Constraints: A health worker gives a man a dose of the Oxford/AstraZeneca Covid-19 vaccine in Francistown, Botswana, in March 2021. Photo: Monirul Bhuiyan/AFP/Getty Images
In early May, President Mokgweetsi Masisi told a CNN journalist that Botswana is “on the verge” of becoming the first African country to vaccinate its entire adult population against the deadly Covid-19.
With unbridled optimism, the president lauded the country’s past experience in fighting pandemics, singling out its spirited campaign against HIV/Aids in the 1990s.
But by mid-July, things began to unravel. Social media feeds surfaced with videos of Covid-19 funerals, wailing relatives outside hospitals and long queues of gasping patients at testing centres.
“My mother just died in the parking lot. [Princess] Marina [Hospital] turned us away, saying there are no beds,” read a Facebook post, highlighting the unpleasant reality of scarcity during the pandemic in mineral-rich Botswana.
At the end of July, Princess Marina, the country’s biggest public hospital, warned that its mortuary was overflowing, while Sidilega, a private hospital in Gaborone, advised patients seeking emergency care to look elsewhere.
Frantic calls for medicines and oxygen, and discussions about the efficacy of Ivermectin, used to treat parasite infections, and Covid tests flooded the social media.
Away from the CNN glare, Masisi changed the narrative. The problem, he said, lies with Covax, the World Health Organisation initiative aimed at providing equitable third-world access to Covid-19 vaccines.
It had swindled African countries that had invested in the facility to buy vaccines, he told people at a vaccination centre near Gaborone on 22 July. He alleged that third world countries made payment in advance but remain at the back of the line while rich nations get the vaccine.
“We have pumped money as developing countries of the African continent into the Covax facility but the returns were not satisfactory,” he told the Weekend Post newspaper. “They cheated us … this is not fair.”
A man receives hand sanitiser as a preventive measure against the spread of the Covid-19 before boarding a taxi in Gaborone on May 21, 2020. Photo: Monirul Bhuiyan/AFP/Getty Images
Three years into his term in office, Masisi has been caught misrepresenting the facts on several occasions, sources say. But statistics do not lie: Botswana is the worst-hit country in the world in terms of infections per 100 000 people.
By mid-June, the nation of 2.3-million people was averaging more than 2 000 new cases a day. Ministry of health statistics show that about 30 people a day are dying while only 1 000 are getting vaccinated.
Six months into the roll-out, only 5% of the population has been vaccinated.
Experts say that if the runway infection rate remains unchecked, Botswana will start recording more than 100 deaths a day by the third week of August.
Things haven’t always been this gloomy. Botswana declared a state of emergency after the first confirmed Covid-19 cases, when three citizens from the United Kingdom tested positive on 1 April last year.
A heavy lockdown and a lengthy state of emergency gave Masisi sweeping powers to rule by decree. Now, with two months to the end of the 18-month state of emergency, the country has confirmed more than 116 000 cases and 1 600 deaths.
Masisi’s critics say the state of emergency has been marked by procurement irregularities and that apart from lockdowns, the government does not have a clear strategy to fight the pandemic.
“Government failed medical experts in so many ways. It doesn’t look like they have a plan,” said a medical source at the University of Botswana, who asked not to be named.
Others say the administration’s ham-fisted mismanagement and neglect have led to the spike in infections.
The ruling Botswana Democratic Party (BDP) battled in April last year to come up with reasons to justify the state of emergency. The leader of opposition in parliament, Dumelang Saleshando, argued at the time that it was a ploy to give Masisi more powers to take decisions unilaterally and that it could also lead to tender irregularities.
Information on contracts awarded to suppliers related to Covid-19 tenders remains hidden from public view. What is difficult to hide is the number of millionaires in Gaborone, which increased by 100 to 1 200 during the pandemic, according to a report produced by AfrAsia Bank.
The ministry of health was accused of procurement irregularities, to the point that social media platforms were awash with copies of leaked documents showing the extent of tender kickbacks.
One example was the exorbitant price quoted for the supply of face masks, which ordinarily cost $0.40 (R5.72) each but were being sold at $21 (R300) each by a shelf company belonging to a connected sympathiser of the ruling party.
Under the lockdown, it was also alleged that the construction of 10 toilets at a primary school for P1-million (R1.3-million) should have cost around P100 000 — prompting an official investigation.
The Covid-19 Relief Fund set up by the government in April 2020 was opaque in its operations. Despite holding more than P2.4-billion in public and private donations, the fund has yet to be audited.
The president’s frequent and often random changes of personnel in the health department have also drawn sharp criticism. Within a year, Masisi has got rid of a health minister, two permanent secretaries, and four directors in the ministry of health, often replacing them with inexperienced officials.
Masisi appointed Dr Edwin Dikoloti, a veterinary surgeon, as health minister in place of Dr Lemogang Kwape, a doctor of epidemiology, in late 2020.
BDP insiders alleged that Masisi and Kwape had clashed on policy direction and Covid-19 expenditure. The president also removed the permanent secretary in the ministry of health, Solomon Sekwakwa, an old hand in government and a respected economist, and his deputy, Dr Morrison Simvula. The reasons for this were never given.
The directors in the ministry of health — key drivers of Covid-19 management and strategy — changed so frequently that one director, Malebogo Kebabonye, lasted just three months.
When the Delta variant was consuming much of India, Botswana relaxed its borders.
The assistant minister of health, Sethomo Lelatisitswe, defended the decision, saying the Delta variant originated in South Africa and that there was no way the country could shut its doors to Indian businesspeople.
Updating parliament on procurement, Dikoloti indicated last week that the country had paid inflated prices for Covid-19 vaccines because it had purchased them late.
The minister indicated that the country paid $29 (R414) for a dose of Pfizer/BioNTech vaccine, compared with the production cost of $1.20 (R17.15), meaning that Botswana is paying almost 24 times the production cost.
The country also paid 15 times the production cost for the Moderna vaccine, according to Dikoloti’s calculations. Now it has run out of vaccines.
On the same day that Masisi claimed to have been short-changed by Covax, the assistant minister of health, Lelatisitswe, appeared to contradict him.
Lelatisitswe told parliament that Covax is anchoring Botswana’s vaccine programme. “We are actually bolstered by the Covax facility in this country,” he said.
A member of the Presidential Task Force said anonymously that the biggest challenge has been government procrastination.
“We did everything right,” he lamented. “We maintained social distance, wore masks, locked people down. But after the lockdowns, what did we do? Nothing. There was no further plan, especially in placing orders for vaccines. We did that very late.”
The coordinator of the task force, Dr Keneng Masupu, also a veterinary surgeon and former director in the department of animal health and production, declined to comment.
The pandemic has exposed structural weaknesses in the ability of the government to deliver basic health and other services and manage public resources responsibly.
The BDP under Masisi is failing to revive the flagging economy, according to an opposition politician, Larona Morebodi.
During the fourth quarter of 2020, the economy contracted by 7.9% — a worse performance than during the global financial crisis of 2009, according to Econsult, an economic think-tank.
Econsult says the increase in VAT from 12% to 14%, the rise in the fuel levy, the introduction of the tax on sugar-sweetened beverages, coupled with higher electricity tariffs will increase pressure on consumers, who already face high unemployment.