Who will live; those with money or all of us?
The Covid-19 pandemic is raging in Europe and USA and infection rates have exceeded those seen during the first wave last winter and spring. Political leaders are under stress and are taking drastic steps to reduce transmission and minimize mortality and morbidity which has provoked riots in some countries. These countries are working feverishly to rapidly vaccinate the population with a view to reaching 70 – 80% of the vaccinated population which is needed achieve effective herd immunity which can enable return in these countries to normal social and economic life as well as save lives.

There is panic in some quarters resulting in decisions to grab all available COVID-19 vaccines including doses to be produced in the future. There was for example a highly publicized call this week that requires vaccine manufacturers not to export any vaccines without permission from political leaders. Vaccine nationalism has cropped up as new terminology. It is counterbalanced by regular calls from the WHO Director-General, Dr. Tedros, and some European leaders, championing humanity, equity, and solidarity to spare and avail some vaccines to LMICs who have no resources to develop and make vaccines for themselves. There is also the epidemiological argument that pockets of the virus anywhere is a threat to all countries and no country is safe until all countries are safe.

Dear Colleagues,

Let's discuss how to live with COVID-19 in our homes, communities, and workplaces.

“So let’s do it. If health development does not happen in African communities, it will not happen in Africa nations’ is a statement by Miriam Were, a famed Kenyan Community Health Advocate in the book African Health Leaders; making change and claiming the future. “The path to UHC is integrated people-centered Primary Health Care’ is another regularly stated position by Dr. Tedros, Director-General of WHO. African Union Health Strategy 2016-2030 “calls for vibrant ways of leveraging community involvement and integration” …well as recommending a paradigm shift to assist the Member States in addressing the effects of public health emergencies in a more systematic and comprehensive manner”.

At face value, these quotations sound obvious and undisputed; however, there is no palpable movement in Africa to translate this vision into reality in African communities.

What is palpable now is the effort on COVID-19 where advocacy is about Standard Operating Procedures (SOPs); namely hand washing, social distancing, contact racing, testing, and care including provision of pulmonary ventilators. There is a flood of education messages sponsored by so many partners in the media which are telling people what to do and none asking for the people’s views. What is NOT palpable is the message that all these SOPSs take place within the homes of people, their communities, and workplaces except for the use of pulmonary ventilators. What is NOT palpable are messages that ask for the views of the population and the challenges that they face accessing water, soap, stigma related to contact tracing, isolation, quarantine, travel, teenage pregnancies, gender-based violence, etc.

Dear Colleagues,

This discussion is trending today. How can we use this debate to improve health outcomes for all?

The current global debate on racism provides an opportunity to discuss the contribution of racism and other forms of sectarianism to population health outcomes. The WHO Commission on Social Determinants of Health and other studies have pointed out racial discrimination as a key social determinant and driver of racial health inequities. This is mediated by direct and indirect pathways such as differential access to societal resources, education, employment and living conditions.

The world has been gripped by the reaction of disgust expressed through widespread global protests in over 60 countries against the killing of Floyd George a black man by a white policeman in Minneapolis, USA. This incident took place in broad daylight and was vividly captured in a live video recording that went viral and touched the hearts of many around the world. This global reaction is a vivid illustration of our humanity at work where we feel the pain of another human being and respond to stop the same from happening again to others. It is this humanity that has enabled our species homo sapiens to collaborate, learn together and prosper by turning planetary resources to our advantage.

Dear Colleagues,

Here is a subject dear to my heart and critical for achieving global health equity.

“Health Workers for All and All for Health Workers’ was the slogan of First Global Forum on Human Resources for Health, March 2008, Kampala, Uganda.

The COVID -19 pandemic has once again exposed the global health workforce (HWF) crisis that is characterized by wide spread shortages, mal-distribution and poor working conditions. This HWF crisis was documented by the report of the Joint Learning Initiative on Human Resources for Health in 2004. The HWF shortages have today resulted in a silent scramble to recruit health workers from poor countries by the richer countries. This scramble is inspired by the urgent needed to fill gaps in the scaled up COVID -19 responses and to address long standing HWF shortages.

Visa requirements for health workers have been eased and I have seen recruitment agencies openly advertising for health workers from Africa, Asia and the Caribbean in web posts of some government agencies and in social media. These agencies are convening meetings in poor countries to pirate away health workers who are needed more in their home countries. Significantly, some African and Caribbean countries have formally protested against these clandestine recruitment but have been ignored. These countries have been left to appeal to the patriotism of their HWF to mitigate the dreaded exodus that would cripple health systems during these times of crisis.

This piracy of health workers, left uncontrolled, carries a public health threat to all countries of the world and is untenable. The pivotal role played by the HWF in public health and health emergencies as exposed by the COVID -19 pandemic is sufficient to classify health workers as a Global Public Health Good at par with or ahead of vaccines and drugs. The G20 leaders met recently with the WHO and agreed to collaborate in urgently in developing and equitably sharing new technologies including vaccines and therapies for COVID -19. They should also have included HWF in these discussions and it is regrettable that global support for the HWF agenda has declined. So what is the problem?

Dear Colleagues,

Here is a pertinent and timely discussion on how to get out of the challenge of lock down from Dr. Patrick Kadama from ACHEST. Enjoy!

The Corona virus (SARS – CoV2) which causes the Corona Virus Disease 2019 (COVID-19) is not going to go away. People are going to have to learn to live with it; doing business and having social relations as, for example like they did with HIV/AIDS. Presently however COVID-19 has no cure or vaccine and as a result countries have sought to slow down the spread of the infection by instituting “lock downs ” to protect people and prevent their healthcare systems from becoming overwhelmed.

Lock downs impose stressful conditions on society and countries are now looking for measures to exit the unsustainable current socio-economic restrictions. A practical approach is to establish a system of National Alerts, with indicators as triggers for easing restrictions such as the New Zealand alert system for COVID-19. Given the limited knowledge about the new disease, the exit will be pragmatic and step wise, focusing on a multi-sector framework based on the following three objectives:

a) Get people back to work to revive economic activities and support livelihoods. (b) Minimize transmission of SARS-CoV2 infection under the new normal; (c) Institute Governance and leadership measures, for strengthening stewardship capability for social services to manage new norms.

Get people back to work to revive social and economic activities:

Opening up economic activities should be gradual and not allowed to cause a flare up in infections. This will be achieved through scale up and strengthening of health and safety measures in workplaces prior to easing restrictions. Populations need to comply with new workplace hygiene and safety measures including sustaining new social conduct standards at work. Health and safety measures for public and private transport also need re-definition.

The return of economic activities should at best be prioritized and phased by sub-population risk profile. Age based relaxations can also start early allowing the young to go back to work, while shielding the seniors and those with underlying health conditions. African countries have up to 80% of the population young and living in sparsely populated rural settings. These should be among the first to benefit from relaxation of restrictions.