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Public health and digital communication in Cameroon in the time of COVID-19

p.awondo11 August 2020

If there’s one thing to remember about the way the Covid-19 global pandemic will affect the world, it’s the unprecedented way it is living and spreading in the digital world. This is such a novel fact that some have called it “a parallel epidemic”. This is characterised as much by an insurmountable number of fake news items as it is by a certain density of scientific information given by experts and commented on by analysts and pseudo-experts through digital platforms such as Facebook, WhatsApp or even forums. This density of scientific information, often left to the layman to interpret, has often created confusion; but more than its density, there is also its changing and sometimes contradictory dimension that has fostered confusion and given rise to misinformation, conspiracy theories and fake news. All this is not new. In a way, the history of major epidemics is punctuated by these panics and uncertainties. What is really new is the way in which, through the mediation of social networks and platforms, the pandemic information has circulated, revolutionising, in passing, even the way leaders communicate in contexts where they sometimes resist ‘the digital’ or legislate against it. This is what happened in Cameroon, where the country’s administration has previously been reluctant to adopt digital means of communication, preferring secrecy. The government’s communication around Covid-19 has gone into digital mode in an unprecedented way and has mainly been centred around the use of Twitter to report on the evolution of the disease and inform Cameroonians.

Tweeting the coronavirus statistics

Cameroon, one of the most affected countries in sub-Saharan Africa, officially has 18,042 cases to date, 2,327 of which are still under treatment. 15, 320 people have recovered and there have been 395 deaths.  The Minister of Health, very active from the beginning of the epidemic in Cameroon in March this year, no longer publishes daily figures on his Twitter account, as was long the case.

Before the first cases were declared on Cameroonian soil, the Minister had shown unprecedented proximity to the situation via his Twitter account. The first tweets concerned preventive measures, already taken in February, and also tried to reassure Cameroonians about the measures their government was putting in place when rumours were already circulating about the existence of cases in the country. Towards the end of February, the tweets started focusing on explanations about the occurrence of the disease on Cameroonian soil. Indeed, the Cameroonian minister had inaugurated a new mode of communication through tweets around the epidemic in a country where government administration continues to be done by decree and signed with a stamp as proof. Even if these administrative acts now circulate on Whatsapp, sometimes before being broadcast on national radio or in offices, the priority remains the paper act. The Cameroonian health minister’s investment in tweeting, therefore, appears like a UFO to Cameroon’s high administration.

Figures 1, 2 and 3: Tweets from the minister of Health before the first case of COVID-19 in Cameroon (1), tweets when the first case occurred (2) and tweets sent by the minister after Cameroon already had multiple cases, which aimed to reassure the nation about measures taken by the state (3).

The third series of tweets talks about the measures taken against the pandemic and what the government is doing to curb its spread – at this point, the virus was already on the country’s doorstep. Finally, once Covid had started spreading in the country, the tweets became concerned with the figures relating to the evolution of the pandemic.

This communication through tweets has fostered two rare things in the relationship between citizens and the authorities, especially health authorities, who have been publicly denounced in recent years for the inadequacies of the health system which were exposed by the AIDS pandemic, and especially for the inability to decrease the country’s infant mortality rate, which is considered too high, not to mention the corruption of personnel. The first positive point in relation to the communication coming from the Ministry of Health is proximity. By addressing citizens directly through tweeting, even though Twitter is far from being used by a large majority of Cameroonians, screenshots of the minister’s tweets quickly made a detour via WhatsApp and spread throughout the country. The first tweets were, therefore, ‘welcomed’ by the population via commentators and part of the press.

The second positive point was the dimension linked to the duty to democratise information and the principle of accountability to the people (two core principles of the republic). The idea that it is the minister’s duty to inform Cameroonians about the country’s health situation on a daily basis is banal at first glance, but not so common in the context of Cameroon, so the minister’s action initially made people forget about how hesitant the administration had initially been about closing borders (it was this hesitation that eventually led to the first cases). Subtly, however, some of the minister’s tweets alluded to the “irresponsibility” of travellers arriving into Cameroon and refusing to comply with the isolation measures, thus endangering Cameroonian lives. These tweets, which came at the time when the epidemic exploded, during April and May, rekindled the stigmatisation of travellers, often Cameroonian, who were known as “coro-mbenguists” (people living in Europe and potential corona carriers) in the context.

Tweets, fears and backlash

The minister’s tweets, initially hailed for their clarity and frequency, gradually found themselves at the heart of a controversy. There are three reasons for this. The first is related to the initial focus on the count of tested cases of travellers arriving from Europe. This was considered to be stigmatising because the press was beginning to relay the idea that the diaspora is responsible for the spread of the disease in Cameroon.

A second reason is related to the fear and psychosis created by the daily count of the minister’s tweets. With the number of positive cases increasing at an exponential rate, making the figures public has created, according to some analysts, significant stress among the population, who do not know what to expect in the coming days, especially since the executive decreed partial containment measures taken in mid-March were received in a mixed manner by a population with low incomes and dependent on the informal sector and therefore dependent on being present in the streets. These daily figures, which the citizens helplessly see going up by the day, echoed those in Europe, particularly in Italy and France, whose chaotic management of the pandemic mirrored the idea of an almost certain death for a large number of people. Beyond the nationalist rhetoric that I mentioned in a recent blog, the conversations on Whatsapp groups were marked by panic and a kind of inevitability of fate that can be summed up in the phrase “if Europeans, with the tools and powerful medicine die so much; what will happen to us? ». These reactions contrast with the analyses of public commentators who, faced with the slow spread of the virus on the continent, show a courageous and imperturbable Africa in the face of the pandemic. In reality, on the streets of Yaoundé, WhatsApp groups are overcome by anguish and fear. This panicked fear is reflected in certain recurring expressions in the discussions. In Yaoundé, in the face of the implacability of an event, people say: “we are waiting, what else can we do » (on attend on va faire comment).

The tone of anguish and panic, exacerbated by the macabre daily death count in Europe and circulating through social networks, with news items coming out of Italy and France, which were under lockdown and where life had stopped, forced the Minister of Health to change his communication strategy:

Fig 4 tweet about the decision to change the Ministry of Health’s communication strategy and stop declaring the number of new cases and deaths (7th April 2020).

On the 9th of April, the online press reported that, after giving in to constant requests from numerous followers (there are 71,000 of them), the Minister would no longer tweet the same way as before,  announcing the following: “Very sensitive to the new direction you wanted to give to our communication, I will therefore From now on, I will endeavour to publish only information on the development of our strategy, serious cases, cured cases, deaths, and barrier measures”.

Although the Minister kept his commitment for a few days, he eventually returned to his more usual tweets, giving his followers the number of new cases and deaths. A third point to note as a backlash to the tweets is that the Minister of Health became popular at the beginning of the epidemic because of the novelty of reporting to the population. However, this popularity is not appreciated by all, and Cameroonians who are not used to government transparency will demand it to the end, especially with regards to the management of the special Covid fund, endowed with tens of billions of CFA francs (Cameroon’s currency) by the country’s Head of State. This turning point is materialised in the tweets where the minister highlights the government’s “achievements” such as measures taken to improve patient care or boost preventive measures.

But the card of transparency played by the minister does not really seem to bear fruit, because to date, he is under the cloud of accusations of misappropriation of public funds allocated for the pandemic, rumours of which pervade the entire Cameroonian web.

In the end, two observations can be made: the first concerns the innovative dimension of digital crisis communication in a context where opaqueness is the norm. Indeed, the COVID-19 pandemic has revolutionised the links that institutional health actors can have with their populations because information (both good and bad) circulates through social networks so much, that leaders have to provide clarity if they do not want to be overwhelmed by the circulation of misinformation, fake news and rumours of a conspiracy involving them. One such conspiratorial rumour is, of course, that international pharmaceutical companies and the local government are plotting to spread the fear of the pandemic in order to aid the vaccine business.  From an information democratisation perspective, there has thus been an advance in propagating the values of the republic in the Cameroonian context, with the government playing its part for once. A second observation illustrates at least one limit to this advance, namely that even if the government’s management of information puts the public’s interests first and tries to do so in a way that reaches as many people as possible, this does not guarantee that tensions and anxieties related to the socio-economic and epidemiological context will be minimised. On the contrary, in the face of the epidemic, uncertainties are growing. At the same time, Cameroonian citizens have rarely had the opportunity to hold their public health authorities to account in this way. This has made the COVID-19 pandemic not only a test for democracy but also the laboratory in which it is made.

Fig 5 & 6: tweets on governmental actions with regards to practicalities and capacity building in the fight against Covid 19 (5) and public statement after a controversy over the misappropriation of a rice donation by a private economic operator (6)

COVID-19 in Cameroon: concurrent narratives and the battle for dignity

p.awondo11 May 2020

In Cameroon, the first case of Cov-2 SARS infection was published on the 6th of March, 2020. It involved a French-Cameroonian national who arrived in Cameroon through the airport of Yaoundé, the political capital, on the 24th of February. He was hospitalised and treated at the care centre of the Yaoundé Central Hospital. Today (the 9th of May, 2o20) Cameroon is, after Nigeria and Ghana, the country with the highest number of Covid-19 cases in sub-Saharan Africa: 2267 cases. Among these patients, 1019 have been cured and 108 have died. The first death occurred in Douala, the economic capital. The patient in question was a 63-year-old man who allegedly took in a woman from France and “escaped” quarantine.

The Cameroonian government had announced a number of measures in early March to stem the rapid spread of the pandemic. These measures were similar to those enacted in other African countries, with the closure of air, land and sea borders, partial confinement, the closure of schools and universities, partial closure of markets, bars and other places of worship, a ban on going out after 6 p.m., the mandatory wearing of masks in public spaces and other barriers such as systematic hand washing and disinfection of certain public places such as markets.

The epidemic of polemics and the reversal of stigma

As soon as the first case was announced, a certain psychosis had spread among the population. The presence of the macabre tally of the pandemic in European countries and particularly in France was so strong on social networks and other traditional media including television and the written press that people feared the worst.

Analysts and specialists on Africa were adding to the psychosis by predicting the worst.

In turn, UN Secretary-General Antonio Guterres and the WHO Secretary-General sounded the alarm by calling on African countries to “prepare for the worst”. While objectively feared because of a history of fairly recent epidemics (Ebola, cholera etc.), these various calls will also create controversy. Many African intellectuals will be outraged by the tone of these UN forums by recalling the condescension that was represented by the fact that they were being attacked by the media on a continent that remained relatively unscathed. On social networks, reactions were pouring in, all denouncing this “Western obsession with Afro-pessimism” which reflexively sees catastrophes in everything on the continent. Other commentators even question the announced health aid. In Cameroon, France’s announced support is viewed with suspicion. This policy of suspicion is exacerbated by a polemic on a video from a French news channel. The video excerpt in which two French doctors discuss the possibility of a vaccine against Covi-19 and in which one of them mentions the possibility of clinical and vaccine trials on the African continent goes viral. On social networks, the polemic is growing, African and Cameroonian intellectuals and public figures are taking a stand. In their substance, these interventions castigate the so-called “colonialist and paternalistic” dimension of French doctors’ statements. They are accused of wanting to impose a vaccine without respect for ethical standards on the continent. These facts are reminiscent of colonial medicine. The tribunes that will continue are the trial of a fixist vision of Africa and of the catastrophism dismissed by Western commentators of the beginning of the epidemic on the African continent.

This controversy, known as the vaccine controversy, is in addition to the controversy that arose when the first cases were announced in Cameroon. In the first week of the epidemic at the local level, the press relaying the moods of the population accused the diaspora of having imported the virus into the country. It is true that Cameroon, open to the world through its two largest cities Yaounde and Douala, saw the first cases from France land on its soil. The press and the communication coming from the Minister of Health will be harmful in terms of stigmatisation of the diaspora to the point where major media will end up opening the debate on the front page.  By recalling the number of passengers disembarked on Cameroonian soil on a daily basis during the first two weeks, by stressing that among them there were positive cases, the ministerial communication did not only serve the need for public health, it also had the effect of stigmatising these “unwise travellers”, scapegoats of a dreadful epidemic which for once is imported from rich countries into the poorest like Cameroon. For a few weeks, the lynching in tabloids and on social networks of the local category known as “mbenguite” (travellers, migrants to Europe) became a stigma. This is a historical reversal in a context where “mbinguists” are often socially valued as providers of economic goods, seen as a resource due to to their migratory lifestyles. Potential carriers of Covid-19, mbinguists have become in Cameroon the paradigmatic repulsive figure of the reverse stigmatisation that took the “disease from Europe” to task.

The quest for medication and the return of African medicine

“In Congo-Brazzaville, covid-organics will soon be administered to the sick. A first shipment was received and symbolically handed over to Florent Ntsiba, chief of staff to President Denis Sassou-Nguesso. Other countries including Guinea-Bissau, Niger and Equatorial Guinea have already received their share of the treatment developed in Madagascar”. this excerpt could be read on the africanews.fr website on the morning of 10 May 2020.

To understand the circulation of this Malagasy potion, we have to go back a few weeks. Since the beginning of the epidemic, the quest for the drug has been ongoing. In French-speaking Africa, as in the rest of the world, the controversy around chloroquine is raging. In the local interpretation, the powerful lobbies of the world refuse to pay attention to the cheapest drug because the famous protocol of the French researcher Professor Didier Raoult already exists. On social networks and online media, users oppose the need to use or not to use the protocol of the one that the media call “the druid of Marseille”, in reference to the manufacturer of the Gallic magic potion in the famous comic book Astérix et Obélix.

The positions taken by Cameroonians on the Internet are similar to those taken by most Africans who are familiar with chloric acid and almost make Didier Raoult a hero.

As with every epidemic, the debate around the capacity of traditional African medicines is re-emerging. This time it is amplified by global controversies and the uncertainties of Western countries disoriented by the force of the virus.

On the 10th of April, Malagasy President Andry Rajoelina announced that Malagasy researchers have found a cure for Covid-19, “Today I am officially announcing here the successful and good results of the trials of our cure,” he said, “and it can be said that it has given a conclusive result on Covid-19 patients in Madagascar and that it can limit and mitigate its effects on the human body”. As the French online journal le Point points out, the controversy will start immediately. “The World Health Organization (WHO) has recognised that some traditional medicines and remedies “can alleviate the symptoms” of the coronavirus, but recalled that “there is no evidence that these substances can prevent or cure the disease”. The organisation even voted as early as 2007 for a resolution “calling for a phasing out of oral artemisinin-based monotherapies from the markets”. Artemisia is banned in several European countries”.

A meme that has been in circulation on Whatsapp groups, talking about standing ‘against’ the WHO, an organisation that ‘does not know Africa’.

Al Jazeera article on the Covid-Organics herbal remedy

In fact, from the very beginning of the pandemic, the African web was stirring with discussions about a local medical formula. Long before the first official case was even declared, many protocols for herbal teas, herbal potions and other so-called traditional barks were already circulating in Cameroon. This return of the traditional pharmacopoeia is accompanied by a militant pan-African discourse about “African solutions” and the “valorisation of the African pharmacopoeia”. A campaign that the Malagasy president will also take up during his many outings during which he values the African support of his fellow leaders as much as the orders already being shipped.

The quest for African medicine is thus becoming a pan-African militancy issue in an epidemic and pandemic context where the fatigue of being assisted by the West has been expressed. In the majority of comments, people react in support of this herbal tea and the WHO’s warnings are interpreted as a posture attributable to imperialism carried by an organisation that plays into the hands of the powerful and in particular the big global pharmaceutical groups.

In reaction to the WHO’s first comments on the issue, African countries such as Senegal are placing orders to Madagascar. On WhatsApp and Facebook, a small anti-WHO campaign is even taking shape, often featuring situations where African pharmacopoeia is used, with subtitles that are addressed directly to the WHO, as if to warn it against any hindrance to the use of African medicine.

The Malagasy herbal tea has also had the effect not only of taking the African world as a witness against the Western medical imperialism protected by the WHO (according to the polemicists) but also of freeing the actors who had hitherto on the continent intended to proceed in the same way.

Thus, in Cameroon, since the beginning of May, a polemic has been raging in the city of Douala since the Catholic Archbishop of Douala, who is a great adept of traditional pharmacopoeia, set up a potion. Advocating pharmaceutical nationalism, the archbishop is running a strong media campaign which has the active support of public figures (for example, he received 50 million XAF from a businessman), but also many Internet users. However, the medical system has been very cautious about taking these potions and any other form of traditional medication against Covid 19.

The quest for the medicine has thus become the quest for African dignity and its opportunity to rebuild its coat of arms in a world that sees it as the childhood of the world according to Hegel’s formula.