August 9, 2022

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Endemic COVID-19: Africa moves to retool its healthcare system

Endemic COVID-19: Africa moves to retool its healthcare system [Graphics: Hope Mukami]

As countries around the world begin reversing strict COVID-19 containment measures, African states are retooling their public health systems to confront the next healthcare emergency – as the current crisis shifts from pandemic to endemic.

Seth Onyango, bird story agency

In South Africa, the continent’s largest production line for coronavirus vaccines is already being adapted to manufacture other drugs, as Africa’s demand for Covid shots falters.

Aspen Pharmacare’s facility near Cape Town, which was being used to produce the Johnson & Johnson vaccines, will instead be used to make anaesthetics.

Dr Stavros Nicolau told BBC that keeping the production line going would no longer be sustainable since orders for Covid shots have not been forthcoming.

Slow vaccine distribution at a local level in Africa has left most public healthcare systems with an oversupply of shots, making Aspen’s vaccine line not commercially viable.

As of March 2022, about 13 per cent of Africans had been fully vaccinated. Although the continent received 693 million doses against a population of 1.4 billion people, about 40 per cent of that is yet to be administered.

Aspen’s facility will be able to manufacture vaccines on a needs or emergency basis, highlighting the increased agency of Africa’s pharma and healthcare industry.

The issues exposed very publically by the COVID-19 pandemic have forced African governments and regional bodies to face up to the dangers of lacklustre healthcare preparedness.

Although the per capita expenditure of health budgets in Africa (5.1 per cent) is lower than OECD member countries (12.5 per cent), the proportion of budgets allocated to health is actually relatively high. Meaning that money allocated to health is not reaching the population.

The African Union, the continent’s apex political outfit, is targeting local production of 60 per cent of all vaccines administered on the continent, by 2040, up from the current 1 per cent.

This push comes against the backdrop of unequal access to COVID-19 vaccines that initially sidelined Africa. The pandemic has been a valuable lesson learned, say many health officials, and Africa now appears keen to build its own vaccine production capacity.

In the aftermath of the pandemic, nearly all African states – the top spenders being South Africa, Senegal, Kenya, Nigeria, Gabon, Mauritius and Egypt – are committing more to healthcare expenditure.

Africa will now aim to align healthcare spending with the Abuja Declaration, where African Union (AU) member states met in 2001 and committed to allocate 15 per cent of their budgets to health.

At the time this was meant to prepare the continent to confront health challenges like HIV/AIDS, malaria and tuberculosis.

Lower-than-agreed allocation of budgets, and a continuing brain-drain of health professionals, lured away by better-paying jobs overseas, has seen further decay in public health care. However, thanks to the growth of health tech on the continent, there have been signs of a turnaround – one which was exacerbated by COVID-19.

Now, the Brookings Institute is pointing to an opportunity in Africa’s healthcare sector, with its figures showing it will be worth an estimated 259 billion US dollars (US$) by 2030.

The institute states that African states can build on the health financing successes of 2021 to strengthen the resilience of this sector and its people.

“Out-of-pocket (OOP) health spending in Africa remains excessively high compared to other continents — just one weakness in Africa’s health systems that the COVID-19 pandemic has exposed,” Brookings analysis read in part.

“Indeed, despite the havoc the virus has wreaked, it has also provided the continent with opportunities to reshape its health infrastructure as well as its supply systems, urging a shift from the donor and externally manufactured products to continental production systems leveraging opportunities created by the African Continental Free Trade Agreement.”

In Senegal, for example, President Macky Sall is ramping up efforts to establish a sovereign national pharmaceutical industry, not just for his country, but for Africa.

“In view of the effects of the Covid-19 pandemic, the Head of State reminded the Government, the imperative to consolidate a resilient national pharmaceutical industry,” he said in a statement last year.

This he said would guarantee the sovereignty of Senegal even when faced with the need for basic necessities.

Sall, who is also the AU chairperson, is ensuring that the organisation, in partnership with the Africa Centre for Disease Control (CDC), is able to spot capacities, pool resources and ramp up vaccine production in Africa, including mRNA vaccines.

According to Nature Medicine journal, the endemic phase of COVID-19 in Africa should also be accompanied by an investment in healthcare workers.

International Federation of Red Cross and Red Crescent Societies (IFRC) regional director for Africa, Mohammed Omer Mukhier-Abuzein, told Nature Medicine that the IFRC is expanding its involvement and will train five million community health workers over the next five years.

“We have a five-year plan for pandemic and epidemic preparedness, including COVID,” Mukhier-Abuzein said.

“Part of that plan for us is to strengthen the community health workers especially [in] the higher risk areas and the most vulnerable communities.”

Sandile Buthelezi, Director-General of South Africa’s National Department of Health, told Nature Medicine that South Africa plans to integrate COVID-19 vaccination into its routine immunization program. As in Rwanda, South Africa also plans to make COVID-19 testing routine, in a similar way to malaria and HIV testing, and further leverage its pioneering genomic sequencing network for pathogen surveillance.

This integration of testing and treatment regimes into existing health infrastructures follows an unparalleled degree of urgency – and agency – on the part of African governments and cities through the COVID-19 pandemic.

A report released last year showed that Nairobi, Lagos and Johannesburg led Africa’s innovation effort against COVID-19 and provided crucial solutions in diagnostics and treatment of the virus.

In StartupBlink’s latest Coronavirus Innovation Map ranking, Nairobi scored 1.314 points to list 24th globally, while Lagos and Johannesburg took positions 34 and 36 respectively.

StartupBlink markets itself as the world’s most comprehensive startup ecosystem map and research centre. Its Coronavirus Innovation Map is a platform of hundreds of innovations and solutions from around the world that help people cope and adapt to life amid the viral pandemic.

African universities have been at the forefront of pioneering many of the solutions needed by communities across the continent during the pandemic. Beyond the health sciences, engineering continues to play a pivotal role in understanding and mapping local contexts, such as a lack of electricity supply.

Wits – among the top 200 universities in the world, according to the Times Higher Education World University Rankings 2020 and the top-rated institute for research in Africa – has already participated in two clinical trials for vaccines, with Oxford-AstraZeneca and Novavax.

Makerere University, another of Africa’s top universities, has created solutions to some of the region’s most pressing issues, from its campus on a hill in Kampala, Uganda,

Scientists there created 3D-printed, biodegradable face shields as well as components for ventilators.

Other African cities featuring in the top 100 COVID-19 innovation map are Tunis (Tunisia) at position 81, and South Africa’s Cape Town and Pretoria, clocking in at 97 and 100 respectively.

bird story agency

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