The pandemic inspired a new generation of creators
The problem of the West is the only problem: how African countries need to adapt to the challenge of climate change and vaccine shortages in the 21st century
The past president of the Nigerian Academy of Sciences is Tomori. I had asked whether he was surprised that high-income countries were buying up monkeypox vaccine supplies and WHO was sharing its vaccines with 30 non-African countries, leaving the continent without access.
He thinks that global health inequalities are inevitable and he doesn’t want to get upset about it. He says that the real problem is that African countries rely too much on the West. Western aid always comes too little, says Tomori. But more important, he stresses, “your help is not helping us. It is making us more dependent.
One of the primary steps toward biosecurity is comprehensive disease surveillance to help rapidly identify and contain novel pathogens — this includes the health-care system treating patients, public health labs conducting tests and epidemiologists coordinating the response. While the World Bank invested a lot in Africa, Mombouli says it isn’t enough because it doesn’t have sufficient protection to stop infections in the more rural areas.
A problem is that of the 47 countries in sub-Saharan Africa only six have a single medical school. By 2030, WHO estimates that Africa will be short 6.1 million health-care workers, relative to the Sustainable Development Goal threshold of 4.45 health-care workers per 1,000 people.
The Burden of Ebola in Guinea: One Hundred Years of Progress in the Guinean Value Chain of Epidemics and Vaccination Systems
It took more than three months to identify the disease in Guinea during the West African epidemic. WHO reported that the country took so long because “Clinicians had never managed cases. There has never been a laboratory that has diagnosed a specimen. The social and economic upheaval that can accompany an outbreak of this disease was never witnessed by a government. So when the virus was finally identified as Ebola, it was already “primed to explode.”
Mombouli also gives the example of Likouala Prefecture, a swampy area in northern Congo and one of the poorest, least developed regions in the country. He calls Likouala a “paradise for pathogens,” rife with everything from the disease-causing bacteria treponema to the viral disease Rift Valley Fever. “You know something terrible is going to come out of that area,” he says. Without proper pathogen monitoring, it’s only a matter of time.
Public health agencies will still have an important role to play, empowering locals with educational programs and coordinating the response, Tomori adds. Those who live on the frontlines of novel diseases have a better chance of getting the best early warning system. He says that taking care of the first case can prevent an epidemic.
Mombouli’s team similarly visited 268 villages in northern Republic of Congo between 2008 and 2018; they were trying to establish community-based surveillance system for Ebola. They encouraged locals to stay out of the way of the wildlife carcasses, and to contact the network if they see any signs of the virus.
As such, Mombouli thinks the continent should develop its own epidemic “value chain,” a term referring to the entire manufacturing process from acquiring raw materials to distributing finished products. There is experience making vaccines from start to finish in a few African manufacturers such as the Biovac Institute in South Africa, and theInstitut Pasteur de Dakar inSenegal.
Deaths from health-care systems have been cut by a thousand in the last three years as attention moves to preparations for disease X, a pathogen that could cause the next pandemic. The public-health community needs to keep ramping up capacity in LMICs. And it mustn’t forget what experience has shown since 2020: that health-care systems under stress are little able to deal with new threats.
“If the company decides to move out,” he says, “then we go back to square one.” As one concrete example, Johnson & Johnson partner Aspen Pharmacare may soon shut down its South African plant making COVID-19 vaccines because of insufficient demand due to hesitancy and difficulties distributing the vaccine (among other reasons ).
This will be long and take time, with clinical trials planned for later this year and vaccine approval coming in 2024, but there can be much done in the interim. Beyond fill-and-finish operations, Tomori says that African countries can identify other aspects of the value chain where they can start contributing immediately. There’s a chance that one could make glass, rubber, testing and other items. All countries don’t have to produce everything end to end, but Tomori says they should be starting somewhere.
Things are starting to change. Namibia, for instance, is one of four African countries that has surpassed the WHO threshold — with 10.28 workers per 1,000.
This fledgling success stems from government prioritization. In a recent paper in World Health and Population, authors from Namibia’s Ministry of Health and Social Services described how they used a WHO tool to diagnose the country’s staffing shortcomings. With this data, they made evidence-based decisions about expanding nurses’ scope of practice and redeploying health-care workers to the regions of most need.
While it’s critical to continue building more medical institutions, such as the Kenyan General Electric (GE) Healthcare Skills and Training Institute and the University of Global Health Equity in Rwanda, there must also be a focus on retention.
In a 2011 study in the British Medical Journal, it was estimated that sub-Saharan African countries lost $2 billion (in terms of returns on educational investment) because doctors trained on the continent moved abroad. “We have to look inward and start paying people the salary they deserve, so that they don’t leave the African continent for other places,” says Happi. As one example, the Zimbabwean Nurses Association says that most nurses in the country earn only $53 a month, a salary lower than the World Bank’s international poverty line.
This wouldn’t necessarily stop the exportation of health-care workers, but having the West fork over the money could help African countries replenish their workforce. “People should be honest enough to say that you cannot deplete a continent of its own resources,” Happi says.
African-Western partnerships can be pursued. The omicron variant was first identified by Sikhulile Moyo, the laboratory director of the Botswana-Harvard AIDS Institute Partnership, who is a research associate with the Harvard T.H. Chan School of Public Health. Similarly, Happi collaborates with Broad Institute computational geneticist Pardis Sabeti, and together they deployed COVID-19 tests in hospitals in Nigeria, Senegal and Sierra Leone well before any U.S. hospital had them. Partners in Health also recently announced plans for the $200 million Paul E. Farmer Scholarship Fund, which will support students at the University of Global Health Equity in order to “educate future health care leaders in Africa.”
The Response of Scientists and Innovators to the Second World War and COVID-19: From University College London to Harvard University and Beyond
Simar Bajaj is an American freelance journalist who has previously written for The Atlantic, TIME, Guardian, Washington Post and more. At Harvard University he studies the history of science and chemistry and at Massachusetts General Hospital is a research fellow. Follow him on social media.
In many ways, the response of scientists and inventors to the COVID-19 crisis echoes the all-hands-on-deck approach to the Second World War, says Bhaven Sampat, an economist at Columbia University in New York City. The National Bureau of Economic Research commissioned Sampat to write a paper that looked at the similarities between the two disasters. As Sampat explains, both crises were urgent, high-stakes and unexpected. Although the Second World War inspired the Manhattan Project, a top-secret multinational effort to build an atomic weapon, COVID-19 triggered an international race to develop vaccines.
There is another COVID-19 technology that emerged from partnerships. Responding to a shortage of ventilators, researchers at University College London and University College Hospital worked with Mercedes High Performance Powertrains, a company in Brixworth, UK, that manufactures parts for Formula One cars, to develop the Ventura breathing aid, a mechanical device used to open the airways of critically ill patients.
Many universities found ways to spend grants more effectively during the swine flu epidemic, as they stripped down bureaucratic restrictions on how grants were spent. The result was a more industry-like approach to speed up the research, development and eventually the commercialization of new products. An analysis1 published in January 2021 found that, in general, universities were able to bring products to market just as rapidly as private companies.
Publishers, too, sped up their processes. COvid-19-related research was published at an unprecedented pace thanks to the speed of peer review. An analysis2 found that, in the first half of 2020, journals took an average of just over 19 days to accept COVID-related articles compared with more than 91 days for non-COVID articles. By the year of 2020, 146 publishers, institutions and journals pledged to make COVID information freely accessible. The problem was exceptional and part of the solution was open access.
The crisis also seemed to bring innovators out of the woodwork, Paunov says. Government agencies and non-profit organizations that put out calls for new ideas or products were suddenly hearing from first-time contributors. “It shows that there is a lot of innovation potential in society,” Paunov adds.
Both initiatives were ultimately successful, but the paths had distinct differences. Sampat explains that the military generated and used much of the innovation in the Second World War. “It’s much more challenging when you need civilians and firms with diverse goals and perspectives to change their behaviours or use particular technologies,” he says.
Seven Years of COVID-19: When the World is Going Globally Safe and The Vaccine Supply is Running Short-Short Unlike It’s Always Been Doped
For Sudan ebolavirus, three candidate vaccines have been identified in early testing, following research and development driven by CEPI, IAVI, the US National Institutes of Health, the US Biomedical Advanced Research and Development Authority and others. Last week, Uganda received the first vaccine shipment for scheduled trials. But for the 56 people who have died and the 142 who have been infected, trials will come too late — and, as there are currently no new cases, they might be too late to determine vaccine efficacy.
I warned about this problem seven years ago in a column in Nature (S. Berkley Nature 519, 263; 2015). Despite the wake-up call, this is one of our biggest chinks in the armour.
‘Short-sighted’ hardly describes the situation. Preparing preventive vaccines for a few million dollars per batch should be seen as a small insurance policy to avoid a repeat of the US$12 trillion the world just spent on COVID-19.
I am not going to write this again for seven years because of catalyse change. We have come far from not talking about this issue and having the topic highlight its relevance every day. I am optimistic that a change in mindset is in view.
The lead should be given to wealthy countries. They should make sure that agencies like the Coalition for Epidemic Preparedness Innovations, based in Oslo, and the International AIDS Vaccine Initiative, based in New York City are fully funded, because they will have to collaborate with government research agencies.
In many places, life took on a semblance of pre‑COVID normality in 2022, as countries shed pandemic-control measures. Governments ended lockdowns, reopened schools and scaled back or abandoned mask-wearing mandates. It was resumed on international travel.
There were positive statements as well. The Prime Minister ofDenmark declared that there is no longer a threat to society. In September, US President Joe Biden remarked during an interview that the pandemic was over. Even Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), has expressed hope that COVID-19’s designation as a global emergency will end in 2023.
This belies the devastation that the disease continues to cause. China is one of only a few countries that have been able to alter their public health policies to cope with the fast-spreading Omicron variant. Scenes emerging from Chinese hospitals now are reminiscent of the havoc that Omicron wrought in Hong Kong nearly a year ago. China might have seen widespread transmission regardless of whether President Xi Jinping had dropped the zero-COVID policy in December. The country has the potential of up to one million deaths over the next year, according to models, as well asWidespread workplace absences and disruptions to the Chinese economy.
The treaty has the potential to “make a tremendous difference for the next pandemic”, says Suerie Moon, a researcher who studies global health policy at the Geneva Graduate Institute in Switzerland. “This is a once-in-a-generation chance to fix some of the big weaknesses that we saw during COVID-19.” The gulf in access to vaccines was one of the failures. Compared with high-income countries, where some 73% of people have received at least one dose of a COVID-19 vaccine, only 31% of people in low-income countries have had one or more doses.
Although it doesn’t say so explicitly, the WHO’s statement can be read as a rebuke to the leaders of high-income nations, highlighting the fact that their response to the ongoing pandemic has not been a model of cooperation or compassion. It was not possible to support a vaccine distribution scheme that was called COVAX. Rich countries over-ordered and held onto vaccines so they wouldn’t be able to reach people who needed them. Some of the world’s best-known and well-respected pharmaceutical companies fought to stop intellectual property (IP) being shared. If they had done so, more manufacturers would have made treatments and more lives would have been saved. The treaty drafted by the WHO is intended to make sure that this doesn’t happen again. Nature has argued before that a treaty isn’t guaranteed to keep promises.
Kelley Lee, the scientific co-director at the Pacific Institute on Pathogens, Pandemics and Society in Canada, says it has more heart and brain than she expected. It has insufficient teeth and spine to ensure we will definitely have a better response next time.
The zero draft of the WHO report is not a treaty for preparing for the next major outbreak of the H1N1 influenza in the world
The first of a series of meetings by WHO member states will discuss the terms of the zero draft later this month. Researchers expect the negotiations to be contentious, and some of the language will probably be watered down before an agreement is adopted.
It is too late to create a new legal instrument for the next major outbreak, according to some researchers. Pathogens with pandemic potential are constantly spilling over from animals to people, and researchers are anxiously tracking a fast-spreading outbreak of H5N1 influenza in birds that has jumped to a number of mammalian species. “Time is not on our side,” says Alexandra Phelan, a global-health lawyer at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
Equity is a key focus of the zero draft. The treaty includes creating a global network for the supply and distribution of ingredients to produce drugs, as well as sharing that knowledge with the world.
Under the terms of the treaty, parties should also commit to allocating no less than 5% of their annual health budget for pandemic prevention and response. They need to set aside a percentage of their gross domestic product in order to help developing countries prepare for the H1N1 flu. Moon says this is the first instance in which a government will set aside a specific amount of money in a treaty. “I don’t think it’s likely, but it’s a bold proposal.”
Even though countries sign up, the treaty in its current form is not strong enough to stop them from ignoring the rules when the next H1N1 epidemic strikes. The document is intended to be binding but in a few places, the text excludes strong language such as ‘Must’ and ‘Shall’, instead using fuzzy terms such as “encourage” and “promote”. “It’s still quite heavily reliant on voluntary compliance,” says Lee.
Negotiations around how to ensure compliance have been pushed back and are not optimal in regards to the occupied Palestinian territories. “None of the promises that states will make in the treaty document itself will have any meaning, any effect, unless there is a robust mechanism in place for holding states accountable.”
But Phelan says it is important not to underestimate the value of the treaty-building process itself. Discussions and debates over the provisions will help to build trust between governments, change behaviour and establish international norms of solidarity.
Climate change and the zero draft of the UN High-Energy Millennium Protocol: a warning to non-comfortary high-income countries
The current wording states the importance of open science and sharing data. Last month the WHO urged China to share sequence data and information on cases, hospitalizations and vaccination rates. The zero draft states that countries that share their knowledge should also share in the benefits.
It is possibly the most important of all, and perhaps not the best way to ensure that an agreement is followed when the onus for action lies with a small number of high-income nations. There’s good evidence from the climate-change COP process that even legally binding agreements cannot compel nations to meet their commitments.
The creation of a framework would make it difficult to get countries to fund it properly, and thus the WHO would suffer even more. Climate change, as well as other concerns, are taken into account by the international community, and that’s why the COPs have time to reach decisions.