One of the most famous attempts to explain justice – as fairness in society– is credited to the Philosopher, John Rawls. He was interested in the policies that will emerge if people made decisions behind the “veil of ignorance” about their identity.
With his metaphor of “veil of ignorance”, he advocates compliance with the Golden Rule: “Do unto others as you would have them do unto you if you were in their place.”
Essentially, Rawls believed if policy makers were blind to their socioeconomic privileges and status (whether rich or poor, healthy or sick, and if I may add, politician or not), their decisions would lead to socioeconomic fairness. His emphasis is on being blind to their status; not being blind to that of others.
He believed if this were the case, the chosen policies will prioritise the well-being of the worst-off in society. Accordingly, the foundation for a good public policy is fairness, which then serves as a tool for social justice.
Is there social justice in our fight against COVID-19?
Presently our case count stands at 14,568 with 3,566 active cases, 95 deaths and 10,907 recoveries/discharge. Keep in mind, that, per the new discharge protocols not all the patients who have been discharged have recovered from the disease.
Moreover, Ghana has seen high profile persons contracting COVID-19; including doctors, members of parliament and our minister for health who has recovered to our delight. I wish the sick speedy recovery and console all bereaved families, including those of Professor Jacob Plange Rhule and Dr. Harry Owusu Boateng.
Applying the “veil of ignorance” to test social justice in our fight against COVID-19, let us assume for a moment that our policy makers did not know their privilege status in society.
As influential men and women who have ready access to quality and responsive health care funded by the taxpayer, do you think their decisions have cleared the bar of social justice?
To answer this question, I invite you my reader – including President Akufo-Addo and his team of advisors – to examine just three issues: Discharge of patients in 14 days; Social justice and allocation of resources; and The parliamentary primaries of the ruling New Patriotic Party (NPP).
Discharge of patients in 14 days
On Saturday, 20th June 2020, Ghana posted 10,074 total COVID-19 recoveries. This represents an unprecedented and astronomical increase of 5,526 recoveries within 24 hours; and exceeds the total recoveries since 12th March, 2020, when Ghana reported the first two confirmed cases of the disease.
We are told the jump in recoveries is because Government has modified its discharge protocols for COVID-19 to reduce both rising costs of testing and increasing workload. This new criterion constitutes a departure from declaring recoveries based on two negative laboratory test results.
We are told, under the new method, asymptomatic patients are de- isolated 14 days after an initial positive test, and symptomatic cases set free 14 days after onset of symptoms with at least three (3) days without symptoms. The modification and the original protocol are both supported by the World Health Organisation (WHO).
The WHO suggests “recent findings that patients whose symptoms have resolved may still test positive for the COVID-19 virus… by RT-PCR for many weeks. Despite this positive test result, these patients are not likely to be infectious and therefore are unlikely to be able to transmit the virus to another person.”
However, the same WHO cautions subtly they “will update these criteria as more information becomes available.” It is therefore curious why theGovernment of Ghana will prematurely jump the gun instead of at leastwaiting for the WHO’s promised update as more information becomesavailable.
Besides, it beggars belief that a Government that proclaims to “know how to bring back the economy”, and not life would take such a defining decision based on evolving evidence and advice filled with uncertainties – the “not likely” and “unlikely” qualifications; knowing very well if the decision goes bad intracommunity infections will spiral.
The fact that COVID-19 is novel and research on it is still at the early stages makes the need for Government to hasten slowly with decisions on clinical management imperative. Human lives are at stake here.
For example, the reputable Lancet and the New England Journal of Medicine (NEJM) have retracted earlier articles on COVID-19 (ref. https://retractionwatch.com/2020/06/04/lancet-retracts-controversial-hydroxychloroquine-study/.)
Interestingly, WHO had based one of its decisions on COVID-19 – the decision to halt studies on hydroxychloroquine – on this publication, which was later retracted. The study has resumed subsequently. The uncertainties are many (ref.https://news.cgtn.com/news/2020-06-11/WHO-calls-for-more-research-on-asymptomatic-transmission-of-COVID-19-Re57bvTvfa/index.html).
These examples justify why Ghana should have hastened slowly and waited for WHO’s promised update on modalities for de-isolation before switching to the new protocol.
Indeed, the Government of Ghana appears contradictory when it comes to adopting WHO’s advice, and the contradiction is antagonistic not synergistic.
How come a paltry GHC2.5 million was released by Government initially to fight COVID-19 when the same World Health Organization had advised that Ghana needed GHC35 million not GHC2.5 million? So it appears officialdom cherry picks WHO recommendations. This does not augur well for social justice because invariably, it leaves the larger citizenry disadvantaged.
Unlike most citizens, I do not believe the President and his team of advisors will not have two negative confirmatory tests before being declared recovered and de-isolated should they be infected with the virus.
Therefore, “what is good for the goose is good for the gander” must apply.
This is the only way we can pass John Rawls’ “veil of ignorance” test and the Golden rule.
Social justice and allocation of resources
It is trite knowledge that the Government of Ghana could not provide food for the poor and vulnerable in Greater Accra and Ashanti Regions and Kasoa during the lockdown. Even what was provided was distributed to favour members of the ruling party.
Also, imagine the quantity of test kits Ghana could have procured before the worldwide demand for it outstripped supply if Government had released GHC35 million on time instead of acting contrary to WHO’s expert advice? It appears the world health body’s advice is taken seriously only when it reduces the cost burden on Government.
Even with the allocation of the initial paltry GHC2.5million, Noguchi Memorial Institute for Medical Research, which has become the cornerstone for COVID-19 testing was left out. Similarly, Korle Bu Teaching Hospital – the premier teaching hospital in Ghana, was also not considered a priority.
I have served in Government before. Therefore, I do not discount the existence of limited resources serving competing interests. However, the decision to opt out of PCR confirmatory tests – and not even opt for Rapid Diagnostic Test – based on WHO’s wobbling updates at a time when Government has GHC 400 million to fund the Electoral Commission of Ghana to create a new voters register shows paucity in Government’s priorities in managing this pandemic.
How come doctors and nurses still spend money from their personal purse and pockets to buy Personal Protective Equipment (PPEs) to protect themselves at work because Government has failed to provide adequate PPEs? Once again, how come volunteers who are working in laboratories and tracing contacts in the field are so demoralized because Government has reneged on compensating them appropriately?
Why do people exposed to COVID-19 patients still face extremely long waiting times – sometimes over ten (10) days before test results become available?
Politicians must not and should not be allowed to make decisions that promote political aspirations over the health and well-being of the citizens we seek to govern after the elections. Spending money on COVID-19 is far more noble and redemptive than wasting money on a new voters register. This leads me to the next issue, which is the recent NPP Parliamentary primaries.
The NPP Parliamentary Primaries
Here, I speak specifically to wearing facemask and social distancing protocols in the context of social justice. Not the fridges, blenders, bicycles and wads of cash (foreign and local) which were distributed across the country during the NPP 20th June Parliamentary primaries.
Regarding wearing of face mask, based on the Imposition of Restrictions Act, 2020 (Act 1012), EI 64 stipulates, “A person shall wear a face mask, face shield or any other face covering that covers his or her nose and mouth completely when that person is in a public place;; or leaving or returning to his or her place of abode.”
Failure to comply with this law imposes a fine between GHC12,000 – GHC60,000, and you could spend 4 – 10 years in prison. For now, just be reminded that the Ghana Police Service’s operational understanding of “public place” includes but not limited to being in your private car.
So how come members of the NPP threw caution to the wind during their primaries and still managed to escape sanctions? This implies selective justice and violates the principles of social justice.
Is the President and his party deliberately opening the floodgate for other political parties to repeat their breach of EI 64? If that happens, will the Government have the moral right to prosecute such opponents who would have breached the law?
Or will it be a case of racing to the bottom for the ‘favoured’ political class while others such as religious leaders and those practicing their faith get punished for breaching COVID-19 laws? Social justice indeed!
I contend that there can be no social justice in our fight against COVID-19 when mosques, churches, conferences and other mass gatherings are rigidly subjected to the protocols while political activities including NIA registration, distribution of their cards and EC’s quest to compile a new but needless voters register are given the green light to proceed.
If I contrast the President’s loud silence on political activities, which are characterized by high entropy and potential recklessness, with the high handedness meted out to those engaged in religious and other social activities, I arrive at only one conclusion.
That is, President Akufo-Addo’s decisions in this fight against COVID-19 have been more to advance his political interest than any other conceivable and altruistic end. He has sacrificed social justice and has pursued partisan interest. The recent NPP primaries is one of such examples. There is no fairness and justice!
The quest for social justice remains noble and immutable in all spheres of life globally and must be demonstrated in our collective fight against COVID-19. Unfortunately, Government has refused to be even-handed in allocation of resources (PPEs, allowances for health workers etc.) and enforcement of laws and sanctions.
Even for those such as Robert Nozick who disagree with John Rawls’ concept of justice as fairness, they converge on the need for fairness in public policies. Therefore, it is necessary that the Government includes PCR tests or at least Rapid Diagnostic Tests in its protocol for the discharge of COVID patients until further and more robust guidance from the WHO firmly and clearly suggests otherwise.
The adoption of the new discharge protocol is premature. Moreover, it does not pass the social justice test if a certain group of privileged persons will not be subjected to the same criteria. Let us expand the testing capacity
Notwithstanding the challenges, I urge everyone not to throw caution to the wind because the disease lives in our communities and in some cases our homes. Stick to higher standards and principles and let us continue to seek social justice in Ghana’s fight against COVID-19.
Dr. Edward Kofi Omane Boamah
Health Policy, Planning and Financing Analyst, former Minister for Communications and Presidential Spokesperson.
24th June, 2020