How Africa is harnessing tech to deliver healthcare

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Jean Kaseya, Director General, Africa Centres for Disease Control and Prevention: When I started my career, I was the only medical doctor for 250,000 people. What do you think one medical doctor can do for 250,000 people?

Robin Pomeroy, host, Radio Davos: Welcome to Radio Davos, the podcast from the World Economic Forum that looks at the biggest challenges and how we might solve them. This week we’re looking at global health, with one of the most senior health officials in Africa.

Jean Kaseya: If I have to close my eyes to think about Africa the next five years, it will be another continent because we leverage on the power of AI and digital transformation agenda.

Robin Pomeroy: It’s a positive message from the head of the Centres for Disease Control and Prevention in Africa, a continent facing the impact of massive cuts to health spending from overseas.

Lora du Moulin, Global Health and Security Lead, World Economic Forum: 30% of Africa's health expenditure comes from ODA. So it's having a massive impact in some countries more than others. In combination with that, Africa's escalating debt crisis is dovetailing with that.

Robin Pomeroy: The head of global health at the World Economic Forum sets out the challenges of the new reality, and the head of Africa CDC explains why Africa is a huge opportunity.

Jean Kaseya: Many people are asking me if we have a market. I'm laughing because I say we have 1.4 billion people. This is the market we have. But the issue is how to open this market.

Robin Pomeroy: Follow Radio Davos wherever you get your podcasts, or visit wef.ch/podcasts where you will also find our sister programmes, Meet the Leader and Agenda Dialogues.

I’m Robin Pomeroy at the World Economic Forum, and with this look at how healthcare can transform Africa.

Jean Kaseya: I have to call local manufacturing the second independence of Africa.

Robin Pomeroy: This is Radio Davos

Robin Pomeroy: Welcome to Radio Davos and this week we are looking at health, with a focus on Africa. And I'm joined by my colleague Lora du Moulin, lead for global health and security at the World Economic Forum. Hi Lora, how are you?

Lora du Moulin: Hi, good, thank you. Lovely to be here.

Robin Pomeroy: Great to have you here. What is it you do at the World Economic Forum?

Lora du Moulin: So I oversee our efforts that are related to global health and security, which includes pandemic preparedness, efforts related to vaccine manufacturing, disease monitoring, and related efforts.

Robin Pomeroy: So you're based in the World Economic Forum's office in New York, but I'm talking to you in person here in the World Economic Forum's office in Geneva. How come you're over here? It's not just for Radio Davos, is it?

Lora du Moulin: No, no, this was actually quite a big week within global health. It was the World Health Assembly this week here in Geneva. And there's quite a few notable events that took place, for example, the pandemic accord was approved here in Geneva, and a draft will be moving forward to ratification.

Robin Pomeroy: What is that?

Lora du Moulin: The pandemic accord, it was a set of how can countries come together in terms of how to better respond in the future, to future pandemics and outbreaks, and how can there be a more collective response moving forward?

Robin Pomeroy: Right, this is what, the lessons we've learned from COVID and how to do it better next time?

Lora du Moulin: Exactly, hopefully have them more institutionalised moving forward.

Robin Pomeroy: And there was an event here at the World Economic Forum as well.

Lora du Moulin: Yes, we had two events. One related to Regionalized Vaccine Manufacturing Collaborative, so that's an effort that the Forum incubated and has since spun out. It's an independent initiative that's hosted at CEPI.

Robin Pomeroy: CEPI is the...

Lora du Moulin: Coalition for Epidemic Preparedness and Innovations, really dedicated to ensuring that there's vaccines, especially within 100 days of an outbreak. That's one of its main missions it's taken on.

And the Regionalized Vaccine Manufacturing Collaborative now as an independent, it's has the vision of ensuring vaccine equity and health security are created for all countries in all regions of the world and that there's establishment of regional vaccine manufacturing and supply chain networks.

As we saw during COVID, it was really the countries that had the vaccine manufacturing capacity within their borders that were the ones that had that first access to vaccines, regardless of their ability to pay. So even countries that were willing to pay, able to pay, because they didn't have that manufacturing capacity on shore, then they were unable to secure that supply. And there's also vaccine embargoes, for example, in terms of not exporting those.

Robin Pomeroy: And so the ideal that you can imagine is there's more around the world, more places that are able to produce vaccines and that would reduce that kind of blockages.

Lora du Moulin: Yes, and I think it's not to necessarily produce more vaccine, but it's to ensure that all regions and all countries have that access and that not every country necessarily needs their own vaccine manufacturing plant and it doesn't make any economic sense, but if you think about regional networks, so how can countries come together and ensure that within their region, not necessarily even a region defined by geography, but maybe geopolitical alliances, for example, how can they have a distributed network that will be able to produce the vaccines that they would need during a pandemic or an outbreak.

Robin Pomeroy: Lora, it's an Interesting time for global health right now, at this World Health Organisation, the Health Assembly and the meetings you've had here in Geneva. This is a time when the US administration has pulled out of the World Health Organisation and also cut aid budgets. What was the feeling you're getting from people you're speaking to and where do you think things go from here?

Lora du Moulin: Yes, it is a difficult time indeed. There was a lot of anticipation that there would be a lot geopolitical changes. However, I don't believe it was on anyone's radar the extent to some of those changes that have taken place.

There's been 70% reduction in official development assistance or ODA this year from 81 billion in 2021 to 25 billion in 2025. So that's a 70% decrease.

Robin Pomeroy: This is overall globally, you mean?

Lora du Moulin: To Africa.

Robin Pomeroy: To Africa. From the rest of the world, or from the US in particular?

Lora du Moulin: From the the rest the world. However, the United States does represent the vast majority of that, not only percentage-wise, but in overall dollar amount as well.

And it represents the most significant kind of retrenchment of foreign health investments perhaps ever.

30% of Africa's health expenditure comes from ODA. So it's having a massive impact in some countries more than others. And in combination with that, Africa's escalating debt crisis is dovetailing with that.

Robin Pomeroy: This is the debt crisis, and we've covered it on Radio Davos, where government debt has become so big, interest rates have gone up, some governments are spending more just servicing, just paying the interest on their debt than they are on government services, such as and particularly healthcare.

Lora du Moulin: Precisely. So the obligations are projected to reach $81 billion U.S. Dollars by 2025. So that's surpassing the anticipated external financial inflows. So that is going to further limit fiscal space and bandwidth to be able to make those critical health adjustments.

Robin Pomeroy: So that figure you just cited, that's the cost of the debt?

Lora du Moulin: The obligations that countries will have to pay.

Robin Pomeroy: Because of the debt .

Lora du Moulin: So because of this, because of the overall impact it will have on health financing, there's going to be tragic consequences and impacts.The WHO, for example, estimated cuts will lead to more than 10 million additional cases of HIV and 3 million HIV related deaths.

Robin Pomeroy: Because, as a direct consequence of this cut in overseas development aid.

Lora du Moulin: Yes, exactly, and that's just for HIV. So up to four million additional people could now die from just treatable diseases in Africa. And that's, I mean, that's related to just the US funding cut, according to the Africa CDC.

Earlier this month, WHO reported that Kenya, Lesotho, South Sudan, Burkina Faso, and Nigeria, that they'll actually run out of the antiretroviral medicine for HIV, within the next few months as a result of the USAID cuts. So the impact is being felt immediately, and right now, and once somebody's off treatment, you immediately, your viral rates start to go up, so the impact is indeed immediate.

Robin Pomeroy: What can be done to counter that? Someone's got to come in and find some money for that, I suppose.

Lora du Moulin: There have been some significant investments announced this week coming from China to the WHO, from the Gates Foundation, from Novo Nordisk Foundation. However, there has been irreparable damage already made in terms of some of the institutions that are funded by that ODA. And a lot of clinical trials, for example, have been halted. People have, as I mentioned, gone off their treatment. There are some gaps that have been filled, but not all. And a lot of the progress that has been made over the past two decades in particular, we're going to see a backtrack on that.

One thing to note is that Africa CDC and Dr. Jean Kaseya , they did just announce recently a new strategy in terms of how to promote domestic financing using types of innovative financing tools, blended financing and what not. That has received support from the African Union, from heads of state, but that's going to take time and we don't have time and lives are on the line and it's going to mostly affect children who are most vulnerable to preventable diseases like malaria, young women and adolescent girls where we see a lot of the new infections from HIV, and those are the people that are gonna be most impacted.

Robin Pomeroy: And I suppose this makes the work you're doing, the work of the World Economic Forum, more important than ever in some ways because this is an organisation that brings together people who are looking for solutions, be that private sector, academic experts, philanthropists even. I guess we have to look at the glass half full in a situation like this.

Lora du Moulin: Yes, I mean, there's definitely going to be some innovative partnerships that will be catalysed and advanced more rapidly because of this. And I mean that's going to fantastic actually. And I think there is, there is absolutely more interest in engaging with private sector now than I have ever seen within this field. There's more openness and willingness for cross-sectoral collaboration. And I think that a lot of the expertise, capabilities, and capacities that exist within the private sector and the ability to scale and to ensure sustained solutions through public-private partnerships can really address some of these changes that have taken place recently.

So yes, in response to your comment, I do think that the World Economic Forum as the neutral convener and platform for public-private partnerships can play a role here.

Robin Pomeroy: Well, let's take a listen then to Dr. Jean Kaseya. He spoke in Davos, the Annual Meeting of the World Economic Forum, in January. So that was just, I remember well, the week that the Trump administration was sworn into office. So it was ahead of these cuts. Although, as you say, some of them were anticipated, probably not quite to the extent that did happen in reality a few weeks after Davos.

Let's hear from Jean Kaseya, the head of Africa CDC. He was speaking in Davos to my colleague, Nicola Rowe, who started by asking Dr Kaseya about the role for AI and other tech in speeding up the detection and response to infectious disease outbreaks.

Jean Kaseya: You know, I have to say to people that Africa can jump, and we don't have to follow all processes, all steps that other continents they took.

If I give you the example for the cell phone, you know, before having cell phone in Europe, you had the landline. In Africa, we didn't have landline, we crossed landline we got the 4G and the 5G. This is also what we are doing to support the surveillance. We need strong digital system in place. And we need also to leverage on the power of AI.

When we decided to accelerate with the digital agenda, we discovered that only 32% of our health centres are connected. People, they heard about this disease X in DRC. For two months, the national level didn't have information about what was happening at a regional level.

It means, before talking about the digital transformation, we need connectivity. And it's the basis.

Now we are working to connect all health centres. And when we connect them, we leverage now the power of AI because we need telemedicine. We have a shortage of medical doctors. And if we have AI, that can help us to push the agenda of telemedicine. We can save life of so many children in Africa.

Nicola Rowe: The Pathogen Genomics Initiative. Can you just tell us a little bit about that?

Jean Kaseya: The main issue, you will just name what you know. The laboratory issue in Africa is a main issue. When we had COVID, we discovered that we had only three countries that could conduct pathogen genomics. Now, we have almost 40 countries out of 55.

In two, three years, we made huge progress. It's based on the Pathogen Genomics Initiative 1.0. Now we are moving to Pathogen Initiative. 2.0. It means we need all African countries to have capacity and capability to conduct genomic sequencing. First. Second, at the centralised level, to have the capacity to conduct appropriate testing and also to ensure that there is a connection, because we want, when there is a public threat somewhere, to get information quickly. We are putting in place mechanics with Pathogen Genomics Initiative 2.0, but we are also bringing the digital component. Africa will be a very well-connected continent using the health sector approach with initiatives like Pathogen Genomics Initiative 2.0.

Nicola Rowe: It might be quite an interesting angle to talk about how by installing the connectivity now it's sort of zero to 100 in terms of connecting the entire continent and getting every country involved. But you'll be using the latest in tech to do so. Seems like this might really, really change the face of healthcare across the continent, which is a huge task.

Jean Kaseya: Yes, I think Africa will use opportunities of AI to change the face of morbidity and mortality in Africa. Because as I was saying, the potential of telemedicine will change a lot.

When I started my career, I was the only medical doctor for 250,000 people. What do you think one medical doctor can do for 250,000 people?

But if we start today to implement the powerful AI system in Africa, this is why I'm talking about telemedicine, I'm talking about early detection, I'm talking about strength and surveillance mechanism. We can jump from zero to maybe 80-90.

Nicola Rowe: In September of last year, the Pan American Health Organisation signed an agreement with the CDC to collaborate on equitable access to vaccines and medicines and other strategic tech. Can you tell us how the two organisations are going to strengthen these regional regulatory and production mechanisms, as well as support local manufacturing of essential medicines and vaccines? What are the major focus areas and accelerators of this agreement?

Jean Kaseya: I have to call local manufacturing the second independence of Africa. Why second independence Africa? Because it's bringing a lot of areas together. We are talking about health security. Like today, we are facing a number of outbreaks, Marburg, cholera, Mpox, and we don't have tools.

Second, it's because of job creation and economic growth. We are talking about a market that is potentially around $75 billion per year. And this $75 million per year will grow because our population is growing. We have around 2.5 billion people in 2015.

We are also talking about youth employment. And that one will reduce the risk of migration of young people from Africa to other continents because we are also levering on the power of digital system linked to the local manufacturing.

Then to accelerate this agenda, we need two major components.

The first one is regulatory process. The regulatory process, we are working on that. We are putting in place what we call the African Medicines Agency, because we don't want a country that will manufacture one product to register that 54 times. African Medicines Agency, like the European Medicines Agency, will cover the whole continent. And our countries or our partners, they will be register once and they have access to the African market.

And the second one is the pool procurement mechanism. Many people are asking me if we have a market. I'm laughing because I say we have 1.4 billion people. This is the market we have. But the issue is how to open this market.

This morning I had a meeting with the Secretary-General of the African Free Trade Agreement. We are working together to open the market using the pull procurement mechanism that Africa is leading. I think we are ready for this agenda and we are accelerating the process.

Nicola Rowe: How do challenges like sort of cultural public scepticism around sharing your health data, and cyber issues and policy and regulation gaps, how does that challenge grow?

Jean Kaseya: Yes, let me first respond to some rumours I'm getting from some partners. Africa doesn't want to share data. This is not true. There are three major issues.

The first one is we don't have reliable data because we don't have strong digital system in place. Today anyone who can give you any figure about a disease in Africa is just a proxy because we do not know exactly what is happening at a rural area. And this is why the agenda of putting all health centres connected is critical for us. This is the first one.

The second one is about what we call the trust that we have. We saw in many countries, when they are coming to share information that they have, they are punished. And the last example that we had was Marburg in Rwanda. Rwanda was declaring this Marburg. And we saw a country coming with travel ban. And that one, all other countries, they are watching that. We need now to rebuild trust to say, please continue to share information because we are also advocating for no travel ban, no punishment.

And the third one is what we call data sharing agreement. To share data, I must know also you are sharing your data with me because it's not just a one way. We need to have this data sharing agreement internally in Africa. We are also talking with our partners to have this data-sharing agreement with European countries, American countries, and others. That one will help us to have a common platform where we can say we are all dealing with the same issue timely.

Nicola Rowe: in terms of opportunities and innovations, what is next for the Africa CDC in terms of mobile health?

Jean Kaseya: We have countries in Africa where the mobile phone penetration is more than 80%. We see in many countries it's not less than 60%. But are we leveraging on this power to connect the health system?

For the next five years, I see each community health worker in Africa - it means people who are at community level, working with communities - each of them will have a mobile phone connected to the health centre, sending information timely, because we are connecting all health centres. This information will be also shared at national and continental level at the same time.

We are also thinking about how we can make opportunity of mobile phones at community level to leverage on the power to record the report. You know, we have young people. We can be connected. We can start to talk about what to do, what not to do. It means to sensitise people, to educate people.

If I have to close my eyes to think about Africa the next five years, it will be another continent because we leverage on the power of AI and digital transformation agenda.

Nicola Rowe: From a professional's perspective, did you ever anticipate that this would be in your lifetime, that these things that you're working on now that will change the lives of millions?

Jean Kaseya: The person who inspired me to become a medical doctor is my mother. She was a nurse, a paediatrician nurse. I was sometimes going with her to see how she was supporting children. And one day I said to my mother, I want to be like you. She said, no, you can be more than me. You can become a doctor. Because me, at that moment, I was not given the opportunity to do medical studies.

And then, when I started my career, as I told you, I was in a rural area called Health Zone Kahemba. Kahemba is bordering Angola. At that moment, Angola was a country facing civil war. And health infrastructures were not in place. Human resources were not place. In addition to my 250,000 people, I was getting also people from Angola. I was not thinking, in a very short period of time things can change like that. This is why I'm also positive.

What I did since I started my career to become the director general of Africa CDC, I think that the next generation of the director general of Africa CDC will not talk what I'm saying today. We'll start to talk about how Africa is influencing the global health agenda. Because we'll have more young people very well connected, educated. And today we are putting in place the mechanism for sustainable financing system.

Africa is where people must be. If I have to give advice to people, make sure that you have your foot in Africa, because tomorrow it will be the leader of the world.

Robin Pomeroy: Jean Kaseya, director general of Africa CDC was speaking to my colleague Nikki Rowe. You also heard in this episode Lora du Moulin, lead for Global Health and Security at the World Economic Forum.

You can find out more about the work of the Forum’s Centre for Health and Healthcare on our website.

And please follow Radio Davos wherever you get your podcasts and please leave us a rating or review. And join the conversation on the World Economic Forum Podcast club on Facebook.

This episode of Radio Davos was written and presented by me, Robin Pomeroy with reporting by Nikki Rowe editing by Jere Johansson and studio production by Taz Kelleher.

We will be back very soon - please join us then , but for now thanks to you for listening and goodbye.