As Covid-19 marches relentlessly into Africa there is one man who has sat at the centre of another similarly urgent health crisis. John Mahama was President of Ghana then. The lessons he learned there and the hard political, social and economic decisions he had to make are now a foundational textbook response for how to deal with this new pandemic in a continent that has just felt the first breach of its walls.
For most of us, the finer details of the virulence, timelines, geography and response to the last Ebola crisis are probably a little foggy. We remember it was some years back, it was a terrible and frightening disease, it happened somewhere in Africa, and it was somehow vanquished. Given where we are now, we would do well to revisit what happened during the Ebola epidemic and how it might inform the brutal global Covid-19 cage fight, where there are no spectators, only combatants. Us.
So, to refresh. The most recent Ebola epidemic started in 2013 and ended in 2016. In West Africa, specifically around the neighbouring countries of Sierra Leone, Guinea and Liberia. Ebola had been seen before in Africa. Mainly in the central part of the continent, as far back as 1976, but this time the disease exploded angrily for the first time in the West African region — 40% fatality rates, and a rapid contagion, overwhelmed health services. The WHO calls it ‘the most severe acute public health emergency seen in modern times.’
At the centre of this firestorm was John Mahama who had taken office in July 2012 leading the NDC party. He was also elected Chairman of ECOWAS (Economic Community of West African States) during his presidency, which turned out to be crucial to the epidemic response. I recently spoke to him about Ebola and Covid-19.
When it became clear that the virus was moving unfettered through the region, transported silently through the busy traffic of trade, travel and tradition between the countries, Mahama immediately saw that the problem was going to quickly become exponential. ‘We realised that the potential for it to spread to our country was great. And so we quickly set up an inter-ministerial task force to plan for contingencies in response,’ he tells me. This was even before Ebola had a chance to gain a foothold in Ghana, which, in fact, it never did.
He had access to a highly experienced Ghanaian medical and health community, and rapidly took steps to collect data and science and policy advice. He established formal governance structures, including setting up an advisory committee of diverse and highly qualified technocrats and experts, which met weekly, and sometimes more often, chaired either by Mahama, the Vice President or the Minister of Health, depending on schedules.
More importantly, he quickly accelerated surveillance at the borders for travellers from the affected countries, reducing the chances of external virus transmission (either in or out). ‘The speed with which this took place was one of the things that largely allowed us to escape the brunt of the Ebola epidemic’, he says.
Given his role in ECOWAS, he was also cognisant of the shared economic burden and the requirement to exchange knowledge between its members. Notwithstanding the deteriorating situation in the ECOWAS countries, he visited each of the affected countries to talk to the heads of states and their teams, some of whom, he recounts vividly, seemed to have been visibly aged by the various human tragedies and economic meltdowns in their own countries.
He speaks about how he convinced President Ouattara of Côte d’Ivoire to resume Air Ivoire flights to the affected countries, while at the same time retaining strict health and decontamination protocols to allay transmission fears in the destination countries. Key to these visits were the consultations between the various heads of state, to share information and to co-ordinate the sub-regional response
The upshot of these visits was the promulgation of a multi-country task force, made up of health officials and experts advisors from Ghana, Liberia, Sierra Leone Guinea and other sub-region countries, and overseen by the ECOWAS. It was the job of this team to meet frequently and regularly, to conceive, debate, agree, document and distribute protocols and procedures around the Ebola response. These were implemented in each country, including matters as diverse as temperature taking, testing, borders controls, hospital processes, education and public awareness.
This multi-country coordination teams seemed to have been the key turning point against the virus. He laughs when I query how he was able to herd the unruly cast of politics, business, media, academia and civil society onto a common path. ‘When it is a matter of life and death, everybody falls in line’, he responds. This was also true of the more fraught matter of cultural rituals like death and funerals, which were eventually relinquished to state controls and processes.
Mr. Mahama also gives credit to the immediate and generous response by the international community — the UN (which he addressed in New York), President Obama, Chancellor Merkel, WHO and others. The US sent 5,000 personnel to the region to assist. Financial, technical and scientific assistance overflowed from many quarters. He considers this massive global response to have been a critical contributor to the efforts undertaken locally.
Not a single case of Ebola was registered in Ghana, an extraordinary statistic given the ravages that occurred nearby.
Which brings us to the present, where the lessons learned then can be brought to bear now.
Covid-19 has now started its grim journey in the region (1,154 cases and 9 deaths in Ghana as of the time of writing), but its near-certain exponential climb are well understood by Mr. Mahama and the health sector. Given the well-known trajectory of the disease and the region’s previous experience with Ebola, Mr. Mahama believes that Ghana is better positioned than most to respond to what is surely coming.
While Mr. Mahama has no formal role in government, he has set up a working Covid-19 committee of professionals and experts from across the political spectrum. While there has been some sniping about ‘parallel structures’ from the ruling party, there is also an acceptance that Mr. Mahama has been here before, and the committee is receiving increasing non-politicised support.
Mr. Mahama believes that the government could have perhaps responded more quickly than they have, but he was careful, at least in this interview, to stay away from political point scoring, emphasising the need for wide-ranging co-operation and lessons learned. He also made note of a need for a national pandemic response plan, currently not in place in the region (and, to be fair, not in place in most countries of the world).
He is very clear about the danger of misinformation, particularly with respect to both social media and public pronouncements, and clear about government’s role to monitor and police this (I wondered whether this was an unspoken criticism of Trump, who has repeatedly punted an unproven anti-malarial treatment).
John Mahama is running again for President in the next election, having lost in 2016. Having heard him stay carefully out of politicking and campaigning during the entire interview, and being surprised that he did not trumpet achievements during his term, like having had nearly 20 hospitals built, I push him as we conclude our call. Why should people vote for you, I ask. ‘I have had 3 years to reflect,’ he says. ’There are some things I could have done better, and some things I did very well’.
Imagine that. A politician who owns both his successes, and more importantly, his missteps.
As this article was going to press on April 24, the Ghanaian government had just lifted most of their lockdown rules, to some consternation amongst epidemiologists.