Equity is needed because it is the right thing to do, it is also smart, as we are only as strong as the most vulnerable among us.
Justice across races, income levels, sexes and ages, will help to propel our societies forward.
Self-reliance is about every community investing in preparedness as part of national development and security. It is about governments working with citizens to create an environment that allows their contribution in the development of their countries, fully expecting those they elected will be answerable. This requires a compact between governments and individuals to be accountable for their respective roles – making sure that national money works for the people and that governments address corruption, for example.
Connections between people should be enriched with Black Consciousness, recognizing the potential and value of every black person, and their role in realizing liberation. Together, we should say: I am proud to be black and I am proud to be African.
Africa is at a cross roads, where there is mounting agency and determination, but there are also grave risks of devastating long-term social and economic impacts of COVID-19.
Our continent is rich with resources and with energized, enlightened people at home and abroad. It is the collective duty of governments and people to make sure our riches translate into wide-ranging societal benefits.
African leaders, governments and people should all say loudly “I know who I am, I accept myself, and I will move forward on my own terms.”