Creating African driven solutions to continent’s public health issues

Dr. Chimezie Anyakora, a Pharmaceutical Chemist by training, was the Chief of Party of Promoting the Quality of Medicines Programme (PQM) of the United States Pharmacopeia Convention (USP) in Nigeria. Anyakora who is now the Project Lead of a new concept, Bloom Public Health, in this interview with The Guardian said the programme was born out of the need to create African driven solutions to solve African public health issues, especially in the pharmaceutical sector. He explained how coronavirus-induced economic meltdown would affect public health financing and increase cost of essential medicines. Anyakora, however, said the programme would support building a resilient health system by developing and strengthening rapid access to medicines and therapeutics in general, including vaccines, which are needed especially for clinical care during epidemics. CHUKWUMA MUANYA writes.

What is this new concept, Bloom Public Health and how is it different from PQM?
Bloom Public Health is a Think tank that convenes the most innovative African minds in Public health, and forges global partnerships to design interventions that are tailored to the continent. Bloom was born out of the need to create African driven solutions to solve African public health issues, especially in the pharmaceutical sector.

Currently, we see many gaps in foreign run programmes, which leads to misuse or underuse of millions of funding dollars yearly. To remedy this, Bloom will apply our decades of collective expertise and strategy, to tailor solutions to the African context. We are different because quite simply, we believe talented Africans need to be on the drivers seat to solve Africans public health challenges.

What issues will Bloom tackle immediately and how?
Our interventions fall under three broad categories in public health: supply chain, pharmaceutical quality systems and policy. When these three concepts are combined Bloom Public Health will be able to make significant impact on public health in Africa and help achieve the universal health coverage.

Does the project have any solution to coronavirus, Lassa fever and other epidemics?
Every epidemic puts a lot of pressure on the health system and it becomes more challenging when the health system is weak as could be found in many African countries. Supply chain within the health system, which involves the flow of goods and services is negatively impacted in the areas of workforce, access to essential medicines, as well as service delivery because of such epidemics. Furthermore, public health financing is also affected because of economic slowdown as evidenced by coronavirus epidemic. Most African countries are import dependent for essential medicines and active pharmaceutical ingredients. The coronavirus for example has had a disruptive impact on global pharmaceutical supply chains. Wuhan where the coronavirus was first discovered is a hub for major active pharmaceutical ingredient makers and many countries depend on them. China because of the crisis they have faced so far have been inclined to hold unto supplies for certain pharmaceutical and by implication export less to other countries. So many drug makers have very low stock of active pharmaceutical ingredients thereby predisposing their customers, which include Nigeria to shortage of finished pharmaceutical products in addition to active pharmaceutical ingredients. Epidemics also lead to the increase in the cost of goods and services. In the case of pharmaceuticals and still using the coronavirus as an example, there has been a lot of cancelation of the sailing of vessels and flights from China with implication in increases in the cost of such pharmaceuticals.

The world is a global village. Global health security is as strong as its weakest link. Nigeria through the Nigeria Centre for Disease Control (NCDC) leadership has made progress in coordinating and responding to epidemics in recent times. Bloom Public Health will support building a resilient health system by developing and strengthening rapid access to medicines and therapeutics in general, including vaccines, which are needed especially for clinical care during epidemics. We will also support lab strengthening to enable quick access to accurate results. Nigeria is doing well in early detection and preventive measures; however, we must be prepared to offer appropriate clinical care. Bloom Public Health will also contribute to massive awareness and education of the population on the appropriate preventive measures against the occurrence of any spread of diseases.

Your journey is quite impressive. How does your background as a Pharmaceutical Chemistry professor, Harvard Kennedy School alumnus and one of the most notable country leads of a global organisation like USP culminate to this?
As an academic I see things with certain depth and rigour. As a public health executive who alongside other notables championed and initiated change in Nigerian public health, I have a very unique context of the situation. Having led the strategy and implementation to successfully strengthen an entire country’s health system. My team has first hand knowledge of the challenges and roadmap required to replicate this across the continent. Being an active contributor at the continental level on various pharmaceutical policies also gives our team insight to help develop practical frameworks. A particular course at Harvard “ Creating public Value” challenged my innovative side and further triggered desire to do more for our continent and we can do more by thinking bigger and better.

Does Bloom Public Health support local production of drugs?
Yes. One of the three pillars of our intervention is pharmaceutical quality system. We fully appreciate that not all countries across the continent can manufacture medicines. There are five levels of pharmaceutical maturity of a given country and in order they are- importation; packaging, manufacturing of finished pharmaceutical products; manufacturing of active ingredients and lastly research and development. Stimulating quality local manufacturing is a priority however most countries in Africa are between level one and three. We will work to build the capacity of those from level one to three and scale up production for those on level four or five. So we will develop a robust in country medicine supply chain system that ensures quality medicines to the patients.

Does it support clinical trials for drugs and vaccine?
Bloom will be heavy on public health policy, so depending on how appropriate it is we would support countries to achieve this. We will be encouraging a lot of South-South collaboration. Our focus will be to provide a tailored made solution to different countries in ways that will suit them most. Clinical trial is important but Africa should not seen as a testing ground for medicines. Working with all the stakeholders and following well-written protocols clinical trial will contribute significantly to the public health in the continent.

When you say think bigger and do better, what do you mean?
Who understands Africa better than Africans? No one. So we must do better by taking ownership of how we want our interventions to be indigenously led but globally operated. Reliance in foreign assistance and intervention will end eventually. And Bloom Public Health is at the forefront of heading the movement to applying homegrown solutions to address our gaps in the most cost efficient, practical and tailored way.

The Bloom philosophy forces us to think bigger by ensuring three S: scalability, sustainability and suitability of every intervention for continental impact.

Since Bloom came into existence, the level of excitement has been amazing and I am confident that we will achieve our aim and give millions of people on this continent opportunity for better health outcome.

Weak supply chain including quality assurance systems have negatively affected the implementation of donor funded projects in the health sector especially in Nigeria. What will Bloom Public Health do differently?
We will combine our expertise, experience, and better understanding of Africa; to support the effective implementation of donor funded projects. We will always focus on the principles of aid effectiveness in line with the Paris declaration on aid effectiveness, and the Accra agenda for action, which have not received adequate consideration in Africa. The principles have to do with the application of ownership, alignment, harmonization, managing for results, and mutual accountability in all donor project implementation. We have discovered for instance, that much as the donors want to hold the recipients accountable for results, the recipients also want to hold the donors accountable on their commitments.

Nevertheless, there is a gap in evidences that could make such mutual accountability be in place and one major contribution to such gap is inadequate operations research that could generate evidences for effective decision-making. We will therefore create awareness for our clients, and also encourage and support efforts by them to strengthen operations research that will lead to the judicious application of aid effectiveness principles especially as it applies to supply chain, which will ultimately improve the quality of services to the aid beneficiaries. We will work for strong and sustainable supply chain systems that will ensure that donor funded health products are not wasted or misused.

Can Bloom address the imminent drug and medical supplies scarcity in Nigeria?
I have earlier listed the five levels pharmaceutical maturity of a given country as importation, packaging, manufacturing of finished pharmaceutical products, manufacturing of active ingredients, research and development. Since most African countries are between levels one and three, dependence on the importation of active ingredients is a huge challenge. Bloom Public health will render services in strategic sourcing of drugs and medical supplies from available alternative sources in close collaboration with relevant stakeholders.