At the United Nations General Assembly in September 2022 in New York, African leaders made a call for the full implementation of a "New Public Health Order for Africa," which they believe will shape the continent's preparedness for future pandemics. They urged greater investment in Africa's health institutions, health workforce, and medical manufacturing capacity, while calling for respectful, action-oriented partnerships across the continent.
Similar proposals have been made in the past. In the aftermath of the West Africa Ebola Outbreak, former Director of Africa CDC Dr. John Nkengasong called for increased country leadership and ownership and regional solutions.
But the COVID-19 pandemic further underscored the need to move towards greater self-reliance, and while strengthened continental cooperation in response to an unprecedented global health emergency. It yielded new initiatives such as the Partnership to Accelerate COVID-19 testing, the African Vaccine Acquisition Task Force, and the Africa Medical Supply Platform. The pandemic also highlighted inadequacies in the global health system. Much of the continent suffered a lack of access to COVID-19 vaccines while wealthier countries hoarded them, sealed off from health innovations by export restrictions and an intellectual property rights regime.
Inequities showcased the need for Africa to be more self-reliant in manufacture of medical products
These inequities showcased the need for Africa to be more self-reliant in manufacture of medical products, which is a focus of the New Public Health Order. Several initiatives to support local manufacture, distribution and regulation are already gathering momentum, including the Partnership for Africa Vaccine Manufacturing, which is led by Africa CDC and African Union, the recently ratified Africa Medicines Agency, and the Africa Development Bank's African Pharmaceutical Technology Foundation. The World Health Organization has also established a hub for mRNA vaccines in South Africa with links to other countries in Africa to support technology transfer and specialized training for local manufacturers.
However, these promising efforts are not without challenges. The ultimate viability of local manufacturing in Africa also hinges on whether countries can reduce risks to investment and the variability of demand, for example with advance market commitments for the produced goods. There are ongoing continental efforts to harmonize markets in Africa and facilitate economies of scale, such as the implementation of a common regulatory framework, a platform for pool procurement, and the Africa Free Trade Area Agreement.
But many low- and middle-income countries also carry a rising debt burden of new loans and are implementing austerity measures under pressure by international financial institutions. This debt burden, which has been further aggravated by the pandemic, rising interest rates, war and instability in Europe, has reduced spending in the social sector including on health commodities.
Development loans can support short-term investments in population health but servicing the debt can constrain longer-term increases in government health expenditures. The Debt Service Suspension Initiative (DSSI), introduced by the G20, was welcome but insufficient: the private and multilateral creditors who make up most debt services in DSSI-eligible countries did not take part, and it ended in December 2021.
African countries also need to be better and more fairly embedded within multilateral pandemic preparedness mechanisms. The World Bank's new Pandemic Fund aims to "support the development, procurement and deployment of countermeasures and essential medical supplies." But low-income countries were only offered a seat on its board after strong global criticism, and regional entities such as the Africa CDC are currently not implementing partners.
The Pandemic Fund needs to fully embrace equity to successfully achieve its ambitions. Otherwise, during the next global emergency the same top-down pattern of global solidarity will repeat, leaving low-income countries at the back of the line.
Some advocates have voiced concerns that the Pandemic Fund could also reaffirm the current intellectual property regime of the pharmaceutical sector, which imposes monopoly prices without adequately considering developing countries' capacities. Africa needs to be represented in the fund's highest decision-making mechanisms: The fund should consider centering a regional organization such as Africa CDC in its governance and operations by making it an implementing partner.
To support Africa's drive towards self-sufficiency, other pandemic financing mechanisms also need to grapple with how to remain sustainable. A recent white paper released by GAVI, the Vaccine Alliance, a major supplier of vaccines in Africa, outlined its plans to diversify procurement by investing in Africa manufacturers. This is a potential step in the right direction and ensures the needs and capacity of African countries are considered.
The ultimate guarantor of sustainable, local production of essential medical supplies is increased domestic investment. African countries need to prioritize health expenditure in their domestic budgets, and ensure health systems are adequately resourced and resources are used optimally. Additionally, the G20 and other institutions could also give countries more budget flexibility to meet their pandemic preparedness and response plans. African countries should be able to leverage development finance, capital markets, and debt restructuring among other tools to create the fiscal space for health investment in line with national and regional priorities.
The COVID-19 pandemic further exacerbated existing disparities within and between countries, and the highlighted limitations of the multilateral system when the world is faced by a shared biological threat. Going forward, it is imperative to design a more equitable and sustainable system which takes into consideration the specific need and capabilities of all countries – with equity at the core of pandemic preparedness and response. At the same time, it is important for Africa to strengthen its resilience, resources and capabilities to prevent and respond to public health emergencies and disease threats. Strong public health institutions such as Africa CDC will play a foundational role in this, enable the continent to be better prepared to respond to disease outbreaks, and save lives.
