Charles Michel, President of the European Council

European Union President Charles Michel congratulated African countries for their efforts to stimulate more vaccine manufacturing capacity on the continent, in a upbeat opening address at the European Union-African Union Summit, which began Thursday.  

But in a more sobering note Wednesday, Stella Kyriakides, the European Commissioner for Health and Food Safety, called on global health players to prioritize preparations for the next pandemic. 

“The pandemic has been a challenge for all of us. For our citizens, for our societies,” Michel said in his opening remarks at the Summit in Brussels. “It opened our eyes and showed us our strengths, our weaknesses, our successes, our failures.”

European Union-African Union Summit opens, 17 Feb 2022

Against those challenges, he lauded the recent AU moves on achieving more vaccine self-sufficiency:  

“We have to look at what you have been doing in the African Union. In less than a year, you launched the manufacture of four vaccines to reduce pharmaceutical dependence on the African continent. And this is a project you devised for Africans, by Africans. Vaccine production capacity has been set up in South Africa, Senegal and Rwanda.” 

“For us as Europeans, we should be looking at a new way of working, of cooperating with you.” 

Michel was referring to BioNTech’s announcement Wednesday that it would set up modular “BioNTainer” vaccine production facilities in Rwanda and Senegal by mid-2022. 

That, in addition to South Africa’s production of the J&J vaccine, and a new WHO-backed mRNA vaccine hub in South Africa, which was the focus of a high-level WHO visit last week. 

In its gala event in Marburg, Germany on Wednesday, BioNTech executives said they will ship the plug-and-play vaccine facilities to Rwanda and Senegal in 2 modules of six standard freight containers, by mid-2022. 

The BioNTech announcement has been praised by leading African Union figures, including Africa CDC’s John Nkengasong and special envoy Michel Sidibé.

South Africa’s dilemma

But not everyone may be as delighted about the BioNTech initiative.   

Although South Africa was explicitly mentioned as a third “possible” participant in a BioNTech press release – President Cyril Ramaphosa was noticeably absent from the stage of Wednesday’s launch in Marburg – which featured the heads of state of Senegal, Rwanda and Ghana – alongside WHO and Africa CDC.  

Entering the Brussel’s summit on Thursday, Ramaphosa told reporters that he remains interested in pushing ahead on discussions about a temporary waiver of intellectual property restrictions on  COVID-19 vaccine production.

“We are going to discuss the TRIPS waiver,” he shouted back to a press pool – in reference to the hotly-debated waiver that has been sitting before the World Trade Organization TRIPS for over a year now. 

‘Not yet’ convinced by Europe’s moves

While Ramaphosa acknowledged that Europe had stepped up its vaccine donations, he said that  he was “not yet” convinced by the European moves. 

“We need to move through the TRIPS dispensation where we can make our own vaccines, and that will be very important,” said the South African leader who has placed his vaccine production bets on a new WHO-supported mRNA vaccine technology transfer hub, that would develop open-access brands of mRNA vaccines for not only COVID, but other diseases. 

That hub is centered around a group of Cape Town research and manufacturing institutions. 

But some of the hub’s success will depend on how easily it can navigate around existing patent rules on some cutting edge products, like mRNA COVID vaccines. 

Meanwhile, the TRIPS waiver has been staunchly opposed by leading EU countries, such as Germany, as well as by pharma groups that say bilateral deals between country and the private sector are a more stable basis for sustainable expansion of production capacity.  

Invest in health systems – prepare for the future 

Stella Kyriakides, the European Commissioner for Health and Food Safety

Speaking Wednesday on the eve of the Summit at the 7th EU-Africa Business Forum 2022, Kyriakides stressed that governments need to invest now in measures that can help prepare for future threats, which are sure to come. 

“We must not wait and be complacent. But we need to prepare today for future health emergencies,” Kyriakides said.

Kyriakides noted that while on its part, the EU has been introducing reforms to strengthen a “European Health Union”, the pandemic has expanded awareness that regional preparedness is no longer sufficient.  

 “In order for us to be truly prepared for emerging health threats, we need to be prepared globally,” she said.

In a related move, the European Investment Bank also pledged Thursday to commit some €500 million to a joint WHO-EU initiative strengthening African health systems on the continent.  Most countries continue to fall far short of the longstanding Abuja Declaration to allocate 15% of national government spending on health – and the pandemic has created further setbacks.

Partnering with the African Union 

Against that context, the EU wants to partner more with the African Union on challenges highlighted by the pandemic, such as the need to reinforce global disease surveillance, and building capacity to undertake emergency countermeasures. 

She also pledged the EU’s readiness to assist in building up preparedness by supporting the African Medicines Agency (AMA) and the African Preparedness and Response Authority (APRA). 

She called for the diversification of international supply chains and the resolution of bottlenecks in addition to the expansion of global production of vaccines and therapeutics. 

“Team Europe”, which includes the EU, EU Member states and European financial institutions, is supporting Africa in this regard with more than €1 billion to create an enabling environment for African vaccine manufacturing, and to tackle barriers related to supply chains and demand, she noted.

She also highlighted that the ongoing partnership between the European Centre for Disease Prevention and Control (ECDC) and the Africa CDC is resulting in mutual learning and improved health security for everyone.

The COVID-19 pandemic has also strengthened the mandate of the ECDC so it will be able to support epidemic and outbreak responses, and establish a more structured cooperation with public health actors in Africa.

Pledging the EU’s contined support for the AMA, she described its creation as a crucial moment in Africa’s journey towards a strengthened regulatory system, which will ultimately contribute to the promotion of sovereignty in Africa.

The COVID-19 pandemic has highlighted the need to build healthier, more resilient and more equitable societies, Kyriakides also underlined. But to achieve this, a number of ingredients are essential: 

“They include the availability of vaccines and therapeutics, but also innovation, data and information sharing. And equally important are the sustainable and locally led development as well as a reformed Global Health architecture. The key ingredient though, are partnerships, trusted and effective collaboration, which needs to be based on the exchange of ideas of experiences and perspectives,” she concluded. 

Summit – focus on health systems and vaccine production 

Health is just one of about eight themes of focus at the two-day Summit – along with education, agriculture, climate change, finance and global governance. 

But in the wake of the destabilization created by the pandemic it clearly has even greater importance to participants now – in comparison with past years. 

The EU and AU leaders also are meeting against the backdrop of high regional geopolitical tensions – posed by the continuing threat of a Russian invasion of Ukraine.

A Summit press briefing reaffirmed the prior EU commitment to provide 700 million vaccine doses by mid-2022 to developing countries, of which at least 450 million would go to Africa. 

“Team Europe has exported more than half of its production since the crisis began; it supported the creation of ACT-A [the WHO-supported Act Accelerator] which has delivered more than one billion doses (including 350 million vaccines for Africa). And European countries have shared doses destined for their own citizens, including 125 million to African countries where it is the principal donor.” 

Emmanuel Macron, President of France

Along with Charles Michel, the Summit is being hosted by the President of the European Commission, Ursula von der Leyen and French President Emmanual Macron, whose country currently holds the rotating presidency of the EU Council. 

In his keynote remarks before the Summit, Macron also reaffirmed the need to support African health systems, wrought by the COVID-19 pandemic.

“The COVID-19 pandemic has thrown all of our agenda into the air. It’s been more difficult for African countries to deal with COVID because it is a health, economic and social crisis which has been brought to bare on more fragile economies which are on the verge of development, making it even more costly. African budgets do not have the ability to absorb these shocks as ours do,” said the French president.

european investment bank
WHO DG Tedros Adhanom Ghebreyesus and EIB President Werner Hoyer.

The European Investment Bank said Thursday that it would commit €500 million to improving African health systems, as part of a new initiative with the World Health Organization and the European Union.

The joint EIB-WHO-EU statement coincided with the start of an EU-African Union Summit, which is set to talk about how to improve health systems in Africa, as well as stepping up vaccine production.

While there have been some recent, big strides to jump-start more African vaccine manufacturing and related R&D, including in the WHO-supported South African mRNA hub and a BioNTech modular vaccine manufacturing initiative, announced only yesterday (hyperlink please to those two stories), much less attention has been focused on health systems, which are the backbone for service delivery.

And recent data suggests that African health systems, like others worldwide, continue to suffer setbacks in delivery of other routine services, due to the pandemic.

That, along with being chronically underfinanced – with most countries far from the Abuja goal of investing 15% of GDP in health services.  Only two countries – Rwanda and South Africa – had reached the 15% target in 2011, while seven had actually reduced their health budgets proportionate to their national budgets.

The situation had deteriorated further in 2016, with 19 African countries spending less on health as a percentage of their public spending than in the early 2000s. According to the 2016 WHO report, countries with high per capita income such as Algeria, Botswana, South Africa, and Seychelles, do not systematically spend more of their budgets on health, while lower income countries such as Ethiopia, Gambia, and Malawi – have in fact surpassed the 15% goal.

The new initiative aims to address both the pandemic-related and more systematic issues, said a WHO press statement on the EIB investment.

It noted that the investments would be focused on “restoring, expanding and sustaining access to essential health services and increasing financial risk protection; access to vaccines, medicines, diagnostics, devices and other health products; scaling innovative primary health care service delivery models and investing in a health workforce to deliver effective quality care.

“The shared goals of the partnership will achieved by applying a country-led and country-driven approach, identifying gaps in national health systems, designing strategies for interventions and their corresponding investments plans, investing in health system projects and programmes, convening capital providers, supporting implementation and monitoring impact,” said WHO.

EIB President Werner Hoyer, said that the goal of the initiative is to mobilize €1 billion of new investment “to strengthen public health across Africa.”

Said WHO Director General Dr Tedros Adhanom Ghebreyesus: “The COVID-19 pandemic is a powerful demonstration that when health is at risk, everything is at risk. Investing in health across Africa is therefore essential not just to promote and protect health, but also as a foundation for lifting people out of poverty and driving inclusive economic growth.”

Image Credits: EIB/Twitter.

depression homelessness
Street scene in Metro Manila, Intramurous district, Philippines. 80-90% of those with depression are left untreated or undiagnosed in low- and middle-income countries. Homelessness is one adverse experience that may cause depression.

With about half of people suffering from depression in high income countries untreated or undiagnosed, with this number rising to 80-90% in low- and middle-income countries, a Lancet and World Psychiatric Association Commission have called for a unified response against this global crisis to reduce the burden of depression.

Depression is estimated to impact 5% of adults globally, with its onset most frequent in young people. COVID-19 has caused ‘mass trauma’ worldwide and has further worsened mental health for millions, creating additional challenges with isolation, bereavement, uncertainty, hardship, and limited access to healthcare. 

To combat the crisis, the Commission’s ‘Time for united action on depression’ calls for a concerted and collaborative front from all – government, healthcare providers, researchers, and people living with depression, to improve care and prevention, fill knowledge gaps, and increase awareness for one of the leading causes of avoidable suffering and premature death worldwide. 

“Depression is a global health crisis that demands responses at multiple levels,” said Commision Chair Professor Helen Herrman.

“This Commission offers an important opportunity for united action to transform approaches to mental health care and prevention globally.”

The report is authored by 25 experts across 11 countries, from experts in neuroscience to global health. It is advised by people with experience of depression. 

Myths surrounding depression fuel inaction 

Myths surrounding mental health have fueled inaction.

While 70-80% of people who die by suicide in high income countries, and around half in LMIC, suffered from mental illness, with depression as the most common cause, myths surrounding this health condition have fueled global inaction towards depression. 

The myths include the misconception that depression is simply sadness, a sign of weakness, or restricted to certain cultural groups.

Depression also has an under-recognized social and economic toll, with the loss in economic productivity linked to depression costing the global economy an estimated $1 trillion a year. 

“There is arguably no other health condition which is as common, as burdensome, as universal, or as treatable as depression, yet it receives little policy attention and resources”, said Commission Co-Chair Associate Professor Christian Kieling, of the Brazil-based Universidade Federal do Rio Grande do Sul. 

The Commission does stress that depression is distinctly a health condition that is characterized by persistence, as it inhibits daily functioning and may lead to long-term health consequences. Depression may also impact anyone, regardless of gender, background, social class, and age, though symptoms and signs of depression may vary among groups.

Society and individual strategies proposed 

Mental health services for children and adolescents have been disrupted due to COVID-19. Solutions to reduce the global burden of depression need to prevent adverse experiences in childhood.

Whole-of-society and individual level strategies have been proposed by the Commission to prevent depression, focusing on reduced exposure to adverse experiences in childhood, lifestyle factors, and other stressful events, including financial crisis or bereavement. 

“Prevention is the most neglected aspect of depression. This in part because most interventions are outside of the health sector”, said co-author Dr Lakshmi Vijayakumar from SNEHA, Suicide Prevention Centre and Voluntary Health Services of Chennai, India.

Vijayakumar further noted how crucial these prevention efforts are. 

“In the face of the lifelong effects of adolescent depression, from difficulty in school and future relationships to risk of substance abuse, self-harm, and suicide, investing in depression prevention is excellent value for money. 

It is crucial that we put into practice evidence-based interventions that support parenting, reduce violence in the family, and bullying at school, as well promoting mental health at work and addressing loneliness in older adults.”

Current classification of depression is ‘too simplistic’ 

The current classification that places people with symptoms of depression into just two categories – either they have clinical depression or not – remains too simplistic, says the Commission. 

Instead, the Commission supports a personalized, staged approach to depression care that tailors and recommends interventions to the individual and the severity of their condition. These treatments range from self-help to lifestyle changes to psychological therapies. 

“No two individuals share the exact life story and constitution, which ultimately leads to a unique experience of depression and different needs for help, support, and treatment”, explained Commission Co-Chair Professor Vikram Patel from US-based Harvard Medical School. 

In addition, the Commission also proposes collaborative care strategies that incorporate locally recruited, widely available non-specialists such as community health workers and lay counselors. 

Ultimately, they conclude that greater investment is needed on behalf of the government to reduce the damaging impact of poverty, gender inequity, and other social inequalities on mental health.

Said Patel: “Tackling the climate emergency, the COVID-19 pandemic and other global and regional emergencies that exacerbate existing inequities and threats to health, including pursuit of the UN Sustainable Development Goals, must also be vital parts of efforts to prevent depression.”

Image Credits: Wayne S. Grazio, Nenad Stojkovic/Flickr, WHO/NOOR/Sebastian Liste.

US Secretary of State Antony Blinken

CAPE TOWN – The US and Africa intend to use the well-established community networks supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) to improve the uptake of COVID-19 vaccines in Africa.  The initaitive would build upon the infrastructure developed since PEPFAR entered as a major player on the African AIDS scene in 2003. 

In addition, USAID has launched an initiative called Global VAX to support the World Health Organization (WHO) target of vaccinating 70% of the world’s population by mid-year against COVID-19, and will soon be announcing priority countries in Africa.

This is according to US State official Mary Beth Goodman, who briefed African journalists on Tuesday on the COVID-19 Global Action Meeting convened by US Secretary of State Antony Blinken on Monday.

“We’re leveraging opportunities through things like PEPFAR, which has an extraordinary network across the African continent in combating HIV/AIDS and has a network of community workers and leaders who are helping to work with us to also talk about some of the importance of COVID,” said Goodman, who is Acting Coordinator for Global COVID-19 Response and Health Security at the US Department of State.

“The same is true of our Presidential Malaria Initiative and other efforts that have long been in place on the continent.

“We actually have launched through USAID and the Centre for Disease Control, a programme that we’re calling Global VAX,” added Goodman. 

“The effort behind Global Vax is all about the uptake issues. How do we turn vaccines into vaccinations? How do we connect the dots to make sure that we are getting these vaccines distributed in a way that allows more people to have the opportunity to take the vaccine and that allows some of these countries which are lagging to meet the 70% target?”

Blinken’s six-point ‘GAP’ plan

Ghana, Africa
Ghanian health worker Evelyn Narkie Dowuona holds up her COVID-19 vaccination card.

Blinken presented a six-point COVID-19 Prioritized Global Action Plan for Enhanced Engagement (GAP) to foreign ministers and senior leaders from countries and international organizations invited to his virtual meeting.

“Together, we identified urgent gaps in response activities and aligned around specific roles to advance global efforts aimed at bringing this pandemic under control and strengthening readiness for future global health threats. We agreed that more political leadership is needed to save lives and end this pandemic cycle in 2022,” said Blinken in a statement issued late Monday.

He identified the “six lines of the global effort to respond to acute pandemic needs” as:

  • Getting Shots in Arms: coordinated efforts to improve vaccine readiness and logistics, in step with increased donations and procurement, toward the goal of at least 70% of the population fully vaccinated with quality, safe, and effective vaccines by September 2022. 
  • Bolstering Supply Chain Resilience: mechanisms to facilitate sufficient and steady supplies of critical products and materials to break this cycle of the COVID-19 pandemic, including establishing mechanisms to identify and remove medical supply chain bottlenecks.
  • Addressing Information Gaps: global efforts to enhance vaccine confidence and combat the spread of false information, enlisting regional champions and medical, civil society, young people, and faith leaders to use evidence-based, accurate, locally relevant messaging.
  • Supporting Health Workers: protecting the health, safety, and wellbeing of frontline health workers, including the need to improve their training and numbers to effectively support the COVID-19 response.
  • Ensuring Acute Non-Vaccine Interventions, including the provision of therapeutics, testing regimes, and oxygen where needed most.
  • Strengthening Global Health Security Architecture to end the current pandemic and. secure future preparedness for health emergencies at the national, regional and global level.

Blinken also announced a direct donation of 5 million doses of Johnson & Johnson’s COVID-19 vaccine to the African Vaccine Acquisition Trust (AVAT), the African Union’s vaccine procurement and distribution effort. The US has now donated more than 155 million doses to Africa and 435 million doses worldwide.

Praise for Uganda vaccine effort

Ugandan Health Minister Dr Jane Ruth Aceng (left) and French Ambassador to Uganda Jules-Armand Aniambossou with donated AstraZeneca COVID-19 vaccines.

In his address to the GAP meeting, Blinken praised Uganda for its massive vaccination effort in November and December last year as an example of what is possible.

“In early November, only 14% of all Ugandan adults had received their first dose of the vaccine,” said Blinken.

“Then a major team effort commenced. The Ugandan government led a mass vaccination campaign, carried out by hundreds of health care workers,” he added, and “by late December, almost half of all adults in Uganda had received their first shot – from 14 to 47% in just six weeks”.

Participants in the GAP meeting included  Australia, Canada, Colombia, France, Germany,  India, Indonesia, Italy, Japan, the Republic of Korea, New Zealand, Saudi Arabia,  Senegal, South Africa,Spain, UK, the African Union/Africa Centres for Disease Control, the European Commission, and the WHO.

They have all committed to coordinating parts of the six key areas identified.

Meanwhile, WHO Director-General Dr Tedros Adhanom Ghebreyesus told the meeting that “in some countries, high vaccine coverage, combined with the lower severity of Omicron, is driving a false narrative that the pandemic is over”.

However, the low vaccine coverage and low testing rates in other countries “are creating the ideal conditions for new variants to emerge”, warned Tedros, adding that 116 countries are off track to vaccinate 70% of the population by the middle of this year.

“We can bring the pandemic under control this year – but we are at increased risk of squandering that opportunity,” said Tedros, adding that “in many countries, the issues are not primarily a problem of absorptive capacity. We need to urgently support political leaders to accelerate the rollout of vaccines”.

Image Credits: WHO, Health Journalist Network.

A mother and her child in the Haji camp for internally displaced people in Kandahar, Afghanistan.

More and more children are losing their lives to a measles outbreak in Afghanistan as the country struggles with a humanitarian crisis under the US sanctions on the country’s Taliban regime.

Following the Taliban’s takeover of Afghanistan, the US Department of the Treasury froze Afghanistan Central Bank’s reserves, mostly held in US banks, as the Taliban has been on its “specially designated global terrorist group” since 2002, and any support for the group is illegal.

The measles outbreak has hit the malnourished children hard in some of the already marginalized and poor communities in Paktika, Ghor, Badakhshan and other provinces of Afghanistan.

The World Health Organization (WHO) last week confirmed that the number of cases and deaths increased by 18% in the week of 24 January, and 40% in the week of 31 January. Health Policy Watch reported last week that WHO Director-General Dr Tedros Adhanom Ghebreyesus met with the Taliban in Geneva to discuss Afghanistan’s health challenges.

Struggle for meals in the pandemic  

According to the global health body, as many as 35,319 suspected cases of measles and 156 deaths have been reported in Afghanistan between 1 January 2021 and 29 January 2022. Of these, 3,221 cases were laboratory confirmed while 91% of these cases and 97% of these deaths were in children under five years of age.

The WHO says that the rise in measles cases is especially concerning because of the extremely high levels of malnutrition in Afghanistan. This weakens immunity, making people more vulnerable to illness and death from diseases like measles – especially children.

Local civil society activist in Paktika, Abdul Bari, mentioned that with the fall of the previous government, thousands of people lost their jobs and could not support families for months now that ultimately led to malnourishment and spread of the diseases.

 “Many families who were doing relatively well in the past now find them among the so many very poor in the society that struggle to feed one or two meals in Paktika”, he said.

Authorities in Badakhshan province told the Health Policy Watch about an outbreak of measles worst affecting the remote Kuf Ab and Kohistan districts of the province where poverty is widespread.

“The measles outbreak has been spreading in the province for the past two months and has spread to ten districts, including the capital Faiz Abad”, he said, adding that so far no organization or health institution has come to their aid and many children have died due to the disease in Kuf Ab and Kohistan districts.

Equally remote and poor, Ghor province in the central highlands of Afghanistan is the second flashpoint for the measles outbreak according to the Afghan authorities. 

The provincial health department head, Mohammad Nazim, told the Health Policy Watch that more than a thousand children have been referred to the province’s central hospital recently and 21 of whom have died because of measles.

“The reason for the spread of measles is the non-implementation of the vaccination program firstly due to the coronavirus pandemic and then the security concerns and lack of funds”, he said.

 Crumbling Healthcare System

In December 2021, a measles outbreak response immunisation campaign was carried out with the support of the WHO in some of the most affected provinces, reaching 1.5 million children.

Battling for survival, Afghanistan’s fragile health system has been on the edge for months in the wake of the COVID-19 pandemic, the Taliban takeover of power and the subsequent US freezing of Afghanistan’s state reserves.

In Ghor, the regional public hospital sources said the doctors and support staff is so overstretched and under-paid that it can collapse any moment in the wake of mounting cases of COVID-19 and now the measles outbreak.

Kabul-based paediatrician Dr Zar Wali told the Health Policy Watch that malnutrition among children was severely compromising their immune system. “On a daily basis I am receiving dozens of child patients from the city (Kabul) as well as the nearby provinces, and there is this clear pattern of malnourishment in almost all, which makes them susceptible to all sorts of diseases”.

This was echoed by the UN Children Fund (UNICEF) last week when it warned that as the humanitarian crisis deepens in Afghanistan, hospitals were receiving so many cases each day of children suffering complications associated with severe acute malnutrition.

After relatively low transmission in 2019 and 2020, new infection cases have been increasing in all provinces since the end of July 2021, with the highest weekly toll observed so far occurring over the last four weeks.

The WHO has warned that although the number of deaths is relatively low, the rapid rise in cases in January 2022 suggests that the number of deaths due to measles is likely to increase sharply in the coming weeks.

Being endemic in Afghanistan, more than 25,000 children get killed by the measles virus annually, according to the Ministry of Public Health, and many more struggle with its impacts.

The WHO has expressed willingness to prepare a plan for a larger measles outbreak response immunisation campaign, which will start in May (or earlier, if possible), aiming to reach more than 3 million children in Afghanistan.

 

Image Credits: © UNICEF Afghanistan.

Margaret Ndomondo-Sigonda, Head of the African Medicines Regulatory Harmonisation Initiative at AUDA-NEPAD

The African Union could decide on the host country for the African Medicines Agency (AMA) as early as July, while the agency’s director-general should be appointed by the end of the year.

This is according to Margaret Ndomondo-Sigonda, Head of the African Medicines Regulatory Harmonisation Initiative at AUDA-NEPAD, the African Union’s development agency.

The AU Assembly had recently decided to “do an assessment of the countries that have offered to host the AMA headquarters”, she told a workshop convened by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) on Monday ahead of the EU-AU Summit which starts in Brussels on Thursday.

“The AU Commission and AUDA-NEPAD are working together, and the teams are set to go out in the first week of March,” said Ndomondo-Sigonda, adding that the country visits may take two months to complete. 

“Once they are done, then the assessment report will be presented before the first meeting of the Conference of the State Parties that is planned to be held sometime in May,” she added.

Whatever decision is made by this body would have to go to the AU Assembly during its meeting in in June or July, “so by July we will know which countries actually hosting the headquarters for the African Medicines Agency,” she added.

The Assembly comprises of all Member State Heads of State and Government is the AU’s supreme policy and decision-making organ. 

Director-General may be appointed by year-end

As far as the appointment of the head of the AMA – its director general –  is concerned, this would take a little longer.

First, the Conference of the State Parties would have to consider the terms of reference for the position at its May meeting, and advertisements will only go out after that.

“By the time we get to know who has been appointed as the director-general, it will probably be quarter three or quarter four this year,” she said.

She added that AMA was being established as “a specialised agency of the African Union with its autonomy in terms of financial and human resources, so it’s going to be operating differently from what you see with Africa Centres for Disease Control at the moment”.

Meanwhile, UNAIDS Executive Director Winnie Byanyima welcomed the imminent establishment of the AMA.

“Since the very beginning of the COVID crisis, the multilateral response may have failed us but African leadership has been remarkable,” said Byanyima at a workshop on Monday. “The newly created African Medicines Agency will harmonise medicine regulations, and negotiate joint purchasing and the manufacture of our own medicines.”

A staff member at Afrigen, the mRNA hub in South Africa, prepares part of the vaccine.

The major players in the European and African pharmaceutical sectors have called on the European Union (EU) and the African Union (AU) to support the creation of a permanent “business platform” to foster the pharma industry’s development in Africa.

This emerged at a workshop Monday hosted by the the European Commission’s Directorate General for Internal Market, Industry, Entrepreneurship and SMEs (DG GROW) along with the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), and other European-based pharma associations. The workshop was part of the European African Business Forum (EABF) taking place ahead of, and along with, the European Union–African Union Summit, which begins Thursday in Brussels.

The business platform should support the development of EU and AU policies conducive to trade and “sustainable financing mechanisms models with access to low-interest capital” and appropriate incentives to encourage local, regional and international private sector investment, according to IFPMA Assistant Director-General Greg Perry, speaking at the Monday EABF session leading up to the Summit.

Businesses also want a “stable business environment that respects business ethics and incentivises local innovation and entrepreneurship, including through intellectual property, ensure development and retention of local skilled workforces”, said Perry, reading from a joint statement by the EABF’s Healthcare Working Group, which also includes the European Federation of Pharmaceutical Manufacturers and Associations (EPFIA) and Vaccines Europe.

The pharmaceutical sector also wants voluntary and mutually agreed upon technology transfers and joint ventures; timely product registration, harmonisation of regulation particularly through the African Medicines Agency, and the implementation of the African Continental Free Trade Area to eliminate non-trade barriers and foster international supply chain security.

“We believe that creating this platform with the support of the EU and the AU, we could facilitate African and European partnerships, support existing continental and regulatory initiatives and create a win-win for both Africa and Europe,” said Perry.

Where is the money that was promised?

Karim Bendhaou, who also chairs the IFPMA Africa Engagement Committee

Emmanuel Mujuru, representing the Federation of African Pharmaceutical Manufacturers (FAPMA), said that the African pharmaceutical industry was struggling to access affordable financing. 

“This financing has to both long-term in nature and have affordable interest rates, either in the form of loans or equity participation in already established African pharma management companies,” said Mujuru.

He added that there was a significant opportunity for European investors as between 70 and 90% of essential medicines consumed in Africa were imported and that the pharmaceutical sector was growing at over 10% per annum, second only to Asia. 

Merck’s Karim Bendhaou, who also chairs the IFPMA Africa Engagement Committee, said that while setting up fill and finish operations “is easy to implement in two years”, he had tried to do so in three different African countries but “local private sector investors have never been able to get access to any finance”. 

“Why? The International Finance Corporation has announced $4 billion for the local vaccine manufacturing and the European Commission has announced one billion Euros,” asked Bendhaou

“We also have to invest in the health system capacity because otherwise, you can have a nice factory in in South Africa, a beautiful factory in Egypt, producing hundreds of millions of doses but if you don’t have a health system in place for the uptake and to absorb this capacity,” he added.

What about Gavi subsidies?

Biovac CEO Patrick Tippoo

Meanwhile, Patrick Tippoo, CEO of the South African company, Biovac and part of the African Vaccine Manufacturing Initiative (AVMI) leadership, said that much of Africa’s vaccine supply “comes in a subsidised form, partially or completely by Gavi through UNICEF”. 

“We know that Gavi drives prices down to make vaccines more affordable so more vaccines can be purchased and therefore distributed,” said Tippoo

“We have a current situation where about 40 of the 54 countries depend on this mechanism. And therefore the market in Africa is actually in Copenhagen, as some people say. 

“This is a structural thing that will have to be addressed because, in order to stimulate and incentivize technology transfers, investment in skills, development, regulatory capacity building –  and all the things that we repeat ad nauseum – there needs to be an assurance that there’s going to be a market when all of this is built,” he stressed.

Tippoo added that African governments and other stakeholders had to understand that a “resilience premium” would need to be paid to ensure that pharmaceutical manufacturing capability is built in Africa.

“There is no way in which vaccines coming out of Africa in the next five or 10 years can compete on a cost of goods perspective, with Indian manufacturer factories, or even multinationals because they’ve monetised the investment over time, and they have economies of scale,” he added.

Diversification a ‘win-win’ for Africa, Europe and globally

However, other participants pointed out that over the long-term, diversification of sources for pharma procurement is going to be a win win, given the comparatively limited number of suppliers, for some key global health products. Interruptions to key medical supply chains were particularly evident during the early stages of the COVID pandemic, exposing their fragility, even for more affluent countries.

Sibilia Quilici, Executive Director, Vaccines Europe, pointed out that from the European perspective, too, it would be beneficial to reduce dependence on what is now a comparatively small number of suppliers, mainly from India and China, and integrate Africa’s supply chains with global ones:

“In the context of this discussion on improving manufacturing capacities in Africa, also for APIs [active pharmaceutical ingredients] it is good to be aware that the EU, the largest API importer in the world is looking for supply chain diversification for products where dependence on a small number of suppliers from India and China is a concern.

“This could be a win-win for Africa, EU, local and global industry”.

Image Credits: Rodger Bosch for MPP/WHO, WHO .

Scientific journals need to cut ties with breast-milk substitute makers and the formula industry if they want to protect infants and young children from being at risk of malnutrition, illness and death, according to a paper published by BMJ Global Health.

“The promotion and support of breastfeeding globally is thwarted by the USD $57 billion (and growing) formula industry that engages in overt and covert advertising and promotion as well as extensive political activity to foster policy environments conducive to market growth,” write the 16 authors, who are mostly paediatricians, nutritionists and child researchers based in South Africa.

“This includes health professional financing and engagement through courses, e-learning platforms, sponsorship of conferences and health professional associations and advertising in medical/health journals.”

The authors report on an exchange they have had with the journal, Nature, since 2018 about removing advertisements from formula companies.

Even when journals merely advertise formula company publications that imply formula is “close to mother’s milk” this could influence health professionals’ perceptions and infant feeding counselling, they assert, adding that these advertisements are misleading. 

“Given these vulnerabilities, scientific journals have a professional and ethical responsibility to put additional protections in place to ensure that their brands are not associated with misleading advertising claims and to warn readers of the high risks associated with suboptimal breastfeeding,” the paper said. The authors push for journals to prioritise public health over profits and thus to have content that is in line with the global public health guidance. 

According to the paper, the risks of promoting breast-milk substitutes are especially consequential in low-and middle-income countries where access to healthcare is poor, and malnutrition in all forms is prevalent. Breast-milk substitutes and formula are neither affordable nor sustainable in such regions and leads to increased infant morbidity and mortality and are causes of suboptimal breastfeeding, the paper said. Suboptimal breastfeeding has caused an estimated 823,000 deaths among children each year, according to the journal. 

Companies that advertise and directly or indirectly promote their breast-milk substitutes in ways that contradict the International Code of Marketing of Breastmilk Substitutes adopted 40 years ago, effectively violate the rights of children to be fed in the best possible way, assert the authors.

 

 

Image Credits: WHO.

Matshidiso Moetic, WHO Regional Director for Africa

A partnership between Africa CDC and MasterCard Foundation, which has included visits to countries with model vaccination programmes, such as Rwanda and Morocco, is making a difference to other African countries facing challenges in getting jabs into arms.  

That and other measures aimed at supporting more rapid African roll out of COVID-19 vaccines are proving effective, said Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC) on Thursday. 

Meanwhile, WHO African Regional officials said that only 0.5% of COVID-19 vaccines received on the continent had actually gone to waste  — despite the fact that another recent  report suggesting that up to 35% of doses so far received are still awaiting distribution. 

Addressing journalists on Thursday, Nkengasong said the Saving Lives and Livelihoods initiative —  involving Africa CDC and MasterCard Foundation — have demonstrated results in at least four countries so far. 

“We have data from Sierra Leone, South Sudan, Cameroon and Tanzania where uptake of the vaccination really increased significantly once we sent in teams as part of the initiative,” Nkengasong said.

Delegations from those and other countries visited Morocco and Rwanda, where about 63% and 55% of the population respectively have been fully vaccinated, to learn about their model for success, he said.

“A set of countries, about 16, have actually been to Morocco to see their experience. Another set was in Rwanda. And as we speak, micro planning is going on for about 40 countries in Africa as part of that initiative,” Nkengasong told Health Policy Watch.

Along with site visits, the initiative is supporting countries to review their procurement processes; develop and finalize rollout plans; and ensure faster deployment of vaccines that are due to expire soon. 

 0.5%  Wastage 

africa cdc
Airfinity estimates of donated doses that have actually been adminsitered

On Wednesday, Health Policy Watch reported that only 65% of donated COVID-19 vaccine doses have been administered so far – with the remaining 35% yet to be used.  The largest proportion of donations, although by no means all of them, have gone to countries in Africa. 

However, Dr Richard Mihigo, WHO Africa Coordinator of Immunization and Vaccine Development, said that while there may be doses still awaiting distribution, actual wastage remains very small. 

Out of 635 million doses received so far, wasted doses have amounted to only about 3.5 million, representing only about 0.5% of the doses received, Mihigo said.

“If we look at the bigger picture, the continent has not done that bad at 0.5%,” Mihigo said.

He noted that the wastage that has occurred, is also due to the fact many donated doses have also arrived too close to their expiration date – making rapid rollout a huge challenge.

“So we cannot really condemn African countries because if you look at developed countries, we have also seen vaccines that have been destroyed,” Mihigo added.

To further ensure that vaccines are not being destroyed by African countries, Mihigo said the COVAX initiative has updated its engagement with African countries, ensuring that it only supplies the amount of doses requested by the countries according to their timelines — responding to country demands instead of pushing out vaccines through a top-down agenda.

“I think that the prospects in the future are looking quite good because countries are requesting vaccines that they can use. 

“But, also, WHO, UNICEF, GAVI, Africa CDC, are also putting out a strong statement on vaccines for each country to only receive vaccines that have a quite extended shelf life so that the country can be able to plan and deliver those vaccines on time,” he said.

Despite spread of new Omicron sub-variants, Africa on track to control COVID-19 pandemic in 2022

Meanwhile, Nkengasong, in his briefing, confirmed that the more infectious Omicron BA.2 subvariant now has become dominant in South Africa – and is slowly spreading elsewhere on the continent – after first being detected last month in Denmark and India. However, while the subvariant appears to be even more infectious than the original Omicron, experts have said it is not more deadly.  See related Health Policy Watch story. 

But WHO’s Regional Director for Africa, Dr Matshidiso Moeti, did not express undue concern over the continued mutation of the SARS-CoV2 virus, saying that Africa is on track to control COVID-19 pandemic in 2022 if current trends continue.

She said that over the past two years, African countries have become smarter, faster and better at responding to each new surge in cases of COVID-19.

“Against the odds, including huge inequities in access to vaccination, we’ve weathered the COVID-19 storm with resilience and determination, informed by Africa’s long history and experience with controlling outbreaks. But COVID-19 has cost us dearly, with more than 242, 000 lives lost and tremendous damage to our economies,” Moeti said.

While admitting that COVID-19 will be around for the long-term, she noted that there is optimism as 2022 can see the end of the disruption and destruction the virus has left in its path, and gain back control over lives on the continent. 

“Controlling this pandemic must be a priority, but we understand no two countries have had the same pandemic experience, and each country must, therefore, chart its own way out of this emergency,” she said.

The Rwanda experience

Albert Tuyishime, Head of Diseases Prevention and Control at Ministry of Health/Rwanda Biomedical Centre

The East African country of Rwanda has been recognised as one of the African countries that has been a model of vaccination progress. With 54% of its eligible population fully vaccinated – Rwanda has raced ahead of more developed South Africa – and ranks only second to Morocco in terms of coverage.   

Speaking at the Thursday Africa CDC briefing,  Dr Albert Tuyishime, Head of Diseases Prevention and Control at Ministry of Health/ Rwanda Biomedical Centre talked about how the country had achieved those results – driven by the highest level of the country’s leadership. 

“We also built on in-country multisectoral collaboration, effective partnerships, regional collaboration, and, especially, community engagement and research, science- and evidence-based decisions as well as interventions,” he said.

He noted that 66% of the Rwandan population had been vaccinated with at least one dose while 55% have received two doses, and 8% of the population have already received their booster dose. In addition, the country is now expanding vaccine access to children aged 5 to 11 years.

Image Credits: https://mcusercontent.com/2fe57162f164ecead64629b83/files/1d4e2b0b-bbe2-6050-0281-6e10c66eb3b2/1_billion_donated_v2.pdf?utm_source=Airfinity&utm_campaign=d1db73af86-EMAIL_CAMPAIGN_2021_08_02_12_31_COPY_01&utm_medium=email&utm_term=0_41a531e556-d1db73af86-517334173.

A molecular model of the Omicron subvariant BA.2

The BA.2 sub-variant of Omicron is now the dominant COVID-19 variant in South Africa, the head of Africa’s Centers for Disease Control and Prevention (CDC) confirmed on Thursday – raising questions about whether the continued global creep of the new SARS-CoV2 sub-variant could dash hopes of a much-needed COVID-19 reprieve.

“We have data from South Africa that the BA.2 lineage has now become the predominant variant in South Africa,” said Africa CDC director John Nkengasong at a regular online media briefing.

He added that the variant had already been detected in Botswana, Kenya, Malawi, Mauritius and Mozambique – and is likely present in other parts of the continent, as well.  That follows earlier reports from Europe, notably Denmark, and India where BA.2 is also overtaking the BA.1 version of the Omicron variant – becoming the latest variant to watch around the globe.

BA.2: Omicron’s ‘stealth’ sub-variant

Artist’s rendition of SARS-CoV2

The World Health Organization began monitoring BA.2 weeks ago, alongside other “sister” or “daughter” variants of the Omicron: BA.1.1 and BA.3. But BA.2 has been referred to as the “stealth” sub-variant because it has genetic mutations that could make it harder to distinguish from the earlier Delta variant, as compared to the original Omicron, according to the American Medical Association.

WHO already classified Omicron as a SARS-CoV2 variant of concern – alongside Alpha, Beta and Delta. Since BA.2 is “related” to Omicron, it is also a variant of concern.

Variants of concern, otherwise known as VOCs, are those variants about which WHO has enough data or signs to be concerned and warn the public to take extra care, explained Dr. Dorit Nitzan, former Coordinator of the Health Emergencies for WHO’s European region. 

“I would probably call it a sister,” Prof William Moss, Executive Director of the International Vaccine Access Center at Johns Hopkins University in Baltimore, told Health Policy Watch. “This sub-variant has actually been around for a long time. It was identified around the same time as BA.1 and so they are obviously genetically related like siblings. But we don’t really know the temporal sequence in which these variants evolved.”

What scientists do understand is that BA.2 is more transmissible, based on evidence that has emerged from India, Denmark and now South Africa, where BA.2 is becoming dominant in these settings – countries where BA.1 was most prevalent.

Last month, Danish scientists reported that BA.2 was around 33% more transmissible than the original Omicron strain.

“We conclude that Omicron BA.2 is inherently substantially more transmissible than BA.1, and that it also possesses immune-evasive properties that further reduce the protective effect of vaccination against infection,” the study’s researchers said.

BA.2: More transmissible, not deadlier

Other studies have found the variant to be as much as 50% transmissible, Nitzan said, though she added that the percentage does not really matter. What is important to know is that you can get infected faster.

Before WHO labels a variant a VOC, it first classifies it as a “Variant of Interest” or VOI, meaning that scientists are tracking the variant, but still learning about it.

“WHO is following many variants in many different lineages,” Nitzan told Health Policy Watch. “We know that many of them are not going to be developed.”

Omicron, however, is a variant that did develop and “it now appears to have its own little family,” she added:

“I think it could happen that just about everyone will have COVID,” Nitzan said. “It can happen if we cannot protect ourselves with masks, social distancing and good hygiene.”

And, of course, vaccination.

Moss said that while BA.2 is more transmissible, the good news is that it does not appear to cause more severe disease than the original Omicron strain, especially in people who have been inoculated. While vaccine effectiveness against Omicron infection appears much lower than what was seen against previous variants, it does still seem to be keeping most people out of the hospital.

He added that “the emergence and spread of BA.2 is not going to dramatically impact the course of the pandemic in the United States or European Union. It may just prolong it a bit.”

NeoCoV: ‘More attention than it deserves’

The research team prepares to gather samples from a dromedary camel in surveillance of MERS.

Another coronavirus discovered in bats last month has raised the eyebrows of some scientists: NeoCoV, a new bat coronavirus, was identified in South Africa.  It is of concern because it is closely related to the deadly MERS-CoV virus that has caused limited outbreaks since 2012 in countries around the Arabian Peninsula, where the virus is typically transmitted to humans from camels.

However, unlike MERS,  NeoCoV uses an ACE-2 receptor to infect cells  – the same mechanisms that has made SARS-CoV2 so infectious.

To date, no cases of NeoCoV have been reported in humans.

However, one pre-print study led by scientists associated with Wuhan’s Institute of Virology, warns that the NeoCoV virus could be on the threshold of human infectivity – due to its uptake of the ACE-2 receptor gene.

“Our study demonstrates the first case of ACE2 usage in MERS-related viruses, shedding light on a potential bio-safety threat of the human emergence of an ACE2 using “MERS-CoV-2” with both high fatality and transmission rate,” states the study, published in late January 2022.

“Notably, the infection could not be cross-neutralized by antibodies targeting SARS-CoV-2 or MERS-CoV,” the paper also adds.

The study also notes that NeoCoV has certain genomic characteristics of MERS-CoV, which was 20 times more deadly than the SARS-CoV2 Delta variant, for example –although much less transmissible.

“This unexpected ACE2 usage of these MERS-CoV close relatives highlights a latent biosafety risk, considering a combination of two potentially damaging features of high fatality observed for MERS-CoV and the high transmission rate noted for SARS-CoV-2,” the report said. “Furthermore, our studies show that the current COVID-19 vaccinations are inadequate to protect humans from any eventuality of the infections caused by these viruses.”

Notably, Wuhan’s Institute of Virology has been under international scrutiny for months due to suggestions from some international virus experts that a biosafety lapse at the laboratory that studies bat coronaviruses could have been the cause of the original Wuhan SARS-CoV2 leap into human populations.  That narrative has been  disputed by other experts who point to wild food chain sources as the  more likely original cause of infection – and even more adamantly by official Chinese sources, who have also sought to point attention to SARS and SARS-like virus threats elsewhere in the world.

A new WHO SAGO group of experts began meeting late last year to explore the narratives further – although China has not agreed to allow a second expert mission to enter the country  to further investigate the SARS-CoV2 virus origins.

Moss, however, said that in his view, NeoCoV is getting more attention than it deserves.

“There is no evidence that it can be transmitted from bats to humans,” Moss said. “My takeaway from NeoCoV is just a reminder that there are a wide-range of potential viruses with potential to cause spillover events.”

Image Credits: Delthia Ricks/Twitter, Trinity Care Foundation/Flickr, NIAID/Flickr.