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Pandemics: A social justice issue

COMMENT

The South African National Defence Force (SANDF) is being deployed in anticipation of the 21-day lockdown beginning Thursday night. The visual impact of having armed forces on the streets is striking. It shows a government that is serious about mitigating the impact and spread of the coronavirus. Words such as “lockdown” and “viral threat” conjure wartime sentiment. We look toward a strong wartime leader and some people may take comfort in seeing a military presence on the streets.

Imagine how concerned the government must be about the projected loss of human life, and the projected economic impact, or both, if it is willing to suspend its business-as-usual behaviour for 21 days. 

The concern is justified. A substantial number of South Africans live in informal settlements that are overcrowded and lack basic hygiene services. We have a large population living with TB and HIV that may be at high risk of viral infection, while our healthcare system is already strained. Many South Africans are in informal employment, don’t have cash reserves and are food insecure or are dependent on wages rather than salaries. In this context, it will be interesting to note what type of “lockdown” can be realistically expected or militarily enforced.

Logistically, increased numbers of “boots on the ground” can be useful. The military would be trained in basic medical services, if only first aid, and it can assist in disaster relief efforts. Patrolling the streets, they serve as a deterrent and a policing force. 

The way in which a security lens is being used to view a health issue such as the present pandemic is no accident. There has been a deliberate global effort between the mid-1990s and 2005 to frame pandemic influenza as a security threat. In this 2012 paper in Global Public Health, authors Adam Kamradt-Scott and Colin McInnes explain how these ideas gained legitimacy through epidemiological studies and economic projections, framing pandemics as an existential threat to countries. 

The positive adjunct to bringing an issue into the realm of state security is that it is placed high on the political agenda, ensuring the mobilisation of extra funding and human resources as well as the activation of laws only used under exceptional circumstances, such as the declaration of a state of disaster in South Africa. 

The downside is that efforts are ad hoc, and a huge amount of resources are diverted to stop-gap measures, which are necessary during an emergency, but could have been better spent during inter-pandemic periods with greater long-term utility. The solidarity fund proposed by President Ramaphosa yesterday would be essential. However, depending upon donor contributions to keep a country running is hardly a sustainable or replicable solution.

Classing health as a security issue means that at an individual level certain civil liberties may be curtailed in the interest of the common good. This becomes more of a concern with the declaration of a state of emergency than a state of disaster. Much trust is handed over to the government during these times, and the government, in turn, needs to prove its worthiness. 

As countries such as the United States and the United Kingdom attempt to develop app-based disease surveillance systems along the lines of the Chinese model, questions around data privacy are being explored (especially in the light of Edward Snowden’s revelations regarding global surveillance). 

Surveillance systems that are put in place during an emergency may persist once the emergency has passed and citizens need to ensure that the appropriate privacy checks and balances are in place. 

This pandemic has already placed public health higher on national and international agendas. Rather than see the issue through a securitisation lens, progressive policymakers and public health advocates have the opportunity to frame pandemics as an issue of social justice. 

Attention can be drawn to whether income differentials within a country determine the impact of pandemics and looking at issues of income and wealth redistribution. Social justice angles may be considered when looking at the influence of pandemics in countries with strong social safety nets. Evidence showing the impact of pandemics on countries with equitable and quality health services versus countries with unequal health services can be investigated. 

A securitised response to the present pandemic may be necessary in this instance, at this moment. But intermittent pandemics are sure to be a feature of the foreseeable future. To repeatedly launch into wartime mode is reactive. Viewing pandemics through a social justice lens is much more constructive and enduring — even beyond these challenging coronavirus times. 

Dr Ayesha Jacub is a medical doctor and global health policy analyst. She previously worked in the South African public health system and is now based in Istanbul.

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