Build Back Better: Next Steps for Africa’s Response to Covid-19
There are currently 3.5 million confirmed cases of Covid-19 in Africa, according to the Africa Centers for Disease Control and Prevention (ACDC). Contrary to initial fears, fatalities have been a comparatively low 88,000 through the end of January 2021. The virus is present in every country on the continent, but the scale of the impact varies widely, from more than 1.4 million cases in South Africa to less than 1,000 reported cases in several countries. The World Health Organization (WHO), the African Union (AU), and individual governments have been cautious in making predictions about 2021.
Lurking behind the immediate Covid-19 crisis is a broader question of how governments will cope with its considerable and sustained economic impact. The continent slipped into recession for the first time in 25 years in 2020, with a negative 3.3 percent growth rate. The International Monetary Fund (IMF) forecasts growth will rebound to 3.1 percent in 2021, but this obscures the lasting damage done to individual national economies and to key job-creating sectors.
Q1: How are regional governments responding to the health and economic fallouts?
A1: Africa has generally done a good job handling these two related crises. Countries scrambled to put in place innovative measures to secure critical personal protective equipment, such as setting up the African Medical Supplies Platform (AMSP) to improve Africa’s bargaining power and expedite logistics and payment issues. Governments also managed the initial economic impacts relatively well, including tapping financial markets to maintain sufficient liquidity to keep businesses open to the extent possible.
One of the most important features of the response to Covid-19 has been strong regional institutions. ACDC director John Nkengasong is fond of noting that every major international health organization was established after a severe health crisis, with the ACDC stood up in response to the Ebola crisis. The ACDC has done a very credible job, providing much-needed health policy leadership throughout the crisis, including offering practical guidance on public and personal health measures to limit the spread of the disease and regularly updating the public on the state of infections and recoveries. The ACDC has received a baptism of fire and will be the stronger for it.
Moreover, the region leveraged its decades of experience coping with serious health crises, including the HIV/AIDS epidemic as well as malaria and Ebola. African countries have steadily increased their capacity to deal with health crises, making remarkable progress in combating HIV/AIDS, for example, as well as on related issues like drug-resistant tuberculosis. African countries have done a lot to build the capacity of national communication networks and testing and evaluation centers in the wake of the Ebola crisis. Africa’s hard-won experience in handling these and other challenges equipped governments to manage the first wave of the Covid-19 crisis, and presumably will help with the current response and prepare them for future disease outbreaks.
Q2: What are impediments to rolling out the Covid-19 vaccine in Africa?
A2: The vaccine rollout is a challenge for most countries, with many struggling to set up the necessary infrastructure, funding, and supplies to get “shots in arms.” While more than 90 million people have been vaccinated in more than 50 (primarily developed) countries, there are concerns that richer countries will pay companies for quick access to protect their populations first, potentially leading to a “race to the bottom” as countries pursue vaccine nationalism. Doing so would be counterproductive given the speed with which the world has already seen new variants spread around the world despite travel bans and local economic lockdowns. The only effective protection will come when all countries have protection. WHO director Dr. Tedros Adhanom Ghebreyesus has called on developed countries to avoid a “catastrophic moral failure” by looking to protect their populations first and leaving poorer countries to fend for themselves.
The best estimates for when the first vaccines could be distributed in Africa currently suggest as late as April, although some countries (e.g., South Africa) are taking steps to procure doses now. The AMSP is accepting pre-orders for vaccines from Pfizer, Astra Zeneca, and Johnson & Johnson for AU member countries through February 15 (and presumably it will include more companies as additional vaccines get approved). This will vastly simplify procurement negotiations, provide a more transparent set of prices, and will also offer critical assistance on logistics, at least in terms of helping get wholesale shipments into countries. The AU—through its Covid-19 Vaccine Financing and Deployment Strategy—is also supplementing the efforts of the COVAX mechanism to provide vaccines for 20 percent of the continent’s population by the end of 2021. The WHO estimates that this initiative could bring the total vaccination for African countries up to 30-35 percent by the end of the year (still short of the 60 percent coverage the WHO estimates is necessary to prevent Covid-19 from becoming endemic in Africa).
While obtaining a vaccine is a huge first step, ample supply alone will not solve the health crisis. African countries will face their own distribution challenges, both in dense urban settings and in rural areas, including logistics and getting sufficient numbers of trained health personnel to provide vaccinations. As the Israeli and Emirati examples suggest, mobilizing plans and resources now can help prepare for a smoother vaccine rollout when supplies do come, particularly if they come from multiple sources.
Q3: What opportunities exist for foreign partners to assist?
A3: African governments and external partners will continue to fine-tune their responses to the health and economic reverberations of Covid-19. There are opportunities for governments and private sectors to fuse their approaches, bolster supply chains, cooperate to prevent vaccine nationalism, and integrate national and regional legislation under the African Medicines Agency (AMA).
- Link work streams. Ongoing discussions under African Continental Free Trade Area (AfCFTA) agreement, as well as on the development of the digital economy and regional economic integration, will all impact the speed with which Covid-19-related agendas can be addressed and implemented. Issues like the digital economy, cross-border data flows, and trade facilitation should include considerations of the impact on the health sector, and vice versa.
- Build on successes. The AMSP made it much easier for companies to work with governments by providing a welcome one-stop shop with effective, transparent access to contracts and procurement mechanisms. Likewise, the newly formed AfCFTA Secretariat is a welcome one-stop shop on non-tariff barriers and will facilitate greater information on trade flows as well as implement new procedures. The AU and member governments can build on these achievements to further facilitate the smooth flow of trade for vaccines and medical equipment.
- Strengthen supply chains. Both companies and governments have had to scramble over the last year to deal with unexpected and profound shocks to supply chains. There is a great opportunity in 2021 for companies and governments to develop a more resilient, secure set of supply chains and expand their collaboration to both create new markets and accelerate African governments’ fulfillment of their 2063 The newly announced African Health Security and Resilience Initiative from the Corporate Council on Africa is a good example of the potential for collaboration to deliver real results. It is also a great time for companies, nongovernmental organizations (NGOs), and African governments to build on the notable achievements NGOs have made in a number of areas, including malaria and reproductive health, as well as to expand collaboration on critical issues like non-communicable diseases and capacity building.
- Prevent vaccine nationalism. While developed nations should refrain from vaccine nationalism, it would also be helpful for developing countries to avoid responding with measures that are effectively the flip side of the same coin. Specifically, it would help to avoid compulsory licensing of vaccine or equipment production or measures that undercut intellectual property rights under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) in an effort to temporarily boost production in Africa (as at least one African country has proposed within the World Trade Organization). While the concerns on all sides are understandable, the scale of production and the number of companies involved is likely to continue to grow exponentially. Governments working with companies to create the right conditions to accelerate existing or begin new production are likely to be faster and more productive. While the analogy is inexact, vaccine production may end up mirroring the evolution of ventilator production last year, which expanded rapidly in many places with government assistance.
- Launch the AMA. The AMA is designed to enhance regulatory oversight and facilitate access to safe and affordable medicines across the continent. Eighteen countries have signed the agreement, and 6 of the 15 required to bring it into effect have ratified it. When it comes into full effect, AMA will offer a strong basis from which to harmonize regulations and legislation, market access authorizations, and approvals for clinical trials. It will also offer a unified basis for inspections of facilities, all of which are important features in making it easier for international private companies to partner with African governments and private sectors. The AMA would be ideally placed to coordinate quick review and authorization for vaccines, equipment, and devices across member states. Accelerating the pace of ratification to bring the treaty into full force would be an important step, ideally combined with more countries signing on to its terms and the AMA building out its staff.
Laird Treiber is a senior associate (non-resident) with the Africa Program at the Center for Strategic and International Studies in Washington, D.C.
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