Paroles de Lauréats : Ingrid Etoke
29 / 04.06.2020

Paroles de Lauréats : Ingrid Etoke

Set up strategic industrial and supply chain initiatives to foster a more independent and resilient healthcare system in Africa

Today, meet Ingrid Etoke (Cameroon), Market Launch & access lead Africa at IVCC and laureate of the Choiseul 100 Africa.

Every day, the Choiseul laureates and alumni, as well as several of our friends and partners, react to the COVID-19 crisis. A series of discussions to share their recovery strategy and their vision of the new world to come.

The pandemic is going to impact negatively on the availability of HIV, malaria, and tuberculosis testing and treatment

Today, Africa is the continent that seems to be the least affected by the Covid-19. How can you explain this situation?

Due to the high demand on testing globally, measuring the exact COVID-19 numbers have been a challenge all around the world and Africa might not be an exception. Nevertheless, the overall death rate comparison versus previous year suggests that Africa has been generally and for now, less impacted by the COVID-19. The African continent is extremely vulnerable to epidemics. Some countries have to deal with several health crises at once. Sadly, Meningitis, cholera, measles outbreaks are “business as usual” for African people. Considering this background, I think that the governments are quite conscious of the issues at stake and tried to handle the COVID-19 situation with a real sense of urgency. Indeed, at the early stage of the global outbreak of the virus, they closed their borders, quarantined travelers coming from overseas, reduced social interactions (ex: bar/church/school closure) and enforced mandatory wearing of masks in public spaces. The local scientific boards decided, despite ongoing clinical research, to include Hydroxychloroquine (a derivate of Chloroquine molecule) in patients care protocols at an early stage of the illness with the right precaution and healthcare monitoring. Chloroquine is very well known by doctors and patients in Africa as it was at some point (and for almost 50 years) the gold standard to treat and prevent malaria. Finally, the local population and businesses were very proactive with tailors, for example, producing reusable cotton masks. Masks became available quickly in urban cities and the population is broadly using them.

Some other factors might have influenced the lower COVID-19 numbers in Africa such as the medium age of the population (19.5 years old in 2019 according to the United Nations) and the whilst the epidemic is concentrated in main cities nearly 60% of the African population live in rural areas. Also, overall people mobility is far behind what we see in developed countries. We certainly need more research to understand the COVID 19 pandemic dynamic in the African context.

What do you think are the main challenges for Africa to continue this trend?

During the past 3 weeks, we saw some relief in government measures which translated into a rise in new cases. Most countries are now reopening. For example, several countries in the continent “reopened” to international flights from all around the world. This is very worrying even if the mortality and the infection rates are still way behind other continents affected by this pandemic, Africa is still at high risk and authorities must stay very vigilant and flexible to avoid an exponential acceleration of the disease.

In my opinion, 4 things need to be in place:

  • Epidemiologic Surveillance: All Governments need to set up simple indicators to track the evolution of the disease. For example, the infection rate, number of new cases and number of deaths are basic indicators. It will require robust expert tasks forces, funding and massive testing availability across countries. These indicators should inform government decision making processes about whether they should carry on with the current strategy or adjust it. This step requires investment, transparency and courage from authorities. In addition to this, accurate modelling scenarios should be designed and adapted for each country,  considering the local specificities (demographic, mobility, urbanism, climate, public health strategies, rural/urban cities, etc.) to try to understand and predict how COVID-19 could evolve in the African context.
  • Protocols: Healthcare Professional training and best practice sharing are crucial. COVID-19 is a new and complex disease. Since the healthcare system and the African communal way of life are very different from what the Western world is accustomed to, there is a need for North/South and South/South collaborations to develop relevant patient care that takes into account the African context. Theses protocols should be mandatory for all health workers from the community to the top pulmonary specialist including the pharmacist who plays a central role in disease management in Africa. COVID 19 shares recognizable symptoms with malaria. Hence, the ongoing confusion between the two diseases on the ground.
  • Information, education and communication: The economic impact of long-term lockdowns is disastrous and increasing disparities amongst vulnerable populations (women, children, refugees). Until we get a vaccine, people need to be well-informed and educated about COVID-19 in order to embrace social distancing rules in a systematic manner. This requires effective mass and community communication initiatives.
  • Research: So far, COVID-19 has been an opportunity for African researchers to be at the frontline of global innovation. From the COVID-19 rapid diagnostic test initiative in Dakar to the controversy surrounding the clinical studies on the Artemisia plant in Madagascar, African initiatives have become visible. The global scientific community is watching them closely. I hope the recent African initiatives will encourage local and global leaders to sponsor African research. Africa has much to offer to the world in terms of innovation, resilience and agility.

You work within IVCC (Innovative Vector Control Consortium) which works on the development of innovative solutions against vector-borne diseases such as malaria. How has your organization approached this health crisis and how did it impact your activity?

IVCC is a Product Development Partnership (PDP). PDPs are nonprofit organizations that bring together stakeholders from the private and public sectors to research, develop and support access to health innovations that target diseases affecting developing countries. 

IVCC is the only PDP working in vector control. Our Research and Development Portfolio spans a broad spectrum of work including active ingredient discovery and development, product portfolio development, formulation chemistry, entomology, field trials, access and delivery. We work with a consortium of partners (industry, global funders, scientists and governments) to facilitate research, development and broad access to new insecticides with a major focus on malaria eradication.

One of our key ambitions is a world free of malaria, saving lives and increasing prosperity. Current global investments in malaria are saving hundreds of thousands of lives and preventing millions of cases per year. This is significant progress but too many people continue to suffer and die. In 2018, there were an estimated 228 million cases of malaria worldwide and an estimated 405,000 deaths – of which two-thirds were children under five in Africa. 

Against the backdrop of COVID-19, it could be easy for the international community to forget about malaria, which could lead to the drastic increase of the figures mentioned above. Imperial College, London recently published a report stating that  » if all malaria-control activities are highly disrupted then the malaria burden in 2020 could more than double that in the previous year, resulting in large malaria epidemics across the region ». 

At IVCC, we are working very closely with all our funders and partners (industry, Ministries of Health, research centres) to mitigate the impact of COVID-19 on malaria prioritization and financing. For example, in one of our Access initiatives, the New Nets Project (NNP), we are closely coordinating with malaria programmes and their implementing partners to modify how nets are distributed and field data are collected to mitigate potential transmission of COVID-19. For example, data collection was temporarily paused during country lockdowns and mitigation strategies were developed.  These modifications include the streamlining of household registration and distribution, implementing a door-to-door distribution model, and ensuring appropriate social distancing and use of personal protective equipment (PPE) during all phases of the project (i.e., distribution and data collection), in line with national guidelines and international best practices.

Furthermore, IVCC is part of several a global task forces who are reflecting about long term mitigation plans (funding, supply chain, etc.) of COVID-19 on the malaria elimination agenda.

In this context conducive to thinking and inventing new models, what advice would you give to international donors to effectively understand the African continent in terms of health?

During this pandemic, we have observed developed countries healthcare systems under pressure and highly dependent on healthcare commodities importation.

According to the French development agency, Africa represents 13% of the global population but hosts only 3% of medicine global production. The continent relies heavily on Asian and European importation. The pandemic is going to impact negatively on the availability of HIV, malaria, and tuberculosis testing and treatment. Children’s vaccination campaigns are also being delayed due to the current focus on COVID-19.  

My call to the global community, the African Union and African governments would be to set up more strategic industrial and supply chain initiatives in Africa, create employment and encourage local industries to reduce the dependency on importing  healthcare commodities. To be viable, these initiatives will require strong political support and a different business model: partnerships, long term view, regional volume guarantees and a moderate margin.

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