COVID-19 in Madagascar:  Curfews, Economic Strife, and a ‘Miracle Cure’

Current affairs on the island of Madagascar are not publicised very often in mainstream media due to a disproportionate focus on the West, resulting in a situation where the Madagascan experience of the COVID-19 pandemic has mostly been overlooked. Although Madagascar is not one of the worst-affected countries in terms of death rate or total cases, the toll the virus has had on both daily life and the economy is significant. In the months following its emergence and the subsequent implementation of lockdowns and curfews, it has caused severe complications for people’s sources of income, particularly within the informal economy. Government regulations put in place to curb the spread of the virus and the increased military and police presence have been received very poorly by the population, and hopes pinned on the local “miracle cure” for COVID-19 have fallen flat. As there is not much awareness of the social and economic devastation caused by the virus, it is important to give a critical overview of the circumstances in Madagascar, which can be intertwined with some local perspective from my uncle Mohamed Akbaraly, a shopkeeper in Toamasina.

Until recently, Madagascar only had a total of a few hundred reported cases, and the national lockdown had begun to ease. However, since June the number of daily cases started to increase by hundreds, and lockdown had to be reinstated in various areas including the capital city, Antananarivo, with the exception of certain areas like Toamasina which had remained continuously under lockdown. However, although some of the West appears to be recovering and is reopening, Madagascar’s challenges were only beginning, and it is likely that the progression of the virus in Madagascar is several months behind countries already hitting or surpassing their peaks.

The virus is widely believed to have originated either in the capital, Antananarivo, where the first three cases were recorded or in the port-town of Toamasina, where the island’s first death was recorded. It seems likely that cases were imported into Madagascar by European businesspeople and workers regularly travelling between their respective countries and Madagascar – particularly France, as France and Madagascar have a long-standing trade relationship. Toamasina is one of the regions that has been most affected in Madagascar and is considered the hotspot of the virus, followed by Antananarivo and Fianantsoa, all of which were placed under lockdown in late March. Here, a curfew from midday to five in the morning has been implemented to reduce social activities.

The instigation of the curfew has been met with general disapproval from the population, but for different reasons. Those who consider the virus a serious health threat tend to be dissatisfied with the less stringent measures, whereas those who are less conscious or aware of the virus are angered about the disruption to daily life. The latter stance is common amongst shopkeepers and stallholders at markets. In Akbaraly’s words, “Lockdown is not respected at all because Madagascar’s population is one which relies on day-to-day wages. I know people who have told me that they would prefer to die from the virus than to die from the effects of the curfew”.

According to the World Health Organisation’s (WHO) recommendations, countries should promote the wearing of masks, social distancing, and increased washing of hands. President Andry Rajoelina has implemented a rule stating masks should always be worn outdoors. However, like towards the curfew, this has also been received poorly by the population, with many people refusing to wear masks because they see no reason to do so or believe that the virus is a hoax. Social distancing measures are not being followed, either due to unwillingness or an inability to spread out in crowded areas.

The controversy surrounding the virus and regulations has also been exacerbated by the police and army presence which has been introduced to enforce these rules. Over 500 soldiers have been sent from the capital, Antananarivo, to Toamasina. Much of the local population holds the perception that the army is an oppressive force and a manifestation of the government’s abuse of power. Following the circulation of various incidents online, many have also critiqued the military for their excessive and unnecessary use of violence against citizens. The unease at the presence of the army is further heightened by an underlying ethnic rivalry between coastal populations and those living on the high plateaus in Antananarivo.

The economic sector has been hard hit, with many shops and businesses struggling to survive and the informal economy particularly at risk. Akbaraly shared his experience, saying “We opened the store from 8 a.m. to noon, and in the afternoon we had to be confined at home. Our turnover decreased by more than 70% during this period compared to last year, because the majority of regions from which our customers come from, especially Analanjirofo, are blocked due to the closure of the RN5 national road.”

Figure 1 President Rajoelina advocating for the use of Covid Organics | Source: Henitsoa Rafalia/Anadolu Agency/AFP

The economic effects are accompanied by the lack of support for the most disadvantaged members of the population, leaving many to fend for themselves. The lack of sufficient healthcare means that many people may have caught the virus without official confirmation, meaning that there are potentially many more cases and deaths in Madagascar which have not been reported.

Amid all these issues, there was a glimmer of hope when it was announced that Madagascar had found a potential remedy against COVID-19. Administrable as a herbal drink or injection, Covid-Organics (CVO) was claimed to be a ‘miracle cure’, with President Rajoelina claiming it could both cure and prevent the virus. As it is made from Artemisia, the same plant used in the malaria treatment Chloroquine, there are concerns that those who take CVO will develop resistance to antimalarial treatments.

Initially, the WHO warned against the use of CVO as it was untested, stating that Africans deserved medicine that had gone through suitable scientific trials. In May, the WHO changed track and expressed interest in the development and research of the remedy and signed a confidentiality agreement with Madagascar to enable clinical observation. Madagascar was registered onto the WHO’s ‘Solidarity Trials’, a programme which fast tracks clinical trials for potential treatments for COVID-19. Both the Africa Centre for Disease Control and Prevention and the South African government expressed their support for the drug trials and rapidly scaling up production if trials were successful.

Unfortunately, there has been no conclusive evidence that the drug is effective enough to be mass-produced. Despite this, the president has remained adamant about the drug’s high efficacy and the so-called ‘miracle remedy’ has been distributed to Madagascar’s population, initially free of charge, without undergoing trials. Schools across the country received the drug so that it was accessible to children, however parents could opt out if they had concerns about its efficacy and side-effects. Akbaraly expressed that “the majority of the population does not trust this treatment. Even the government has backtracked concerning the obligation to give the remedy to children at school.”

If the trials and research had been successful, this could have been an opportunity for Madagascar to revitalise its economy and improve its international recognition, as well as control the spread of the virus. However, local support for the drug is low.

While it appears that Madagascar is still in the early stages of the virus, many underlying problems such as poverty, a weak healthcare system, and lack of social cushioning have already become aggravated by lockdown measures. As the virus inevitably spreads and growing numbers of people require intensive care, it is becoming increasingly clear that the country’s infrastructure is unlikely to withstand the pandemic. The only viable hope of eradicating the virus in countries such as Madagascar would be through a vaccine, in order to prevent further economic and social devastation.