By Annalisa Primi, Head, Structural Policies and Innovation, OECD Development Centre, and Stephen Karingi, Director, Regional Integration and Trade, United Nations Economic Commission for Africa (ECA), and with Lily Sommer, Wafa Aidi, ECA, Vasiliki Mavroeidi, Manuel Toselli, OECD development Centre
This blog is part of a series on tackling COVID-19 in developing countries. Visit the OECD dedicated page to access the OECD’s data, analysis and recommendations on the health, economic, financial and societal impacts of COVID-19 worldwide.
Africa is at high risk. The most externally oriented economies, South Africa, Egypt, Morocco and Algeria account for 52% of the confirmed COVID-19 cases (32,979 as of April 28th). The continent lacks adequate healthcare systems. Hospital capacity is weak with 0.3 beds per 1,000 people in Senegal and 2.8 in South Africa, versus 6.5 in France and 8.3 in Germany. The continent is highly dependent on imports of medical supplies: 94% come from countries that have been hard hit by the pandemic, many of which are now limiting exports to ensure domestic provision of critical equipment. The pandemic magnifies the continent’s structural weaknesses, which make self-isolation and lockdown measures costly and hard to implement: 60% of the world’s poorest people live in Africa and the majority of the workforce is informal. The digital gap hampers telework and automation and governments are not able to mobilise investments at the scale needed to secure all citizens. African governments have taken important steps already, also building on lessons learnt in previous pandemic outbreaks. But the challenge is unprecedented: a global solidarity deal is needed.
Limiting the contagion and ensuring proper treatment of affected patients is of primary importance. An effective strategy requires four prongs:
Improved testing capacities for diagnosis. Africa needs urgent access to affordable and adequate serology test kits. These can be deployed in decentralised settings, quickly and without the need of highly skilled medical personnel. Of the estimated 306 commercialised kits, only one is manufactured in Africa (in Egypt). African solutions are however beginning to emerge. Senegal, in collaboration with the UK and France, is prototyping a pocket-sized kit which will cost less than 1 USD and in Ghana a diagnostic firm in cooperation with a local university developed a test that delivers results in 20 minutes. Cooperative research and local manufacturing need to be scaled up to enable access to self-diagnostic kits.
Timely availability of Personal Protective Equipment (PPE) for protection. PPE, such as masks, gloves and sanitisers, make a big difference in the capacity to contain contagion among health workers, patients and citizens. Major shortages of these “commodities” in Italy, Spain and France reveal that their availability cannot be taken for granted. Fast-tracking trade through green lanes for medical supplies, facilitating industrial reconversions and establishing price control mechanisms are key to ensure access to these devices. In South Africa, U-Mask has shifted from mining and agricultural masks to medical masks, and the Ghanaian government is collaborating with local manufacturing firms to scale up PPE production. Trade should be simplified, within Africa and globally as the top ten exporters of PPE account for 70% of exports, with 32% originating from China.
Increased ventilators and medical personnel for treatment. Africa faces a chronic shortage of doctors and paramedical personnel, and with COVID-19, also needs more ventilators. The pandemic has created a steep increase in the demand for ventilators creating shortages globally. The scarcity is even more acute in Africa. With supply chains disrupted by lockdown, and several countries banning exports to address national health emergencies, it is critical to ensure the availability of ventilators and their spare parts in Africa. Donations can help but they are not enough. Fast-tracking imports through green lanes must be urgently implemented. Lead producers should share their expertise, business protocols and intellectual property to facilitate local manufacturing in industrial poles in Africa where critical capabilities are available. The automotive industry could help. In Europe and in the United States, this industry is racing to ramp up ventilator manufacturing in partnership with governments and specialists. Auto players could support Africa through their manufacturing sites on the continent. This is a precious occasion to accelerate the scaling up of manufacturing in Africa; and in fact, home-grown projects are emerging. The National Agency for Science and Engineering Infrastructure has just produced the first “made in Nigeria” ventilator.
Affordable access to drugs and vaccine for curing. There is no cure available for COVID-19 yet. Lead pharmaceutical firms, biotech start-ups and research laboratories (led by the United States and followed by China) are working on testing potential drugs and developing vaccines. Once certain treatments prove effective and when a vaccine is available, supply shortages will impede affordable and timely access for Africa’s citizens, unless a global agreement is reached in advance. The recent Abbvie lifting of all intellectual property protection on its anti-HIV drug currently tested for treating COVID-19 is a step in this direction, but more needs to be done to guarantee affordable access to drugs and a vaccine as soon as they are available.
What can be done in the short-term to advance these efforts and ensure Africa can effectively Test, Protect, Treat and Cure?
Africa is already implementing smart trade and industrial policies to address these challenges. Beyond travel restrictions and lockdowns, governments are engaged in a continental strategy to pool standards and resources to scale up local manufacturing. Local firms are innovating and reconverting production lines and service delivery, as demonstrated by the pan-African e-commerce leader Jumia, which has switched its logistic network to bridge last-mile gaps in delivering medical and essential supplies.
Three priorities stand out for African governments. First, fast tracking imports and exports by creating green lanes for medical supplies, urgently suspending tariffs on all COVID-related medical supplies, and establishing price control mechanisms to avoid speculations, are priorities to grant fair access to these essential goods. Second, scaling up local manufacturing and facilitating industrial reconversions by expanding financing to local firms engaged in the COVID-19 response and facilitating access to technical know-how and business-to-business knowledge sharing. Third, accelerating the African Continental Free Trade area, which provides an opportunity for scaling up manufacturing capabilities on the continent, notably in the medical, pharmaceutical and food industry.
The international community also has a crucial role to play. First, by mobilizing financing. The recent G20 endorsement of debt relief for the poorest nations is a positive sign, but it is not up to the needs. ECA is calling for USD100 billion through budget support to deal with health, social safety net and economic stimulus across Africa. Financial support should also be channelled to development banks involved in supporting governments and firms in addressing the emergency. Second, by lifting intellectual property on COVID-19 related medical supplies. The flexibilities of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement and the Doha Declaration enable national governments to exclude medical supplies from patent subject matter, grant patent use without the consent of the patent holder, and recur to parallel imports by establishing international exhaustion of intellectual property rights in response to domestic policy objectives. Some countries like Canada, Germany and Israel have already enacted laws of this type, enabling compulsory licensing and parallel imports even beyond what is allowed by the international agreements. South Africa, Egypt, Morocco, Kenya and Nigeria possess pharmaceutical capabilities that could be scaled up to supply the continent, in conjunction with parallel imports from India and others.
A new global intellectual property solidarity deal is needed to make medical supply, treatment and vaccine available and affordable to all. This is essential, for Africa, and for the world. An increasingly frequent phrase we hear is that “we are all in this together”. This must be translated to all spheres of life, and be maintained as the norm even after the crisis.
This blog builds on a forthcoming report “Speeding Up Africa’s Response to COVID-19: What Can Technology, Manufacturing and Trade Do?”