While a global pandemic agreement is essential, it shouldn't worsen the weaknesses and inequalities already present in health care systems around the world, especially in Africa.
A health worker prepares a COVID-19 vaccine at a makeshift tent in downtown Nairobi, Kenya, in December 2021.
A proposed pandemic agreement is much needed, but its form, content, and structure should not perpetuate fragility and disparities across global health systems, particularly in Africa.
The inequities laid bare during the COVID-19 pandemic touched a raw nerve, evidenced by the outcry from the global health community about our flawed global health security frameworks. A global pandemic agreement must put equity at the heart of the prevention, preparation, and response work for the next outbreak. African states are working together to ensure that we are in a position to ensure a strong pandemic response for our communities and for the world.
During the early days of COVID-19, the development and distribution of vaccines saw a haphazard
response, undermined by a lack of transparency in data sharing and poor coordination. Vaccine nationalism manifested itself, as some nations hoarded drugs, diagnostics, and vaccines, while other countries were unable to buy the necessary lifesaving equipment. They had to wait for vaccines later in the production line, or vaccines that were close to expiry, which were as we now
know, illustrative of inequity and a lack of inclusivity.
We saw countries having to contend with conflicting advice, politicized pandemic response processes, inadequate compliance management systems, and a lack of resources to purchase vaccines bilaterally in the face of the failure of global frameworks.
These problems call for multilevel solutions. The World Health Organization formed an Intergovernmental Negotiating Body to draft a new legally binding pandemic agreement. If all goes to plan, member states will conclude negotiations in the upcoming World Health Assembly in May 2024.
Undoubtedly, this new agreement must fill the gaps seen in the IHR to ensure equity worldwide.
What does this mean vis-à-vis what WHO member states should do in these next weeks? As they grapple with textual negotiations and key areas of disagreement, such as pathogen access and benefit sharing, research and development conditionalities, and technology transfer? While we urge consensus by May, we also urge that we end up with a win for Africa.
Some of the debates that have emerged are: How will this agreement be governed? How will member states comply in the absence of funding commitments? And where will the body conducting checks and balances over implementation sit?
Additionally, there is scrutiny on the use of discretionary language and potential loopholes such as
"in accordance with national laws," scrutiny on traceable pathogen and genetic sequence data sharing, and equitable benefit sharing.
We note that many high-income nations have intellectual property rights exemptions in their domestic laws. As issues of IP waivers were a big concern during COVID-19, we believe these disparities must be exhaustively addressed.
A time for Africans to speak with one voice
In a letter signed by South African President Cyril Ramaphosa on March 1 to African leaders, he urged negotiating teams representing the African continent within the Intergovernmental Negotiating Body and the working group on international health regulation amendment to present a "united front."
"We want to see a final pandemic treaty that provides unfettered ground for meaningful participation and co-creation of decisions."
"An undivided stance is paramount for the strength and effectiveness of our collective efforts, especially concerning the contentious issues that might strengthen our ability to prepare for pandemics," he wrote.
This is once again a time for Africans to speak with one voice. Efforts to do so are underway, including through the Common African Position on Pandemic Prevention, Preparedness, and Response, or CAP PPPR, which was approved on May 20, 2023.
Spearheaded by the African Union and Africa Centres for Disease Control and Prevention, the CAP PPPR is designed to strengthen Africa's negotiating position in the pandemic treaty discussions, guaranteeing that the continent's priorities are adequately reflected in global pandemic prevention, preparedness, and response mechanisms.
The Africa Working Group and Africa CDC are committed to supporting African Union Member States on these negotiations and will provide an update on the outcome of the pandemic agreement negotiations at the next AU assembly in February 2025.
Modeling has shown a 47%-57% chance of a pandemic as serious as COVID-19 occurring in the next 25 years. With support, coordination, and a pandemic agreement that enshrines equity, Africa CDC can help counter this threat on the continent and globally. African leaders have pledged to increase the share of vaccines locally manufactured in Africa from 1%-60% by 2040.
We can mitigate the anticipated threats if we build the capacity to manufacture vaccines, diagnostics, and therapeutics locally. We want to see a final pandemic treaty that provides unfettered ground for meaningful participation and co-creation of decisions. Benefit sharing has to be fairly addressed, technology transfer must be facilitated, and clear research and development conditions upon pandemic funding must be clearly stated and established in domestic laws, including on affordable pricing plans.
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As the Africa CDC, we are on a crusade to see the success of the New Public Health Order, which prioritizes the establishment of resilient national and continental public health institutes, and health
workforce development across the continent. We need an agreement that favors this growth.
As we negotiate for this global consensus, lessons Africa learned from the COVID-19 pandemic must not be forsaken. When COVID-19 vaccines became available, Africa was never a priority. As mentioned earlier in this article, fewer vaccines were accessible for African countries, resulting in lower vaccination coverage. Delays in raising financing to coordinate a pandemic response cost lives. Export bans compromised vaccine access -- and so on.
A new pandemic agreement must enshrine safeguards to prevent these incidents from repeating.
About the author
Jean Kaseya, a Congolese medical doctor with advanced degrees in epidemiology and community health, was appointed director-general of the Africa Centres for Disease Control and Prevention in February 2023. Kaseya brings to this position over 25 years of expertise in the field of public health, having held pivotal roles both at the national and international levels with various organizations from the private sector, philanthropies, and bilateral and multilateral development partners.
