CategoriesWACI Health News

COVID 19 AND LACK OF FUNDING NEGATING GAINS HIV PROGRESS

Stakeholders have warned that COVID 19 disruptions are likely to set back efforts made in curbing HIV infections back to ten years or more. According to UNAIDS’ new report released in July 2020, while securing antiretroviral therapy has been steadily improving, the progress is inequitable. In its report, Seizing the moment, the World Bank warns that if we don’t act, even the gains made will be lost. To reach the Millions still left behind, nations must double down and work with more urgency.

Unequal progress

Prevention of new HIV infections in Africa is far behind the rest of the world. Nearly two million people were newly infected with the virus, more than three times the global target. Seizing the moment report shows unequal progress, leaving behind vulnerable people and populations. For example, infected key populations such as gay men and their partners, men who have sex with men, sex workers, drug users and people in prison, accounted for 62 per cent of these new HIV infections. Women and girls from marginalised communities face barriers to accessing reproductive health services, especially contraception and HIV services. Those living with HIV/AIDS face stigma. A total of 59 per cent of all new HIV infections in Sub-Saharan Africa in 2019 were among women and girls, with 4500 girls and young women between 15 and 24 years old becoming infected every week. Thus, a growing number of young women are getting HIV infection, despite only making up 10 per cent of the population in sub-Saharan Africa.

Exclusion, stigma and discrimination

Social inequity and exclusion, stigma and discrimination have proven to be significant obstacles in curbing the new HIV infections. At least 82 countries criminalise HIV transmission, exposure, or non-disclosure, 103 criminalise sex work, and 108 criminalise the use, possession, or consumption of HIV related drugs.

 

Progress in targets

There is, however, a significant reduction in HIV transmission levels where comprehensive HIV services are provided. In addition, combining proactive medical practices with social and economic support for young women in Eswatini, Lesotho, and South Africa has narrowed inequality gaps and driven down the incidence of new HIV infections. Fourteen countries have achieved the 90–90–90 HIV treatment targets (90% of people living with HIV know their HIV status, of whom 90% are on antiretroviral treatment and of whom 90% are virally suppressed), including Eswatini, which has one of the highest HIV prevalence rates in the world, at 27% in 2019, and which has now surpassed the targets to achieve 95–95–95. The expansion of antiretroviral therapy has saved countless lives.

 

However, in 2019, 690 000 people died of AIDS-related illnesses 2019, and 12.6 million of the 38 million people living with HIV did not receive life-saving treatment. Although progress has been made, it is masking the lack of progress and challenges that continue to persist, threatening the progress made during the past decade, with tragic consequences for people’s lives, economies, and health security. Again, Sub-Saharan Africa is most affected.

 

A case for biomedical research

Reducing new HIV infections need to be a deliberate act in Africa. It is imperative that the locally tailored, evidence-based, and community-owned programs be tailored to sustainably reduce new HIV infections.

In the just-concluded 5th Biomedical HIV Prevention Forum (BHPF) hosted virtually in South Africa which focused on Financing of HIV Prevention Research in Africa, findings revealed that most countries did not have funding for biomedical research, and where research happened, it was mostly donor-driven.

To achieve Africa free of New HIV infections (AfNHi)’s vision of ending new HIV infections in Africa, the BHPF aims at mobilizing scientific knowledge and building bridges between science and policy. In addition to mapping potential for collaborative national and regional activities within the AfNHi network, the forum looks to strengthen connections between policy and research through information exchange with HIV prevention advocates.

 

Reporting on the state of funding biomedical research in Africa, Dr Caleb Mulongo, in his research findings based on four countries; Kenya, Rwanda, Eswatini and Malawi noted that none of the four countries met the recommended allocation of two per cent of a country’s domestic budget to biomedical research.

 

While the Abuja Declaration targets that 15 per cent of the national budget be allocated to the health docket, none of the four studied countries (Kenya, Rwanda Eswatini and Malawi) met the target. The highest was Malawi with 11.5 per cent, with Kenya reporting the lowest allocation at less than seven per cent. Rwanda allocated about eight per cent while Eswatini allocated about nine per cent of their national budget to health.

When it comes to research allocation, Malawi set aside 1.06 per cent, which was the highest allocation from the studied countries. Eswatini had the least allocation, at 0.3 per cent.  Kenya allocated 0.79 per cent while Rwanda 0.27 per cent. It is evident low allocation in the health sector which is not adequate to support quality and universal coverage of health means there is very little if any funding to allocate to biomedical research.

More than underfunding

The mini-BHPF conferences held in Rwanda, Zimbabwe and Cote d’Ivoire, presented during the main BHPF forum had similar findings, that their respective countries had not prioritized biomedical research for preventing new HIV infections. More challenges beyond funding were nevertheless noted. There was a lack of expertise in writing proposals, those in charge do not know how to bind for funds to support their activities and where research was conducted, it was noted that because it was donor-driven, it did not particularly priorities local issues, but rather ran with the donors’ agenda.

 

Own the process

A challenge has been thrown to African governments to invest more in biomedical research for HIV prevention funding, as well as invest in making sure systems are in place for translating findings into actions. A case of Malawi was noted, whose National Research Council of Malawi (NRCM) is domiciled in the Office of the President. This positioning is thought to be responsible for the higher allocations in the Health docket, hence elevating research as a national priority.

 

Other stakeholders including advocates for change, Civil Society and communities, Researchers and Front-line providers were called upon to keep the momentum for biomedical research HIV prevention funding, by pushing for better allocations of funds, elevating the discussion to the national level where policymakers sit and as well as information sharing across the countries.

CategoriesWACI Health News

Speeding up Investments in Research and Development to Meet Public Health Needs

For over a decade, advocates for HIV prevention research have called for stronger political will and global solidarity towards a preventive vaccine and other prevention tools for HIV. COVID-19 has demonstrated how political will can help accelerate scientific breakthroughs. The COVID-19 vaccine is a case in point: science, political will and global solidarity came together to find a tool that has helped protect millions and could protect billions if inequitable access issues are addressed.

As advocates call for action, it’s clear that greater domestic investment in health research and development (R&D) will be critical for improving health, equity and development. However, despite a disproportionately high burden of disease, Africa still lags in health R&D to address the region’s health challenges. We attribute this in large part to inadequate funding among other factors.

A recent publication, ‘Situation analysis report on the mobilization of resources for health research and development’, commissioned by Africa Free of New HIV Infections (AfNHi)WACI Health and Coalition to Accelerate & Support Prevention Research (CASPR), examines the financing problem of health R&D in Africa. It reports on progress but finds efforts have fallen gravely short of the target, with serious implications. This report comes at an opportune time, as COVID-19 puts a spotlight on the importance of health R&D and the need for greater domestic leadership and international commitment.

Accounting for over 15 percent of the world’s population, the continent bears 25 percent of the burden of disease at the global level, produces only 2 percent of the world’s research and only accounts for 1.3 percent of publications on global health. As explored in the report, regional commitments have been made to increase government spending on health R&D. For instance, the 2008 Bamako declaration calls on African governments to allocate at least 2 percent of budgets of ministries of health to research. Similarly, the 2008 Algiers Declaration calls on African governments to invest at least 2 percent of their national health expenditures and at least 5 percent of their external aid in projects and programs that build capacity and advance health research. However, despite such commitments, such investment remains gravely low in Africa.

Source: Simpkins (2019); Analysis by AfNHi Consultant

Based on the map above, domestic funding is inadequate for sustained and impactful research in health as most governments are investing less than 2 percent of their GDP, yet several health problems demand more investigation, arising from specific conditions, such as HIV, Malaria, challenges to maternal health, that are so widespread that they undermine public health at large.

Financing for health, especially R&D, relies heavily on foreign aid. This presents opportunities and challenges. Foreign aid brings skills, technology transfer, infrastructure for research and other resources. But the challenges are important to consider. Foreign aid can put funder research priorities ahead of host country priorities. Foreign aid can also be tied to a lack of local ownership, exploitative research partnerships, focus on publications vs. investing in the capacity for sustained research and development, and undermining the independence and success of innovative domestic research institutions. In some countries where governments have committed significant investment for health R&D, it’s often not financial, and often not useful. For financial investments, for instance, in 2017, the SciDev.Net reported that Uganda committed 30 billion Uganda Shillings (about USD 9Million) to support innovation and technology, and the first round of grants would be given mostly to individuals who had products in place. But critical voices point out that giving these funds to individuals rather than institutions undermine efforts to develop a sustainable ecosystem for innovation, one that supports individuals and a system that nurtures them.

Some of the sharpest criticism among African scientists, ministers, advocates and other observers say research in Africa too often can be experienced by African scientists as extractive, a ‘slave model’, where foreign funders reap the benefit of African intellectual labour but leave behind few benefits for ordinary Africans. Researchers are sustained by their own governments to continue their work with salaries and operational costs. Those same researchers advance proposals to foreign donors, often in consortia, and may individually benefit from publications, promotion, peer recognition and presentations at international conferences. But the true impact of their labour—the field advances with new tools, products and interventions—is not felt at home. An African scientist quoted in Scidev.net noted “Maybe we should have an incentive system structured differently in research institutions. Innovation is a public good with commercial value and industrial application, but a publication has knowledge value. When we reach an extent where they will use the commercial output from innovators other than publication, we shall see more innovations come out.”

The Situation analysis report on the mobilization of resources for health research and development finds that Africa has made progress towards financing for health R&D, especially in the past decade, but many African countries still have significant gaps to address. Of all the sampled countries, the report showed that Malawi had the highest proportion allocated to research in general at 1.06 percent of GDP, while Kenya had 0.79 percent, Rwanda 0.66 percent and Eswatini 0.27 percent. The report has clear recommendations – for policymakers and civil society organizations to address the challenges.

The reports’ findings and recommendations call for:

a. Increased government funding for health and research, which signals government leadership and commitment, and encourages greater investment from domestic partners
b. Strengthening existing laws, regulations and policies and enacting new ones were needed to guide research
c. Increase the influence of research on government policy by locating research closer to political power and aligning research priorities between researchers and governments
d. Governments must lead and facilitate collaboration between government and the private sector to fund and conduct contextually relevant health research
e. Research in Africa must prioritize benefits to Africans in research and development Incorporate robust accountability structures for efficient use of research resources
f. Advocating collectively for an enabling democratic environment for effective research
g. Strengthen cross-sectoral partnerships among CSOs to advocate for health research and development
h. Strengthen the advocacy capacity of CSOs in health financing and health research

The following are key strategies that advocates should consider:

1. Demonstrate to governments how specific investments are cost-effective, bring health and socioeconomic benefits, and enable broader governmental objectives
2. Explains the consequences of not investing in health R&D, including a slowing economy, reluctance of business and funder entities to invest, a “brain drain” of science and medical professionals, and cascading losses of the R&D benefits to other countries
3. Choose a collaborative approach to ensure that key government officials and policymakers view advocates as assets, partners and problem solvers with whom relationships can be formed towards the realization of health objectives and the mobilization of resources
4. Partner with experts in disciplines such as economics, public finance, business and international development for the strongest possible advocacy for health R&D
5. Strengthen capacity to interrogate and track government funding and actual expenditure on health R&D

The report concludes that governments, among others, in low and middle-income countries (LMICs) must prioritize and ensure budgetary allocations to health R&D, beyond the non-financial investments. Budget commitments have the potential to attract additional investments by partners and demonstrate political will. It’s time to champion this work!

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