Keynote remarks by WHO Regional Director for Africa, Dr Matshidiso Moeti, Global Health Council Advocacy Summit
Thank you, thank you very much Ngozi. First, thank you so much for having invited me to this wonderful panel of women and a couple of men. John, you are in great company.
I’d like first to recognize and thank Loyce Pace, the President and Director of Global Health Council for having invited me to this panel. Loyce is an old friend and colleague and I’d like to congratulate Loyce for the important role that she’s going to be playing going into the future. I’d like to greet my fellow panelists. It’s so great to be with you and I look forward very much to a wonderful conversation. I’d also like to greet those who have joined us, our guests, colleagues, ladies and gentlemen.
It is my great pleasure to open this session on pandemics and “building back better after COVID-19 – to what? And for whom?” and again, thank you for having invited me.
Globally, COVID-19 has been a cruel teacher, causing the loss of more than 1.3 million lives, infecting more than 55 million people, hitting economies hard and leading to social unrest and political instability.
Both rich and poor countries have been affected, and the pandemic has fed on and exacerbated inequities, including in high-income countries, where in some of them, histories of colonialism and slavery have resulted in societies with marginalized and disadvantaged ethnic minorities.
In the United States, for example, one in a thousand black Americans has died of COVID-19, compared to one in more than two thousand white Americans.
This disparity, just an example, relates to longstanding, multi-generational, socio-economic inequities, difference in access to health insurance and health care and a higher prevalence of underlying conditions. Black Americans are twice as likely to have asthma or diabetes as white Americans. They generally earn less and are more likely to work in service industries where physical distancing is a challenge. They are challenged also to consistently afford and have access to a healthy diet. All of these coalesces to comorbidities.
We need to understand why these inequities have remained a little bit under the radar until COVID-19 coincided with the black lives matter movement and have forced the discussion.
At the start of the year, the world watched as cities in Europe, in the eastern United States of America, and elsewhere went into lockdown and hospitals were overwhelmed, and many feared that COVID-19 would devastate African countries. However, the African countries now account for less than 4% of the global burden of cases and deaths.
While the health impacts of COVID-19 in Africa have been less severe than the initial projections, the economic fallout will lead to very challenging situations for years to come – potentially rolling back years of health and development progress.
African governments took tough decisions early on in the pandemic, recognizing their risks and their vulnerabilities of their health systems, and learning from past severe outbreaks. Many governments also imposed lockdowns, while working very hard to scale-up public health capacities with support from ourselves in WHO and other partners including the Africa CDC. John and I and our teams have worked very hard together throughout this response. They took courageous and comprehensive action, but have to admit it comes with significant costs for households and for national economies and will also exacerbate inequities in African countries.
The dominant global narrative of African countries not doing enough testing needs to be understood in the context of the implosion of the global supply chain system with high-income countries safeguarding supplies, prohibiting the exportation of those items that they produce, leaving low-income countries, and many of the countries in the African Region struggling to get hold of these commodities.
The result is reflected, for example, in differences in testing – in the WHO African Region almost 15 million COVID-19 tests have been done, so that means in sub-Saharan Africa, mainly and in Algeria. By comparison, the United States of America has done almost 170 million tests (or 11 times the number done in 47 African countries).
Low-income African countries are testing at rates of 3 per 10,000 people, very well below the WHO recommended minimum of 10 per 10,000.
So, critical supply of the key tools of diagnostics, therapeutics, personal protective equipment have been a tremendous challenge for African countries throughout the pandemic and this I believe has lessons for what we need to do in building back better.
After the West Africa Ebola epidemic there were positive steps, including the creation of global platforms like the Coalition of Epidemic Preparedness Innovations, or CEPI, in 2016, to finance and support vaccine and therapeutics research for diseases that primarily affect low- and middle-income countries.
Now the world is poised to have effective vaccines for COVID-19 and we’ve discussed and heard about this a lot in the last few days, the last week and global platforms – WHO’s ACT Accelerator and the COVID-19 Vaccine Global Access Facility, or COVAX for short – have been established to promote solidarity, to promote pooling of resources and efforts with a view to having equitable access to these new tools.
The African Union has also established a vaccine access platform which complements and works with this effort.
We know that some wealthy countries have already reserved hundreds of millions vaccine doses, and this will be a true test of whether solidarity will translate into action in a very challenging geopolitical context.
For African countries, there remains much more to do to mobilize sufficient financing for vaccine supplies and most importantly for the delivery operations. This again could amplify inequities.
So, turning then to consider, how can we build back better:
COVID-19 has confirmed that we need to invest in equity and justice across all development sectors because this is what makes people, countries and their economies resilient. Also, people play a critical role in stopping the spread of epidemics. Therefore, their buy in, their agency, to adhere to and to practice preventive measures are essential.
Engaged communities must be a core part of health systems at all times with a voice in making policy, a seat at the table and also a role in evaluating progress and outcomes and ensuring that accountabilities are fulfilled, including through strong networks and organization. We should learn not to hurriedly engage people as part of the outbreak response when something like a pandemic is rolling out.
The pandemic has also shown that investing in health is not an end in itself. It is critical to national development and stability. Such investment and national policies should explicitly address inequities related to race, ethnicity, gender, geography, economic status and other determinants. This, we know will pay dividends in improving health.
Globally, we also need equity, as well as efficiency in supply chains, for example. The United Nations created a supply portal for COVID-19 and platforms like these should be scaled-up, with different stakeholders involved, as part of preparedness and resilience for future threats and for the procurement of essential health supplies in the process of implementing health programmes.
The lessons from, and links with, outbreak response should be more explicitly incorporated into national policies and actions to strengthen health systems and service delivery for better preparedness, readiness and resilience. After the Ebola epidemic in West Africa, almost all African countries assessed their emergency preparedness and response capacities and developed plans, costed at that time at 7 billion dollars to address critical gaps. These now need to be funded and implemented and we need both global solidarity and commitment at the national level because we understand that vulnerability in one country is a shared vulnerability across the globe.
Disruptions to essential health services such as child immunization and treatment of HIV and the risks to gains made on other priorities over decades, show us the challenges that are implicit in narrow global health investments and encourage further efforts to be made in integration.
The blossoming of innovation, of public-private partnerships, the application of technology and digitization during the pandemic are all entry points to building back better, to expand local production (I know that John and the Africa CDC, the African Union have been very strong in promoting this), expanding the training of health-care workers, connecting actors across continents and sectors, empowering people with the information and tools to improve their health, as well as monitoring risk elements such as population movement.
More investment is also needed, if I speak now from the perspective in African countries. We need answers that come from research done here in Africa, by African researchers who understand the context best.
We are seeing that pandemics are everybody’s business – they cannot be managed by the health sector alone, they require action on water and sanitation, on education, communication and on the labor market. More broadly, the all-of-society approaches used in response to the pandemic, should be used to advance other priorities.
COVID-19 provides the lesson that we need to invest more sustainably.
This calls for the international community to strive for greater coherence, harmonization and inclusive policy dialogue, including in how international resources are invested. The space needs to be created for people in African countries to use their own understanding of their own systems, of how value for money can be achieved, and which ways of working are likely to produce sustainable results. We often hear about something called “ownership” as we who come from outside talk to our governments, we need to provide the space for ownership.
For low- and middle-income countries greater attention is needed to use domestic funding smartly as the bedrock of sustainable financing for health and development.
In closing, I’d like to say that the COVID-19 pandemic has confirmed that we need to redress inequities to achieve sustainable goals in health and development. We now need to walk the talk with global solidarity so that all people can live in better, more resilient societies.
I thank you very much for your attention.