African Development Bank Group 2021 Annual Meetings: 25 June 2021, Remarks by WHO Regional Director for Africa, Dr Matshidiso Moeti
First, I’d like to thank sincerely President Adesina for the invitation. It’s been some time since I came to visit you in Abidjan and I’m very happy to reconnect, very honoured to be asked to join this session.
I’d also like to greet the panellists of the session, Honourable Amadou Hott, the Chief Executive Officer of IDB and my colleague and friend Dr John Nkengasong whom I saw was connected. I’d also like to say a special greeting to Dr Jim Kim who worked with and inspired me as his counterpart in the Region on our collective work at WHO on an initiative to address a huge injustice and future of inequality of access to treatment for HIV for African people. Thank you for referring to that and for that shared experience.
It is a pleasure for me to join this conversation on the strategic imperative of boosting local pharmaceutical production in African countries, and to start with some reflections and questions to start off the discussion by our distinguished panellists.
And leading on from the previous panel, I have to say that you have laid out the issues, the ideas extremely well and we can see clearly that investing in health is incredibly important. This includes investing in securing critical supplies as well.
The World Bank has estimated that every month of delay in rolling out COVID-19 vaccines on the African continent, costs $13.8 billion in lost GDP.
While advanced economies are pushing forward with recovery, the IMF projects that sub-Saharan Africa will be the world’s slowest growing region in 2021 – and here I am speaking to an audience that understands this better than I do as a health professional – but it’s estimated that the region’s economy contracted by almost two percent in 2020.
We have seen this before as several speakers have already said. So, I’ll just take the example of the West Africa Ebola epidemic, where more than 3.6 billion dollars was spent on the response and the economic impact is estimated at about 54 billion dollars.
These examples highlight that health and the economy are inextricably linked as has already been eloquently illustrated and health is a pre-requisite to economic growth.
Health is a transformative area where the African Development Bank’s investments can spur sustainable economic development and social progress, and concretely fight poverty and as WHO, I’d just like to add our voice in welcoming and encouraging this engagement and indicating that we will commit ourselves to working closely in partnership as we play our complementary role of advising governments, partners and stakeholders on policies, on evidence-based norms, support the building of capacity, which has very much been referred to in the previous session and evaluating to demonstrate that investments are delivering tangible results or not.
It is possible to prevent or mitigate the impacts of health emergencies on lives, livelihoods and economies. African governments have recognized this and increasingly are adopting policies linking improving their health systems as a path to Universal Health Coverage with developing the resilience that is so important. The key is to deal with the vulnerabilities of health-care systems in African countries.
This includes addressing weak governance, policy-making and prioritization, these have already been emphasized and also addressing the increasing fragmentation. I’d like to confess that as an international community we are partly responsible for the fragmentation of the health systems in Africa. We are starting to work to stop it.
What can be done, for example, to create a robust system and a supportive regulatory environment for public-private partnerships? I join those who have emphasized that this is absolutely critical for health development in Africa.
We need data systems that are capable of monitoring, evaluating, ensuring accountability and assuring learning of lessons as well so that we continue indeed to build back better from this pandemic.
Key inputs into a resilient health system capable of delivering health care to the poorest people who are at the most, the furthest distance from capital cities, requires attention such as infrastructure. I’ve heard infrastructure mentioned in several sentences, starting from the most peripheral health posts which constitute the contact between people and the health system that will enable you to know when a strange pattern of disease is starting to spread, meaning an epidemic is starting to spread. That’s absolutely vital, in addition to providing access to basic health-care services.
It’s very important as well to leverage hugely the potential of digital technology, to address the human resources gaps and the shortages of supplies and equipment, and also to invest in expanding homegrown research and innovation.
At WHO, several years ago we launched an innovation challenge and I’d like to echo what was said by the young people in the forum that it mobilized hundreds of young innovators in different spheres of health development. So, certainly the talent is there, the creativity is there. It just needs nurturing and it needs investment.
And similarly, we have many researchers in Africa who are basically carrying out research to the agendas of international funders because local and domestic financing for research and development is relatively limited. So, these are some of the areas that really do need financing.
And indeed, at the base of these vulnerabilities is financing for health. As a percentage of government expenditure, allocations for health have stagnated at around 8% in the past decade. So, what are the barriers to raising the share for health?
I was very happy to hear it very strongly stated by the Honourable Ministers of Finance who are the Governors of the African Development Bank the recognition of the importance of financing for health/ I think that we can also see what is the best way to finance health in such a way that it drives equity, it leaves no-one behind, it engages the private sector as well so that we pull together these financing resources.
Coming now in terms of access to medical products, first of all, it is a very painful realization that Africa is a prime market for fake medicines with serious and often disastrous impacts on health – and also to note that 99% of vaccines and 70% of pharmaceuticals are imported to African countries.
During the pandemic, we’ve pinned hopes on global solidarity and are right now being hit with a huge reality check, brought home dramatically in the example of access to COVID-19 vaccines, and this has highlighted the need for self-reliance. This is an extension of the enormous difficulties that countries have had in accessing testing supplies in the early phases of the pandemic.
I have to share that as somebody who has been leading WHO’s efforts in Africa to provide support to our countries through the pandemic, one of the most painful aspects has been the ongoing chronic difficulties in our countries of accessing testing supplies and the realization that about 12 low-income countries in Africa have never managed to test at the minimal level that WHO recommends in order to really know what is happening and this was because of difficulties in accessing supplies, accessing equipment, decisions to stop exportation by some of the countries where companies who produce some of these items are located. So, this has been a huge wake up call for all of us.
So, learning from this experience, how can governments and partners address the vulnerabilities in the global pharmaceutical supply chain?
How can we build resilience through investments in local production? And what aspects should be considered in pursuing this?
African Heads of State have expressed their ambitions for industrialization, and the African Continental Free Trade Area will be a key enabler. So, successfully translating this political will into action, will be a collective enterprise.
A very exciting example was announced this week, of the first COVID-19 messenger RNA vaccine technology transfer hub, to be established in South Africa. This international public-private partnership is an important start to building the infrastructure and human resource capacity to contribute to closing the gap in access to vaccines on the continent. I see the African Development Bank playing a critical role in accompanying the continent on this journey, working with the African Union Commission and the Africa CDC. And I engage that WHO will be an active partner in this enterprise.
Clearly accountability will be important – between states and we have learned from other examples of working collectively that this may be a challenge, but it is absolutely needed – so, how can we establish systems and use technology to ensure that all the stakeholders play their roles?
And fortunately, we can catch-up on missed opportunities. There is some expertise among manufacturing entities in African countries, but many of these are operating at a fraction of their capacity. So, how can their experience and expertise be leveraged? Can the local output be increased to meet Africa’s needs? And if so, what would it take? And what socio-economic gains would this bring? I believe personally this will bring enormous socio-economic gains to the continent.
In considering economies of scale, we are aware of course that the market share is to some degree dominated by some mega-producers like India and China. So, we have to consider how local production can be developed in ways that are sustainable and that capture a certain proportion of the market and assure African countries of access to essential supplies even when there is no pandemic.
To make local production as competitive as possible, what are some of the efficiencies that need to be put into the systems?
All this needs to be looked at and agreed beyond national borders, to establish multi-country approaches, agreeing on where hubs should be placed and using platforms that don’t delay the final decision-making.
I’d like to add that the regulatory side will also be critical – including on quality control, market creation, procurement, and facilitating buying and acquisition.
The establishment of the African Medicines Agency will support the growth of local production and I am aware that our colleague and friend, Honourable Michel Sidibe is traveling actively around the continent getting countries to ratify this. This institution needs to get up and run efficiently as soon as possible. So, we need to reflect together what needs to happen over and above its establishment. It will be a unique partnership among African countries.
For now, many national regulatory authorities are severely under-resourced and understaffed in African countries. As WHO, we are working with countries to strengthen regulatory systems towards manufacturing excellence, including through the African Vaccines Regulatory Forum, which enables the regulatory authorities to share capacities, approaches and tools. So, how can the strengthening of regulatory capacities be fast-tracked to boost local production?
Past attempts to increase pharmaceutical manufacturing, have tended to hit against barriers of pricing and to some degree quality.
Some of the biggest drivers of high prices are taxes and we are informed power supply shortages. In some countries, taxes are low on finished pharmaceutical products, but high for the raw materials, so imported pharmaceuticals end up being cheaper. How can this balance be redefined?
If taxes are lowered on the other hand, where will the money come from to finance essential services for populations? Is there an opportunity and I believe there is really an opportunity for institutions like the African Development Bank to provide support to governments perhaps to offset some of the short-term losses?
All of this relates to the issue of fairness and high interest rates in African countries: Investors find lower risks, costs and higher returns elsewhere perhaps. So, what else can be done to encourage investments on the continent?
And indeed, what should be the formula for working with the private sector? Companies and individuals have mobilized resources and networks to support the COVID-19 response, yielding huge benefits. How can we build on this momentum to support manufacturing and health systems strengthening on the continent? There are very challenging discussions going on currently on patent waivers and technology transfer, which it is important for all of us, our Member States, to engage in with the private sector. But what additional ways are there of collaborating, in particular to facilitate the emergence of a local pharmaceutical industry?
In the coming years, the African vaccines market is expected to continue to grow steadily, and this needs to be accompanied by human capital development – to ensure the availability of the right expertise. This will also require partnerships across sectors. It’s already been said. There are opportunities to mobilize the African diaspora – a huge plus. What incentives would be needed for skilled Africans working abroad to return home and contribute to industrial growth?
In closing, local manufacturing is an example of an immediate opportunity to address a crisis, and it calls for financing, a conducive environment, incentives for investors, and creating production capacity including a skilled workforce.
Building health systems resilience and boosting production are multi-faceted issues that call for work across development sectors. The Bank, in partnership with Ministers of Finance, are in a unique position to influence, to advocate, to invest and to take action that could be transformative and deliver long-term benefits for health and economic growth.
So, I look forward very much to a thought-provoking discussion today and thank you for the wonderful start in the previous session. As WHO, I commit that we stand ready to partner strongly with, and complement, the African Development Bank and other partners as they engage in health investments on the continent.
Thank you for the opportunity.