12 leaders’ perspectives on supporting Africa’s health systems through Covid-19

23 October 2020
Donald Kaberuka, Lia Tadesse , Uzziel Ndagijimana, Zweli Mkhize, Mthuli Ncube, Amira Elfadil Mohammed, Ngozi Okonjo-Iweala, Muhammad Ali Pate, Tedros Adhanom Ghebreyesus , Peter Sands, Seth Berkley, Mark Dybul
Insight
African flags at the 33rd African Union Summit, February 2020. Photo: Paul Kagame CC BY-NC-ND 2.0

Africa came into the fight against Covid-19 battling the world’s most acute public health threats, with just 1% of global health spending for 17% of the world’s population. Covid-19 has led to a large economic shock globally, with the latest International Monetary Fund (IMF) forecasts predicting that Africa’s gross domestic product (GDP) will shrink by 4% in 2020. Many African governments are responding to the Covid-19 crisis by increasing spending. As a result, total government expenditures are projected to be on average 4% higher in 2020 than in 2019.

However, the Covid-19 crisis and the global slowdown are also hitting revenues, so in many countries this increase in expenditures is being financed through increased borrowing. Increased borrowing will cause African countries’ debt-to-GDP ratio to rise by eight percentage points of GDP on average in 2020. Unfortunately, most lack the fiscal capacity to sustain such high levels of borrowing. As a result, the IMF is currently projecting that governments will need to scale back spending from 2021 onwards.

This will leave many governments with difficult choices over whether to cut spending in other sectors to reallocate funds to health. Further international support will be essential to help maintain spending. Even prior to the crisis inequitable private spending, rather than public spending, was the largest source of health financing in more than half of African Union (AU) Member States in 2017. And official development assistance still accounts for more than 20% of total health spending in 20 of 55 African countries.

The AU Commission’s joint meetings of African Ministers of Health and of Finance build on the African Leadership Meeting Declaration (ALM), in which governments committed to both increasing domestic investment in health and improving the efficiency and effectiveness of health spending. These meetings could hardly come at a more important time. They provide an opportunity to share experiences in sustaining health gains through reforms to mobilise additional resources for health and to improve the value for money of health spending.

To inform these discussions, ODI and the Global Fund to Fight AIDS, Tuberculosis and Malaria have brought together perspectives from eminent leaders from Africa and from the global health community on the key priorities for African governments in responding to Covid-19 and investing in health.

The contributions highlight three critical areas that have been central to discussions:

  1. They recognise the decisive policy response to the pandemic across the continent and the ongoing importance of strong leadership and robust governance at national, regional and global levels.
  2. Reforms are important not just to mobilise more resources but also to drive efficiency gains. Creative responses to Covid-19 have led to innovations that can be scaled up to improve the productivity, resilience and sustainability of health systems.
  3. As Africa faces its sharpest economic contraction since the Great Depression, equity must be considered. This creates an imperative to rethink and redesign the social safety net to protect those with the fewest resources. This requires a focus on primary health care, addressing socioeconomic determinants of health and strengthening financial risk protection to ensure that out-of-pocket expenditures on health do not perpetuate inequity and create an additional ‘tax on the sick’.

The ALM aims to support governments to undertake the health financing reforms needed to achieve these goals through building capacity to make the right policy choices, tracking progress and to help governments to account to transform and build strong primary health care systems in countries.

Tom Hart, Research Fellow, ODI

Shu-Shu Tekle-Haimanot, Senior Advisor for political advocacy, resource mobilisation and partnerships, and health financing advocacy lead at the Global Fund to Fight AIDS, Tuberculosis and Malaria

Donald Kaberuka: sustainable funding for heath

We need to think differently about sustainable funding for health in these unprecedented times. The Covid-19 pandemic represents a dual threat – to our goals and ambitions and to the gains of the past 30 years. Health systems in low- and middle-income countries are grappling with addressing the double challenge of stepping up their response to the pandemic while protecting other essential services and maintaining the gains made over the past several decades, such as the fastest infant mortality reduction in history. We need to adjust to the ‘new normal’ since we may be living with Covid-19 and its consequences for a long time to come. We must think differently about financing a vaccine when one becomes available.

Increasing investment in health in a new economic landscape

The Covid-19 pandemic will probably turn back Africa’s economic gains of the past 30 years. Returning economies to a growth path in a more inclusive, sustainable manner will require increasing investment in ‘public health goods’ for effective pandemic control, inclusion and robust social protection. This will represent a good development for public health and social justice and boost the economy. At a time of reduced fiscal space and probably declining international support, unprecedented efforts are needed from governments and development partners to address the critical requirement to invest more in health in Africa, sustainably and with great value for money. This is a long-term undertaking that implies joint planning by Health and Finance Ministers.

Exacerbation of inequality and the imperative to rethink and redesign the social safety net

The major brunt of Covid-19 is borne disproportionately by those with the fewest resources, the least education and the least access to opportunities and safety nets. All these imply that we have to prioritise a redesigning of safety nets to protect those who are at greatest risk and least able to respond during the pandemic.

Learning lessons from the crisis

One important lesson from this crisis relates to the importance of innovation at community, national and global levels. We have seen remarkable innovations, including cheaper tools and technologies that improve diagnostics, epidemiological data collection and access to and quality of services. The challenges posed by lockdowns and social distancing are pushing us to reimagine and restructure service delivery in more efficient and accessible ways. Scaling up of some of these lessons to broader health systems will enhance their productivity, resilience and sustainability.

Why now?

Covid-19 has ‘stress-tested’ our health systems and our economies. We do not know how long it will be with us. We do not know when an effective vaccine will be available. Even when a vaccine is available, there is little certainty on access and affordability for African countries. At a time of reduced fiscal space, robust plans for our health sector and its resilience will be at a premium.

Lia Tadesse: three lessons learnt from Covid-19 and other emergencies

Covid-19 has revealed not only the obvious weaknesses of our health systems but also how we have underestimated health in our development agenda. We have seen how everything froze when Covid-19 hit the world. We have witnessed how a crisis in one sector compromised others in a short period when the magnitude was of a global nature. We went into such calamities unprepared, even though international public health agencies such as the World Health Organization, and prominent global figures, flagged threats years ago.

We have shown a positive attitude, passed dozens of resolutions and entered into several commitments to build resilient health systems and eliminate inequity and impoverishment. However, despite having the knowledge and commitment to improve our health systems, we have failed to put these into practice. Cases in point include the Abuja Declaration, which only a few African countries have complied with; our commitment to the Astana Declaration (renewed commitment to the Alma-Ata Declaration on Primary Health Care) is not yet gaining momentum; work on the Bali Declaration (recalling the Global Health Security Agenda in the Kampala Declaration) has in many countries not gone beyond carrying out assessments and producing strategic documents. Governments are still struggling to fund their health system adequately – partly because of budget constraints but mainly because of low attention to health and its impacts on other development agenda items. Covid-19 has taught us that depriving the health sector of resources has heavy implications for the economy, social dynamics and politics.

The way forward, building on lessons learnt from Covid-19 and other emergencies of local or global scope, should include:

1. Policy level

Put health in its rightful position on the development agenda as a means to achieve economic, social and political development, as well as the result of this development. Building a resilient health system is not only a national priority but also a global commitment to safeguard humans from health crises and their consequences.

2. Approach

Invest more in building a stronger primary health care system to ensure those in need access and use essential services. This means creating health-promotive capital by addressing the socioeconomic determinants of health through engaging other sectors and empowering individuals and communities to produce their own health.

3. Enablers

Capitalise on enabling factors such as use of technology, engagement of the private sector in all sectors and global health diplomacy. Covid-19 has obliged us to use technologies, embrace all actors, including the private sector, and partner globally to create awareness quickly, exchange information, test more people, avail ourselves of personal protective equipment and increase facility readiness. Diplomatic engagements with countries and organisations have helped us access essential commodities.

Uzziel Ndagijimana: building resilient health systems

Covid-19 has caused a major economic downturn. In its June update of the World Economic Outlook (WEO), titled “A Crisis Like No Other, An Uncertain Recovery”, the International Monetary Fund projects global growth at -4.9% in 2020 and a -3.2% contraction of sub-Saharan Africa’s economy (compared to 3.6% growth forecast in the WEO of a year earlier). For sub-Saharan Africa, this represents more than $ 200 billion loss in gross domestic product (GDP) due to Covid-19. And this is considered a conservative estimate with persisting downside risks.

This loss could have covered more than four years of investing 15% of Africa’s budget towards health. The same report considers that we may lose a decade in terms of development on average. The adverse impact on low-income households is particularly acute, imperilling the significant progress made in reducing extreme poverty in the world since the 1990s. Remember this is only for the current 2020, while we all know recovery is already slower than initially anticipated.

Before the pandemic, major progress was made in improving the health of millions of people. Covid-19 came at a time when African countries were busy implementing their own long-term visions, Africa Agenda 2063 and the UN Agenda 2030 (SDGs). Significant strides were made in increasing life expectancy and reducing both child and maternal mortality. In a sense, we, as the rest of the world, were taken very much off-guard by Covid-19, showing us the critical need for preparedness.

In anticipation of a second wave of Covid-19 or if another epidemic of this kind happens in the future, we need to take the necessary measures and make the necessary investment to prevent and/or mitigate an impact of today’s magnitude. This implies building resilient health systems that ensure universal health coverage. This means more and accelerated efforts towards 100% immunisation, focusing on providing more funding to develop health systems, health infrastructure, health insurance, and human resources for health.

Zweli Mkhize: key policy lessons: the case of South Africa

Covid-19 continues to take a heavy toll on our continent, with the after-effects likely to affect Africans for the next generation. When seen in the global context, the continent’s response has much to be heartened by: a lower mortality rate and a higher recovery rate. Unfortunately, this does not provide solace to the thousands of families and communities who have lost loved ones, both directly and indirectly, as a result of the pandemic.

In South Africa, as in many countries in the region, we have faced an uphill battle on both a health and an economic front. We have been facing a challenging economic and fiscal environment for the past 10 years: elevated unemployment, inequities, a high level of indebtedness and many people on government support grants.

From a health perspective, South Africa came into the pandemic facing one of the highest burdens of HIV/AIDS in the world, and with a large number of patients with chronic conditions. In dealing with Covid-19, our country took some key decisive policy measures, including following expert advice to use research outcomes to guide policy direction to contain the spread of the epidemic. In addition, repurposed health facilities created space for the management of Covid-19 confirmed cases. A rigorous approach to testing and tracing the spread of the virus has helped suppress new rates of infection and contributed to our high recovery rate of 90%. The fight is not over, though, and measures to contain the virus will be critical to prevent a second wave of infections.

Community engagement and behavioural change in communities are vital to help disseminate key health information and messages, and in supporting track and trace efforts. The focus is now shifting to community mobilisation for sustained behavioural change. Digital interfacing has also been encouraged, by introducing digital tracking and tracing systems to empower citizens to cooperate with containment measures.

As South Africa looks forward to recover from the economic and health impacts of Covid-19, some key policy lessons have emerged to inform our ongoing health reforms. The health sector needs adequate and predictable levels of financing in all countries. We hope these joint sessions of Ministers of Health and Finance will assist the continent in sustaining the gains made during the Covid-19 pandemic. In addition, it is important to ensure that policy responses continue to be informed by high-quality research, to ensure that interventions are evidence-based.

The establishment of global collaboration to accelerate the development and production of and equitable access to new Covid-19 diagnostics, therapeutics and vaccines (the Access to Covid-19 Tools Accelerator (ACT)) offers an opportunity to achieve global equity in this area. We cannot afford to continue to live in a situation whereby the wealthy nations procure scarce commodities leaving low- and middle-income countries (LICs and MICs) with poor access. The Accelerator is chaired by South Africa and Norway. We commit to ensuring that LICs and MICs are not left behind. We urge Member States of the African Union to support the work of the ACT Accelerator.

Mthuli Ncube: the role of Ministries of Finance: the case of Zimbabwe

Economies around the world have been devastated by the Covid-19 pandemic. Zimbabwe has not been immune to the economic and health impacts, which continue to take their toll and to place a downward pressure on global economic growth. This year, it is expected that economic growth in Zimbabwe will be negative; however, as a nation we are continuing to engage in a comprehensive set of efforts to ensure we will bounce back stronger.

Finding a balance between public health and social measures has been very challenging. Lockdowns have proven an effective tool in managing the pandemic but the resultant loss of incomes for households, especially in countries like Zimbabwe, with a high informal economy, has been dire. Consequently, the government of Zimbabwe has resorted to gradually easing movement restrictions and opening the economy to ensure that both the government and the general public can earn a living.

The government faces financial constraints in responding to Covid-19, including in paying competitive wages to retain critical and experienced health personnel and build and upgrade health infrastructure in general. The government has had to divert resources from other planned programmes and projects to respond to Covid-19 to enable financing of the construction, rehabilitation and upkeep of isolation and quarantine centres; to support the production of personal protective equipment by universities; and to enable access to water. Development partners have played a pivotal role in financing these Covid-19 health-related expenditures, pledging combined resources amounting to $206.8 million in both cash and kind. Of this amount, $60.1 million has been disbursed so far.

With an eye to the future, the fiscal space to expand investments in the health sector looks set to be constrained. Throughout 2020, our public spending per capita is expected to decline, in part through commodity price-related pressures reducing fiscal space but also through ongoing challenges in accessing external financing, particularly from the International Monetary Fund. Zimbabwe is continuing its re-engagement with the international community to support efforts to achieve economic sustainability and address the ongoing health crisis. It is in this vein that a renewed focus on policy reforms that improve the effectiveness and efficiency of health spending will be even more critical, as Zimbabwe looks to build back. The Ministry of Finance supports this.

Looking across the region and the continent, we believe Ministries of Finance have a pivotal role to play in supporting efficiency reforms in health systems, in terms of driving efficiency in service delivery but also in the integration of vertical disease programmes to provide cross-programmatic efficiencies. The Ministry of Finance supports Zimbabwe’s vision to have a national health system that ensures all citizens have equitable access to health care services of sufficient quality, thereby leaving no one behind.

Amira Elfadil Mohammed: the African Union and building well-financed health systems

Endorsement of the African Union (AU) Agenda 2063 – which calls for healthy and well-nourished citizens – by AU Member States reaffirms the continental commitment to establish high-quality, well-financed health systems in Africa. However, with varying country priorities and unprecedented health crises such as the Covid-19 pandemic, health financing capacities fluctuate. A recent estimation by the United Nations Economic Commission for Africa (UNECA) indicates that Africa needs $100 billion to tackle Covid-19 across sectors. This financing gap, among other coronavirus-related challenges, is affecting how health systems function and how health care is financed in Africa. We are witnessing Member States significantly prioritise and finance health as a key emergency response measure. The Commission encourages Member States to adopt this approach as a standard practice rather than as a short-lived contingency plan.

The absence of resilient health systems and sustainable health financing results in a lack of continuity and coordination of health care services, redundant processes and excess costs that leave communities in abject poverty. People and communities must be engaged in the design, delivery and assessment of health services and how they are financed, to ensure they are built to meet local health needs – rather than those of donors or commercial or political interests – lest the citizens remain unheard and with unmet socioeconomic needs. We must also foster strategic collaborations that bring about innovation and utilisation of domestic resources. Africa’s wealth lies in its people, so leaders must seek to understand the needs of their countries, create enabling environments for good health and prosperity and empower their populations to lead the change we aspire to see.

The 55 AU Member States have been resolute in their efforts to achieve ambitious health targets for the continent. Strong political leadership has ensured that health remains high on the continent’s development agenda. While some targets have not been achieved, Africa has made great strides in improving health outcomes across a range of performance metrics. Africa’s long-term development framework, AU Agenda 2063, calls for an African-led transformation. Although we are guided by this robust policy and its strategic pillars, we must continue to identify radical strategies of implementation while exercising accountable leadership.

Ngozi Okonjo-Iweala: global access to Covid-19 vaccines

Six months into the pandemic, the coronavirus is still winning. With nearly a million people dead and over 31 million infected, and with the global economy expected to shrink by more than $6 trillion in 2020 alone, this crisis continues to escalate. Governments have spent trillions of dollars on domestic economic stimulus but this is not sustainable if we do not also invest in an exit plan. Thanks to unprecedented global solidarity, we now have that exit plan – the COVAX Facility. A unique international collaboration, COVAX is the only truly global solution to Covid-19 and our best hope of ending the acute phase of the pandemic. This is because it is the only way to get fast, fair and equitable access to Covid-19 vaccines, for every country, not just the wealthy few.

Global access to Covid-19 vaccines will be absolutely essential to end this pandemic, because no one is safe until everyone is protected. However, for many the crisis will not end with the vaccine. Livelihoods have been wiped out, health systems devastated and economies crushed. For many countries, economic recovery could take years; the impact on the poorest nations, particularly across Africa, could be far greater. It is critical that we do not let this set them back and unravel decades of development and economic progress in the process. Already, the response across the continent has been remarkable, and as an African and AU envoy I would like to praise the unity of purpose with which African leaders have acted during this pandemic. Their work with Africa Centers for Disease Control, for example, in building the medical supplies and equipment platform, has been rapid and effective, helping mitigate the impact of the pandemic. I also commend Health and Finance Ministers for organising this meeting because this is exactly what is needed to forge solutions. The continent has handled this crisis responsibly and COVAX is there to make sure Africa does not wait behind in a queue while rich countries get their people vaccinated.

The road to recovery, therefore, must begin with investment in Covid-19 vaccines and vaccine delivery through the COVAX Facility. For African nations, this is not just a chance to end this immediate crisis; it also represents an opportunity to ‘build back better’. Part of this will involve innovation in health care systems, as well as continued domestic resource mobilisation and investment in immunisation and health services. But also, the same kind of collaboration and solidarity that underlies COVAX will now be key to recovery and future resilience. At the moment pandemic response is costing low- and middle-income countries more than $52 billion every four weeks. This could push countries even further into debt, unless there is simultaneous investment in tools that can help end the pandemic, such as Covid-19 vaccines. By working together, through a unified approach towards investment in COVID-19, health and immunisation, Africa can not only rebuild but also ensure it is better prepared for the next pandemic.

Muhammad Ali Pate: World Bank and Global Financing Facility efforts

These are unprecedented times and I know all of you are feeling a heavy weight on your shoulders as you make tough decisions about how to address this pandemic. What started as a health crisis rapidly escalated to a broad social and economic crisis, with potential to unleash significant transformations of societies for many years to come.

Despite its relatively lower share of cases and deaths, several factors make Africa particularly vulnerable to Covid-19, including pre-existing weaknesses in health systems, high poverty and vulnerability, limited safety nets and widespread macroeconomic and fiscal challenges.

Additionally, the strong effort to contain the pandemic has led to severe secondary impacts. A survey by the Global Financing Facility (GFF) across 63,000 health facilities – many of them in Africa – reveals grim statistics. For example, facilities in Liberia have experienced a 35% drop in the number of fully vaccinated children; facilities in Nigeria have seen a 16% decline among women seeking medical care during pregnancy. These disruptions confirm early warnings that secondary health impacts caused by Covid-19 are putting at risk many years of hard-fought gains in women and children’s health and nutrition.

At the same time, there is cause for optimism. Many countries in the region took quick and decisive action on Covid-19, scaled up testing and rapidly increased public spending to respond to the pandemic. The strong leadership by the newly established Africa Centers for Disease Control in coordinating a response and strengthening the capacity of public health institutions is particularly encouraging. I would also like to commend countries and the AU for their leadership in calling for expanded domestic financing for health. This meeting between Ministers of Health and Finance – originally conceived as a means to address historic underfunding of health systems – is now more important than ever. Recent World Bank estimates project that public health expenditure will contract by 2.7% in 2021 in Africa, highlighting the need to try to avert this through a number of actions. As leaders, you have the potential to expand domestic resources across the board, finding opportunities to allocate a greater budget to health and working towards greater value for money in the health sector, including by protecting spending on primary health care and ensuring access to essential health services. These are all issues where joint dialogue between Ministries of Finance and Health would be beneficial.

The World Bank and the GFF are proud to be part of this effort and stand ready to support your countries in the years to come. In the initial response to Covid-19, the World Bank committed $568 million to 31 African countries through the Covid-19 Strategic Preparedness and Response Program, on top of existing commitments. We expect to expand on this as vaccines become available. We thank you for your leadership and know that, together, we can lead in global solidarity to address the challenges before us.

Tedros Adhanom Ghebreyesus: investing in the global recovery

The Covid-19 pandemic has exacted a heavy toll on lives, livelihoods, societies and economies. Faced with a fast-spreading and fatal virus, many countries have resorted to the blunt instrument of lockdowns to save lives and take the pressure off their health systems. But the social and economic consequences of these measures have been severe. In response, many countries have also greatly increased public spending on health, social assistance and other measures to ensure the well-being of their populations. At the same time, tax revenues have fallen more rapidly even than has gross domestic product growth. Fiscal deficits are growing, and countries are borrowing to finance this much-needed spending. As a result, health financing is likely to come under even more pressure.

Evidence from around the world on health financing for universal health coverage (UHC) is clear: more and better-utilised public financing is the key to progress. Dependence on out-of-pocket spending creates barriers to service use; for those who do pay, it may create financial hardship for individuals and families. Voluntary prepaid health insurance tends to raise very limited funds; where it is large, it tends to exacerbate inequities and divert scarce health human resources to serve the needs of the wealthy rather than the poor. So the medium-term threat to public finance that Covid-19 poses is a major challenge to progress towards UHC. This requires a multi-pronged strategy: spend on the right things, make better use of resources, service the vulnerable and reach a global consensus to ease pressures on public revenues.

Patterns of public revenues and expenditures suggest that many countries are heading towards a new debt crisis that risks impeding the capacity of governments to spend on health even as economies recover. If nothing is done to ease this, debt servicing will absorb a growing share of public spending. The nature of this debt crisis calls for a global response, and I call on the international community and international financial institutions to consider measures, such as debt relief or restructuring, to enable poorer countries to ease the adjustment of their public finances so that health and other social spending can be sustained.

But fiscal measures alone will not be enough. The world will recover faster if the crisis is shortened by investing in critical global public health measures. Effective vaccines, diagnostics and therapeutics will be vital to end the pandemic and accelerate the global recovery, but only if they are available equitably and simultaneously in all countries. The Access to Covid-19 Tools Accelerator (ACT) is the agreed international mechanism for speeding up the development, production and equitable distribution of these life-saving tools. The current financing gap for the ACT Accelerator stands at $35 billion – less than 1% of what G20 governments have already committed to domestic economic stimulus packages. Of that amount, $15 billion is needed immediately to fund research and development, scale up manufacturing, secure procurement and strengthen delivery systems. This is not charity; it’s an investment in the global recovery that will be repaid very quickly.

Peter Sands: leaving no one behind

Africa has responded remarkably well to the challenge of Covid-19, through strong political leadership and by leveraging the lessons and capabilities from the fights against HIV, Tuberculosis (TB), malaria and Ebola. But we are still a long way from beating the new virus. Securing equitable access to vaccines will be vital but not a silver bullet. Africa will also need better treatments, better diagnostics and better personal protective equipment to protect the front-line health workers without whom no health system can function.

Confronted with this extraordinary array of urgent and difficult challenges, Finance and Health Ministers need to focus both on these immediate priorities and also on the long-term implications of the pandemic, as decisions made now could have a fundamental impact on people’s health across the continent for decades, and consequently on the overall trajectory of economic and social development.

Many political leaders across the globe have declared that, in the fight against Covid-19, we should leave no one behind, that no one is safe until all of us are safe. But the unfinished fights against HIV, TB and malaria tell a cautionary tale. Once these pandemics were eliminated as public health threats in the richer parts of the world, they dropped off the global health security radar screen, and momentum and resources slowed. There is a real risk that the same will happen with Covid-19, that it will become another ‘residual pandemic’, no longer a significant threat to those living in rich countries but still killing millions in the poorest and most vulnerable communities, not least in Africa.

Yet a different future is possible, one where we don’t just defeat Covid-19 but also use this pandemic as a catalyst to finish the unfinished fights against HIV, TB and malaria. Covid-19 has shown us the staggering economic downside of a new pathogen. Just as significant, but less immediately visible, are the economic upsides from freeing communities of the burdens of HIV, TB and malaria. This prize is enormous. To achieve this future, we have to reframe the current fight and rethink the way we talk about global health security. This fight against this pandemic should not be narrowly defined as a battle against this specific new pathogen, but must become a commitment to finish the unfinished fights against existing epidemics, and a pathway towards building resilient systems of health that can counter threats as yet unseen. Meanwhile, our concept of global health security must be expanded so that we do not just work to protect people against the diseases that may kill them but also invest more to protect people against the diseases that are actually killing them. Africa’s leaders have already demonstrated boldness and courage in their immediate response to Covid-19; we need equal boldness and courage in charting the longer-term strategy. The Global Fund is, more than ever, committed to working side by side with African leaders and partners. We must unite to fight.

Seth Berkley: delivering Covid-19 vaccines

We may still be in the midst of the worst global health crisis in a century but we have nevertheless reached a critical turning point. At a time when almost every country is experiencing an unprecedented existential threat, governments the world over have looked beyond the immediate needs of their citizens in favour of a solution that benefits everyone. That solution is the COVAX Facility. Coordinated by Gavi, the Coalition for Epidemic Preparedness Innovations and the World Health Organization, COVAX is the biggest multilateral effort since the Paris climate agreement and the world’s best hope of ending the pandemic, because it is the only way to protect people in all countries from Covid-19.

With nine candidate vaccines already in development, more under evaluation and a willingness to look at any promising vaccine, COVAX has the largest and most diverse portfolio of Covid-19 vaccines. If successful, its initial aim is to have two billion doses of safe and effective vaccines available by the end of 2021, which should be enough to protect high-risk and vulnerable people, as well as front-line health care workers. But we are not there yet. With more than 170 countries and economies now involved, including almost every African Union (AU) Member State, work has begun to ensure manufacturing is in place so that vaccine doses can be procured from our pharmaceutical partners at scale as soon as they are approved. Similarly, through the Gavi COVAX Advance Market Commitment (AMC), we must secure the remaining funding needed to ensure lower-income countries are not restricted by an inability to pay and obtain access, and are ready to deliver the billions of doses needed when the moment comes.

Gavi is only too aware of the challenges this will present, which is why we need your support to help make COVAX work, by championing the Gavi COVAX AMC, because ultimately this is a solution for you, your nations and your people. Gavi already helps countries vaccinate half the world’s children, including most countries in Africa. But the global delivery of Covid-19 vaccines will dwarf this and be the single largest and most rapid vaccine deployment the world has ever seen. In the meantime, to minimise the impact of the pandemic, as we work towards this it will also be important to ensure that routine immunisation programmes against killers such as measles, pneumonia and diarrhoea continue, and that vaccination campaigns resume as soon as possible. While it is necessary to avoid activities that risk spreading Covid-19, research suggests that any suspension of routine immunisation sessions to reduce Covid-19 deaths will bring 84 deaths from vaccine-preventable diseases for every Covid-19-related death prevented. Gavi has been working with countries, particularly in Africa, to help keep these vital services running during the pandemic. Vaccines not only are essential to end the pandemic but also have a crucial role to play in preventing outbreaks of other diseases, which can place additional stress on health care systems, and in improving long-term pandemic preparedness.

Mark Dybul: three considerations for the next pandemic

The African Union (AU) has implemented the most coherent and rapid regional response to Covid-19 in the world. Many African countries rapidly closed borders and initiated ‘lockdowns’ and other public health measures, including fielding large cadres of contract tracers. The AU was also the region to most rapidly identify the inextricable link between health crises and economic devastation. Chairperson of the AU H.E. President Ramaphosa has held regular calls with Heads of State and key partners from the outset. The speed, breadth and depth of the response is a model for the world.

Sadly, there will almost certainly be another pandemic in the future. To build on the impressive efforts thus far to control and manage Covid-19, but also to ensure continent-wide systems are in place for the next pandemic, there are a few key areas for focus:

1. Leadership and governance

As the AU has demonstrated, leadership and governance across sectors are key. However, to continue to advance against Covid-19 and to establish systems for pandemic preparedness to prevent future crises, active engagement of Heads of State and the AU Commission with relevant declarations could be important. Effective processes, systems and structures to ensure rapid health and economic response could be pivotal.

2. Dialogue and joint action by Ministers of Finance and Health

While many have tried to put health and finance in opposition, the AU’s actions show clearly that health and economic recovery and growth are inseparable. Covid-19 will dominate the AU’s proceedings but it is worth noting that the concept pre-dated Covid-19. Then Chairperson H.E. Paul Kagame led the Africa Leadership Meeting: Investing in Health (ALM) that created the foundation for the adoption of the AU Declaration on ALM. Significant progress has been made on the commitments of this Declaration. The ALM also led to the adoption by the AU/AU Commission of biennial Meetings of Ministers of Finance and Health to accelerate progress on domestic finance for health.

3. Linking the Covid-19 response and the ALM for domestic finance for health

The foundations of the ALM have become even more important in the time of Covid-19 and preparedness for the next pandemic. As longstanding AU Declarations affirm, it is through the strength of each country and the AU that sustainable economic growth and health will occur.

Authors

Donald Kaberuka

Dr Donald Kaberuka is the African Union Covid-19 Special Envoy and Chair of the Board of the Global Fund to Fight Aids, Tuberculosis and Malaria. 

Lia Tadesse

Hon. Dr. Lia Tadesse is the Minister of Health of the Federal Democratic Republic of Ethiopia. 

Uzziel Ndagijimana

Hon. Dr Uzziel Ndagijimana is Minister of Finance and Economic Planning of the Republic of Rwanda.

Zweli Mkhize

Hon. Dr. Zweli Mkhize is Minister of Health of the Republic of South Africa.

Mthuli Ncube

Hon. Prof. Mthuli Ncube is Minster of Finance of the Republic of Zimbabwe.

Amira Elfadil Mohammed

H.E. Amira Elfadil Mohammed is Commissioner for Social Affairs of the African Union Commission. 

Ngozi Okonjo-Iweala

Dr Ngozi Okonjo-Iweala is African Union Covid-19 Special Envoy and Chair of the Board at GAVI, the Vaccine Alliance.

Muhammad Ali Pate

Dr Muhammad Ali Pate is Global Director of Health, Nutrition and Population Global Practice at the World Bank, and Director of Global Financing Facility for Women, Children and Adolescents.

Tedros Adhanom Ghebreyesus

Dr Tedros Adhanom Ghebreyesus is the Director General of the World Health Organization.

Peter Sands

Peter Sands is Executive Director at the Global Fund to Fight Aids, Tuberculosis and Malaria. 

Seth Berkley

Dr Seth Berkley is CEO of GAVI, the Vaccine Alliance.

Mark Dybul

Hon. Mark Dybul is Professor at Georgetown University Medical Centre.

Donald Kaberuka

Donald Kaberuka

Lia Tadesse

Lia Tadesse

Uzziel Ndagijimana

Uzziel Ndagijimana

Zweli Mkhize

Zweli Mkhize

Mthuli Ncube

Mthuli Ncube

Amira Elfadil Mohammed

Amira Elfadil Mohammed

Ngozi Okonjo-Iweala

Ngozi Okonjo-Iweala

Muhammad Ali Pate

Muhammad Ali Pate

Tedros Adhanom Ghebreyesus

Tedros Adhanom Ghebreyesus

Peter Sands

Peter Sands

Seth Berkley

Seth Berkley

Mark Dybul

Mark Dybul