Governments across Africa are scrambling to reinforce health systems and accelerate vaccine drives as a third wave of Covid-19 infections threatens to overwhelm hospitals and kill tens of thousands of people.
South Africa, the worst-hit country in the continent, has reported a doubling of new daily cases over the past two weeks, with no sign of the rise slowing.
Gauteng province – home to a quarter of the country’s population of 60 million as well as the administrative capital, Pretoria, and financial hub Johannesburg – is the centre of the latest outbreak, accounting for about 60% of the latest national daily increase.
Hospitals and health workers are close to being overwhelmed. One large hospital was shut earlier this year after a fire and other big facilities are closed because of a lack of trained staff. Doctors are making dozens of phone calls to secure a bed for critically ill patients.
South Africa has suffered two major waves already, pushing its official death toll to 60,000, though excess mortality figures reveal that at least another 100,000 people are likely to have died in the pandemic.
Last week, Cyril Ramaphosa, the president, imposed light restrictions that most experts have said are unlikely to make much difference.
Expectations of the government are low, with much anger at a series of corruption scandals involving Covid-19 spending. Earlier this month, the health minister, Zweli Mkhize, was forced to step down while allegations of impropriety in the awarding of Covid-19 response contracts were investigated.
The 60 or so inhabitants of Union Street, a narrow alley in Soweto, said they have learned the hard way not to hope for too much. “All the times were bad. It has always been tough here. But this is really worse. We have orphans in our church now,” said Leonard Magrwanya, 74.
“I trust in God. I have faith in God. One day Covid will be finished and we can go back to normal, but that lies only in the power of God,” he said.
South Africa had many advantages over other African countries before the Covid crisis: a greater ability to borrow money, a more extensive public health system reinforced by a large private sector, world-class scientists and long experience of dealing with pandemics.
Yet after a much-lauded early response, the authorities have struggled. The economic damage wrought by the pandemic has already been severe.
Tasneena Sylvester, 35, who has lived on Union Street for 11 years, lost her job as a cleaner, and her husband was laid off by the construction firm that had employed him for years during the hard lockdown in March and April last year.
Now the couple and their three children live on government handouts, and spend their days watching television and pirated Netflix films traded on USB drives.
“I want education for my children, and a job to survive. But there is nothing now,” she said.
At the tiny shack that is the headquarters of the Soweto Kliptown Youth organisation, Bob Nameng, the 51-year-old founder, accused the government of mishandling the crisis.
“There is too much corruption. The rich are benefiting from the tears of the poor. The poor are weeping. The rich are dancing,” he said.
Nameng said he believed the ruling African National Congress, in power since 1994, had “become the opposite of what the people of Soweto fought for” during the long battle against the racist, repressive apartheid regime.
“They don’t care about anyone but themselves. We supported the ANC but we won’t for ever. They have lost a lot of votes. A hungry man is an angry man,” he said.
South Africa’s faltering vaccination campaign has yet to reach more than one in 30 of the population, after a series of missteps and misfortunes were compounded by bad decision-making, critics say.
Officials were slow to initiate discussions with manufacturers, and the talks were then held up by bureaucracy and internal factional battles.
The UN-backed Covax programme delivered a million AstraZeneca jabs, which were retjected once it became clear they were less effective against the new local variant.
Finally, a consignment of 2m Johnson & Johnson vaccines had to be destroyed when regulators decided it might have been contaminated after breaches of safety and sanitary rules in a factory in the US.
With wealthy nations in the west buying up millions of doses for their populations, it has been hard to secure supplies for South Africa.
“What has constrained us has been the lack of vaccines. All the provinces and private sector have been champing at the bit to open additional sites,” said Nicholas Crisp, the deputy director general of the health department.
The vaccination campaign has also been suspended at weekends to allow health workers to rest, and because there is “no overtime budget”.
In a media briefing last week, the acting health minister, Mmamoloko Kubayi-Ngubane, promised the campaign would accelerate, as sufficient shots finally began to arrive, and said army medics would be brought in to reinforce the health system in Gauteng.
One big problem is vaccine hesitancy. In a recent survey, 67% said they would definitely take the vaccine, with 18% saying they would not. The survey found that those who think Ramaphosa and his government are doing a bad job are much less likely to accept a vaccine.
On Union Street, some even doubt the existence of Covid-19.
“I think it is all made up. They want us to believe there is Covid and follow their instructions. And I’ve heard the vaccines shut down your body systems,” said Jemima Dtadegane, 54.
Officials say they are aware of the problem and will try to communicate better in the future. After extensive interaction in early months of the pandemic, ministers and government specialists have rarely given briefings. Ramaphosa has limited interventions to infrequent televised speeches.
Alex van den Heever, professor of public administration at Wits University, Johannesburg, said the failure to acknowledge the true death toll in the pandemic, as revealed by excess mortality figures rather than recorded hospital deaths, stemmed from a “political decision made early on”.
“They wanted to make sure the pandemic management was seen as being done by the ANC, and negative issues minimised. That is an improper intent. The information must be made public, mistakes need to be dealt with and any questions answered,” he said. “The reality is we have had a severe, severe epidemic.”
Most residents of Union Street have seen images from the US or Europe, and are aware that the pandemic is ebbing there.
“In the rich countries, they are going out and working. They have better governments, I think,” Rebecca Mfungquza, 23. “Maybe they could help us a bit. We need it.”