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The country needs to get back on its feet

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EDITORIAL

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President Uhuru Kenyatta has rolled out a Sh53.7 billion stimulus package to insulate Kenyans from the pangs of the coronavirus and, consequently, set the stage for post-pandemic economic recovery.

For a good measure, the deal has been broken down into eight components, including health, tourism, agriculture and education.

Besides the contagion, the country has been ravaged by floods arising from unusually long and heavy rains that submerged homes, demolished infrastructure such as roads and bridges and swept away farm produce.

In the mix are locusts that have invaded several counties. Cumulatively, the country has been confronted with multiple devastations that combine to create economic, environmental, health and social wreckages.

It is widely acknowledged that the coronavirus pandemic is not only a health challenge but also economic and social.

Economic think tanks have made grim projections on the virus’ adverse effects on global, regional and national incomes.

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For Kenya, many workers in formal employment have been laid off and those in service forced to take pay cuts or unpaid leave.

Those in informal sectors have witnessed revenues evaporate. Uncertainty about the future has killed investment and forward planning.

President Kenyatta’s eight-point agenda certainly comes at the opportune moment.

More cash ought to be injected into the economy to spur productivity. Importantly, subsidies disbursed directly to the needy and elderly are vital in alleviating pain and restoring human dignity.

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However, questions have to be asked about the efficacy of some of the proposals. Top on the card is infrastructure cash.

A sum of Sh5 billion has been earmarked for infrastructure reconstruction, and the plan is to use local labour and materials, which, arguably, would cut costs and, importantly, put money in the pockets of residents.

The principle is noble. However, this must be treated with caution. Often such cash is lost or wasted due to corruption.

The hospitality sector has been hit worst with the closure of airports, a ban on movement into and out of some counties and the shutdown of hotels and restaurants, hence the reason it requires a major boost.

But this should come with other measures that guarantee consumer spending. Notably, credit facilities proposed for small-scale enterprises are pivotal in resurrecting the sector. Even so, proper financial education is required to cushion borrowers.

Granted, the government must build in systems to guard against pilferage and wastage. Ultimately, the cash should be deployed appropriately.

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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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