Africa’s Health Compact - Ministers set deadline for universal access to care
At a meeting in Johannesburg, South Africa, in April, Africa’s health ministers adopted a continentwide health improvement strategy that calls for universal access to essential care by 2015. The Africa Health Strategy covers four key areas: local pharmaceutical manufacturing; integrating African traditional medicines into general health care; reducing H.I.V. and AIDS, malaria and tuberculosis; and developing human health resources. It makes clear that partnerships can be formed with Africans in the diaspora, especially for knowledge transfer and research and development.
African officials worry that their vision of an integrated and prosperous Africa will remain “just a dream until the continent’s disease burden is eradicated.” Heads of state pledged in 2001 to direct 15 percent of their national budgets to public health services, but to date most have only managed to devote 10 percent of national spending. The African Union, the representative body of national governments charged with propelling the continent toward unity, peace and prosperity, says the continent is saddled with the triple burden of communicable and noncommunicable diseases and the re-sults of injuries and violence.
The health ministers met in Johannes-burg for the Third Ordinary Session of the African Union Conference of Ministers of Health. Under the theme “Strength-ening Health Systems for Equity and Development,” a draft of the pharmaceutical manufacturing plan took center stage. Not only would local production of essential generic drugs bring about self-sufficiency in the supply of those drugs, the ministers contended, it also would save foreign exchange, create jobs, facilitate technology transfer and even stimulate exports. Raw materials produced locally to make medicines clearly would be readily available and cheaper.
A number of African countries rely on India and China for imports of affordable generic drugs and raw materials. However, since 2005, those two countries have been complying with international process and product patent laws, which could threaten the affordability of and access to those drugs in Africa.
Pharmaceutical manufacturing by no means is absent from Africa. Egypt has more than 30 drug manufacturing plants and Nigeria and South Africa already produce medicines. A World Health Organization assessment of 46 countries in 2005 showed 37 had pharmaceutical industries, albeit at various levels. Thirty-six had secondary-level production, which includes the production of finished dosage forms from raw materials and excipients, and 25 had tertiary production, which involves packaging and labeling finished products, or repackaging bulk finished products. Only one country had limited primary production—the manufacture of active pharmaceutical ingredients and intermediates from basic chemical and biological substances. Nine had no production capacity.
The draft plan raises a number of challenges. With the requisite technical expertise in short supply in Africa, the continent will have to invest in producing scientists skilled in biology, chemistry, process engineering, medical engineering, biochemistry, biocomputer science and physics, as well as clinicians, pharmaceutical scientists and a range of technicians. The plan calls for forging links with external universities and funding entities to ensure a sustainable supply of these skills. It also notes that “Africans in the diaspora can probably assist in this regard.”
Officials are watching for the response of multinational drug companies, which stand to lose market share in Africa if local manufacturing is enhanced. The concern is that these companies may refuse to play ball by, say, not transferring technology to Africa and/or lobbying their governments to hold back funds, or put pressure on African countries to keep their markets open to foreign drugs. In an all’s-fair-in-love-and-war scenario not uncommon in global commerce, multinationals could easily undercut local African prices, which would wreak havoc on the continent’s emerging industries.
The draft specifically cites the U.S. industry’s lobbying clout. “The response of big PhRMA (The Pharmaceutical Research and Manufacturers of America) and other, similar structures to the plan and their geopolitical influence may need to be analyzed, particularly with regard to the donor community.”
Meanwhile, a huge breakthrough in health collaboration came when officials from Uganda, Sudan and Congo, still reeling from a meningitis epidemic that killed hundreds of people in the region, in April adopted a common strategy to share information to avert outbreaks of epidemics in their border communities. Conceding that increasing mobility in the region will exacerbate the transmission of infection, officials from the three countries agreed to cooperate on an epidemiological surveillance mechanism to detect, stimulate quick response and reduce damage in case of an outbreak.
By Rosalind McLymont