Africa and the Emerging Global Health Architecture
By Gilbert Khadiagala and Bob Wekesa
In July 2020, the authors of this article, observed in these pages the uncertainties that the Covid-19 pandemic had caused in the international system. We argued that the countries of the Global North and emerging powers such as China were more focused on tackling the pandemic in their own countries rather than assisting African nations. Among the suggestions we made was that African countries needed to work together to realize the vision of “African solutions for African problems.” In this article, we provide an overview of the current global contestations over Covid-19 vaccines and the implications for Africa. We also briefly suggest some of the building blocks of a new global health architecture.
A year after the World Health Organization (WHO) declared Covid-19 as a pandemic, the geopolitical tensions have not abated. These tensions relate to debates about immunization as the means to boost human immunity and stop the pandemic. The publication of a joint article by world leaders in late March 2021 calling for a new global health architecture presents perhaps the best opportunity that the pandemic presents for lessening the effects of zero-sum competition. The article was signed by 28 leaders including five from Africa – Rwanda’s Paul Kagame, Kenya’s Uhuru Kenyatta, South Africa’s Cyril Ramaphosa, Kais Saied of Tunisia, and Senegal’s Macky Sall. Premised on the conviction that the world will not remain the same during and after the Coronavirus, the article is an important global policy commentary on multilateralism as a pathway for tackling current and future health problems.
But first, why is multilateralism significant in the times of Covid-19?
If the perils of nationalistic isolation were already ascendant before the arrival of the Covid-19, the pandemic catalysed divisions among nations. As a World Health Organization (WHO) paper observes, “The world’s states, with their distinct national territories, are reacting individually rather than collectively to this pandemic. Border closures and travel bans create tensions as countries label others, but resent being labelled themselves, as unsafe or risky places to travel.” A more recent trend revolves around the manufacture and distribution of vaccines principally Covid-19 manufacturing countries with advanced pharmaceutical industries concentrated in the United States, European Union (EU), the United Kingdom (UK), China, India, and Russia. While wealthy countries are far ahead in vaccine production, distribution, and inoculation, poor countries, particularly in Africa have lagged behind. With the vaccines being framed in competitive terms of a “race” where nations with capabilities can “stockpile” and “hoard” them at the expense of poor countries, there has emerged a narrative of Africa being “left behind.” This underscores that the global political economy of Covid-19 is further deepening long-standing asymmetries between the developed and developed worlds. Africa’s fragile economies have been negatively impacted as resources are diverted to health expenditures on top of the devastating consequences of the pandemic on local and regional trade patterns.
One of the initiatives that seeks to help African countries boost their Covid-19 vaccination programs is the Covid-19 Vaccines Global Access Facility, COVAX, part of the global Access to Covid-19 Tools (ACT) launched in April 2020 by state and non-state actors with the backing of WHO. The key objective of the plan is to ensure that all countries – regardless of their wealth – have equitable access to a pool of vaccines because no country is safe until all countries are vaccinated. Most African countries signed onto COVAX because of their reliance on the collective action presented by multilateralism.
COVAX exemplifies collective mobilization in the service of global public goods with tremendous benefits to poor countries. For many African countries, the first immunizations from late February 2021 onwards came from COVAX. China, India, the EU, and the US have pledged donations to COVAX, providing a sliver of hope for multilateralism. However, given the enormity of the COVID-19 crisis in Africa, the initial vaccine rollouts have been woefully inadequate. Even as the distribution of COVAX doses kicked off in several African countries, leading voices, including John Nkengasong, head of the Africa Centres for Disease Control and Prevention (CDC), pointed out that vaccines through the COVAX scheme would be insufficient in immunizing enough African populations. Countries such as Kenya have estimated that at the current rate of vaccinations, they will not be able to achieve herd immunity at least until the end of 2023.
Apart from COVAX, some of the major vaccine manufacturing countries have favoured direct deals with African countries, igniting vaccine diplomacy, a new form of soft and smart power. In the competitive realm of vaccine diplomacy, countries such as China and Russia have preferred bilateral deals that strengthen their existing partnerships rather collective mechanisms such as COVAX. This is understandable as vaccine wars take centre stage in the global domain of power and resources. At this point, poor countries are ready to accept vaccines from anywhere to check the worsening situation. As more vaccine producers begin to have surpluses, it will behove on them to be more generous in contributions to COVAX or bilateral arrangements. In the US, for instance, there are projections of a vaccine glut by mid-May 2021 that is going to force the export of existing stocks of vaccines, particularly to its allies and friends.
What then, should be the foundations of a new global health infrastructure?
To be genuinely universal, the new international health regime for managing pandemics will need the buy-in of all global players. The current leading Europeans proponents for a new world health architecture are the UK, France, and Germany but in the immediate term, the list should include China, Russia, the US, and India in the leadership roles. Since the Joe Biden administration has signalled interest in multilateral approaches, it should get on board with its vast expertise and resources. In our initial postulation of the new health regime, we hinted that the negotiations for the framework may be an opportune moment for the US and China to begin to mend their frayed ties. India’s proven leadership in health technologies makes it a core actor in the articulation of this architecture. But we are not proposing a “G20 on health” along the lines of the global conclave constituted among a few major countries in the wake of the 1999 Asian financial crisis. Rather, current, and future pandemics require that all countries be at the table and contribute meaningfully to the debates. Many developing countries who are most vulnerable to pandemics and are by nature inclined towards multilateralism should participate in the deliberations.
Second, the leaders who signed the recent statement correctly noted that the proposal for a new health regime should “be rooted in the constitution of the World Health Organization.” The Covid-19 pandemic has partially dented the image of the WHO, but this is not irreversible. With its broad knowledge, expertise, and organizational power in spearheading global health efforts, the WHO should remain the fount of new ideas and implementation of strategies for the new pandemic framework. The reaffirmation of confidence in the WHO would also jumpstart the US-China bilateral relations that are going to be critical in anchoring the multilateralism of the new architecture.
Third, the new global regime needs to introduce a novel principle of health and disease transparency for all countries. Since the world needs to be better prepared for future health crises, the current loopholes in reporting about disease outbreaks should be a priority in any new global rules. The Chinese government has not been sufficiently transparent in reporting about the initial phases of the Covid-19 pandemic and there should be lessons from this experience in the new global health architecture. It is ironic that while China has pioneered some of the surveillance technologies that have contributed to managing the Covid-19 pandemic, it has shown reluctance to be more transparent in efforts to identify its origins.
Fourth, the global framework would require a new Pandemic Financing Mechanism that builds on, but transcends, the COVAX initiative. The latter is a palliative to meet the immediate financial shortfalls occasioned by Covid-19, but is not a long term solution to the multiple health and economic problems confronting most of the globe. This is why major multilateral institutions such as the World Bank, International Monetary Fund (IMF) and others need to be part of the negotiations for financing mechanisms for pandemic preparedness, including vaccines. The emerging wisdom from the 2021 spring meetings of the Bretton Woods Institutions about the centrality of governments boosting public spending on health to overcome the scourge of Covid-19 points in the right direction and the two institutions are well positioned to provide leadership on the new architecture. The signatories to the recent statement on a global architecture have suggested the need to “ensure universal and equitable access to safe, efficacious and affordable vaccines, medicines and diagnostics for this and future pandemics.” This objective can be realized with more creative pooling of financial resources by all world leaders.
Finally, for most poor countries, the Covid-19 crisis has underscored the significance of investment in functional water, sanitation, and hygiene (WASH) systems that prevent and manage pandemics. It is important to elevate WASH systems to global public goods in which states are urged to invest as a matter of national and global responsibility. In Africa, for instance, the African Union (AU) Abuja agreement of April 2001 required all countries to invest 15 per cent of annual budgets on health, but less than 5 countries have met this target. The new global health framework could be a critical moment for nudging countries to recommit to global benchmarks for WASH systems. The 28 countries that have signed onto the call for a new global policy framework on health have paved the way for discussions on its core parameters. It now requires the mobilization of further diplomatic efforts to bring on board all UN member states and relevant international institutions. Africa’s 28 percent presence at the UN would be crucial in this respect. Overall, African countries are ready to embrace the new idea and robustly contribute to the re-imagination of a global system in which they have mostly featured on the periphery. After the unveiling of the new architecture, the AU will be important in urging its member states to lobby for its ratification.