For too long Africans have been dependent on aid and medicines from the west—imported knowledge, drugs and dollars. A welcome paradigm shift is occurring in our backyard and around the African continent.
In October 2012, we attended the launch of the KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH). What is inspiring is the translational, innovative research being done in South Africa, at the heart of the HIV/TB co-epidemic, with state-of-the-art equipment. Among the distinguished guests were Anthony Fauci the Director of the US National Institutes of Allergy and Infectious Diseases, South African Minister of Health Aaron Motsoaledi and the KwaZulu-Natal Provincial Premier Zweli Mkhize.
A few months ago, South Africa hosted the 5th annual BRICS Summit in Durban. This forum, meeting in Africa for the first time, convened leaders from the geo-political grouping of Brazil, Russia, India, China and South Africa on the theme “BRICS and Africa: Partnership for Development, Integration and Industrialisation.”
Good health is a catalyst for economic growth and development. Twenty years ago, the World Bank’s 16th World Development Report, subtitled ‘Investing in Health,’ argued health contributes to and is critical for economic growth. It identified four concrete ways: reducing lost productivity caused by illness; enabling the use of natural resources previously inaccessible because of disease; increasing school performance and enrolment of children; and freeing resources that would otherwise be spent to treat illness (World Bank, 1993).
Across the world, health care innovation has allowed us to live longer than ever. Over the last several decades, global life expectancy has improved dramatically—35 years since 1970 (GBD 2010). Gains in life expectancy have been seen everywhere except southern Africa, where adult mortality from AIDS has erased years of life expectancy, and Haiti due to the 2010 earthquake (GBD 2010).
The pattern of disease is changing. Today, non-communicable diseases (NCDs) are the leading cause of premature death globally, contributing to 50% or more of all healthy years lost in most countries outside of sub-Saharan Africa (GBD 2010). Many of the NCDs are lifestyle diseases, caused by poor diet, lack of exercise, (an unfortunate by-product of development and economic growth) and family history.
Although the growth of NCDs is shifting the disease profile of African countries, communicable diseases remain the primary cause of life years lost. This region has been held back from the gains in health made around the world by AIDS; maternal deaths; and child mortality caused by infectious diseases and malnutrition. In the southern cone of Africa, AIDS is the leading cause of death. In South Africa, 5.6 million people are currently living with HIV, 50% of new TB cases are co-infected with HIV, and the epidemic accounts for almost half of years of life lost (GBD 2010).
Health, in the form of research and development agendas, financing, infrastructure and delivery systems, must be responsive to disease and epidemic trends. Health care has innovated considerably. We now have the tools to fight many of the continent’s most devastating diseases.
Innovation happens at every point from the laboratory to the patient. Drug delivery is becoming more efficient and effective with advancements in diagnostics and routine point-of-care services. For example GeneXpert, an automated DNA test for TB, procured in South Africa through concessional pricing, is revolutionizing TB diagnostics, bringing earlier treatment and saving lives.
Advanced market commitments (AMC), an innovative financing mechanism create a viable market for pharmaceutical companies to invest in vaccines and drug development for diseases affecting the world’s poorest countries. Through the pneumococcal AMC, 101 million doses of the pneumococcal vaccine were procured and delivered to 51 GAVI-eligible countries between 2010 and 2012.
Partnership needs to be a core component of effective innovation and is key for benefiting the health of developing countries. This was seen at the K-RITH opening and in the declarations made at the Durban BRICS Summit.
In the late-1990s, Brazil played an instrumental role in shifting the paradigm of health care and human rights when it challenged the World Trade Organization (WTO) and its intellectual property regime. Brazil violated a WTO clause in order to provide antiretroviral drugs and to lower ARV drug prices. This reaffirmed medicine as a fundamental human right.
While many drugs continue to be developed in laboratories in the West, India has stepped in to manufacture generic medicines for the world’s poorest countries. Through low-cost support and commodities, India has filled a gap in the global market.
China has an increasing role to play in the global health arena. China’s incredible investment in research and development (US$36.1billion in 2011) places it in a position to become a major player in health care innovation. Additionally, given the sheer scale of industry and financial resources available, China has the capacity to develop and supply HIV drugs and technologies to meet the needs of the African epidemic.
Traditional donors are beginning to recede from the global health landscape and countries are becoming more dependent on domestic resources. The British Department for International Development (DFID) and US President’s Emergency Plan for AIDS Relief’s (PEPFAR) planned transition out of South Africa are recent examples of this trend. Their departure presents an opportunity for new sources of engagement including from the growing BRICS economies. Investing in the health of Africa will fuel development, enhance diplomacy, and build South-South solidarity.