African nations are often at the mercy of the international community to receive essential global health resources in times of crisis. To change this, we must expand how we imagine health security and develop locally owned research and development capacity.
When global health action is urgently needed, dependency on global actors is almost often too late and too imprecise of a strategy. Take, for example, the COVAX mechanism which was supposed to ensure speedy and equitable access to vaccines. Richer countries bypassed this mechanism to secure access for their citizens first, while vaccines arrived in poorer nations months later.
This is not the first time an inequitable global scramble for life-saving goods has left poorer countries at the back of the line. Medications for HIV/AIDs remained out of the reach of countries with the highest burden years after they were commonplace in richer nations. Therefore, while we can expect more border-spanning health crises in the future, what we cannot expect is that global cooperation will reliably deliver solutions for those most in need. While advocacy for global goods remains needed, it is worth considering how to build locally owned research and development capacity. This requires a larger conception of health security.
(RE)CONCEPTUALIZING HEALTH SECURITY
Health security refers to the sum total of activities necessary to prevent and respond to border-spanning health threats. However, there is a tendency to take a reactive and often militarized approach to health security, tied more to protecting richer countries from threats perceived as ‘other’ than sustaining global health, and more importantly, protecting health systems.
For example, the currently proposed pandemic treaty, which aims to coordinate surveillance, reporting and response to future pandemics, runs the risk of focusing overwhelmingly on surveillance—detecting and reporting outbreaks. Yet true health security is about being resourced. It requires holistic planning, ranging from protocols during emergencies, to health systems that are capable of learning, sustainable human resources for health, preventive neighbourhood infrastructure and culturally responsive tools to diffuse science. South Sudan’s noteworthy COVID-19 response protocols came from being prepared after a previous Ebola outbreak.
To extend the conversation beyond a narrow conception of health security, we could frame it toward building ‘wellbeing infrastructure’: a broad set of inputs that intersect diagnostic capacity, clinical cures, environmental solutions, and behaviour change, all channelled toward the goal of improving human wellbeing.
ENCOURAGING CROSS-FUNCTIONAL COLLABORATIONS FOR HEALTH
Well-being infrastructure requires a cross-cutting agenda. It is important to connect what may appear to be disconnected problems given that unlimited funds to manage conditions which are better prevented do not exist. Conditions like Lassa fever for example, are impacted by sanitation conditions that foster the breeding of rodents that carry the virus. Yet, it is typical that sectors dealing with these interconnected drivers are not resourced to coherently collaborate. In several countries, responses to COVID-19 lacked contingencies for endemic killers such as malaria, drawing resources away from their management and weakening other core health system functions. Outcome rather than disease-focused financial management, undergirded by strong data systems can fuel this reorientation.
BUILDING STRONG KNOWLEDGE-TO-INNOVATION PIPELINES
Considering that 50 per cent of urban and 70 per cent of rural dwellers do not have electricity in Africa, a local manufacturer would likely have to rely on air-polluting diesel generators to make solar panels for cleaner air. This irony illustrates the need for a coordinated approach to investing for well-being that considers the inputs and not only the outputs. The diffusion of COVID-19 vaccines required consideration for the entire supply chain, not just the singular therapeutic breakthrough. In addition, the vaccines were only created in less than a year because research and development capacity had been invested in vaccine innovations long before they were needed.
Currently, there is a large gap between academic research and such a strategic approach to its application. Al-Bader and colleagues found socially relevant technologies such as diagnostic kits and plant-based remedies stalled at various stages of development in research institutions such as Kenya’s Medical Research Institute (KEMRI) and Ghana’s Noguchi Institute. Institutions attributed this to the challenge of working with the priorities of donors who did not provide incentives to transform research, once generated, into practical solutions.
For research to solve local problems, governments need reliable architecture for funding relevant local research, freeing them from dependence on donor-driven priorities. This needs to include strong pathways for the uptake of promising inventions, strengthened network effects through Africa-wide collaborations, and an emphasis on translating knowledge into resources that build a robust local research and development ecosystem.
Yet what does the local research and development ecosystem look like on a continent with a net emigration? Africa has about 12.5 per cent of the world’s population but it produces less than one per cent of the world’s research output, and its best minds often have more competitive opportunities elsewhere. While global funding may involve African partners, much less is housed on the continent, and therefore much less involves the continent’s priorities.
Technical skills in sectors linked to well-being can be enriched by retaining existing capacity and bringing expatriated skills back home. China is an example that has managed to turn its brain drain around in recent years. Using a combination of research and development investment which it increased by 17 per cent in the span of 17 years through its National Natural Science Foundation of China and its ‘Thousand Talents’ programme, the country grew its return rates for foreign graduates, called ‘sea turtles’ from 5 per cent in 1987 to 31 per cent in 2018. China currently publishes more papers in computer science, artificial intelligence and biomedical engineering than either of the United States, United Kingdom, and Germany. Its research and development funding landscape is significantly channelled toward well-being infrastructure such as the environment, health and technology, which are considered mission critical.
CHANNELLING RESEARCH AND DEVELOPMENT FUNDING TOWARD WELL-BEING
A potential low-hanging fruit is aligning research and development capacity typically housed in small and medium-scale enterprises (SMEs), with mission-critical goals. For example, a significant proportion of COVID testing capacity in Ghana was built on private sector infrastructure. Policies, regional frameworks and incentives for collaboration to achieve well-being targets can encourage scientific collaboration between SMEs, contributing to skill development, spin-off innovations, and strengthened infrastructure.
Another possibility lies in channelling levies on economically viable industries toward well-being research and development. Starting in 2008, Gabon extended health insurance for the poor, young and elderly through levies on mobile phone companies and international money transfers outside the region. Corporate social responsibility funds, which are already normative in various industries, can also be directed this way.
These approaches would be attractive if the gains created by well-being infrastructure were appreciated. In addition to protecting health and strengthening resilience locally, the benefits of strengthened well-being infrastructure can enable African countries to meet global supply chain deficits. A country like Kenya which is primarily reliant on agriculture but contributes less than one per cent to global food exports could thus be positioned to address global as well as local access to healthy food. This will serve the secondary purpose of strengthening the continent’s soft power through trade, a helpful resource in advocating for access to global goods.
The political will to galvanize existing innovative policy approaches can wean African countries off over-dependence on global actors, so that they can put their priorities first⎈
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