Registered nurses look after newborns at the Princess Christian Maternity Hospital, in Freetown Sierra Leone

Geneva Health Forum’s Global Health Lab 3-5 May will showcase over 100 new diagnostics and treatment tools designed for resource-constrained settings. The Autothermo device for continuous, real-time temperature monitoring is one of the innovations being featured there. 

Early detection of patients’ temperature changes, especially in the case of newborns who lack adequate temperature control, can be lifesaving in almost any setting. 

This is especially the case for infants and newborns in hot climates, where conditions like hyperthermia, informally known as “evening fever syndrome” EFS can be life-threatening, particularly for premature babies in hospital and health clinic nurseries where cooling systems are inadequate  and air conditioning frequently fails. 

In addition, being able to leverage technology to monitor a child’s temperature in real time can also be important in many other contexts of childhood illness. 

And this is what the new device Autothermo aims to achieve. Autothermo is a wearable continuous temperature measuring bracelet with a remote display. It includes an alarm system and SMS capability for remote caretaker notification. It  is among more than 100 innovations on display at the Global Health Lab innovation exhibit next week. 

The exhibition is part of the Geneva Health Forum 3-5 May, which brings hundreds of global health policymakers and practitioners together from around the world. 

The Global Health Lab will be showcasing dozens of low-cost, digital, and hand-held tools that aim to make common diagnostic procedures and treatments more accessible, especially for resource-constrained countries.

Simple needs often overlooked in access to healthcare debates   

Autothermo team leader Nura Izath

When the poor state of healthcare in some African regions is discussed, it is often in the context of the lack of easy access to advanced automations and complex lifesaving procedures. 

While these concerns are valid, they often occlude, or minimize, the importance of certain basic-yet-essential indices such as body temperature. 

In human physiology, temperature is regarded as an index of illness because every metabolic reaction in the human body occurs at a certain temperature level. This makes it an age-old, but oft-forgotten index of disease and body states. 

However, a wide range of factors make adequate monitoring of this simple and basic metric challenging resource-constrained settings – including newborn nurseries. And this is what Autothermo is trying to address, the project’s team leader, Nura Izath, told Health Policy Watch.

“First of all, we have very few health workers, including pediatricians, versus the large number of newborns they have to manage at a time. It becomes hard for them to identify which newborns are in urgent need of thermocare interventions,” said Izath, a science and tech developer based in Mbarara, a city in south-central Uganda, who is the front-end developer and co-founder of the Autothermo innovation.

Managing 40 newborns at a time 

Autothermo’s innovation can be used to manage babies at risk.

At the Mbarara Regional Referral Hospital, for instance, there is only one nurse per shift, managing over 40 newborns in the hospital nursery at a time, notes Izath, who holds a degree from the Mbarara University of Science and Technology. 

Many of the newborns are premature or have other sensitive conditions, in which slight and subtle changes in temperature could signal the difference between life or death.  

“It’s so hard that by the time this nurse knows there is a baby in need of thermocare, it’s very late. In such scenarios we have lost lives. These are things that can be prevented by using interventions such as Autothermo.”

She says that the innovation should change the narrative regarding temperature management for newborns – insofar as health workers can remotely monitor babies at risk, and will also be able to prioritize thermocare interventions through the alerts they receive about newborns in need of the intervention.

“It will help them to manage the daily routines and will also save many lives,” she added.

Innovation emerged out of personal experience watching a young infant 

Izath’s innovation emerged out of a personal experience minding  newborn at home. 

“In 2014, I was tasked to babysit my one-day old nephew as his mother had to go for an exam,” she relates. “I was excited and at the same time understood the importance of this task. At the beginning, I held the baby until he slept, then kept checking on an almost 10 minute interval while I was doing other house chores. 

“To be honest, the back and forth was a bit tiresome. That’s when I thought of innovating something that could monitor and inform the parent or caregiver the status of their newborns in case of emergency and also support health workers in hospitals during admissions.” 

She shared the idea with a local clinician and pediatrician, Dr. Gloria Karirirwe – who quickly recognized the need such a device could fill in light of the challenges she had faced in her own practice, managing newborns with temperature-related challenges. 

They shared the idea further. Together with a group of six other professionals, they took the concept to Dr. Data Santorino, director of the Consortium for Affordable Medical Technologies, an innovation hub based at Mbarara University of Science and Technology, where Izath earned her degree.

“Dr. Data, together with his team, took us through concept development, proposal writing and the initial prototype development. Both the proposal and the initial prototype were helpful in aiding Autothermo to acquire its seed grant from the Ugandan Ministry of ICT and National Guidance. This fund was used to develop the minimum viable product that we currently have for studies.”

Also practical for outpatient clinics – where fever is one of main motives for seeking healthcare 

Other diagnostics and treatment tools, including Autothermo for newborns, will be found at Geneva Health Forum’s Global Health Lab 3-5 May

A fever also is one of the most common reasons for which parents will bring their toddlers and young children to a local health clinic or hospital, Izath adds. In fact, some 60% of children presenting to most medical emergency departments in Uganda have a raised temperature, she notes.

Unfortunately, many arrive too late — after complications have already set in — leading to febrile seizures and worsening of the underlying illnesses. High fever among under-fives can also result in heat stroke, often leaving affected children paralyzed and, sometimes, death.

Another selling point for Autothermo is that caregivers can easily interpret the temperature fluctuation situations and respond accordingly – based on the color-coded bars that it reports. And at a production cost of just $18 – it is a device that could be made widely available at simple health posts as well as hospitals. 

However, the Uganda-designed prototype still faces a long road ahead to obtain regulatory approval from the Ugandan National Council for Science and Technology.

“The health workers want to start using it but they cannot use it yet because we need  approval,” Izath said. “We are now seeking approval from the Mbarara University Of Science and Technology Ethics committee. After that, we will be moving to the Council. All these are the bodies that need to authorize the use of the Autothermo.” 

Izath will be attending the Geneva Health Forum, which will give her an opportunity to learn from other innovators in attendance, as well as seek out partnership and fund-raising opportunities.  

“We hope to see partnerships that can help us pilot studies in different facility settings. We also believe that the problem we are trying to solve is not only in Uganda, it’s a global challenge. We are not doing a solution only for Uganda. We would like to reach out to many stakeholders and see how we can make this come to light,” she concluded.

See the complete GHF 2022 programme. Register here: Until 2 May fees are CHF 400 for the entire event and CHF 150 for participants from low- and middle-income countries (OECD classification).  Daily rates are also available. 

Check out Health Policy Watch’s ongoing coverage of other themes featured at this year’s Forum on our GHF 2022 microsite

Image Credits: World Bank/Flickr, Unicef, Geneva Health Forum .

ebola
Ebola vaccination campaign in Mbandaka, Équateur Province (DRC) in 2020

In DR Congo’s latest Ebola outbreak, the two people with confirmed cases are dead and response is focusing on identifying and vaccinating contacts – because of insufficient doses to conduct a mass vaccination campaign in the outbreak area. Meanwhile, public health officials are trying to reboot Africa’s mainstream immunization programmes, which saw setbacks during the COVID pandemic. 

A targeted Ebola vaccination campaign aimed at tracing and immunizing contacts is underway in Mbandaka, a city in DR Congo’s north-western Equateur Province where two people with confirmed cases of Ebola have both died, according to the World Health Organization (WHO) on Thursday.

Addressing a press briefing on Thursday, Dr Mory Keita, Incident Manager for Ebola outbreak response in the DRC, confirmed the deaths of the two people with confirmed cases since the country’s latest outbreak was declared on April 23.

“So far, 78 direct contacts have been vaccinated and we are using the method of identifying contacts to vaccinate, because it has proven to be an effective means of quickly stopping outbreaks. And we do not have enough doses to vaccinate everyone in the country,” Keita said.

Dr Mory Keita, Incident Manager for Ebola outbreak response in the DRC

The vaccination exercise is commencing while DRC joins the rest of the world in marking the African Immunization Week, part of the larger World Immunization Week observance. For this year, attention is being drawn to what the WHO described as a surge in outbreaks of vaccine-preventable diseases over the past year.

Between January and March 2022 alone, WHO almost 17,500 cases of measles were recorded in the African region and this represents a 400% increase compared with the same period in 2021, WHO’s Africa Regional Office noted: 

“20 African countries reported measles outbreaks in the first quarter of this year, eight more than that in the first three months of 2021.” 

In 2021, 24 countries in WHO’s Africa region also confirmed outbreaks of a polio variant.  New yellow fever outbreaks were reported in 13 countries. as compared to nine  in 2020 and three in 2019. The agency has not yet reported on 2022 data. 

WHO noted that inequalities in accessing vaccines, disruptions by the COVID-19 pandemic including a huge strain on health system capacities impaired routine immunization services in many  countries and forced the suspension of other more routine vaccination drives.

“The rise in outbreaks of other vaccine-preventable diseases is a warning sign. As Africa works hard to defeat COVID-19, we must not forget other health threats. Health systems could be severely strained not only by COVID-19 but by other diseases,” said Dr Matshidiso Moeti, the WHO Regional Director for Africa. “Vaccines are at the heart of a successful public health response, and as countries restore services, routine immunization must be at the core of revived and resilient health systems.”

Lessons from COVID about vaccination in Africa

Professor Helen Rees, Executive Director, Wits Reproductive Health and HIV Institute, University of Witwatersrand, South Africa

As of April 28, only about 16% of the African population has been fully vaccinated against COVID. Even though this is still far from the 70% vaccination goal, it has been an enormous task for the continent’s public health stakeholders, as well as an eye-opener to the issues that influence and direct impact vaccination on the continent.

Delays in COVID vaccination in Africa – as rich countries hoarded vaccines – damaged overall uptake of COVID vaccines on the continent, said Professor Helen Rees, Executive Director, Wits Reproductive Health and HIV Institute, University of Witwatersrand, South Africa.

Africans, having already lived through two years of the pandemic without the vaccines, are now no longer very keen on getting the shots, she observed.

“The delay in accessing vaccines allowed misinformation and disinformation to come in. But it also allowed questions to be raised at the population level about “well, is this disease really as bad for us as we see in the northern hemisphere?

“And people don’t necessarily understand that we have different demographics, we have younger populations, we’re going to see more asymptomatic mild infections,” she said.

Dr Benido Impouma, Director of Communicable and Noncommunicable Diseases Cluster at WHO Regional Office for Africa

The perception of a reduced risk now presents a conundrum, necessitating a combination of strategies to scale up COVID-19 vaccination, Dr Benido Impouma, Director of Communicable and Noncommunicable Diseases Cluster at WHO Regional Office for Africa. 

“We are trying to diversify. In fact, our strategy is to ensure that we can first of all achieve high coverage in priority groups, and then as time goes on, we now go to the lower priority groups,” he said.  That has included running public service ads in social media in countries with a history of vaccine hesitancy during African Immunization Week, urging the general public to speak to their health care workers about the benefits of COVID vaccination. 

https://twitter.com/WHO_Tanzania/status/1520032402462158855

Image Credits: WHO/Junior D. Kannah.

Members of the WHO Working Group on Sustainable Finance hammer out the final agreement on increasing member state contributions this week, Germany’s Björn Kümmel on far left.

A core group of WHO member states have agreed on a landmark move to boost their annual “assessed” contributions to the global health organization to cover 50% of its core budget needs by 2028-2029 – but contingent on internal WHO reforms to boost efficiency and transparency.  

Partly in response to the reform call, a reshuffle of WHO’s senior management is expected to be announced shortly after WHO Director General Dr Tedros Adhanom Ghebreyesus is re-elected at the 75th World Health Assembly, which meets 22-28 May. 

That reshuffle is likely to include the departure of WHO Deputy Director Dr Zsuzsanna Jakab as well as WHO Health Emergencies Executive Director, Mike Ryan who has led the agency’s pandemic response in its first two years, diplomatic sources told Health Policy Watch.  

Jakab, a Hungarian health professional born in 1951, is already well over the WHO mandatory retirement age of 65 – which can be exceptionally extended only by three years at the decision of the WHO director general. She previously was the Regional Director for WHO’s European office.

Ryan, a seasoned health emergencies professional, may leave WHO to return to his family in Ireland, sources say, noting that two-years leading a response to the COVID pandemic has taken its toll on senior staff. However, others say that Ryan’s departure also reflects Washington’s desire to see new leadership in the WHO emergencies operations – which was criticized for being unduly slow and cautious at key moments – including the WHO’s declaration of a public health emergency and WHO’s months-long resistance to acknowledging that the virus is “airborne” and required public use of face masks as well as by health personnel. 

Asked by Health Policy Watch about the pending senior management reshuffle, a WHO spokesperson was reportedly ‘checking into’ them – but would neither confirm nor deny the reports. 

Other sources said that a shakeup in the Organization’s senior leadership is to be expected anyway following Tedros’ re-election to a second term as WHO Director General, for which he is running unopposed. 

Decision on more sustainable WHO funding formula announced by Germany  

Regular, assessed US contributions to WHO have remained frozen for over a decade, while the majority of funding has been as “voluntary” contributions.

The decision on the new formula for WHO funding, by a Working Group on Sustainable Finance, was announced near midnight Wednesday, by Germany’s UN Mission in Geneva – following three days of intensive negotiations. 

It overcomes the impasse encountered in late December and early January 202, when a handful of holdback nations, including the United States, had blocked consensus over the move.   

The move is significant because member state contributions have stagnated over the past two decades to the point where they comprise only about $475 million a year – or  about 16% of WHO’s $3 billion annual budget – of which about $2.2 billion is regarded as “core.”

Large “voluntary contributions” from rich member states, including the United States, and donor organizations, led by the Bill and Melinda Gates Foundation, have played a growing role in WHO’s budget. That also gives a handful of member states and donors outsize influence in the member state body, critics have said. 

WHO’s Director General Dr Tedros Adhanom Ghebreyesys had repeatedly complained that such “voluntary donations” often made it more difficult to plan strategically, as well as making WHO vulnerable to donor whims about what they do and don’t want to finance. 

Stepwise increase conditioned on WHO reforms 

member states
Top contributors to WHO’s Budget (2018)

Sources told Health Policy Watch that the real breakthrough on the new finance formula came after the US shifted from being a holdback to a leader in the initiative. 

The breakthrough came as the Working Group agreed to link the new funding formula  to a member-state review of WHO progress on promised internal reforms – at each step of the step-wise increase toward the goal of 50% funding by member states. 

The US had previously stressed that it wanted to ensure any new finance formula would be tied to better WHO performance, including with respect to key gaps identified during the pandemic. 

Those reforms aim to make the Organization more efficient, accountable and transparent – in line with a series of recent external reviews of WHO’s response during the pandemic crisis, including a review of WHO Emergencies functions and another, even more sweeping review of pandemic response by The Independent Panel.  

Setting better priorities improving efficiencies

Ebola response workers in the DRC – at least 21 WHO staff and consultants were accused of abusing Congolese women, obtaining sex in exchange for promises of jobs.

“Practically speaking, it means setting better priorities, making sure that member states are well informed. financial situation, clarifying any new initiatives that need to be seen by governing bodies, ensuring that we have an agile workforce,” said one member of the Bureau, who requested anonymity. 

“Most of that is already in the mandate,” the Bureau member added, noting that in any case, approval of WHO’s biennial budget is conditioned upon member state support – but the compromise makes the conditionality more explicit.  

The source added that the sexual exploitation and harrassment scandal involving WHO Ebola response workers in the Democratic Republic of Congo, which came to light in late 2020 as a result of an investigation by The New Humanitarian and Thomson Reuters Foundation, “was a big concern for the US.

“But overall, it becomes clear that we need to set better priorities with what needs to happen with the available resources, and this is not new. 

“Obviously, some member states need to clarify to their constituencies, to their Parliaments or Congress, etc, that they are not giving carte blanche to an organization, but rather than providing the right resources, but at the end, also taking care that these resources are used the most appropriate way under the control of member states.”

The Working Group also agreed that the aspiration to reach the 50% goal in member state contributions by the 2028-29 budget biennium, could be delayed until 2030-31 as deemed appropriate at that time.   

US support led to other countries to swing behind financial reform measure 

(left) World Health Organization Headquarters in Geneva; White House in Washington, DC

A handful of other countries, ranging from Russia and Poland to Japan and Brazil had also been holdouts in agreement on the finance reforms. 

But once the US changed position, that opposition also melted away, other sources told Health Policy Watch.  

“The US has shown that they are back in the game. They want to be seen as a supporter of the WHO. I think that has changed in the negotiations. 

“Obviously, at the start, they were rather reluctant. Then there was a tipping point. And the US was very, very much supportive of the whole thing of the last three days that we wouldn’t have gotten to where we are without the strong support of the US.”

Indeed, Germany’s announcement was followed by supportive messages from the US Mission in Geneva – as well as Health and Human Services in Washington, DC.   

Germany’s Björn Kümmel credited with sustainable finance reform’s success

Björn Kümmel, Germany’s deputy head of global health in the Ministry of Health

Following that, Latin American states such as Brazil, as well as close US allies like Japan and Poland fell into line supporting the finance reform measure, sources said. 

And Russia, another holdout – also shifted its position to support the moves so long as they were linked to more WHO transparency.  

But it was Germany’s Björn Kümmel, deputy head of global health in the Ministry of Health, who was widely credited with saving the day on an agreement – nursing the negotiations to a successful conclusion over more than a year. 

Kummel, who in mid-December 2021 had bluntly declared that the current WHO finance structure is “fundamentally rotten” had made it an almost personal mission to leverage this highly-technical, but equally significant, institutional change.  

He also has underscored that the aggregate demand of the increased commitment from countries remains very modest – requiring only about $600 million more a year from all 194 WHA member states by 2028-2029 – or at the latest 2030-31. That would bring countries’ assessed contributions up to the desired 50% share of what is now WHO’s core annual budget of about $2.2 million a year.

And he “never gave up” said global health influencer Ilona Kickbusch, founding director of the Geneva Graduate Institute’s Global Health Centre, in a Twitter post. 

 

Achievement noteworthy in time of rising geopolitical tensions. 

The agreement is all the more noteworthy in a period in which the US, Germany and Poland are faced off squarely against Russia over the latter’s invasion of Ukraine. 

And while NATO-Russian geopolitical tensions could very well erupt somewhere on the WHA stage – and are even likely to do so somehow – for now, it appears that pitfall may have been avoided in the case of the sustainable finance accord.  

Agreement by the Working Group signals the likely smooth passage of the measure through the upcoming WHA – in line with traditional practice where most serious member state disputes are ironed out behind closed doors, and in advance of the member state assembly.  

The expected approval was signaled by comments from senior WHO officials, including Tedros himself, who said the “recommendation to increase assessed [member state] contributions to 50% will empower WHO & safeguard its unique expertise, mandate & legitimacy.”

Against the current regional and global diplomatic landscape, that is no little accomplishment, noted Olaf Wientzek, Director of Multilateral Dialogue at the Geneva-based branch of Konrad-Adenauer-Stiftung, a German foundation. 

He noted that at the UN’s New York headquarters, countries’ attention has already shifted well away from the pandemic to issues like Russia’s war in Ukraine as well as other burning regional conflicts. 

That, in turn, leaves a “closing window of opportunity” for key reforms in the health arena that were identified as so critical during the COVID pandemic – to prevent and curb the risks from future epidemics and pandemics.   

“If you look at what we are seeing now, the war between Russia and Ukraine has repercussions across the UN spectrum; there is a strong danger of reduced funding [from member states] in certain cases; and we have seen that recent contributions from donor conferences, for instance in Afghanistan, were far less that had been expected,” Wientzek observed. 

“So against all of that, having an agreement on this is a big thing.”

Image Credits: Germany's UN Mission in Geneva , Kaiser Family Foundation , WHO , WHO AFRO, WHO/P. Virot; Obama Whitehouse Archives .

Women wait to be screened by Illumigyn's Gynescope in Qalansawe, Israel.
Women wait to be screened for cervical cancer using a new digital device at a discreetly placed mobile station, in Qalansawe, Israel.

Qalansawe, Israel – The women, heads covered in hijabs, sat outside a small purple aluminium mobile health station parked in a residential neighbourhood here, shooing away any men who happened to pass by.

Plastic chairs formed a small and intimate circle for the women waiting to be screened for cervical cancer – some for the first time ever, and others who had skipped their annual screenings for decades.

Once inside the mobile station, the women were greeted by a female nurse with a digital scope not much longer than the palm of her hand with a full HD camera at the top.

The Gynescope, which is produced by Israeli firm Illumigyn, digitally documents the cervix, vagina and external genitalia, using high-resolution and superior magnification.

It doesn’t need a fancy lab setup and can produce results within minutes. The digital cervical footprint is saved to the cloud and can be used for remote diagnosis, ongoing medical supervision and follow-up consultations.

“I do not have specific numbers,” Dr Gasem Jauousi, head of family medicine for the city’s largest health fund, told Health Policy Watch. “But Arab women get screened less than the Jewish women. They are less connected [to the health system]. If we do not call, they won’t come.”

Janousi, who spoke from his office adjacent to the caravan, is one of the lead collaborators in a field trial of the Gynescope, one of the latest of the new generation of cervical cancer screening tools that are easier diagnosis for the disease that killed more than 340,000 women in 2020, according to the World Health Organization.

Smart-Scope pencil-like device

The Indian-developed Smart-Scope device and monitoring screen can fit into an A-4 sized computer bag

Other devices include the handheld Indian “Smart-Scope” which will be feature in the innovation fair of the Geneva Health Forum 2022 (3-5 May). The Forum also is hosting a special day-long meeting on innovations in cervical cancer screening and care, Wednesday 4 May.

The Smart-Scope is an even smaller and more portable device, can detect cervical abnormalities in less than 10 minutes using artificial intelligence, with the aid of a tablet and an intuitive app, Veena Moktali, the founder of the Indian start-up Periwinkle Technologies, told Health Policy Watch.

The test result is color-coded and supplemented by a visual report, Moktali explained. The Smart-Scope stores data on a tablet not the cloud, which makes it accessible to clinics without internet access.

Key features of these new devices is their reliance on high-quality digital imagery instead of old-fashioned lab smear samples that entails taking a sample from a woman’s cervix which then has to be analyzed.

The digital storage of images makes for easy referral and portability, and mobile health clinics can offer the service to women who may not otherwise come to a clinic for a screening test, said Moktali.

Moktali is also speaking at the Geneva Health Forum hosted meeting on cervical cancer about how new AI devices like the Smart Scope are enabling improved point-of-care screening for cervical cancer. The full-day workshop, which evolved out of interactions by innovators and health care professionals at the biennial GHF meetings, will look at how new devices and strategies for cervical cancer screening and treatment can advance the World Health Organization goal of eliminating cervical cancer by 2030.

Solutions for harder-to-reach communities

While Israel is a high-income country with a strong public health system, more marginalized communities – including new immigrants, African asylum seekers, and Arab-Israeli citizens – can fall through the gaps of routine checks.

This is especially true when it comes to sensitive medical interventions such as cervical cancer screening around which there may also be cultural taboos.

For several decades, routine screening for cervical cancer has involved a “Pap smear,” a procedure developed in the 1920s by Georgios Papanikolaou and Aurel Babeș.

A trained health worker scrapes a woman’s cervix for a cell sample, which is then relayed to a laboratory for analysis by a trained technician seeking abnormalities that could indicate cancer or a precancerous growth.

Aside from needing laboratory and diagnostic capacity that is unavailable in many parts of the world, many women find Pap smears invasive and uncomfortable.

Over two days in March, Illumigyn in collaboration with the government health-fund Clalit, set up caravans in two disadvantaged Israeli neighborhoods, one of them Qalansawe. Clalit contacted women enrolled in the health fund, who had not previously been screened, and invited them to come for a visit. No appointment was needed.

Digital image of cervix illuminated on a Gynescope

The women were able to enter the mobile clinics, positioned in a fenced-off area near the neighborhood health clinic, and be screened by a female nurse. The image was sent to their doctors in real time to inform the women if further evaluation or other action was required.

“They told me to go to the hospital and get an ultrasound,” one woman, who asked to remain anonymous, told Health Policy Watch as she left the caravan. “I need to follow up,” she added, saying that she intended to follow their advice.

Another woman, who also asked to be anonymous, said that when she came to the mobile station, she didn’t even know what the check was intended to diagnose.  Her experience raised her awareness about the whole cervical cancer issue:

“I had no idea what to expect,” she said. “But I am told this is a good thing, that it could save lives, God willing. … Doing these screenings, thinking about people and worrying about them. It is really good,” she said, after leaving the mobile station, full of praise for the initiative.

“We know that women are busy – we don’t have time,” said Illumigyn vice president Yam Salman. “Especially women who are raising their families. But women want to live and now we have the technology that can help them do so. Illumigyn can save their lives,” she said.

Eliminating cervical cancer

Cervical cancer claims the lives of around 300,000 women each year, one woman every two minutes, according to WHO.

At the same time, the disease is highly preventable either by being vaccinated against the human papillomavirus (HPV), which causes the majority of cervical cancers, or by early detection through screening.

Most cervical cancer deaths now occur in low- and middle-income countries where fewer girls are vaccinated and women don’t get regularly screened.

In 2020, the World Health Assembly adopted a global strategy to eliminate cervical cancer, with weighty targets to be hit by 2030. The strategy focuses on three aims: vaccinating 90% of all girls against HPV by the age of 15; expanding access to screening services for 70% of women; expanding access to treatment for 90% of women with precancerous lesions; and offering palliative care for 90% of women with invasive cancer.

Smart Scope cervical cancer screening campaign in rural India

“Cervical cancer is the fourth most common cancer among women globally, but it is almost completely preventable and, if diagnosed early enough, is one of the most successfully treatable cancers,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus on Cervical Cancer Elimination Day in 2021.

“Like COVID-19, we have the tools to prevent, detect and treat this disease. But like COVID-19, cervical cancer is driven by inequitable access to those tools,” Tedros said.

The COVID pandemic has slowed progress to eliminating the cancer, but the new, low-cost screening measures that “democratize women’s health care” can help change that, argues Salman.

New AI devices can be used by any trained caregiver

Both the Smart-Scope and the Gynescope can be used by any trained caregiver or a nurse practitioner, allowing women to be screened and diagnosed even in locations where doctors may be unavailable or in short supply.

That is significant, insofar as around two-thirds of cervical cancer deaths now happen in low- and middle-income countries or communities, explains Dr Nomonde Mbatani, a gynaecologist at Groote Schuur Hospital in Cape Town, South Africa.

Women in rural settings also have a tough time taking off a day of work to reach distant clinics to get their Pap smear. And, if they do take off for the screening, they are unlikely to take a second day off to return to the clinic to get their results – which take several days or even longer to produce.  And that makes follow up action even more difficult, she said in an interview with Health Policy Watch.

“Sending them home is not ideal. The ideal is where their results can be readily available on the same day,” Mbatani said.

Awareness and cultural barriers also exist, she added.

“There is very little understanding of how cervical cancer is caused,” Mbatani said. “Some women feel uncomfortable about presenting problems they are experiencing in their lower genitalia or even having it looked at by a male doctor, except when it comes to birthing their children.”

Resistance to HPV vaccines

Along with better and more frequent screening of adult women, vaccination of pre-adolescent girls against the human papillomavirus virus (HPV), a leading cause of cervical cancer, is another important strategy being touted by WHO for eliminating cervical cancer.

South Africa, which has one of the best health systems in Africa, routinely offers the vaccine to young children in public schools, Mbatani said, noting the vaccines have been availalbe in the country for about a decade already. But any girl living in a rural area who does not regularly attend school may still miss out.

In addition, parents of children enrolled in the country’s extensive private school system have to “opt-in” and request that a doctor vaccinate their children in a private clinic, making immunization rates among these youths much lower.

“In public schools, they opt out rather than in,” Mbatani said.

More frequent exams are important

In South Africa, women are only recommended to get a Pap smear once in every 10 years.  It’s too long between examinations, Mbatani says.

WIth screening every 1-3 years, there is a 95% chance that any developing cervical cancer will be caught in time and can be treated. With screening every 10 years, the reduction of cancer risk drops to about 66%.

“That is not ideal, but to make this available to most women is better than not doing anything,” she said. “WHO suggests if women could even have one Pap smear once in their lifetime this could still reduce cervical cancer. The problem is that screening is opportunistic and not everyone takes advantage of that opportunity.”

Over time, it is hoped that the new AI devices can help overcome some of the barriers that Mbatani describes – allowing for better integration of cervical cancer screening into more routine, primary health care services that are already offered for women’s reproductive health or HIV/AIDS prevention and treatment.

As Salman says: “Why do we need to die from something that can be prevented?”

Image Credits: Illumigyn, Periwinkle Technologies , Illumigyn , Periwinkle Technologies.

A child is vaccinated against measles at the DFID and UNICEF-supported Nutrition Health Centre in Hargeisa, Somaliland on 3rd February 2021.

A 79% rise in the reported measles cases in the first two months of 2022, compared to the same period last year, has raised concerns over the possibility of an outbreak that could affect millions of children this year. 

Pandemic-related disruptions, increasing inequalities in access to vaccines, and the diversion of resources from routine immunization have created the ‘perfect storm’ of conditions for a measles outbreak, WHO and the United Nations Children’s Fund (UNICEF) warned on Wednesday. Children are not only at risk of being infected with measles –a disease which is preventable through vaccination– but also other vaccine-preventable diseases. 

Risks of a bigger outbreaks have also been heightened by the relaxation of social distancing norms in communities around the world, along with the mass displacement of people, including many children, due to conflicts and crises in countries ranging from Ukraine, Ethiopia, Somalia and Afghanistan.  

Some 17,338 measles cases were reported worldwide in January and February 2022, compared to 9,665 during the same period last year, said WHO and UNICEF. The possibility of underreporting looms large as the pandemic has disrupted global surveillance of cases and vaccinations. 

23 million children have missed out on basic vaccines  

There is rising concern over children becoming more susceptible to other vaccine-preventable diseases too.  Some 23 million children have missed out on basic childhood vaccines through routine health services in 2020. This is the highest number since 2009 and 3.7 million more than in 2019.

As of April 2022, 57 vaccine-preventable disease campaigns in 43 countries that were scheduled to take place since the start of the pandemic are still postponed, impacting 203 million people, most of whom are children, WHO and UNICEF said. Of these, 19 are measles campaigns, which puts an additional 73 million children at risk of measles due to missed vaccinations. In Ukraine, the measles catch-up campaign of 2019 was interrupted firstly by the COVID-19 pandemic and more recently, by Russia’s recent invasion.

“It is encouraging that people in many communities are beginning to feel protected enough from COVID-19 to return to more social activities. But doing so in places where children are not receiving routine vaccination creates the perfect storm for the spread of a disease like measles,” said Catherine Russell, UNICEF Executive Director.

According to Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO, the disruptions caused by the COVID-19 pandemic in immunization services for many other diseases will be felt for decades to come. “Now is the moment to get essential immunization back on track and launch catch-up campaigns so that everybody can have access to these life-saving vaccines.”

Humanitarian crises disrupting vaccination programs 

In  2017-2019, there were over 115,000 cases of measles and 41 deaths in Ukraine which was the highest incidence in Europe.

Top 5 countries with reported measles cases in the last 12 months, until April 2022

Along with Ukraine, humanitarian crises in Ethiopia and Afghanistan are seriously disrupting vaccination programmes for measles and other diseases. 

Three of the five countries globally with the highest measles cases so far this year – Somalia, Ethiopia and Nigeria – are in Africa. Afghanistan and Yemen are the other two countries whose caseload of measles puts them in the top five countries burdened with measles. 

Because measles is one of the world’s most highly contagious infectious diseases, it has a high threshhold for herd immunity, meaning that vaccination rates need to be particularly high to prevent outbreaks. “When vaccination drops, measles is typically the first childhood disease to have an outbreak.” Andrew Noymer of the University of California was quoted as saying in an article on Ethiopia’s measles outbreak, published in The Lancet Infectious Diseases’ May 2022 edition. 

In the first three months of 2022, there were 2,156 confirmed cases of measles and 2,755 suspected cases, WHO’s Regional Office for Africa has reported. The vaccination status of 40% of the suspected cases was not known. The measles outbreak in Ethiopia comes at a time when the country is facing a complex humanitarian and armed conflict that has led to a high number of refugees and internally displaced people.  Other measles outbreaks are occurring in Chad, Congo, the Democratic Republic of Congo, Guinea, Liberia, Mali. Mozambique, Niger and Nigeria, Sierra Leone, South Sudan, and Togo, with thousands of confirmed cases and tens of thousands of suspected cases across the continent, WHO said. 

Measles also is known to weaken a child’s immune system and makes them susceptible to other infectious diseases like pneumonia and diarrhoea, the WHO and UNICEF said. At population level, vaccine coverage at or above 95%, with two doses of the safe and effective measles vaccine, can protect children against measles outbreaks.

Image Credits: UNICEF, UNICEF , UNICEF/WHO.

health misinformation
Mike Ryan, Executive Director of WHO Health Emergencies

Following the purchase of Twitter by billionaire Elon Musk on Monday, the World Health Organization warned about the dangers of health and vaccine misinformation on social media, and expressed hope that the acquisition would lead to an ‘improvement of quality information’. 

“There is misinformation and disinformation out there across whatever platform you wish to go to. The good stewardship of these platforms is extremely important,” said Mike Ryan, Executive Director of WHO Health Emergencies, in response to a reporter’s question at a media briefing Tuesday afternoon.

“Anyone who reaches a position in life where they have so much potential influence over the way information is shared with communities takes on a huge responsibility. We wish Mr. Musk luck with his endeavors to improve the quality of information that we all receive.” 

Musk purchased the social media platform Twitter in a $44 billion deal, sparking concern and fear for free speech on the site. 

While Musk has called himself a free speech absolutist and has criticized Twitter’s moderation, political activists expect that this means less moderation and reinstatement of banned individuals including former US President Donald Trump – which has led to cheers from conservatives and concerns that this may lead to a rise in hate speech and misinformation. 

WHO maintained that it engages with platforms such as Twitter in order to disseminate the best possible health and vaccine information. 

‘Critical’ that health information across social media remains ‘credible’ 

WHO Director of Immunization Kate O’Brien

WHO also emphasized the ‘critical’ nature of accurate health information, especially when it comes to life-saving vaccines. 

Added WHO Director of Immunization Kate O’Brien: “People’s lives are lost as a result of misinformation or intentional incorrect information. It’s just incredibly critical on vaccines and on other health issues that people are seeking credible information from credible sources.” 

She stated that this matter was not just “chatter on social media channels” and emphasized the role that social media played in conveying information to the public.

“It really has an impact on what people do, what people chose to do, what they chose to do for themselves, for their children, for their families.”

“It’s something we really take seriously. We have to recognize that for a vast majority of people, they [need to] understand the value of vaccines, they understand the frankly life-threatening risks of the diseases against which we have life-saving vaccines [for], and are seeking vaccines and getting vaccinated.” 

ebola
Healthworkers during the 2017 Ebola outbreak in the DRC.

The World Health Organization has announced an outbreak of Ebola in the Democratic Republic of Congo and its continued investigation of almost 200 cases of unexplained acute hepatitis in the US and Europe in a media briefing Tuesday afternoon. 

Two cases of Ebola have been confirmed in the northwestern Democratic Republic of Congo, prompting health authorities to declare an outbreak.

The cases were found in Mbandaka, a city in the northwestern Equateur province of DRC. The second case, confirmed yesterday, was a relative to the first patient. 

Both patients have died from the virus.

The densely populated nature of the city of Mbandaka has WHO “concerned” about possible spread of transmission.

“It is always concerning when an area like Mbandaka, with the density of the population, but also with the risk of [Ebola] spreading across the river to countries like the Central African Republic,” said Ibrahima Soce Fall, Assistant Direct-General for Emergencies Response. 

WHO is supporting DRC’s government to scale-up testing, contact tracing and public health measures. Stockpiles of Ebola vaccines in the cities of Goma and Kinshasa are being transported to Mbandaka so that vaccination can start.

“The government and people of DRC have a great deal of experience stopping Ebola outbreaks and WHO will support them to do whatever is needed,” said Director-General Dr Tedros Adhanom Ghebreyesus.

The two outbreaks of Ebola in the DRC were reported in 2021, one in February and another in October, though both were declared over within months. 

Acute hepatitis may be linked to adenoviruses

Philippa Easterbrook, Senior Scientist in the Global Hepatitis Programme at WHO

WHO is currently investigating the origin of 169 cases of acute hepatitis that have been reported in 12 countries across Europe and in the United States in children aged one month to 16 years. 

Some of these cases have been reported to be confirmed or suspected to be ill with the mysterious and potentially deadly disease since January. 

17 children – about 10% of reported cases have required liver transplants. One has reported several acute hepatitis, with symptoms including abdominal pain, diarrhea, vomiting, jaundice, and increased levels of liver enzymes. 

However, the virus that commonly causes acute viral hepatitis has not been detected in any of these cases, with no virus being detected in at least seventy-four cases. 

Philippa Easterbrook, Senior Scientist in the Global Hepatitis Programme at WHO, pointed to a possible link to adenoviruses, a common infection in children, as an underlying cause. 

Adenoviruses are a group of common viruses that spread from person to person and can cause respiratory gastrointestinal infections, especially in children. However, the report of adenoviruses in around 74 of reported cases has been called “unusual”. 

“It is very unusual for an adenovirus to cause these types of severe symptoms,” said Easterbrook.

Image Credits: WHO.

The precipitous drop in COVID-19 testing across the world since January has made it harder to track the evolution of variants, and is also undermining the potential of new antiviral drugs that have to be taken early to be effective.

Testing was a major focus of Tuesday’s meeting of the Access to COVID Tools Accelerator (ACT-A) facilitation council and the World Health Organization (WHO) media briefing that followed, which celebrated the publication of the Accelerator’s two-year impact report.

The ACT-A was created to develop and equitably deliver vaccines, therapeutics and diagnostics to those that need them the most, and the global vaccine delivery platform, COVAX, is its most renowned component.

“As many countries reduce testing, WHO is receiving less and less information about transmission and sequencing. This makes us increasingly blind to patterns of transmission and evolution. But this virus won’t go away just because countries stop looking for it,” chided WHO Director-General Dr Tedros Adhanom Ghebreyesus at the media briefing.

Earlier, he had told the council meeting that “low-income countries are testing at an average of two tests per day per 100,000 population. This is over 100 times lower than the testing rate in high-income countries.”

“In the last four months in the midst of Omicron, as cities in East Asia go on lockdown and vaccination rates stall, testing rates have plummeted by 70 to 90% worldwide,” added Bill Rodriguez, CEO of the Foundation for Innovative New Diagnostics (FIND). 

Limited access to new antivirals

Last Friday, the WHO approved Pfizer’s Paxlovid antiviral – a combination of nirmatrelvir and ritonavir – for patients with mild or moderate COVID-19 at high risk of hospitalization. But Paxlovid needs to be taken within three to five days of infection to be effective – which means access to testing.

While COVID-19 therapeutics hold a lot of promise, “there are some caveats and considerations around these treatments, particularly given the need to align with testing strategies and given those very testing strategies and rates are so low”, Loyce Pace, US Health and Human Affairs Assistant Secretary for Global Affairs, told the council.

MPP licensees for COVID treatments, April 2022

The Medicine Patent Pool’s (MPP) Charles Gore told the council meeting that generic versions of Paxlovid were only likely by the end of the year.

He added that the MPP, which has an agreement with Pfizer to license generic producers to make Paxlovid for 95 low and middle-income countries, “cannot give a licence unless somebody applies for one” and when a company did apply “they’ve got to be able to meet our quality standards”. 

The MPP had offered two licences to companies in Africa, “but they for various reasons declined to sign the licences”, he added

“There is a clear gap here in terms of promoting and supporting companies to be able to get to a standard where they can apply for licences, so that we have the most geographically dispersed manufacturing base that we can have in order to ensure this sort of supply security that we’ve been talking about so much in vaccines,” added Gore.

ACT-A achievements

Seth Berkley

Despite the ongoing issues, various speakers lauded the ACT-A’s achievements.

COVAX has delivered over 1.4 billion to date across 145 countries worldwide, with Seth Berkley, CEO of Gavi, The Vaccine Alliance, calling it the “largest and most complex global vaccine rollout in history.” 

It has also enabled 40 countries to begin their COVID-19 vaccination campaigns, helped build the sequencing capacity in Southern Africa that first detected the Omicron variant, and negotiated unprecedented deals with the world’s largest oxygen suppliers to increase access in more than 120 low- and middle-income countries. 

But in spite of these accomplishments, Berkley noted: “We still have plenty to do.” 

While 44% of people in lower-income countries have now been vaccinated with at least two doses of a COVID-19 vaccine and global coverage is 59%, the global vaccine equity gap is still too wide, said Berkley. 

There are some 18 countries that have only protected 10% or less of their populations.

A  key criticism of the ACT-A in the first year of its operation was that it took COVAX too long to buy the mRNA vaccines  because it lacked the cash to compete with rich countries’ pre-market commitments to Pfizer, Moderna and Johnson & Johnson. 

“The good news is that today we have access to as much supply as countries need to meet their national targets,” said Berkley. “That means that countries in turn can plan large scale rollouts with confidence that the doses they have requested. will arrive on time, including usually with our product of choice. 

“But we cannot ignore the fact that many country’s health systems lack the capacity to simply switch on massive vaccination programmes alongside the other vital routine immunization services,” he added.

To address this Gavi has already made $600 million available for COVID delivery support to lower-income countries.

First steps towards a pandemic contingency fund 

Loyce Pace

Berkeley also said that Gavi is creating a “pandemic vaccine pool” that could respond more quickly in the future. 

A Gavi/ ACT-A pledging event on 8 April that raised $4.8 billion earlier this month, was the first step towards that ambition, said Berkley. 

“Our donors stepped up and helped us launch a contingent financing facility that will help us ensure that when the need arises, and COVAX can step up and order new doses immediately,” he added.

While COVAX may not be fully funded, “this is still in stark contrast to 2020, when we first had to raise cash before we could place any orders, and it’s a sign of how far we have come as a multilateral solution, not just in helping address the challenges of this pandemic, but leaving us better prepared for the next one.” Berkeley said.     

To rally the global community to support the flagging vaccination drive, a global COVID-19 summit co-hosted by the governments of Belize, Germany, Indonesia, Senegal and the US will be held on 12 May.

“We are inviting ambitious policy or financial commitments for that particular engagement. It’s going to be very important for all of us to come up with a new set of commitments that will help continue to drive this change and ensure that we are closing the gap and reaching those most in need or and most often left behind,” said Pace.

We’re particularly focused on locally-led solutions and opportunities.”

Image Credits: UCT.

A premature baby in the neonatal unit in Nelson Mandela Children Hospital in Johannesburg, South Africa.

More newborn babies with sepsis are dying because their infections are not responding to the usual antibiotics, according to the biggest global study on the subject yet.

The study’s sponsor, the Global Antibiotic Research and Development Partnership (GARDP), is now designing an interventional trial to identify better treatment regimens. to combat rising resistance.

GARDP’s study, which involved over 3200 newborns diagnosed with sepsis in 11 countries, was released at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) on Tuesday.

It found that many physicians were forced to use last-line antibiotics such as carbapenems due to the high degree of antibiotic resistance in their treatment units. 

Last-line antibiotics were prescribed to 15% of babies enrolled in the study. Overall, 11% of the newborns died over the course of the study – but there was huge variation between countries and hospitals.

In 2019, nearly 1.3 million deaths – including nearly 140,000 deaths of newborns – were caused by bacterial antimicrobial resistance (AMR).   

Major threat to newborns

“Our study has shown that antibiotic resistance is now one of the major threats to newborn health globally,” said Mike Sharland from St George’s, University of London and the principal investigator. 

“There are virtually no studies underway on developing novel antibiotic treatments for babies with sepsis caused by multidrug-resistant infections. This is a major problem for babies in all countries, both rich and poor. 

The World Health Organization (WHO) recommends the standard antibiotics – ampicillin plus gentamicin – for the treatment of neonatal sepsis, but the study showed that many hospitals are using other combinations due to high levels of resistance to the WHO-recommended treatment.   

But the use of antibiotics varied noticeably across sites in Bangladesh, Brazil, China, Greece, India, Italy, Kenya, South Africa, Thailand, Vietnam and Uganda, “with many different antibiotic combinations being used, often without any underlying data”, according to GARDP.  

Okwenathi Sibango, born prematurely at six and a half months, was one of the babies enrolled in the study. After fighting off an intestinal infection, the tiny boy, who weighed less than a kilogramme, picked up a life-threatening antibiotic-resistant infection in the hospital. He also developed meningitis and his doctors had to treat him with antibiotics of last resort.

“Over the past decade we have a seen a year-by-year increase in antibiotic resistance,” says Dr Angela Dramowski, Clinical Head of General Paediatrics at the Cape Town hospital that treated Sibango.

“We urgently need new antibiotic options. We are also hopeful that the study by GARDP and partners will go far in working out the best treatment options for babies, with the right dose and the least possible toxicity. This will help us in treating babies like Okwenathi.” 

Testing new antibiotic combinations

The GARDP trial will test the safety and effectiveness of three potential new antibiotic combination treatments, ranking them against existing commonly used antibiotic regimens for neonatal sepsis. It will also look into the comparative efficacy of other approved but less common antibiotics and describe local patterns of antibiotic resistance.

It starts in Kenya and South Africa later this year and will expand to up to eight other countries next year.   

“There is an urgent need to develop and ensure access to novel antibiotic treatments to keep pace with rising rates of drug-resistant infections among babies with neonatal sepsis,” said GARDP Executive Director Manica Balasegaram.

 “We are incredibly grateful to our numerous partners and funders who have given us essential support to make this observational study possible. Guided by these new insights, we have the opportunity to place children at the centre of the international response to antibiotic resistance.”  

Image Credits: 20 May 2021South AfricaKL Schermbrucker/GARDP.

UNICEF’s Global Supply and Logistics Hub in Copenhagen

CAPE TOWN – As the health sector celebrates World Immunisation Week, one of the most pressing related problems is Africa’s almost total dependence on imported vaccines –  something that predates, but was highlighted by, the COVID-19 pandemic.  

But addressing this dependence will mean dismantling the ‘charity’ model that has underpinned many of Africa’s immunisation programmes over the past two decades at least – since the creation of Gavi, the Vaccine Alliance.

The terrible price of Africa’s vaccine dependence was brutally highlighted a year ago at the height of the Delta period of the COVID-19 pandemic. India banned the export of vaccines produced by its generic companies. Western countries bought up the limited international global supply of vaccines. And there were no vaccines left for Africa, which had been relying on COVAX for supplies.

It was a bitter replay of the HIV pandemic when antiretroviral drugs were not affordable or available on this continent. 

Key African leaders resolved that there was only one feasible way forward to break this dependence: to build continental vaccine production capacity.

John Nkengasong, director of the Africa Centre for Disease Control, then-Africa Union chairperson and South African President Cyril Ramaphosa, and Strive Masiyiwa, appointed as the African Union Special Envoy on COVID-19, have led the quest to change the balance of manufacturing power and prowess.

Under pressure to address this inequity, wealthy nations, the global health sector, and the pharmaceutical industry have responded with an array of African-based endeavours.

The most committed initiative to addressing structural inequity is the mRNA vaccine production hub in South Africa initiated by the World Health Organization, which produced a copy of the Moderna-based COVID-19 mRNA vaccine in a few months flat, and is now preparing the product for trials.

Another promising initiative includes generic producer Aspen, which was recently licensed to package, distribute and sell the Johnson & Johnson COVID-19 vaccine under its own name in Africa. 

There also are fill-and-finish operations in South Africa, Egypt, Senegal, Morocco, and Algeria for a range of vaccines from Pfizer’s mRNA COVID vaccine to the Russian Sputnik.

About 40 of Africa’s 54 countries depend on partially or wholly subsidised childhood vaccines from Gavi through UNICEF. 

The donor as ‘competitor’

But the elephant in the room is how these newer – and initially more expensive – innovations will be able to ‘compete’ with donated or subsidised vaccines from Gavi-UNICEF and more recently the COVAX platform, in the case of  COVID-19 vaccines, without derailing entire countries’ immunisation programmes

UNICEF’s Supply Division based in Copenhagen is the world’s biggest buyer and supplier of vaccines for developing countries and it procures the majority of Gavi-funded vaccines.

Patrick Tippoo, Biovac

Back in February, Patrick Tippoo took this elephant by the trunk in a webinar organised by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).

Tippoo has over 30 years’ experience in the vaccine manufacturing arena, and is a founding member of the African Vaccine Manufacturing Initiative (AVMI).  He also is an executive at Biovac, the South African company playing a key role in the mRNA vaccine hub alongside Afrigen.

“Critically important is the whole issue of sustainability of that which is being built and is being invested in going forward,” said Tippoo. “Without a significant change in the market dynamics on the African continent there’s very little likelihood of successful sustainability of all our efforts behind this initiative.”

Tippoo explained that about 40 of Africa’s 54 countries are “wholly or partly dependent on partially or wholly subsidised vaccines from Gavi through UNICEF. Much of the vaccine supply into Africa comes in a subsidised form, partially or completely by GAVI through UNICEF.” 

And that market is not just COVID-19 vaccines but billions of dollars of vaccines for childhood diseases ranging from measles and mumps to polio.

Traditionally, Gavi and UNICEF have focused on buying the cheapest medicines rather than addressing supply chain diversity or equity, insiders have told Health Policy Watch.

More recently, however, Gavi has given the Developing Countries Vaccine Manufacturing Network (DCVMN), an alliance of 44 companies from 16 developing countries, a seat on its board. It also says that “by 2017, nearly two-thirds of our vaccine suppliers were based in Africa, Asia or Latin America”, although this statement obscures the fact that precious few African companies are part of the mix.

The procurement patterns of the big donor-driven agencies have also tended to foster market dominance by a few, larger firms – whether based in India, China or western nations – at the expense of smaller, start-up (and often African) manufacturers whose products also are inevitably going to be more expensive, at least in the early years.    

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

“So some say that the vaccine market in Africa is actually in Copenhagen [the headquarters of UNICEF’s Global supply and Logistics Hub]. 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 these things that we repeat ad nauseum, there needs to be an assurance that there’s going to be a market [for African vaccines] when all of this is built.”

Gloomy forecast for African vaccine manufacturing 

Hardly two months later, Tippoo’s gloomy forecast of the market dynamics has already proven accurate: Aspen has not received a single order for its J&J COVID-19 vaccine from African countries that are getting free or heavily subsidised vaccines either directly from rich countries or indirectly through COVAX-backed procurement orders.

This was disclosed two weeks ago by Africa CDC’s John Nkengasong recently, who appealed to Gavi and COVAX to “rally around” Aspen to protect vaccine production on the continent.

It was “shortsighted” of African countries to rely on vaccine donations at the expense of the continent’s vaccine manufacturing capacity, Nkengasong told an Africa CDC media briefing:

“There is a global consensus that, in order to ensure global health security, there must be regional vaccine manufacturing capacity,” he said.

“Here we are with a company that is producing an amazing vaccine that the continent is using, that is running a risk of shutting down that production. We cannot and must not allow that to happen.

“If we only rely on donor vaccines and do not invest in and promote our own facilities on the continent that is a recipe for going backwards the next time we are hit with another pandemic.”

South African President Cyril Ramaphosa visits Aspen Pharmacare manufacturing facility in Gqeberha.

Gavi ‘in discussion’ about Aspen

A GAVI spokesperson told Health Policy Watch on Monday that “COVAX is committed to diversifying global supply, including through the development of regional manufacturing sites, especially in Africa. 

“In the case of Aspen, the current overall demand situation means we are currently not in a position to buy large quantities of vaccines. However, we are in discussion to see if a collaboration would be feasible as part of expanding regional supply.” 

Nkengasong confirmed that there were discussions with Gavi, which manages COVAX, about supporting Aspen’s COVID-19 vaccine production line, which the company has warned it will have to close soon if it doesn’t get orders.

But the immediate outlook is not rosy now that there is a glut of COVID-19 vaccines.  And competition between the big global pharmaceutical players for the African vaccine market is becoming more intense as the continent is the last major source of unvaccinated people on the planet. 

More equity also equals more global health security 

In all the many discussions about a pandemic instrument to address future pandemics, all WHO member states have committed themselves to the principle of equity. But the diversification of vaccine procurement is not just about equity. It will also ensure more robust and flexible supply chains during a pandemic, which will strengthen global health security. 

“We need diversification in terms of geographic locations, where these capacities might be located across the continent, diversification in terms of product mix, what different entities are going to focus on in terms of vaccine development and vaccine manufacturing pipeline, but also diversification in terms of technologies,” Tippoo said. 

“This is not only about Africa for Africa. This is about Africa gearing up to take a significant position and place around the global table. Africa can contribute to a diversified global supply chain when it comes to vaccines.”

Image Credits: UNICEF South Africa/2013/Hearfield.