Africa’s Response to COVID-19

HULTMAN: Good afternoon, everyone. I’m Tami Hultman from AllAfrica, a pan-African news organizations operating from offices in East, West, and Southern Africa. Welcome all of you to this Council on Foreign Relations conference call on “Africa’s Response to COVID-19.” This call is on the record, and the audio and a transcript will both be posted on CFR.org.

You have biographies of Ambassadors Gavin and Campbell, and I encourage you to click through to appreciate the full extent of the expertise they will share with us. But very briefly, John Campbell is the Ralph Bunche Senior Fellow for Africa Policy Studies at CFR in Washington, D.C. He has taught history, was a professor of international relations, has published books, writes the blog Africa in Transition, and he edits Security Review. His several diplomatic postings include South Africa and Nigeria, where he was ambassador from 2004 to 2007, during the period when Olusegun Obasanjo served as elected president, following the years of military rule.

Michelle Gavin is a senior fellow for Africa studies at CFR. She held several positions on Capitol Hill, including staff director for the Senate Foreign Relations Committee, the Subcommittee on African Affairs. She became senior director for Africa at the National Security Council before serving as ambassador to Botswana from 2011 to 2014, when the country launched the world’s most ambitious HIV prevention study and hosted the Southern Accord joint U.S. military exercises. We’re fortunate to have them both with us.

This morning the heads of the United Nations agency said that without increased funding and common logistics services the global response to COVID-19 could sputter to a halt. There are nearly twenty-four thousand confirmed cases across Africa, topped by South Africa with over three thousand, and testing is at an early stage. The Economic Commission for Africa says the crisis could push twenty-seven million people into extreme poverty, joining the twenty-five million already there.

John, could you start us off with a couple of sentences to put Africa’s situation in context and tell us what you think are the most important ways Africans are responding to the crisis, what more should be done, and are any countries providing useful models?

CAMPBELL: Thanks so much. I very much appreciate the opportunity. In terms of context, Africa’s a pretty big place. It’s got more than a billion people. And depending on how you count it, there’s some fifty different countries. So generalizations are always risky. Nevertheless, I’m going to take the risk simply to put out there certain issues that I think are important and shape how Africa can respond to the virus.

The first is, if you look at Africa from a worldwide context, the poverty is striking. Fifty-six percent of the urban population is packed into slums. Fifty-six percent of the urban population. And the urban population is now almost half of the total population. Further, economically—though there are bright spots scattered all over the continent—but economically it’s important to remember that a large percentage of Africans are outside the modern economy altogether. They are in the informal economy, where the essential ingredient is face-to-face contact.

The second is that Africa’s population is vulnerable. About 40 percent of the continent’s children are under-nourished. And the continent has the highest percentage in the world of what we refer to as underlying medical conditions, such as HIV, or TB, or diabetes. Then there is the fact that, again with a few shining exceptions, most countries in Africa have a weak or nonexistent public health infrastructure. To simply take one statistics, and the number of statistics is legion, but to take one: For intensive care units, ICUs, in Africa there are five beds per one million people. Whereas in Europe the figure is four thousand beds per one million people.

And then finally, again with some notable exceptions, there is widespread distrust by ordinary people of African governments. In many places current African governments are seen as exploitative, in some respects a continuation of the old colonial regimes. Now, all that’s pretty bleak, but there’s some mitigating factors that might reduce the toll of the virus.

The first is if half the population lives in urban areas, half the population lives in rural areas. And in fact, the rural population, which is obviously dispersed, the percentage is the highest in the world. The second is that the elderly, who have been such a high percentage of the victims of the disease in Asia, Europe, and the United States—the elderly in Africa are not isolated from the general population. They don’t live in nursing homes, or retirement homes. Instead, they live with their families and they’re dispersed. They’re not all concentrated in one place. And then finally, there is the strength of traditional institutions and also the strength of traditional religion. And these can be—these can be real sources of strength in terms of educating a population with respect to public health.

I like to think a little bit about South Africa, because the government of Cyril Ramaphosa has done so much that is right, and yet carries high risks. The South African government has introduced social isolation and quarantine not very different from what was imposed in South Korea and Thailand, and eventually in China. And it has had a desired effect. The curve has, indeed, flattened. The issue, though, is rather as in this country and in other places, there was insufficient provision made for the impact of quarantine and social isolation on the poorest part of the population. And the enforcement of quarantine and social isolation by the security services has often been brutal. And in fact, there have been a number of people killed in South Africa by the security services. This carries the risk that public acceptance, public toleration for what would appear to be an effective health policy may start to evaporate. I’ll stop there.

HULTMAN: One quick follow up, John. Given the diversity of countries across Africa are there lessons from South Africa for other countries? Can any other country try to replicate what South Africa is doing—the good parts of it, the effective parts of it?

CAMPBELL: Yeah. I think the lessons are—the lessons are what not to do. That is to say enforcement of those policies require greater attention, greater subtlety, greater training for the security services.

And the second part is how do you respond to the needs of the poorest part of the population that is almost entirely in the informal economy, which requires face-to-face contact?

HULTMAN: OK, thanks.

Michelle, in either a broader context or at the specific country level, could you tell us what you think are responses that African policymakers can craft to reduce the immediate and longer-term damage, whether to social systems or to economies? What do you see as the major threat to stability? And are there any opportunities for progress in the midst of this chaos?

GAVIN: Sure, sure. Let me start by saying, you know, I agree with the point that John was making about societies where the majority of people are engaged in the informal economy and are living an experience where, if they don’t do their work that day, they don’t eat that day.

And so I think that in the immediate term one of the things that needs to happen really is some innovation and some experimentation on how to try and control the virus and its transmission, acknowledging that it is not reasonable to ask these communities to simply shelter in place in the absence of a massive effort to get to them means of survival, meaning, you know, food, access to water, et cetera.

There’s just a whole new playbook that has to be written because the context is different, so kind of rolling out the same policies that have looked really good in, say, Germany doesn’t make sense in lots of parts of the continent. And so I think that’s a huge challenge. And there will be mistakes and there will be—there will be some winning strategies as well.

I do think another kind of immediate priority actually comes around messaging. There is such an important role for trust in successful responses to public-health crises. In countries where trust in state authority figures is low, it’s going to be really important to work with some unlikely allies sometimes, to be working with civil society, even civil-society groups that have been critical of government in the past, to be working with traditional leaders, with faith leaders, so that trusted voices of authority are really being heard that can cut through misinformation and the kind of clouds of suspicion that come up in our society and any society in a scary situation, and get people the information they need to make smart choices for their health.

Then in the longer term—and I think that African policymakers, in particular Prime Minister Abiy in Ethiopia, President Ramaphosa in South Africa, and others have been very good and very clear on this. In the long term, the economic consequences of this pandemic are absolutely devastating for Africa. And thinking now about how to mitigate that and how to steer the continent through what the World Bank expects to be, you know, a major contraction in African GDP, so the whole continent tipping into recession.

And what we see already is Africans feeling the squeeze, right, with decline in global demand, decline in remittances, which are such an important part of some economies. And you’ve got the diaspora either unable to send them because so much of the connectivity of the global system is on pause or because they’ve lost their jobs in America or in Europe and have no money to send. And you see a rise in food prices.

And so I am very, very concerned—to move to your question about threats to stability, I’m extremely concerned about food security. If you look at the Horn, where they were already dealing with literally a plague of locusts—and the second wave of locusts is coming; it’s bigger than the first—the declines in agricultural productivity are startling, and it is a very concerning situation.

Similarly in West Africa, they were already dealing with serious food insecurity. Or you look at a country like Zimbabwe, where you had, you know, most of the country needing food assistance. Now you’ve got an unfortunately heavy-handed state response. Recently security forces were destroying markets in Harare just over the weekend as part of this kind of overall lockdown. We’ve seen what the consequences of that kind of intervention has been in the past in Zimbabwe. There are real concerns about hunger there.

So major threats to stability I’d say in the immediate term of food security, and political as well. There are countries undergoing very fragile and very important transitions. And in the context of this kind of pandemic, where often the tools that states reach to in the toolbox are pretty heavy-handed responses, there’s the danger of kind of tipping fragile situations either into conflict or tipping them toward kind of military and authoritarian—(inaudible). And I think here specifically of the fragility of Sudan and Ethiopia.

And then I’ll just finish trying to respond to your big questions here by talking about opportunities for progress, and I do think that they exist. You know, I think we’ve seen, as I alluded to, real bright spots in terms of some African leaders asserting themselves on the global stage, making very clear the case for what Africa needs from the international community, from the international financial institutions, from the creditors, and coordinating among African states fairly effectively, ensuring that all states have access to good science, from the African CDC and the World Health Organization, to good information, having regional response teams working together.

I think this is very positive and really speaks to kind of a bigger trend that I think we may see in the world emerging from COVID-19, which is one where Africans are really at the table in the global discussion from the beginning and not as an afterthought.

And the last thing I would say in terms of opportunities for progress, I would say that this entire experience is a wakeup call to people around the world that governments and governance matters. And I think that is a positive thing. Sort of as important as private sectors are—and they are—there are some things that we all needs governments to do for us; and so investing in governance that works, and perhaps will become a little more into fashion. And I think that’s a good thing.

HULTMAN: You mentioned conflict. The African Union has a theme, Silencing the Guns. And there seemed to be initial progress towards that. But recently there have been many rising security threats with attacks coming all the way down from the Horn of Africa into northern Mozambique, and, of course, in West Africa at the Lake Chad Basin, many, many attacks and conflicts that already have people in turmoil and have made lots of internally displaced persons in this situation of the virus.

What do you think are the prospects for addressing those real security concerns?

CAMPBELL: I think it’s a big issue. There have been a variety of statements from various jihadi groups in the Lake Chad Basin, but also further to the west, Niger and Mali, to the effect that this provides them with a particular opportunity to move forward towards achieving their goal, which is the destruction of whatever secular state there is that they’re operating in. And some have been pretty shameless about saying, in effect, your religion will protect you from the virus and in a—an area plagued with conspiracy theories and lack of information, this can be—this can be pretty powerful.

HULTMAN: Yeah, many challenges. Thank you both for that enlightening introduction and let’s now turn to questions from those of you who have dialed in. Please say your name and state your affiliation, and please, ask one question, a precise and brief one, to allow as many people as possible to participate. Casey (sp), our call operator, will now give you instructions about how to ask questions.

OPERATOR: Thank you. At this time we will now open the floor for questions.

(Gives queuing instructions.)

Our first question comes from Laurie Garrett of the Bush Initiative.

Q: I am not sure who you identified me with, but this is Laurie Garrett. Can you hear me?

CAMPBELL: Absolutely, and it’s good to hear from you.

GAVIN: Yes.

HULTMAN: We can. Let’s go to Laurie.

Q: Yeah, I have a quick—I have a quick question that goes to U.S.-China foreign policy vis-à-vis Africa. Both sides, in their own ways, have been romancing Africa for a while. There were the riots in Guangzhou and in Shenzhen and attacks on African students there that have been denounced as racist and had a huge impact that I see across African media that is turning into kind of an anti-Chinese sentiment, and that seems to also be associated with recognition that a lot of the soft power, if you will, attempts by China to change the narrative about this epidemic by offering medical assistance in Africa is coming with a steep price tag.

On the flip side, the U.S., which, under the Trump administration, has not placed much of a priority on the entire continent, has been responsible for pushing the pricing on all sorts of supplies for humanitarian relief and medical use around the world because we’re outbidding everybody for every mask on the planet, every thermometer on Earth, every pulse oximeter, every—everything. And humanitarian groups report a 2,000 percent increase in the price of most basic goods, even aspirin, related to health care.

So it looks like if I’m African I’m going to say both these countries—a pox on both houses. How do you think this is going to shake out politically?

HULTMAN: Thank you, Laurie.

John, would you like to first look at that?

CAMPBELL: Sure. Thanks.

Yeah, absolutely, and further, there is, at least in this country in some circles, the approaching or putting the virus in the context of U.S.-China rivalry, whereas, in fact, what is desperately needed is cooperation between the U.S. and China in responding to the African crisis.

As to what the African response is going to be, right now my sense is that the Chinese are getting the worst part of the deal. Part of that is because the market forces that you referred to—running up the price of aspirin, trying to corral the world’s supply of face masks—that kind of thing has not yet moved much beyond the capitals and the major newspapers. When it does, we may pay a fairly steep price.

Now, what could mitigate that price is if we were to do what we do really well, things like massive deliveries of food to famine-prone areas or the very rapid construction of field hospitals, as we did in West Africa during the last—the last phases of the Ebola crisis. So I think a lot is going to depend, over the long term, in terms of what we actually do.

HULTMAN: Thank you, John.

Could you just follow up, Michelle?

GAVIN: Yeah. Yeah.

HULTMAN: Because you wrote of Africa—(inaudible).

GAVIN: I just have a slightly different perspective.

HULTMAN: Yes. Go ahead.

GAVIN: Go ahead. OK. Sure. So I just had a slightly different perspective. I don’t disagree with what John had to say and I certainly agree with you, Laurie, that nobody’s covering themselves in glory in the context of this conversation.

But until these incidents in Guangzhou, I would say that China was making out pretty well and in part it’s simply the power of their narrative and the very obvious situation of United States not handling its own outbreak very effectively, right.

So our own shambolic was front and very much on global display and that absolutely affects the way people overseas understand our leadership and choose to admire, or not, our system of governance. And in contrast, right, China has been able to articulate a narrative. It’s probably not the whole story but it’s the story that is getting out there, right, of having controlled their outbreak effectively and rapidly pivoted to international assistance.

And because their messaging is centralized, because their philanthropists, their private sector, and the state are all working in concert to kind of maximize the messaging value of their assistance, folks that I talk to on the ground in Kenya and in southern Africa as well a week ago, right, were saying that this really looks to them like China sort of assuming a leadership role on the continent.

Now, I do think that that was—even without these alarming incidents in China of discrimination directed at Africans, I think that that was going to be a little bit short lived in that the economic crisis coming at all of us is very serious, as I suggested, in Africa and the issue of debt and servicing debt is at the top of the list and it’s, I think, highly unlikely that the Chinese are going to be willing to forgive much of the, you know, $145 billion that Africa owes to them.

And so I think that really managing the messaging in the short term is going to be actually easier for them than dealing with the very concrete demand for debt relief over the long term.

HULTMAN: And, Michelle, what about the implications of the fact that every one of Africa’s fifty-five countries is dependent on imported pharmaceuticals? What does that mean for HIV, TB, vaccine-preventable diseases like measles and polio and for malaria, which is already surging?

GAVIN: Well, I mean, obviously, it’s incredibly alarming the sort of global shortage, the price spikes, all of which, again, speaks to a real lack of international leadership, you know, a global crisis without the usual suspects trying to step up and assert some order, and instead, the U.S. is busy attacking the WHO. So it’s perverse in the extreme.

But I think—you know, I think around the world they’re going to be having kind of a rethink about how much people want their supply chain for, you know, critical medical goods to be dependent on certain actors, and I think that Africa will be a part of that conversation.

CAMPBELL: And, actually, that could be a long-term consequence of the virus. There is a nascent pharmaceutical industry in Nigeria and in South Africa and perhaps elsewhere as well, and this whole experience may prove to be a boost to those industries.

HULTMAN: Thank you both.

Casey, could you please queue the next question?

OPERATOR: OK. Our next question comes from John Stremlau of the University of Witwatersrand.

Q: Good evening. I hope you can hear me.

CAMPBELL: Yes.

Q: Good.

John, a couple of questions very quickly. One, in the short term, the—you made a reference to Liberia or West Africa and Ebola. As I recall, the Carter Center did a lot of work with chiefs and others in building a network that actually seemed to work there. And is there anything in the Ebola lessons of prevention and mitigation before any vaccine comes? And then secondly, with regard to the vaccine, how much effort is being made through the Gates Foundation and others to work through the WHO to be sure that Africa gets a fair shake when therapies and vaccines do come online as everyone’s crashing to make them available now? Do you have any insights onto the—onto the WHO and satisfying Africa, one? And secondly, anything—lessons from West Africa from Ebola more than you’ve alluded to?

CAMPBELL: Well, I think in terms of lessons from West Africa and Ebola, you are dead-on. We also saw it in the eastern Congo, that the building of networks, often led by NGOs and often involving traditional leaders or religious leaders, can play an extraordinarily positive way. And where it’s lacking, it can also—it can also be a serious impediment to moving forward. In terms of what the big American foundations are doing, working with the WHO, I just don’t know. I do know that in an African context there is considerable anxiety that if and when therapies or, ideally, a vaccine are developed, if its distribution is left solely to market forces, then Africa will be at the end of the line, with devastating consequences.

 HULTMAN: Michelle, you witnessed when you were in Botswana a global coalition of philanthropists and health organizations intervening to fight HIV/AIDS. Are there lessons from that that can be applied? Do you think there’s any prospect of a community coming together?

GAVIN: Well, I absolutely think that there are, you know, entities who have gotten to know each other and speak each other’s language over the course of responding to HIV/AIDS, and in some cases to Ebola as well. And I know that in the philanthropic community right now that there is a lot of conversation about making sure that there is global access to solutions—be they treatment solutions or eventually a vaccine. You know, how have those conversations gone? I couldn’t say. But I will just say, you know, one of the things the Botswana case makes clear is that however strong a coalition of external actors in Botswana had success because the national government was willing to invest their own money year after year in strengthening health systems. And I just don’t think it’s possible to achieve kind of sustainable gains on addressing public health issues without having committed national partners as well. So it’s—you know, it requires all of these elements.

HULTMAN: Thank you. Many people calling in have questions, so please remember to make your questions brief and to the point, and we’re ready for the next one.

OPERATOR: Our next question comes from Madison Hirneisen of the Washington Times.

Q: Hi, there. can you all hear me?

CAMPBELL: Yes.

HULTMAN: Yes.

Q: Great. So I know you guys have touched—my question has to do with something you briefly touched on before. But I’m kind of just looking to see if there’s anything you wanted to add. I’m wondering, how is the virus impacting China-Africa relations?

HULTMAN: Michelle, do you want to add anything to what John said about that earlier?

GAVIN: Sure. I guess I would say that China is absolutely trying to make the most of this moment. So I would say that, you know, how has this impacted—I think it’s seen as a moment of opportunity for China to assert leadership. There have been very strong and very direct kind of Chinese challenges to the West that you see on the continent. Where you have diplomats, you know, kind of not just touting China’s assistance, but casting aspersions on what others have done, or failed to do. So in that sense, I think it’s seen as kind of a critical moment to pivot to bolster support for the so-called Chinese model. But again, I think it’s all going to be complicated, as the questions of debt in particular come to the forefront.

HULTMAN: Thanks. John, did you have anything quickly to add on that?

CAMPBELL: No, I think that’s it.

HULTMAN: OK, great.

Next question, please, Casey (sp).

OPERATOR: We’ll take our next question from Herman Cohen, of the Academy of Diplomacy. Your line is live, Mr. Cohen. You may have your phone muted.

HULTMAN: Maybe we should move on to the next question and then come back.

OPERATOR: Yes, ma’am. We have Leslie Warner (sp) of the House of Foreign—

Q: Hi. Thank you all for putting this together.

I was actually going to ask the question about lessons learned from the Ebola outbreak in West Africa and the recent outbreak in eastern DRC, just because what was so shocking about the response to the eastern DRC outbreak was that people were still relearning the lessons of dealing with, you know, lack of trust in local communities. But since that question’s already been addressed, I guess I would ask: What can be done to mitigate the risk of COVID response being politicized by various governments? For example, with the elections that are—with elections that are supposed to be held in several countries this year, how do we—how can governments—I guess, how should civil society, that’s a better way of putting it, mitigate against governments either postponing elections or going ahead and holding them, even though there’s a great health risk with turnout? Just, how can that be managed?

HULTMAN: John, do you want to start?

CAMPBELL: Yes, thank you. Politicizing the virus. The questioner I think very nicely set up the two dimensions of the issue. The first is the temptation, I think, particularly among some authoritarian governments or governments that are moving in an authoritarian direction, to use the virus crisis either as an opportunity to postpone elections to a more fortuitous time or, alternatively, to use panic over the virus as a means of reinforcing their own authority. I think both are big risks. Now, there are real policy dilemmas, I think, for we outsiders. And I think the—an outsider response to either of these phenomena is very much going to depend on the specific country that is involved, and the particular government or regime that’s trying to exploit for its own purposes the virus. The bottom line, I think, is vigilance on the part of outsiders, and also publicizing whatever the particular governments involved are doing.

HULTMAN: Michelle, you have a background in the nonprofit sector. Go ahead.

GAVIN: Yeah. Sure, no I think civil society has an incredibly important role to play, and it’s a really heavy burden on their shoulders as, you know, they’re made—(laughs)—these organizations are made up of individuals like all of us right now, sort of muddling through and trying to be their best, and juggling a lot of different demand and stresses. But I think that providing support and assistance to civil society groups so that they can work to ensure that tricky political questions—like, for example, how to deal with Ethiopia’s postponed elections, right? Incredibly important country, in the midst of fragile transition, has had to postpone elections that had been scheduled for August. It’s not clear when the elections will occur.

It’s not clear under what kind of legal basis government will continue to operate after September. States of emergency, such as the one that they are under right now, have been misused in the past for purposes of political oppression. There are groups who are going to mistrust the situation based on their lived experience. So how can civil society, right, step up to help ensure that the plan for the way forward is one kind of forged around consensus, around ensuring that those who have often been disenfranchised are kind of heard and protected. I think these are incredibly important questions because as devastating as this health crisis is, and as devastating as the economic consequences would be, what would be even worse would be to tip more places into conflict. So I actually think this is an incredibly important priority for these states right now.

HULTMAN: Thank you. Let’s have another question.

OPERATOR: Our next question comes from Lyric Hale of EconVue.

Q: Yes. Thank you very much for your presentation.

The external debt of Africa as a whole is about $700 billion. You mentioned 145 billion (dollars) of that was China’s. Just the debt service alone is fifty billion (dollars) a year. The IMF has promised five hundred million (dollars), only a half a billion (dollars) in relief. Are we headed towards a financial crisis in Africa? And what does that look like? And which countries would be most affected? Thank you.

HULTMAN: Thanks. Michelle, would you like to begin?

GAVIN: Sure. Yes, we are absolutely heading to a crisis. (Laughs.) Which is why, you know, to their credit, African leaders have been very clear on the urgency of this point, right? The Economic Commission for Africa has been out there, clearly the AU is very clear about seeking, you know, some sort of forty-four billion (dollars) in debt relief—one hundred to one hundred fifty billion (dollars) in stimulus to create a fiscal space for governments. And you know, so far the international response has been kind of tepid, right? You have some movement from the G-20, some suspension essentially of debt service payment for a while. But there isn’t international consensus around really important parts of this relating to debt relief and to, you know, things like—(inaudible)—like the IMF. So there’s a lot of work to be done.

And China, again, figures really prominently into that. It’s a lot of credit and they’re really reluctant to relieve debt if they believe that governments are still going to be servicing Chinese debt. And it feels like, essentially, a transfer to China. And so there needs to be, again, international leadership on this, as John said. The U.S. and China working together and in concert with African leaders to try and avoid making a bad situation even worse.

CAMPBELL: Could I—

HULTMAN: John, do you have a slight—yeah, I was going to ask if you have a slightly different perspective on debt relief and what it can do.

CAMPBELL: Well, yeah, it’s not different. It’s perhaps supplementary. And that is, if we leave aside debt, still there seems to me to be a huge economic crisis on the horizon not related to debt. And that is as of this morning the international price for a barrel of oil, I think, was at zero. Well, in the case of Nigeria, oil provides more than 90 percent of the foreign exchange, and more than half of all government revenue. If I’m recalling correctly, oil by value is something like two-thirds of the value of all African exports. Well, right now that’s almost zero. That has incalculable consequences for government budgets of all sorts straight across the continent.

HULTMAN: Thanks very much. That’s an important perspective.

Another question, please, Casey (sp).

OPERATOR: OK. Our next question comes from Walter Carrington, former United States ambassador.

Q: Yes. Good afternoon.

I’m wondering what you think is likely to be the size of the surge in sub-Saharan Africa during the next few weeks. I have been interested in seeing the WHO weekly sitreps, and the latest one, which is a week behind—I guess the next one won’t be out until tomorrow or Thursday—shows that for a continent of over a billion people, the number thus far is rather small. And that it seems to be sort of regionally concentrated. With the exception of South Africa, the next nine countries are all in West Africa. Do you—do you expect this to change? And why haven’t there been, in your estimation, more cases in Africa than we’ve seen so far?

HULTMAN: John, do you want to address the issue of testing and whether we’re at the tip of the iceberg or not?

CAMPBELL: Well, I can try. I think the first and the most important fact about the disease in Africa is nobody really knows how widespread it is because of the extremely limited testing facilities and the very limited amounts of testing that has actually happened up to now. It’s perfectly true that there are apparently more confirmed cases of the virus in Washington, D.C. than there is in all of South Africa. But I think the really crucial reality is we don’t know. We won’t know until there is a massive expansion of testing or, alternatively, we’ll know well enough when death rates are going up in a very visible way.

HULTMAN: Michelle, do you have anything you want to add, or should we go to the next question?

GAVIN: I’d just really quickly say—you know, agree with what’s been said. And it is interesting to see the numbers of Djibouti, which are climbing. And I expect numbers to go up in tandem where you have had an example of a leader who continues to encourage people to go to mass gatherings, specifically religious services, and basically some really irresponsible guidance from their head of state.

HULTMAN: Right. Thanks. Casey (sp), the operator, did you get Hank Cohen back on the line?

OPERATOR: We did. Our next question comes from Herman Cohen of the Academy of Diplomacy.

Q: Hello? Thank you very much. It was a very good presentation.

I have a question about PEPFAR. Millions of Africans are taking antivirals for HIV, or TB, and other diseases. Is there any anecdotal evidence or number evidence that these people have less of the new disease? Thank you.

HULTMAN: Michelle, could you address that, partly from the perspective of having been in a situation where there was a challenge of both identifying and preventing HIV infections?

GAVIN: Sure, I can try. I certainly don’t want to bill myself as something I’m not. I’m not a doctor and I’m not a public health expert. (Laughs.) So I can only speak—and I know that Hank is well-read. I can only speak to what I’ve read.

There is—one of the things that interests me is there does seem to be some suggestion that the virus is less serious—and this is the suggestion—that it might be less serious for people who’ve had a certain TB vaccine, which is used quite widely on the continent. And I know that there are more studies going on right now to investigate that further. It’s an interesting inquiry.

But I have read different things regarding, you know, what kind of vulnerability people who have HIV might have. And to me the literature is unclear. I would just say, maybe kind of panning back a bit, that it is a strength of the continent that you do have a health system and an awful lot of impressive scientists and labs who know a lot about viral transmission and have spent a lot of time thinking about that. And so I do expect, in terms of kind of some of the scientific innovation that comes out of this global experience, a good bit of it to be coming from Africa.

HULTMAN: Yes, I think it’s fair to say that any speculation about protective effects of medications is just that. It’s speculation and theory at this point. But you’re right; there’s lots of work going on and research going on in Africa, which we can look towards.

Another question, please, Casey (sp).

OPERATOR: OK, our next question comes from Patricia Rosenfield of the Rockefeller Archives Center.

Q: Thank you very much. Can you hear me?

CAMPBELL: Yes.

GAVIN: Yes.

Q: Great. Greetings to all three on the panel today; moderator. It’s great to hear your voices. And it’s really important to hear such a nuanced conversation about the African continent and African countries in this regard, and others as well.

Michelle and John have both emphasized, in addition to international leadership—and Tami just mentioned right now, too, the importance of local expertise, local organizations really contributing to the prevention and control of COVID-19.

I wanted to ask about one part of that local sector that you have not mentioned, and that is the role of the local philanthropic community. There’s now increasing numbers of private grantmaking foundations that are networked, and there’s a strong network of community foundations.

I’m wondering who—are you seeing a leadership role from the local African foundations across the continent that are capable of doing this, of playing a role in this area? And how—what influence are they having on government and local communities?

HULTMAN: Which of you would like to field that, John or Michelle?

GAVIN: I can start—

CAMPBELL: Yeah, please.

GAVIN: —just by saying that I’ve—you know, I’ve noticed that Strive Masiyiwa has once again sort of swept into the breach in Zimbabwe to try and assist the beleaguered health sector there. So you do see prominent—a prominent African philanthropist like that, right, kind of stepping up and trying to address some immediate needs. You know, in so doing, does that give that person some leverage in discussing with the government kind of critical policy questions around the response? I think that’s really situational and country by country.

So I absolutely think that you’re right that there’s an important role for philanthropists on the ground. And, you know, I see that as part of kind of the overall civil-society response, which is, you know, if there’s one essential ingredient, that’s probably it, along with governments that work. But I do—I don’t think that it’s—I think it’s hard to extrapolate, right, continent-wide, clear lessons, because I do think the questions quickly become political and situational.

HULTMAN: And John, do you think there is a specific role to be played by women’s organizations like the African Women’s Development Fund, based in Ghana, which works with women’s groups all over the continent, given the particular vulnerability of women, both as health workers and as service workers?

CAMPBELL: I think there certainly is potentially. Let me give you a specific example. During the height of the narcotics plague in West Africa, in Nigeria, a very important ally of the anti-narcotics effort was the Association of Lady Pharmacists. And that’s exactly who they were. They were ladies who were pharmacists, and their little pharmacies were in markets all over the country. And they were firmly opposed to the narcotics trade; did everything they could to stop it, and in certain localities were remarkably successful.

Now, that was totally grassroots. And I think the more grassroots those kinds of efforts are, the likelihood of success is greater. But paradoxically, the more grassroots they are, the less their specific experience may be transferrable to another situation.

HULTMAN: Right. That’s a lovely example, and may be transferrable. Let’s hope it’s replicable.

We have less than five minutes left, and let’s see if we can get a couple more questions in. Please, Casey (sp).

OPERATOR: Our next question comes from Maureen Farrell of the U.S. African (sic; Africa) Command.

Q: Thanks very much.

I’m wondering if you could analyze the flip side of Laurie Garrett’s question in terms of the reaction to China as we move into a new normal with COVID-19 in everybody’s societies. What does it look like in terms of the trust and confidence that our African partners may have in U.S. organizations as we try to restart programming and restart engagements that we used to do in non-health sectors? Thank you.

HULTMAN: Michelle, you talked about trust. Do you want to address that please?

GAVIN: Sure. Well, I do think, you know, one of the realities of the nature of our society, right, is that our dirty laundry is on display. And it’s just a fact that the kind of sniping, finger pointing, inability to get our act together on testing, all of this is something that is carried in the global media. And basically, you know, we don’t look great. We don’t look terribly effective.

I think that, you know, some decisions from some of the tone at the top issues and some decisions to attack the WHO, which really went over badly in Africa—there’s a lot of respect for Dr. Tedros and a lot of pride in his leadership—it’s just—I would say that kind of U.S. stock has declined in terms of people having a lot of admiration for our system. And so a healthy dose of humility, I think, is going to be required going forward, an acknowledgement that we don’t always have all the answers and we don’t always get it right when we’re working with partners, which was a good idea before this too.

HULTMAN: Thank you.

Let’s see if we can get in one more question.

OPERATOR: Our next question comes from Jean Duff of the Joint Learning Initiative on Faith and Learning (sic; Local) Communities.

Q: Good afternoon, everybody. Thanks for an excellent discussion.

I’m returning to something that both speakers raised, the importance of religious influence, both positive and negative, in this context of high levels of distrust of public institutions and disinformation.

There are significant initiatives under way to equip and mobilize faith leaders around the world with information about safe gatherings and rituals and stigma and vulnerable populations and child protection and so on. WHO, Islamic Relief, JLI, all have guidance materials tailored to faith actors. This morning, for example, the Council—African Council of Religious Leaders and UNICEF launched in East Africa region a multireligious faith-in-action COVID campaign.

My question is about opportunities and what’s working in low-resource settings, where religious leaders are usually very present. What are particular roles faith actors can play to mitigate the impact on the poorest of the poor? Thanks.

HULTMAN: Thanks.

John, do you have a perspective on the religious influence?

CAMPBELL: I do, but it’s specifically with reference to Nigeria. In Nigeria, it has been very striking how the, for want of a better term, the mainline churches and also the mainline Islamic societies have supported the government’s efforts, particularly with respect to social distancing. For example, the Principal Islamic Society in Nigeria closed all the mosques in the country a week before the government’s shutdown. Most Nigerians, I think it’s fair to say, have more trust and believe in the credibility of their religious leaders to a greater extent than they do—they do the government as a whole.

Now, there’s a—there’s—

HULTMAN: Thank you, John. I think you both—I think we’re out of time. But I think you both are leaving us with lots more questions that we’d like to ask. I think we are out of time. Is that right, Operator?

OPERATOR: We are at the bottom of the hour.

HULTMAN: OK. Thank you so much, everybody who participated, and especially to you, John and Michelle. I hope somehow this discussion can be continued.

GAVIN: Thanks so much. Thanks to everyone for joining.

CAMPBELL: Thank you so much.

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