A pandemic pact still eludes world governments, so what should African countries do?

Many Africans hoped that the World Health Assembly (WHA) in May would bring the conclusion of negotiations of a binding international legal instrument – the Pandemic Agreement – which would codify principles of solidarity, equity and cooperation into the global response to future health emergencies of global nature and pandemics. This agreement would prevent a repeat of the catastrophic failures in the global response seen during the Covid pandemic.

Yet again, these hopes were dashed. After more than two years of intergovernmental negotiations, the agreement receded even further as countries agreed to postpone the negotiations for another year until May 2025. Before the WHA, several intensified efforts to conclude the negotiations were made in February, then March, then April, and again in May before the start of the WHA.

None of them succeeded in concluding the negotiations. A colleague from the European negotiation team anticipated a similar WHA outcome because of misaligned expectations. African countries want to conclude the Pandemic Agreement as soon as possible, while wealthy nations prefer to take more time.

Behind the repeated inability of multilateral negotiations to conclude the agreement are multiple substantive issues. According to the South African co-chair of the negotiations, Precious Matsoso, the biggest stumbling block is intellectual property issues.

Others have noted that the expectation that there would be equitable sharing of benefits like tests, vaccines and other medical products in return for sharing of pandemic materials like viruses and genetic sequences has been a major sticking point.

New amendments to the International Health Regulations (IHR) made an important first step towards addressing inequity in access to medical products during global health emergencies. African countries welcomed the IHR’s explicit recognition of the need to ensure access to health products during health emergencies, including in humanitarian settings.

However, they were disappointed by the removal of any reference to compliance from the text of the IHR Amendments because, without a robust (independent) compliance mechanism, there will be no accountability.

Africans had hoped that the pandemic would mark a turning point in the understanding between wealthy and poor nations of the importance of equity in global pandemic cooperation. Little seems to have changed.

Precious Matsoso explained that nations remain at an impasse now because “some countries started by not understanding the context in which we are operating, particularly concerns about equity – that other countries have experienced inequity.”

After the pandemic, it is not credible that any nation does not understand the context or why the international system needs to address the inequity that denied low- and middle-income countries access to tests, vaccines, therapeutics and protective equipment needed for effective pandemic response.

The inability to find mutual interest as a basis for reaching an agreement is more likely a result of zero-sum thinking on the part of high-income countries. So, given that the agreement continues to elude multilateral negotiation, what should African countries do?

They should stick to their game plan born of Africa’s extreme vulnerability and insecurity during the pandemic, in which the continent’s response languished due to being denied access to pandemic response products. This occurred because nearly all medical products required to meet Africa’s medical needs are manufactured outside the continent, making Africa extremely vulnerable to supply chain disruption in times of scarcity.

The pandemic led African leaders to resolve to never again find themselves in the same situation. They resolved to collaborate and promote investment in domestic manufacturing to improve Africa’s security of access to medical products during future pandemics and health emergencies of international concern.

A Pandemic Agreement was never going to be the panacea to Africa’s access challenges where a similar instrument like the just-amended IHR failed to promote a collective equitable international response. Restricted access to medical products by African countries during international health emergencies has been a recurring cycle in every pandemic in recent memory.

So come the next pandemic, Africa must have robust practical answers to this recurring challenge. The best answer is one that does not depend on multilateralism, but rather on regional collaboration and intra-African trade to develop viable manufacturing on the African continent.

Regionalising medical manufacturing remains Africa’s best chance of improving its future pandemic preparedness. This must remain the cornerstone of African government efforts to ensure the security of access during global health strife.  

After the pandemic, all nations should now understand that the idealism of an international agreement that codifies equitable access based on global solidarity among nations has little practical consequence. Solutions that require others to make donations to Africans at the expense of their people are doomed to fail.

African nations may hope that things will be different next time, but hope is not a strategy. Localising medical manufacturing in Africa is the only way to ease Africa’s burden. Achieving it requires many moving pieces that will take time, resources and sustained effort to put into place.

It requires governments to lead with conviction and strong political will. They need to do what it takes to persuade partners, investors and industry to support efforts to reduce Africa’s current near-total dependency on imports by investing in a globally distributed manufacturing base that brings supply chains closer to African markets.

Among other things, governments need to ensure stable and predictable markets for locally manufactured products in order to have sustainable domestic manufacturing. 

Governments must become the biggest champions for local manufacturers having better access to domestic, regional and international markets.

This is pivotal to improving the viability of manufacturing businesses on the continent. It will help them to attract the investment they need to scale up their manufacturing operations to serve more people, invest in quality upgrades and take measures needed to become sustainable businesses.

Governments must do what they have been averse to doing – consolidating the African market to create economies of scale. They must also prioritise the purchase of domestic products in government procurement of medical products. As much as possible, they should provide additional incentives like advance market commitments and framework contracts that span several years to signal stable business demand.

Improving the ease of doing business within and between African nations is an unfinished agenda and a pillar for success towards Africa’s aspiration for health security.

Robust manufacturing infrastructure alone is not enough without investing in developing the human capital necessary to drive successful businesses. African governments must leave no stone unturned in their efforts to leverage public-private partnerships and collaboration with diverse partners who bring essential solutions to industrial development.

This requires training programmes that sustainably build a skilled workforce capable of supporting advanced pharmaceutical manufacturing and retaining those skills. 

Proposed initiatives to set up capability and capacity centres to promote partnerships between research institutions, manufacturing companies and educational institutions would do just that if implemented.

Africa must engage in “intelligent cooperation” to create a supporting and enabling environment in which public and private sectors and civil society as well as development partners join hands to drive the necessary change to build a strong medical manufacturing ecosystem where business thrives.

This means finding new mutually beneficial ways of collaborating with development partners and regional and international procurement agencies, as well as South-South cooperation to boost African manufacturing and improve health and economic security.

For instance, persuading development partners to spend a small fraction of some of the aid funds on buying local will yield a significant impact on African populations. This and much more is necessary for African countries to achieve health security.

The bottom line is that there is a reason why multilateralism continues to fail to provide a practical solution that works for all nations globally. Simply put, Africa’s negotiating counterparts do not want it. That is why repeated efforts to conclude the Pandemic Agreement continue to fail.

The best outcome Africans can expect of these multilateral negotiations is most likely a watered-down toothless text of little practical consequence vis a-vis equitable access to medical products. This should push African nations to redouble their efforts to find their own fit-for-purpose solutions within their control.

More than ever, Africa needs domestic production of high-quality medical products that meet the medical needs of African populations. Achieving this at a sufficient scale and quality will take hard work, but it is possible. It will require compromises.

Above all, it will require African nations to find credible answers to the ultimate question that Jay Naidoo posed – “What is the intelligent cooperation that Africa needs to achieve health and prosperity?” If African nations find that answer and continue to doggedly move towards this goal, Africa can. DM