b. Commitments to organize and resource technical support on the range of matters covered by the draft agreement, including all equity-related provisions, as well as pandemic prevention and public health surveillance, preparedness, readiness, and resilience, and health and care workforce through WHO coordinated mechanisms that are accountable to the Conference of Parties.

c. Appropriate safeguards and limitations that should be placed on the use and sharing of data and information provided by State Parties to WHO, such that the information shared should not be used to the detriment of the interests of the State Parties providing the information such as disproportionate travel or trade bans, devaluation of credit rating and/or sovereign bonds.

2. PANDEMIC PREVENTION, PREPAREDNESS AND RESPONSE (PPPR)
a. Formulate coherent national and regional strategies for emergency preparedness and response and health workforce development, including community health workforce.

b. Enact domestic laws providing for broad exemptions and limitations to intellectual property to address public health emergencies.

c. Increase supply chain diversification and logistics streamlining (continental, regional and national), including through initiatives with other Global South countries.

d. Make incremental steps, in line with respective capacities and nationally self-determined priorities, on PPPR competencies.

e. Operationalize various WHO coordinated mechanisms such as on coordinating R&D and technology transfer, in a manner that such mechanisms are accountable to the Conference of Parties and take guidance from the Conference of Parties in their operations.

3. PREDICTABLE, SUSTAINABLE FINANCING AND GOVERNANCE
a. Call for an International financing mechanism that is accountable to the Conference of Parties and enshrining explicit commitments to new, sustainable, and increased funding support from developed countries for country-level pandemic prevention, preparedness and response in developing countries, debt relief and debt restructuring mechanisms including debt for PPPR swaps.

b. Accelerate the operationalisation of the financing of the African Epidemic Fund.

AFRICA STANDS READY TO PLAY ITS PART AND COMMITS TO ENGAGE ACTIVELY IN THE ONGOING NEGOTIATIONS AND FINALISATION OF THE DRAFT PANDEMIC AGREEMENT.

Addis Ababa, 27 April 2024

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On 20 January 2024, Africa CDC sensitised Heads of State and Government from the Southern Africa Development Community (SADC) regarding the increase of cholera-related cases and deaths in the region.

Heads of State and Government then decided to organise an extraordinary summit hosted by the SADC Secretariat and led by President Lourenco from Angola as the Chair of SADC. This meeting was held virtually on 2 February 2024 to receive and consider a report on the status of the cholera outbreak in the SADC region. They expressed concern on the progress made in curbing the situation and the challenges that continue to hamper the effective fight against the recurrent outbreaks.

The extraordinary summit followed the meeting of the Committee of SADC Ministers of Health on 27 January 2024 and the SADC Executive Council (Ministers of Foreign Affairs) on 29 January 2024.

What We Know

The cholera situation in Africa is aggressive and more protracted in multiple countries. From January 2023 to January 24, 2024 (13 months), a total of 252,934 cases and 4,187 deaths (CFR 1.6%) have been reported from 19 African Union Member States. Over 72.5% of the total cases are reported from the SADC region.

Table 1: Reported Cholera cases and deaths in the SADC region from 1^st January 2022 to 24^th January 2024

*Source: Member States

1. The cholera situation is created and/or exacerbated by climate change. The climate outlook for the SADC region for the period between December 2023 and February 2024 projection increased chances of normal to above-normal rainfall in Angola, Botswana, DRC, Lesotho, Malawi, Mozambique, Namibia, South Africa, Tanzania, Zambia, and Zimbabwe.  

2. The overall performance results from the WHO Afro cholera readiness and preparedness survey conducted in 2023 indicated a limited capacity in Water Sanitation and Hygiene (WASH) infrastructure amongst the SADC countries. As the region continues to experience an increase in cholera outbreaks, more investments in cholera preparedness and readiness are urgently required.

3. The Director General of Africa Centers for Disease Control and Prevention (Africa CDC), H.E. Dr. Jean Kaseya, emphasised that cholera is not only a health sector problem. He advised adopting a multisectoral approach to eliminate cholera in the continent, considering the long-term investment in Water, Sanitation, and Hygiene facilities across Member States. He reiterated that the main driver for cholera outbreaks is limited access to water, hygiene and sanitation, which requires significant involvement of other sectors. 

Recommendations for Action

4. The Heads of State and Governments for the SADC region unanimously agreed on the following recommendations and action in addressing the Cholera outbreak in the region by urging Member States to:

a) Develop and implement regional solid and country multisectoral response plan that encompasses natural disasters and climatic effects on cholera re-emergence to control its spread effectively,

b) strengthen regional collaboration on cross-border outbreak risk assessment and public health surveillance to enhance early detection and prevention of outbreak-prone diseases,

c) jointly plan and implement synchronised cross-border cholera vaccination campaigns, as appropriate, and mobilise vaccines for affected and non-affected countries., and report to the council annually,

d) increase investment in the current cholera emergency response while long-term investment for a sustainable solution to the recurrent cholera crisis,

e) develop and implement climate-resilient water, sanitation and Hygiene (WASH) and Disaster Risk Reduction programmes to prevent future cholera outbreaks,

f) Accelerate local and regional manufacturing of cholera vaccines to scale up production and increase access to commodities such as Oral rehydration Solutions (ORS) and Cholera beds to improve control on the supply chain security and accelerate technology and knowledge transfer,

g) Increase investment in WASH infrastructure and provide efficient waste management and sustainable supply of clean water,

h) Increase budget allocation towards WASH Programmes and

i) Strengthen accountability tools for monitoring WASH interventions and local governments reporting on their WAS performance.

5. The SADC Summit commended the Africa CDC for technical and financial support towards the cholera response in the SADC region and recommended the AFRICA CDC to bring more epidemiologic data to facilitate the decision to Heads of State and Government to declare Cholera as a Public Health Emergency of Regional concern.

6. The Summit further designated His Excellency Mr Hakainde Hichilema, President of the Republic of Zambia, as the regional Cholera Champion to spearhead the fight against Cholera in the SADC region.

7. In response to this SADC Extraordinary Summit, the Director General of Africa CDC welcomes the recommendations from the Heads of State and Government and reiterates his commitment to work with the Member States and partners to urgently contain the ongoing Cholera outbreak by deploying personnel and resources in collaboration with the Ministries of Health.

8. The Africa CDC counts on the commitment of Member States to address the root cause of the recurrent cholera outbreaks to attain the goal of Cholera elimination by 2030.

Additional Resources:

 Communication and Public Information Directorate, Africa CDC, Email: Communications@africacdc.org | Ms. Ndahafa Nakwafila at: NakwafilaN@africacdc.org

Done on 02 February 2024

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APPELONS les États membres de l’UA de la région de l’Afrique centrale à :

• Mettre en place et/ou renforcer les COUSP dotés d’un mandat légal, d’une infrastructure adéquate et de ressources humaines dévouées et bien formées au cours des deux prochaines années ;
• Fournir aux COUSP nationaux un financement durable pour des opérations efficaces en réponse aux urgences de santé publique ;
• Soutenir la création d’un groupe de travail technique (GTT) régional sur les COUSP qui fixe les priorités et suit les progrès de la mise en oeuvre des COUSP dans la région ; et Inscrire les COUSP comme point permanent à l’ordre du jour des réunions du comité de pilotage régional.
• Établir des accords/instruments bilatéraux et multilatéraux pour faciliter la collaboration transfrontalière et l›échange d›informations sur la santé publique dans le cadre d’une approche une santé.
• Élaborer et mettre en oeuvre des plans d›action conjoints pour renforcer les activités de surveillance transfrontalière en vue de prévenir les urgences de santé publique de portée internationale et d›y répondre.
• Renforcer la prévention et le contrôle des infections en milieux hospitalier et communautaire.
• Renforcer les soins de santé primaires pour mieux préparer la riposte aux évènements de santé publique et épidémies.
  DEMANDONS au CDC Afrique de :
• Mettre en place et faciliter un Groupe de travail technique régional sur les COUSP afin de définir les priorités régionales et de suivre les progrès de la mise en oeuvre des COUSP dans la région ; et
• Mettre en place un programme continental de formation à la gestion des urgences sanitaires afin de répondre aux besoins croissants en ressources humaines bien formées pour les COUSP ;
• Élaborer un cadre continental pour guider le renforcement de la surveillance transfrontalière et le partage d›informations en mettant clairement l›accent sur les priorités régionales et les plans d’action stratégiques.
• Mettre en place un comité composé d’experts juridiques de CDC Afrique et de représentants des États membres de l’Afrique centrale pour convenir des modalités de conclusion de l’accord de partage de données, y compris l’offre d’un soutien politique et réglementaire dans le cadre d’un engagement global pour l’accord de partage de données dans la région de l’Afrique centrale ;
• Aider les États membres de l’UA à adapter et à rendre opérationnelle la stratégie continentale de surveillance transfrontalière.
• Apporter un appui technique pour le renforcement de la prévention et le contrôle des infections en milieux hospitalier et communautaire.
  APPELONS EN OUTRE l’OMS, les autres partenaires et les parties prenantes de la préparation et de la réponse aux situations d’urgence à :
• Assurer une coordination et une collaboration étroites avec le CDC Afrique et d’apporter le soutien nécessaire au groupe de travail régional COUSP et aux efforts de renforcement de la surveillance transfrontalière
• Aider les États membres de l’UA à accélérer la mise en oeuvre de l’appel à l’action de Lusaka ; et
• Mobiliser les ressources et les experts nécessaires pour accélérer la mise en oeuvre des feuilles de route nationales COUSP, de la stratégie continentale de surveillance transfrontalière et des plans d’action transfrontaliers conjoints.
  
  Fait le 27 octobre 2023, à Oyala en Guinée équatoriale.

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The meeting was represented by eleven (11) of the thirteen (13) vaccine manufacturing Member States: Botswana, Egypt, Ethiopia, Ghana, Kenya, Morocco, Nigeria, Senegal, South Africa, Rwanda, and Uganda, including National Regulatory Authorities (10), African Continental Free Trade Area (AfCFTA), Regional Economic Communities (3), Gavi, UNICEF and UNECA and manufacturers from potential African vaccine manufacturing countries. The delegates deliberated on the submission by Africa CDC and UNECA on the proposed Legal Instrument for the adoption of AU Pooled Procurement Mechanism (PPM).

The meeting:

1. Recalls the 55th Decision of the African Union (AU) Assembly (AU/Dec.55 (IV), during the Abuja Summit in January 2005, requesting the AU Commission to develop the pharmaceutical Manufacturing Plan for Africa (PMPA);

2. Further recalls the establishment of the Partnerships for African Vaccine Manufacturing (PAVM) in April 2021 and endorsement by the Executive Council (EX.CL/ Dec.1129(XXXIX));

3. Recognizes the call by the AU Heads of State and Government for Member States, Regional Economic Communities, and Regional Mechanisms (RMs) to adopt measures to promote resilience against future pandemics, including investment in domestic vaccine manufacturing capacity (Assembly/AU/Dec. 829(XXXV));

4. Further recognizes the significant role played by AfCFTA, Africa Medicines Agency (AMA), to enhance access to quality medical products and boost trade;

5. Cognise the recommendations of the May 2022 Communiqué of the Video Teleconference meeting of the Bureau of the Assembly of the AU Heads of State and Government extended to African vaccine manufacturing countries to (i) Establish a working group for vaccine manufacturers in Africa, coordinated by the Africa CDC as part of the Partnership for Africa Vaccine Manufacturing, inclusive of other Countries aspiring to produce vaccines; (ii) Set up a procurement mechanism for public health products through AVAT/T, Africa CDC, and Common African Pooled Procurement Systems for public health products to ensure certainty of demand for African-manufactured vaccines and other relevant pharmaceutical products by the end of 2022; (iii) Set up a mechanism to support manufacturers with business case development (iv) Engage high-level advocacy with the GAVI, COVAX, African governments and stakeholders to encourage support for the merging African Vaccine manufacturing industry, and (v) Committed to increasing the demand of vaccines in Africa with a political will and commitment to reach the vaccination targets agreed by the AU and to meet the 70 percent target set by WHO by the end of the year. As such, we committed to fulling the significant lag in deliveries relative to the contractual delivery program through AVAT/T and Afreximbank and called on Member States to take delivery of their contracted vaccine doses and make payment payments on due dates.

6. Commends Gavi on its efforts to uphold the recommendations of the May 2022 communiqué and urge Gavi to move swiftly to adopt the African Vaccine Manufacturing Accelerator (AVMA) by the end of 2023 with a provision of $1 billion;

7. Encourages AVMA to be fit for African Manufacturers, including through preferential procurement by African Union Member States and strengthening of National Regulatory Authorities (NRA);

8. Acknowledges the need for expansion of ongoing efforts of vaccine manufacturing and other health products as per the recommendations of the Ministerial meeting at the sidelines of the 76th World Health Assembly;

9. Appreciates the urgent need for an African mechanism to jointly procure vaccines and other health products by sharing information, conducting market research, negotiating, contracting, tendering, forecasting, supplying, delivering, and administering which can lead to cost savings and promote the growth of the continent’s industry;

10. Pronounces that such a mechanism requires demand and production information, evidence-based policies and programs, adequate resources, and a procurement framework.

11. Commits to advocating for empowering the African National Regulatory Authorities and African manufacturers through lessons learned and good practices worldwide to aggregate demand for health products.

The meeting recommended the following next steps:

1. A Framework Agreement for pooled procurement of vaccines, medicines, and other health products shall be prepared by the Africa CDC to facilitate the pilot pooled procurement mechanism for vaccines while awaiting a legal instrument to expand regional health product manufacturing. The framework will be submitted to the Africa CDC Governing Board and the Committee of the Heads of State and Government for approval, while the draft legal instrument will be tabled for approval at the next AU Summit in February 2024.

2. The framework can be administered through Service Level Agreements, which can be tailored to individual Member States or manufacturers when the need arises. These Service Level Agreements shall;

(a) Encourage regional manufacturing of good quality vaccines, medicines, and other health products in African Union Member States;

(b) Ensure uniformity in the contract for the pooled procurement. The contract shall include transparent clauses about pricing, quantitates, production and delivery timelines, rights and liabilities, and conflicts of interest.

(c) Ensure timely access to vaccines; AU Member States shall focus on infrastructure and digitalization for efficient acquisition and distribution;

(d) Establish a specific funding mechanism, along with the utilization of existing financing arrangements, to support the relevant investment and procurement of essential medical supplies;

(e) Invest in developing local technical skills with continuous training and promoting collaboration between the manufacturers and regulators.

3. The Africa CDC will prepare and implement an activity rollout plan for the negotiations for a legally binding instrument to:

(a) Resolve to develop the “Common African Legal Instrument for Pooled Procurement of Vaccines, Medicines, and Other Health Products” under the African Union Legal framework;

(b) Advocate for global partners to join in seizing this unprecedented opportunity to accelerate regional manufacturing;

(c) Call Upon WHO to support and expedite the Prequalification of African manufactured products to enable donor-funded markets for vaccines, medicines, and other health products;

(d) Urge Gavi and UNICEF to consider alternative prequalification processes, such as recognized African regulatory authorities at maturity level 3, that provide adequate processes to ensure the safety and quality of vaccines;

4. Call Upon the Heads of State and Government to approve the roadmap for the Platform for Harmonized African Health Products Manufacturing (PHAHM) to be developed by Africa CDC, to ensure the expansion of regional manufacturing for all health products;

5. Uphold the principles stated in this Communiqué by ensuring and advocating for alignment with domestic legislation.

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Dr. Sofonias  Kifle Tessema

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19th September 2022 – We, African Union Heads of State and Government, and Heads of Delegations participating at the Special Side Event, “Reimagining Health Workforce Development for Africa’s Health Security” in the margins of the 77th Session of the United Nations General Assembly.

PREAMBLE

MINDFUL that Africa, a continent of more than 1.3 billion people, continues to experience the highest incidence of public health emergencies annually.
DEEPLY CONCERNED by the detrimental impact of the ongoing COVID-19 pandemic across Africa’s health, security, social and economic sectors; FURTHER CONCERNED by the potential negative consequences of existing public health emergencies including the multi-country monkeypox outbreak; the persistent pandemics of HIV, tuberculosis, and malaria; maternal and infant mortality; non-communicable diseases; and impacts of climate change.

RECOGNIZING that Africa bears 25% of the global burden of disease and has only 3% of the world’s health workforce.
RECALLING the commitment by African Union (AU) Member States to meet the Abuja Declaration target of allocating at least 15% of their annual budgets to the health sector.
NOTING the AU Heads of State and Government Declaration, EX.CL/1026 (XXXI) of 2017 on Accelerating the Implementation of International Health Regulations in Africa.

FURTHER NOTING the critical shortage of health workforce in Africa projected to reach about 6.1 million by 2030, and which is made worse by the numerous public health emergencies.
RECALLING the AU Assembly decision, Assembly/AU/Dec.649 (XXIX) of 2017, that urged the AU Commission, together with UNAIDS, WHO and other partners to rapidly recruit, train and deploy two million Community Health Workers equitably across the continent.

FURTHER RECALLING the AU Assembly Decision, Assembly/AU/Dec.4(XXXV) of 2022 that called on AU Member States to accelerate investment in health workforce development and mandated Africa CDC to champion this continental drive.
WELCOMING the progress made by Africa CDC in increasing the quality and quantity of African public health professionals through the delivery of tailored capacity building initiatives.

WE, the Heads of State and Government hereby call for further investment in health workforce
and a new compact for health workforce development in Africa, that include:

1. Redefining and building a fit-for-purpose health workforce
   • Call upon the AU through the Africa CDC, to establish the health workforce task team to implement a compact for health workforce development in Africa as per the Assembly decision.
   • Call upon AU Member States to mobilize all sectors such as health, veterinary, labor, education and finance to strengthen health workers training, deployment and retention.
   • Call upon AU Member States to collaborate through compacting and agree on a set of evidence driven targets to promote harmonization and accountability.
   • Call upon AU Member States to ensure all health workforce are adequately remunerated, particularly community health workers.
   
   
2. Investing in the female health workforce
   • Call upon AU Member States to establish a framework for investment in women health workforce, to ensure systemic and institutional recognition for women’s contributions and leadership.
   
3. Increasing domestic financing and private sector engagement
   • Call upon AU Member States and partners to increase domestic financing for a fit-forpurpose
   health workforce to ensure sustainability.
   • Call upon partners including bilaterals, multilaterals, and finance institutions to mobilise
   more resources for sustainable investment in health workforce in Africa.
   • Call upon AU Member States to provide an enabling ecosystem for collaboration with the
   private sector to leverage their technical and financial resources.
   
4. Transforming and strengthening monitoring, evaluation and learning for health
   workforce.
   • Call upon Africa CDC with support from partners to design, develop and facilitate adoption of a comprehensive metrics framework for health workforce in Africa.
   • Call upon AU Member States to document the socio-economic impact of investing in health workforce and progress towards the Agenda 2063.

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ACKNOWLEDGING the relevant existing frameworks, protocols, strategies and agreements;
WELCOMING the Lusaka Call-to-Action to strengthen Public Health Emergency Operations Centres (PHEOCs) in Africa;
COMMENDING the close collaborations and the efforts being made by the Africa CDC, WHO, and other
partners to strengthen and establish PHEOCs;
MINDFUL that the African Union Member States are at different stages of establishment of national and functional PHEOCs to fulfil the International Health Regulations (IHR) commitments.
CALL UPON AU Member States in the Southern Region to:
• Establish and/or strengthen PHEOCs with legal mandates, equipped with the right infrastructure, and dedicated, well-trained human resources within the next 2 years;
• Provide national PHEOCs with sustainable financing for effective operations in responding to public health emergencies;
• Support the establishment of a regional PHEOC technical Working group (TWG) that sets the priorities and tracks the progress of PHEOC implementation in the region; and
• Include PHEOCs as a standing agenda item in the Regional Steering Committee meetings.
CALL UPON Africa CDC to:
• Establish and facilitate a regional PHEOC TWG to set the regional priorities and track progress of PHEOC implementation in the region; and
• Establish a continental public health emergency management training program to meet the growing needs of well-trained human resources for PHEOCs;
FURTHER CALL UPON WHO, other partners and stakeholders in emergency preparedness and response to:
• Closely coordinate and collaborate with Africa CDC, and provide the necessary support to the Regional PHEOC TWG;
• Support AU Member States to fast track implementation of the Lusaka Call to Action; and
• Mobilize resources and experts necessary to accelerate the implementation of the national PHEOC roadmaps
This communique is delivered at the High-level Meeting of Health Ministers of the AU Southern Region Member States on the 10th of September 2022, in Livingstone, Zambia.

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 Recognizing: the decision of the 58th Ordinary Session of the ECOWAS Authorities of Heads of States and Governments held virtually on 21 January 2021 to develop a strategy for the availability of anti-COVID-19 vaccines in the ECOWAS region and establish the Regional Revolving Fund for the pooled procurement mechanism to accelerate access of vaccines.

Noting: the Africa Centres for Disease Control and Prevention (Africa CDC) and PAVM-Framework for Action meeting held in Kigali, Rwanda from 06 to 07 December 2021, on the fourth objective to build the momentum of vaccine manufacture hubs and pilot a drug API-final drug product Hub program.

Noting: that the ECOWAS region’s share 35% of vaccines market volume demand on the Africa continent, driven by population size.

We the stakeholders in Vaccines Manufacturing in the West Africa Region under the leadership of ECOWAS/WAHO and Africa CDC met in Accra, Ghana from May 10^th to 11^th, 2022 to discuss on how to collaborate to ensure the production and availability of quality, safe and efficacious vaccines in the region.

The main objective of the high-level meeting is to create a framework for collaboration, information exchange and develop a framework for vaccines producers in the West African region to discuss strategically how to support each other build the regional hub for vaccines production.

Specifically, the meeting aims to:  

• Identify the bottlenecks in vaccines research and development and production.
• Identify and define the types of vaccines to be produced for the region by each manufacturer.
• Define short, medium, and long-term strategies to boost vaccines production in the region
• Engage more partners and biotechnology developers to liaise with manufacturers.

Background

• The ability to manufacture hundreds of millions to billions of doses of vaccines requires the vaccine-manufacturing capacity of the entire world. (Corey et al 2020., Science, 368: 948-950).

• Africa has around 16% of the world’s population and carries about 25% of the world’s global disease burden. Over 50% of the world’s infectious diseases burden (HIV, Ebola, Lassa fever, etc…) is borne by Africa. Less than 1% of the vaccines required by Africans are produced in Africa, creating a significant health security risk.
• Building regional manufacturing capabilities will contribute to pandemic preparedness and strengthening the response to future outbreaks. This should include training in current Good Manufacturing Practices (cGMP), Regulatory issues, etc. Consideration should also be given to investing in pre-clinical research and development (R&D) activities as well to drive more ownership of the R&D value chain in the region and the continent.
• Investing in late-stage clinical trials, trial sites and production capacity for endemic/pandemic disease products could improve access to vaccines, therapeutics, and diagnostics in Africa.
• Economic returns would be especially high if new vaccines were produced for regional markets rather than narrow domestic markets only. Each country can also seize the African Continental Free Trade Area (AfCFTA) opportunity to trade with other countries outside the West African region. This means that developing and producing vaccines for a larger group of countries is favorable compared to narrowly targeting domestic markets, where currently 99% of Africa’s vaccines are imported due to very limited vaccine upstream and downstream production.

Recommendations:

1. The meeting agreed on types of vaccines to be produced in the region into considering that diversification of vaccines products (combining child immunization programs and adult vaccination programs that will require demand generation) will also help support manufacturers.

This includes twenty-two (22) identified vaccines which were further divided into 3 based on current and planned vaccine manufacturer’s capacities and capabilities in s terms of short-term, medium-term and long-term depending on the period of production.

Short term: Yellow Fever vaccines, Anti snake serum, Covid-19 vaccines, Pentavalent, Rabies, Measles, Ebola, Typhoid, Lassa, Rotavirus, Tetanus and Polio Vaccines (IPV)- 2022 to 2024

Medium term: Human papillomavirus (HPV), Pneumococcal (PCV3), Polio Vaccine bOPV-4 (oral), Malaria, Measles MMR, BCG, HepB-Pediatric, Meningitis A and 2025 -2027

Long-term: Anti-cancer, 2028 to 2030

2. There is a need for collaboration among manufacturers to prevent duplication of efforts. Focus should be on building sustainable bio-manufacturing capacity to meet regional health needs. Such an aspiration will require a completely new way of thinking than what is currently being planned. It should be borne in mind that multiple Fill and Finish plans for COVID-19 vaccines outstrip the needs or current demands). For example, the current mRNA technology will need to be utilized to develop other priority diseases. The region can work closely with Partnerships for African Vaccines Manufacturing (PAVM) which will have oversight of vaccines manufacturing activities in the region and the continent.
3. ECOWAS countries and partners should deliberately support manufacturers to de-risk their investments, finance/funds e.g. Advance purchase commitments, grants, soft loans, and other regional or country specific incentives. Strengthening routine immunization programmes will also demand for locally manufactured vaccines.
4. ECOWAS/WAHO should play the role to build human resource capital/training, support research development, infrastructure /equipment, logistics and market shaping (design) and technology transfer.
   
5. R&D capacity available in the region needs to be strengthened and utilized in complementary fashion to fulfil gaps in the vaccine R&D value chain on the African continent. Further, the great potential regional organizations offer in manufacturing and R&D talent development should be fully explored and utilized to support the continental needs.
   
6. ECOWAS/WAHO should establish pool procurement to guarantee offtake of vaccines in the region. (Discussion should start with plans to develop strategic stockpiles and distribution plans to support national vaccination programs. That will mean that countries will have to quantify their national needs, pool it across the regional, and use that to provide advanced market commitment to the industry over extended periods of time – at least 5yrs. This way the industry will be able to manage idle facilities).
   
7. ECOWAS/WAHO should also consider endorsing and engaging in a continental pooled procurement mechanism- the Africa Vaccines Acquisition Task Team (AVATT) and get all institutions such as COVAX facility, GAVI, UNICEF and other partners to purchase vaccines produced in the region for its population. This will help drive the continental ambition of growing vaccines manufacturing across other regions as well.
   
8. ECOWAS governments should work to enhance existing trans-border trade policies to enable sale of vaccines within and across the region.
   
9. There is an urgent need to implement harmonization of NRAs and the establishment of the ECOWAS Regional Medicines Agency (ECOMA) in the region and link to Africa Medicines Regulatory Harmonization (AMRH) and Africa Medicines Agency (AMA) to support implementation of the continental strategy in line with the framework for action of PAVM/Africa CDC, with the support from WHO to coordinate for optimal implementation of activities on the continent.
   
10. Market fragmentation will kill all interventions to get vaccines and biologics to the market. Market approvals must be regional in the minimum or continental. There’s a need that this becomes the immediate area of work for ECOMA and AMRH/AMA.
    
11. Regional or continental approval decisions will have to be domesticated by individual countries.
    
12. The need to strengthen individual NMRAs regulatory systems in the ECOWAS region and improve on current good manufacturing practices (cGMP) to international standards for the sustainability of the vaccines manufacturing.
    
13. The need to strengthen relationship with the United Nations Economic Commission for Africa (ECA) reaffirm its support and commitment to continue working with all relevant partners to transform ideas into action for the Africa.

REQUESTS:

1. Heads of Governments, Health Ministers, Ministers of Industries and relevant Ministries to help facilitate adoption of the recommendations of this meeting by providing stronger political commitment.
2. ECOWAS/WAHO to engage stakeholders, technical and financial partners to fund the vaccines manufacturing in the region.
3. That national vaccines manufacturing plans are aligned with the regional and continental plans to prevent duplication of efforts.
4. ECOWAS/WAHO to follow up with stakeholders to ensure that the regional priorities are achieved.

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In 2020, the African Union (AU)/Africa CDC launched the Partnership to Accelerate COVID-19 Testing (PACT). As of 4 February 2022, more than 95.5 million tests have been carried out and more than 10.8 million cases of COVID-19 have been detected in AU Member States, representing 3% of all cases globally[1]. According to WHO Regional Office for Africa, 85% of COVID-19 cases remain undetected in Africa[2]. Despite all the efforts to scale-up COVID-19 testing in Member States including wider use of rapid antigen diagnostic tests (RDTs), accessibility of diagnostic testing still remains an area for improvement. Furthermore, the recently emerged and rapidly transmissible Omicron variant[3] could make the situation more challenging. As with asymptomatic infections, the mild symptoms from infection by variants of concern such as Omicron may further contribute to an increase in the number of infected people who do not seek testing and/or medical attention. There is therefore;  a need to intensify COVID-19 testing in AU Member States using all existing testing approaches, including introduction of rapid antigen self- testing. Access to self-testing can improve the detection of asymptomatic and mildly symptomatic cases and increase the current coverage of the COVID-19 testing with linkage to treatment and self-isolation.

Self-testing as adopted from the WHO guidelines for HIV self-testing and partner notification (2016), is a process whereby a person collects their own specimen from their body using a simple device and uses that specimen to perform a diagnostic test and interprets the results usually in a setting, either alone or with a person they trust[4]. In the case of COVID-19 self-testing, this process involves an individual using approved SARS-CoV-2 In vitro diagnostic kits and devices to privately collect their own sample and perform a COVID-19 antigen rapid diagnostic test (Ag-RDT).

Advantages of Self-Testing

Like point-of-care (POC) COVID-19 Ag-RDTs, COVID-19 Ag self-tests have many advantages: a) ease of use, b) short turnaround time, and c) lower cost compared to Nucleic Acid Amplification Test (NAAT), ultimately allowing widespread utilization of COVID-19 testing in Member States. Moreover, the COVID-19 Ag self-tests allow for even greater decentralization of testing away from testing centers or facilities, including the convenience of at-home testing.  

Many of COVID-19 Ag-RDT kits for professional use are simple and reliable, but they are not applicable for a home testing strategy due to their sampling strategy (most require nasopharyngeal or oropharyngeal specimens). Recently COVID-19 Ag self-tests that use nasal swabs have received regulatory approvals and are available in the market.

Potential benefits of Self-Testing

Self-tests allow individuals to obtain a rapid result, thereby enhancing the early detection, self-isolation, and treatment of infected individuals, which in turn is essential for the pandemic control. From a public health perspective, COVID-19 Ag self-tests can conveniently complement POC tests by allowing wider access to testing throughout the country. COVID-19 Ag self-testing overcomes the downside of POC Ag-RDTs, which may include a high burden on health workers; limited access by individuals who would otherwise get the service within the confinement and convenience of their privacy; delayed diagnosis from suspected onset of COVID-19 symptoms; increased travel costs incurred to reach centralized testing; and risks of further exposure as people gather at testing facilities.

The AU/Africa CDC recommends the implementation of COVID-19 Ag self-testing in AU Member States as an adjunct strategy to improve access to COVID-19 testing. Africa CDC working through the continental laboratory technical working group will publish interim guideline on the use of COVID-19 Ag self-testing very soon. Based on lessons learned from self-testing for other diseases, the COVID-19 Ag self-test, will be critical in fighting the current pandemic.

The AU/Africa CDC is launching the “Know your COVID-19 Status Initiative” as part of the Partnership to Advance COVID-19 Testing by scaling up Rapid Antigen Self-Testing

[1] Coronavirus Disease 2019 (COVID-19) – Africa CDC
[2] Six in seven COVID-19 infections go undetected in Africa | WHO | Regional Office for Africa
[3] Science Brief: Omicron (B.1.1.529) Variant | CDC
[4] 2016 WHO guidelines for HIV self-testing and partner notification

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