Today in 2023, Africa remains one of the most unvaccinated places on earth with treatment and testing, which are mainly available in the global north, a distant prospect. Mr Tian Johnson talks about funding pandemic preparedness.
What were the biggest bottlenecks in funding Covid-19 vaccine equity programmes?
While financing will always be an area of concern with respect to the continent’s health response, be it the decrease in public health spending, the betrayal of our “leaders” who have failed to keep the promises they made over a decade ago in Abuja or the lack of an inclusive financing mechanism for pandemic preparedness, at the outset of Covid-19, greed, racism and white supremacy played equally damaging roles in hampering our response.
It shaped the way in which we experienced the pandemic. Unelected and unaccountable bodies like Covax, while well-intentioned, fell short of meeting their lofty goals partly because of the misplaced trust put in the pharmaceutical industry, which has for decades prioritised profits over people’s lives – be it HIV or Covid-19. Disgusting scenes of hoarding characterised the second year of the pandemic where, despite many African nations paying for their vaccines, politics and greed facilitated an environment where Global North countries were flooded with vaccines and Africans were told to wait in line for medicines they were promised (and had paid for).
When the doses did come (sometimes at double the price of what the Europeans were paying), they came sporadically, fuelling an already volatile environment of community mistrust and governments who consistently failed to ensure that communities were meaningfully engaged and vaccine confidence built. Today in 2023, Africa remains one of the most unvaccinated places on earth with treatment and testing, which are mainly available in the global north, a distant prospect.
Further, how can we close the estimated $10.5 billion annual gap in global pandemic preparedness? And are vaccine bonds the solution to raising funds more efficiently?
The International Health Regulations (IHR) of 2005 are a legally binding agreement of 196 countries to build the capability to detect and report potential public health emergencies worldwide. IHR requires that all countries detect, assess, report and respond to public health events. CDC works with member countries across the globe to comply with IHR.
For a revamped IHR to succeed, the World Health Organization (WHO) must have the financial support, authority, and trust to ensure better compliance with these potentially life-saving regulations. An increase in funding of $1 billion annually in assessed contributions for the WHO would be a start.
One widely cited example of innovative vaccine financing is the International Finance Facility for immunization (IFFIm). The facility issues vaccine bonds to investors, who are primarily based in developed countries, thus mobilising the funds to ensure the immunisation of children in developing economies with secondary support from government donors.
Bond financing could be critical in pandemic preparedness as the pledging conference would urgently raise funds from donors faster, making financing available when it’s needed. The IFFIm has helped deliver vaccines to children who would have otherwise missed out, but its model has additional costs: the first is the management costs of the fund, which range from 4.4 per cent to 4.6 per cent of the money pledged and with a total of millions of dollars annually on average. The second is making interest payments to bondholders, which can be challenging to calculate because they are based on market and currency conditions.
However, IFFIm has had troubled relations with the aid community. This is because the private capital market transfers a large portion of earnings to the associated private actors in the form of high transaction costs or interest that carries financial risks supported by public funds. Over the years, all these factors have gradually lowered the policy importance of the IFFIm.
Current global health funds are financed voluntarily by countries and corporations. Can Africa solely rely on these actors to fund interventions in future pandemics?
Governments, corporations and, occasionally, philanthropies provide funding for global health organisations. However, governments, donors, bilateral funds, global health programmes and private actors pay for healthcare in most nations.
Africa needs to massively increase funding for healthcare and look at innovative ways of improving economic value by building up its healthcare systems. Africa has several promising avenues for this: building its own pharmaceutical industries and their supporting supply chain systems, improving and massively expanding training of Africa’s youthful population to serve local populations and exporting labour to the world’s aging population.
The movement towards universal health coverage (UHC), for which many African governments have made political commitments to or developed associated policies for , is one way to generate domestic funding for national health. The purpose of UHC is to ensure a full spectrum of essential, quality health services like health promotion, disease prevention, treatment, rehabilitation and palliative care.
However, realising the UHC dream is challenging where there are fragile healthcare systems and economic problems.
One of the biggest challenges is financing pandemic preparedness and response. How does Africa address financial challenges that hamper pandemic preparedness?
Outbreaks of known infections and new diseases occur regularly. Pandemics are not random events. Therefore, we should approach funding preparedness the same way we plan to finance development projects for, for instance, the education or energy sectors.
For countries to efficiently and reasonably respond to future pandemics, the World Health Assembly adopted a resolution in December 2021 that set up a procedure for WHO member states to develop a new legal instrument referred to as a “pandemic treaty”. The negotiations present a chance to address challenges in pandemic preparedness, implement practical solutions to improve production, research and development (R&D) and ensure fair access to medical countermeasures.
However, civil society is cautious that this approach may have the potential to replicate the inequity, greed and profiteering that characterised our pandemic response to date.
African governments can commit to Global Public Investment (GPI), a system of international public finance in which states collaborate to guarantee global public policy outcomes through minuscule payments from state revenue. The tenets of “all contribute, all benefit and all decide” are the foundation of GPI. It advocates for a system in which each nation contributes based on its capacity and receives benefits per its needs. Government funding is significant for developing robust public health systems, surveillance capabilities, R&D for countermeasures, regional procurement, and regional preparedness.
Governments can also potentially enact a financial transaction tax, with the money raised going toward funding R&D, healthcare and other pandemic preparedness measures. Additionally, regulatory reforms can be made to establish openness and accountability regarding public and non-profit organisations’ contributions to the cost of R&D and manufacturing. They can also advocate for transparent goods pricing for all buyers worldwide.
African countries can increase the ability of their national revenue agencies to collect taxes, stop illegal financial flows, and increase the progressiveness of their corporate and individual income tax systems by raising top rates for big businesses and their wealthiest citizens. African nations should always maintain robust participation and representation while standing firm on the collective healthcare goals.
The continent relied on Covax to get Covid-19 vaccines. Was this a failure by countries in the West to honour their pledges? What can be done to avoid a repeat of the same?
With the support of Unicef, African countries carried out direct outreach to countries with supplies for direct donations through an open letter to the G7. Several countries carried out direct procurement and, most importantly, the AU-Africa CDC-led Africa Vaccination Acquisition Trust (AVAT) strategy.
There were other methods that African countries used to acquire Covid-19 vaccines, including directly negotiating with producers and independently receiving the jabs.