Vital Interests: Alex, thanks for participating in the Vital Interests forum. We will be discussing the potential impact of the COVID-19 pandemic in Africa, but let's start with discussing your recent book Mass Starvation: The History and Future of Famine.

You started the book with the optimistic view that famine had been nearly vanquished from the world, that the international community had figured out a way, with the Green Revolution and the assistance of international organizations, so that mass starvation due to famine were not a constant killer of millions of people.

Then you switch your view to a cautious warning that in fact famines are resurgent. Not because of the lack of foodstuffs but because of wars, blockades, hostility to humanitarian goals, and a more volatile global economy. Can you provide an overview of the book and its new relevance to the current pandemic?

Alex de Waal: Thank you for asking me to contribute. I spent quite a lot of my career studying the question of famine. I started writing about it in the 1980s. In 1997, I published a book called Famine Crimes in which I looked at the way in which failures of political accountability, along with some particular war strategies, had led to most of the famines in recent experience in Africa. As the 20-year anniversary of that book was coming up, I reflected, why is it that these famines that were a regular drumbeat in the middle part of the 20th Century seem to have faded?

I started writing a book which was going to be a reflection on why famines have gone away. Looking at the hundred or so million people who died in famines from the late 19th century to the current day, almost all of them died prior to the 1980s. Until about 1980, about ten million people died in famines every decade; since then the figure has been one tenth of that or less. The older pattern of great famines had been very closely associated with colonialism, with the great wars, and with communist dictatorships. The greatest famines of the 20th Century were caused by Mao’s great leap forward, by the Nazi hungerplan on the Eastern Front in World War II, by Stalin in Ukraine, by Pol Pot, and other cruel tyrants. Then more recently by vicious counter-insurgency in Africa. 

So I began by posing the question: why have these terrible famines gone away? I pointed to a number of reasons - massive improvements in public health, in food supplies, the Green Revolution, the improvement in living standards, particularly in China, were all parts of the story. The other big part of the story was the end of communist dictatorships and the end of wars of extermination. Once these had been consigned to history, we no longer saw mass starvation on the scale that we witnessed in the earlier parts of the 20th Century.

It was really a good news story. It was also saying to the humanitarian community, whom I had criticized quite a lot back in the '80s and '90s, yes there are many things that you get wrong or missed, but some things that you got very right. Humanitarians are relentlessly self-critical, seeking to highlight the suffering in the world and focusing on the disaster of the day; always asking themselves why they haven't succeeded in preventing it from happening. 

Very rarely do the humanitarians take a big step back and ask themselves, what is the overall trajectory, what is the great arc of the history of famine? If you do that you find that there have been fewer famines and many fewer fatalities over the decades. There are a number of reasons for this, some of which I just mentioned, and an additional one that must be included is the achievement of the international humanitarian enterprise. Crises, such as wars, that in the past resulted in terrible famines today will today cause humanitarian suffering but on a considerably smaller scale. It may be hard to discern when we see heart-rending pictures of human suffering, but the statistics tell us that the positive story is true. Today’s humanitarian expertise, professionalism, and reach are such that these crises cause many, many fewer deaths. That's something that we can all be proud of, something worth preserving.

Then, during the writing of the book, we saw a resurgence in famines. There were famines in Yemen, in South Sudan, in Somalia, and in North-Eastern Nigeria and a major starvation crisis in besieged areas in Syria. I looked into those and what they all had in common was that starvation was being used either as a weapon of war, as in Syria, and to a large degree also in Yemen, or it was the foreseeable outcome of reckless policies pursued by warlords and armies. Famine and mass starvation, in the contemporary world, should be seen not in the historic way as a hardship that is suffered by unfortunate populations, but as a wrong inflicted, deliberately or recklessly, by political and military leaders.

VI: What about droughts and other climate change impacts on food scarcity? There were severe droughts in Syria that drove people off the land and into the cities which upset the social order and contributed to instability and ultimately civil war. Are these factors also being manipulated by governments so that food is not equally distributed?

Alex de Waal: Certainly droughts occur; they are a part of a natural cycle, and climate change is exacerbating that cycle, causing not just drought but also serious floods in a number of places. There's no doubt that those events cause hardship and hunger, and they also cause social instability. However, the question of where the burden of hardship and hunger falls, who starves, is a choice. It's a political question, always. The type of natural adversities that 150 years ago would have caused famines no longer cause them, and there is no reason why the climate crisis should cause them today or in the foreseeable future. If climatic adversities do cause starvation, it's because someone has made a political decision that human lives are dispensable and that other political or economic goals should be pursued, at the cost of human suffering.

Or, sometimes the decision has been made, that humanitarian operations, which are now very routine and very large scale, will either be prohibited or be carried out under the utmost restrictions resulting in a meager effort. If we take a case like Yemen, the poorest country in the Arab world, it has chronic issues of food insecurity and especially water insecurity. However today’s crisis, and the humanitarian crisis that has killed unknown numbers of Yemenis in the last few years is entirely the product of political decisions by the belligerents, including the Saudi led coalition and also the Houthis. Yes, Yemen was poor beforehand. But that was known to the belligerents. Pre-existing food insecurity does not exculpate them. Rather it compels us to ask them, if you knew that Yemenis were vulnerable in this way, why fight a war of starvation there? It was political decisions that brought about starvation in Yemen; it is a starvation crime of the first order     

VI: The welfare of large parts of the world is now threatened by the COVID-19 pandemic, which will affect supply chains and economies.  You've written a number of research memos on the governance implications of epidemic diseases in Africa in light of their experience with malaria, Ebola, and HIV/AIDS. Can you put the current COVID-19 outbreak into an African context?

Alex de Waal: The biggest and most lethal epidemic that Africa has suffered over the last 25 years is HIV/AIDS. Until antiretroviral therapy became widely available, it caused an absolutely catastrophic drop in life expectancy. The greatest pandemic of the 20th century, the 1918 influenza pandemic, cut life expectancy in the United States by 12 years over one year. By comparison, what HIV/AIDS was doing in southern Africa recently was cutting life expectancy by 20 years over a protracted period of a decade or so - much, much greater devastation even than the flu pandemic. 

It looked at one point in the early 2000s as though the combined effects of HIV/AIDS, weak governance, and economic vulnerabilities and drought would lead to what we called at the time “New Variant Famine.” The then UN Secretary-General Kofi Annan talked about what he called the “triple threat” of HIV/AIDS, poor governance, and food insecurity unfolding, driving a new crisis in Sub-Saharan Africa.

What's very interesting is that it didn't turn out that way. Those doomsday scenarios did not play out. The reason was that African societies turned out to be a lot more resilient than was expected. In particular the numbers of children orphaned by HIV/ AIDS, though huge, did not overwhelm the social fabric. The orphaned children were cared for, at great cost, by families. The other part of that story is that there was an extraordinarily effective regional, that is African, and international response to it. 

There was a lot of cooperation and leadership among African states. This was the time of the post-Apartheid African boom, and we had international leadership in the form of the United Nations with UN AIDS and—in the case of the AIDS-related food crisis--the World Food Program. There was also significant assistance from the U.S. government at that time. President George W. Bush, whose foreign policies are on the whole not held up as a model of success, in this case of responding to pandemic disease and hunger in Africa, he was undoubtedly successful.

President Bush adopted a policy of “no-famine-on-my-watch”. He was quite explicit in saying that the U.S. government should have a no-regrets humanitarian response policy. Thus, if a USAID country director saw famine unfolding in a country he or she was working in, they should respond to it no matter what, regardless of the politics. Also, global health was a priority. The Bush administration rolled out support for global health initiatives, including PEPFAR, the President's Emergency Program for AIDS Relief, and also pandemic preparedness. There was a combination of U.S. and UN leadership, which weren't always on the same page but were working towards pretty much the same goal.

This meant that the enormous AIDS-related social crisis in Africa, which many of us feared would result in the worst political and economic crisis in a generation, didn't unfold as predicted. In fact, Africa weathered that storm remarkably well. 

One of the things that emerged from not only HIV/AIDS, but particularly from Ebola, which came along a little bit later, was the epidemiological literacy of African populations. By that, what I mean is the efficacy of a social response to an outbreak of a severe infectious disease, be it in HIV/AIDS, Ebola or something else. These are epidemics for which there is no bio-medical solution: no cure, no vaccine. The only effective response is behavioral change - in the case of HIV/AIDS, by reducing risky sexual behaviors, in the case of Ebola by managing the key risk points, such as handling the bodies of the deceased for funerals and self-isolation measures for people who feared they might be at risk of being infected. Communities were actually very quick to adopt these. 

I have a colleague, Paul Richards, a social anthropologist who worked in Sierra Leone. He said the trick, for getting on top of Ebola, was getting communities to think like epidemiologists and epidemiologists to think like communities. Paul said this actually was a lot easier to do than you might have anticipated because people understood the risk. Also, epidemiologists appreciated the need to understand those intimate social behaviors - how you treat the dead, how you shake hands, how you interact with your loved ones, in the case of HIV/AIDS your sexual practices – and how those can change. It's only when they change that such an epidemic is brought under control. 

Africa, as a whole, and this is an enormous generalization, but vulnerable Africans, particularly women, are very well aware of what's needed, in terms of the types of behavioral changes, to bring epidemic diseases under control. 

VI: Local initiatives brought the epidemics under control in impacted African communities.  So was it bottom up actions rather than top down controls that mattered the most?

Alex de Waal: It was a mixture of both. One of the things that was always underestimated by the experts and the authorities was the degree of grassroots mobilization and understanding. It's not as though people are ignorant and superstitious and need to be told what to do. Rather if they're encouraged to change their behavior, and because they're made aware of the risk factors of a communicable disease, they will respond. They'll respond much more quickly than is often expected, and that is a very positive message. Our relentless focus on biomedical technologies, and the esteem we extend to the expertise of physicians, tends to neglect this simple reality.

VI: Local communities in Africa tend to be tribal and hierarchical with recognized elders who are accepted as leaders. They are also matriarchal societies where women have always had responsibility for the care and wellbeing of their extended families. Did this also play a role in compliance with epidemic lessening practices? 

Alex de Waal: That's correct. Also, these tend to be young communities. Africa is a very young continent. With a predominance of youth who are eager to learn and ready to change, there's a speed of adaptation that can be very impressive.

VI: Taking those experiences to the COVID-19 threat, as it spreads into Africa, do you think these lessons will be applied or do you think it's a qualitatively different kind of threat?

Alex de Waal: I think what we've seen in the first stage of COVID is a number of rather contradictory things going on. First of all, COVID has not hit Africa as badly as was feared—at least not yet-- and we don't know the reason for that. Some speculate that it's because Africa's population is a lot younger, so you have a lot fewer people who are in the very vulnerable older age categories. On the other hand you have an extremely high prevalence of tuberculosis in many countries, and that is definitely a risk factor, and also a high prevalence of HIV. At the moment, the reason for the slow uptick in COVID cases in Africa is a bit of a mystery. We don't know the reason—it may be that Africa is simply behind the curve, and it will come.

VI: There is speculation since people in African countries don’t travel internationally as much as in Europe and the United States there was less early exposure to the virus. Could this be a factor?

Alex de Waal: You get quite a lot of international interchange in Africa as well. If you think about Ethiopia, there are daily flights to several Chinese cities, and it is a major international hub. If you think about the settlement patterns of Addis Ababa and other African urban centers, they are very densely settled where social distancing would be remarkably difficult to do. People are living in very close proximity to one another. One would have expected the COVID virus, if it entered the cities, would have spread very, very quickly.

One of the fears of Africans-- and Indians and Latin Americans too-- is that in these informal settlements where people are packed in very closely, the social distancing and isolation measures that are possible in a European or North America city simply can't be implemented effectively.

One of the things that immediately happened in Africa is that governments implemented lockdown policies, essentially borrowing from the European model and the East Asian model. But they did that without really asking the question, what is the goal?  How are we going to make a lockdown work in terms of a longer-term strategy of containment and disease control?

Basically there are three strategies for lockdown. One is the East Asian strategy, the Wuhan strategy, the Singapore strategy, which is you close down everything until you get to zero cases or near zero. Then you put in very intensive surveillance along with contract tracing and isolation. Wuhan has more than 10,000 people doing neighborhood policing and contact tracing. That is very hard to replicate outside a very well administered police state like China or Singapore. The only place where that might be possible in Africa would be Rwanda, nowhere else would that work.  It's not even possible here in the United States.

The second approach is the “flattening the curve” approach, which is you reduce the burden of caseload on the medical facilities. That's viable in Italy or here in Massachusetts, where you have good hospital facilities, and you're confident that if you flatten the curve then when you relax the restrictions and when the second wave comes, you have sufficient medical facilities to be able to handle the caseload. More people will get infected but their mortality will be lower because there are health facilities that can cope.

Now that simply isn't viable in Africa, with the possible exception of Tunisia and South Africa.  Countries like Uganda, they simply don't have intensive care beds and the means to do intensive case management. There simply isn't the health facilities to cope with really any serious level of COVID morbidity. That health capacity can't be built up in a few years, let alone a few months. It's just going to take far too long. Flattening the curve would help but it's not going to solve the problem.

The third strategy is the “shielding” strategy, which is that you use that time to put in place the measures that are needed to protect the most vulnerable. You use it to identify the elderly and the people with comorbidities like TB or diabetics and say, these people need to be protected from infection. The elderly, maybe this is time for you to go and stay in the village for a while.  Or think of the people who are in TB care, let's make sure that we can put you in places where you can be isolated and protected for a long period of time.

It seems that almost everywhere in Africa they went into lockdown without thinking through the strategy. They bought some time but they didn't then use that time for developing an effective shielding strategy for when to come out of a lockdown. Or indeed developing any effective strategy for slowing transmission in key places where transmission is going to happen. 

In addition, in Africa we have economies that rely very heavily on the informal sector and we have large numbers of people who need to go to the market every day, or who have no savings and need to earn a living on a daily basis. A lockdown is really putting these people in an impossible dilemma, to take your chances with the lottery of infection or face the certainty of hunger.

A lot of the popular outrage and hostility towards lockdown has come because people say, "We are being condemned to hunger. We are being condemned to destitution. We are going to have to surrender our modest livelihoods. And for what? We would rather run the risk of getting infected." Unless there is a strong capacity for welfare payments, for supporting people's livelihoods, and food security, lockdown simply ain't going to work. People are well aware of this; they will resist or find ways to work around it. 

In many cases, the last couple of months have been an opportunity that is largely missed for developing a set of effective and locally-appropriate strategies for Africa to get through this pandemic.

VI: Does each African country have to implement its  own policies to confront the COVID threat? Does the African Union or some other organization provide guidance and support?

Alex de Waal: At the level of the African Union and other intergovernmental organizations, there's been attention to two things, both of which are warranted but neither of which are sufficient. One is the health care strategy, for beginning to ramp up a medical response, which is necessary but is inevitably going to be hopelessly short of what is required. The other is attention to food supply chains and seeing what can be done in terms of keeping African food security on a good footing. And, in support of both of these, coordinated approaches to international donors and creditors.

In this area, we are helped by the fact that while many commodity prices have collapsed, food prices have been relatively stable. There is a fairly robust food economy in Africa but a lot of work needs to be done to reorient African food supply chains so that food-exporting countries, which have lost their markets, can reorient their trade towards food-importing countries that maybe have lost their supply.

VI: Let's look at some of these economic factors. The UN Secretary-General, Antonio Guterres, has warned that the COVID virus could push millions of Africans into poverty. In a vast majority of African countries people live on the margin, the governments are heavily indebted, and there is significant dependence on foreign assistance. How rapidly can a downturn or recession in the global economy impact in Africa?

Alex de Waal: It could happen very quickly and very disastrously. Actually, Africa as a whole has not seen a continent-wide recession for nearly thirty years. It's survived the other major recessions, such as the financial crisis of 2008, relatively well. That’s because commodity markets didn't collapse too badly and because the internal informal sector was pretty robust.

What's really worrying about the current economic crisis is that it has some of the features of the last great recession in Africa in the '80s and '90s, in that it is hitting the formal economy, but it is also hitting the informal economy too.

The current economic downturn is devastating for government revenues: taxation is down and expenditure is up. It is particularly severe for oil-producing countries because the bottom has dropped out of the oil market. So Nigeria, Angola, South Sudan, Chad have lost their hard currency, that revenue, overnight. We have tens of thousands of people in different sectors becoming unemployed. For instance the market for cut flowers has completely collapsed. That's 100,000 unemployed in Ethiopia and Kenya. We have a complete suspension of employment in the tourism sector.

What is different to the crisis of 25, 30 years ago, is that the informal private sector is also being hit. In the last great African recession we had downsizing of state budgets in order to promote the private sector. That was partly by design because of structural adjustment policies put in place to bring African economic management into line with the Washington Consensus. What brought Africa through was a thriving private sector, especially that informal sector. Today, the big problem with the lockdown policy, and the disruption of local movement and local trade, is that the informal side of the economy is being hit too. It's the first time that this sector has been undermined at this scale in living memory or even beyond.

The current African debt crisis also has a new dimension. The previous great recession was in part a debt crisis, and in due course there was a slow but nonetheless decisive movement by the major Western creditors, the Paris Club, World Bank, et cetera to provide debt relief. This took the form converting debt into social sector payments, enabling Africa to climb out of its indebtedness. 

Since then, unfortunately, African governments have contracted a whole lot of new debt, particularly from China. Twenty percent of Africa's debt is now held by China, and there's no sign that China is going to be merciful in the way that the Jubilee Campaign compelled Western countries to be generous. China may suspend debt repayments, but debt forgiveness doesn't seem to be in the cards. Much of the other debt is commercial loans. Therefore the obvious ways out of today’s debt crisis - through a booming informal sector and debt forgiveness - don't seem to be open at the moment.

VI: When you're talking about the economic vulnerabilities, the middle class that has grown considerably in many African countries will lose that status and the struggling poor will be in dire condition. How many millions of people on the African continent could be, even in the short run, in difficult circumstances?

Alex de Waal: The Africans’ rising middle class was beginning to surpass a couple hundred million. We may yet see a large percentage of them plunged back into poverty. 

There is a political element to this that should not be overlooked. The salaried classes, many of whom are people who rely on either government wages whose numbers have been growing, or on the private sector which has been expanding with the recent commodities boom, have political demands on their leadership. If the funds for paying salaries, for keeping businesses afloat, and also the flows of political patronage fueled by oil money (for example in Nigeria) begin to dry-up, political crisis will follow. Not only do you have unemployment but you have political systems beginning to seize up and plunge into crisis. It's a very disturbing picture, to have all the key indicators pointing in the wrong direction at the same time.

VI: Is that what we see now or have we not yet reached the point where all the indicators are a cause for concern?

Alex de Waal: All the warning lights are on, to be frank. They're all flashing red.

VI: Not orange but red?

Alex de Waal: Some orange but most are red, let me put it that way. The food supply one is still orange.  All we need is a few additional natural disasters, like the locust infestation we are seeing in Northeast Africa, on top of that and then it becomes pretty serious.

VI: If serious warning signs are flashing, are the predictions of government instability and civil unrest in Africa that were made a decade or so ago because of HIV/AIDS and other epidemics, now feasible?  

Alex de Waal: The short answer is yes: feasible but not inevitable. What was remarkable about prior epidemics was that they didn't cause popular unrest on the scale that was feared. There was considerable unrest in Africa already, but very little of it was directly associated with epidemic diseases, or disease-related poverty. The unrest had more proximate political causes; and the progress of Africa was built on a foundation of economic recovery. Today, the resilience of African economies and societies is going to be severely tested. I fear we should be grimly pessimistic about economic prospects; I would be cautious in saying there's going to be a major political or societal crisis in the near term, but there is every reason to be very worried.

VI: Can the UN and other NGOs provide the needed support to stop the lights from flashing? Or will it take the global economic powers offering economic lifelines like debt relief and generous aid packages?  Or is the global community in a situation, due to the pandemic and general discord, where there is no one to answer the calls for help?

Alex de Waal: Well, what is so tragic about the current situation, of course, is that many of the governments and international organizations of the world spent a lot of time and effort preparing the mechanisms for a collaborative response to precisely such a crisis as this. The WHOs pandemic preparedness plans were not just a medical plan, they were all of government, all of society plans.

It's not to say that they would have been necessarily up to the job of responding to COVID-19 but nonetheless they  did provide a template, a beginning point, for global cooperation between the United States, China, and the European Union and others - a coordinated response on the health side and on the economic and social sides. It's not that we weren't prepared for COVID, it was that we were de-prepared. Those mechanisms for preparedness were deliberately dismantled and their absence is keenly felt.

By way of comparison, what we saw in Africa in response to the triple crisis of HIV/AIDS in the early 2000s was exactly the model which is called for today. That response was a mixture of a U.S. led response and a multilateral UN and African-led response, which successfully managed the problem. The challenge with COVID-19 today is not bigger in Africa, it is bigger in the world as a whole. The types of resources that were mobilized for Africa fifteen or twenty years ago would, my guess is, be sufficient to cope with COVID-19 now, but the will to mobilize them in the rest of the world is not there.

VI: Alex, we're coming to our end of our time. We try to end our discussions on some positive note. Looking at the situation as it is now at the end of May 2020, we're not certain how the COVID pandemic will play out. In Africa where is the hope that they can get through this?

Alex de Waal: The hopeful story in Africa is how it came back from the brink in the '90s. In the post-Cold War years, Africa was essentially neglected by the world. The international donors turned their backs on the continent.  Conflicts raged, the Rwanda Genocide was perpetrated, and HIV and AIDS and other diseases spread unchecked. The African leaders essentially looked collectively into the abyss and said, we don't want to go there. They began a process of establishing the norms and principles for regenerating the continent.

They didn't have strong material means but they had the vision and they had the normative power to say. “we can get through this.” There was a tremendous community-level response as well, which was particularly significant because Africa is a young continent and young people are energetic and creative. Africa rebounded. From the point at which Africa was really regarded, in the mid-'90s, as the doomed “hopeless continent” (there was a famous Economist front cover with these words), Africa recovered to a point in which it was seen as the most hopeful continent barely a decade later.

That experience of, as it were, collectively drawing a breath and recognizing that there is an abyss but the abyss can be avoided is an enormously strong resource on which to draw. In particular, the African sense of collective responsibility, of feeling that we have to do this ourselves as the rest of the world doesn't really care about us, can be turned from a cry of despair into a mantra of hope.

Alex de Waal is the Executive Director of the World Peace Foundation. Considered one of the foremost experts on Sudan and the Horn of Africa, his scholarly work and practice has also probed humanitarian crisis and response, human rights, HIV/AIDS and governance in Africa, and conflict and peace-building. His books include Mass Starvation: The History and Future of Famine and The Real Politics of the Horn of Africa, and AIDS and Power: Why There is No Political Crisis - Yet.  Prof. Alex de Waal regularly teaches a course on Conflict in Africa at the Fletcher School, Tufts University.