WITH globalization, the world has become a massive, singular unit—and no amount of restrictions can stop human interaction. It is inexcusable that after HIV/AIDS, Ebola, and Covid-19, the world and its political leaders still have not learnt from past mistakes.
Pandemics know no borders, race, or social class—and it’s selfish and myopic to fight a disease in a specific territory or region while ignoring your neighbors.
As we speak, the world is reeling under the current global outbreak of monkeypox, a zoonotic viral disease with a case fatality rate as high as 3-to-6%. However, African countries and other lower-middle-income countries (LMICs) elsewhere have been left without access to diagnostic technology and vaccines for monkeypox. Additionally, very few African countries have managed to perform enough surveillance and track the disease to effectively control it epidemiologically.
As of August 31, 2022, 11 African Union Member States had reported 3,549 monkeypox cases (3,066 suspected, 483 confirmed), accounting for 107 deaths, according to the Africa Centres for Disease Control and Prevention. These statistics clearly indicate there is minimal surveillance and diagnostic capacity, while the case fatality rate of 3% is the highest in the world.
The argument also goes on about whether it must be declared a sexually transmitted infection. African countries are mum and cannot contribute much because they have been left without resources for diagnostic technology, surveillance, and infection control. Could this be the case, like HIV, where it was initially discovered among a specific marginalized group? We might not know since African countries and other LMICs have been left out in the fight against this newest outbreak.
The emergence of zoonotic viral epidemics over the last century has highlighted the importance of diagnostic and genomic surveillance. During the Covid-19 pandemic, discovering the Delta and Omicron variants in South Africa and Botswana, which helped determine the appropriate vaccines for the region and helped vaccine manufacturers stay up to date with adapting their vaccines to remain relevant. Additionally, genomic surveillance for Covid-19 and sharing that data quickly and globally via GISAID was the primary reason vaccines were developed in record time.
The current global health paradigm of the donor-recipient approach, coupled with the capitalist notion of pharmaceutical industries putting profits ahead of humanity, has fueled inequity in access to health interventions, resulting in the poor control of global pandemics.
Global health colonialism, which results in funding, technology, and innovations being withheld entirely from, or solely allocated to developed countries, has allowed some pandemics to ravage certain parts of the world while other regions hoard lifesaving interventions. A gross power imbalance exists when drug and diagnostic technology developers and wealthy countries use patents to withhold lifesaving innovations to protect profits amid these global pandemics.
Africa, and other developing countries in Asia, termed the Global South, have always borne the burden of infectious diseases, with millions of lives lost in the process. Unfortunately, political leadership and the global public health fraternity choose not to learn from past mistakes. One would expect that lessons learnt from the HIV/AIDS and Covid-19 pandemics would make the world respond better to current and future global health crises.
Regarding disease control, world leaders must realize that borders, race, and economic status will never act as barriers to disease transmission. Unity and equitable distribution of resources, along with transparency and accountability, are the only ways infectious diseases can be identified, controlled, and eradicated quickly, with minimal loss of life.
The pharmaceutical industry, like all medical interventions, should move away from capitalist idealism and focus on saving lives as the primary goal. The developed world must understand that protecting profits before human lives will always be more costly in the long term and continues to promote inequality among human beings. The global health focus should also never be on race and ethnicity.
Take Ebola, for example. The Global North had previously not participated or invested many resources in developing the Ebola virus vaccine, as they felt safer from it. There were not many profits to be made, as it only affected poor people until that pandemic started crossing imaginary boundaries. Unfortunately, they are repeating the same mistake with monkeypox.
The Global North’s neo-colonialist attitude clearly shows they want to keep Global South LMICs as consumers of their expensive health interventions, denying opportunities to manufacture or participate in developing these interventions. The approach is colonialist in nature but packaged as charity, where wealthy governments and drug companies refuse to waive rights to intellectual property.
As we saw during Covid-19, had governments and big pharma acted more collaboratively, drugs and diagnostic equipment could have been manufactured regionally, at more affordable rates, and made available to lower-income countries. Instead, the capitalist wheel continued to turn, and developing countries were forced to pay higher prices. This proved the inherently skewed negotiating power between the Global North and South, caused by many World Trade Organization Member States’ focus on protecting the profits of developed countries at the expense of human lives in poorer countries.
The donor-recipient narrative has also resulted in non-consultative interventions, where top-down health initiatives are imposed with minimal involvement of the beneficiaries. The number of years it took to secure waivers for the manufacturing in Asia of cheap antiretroviral medicines for HIV to save the hardest hit continents like Africa resulted in countless avoidable deaths. Up to now, Africa has the largest population of people living with HIV and has no ARV manufacturing facilities – by big pharma’s choice, not by accident. The same happened for Ebola and Covid-19 vaccines and is happening again for monkeypox.
The delay we saw in the negotiations for a patent waiver for ARV drugs in the late ‘90s is the same delay we saw in the latest negotiations on IP waivers for Covid-19 vaccines. South Africa and India tried from the pandemic’s onset to get access to the required IP, which would allow for locally produced, approved vaccines at cheaper production costs. Partial patent waivers were only given years after millions of people endured preventable suffering at the hands of the Covid-19 pandemic.
The Africa CDC has begun ramping up preparedness and response efforts for monkeypox, including training technicians on diagnostic methods. It is also collaborating with relevant global and regional partners, distributing test kits, and supporting surveillance and detection needs in both endemic and non-endemic countries.
While these efforts are valuable and needed, more must be done, including:
1) Formation of a new Global Public Health Convection or platform where public health experts can discuss global health and pandemic control outside of political and capitalist influence.
2) Drug and diagnostic technology patent waivers for diseases declared public health emergencies and discussions outside WTO jurisdiction via the neutral Global Health Public Convention.
3) Africa CDC to be considered an equal partner with sufficient technical expertise to act as an adviser to WHO in terms of classifying infectious disease outbreaks as epidemics and negotiating for waivers on intellectual property.
4) WHO to push for waiving patents for drugs and diagnostic equipment for drugs affecting Africa and for their manufacturing to be accomplished in Africa.
5) African scientists and academic institutions are to be supported and treated as equal partners in disease surveillance and product development for medical technologies for diseases common in the continent.
6) WHO participatory membership and voting powers must depend on represented populations and disease burden, not on financial contributions from WHO Member States.
The Global South and its citizens deserve the right to determine their path in all aspects of life, especially in global public health. It is high time that colonialist, donor-recipient mentalities are replaced with attitudes of fairness and equality for all, which must start in Africa and be supported by all nations globally, particularly the Global North.
Author: Dr. Nduduzo Dube, Director of Quality Management & Clinical Operations, Africa Bureau, AIDS Healthcare Foundation