Interview by Tamsin Rose, senior fellow for Health at the Africa Europe Foundation, working on health policy at the European level since 2002
1. How would you like to see the recommendations made in your recent paper on Pandemic Preparedness and the Future of health care taken forward? How would the strengthening of health care systems be integrated into these recommendations?
I would like to see them implemented. Our report on Pandemic Preparedness was the result of conversations with our strategy group and with our High-Level Group of personalities. Ellen Johnson Sirleaf, one of the co-chairs of the Independent Panel for Pandemic Preparedness and Response (IPPPR), was part of the group. We entirely endorse the messages she put in that report calling for a specific financing mechanism at a global level to support countries in their responses.
There are two elements that have come forward from our health strategy group. First, the power of data. The pandemic taught us the critical importance of having accurate data for policymaking. This reality is illustrated with the emergence of the new variant Omicron. It was largely picked up because the first cases were found in a country, South Africa, with sufficient capacity to carry out systematic genomic sequencings of the virus samples and with an infectious disease community that is well integrated into global networks, allowing the country to alert the world early on. This is the level of security needed for everyone. In the area of Pandemic Preparedness, so data is critically important. In Europe, there is the new European Health Data Space, designed to promote a more robust exchange and access to a broad range of health data to both support healthcare delivery and policymaking purposes. The same level of ambition should exist in Africa. There are 1.3 billion people on the continent, with a very young population increasingly comfortable with digital tools even though mobile penetration isn’t sufficient yet there. It is a great opportunity.
Second, the world response to Covid19 has been lacking and the mantra “no one is safe until everyone is safe” rings hollow. Our report calls for a stronger response. On intellectual property (IP), the European Union (EU) has not played a strong and positive role, quite the opposite. Our report calls for support of the Indian and South African governments’ proposal for IP waivers. Of course, it is not the miracle solution, but it is an important signal that IP should not be a barrier for medicines to be available around the world. It is fundamentally an equity issue, and the pandemic has exposed the global inequity. Looking across other areas of the work of the Africa-Europe Foundation, we link Pandemic Preparedness to the climate-health nexus. The Covid19 pandemic, like climate change, is still waiting for an extraordinary response. If countries need to trust each other to take radical actions to address climate change, this health crisis has not set a good example. The richer countries have taken care of themselves first. This wasn’t just a question of humanitarian donations: African countries wanted to invest money in buying the vaccines, sometimes at a higher price than European countries had negotiated. And yet, manufacturers prioritized deliveries for European countries over orders from the African continent. It is another example of the system that is stacked against Africa’s efforts to achieve better health. This is another thing we call out in our report. For us, it is not a partnership of equals if one party is always put first in the queue to be served. In the report, we highlight that a partnership of equals requires the EU to acknowledge that the pandemic has widened the inequalities and these power dynamics that must be addressed.
2. In your opinion, what would it take for the EU to lift patents?
It can be challenging for the EU to agree on anything, particularly in areas such as trade. The intention of the TRIPS waiver proposal is clear: to ensure access to COVID-19 vaccines. The logic of the EU’s position is that IP isn’t the immediate barrier because there are many other barriers that also need to be addressed. However, 20 years after the first HIV medicines were available in Europe but not in developed countries because patent protection kept prices very high, Africa’s campaigners who fought to bring ARVs to the continent are repeating the powerful message: it should never have happened again. This was why the TRIPS waiver mechanism was created. If, in a global pandemic, it is not appropriate to use that mechanism, then when is it? That, to me, is the burning question. When the United State took the unprecedented step to say that it would support the move, Europe was unable to match it with an equivalent gesture, however symbolic.
An effective vaccination campaign needs an integrated data collection system, cold chain storage, an enormous number of people to carry out vaccination, a public health information campaign on vaccination and a whole series of different things that need to be put into place. Of course, IP is just a small part of that. But if efforts are being made, IP should not be a barrier. Furthermore, lifting patents is symbolic for the future health challenges that are coming. Infectious diseases specialists predict that every 10 years, possibly 5 years, another pathogen will emerge with a potential epidemic or pandemic capacity. For these future, unknown threats, IP must not be a barrier to keeping us all safe. From a citizen standpoint, it is very clear that there needs to be greater solidarity in reality rather than rhetoric.
3. The EU has stated its intention to establish a partnership of equals with the AU. In your opinion, what has the EU accomplished so far? What more needs to be done in the near future to accelerate progress?
I would reframe that question by saying that one of the most extraordinary things I noticed in the last 18 months has been how much African political leadership has stepped up during the pandemic. The African Center for Disease Control (CDC) has moved very fast to set up the Africa Medical Supplies Platform.
Something new is emerging: the African Medicines Agency (AMA). The AMA has been a ‘work in progress’ while waiting for the treaty to be ratified. Suddenly it is happening. I see this as a resurgence of African political leadership and commitment to invest in the technical infrastructure and then the regulatory capacity. Now, how could Europe be a good partner in this? Although it has experience to share, Europe should not propose a copy-paste of the EU institutional landscapes, it should acknowledge the leadership and the messages coming from Africa to adapt its position. The EU is a source of funds, but to us, a partnership goes beyond the money. The messaging of the EU shouldn’t be about how amazing they are because they delivered x number of vaccines through COVAX; that misses the point. Instead, the EU should look at the broader relationship. The EU should see and acknowledge the steps taken by African leaders and see how they can build on that. It is about the quality of the relationship more than anything else. The recent announcements about the investment for the Institut Pasteur in Dakar and for the creation of the regional manufacturing hubs led by the STDCs are welcome. But the initiatives backed by the EU should be those decided by the African Union. The leadership and decision-making must come from Africa.
4. How can France, during their Presidency of the European Council, support the EU’s actions towards strengthening Africa’s public health sector in the long term?
The challenge is that the EU Presidency that France holds lasts just 6 months while the question focuses on the long term. Furthermore, France will have presidential elections in the middle of its EU presidency. Therefore, my response is nuanced.
The EU/AU summit is scheduled for mid-February but given the epidemiological context I am not sure if it will go ahead as planned. In my opinion, strengthening Africa’s public health sector needs to be a continued focus. However, according to our Health Strategy group, resilience and pandemic preparedness are important but shouldn’t rely solely on technical solutions. In past health crises, the EU response has been to create a technical agency to address it – for example, European Food Safety Authority (EFSA), European Centre for Disease Prevention and Control (ECDC), European Medicines Agency (EMA). Yet, the past two years have highlighted that the virus exploited vulnerabilities created by inequalities in society. When working on pandemic preparedness and surveillance with the AU, the EU must go beyond investments. It is a much broader, more complex, and more nuanced relationship that includes areas such as scientific excellence and health workforce. Europe has attracted many trained health workers from Africa. Health workers were badly needed and even during the pandemic, some European countries were actively recruiting in Africa. Both continents have a gap, which continues to grow. The WHO projects a global shortage of 18 million health workers by 2030. Our proposal at the Foundation is to create an Observatory for future health workforce, to look toward 2030 and have a deep reflection on what health systems would look like then. We aim to map the skills, competences and workforce that will be needed, identify how to build training pathways in ways that are mutually advantageous and don’t involve poaching each other’s scarce health workers. Both the EU and the AU have identified healthcare systems as potential growth engines for jobs for a young population that need economic opportunities. However, without investment in creating universal access healthcare systems, newly graduated health workers won’t find jobs.
Our perspective for the Observatory is that it will have a broad definition of the health workforce. Public health is much more the usual list of doctors, nurses, and midwives. Public health includes digital skills, biostatisticians, epidemiologists, logistic and supply chain managers, hospital managers, quality assurance controllers and a whole range of skill sets needed for functioning, modern public health systems.
A key area to strengthen is higher education. The future of medical research is in the 1.3 billion people of Africa – an incredible pool of talent. The future scientific breakthroughs could come from there. The potential for clinical trials there is enormous but can only happen if investment is made in high quality research in universities and support is given for industrial and commercial spin offs. For example, the COVID AstraZeneca vaccine for COVID-19, one of the first vaccines approved for human use, was built on research from the University of Oxford and one of their commercial spin offs. Investing in a higher education system isn’t just about training people to get a degree but becoming a magnet for bioscience commercial clusters that combine access to financing and business skills. A leading researcher that wants to advance the frontiers of science on Artificial Intelligence or genomics should be able to find an opportunity to do it at a leading global institution within Africa. Part of this will have to involve mutual recognition of qualifications and a plan for professional mobility within the continent. This will enhance the skills of the researchers that we will need for the health system of the future. The goal is for Africa to be at the front of the queue for medical innovation rather than the back.
The African Union ‘Agenda 2063: The Africa We Want” has a clear ambition for greater autonomy in medical products and better healthcare. 2063 may seem like a long time away but we need to start now to design pathways to get us there and achieve the vision.
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