1 July 2021

In this issue:

1. "Like the water between the islands": The Health Systems Connector touches all aspects of the fight against COVID-19

2. In eastern Kenya, a public hospital is stronger than before, but vulnerable spots remain

3. In brief: Leaders call upon G20 to support poor countries fighting COVID-19; South Africa to host vaccine technology transfer hub; COVAX publishes its vaccine supply forecast, G7 countries pledge doses

4. ACT-A in the media

5. On the agenda

"Like the water between the islands": The Health Systems Connector touches all aspects of the fight against COVID-19

Dr. Muhammad Pate, global director for health, nutrition and population at the World Bank, says he thinks of the ACT Accelerator's Health Systems Connector as “the water between the islands”— currents of activity that connect COVID-19 tools to those who need them.

Countries across Africa, Asia and South America are struggling to beat back new surges of COVID-19, but weak spots in their national health systems place them at a dangerous disadvantage.

“There’s a massive, urgent need in countries that is just not being met,” said Dianne Stewart, the Global Fund’s deputy director of external relations and communications. “Countries are asking for support across the board.”

Pinpointing and overcoming weaknesses in countries’ health systems has been the focus of the ACT Accelerator's Health Systems Connector since early in the pandemic. Although lagging far behind in donor support, this fourth dimension of ACT-A helps ensure that vaccines, diagnostics and treatments get to their destinations and make an impact.

"If you don't have health systems, you just have nice tools," Ms. Stewart said.

Led by the Global Fund, the World Bank and WHO, with the participation of UNICEF, the Global Financing Facility and many other partners, the Health Systems Connector guides countries as they work to resolve dozens of vital, behind-the-scenes details. The partners have been helping countries train battalions of health workers and seek funding sources, set up cold chains to keep vaccines from spoiling and persuade hesitant communities to get vaccinated.

Partners advise countries as they upgrade diagnostics laboratories, build digital information systems to track the virus, erect new plants to produce medical oxygen, and procure staggering numbers of protective gowns, gloves and masks. During the first year of the pandemic, Connector partners procured more than US$ 500 million in personal protective equipment.

In Zimbabwe, health workers have been able to dump the dusty, heavy books they were using to register patient data in favor of laptops and tablets, a COVID-driven transformation that benefits not only the country's pandemic response, but programs for tuberculosis, mother-to-child transmission of HIV, and its health system as a whole.

"My wish now is that every health facility gets equipped with Wi-Fi through infrastructure investments to reduce the extremely high costs of internet and data transfer in a country like Zimbabwe," said Tatjana Peterson, senior fund portfolio manager at the Global Fund.

The Health Systems Connector guides countries all over the world as they train health workers to respond to COVID-19. Above, hospital ICU staff in the Lao People's Democratic Republic learn techniques to decrease the need for mechanical ventilation. (photo: Bart Verweij, WHO/Blink Media)

Of uppermost concern to the partners of the Health Systems Connector is providing the support countries need to keep their essential services running while adding what's needed to cope with the emergency presented by COVID-19, said Dr. Patrick Zuber, WHO's Health Systems Connector lead. For example, the Connector has supported state-level service delivery in India, critical care nursing in the Caribbean, and in Somalia, emergency services, stronger oxygen systems and critical care for COVID-19.

"For the moment we are in double trouble," Dr. Zuber said, "because health systems are so overwhelmed that they have to interrupt other essential health services. The Health Systems Connector is a way to provide this surge capacity without tapping into the essential services. It's basically trying to reverse the tide."

Despite its indispensable place in the COVID-19 response, the Health Systems Connector went entirely unfunded during 2020, prompting its three lead organizations to repurpose staff and funds to advance the work. Today, although it has received support from Germany, Canada, Norway, Sweden, Denmark, New Zealand, Italy and FIFA, the Health Systems Connector is still the least funded of the ACT-A efforts. As of late June, it had about $US 600 million in funding commitments for 2021 to cover needs of $US 7.9 billion.

The struggling of unprepared countries comes across in the recent flood of funding appeals to the Global Fund. As of late June, 130 countries from across the globe--among them Bhutan, Burundi, Cambodia, Ethiopia, The Gambia, India, Kenya, Malawi, Morocco, Nepal, Philippines, Sri Lanka, Togo--had applied for COVID-19 assistance from a US$ 3.7 billion war chest the Global Fund established to fill health systems gaps and support diagnostics and treatments. But that money is expected to run out this summer, leaving a queue of unfunded appeals for oxygen, protective gear and other fundamentals.

“We’re moving as quickly as we can to make the allocations because we see the demand is so high,” Ms. Stewart said. “But we’re concerned that we will have allocated everything we have available in the next couple of weeks, and there will still be needs.”

Trained health workers and engaged communities are vital to the pandemic response. In Colombia, systems have been set up to get COVID-19 vaccines to communities that are accessible only by air or by river. Above, health workers go door to door in Inírida, Colombia. (Photo: Nadège Mazars, WHO/Blink Media)

"As we invest these billions of dollars to support our client countries to deploy the COVID-19 vaccines, we should also be focused on what benefit would remain, post this phase of the pandemic, that strengthens their ability to deliver basic services." -- Dr. Muhammad Pate, global director for health, nutrition and population, World Bank. (See the full interview above.)

In eastern Kenya, a public hospital is stronger than before, but vulnerable spots remain

Makueni Hospital sits in a semi-arid part of eastern Kenya known for its mangoes and oranges and where many people make a living raising crops and livestock. Last year, the hospital was one of thousands of health care facilities across the world to be caught off guard by the COVID-19 outbreak.

Patients died because there weren’t enough oxygen-equipped beds to go around, and sick people were turned away for lack of resources. Essential medicines were inaccessible because they were too expensive.

“Seeing patients pass away when you know they could have been saved … that was very frustrating,” said Dr. Gavin Orangi, a physician at the 217-bed public facility.

Now another surge is hitting Africa. But this time, Makueni Hospital is much better prepared. Over the past year, the Kenya Ministry of Health, supported by ACT Accelerator partners, has helped the facility add oxygen beds, procure medicines, train staff and create a referral system to cope with any overflow of COVID-19 patients—work that falls under the mandate of ACT-A’s Health Systems Connector.

The Ministry also helped raise vaccine rates in the community by distributing leaflets on vaccine safety and promoting vaccination on social media. Dr. Orangi joined the effort, posting his own vaccination on social media and answering questions.

“We even had healthcare workers who at first did not want to get the vaccine, mainly because of the myths and the rumors about it,” he said. “People were thinking about cardiac arrest, blood clots, strokes, fake or counterfeit vaccines.”

Despite the improvements at Makueni Hospital and other facilities over the past year, alarming gaps in Africa's health systems remain. A study published in The Lancet medical journal in March suggests hospital patients who are critically ill with Covid-19 in Africa are far more likely to die than in other parts of the world because of limited healthcare resources.

Dr. Orangi points out that many health care workers in his community are only half vaccinated, and his facility’s stock of protective gear—gowns, gloves, masks—is only about 10 percent of what is considered adequate preparation for a surge. Maintaining a surge-level supply is difficult, he says, when global demand has driven the prices so high. A box of medical gloves that cost less than US$ 2 at the outset of the pandemic now goes for more than US$ 10.

Newly vaccinated in Kenya: Dr. Gavin Orangi posted his vaccination on social media to fight vaccine hesitancy, which had taken root even among health workers at his hospital. Community outreach on vaccine safety changed minds and raised vaccination rates.

In brief

New task force calls upon G20 to support poor countries fighting COVID-19

The heads of four major international organizations, acting as a new task force, appealed this week to G20 countries for urgent action “to arrest the rising human toll due to the pandemic and to halt further divergence in the economic recovery between advanced economies and the rest.”

The Task Force on COVID-19 Vaccines, Therapeutics and Diagnostics for Developing Countries is made up of the leaders of the World Bank Group, the International Monetary Fund, the World Health Organization and the World Trade Organization.

At its 30 June meeting, the task force called upon the G20 to embrace targets of vaccinating 40 percent of the people in all countries by the end of this year, and at least 60 percent by the first half of 2022.

Read ACT-A's news release

WHO welcomes G7's dose pledges but says more are needed

At its June summit, the Group of Seven announced donations of 870 million COVID-19 vaccine doses for lower-income countries, at least half them to be delivered by the end of the year.

WHO Director-General Dr. Tedros called the donations "a big help" but cautioned that, "We need more and we need them faster."

To end the pandemic, "our shared goal must be to vaccinate at least 70 percent of the world’s population by the time the G7 meets again in Germany next year," Dr. Tedros said, speaking at a press conference the day after the summit. To do that, we need 11 billion doses. The G7 and G20 can make this happen."

Read ACT Accelerator's news release about the G7 summit.

COVAX publishes its latest vaccine supply forecast

On 23 June COVAX published its Global Supply Forecast, an up-to-date overview of the supply of vaccines to the COVAX Facility

COVAX Facility Managing Director Aurélia Nguyen called the forecast "encouraging given the supply disruptions COVAX and countries with bilateral deals are currently experiencing, as well as the general challenges manufacturers are experiencing as they ramp up supply at historic speed and scale."

See her full article, What does COVAX’s latest supply forecast tell us?

WHO and South Africa make a move to boost Africa's access to vaccines

WHO and its COVAX partners are working with South Africa and Afrigen Biologics on a tech transfer hub that could enable African companies to manufacture cutting-edge mRNA vaccines within a year.

"This landmark initiative is a major advance in the international effort to build vaccine development and manufacturing capacity that will put Africa on a path to self-determination," South African President Cyril Ramaphosa said during WHO's announcement of the plan on 21 June.

According to the World Trade Organization, Africa is the continent with the lowest rate of vaccine delivery--1.1 doses per 100 people. Africa imports 99 percent of its vaccines.

WATCH (below): Reactions from WHO Director-General Tedros, President Cyril Ramaphosa of South Africa and President Emmanuel Macron of France:

COMMUNITY PERSPECTIVE: Edwin Ikhuoria, One in Africa executive director, discusses the continent's need to end its reliance on imported vaccines.

In the media

A WHO press conference on COVID-19, Geneva (Photo: Pierre Albouy/WHO)

Tracking Coronavirus Vaccinations Around the World, New York Times

Settlements locked down as Fiji endures deadly coronavirus wave, Reuters 28 June

South Africa tightens Covid rules as ‘devastating wave’ gathers pace, The Guardian, 27 June

WHO Chief: Corona Delta Variant 'Spreading Rapidly', VOA 26 June

WHO's Tedros says vaccine shortage in poor countries a global failure Reuters, 25 June

COVID-19 cases surge in Africa, less than 0.8% of people fully vaccinated, say officials, Reuters, 18 June

A Pill to Treat Covid-19? The U.S. Is Betting on It., New York Times, 17 June

On the agenda

6 July, 12:30-3p.m. -- Special ACT-A Facilitation Council briefing for WHO Member States. Among the topics for discussion are vaccines coverage, COVAX supply outlook, most urgent pandemic needs and funding requirements for tests, treatments and protective gear. Watch the meeting live.

9-10 July -- G20 finance ministers and Central Bank governors meeting, Venice

5-6 Sept. -- G20 health ministers meeting, Rome

14-30 Sept. -- United Nations General Assembly, New York City

30-31 Oct. -- G20 Leaders Summit

Did you miss last month's issue of The Accelerator? Read it here.

To subscribe, or to send a comment or suggestion, write to ACTaccelerator@who.int or to Carol Masciola in the ACT-A hub at masciolac@who.int.