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Opinion: A Call to Boost African Manufacturing for COVID-19 and Other Vaccines

As governments begin to issue the first emergency use authorizations to deploy a COVID-19 vaccine, the world is facing the stark reality that the need for these vaccines far outstrips global production capacity.

An estimated 14 billion doses of vaccine would be needed to stop the pandemic. Governments of high- and middle-income countries have already made deals with the leading vaccine manufacturers to reserve at least 6.8 billion doses, leading to a situation where lower-income countries may be waiting until 2023 or 2024 before gaining widespread access to COVID-19 vaccines.

Funding to purchase COVID-19 vaccines in low- and middle-income countries is beginning to amass through the COVAX Facility and other mechanisms. More will be needed. However, even if the money materializes, there are insufficient vaccine doses available for purchase and significant infrastructure and logistical challenges.

To compound matters, without a stable supply, opportunities for substandard and falsified vaccines to enter the supply-chain may increase, diminishing trust in vaccines and health systems.

In the face of this global shortfall, calls to scale up vaccine production capacity in Africa are growing louder. While not a panacea for filling the COVID-19 vaccine production gap in the immediate term, bolstering capacity in Africa to conduct key aspects of the manufacturing process, namely, formulation, filling, and packaging for COVID-19 vaccines will help facilitate access.

Developing the fledgling industry will also help countries prepare for greater self-sufficiency in meeting their growing vaccine needs and prevent future vaccine access crises when the next pandemic hits.

The role of regional manufacturing in Africa

In recent years, a concerted effort to build up local pharmaceutical manufacturing capacity in Africa has begun to pay dividends, paving the way for the nascent vaccine industry. Manufacturers in Nigeria, Ethiopia, South Africa, Egypt, and elsewhere are becoming major producers of priority medicines for their countries and regions.

A concerted, decades-long effort by USP, the United States Agency for International Development, and others to bolster the quality assurance systems of pharmaceutical manufacturers in LMICs toward achieving international quality standards has made many products more competitive.

Although 70%-90% of pharmaceuticals used in Africa are still imported, local manufacturing sectors are poised with latent capacity, and bolstering local production is being urgently prioritized in the face of COVID-19 related shortages.

On the other hand, vaccine production in Africa has largely failed to launch. African vaccine manufacturers currently produce less than 1% of the vaccines that are used across the continent. Many manufacturers ceased production over the last 25 years due to inability to compete with imported vaccines.

As of 2017, there were eight vaccine manufacturers in Africa, only two of which were performing all aspects of the vaccine manufacturing process from active ingredient production through packaging.

COVID-19 as a stimulus for expansion

The COVID-19 pandemic has the potential to tip the scales in favor of accelerating local vaccine production in Africa. Major barriers — including a fragmented vaccine market, high cost and complexity of manufacturing, and absence of political will to invest — are no longer insurmountable with the pooled procurement mechanisms, capital investments, and urgent political mandate brought on by the pandemic.

Building on current vaccine production capacity for the last steps of vaccine manufacturing — including fill and finish in countries like Senegal, Egypt, Tunisia, Ethiopia, and South Africa — may provide an opportunity for stepwise integration of vaccine production capacity on the continent.

Recent technology transfers by major vaccine developers are providing a stepping stone to address current and future threats like COVID-19. For example, Biovac of South Africa has begun producing the six-in-one vaccine Hexaxim — given to children to prevent diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and Haemophilus influenzae type b — for the South African market and will begin production of Pneumovax — which prevents pneumococcal disease — as soon as next year.

One major COVID-19 vaccine developer has already struck the first deal with South Africa’s Aspen Pharmacare to perform the final steps of COVID-19 vaccine manufacturing on the continent.

In addition, the Africa Centres for Disease Control has identified and is working with eight companies in Africa that may be able to help manufacture COVID-19 vaccines, particularly if booster shots are needed on an ongoing basis. These companies could serve as sites for future vaccine production across Africa.

Ingredients for success

Beyond the complexity of the vaccine manufacturing process itself, the prerequisite supplies, equipment, facilities, and highly specialized scientific expertise needed to make quality-assured vaccines is beyond the purview of any one company. For example, sourcing inactive ingredients, vials, and stoppers can be limiting factors.

Simultaneously, like any other business, vaccine manufacturers in Africa must be able to make a return on investment while competing with established manufacturers in countries like India, China, Indonesia, and Pakistan. Important factors include sufficient demand in the country or region, government investment policies and incentives, cost of labor and capital, availability of raw materials, and physical infrastructure.

Each of these individual barriers can be overcome, but taken as a whole, expanding vaccine manufacturing capacity in Africa requires cohesive national and regional strategies that align with national pharmaceutical and industrial policies while addressing areas of weakness and laying out incentives to attract investment.

For instance, a regional strategy for manufacturing active pharmaceutical ingredients could help support this nascent industry while avoiding fragmentation and redundancies. In addition, international procurement agencies could support sustainable access to vaccines and other health products in Africa by carving out a portion of global procurements for African manufacturers producing quality-assured health commodities.

Investing now in strengthening vaccine production capacity on the continent will set countries up for success as they prepare to graduate from receiving foreign assistance.

Quality is paramount

Access to poor-quality vaccines is worse than no access. The goal of local manufacturing must be to ensure quality, protect patients, and foster trust in vaccine safety.

Therefore, quality assurance is an essential ingredient to make vaccine production sustainable. Very few national regulatory authorities in Africa have achieved the level of maturity required to enable the production of quality-assured vaccines in their countries. However, there are feasible steps regulators can take to expedite access to COVID-19 vaccines.

Additionally, efforts to pool expertise and streamline regulatory oversight of vaccines on the continent are moving forward through the African Vaccine Regulatory Forum. For their part, local vaccine manufacturers should work with partners — like Africa CDC, the Developing Countries Vaccine Manufacturers Network, the African Vaccine Manufacturing Initiative, the Federation of African Pharmaceutical Manufacturers Associations, and USP — to strengthen their quality management systems toward attaining international standards.

Boosting pandemic preparedness

Gavi CEO Seth Berkley projected that COVID-19 vaccines “will be the single largest and most rapid global vaccine deployment we have ever seen.”

By harnessing the strong political will and investment behind COVID-19 vaccines to advance regional vaccine manufacturing in Africa, we have the opportunity to facilitate greater access in the immediate term and prepare for future vaccine needs for both routine immunization programs and unexpected health emergencies.

About the authors

Perrer Tosso
Dr. Perrer Tosso is a scientist and thought leader with over a decade of experience in drug discovery and drug development. He is currently the senior manager of advanced manufacturing technologies at USP. Tosso has worked with governments and public health organizations to enable manufacturing in low- and middle-income countries to increase access to affordable, safe, quality-assured, life-saving medical products. He holds a Ph.D. in medicinal chemistry from Georgetown University.

Skhumbuzo Ngozwana
Dr. Skhumbuzo Ngozwana is CEO of Kiara Health and chairman of the board of Biovac, a South African vaccine manufacturer and a board member of the Federation of African Pharmaceutical Manufacturers Association. A tireless advocate for local biopharmaceutical manufacturing in Africa, he has worked with several global public health organizations. He has consulted for the World Health Organization, the United Nations Industrial Development Organization, and USP.

While First COVID-19 Vaccines Arrive, Much of the World Will Have to Wait

While the first shots against COVID-19 are rolling out in the United States, Britain and Canada, nearly a quarter of the world’s population likely will not have access to a vaccine until at least 2022, according to a new study.

Even in a best-case scenario, the world does not have the manufacturing capacity to cover the entire global population.

Wealthier countries made deals to buy the bulk of vaccine doses before the shots have even finished testing or received regulatory approval.

Meanwhile, a partnership aimed at securing vaccines for low- and middle-income countries has so far reserved only a fraction of the doses it has promised to deliver.

“Many governments in the poorest parts of the world are very, very concerned about the significant lag of when these vaccines are hitting these wealthy countries … and when they’ll actually be in developing countries,” said Kate Elder, senior vaccines policy adviser at the nonprofit Doctors Without Borders, who was not part of the study.

First arrivals

Last week, pharmaceutical and biotech partners Pfizer and BioNTech began delivering their COVID-19 vaccine in Britain. The first patients in the United States and Canada received their shots on Monday.

A second vaccine from biotech firm Moderna is expected to receive U.S. Food and Drug Administration authorization this week.

The World Health Organization is reviewing these vaccines, along with a third from pharmaceutical company AstraZeneca and Oxford University.

While these and other vaccines were still in clinical trials, countries committed billions of dollars to secure hundreds of millions of doses for their residents.

According to the new study, 13 manufacturers have signed preorder deals for nearly 7.5 million vaccine doses. Just over half of those preorders are from high-income countries, though they account for less than 14% of the world’s population.

Canada has secured enough vaccines to immunize its population nearly five times over, while the United States has reserved just over one vaccine course per person. Brazil and Indonesia have not ordered enough to fully immunize even half their populations.

Uncertainty

According to the study, the leading vaccine manufacturers have said they will have the combined capacity to produce enough vaccines to immunize 6 billion people by the end of 2021.

That means in a best-case scenario, in which every vaccine candidate works and there are no financing shortfalls or manufacturing glitches, supplies would be more than 1.6 billion courses short.

While most of the world’s manufacturing capacity will be tied up with preorders next year, up to 40% may still be available for low- and middle-income countries that have not reserved doses, the study says.

However, some of the countries that preordered vaccines have the option to buy more. Because the details of the deals are not public, it is not clear whether those countries would get priority.

“What these agreements between vaccine manufacturers and countries really entail is the uncertainty factor that makes many (other) countries wonder whether or not they will be at the front of the line or the back of the line,” said study co-author Anthony So, director of the Johns Hopkins University Innovation+Design Enabling Access (IDEA) Initiative.

With low- and middle-income countries at risk of being left out, WHO helped put together a system, called COVAX, to ensure more equitable COVID-19 vaccine access.

Countries put money into COVAX to support development of several vaccines at once. Since some are likely to fail, backing more than one raises the odds that a country will have access to at least one successful vaccine.

COVAX members get access to enough vaccines for up to 20% of their populations. The organization aims to deliver 2 billion doses by the end of 2021.

At least 184 countries have joined COVAX, including 92 donor-funded, low- and middle- income countries.

Not included

The Pfizer and Moderna vaccines are not part of COVAX.

Some middle-income countries are signing bilateral agreements for these shots outside COVAX, “but this is all done through untransparent backdoor deals,” said Elder, of Doctors Without Borders.

As for when these vaccines might arrive in the rest of the world, she added, “I think a lot of us are scratching our heads.”

Of the 13 manufacturers that have signed preorder deals, COVAX has agreements with three. That includes 300 million doses from AstraZeneca and 200 million from Novavax, which has a product in late-stage clinical trials.

COVAX also committed to buy 200 million doses of a vaccine from drugmaker-collaborators Sanofi and GSK.

That vaccine suffered a setback Friday, when early data showed it fell short in older adults.

Sanofi and GSK said they are continuing their studies with a reformulated vaccine.

COVID-19 to Add as Many as 150 Million Extreme Poor by 2021 – World Bank Group

Eight out of 10 ‘new poor’ will be in middle-income countries

WASHINGTON, Oct. 7, 2020 — Global extreme poverty is expected to rise in 2020 for the first time in over 20 years as the disruption of the COVID-19 pandemic compounds the forces of conflict and climate change, which were already slowing poverty reduction progress, the World Bank said today.

The COVID-19 pandemic is estimated to push an additional 88 million to 115 million people into extreme poverty this year, with the total rising to as many as 150 million by 2021, depending on the severity of the economic contraction. Extreme poverty, defined as living on less than $1.90 a day, is likely to affect between 9.1% and 9.4% of the world’s population in 2020, according to the biennial Poverty and Shared Prosperity Report. This would represent a regression to the rate of 9.2% in 2017. Had the pandemic not convulsed the globe, the poverty rate was expected to drop to 7.9% in 2020.

“The pandemic and global recession may cause over 1.4% of the world’s population to fall into extreme poverty,” said World Bank Group President David Malpass. “In order to reverse this serious setback to development progress and poverty reduction, countries will need to prepare for a different economy post-COVID, by allowing capital, labor, skills, and innovation to move into new businesses and sectors. World Bank Group support—across IBRD, IDA, IFC and MIGA—will help developing countries resume growth and respond to the health, social, and economic impacts of COVID-19 as they work toward a sustainable and inclusive recovery.”

The report also finds that many of the new poor will be in countries that already have high poverty rates. A number of middle-income countries will see significant numbers of people slip below the extreme poverty line. About 82% of the total will be in middle-income countries, the report estimates.

The convergence of the COVID-19 pandemic with the pressures of conflict and climate change will put the goal of ending poverty by 2030 beyond reach without swift, significant and substantial policy action, the World Bank said. By 2030, the global poverty rate could be about 7%.

Increasing numbers of urban dwellers are expected to fall into extreme poverty, which has traditionally affected people in rural areas.

Progress was slowing even before the COVID-19 crisis. New global poverty data for 2017 show that 52 million people rose out of poverty between 2015 and 2017. Yet despite this progress, the rate of reduction slowed to less than half a percentage point per year between 2015 and 2017. Global poverty had dropped at the rate of around 1 percentage point per year between 1990 and 2015.

In addition to the $1.90-per-day international poverty line, the World Bank measures poverty lines of $3.20 and $5.50, reflecting national poverty lines in lower-middle-income and upper-middle-income countries. The report further measures poverty across a multidimensional spectrum that includes access to education and basic infrastructure.

While less than a tenth of the world’s population lives on less than $1.90 a day, close to a quarter of the world’s population lives below the $3.20 line and more than 40% of the world’s population – almost 3.3 billion people – live below the $5.50 line.

The COVID-19 crisis has also diminished shared prosperity – defined as the growth in the income of the poorest 40 percent of a country’s population. Average global shared prosperity is estimated to stagnate or even contract over 2019-2021 due to the reduced growth in average incomes. The deceleration in economic activity intensified by the pandemic is likely to hit the poorest people especially hard, and this could lead to even lower shared prosperity indicators in coming years.

The prospect of less inclusive growth is a clear reversal from previous trends. Shared prosperity increased in 74 of 91 economies for which data was available in the period 2012-2017, meaning that growth was inclusive and the incomes of the poorest 40 percent of the population grew. In 53 of those countries, growth benefited the poorest more than the entire population. Average global shared prosperity (growth in the incomes of the bottom 40 percent) was 2.3 percent for 2012-2017. This suggests that without policy actions, the COVID-19 crisis may trigger cycles of higher income inequality, lower social mobility among the vulnerable, and lower resilience to future shocks.

The report calls for collective action to ensure years of progress in poverty reduction are not erased, and that efforts to confront poverty caused by COVID-19 also face threats that disproportionally impact the world’s poor at the same time, particularly conflict and climate change.

Pandemic Could Push 115 Million into Extreme Poverty in 2020 – World Bank

As many as 115 million people could be pushed into extreme poverty this year due to the economic downturn caused by the coronavirus pandemic, the World Bank warned on Wednesday.

That is higher than the bank previously estimated, even as recently as August, when the worst case was put at 100 million. And the bank’s new report estimates that by 2021, 150 million could be living below the extreme poverty threshold of less than $1.90 a day.

“The pandemic and global recession may cause over 1.4 percent of the world’s population to fall into extreme poverty,” World Bank President David Malpass said in a statement.

If the pandemic had not struck, the global extreme poverty rate was expected to fall to 7.9 percent, but now could climb as high as 9.4 percent, the bank said in its flagship report.

World Bank economists say the dire estimates for new victims of poverty this year, which range from 88 million to 115 million, depending on the outlook for the global economy, which the Washington-based crisis lender estimates range from a contraction of five percent to eight percent in the worst-case scenario.

That would erode decades of progress in reducing extreme poverty, and the authors warn create “poverty hotspots” in areas that face a double-hit from economic crisis and conflict.

The research also finds a rising share of those living in extreme poverty are in urban areas, which threatens to overwhelm existing support programs that are designed for rural populations.

Instead of achieving the goal of eradicating poverty by 2030, the convergence of the COVID-19 pandemic with the pressures of conflict and climate change will put the goal “beyond reach without swift, significant and substantial policy action,” the World Bank said, warning that the global poverty rate could be about seven percent in the next decade.

“In order to reverse this serious setback to development progress and poverty reduction, countries will need to prepare for a different economy post-COVID, by allowing capital, labor, skills, and innovation to move into new businesses and sectors,” Malpass said.

The bank said the policy response must be commensurate with the severity of the crisis, including modernizing education and online learning and deploying new technology to expand the reach of social protection programs.

Looking at a broader definition of poverty, the report found that close to a quarter of the world’s population lives below the $3.20 line and more than 40 percent — almost 3.3 billion people — live below the $5.50 line.

Trump Halts World Health Organization Funding over Coronavirus ‘Failure’

Donald Trump was condemned for putting countless lives at risk on Tuesday when he announced the US is freezing payments to the World Health Organization (WHO) over its handling of the coronavirus pandemic.

The US president said funding would be on hold for 60 to 90 days pending a review of the WHO’s warnings about the coronavirus and China. He accused the global body of “severely mismanaging and covering up” the threat, even though it declared a public health emergency on 30 January – after which he continued to hold rallies, play golf and compare the coronavirus to the common flu.

Critics were stunned at the move to cut money from a critical UN agency during a global pandemic. António Guterres, the UN secretary general, declared now was “not the time to reduce the resources for the operations of the World Health Organization or any other humanitarian organization in the fight against the virus.

“As I have said before, now is the time for unity and for the international community to work together in solidarity to stop this virus and its shattering consequences,” he said in a statement.

Lawrence Gostin, a professor of global health at Georgetown University, told the MSNBC network: “Without a WHO that’s empowered there will be many, many more deaths, and not just as it marches through sub-Saharan Africa, which is next, but also here in the United States.”

America contributed more than $400m to the WHO last year, making it by far the biggest donor. The organization’s budget for 2018-2019 was around $6bn.

Speaking in the White House rose garden, Trump said: “With the outbreak of the Covid-19 pandemic, we have deep concerns whether America’s generosity has been put to the best use possible. The reality is that the WHO failed to adequately obtain, vet and share information in a timely and transparent fashion.”

He added: “If we cannot trust them, if this is what we will receive from the WHO, our country will be forced to find other ways to work with other nations to achieve public health goals.”

The WHO failed in its “basic duty and must be held accountable”, the president went on.

But critics said the move fit two distinct Trump patterns. One is his long antipathy towards multilateral organisations; for example, he also used a rose garden event to announce the US departure from the Paris climate accords. The other is an attempt to blame others for his own inaction in combatting the coronavirus; on Monday, he accused the media of downplaying the dangers.

Trump’s main criticism of the WHO was its “China-centric” failure to investigate credible reports from sources in Wuhan about the outbreak of the virus. “Through the middle of January, it parroted and publicly endorsed the idea that there was not human to human transmission happening, despite reports and clear evidence to the contrary,” he told reporters.

“The delays the WHO experienced in declaring a public health emergency cost valuable time – tremendous amounts of time.”

But this critique is at odds with the actual timeline. It emerged last week that in technical guidance notes, the WHO warned the US and other countries about the risk of human-to-human transmission as early as 10 January.

On Tuesday Jeremy Konyndyk, the former head of the Office of Foreign Disaster Assistance at USAid, noted that although on 14 January the WHO tweeted that “preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission”, by 23 January it had published an official report warning of human-to-human transmission and transmissibility higher than seasonal flu.

Konyndyk, now a senior fellow at the Center for Global Development, wrote on Twitter: “So to pin the blame on WHO for this, you have to believe that somehow those 9 days between 14 and 23 January were critical to the lack of US preparedness. It’s lunacy. The administration spent the whole month of February doing nothing to meaningfully prepare the homeland.”

On Tuesday, Trump complained that the WHO “defended the actions of the Chinese government, even praising its so-called transparency”. Yet on 24 January, Trump tweeted: “China has been working very hard to contain the Coronavirus. The United States greatly appreciates their efforts and transparency. It will all work out well. In particular, on behalf of the American People, I want to thank President Xi!”

And on 7 February, by which time the WHO had declared a public health emergency, Trump was asked if China was engaged in a cover up. “No, China’s working very hard … and I think they’re doing a very professional job. They’re in touch with World Health.”

And even by 27 February, despite multiple warnings from the intelligence agencies and his own advisers, he was still minimising the virus, stating: “It’s going to disappear. One day – it’s like a miracle – it will disappear.” By the end of the month, the US had only conducted around 4,000 tests for coronavirus while other countries tested tens of thousands of people.

Leslie Dach, the chair of the pressure group Protect Our Care, said of the WHO defunding: “This is nothing more than a transparent attempt by President Trump to distract from his history downplaying the severity of the coronavirus crisis and his administration’s failure to prepare our nation.

Dach, who served as the global Ebola coordinator for the health department, added: “To be sure, the World Health Organization is not without fault but it is beyond irresponsible to cut its funding at the height of a global pandemic. This move will undoubtedly make Americans less safe.”

At Tuesday’s briefing, Trump backed away from his Monday claim of “total” authority over states, a remark that prompted Andrew Cuomo, the New York governor, to note that Trump is not a king. “I will be speaking to all 50 governors very shortly,” the president said. “And I will then be authorising each individual governor of each individual state to implement a reopening, very powerful reopening plan of their estate in a time in a manner which is most appropriate.”

He added: “The governors will be very, very respectful of the presidency… You can talk about constitution. You can talk about federalism. You can talk about whatever you want. But the best way, I am talking now from a managerial standpoint, to let individual governors run individual states and come to us if they have difficulty and we will help them.”

COVID-19: Looming Crisis in Developing Countries Threatens to Devastate Economies and Ramp Up Inequality

New York – The growing COVID-19 crisis threatens to disproportionately hit developing countries, not only as a health crisis in the short term but as a devastating social and economic crisis over the months and years to come.

Income losses are expected to exceed $220 billion in developing countries. With an estimated 55 per cent of the global population having no access to social protection, these losses will reverberate across societies, impacting education, human rights and, in the most severe cases, basic food security and nutrition.

Under-resourced hospitals and fragile health systems are likely to be overwhelmed. This may be further exacerbated by a spike in cases, as up to 75 per cent of people in least developed countries lack access to soap and water.

Additional social conditions, such as poor urban planning and overpopulation in some cities, weak waste disposal services, and even traffic congestion impeding access to healthcare facilities, may all add to the caseload.

“This pandemic is a health crisis. But not just a health crisis. For vast swathes of the globe, the pandemic will leave deep, deep scars,” noted Achim Steiner, Administrator of the United Nations Development Programme (UNDP). “Without support from the international community, we risk a massive reversal of gains made over the last two decades, and an entire generation lost, if not in lives then in rights, opportunities and dignity.”

Working in close coordination with the World Health Organization (WHO), UNDP is helping countries to prepare for, respond to and recover from the COVID-19 pandemic, focusing particularly on the most vulnerable.

UNDP is already working to support health systems in countries including Bosnia and Herzegovina, China, Djibouti, El Salvador, Eritrea, Iran, Kyrgyzstan, Madagascar, Nigeria, Paraguay, Panama, Serbia, Ukraine and Vietnam.

A UNDP-led COVID-19 Rapid Response Facility has already been launched, funded by existing resources and capitalized with an initial US$20 million. This facility is disbursing through a fast-track mechanism enabling UNDP teams to offer immediate assistance to countries for their national response. UNDP anticipates a minimum $500 million need to support 100 countries.

Call to action

UNDP has made a call to action to the international community to think beyond the immediate impact of COVID-19. The organization has emphasized the need for three priority actions: resources to help stop the spread of the virus, support to respond during the outbreak itself, and resources to prevent the economic collapse of developing countries.

As an immediate response, UNDP is building on the support it has been providing to China and other Asian countries to help strengthen their health systems. This includes helping them procure much-needed medical supplies, leverage digital technologies and ensuring health workers are paid.

At the same time, UNDP will support countries to slow the spread of the virus and to provide social protection for vulnerable populations, promoting a whole-of-government and whole-of-society response to complement efforts in the health sector.

In the longer term, UNDP will work with countries to assess the social and economic impacts of COVID-19 and take urgent recovery measures to minimize long-term impact, particularly for vulnerable and marginalized groups, and to help societies to recover better.

Tackling COVID-19 and its impacts will require partners who can work across systems and sectors and in contexts that are both complex and uncertain. With years of experience on the frontlines, this is what UNDP is designed to do. UNDP is fully operational in 170 countries and territories and focused on its COVID-19 response, mobilizing all its assets to respond to this unprecedented challenge.

DFID Goes Quiet on COVID-19 Response

LONDON — The U.K.’s international response to the COVID-19 pandemic has been criticized by insiders as “disappointing” and poorly communicated.

Some observers said the U.K. government’s performance has not been living up to its “development superpower” reputation, as it struggles to manage an outbreak within its own borders.

With the pandemic continuing to gather pace, concerns are rising about the potential impact in low-income countries.

The U.K. on March 6 announced a £46 million ($60 million) aid package to support vaccine and diagnostics development, and it was praised for supporting a rapid test to be produced in Senegal. It later said it would commit up to £150 million for the International Monetary Fund’s Catastrophe Containment and Relief Trust to help lower-income countries deal with the economic fallout of the crisis.

However, despite holding the world’s third-largest aid budget and a force of aid workers around the world, there has been no further word on plans for the U.K.’s international response.

While acknowledging the challenging circumstances, experts warned that vision was needed to adjust all of its development programming, given the scale of the crisis.

The Department for International Development — the government department largely responsible for aid — has not made a public announcement on its COVID-19 response for two weeks, nor have there been any ministerial statements about how it intends to lead or influence the global response.

DFID’s response has been “very inward-looking” with constraints on spending because of the end of the financial year, according to a staffer who spoke to Devex on condition of anonymity to preserve his job. He added that “bureaucrats, rather than public health experts, were calling the shots” and that there was interference from Foreign & Commonwealth Office officials who joined a London-based task force dealing with the pandemic.

The situation has not been helped by DFID’s secretary of state, Anne-Marie Trevelyan, being in self-isolation as a precaution after being exposed to the virus and — unrelatedly — the unexpected move of the department’s most senior civil servant to another department last week.

Shadow Secretary of State for International Development Dan Carden wrote to Trevelyan this week, urging her to “do more to lead the global response to support the most vulnerable people across the world.”

“We are concerned that DFID – the Department that should be leading Britain’s global response as a humanitarian superpower – has so far been quiet,” Carden and other members of the Labour Party’s international development team wrote.

Mukesh Kapila, professor of global health and humanitarian affairs at the University of Manchester and former head of conflict and humanitarian affairs at DFID, agreed. “It’s disappointing they are not prominent as a major, major donor in taking some kind of lead in financing the response to COVID-19, especially among the most fragile countries,” he said.

Kapila, who is also working on an initiative responding to COVID-19 in Africa, told Devex: “What’s needed, considering the catastrophic nature of this whole crisis … [is] to reorient all the development programs they have, wherever they are, and find resources from existing programs and integrate COVID work within those programs. Otherwise, the development gains that might be achieved … are going to be completely unrealized.”

Citing unprecedented commitments from the British chancellor, Rishi Sunak, in response to the U.K.’s own economic shutdown, Kapila added that “I don’t see the transformative thinking coming out of DFID in the same way that other government departments in the U.K. have been forced to change.” He said DFID would need to completely transform its strategy in the face of the challenge presented.

There was also confusion about how DFID would engage NGOs to help with the COVID-19 response in low-income countries. “We were expecting probably a bit more of a proactive reach out to the sector,” said Laura Taylor, head of advocacy at Christian Aid.

“An announcement of what their [DFID’s] strategy is, what funding options are available for people other than global institutions, and how they would like to work with civil society, both globally at the national level, would be really good to know,” she added.

Kalipso Chalkidou, director of global health policy at the Center for Global Development think tank, said people were trying their best amid difficult circumstances, noting that the global response to COVID-19 generally had been “underwhelming.”

Still, she said, the U.K. could be “more of a shining example.” DFID needs to communicate to other government departments that “whatever the U.K. does, whatever is happening in the developed world, will have direct implications on people’s lives in developing countries, mostly through the economic implications of measures being taken,” she said. “It’s very important to communicate to their colleagues and the public that they are aware this is a global crisis and whatever we do in the G-7 will have direct implications on the poorest countries.”

A DFID spokesperson said there would be more announcements to come on its COVID-19 response.

William Worley

William Worley is the U.K. Correspondent for Devex, covering DFID and British aid. Previously, he reported on international affairs, policy, and development. He also worked as a reporter for the U.K. national press, including the Times, Guardian, Independent, and i Paper. His reportage has included work on the Rohingya refugee crisis in Bangladesh, drought in Madagascar, the “migrant caravan” in Mexico, and Colombia’s peace process.

COVID-19 Forces International Aid Groups to Limit Travel, Rethink Operations

NEW YORK — Multiple relief and development organizations are eliminating noncritical missions to limit staffers’ exposure to the novel coronavirus, while also creating contingency plans as the global pandemic continues to escalate.

Mercy Corps, Relief International, Norwegian Refugee Council, Catholic Relief Services, CARE, and Save the Children are among the nongovernmental organizations issuing new travel restrictions for staff while also rolling out prevention and response plans in impacted and at-risk countries.

“Hopefully it will not impact the work we are doing in the field, with refugees and IDPs [internally displaced people] as much. But as time goes by, it is also restricting training and global seminars where we are supposed to have strategies develop. It is the long-term work that could be affected on a global level,” said Tuva Bogsnes, spokesperson for the Norwegian Refugee Council.

NRC is limiting international travel to critical work and shuttered its headquarters in Oslo, Norway, this week. It is also boosting its water, sanitation, and hygiene work in countries with weak health systems, such as Afghanistan.

“As this affects more and more countries, it is going to be harder for us to find ways for staff to go in and out of countries,” Bogsnes said.

The World Health Organization elevated the COVID-19 outbreak to pandemic status Wednesday. The virus has spread to more than 125,000 people across 118 countries and territories in Asia, the Middle East, Europe, and the U.S., according to WHO’s latest available estimates.

Experts at relief organizations described a dynamic situation that is requiring them to rapidly develop, and continuously review, staff travel and community engagement policies. The impact on lifesaving work, such as emergency humanitarian response in conflict zones, is still minimal, experts say, but the situation remains fluid. Supply chain shortages present another emerging concern, several global health and development experts told Devex.

The United Nations is also undertaking risk assessments “to evaluate how critical proposed travel is in relation to the risk posed to the traveler,” wrote U.N. spokesperson Stephane Dujarric in an email to Devex. Some cases of COVID-19 have been confirmed in countries, such as Iraq, that are already in crisis because of natural disasters or conflicts and have a large number of people in need of emergency assistance.

“To date, the U.N. and partners are maintaining humanitarian operations while taking precautions to ensure staff safety. U.N. agencies are currently assessing where and how humanitarian operations are being disrupted to try to identify solutions as quickly as possible,” Dujarric wrote.

Individual U.N. agencies are adopting their own health security protocols as well. The U.N.’s World Food Programme is limiting all international duty travel to mission-critical and time-sensitive work and postponing all seminars, workshops, and other large meetings, according to spokesperson Shada Moghraby. The United Nations Development Programme is encouraging staff to work remotely, which “reduces the footprint in our offices and mitigates the risk for all involved,” according to Angelique Crumbly, director of UNDP’s Bureau for Management Services.

Several international NGOs also shared their individual health security strategies with Devex:

Plan International has canceled all noncritical international travel and activities through March 31 and is looking at business continuity plans on how field offices could operate in low-, medium-, and high-transmission situations, according to spokesperson Davinder Kumar.

Mercy Corps is restricting travel for all employees through countries under the Global Level 3 Health Advisory by the U.S. Centers for Disease Control and Prevention and is undertaking preparedness activities across many of its country offices, according to spokesperson Kelly Hysan.

CARE International has moved to “business critical” travel but continues to undertake programs in compliance with local government restrictions. “The majority of CARE’s programs are continuing where CARE operates,” Chris Williams, director of security at CARE, wrote in an email.

Relief International is now “constantly” reviewing risk levels and authorizing travel on a case-by-case basis, according to Azadeh Hasani, the organization’s global humanitarian director. Relief International continues to respond to the health crisis in Iran and other countries, distributing protective health care equipment to hospitals.

Catholic Relief Services temporarily closed its Beirut and West Bank offices for deep cleaning, and its Cambodia office is now working remotely. Staff can only travel for “mission-critical” work. “It is changing so rapidly that, depending on the situation in each country, we may experience delays, including temporary office closures,” said Marieke van Weerden, director of staff safety and security.

The changes come as development events worldwide continue to be canceled or transitioned to a virtual format, and multiple governments — from the U.S. to Uganda — issue new travel restrictions.

One immediate issue for aid and development agencies is the sudden challenge in procuring health care supplies, according to Relief International’s Hasani.

“We now have a lot of our procurement teams trying to find these items and ship them. In some cases, we are not being able to find them. We really had to go to many suppliers and buy masks from one, goggles from another one,” Hasani said. “It wasn’t easy to find, and yes, in terms of pricing, of course they are more expensive than we would have initially planned for.”

Catholic Relief Services is also thinking through its “call to home” scenarios for international staffers, so they can return to their countries of residence if government travel restrictions escalate.

“The reason why we are going ‘mission-critical’ is not necessarily because of the virus. … It is because of travel restrictions governments put in place. If staffers are quarantined, they cannot work with communities where we need them most,” van Weerden said.

Save the Children has also issued a “blanket pause” on nonessential travel, according to Negin Janati, director of communications for Save the Children’s humanitarian response and emergency work. Save the Children’s China office remains closed, as staffers continue to work from home.

“With the number of cases and community transmissions that are present, we are asking everyone, ‘If you can do a meeting virtually or attend a conference virtually, do it that way,’” Janati said. “We have colleagues who are helping run pandemic-preparedness workshops throughout Asia, Middle East, and Africa. Their work is mission-critical, and they have to travel for it.”

The changes are challenging the traditional methods of work that Save the Children uses, leading it to pause and consider the feasibility of virtual training sessions or online partnerships and advocacy meetings.

“We live in a digital world and are used to doing things digitally, but there are certain things, like community engagement, that I do not know if people have considered how to do that exclusively online. We are just having to make it work,” Janati said.

Back Poor Countries Fighting COVID-19 with Trillions or Face Disaster, G20 Told

Economists and global health experts have called on G20 leaders to provide trillions of dollars to poorer countries to shore up ailing healthcare systems and economies, or face a disaster that will rebound on wealthier states through migration and health crises.

Twenty experts, among them four Nobel prizewinners, including Joseph Stiglitz, Lord Nicholas Stern and seven chief economists of the World Bank and other development banks, have written to G20 leaders to warn of “unimaginable health and social impacts” as coronavirus rips through the developing world, taking overburdened healthcare systems beyond breaking point, and causing economic and social devastation.

Countries are “falling apart because of the collapse in commodity prices, tourism and remittances”, said the signatories, even before the ravages of the virus itself takes hold across south-east Asia, Latin America and Africa, where at least 43 out of 54 countries have confirmed cases.

The G20 held a virtual meeting by video conference on Thursday to discuss the Covid-19 crisis.

Poorer countries are likely to be hit harder than rich states, since they have less capacity to absorb the shock and overcrowding, poor infrastructure and lack of resources hamper public health efforts. Basic hygiene and a lack of handwashing facilities and soap will be a major issue for poorer people.

“Developing countries are facing an unprecedented collective threat to human life, social cohesion and economic devastation,” the letter to the G20 leaders said. “Massive economic losses will be incurred as countries desperately try to cope, people will migrate out of fear as the epidemic takes hold, leading to social disruption, violence and security issues.”

The group wants swift action to devote emergency spending to stricken developing countries, and longer-term reforms that make nations more resilient to outbreaks and natural disasters.

At least $8bn (£6.5bn) in emergency funding has been requested by the Global Preparedness Monitoring Board, but that should be just the beginning according to the letter’s signatories, who make it clear that the money required will be “of a different order of magnitude” to the amounts pledged so far.

The US is implementing a rescue package worth about $2tn, the UK government is spending more than £330bn on its recovery, and other countries are coming up with packages of their own. Poorer nations will need far greater levels of assistance than have yet been planned, according to the letter.

Erik Berglof, director of the Institute of Global Affairs at the London School of Economics, and an organiser of the letter, told the Guardian: “If it will take more than $2tn, perhaps as much as $6tn, to fix the US, we are not going to fix the rest of the world for less. To attach a specific number now is almost meaningless. What we need are new and creative ways of using the global financial muscle to back up existing international financial institutions.”

He said that emergency resources and medical help could be provided quickly, but it was important to manage the process with a long-term view, expanding existing international institutions and programmes. “You cannot sprinkle money from helicopters in these economies because it would never reach the intended receivers,” he said. “You need carefully managed programmes and projects that can help these countries through this extremely difficult period.”

Infrastructure investment would be vital to ensure recovery from a shock that, the economists said, would be greater than that of the 2008 financial crisis.
‘We fear, but have to work’: isolation not an option for the poor of Nairobi
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If efforts to control Covid-19 fail, “the virus could become endemic, producing new waves of destructive outbreaks around the world”, the letter warned, adding: “We have a rapidly closing window to ensure that we give these countries at least a fighting chance to manage the crisis and provide some light at the end of what could be a long tunnel.”

The letter concludes: “We are now urging you, the leaders of the G20, to urgently provide the necessary resources to reduce the losses in human life and back up those most vulnerable. The required investment is minute compared to the social and economic costs of inaction. History will judge us harshly if we do not get this right.”

Uncertainty in Ending Extreme Poverty – Brookings

Whereas sustained economic growth is considered the primary driver of poverty alleviation, the different ways in which growth interacts with changes in income inequality mean that the future of poverty reduction is highly uncertain.

In a recently published working paper, I use historical (1980-2014) data to model and simulate future paths of income inequality and growth, which, in turn, enable us to quantify country-specific changes in poverty rates and income distribution. Our historical-based simulations estimate that the probability of alleviating extreme poverty below the 3 percent threshold by 2030 (Sustainable Development Goal 1) at the global level is small—less than 2 percent.

Furthermore, our results indicate significant variation in future poverty outcomes. For instance, by 2030, the most favorable estimate of poverty headcount at the global level displays a median value of 4.6 percent, with a standard deviation of 0.5. Conversely, our most pessimistic result shows a median outcome of 8.9 percent with a standard deviation of 0.9. These median estimates represent approximately 370 and 720 million people around the world subsisting on less than $1.90 a day (2011 PPP).

In terms of country groupings, in relative terms, extreme poverty is expected to decline in the period 2015-2030 in economies with low, middle, and high rates of per capita output growth. However, in low-output growth economies, the absolute number of poor is expected to increase. The model simulations also predict that high-output growth economies—countries with steady growth rates above 4 percent—will reach poverty rates below a 3 percent level before 2030. Noticeably, the simulations display a low degree of uncertainty around the expected poverty rates in these high-output growth countries.

Moreover, non-resource-output oriented—or more diversified—economies, are predicted to achieve and go below the 3 percent poverty target by 2030. By contrast, several simulation exercises show resource-based economies witnessing an increase in absolute poverty during the period 2015-2030. We find significant dispersion in the estimated paths of poverty outcomes in these resource-based countries, implying that given recent history, it is hardly possible to predict precise estimates of poverty rates in these economies.

Resource-based economies. What is the current and future poverty situation in countries that rely heavily on natural resources? Figure 1 depicts two conditions. First, most countries with abundant natural resource rents in the period 1970-2015 have high rates of extreme poverty. Second, the majority of countries with high poverty headcounts had median annual growth rates of GDP per capita during 1970-2014 below the 4 percent threshold. In sum, it is quite likely that resource-based countries will keep elevated poverty rates by 2030: The most optimistic and pessimistic simulations show median poverty rates of 9 and 20 percent, respectively.

What can resource-based countries do? The main goal in resource-based countries can be the same as for the majority of countries in the world with high poverty rates: to expand the economy more quickly. Because of the volatility of resource prices, the primary strategy could focus on providing more stable economic and financial conditions. This strategy can be reached by developing sustainable debt management frameworks, improving investment and business climates, as well as implementing more transparent and accountable rules to administer resource rents. Additionally, these economies can benefit from strengthening their institutions, including those involving risk management backgrounds. Potential reforms include fiscal rules (probably balanced budget designs) for commodity revenues,
commodity price hedging, diversification strategies of the economic activities, among other actions.

Income inequality. What do the simulations suggest about shifts in income inequality? Most changes in relative income inequality are predicted to be on the positive side. The Gini coefficient across the board is generally predicted to decrease on average over the period 2015-2030. Across this 2015-2030 horizon, our estimates of the Gini coefficient at the global level—population-weighted averages—are expected to decline between 0.7 and 1.9 Gini points (in the Gini scale of 0-100). However, some of our country-grouping estimates of the Gini coefficient display substantial uncertainty and downside risks that imply an increase in the level of inequality in the 2015-2030 period; these negative estimates are especially significant in more diversified countries, and in economies with historically high and low rates of output per capita growth.

A multiplicity of historical-based results exacerbate uncertainty. In comparison with point predictions and perfect-foresight methods, our approach considers both the outcome precision of a multitude of historical-based scenarios and the uncertainty—standard deviation of simulated outcomes—embedded in the predictive fan chart generated for each situation. This multiplicity of results and the predictive fan chart and associated uncertainty provide strong incentives for the improved design of policies for poverty reduction and income redistribution. It is crucial to continue thinking in the design of
hedging mechanisms against risks under variable economic environments affecting poverty and income distribution.