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Omicron And The Politics Of Power In Global Health By Chinwe Madubuike, PhD

December 14, 2021

Omicron is revealing a gradual global power shift.

Omicron is revealing a gradual global power shift. 

The reactions to the recent travel ban against African countries has shown two things. 

First, not every country is on board with the slogans of global solidarity that were bandied  about like a football being kicked around in a UEFA Champions League match. The recent racist  headline in a Spanish newspaper demonstrates that we are not in this together. Worse, these  headlines, along with the travel bans, raises questions on why we’re not yet in this together and how we can be. 

Second, scientists in Africa and other developing countries are harnessing decades of fighting  infectious disease and are making important discoveries and contributions. The fact that South  African scientists identified, genome-sequenced, and reported Omicron demonstrates strong scientific leadership. But as many have pointed out, instead of being rewarded like other  scientists that have made similar discoveries, African countries are being punished – an exercise  that seems discriminatory now that Omicron has been identified in more than 50 countries. But over a dozen countries have issued travel bans against eight African countries. 

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But why should discriminatory global health policies and the racialization of infections surprise  anyone when it is one of the less flattering feathers in global health’s cap? 

Stigmatizing, Discriminatory Policies: The Ties that Bind HIV/AIDS and COVID-19 

In the United States, when Georgia’s governor, Brian Kemp, asserted that mandating a non existent “AIDS vaccine” failed, it looked like he was about to be cancelled.  

While his statement was bereft of facts, it is almost inevitable that comparisons be made  between HIV/AIDS and COVID-19 – recognizing that COVID-19 is a respiratory illness caused by  severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) while AIDS is caused by the  bloodborne human immunodeficiency virus (HIV). Comparisons are also made because of the  global fear unleashed with each virus early on. 

Some ties that bind HIV/AIDS and COVID-19 are that, during their early phases, both had death  sentences attached to them evidenced by hospitalization and death rates that were shocking  for their time. Early on, both were marked with little preliminary understanding of the viruses,  and no cure – not to mention a vaccine -- to prevent infection. Like HIV/AIDS, preventing pre vaccine COVID-19 relied on behavioral protocols (like wearing condoms or masks). 

Another tie that binds HIV/AIDS to the Omicron variant is that people stigmatized the population in which the viruses were discovered or flourished. In the early days of HIV/AIDS,  two groups seemed the most hit: gay men and Africans. 

The American Psychology Association reports that in 1981, there were 270 reported cases of  severe immune deficiency among gay men, with 121 individuals dead by the end of the year.  These are relatively low numbers but were high enough to name the disease the Gay-Related  Immune Deficiency (GRID).  

A few things helped slowly shift the narrative. Larry Kramer founded the Gay Men’s Health  Crisis (1982) and ACT-Up! (1987) to advocate for research, treatments, and fair policies towards  people living with HIV/AIDS.  

HIV/AIDS was also found among other groups which expanded the gaze to include intravenous  drug users, blood transfusion patients that included women and children like Ryan White who  was banned from attending school following an AIDS diagnosis but fought in court and won. 

Africans with HIV/AIDS also faced discrimination. Ever plagued by images of disease, death, and  dying – the unholy trinity of negative African tropes -- pictures of AIDS stricken men, women,  and children travelled the globe through television, posters, and pamphlets. How best to raise  awareness and funds if not by showing images of dying African children? 

Some research analyzed social structures and beliefs that underpinned sexual relations which  tended to hypersexualize Africans as promiscuous, suggesting a contrast to more “civilized” intimate relationship structures. 

So, the discrimination came in the form of recognizing expertise as Western and framing  Africans as vulnerable, hypersexual, and needing to be "empowered". While this may be true in  some cases, it seemed public health was bent on placing these labels on the entire continent  under the rubric of “AIDS in Africa” so that they could introduce interventions such as awareness raising, assertiveness training, and proper condom application. While some of these  were helpful, based on my research in Nigeria, they were not helpful to people who did not see  themselves or identify as vulnerable or disempowered. This created missed opportunities to  have different types of discussions and approaches around preventing HIV. 

Post-colonial critic, Edward Said would have called this “othering”, a conscious or subconsious  perception of “us versus them”. Works by Franz Fanon, his teacher Aimé Cesairé (who  considered himself to be Igbo from Nigeria), Achille Mbembe, Paolo Freire, and Michel Foucault have addressed the way geopolitics and other power imbalances have been harnessed to organize global structures in ways that harm the “Other”. 

So, the recent outpouring of rage against “the Africanization of Omicron” shouldn't be  surprising. While global health has undoubtedly saved lives, prevented infections, and treated  diseases, it also has a legacy of colonialism and discrimination which needs to be addressed. In fact, the pushback from both Africans and non-Africans offers a few opportunities for the global  health community to explore, going forward. 

Most of this research published was carried out by Westerners as principal researchers with  Africans assisting. This, intentionally or unintentionally, perpetuated the notion that Western  researchers were mostly responsible for generating scientific knowledge thus reserving the role  of “expert” for Westerners. 

Unfortunately, the travel bans show that this sentiment has crept into the world’s covid  chronicles. Despite Dr. Angelique Coetzee, the physician who first reported Omicron’s mild  symptoms, which has been echoed by doctors in the other countries in which Omicron has  been found, the bans have not yet been lifted or expanded to include the growing number of  countries hosting the new variant. Senior health officials in the UK and US have promised to  review their policy as soon as more is known about Omicron. While there’s a need for further  research, the bans feel a bit like administering medicine after death. 

Recommendations: 

Political Leadership in Africa. It’s hard not to disrespect the corruption, negligence, and  underdevelopment perpetuated by many African leaders. It’s time to stop the countless  medical trips abroad, build up medical facilities and infrastructure like basic electricity,  strengthen economies, stop begging for hand-outs and squandering loans. Countries like  Nigeria ranks high in human and cultural capital. But it’s time to get some strong economic  capital, leverage the social capital accrued from having a strong economic, and be a true global contender. Yes: like China, India, and Singapore! 

Hack the Science: This means expand the conversation and reviewing tools. For example, while  many African practitioners anticipated vaccine hesitancy, Western discourse has focused on  vaccine equity. South Africans are in the middle of reconciling the two. The current focus on  biomedical science is undoubtedly justifiable and critical but we need to enlarge the toolbox to include behavioral sciences, sociology, economics, etc. to help us understand knowledge  attitudes and practices around vaccine hesitancy but to also make sure that the research  approaches are reflexive and consider geopolitics and other power dynamics by looking at the  intersections of race, gender, class, ethnicity, sexuality, nationality, disability, and more. 

Global leadership: Leaders are obliged to ensure that the same discriminatory practices that  flourished around AIDS do not rear their heads simply because African scientists dared to  exhibit their sharp skills.  

The truly more “equitable” way to go is to either drop the bans against African countries or  issue bans against every country with the variant. Yes, another lock down. But one that is  short and allows leaders time to assess risks and plan next steps. Then countries can work  separately or together to address the structural and behavioral gaps in ways that enhance – not strip—citizens from those nations of their dignity. But it’s not just a matter of dignity that is  important, but the shifting of power inherent in African scientists and practitioners generating – not just contributing – to global health and what we are all in the process of learning about  covid and its variants. Like much of the world that has decided to travel once the global  lockdowns ended, citizens of banned countries have business to conduct, meetings to attend,  loved ones to see, and lives to live. Unfortunately, the bans suggest that African black lives don’t  matter. 

The author would like to thank Ufo Eric Atuanya and Dr. Jay Nmachi for their constructive review of this article. 

Chinwe Madubuike earned her PhD from the London School of Economics and Political Sciences  by researching the politics of power in HIV prevention programs and their social and economic  impact in Nigeria. She holds a Masters in Public Health from Maastricht University where she  served as a WHO Fellow. She was also a fellow of the American Political Science Association. She  currently researches and writes about global health, international development, and trade. She  can be reached at [email protected]