PHM-Exch> Equitable Access to COVID-19 Health Technologies in South Africa

Thu Dec 17 19:37:48 PST 2020

From: <dlegge at phmovement.org>

Please find below the introduction and summary of the rapid situational
analysis carried out by PHM South Africa regarding equitable access to
Covid technologies. The full report is here
<https://www.phm-sa.org/barriers-and-enablers-to-equitable-access-to-covid-19-health-technologies-in-south-africa/>.

This work was carried out under the aegis of PHM’s EACT Project
<https://phmovement.org/eact/>. We commend the report for wide distribution
and consideration. It provides a very useful case study of the barriers and
enablers to equitable access and provides an invaluable foundation for
further organizing and advocacy.

The EACT Project urges PHM networks and circles around the world to
consider undertaking similar situational analyses regarding barriers and
enablers to equitable access to Covid technologies. If you are interested
in undertaking such an exercise please let us know (write to
Prasanna at phmovement.org).

Our South African comrades have indicated that they would be happy to
resource an online workshop to share their approach and methods with
activists from other countries who are considering undertaking a similar
exercise. If you are interested please contact Prasanna.
*Barriers and Enablers to Equitable Access to COVID-19 Health Technologies
in South Africa *

This rapid situational analysis was conducted by PHM SA (and endorsed by
SECTION27, RHAP, Cancer Alliance, 80+ SA affiliated academics and
researchers) during October 2020 to gain insight into the current situation
with respect to access to quality health technologies (PPE, diagnostic
tests, ventilators) for COVID-19 in South Africa, as well as potential
barriers and enablers to access to health technologies currently under
development (vaccines, treatments). The situational analysis further sought
to understand how regulatory frameworks, health financing, local
manufacturing capacity and domestic research activities impact/may impact
health technology access in the country.

CLICK HERE
<https://www.phm-sa.org/barriers-and-enablers-to-equitable-access-to-covid-19-health-technologies-in-south-africa/>
FOR THE FULL REPORT

Data for the situational analysis was collected through in-depth interviews
with key informants, stakeholder engagement, and an extensive review of
grey literature related to health technology development and access in
South Africa. Five in-depth interviews were conducted with key informants
actively involved with or leading government’s efforts to respond to
COVID-19 and deliver needed health technologies (this input is referred to
in the report as interviewee input). Input was also sourced from
stakeholders (civil society members and PHM partners and colleagues)
through phone and email communication (this input is referred to in the
report as stakeholder input).

The purpose of this situational analysis is to inform and strengthen civil
society’s engagement towards ensuring that health technologies for COVID-19
are broadly and equitably accessible in South Africa, including for
marginalised and vulnerable groups.

The report is organised in two sections:

1.     The first section gives an overview of the current situation with
regards to access to health technologies (and key services) for COVID-19 in
South Africa

2.     The second section explores how South Africa’s research,
development, and manufacturing capacity, as well as legal frameworks and
process for protecting intellectual property and regulating health
technologies impact/may impact access to COVID-19 health technologies in
the country.

Health technology access barriers identified and described in the report
are summarised in Table 1 (see page 6). The table also identifies potential
areas for community monitoring or advocacy towards improving equitable
access to COVID-19 health technologies in South Africa.
Executive summary

Since the appearance of SARS-CoV-2 in late 2019, the novel virus has
rapidly spread across the globe and caused a staggering toll in terms of
loss of life and health impairment. By end-October 2020, more than 43
million cases of COVID-19 were confirmed and over a million deaths were
reported.

COVID-19 and its responses have also significantly disrupted routine health
care services—including childhood vaccinations, HIV, and TB services—and
upended economic systems—severely increasing economic vulnerability and
food insecurity. Morbidity and mortality due to increased economic hardship
and disruption of regular health services may surpass and outlast morbidity
and mortality due to COVID-19.

Effective health responses and access to health technologies for COVID-19
are critical to reduce COVID-19 illness and death, enable broader health
service functioning, and repair damaged industries and economies.  While
country responses to COVID-19 have significantly varied, access to health
technologies have fallen into long entrenched patterns of inequality both
between and within countries.

High-income countries (HICs) have pushed aside the needs of low- and
middle-income countries (LMICs) in seeking to secure health technologies
for their own populations. In the early months of the pandemic, wealthy
countries used their financial and political strength to secure and hoard
critical personal protective equipment (PPE) and diagnostics for their
populations. As the development of vaccine candidates has progressed,
wealthy countries have pre-bought vaccine supply at-risk—impeding efforts
by the World Health Organisation (WHO) to facilitate equitable distribution
of vaccines (once available) across all countries.

Within South Africa, access to COVID-19 health technologies has also been
stratified across income levels, due to existing inequities in the
distribution of critical resources between the public and private health
sectors. The private health sector which serves around 15 percent of South
Africa’s population and consumes around 50 percent of health spending in
the country is significantly better resourced than the public sector to
respond to COVID-19. At the start of the pandemic, two-thirds of the
country’s ventilators and over 80 percent of the critical care bed capacity
was located in the private sector.,

Significant work has been undertaken by government agencies to prepare and
enable South Africa’s public health sector to respond to the pandemic, with
support from local industry and other stakeholders. The public sector
brokered a deal to procure critical care beds from the private sector,
supported the ‘National Ventilator Project’ which developed and distributed
20,000 CPAP machines  across the country, and is supporting local
development and commercialisation of COVID-19 tests and test materials.
Government is also supporting local trialling of COVID-19 treatments and
vaccines, which will provide important evidence on their effectiveness in
local populations.

South Africa has also been an international leader in seeking to ensure
that commercial monopolies and barriers to knowledge do not impede the
development of and access to health technologies for COVID-19. In this
vein, South Africa (together with India) has asked the World Trade
Organisation (WTO) to grant a waiver to allow countries to not grant or
enforce patents on COVID-19 health technologies throughout the pandemic,
stating that *“The waiver should continue until widespread vaccination is
in place globally, and the majority of the world’s population has developed
immunity”.*

On 16 October, South Africa told the TRIPS Council that *“**the COVID-19
pandemic is a clarion call for us to answer to the better angels of our
nature”, adding * “*Given this present context of global emergency, it is
important for WTO Members to work together to ensure that intellectual
property rights such as patents, industrial designs, copyright and
protection of undisclosed information do not create barriers to the timely
access to affordable medical products…to combat COVID-19*”.

Yet, despite South Africa’s leadership in seeking to address intellectual
property (IP) access barriers at an international level, domestic reform of
the country’s patent laws to improve health technology access, which has
been the subject of a sustained campaign by civil society organisations,
remains overdue and sluggish. The country’s response to COVID-19 has also
faltered in other critical areas. Procurement of PPE has been mired in
corruption and shortages and poor-quality PPE have placed health care
workers’ lives at risk. Further, despite massive efforts by the South
African Health Products Regulatory Authority (SAHPRA) to rapidly establish
and enforce systems to ensure the safety and efficacy of COVID-19 health
technologies, slow regulatory processes have impeded the introduction of
and access to critical health technologies—the National Ventilator Project
reportedly ‘missed the peak’ due to slow regulatory guidance and approval
of CPAP machines.

Lessons from experiences to date can help South Africa prepare for a
potential second and any subsequent surges in infections, strengthen its
ongoing response to COVID-19, and prepare for the mammoth task of procuring
and delivering COVID-19 vaccines in the face of significant and daunting
unknowns.

Civil society has a critical role to play in ensuring that lessons are
learnt from responses to date and that shortcomings are addressed,
including through: challenging legal barriers to health technology access;
highlighting incoherence between South Africa’s statements regarding IP at
an international level and domestic laws and policies; engaging with the
rapidly changing regulatory environment for medical devices and demanding
greater transparency from the regulator; challenging procurement processes
that enable corruption; and holding corrupt officials to account. Civil
society is already making important contributions in these areas through
the Fix the Patent Laws Coalition, the Moral Call Collective,
#orangemaskfridays, the C19 Peoples Coalition and other community
initiatives.

Civil society also has a role to play in monitoring health technology
access and raising awareness of shortages and quality challenges. While
this report is focused on access to medical technologies, the availability
of running water and soap at health facilities is also critical to prevent
the spread of COVID-19 and other pathogens.

Fear of contracting COVID-19 has impeded access to and reduced uptake of
other critical health services such as TB and HIV services, and childhood
vaccines. Civil society can play an important role in mitigating these
disruptions through engaging communities on the science of COVID-19 and
monitoring and reporting health facilities not implementing proper
precaution and hygiene measures—as done by the Treatment Action Campaign in
the Eastern Cape.

Finally, as government grapples with difficult decisions about who will get
first access to vaccines, civil society must ensure that community voices
and preferences are heard and accounted for in the rollout plan, and that
the most marginalised and vulnerable members of community are protected.

REFERENCES

World Health Organization. WHO Coronavirus Disease (COVID -19) Dashboard.
https://covid19.who.int/.

Khan M, et al. Mitigating the impact of COVID-19 on tuberculosis and HIV
services: a cross-sectional survey of 669 health professionals in 64 low
and middle-income countries. medRixv Preprint. 13 October 2020.
https://doi.org/10.1101/2020.10.08.20207969.

Bradley J, In Scramble for Corovirus Supplies, Rich Countries Push Poor
Aside. New York Times. 9 April 2020.
https://www.nytimes.com/2020/04/09/world/coronavirus-equipment-rich-poor.html
.

Cowan K, Evans S. Just 207 critical care beds and 350 ventilators added to
public hospitals during lockdown. News24. 7 June 2020.
https://www.news24.com/news24/southafrica/investigations/exclusive-just-207-critical-care-beds-and-350-ventilators-added-to-public-hospitals-during-lockdown-20200607.

van den Heever A. South Africa sets aside more money for COVID-19 but lacks
a spending strategy. The Conversation. 29 June 2020.
https://theconversation.com/south-africa-sets-aside-more-money-for-covid-19-but-lacks-a-spending-strategy-141619
.

CPAP (or continuous positive airway pressure) machines use air pressure to
keep airways open and can be used to deliver supplemental oxygen to
patients. Unlike ventilators, CPAP machines do not require intubation
(inserting a tube through the mouth into the airways).

Knowledge Ecology International. WTO TRIPS Council (October 2020): South
Africa issues clarion call urging support for TRIPS Waiver Proposal. 16
October 2020. https://www.keionline.org/34235.

Fix the Patent Laws. A Timeline of Intellectual Property Reform in South
Africa. 2017.
https://www.fixthepatentlaws.org/wp-content/uploads/2017/10/IP-reform-timeline-2017-continuous.pdf

SAHPRA, or the South African Health Products Regulatory Authority is the
national regulatory body responsible for ensuring the safety and efficacy
of medicines and medical devices used in South Africa.

Stakeholder interview

Khan M, et al. Mitigating the impact of COVID-19 on tuberculosis and HIV
services: a cross-sectional survey of 669 health professionals in 64 low
and middle-income countries. medRixv Preprint. 13 October 2020.
https://doi.org/10.1101/2020.10.08.20207969.

Mbovane T. Dire conditions in Eastern Cape clinics made worse by pandemic.
GroundUp. 24 August 2020. https://allafrica.com/stories/202008240941.html.
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