During a conversation I recently had with the founder of a Nigerian rural healthcare nonprofit, I got a real taste of what COVID-19 looks on the ground for healthcare practitioners in the developing world. Nigeria has not yet faced the full force of COVID-19, with approx. 300 cases and less than a dozen deaths as of April 10th. However, the pandemic is already having a tremendous impact on the economy and health services of the country. According to the nonprofit founder, ever since President Trump declared hydroxychloroquine, a drug used to treat malaria, as a potential therapeutic, it has become 25 times as expensive. According to the U.S. Embassy in Nigeria, Nigeria faces almost 100 million malaria cases every year, with over 300,000 deaths. The rising cost of this drug poses an enormous health concern for the country, especially as it enters a wet season conducive to malaria spread.
This is just the tip of the iceberg of issues that Nigeria faces in light of COVID-19. While the disease in isolation has not afflicted Nigeria to a great degree, it will exacerbate countless other pre-existing conditions, making COVID-19 even more dangerous and amplifying it through a positive feedback loop. Looming debt payments, PPE and testing kit shortages, a slowing economy, and already-weak health systems compound the COVID-19 threat. On the micro-level, it means that this nonprofit and others like it cannot administer the rural aid they typically would, which will elevate malaria deaths and further overwhelm health systems.
However, it seems that all is not lost, as the U.S. and China are scaling up their international aid in light of the pandemic. China recently sent an 18 person medical envoy to the country to contribute to response efforts. Given the COVID-19 threat, one might imagine that China’s envoy would have been positively received. Instead, however, there was massive Nigerian backlash. Politicians, medical officials, and journalists have all pushed back against these Chinese doctors, sharing a common sentiment that the envoy is unnecessary. On the surface level, these two positions seem incongruous, one being that Nigeria faces overwhelming challenges from COVID-19, and the other being that Nigeria has no need for external personnel. This article is my attempt to disentangle and assess these seemingly contrarian positions.
Firstly, one must recognize that Nigeria has a solid medical base and history of responding to infectious diseases, such as bird flu, Lassa fever, and Ebola. Despite their proximity to Sierra Leone, Liberia, and Guinea, they were able to stop Ebola’s spread in Nigeria in 2014 and remain Ebola-free for nearly two years before the end of the West African Ebola crisis. In regards to COVID-19, the Lagos State Ministry of Health has just announced a two week door-to-door search for active cases across Lagos, and is simultaneously ramping up its medical capacity nationwide. It is clear that Nigerian policymakers and medical officials are taking appropriate precautions.
Secondly, Chinese “Mask Diplomacy” is tinted by its surrounding politics on the individual, governmental, and international levels. On an individual basis, there appears to be a growing divide between Nigerian citizens and the Chinese, as reports have come out of a crackdown on Nigerian migrants in Guangzhou, China. A video on Twitter of a Nigerian diplomat arguing with a Chinese official is rapidly going viral, with the diplomat being praised for “standing up for mistreated Nigerians” and for “making the whole of Africa proud.” There are now allegations that he was assaulted following the video, only exacerbating tensions.
On the governmental level, there is also a growing divide with the Chinese surrounding the topic of debt forgiveness. Chinese creditors make up 80% of all bilateral lending to Nigeria, placing debt relief as a forefront issue in Sino-Nigerian relations. Finally, on the international level, there is a growing debate about the underlying motives of Beijing’s Mask Diplomacy. Reports of faulty Chinese test kits and PPE in other countries have shed further doubts about the program’s efficacy.
Thus, Nigeria’s belief in its own preparedness coupled with its growing tension with the Chinese seems to be fueling distrust of the medical envoy. While this does pose a hurdle for China’s COVID-19 strategy, it certainly is not the new normal. Chinese medical envoys still received much praise in other countries across Africa and Europe. However, there are still several key takeaways within this situation, not only for the Chinese but for medical aid models in general.
Firstly, the Chinese must consider lessons from the Ebola outbreak regarding foreign influence during an epidemiological crisis. During the Ebola outbreak, foreign aid workers faced enormous obstacles as they tried to fight the disease, primarily because they did not consider long-standing cultural norms such as burial practices. Thus, they were viewed through a lens of distrust, leading to violence against medical centers and workers in Monrovia and in rural areas. Similarly, medical personnel that China, or any nation, tries to send abroad to contribute to the medical response must attempt to integrate into pre-existing systems, rather than impose upon them. To do otherwise means risking backlash like what we see in Nigeria, which is only bound to grow given the controversy emerging from Guangzhou.
Moreover, the narrative surrounding COVID-19 aid plays a critical role as well. Mask Diplomacy has invited criticism from the United States and several other major states. Meanwhile, the U.S is also facing mounting backlash for President Trump’s recent negative claims about the World Health Organization. All of this is occurring at a time of growing Sino-U.S. competition over global leadership against COVID-19 and questions of where the virus originated. This global head-butting does nothing but fuel distrust of foreign aid coming from any nation.
COVID-19 is a pandemic that has afflicted people on the deepest personal levels. Its threat to our individual lives has fueled dissent, fear, and distrust and the Chinese, along with any other foreign aid agents, must consider this human element in their aid plans. The Nigerian backlash to the Chinese envoy of medical workers is a clear case that demonstrates how sending aid and medical personnel is far more complicated than a mere gesture of goodwill. As COVID-19 continues to spread across the international community, provoking an even greater international response, these lessons will grow increasingly relevant.
Atharv Gupta is pursuing a B.S. in Foreign Service at the Georgetown University School of Foreign Service, with a Science, Technology, and International Affairs major alongside minors in Mandarin Chinese and International Development.
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