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Table 2 Major risks posed/escalated by the COVID-19 pandemic on the equitable access to essential medicines and vaccines for universal health coverage, along with the recommendations and stakeholders relevant for issues pertaining to each area. Regional intergovernmental organizations and economic communities include: African Union, Southern African Development Community, Common Market for Eastern and Southern Africa, East African Community, Economic Community of Central African States, Economic Community of West African States, Intergovernmental Authority on Development, Community of Sahel–Saharan States, and Arab Maghreb Union

From: A review of prospective pathways and impacts of COVID-19 on the accessibility, safety, quality, and affordability of essential medicines and vaccines for universal health coverage in Africa

Area Risks Recommendations Stakeholders
Assuring the financing and supply of essential medicines and vaccines -Poor financial capability of national health and economic systems to purchase the basic basket of essential medicines and vaccines
-Disruption of global supply network due to COVID-19
-International partners focusing only on COVID-19 at the expenses of other major diseases and internally
-Resource allocation informed by CRA
-Include sustainable financing and stable supply of EMV in the workstreams of COVID-19 supply task forces
-Integrate logistics system of COVID-19 with those of other major diseases
-Joint tenders and contract awarding at regional level
-Joint price negotiation and supplier selection at regional level
-Joint market research, monitoring, and evaluation at regional level
-Strategic procurement and regional information sharing about suppliers and prices
-World Health Organization
-Regional intergovernmental organizations and economic communities
-National governments
-Nongovernment organizations
-Private sector
Making essential medicines and vaccines affordable -Reduced availability of suppliers
-Reduced capacity of patients to purchase health services because most people in the productive age work in the informal sector, with household income based mainly on daily earning
-Unavailability of transportation and/or long distance to health facilities
-Inefficiency or inexistence of effective social protection programmes
-Mobile clinics
-Fees exemption for under-served and vulnerable segments of society
-Microfinance loans (with transparent selection of participants informed by literature of predictors of repayment rate)
-CHW programmes (conditional on significant increase in ODA and/or important innovations in health financing)
-Multi-month dispensing of essential drugs for selected diseases
-Integrated service delivery
-National and subnational governments
-Private sector
-Nongovernment organizations
Assuring the quality and safety of medicines to prevent harm to patients -Limited human and technical capability
-Poor transparency in procurement of essential drugs (e.g., lack of competitive bidding, corruption embedded in health systems)
-Restrictions to national and international business and travel imposed as part of national COVID-19 responses
-Investment in good governance at global, national, and local levels
-Investment in sustainable financing at global, national, and local levels
-Strategic investment in human and technical capacity building
-Joint market research, monitoring, and evaluation at regional level
-Regional information sharing about suppliers and prices
-Medicines regulatory harmonization at regional level
-International cooperation to equip LMIC with the necessary technology for post-marketing surveillance of medicines
-United Nations Development Programme
-International and national financial institutions
-World Health Organization
-National governments
-Regional intergovernmental organizations and economic communities
-International and national financial institutions
Promoting quality use of essential medicines to ensure better health outcomes -Increased workload per HCW because of change in work modality as part of COVID-19 measures
-Reduced quality of HCW because of risks to health work force regeneration processes
-Reduced capacity of the health sector to make payments
-Poor health literacy and numeracy of patients
-Limited health-literate healthcare organization
-Task delegation
-Telephone triage
-Sustainable international exchange of HCW targeting jointly delivery of clinical services (immediate needs) and capacity building of LMIC to generate quality health workforce efficiently (improve preparedness)
-Payment of risk allowances to frontline HCW
-Investment in health literacy and numeracy of populations and patients
-Careful staff recruitment
-Detailed training of HCW
-Authorization to provide autonomous care
-Reliable data systems
-Fair and performance-based compensation of HCW
-National governments
-Bilateral partners
The need for global research and policy framework to develop missing essential medicines -Limited availability of high-level human, technological, and financial capability
-Patents restrictions
-Low investment in R&D
-Poor medicines regulatory capacity
-Substantial increase in investment in R&D capability
-Sustainable technology transfer and international financing
-Strategic investment in human and technical capacity building
-Facilitate cross-border trade of pharmaceutical goods in the region
-National governments
-United Nations Industrial Development Organization
-World Trade Organization
-Regional intergovernmental organizations and economic communities
-Private sector
-Universities and research institutions
-International and national financial institutions
  1. CHW = community health worker, COVID-19 = coronavirus disease 2019, CRA = comparative risk assessment, EMV = essential medicines and vaccines, HCW = healthcare workers, LMIC = low- and middle-income countries, ODA = official development assistance, R&D = research and development