Explainer: what's behind the rabies outbreak in South Africa

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In the last four months five cases of rabies in humans have been reported in South Africa, and an additional two cases are probable. The country’s National Institute of Communicable Diseases warns that steps need to be taken to curb the trend. The Conversation Africa’s health and medicine editor Candice Bailey spoke to the institute’s Jacqueline Weyer about these concerns.

How prevalent is rabies in dogs in South Africa?

The recent confirmed human rabies cases were spread geographically across South Africa and reported from locations in the north and east of the country. This included four provinces: Limpopo, Mpumalanga, Eastern Cape and KwaZulu-Natal. Two probable cases were reported in the Free State and Eastern Cape provinces, but appropriate samples were not available for laboratory confirmation.

Historically, locations in KwaZulu-Natal and Eastern Cape have been affected the most by dog transmitted rabies. But in the past decade cases have been increasingly reported from areas where it has been controlled before. This includes outbreaks of dog transmitted rabies in areas of the Limpopo Province, Mpumalanga, North West and Free State Provinces.

The epidemiology of the disease is dynamic and changes based on factors such as vaccination coverage, the movement of animals and other issues that may affect the ecology of dogs in a given area. For example in 2010, a rabies outbreak was reported in dogs in the south west of Johannesburg. The outbreak could be traced back to a rabid dog from KwaZulu-Natal. With low vaccine coverage in Johannesburg, the outbreak lasted for the better part of year before it was brought under control.

How big of a threat is it to humans?

Rabies is the most fatal infectious disease known to mankind. It is spread through the infected saliva of a rabid animal. This means that any encounter that allows the contaminated saliva to enter the body – through a scratch, wound or through contact with mucous membranes – could lead to infection. Most human rabies cases in the world happen when a person has been exposed to a rabid domestic dog. There are very few cases linked to rabid cats and other mammals like wildlife and domestic livestock.

There is no cure for rabies once the symptoms of the disease become evident and the virus has spread to the brain. This is true for both animals and humans. Although there is no cure for the disease, rabies is preventable and a single case of the disease remains a tragedy.

If someone has been bitten by a rabid animal, the wound, no matter how big or small, must be washed thoroughly with soap and water. In addition the person must see a doctor as a matter of urgency. At the health care facility, the risk for rabies virus transmission will be assessed based on the particulars of the case and rabies vaccination and rabies antibody therapy provided as preventative treatment post exposure.

What needs to be done to control and eliminate rabies?

Dog rabies has been eliminated in many countries around the world. In the US, this was achieved nearly 60 years ago. And in the developing world, Mexico has also managed to control dog transmitted rabies.

Their keys to success were progressive and systematic programmes for rabies vaccination in dogs. And these were underpinned by commitment from their governments as well as the public health and veterinary health authorities.

The fact that rabies is a zoonotic disease, affecting both human and animals, presents a massive obstacle. The control of rabies relies almost solely on the vaccination of domestic dogs. In South Africa one of the challenges is that the country doesn’t have enough resources to make sure this happens uniformly.

Dogs need to be vaccinated when they are puppies (at four months) and then again when they are one year old. After that, vaccinations need to happen every three years. In South Africa, vaccination of dogs and cats are mandatory by law. It’s the pet owners responsibility to ensure that their animals are vaccinated.

South Africa has committed to eliminate rabies by 2030. In 2014, the National Rabies Advisory Group of South Africa estimated that the country had spent about R70 million (USD$ 6 million) in vaccine and immunoglobulin purchases.

Bridging the gap in South Africa needs an integrated multisectoral, or “one health” approach for rabies control and prevention. Lessons from countries where dog rabies has been brought under control are ample, and policies and programmes should be adopted with these lessons and local challenges in mind.

Jacqueline Weyer, Senior Medical Scientist, National Institute for Communicable Diseases

This article was originally published on The Conversation.

Trump should be the trigger for Africa to find common cause with Americans

US President Donald Trump after sacking Secretary of State Rex Tillerson.
EPA-EFE/Shawn Thew

To reassure and reiterate America’s commitments to a positive Africa agenda of cooperation US President Donald Trump sent his Secretary of State, Rex Tillerson, to the continent in early March. But four hours after he arrived back in Washington after a whistle-stop tour of five African countries, Tillerson learned in a Trump tweet that he had been fired.

Africans had reasons to be sceptical about the Tillerson trip even before it began, as I argued before he set off. But I had not anticipated that Tillerson and his mission would also be dramatically and precipitately diminished.

It is unlikely that Africa-US relations will improve as long as Trump remains president. The president has appointed Mike Pompeo, director of the CIA, as his new secretary of state. Before joining the administration, Pompeo served as a conservative Republican congressman from rural Kansas. He has no notable foreign policy experience, much less interest in or knowledge of, African affairs.

But that doesn’t mean that African leaders should throw up their hands in despair. The Trump era, if approached with wisdom, offers opportunities for new ways of examining issues, new alliances and new areas of cooperation. This is because Trump has triggered concerns that are shared by democrats on both sides of the Atlantic, such as the need to fight racism and the need for strong democratic institutions.

Partnerships

Africans, of course, have other important relationships to pursue with other non-African partners. Planning for the next Forum for China-Africa Cooperation, is well underway, and most African leaders are expected to attend the September gathering in Beijing.

Africa was also high on the agenda of last June’s G-20 summit in Germany, despite Trump’s indifference to the gathering.

But the US is too important for African countries to ignore. Preparing and promoting a more active and constructive African strategy for engaging America, whoever is in power, was discussed at a diverse gathering of scholars and officials at Wits University, on March 8 to 10. This also marked the official launch of a new African Centre for the Study of the United States.

Three aspirations of the new centre are noteworthy. One is that its agenda will be demand driven. This means it will be set by what Africans from around the continent most need – and want to know – to manage their relations with America.

Another is that the agenda will be much broader and deeper than conventional international relations and the foreign police agendas of sovereign states.

Thirdly, a multi-disciplinary approach to research and training will be adopted. The aim will be twofold. Firstly to achieve short-term political and policy relevance for Africa. Secondly, to illuminate longer term trends of integration regionally and globally that can accelerate as Africans and Americans learn and teach each other.

Shared agendas

One potentially positive, if unintentional, effect of Trump’s actions thus far, has been to stir up resistance and fresh soul-searching among Americans about basic issues and values that are shared with Africa. Several examples stand out: gender, race, economic inclusion, the freedom and integrity of the press, the judiciary and elections. All are complex yet crucial for sustainable democracy and constitutional order in African countries as well as the US.

Since Trump’s inauguration in January 2017, new political pressure has been unleashed for gender justice and equality. Campaigns such as the #MeToo movement, for example, have quickly spread globally. If, as current US polling suggests, this influences voting patterns in upcoming Congressional and Presidential elections, there will likely be secondary foreign relations effects across Africa as well.

Trump has also been the catalyst for new degrees of both racial awareness as well as injustice. One of America’s leading black writers, Ta-Neshi Coats, aptly describes Trump as America’s “first white president’ in his book We Were Eight Years in Power: An American Tragedy. This is because Trump, unlike any of his predecessors, campaigns and rules as a white-ethnic-nationalist.

Africans need to critically assess whether, in reaction, a coalition of diverse identities predominates in upcoming elections. Either way, the outcome will have an impact on Africa-US relations.

Containing Trump

Three key elements essential to protecting and defending democracy – on the continent and elsewhere in the world – are now crucial in containing Trump’s threats to democracy.

One is maintaining the integrity of free and factual reporting by the media. The others are a strong and resilient independent judiciary, and credible elections. The world is living through a period of ill-liberalism. This is being marked by the triumph of strongmen over constitutional orders which has become a global scourge.

Trump will continue to dominate world headlines in 2018. But on July 18, South Africans and the world will pause to celebrate the centennial of the birth of Nelson Mandela. No one better exemplifies the democratic ideals that Trump defiles. Africans and Americans must rededicate themselves to strive for the standards Mandela revered. Perhaps then we will be touched again by what America’s greatest president, Abraham Lincoln, knew were "the better angels of our nature”.

John J Stremlau, 2017 Bradlow Fellow at SA Institute of International Affairs, Visiting Professor of International Relations, University of the Witwatersrand

This article was originally published on The Conversation.

Land debate in South Africa is about dignity and equality - not the constitution

Angry protests for free higher education by South African students forced the country to search for a solution.
EPA/Kim Ludbrook

If you want economic change in South Africa, create a crisis – then stand by to negotiate a way out of it.

The country’s current debate over land expropriation without compensation, which has now been endorsed by Parliament, is important. Not because, as some fear, it will radically change the constitution. Rather, it tells South Africans how, in the economy and other spheres, the country deals with its minority ruled past: by crisis followed by compromise.

Crises are the only way change happens because, since the 1970s, the goal of the minority which has called the shots in the society for decades has been to ensure that changes alter as little as possible. Which, of course, means clinging to many of the inequalities which existed before all adults were allowed to vote in 1994.

So most businesses – and professional practices and places of learning - do not change until a crisis forces them to look again at what they need to give up to keep things as much the same as possible. Because this means keeping black demands for change at arm’s length, the crises always happen when black people get angry with current arrangements and make demands which force a reaction.

The negotiations which produced the 1994 constitution began because the costs of black anger at apartheid were growing. They followed reforms to labour law, which were triggered when angry strikers in Durban demanded pay increases in 1973, and the end of curbs which kept black people out of the cities, a reaction to the anger of the 1976 Soweto protests and the refusal of angry migrant workers in the same year to live in single-sex hostels.

Recently, it took angry protests on campuses to trigger discussions at universities on how to change to meet the needs of black students. Race is debated seriously only when black people get angry over racial prejudices in advertising or company behaviour or on social media.

The crises always end in compromises because none of the country’s key interests can impose what they want on the others without severely hurting themselves. This is particularly so in the economy: forcing change on the owners of capital will kill investment and growth – ignoring demands for reform will trigger costly resistance.

The land debate’s message

The land debate illustrates the point.

Moves to change the constitution are dramatic because they threaten the property rights on which the market economy rests. They are, therefore, the most significant expression of black anger at the survival of pre-1994 inequalities since South Africa became a democracy.

Inevitably, they have prompted a crisis: a public debate which has been fixated on former president Jacob Zuma is now discussing economic divides. The debate is polarised and heated – but among middle class black people, support for the change seems overwhelming.

Outsiders might be surprised that tensions caused by economic inequalities focus on land – farming has not been South Africa’s key industry for decades. The reason it triggers such heat is that for South Africans, “land” is a symbol of far more than an expanse of soil. For most people, it has nothing to do with agriculture at all.

Historically, the demand by black freedom movements for the return of the land meant the return of the country to its people – it was directed not only at ownership of farms but at minority control of the economy and society . This is why expropriation without compensation has become a rallying cry for many who have no interest in farming but who feel that a quarter century of democracy has not ended white privilege. It symbolises a much broader demand for change.

It is also why no-one has paid much attention to arguments about the technical merits of land expropriation and why there is such support for a constitutional change despite the fact that there is no need for it because expropriation without compensation is possible now.

Property rights are protected by Section 25 of the constitution which stipulates that compensation must be paid. But it also says that this may not be used to

impede the state from taking legislative and other measures to achieve land, water and related reform, in order to redress the results of past racial discrimination.

So, if the government can show that expropriation redresses race discrimination, it need not pay compensation.

But this has been ignored because the dispute is about dignity and equality, not constitutional clauses.

Compromises will be made

Like all South African crises, this one will end in a compromise – its details have been discussed by lawyers and reported by newspapers. It seems likely that Section 25 will be changed to allow for expropriation without compensation. But the clause will specify very clearly that this can only happen in very particular circumstances, which it will carefully define.

If it does this, property rights will be protected because owners will know that they are entitled to compensation unless they act in a way which forfeits their right. It seems likely that investors will not have to do much to retain the right to compensation.

On the surface, this, like all good compromises, will solve the problem by giving both sides some of what they want. Land owners who hold the state to ransom will risk losing compensation; property rights will be protected, making investment safe. But, if that is all that happens, an opportunity will be missed.

The pattern described here – in which the country’s elites are very good at compromising in the face of crisis but just as good at creating the crises which force them to compromise – is hardly the ideal way to build a fairer economy and society.

Past wrongs need to be addressed

Crisis drives change because elites have avoided negotiating economic reforms which will redress past wrongs while protecting the assets of investors who play by the rules. This forces black people to get angry if they want to be heard and will create new crises if it is not addressed now.

Since the dispute is really about the economy, the solution lies in negotiating the economic changes which cause the anger in the first place.

The dispute’s importance depends not whether it produces a compromise on land but on whether it begins negotiations on opening the economy to the excluded. This alone will reduce the anger which makes crisis the only mode of change and ensure a less dramatic but more lasting way of addressing economic challenges.

Steven Friedman, Professor of Political Studies, University of Johannesburg

This article was originally published on The Conversation.

Survey shows Zuma and ANC's mutual dance to the bottom

Former South African President Jacob Zuma sings at the ANC National Conference in December.
Reuters/Siphiwe Sibeko

Opinion polls in South Africa have clearly shown the sharp decline in citizens’ approval of Jacob Zuma’s performance as president over the past three years. What has been less clear is the impact on the governing African National Congress (ANC). He was also the president of the ANC, until his term ended in December and he was replaced by Cyril Ramaphosa.

For many years, Zuma was considered a “Teflon” president. He seemed to maintain public support even in the face of controversial decisions and scandals because of his personal appeal as an affable populist. Several surveys placed his approval ratings in the 60% to 70%
range throughout his first term in office. Once that image was finally pierced, one might have logically expected his downfall to be equally personal, and not take the party down with him.

But new results from the December 2017 South African Citizen Survey demonstrate just the opposite. Asking a widely used measure of party support called partisan identification, a strong predictor of both voter turnout and vote choice, only 32% of those surveyed said they “felt close” to the ANC. This is the worst result recorded in the past 17 years, and statistically tied as the lowest level since 1994.

Zuma, it seems, pulled the ANC down with him. But this question is not asked very frequently by South African polling organisations. Fortunately, it’s possible to turn to an alternative indicator to get a more fine grained take on recent trends in ANC support.

The South African Citizen Survey also asks respondents to rate how much they “like or dislike” each major political party on a scale of 0 to 10. In mid-2015, 61% of South Africans held a positive view of the ANC. Two and a half years later, only 43% feel this way. More importantly, the proportion who give the ANC a higher score than any other party has shrunk from over one half of the electorate in mid-2015 (55%), to just over one third (37%) in the most recent survey as shown below.

Presiding over electoral decline

To be sure, it was already clear from the ANC’s loss of seats in the National Assembly and provincial legislatures in the 2009 and 2014 national elections that Zuma was presiding over an electoral decline, however small. This should have become even clearer in 2016, when large numbers of ANC members lost their seats as municipal councillors, positions in executive councils, and mayorships of major metropolitan councils.

Yet many of these losses could have been pinned to the poor performance of the post-2008 economy. Indeed, ever since 1994, the degree of economic optimism (as measured by the proportion of South Africans who expect the economy to improve in the next year) has been a strong predictor of popular support for the ANC.

But the evidence suggests that over the past year, voter support for the ANC became tied to their views of Jacob Zuma, rather than the economy. While Zuma’s popularity has fallen steadily since at least the end of 2015, the biggest single drop took place in April 2017 when his support levels plummeted by 12 percentage points on the heels of the public firestorm that followed the March cabinet re-shuffle and sacking of Finance Minister Pravin Gordhan.

Yet, even with the resultant damage to the currency and the markets, South Africans began to sense an economic turnaround. By year’s end, 48% expected the economy to get better in the next 12 months, and 59% expected their household living conditions to improve. But peoples’ evaluations of Zuma’s job performance continued to plummet (to just 22%), and the public image of the ANC remained at historically low levels.

Thus, voters finally turned on Zuma, but only after a long string of personal scandals, bad political decisions, and public outrage over the use of public money on his private homestead Nkandla, the “capture” of key state institutions by Gupta-friendly ministers and directors, and cabinet reshuffles.

Yet the ANC continued to shield him from the courts, the Public Protector, and from successive votes of no confidence in parliament. Indeed, the party came very close to electing his hand-chosen successor, Nkosazana Dlamini-Zuma, as its new leader and presumptive national president.

But at some point in the past few months, a sufficient number of party members finally seemed to grasp the fact that Zuma’s continued presence threatened the electoral interests of the party as well as their own political futures, particularly those who appeared downwind on the party list. But it took them a very long time to reach this conclusion, and the party has paid dearly in terms of its connection with the electorate.

Zuma dragged the ANC down with him. Yet many might justifiably argue that it has been a mutual waltz to the bottom: while his behaviour and decisions damaged his own image, the ANC’s tolerance of his sins of governance has tarnished theirs.

President Cyril Ramaphosa therefore faces a double challenge. Not only must he reestablish a positive connection between the residency and the people, but he must also transform the battered image of the ANC.

The South African Citizens Survey is based on face-to-face interviews with a nationally representative sample of 1,300 respondents a month. Results are reported quarterly on a total of 3,900 respondents, which produces results with a margin of error margin of error of ±1.5 percentage points at the 95% confidence level. Sampling sites are chosen at random across all provinces, and metro, urban and rural areas, with probability proportionate to population size, based on the latest StatsSA estimates of the population aged 18 and older. Interviews are conducted in English, isiZulu, isiXhosa, Afrikaans, Sesotho, Sepedi, and Setswana. Weights are applied to ensure the sample represents the most recent national population with respect to province, race, gender, age and area type.

Robert Mattes, Professor in the Department of Political Studies, University of Cape Town

This article was originally published on The Conversation. .