American Scientist

Collecting and sharing data during public health crises is typically considered a benefit to everyone. Among other advantages, data can bolster researchers’ understanding of viral spread, inform politicians’ policy decisions, and alert people to potential risks. As the coronavirus pandemic has highlighted, however, data sharing is no guarantee of data validity, and according to Ruth Carlitz, data originating in authoritarian regimes requires special scrutiny. An assistant professor of political science at Tulane University, Carlitz studies public-service provisions in developing countries such as Tanzania, where she conducts much of her field work. Carlitz spoke with Scott Knowles, a historian of risk and disaster at the Korean Advanced Institute of Science and Technology, on his daily podcast, COVIDCalls (episode 284: COVID Data in Authoritarian Regimes). On the podcast, Knowles speaks to guests about their research and the far-reaching effects of the pandemic. He began their conversation by noting the number of COVID-19–related deaths in various countries, including 21 fatalities reported in Tanzania. Carlitz pointed out that the Tanzanian government stopped reporting pandemic data in May 2020, which illustrates the need to question information from authoritarian regimes. This interview is part of an ongoing collaboration between American Scientist and COVIDCalls. It has been edited for length and clarity.

You recently coauthored a paper in the Journal of Health Politics, Policy, and Law on open data from authoritarian regimes. What are some of the indices that you use to classify a country as authoritarian?

Indices such as the Democracy Index [produced by the Economist Intelligence Unit] are certainly helpful for identifying countries that have similar systems of government and similar constraints, especially on the free flow of information. Another factor is the processes through which governments are selected, the degree to which the popular will translates into who’s selected.

But I also find the scientific measurement and ranking of democracy a bit troubling and ahistoric. The indices often ignore factors such as the legacies of colonialism, especially in the part of the world that my research has focused on. I’m more comfortable with systems of classification that say, “These are features of a system of governance that we associate with democracy.”

Once we put numbers and rankings on things, we take them to be objective, but behind these numbers are a lot of assumptions. Many of these rankings are based on the subjective opinions of experts. But who gets to be an expert? And when you’re comparing a country rank of 97 versus 96, what does that mean?

There are a lot of boxes that don’t get opened once something has a number on it. The ranking becomes a cold, hard, objective fact. I do use these rankings in my work, so I’m being a little hypocritical, but they do sometimes make me uncomfortable.

That’s the bind we’re all in, simultaneously critiquing and relying upon the numbers related to COVID-19. To what extent are reported health statistics part of the calculations used to understand how democratic a given country might be?

Population health and well being is a really important indicator of how well that society is doing. When you have serious inequities in health outcomes, that often points to governance issues. Even in the United States we have very different mortality rates among people of different races and people who live in different parts of the country, not only from COVID, but also from giving birth and other medical matters. Some of that disparity is definitely due to governance-driven decisions about what sorts of publicly funded care is made available to people and whose influence is restricting access to certain types of care.

Some of your recent research concerns COVID-19 denialism in Tanzania, including among what you call street-level bureaucrats. You haven’t been able to travel to Tanzania during the pandemic, so how did you conduct this research, and what have you found?

Having a collaborator in Tanzania is vital. Tanzania completely stopped reporting on COVID cases and deaths in May of 2020, around the same time that Tanzania’s president, John Magufuli, declared the country COVID-free. Magufuli’s main action on the pandemic was to encourage people to attend national prayer services and to live their lives without fear. But his Ministry of Health did issue some guidelines at the beginning of the outbreak reflecting international best practices, such as social distancing, handwashing, and use of PPE [personal protective equipment].

“Once we put numbers and rankings on things, we take them to be objective, but behind these numbers are a lot of assumptions.”

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My collaborator at American University, Nina Yamanis, and I wondered how social distancing works in a society such as Tanzania’s that’s much more communal and where informal living arrangements are common. We reached out to Henry Mollel of the Department of Health Systems Management at Mzumbe University in Tanzania, asking him to join us, and thanks to his great efforts, we were able to get interviews on the ground with 40 local health officials at different levels of government, including hospital administrators, district health officers, and village health officers.

Just two months after the president declared victory over coronavirus, we found out about a whole lot of work done by these tireless local officials to get people to wash their hands, to socially distance, and to wear masks. They were running public education campaigns to tell people how to report suspected cases and how to quarantine.

We didn’t hear a lot of pushback to the national-level messaging. Rather, our respondents overwhelmingly praised the president, saying that the limited national response was helpful for reducing fear and stigma. One of our interviewees said the absence of a national response allowed them to treat COVID like any other disease. And this is a context where local officials have a lot of experience working with other communicable diseases, such as Ebola and HIV-AIDS. For some of our interviewees, having the national response be “COVID is nothing special” let them go on with their lives and adapt their best practices that they had developed from dealing with other diseases.

That being said, we are aware of a potential social desirability bias—interviewees or survey respondents saying something that they think you want to hear, or maybe that they think their higher-ups want to hear. So we weren’t going in and expecting people to tell us their deepest, darkest hopes and fears. But we heard enough criticism along with the praise that we thought a lot of the responses were pretty genuine.

There was a disconnect between what someone only reading the headlines might think was going on in Tanzania versus the perspectives of local officials. But it was not a comparative study. It looked at Tanzania at one point in time.

To what degree are the populations that you have studied complying with pandemic safety recommendations?

Moraka Makhura [of the University of Pretoria, South Africa] and I conducted a study in South Africa where we examined subnational data on population mobility from cell phones [published in World Development, January 2021]. A number of scholars have used this data to get at the extent to which people are complying with lockdown orders—or in places where there isn’t a strict lockdown, such as Sweden, to see whether people are still staying home. If the cell phone is moving, we assume the person is, too. These measures work best in places where a lot of people use smartphones, so South Africa is a better place to use them than in some other parts of Africa.

Our subnational analysis of this mobility data in South Africa showed that the people complied less in parts of the country where their livelihoods were more subsistence-based, where it was much harder to work from home in these sorts of situations. That was a driver of variation in compliance or in population mobility in South Africa.

For emergency management in the United States and in Europe, accounting can’t always be done in the moment, but there’s a sense that when the disaster ends, we’re going to get an accounting of what happened. When the pandemic is declared over, what confidence do you have that we will begin to get a clearer picture in Tanzania, for instance, where the government stopped reporting statistics last year?

“The pandemic is affecting the rich countries, and that can have a leveling effect. There’s the potential to disrupt hierarchies of knowledge and expertise.”

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I think it’s unlikely anywhere to have that accounting, especially with something that has generated just so much fatigue. But I think Tanzania is a very interesting place to be watching right now because President Magufuli, who really took the country in a more authoritarian direction, died this spring, a few months into his second term—suspected by some of COVID. He was succeeded by his vice president, Samia Suluhu Hassan. She’s in the same party and is not necessarily seen as a reformer who’s going to reverse Magufuli’s directives, but she is taking a very different tack with respect to COVID.

Hassan has been seen in public wearing a mask. She’s convened a committee to develop recommendations for managing the pandemic. It’s really night and day regarding a commitment to access to information, reporting, and surveillance. The government is also joining the global vaccine alliance to get Tanzania access to vaccines through COVAX or other initiatives. But I don’t imagine that a lot of their efforts are going to be backward-looking.

Tanzania is still a society—a system of governance—that often doesn’t feel very comfortable publicly questioning authority. So my sense is there’s a feeling of relief in many quarters that Hassan is operating very nimbly and, I imagine, diplomatically. I’m cautiously optimistic that her policies will improve health outcomes for people in Tanzania in aggregate. It will be really interesting to keep an eye on.

Are the United Nations, the World Health Organization, and other non-governmental organizations that focus on health provision or press freedom motivators for transparency at the national level?

It’s hard to tell, when there are so many fires to put out. Something that’s striking about the COVID-19 pandemic when compared with other health or governance crises in a country like Tanzania, is that it’s also affecting the rich countries, and that can have a leveling effect. There’s some potential to disrupt hierarchies of knowledge and expertise. When it’s clear that some of the richest and most powerful countries in the world really don’t know what they’re doing either, maybe that opens the door for more listening to the experiences and judgments of countries like those in Africa that have deep reserves of experience in dealing with communicable diseases and practices such as contact tracing that rely on communities sharing information.

Now that Samia Suluhu Hassan has become president, Tanzania is under the leadership of a woman. Back in the darkest days of the pandemic there were reports that nations led by women were more successful in containing COVID-19. What do you think about that framing of looking at national leadership styles with regard to gender?

I’m pretty wary of centralizing gender. I think we’ll have true equality when women leaders can be just as corrupt and incompetent as men [laughs]. I think it’s more likely that there’s something about the overall systems of governance in countries that elect women to the highest offices. It’s sort of epiphenomenal rather than a causal effect of female leadership.

That said, given how women are socialized in many countries and the norms that surround women’s roles in society—or even in the household—there’s reason to believe they may be more responsive to certain public health concerns or more likely to adopt approaches that can have beneficial effects. I have done some work looking into that, and it’s really about considering the different experiences and lived realities of women versus men in many countries, and then what the implications are when women are in positions of power. There may just be things that men in their same positions wouldn’t be thinking about and wouldn’t be aware of, and that can have a number of consequences down the line.

Crises can be opportunities, because they are situations in which the status quo is disrupted, and that can lead to a reevaluation of some of these assumptions that inform social norms. So I think with the pandemic there is potential for the restructuring of gender divisions of labor in the household and seeing how that filters up into national politics. I don’t think we want to speculate too much, but we’re at a critical juncture in so many ways, so it’s something to keep an eye on.

The original interview is presented below in its entirety: