In March 2020, Indian author and activist Arundhati Roy wrote, “Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next.”
For Africa, the Covid-19 pandemic has not only forced us to imagine a different future but to urgently act for one where the continent can stand on its own against pandemic threats. As outbreaks continue to rise, we must ask ourselves: are African leaders willing to invest to make our imagined pandemic-proof future a reality?
The inequities that Africa has faced in accessing vaccines, tests, treatments, and even personal protective equipment (PPE) have been yet another reminder that charity models to address African health priorities are unreliable, particularly during global pandemics. In response, African leaders have committed to an ambitious pandemic prevention, preparedness, and response agenda for the continent.
But as leaders gather in the coming week for both the second Conference of Public Health in Africa (CPHIA) in Kigali and the U.S.-Africa Leaders’ Summit in Washington, DC, words of commitment won’t be enough. Now is the time to ensure commitments are turned into actions supported by the resources necessary to turn the tide in the fight against pandemic threats across the continent — including polio, malaria, Ebola, COVID, AIDS, TB, and others.
The proposals and initiatives African leaders have put forward thus far show promise and indicate that lessons are being heard. But, are they pushing past the tendency to simply document lessons rather than take action on lessons learned? Perhaps the boldest indication that the Africa Union is taking the continent’s health agenda seriously in the aftershock of COVID-19 was the decision to elevate the Africa CDC to an autonomous public health agency, giving it even a stronger mandate to drive its vision of a “New Public Health Order” for the continent.
To address the perennial shortfall of essential medical countermeasures for routine and emergency public health needs, the Africa CDC has established the Partnership for Africa Vaccine Manufacturing, which has developed an audacious 20-year plan with a projected $30 billion investment. The plan lays out ambitions for Africa to produce 1.5 billion vaccine doses by 2040 to meet 60 of its needs, compared to the less than 1 percent it meets today.
These and other initiatives, if translated into actions, are perhaps Africa’s best chance to advance its health sovereignty and security. However, the domestic financial commitment to these bold plans and ideas remains meager and uncertain. Contrary to the envisioned future, a recent World Bank report shows that health spending in Africa is actually dropping.
So, what will it take for African leaders to mobilize new and additional resources for Africa’s future health vision? While it is undeniable that governments in the continent face adverse conditions to expand the available pool of resources, leaders have choices and alternatives to explore.
On one side, policy reforms, innovation, and partnerships can unlock new funding, while on the other clear prioritization is crucial to advance those initiatives offering the most significant impact and benefits. Here are three actions Africa leaders can and must take:
1. Prioritize and ensure national and Africa-level pandemic prevention, preparedness, and response policies are adequately funded. National leaders must prioritize national budget allocations to implement the policies adopted in agreement with Africa CDC, and maximize their outreach and impact through coordinated investment with regional and global financing mechanisms, such as the Pandemic Fund. Leaders must also urgently operationalize the strategy to bolster the continental health emergency infrastructure.
2. Advance fiscal policy reforms that increase funding and position health spending as a whole-of-government investment. The far-reaching impacts of the Covid-19 pandemic — with economies contracting between 1 percent to 4 percent and pushing many Africans into poverty — are primarily explained by the continent's lack of preparedness. Africa’s leaders must advance domestic fiscal reforms that allow higher and sustained investment in preparedness and response capacities and reduce the risks of costly disease outbreaks. Moreover, pandemic prevention, preparedness, and response investments must be a shared priority across ministries and government units and shielded from cuts during economic downswings or periods of fiscal stress.
3. Increase investment and support programs on research, development, and innovation. A recent report on the state of Africa's Pandemic Preparedness by Future Africa Forum and Pandemic Action Network found that the most glaring gap is in local research and development (R&D) of diagnostics, vaccines, and medicines for diseases impacting the continent. PATH compiled data in 2020 also shows Africa accounts for only 1 percent of the global investments in R&D and 2 percent of the world research output, despite carrying 25 percent of the global disease burden. To be prepared for when an outbreak happens, leaders must prioritize and increase the funding directed to local and regional programs that focus on developing vaccines and other essential health security countermeasures for the continent.
As political leaders gather in Washington, DC for the US-African Leaders Summit and public health leaders converge in Kigali for the second Conference of Public Health in Africa (CPHIA), the key indicator of their success will be how much new and additional resources are mobilized for Africa’s future health vision.
Or in simple terms, if African leaders put their money where their mouth is! Sustainable financing for Africa’s future public health and health security should not only be at the top of the continent’s shared agenda, but also be met with political drive and results.
In this era of pandemic threats and climate crises, leaders should be measured by the strength of our health systems to weather the storms that are coming. Africa's resilience depends on translating good commitments into real — and adequately funded — action. There is no time to lose.
Mr Aluso is the Africa Director, Pandemic Action Network while Ms Mburu is the Executive Director, WACI Health.