“COVID-19 has robbed us of people we love. It’s robbed us of lives and livelihoods; it’s shaken the foundations of our world; it threatens to tear at the fabric of international cooperation. But it’s also reminded us that for all our differences, we are one human race, and we are stronger together…Now more than ever, we need a healthier world. Now more than ever, we need a safer world. Now more than ever, we need a fairer world.” Dr Tedros, WHO, Director-General
The most heart-breaking people I see, who are most robbed of their lives and livelihoods are the homeless children of Kaduna State in Northern Nigeria. Their Koranic schools have been closed, because of the virus, and these children now have nowhere to go. These almajirai are reduced to begging and are often physically and sexually abused.
Pandemic, Vulnerabilities and Poverty
Covid-19 has exposed the vulnerabilities in our world today. It is affecting the most vulnerable members of our society—children and the elderly. It is obvious that there are limits to our humanly designed systems, structures and institutions. Covid-19 has revealed the false sense of security on which the world has been built. We humans have lived as if we were the center of the universe. Our world operates on a dysfunctional value system which glories in all forms of iniquitous hierarchies of power and hardened walls of indifference and isolationist national and cultural practices and stratagems. Covid-19 through the flaccid paralysis that it has left in its wake has laid bare our collective vulnerabilities. Indeed, this pandemic offers a mirror into the brokenness and woundedness of our world which was already bleeding before the pandemic. This situation rather than frightening us should motivate us to embrace the vulnerabilities and sufferings in the world today and the fragility of the earth with humility, courage and hope.
The first vulnerability which I will like to point to is the poverty of the world and the suffering of the poor among us. As Paul Farmer of Partners in Health once noted, sickness has a preferential option for the poor. According to him, the right to survive, and the problem of the ‘destitute’ sick is the most pressing question of our times. This plea was made more than 15 years ago by Farmer, yet today the pandemic has shown the destitution of so many people who are poor and unwanted by society. Covid-19 has revealed to many discerning minds and hearts the unjust and broken social construction of poverty and health inequities which we find locally and globally. This is why Pope Francis speaks of “the culture of indifference” in the healthcare system while calling for the elimination of “inequalities, to heal the injustice that is undermining the health of the entire human family.”
These inequities are all too evident everywhere. African American author, Harriet Washington refers to these health inequities as ‘medical apartheid.’ When the statistics began to emerge of the disproportionate number of African Americans and Latinos dying in the U.S and of a higher number of Africans and Indians dying in the UK from Covid-19, many people were shocked. However, most scholars and medical practitioners in the healthcare systems were not surprised. Washington has chronicled in her book, A Terrible Thing to Waste, the statistics that show the growing health disparity between African Americans/Latinos and White Americans. For example, about 69% of Hispanic children, 68% of Asian American children, and 61% of African American children live in areas whose air quality exceeds EPA ozone standards, compared to only 51% of white children.
Black Americans, Washington argues further, are dying not of exotic, incurable, poorly understood illnesses or of genetic diseases that target only them. The reason why Black Americans are dying of more common ailments that are more often prevented and treated among whites than among blacks like diabetes, heart disease, asthma, HIV/AIDS, hepatitis C among others is because of racism. She was quite prescient in his book published in 2017 as if she was thinking about the devastating effects which Covid-19 would bring upon blacks and minorities in America, when she writes, “As with lead, air pollution, and other toxic exposures, the distribution of infectious disease in America is inextricably linked to the tangled factors of poverty and race. Such intelligence-eroding pathogens do preferentially affect the poor. But within the ranks of the poor, it is racial-minority groups who sicken most often and fare the worst” (A Terrible Thing to Waste219).
For many poor people in the world and many others who are vulnerable like the elderly and those who are afflicted with other underlining health conditions, Covid-19 is another layer of agony built on a life already bruised and broken by suffering, pain, sickness and being surrounded by death. The children abandoned on the streets of Kaduna represent for me the conditions of so many people who are abandoned to die as a result of this pandemic. In many African countries, governments have imposed shutdown rules, but have failed to provide for the most vulnerable members of society—children, the elderly, women, the sick and the poor.
Early in March, I received a distressing email from one of the Kenyan agents of the Canadian Samaritans for Africa—a charity I founded with some Canadians in 2003—asking us to come to the help of the women in the slums of Kibera, where we support a micro-credit community agency, the Village of Love. These women who received training and financial support to set up businesses ranging from agro-based mini marts, grocery shops, to skills-based income generating activities, have lost all their savings to the shutdown and could no longer provide food for their children. They needed food to stay alive because the government has offered them no support to cushion the effects of the shutdown. I have heard similar stories from our women groups in South Sudan, Uganda, Nigeria, Burkina Faso, and Central African Republic. Most African countries followed the advice of the WHO to shut down their countries as a way of mitigating and suppressing the spread of Covid-19, but the governments have failed to address the hardship and suffering of the people.
In Africa many public health officials also worry that the focus on fighting this infection has led not only to the abandonment of the people with regard to food security, but also to the neglect of other diseases which kill more people than Covid-19—HIV/AIDS, Ebola (with new outbreaks in the DRC), malaria, Lassa fever, and non-communicable chronic diseases like heart conditions, high blood pressure and diabetes. The World Health Organization (WHO) has warned that nearly 250 million Africans could contract coronavirus in the first year of the pandemic, with between 150,000 and 190,000 of them dying. Africa could become the next epicenter of the coronavirus after Latin America. UN officials also say that this pandemic will push more than 30 million Africans into grinding poverty. This is why the UN Economic Commission for Africa is calling for a $100bn safety net for the continent, including halting external debt payments. Whether this will be sufficient to address Africa’s vulnerabilities is an open question.
Another vulnerable part of our population who has been badly affected by the pandemic are the seniors. According to the Catholic charity, Sant’Egidio, the generation that fought against dictatorships, struggled for reconstruction after the war and built Europe are being left to die through ‘selective healthcare’ built on a mentality which Pope Francis calls ‘a culture of waste.’ The acceptance of the “early” death of the elderly, it argues, creates a hypothecation on the future, dividing society into age groups and introducing the dangerous principle of inequality and scale of values to human life.
There have been cases of nursing homes where elderly citizens were simply abandoned to die. Covid-19 is thus challenging our healthcare ethics, not only locally, but also globally. The pandemic is revealing new forms and dimensions of global health inequities. This requires a new ethical reasoning on how to dismantle global injustice, and its devastating impact on the poor and the weak as a result of neo-liberal capitalism built on the myth of physical efficiency and productivity, and a global economy, social policies and consumer-driven health care systems that give death rather than save lives.
Another vulnerability revealed in this pandemic is the limitation of our religious response to pandemic and the limited horizon of our religious explanations for pandemics. Historically, Christians have relied on prayer in moments of anxiety and uncertainties. Religious historian Daniel Reff, attributes the rise of Christianity in the Roman Empire to the ability of the religion to offer people healing rituals and charitable outreach in the frequent plagues and infectious diseases which besieged the population.
The people of Rome, for instance, have a long tradition of praying before icons, shrines, and tombs of the saints in times of plague, war, and other calamities. The icon of Mary, the Protectress of the Roman people, was first carried around the city in 595 by Gregory I with the hope that the Mother of God will help to ward off the plague. The miraculous crucifix of St Marcello was carried in procession through Rome in 1522 as people prayed for an end to the Great Plague. It is not surprising that Pope Francis visited the shrines containing the icon of Mary and the Crucifix of St Marcello during Lent. Following ancient tradition, he prayed for an end to the outbreak, and healing for the sick.
The arguments on the virtualization of the Mass and the politics and poetics of church closures continue apace with new questions and concerns about when to open the churches. Churches have struggled during this pandemic and the jury is still out on the effectiveness and adequacy of the pastoral ministries of the churches in this time of great need. Have theological ethicists accompanied our church leaders, healthcare workers, the sick, suffering, and poor among us, with an ethical compass with which to navigate this terrible and trying time?
Towards a Biosocial Ethics of Global Solidarity for Health
There is the need for a new ethical reflection that can spur humankind to appreciate our common humanity, and steer the world towards the collective action which we need to bring to birth a new heaven and a new earth for human and cosmic flourishing. Covid-19 is teaching the same lesson as the ecological crisis, even though humanity fails to listen: we live in a common world; we require collective, collaborative, and co-operative action in order to meet our common needs. In this new world, no one can go it alone. We need to find common ground to live and work together as friends, or we will die as fools.
None of us is safe until all of us are safe. Something dies in each of us when anyone dies. We are all sick when any one of us is sick. We all share a common origin and a common future. We are dressed in the same robe of destiny. We must come together as one family to fight this pandemic, and fight against injustice, poverty, violence, ecological threats to our world so that we can be heirs to a new world and a new creation where all God’s people and God’s planet are flourishing.
The ethics which will bring this about is the biosocial ethics of global solidarity for health. This ethic is grounded on the intrinsic goodness of all lives, and a firm commitment by every human being to make ethical choices to promote human and cosmic wellbeing. This ethics reflects on, and proposes what ought to be done by individuals, societies, nations and all people of goodwill to promote holistic health. Biosocial ethics of health focuses on all the factors which interact in the procurement of abundant life—nutrition, sanitation, water, clean air, quality of social relationships, cultural and spiritual traditions, politics, economy, religious beliefs and practices, traditional and modern knowledge about health, sickness, diseases and healing. It examines the adequacy of human actions and value preferences—cultural, religious, social, political etc. —in hampering or advancing the proper interaction of these integrative factors which work together in bringing about human wellbeing.
The biosocial ethical approach to global health is grounded on the principles of social justice. This is because it seeks to answer the question of why diseases and outbreaks like Covid-19, Zika, Ebola, and HIV/AIDS have a “preferential option for the poor” in the Global South and among minority groups in the Global North. Biosocial ethics must critically examine the causes of the underlying diseases among the poor which make them susceptible to Covid-19. It must also unmask underlying power differentials in local and global systems. It looks at the close connection between disease and poverty, the disparity between the sick poor and the healthy rich.
In the current search for global solidarity, this ethic should be concerned with how to evaluate the link between healing through pastoral care, and traditional healing with the use of modern medicine and the rapid, transparent, and free exchange of knowledge, skills, medical science and intervention in the globe. Biosocial ethics guides how this exchange should proceed from each part of the world according to its capacity and specialization, and to all parts of the world in an equitable manner according to needs, in order to bring about holistic global healing and restoration. A biosocial approach promotes a culture of life which motivates small acts of solidarity at local communities which could grow to become a globalization of solidarity which recognizes global health for all as actionable human rights.
We need such an ethics to help theologians to show how poverty and global indifference, nationalism and racism, violence and rising inequalities, continue to potentiate the global and local health inequities which are glaringly evident in this pandemic.
Conclusion: The Power and Politics of Love
Ethical reflection on healthcare in the light of Covid-19 should go beyond simply examining prevention protocols for the mitigation and suppression of the virus, and treatment of those who are sick. At the end of a comprehensive study of the history of epidemics in world history, Paul Slack observed that identifying the ideologies and mentalities of societies and public health polices and politics is an important ethical concern in the interpretation of the sources, causes, and treatment of infectious diseases.
One egregious example of the indifference, self-centredness, ideological divisions and forgetfulness decried by Pope Francis is the current tension between the U.S and China. Both countries refused to participate in the recently concluded 73rd Session of the World Health Assembly on the theme of Global Solidarity in the fight against Covid-19.
Those who are gasping for breath and fighting for their lives in the ICUs all over the world need help, not politics: The vulnerable of our societies, like the almajiris of Kaduna, the seniors in hospitals and nursing homes in the West, and migrants and refugees exposed to this disease and other health hazards, have no other way to resist the powers of entropy. The weapons of the weak, James Scott reminds us, are often ‘quiet and anonymous.’ Let us not reduce anybody to an anonymous statistic, but embrace an inclusive, loving biosocial ethic of solidarity.