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Kenyans flying high in UN

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EDITORIAL

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For a country starved of good news lately, the elevation of two Kenyans to key international positions in the United Nations system is heart-warming, indeed.

This development has given Kenyans an opportunity to momentarily take their minds off the coronavirus pandemic that has literally brought the country to a standstill.

With slightly more than 1,000 people infected with Covid-19 and over 50 deaths, this has been one of the gloomiest periods in the country for a long time.

Now Kenyans can savour the recognition of two of their own by international organisations, which recognise their abilities to contribute to global causes.

Incidentally, the acting director-general of Health, Dr Patrick Amoth, who has emerged as one of the key faces in the campaign against the spread of Covid-19, has been elected as the vice-chairperson of the executive board of the World Health Organisation.

Another Kenyan enjoying the international limelight is Ms Sanda Ojiambo, a Safaricom executive, who will be joining the United Nations at a significantly high level.

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She has been appointed to head the agency that engages private companies all over the world to persuade them to align their businesses to the UN’s Sustainable Development Goals.

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Secretary-General Antonio Guterres has appointed Ms Ojiambo as the new executive director of the UN Global Compact agency.

She will assume her new role on June 17, taking with her 20 years of experience during which, besides her stint at Safaricom, she has worked in civil society in various capacities, winning accolades.

It is, however, a little disappointing that Dr Amoth, whom the WHO has seen as a complete professional ready to make a difference in the UN agency at that high level, remains an acting DG in Kenya’s Health ministry.

This confirms that we sometimes underestimate ourselves or totally fail to see the talent sitting right there amongst us.

However, Dr Amoth and Ms Ojiambo have an opportunity to demonstrate to the rest of the world that Kenyans have the capacity, knowledge and expertise to serve among the best in the world.

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NININAHAZWE: Make vaccines affordable to poor nations

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By DORINE NININAHAZWE

The intensified search for an effective and safe vaccine against Covid-19 has renewed the urgency to ensure that poor countries have access to all essential vaccines affordably and at the right time.

Since the WHO introduced expanded programmes on immunisation in the 1970s, global efforts have focused on increasing the benefits of vaccines across all countries and population groups. Today, vaccines are considered one of the most cost-effective means of promoting the health, well-being and survival of children. Overall, few medical interventions have been as successful in improving public health.

Millions of children’s lives have been saved from vaccine-preventable diseases such as measles, diphtheria, polio, influenza, hepatitis, meningitis, mumps, whooping cough, rubella, tetanus, TB and yellow fever. Yet more than 22 million babies born every year go unvaccinated, leaving them at risk of lifelong scars and disabilities or death.

In Africa, Nigeria ranks second in the unenviable top 10 countries with the most unvaccinated children. Others are Ethiopia, DR Congo, South Africa and Uganda. The 10 collectively account for more than 70 percent of the world’s tally.

The low immunisation coverage rates are often the result of many issues, including weak health systems and inadequate cold storage and transport systems to rapidly deliver vaccines to remote areas that often lack electricity and refrigeration facilities.

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The unprecedented increase in the prices of vaccines over the past 20 years — from single digits to sometimes triple — is another big worry.

Almost all of the world’s essential vaccines are researched, developed, patented and sold by a multibillion-dollar pharmaceutical industry operating from rich countries. The industry and its investors argue that they have to recoup research and development costs to continue to innovate.

Rich countries, the major purchasers of pharmaceuticals, often negotiate favourable prices with manufacturers or impose price controls for vaccines for their populations. But poorer countries, who bear a disproportionate burden of vulnerable populations desperately in need of the vaccines, pay the full price. For them, the industry will offer fixed lower prices for vaccines only when they see a market with sufficient size and income to cover costs.

Affordability concerns have troubled the global development community, which advocates universal access to essential vaccines. Essential medicines and vaccines are public goods for the benefit of all, a critical component of the right to health. Vaccine prices must, therefore, be fair, equitable and affordable, especially for poor populations and the health system that serves them. To effect this equity principle, GAVI, the global vaccine alliance, was set up in 2000 to accelerate equitable uptake and coverage of vaccines, especially in poor countries and for underserved populations. Its business model is to aggregate demand from eligible countries and then mobilise sufficient funds for the large-scale demand.

This has created an incentive for the industry to set up tiered pricing, with low-income countries being charged less than higher-income countries for the same product. Some 58 countries, 38 of them in Africa, now pay a fraction of a vaccine’s market price in industrialised countries.

However, only countries with Gross National Income per capita of $1,580 (Sh158,000) are eligible for the subsidies. Kenya, for example, contributes just Sh21 ($0.21) to the full cost of the PCV vaccine, which has reduced hospital admissions due to pneumonia by over a quarter since 2011. But by 2022, it will enter an ‘accelerated transition’ phase that will see the GAVI subsidy reduce rapidly until 2027. It will pay the full Gavi-negotiated price of Sh305 ($3.05) per dose.

With an annual allocation of Sh700 million, there are real concerns how Kenya will fund the immunisation budget when the total cost of vaccines shoots to Sh5 billion by 2026. This predicament that Kenya and other African countries with severe immunisation woes face is now more urgent, given the Covid-19 deaths.

Governments and international partners must unite around a global guarantee that, when a safe and effective vaccine is developed, it is produced rapidly at scale and made available to all affordably. Governments and pharmaceutical companies should also pool intellectual property to allow widespread, low-cost manufacturing of vaccines.

Monopolies, crude competition and short-sighted nationalism should not stand in the way of affordable vaccines.

Ms Nininahazwe is the African Union and East Africa director for ONE Campaign; [email protected]

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NDINDA: Dream about baby symbolises opportunities

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By DIANA NDINDA

I’m jolted awake at 11.45pm by a strange dream. In the dream, a baby is sleeping beside me, his small arm draped over my neck. I can feel his rhythmic breathing on my neck.

I try to move his arm, but for some reason, I cannot. After struggling to the point of breathlessness, I manage to move and turn so that I can see the baby better.

He wakes up and starts to whimper. He looks scared, so I pick him up and sit him on my lap. I touch his forehead and he has a burning fever. Concerned, I say, “Let me get you something for your fever,” but he puts his small arms around my neck — he doesn’t want me to leave.
I ask, “Who is your  mummy?”

“Mr Pee Pee is not my mummy,” he replies in a tiny voice. Were this conversation taking place in real life, I would have probably laughed out loud at this answer, but since this is a dream, I don’t get to appreciate the sense of humour.

INTERESTING DREAMS
Like happens in all interesting dreams, I wake up suddenly, and voilà! There’s no baby, it’s just me in my bed in the hotel, still stranded in Nigeria where I’ve been since March 21, and sorely looking forward to going back home. With nothing better to do, and aware that I will not go back to sleep until morning,  I spend quite a bit of time mulling over what that dream means.

After all, this is not the first time I’ve had it. I had dreamt about this baby a day ago and the day before that. I go through one theory after another, striking each out until I settle on the one I decide is the most probable.
I believe the baby is symbolic of new opportunities I hadn’t envisioned knocking on my door in the near future.

The dream seems urgent and is unrelenting, trying to find space in my life no matter how resistant I am. I figure out that I only need to accept  it, and allow it to take me where it wants to. However, no matter how much I try decipher what “Mr Pee Pee is not my mummy” means, I don’t succeed, so I let it go.

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WISHFUL THINKING
True, my conclusion may be wishful thinking, but I’m determined to look on the bright side of things, to remember that in the midst of gloomy situations, good things do happen.

Satisfied and at peace, I go online to catch up with  the news in Nigeria, Kenya and the rest of the world, as well as what’s trending on Twitter. Twitter can be quite interesting sometimes.
When morning comes, I call my first-born son.

It’s his birthday today, and it saddens me that I’ll not be able to wish him a happy birthday in person and spend some time with him.

Had I been at home, I would have probably bought  him cake, and together with close relatives, we would have shared a meal together.
I refuse to despair though, I tell myself that there is always tomorrow, that come next year, I will not be stranded far away from my family, and will therefore get to celebrate this important day with him.                       
                            
Ms Ndinda is Research Manager, Transform Research Africa Ltd. She is stuck in Nigeria, where she has been since March 21.                                             

TOMORROW: The number of Kenyans looking forward to returning home keeps growing. I know I should be patient. After all, I have been here for weeks, so what’s another week? But  I can’t help getting anxious as we inch towards to D-Day.

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CHESOLI & MAJE: Why post-Covid-19 mitigation must have disaster prevention at its core

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By KENNEDY CHESOLI

By HAFIZ MAJE

The fallout from Covid-19 pandemic could rise to the levels of the World Wars, the Great Depression and the Spanish influenza of last century. Governments are scrambling to mitigate and control its spread even as the response against other threats — such as climate change, terrorism, cyber-insecurity and economic sabotage — has to be preserved and upgraded.

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INFECTION CONTROL
Though laudable, some of the current infection control or prevention and treatment measures will not work for an epidemic caused and transmitted by a different infectious agent.

Social distancing, hand hygiene and face masks will not protect us against an infectious disease transmitted by, say, mosquitoes.
Ventilators would not be useful if the next epidemic, which, instead of causing respiratory failure, affects the kidneys — in which case we will need dialysis machines.
So as not to be blindsided by an infectious disease again, we would need adequate stockpiles of antimicrobial agents and vaccines directed against threats.

These include the potential use of infectious disease agents, such as anthrax and plague, by hostile nations and terrorists.

The challenge, however, is to have rapidly scalable domestic production and supply chain capabilities to meet emergency needs — sometimes for items whose need cannot be anticipated or predicted ahead of the actual epidemic.

PERIODIC UPGRADES
Here, public-private partnerships could be a game-changer. Existing stockpiles would need constant replenishment since drugs expire and machines need periodic upgrades.

Interventions such as social distancing, lockdown and curfews come at a cost, which we must check if they are commensurate with the threats.

After all, engineers grapple with how much resilience to incorporate into the design of a structure by weighing the cost against the risk and consequences of any threat.
Since prevention is always better than cure, communities must decide how much to invest in disaster prevention.

The current Covid-19 toolbox may be ineffective against future pandemics but a range of general measures could avert or mitigate their impact.
An adequately funded fit-for-purpose public health infrastructure with a sound grassroot footprint will be critical.

It would be designed to collaborate with the relevant regional and international health organisations and ensure public health measures that come out of centuries of knowledge and experience pertaining to food and water safety and sanitary living conditions are enforced.

FEAR
A constant source of angst in infectious disease practice is the fear of missing the first case, which then goes on to become an outbreak.

Vigilant public health institutions would be on the forefront performing disease surveillance, identifying incipient outbreaks and rapidly instituting control measures.

Detecting disease patterns in real time, bearing in mind that some infectious agents may be novel, could prevent sporadic cases from becoming outbreaks.

Ordinarily, knowledge of a disease, such as transmission patterns and cell and tissue-level damage inform the choice of control measures, treatment and vaccine. However, the explosive nature of Covid-19 has necessitated reliance on “make-shift” science instead of well-performed research.

There is no assurance that future work may not prove the current control and mitigation efforts to be ineffective or even counterproductiv — thus the need to rapidly scale up research and development capacities, harnessing the power of artificial intelligence.

COVID-19

Covid-19 has affected the private sector and corporations have played a vital role in its prevention and mitigation.

In the post-pandemic world, they should invest in infection control infrastructure and processes, analogous to their investments in physical, cybersecurity and other risks, including in a strong layer of infection control personnel to advise on production and customer care processes.
It is imperative to institutionalise these as well as optimise our overall healthcare infrastructure. Reduction of poverty and income disparities will, obviously, be critical to achieving these goals.

Dr Maje is an infectious disease-trained physician, [email protected]; Mr Chesoli is a developmental economist, [email protected]

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