Two years after the COVID-19 pandemic started, the leaders of the European Union (EU) and African Union (AU) met in Brussels. By then, six million people including 200,000 healthcare workers had died. Yet only one in five healthcare workers in Africa had been vaccinated. This is not good enough.

The rollout of COVID-19 vaccines was neither inclusive nor adequately planned. Of more than nine billion doses produced, Africa – with a population of 1.3 billion – only received approximately 540 million and administered 309 million. In other words, some 1.2 billion Africans have not received a single dose. 

Correcting this injustice as fast as possible is required for the benefit of all. So how can we make it happen? What are some of the urgent and longer-term structural actions needed to get to the other side of this pandemic and, crucially, be better prepared for the next one? It’s only a matter of time. What actions can Africa and Europe take together, at a global level?

I will focus on three main topics. First, is the need to localize production, procurement and supply of pharmaceutical products in Africa, including the most recent mRNA vaccines. Second, the importance of ‘rebooting’ health-related research in the public interest, with more public health professionals and data management for health. And third, we need to move towards a more meaningful and equal partnership between Africa and Europe.

Localizing production, procurement and supply of pharmaceuticals

When the pandemic, and rush to develop vaccines and treatments, accelerated from February 2020, we already knew certain things. We knew this situation would require a different approach. We knew the entire world would need personal protective equipment (PPE), diagnostics and vaccines, ideally everywhere at the same time. We needed to boost production and make the cake big enough to share.

We also knew that Africa only produced 1% of the vaccines that it uses and that most supplies are procured by global entities in the northern hemisphere. We knew that if the cake wasn’t made bigger fast, richer countries would help themselves as a priority: a “me first” approach.

What I didn’t know was that the G7 Countries would monopolize access and purchase quantities in advance that would be far larger than needed for their own populations. However, when COVID-19 started in March 2020, I had written a proposal for a planned  African-EU summit arguing for localization of production and supply of pharmaceuticals, with a close partnership between Africa and Europe to rapidly invest in Africa’s ability to produce tests, vaccines and therapeutics.

The summit never took place. However, my proposals were strongly echoed by the AU and Africa Centers for Disease Control and Prevention (ACDC) some months later, in October 2020. 

In April 2021, Africa developed an ambitious strategy for the manufacturing of vaccines to move from producing only 1% locally to producing 60% locally by 2040. By the end of last year, enough African countries had ratified the African Medicine Agency for it to be set up as a specialized agency of the AU and set up the start of a co-operation with the European Medicines Agency (EMA).

At the end of 2021, the EU announced its support for some manufacturing sites in Africa. Of course, donations had arrived from the G7 countries and from China, Russia and India. But not enough, not fast enough, and not always with the predictability needed to prepare. Hence the fact that, as I write, 1.2 billion Africans remain unvaccinated.

This is not looking back with the benefit of hindsight. I have repeatedly argued that if the world had moved earlier, if donors and investors had made investments in local manufacturing, if pharma companies had transferred technologies, we would not be in the shocking situation that we find ourselves today.

My pitch to the 2022 Africa-Europe summit was this: it needed to clarify just how ambitious EU initiatives to support localization of production are, how these initiatives align with plans prepared by the AU, how they will go further than focusing on the final stages of filling and packaging, and go beyond voluntary licensing, as so far this has been scarce.

I was also keen to hear how producers on the African continent will be protected from potential patent infringement claims when they produce vaccines while the waiver on intellectual property rights is still on hold unless the EU and Africa could come to a mutual understanding during the summit.

If done properly, localization will benefit Africa, Europe and the rest of the world. I also believe that Africa and Europe can do more to work together to resolve policy issues at a global level. 

Because many donations and the procurement of vaccines in general, and COVID-19 specifically, are organized in Geneva or Copenhagen, this poses a challenge for local producers in Africa to be sustainable – unless the market and procurement are moved to Africa. A change in global health architecture is needed involving Gavi, Unicef and Covax.

Science preparedness and health professionals

Effective emergency responsiveness now and in the future also requires science preparedness. Africa’s share in the global production of research has more than doubled in the last 20 years, from 1.5% to 4%. Indeed, European-African university collaboration is a longstanding tradition. 

Specifically, epidemic-related research in Africa has been valuable to Africa and the world. A recent example is how, in December 2021, South Africa’s genomic sequencing was instrumental in alerting the world to an unusual profile in samples tested for coronavirus. The African Pathogen Genomics Initiative includes locations in many African nations.

At the same time, ACDC has attempted to co-ordinate research to promote synergies and resource optimization, and to disseminate and translate emergency research outputs rapidly. In general, Africa contributes regularly and significantly to the development of vaccines and treatments for Ebola, malaria and COVID-19 – however, some of the countries that hosted Covid vaccine trials received fewer doses per capita than did higher-income countries. Is this fair and proper?

While the AU recognizes that the EU-AU co-operation in research and innovation has gained momentum, more is still needed. One critical step towards strengthening Europe-Africa science collaboration is a shift from time-limited project-based funding to long-term commitments. Clusters of excellence in certain fields will strengthen the research and innovation capacity of African universities significantly and sustainably, while also benefiting Europe.

Indeed, science preparedness should be embedded within a wider scientific capacity-building agenda to be developed in partnership. A policy area that we can improve on, together at a global level, is reconsidering the relationship between public and private R&D. 

The issue to resolve is whether governments can negotiate differently when signing one purchase contract after another and transfer value from taxpayers to investors in pharma companies. Knowledge and technologies crucial to Covid-19 vaccine development and production were created with the contribution of the public purse; patents filed by pharma companies do not protect the public interest arising from such earlier research.

In addition, the Covid-19 pandemic demonstrated how reliable epidemiological data are often unavailable in resource-limited settings in sub-Saharan Africa, and this knowledge gap is aggravated further by a serious shortage of skilled personnel in epidemiology and biostatistics to efficiently monitor, analyze and interpret these data to inform policy and decision making.

Health professionals need to play an important part in this refreshed narrative. Yet the World Health Organization’s Global Strategy on Human Resources for Health Workforce 2030 has estimated that by 2030, the shortfall in the health workforce in Europe will have reached 1.4 million – and 6.1 million in Africa The situation in Africa has worsened due to COVID-19; a lack of public health professionals and epidemiologists could seriously hamper efforts to equip Africa for outbreak preparedness and response, and for the Africa-Europe partnership to succeed. The Africa CDC has already developed a framework for public health workforce development, and this requires strong support from Europe.

 African health data is a game-changer

The pandemic also accelerated digital transformation, for some at least. And as we know from various commercial and public arena, power and impact today is all about data: who controls it, how data can be accessed, and how it can be harnessed to inform planning and more positive outcomes. I am therefore arguing for a pathway towards an African Health Data Space.

The creation of a European Health Data Space is already one of the European Commission’s priorities for 2019-2025. An African Health Data Space would promote more robust exchange and access to different types of health data including electronic health records, genomics data, data from patient registries, to support healthcare efforts, health research and policymaking.

Europe’s contribution to such efforts might include pioneering the ethical and human rights-based legal frameworks for effective and secure digital health and data management. Indeed, there will be best practices and lessons learned of interest for the AU in designing and developing its own data frameworks.

The successful planning and launch of an African Health Data Space in partnership with a similar European initiative could be a game-changer. Indeed, there is a global policy interest: if Africa can establish a similar space, the two data spaces could provide a strategic gateway for Europe and Africa to collaborate on mutually beneficial research.

The global level opportunity arises if both data spaces are aligned to goals for interoperability and promoting open standards, personal data protection and privacy. The result would be to foster and build a vibrant approach to digitalization for health, including the development of telehealth to reach and benefit the most vulnerable citizens while protecting healthcare personnel. Such outcomes are well worth pursuing.

No more ‘me first’

Throughout this and previous pandemics, the strength of regional co-operation, the national health systems of individual countries, and community healthcare workers have been critical success factors. But that is not enough.

True pandemic preparedness requires speed, agile systems, trust, the highest levels of ambition, efficient regional institutions, and enlightened political leadership that shuns a “me first” attitude. European and African leaders need to take bold decisions and pursue ambitious actions to correct the scandal of vaccine inequity, to strengthen Africa’s systems to deliver vaccines, to support African research and manufacturing capacities, and together to reshape the global health architecture to be better prepared.

The good news is that Africa recognizes the need to emancipate itself from “the global north”. This itself might help the continent to become more resilient and not create new dependencies. Countless examples exist that demonstrate how global health structures are about the north giving the south what the north thinks it needs. Not what it actually wants. Together, we can make health about the global good — and not about the north’s priorities alone.

Dr Lieve Fransen is a global health expert who advises several think tanks. She is a former senior director at the European Commission, lead the creation of the Global Fund for HIV/AIDS, Malaria and TB and is a medical doctor with a PHD in policies and long experience working in Africa and Asia. The article is based on the keynote speech that she delivered at the European Union-African Union Summit, at a session on Critical Issues For AU-EU Collaboration On Health And Science

Image Credits: Kerry Cullinan.