The COVID-19 pandemic has forced a reflection on the origins of supplies in African healthcare market and underscored the need for an increase in local manufacturing of medical supplies. Several African countries’ health markets have been heavily reliant on imports. This article demonstrates how the African healthcare market has had a high import dependency and the role that the African Continental Free Trade Area (AfCFTA) could play to reverse this. It is estimated that African countries import between 80% and 94% of medical supplies, 75% of testing kits, between 70% and 95% of pharmaceuticals, and 99% of vaccines. During the COVID-19 pandemic, countries imposed export restrictions which impacted the flow of medical supplies to African countries. This finding highlighted the limited production capabilities on the African continent and reiterated the need to strengthen continental value chains and local manufacturing capacity for public health on the continent. Local innovations sought to minimize the impact of these supply chain disruptions. Using case studies on the local production of COVID-19 testing kits and personal protective equipment, the article highlights progress made toward health market reform. It calls attention to the implementation of the AfCFTA to strengthen the supply, manufacturing, and trade of medical resources. The article highlights countries that have African-made pharmaceuticals and vaccinations and the importance of regional hubs to expand these products in African healthcare markets. The author concludes by discussing investments made to expand local manufacturing of health products.
Health equity in economic and trade policies
This paper aimed to assess community members’ perceptions regarding health risks associated with potentially toxic elements and cyanide pollution in Kwekwe City. An explorative cross-sectional study was conducted with key stakeholders and industrial settlements’ residents. Face-to-face interviews with key informants and focus group discussions with residents and workers were used to gather data. A thematic approach was utilised in data analysis. Study participants, who played a crucial role in the research process, perceived that industrial pollution principally linked to cyanide, mercury and chromium posed significant environmental and health risks. This participatory approach in risk perception assessment is critical in providing insight into the scope of the problem and formulating intervention strategies. However, given that qualitative study results lack generalisability and replicability, quantitative studies need to be undertaken to determine environmental levels of toxic chemical pollutants as a complementary measure.
The World Bank’s 2024 Global Economic Prospects report, indicates that global economic growth will stabilize in 2024 at a pace that is insufficient for progress on development goals.The needs for adaptation, Africa’s priority, remain underestimated, particularly for universal access to energy. To address these daunting challenges, the report asks where is the money? External resources are substantial, but with problematic accessibility, conditionalities and ineffective utilisation. Debt has become an impossible option, as Africa’s external debt has already tripled since 2009, and is compounded by a complex structure that renders traditional relief mechanisms obsolete. Foreign Direct Investment (FDI) and participation in global financial markets remain disproportionately low. To move forward, the foundation calls for a radical reboot of the current multilateral financial system and more effective organisation and use of domestic resources. According to the African Union, the mobilisation of the continent’s domestic resources is expected to cover up to 90% of the financing required for Agenda 2063. This means drying up illicit financial flows, strengthening tax systems- African states cannot afford tax holidays for foreign companies-, leveraging remittances, sovereign funds, pension funds and private wealth, monetising Africa’s green assets – biodiversity, critical minerals, carbon-sinking potential. This is argued to demand a paradigm shift that avoids any trade-off between climate and development, that moves beyond the aid and charity model to a cooperative, deal- making one, and that puts ownership in Africa.
Researchers have argued that wealthy nations rely on a large net appropriation of labour and resources from the rest of the world through unequal exchange in international trade and global commodity chains. The authors assess this empirically by measuring flows of embodied labour in the world economy from 1995–2021, accounting for skill levels, sectors and wages. They find that, in 2021, the economies of the global North net-appropriated 826 billion hours of embodied labour from the global South, across all skill levels and sectors. The wage value of this net-appropriated labour was equivalent to about USd18 trillion in Northern prices, accounting for skill level. This appropriation roughly doubles the labour that is available for Northern consumption but drains the South of productive capacity that could be used instead for local social needs and development. Unequal exchange is understood to be driven in part by systematic wage inequalities. The authors find that Southern wages are 87–95% lower than Northern wages for work of equal skill. The authors argue that this means that while Southern workers contribute 90% of the labour that powers the world economy, they receive only 21% of global income.
Colonialism, which involves the systemic domination of lands, markets, peoples, assets, cultures or political institutions to exploit, misappropriate and extract wealth and resources, affects health in many ways. In recent years, interest has grown in the decolonization of global health with a focus on correcting power imbalances between high-income and low-income countries and on challenging ideas and values of some wealthy countries that shape the practice of global health. The authors argue that decolonization of global health must also address the relationship between global health actors and contemporary forms of colonialism, in particular the current forms of corporate and financialized colonialism that operate through globalized systems of wealth extraction and profiteering. They present a three-part agenda for action that can be taken to decolonize global health. The first part relates to the power asymmetries that exist between global health actors from high-income and historically privileged countries and their counterparts in low-income and marginalized settings. The second part concerns the colonization of the structures and systems of global health governance itself. The third part addresses how colonialism occurs through the global health system. Addressing all forms of colonialism is argued to call for a political and economic anticolonialism as well as social decolonization aimed at ensuring greater national, racial, cultural and knowledge diversity within the structures of global health.
At the Mining Indaba in Cape Town in the week of February 5-9 countless references were made to mining-affected citizens of African countries. However, the author of this blog notes that absent from almost all of the rooms where this word was repeatedly invoked were…members of mining-affected communities. Tengi George-Ikoli shared an African adage: “A man’s head should not be shaved in his absence.” Community voices are observed to be essential in spaces like Indaba to ensure that decision makers account for the social, economic and environmental impacts of mining and minimize them. One place that was replete with community stakeholders was Alternative Mining Indaba, which has operated in distant parallel to the main Indaba for 15 years. However the author argues in this blog that until communities and civil society have a more fixed and prominent seat at the table, and agendas reflect the importance of their voices, progress on challenges such as adding value to raw commodities will be difficult.
While low and middle income countries have called for the principle of Common but Differentiated Responsibilities (CBDR) to be embedded to meet equity objectives in the on-going global health negotiations on climate change and pandemic preparedness, drawing on environmental policies, they face resistance from other countries. The author suggests two possible scenarios ahead: In the first, the CBDR principle is broadly accepted and implemented in a more equitable and effective pandemic response that acknowledges the differentiated capacities of nations and allocates obligations accordingly, through inclusive global health governance. In a second scenario, if the CBDR principle is rejected or adopted in a very diluted form, the author argues that the pandemic accord may struggle to meet its objectives. An uneven distribution of responsibilities could overwhelm less capable nations during health crises, leading to an inefficient and unjust response. Failure to consider the unique needs and vulnerabilities of developing countries could perpetuate existing global health inequities, diminishing the resilience of the global health system in the face of future crises and putting all populations at greater risk. The author proposes that striving towards equity and inclusion through the careful implementation of the CBDR principle may prove vital in realising a pandemic accord capable of meeting the challenges of global health crises.
On 06 August 1945, the United States dropped the world’s first atomic bomb on Hiroshima, Japan during the Second World War. A large amount of uranium used in making the first atomic weaponry was sourced from the Shinkolobwe mine in the Katanga province of the DRC, mined by workers who worked under secret contracts and low wages for the United States national security. To prevent information from leaking, Shinkolobwe was erased from maps. Misinformation was spread to make it appear that uranium was sourced from Canada, whose ores yielded 0.03% uranium while Congolese ores yielded 65% uranium. In a 2004 assessment of the mine, the United Nations found ‘high risks of mine collapse and potential chronic exposure to ionizing radiation’, recommending that the mine remain closed, while local Congolese families are reported to believe that their history has been tarnished by the uranium exploitation and use.
This study investigated how inhabitants of Mukuru informal settlement in Nairobi, Kenya in 2021 experienced climate change and its health impacts, and assessed related knowledge, attitudes and practices, using a cross-sectional study. Out of 402 study participants, 76% had heard of climate change before the interview, 91% reported that climate change was affecting their community, and 93% were concerned with the health-related impact of climate change. Having lived in Mukuru for more than 10 years and living in a dwelling close to the riverside were factors significantly associated with experiencing a climate change related impact, including chronic respiratory conditions, vector-borne diseases, infectious diarrhoea, malnutrition and cardiovascular disease. With most respondents knowledgeable about climate change and experiencing its impact, the authors propose that policy makers, planners and researchers to work locally with affected communities on mitigation and adaption strategies.
Regional vaccine production features in the draft pandemic accord, but there is still a long road before this becomes a reality. Aspen Pharmacare invested millions of dollars in scaling up its South African production plant to make COVID-19 vaccines – yet it never sold a single vial. Three key factors combined to undermine Aspen’s vaccines. First, despite the hype about the need for African-produced vaccines, African governments failed to buy the locally-made vaccines. While the pandemic accord currently being negotiated is almost certain to support regional vaccine production, setting this up is complex and the COVID-era failures offer a number of sobering and cautionary lessons. Then Aspen became caught in a political stand-off between Africa and Europe about the fate of African-produced vaccines which delayed production by months. When that was eventually resolved, the world had fallen for mRNA vaccines and no longer wanted the viral vector vaccine that Aspen had been licensed to produce by Johnson & Johnson. With the waning of COVID-19, maintaining countries’ and companies’ interest in building regional vaccine manufacturing ability is a challenge and the authors suggest that Aspen’s difficulties should be well noted.