EU – AU Summit, February 2022

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

South Africa’s mRNA hub, Afrigen

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

Inside Biovac – which is to be the first manufacturing spoke for the mRNA products produced by the South African Hub.

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.

 

Lieve Fransen

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.

Wild animal carcasses in the Huanan market in Wuhan on display just after slaughter.

Three pre-print papers published over the past few days have strengthened the case for the theory that SARS-COV2 first spread among people via infected animals sold and slaughtered at the Huanan wildlife market in Wuhan – rather than from the Wuhan Institute of Virology, the laboratory studying coronaviruses in bats.

The two theories have been hotly, and often bitterly, disputed by scientists around the world for over a year.

Significantly, one of the pre-print papers was published by a large group of Chinese researchers based at the China Center for Disease Prevention and Control.

It offers, after two years of silence, evidence that the first strain of the SARS-CoV2 virus to be identified circulating among people in Wuhan, dubbed SARS-CoV2 Lineage A, was also circulating  in the Huanan market in the early days of 2020 alongside its sequel, Lineage B.

That provides a critical missing link, insofar as other studies had previously only succeeded in identifying Lineage B in environmental samples taken from the Huanan market  – whereas Lineage A was the first to spread among people in the city of 10 million.

China study corroborates findings of University of Arizona researchers

Equally significant, the findings of the China researchers also corroborate the conclusions of two studies led by Michael Worobey, Head of Ecology and Evolutionary Biology at the University of Arizona, and colleagues.

The latest paper, published on 26 February, concludes that critical events of virus transmission from animals to humans happened in two different events at the market, possibly a week apart, and involving strains of the virus dubbed SARS-COV2 A and SARS-COV2 B – the main cases circulating in China during the early days of the outbreak.

While all of the samples reviewed in both the Chinese study, as well as the one by Worobey, were taken from environmental surfaces – not the animals themselves – they are most evident in the areas of the market where wild animals were kept captive and slaughtered – including items like cages where the animals were held.

The newly-published papers recently still fail to identify a single species as that elusive ‘Animal X’ – the so-called “intermediate host” that transmitted the virus originating harbored by  bats to humans. But the studies still offer the most conclusive evidence, to date, that animals in the Huanan market indeed may have been the first to infect people in the city of 10 million people with SARS-CoV2.

Where is ‘Animal X’? Summary of SARS-CoV2 Origins Report

Worobey and colleagues examined over 700 complete genomes of SARS-CoV-2 that could be mapped from the environmental samples in the market, taken between December 2019 and up until mid-February 2020.  Around one-third were lineage A and two-thirds were lineage B.

“We find that there were very likely at least two origins of SARS-CoV-2 – one for lineage A and one for lineage B.  The patterns in the phylogeny are the giveaway,” according to Worobey.

The study adds that “multiple lines of evidence” from the environmental samples all point to wild animals – even if animal samples, per se, were not available for the study. Those include:  a high concentration of SARS-CoV2 positive samples taken from surfaces in the southwestern corner of the market where wild mammals were sold and slaughtered, and the highest concentration of early SARS-CoV2 cases among vendors in the areas where live mammals were sold.  And while no single animal was identified as the main cause of transmission, the study also singles out a particular cluster of positive virus samples in the area where racoon dogs were illegally sold, as well as a cage where the dogs were housed.

In a detailed series of tweets, Worobey zeroes in on the racoon dogs further saying: “One striking (to us at least) finding: one stall had 5 environmental positive samples for very animal-centric surfaces, including a “metal cage in a back room”. …one of the stalls we know was selling live mammals illegally in late 2019. But, there’s more…

“It happened to be a stall that one of us, @edtwardcholmes, had visited 5 years before the pandemic, and where he had taken a photo of this racoon dog” – an animal susceptible to the SARS-CoV2 virus.

Market is epicentre

The other paper makes a detailed examination of the spatial evidence on the proximity of the market to the first clusters of human cases in the Wuhan community. It refers to maps from the World Health Organization (WHO) report on the origins of SARS-CoV-2, which enabled researchers to plot the density of the first COVID-19 cases in Wuhan in December 2019 – even before the outbreak was publicly reported.

According to Worobey, “We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the epidemic.”

Based on these maps, “Huanan market sits right in the highest density region,” he adds. 

“This is a clear indication that community transmission started at the market,” added Worobey in his lengthy Twitter thread explaining the findings of the two studies. 

In addition, the mapping showed that both cases of people infected with both SARS-CoV-2 lineage A and lineage B had a strong association with the market.

Chinese paper also points to the market

In the case of the other pre-print published by the group of China CDC researchers led by George Gao, Gao and colleagues examined 1380 samples collected from both the environment and animals at the market in early 2020. Of these, 73 environmental samples tested positive for SARS-CoV-2 and three live viruses were successfully isolated, they reported.

The viruses “shared nucleotide identity of 99.980% to 99.993% with the human isolate”, they reported.

Here too, no SARS-CoV2 virus was detected in the animal swabs covering 18 species of animals on sale in the market – despite the fact that such samples were taken and study.

But the paper still concludes that there is “convincing evidence of the prevalence of SARS-CoV-2 in the Huanan Seafood Market during the early stage of COVID-19 outbreak”.

Although that conclusion does not go as far those of Worobey and his colleagues, it is significant insofar as the study’s authors are affiliated with China CDC.

This also suggests that Chinese authorities may be finally coming to terms with the overwhelming evidence about the Chinese origins of the virus outbreak in humans, which some reports earlier had tried to attribute to factors such as the import of frozen foods, or an imported outbreak from a foreign military base.  And in light of that, scientists are being allowed to release some long-sought evidence about the presence of the virus in the Wuhan market during the early days of the outbreak.

-Elaine Ruth Fletcher contributed to this story.

Image Credits: Arend Kuester/Flickr.

Nearly half the world’s population lives in climate danger zones, according to the latest United Nations Intergovernmental Panel on Climate Change (IPCC) report, which UN Secretary-General Antonio Guterres described as “an atlas of human suffering and a damning indictment on failed climate change leadership”.

“Many ecosystems are at the point of no return now, and unchecked carbon pollution is forcing the world’s most vulnerable on a frogmarched to destruction now,” added Guterres at Monday’s launch of the report, which focuses on climate impact, adaptation and vulnerability. 

“Increased heatwaves, droughts and floods are already exceeding plants’ and animals’ tolerance thresholds, driving mass mortalities in species such as trees and corals,” according to the report, compiled by 270 scientists from 67 countries.

With more than half of the world’s population living in cities, “people’s health, lives and livelihoods, as well as property and critical infrastructure, including energy and transportation systems, are being increasingly adversely affected by hazards from heatwaves, storms, drought and flooding as well as slow-onset changes, including sea level rise,” according to the report.

“These weather extremes are occurring simultaneously, causing cascading impacts that are increasingly difficult to manage. They have exposed millions of people to acute food and water insecurity, especially in Africa, Asia, Central and South America, on Small Islands and in the Arctic.”

The extent and magnitude of climate change impacts “are larger than estimated in previous assessments”, and the substantial damage is “increasingly irreversible”, according to the report.

Meanwhile, around half of the species assessed globally had shifted polewards or to higher elevations, while hundreds of local species losses were driven by heat extremes. 

Even temporarily exceeding global warming of 1.5°C (2.7°F) will result in additional severe impacts, some of which will be irreversible, warns the report.

“This report is a dire warning about the consequences of inaction,” said Hoesung Lee, Chair of the IPCC. “It shows that climate change is a grave and mounting threat to our wellbeing and a healthy planet. Our actions today will shape how people adapt and nature responds to increasing climate risks.”

Russia-Ukraine conflict may accelerate renewable energy

Hans-Otto Portner, IPCC
Hans-Otto Portner, IPCC

Dr Hans-Otto Pörtner, co-chair of IPCC Working Group 2 that co-ordinated the report, called for an end to fossil fuel subsidies driving the heating up of the world. On the brighter side of a grim conflict, he suggested that Russia’s invasion of Ukraine, which has led to the suspension of the Nord Stream 2 natural gas pipeline to Europe, may also accelerate countries’ impetus to move to renewable energy to “avoid dependence on fossil fuels, especially during conflict”.

Petteri Taalas, Secretary-General of the World Meteorological Organisation (WMO), described the world’s atmosphere as being “on steroids, doped with fossil fuels”, adding that the report had identified 127 risks “covering a very wide range of sectors like health, agriculture, economy, infrastructure, and ecosystems”.

Meanwhile, Guterres said that coal and other fossil fuels “are choking humanity”, adding that only 20 governments had agreed to stop funding the development of new coal production plants abroad. 

“They must now urgently do the same at home and dismantle their coal fleets,” he added. “Those in the private sector still financing coal must be held to account. Oil and gas giants and their underwriters also must be put on notice. You cannot claim to be green while your plans and projects undermined the 2050 net-zero target and ignore the major emission cuts that must occur this decade,” said Guterres.

Strengthening nature

The report urges  “ambitious, accelerated action” to adapt to climate change, “at the same time as making rapid, deep cuts in greenhouse gas emissions”. 

Just as human society causes climate change, so it can “adapt to, maladapt and mitigate climate change”, according to the report.

Solutions involve strengthening nature, which has the potential to reduce the impact of climate change.

“Healthy ecosystems are more resilient to climate change and provide life-critical services such as food and clean water”, said  Pörtner. 

“By restoring degraded ecosystems and effectively and equitably conserving 30 – 50% of earth’s land, freshwater and ocean habitats, society can benefit from nature’s capacity to absorb and store carbon, and we can accelerate progress towards sustainable development, but adequate finance and political support are essential.”

Cities as a nexus of crisis and opportunities

Debra Roberts, IPCC Working Group 2 co-chair.

The report also points out that climate change interacts with global trends such as growing urbanization, social inequalities, losses and damages from extreme events and a pandemic, jeopardizing future development.

“Together, growing urbanization and climate change create complex risks, especially for those cities that already experience poorly planned urban growth, high levels of poverty and unemployment, and a lack of basic services,” IPCC Working Group 2 co-chair Debra Roberts.

“But cities also provide opportunities for climate action – green buildings, reliable supplies of clean water and renewable energy, and sustainable transport systems that connect urban and rural areas can all lead to a more inclusive, fairer society.”

Importance of indigenous knowledge

She added that some adaptation has caused “unintended consequences”, including by destroying nature, putting peoples’ lives at risk or increasing greenhouse gas emissions. “This can be avoided by involving everyone in planning, attention to equity and justice, and drawing on Indigenous and local knowledge,” said Roberts, urging governments, the private sector, civil society to work together to “prioritize risk reduction, as well as equity and justice, in decision-making and investment”.

“In this way, different interests, values and world views can be reconciled. By bringing together scientific and technological know-how as well as Indigenous and local knowledge, solutions will be more effective. Failure to achieve climate-resilient and sustainable development will result in a sub-optimal future for people and nature.”

Early warning systems

Petteri Taalas, Secretary-General of the World Meteorological Organisation (WMO).

“One of the powerful ways to adapt is to invest in early warning services,” said the WMO’s Taalas. “But the basic weather and climate observing networks have serious gaps in Africa and Small Island States. Only half of the 193 members of WMO have proper weather, climate and hydrological services.”

“This report recognises the interdependence of climate, biodiversity and people and integrates natural, social and economic sciences more strongly than earlier IPCC assessments,” said Hoesung Lee. “It emphasises the urgency of immediate and more ambitious action to address climate risks. Half measures are no longer an option.”

R&D for new vaccines, tests and treatments: Despite the ever-increasing complexity of the pure science, political and community buy-in and ecosystem approaches to prevention remain equally critical.

From increasing disease surveillance and developing a pan-coronavirus vaccine to ‘eco-health’ and public trust, participants in the COVID-19 Global Research and Innovation Forum considered ways to globally prepare for future pandemics and end the current one.

The third such forum, hosted by the World Health Organization, brought together over 100 research scientists, experts, policy makers, and donors worldwide to discuss and strategize about the future of COVID-19 research 24-25 February. 

Along with the more technical aspects of disease tracking, diagnostics and new vaccines, speakers emphasized the need for research to go beyond the narrow confines of laboratories and clinical trials so as to strengthen health systems to use the science well – and build public confidence in its value.  

Wellcome Trust Director Jeremy Farrar

Ultimately it’s about preparedness, said Wellcome Trust Director Jeremy Farrar, in a Thursday keynote address, “what you have before a crisis hits will determine your ability to prevent it and respond early.”

Public trust in scientific solutions also needed to be rebuilt, he added, making indirect reference to the public protests seen in the last pandemic over issues like masks and vaccines.

“No amount of science will deliver vaccines, therapeutics, diagnostic tests, or anything else that we can intervene with, unless we have the trust of societies.  And all of us, myself included, have taken that trust for granted for too long.” 

To do that, as well as ensuring equitable access to tools and solutions, Farrar and others urged policymakers to ‘reinvent’ health systems, science, and research ensuring that they are anchored within the communities that are to be served. 

Increased access to data surveillance through WHO Pandemic and Epidemic Hub 

Dr Chikwe Ihekweazu

Getting down to the nitty-gritty, Chikwe Ihekwazu, the recently-named director of the new WHO Hub for Pandemic and Epidemic Intelligence, explained how increased global surveillance data, inclusive animal and environmental health, is critical to quickly identifying and tracking outbreaks. The new hub, a collaboration with the German government, is based in Berlin.  However, data alone is not enough. 

“Often we have the data but we are unable to use it, because we don’t have access to the analytics, both in terms of the tools, the human resources, and all the governance in place,” said Ihekwazu. 

“Our problem, our challenge, is not to ensure that [politicians] make the right decisions, we need to provide them [with] the best possible opportunity of making the right decisions for humanity.” 

What is needed for pandemic and epidemic intelligence.

The role of the WHO Hub, inaugurated last September, is to fill critical surveillance gaps, supporting national public health experts and policy-makers in acquring and developing the very tools needed to forecast, detect, and assess epidemic and pandemic risks through a ‘system of collaborative intelligence’.

‘Collaborative’ is the key word, noted Ihekwazu.

“This is not something we will do for the world. This is something we will do with the world.” 

Pan coronavirus vaccine is next step  

research
The technology to develop a pan-coronavirus vaccine is already in place.

Along with the continuous evolution of SARS-CoV2, there is a high likelihood that other coronavirus strains could emerge from the wild, and so the holy grail of vaccine R&D now should be the development of a pan-coronavirus vaccine, many researchers also agreed. 

They spoke just a day after the CEPI announced a major grant to India to develop such a jab.  Moderna and US-based Duke University also are working on pan-coronavirus technologies that would offer broader protection against both existing and future SARS-CoV2 variants, as well as all beta coronaviruses.   

“It’s not a sustainable strategy to continue to have to boost people as variants continue to rise, and at some point, this boosting may not adequately address future variants,” said Phil Krause, chairperson of the WHO COVID vaccines research expert group. 

“We wouldn’t have gotten to where we are today if there hadn’t been some work on previous pandemics or epidemics including MERS. [We need to keep] both speed and rigour in developing and evaluating vaccines.” 

Pandemic saw boom in vaccine R&D

As a silver lining in the cloud, the pandemic has accelerated know-how that makes development of a pan-coronavirus vaccine, as well as other types of new vaccines, more feasible, said Stanley Plotkin, of the US-based Johns Hopkins University.  

“Despite the death and destruction and disease that this SARS-CoV-2 has caused us, these last two years have been the best years in vaccinology since the polio days, because we now have multiple strategies for developing vaccines.  

“The advantage of this extends beyond coronavirus,” Plotkin added, noting that new and improved vaccine technologies can be applied to a range of deadly diseases with epidemic potential, including Zika virus, Nipah virus, and Ebola. 

Embedding the ‘one-health’ approach into prevention strategies  

Drivers of disease emergence over last 60 years

Beyond vaccines, broader “ecosystem” and one-health approaches are needed to address pandemic risks.  

That’s not only because prevention is better than cure – but because coronaviruses, as such, are not the only risk. The risk can be from a range of infectious respiratory, vector-borne or water-borne viruses that come into increased contact with people, as a result of urbanization, wilderness degradation and industrialised food production, and then adapt to infect humans.  

So looking at the drivers of disease emergence, are equally important, said William Karesh of the Canadian-based EcoHealth Alliance, as “many of which lead to pandemics and some of which do not.” 

Those include land use changes that bring wildlife and humans in closer contact, as well as certain patterns of intensive agriculture and meat production, which stimulate disease transmission between animals and between animals to humans.  

Karesh proposes a ‘society-wide approach’, echoing Farrar about the importance of engaging with communities to influence health, economic, and social wellbeing outcomes. 

This doesn’t mean that investments should shift away from the health sector, but investments in pandemic preparedness and prevention should be ‘diversified’ with other stakeholders.

“We need to expand the pie by engaging other sectors of society.”

Better planning of pig farms to prevent Nipah virus in Malaysia 

He and others described, for instance, how the better planning of pig farms had been used to help prevent the transmission of Nipah virus in Malaysia from bats to pigs and finally humans. 

Nipah virus was first identified in pigs and pig farmers in the country in 1998; however, the virus itself originates from fruit bats. The practice of planting fruit trees, which harbour bats, on land that is also used for livestock production is the most likely pathway of transmission to humans. 

With this in mind, farmers have been encouraged to separate their pig styes from areas where they are raising orchard trees. 

These “practical solutions that are at our disposal already” said Catherine Machalaba, also of the EcoHealth Alliance, saying: “[We need to build that] into how we plan our new developments and make prevention embedded into our other sectors.”

Image Credits: Afrigen , (Photo: Adobe Stock), WHO , WHO, Eco Health Alliance , EcoHealth Alliance .

african medicines agency
Margareth Ndomondo-Sigonda

Some thirteen African nations have expressed interest in hosting the new African Medicines Agency, with an AU decision on where to establish the AMA’s headquarters set for July 2022, senior African Union officials say.

A decision on a headquarters would also pave the way for the recruitment of a director general for the new AMA agency.  And if the DG selection is completed by the third or fourth quarter of 2022, as expected:  “from there the AMA will be ready for takeoff.”

That was the forecast of Margareth Ndomondo-Sigonda, Head of the Health Unit at the African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD).  She was speaking at a special briefing Thursday on the AMA, sponsored by the US-based Center for Global Development.

COVID pandemic has accelerated AMA’s establishment

Jean Baptiste Nikiema – WHO Africa Regional Office

The COVID-19 pandemic has played a crucial role in accelerating the emergence of the AMA, said Jean Baptiste Nikiema, Regional Advisor for Essential Medicines, World Health Organization Africa Regional Office, also speaking at the briefing.

Nikiema noted that the current regulatory system, which meant all 55 African Union countries had to  individually assess the complex biomolecules, therapeutics and vaccines associated with the COVID pandemic at a rapid pace – had underscored the need to have a continental regulatory authority.

“The need arose for an authority to put the sectors together and assess and save time,” he said.

“AMA will be the solution in the future [because] we know that this pandemic will not be the last one,” he said. WHO is supporting African countries in the areas of organization, review and to build capacity, he said. 

Widespread support across continent 

Nikiema described 2022 and 2023 as very critical years in terms of getting the AMA onto the right path; the momentum created over the past months should be maintained considering the agency is enjoying widespread support across the continent.

“When we are speaking to member states, there are no bottlenecks to the treaty’s ratification. The issue is mainly related to country processes,” he said.

He therefore enjoined the stakeholders to go beyond the continent-wide approach and start driving the cause nationally too so that the agency can best perform its saddled tasks.

“Let’s look at the country level also and maybe have a set of mechanisms to push for the ratification of the treaty because we need AMA for the next pandemic, including this one which is not yet finished,” he said.

Dealing with holdouts

As of early February, 30 countries had committed to the AMA by either signing or ratifying the AMA treaty, as reported by Health Policy Watch.

However, the continent’s economic powerhouses are still holding out, including Nigeria, South Africa, Ethiopia and Kenya. 

Responding to the concerns about foot-dragging among these countries, Ndomondo-Sigonda, called for patience and more advocacy, adding that their sovereignty also must be recognized and respected. 

“These are sovereign states that have the prerogative of determining what is the priority for their respective countries and therefore, we need to not only be patient but I think we need also to do our part in terms of advocacy so that they can understand the value that AMA brings on board when it is operational,” she said.

She added that the strength of the AMA also hinges on the strength of national regulatory authorities as such, she said this should be brought to the attention of the strategic countries that their respective national regulatory authorities would also be strengthened in the process.

“We know that it’s not just that they will be supporting other countries, but they will also benefit from the outcome of the undertaking. Our advocacy, I think, is very key when it comes to engaging those countries that are considered very strategic,” she added.

Calls for patience in operationalizing up the agency 

David Mukanga, The Bill and Melinda Gates Foundation

Even though the AMA would certainly be relevant to the present pandemic, there are also calls for patience with the process – and a long-view perspective.  

David Mukanga, Senior Program Officer of Regulatory Affairs at the Bill and Melinda Gates Foundation, observed that the Africa CDC was set up about six years ago – and now it is having visible impacts across the continent.

“We will need to count on the leadership of the African Union and whoever the AMA DG will be, and the governing board — to really set the tone and the pace, so that people remain excited to continue to support, not just the partners, but more importantly the member states,” Mukanga said.

What’s next? 

Ndomondo-Sigonda said the next step in the AMA’s establishment is the assessment of the proposals by the 13 countries that have offered to host the agency – a process that will take place   between March and April 2022. 

“We’re busy preparing for that. So once that is done, approved and the report is ready, then the plan is to convene the first meeting of the Conference of the State parties which is the highest policy making organ of the AMA,” she said.

That AU conference is planned for May 2022. At the AU Assembly to be held in July 2022, the final decision on which country will host AMA headquarters will be made. 

This, in turn, would pave the way to recruitment of a Director-General of the agency.

“So, we are hoping that if all goes well, then in Q3 or Q4 of this year, we’ll have the Director-General in office and, AMA will essentially be running from there and will be ready for takeoff.”

See more of our AMA countdown coverage here:

African Medicines Agency Countdown

 

pandemic
Midwife vaccinates an older man during a COVID-19 vaccine campaign in Madagascar.

The past 10 days have seen a flurry of new US initiatives to meet the World Health Organizations target of vaccinating 70% of the global population – including a new Global Action Plan; involvement of PEPFAR networks to strengthen health system response; and most recently, a special US thrust in Nigeria, the continent’s most populous nation.

Underlining these efforts, as noted by US Secretary of State Antony Blinken in his announcement of the GAP plan, is the urgency of solving so-called ‘last mile’ challenges, like access to cold storage for transporting vaccines to places of implementation. Along with generating demand for vaccines, strengthening community health systems is a vital part of bringing the pandemic to an end.

At the same time, we are seeing developed countries finally moving on from the pandemic. Europe is lifting COVID restrictions. Most US states are abandoning mask mandates, and even countries such as Australia are finally reopening to tourists – steps Africa took some months ago.

Prioritizing the last mile – investing in the future

Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria.

But there is a danger, as societies move on – leaving global health agencies to carry out the unfinished business of vaccinating the world – that we will quickly forget the lessons of the last two years.

If we only focus on the moment, we will not invest in what needs to be done for the future, to meet the next outbreak, when it happens.

In addition, it is essential that we do not forget the importance of investing in local capacity, primary health care and disaster management.

The next disease outbreak, just like this one, will begin at the household and community level and reverberate outward as infections spread – we need, therefore, to put the “last mile” first and prioritize local solutions. Vaccines take time to develop and even longer to roll out. Local jurisdictions must be able to respond without waiting for assistance from often overtaxed national health care systems. As we’ve seen throughout the pandemic, a country’s success or failure will correlate with the aggregation of local efforts.

From the lessons of the last two years, we recommend action on three fronts:

1. Act local 

Witoto indigenous nurse technician, Vanda Ortega, sets an example as the first person in her community to receive a COVID-19 vaccine in Manaus, Amazonas, Brazil, on January 18, 2021.

National preparedness and response plans, including mitigation policies and vaccination and testing campaigns, must include training of local responders on the ground. These plans should include a pandemic planning scenario and be informed by a multisector, whole government approach with local flexibility.  

Local jurisdictions also need a legal framework established by the central government that gives them authority for early action. Without this, time is lost, and the window for containment closes. If they have the authority to act, and act quickly, local leaders are better able to manage the response, provide public messaging and risk communication, engage communities, and make key policy decisions.

2. Don’t forget about the importance of primary care and resilience of the public health infrastructure 

A volunteer carries out COVID19 prevention and risk communication activities under a USAID-supported ‘ACCESS’ programme to strengthen community health services in Madagascar.

Who can forget the images of overwhelmed hospitals from New York to South Africa, with makeshift morgues and patients on gurneys clogging crowded hospital halls? Years into the pandemic, we’re now learning of collateral damage: significant excess deaths as cancer, TB, and other diseases go undiagnosed and untreated by overwhelmed hospitals or because people avoid health care institutions. These examples reflect the challenges in pivoting to triage care in a health emergency.

Two capabilities are therefore needed when health system resources are overwhelmed: a framework to identify nonessential services that can be temporarily halted and the resources diverted to essential care, including non-pandemic essential care, and a holistic approach to identify additional capacity in the community so resources can be triaged to save the most lives. 

3. Give public health a seat at the table with disaster management agencies

Sudan: Physical distancing and clustered aid distribution times at this refugee camp during the COVID pandemic – among the critical public health measures taken in humanitarian settings.

Pandemic preparedness and response must be fully integrated into existing disaster management agencies at the national and subnational levels. Multisector plans that provide for incident management and cross-sectoral collaboration and include continuity of essential operations should be developed and routinely exercised at the national and local levels. 

For example, the ability to transport medical supplies or set up security at mass vaccination sites cannot be handled by public health officials alone. The funding mechanisms, surge personnel, and expertise from the other sectors need to be accessed and coordinated through a single management entity.  

What’s needed are routine, annual exercises that reflect actual national and local plans and include the people who will be tasked with responding. Simulations geared to the highest levels are important, but insufficient.

The nonprofit global health organization we work for, Management Sciences for Health, offers a toolkit for local leaders, in low resource settings to help with these efforts.

Let’s build on the protocols and strategies developed throughout this pandemic and not forget the lessons learned as the current crisis eases. There will be another one, and we must be better prepared than we are now.

Elke Konings, PhD, MSc, is a senior director for pandemic preparedness, response and recovery at Management Sciences for Health, a nonprofit global health organization.

Lisa Stone, MD, MPH, is a pandemic preparedness and response consultant.

Image Credits: Samy Rakotoniaina/MSH, Munira Ismail_MSH, Flickr: IMF/Raphael Alves, MSH, UNHCR/Elizabeth Marie Stuart.

Special to Health Policy Watch: Eyewitness view of smoke from Russian bombing hovers over residential area in Ivano-Frankivsk on in south-western Ukraine, on 25th February as Russian attacks spread throughout the country.

The World Health Organization said it had released $3.5 million to support delivery of urgent medical supplies to the people of Ukraine, after Russia invaded the country on three fronts simultaneously early Thursday morning.

Meanwhile, WHO’s European Regional Office called for an end to hostilities saying: “any further escalation could result in a humanitarian catastrophe in Europe, including a significant toll in terms of casualties as well as further damage to already-fragile health systems.”

WHO’s Director General Dr Tedros Adhanom Ghebreyesus said he was “heartbroken and gravely concerned” for the health and well-being of Ukrainians, as tens of thousands of Ukrainians streamed towards the country’s western borders. Millions of others huddled in homes or shelters, as Russian shelling and bombing expanded even to western parts of the country, previously considered “safe zones.”

Tedros added that WHO would be monitoring Russia’s actions to ensure that no health facilities, healthcare workers or patients were targeted and, if they were, WHO would document and report such incidents.

The director-general’s statement stressed that WHO is “deeply concerned for the health of the people of Ukraine in the escalating crisis” and said that his organization would help ensure that the country’s health system would continue to function “to deliver essential care to people for all health issues, from COVID-19 to cancer, diabetes and tuberculosis, to mental health issues, especially for vulnerable groups such as older persons and migrants.”

The initial $3.5 million offered “is expected to rise following further needs assessments,” said Tedros.

WHO Regional Office calls for halt to “escalation”

COVID-19 patient in severe state in Chernivtsi, Ukraine
COVID-19 ward in Chernivtsi, southwestern Ukraine. As SARS-CoV2 wanes, health services must deal with a health emergency – created solely by human forces.

A statement by the WHO Regional office called for a halt to the Russian attack – without naming the country directly:

“Further escalation could result in a humanitarian catastrophe in Europe, including a significant toll in terms of casualties as well as further damage to already fragile health systems,” WHO/Europe warned.

The office said it was working closely with all UN partners in rapidly scaling up readiness to respond to the expected health emergency triggered by the conflict, protecting WHO and other medical staff, and minimizing disruptions to the delivery of critical health care services.

“The right to health and access to services must always be protected, not least during times of crises,” the statement said. “The protection of civilians is an obligation under international humanitarian law.”

UN Secretary General Antonio Guterres said Friday that other UN agencies also would be scaling up its aid efforts – “in and around Ukraine.”

US Secretary of state Antony Blinken, meanwhile, commended Guterres’ response, hours after President Joe Biden said that the United States would be sending Ukraine “humanitarian relief to ease their suffering” – along with imposing economic sanctions on Russia.

On Thursday, the UN also allocated $20 million from its Central Emergency Response Fund (CERF) to provide humanitarian response. Up to five million people, among Ukraine’s 44 million population, could wind up as war refugees, according to US reports, and the International Committee of the Red Cross as well as other international relief agencies are ramping up appeals to support civilians who are now stranded, under fire, and lacking adequate food, water and medical support.

Other offers of health and humanitarian aid were also being heard from other countries as far-flung as Poland and Israel, while Reuters reported that both Democratic and Republican Congressional leaders might move as early as next week to approve a sharp increase in defensive military aid and humanitarian support to the beleaguered country.

Attacks spreading westward and including hospitals, eye-witnesses report

On Friday, local and international media reported that Russian troops had entered parts of the Ukrainian capital of Kyiv. Russia has also been carrying airstrikes throughout the country since the escalation began overnight on Wednesday.

In Ivano-Frankivsk deep in south-western Ukraine, near the Moldova-Croatia border, an eyewitness shared with Health Policy Watch photos of Russian bombs hitting residential areas of the city.

Ukranian and Kyiv expert sources,  meanwhile, posted photos of residential areas in far-flung parts of the country being targeted in the attacks. Said Olga Tokariuk, a freelance correspondent in Kyiv, affiliated with the Center for European Policy Analysis (CEPA), quoted Ukranian Health Minister Viktor Liashko saying that the Russian military attack also was hitting hospitals, saying: “This is a a violation of [the] Geneva Convention.”

On Sunday, 27 February, WHO issued a further warning that medical oxygen supplies were already running “dangerously low” as a result of the crisis.  The shortage of medical oxygen threatens the recovery of some 1,700 seriously ill COVID patients, mostly older people, as well as neonates, women with pregnancy and childbirth complications, as well as people with other chronic conditions as well as people who have suffered injuries and trauma during the past days of conflict, said a joint statement issued by WHO’s Geneva headquarters and the European Regional Office.

“The majority of hospitals could exhaust their oxygen reserves within the next 24 hours. Some have already run out. This puts thousands of lives at risk,” said a WHO statement.

The Agency called for the safe transport of the supplies “to those who need them.”

– Updated on 2 March 2022

Image Credits: Anonymous eyewitness , Mstyslav Chernov/ Wikimedia Commons.

March on behalf of better diagnostic and treatment services for people affected by hepatitis C (HCV), Madrid, 2015.  Some 75% of people in Europe living with HCV or Hepatitis B don’t even know they have the disease.

Somewhere between 10 and 14 million people are living with  viral hepatitis B (HBV)  or hepatitis C (HCV) in WHO’s European region alone.  And over three quarters of those people do not even know they have either disease.

It’s no surprise then, that approximately 300 people die each day due to HBV and HCV -related disease in WHO’s 53 European region countries, the majority related to cirrhosis and liver cancer.

If we are to be better prepared  for  future pandemics we need to seriously step up efforts to end other infectious diseases such as HIV, malaria, tuberculosis and viral hepatitis. Ending those diseases helps to strengthen health systems, supply chains, surveillance and increase access to essential health services, like screening, testing, contact tracing and access to essential medicines and life-saving antiviral drugs for hepatitis B and C, antiretroviral drugs  and vaccines.  But as the response to COVID-19 has demonstrated, it’s how quickly we act that counts. Vaccines have transformed the pandemic´s response. Scientific advances, properly implemented, can help us to transition out of any number of diseases.

In the European post-COVID recovery, we now need to drive towards elimination of viral hepatitis as a preventable and curable disease – addressing a major public health problem and setting an example for the rest of the world. 

Vaccines and cures 

A healthcare worker in Lao PDR provides the first dose of the hepatitis B vaccine, given within 24 hours of birth.

As we conclude the Viral Hepatitis Elimination 2022 special conference Friday, 25 February, organized by the European Association for the Study of the Liver, it is a good time to reflect on the successes and challenges seen in the battle against viral hepatitis over the past few years.   

We´ve had a vaccine for Hepatitis B (HBV)  for over a half a century. The introduction of HBV vaccination in the 1990s among newborns was a landmark event in hepatology; this intervention has had a marked positive effect on reducing liver cancer by preventing HBV infection in children. Hepatitis C  virus  (HCV),  identified only in 1989, is now curable thanks to the introduction  of  oral  direct acting  antiviral drugs.  

A hidden epidemic

Just 10 countries among the 53 member states in WHO’s European region – which spans the continent from the United Kingdom to the central Asian republics of the former Soviet Union (FSU), account for three quarters  of the total viral hepatitis burden. Most of this burden is in eastern Europe and FSU nations.  

Robust estimates of incidence and prevalence of chronic HBV and HCV infection remain challenging even in countries with well-developed surveillance systems, due to the high frequency of asymptomatic and thus largely undiagnosed infections, the scarcity of formal screening programmes, and poor access to diagnostic testing.

Although vaccination has reduced the prevalence of HBV in children, vaccination programmes will not alleviate the large existing burden of chronic HBV infection in older generations. Thus, many countries, such as Bulgaria and Romania, still have a heavy disease burden in older cohorts. Furthermore, low-endemic countries in  Europe with an overall HBV prevalence of less than one per cent among the general population have rates of HBV infection in foreign-born immigrants of up to five per cent, contributing to an important fraction of the total number of  HBV cases in these countries. The 2030 goal of preventing new cases of chronic HBV infection in Europe requires widespread birth dose vaccination and additional interventions, including third trimester nucleoside analogue prophylaxis, to prevent mother-to-child transmission from mothers with high viral load.

 A scarcity of consistent and efficient screening programmes for viral hepatitis C combined with the high costs of drugs due to variable European reimbursement systems result in reduced access to treatment and delays in hepatitis C elimination programmes.

These challenges resonate through European hepatology given the ageing population and changes in demography caused by immigration from areas with a higher prevalence of HBV, HCV, and hepatitis D virus (HDV, also known as hepatitis delta virus). An increase in the prevalence of obesity in younger people and, more generally, liver disorders  associated with low socioeconomic status add to the global burden of liver disease.

Impact of COVID-19

Rwanda: People waiting to receive free hepatitis C tests and vaccines on World Hepatitis Day 2016 – pre-pandemic

Not only in Europe, but worldwide, COVID-19 has disrupted existing viral hepatitis elimination programmes across the cascade of care at a critical juncture, with only nine years left towards WHO-defined elimination goals.

Quarantine and physical distancing for COVID-19 have affected screening, diagnosis, treatment, and harm-reduction programmes. The COVID-19 pandemic has hindered access to hospitals and community clinics for diagnosis and treatment; deferring HCV treatment became an almost universal practice at peaks of the pandemic. Moreover, the incidence of viral hepatitis might have been increased by the reduced activity of harm-reduction centres.

Yet conversely the pandemic also presents  opportunities around infectious disease control that have previously stagnated on health agendas.

The way forward: Testing, treating and access to drugs

The widespread implementation of mass COVID-19 testing has shown that, with political will and adequate investment, population-level screening is feasible. These lessons can and should be applied in the context of viral hepatitis and can be useful to design and strengthen strategies to scale up testing and treatment by point of care testing  for hepatitis C and B.

In countries with high burden of tuberculosis, for instance, the GeneXpert diagnostics long used to identify TB were also used for SARS-2-CoV screening. Why not to do something similar for HBV or HCV? Why not to go that step further and leverage COVID-19 vaccinations efforts to screen for HCV and HBV? A recent pilot study in a suburb of Madrid with a high density of drug use, did just  that.  Nearly 1 out of 10 people tested positive for HCV at the COVID-19 vaccination site.

 An economic modeling analysis undertaken for the recent EASL-Lancet  Commission on Liver Disease in Europe indicated HCV elimination in Europe will not be achieved without the scaling up of testing, treatment, and prevention interventions. HCV elimination requires a very high coverage of testing – 90% diagnosis rates by 2030 and more than 80% cent  of infected people treated. It also requires expanded harm-reduction initiatives among people who use drugs (PWID) and thus are among those at highest risk of infection via contaminated needles. Estimates are that meeting the elimination goals would require increased uptake of clean needle and syringe exchange programmes among PWID groups from roughly 12% to 50%.

Another crucial component to achieving HCV elimination is movement of treatment from the hospital  to the primary care or community settings to help ensure that countries have the capacity to treat the increased numbers required and vulnerable populations. In addition, there is increasing evidence that providing treatment in primary care or community settings increases retention in the care cascade and is cost-saving compared with treatment in tertiary settings.

 And much like the debate around COVID-19 vaccine inequity, high prices  for licensed HCV treatments are simply another a barrier to ending the disease for those people most affected. Drug  prices are arrived at by negotiations on a country-by-country basis and these negotiations in turn depend on budget allocations but also target treatment numbers and the consequent revenue stream guaranteed to the originators. The United Kingdom is a good example of this.

Harmonisation of pricing will improve transparency and enhance treatment strategies. A post-pandemic Europe needs to adopt policies designed to maximise equitable actions to improve health, ranging from pooled procurement and drug use.

The World Health Assembly has a strategy for the elimination of viral hepatitis as a component of the 2030 Agenda for Sustainable Development but only a few high-income countries are projected to meet that target.  The WHO viral hepatitis elimination aims are, however, achievable. Eliminating viral hepatitis is one of the most achievable health SDG targets. We have the tools to effectively prevent, diagnosis treat and cure viral hepatitis. The science is there. We just need to get on with it.

Maria Buti is the European Policy Councillor at the European Association for the Study of the Liver (EASL). EASL is hosting the Viral Hepatitis Elimination 2022 Summit 24-25 February.

Image Credits: hepatitisc.org.au, David Moreno Gonzalo/YPYD , Flickr: CDC Global, WHO.

WHO representative, Francis Kasolo, left, with UNICEF representative, Anne-Claire Dufay as first COVAX vaccine doses arrive on 24 February 2021 in Accra, Ghana,

Within one year, Africa has gone from waiting for its first COVID-19 vaccine shipment from the WHO-supported global COVAX facility to having excess doses available that some countries are  struggling roll out efficiently.  Reflections on the first anniversary of the massive COVAX vaccine rollout. 

On 24 February 2021, Health Policy Watch reported the global COVAX facility delivered its first doses In Accra, Ghana’s capital city.  It was a feat that WHO Director General Dr Tedros Adhanom Ghebreyesus described then as the culmination of many months of planning, research, negotiation & coordination.

“But it’s just the beginning. We still have a lot of work to do to realize our shared vision for vaccine equity by starting vaccination in all countries within the first 100 days of the year,” he said.

One year later however, hundreds of millions of doses have now been received by more than 50 African countries, and the challenge now has shifted to the ability of countries to efficiently roll out available vaccines. 

Dr Phionah Atuhebwe, WHO Regional Office for Africa

Addressing journalists on Thursday, Dr Phionah Atuhebwe, “new vaccines introduction officer” at the WHO Regional Office for Africa, said when the first shipment of COVID-19 vaccines was received by the COVID facility to Ghana, it came with a wave of hope and excitement that the milestone would signal a turnaround in the pandemic that was raging through the world and the continent.

A year later, around 680 million doses have been delivered to Africa. 65% of these from COVAX, 6% from the African Vaccine Acquisition Trust, and the rest from bilateral deals and donations.

But the continent lags behind the rest of the world. “Only 13% of the African population has been fully vaccinated in comparison with 55% globally,” Atuhebwe said.

At the same time, the picture is not all gloomy, she said noting that “over 400 million doses of these have been administered amidst excitement and disappointments, some highs and many lows. Africa has taken on the largest vaccine rollout in its history.”


Aurélia Nguyen, managing director of the Office of the COVAX Facility, at Gavi, the Vaccine Alliance told reporters that despite the severe supply setbacks experienced for COVAX during most of 2021, a "new paradigm" is happening today.  

“I'm happy to say that COVAX is operating under a new paradigm with current supplies that is now able to meet demand,” she said. “We have the ability to be responsive to countries' individual vaccination strategies. And this means ensuring that countries have stocks in countries so they can administer literally as fast as they are able to. It also means operating longer term feasibility [assessments] on supply.”

Nagging problems remain with roll-out in the 18 countries in the region that have fully vaccinated less than 10% of their populations - including three countries that have not yet vaccinated even 1% of their population fully. Moreover, 29 countries have used less than 50% of the vaccine stocks that they currently have at hand. 

Among the 24 countries that are reporting complete data on vaccination, only 21% of adults over the age of 50 years have been fully vaccinated; and only 11% of people with comorbidities are reported to be fully vaccinated in 20 countries that are providing this data.

“Worryingly, a sizable proportion of the highest risk populations in Africa remains unvaccinated,” Atuhebwe told journalists.  And even if Omicron passed over region with comparably fewer deaths, lack of vaccination still leaves people more vulnerable to future SARS-CoV variants, experts worry.  

Still aiming for 70% target

Africa CDC director John Nkengasong says Agency is still aiming for 70% coverage

Even if Omicron is receding now, the WHO remains committed to a 70% vaccination goal for the continent - as a means of protection against future threats.  

“Countries have recognized this and are stepping up the pace rapidly as we race towards the mid-2022 target of fully vaccinating 70% of the world's population,” Atuhebwe said.

Of the 20 priority countries identified by the WHO in the African region for intensified support in vaccine rollout, 10 are currently conducting mass vaccination campaigns, which aim to reach at least 100 million people by the end of April.

Kenya setting an example

Kenya is one of the countries setting a new pace for scale-up.

During the first two weeks of the new campaign in February, Kenyan health services reportedly tripled the number of vaccine doses administered, as compared to the two previous weeks. In Guinea Bissau around 125,000 doses were administered during a two week campaign in February, as compared to 11,000 in the whole month of January, WHO officials reported.

WHO said mass vaccination campaigns will be rolled out in a phased approach in 2022 not only in these priority countries, but also in other countries across the continent. Gavi, UNICEF, Africa CDC, the World Bank and other partners are all working to support countries with the logistics, financing, planning and implementation of the campaigns, as well as helping to ensure that there is a robust social mobilization to drive demand for vaccines.

At a separate briefing, the Africa CDC forecasted that by the end of the first quarter of 2022, Africa will have received a total of nearly 304 million vaccine doses of vaccines from both AVAT and COVAX. 

AVAT’s Q1 2022 forecast is 44.6 million doses while Covax’s delivery forecast for the same period is 261.1 million. Some 13.2 million doses are also expected by AVAT as donations. Moreover, 25 African Union Member States are now offering booster shots (Pfizer BioNtech, J&J) following “full” vaccination with either a one- or two-dose regimen.

Strong coordination to get to 70%

Improved coordination among vaccine donors, AVAT, COVAX and African countries remains crucial if the continent will achieve the target of vaccinating 70% of its population by mid-2022, asserted Dr John Nkengasong, Director of the Africa CDC, in a separate briefing on Thursday. .

“COVAX and AVAT coordinate all the time. We talk all the time. We talk to vaccine donors and we speak to issues of expiration — what are the conditions of the vaccines you want to donate? When do they expire?

"We now take the responsibility to engage with member states. That is what we mean by coordination so that we don’t get ourselves in a situation where Donor A is giving vaccines to a country and Donor B is not aware,” Nkengasong said.

Loyce Pace, US Health and Human Services Assistant Secretary for Global Affairs at a briefing at the US Mission in Geneva on Wednesday, 23 February.

The United States will support Dr Tedros Adhanom Ghebreyesus in a second term as head of the World Health Organization – a move that is largely symbolic insofar as Tedros is running unopposed in the elections, scheduled for the 75th World Health Assembly, 22-28 May. 

Although over a dozen countries in Europe and elsewhere lined up as co-sponsors of Tedros’ bid for re-election last autumn, Loyce Pace, US Health and Human Services Assistant Secretary for Global Affairs, made what are probably the first overt expressions of support for Tedros’ candidacy, in a briefing with journalists on Wednesday. 

“It’s been really helpful to be able to work so closely with him,” Pace said in a conversation with a small group of journalists at the US Mission to the UN Geneva during a visit to city, where she was meeting with WHO, member states and other global health officials. 

‘Skim off’ most critical reforms on pandemic response with IHR rule revisions

Pace also spoke about the new US proposal to reform the International Health Regulations that govern WHO and member state responses to disease outbreaks – in a resolution that Washington wants to put before the upcoming WHA session.

The reforms were detailed in an exclusive report by Health Policy Watch published Wednesday. They would create clear criteria and timelines for countries to assess and report emerging disease threats to WHO, and WHO to other member states – within a matter of days.

Pace said the reform of the IHR was “really looking at how we can approach targeted amendments” to improve pandemic response – while longer-term negotiations over a broader pandemic convention or other multilateral agreement get underway.

“And so, so we really tried to just skim off what we thought would be the most critical enhancements that could be made…whether we’re talking about improved alert systems or, or other components, and some of the issues that are maybe tougher to tackle than others,” she said.

Greater opportunity to work in ‘partnership’ in DG’s second term

On the re-election of the WHO Director-General, Pace added, “In his first term, I think Tedros has always signaled his responsiveness to feedback from all member states. And we’ve seen that to be true in this administration, over the past year, certainly. So that’s encouraging.”

But she underlined that “Term Number 2 – that will overlap … with more time working with the Biden administration. And so that presents yet another opportunity to really think deeply and look closely at what we we do together moving forward.”

Indeed, Tedros first three years as WHO director general were rocky ones for WHO-US relations. Then US President Donald Trump, never a fan of the UN system, grew increasingly antagonistic to WHO and its DG as the COVID pandemic spread – accusing both of being China-leaning, before announcing that the US would pull out of the organization altogether in July 2020.

On January 21, 2021, just after being inaugurated, new President Joe Biden revoked Trump’s moves. In a video appearance at a WHO governing board meeting the same day,  Biden’s chief medical advisor Anthony Fauci greeted Tedros warmly as a trusted colleague and “dear friend“.  

Pressing Restart – United States Rejoins World Health Organization; “Leadership Is the Ultimate Vaccine” Says Top WHO Official

More transparency ?

However, behind the scenes, the Biden administration, Pace included, have not not been without their criticism of WHO and Tedros.

US officials have said that WHO needs to become more transparent about its budget planning and financial management – before Washingon would agree to a European initiative to increase fixed member state contributions along the lines of a German proposal – aimed at creating more budget stabiity for the world’s global health agency.

In her comments Wednesday Pace alluded only indirectly to such tensions, saying:

“I have no doubt that that openness on his part, on behalf of his team, will change.

“Given that the US is back so robustly and ready and willing to engage, I see even greater opportunity to work in partnership with him on that,” she added, without elaborating. 

Support for WTO waiver  – as negotiations resume in earnest 

Pace also reaffirmed the US support for a temporary waiver on intellectual property rights on COVID vaccines, as negotiations over the log-jammed measure resumed this week in the World Trade Organization.  

In October of 2020, India and South Africa brought forward a resolution to waive the WTO agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) for COVID vaccines – saying this would help jump-start more production and reduce prices for low- and middle income countries. But European Union opponents have blocked approval of the waiver for months, tabling counter measures for more limited technical changes to IP rules in a polarizing debate. 

Now, however, there are signs that the two sides are resuming talks in earnest with the aim of reaching agreement for the WTO’s 12th Ministerial Conference (MC12). The WHO MC12, postponed last November due to the pandemic, is now set for the week of 13 June in Geneva.

On Tuesday, following a meeting of the WTO’s TRIPS Council, Geneva-based trade officials said that talks had been “difficult but are moving in the right direction,” quoting WTO Deputy Director-General Anabel González. 

Bilateral dialogue between ministers and senior officials of the opposing WTO member blocs have intensified in the past weeks and days, and González has hopes that with some additional dedicated work a compromise could be reached soon, the officials reported. 

European Commissioner Ursula von der Leyen also said that she believed a “bridge” could be created between the positions on the waiver issue – after South Africa’s Cyril Ramaphosa called out Europe for blocking the initiative at the European Union-African Union Summit last week.  

Said Pace of the TRIPS waiver: “It’s something that we continue to speak to. You’re well aware also of our stance on the TRIPS waiver and our support of a TRIPS waiver for vaccines.”

But she added that:  “The President also has called for voluntary tech transfer. And that came through, hopefully, clearly in the summit he convened last year.” 

Scaling up regional vaccine manufacture and distribution

Pace also spoke of the need to scale up regional manufacturing of vaccines – as well as overcoming bottlenecks to actual vaccine distribuition.

 “And I mean by that, I mean shots in arms. You can talk about distribution, but it really has to make it to the end user, if you will, it’s something that we saw first-hand in our own country,” said Pace, referring to vaccine hesitancy and supply chain breaks that have characterized the US vaccine rollout.

Pace said the United States has been investing in South Africa, India, Senegal, and elsewhere, to try and spur investments in vaccines and other medical products to fight COVID.

Short-term, she also said that delivery of promised vaccine donations is “critical”, although not enough on its own. 

 “So obviously, we’ve shared 450 million vaccines with the world to date. And we’ve made a commitment to share over a billion. But it’s not just about sharing,” said Pace.