Photo: Annie Spratt on Unsplash.
The global community is being tested on its commitment to “leave no one behind” as Africa faces multiple interconnected health crises. For effective health responses and better pandemic preparedness, experts at a recent side event at the 8th Tokyo International Conference on African Development (TICAD 8) stressed the need for stronger strategic partnerships that build in equity and resilience in health systems, and enable health security for all.
The African region faces more than 100 major public health emergencies each year, more than any other region around the world. The health and knock-on economic effects of the COVID-19 pandemic have highlighted pre-existing challenges and weaknesses facing health emergency preparedness and response, and health security in African countries.
Organized by Japan’s Ministry of Foreign Affairs, the Global Health Innovative Technology (GHIT) Fund and the United Nations Development Programme (UNDP), the event featured key stakeholders who shared their insights on the required measures to achieve health security and ultimately human security in Africa.
Dr. Mandeep Dhaliwal, Director of the HIV, Health and Development Group at UNDP, noted that an end-to-end approach that assures the availability, access and timely delivery of health technologies is crucial for pandemic preparedness on the continent.
“We know that global collaboration and partnerships at scale and speed is possible because we have seen this in the collaboration for the research and development of the multiple COVID-19 vaccines,” said Dr. Dhaliwal.
She noted however, that there were and still are deficiencies in the collective response to COVID-19. Dr. Dhaliwal stressed that an improved response to COVID-19 and future outbreaks must also not neglect other health priorities such as tuberculosis (TB), malaria and neglected tropical diseases (NTDs) which persist in many low- and middle-income countries, and create significant health, economic and social consequences.
Turning to the issue of universal health coverage (UHC), Dr. Satoshi Ezoe, Director of the Global Health Policy Division in Japan’s Ministry of Foreign Affairs, said achieving comprehensive coverage in Africa and the rest of the world remains a major goal of Japan’s global health diplomacy.
Leveraging its own experience, Japan has championed the need to include UHC in global agreements, such as introducing the concept into the Sustainable Development Goals (SDGs) and launching UHC2030, an international initiative to promote UHC at the G7 Ise-Shima Summit in 2016.
“Japan has been contributing to strengthening health systems in Africa for many years through capacity building of the infectious disease control and regional research hubs, such as Noguchi Memorial Institute for Medical Research in Ghana, the Kenya Medical Research Institute (KEMRI) and Africa Centre for Disease Control, in order to achieve UHC,” said Dr. Ezoe.
Since pre-COVID, at least half of the world’s population, including Africa, could not get essential health services and the situation has worsened. In particular, the relatively large amount of resources devoted to the COVID-19 response has affected measures against traditional infectious diseases such as TB, malaria and NTDs.
“Supporting the research and development of medicines for these diseases is extremely important in order to realize the principle of UHC. If Africa is not healthy, our world will not be healthy and UHC won’t be achieved,” stressed Dr Ezoe.
He said the Government of Japan will continue to lead efforts towards better health security in Africa, including a focus on TB, malaria and NTDs. Through the continuing partnership with UNDP and the GHIT Fund, the Government of Japan has been promoting research and development (R&D) of pharmaceuticals for such diseases through public-private partnerships. The GHIT Fund is a pioneering international public-private partnership that promotes R&D of therapeutic drugs, vaccines, and diagnostics for TB, malaria and NTDs. In addition, through the UNDP-led Access and Delivery Partnership, Japan has contributed to promoting access and delivery of medicines and strengthening health systems in low- and middle-income countries.
Dr. Sultani Hadley Matendechero, Head of the Kenya National Public Health Institute, highlighted that many countries initially could not contain the pandemic primarily because of uncoordinated efforts within the public health care system. However, by acknowledging how fragmented its health system was and identifying the shortcomings in its pandemic preparedness, Kenya together with external partners such as Japan, UNDP and the World Health Organization (WHO), developed its own national elite responders, built robust surveillance systems and invested in pandemic preparedness to strengthen their response time in tackling future health emergencies.
“The National Public Health Institute, which we have established in Kenya, has become the single focal point that various public and private sector entities recognize as leading and coordinating the public health functions,” he said.
A recent WHO report tracking UHC in the African region noted the need for investments in health system resilience, both for enabling effective responses to emerging threats and the continued provision of essential health services.
Prof. Padmashree Gehl Sampath, Senior Advisor to the President on Pharmaceuticals and Health at the African Development Bank Group, agreed with the report’s call for investments in common goods for both UHC and health security simultaneously.
“The spectrum of health care activities is not just about reforming and strengthening health systems, and increasing the coverage of drugs and services, but its also about ensuring the introduction of drugs, vaccines and diagnostics in a timely manner. Financing the entire spectrum is important,” she said.
However, Prof. Sampath said the COVID-19 experience proves that even if there are timely drugs and vaccines, these are not readily available in different places, so production infrastructure also needs financing.
The panel of experts agreed that the experience of the current response to COVID-19 provided critical lessons for the design of an improved response not only for the current pandemic but also to prevent future pandemics. Through the GHIT Fund and the Access and Delivery Partnership, Japan and UNDP are addressing gaps within the health innovation, access and delivery continuum in low- and middle-income countries by stimulating R&D and strengthening health systems.
Despite the need for increased research and development, and resilient health systems, Dr. Osamu Kunii, CEO of the GHIT Fund, said funding is lacking.
In 2020, COVID-19 disruptions caused TB and malaria diagnoses to drop by 59 percent and 31 percent, respectively, and there were one million fewer people treated for TB and 45,000 additional malaria-related deaths. Dr. Kunii said the GHIT Fund is now focused on how to adapt current pandemic preparedness towards TB, malaria and NTDs despite funding shortfalls.
Dr. Kunii’s assessment of the situation suggests it is now more crucial than ever for the global community to marshal its combined resources to invest in innovative partnerships that can provide a foundation for effective and sustained action.
Innovative partnerships are not just beneficial to the development and rollout of timely action in health emergencies, but also contribute to the growth and sustainability of start-up businesses in the affected countries, such as with diaTROPIX, a Senegal-based company.
Dr. Cheikh Diagne, Head of Operations at diaTROPIX Senegal said the business is the first non-profit platform for manufacturing fully dedicated rapid diagnostic tests with an economic model that makes them accessible at cost price in African countries.
On the importance of investor interest and support, and transfer of technology in the growth of start-ups such as diaTROPIX, he said, “I would say the key factors for success are a strong collaboration, or North-South collaboration, with companies that will share their technology with us, and also train the team in order to manufacture their products.”
WHO estimates that approximately one-third of the developing world's population does not have regular access to quality essential medicines and ensuring that African people have access to essential medical products and technologies is an ongoing struggle on the continent, especially with strict regulatory processes.
Although regulatory approvals are essential in ensuring the safety and effectiveness of these products, regulatory processes and challenges differ from country to country across Africa, resulting in delays in introduction and scale-up, according to Dr. Margareth Ndomondo-Sigonda, Head of Health Programs and Coordinator of the African Medicines Regulatory Harmonization (AMRH) Initiative at AUDA-NEPAD.
She said challenges include weak or non-coherent legislative frameworks, redundant and duplicative processes, sluggish medicine registration processes and inefficiency and limited technical capacity.
“We face challenges where countries do not have necessary financial and human resources to undertake some of their activities. Through our AMRH partnership platform, various partners can provide either financial support or technical support to these countries,” said Dr Ndomondo-Sigonda.
An initiative aimed at addressing implementation challenges to effective and efficient delivery and uptake is the Sustainable Access and Delivery of New Vaccines in Ghana (SAVING) consortium. The SAVING Consortium has worked together with national institutions to strengthen capacities towards the effective delivery and uptake of the new RTS,S malaria vaccine.
On the lessons learned from her time working on the consortium, Prof. Margaret Gyapong, Director of the Institute of Health Research at the University of Health and Allied Sciences in Ghana, noted the importance of assessing and addressing the needs of the different institutions along the access and delivery value chain when new health technologies are deployed, and addressing the challenges and capacity gaps in a systematic way.
Wrapping up the event, Dr. Mandeep Dhaliwal, Director of the HIV, Health and Development Group at UNDP, reiterated the value of collaboration and partnerships to advance health systems and build greater pandemic preparedness.
“We have to keep our eye on impact, be open to innovation, adaptation, learning from each other, and be open to new partnerships that will enable us to do this,” she concluded.