Invest more in the continent, experts tell African leaders

For decades, pandemics have wreaked havoc in Africa, killing thousands of people. In Uganda, for example, the situation is dire, with about 32 people succumbing to the Ebola virus and at least 64 suspected to have been infected in the last month.

With no vaccine or treatment available, scientists have now raised the alarm, fearing that the outbreak will not be easy to contain following its rapid rise and spread. This has placed neighbouring counties and the continent on high alert. But are the countries prepared to respond if there is an outbreak?

According to the Africa Centre for Disease Control, as of October 3, some 12 million Covid-19 cases were reported in Africa by the 55 African Union member states, with 255,000 deaths recorded. These represent two per cent of cases in Africa and four per cent of deaths globally.

Since the pandemic began, the continent has reported several other viruses, including swine flu, monkeypox, mumps in Kenya, and Ebola in the Democratic Republic of Congo. The cases are of the Sudan strain of the virus, which has no approved vaccine and hence the need for neighbouring countries to get prepared for outbreaks.

The continent has also reported about 5,600 cases of monkeypox with 137 deaths.

Twitter Space forum 

Is Africa prepared and staying ahead of the pandemic by using available data, science and solid health policies? To help answer this question, Nation.Africa held a Twitter Spaces forum with several experts, including immunologists, infectious disease, vaccine and vaccine modelling experts.

What are some of the lessons that Africa has learnt as far as the current pandemics are concerned and what do we carry forward to handle the next pandemics?

Dr Moses Masika, infectious diseases expert at the University of Nairobi said: “Quick detection, collaborative response and sharing information were key.

“If we delay in detecting [the viruses], we are likely to have a bigger problem on our hands when we begin to take action. With Covid-19, the continent became better at regional and national collaboration. The government [tapped] many experts' knowledge and expertise.

“Investing in research and development was crucial, going by the pandemics that we have had in many countries, Many African countries do not invest and allocate money on research and development. 

“We cannot continue to beg for research funding from high-income countries. We need to start investing and time is now so that we develop and invest in our people while coming up with continent solutions.

“Research that has been done by the global communities came in handy and helped us develop faster vaccines. I hope the lessons can be taken forward.”

Global solidarity 'is a lie'

Tian Johnson is the founder and strategist for the Africa Alliance and member of the Ministerial Advisory Committee on the Covid-19 vaccine that was mandated to develop a Covid-19 vaccine allocation framework for South Africa. On access to vaccines in a pandemic, he said, African countries had to wait for developed countries to vaccinate their population for Covid-19 before vaccine donation started trickling down to them.

“The way we think about research and development in the continent is very crucial to how we not only respond to the pandemic but the next pandemic,” Mr Johnson said.

“From the pandemic, the concept of global solidarity is a lie. Waiting for the high-income countries to give us the leftover vaccines should be a lesson. We were waiting as they vaccinated their population.

“This was the first indication that the systems were not working. There was also the spectacular greed of the pharmaceutical companies [which made billions] because of the pandemic.

“These are companies that continued to supply wealthy countries to hoard vaccines that they did not need while continuing to ignore the African countries that had paid for the vaccines and could not get them.

“Many African governments struggled for months [and] even a year to secure vaccines in a system where wealthy countries took the lion’s share, hence the global inequalities. For most countries in the region, that challenge continues. With the Ebola outbreak in Uganda without a vaccine, the situation is worse.

“A problematic narration is that we were waiting for donations. However, there were countries in Africa that had paid for their own vaccines but they were never delivered.

“Some of us paid for our vaccines and up to date, many of us have not received what we paid for. So the role of pharmaceuticals is key in this pandemic.”

He retaliated that the concept of solidarity was hollow and the pandemic experience showed that African countries were largely on their own.

Africa countries, he said, should invest in manufacturing their own vaccines because the will is there.

“The pandemic has been characterised by racism, and white supremacy,” he said. 

“We were slapped in the face with troubles and Africa was closed. It was said at the beginning of the pandemic that Africa will be shut out and known as the continent of Covid-19. These words came true.”

He challenged African researchers that as much as they are holding the high-income countries to account, the more difficult work is doing so for African heads of state.

“Our leaders should walk the talk. Why is it that over 20 years [since the Abuja Declaration], we have not been able to manufacture our own vaccines? We need to make all the declarations that we made a reality,” Mr Johnson said.

Link research and development

What can be done differently from the lessons learnt from the Covid-19 pandemic?

Prof Shem Otoi, Lake Region Economic Block and infectious modelling expert, said many things could be done differently and that there is a need to link research and development.

“When the pandemic hit, a lot of disciplines were involved in research, with some leading to interventions, policy briefs and advisories which were picked up by policymakers and many countries remained safe,” Prof Otoi said.

“On a larger scale, we need to invest heavily in research and development. In many African countries research is funded by foreigners, and we cannot fund our own issues.

“We should also increase diagnostic capacity to do early detection of infection and act in good time to avoid the spread of the virus.

“Once we do an assessment of facilities and realise the gaps, then we need to stock our facilities so that in case of an upsurge, our health infrastructure is not overrun.

“We should produce our own medical supplies. Africa as a continent has no priority in investing in research and development. That’s why the continent is suffering.

“A continent of 55 countries waiting for one country to bring them vaccines – this is a tragedy. We have the capacity to design and develop medical supplies, bring up the scale and reach the vulnerable by using digital technology to penetrate deep in places where the response was weak.”

Africa as a continent has the capacity to produce its own vaccines and medical supplies, but are we willing to buy from our own and trust our products?

Dr Masika: “We must ensure that our products are available to countries in the continent and have a sufficient market to make the company viable so that it does not have to close up.

“We need an engagement politically so that countries buy the products. The demand from the user should be positive and this is where we need to involve the community and communicate to them the benefit of vaccines to increase the uptake.

“We need to reach the community to consume the products. This is a challenge that needs to be handled by all countries.”

With the modelling that you came up with, apart from a few vaccines that were brought in, why do you think that the uptake of vaccines was low?

Prof Otoi: “We need to take vaccines to the people and not wait for them to come for the vaccines. 

“At Lake Region Economic Block that led in the vaccination numbers in Kenya, we reached out to many stakeholders and even reached most of them by conducting a door-to-door vaccination, which was more effective than having people going for the vaccine in the facilities to get vaccinated.

“In Africa, people go to facilities not to prevent disease but to be treated. Someone feeling well may not go to the facility to get vaccinated. There is no prompt.

“Taking vaccines to their doorstep paid some dividends.

“Going forward, we need to involve communities [and improve] access to vaccines. In this way, together with other measures, we are likely to survive without much devastation.”

Role of government

What’s the role of governments in funding future pandemics?

Dr Johnson: “The leaders just need to do what they said they were going to do. Twenty years ago during the Abuja Declaration, the governments said they were going to invest in manufacturing, but there is nothing yet to show this commitment in the continent.

“They said the continent would not see a shortage of drugs in our clinics, and that nurses and doctors would not sideline communities that are regarded as marginalised … They made promise after promise.

“What they have done instead, they have turned around and disinvested in the public health system. They contributed less and less to the health sector.

“They lied to us. They need to invest in a public health system that is grounded in our dignity and that covers people equally.

“Our leaders have consistently failed to do what they said they were going to do. Our health care in the continent has never been people first, it has always been personal and politically driven, we have seen a failure in our leadership.

“It is time for them to walk the talk, our people are dying and sick. We have stockouts across the continent of contraceptives, condoms, antiretroviral drugs and basic medications. 

“This is a shame on our leaders. Our leaders leave the continent for high-income countries to seek medical care, leaving their people to face the violence of a public health system that they have systematically weakened.

“Africa needs to look at investments … including the mRNA in the countries that are set up to manufacture our own vaccines.

“Our governments need to put the money where our mouths are. We need to invest more since there is no dignity in how Africans access health care. This is shameful.”

Dr Masika: “We have to push our governments to allocate more resources and research funding to our own problems to have more control over what is ours.

“Having a centralised body with the ability to test the quality of our products and even the vaccines is key for the governments to see that the continent is on the right track.”

What steps should the continent take to ensure that it builds pandemic preparedness and self-reliance for the future?

Dr Johnson: “Funding for local production in Africa must be free of strings and intellectual property provisions that will continue to benefit the big pharmaceutical industry. Most pharmaceutical companies are funded using public money and there is no reason they should not share the property.

“We must challenge such greed that has resulted in Africans being left on their own as beggars of vaccines.”

Dr Masika: “As African leaders develop local manufacturing, governments must retain sufficient ownership of these new facilities to ensure their strategic direction and output serves the public interest first by buying from Africa and building Africa.

“Our response to pandemics should not be reliant on a few companies. No other event like the Covid-19 virus has shown that relying on a few companies to supply medical products and vaccines is dangerous.

“Covid-19 amplified issues of how Africans are not realising health justice on the continent. The virus provided space to continue holding our leaders to account and reignite conversations that we have been having every year to speak about our capacity and ability to respond to pandemics independently.

“World solidarity is great, though it should not be treated as a cornerstone of our response. We need to create the political will and support for vaccine hubs to ensure that a continent like Africa is able to manufacture its own vaccine and not rely on those outside the continent.

“We need to bring pandemic response into the context of our national governments because at the core it is not about the pandemic but ensuring that our health system is robust and that our health facilities are staffed and resourced.

“We need to stand by the World Health Organisation to ensure that African priorities are taken care of and that the African pandemic cannot be shaped by white people but Africans.

“Our leaders must have the courage to stand up for the people who have put them in power by defending their interests. We have to strike the balance of ensuring that we become the solutions that we seek.

“We have to seek the agenda of ensuring that we are represented on the technical committees. We [need to] create solutions that are truly Africans.

Prof Otoi: “A nation that cannot protect its sciences cannot hold its own in the committee of nations.

“African research institutions are underfunded and understaffed and therefore not in a position to do quality research and come up with viable products that can be incubated, upscaled and trusted the world over.

“We need to engage African governments to ensure ease of doing business and setting up a manufacturing business should be easy by giving rebates and making it easy for people within the continent to set up their own companies and run them effectively because, with this, we are likely to have enough medical suppliers when they are needed.

“African countries need to have an agreement at an African Union level that the cost of setting up a drug factory in Africa must not exceed a certain amount and threshold in terms of cost
“With this, we will be in a possible to compete effectively with those outside our borders because we have the labour, the knowledge and the product that can be used to produce the products. We just need a conducive business and policy environment.

“This will also help the continent penetrate the market outside Africa.”

Dr Masika: “There is a need for countries to invest in the vaccine hubs to ensure that the cost of production is not too high that will in return make the pricing too expensive.

“Countries need to ensure that there is no payment of premium on products moving within the continent and also a premium on capital so that the inputs going towards the production do not make the price too high to compete with other organisations outside the continent.

“Countries in the continent need to make a commitment of what percentage of products they need to buy from the African hubs for self-reliance and sustainability of the hubs.”