The elephant in the room: Why African countries are not poor in fighting West Africa’s most lethal disease, or how African countries can afford to treat it
What happened in the meantime? The virus receded: Since a peak in early August, reported monkeypox cases in the U.S. have fallen more than 85 percent through yesterday.
The millions of smallpox vaccines purchased by and distributed throughout wealthy countries such as Canada and the United Kingdom have also largely been out of reach for fighting mpox in African nations. (The viruses that cause smallpox and mpox are related, so health officials hoped that smallpox vaccines would also work for mpox.) The African Union will receive a 50,000-dose donation from South Korea — the continent’s very first vaccines not designated for research purposes — according to a 29 November announcement by the Africa Centres for Disease Control and Prevention. The agency, however, did not respond to Nature’s queries as to when those doses would be delivered, or to which countries.
Tomori does not believe in the idea of Western philanthropy being the answer. “Don’t buy the story that Africa is poor,” he says. “We’re not poor, it’s that we’re not using what we have.”
Beyond detecting pathogens early, African countries need the resources to mount a robust response against infectious diseases, from personal protective equipment to antivirals to vaccines. Unfortunately, “the medical equipment and supplies needed,” the Africa Centers for Disease Control and Prevention noted in a press release, “are largely manufactured outside Africa.”
The elephant in the room is if it’s possible since African public health systems have long been under funded. African Union member states promised to spend 15% of their national budgets on health in 2001. In the two decades since, that’s only happened in five countries.
It took nearly three months for the West African epidemic to be identified, making it one of the most notorious examples. Clinics had never managed cases, which was the reason for the country taking so long. No laboratory had ever diagnosed a patient specimen. No government had ever witnessed the social and economic upheaval that can accompany an outbreak of this disease.” The virus wasprimed to explode when it was finally identified as Africa’s most lethal disease.
Likouala Prefecture is a swampy area in the northern part of the country that is one of the least developed regions. He calls Likouala a “paradise for pathogens,” rife with everything from the disease-causing bacteria treponema to the viral disease Rift Valley Fever. Something bad is going to happen in 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. Indeed, the best early warning system might come from those living on the frontlines of novel diseases. He says that if you take care of the first case, you can prevent an epidemic.
Local hunters began to report the carcasses they found so that the network could test them for the deadly disease. The most rural areas of the Republic of Congo were covered by a closed circuit system that lasted for 50,000 square kilometers.
Mombouli thinks that the continents should develop a value chain from acquiring raw materials to distributing finished products. The Biovac Institute in South Africa is an example of a vaccine manufacturer in Africa that has experience making vaccines from start to finish.
But building the value chain for novel health threats has proved more elusive. In the case of COVID-19, the secret of the technology is closely guarded.
If the company moves out, we’ll get 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 ).
Undoubtedly, this will take time, with Afrigen expected to enter clinical trials later this year and vaccine approval coming in 2024, but much can be 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. One can make glass bottles, rubber tubes, testing probes, and so on. Tomori said that each country doesn’t need to produce everything, but should start somewhere.
Things are beginning to change. A few countries in Africa have surpassed the WHO threshold, which is 10.28 workers per 1,000.
This policy is only able to improve the efficiency of the health-care system. But in 2010, the University of Namibia established the country’s first school of medicine and has since trained hundreds of practicing doctors “who can respond to the healthcare needs of the Namibian people and are advocates for the poor, underserved and marginalised in our society,” according to associate dean Felicia Christians. A call from Namibia’s founding president to invest 50% of the national budget in education and health care emphasizes the country’s steadfast commitment to progress.
It’s vital to continue building more medical institutions, but 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. “Africa has to look at how it’s doing and start paying people what they deserve, so that they stay on the land,” said 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 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.
That’s not to say African-Western partnerships shouldn’t be pursued. The laboratory director at the Botswana-Harvard AIDS Institute Partnership and research associate of the Harvard T.H. Chan School of Public Health were the first to identify the omicron variant. 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. The $200 million Paul E. Farmer Scholarship Fund is being set up by Partners in Health to educate future health care leaders in Africa.
What is the best way to ensure COP? The case of COVAX, vaccines and human-rights violations in high-income countries
Simar Bajaj is an American freelance journalist who has previously written for The Atlantic, TIME, Guardian, Washington Post and more. He studies the history of science and chemistry at Harvard University and is a research fellow at Massachusetts General Hospital. He can be followed on the social media site, @SimarSBjaj.
It doesn’t say so, but the WHO does. 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. COVAX was undermined by a promise to properly support it. Vaccines could not be available to people in other countries who needed them because rich countries were over-ordered and kept their own supplies. Some of the world’s best-known and well-respected pharmaceutical companies fought to stop intellectual property (IP) being shared. Had they not done so, more manufacturers could have produced vaccines and treatments, and more lives could have been saved. The treaty drafted by the WHO is intended to ensure that this behaviour is never repeated. But as Nature has argued before, a treaty on its own offers no guarantee that promises will be kept.
Perhaps most important of all, a forum of 200-odd countries, plus tens of thousands of observers and lobbyists, is, arguably, not the best way to ensure that an agreement is adhered to, especially when the onus for action lies with a relatively small number of high-income nations. The COP process has shown that legally binding agreements can not force nations to meet their commitments.
But COPs are expensive to run, and the creation of such a framework would mean that the WHO — which faces a constant struggle to get countries to fund it properly — would struggle even more. We know from those governing international action on Climate change and other issues how long it takes COPs to reach decisions.
Thankfully, the virus is still alive: what can Africans have to learn about mpox in Africa? A case study of Ogoina
All of the world’s human cases of mpox had been in Africa. The diseases causes a rash on the face, hands, and feet, and in severe cases can lead to death. Some African nations have been grappling with mpox outbreaks ever since scientists identified the first human infection in the DRC in 1970.
The virus has spread to men who have sex with men in close skin to skin contact outside of Africa. Transmission patterns and clinical manifestations of the disease are much harder to pin down in some African countries, where rodent species are thought to naturally harbour the virus and regularly spread it to humans. For example, whereas more than 95% of people infected with the virus in the United States have been men, only about 60% of those who have had confirmed infections in Nigeria are men.
Still, the global focus on the virus has changed a few things in Africa. For one, because of all the published case reports, physicians who had never heard of the disease now know what the telltale lesions look like, Ogoina says.