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The importance of telemedicine technology for Africa

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Many African countries are still consistently looking forward to improve healthcare delivery to millions of people living in rural communities with little success. In this interview, Professor Mikhail Y. Natenzon, chairman of board of the “National Telemedicine Agency” Research-and-Production Union and also deputy head of the Regional Working Group for Telemedicine of the Regional Commonwealth for Communication of the CIS countries, tells Kester Kenn Klomegah, an independent researcher and policy consultant on African affairs in Russia and Eurasian region that the establishment of compatible national telemedicine systems, which has many advantages, can suitably be adapted to the local conditions of any particular African country.

How important is modern telemedicine technology for African countries? And the reasons why you are passionately exploring Africa?

Economic development of African countries reached the level where the government can begin a strategic reform of health systems to create a modern, meeting the world standards of health care. The implementation of these programmes will solve health problems and give African countries the opportunity to take the next leap forward in economic and social development.

African governments and international specialized organizations have now developed and are implementing various programmes to improve the quality of life of African populations. The most advanced project is the elimination of the epidemic of socially dangerous diseases such as HIV/AIDS, tuberculosis and malaria and allocate significant funds for it. Indeed, one of the problems of the slow development of African economies is the fact that people suffering from malaria are unable to work effectively and vigorously. Another important international project is the maternal and child mortality reduction programme.

Significant, multi-billion dollar funds have been allocated by governments and international organizations to these projects, and the results are clearly not in line with the efforts made. The efficiency of investments is not large enough.

The reasons for this are, inter alia, the inadequate health infrastructure in Africa, its concentration in major cities and the almost total absence in rural, remote and hard-to-reach areas, where about 60 per cent of the population-600 million people-live. It is obvious that the traditional methods of providing medical care can not work in the current situation.

Therefore, we have developed new methods to ensure accessibility and a single high standard of quality medical care for the population, especially in rural areas and remote areas. These system solutions, technologies and equipment are based on the widespread use of Russian information and telemedicine technologies. These proposals are now practically non-alternative, as confirmed by the documents of the UN, the world Health Organization, the International Telecommunication Union, the African Development Bank and other international organizations.

As it’s already known, many African rural communities are very limited or disadvantaged with sources of energy (electricity), but how could telemedicine be useful for these remote areas of the continent?

The problem of all rural areas in Africa is the underdeveloped social and health infrastructure. Its creation with the traditional approach is a long and very expensive project. Moreover, such infrastructure will always experience a shortage of qualified medical and technical staff. But most importantly, its exploitation will require large funds that are not available to either rural communities or the state. The only solution for the cost effective implementation of social development goals in Africa so far is the establishment of an integrated telemedicine system.

It consists of two parts: network of telemedicine consulting-diagnostic centers, established in stationary medical institutions of different levels, and communication associated with them system of the mobile telemedicine laboratory diagnostic facilities (the ITC) in various fields. The ITC is designed to address a wide range of health challenges and provide social services to people in rural, remote and remote areas. Built on international standards, it integrates with similar systems in other African countries and Russia, interacting with telemedicine systems in other countries.

A key element of the mobile telemedicine complex and mobile hospitals can provide medical care to the population in remote and inaccessible areas in a completely autonomous manner. They have their own power supply system, communication system, up to the satellite, life support systems, crew systems cleaning air and water and many other optional installed systems required for successful operation. Most importantly, the personnel of the ITC may not be a doctor, but an average medical worker. Use MTK allows radically solving the problem of comprehensive medical services to the rural communities. Their residents will not have to get to the city hospitals. The hospital will come to them.

At the same time, qualified doctors working in provincial hospitals, to which the ITC is assigned, can provide advice through telemedicine equipment to personnel of several ITC operating in different parts of the province. This solves the problem of shortage of qualified doctors and reduces the cost of operation of MTC.

Can you discuss innovative tools available in the plant and key competitive advantages? Do you have all the equipment and / or components manufactured in Russia?

The main goal and the main competitive advantages of the medical complex are the solution of four socially important tasks: ensuring accessibility of medical and social services to the population; providing a unified high quality medical and social services for citizens regardless of their place of residence and social status.

It helps optimization of the cost of healthcare while improving its quality and coverage and creation of permanent jobs for highly qualified technical and medical personnel, ensuring the creation and operation of complex.

Other important competitive advantages of the systems offered by us are: High capacity of MTC – up to 20,000 people per year, and therefore, almost 100% coverage of health care for the entire population.

Low cost of rendering medical services to the population due to use of the average medical personnel and absence of need to build stationary medical institutions and to spend means for their operation.

Possibility of step-by-step realization of the project, the complex telemedicine system. At the same time, the system itself begins to function fully from the start of its first segment. Connecting the following segments extends the functionality of the system and without requiring structural adjustment.

There is high investment attractiveness. The expected return on investment in the project is 5-6 years. The functioning of the system is an important contribution to the stable development of the state, providing an increase in the human capital development index. There is also professional development of medical personnel and the use of international standards and the possibility of organizing cross-border telemedicine consultations.

All equipment which is a part of complex telemedicine systems: stationary telemedicine consulting and diagnostic centers for stationary medical institutions of all levels (from the Central hospitals in the capital, to the para-medicine point in the small village), mobile telemedicine laboratory and diagnostic complexes of various medical appointment with all equipment, communication equipment, satellite communication systems, guarantee maintenance of system, preparation of medical and technical personnel for system functioning is the Russian know-how, certified and manufactured in Russia.

At the request of the customer, the system offered by us can be connected with the existing telemedicine systems in the country. The system can begin to operate immediately after the installation of equipment in the country and completion of training. The system is delivered on the principle of “turned on and work” without any complications.

What will be the main direction in terms of implementation of this medical technology projects in Africa? And what are your expectations from African governments?

The main direction of our project for Africa is the gradual creation of compatible national telemedicine systems that can interact with each other and in the long term to create a pan-African telemedicine system. The telemedicine system becomes economically and socially effective when it is a queueing system. This is exactly how the proposed system is designed.

Health systems in almost all countries of Africa basically are state-owned. Therefore, the establishment of compatible national telemedicine systems is possible only in close cooperation with the regional Ministries of health, so that the project can be adapted to the conditions of a particular country and at the same time maintain the universality of national telemedicine systems, so that they can interact with each other. We know the serious efforts that African Governments are making to promote health, and we hope that our cooperation in implementing telemedicine systems will yield significant, qualitatively better results.

MD Africa Editor Kester Kenn Klomegah is an independent researcher and writer on African affairs in the EurAsian region and former Soviet republics. He wrote previously for African Press Agency, African Executive and Inter Press Service. Earlier, he had worked for The Moscow Times, a reputable English newspaper. Klomegah taught part-time at the Moscow Institute of Modern Journalism. He studied international journalism and mass communication, and later spent a year at the Moscow State Institute of International Relations. He co-authored a book “AIDS/HIV and Men: Taking Risk or Taking Responsibility” published by the London-based Panos Institute. In 2004 and again in 2009, he won the Golden Word Prize for a series of analytical articles on Russia's economic cooperation with African countries.

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Africa

African Union’s Inaction on Ethiopia Deplorable – Open Letter

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The crisis in northern Ethiopia has resulted in millions of people in need of emergency assistance and protection. © UNICEF/Christine Nesbitt

A group of African intellectuals says in an open letter that it is appalled and dismayed by the steadily deteriorating situation in Ethiopia. The letter, signed by 58 people, says the African Union’s lack of effective engagement in the crisis is deplorable. The letter calls on regional bloc IGAD and the AU to “proactively take up their mandates with respect to providing mediation for the protagonists to this conflict”.

The letter also asks for “all possible political support” for the AU’s Special Envoy for the Horn of Africa, Olusegun Obasanjo, whose appointment was announced on August 26, 2021. A United Nations Security Council meeting on the same day welcomed the former Nigerian president’s appointment.

Earlier in August 2021, UN  chief Antonio Guterres appealed for a ceasefire, unrestricted aid access and an Ethiopian-led political dialogue. He told the council these steps were essential to preserve Ethiopia’s unity and the stability of the region and to ease the humanitarian crisis. He said that he had been in close contact with Ethiopian Prime Minister Abiy Ahmed and had received a letter from the leader of the Tigray region in response to his appeal. “The UN is ready to work together with the African Union and other key partners to support such a dialogue,” he said.

August 26, 2021 was only the second time during the conflict that the council held a public meeting to discuss the situation. Britain, Estonia, France, Ireland, Norway and the United States requested the session.

Fighting between the national government and the Tigray People’s Liberation Front broke out in November 2020, leaving millions facing emergency or crisis levels of food insecurity, according to the United Nations. Both sides have been accused of atrocities.

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Africa: The G20 Must Recommit to Covax

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It is one year since the international community gave its backing to the COVID-19 Vaccine Global Access (COVAX) facility to lead a worldwide effort to end the acute phase of the pandemic. The initiative aimed to ensure that every country, and not just those with sufficient money or resources, could access life-saving vaccines once they became available. As G20 health ministers prepare to meet in Rome on September 5-6, they are in a position to ensure that COVAX fulfills its mission.

A year ago, no one knew when or even if it might be possible to develop a safe and effective vaccine against COVID-19, let alone the 20 that are available today. But since making its first international deliveries in February, COVAX a partnership established by the Coalition for Epidemic Preparedness Innovations, the World Health Organization, UNICEF, and Gavi, the Vaccine Alliance has delivered more than 235 million vaccine doses to 139 countries, and expects to deliver another billion doses in the fourth quarter. Only China, India, and the United States have delivered more. This start to the largest and most complex vaccine rollout in history has given hope to millions of people and laid solid foundations for how we respond to future pandemics.

Yet, so much more could, and should, have been achieved by now. It is unacceptable that only 1.8% of people in low-income countries have received their first dose of a COVID-19 vaccine, compared to 82% in high- and upper-middle-income countries. This shocking inequality is as economically senseless as it is destructive to human life, with the latest estimate of the cost of the slow rollout amounting to $2.3 trillion.

The world was woefully unprepared for a pandemic, and this is reflected in the challenges COVAX has faced. By the time initial funding arrived, wealthy countries had already locked up early vaccine supplies. Export bans affecting key suppliers, and difficulties experienced by many manufacturers in scaling up production to the required level, also undermined COVAX’s ability to access doses early.

Given increasing global vaccine inequity and the rise of new, more contagious coronavirus variants, we must put these challenges behind us. Thanks to the support of almost all G20 governments, alongside that of foundations and private businesses, COVAX has now raised nearly $10 billion and secured more than 600 million donated doses. All the preparations are in place for the most comprehensive vaccination effort that the world has seen.

Based on the committed orders COVAX has placed with vaccine manufacturers and the additional donations, hundreds of millions of new doses should now be available each month. We need to make sure they reach poorer countries and get into people’s arms. To avoid further delays, and for the facility to succeed, we need support from G20 leaders in four key areas.

First, we need doses, and we need them now. The premise of COVAX was always that the facility should be able to negotiate and buy its own doses. With our early vaccine access compromised, donations have played a vital role in maintaining our ability to keep doses flowing to those most in need. Of the 600 million doses pledged to COVAX to date, 100 million have now been delivered. We need more, and soon, with longer shelf lives and greater certainty so that recipient countries have time to plan their rollout. This can be achieved without jeopardizing high-income countries’ national vaccination efforts.

We also need G20 leaders to support our call for transparency. COVAX has legally binding agreements with manufacturers for more than four billion doses, but has all too often faced delays in accessing them. Without greater clarity regarding firms’ order books, it is impossible to know whether these holdups are due to production challenges or preferential treatment for bilateral arrangements. Insisting that manufacturers are transparent about their order timelines can ensure a level playing field where no one particularly those living in developing countries gets bumped to the back of the vaccine queue because of another bilateral deal.

In addition to ensuring that manufacturers keep their commitment to COVAX, governments should make global vaccine access their highest priority. Countries with pending orders for doses that they currently do not need should allow COVAX to take their place in the queue so that we can get doses to needy countries now.

Finally, lower-income countries require continued financial and technical support for their COVID-19 vaccine rollouts. Strengthening national health systems will help these countries to ensure delivery of doses and mitigate the pandemic’s secondary effects, and will leave in place infrastructure critical to future global health security.

By recommitting to COVAX, G20 leaders will recommit to a multilateral solution that builds on the astounding scientific progress of the past year. Based on COVAX’s latest forthcoming supply forecast, when topped up with doses through bilateral deals, equitable COVID-19 vaccine access can protect up to 60% of the adult population in 91 lower-income countries. This would represent a huge step toward the WHO target of 70%, which is needed to suppress the coronavirus everywhere, and COVAX represents the best opportunity to achieve it.

Failure would mean more lives lost, broken health-care systems, even deadlier and more transmissible variants, and a pandemic with no end in sight. The G20 must not allow that to be an option.

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More African Countries Register Russia’s Sputnik Vaccine

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Africa Centres for Disease Control and Prevention (Africa CDC) is a specialized technical institution of the African Union (AU) that strengthens the capacity and capability of Africa’s public health institutions as well as partnerships to detect and respond quickly and effectively to disease threats and outbreaks, based on data-driven interventions and programmes.

During the outbreak of the coronavirus, the African Vaccine Acquisition Task Team (AVATT), was established by African Union, as a component in support of the Africa Vaccine Strategy and was endorsed by the AU Bureau of Heads of State and Government on 20th of August 2020.

Dr John Nkengasong, Director of the Africa Centers for Disease Control and Prevention (Africa CDC), has emphasized: “Africa has to team up with development partners to achieve its 60% continent-wide vaccination in the next two years. I think that is why we should as a collective of the continent, and of course, in partnership with the developed world make sure that Africa has a timely access to vaccines to meet our vaccination targets.”

An official media release in February 2021, the Africa Vaccine Acquisition Task Team from the African Union (AU) informed that Russia would supply and deliver 300 million Sputnik V vaccines to Africa. That step was intended to support African countries to attain their targeted immunization of 60% of the population by the year-end. That vaccine story disappeared, but instead what become so common is the speedy registration of Sputnik V on bilateral basis in various African countries.

According to the latest, Nigeria has become the 68th country in the world to approve the Russian vaccine. The use of the Sputnik V coronavirus vaccine has been approved in Nigeria, the Russian Direct Investment Fund (RDIF) said in an official statement.

“The Russian Direct Investment Fund (RDIF, Russia’s sovereign wealth fund) announces the approval of the Russian Sputnik V vaccine against coronavirus by the National Agency for Food and Drug Administration and Control of Nigeria (NAFDAC). Nigeria has become the 68th country in the world to approve the Russian vaccine. Total population of all countries, where Sputnik V is approved for use, now exceeds 3.7 billion people, which is nearly half of the global population,” the statement said.

“Nigeria is the most populous nation in Africa, and the approval of Sputnik V will provide for using one of the safest and most effective vaccines in the world. Sputnik V is based on a proven human adenoviral vectors platform and is successfully used in over 50 countries. Approval in Nigeria will make an important contribution to the country’s fight against the pandemic,” CEO of the Russian Direct Investment Fund (RDIF) Kirill Dmitriev said.

Besides Nigeria, other African countries have registered Russia’s Sputnik V vaccine. Reportedly, the vaccine has been registered in Algeria, Angola, Djibouti, Egypt, Gabon, Ghana, Guinea, Kenya, Morocco, Namibia, Tunisia, the Republic of Congo (DRC) and Zimbabwe.

Russia’s drive to share Sputnik V vaccine, of course, offers a chance to raise its image and strengthen alliances in Africa. Ministry of Foreign Affairs of the Russian Federation has made efforts promoting the vaccine using all its channels. But supply and delivery have largely lagged behind, the pledges have simply not been fulfilled. Russian authorities have oftentimes said that they would step up efforts for fruitful cooperation in combating coronavirus in Africa.

Promising more than can be delivered appears to be a universal problem with coronavirus vaccines, and it is a real risk for Russia as well, said Theresa Fallon, Director of the Brussels-based Centre for Russia Europe Asia Studies. “They have won the gold medal for creating this very effective vaccine,” she said. “But the problem is how are they going to implement production and delivery?”

Russian Direct Investment Fund (RDIF), with profit motivation, has attempted supplying the Russian vaccines through, Sheikh Ahmed Dalmook Al Maktoum, from the Monarch family and a third party in Dubai, United Arab Emirates, to a number of African countries. For instance, the Republic of Ghana reportedly signed US$64.6 million contract for Sputnik V vaccine from Russia through Sheikh Ahmed Dalmook Al Maktoum. It was double the price from the producer as reported in the media.

On the other hand, Russian President Vladimir Putin has noted, in a speech early September, that advanced countries that produce vaccines against the coronavirus do little to protect humanity from the pandemic.

“The benefits of vaccination are enjoyed mostly by advanced economies. The bulk of the vaccines is made there, and it is used to protect their own population. But very little is being done to protect humanity in the broad sense,” Putin said at the plenary session of the Eastern Economic Forum in Vladivostok, the Far East of Russia. “This is very bad for the producers, because all this boomerangs around the globe. For instance, in Africa the level of protection with vaccines is minimal, but contacts with the African countries continue. There is no getting away from this. This infection will return again and again.”

According to an official release obtained late February, the Sputnik V vaccine the following advantages:

• Efficacy of Sputnik V is 91.6% as confirmed by the data published in the Lancet, one of the world’s oldest and most respected medical journals; It is one of only three vaccines in the world with efficacy of over 90%; Sputnik V provides full protection against severe cases of COVID-19. 

• The Sputnik V vaccine is based on a proven and well-studied platform of human adenoviral vectors, which cause the common cold and have been around for thousands of years. 

• Sputnik V uses two different vectors for the two shots in a course of vaccination, providing immunity with a longer duration than vaccines using the same delivery mechanism for both shots. 

• The safety, efficacy and lack of negative long-term effects of adenoviral vaccines have been proven by more than 250 clinical studies over two decades. 

• The developers of the Sputnik V vaccine are working collaboratively with AstraZeneca on a joint clinical trial to improve the efficacy of AstraZeneca vaccine. 

• There are no strong allergies caused by Sputnik V. 

• The price of Sputnik V is less than $10 per shot, making it affordable around the world. 

In February, peer-reviewed medical journal The Lancet published an analysis from Phase III clinical trial of the Russian vaccine, showing its 91.6-percent efficacy against symptomatic COVID-19. The Sputnik V vaccine was developed by the Gamaleya Research Institute of Epidemiology and Microbiology.

Sputnik V was registered in Russia on August 11, 2020 as the world’s first officially registered coronavirus vaccine. Russian vaccines have advantages as no deaths have been reported after vaccination with the Sputnik V, Alexander Gintsburg, Director of the Gamaleya Center, the vaccine developer, said and was reported by TASS News Agency. “As of today, no deaths after vaccination with Sputnik V have been registered,” he said.

Russian Direct Investment Fund (RDIF) is Russia’s sovereign wealth fund established in 2011 to make equity co-investments, primarily in Russia, alongside reputable international financial and strategic investors. RDIF acts as a catalyst for direct investment in the Russian economy. RDIF’s management is based in Moscow.

In Africa, during first of September, the coronavirus-related death toll has topped 196,190, while more than 6.9 million recoveries have been reported. South Africa accounts for a majority of coronavirus cases and deaths across Africa – 2,777,659 and 82,261 respectively. The death toll in Tunisia climbed to 23,451, and 664,034 cases have been confirmed. Egypt recorded 16,736 deaths and 288,441 coronavirus cases.

In Sub-Saharan Africa, Ethiopia is ranked second to South Africa (308,134 cases and 4,675 deaths) and is followed by Kenya (235,863 cases and 4,726 deaths) and Nigeria (191,805 and 2,455). The total number of COVID-19 cases has reached almost 8 million in Africa, according to the World Health Organization’s (WHO) Regional Office for Africa.

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