Anyone who’s been out and about at month-end will attest to the fact that Botswana has an on-going love affair with old-fashioned, footfall shopping.
The furniture and appliance stores are packed to the rafters, long queues at the tills are commonplace, car parks are full to overflowing and main thoroughfares are jam-packed as the nation rushes to shop till it drops. So much so that at the end of last month, in a post-Lockdown feeding frenzy, the Western By-pass was gridlocked at the northern end and traffic cops had to be called in to sort the situation.
There are numerous reasons for this, not least of which is that shopping online mainly means buying from overseas, incurring hefty postage and customs duty charges, mail is often delayed if not lost and the exchange rates sometimes punitive so, all in all it’s cheaper and more convenient to purchase in person from a local store.
Overseas, however, this is not the case. Consider the rise in growth of online retail giant Amazon. Originally a purveyor of CDs, DVDs and books, there is now almost nothing you can’t purchase from one of their sellers, ditto Alibaba, eBay and others.
Add to that the fact that most major retailers now have an online purchase facility and it’s easy to see why First World consumers are deserting the High Street in droves, preferring to shop from their laptop, smartphone or tablet for anything from socks or suites of furniture.
Add to that the increase in floor rental and heavy council rates and levies on commercial premises and the result in countries such as the United Kingdom is that small shops, large stores and even big name department chains have been closing in drovers over the past decade, leaving only coffee outlets, bookies and boarded-up shop fronts in their wake.
Sticking in the UK, their Lockdown has been extremely severe and long-lasting. Unlike here, supermarkets that carried a wide range of goods were not required to rope off ‘non-essential’ items, nor were they barred from selling them but there were some well-publicised incidents in its initial stages where over-zealous police officers had stopped shoppers inside and outside stores to inspect their purchases and issue warnings for being in possession of items deemed ‘non-essential .
After a public outcry the government was forced to issue a clear statement to the force stipulating that if an item was on a shop shelf, it was legal and permissible for shops to sell it and consumers to buy it. Nonetheless, other stores such as clothing, furniture, appliance and book shops were forced to remain closed, in spite of their sustainability being in jeopardy even before the Corona Lockdown. And indeed, in the ensuing three months, many did go under. Even some big, household names such as Debenhams, whilst not completely going out of business, were forced to close less profitable branches and lay off hundreds of employees.
But as of last week, the long hiatus was over. Those shops still solvent were given the all-clear to re-open, albeit with strict sanitation guidelines. Speaking during a visit to the Westfield shopping centre in east London to mark the event, British Prime Minister Boris Johnson said he hoed to see a ‘gradual’ build-up of people visiting the high street.
‘I am very optimistic about the opening up that’s going to be happening,…I think people should shop and shop with confidence but they should of course observe the rules on social distancing and do it as safely as possible.’ At the same time it has been revealed that British Chancellor Rishi Sunak is considering a VAT cut to stimulate spending, following concerns that social-distancing rules and anxious shoppers will keep sales figures low.
Furthermore, half of Britain’s shoppers could avoid the high street in the immediate future, with four in ten spending less money than they did pre-lockdown, according to a YouGov poll for The Daily Telegraph. Of course that statistic doesn’t reveal whether the majority six out of ten will be spending the same or even more to mitigate the drop.
The reluctance to spend might reasonably be attributed to loss of consumer confidence in what is now a global recession. For those who lost their jobs as a direct result of Lockdown, their future is uncertain and it’s fully understandable they wouldn’t want to be splashing the cash on luxuries and non-essentials. And surely anyone laid off – or ‘furloughed’, as became the government buzzword, for those 3 and a half months would also be feeling the pinch?
Well, curiously not! In a generous parachute package to staff forced to stay at home due to the closure of their places of work, the above-mentioned Sunak had offered those furloughed personnel a government hand-out amounting to a massive eighty percent of their salaries.
And with the closure of all places of entertainment and the elimination of travel costs and other expenses such as eat-in or take-out lunches, many employees have found themselves not only saving money during their enforced leave but saving money, i.e, salting some funds away in their bank accounts. In other words, they found themselves financially better off, being off than on! On that basis, then, they could be expected to be keen to splurge on the nation’s favourite pastime of retail therapy, particularly in view of the fact that stores including Zara, John Lewis and Debenhams have slashed prices by as much as 70 per cent in a bid to lure shoppers back. Desperate fashion chains are sitting on as much as £15billion (P225billion) of unsold stock they are keen to shift.
So it all boils down to a question of consumer confidence, rather than simple economics. Whilst most of us will have rushed out to the shops as soon as they re-opened to purchase something the government might not have deemed ‘essential’ but which is certainly necessary to us as individuals, how may of us are actually prepared to lay out for a big-ticket item when the economic future is still so uncertain, not least of which the dreaded ‘second wave’, should it arise?
Only time will tell, but for all those redundant retail workers, metaphorically if not literally left on the shelf, it might anyway be a sad case of too little, too late.
The great Thomas Edison, who logged a total of 1093 patents singly or jointly in his 84-year lifespan and who was the driving force behind a whole host of innovations which included the incandescent light bulb, once said, “I’d put my money on the sun and solar energy.
What a source of power! I hope we don’t have to wait until oil and coal run out before we tackle that.” At the onset of the still-in-force NDP 11, which runs from April 2017 to March 2023, government hived off P2.25 billion (a move engendered by the irregular, if not corrupt, depletion of the National Petroleum Fund) from the BPC subsidy budget pertaining to that time horizon and re-oriented it toward the development of the bulk petroleum product storage terminal at Tshele Hills near Rasesa village in Kgatleng District.
Both the two contenders for the Egyptian throne, General Atiku, had made their case and it was now up to the Wise Men to pass a vote indicating whose deposition had convinced them.
To Ramesses’ surprise, General, the Wise Men all voted for Moses. The vote was indicated by bowing their knees in front of Moses, thus confirming that he had a superior claim to the throne. Sadly, Ramesses was not having any of that. He immediately put his army on the alert and when word seeped through that Moses was to be the new Pharaoh, Zaru erupted into jubilation on the streets.
The Human Immunodeficiency Virus (HIV) was first detected in Botswana in 1985. The coronavirus that causes Covid-19 was detected in 2020. Both viruses were new, and it was their global occurrence that led to their classification as pandemics.
They have both been traced to animals, something not surprising as most new viruses are actually cross-overs from animals. A virus crosses species, in this case to humans, and its subsequent behaviour depends on how it adapts to the new species. Many are “dead-ends”, the virus cannot multiply or be transmitted between members of the new species.
In the case of the two which are our subject in this paper, the viruses adapted to the new species (human) and underwent mutations that allowed them to be easily transmitted between humans, hence the rapid spread.
The two viruses, HIV and the Covid-19 virus are very different, hence their mode of spread is different and their mechanisms of disease causation and epidemiology are very different. The approach to their control is of necessity very different. To illustrate their difference, HIV is transmitted mainly by sexual intercourse, Covid-19 virus mainly by the droplet method through the respiratory tract.
HIV causes ill health a long time after infection, which can run from about two years to many years (incubation period); the incubation period of Covid-19 is a few days, estimated at between 10 and 14 days. HIV infection leads to the destruction of the immune system, and when the victim gets ill, it can be from any of a wide variety of diseases caused by “opportunistic infections or even cancers”, hence the name Acquired Human Immunodeficiency Syndrome (AIDS).
Covid-19 on the other hand presents generally as an upper respiratory tract infection (URTI) although there are some presenting differently, especially with lower respiratory infection (lungs affected) in the more severe cases. Another but very important difference is that, while Covid-19 is generally an acute, self-limiting illness, with most patients recovering fully within a few weeks, and in fact many showing no symptoms, HIV/AIDS is a chronic condition; once the patient starts signs and symptoms, usually years after infection, this leads invariably to death from one of the opportunistic infections or diseases.
This last scenario used to be the case in the first decades of HIV/AIDS, but has fortunately changed after the development of drugs that in combination are referred to as Highly Active Anti-Retroviral Therapy (HAART, now known as ART).
HIV/AIDS is now treatable and no longer a death sentence, although treatment lasts for life as the drugs do not eliminate the virus from the body but suppress it. As for Covid-19, there is currently, as is the case generally with viral infections, no effective antibiotic or antiviral drug that kills the virus or eliminates it from the body.
Where does this put us? We are essentially dealing with two diseases or pandemics that are very different from each other. I did my post-graduate studies in Public Health during the last years of smallpox eradication, actually I finished the studies in 1978, the year Smallpox eradication was certified in Botswana.
What used to be emphasized, why the world succeeded in eradicating Smallpox was that it had epidemiological characteristics that supported eradication: it was easy to diagnose, even by lay people; it had a consistent incubation period of about 10 days; it virtually had a 100% manifestation rate (everybody infected showed typical signs and symptoms); there was a vaccine against it that was virtually 100% effective. Unfortunately, there have been few diseases with such favourable characteristics for eradication. Hence the next disease targeted for eradication, Polio, is almost done but still causing some problems.
Response to the HIV/AIDS and Covid-19 pandemics in Botswana
When HIV was detected in Botswana in 1985, the world had been aware of the existence of AIDS for about five years, that is, since the outbreaks among gays in America in 1981. By 1985 the virus had been identified but little was known about it; it was still a subject of intense research. However we knew that it caused AIDS and was no longer just transmitted in gay sex, but that most transmission in Africa was through heterosexual sex, and that sexual transmission was responsible for more than 90% of transmission occurring in Africa.
Some African countries were already experiencing severe HIV/AIDS epidemics, especially in Central and East Africa. In some of them (Uganda is sometimes quoted) people started dying in large numbers before the cause was known, only for people to move to neighbouring villages and infect others there!
The Botswana HIV epidemic, as well as those of SACU countries generally, was later than those of Central and East Africa. The latter had already experienced high disease and mortality rates for some years. In the late 1980s, Botswana was experiencing a big economic boom, and this attracted professionals, technicians and artisans from African countries badly affected by HIV/AIDS, and this really speeded up transmission in the country.
When the first seropositive people were identified in 1985, I was Assistant Director of Health Services responsible for Primary Health Care. So, Disease Control fell in my Department, and I had the responsibility of reporting to my seniors at the Ministry and hence to the country that we now had HIV.
Control measures were started immediately, such as screening all blood donated for transfusion and putting together with the help of WHO, the first short-term control plan. A unit was created which was headed by an appropriate professional. In 1986 I became Director of Health Services and Deputy Permanent Secretary, and in January 1990 I became Permanent Secretary.
In all these positions I was intimately involved in HIV/AIDS control, working intimately with those directly responsible for the unit/programme, and also doing at least one assignment with Global Programme on AIDS (GPA) when it was still with WHO before UNAIDS was created to share the AIDS programme with other UN Agencies. In the same manner, here at home we started pushing for the multisectoral approach to HIV/AIDS control in the early 1990s, that resulted in the formation of the National AIDS Council and eventually NACA.
The Ministry of Health undertook a very intensive public education from early in the HIV epidemic. The Ministry warned the people of Botswana (through and including the political, traditional and community leaders) about what was going to happen, the impending doom of high morbidity and mortality. What was needed was change is sexual behaviour.
Everyone knows that the main message from the Ministry was “ABC” (abstain, be faithful, condomise), which had become a universal message especially in Africa was used by the Ministry. Put in other words, the message aimed at three things; i) delaying sexual debut, ii) avoiding multiple concurrent partners and iii) consistent condom use.
This message never made an impact on the Botswana population, so when the clinical cases started hitting the country after the several years of silent spread (the silent phase of HIV spread), the effect was disaster. We had a nasty surprise in the health system that while the countries in central Africa that had early HIV/AIDS epidemics had their HIV prevalence plateauing at 15% and we thought the same would happen here, in Botswana and Southern Africa prevalence rates went past 30%.
This was due partly to the sexual practices of our people but also to the HIV sub-type that was prevalent in our part of the world. By 1966 Botswana was declared as having the highest prevalence of HIV in the world.
The real heavy load of cases in Botswana started in the mid-1990s, and everybody remembers it; funerals and funerals and funerals. That time ARVs were still under development, and it was only at the end of the 1990s that they became available but very expensive, so most poor and middle income countries could not immediately afford them.
Thanks to India, Thailand and Brazil who broke the patents and manufactured the drugs, their availability to many developing countries would have taken a long time. Here in Botswana, it was due to the initiative of the then President that HAART became available for general use in Government facilities in 2002, with massive aid from PEPFAR and ACHAP (supplied by Merck Foundation and the Bill and Gates Foundation).
Otherwise there was talk of extinction, and the expected population pyramid produced by UNAIDS was frightening. Luckily because of ARV’s that scenario did not occur. The rest of Botswana’s HIV/AIDS trajectory up to now is history. I left Government service on 31st December 1996 after seven years as P.S. and joined WHO.
I had almost joined WHO in 1989 but deferred it when I was appointed PS and did not want to appear unpatriotic and disappoint President Masire and PSP Legwaila with both of whom I had very excellent relations. My initial job with WHO was in Tuberculosis, a disease that had been my passion since I did Public Health and took over its control as head of disease control in 1979.
No matter what post I held in the Ministry thereafter, I participated directly in Tuberculosis control. And as we all know. Tuberculosis became and is still one of the manifestations of HIV globally and in Botswana.
HIV/AIDS was and is a slow epidemic. So, the public did not really perceive it as a threat in Botswana, except perhaps in the late 1990s and early 2000s when it caused very high mortality in the country. The Covid-19 epidemic/pandemic is different. Although it doesn’t kill everybody who gets it like HIV-related disease did, we have seen in highly affected countries that the 2-5% it kills translate to large numbers, because this is an acute infection that spreads very quickly. So, it should be easy for the public to perceive its danger.
The surveillance and containment that has been employed so far in Botswana to control the spread of Covid-19 has been very effective. Those responsible, the Ministry of Health and Wellness and the Task Force deserve to be acknowledged and thanked for a job well done. I am confident that the health care system can also adjust itself and not be disrupted by this new threat.
Since the chances of developing a drug against such a virus seems a bit remote, we are all putting our hope on a vaccine. Many viral diseases have very effective vaccines, so this keeps our hope up. We also need to know if one attack of this disease results in life-long immunity (like measles, mumps, chicken pox etc.) or if one can be attacked more than once, implying that the virus keeps mutating and bringing up new sub-types.
We are still to see if the public will do better than they did with HIV/AIDS and follow the health education. Experience is what usually persuades people to change; that is why many believe the celebrated change in Uganda when people changed and HIV infections dropped was due to the large mortality they had experienced before they even knew what was killing them.
Regarding Covid-19, we are seeing in a number of badly affected countries, people ignoring or resisting social distancing measures and masks, sometimes encouraged by politicians! Here in Botswana we have not yet experienced large losses of lives from Covid-19, so it is still to be seen how the public will really conform to advice, especially on social distancing and other measures like masks and hand washing.
What one sees so far is not very encouraging -in combis, bars etc., and during weekends in homes. In health we talk of KAP (Knowledge, Attitude, Practice). We know that K does not always lead to change in A, and to P. We saw this plainly in HIV/AIDS, what is going to happen in Covid-19?