Question 1

In December 2019, a cluster of pneumonia cases was reported in China, which eventually led to the identification of the first case of COVID-19. Since then, COVID-19 has spread across Asia to Europe and through to the USA before the first case was reported in Egypt on February 14. Daily updates from the Africa Centres for Disease Control (Africa CDC) show that the number of recorded cases has risen daily with (as of June 18, 2020) 52 African Union Member States reporting 267,519 cases, 7197 deaths, and 122,661 recoveries. Together with Egypt and Algeria, South Africa was considered to be at the
the highest risk of the virus being imported and spreading with a moderate to high capacity to respond to an outbreak.

South Africa’s National Institute of Communicable Diseases (NICD) reported its first confirmed case on March 5, 2020. Since then, the number of recorded cases has steadily increased, but not at the exponential rate that was initially expected. To date (June 16, 2020), 73,533 confirmed cases and 1568 deaths have been reported by the NICD. With the arrival of COVID-19, the initial advice to South Africans focused on regular hand washing and social distancing. However, the declaration of COVID-19 as a pandemic by the World Health Organization (WHO) on March 11, 2020, the global daily rise in reported cases, but crucially, the first case of community transmission in South Africa recorded, prompted President Cyril Ramaphosa and his government to act. Although the number of cases at the time remained relatively low (61 confirmed cases; 0 death), a national State of Disaster was declared on March 15, 2020, and a series of measures limiting the rights of South Africans were announced.

Decisive action was indeed necessary. South Africa is a deeply unequal society. Only 16 percent of the South African population has access to medical aid, with most of its population relying on the public healthcare sector which is underresourced and poorly administered. In its 2016–2017 Annual Inspection Report, the Office of Health Standards reported that out of 851 public sector health establishments, 62 percent of these were non-compliant with the norms and standards for healthcare quality. Areas of deficiencies identified included a lack of or poor leadership and management, knowledge, competencies, and support from senior staff.

In addition, the South African healthcare system carries a significant burden of tuberculosis (TB), HIV, and HIV/TB co-infection, with millions of the population on immunosuppressant drugs as well as others who are HIV positive but not receiving treatment for HIV. There are concerns that those with these comorbidities are more susceptible to SARS-CoV2 infections and have a higher risk of developing severe COVID-19 disease. Data shows that the younger populations have also been affected more than in other parts of the world.

COVID-19 has disrupted the provision of routine healthcare in other parts of the world and will likely similarly affect South Africa, including the delivery of South Africa’s routine chronic illnesses and its TB and HIV antiretroviral programs. South Africa’s
already overstretched public healthcare system is thus unlikely to be able to withstand an explosion of COVID-19 cases, particularly when considering that better-managed healthcare systems in some high-income countries (HICs) are
overwhelmed. Preventing and containing the spread of COVID-19 in South Africa was thus a critical priority.

Despite these socio-economic realities, South Africa’s COVID-19 response needed to focus on containing and slowing down the spread of the virus. It is unsurprising that the regulations promulgated under the State of Disaster mainly focused on severely limiting the freedom of movement and assembly of its citizens. It was clear from the outset that this would have a considerable economic impact, and on March 31, South Africa was downgraded to junk status with the South African Rand falling to a record low.

President Ramaphosa was left with a choice of sacrificing the economy to slow the spread of the virus or putting the economy first and risk exposing an already weakened healthcare system and the population suffering from other comorbidities to the virus. Faced with this choice, his decision to lock down the country cannot be criticized and may prove decisive in containing and slowing down the spread of the virus. Considering the time it took to reach its borders,
South Africa had time to prepare a COVID-19 response and draw on the importance of its community-informed response to other epidemics. However, despite the impact that these regulations were going to have on civil society, the lack of public deliberation and community engagement in developing these regulations is concerning. Furthermore, the criminalization of non-compliance with these public health measures seeks to undermine their aims, has the potential to increase stigma and discrimination against the disease, and fails to address the real issue: ensuring that the population has the means to comply with the regulations.

Combined, these factors question whether South Africa has learned from its response to its HIV epidemic. It is argued that any discussion on the development, formulation, implementation, and monitoring of policy should take note of the composition of the state as that is the political domain within which policy is practiced. Implementation of a policy entails a complex political process, rather than a mechanically administrative one. the study of implementation becomes an attempt to unravel the complexity of the following policy as it travels through the complex, dynamic maze of implementation; to understand how it changes its surroundings and how it has changed itself in the process; and, most importantly, to see how it can be influenced to better accomplish the goals it set out to achieve.

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