The Role of Religion, Philosophy of Life, Global Health, Traditional Medicine, and Past Experiences in the Covid-19 Pandemic Response: Zambia Case Study

Contrary to expectations, Zambia, similarly to many other Sub-Saharan African (SSA) countries and unlike most high-income Western countries, protected the public health against Covid-19 relatively successfully, at least during the fi rst year of the pandemic. How is this possible given the resource-limited health care system, widespread comorbidities, and other adverse conditions in SSA? In this paper we discuss the possible role of religion, philosophy of life, global health approach, traditional medicine, as well as experiences with previous deadly epidemics, that might have contributed to Zambia’s public health success. We draw on previous research concerning similar pandemic situations, as well as on current Zambian experiences, including those expressed in media and contained in accessible government records. We take Zambia’s approach to be an inspiration for other societies so that it is not only the case that the more developed countries can contribute to the less developed ones, but indirectly also

pursued in an interdisciplinary fashion and draw on methodologies commonly used in more basic, non-comparative disciplines). We do not aspire to identify all the factors of Zambia's success and we also do not discuss some of the well-established ones, such as the quick proactive prevention, strict hygiene measures and face masks, eff ective and trustworthy communication by public health authorities, etc. We are also aware of at least one other signifi cant limitation of our paper, namely that we oft en draw not on resources specifi c to Zambia but applicable more generally. Hence our study is not a pure case study but a study in which we take up Zambia as an example whenever we are able to, tacitly drawing on rich direct personal experiences that three of the four authors of this paper have had with Zambian culture. As already mentioned, we focus on some of the less-known factors of Zambian pandemic response with the hope that more research will be carried out on them and the lessons learned will inspire other nations to improve the protection of human life and its dignity vis-à-vis the challenge of emergent infectious diseases.

Background
Zambia is a SSA country with an area of 752,618 km 2 and a population of approximately 18 million, which means a relatively low population density of about 24 inhabitants/km 2 . It is an inland state, bordering eight other countries, which makes it the region's transport hub, although the basic infrastructure remains underdeveloped. It has many national parks that have attracted tourists in recent years. 7 It is divided into ten provinces. Th e Human Development Index ranks the country in the medium range and slowly rising. More than half of the population depends on agriculture, which is still the main source of income for women, who make up the majority of the rural population. Th e region of today's Zambia was originally inhabited by Khoe-Sān (i.e., non-Bantu) peoples, belonging to the oldest evolutionary group of homo sapiens. In more recent times, coinciding with the European Middle Age, the Bantu-speaking population became prevalent. Europeans learned about Zambia especially thanks to the missionary, physician, and traveller David Livingstone (1813-1873), who came to the upper areas of the Zambezi River in 1855. 8 Th e number of European settlers began to increase aft er the opening of mines in the north of the country, in the so-called Copperbelt. 9 In 1899 and 1900 Barotziland-North-Western Rhodesia and North-Eastern Rhodesia, respectively, were formed as British protectorates, merging in 1911 into Northern Rhodesia, that was later to become Zambia. Northern Rhodesia was also federated at a time with Southern Rhodesia (now Zimbabwe) and Nyasaland (now Malawi) in the Federation of Rhodesia and Nyasaland. Over the years, Rhodesians increasingly objected to colonial rule. In 1962 the fi rst democratic elections were held and on 24 th October 1964 the country became the independent Republic of Zambia, with Kenneth Kaunda (1924-2021) serving as the fi rst President. 10 Zambia's independence struggle and state-formation were grounded in Kaunda's Zambian Humanism, a socialism with theistic foundations, rooted in traditional Christian and African values such as altruism and community. 11 (Similar ideas and ideologies were also introduced by other African independence politicians in Tanzania, Zaire, Ghana, etc.) Kaunda's socio-economic views failed, but many of his underlying ideas and principles, such as the human person at the centre, human dignity, non-exploitation, equal opportunity, hard work, working together, extended family, loyalty and patriotism are not specifi c to Kaunda's Zambian humanism and live on. 12 During the early years of independence, Zambia was comparatively prosperous thanks to its copper mines. In 1972, a one-party government seized power in Zambia, a new constitution was introduced, and the president gained extraordinary powers. Under Kaunda's leadership, Zambia underwent a period of economic and political crisis until 1991 when his regime ended. 13 Th e new political leadership of the second President Frederick Chiluba (1991 to 2002) sharply criticised the former president and promised a new and better era, which, however, did not come. 14 A slow economic recovery only came with the third President Levy Mwanasa (2002 to 2008). Reforms and anti-corruption eff orts continued also under the next four presidents (including a brief acting presidency of Guy Scott, a white Zambia-born economist of Scottish origin). In 2011, Zambia reached the status of a middle-income country. 15 However, in 2015, because of an interplay of high government spending, a budget defi cit, a fall in world copper prices (the main trade item), reduced agricultural yields, and an energy crisis caused by water scarcity and rising infl ation (GDP hit a 15-year low in 2015), the International Monetary Fund ranked Zambia among the economically most aff ected non-oil economies in SSA. Zambia ranks among the countries with the largest social disparities between rich and poor people in the world (high Gini index) and one of the highest levels of chronic poverty. Girls and women are particularly vulnerable and suff er from poverty and lack of education. 16 According to UN estimates, Zambia has one of the fastest growing populations in the world, with the current population expected to triple by 2050. At the same time it is one of the countries with the lowest life expectancies in the world, which is due to the lack of aff ordable quality health care, including neonatal and paediatric care, resulting in high maternal and infant mortality rates. 17 In 1991, the Zambian government launched health policy reforms characterised by a transition from a heavily centralised health care system. 18 (Th e protection of public health in Zambia is set out in Act No. 295/1995 Coll. -on the prevention and reduction of diseases and on the general regulation of all matters relating to the protection of public health in Zambia.) Zambia is a multi-ethnic state with over seventy ethnic groups. Th e Zambian population is made up of 99.5% of indigenous African tribal groups, the most signifi cant of which are: Bemba 21%, Tonga 13.6%, Chewa 7.4%, and many others. Economically important groups are Indians, Lebanese, Zimbabweans, and South Africans. Zambia is deeply religious with 92% professing Christianity (mostly Protestants, but with signifi cant Catholic and African Christian confessions). Th ere are also religious minorities (Muslims 3%, Buddhists and Hindus 3%, and local religion 2%). 19

Covid-19 in Zambia
Zambia reported its fi rst cases of Covid-19 on 18 th March 2020. 20 As of 21 st January 2021, there had been over 42,213 confi rmed cases, 597 deaths (1.4% case fatality rate), with nearly 75% recovery rate to date. Confi rmed cases were most prevalent in three provinces: Lusaka, Copperbelt, and Central. Th roughout most of the period of the epidemic, Zambia maintained a relatively low caseload with less than 2,000 cases per month. Th e country experienced a surge in cases in the period of June -September 2020 (up to 6,200 cases per month) and was on the above date currently facing a second wave of cases that started in December 2020. According to the dashboard of the Zambian Ministry of Health, the monthly rate increased in January to about 23,000 cases; the eff ect of this second wave remains to be seen. 21 Still, Zambia's cumulative mortality, that is, the number of deaths per million, remains rather low: 41 as of January 2021, which is 33 times lower than in the U.S. and 47 times lower than in Czechia. Even when we adjust for probable Covid-19 death underreporting and lower testing rate we may still consider the handling of the epidemic to have been a success so far and acknowledge the remarkable resilience of the Zambian population and the effi ciency of public health system. Even when one adjusts for the relatively low-rate of testing, underreported Covid-19 deaths, 22 and demographically one of the world's youngest population structures, Covid-19 mortality and infection rates are dramatically lower in Zambia than they are in most very high-income countries: as of mid-April 2021, the cumulative registered mortality is around 40 times lower than in Czechia and 25 times lower than in the U.S.). 23 Th is is despite the resource-limited health care system and widespread comorbidities. How can the comparative success of Zambia and a few other SSA countries in dealing with the pandemic be explained? Each nation and community has its own unique set of characteristics applied to internal structures, local history, and traditions, with social, cultural, philosophical, legal, and economic backgrounds, political manifestations, as well as religiosity. Th ese factors infl uence a community's outlook and perception. 24 Various factors explaining or at least contributing to the resilience of countries such as Zambia have been suggested: • Biological: Africans are biologically more resistant to infection, e.g., genetically. 25 • Geographical: Some conditions, such as higher average temperatures, may promote lower rates of infections. Sunlight, which results in the formation of vitamin D, is known to boost immunity. Th ere is lower population density in most parts of SSA where people live in communities that are tens of kilometres apart in most of the land. • Political: Although the central government is widely distrusted by the population and corruption has been notoriously widespread, 26 there are many well-respected local leaders who took on a proactive stance early, as soon as they learned about the deadly virus. 27 Also, it needs to be acknowledged that the central government reacted rather quickly and effi ciently in at least some respects, for example, by implementing nation-wide measures even before the fi rst case was detected in the country. 28 • Religious: Zambians are deeply religious with a great respect for various religious authorities and the views of local religious authorities seem to have helped to respond to the pandemic eff ectively. Unlike in countries such as the U.S. and Brazil, masks, physical distancing, handwashing, and other eff ective non-pharmacological interventions were promoted by leaders across the religious spectrum. • Philosophical: there are several aspects that seem to contribute to the pandemic resilience, such as the traditional African emphasis on communality, solidarity, and respect for the elderly. (Additionally, the Zambian humanism of the fi rst president-philosopher Kaunda, despite a rather failed economic theory as part of it and its current unpopularity, may have had an indirectly benefi cial eff ect, too.) 29 24 Brankica MILOJEVIC, 'Infl uential factors in the urban transformation of cities in Bosnia and Herzegovina during the transition period' , ISOCARP (online), available at: http://www.isocarp.net/Data/case_studies/2146.pdf, cited 20 th January 2021, p. 1. 25 Th is seems to be a popular but unfounded hypothesis, although there are diff erences in immune responses across races. Cf. © Hélène QUACH et al., 'Genetic Adaptation and Neandertal Admixture Shaped the Immune System of Human Populations' , (online), available at: https://pubmed.ncbi.nlm.nih.gov/27768888/, cited 17 th January 2021, 643-656. However, so far the infl uence seems to be going the other way around, that is, Africans appear to be more vulnerable, although how signifi cant the biological contribution is remains to be seen. Cf. © Christine RO, 'Why some racial groups are more vulnerable' , BBC (online), available at: https://www.bbc.com/future/ article/20200420-coronavirus-why-some-racial-groups-are-more-vulnerable, cited 21 st January 2021. 26 'Corruption remains a major problem in Zambia despite the existence of a number of anti-corruption watchdogs and rigorous changes in the law to curb the vice. Th e public sector remains the most severely aff ected. Reviewing corruption trends in Zambia from 1964 to 2017 shows that corruption has increased since the transition into multiparty democracy and the subsequent economic liberalization of 1991. … corruption had found its resting place in Zambia spreading its ugly fangs across all sectors of the economy because of lack of political will to fi ght the vice, lack of transparency and accountability, poor enforcement of the law and a rampant culture of political patronage. ' © Bahadur SAPKOTA and Martin MUSAMBA, 'Understanding corruption in Zambia: an analysis of the challenges in eradicating the scourge' , (online), available at: https://www.researchgate.net/publication/322222474, cited 29 th January 2021. 27 As far as we can say from interaction with local people, most Zambians have lost trust in the central government to the extent of relying mainly on local authorities and local media, such as local radio stations and social media for credible information. • Global health related: Zambia adopts an approach to health care that is informed by results from global health discipline that encourages, for example, task shift ing, community involvement, and other eff ective means in public health protection. Th ere has also been emphasis on suppression and minimising the number of infections rather than mere mitigation of and reliance on rather poor capacities of hospitals. 30 • Medical: Th ere is a tradition of local medicine complementary to standard 'Western' medicine.
Some of these practices and beliefs may have been benefi cial in the mitigation of the epidemic. • Historical: One of the factors contributing to the so far low number of Covid-19 infected persons and deaths in Africa is probably the countries' experience of previous and current epidemics, so the population is well disposed toward collaboration with public health offi cials.
Biological, geographical, and political factors do not seem to have contributed substantially to the Zambian resilience to the Covid-19 epidemic: there is little evidence for greater biological resistance of Zambians to Covid-19. Additionally, weak population health, high mortality, comorbidities, and a resource-limited health care system work against the eff ective pandemic eff ort. Geography as a factor in pandemic resilience is also weak as one may easily object that Zambia has many so-called compounds (slums) which are very crowded. Large families live, for example, on fi ve square meters. 31 Mobility within and across communities may be lower than, for example, in Western countries but it is still rather intensive. As for political factors, we have already noted that central authorities reacted early to the news of the pandemics and eff ective measures such as masks, physical distancing, and hand washing were implemented, also with the help of trusted local authorities. (Th e central authority encouraged this and did not play a negative role as it did in some other countries, where the central governments sometimes undermined a more proactive grassroots approach to the pandemic by downplaying the risks and benefi ts of eff ective non-pharmacological interventions fearing adverse short-term eff ects on economy.) We take the remaining fi ve factors, that is, (a) religion, (b) philosophy of life, (c) global health (d) medical beliefs, and (e) past experiences to be more signifi cant than the rest; at any rate we will focus on them in what follows.

(a) Religion
Religion is a fundamental infl uence in the lives of most Africans, including Zambians, even perhaps the most important one. 32 Religion aff ects every aspect of the life of the African people. Since it is rather well established in the literature that religion signifi cantly contributes to or at least correlates with resilience during adverse circumstances such as natural disasters, war, or personal tragedy, we consider this to be the case also in Zambia's Covid-19 response. 33  a powerful resource for mental health as it involves a framework of meaning-making, which is associated with reduced psychological stress and a value-based pursuit of psychological well-being. Religion provides a source of attitudes and cognitions that can reframe negative events into less stressful frames. When applied in the context of life stressors, religion can be also a positive coping mechanism involving the use of religious beliefs and behaviours to facilitate problem-solving or to alleviate the negative emotional consequences of stressful circumstances. 34 Zambians during the pandemic and people in general oft en turn to religion when coping with stressful phenomena and they do so mostly with positive outcomes. 35 As with most value systems and systems of ideas, religion addresses among other things issues of human well-being, good life and good society, and transformation of the world. As such, an African perception of human well-being as well as health risks, such as the Covid-19 pandemic, can also be framed in a religious story that appeals to beliefs and values in a conceptual response and required control measures. 36 Religion in Zambia and Africa in general is intrinsically linked to how people perceive life, including health and disease, such as the Covid-19 pandemic. People's religious beliefs aff ect their perception of the living situation and provide resources for their adherents, which can be mobilised by required behavioural reactions and corrective interventions. Th e Dutch scholar of religion and development Gerrie Ter Haar and the British historian Stephen Ellis identify four sources in which religion is integral to Africa's development. 37 (As a worthwhile project one could apply these in more detail to analyse Zambia's Covid-19 response in light of its religiosity; here we make only a few preliminary suggestions on how it could be done.) • Religious ideas, or people's beliefs, contribute to the formation of values and assumptions that people consider, individually and collectively as a society. Matthew Clarke (2011), an Australian scholar of development studies, also argues here that the religious ideas aff ect the moral base of the society, which in turn aff ects people's perceptions and their response to the circumstances of human well-being, poverty, or deprivation. 38 Zambian Christians, for example, believe that Christianity informs the way our society is and should be organised and the way we live, including things pertaining to our health, customs, laws, economy, politics, art, ca- 597-613. 35 One of the reviewers has pointed out that the point we make in this section is not quite coherent as Covid-19 pandemic in Zambia does not have manifestations either of 'disaster' or 'trauma' and anyway what we say is rather applicable to Western way of religious coping. As to the fi rst part of the objection we take a pandemic to be a challenging situation in any society, even those that have successfully suppressed the spread of the infection. (Th ese societies need, for instance, at least to remain vigilant for a possible re-introduction of the infection from areas and countries that have not been able yet to get the virus under control). So, the current pandemics negatively aff ected most if not all societies worldwide, and at any rate also Zambia. In all societies people need to cope with some negative impact. We acknowledge, however, that the second part of the objection is quite valid: cross-cultural empirical study would need to be carried out to determine how much one can apply results from one culture to another in the current context; our suggestions here are quite tentative. lendar, holidays, and other moral and cultural priorities. 39 Th erefore, the perception of health and well-being, as well as the means to achieve it in an African context, cannot be formulated exclusively materially, but should also draw on religious sources. 40 • Religious practices, including ritual behaviour, in Africa can make a signifi cant contribution to how people perceive health risks. Practices such as social activity or caring for the poor during a health pandemic, such as the current Covid-19 pandemic, have direct religious roots and consequences. Church services, including sermons and prayers for the sick, can also be mobilised in the service of corrective goals, as is the case in the 'Channels of Hope World Vision HIV/AIDS' stigma interventions that operate through Church services. 41 • Religious organisations, such as church denominations and other faith-based organisations, can be mobilised for preventive and corrective intervention. As such, they act as important agents, partners, and vehicles in the process of fi ghting the pandemic. In Zambia, for example, the UN Emergency Call for Zambia 42 accepts faith-based organisations, such as Expanded Church Response, as important agents and partners in the fi ght against the Covid-19 pandemic. In several other repeated cases, the Zambian government has called on the churches to work corporately with the government's line of ministries in sensitising the nation's general population in light of the Covid-19 global pandemic and the control measures needed to reduce it. • Religious or spiritual experiences, such as the subjective experience of internal change or transformation, serve as sources of inner strength and a path to empowerment. 43 In this case, inner strength is a necessary dimension and precursor to the individual's perception of life, because access to spiritual empowerment creates an incentive for actions that can change the material world of man or community. Looking from this perspective, it is quite vivid why most African religious beliefs, such as Pentecostal and charismatic Christians, also believe in divine healing and protection, an aspect that casts a somewhat less threatening picture of disease and pandemic for most of those who adhere to such a belief system. 44

(b) Philosophy of Life
Since the seminal work La Philosophie Bantoue by Placide Tempels , a Belgian Franciscan missionary in Congo, published in 1945, it has been acknowledged that not just religion but philosophy plays a signifi cant role in the lives of SSA populations. 45 Th e nature of SSA philosophical elements and practices is subject to debate, for example, with respect to questions such as whether they are implicit (ethnophilosophical, folk philosophy) or explicit (oral or literary sage philosophy). However, all these are called 'philosophy of life, ' a term used to refer to the cultural dispositions of communities and individuals toward the meaning of life and toward the fundamental values related to it, especially, in our context, health and disease, regardless of whether implicit or explicit. Although philosophies overlap with religions, the two should be distinguished, for example, by emphasis on reasoned discourse and only an external relation to the authority of divine persons, traditions, or revelations. 46 In Zambia, the fusion between religion (Christianity and indigenous traditions), philosophy (Zambian humanism and other local traditions), and politics (Kaunda's socialism and Christian nation) is particularly strong. Since 1991 Zambia has been a self-proclaimed 'Christian Nation' . President Chiluba was supported by various Christian churches during the campaign of 1991, through which he became the second president of the republic. 47 Th is study has established that President Chiluba felt obliged to pay to the Christian churches back for their support by declaring Zambia a Christian nation and appointing some pastors to serve in his government. Furthermore, President Chiluba was a 'born-again' Christian who felt that the peaceful transition from the second Republic to the third Republic was due to divine intervention. Th erefore, to show appreciation to God and the Christian community, Zambia was to be declared a Christian nation. 48 Th e president also publicly donated money to Christian churches, which caused a major rift in church-state relations as those who supported the declaration saw themselves as allies of the political administration and of 'true Christians' . On the other hand, those who opposed the declaration were perceived by 'born-again' Christians as leaders opposing the President, who was the anointed one of God. While it is oft en diffi cult to draw practical distinctions between religion, philosophy, and politics in the Zambian context, we may do so at least conceptually. Central to the Zambian philosophy of life is solidarity, which is viewed as one of the fundamental values. 49 A sense of national unity is also very much alive in Zambia, as expressed in the motto 'One Zambia -One Nation' . Despite various shortcomings, both the population and the government draw on these values in their commitment to public health. In this, a connection can be perceived between Kaunda's humanism, thought to be long gone and failed as it did not promote self-reliance and capitalistic innovativeness, and current popular philosophy or philosophy of life, as we call it here. Th ese philosophical attitudes implicit in Zambian and other African cultures are also described by researchers dealing with public/global health. For instance, Airhihenbuwa and Iwelunmor argue for the importance of culture in Africa's public health as it determines how individuals 46 Some of what we call 'philosophy' here would be relegated by many philosophers to anthropology departments. We adopt a more and communities interpret diseases. 50 In other words, culture is a building block for contriving a personal understanding of health and disease, whether in relation to the perceptions people may have about their health, or in describing their health-seeking practices. It would be therefore useful to decipher the impact of the African cultures on the perception of the Covid-19 pandemic so that more eff ective control measures capable of reducing the impact of the pandemic could be found. 51 According to De Wet, 52 cultural values and norms are the most touted perceptions of physical well-being and also appeal to spiritual power and infl uence. Airhihenbuwa and Iwelunmor point out that 'culture is a collective sense of consciousness with both quantifi able and incalculable components' . 53 In 1989 Airhihenbuwa developed a useful framework for thinking about cultural, that is, also philosophical and religious, components relevant for public health and health education programmes in Africa, called PEN-3. Th is framework makes use of three primary domains: cultural identity, relationships and expectations, and cultural empowerment. Each domain consists of three factors that make up the acronym 'PEN': person, extended family, neighbourhood (the domain of Cultural identity); positive, existential, negative (the domain of Cultural empowerment); and perceptions, enablers, nurturers (the domain of Relationships and expectations). Th e PEN-3 framework emphasises behaviour in the broader context of culture to recognise roles, values, and norms, that is, the ethical, epistemic, and ontic aspects of a culture, which are conducive or not to diff erent types of activities aimed at promoting health and well-being. It off ers a way to deal with the philosophical and cultural dimension for solving health problems.

(c) Global Health Approach
Th e Zambian approach to the protection of public health has been informed by global health initiatives. 54 Th is means, among other things, that the Zambian public health system is well integrated with various well-established and eff ective home-based and community involvement methods such as the task shift ing of simple health care to trained community workers. 55 During the Covid-19 pandemic, this system has been utilised to a larger extent, allowing health care facilities to focus only on the most serious cases. 56 Hence, in spite of the severely limited capacity of health care services in the country, the Zambia Covid-19 emergence response and health systems preparedness project revealed reasonable strengths in Zambia's public health preparedness and response capacity. 57 Furthermore, the Ministry of Health implemented home management of Covid-19 infected patients to take the burden off the healthcare system and avoid severe overstretching of hospitals. 58 Accordingly, under the home-based care system, asymptomatic and mildly symptomatic Covid-19 patients under fi ft y years of age without underlying conditions or co-morbidities have been cared for at home by families with the support of community-based volunteers. Only patients with moderate or severe symptoms are admitted to a health facility. Th e home-based care had been envisaged in the national response plan and became operational in May 2020. Rotating clinicians oversee the community volunteers. To ensure eff ective care at home, an environmental health offi cer assesses key aspects such as the number of people sharing a house, whether the patient can have a room to self-isolate and whether there is anyone with co-morbidities who could be at risk. Once the right conditions are met, a community health worker is assigned to provide care, making frequent visits to check progress and ensure that infection is not spread further in the community through those providing the home care. 59

(d) Traditional Medicine
Th e limited access to the health care system left many to resort to traditional remedies. While the biomedical eff ectiveness of these remedies has not been always established, even if used as placebos, such medicines may contribute to a population's resilience to the adverse impact of the pandemic (medical, mental, economic, and social). Home-based care in Zambia includes the use of local-based solutions such as steaming and consuming vitamin-rich fruits, ginger, garlic, honey and cinnamon concoctions. 60 Steaming hereby involves putting leaves of trees such as mangoes, guavas and eucalyptus into boiling hot water from which the steam rises. Reportedly the desire to resort to home-based solutions has taken a surge in Zambia. Th e Minister of Health Jonas Chanda echoed the President's remarks and said local home-based and traditional remedies were vital in managing less severe and non-symptomatic patients at home when he said, 'Th is is what we have always used before the western medicines came' . Th e minister also emphasised that the home-based remedies should be used as supplements to the conventional methods provided by health experts. Africa, including Zambia, has a long history of traditional medicine and practitioners, and its benefi ts are recognised. Both the international community and Zambia have long attempted to regulate the use of traditional medicine to prevent overreliance and/or its dangerous applications. Most recently, the Zambian Ministry of Health issued Guidelines for Research in Traditional, Complementary, and Alternative Medicine in Zambia in 2018. 61 Facing the novel virus, the WHO and the Africa Centres for Disease Control and Prevention (Africa CDC) also established the Regional Expert Committee on Traditional Medicine for Covid-19 in July 2020 to formalise an independent scientifi c review and support countries on the safety, effi cacy, and quality of traditional therapies. 62 Th is was done to prevent the use of traditional practices and remedies that could be potentially harmful. However, anecdotally, the approval process did not stop Zambians from relying on traditional remedies, particularly in light of the lack of resources and access to health care. As mentioned above this may be benefi cial if used as complementary and not as the alternative to standard evidence-based medicine. Th ere are dangers linked to traditional medicine too: an extreme example is a Covid-19 denialism in Tanzania that misuses traditional medicine as an alleged panacea. Th is has made Tanzania a poorly performing country when it comes to Covid-19 response. 63 Fortunately, Zambian public health offi cials did not adopt this eccentric approach. A deep-seated belief in traditional remedies has been refl ected also in the Zambian president's speeches in response to the Covid-19 pandemic. Th e President recommends home care solutions, such as 'steaming, ' using eucalyptus leaves, ginger, garlic, honey, and cinnamon potions. 64 Th e fi nding that all other control measures against the Covid-19 infection that Zambia's president outlines are lined with natural home care solutions strongly suggests the importance the Zambian president and population attach to these natural solutions. 65 In addition to this, there are also various religious medical practices of faith-healing connected with African traditional medicine. 66

(e) Experience with Previous Epidemics
Finally, in our overview of positive factors contributing to relative Zambia's success it is important to consider African perceptions of and experiences with past infectious diseases and how they have aff ected the Zambian response to the current pandemic. Th e factor of past experiences is generally recognised but sometimes it is not properly understood: the experiences with past infectious diseases as such would not be too helpful if not translated into a well-organised community-based approach to the protection of public health. Th is process starts with people's basic perception of the situation or a new epidemic phenomenon as risky even before it is locally manifested in actual sick or dying people. Th is perception is an important aspect for the eff ective control of infectious diseases in general. David S. Gochman (b. 1936), a U.S. professor of social work and an expert on health behaviour and health beliefs put together ample evidence from various empirical studies indicating a causal link between the cognitive factors and various behavioural results, such as compliance with public health recommendations. 67 Gochman and many other authors working in this fi eld argue that in what he defi nes as health behaviour, mental states such as beliefs, expectations, motives, values, perceptions, and other elements such as personality charac-teristics, aff ective and emotional traits, and overt behaviour patterns, actions, and habits, all relate to health maintenance, health restoration, and health improvement. 68 Hence, public health must include a perception of both the risk and of the eff ectiveness of the recommended risk reduction measures or control. 69 Th is has been shown even for particular diseases: perceptions drawn from people's mental representations largely shape the nature and extent of their behavioural responses to control health risks, such as SARS or H5N1. 70 Covid-19 is not the fi rst pandemic Africa has experienced. Th e continent has been through several other deadly pandemics and outbreaks of infectious diseases, such as Ebola, polio, HIV/ AIDS, resistant strains of Tuberculosis, malaria and other mosquito-borne diseases, yellow fever, typhoid, cholera, and many more. 71 Zambia and SSA in general is also subject to other widely spread health problems, for example, cancer, including cancers related to a virus such as HPV and cervical cancer. Early detection, patient isolation and preventative measures developed in patient care during past epidemics can also be used to combat the currently new Covid-19. African countries have oft en well-established frameworks and systems of public and global health (Africa CDC, CDC Zambia), unlike some developed countries such as the Czech Republic and other countries of Central and Eastern Europe. Th is helps them to integrate and react in time to emergent infectious diseases with surprising and substantially greater eff ectiveness and success.
In spite of various huge economic, social, and political problems, Africa is more eff ective when it comes to disease control than many countries in the West. Th e current pandemic is yet more evidence for it. Hence, Africa's history of infectious diseases and lessons taken from countries such as Zambia may be helpful and inspiring even for high-income countries in other continents and with other cultural traditions.

Conclusions
When it comes to mortality or the relative number of the infected, Covid-19 has so far had a much lesser negative impact on Zambia and many other SSA countries than WHO and many in the Western scientifi c community had predicted. 72 While there may also be other reasons for this success, we focus here on the role of religiosity and spirituality, philosophy of life, global health approach, traditional medical remedies, and previous experiences with deadly epidemics and outbreaks. More research is needed in this area to explore the specifi c roles these factors play in increasing pandemic resilience. Furthermore, we are aware that we have not provided a complete general framework for pandemic resilience but have rather only drawn attention to some of the