Preparing for the next pandemic: lessons from Zimbabwe

There is a lot of talk about pandemic preparedness, but what does it mean? Too often there are narrow, medicalised versions – focused for example on drug stockpiling, vaccine banks and so on. A COVID Collective report – Pandemic Preparedness for the Real World – has critiqued this view, offering a wider perspective on pandemic preparedness. What might a more locally rooted version of pandemic preparedness look like? Can wider understandings of how building resilience within communities can assist? There have been many important lessons emerging from the pandemic experience, but are they being learned? The relatively quiet and calm inter-pandemic period is crucial, as there will surely be a next one.

During November and December 2022, we tested the ideas in the then forthcoming COVID Collective report with different communities in six sites across Zimbabwe in a series of dialogues. This built on real-time research in the same settings from March 2020 to February 2022. From Chikombedzi in the dry, far south, via the sugar estates of Hippo Valley and Triangle to the livestock farming area of Matobo and the maize/horticulture zone of Masvingo and Gutu to the tobacco growing area of Mvurwi, we engaged with a real diversity of rural settings (see map). There has been remarkably little commentary or research on rural contexts and we aimed to fill this gap. Our work did not rely on snapshot surveys, but on real-time discussion and reflection – involving six field researchers living in the sites, a field coordinator and Ian Scoones at IDS.

The result was a series of 20 blogs published from March 2020, when the first case identified in Zimbabwe,  to February 2022. They are all available on Zimbabweland, and also in a new book, which can purchased or downloaded online (see cover, below; full details in sources).

About 20 people who had engaged with our real-time learning during the pandemic were invited to the dialogues, each of which lasted around 3 hours, with discussions following on over lunch. Participants included farmers, local leaders, church leaders and government personnel. In one dialogue we had representatives from five ministries: Agriculture (Agritex), Health (a nurse and village health worker), education (teacher), local government (a councillor) and Home Affairs (police), along with farmers and others. We invited participants to reflect on lessons learned during the COVID-19 pandemic and the implications for preparing for a next pandemic.

Following the wider COVID Collective report, we discussed three themes: the diverse forms of knowledge, the role of reliability professionals and how formal and informal institutions interact. These combined to generate an understanding about how resilience – and so preparedness – can be built.

Knowledge

A key theme from our real-time reflections and from the dialogues was the importance of making use of multiple knowledges. Under conditions of uncertainty, using varied, plural knowledges is essential, people argued.

In one of the dialogues there was an interesting exchange around how local knowledge about treatments (which became really essential during the pandemic) was devalued by formal medical knowledge systems. A particular concern was vaccines, around which there many concerns expressed. Were these being used to experiment on or worse exterminate Africans? What was the role of the Chinese in this? This raised in particular the whole question of trust in knowledge and how it carries authority – and particularly trust in the state. This was clearly lacking for much of the pandemic and remains a big challenge for preparedness plans.

During the pandemic people felt very much on their own, without the help of the state, but the processes of local innovation and information sharing were impressive. The huge array of local remedies – centred of course on the famous plant Zumbani – became central to how people managed the disease. These were shared rapidly through WhatsApp groups, allowing knowledge for example of the Omicron variant to spread from our sites in Chikombedzi near the SA border to Mvurwi and on to the UK within a week or so – far, far faster than the published scientific information and public health advice.

So, what are the implications for pandemic preparedness. The dialogues confirmed that it is vital that different knowledge systems work together – not just informally but formally. This means more investment in assessing local treatments and integrating them into pandemic responses. Also important is the task of reinforcing the knowledge networks that allow the exchange of validated information (not just from public health sources) across communities and into the diaspora. And all of this exchange must help build trust between different sources of expertise, avoiding the dangers of vaccine anxiety for example experienced this time. 

Reliability professionals

When health systems are weak and ineffective in the face of an unknown threat, then certain key professionals on the front line, embedded in networks become key. This is an important lesson from Zimbabwe. Literatures on critical infrastructures (for example water or electricity supply systems) tell us that it is ‘reliability professionals’ – not standardised protocols and routines – allow for the services to be delivered, even in contexts of high input variability. They can scan the horizon for impending dangers, while attending to day-to-day responses on the ground.

Who were these reliability professionals during the pandemic? In our real-time research we met one – a young nurse at a rural hospital. He had been training at the very beginning of the pandemic in a large hospital in Harare and had learned some of the features of COVID-19. His superiors in the hospital were fearful as they knew that COVID was coming – particularly given the proximity to the South African border. The Ministry had cut and pasted some instructions from WHO – it was all they had – but these were not enough.

When the first disease arrived in the area (during the delta phase), he worked with other local officials – traditional leaders, church pastors, heads of women’s groups – to share information but also learn from the ground. He had a good idea of the big picture, but also a sense of what was happening locally. As the pandemic changed (as it soon did), then he instituted new arrangements at the hospital and helped patients in the wards and at home. He was allowed to do this by his superiors, but it wasn’t in his job description. Crucially, he was given the latitude to use his professional skills and his networks to generate reliability in a difficult setting. But this work was not recognised or rewarded.

There are always people like him. In one of our dialogues, we heard of a Village Health Worker and an Environmental Health Technicians, who played similar roles. But it could equally have been a church leader, a party official, a councillor or whoever. The important point is that to generate reliability in the face of uncertainty –and so assured preparedness – you need these people, and their networks. And they need to be rewarded and recognised.

Institutions                                                                  

There was some quite heated debate in our dialogues about the role of formal institutions in the pandemic. As in our real-time reflections, there was much critique of heavy-handed, unthinking approaches to lockdowns. Everyone appreciated why COVID was a disease of crowds, but did not understand why this meant livelihoods being undermined through lack of transport, closed markets and so on and the education and mental health of children compromised through closed schools, leading to wider social problems of drug taking, teenage pregnancies and crime?

Many thought it was these lockdown measures that caused more hardship than the disease itself. Why couldn’t the Ministry of Health relax the form of lockdown over time as the disease changed with different variants? Why couldn’t the police allow for certain types of marketing (say door to door not large market gatherings)? Why couldn’t the education ministry allow classes to be held in smaller groups for shorter periods, so kids at least had something to do? Why couldn’t the police allow some church services if they were safe, without large crowds? Why couldn’t the ministries speak with each other, so people could make the case that lockdowns were causing untold hardship.?

We always talk about cross-sectoral coordination and integration, but the tendency to centralise and control is strong, especially in an emergency. However, such interaction does happen at the local level (all the people from the five different ministries at one of our dialogues knew each other – but they rarely met together). The problem is that decentralised decision-making is often restricted from on high. The opportunities to negotiate compromises at the local level was because the lockdowns were national requirements (often simply replicating global advice) and implemented with a military style, top-down approach. But global even national advice may not make sense – a pandemic is always local and the politics of response must be local too.

So, a key lesson for preparedness is to decentralise, to trust local negotiations and to be flexible in implementation, responding to local conditions. This may help (in part) address the lack of trust people had in formal institutions because of the nature of an often predatory, autocratic state. In our real-time discussions there was no love lost between farmers and the police who were endlessly taking bribes, preventing marketing and so on. But interestingly in our dialogues, after some barbed exchanges, there developed more of a compromise; an acknowledgement that during the pandemic the police were following orders, working absurdly long hours and were barely paid. Talking together and building relationships helps institutions function better. This work is vital for being prepared for the next pandemic.

Rural people in all our sites have a good understanding of the epidemiology, which improved impressively through the pandemic (often again rather faster than the science). But they also knew how their livelihoods had suffered. Making sure that pandemic responses are livelihood-compatible – perhaps working out a series of options – is vital, and public health and livelihoods more generally must be seen in one holistic approach with local people and formal institutions working together. 

Resilience

These three themes together offer insights into how to build resilience in ways that allow people to be prepared for the next pandemic. There is a lot of lip service paid towards ideas of community resilience in the health sector. Indeed, resilience is a development buzzword that often lacks meaning, even if it attracts donor dollars (see our BMJ-GH paper for a reflection). 

So, from our studies what is resilience? First, resilience isn’t a thing that can be planted, implemented, created as part of a project, it’s a process, emerging from relationships. Second, resilience isn’t just about bouncing back to what existed before (often vulnerability and poverty), but it’s about transforming structural relations – yes, it’s political. Third, building resilience at community level is essential, but it’s not a panacea, or an excuse not to build the staff, stuff, space and social support central to health systems, as Paul Farmer liked to put.

The ‘communities’ in our research sites are not uniform – contests exist between those with different religious beliefs, between men and women, young and old, rich and poor. Finding a collective way through the pandemic was always negotiated politically, and some were left behind. As with all pandemics, COVID-19 accentuated already existing inequalities and vulnerabilities – meaning that local solutions through romantic visions of community action were not enough and external intervention and support was needed.

What emerged through our discussions was the understanding that the resilience building was all about relationships. The work of reliability professionals focused on relationships and networks (even if centred on a skilled individual), while debates about knowledge were about how different knowledge systems need to relate. Equally, innovation for a more resilient outcome had to involve multiple actors interacting with each other. And, in relation to institutions, again it was all about working together, between ministries and between the state and local actors, with different interests.

In other words, while focusing on the community (broadly understood, and often stretching far through knowledge networks), community resilience should not result in a reification of indigenous knowledge or local ‘community’ practice, somehow isolated from the world. Instead it involved diverse communities interacting with a range of players, including the formal health system. In other words, a hybrid, plural health system was envisaged as the basis for long-term resilience, and the cornerstone of pandemic preparedness.

Lessons and priorities

Where does all this leave us? How has learning in a pandemic and convening dialogues about it afterwards help us develop more effective approaches to pandemic preparedness?

We need to do better than last time. Those countries that were according to WHO the most prepared for a pandemic, had some of the worst outcomes (including the UK and the US). Why was this? It was because they relied on a narrow form of preparedness, reliant on a particular type of knowledge (mostly epidemiological modelling) and a standardised approach to pandemic response (movement control, lockdowns etc.). What they didn’t do was listen to local reliability professionals in decentralised institutions (the doctors and nurses and local government workers in the British Asian communities in the UK Midlands, for example). Nor did they work with the most vulnerable communities (in the case of the UK/US, densely packed multigenerational urban households) to help build resilience (of networks and relationships).

The four themes that emerged from Zimbabwe are therefore as relevant in the UK or the US. But they need to be thought about and implemented in different ways, with local contexts in mind. This is the job now – in the inter-pandemic period when things are calmer and lessons still fresh in the mind. It’s too easy to forget and go for knee jerk responses that replicate past mistakes when a new emergency arises. The impulse to centralise through a securitised, authoritarian response is strong, but other alternatives are essential and need to be fostered now.

Three priorities to help build resilience for preparedness emerge:

• Support knowledge networks that connect formal and informal, local and scientific knowledges, and carry out research on local treatments and the processes by which they are developed and shared.
• Identify and map reliability professionals and their networks across communities, and provide support and recognition to them
• Encourage the decentralisation of decision-making across ministries, including convening cross-sectoral fora for emergency pandemic response.

All of these priorities need to be addressed now. There’s an important role for donors in this, including providing contingency funds at the local level to allow for rapid response around knowledge sharing, reliability professional support and decentralised institutional interaction.

Virtually none of these things are being done in Zimbabwe yet (or indeed anywhere else), and it will require significant finance both to local communities and the state in ways that are flexible and crucially with finance arriving in advance of the inevitable next crisis.

Further sources:

Bwerinofa, I.J.; Mahenehene, J.; Manaka, M.; Mulotshwa, B.; Murimbarimba, F.; Mutoko, M.; Sarayi, V. and Scoones, I. (2022) What is ‘community resilience’? Responding to COVID-19 in rural Zimbabwe, BMJ Global Health

Bwerinofa, I.J. et al. (2022) Living Through a Pandemic: Competing Covid-19 Narratives in Rural Zimbabwe, IDS Working Paper 575 https://opendocs.ids.ac.uk/opendocs/handle/20.500.12413/17593

Bwerinofa, I.J et al. (2022). Learning in a Pandemic. Reflections on COVID-19 in rural Zimbabwe. IDS: Brighton, 160 pages (colour) Amazon (£12.72, paper, £1.25, Kindle) or download in high- or low-resolution versions here and here).  

This blog was written by Ian Scoones and Felix Murimbarimba and was originally a presentation at FCDO Harare in November 2022. It draws from research on the impacts of COVID-19 in rural areas of Zimbabwe carried out from March 2020. The dialogues held in November and December 2022 were supported by the FCDO-funded COVID Collective.

Drought politics in southern Africa

Why is it that droughts always seem to surprise, despite the warnings? The current El Niño drought is no exception, and the patterns of response (and lack of response) are remarkably familiar when looking back at the 1991-92 El Niño drought. There is a scary sense of déjà vu 25 years on, with important political implications, both in Zimbabwe and South Africa.

In 1991-92 I was working with the Ministry of Agriculture’s Farming Systems Research Unit on a project on risk, livelihoods and dryland farming in Chivi district. We had the opportunity of studying the drought up close. The findings are reported in the book Hazards and Opportunities: Farming Livelihoods in Dryland Africa. Lessons from Zimbabwe. It’s now out of print, but you can still find copies second hand. In the coming three weeks, I will share some of the findings from back then, but also reflect on what’s changed since.

Here is an extract from chapter 10. Sound familiar?

“The national Early Warning Unit first sounded the alarm about impending food shortages in July 1991. At that time they alerted the government that food stocks would run out in early 1992. This proved to be ominously accurate…..[A SADC Food Security Bulletin dated July 1991 noted} “An overall cereal shortfall of 189,000 tonnes is anticipated… Although the country has no exportable maize surplus, the GMB has an export commitment of 228000 tonnes… Imports of 383000 tonnes will be needed. So far, however, no import plans for maize have been formulated”.

Through 1991, the multiple warnings were basically ignored. As we discuss in the book:

”Indeed, no-one appeared to trust them. Even when the situation was obviously critical the government insisted on commissioning its own monitoring exercise to investigate the food situation in the country. Similarly the United Nations World Food Programme and Food and Agricultural Organisation sent their own mission to confirm the results emerging from the early warning system, before committing themselves to food relief activities….

….It was only when the failure of the 1991-92 rains became very clear and the national press started to highlight the issue,that government started to act. In April 1992, The Herald reported the concerns of Syndey Malunga MP: “The government must ensure that its promises to the nation to make food available during the drought are met, otherwise the rift between the Government and the people will cause the failure of the economic reform programme” (Herald, 8.4.92). Stories of how people were driven to extreme lengths by the failures of the relief effort were common. For instance, The Herald reported how Mberengwa villagers forced a train driver to stop and stole over 300 bags of maize and how Masvingo residents were scavenging for food in dustbins (Herald, 5.10.92).

In February 1992 the government announced significant increases in producer prices for white maize… However such incentives were too late to provide the necessary maize for the year. By February the GMB only expected 250,000 tonnes of maize to be delivered from Zimbabwean producers, but demand was likely to rise during the year to around 150,000 tonnes per month because of the near complete failure of the communal area crop. The Chairman of the GMB suggested….that Zimbabwe would have to import up to 2 million tonnes of maize to meet local demand.. (Herald, 21.2.92). A columnist in the Financial Gazette commented:

“This predicament need never have arisen. The primary cause of the problem has been the totally impractical maize price. Droughts do come but the nation has had three reasonable seasons…Stockpiles are a necessity. It is now evident that at least one year’s supply should always be retained rather than selling maize for foreign currency” (Financial Gazette, 13.2.92).

The food import programme started during December 1991. The arrival of food aid in the country was plagued by logistical problems, made worse by the widespread nature of the drought in the region. Hazards and Opportunities recalls:

“Road and rail transport was commandeered in order to bring American grain from South Africa and Mozambique. By March 1992 the country had effectively run out of reserves and people waited expectantly for supplies. By the end of March the President had appointed eight ministers to oversee food relief in the provinces. The first American maize arrived at the ports at the end of March, but by the first week of April there was still none inside the country, although six maize trains a day supplemented by road transport were expected (Herald, 7.4.92). The government committed itself to the feeding of some 4-5 million people during the drought requiring the eventual importation of around 1.7million tonnes. The initial monthly ration allocation of 10kg per person was later reduced to 5kg as supplies became uncertain and costs escalated…

…..However by mid-1992, public and political pressure mounted sufficiently and by most accounts a highly effective and efficient drought relief and food distribution campaign was launched. By this time, the cost of relief was around Z$30 million per month, much of which was paid for by government. During 1992 in Masvingo Province, around 250,000 children were being given regular supplementary feeding rations and around one million people (practically the whole communal area population) were receiving food relief. Churches and NGOs also played an important role in providing distribution facilities. The total costs of the drought relief operation were estimated to be around 2.7% of GDP in 1991-92 and 4.5% of GDP in 1992-93, requiring a significant increase in government borrowing”.

Drought and politics

Those who remember the situation in 1991-92 in Zimbabwe, will recall how things were increasingly desperate. Government seemed unable to respond, and donors were equally silent. But the drought soon became political. In the book, we wrote:

“For a time during 1992 the government had lost control; its food security policy was completely discredited, its maize pricing policy was suddenly drastically revised, the Minister for Agriculture was hurriedly shifted and the highly unpopular economic structural adjustment policy looked to be going off course. The rumblings of discontent had reached even the remotest rural areas, usually the stalwarts of support for the ZANU-PF party and government….

….Politicians did not trust the information emanating from their own civil servants, nor from international sources. Despite the claims of scientific certitude of the early warning bulletins, the government failed to act early on. It was only through a wider political process of lobbying and petitioning, by government officials in the districts, by the press and by churches, NGOs and others that forced action…. Uncertainty over what to do about the drought had resulted in a certain helplessness and a loss of political control and power.”

Indeed it was not until well into 1992, that the state took control of the situation. Indeed President Mugabe himself intervened. The book comments:

“Not until the launch of the food aid programme and the country-wide tours by President Mugabe was some confidence restored. Only then was it realised by rural people that Mugabe and the ZANU-PF government had not broken their post-independence bargain and would not let the people of Zimbabwe starve….”.

Indeed it was this political intervention, and not the early warning statistics, and the dire warnings from the districts, that meant that the 1991-92 drought was not the disaster it might have been (although it was pretty bad). Drought is inevitably political. And failure to act as people are suffering is not looked at kindly. While Mugabe’s intervention was welcome, it was also seen as too little and too late. We commented:

“The politicians did not know what to do. They refused to believe the science of prediction and would not listen, at least initially, to their constituents. The uncertainty surrounding drought resulted in a perilous loss of control and an unnerving loss of power. Power and control were only regained by firm action later on, when political and social processes, and not rational scientific argument, provided the impetus for action…”

Lessons for southern Africa?

Uncertainties around climate always exist. Climate models never can predict exactly, and even shorter-run weather forecasts are notoriously unreliable (how many times have the Met Office predicted imminent rains this year?). This is compounded with our lack of knowledge – and associated poor statistics – on Zimbabwe’s food economy. We simply don’t know how much food is being produced by whom and where, and how much is being sold in local markets, shared through local networks, or being transported to different areas, including towns. As I have mentioned before on this blog, the post 2000 land reform has radically changed the food system, and we don’t down its implications. My best guess, based on the mismatches between our local data and the aggregate statistics, is that the official stats are way off, but I don’t know by how much, and how this varies across the country.

Getting to grips with this, and improving the statistical basis for responses to drought is essential. At the moment huge efforts are based on massive guesswork. So it’s not surprising there’s large dispute about the statistics – some calling an impending catastrophe, others arguing things are not as bad as we thought. Bottom line is we just don’t know, and this is a dangerous situation.

It is dangerous practically, but it is also dangerous politically. We saw from 1991-92 how a late response in Zimbabwe was only salvaged by later decisive action. Famine was averted, and although many hardships were suffered, and a devastation of the livestock population occurred, a major humanitarian disaster did not unfold, despite huge economic losses. This of course was in a setting where politics looked very different. Today with fragmented authority and endless battles for political supremacy and a President who is 25 years older, decisive leadership are not qualities often seen. The government has however declared the drought a ‘national disaster’, although ministerial ineptitude and bungling has been widely condemned, with the opposition highlighting the confusion

It is interesting to contrast Zimbabwe’s experience with that of South Africa. In 1991-92 in South Africa, the drought response was impressive and coordinated, and drew on the incipient state structures of the ANC, impressively led by the Land and Agriculture Desk of the ANC’s Department of Economic Planning. As Coleen Vogel reminded me in a paper presented at a recent workshop, the decentralised network of Drought Forums provided the basis for a focused and effective response, and these in turn became the foundation for the post-1994 development committees, and the basis of the short-lived but radical Reconstruction and Development Programme effort. Fast forward to 2016, the ANC has been unable to respond effectively to the ravaging drought, with President Zuma failing to present a coherent policy, and getting heckled in parliament by opposition groups.

Wherever you are in southern Africa, politics and drought are intimately connected. And in 2016, the conditions for an effective response both in Zimbabwe and South Africa look worse than 25 years ago. And this despite huge amounts of effort invested in drought proofing, livelihood programmes, resilience building and so on in the intervening period; and yet more projects expected on the back of climate adaptation finance.

What has gone wrong?

Why is drought response as bad today, or often worse than before? Several things strike me.

First, despite all the hype about climate change and resilience building, very few such programmes look at the underlying patterns of vulnerability and how these have changed. Vulnerabilities arise very often from social and political factors, and so are less amenable to technical, donor-led interventions. Just adding sticking plaster in the name of climate ‘adaptation’ or ‘resilience’ is not enough. As we argued long back in our Hazards and Opportunities book, responses require tackling the root causes of vulnerability – including as I will show in a blog in a couple of weeks addressing inequalities, including of land.

Second, uncertainties cannot be planned for. By definition we don’t know the probability of the outcome, and very often we don’t know what outcome will result, meaning we are in the realm of ignorance. For administrative, bureaucratic and financing systems to respond in such settings is tough. Such systems are conventionally geared towards certainties, or at least predictable risks. This is why they so often fail. Predictions (based on risk assumptions) very often turn out not to be the case, and so trust is undermined. And administrators may argue for more funds or food reserves, only to be rebuffed. Dealing with what Emery Roe calls ‘mess’ in order to generate reliability in system response is essential, but it requires a radical overhaul of approaches. Governments, UN agencies, NGOs, district administrations and others are just not geared up, and they almost inevitably fail, as they are doing now.

Third, we have to remember drought is always political. The basic ‘contract’ between the state and people has to be renegotiated in drought periods, meaning engaging with rural people. For far too long elite politics in Zimbabwe (and of course in South Africa) has often ignored rural areas. The implicit deal is that rural votes for a ruling party are secured by making basic support available, including food in times of drought. But this dependency relationship cannot persist. People want more, and that means proper investment and support, not just palliative forms of development. As Zimbabwe’s (and South Africa’s) politics fragments, and the liberation parties struggle to maintain power, then people are going to look to others. This makes addressing drought firmly and effectively even more important, yet both ZANU-PF and the ANC are currently failing, as other political issues dominate.

Ignoring the drought, however, may well have long-term political consequences if the current failures continue. Watch out for some big impacts of drought on politics across southern Africa.

This post was written by Ian Scoones and first appeared on Zimbabweland