NAIROBI — When John Peters, who lives in Dar es Salaam, tested positive for COVID-19 in mid-May, it was about two weeks after the Tanzanian government stopped reporting cases to the World Health Organization.
Others all around him also started getting sick. He personally knows about 25 people who tested positive.
The pandemic response across the globe
After he received the results — about a week after he was tested — he was not asked for the names of the people he had been in contact with over the past few weeks to enable contact tracing. But Peters, whose name has been changed to avoid retribution from the government, was asked to sign a form saying he would stay home for 14 days.
Around this same time, there were reports of many hospitals in Dar es Salaam becoming overwhelmed, and three members of Parliament died in the span of 11 days of unknown causes — all raising suspicions that the government was covering up its COVID-19 caseload with its decision to not release figures.
While some businesses did close, and the government shut schools and banned mass gatherings at weddings and funerals, a full economic lockdown was never implemented.
In recent months, Tanzanian President John Magufuli has repeatedly minimized the risks of COVID-19, and he announced in June that God had removed the coronavirus from Tanzania. This has created a complicated environment for organizations focused on health communications to navigate as they work to educate communities about how to deal with the ongoing pandemic.
“This is a government in denial,” said Judd Devermont, director of the Africa program at the Center for Strategic and International Studies. “If you are an organization that is focused on preventing COVID cases from spreading and the government says there are no more COVID cases or is unwilling to share any information, how do you operate in that space?”
COVID-19 likened to Satan and goats tested
Tanzania, in some ways, started to lay the groundwork for an effective COVID-19 response in the months leading up to the pandemic.
In September, there were unofficial reports of people suffering from Ebola-like symptoms in the country. But while the government said that these people tested negative for the Ebola virus, it refused to provide WHO with requested information to further verify this.
But the risk of Ebola spreading to Tanzania from the outbreak in neighboring Congo led the government to convene its national task force on emergencies to prepare prevention and response mechanisms, including a committee on risk communication and community engagement, according to sources.
When COVID-19 hit, these structures were in place, ready to respond to the new threat. The government galvanized to distribute prevention messaging with its partners.
At the start, things were heading in the right direction, sources told Devex. But then the messaging from the top of the government began to change.
At the end of March, Magufuli encouraged people to continue visiting places of worship — a move that bucked international public health recommendations — while comparing the virus to Satan and saying that it “cannot survive in the body of Jesus Christ.”
Then in May, the president cast doubt on the data around cases by suggesting that people who test positive might not actually be infected. He said he secretly tested a papaya, a goat, and a quail for COVID-19 — all testing positive — to prove his point.
“There is less conversation now ... that there is COVID-19 in Tanzania — which makes now the response to be almost impossible.”— Mwanahamisi Salimu Singano, development expert
Then on June 9, Magufuli declared that “Corona in our country has been removed by the powers of God.” Celebrations followed.
He reiterated that COVID-19 was eliminated from Tanzania in a speech on Monday.
"Our enemies will speak a lot, but the reality remains that Tanzania is safe and that is why none of us here is putting on a mask. Does it mean we are not afraid of dying? No, it is because corona has been eliminated,” he said.
Now, life has largely returned to normal in Tanzania, sources tell Devex. Schools have reopened, many people are walking around without masks, and the government has closed many of its COVID-19 centers.
“If you went into a coma last year and you woke up right now in Dar es Salaam, you would think that life is normal,” Peters said.
While the government stopped reporting cases to WHO at the end of April, the health agency and other partners continue to provide the Tanzanian government with technical support on its response, including on case management, infection prevention and control, surveillance and laboratory strengthening, risk communication and community engagement, and logistics, according to an email from WHO.
Confusing narratives, ineffective messaging
The president’s messaging on the pandemic, along with the Ministry of Health’s failure to approve messaging around COVID-19 for groups to use, was a “massive blow” to organizations working to educate populations on protecting themselves from the spread of the virus, said a health communications expert, who wished to remain anonymous due to concerns around publicly criticizing the government.
“The wind is very much out of the sails of the health communications sector,” the expert said. “There is a very steep hill now because there are counternarratives that are more attractive and louder. The population must be just completely confused.”
One of the problems is that the measures that are recommended — washing hands, wearing masks, and social distancing — are inconvenient and can be expensive for people living in poverty. It can be hard to convince a population of the importance of taking these inconvenient measures to combat a disease if they do not understand how many people in the country are infected and their personal risk of contracting the virus, sources said.
Civil society groups are in a tricky position because of the shrinking space for them in Tanzania under Magufuli and the need to act in accordance with government messaging, said Mwanahamisi Salimu Singano, a Tanzanian development expert. Now that the government has said the COVID-19 outbreak is over in the country, they are pressured to accept this.
Some of these groups would have likely played a significant role in an inclusive response to the pandemic that would reach vulnerable communities, such as people living with disabilities, she said.
"There is less conversation now, whether in a civil society space or an individual space, that there is COVID-19 in Tanzania — which makes now the response to be almost impossible," she said. "Most people went back to business as usual. That is where we are at in Tanzania, in my sense."
In the absence of data on case count, it is also difficult for organizations to effectively target their programs, sources told Devex.
“Without guidance, there's no light to guide you in terms of how you allocate limited resources to do the greatest good,” CSIS’ Devermont said.
Balancing risks, improving communication
Sources told Devex that there do appear to be fewer cases of COVID-19 in Tanzania now than in the initial months of the pandemic.
While it is uncertain whether this is true or why that might be, sources told Devex about some theories. Perhaps people have developed some level of immunity after months of spiking cases — although a growing body of research suggests that any immunity among people who had COVID-19 is short-lived.
There is also speculation that people with COVID-19 symptoms are no longer getting tested, due to the lack of government emphasis and the population’s feeling that the pandemic is under control, Singano said.
As for the government’s approach overall, some sources told Devex that the decision to avoid a full lockdown might have made sense in the Tanzanian context.
A lockdown is intended to space out the number of infections at any given time so that a country’s health system can cope with the caseload, said Risha Chande, director of advocacy and engagement at Twaweza, a Tanzanian organization focused on enhancing society engagement.
“You might even be flattening the curve for 10 years without making it possible for our health sector to cope if our caseload and severity had been comparable to the U.S. and the U.K.,” she added.
Given the limited utility of a lockdown, the economic consequences might not be worth it. But even so, sources said, the Tanzanian government could have communicated its decision to avoid a lockdown in a more transparent way. This could have involved discussions around protecting vulnerable populations while still keeping the economy open.
“A coherent line could have emerged, which would maybe not be all that different than the practice in Tanzania, which is to say: ‘Honestly, folks, we're not going to lock down because we have an economy that’s not up to it. But here are some things that you can do in your own lives that can help you to be safer,’” the communications expert, who wished not to be named, told Devex.
Update, July 21, 2020: This article has been updated to include comments made by President Magufuli on July 20.