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Neglected diseases

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Visceral leishmaniasis (VL), also known as kala-azar, is the most severe form of leishmaniasis and, without proper diagnosis and treatment, is associated with high fatality. Leishmaniasis is a disease caused by protozoan parasites of the genus Leishmania.
The parasite migrates to the internal organs such as the liver, spleen (hence “visceral”), and bone marrow, and, if left untreated, will almost always result in the death of the host. Signs and symptoms include fever, weight loss, fatigue, anemia, and substantial swelling of the liver and spleen. Of particular concern, according to the World Health Organization (WHO), is the emerging problem of HIV/VL co-infection. This disease is the second-largest parasitic killer in the world (after malaria), responsible for an estimated 20,000 to 30,000 deaths each year worldwide. Dr Lutz Hegemann, Chief Operating Officer for Global Health at Novartis talked to Capital about the disease and the fight to overcome the disease. Novartis is a global healthcare company based in Switzerland that provides solutions to address the evolving needs of patients worldwide. Excerpts;

Capital: Tell us about visceral leishmaniasis, and the most affected areas.
Lutz Hegemann: Leishmaniasis is a neglected tropical disease caused by protozoan Leishmania parasites transmitted by the bite of infected female phlebotomine sandflies. Cutaneous leishmaniasis is the most common form of the disease. It usually produces ulcers on the exposed parts of the body, such as the face, arms and legs. Visceral leishmaniasis (VL), also known as kala-azar, is the most serious form of the disease. It is characterized by irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and anemia. If the disease is not treated, it is fatal for over 95% of the cases. Most cases of VL occur in East Africa, South-East Asia (mainly India) and Brazil. An estimated 50 000 to 90 000 new cases of VL occur worldwide each year.

Capital: The highest burden of the disease takes place in East Africa, why is that? What does a study show?
Lutz Hegemann: Leishmaniasis is highly endemic in East Africa. Additional risk factors include: poverty, malnutrition, population displacement, poor housing, a weak immune system and lack of financial resources. Leishmaniasis is also linked to environmental changes such as deforestation, building of dams, irrigation schemes, and urbanization.
Capital: Do you think the global community is aware of the disease?
Lutz Hegemann: Leishmaniasis is among the most neglected tropical diseases and affects some of the poorest populations.

Capital: What can we say about the existing treatments, in terms of affordability, effectiveness etc?
Lutz Hegemann: As with other NTDs, the drugs we have for leishmaniasis are outdated and lacking. People suffering with the disease are often subjected to a prolonged and painful regimens of toxic drugs that vary according to the species of parasite. For example, a treatment can require 17 days of painful double injections, and can be cardiotoxic. DNDi and Novartis are co-developing LXE408, a first-in-class oral compound with a novel mechanism of action that has shown efficacy in preclinical models of the disease.

Capital: Tell us the collaboration between Novartis and DNDI and the tasks done so far?
Lutz Hegemann: Novartis and the Drugs for Neglected Diseases initiative (DNDi), a not-for-profit research and development (R&D) organization, have signed collaboration and license agreement to jointly develop LXE408, as a potential new oral treatment for visceral leishmaniasis, one of the world’s leading parasitic killers. Novartis is responsible for completing Phase I clinical trials, currently in progress, and completing the regulatory submission for LXE408. Upon approval, Novartis has also committed to maximizing access in endemic countries. DNDi will lead Phase II and III clinical development, starting in India with additional trials planned in East Africa.

Capital: What can we say about the new development of LXE408 and when will the trial expected to be launched in East Africa? How far that new development transform the treatment in terms of effectiveness, affordability etc?
Lutz Hegemann: It is still early to specify the completion date for the full clinical development of LXE408 and registration in the countries. DNDi and partners will need to carry out Phase II and Phase III clinical trials with representation from the different endemic countries in Eastern Africa. The studies are set to begin in 2021, and the process may take at least 5-7 years. It is important to undertake both phases of the study to help ensure that the treatment is safe and effective for leishmaniasis patients. Strategies will thereafter be developed together with other stakeholders to help ensure that patients affected by leishmaniasis access the treatment.

If Covid-19 is not beaten in Africa it will return to haunt us all

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Only a global victory can end this pandemic, not a temporary rich countries’ win

By Abiy Ahmed

There is a major flaw in the strategy to deal with the coronavirus pandemic. Advanced economies are unveiling unprecedented economic stimulus packages. African countries, by contrast, lack the wherewithal to make similarly meaningful interventions. Yet if the virus is not defeated in Africa, it will only bounce back to the rest of the world. That is why the current strategy of unco-ordinated country-specific measures, while understandable, is myopic, unsustainable and potentially counter-productive. A virus that ignores borders cannot be tackled successfully like this. We can defeat this invisible and vicious adversary – but only with global leadership. Without that, Africa may suffer the worst, yet it will not be the last. We are all in this together, and we must work together to the end. Fragile and vulnerable at the best of times, African economies are staring at an abyss. Let me illustrate this with the situation in my own country. Ethiopia has made steady progress in the provision of health services over the past two decades. But nothing has prepared us for threats posed by Covid-19. Access to basic health services remains the exception rather than the norm. Even taking such common-sense precautions as washing hands is often an unaffordable luxury to the half of the population who lack access to clean water. Even seemingly costless social distancing is hard to implement. Our lifestyle is deeply communal, with extended families traditionally sharing the burdens and bounties of life together, eating meals from the same plate. Our traditional and rain-dependent agriculture is dictated by the fixed timeframes of weather cycles in which planting, weeding and harvesting must happen. The slightest disruption to that chain, even for a brief period, can spell disaster, further jeopardising already tenuous food supply and food security. Take Ethiopian Airlines, the country’s largest company, which accounts for 3 per cent of national output and is a major source of hard currency. It will be pushed to the brink as its business is upended by the pandemic. Shortage of hard currency will then make it all but impossible to source essential medical supplies and equipment from abroad. The cost of servicing our debts is already often more than our annual health budgets. The list continues. This grim reality is not unique to Ethiopia. It is shared by most African countries. But if they do not take appropriate measures to tackle the pandemic, no country in the world is safe. Momentary victory by a rich country in controlling the virus at a national level, coupled with travel bans and border closures, may give a semblance of accomplishment. But we all know this is a stopgap. Only global victory can bring this pandemic to an end. Covid-19 teaches us that we are all global citizens connected by a single virus that recognises none of our natural or man-made diversity: not the colour of our skin, nor our passports, or the gods we worship. For the virus, what matters is the fact of our common humanity.
That is why the strategy to tackle the human and economic cost of this global scourge must be global in design and application. Health is a worldwide public good. It requires global action guided by a sense of global solidarity. But Covid-19 has also exposed our dark underbelly. The world community desperately needs global-level leadership to tackle swiftly pandemics such as this, and in a way that is institutionalised rather than ad hoc. A good place to start is with the World Health Organization. As countries with the necessary resources focus on fighting the pandemic through their national institutions, the WHO must be empowered and resourced sufficiently to co-ordinate responses globally and directly to assist governments in developing countries. In the meantime, the G20 must provide collective leadership for a co-ordinated global response. There is no time to waste: millions of lives are at risk. Building on what has been announced by international financial institutions, the G20 must launch a global fund to prevent the collapse of health systems in Africa. The institutions need to establish a facility to provide budgetary support to African countries. The issue of resolving Africa’s debt burden also needs to be put back on the table as a matter of urgency. Finally, all of Africa’s development partners must ensure that their development aid budgets remain ringfenced and are not diverted to domestic priorities. This is where true humanity and solidarity must be demonstrated. If such aid were ever necessary in Africa, it is now more than ever before.

The writer is prime minister of Ethiopia and the 2019 Nobel Peace prize laureate (Financial Times)

Gov’t outlines new coronavirus support measures for businesses

Floriculture actors asks the government for expedite measure to keep the sector from damage due to the outbreak of coronavirus epidemic. Government officials and exporters discussed the latest situation and the way-out.
Mid this week in the meeting co-chaired by Girma Birru, Advisor at the Prime Minister Office, and Omer Hussein, Minister of Agriculture, exporters including the coffee, leather, textile, livestock and meat, and sesame expressed their concern and challenges that might occur and already happening in their business.
According to those who attended the meeting that include few individuals due to the fear of the pandemic, the private sector expressed its fears related with the virus, while most of the export challenge related with corona is mainly affecting the horticulture sector than other major export businesses.
Tewodros Zewdie, Executive Director at Ethiopian Horticulture Producer Exporters Association (EHPEA), who attended the meeting, told Capital that the concerns have grabbed the attention of government officials. “We are looking swift measure by today or Saturday,” he told Capital on Friday via telephone conversation.
“The concern of others looks like they keep working in the export, while we are now almost inactive on the business,” he explained.
According to the information from EHPEA the export of flower has dropped by 80 percent from the normal time. Most of the product is transported to the Netherlands market.
Friday afternoon Prime Minister Abiy Ahmed announced some macro-economic measures besides several other mitigation strategies.
He announced that the government decided National Bank of Ethiopia to avail Birr 15 billion liquidity for private banks to enable them to provide debt relief and additional loans to their customers in need.
Abiy’s measure also included the removal of the minimum price set by the National Bank of Ethiopia on the horticulture sector for flower exports, and the Ministry of Revenue to expedite VAT returns to support companies with cash flows.
The association asked the government to reschedule ongoing loans and provide working capital for the farms to keep running the operation, which have over 150,000 employees.
The VAT refund is also the other area that the government is expected to extradite to support the growers cash flow. Besides the VAT refund suspension the association wants a protection from labor laws in case of downsizing the labor force.
Ease the hard currency repatriation threshold, which is USD 3.86 per kilogram of flower, is also the other area the association needs from government to be considered.
Making sure that airfreight cargo services are accessible even with less frequencies and with reduced rates is also the other area that the growers needs to be soft.
After the PM disclosed some measures the association appreciated the government decision.

Economic policies to combat COVID-19 in Africa

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The COVID-19 pandemic is likely to impose heavy human, financial, economic, and social costs on Africa. But the crisis also creates an opportunity to re-examine the continent’s fiscal and economic-policy priorities, build stronger health and social sectors, and establish a global fund to support productive investment.

By Célestin Monga

The coronavirus pandemic could not have come at a worse time for Africa. Despite improved macroeconomic management over the last decade, the continent still lacks the resources to tackle high levels of poverty and inequality, create formal-sector jobs, and foster the structural transformations needed to absorb 12 million young people into the labor market every year. And now COVID-19 threatens to break Africa’s back economically.
Africa’s low average annual growth of 3.3% in 2014-19 was mainly the result of erroneous development strategies that focused on unviable capital-intensive industries (often in commodity sectors), instead of promoting competitive labor-intensive sectors. Insufficient growth has in turn constrained public finances, leading to underfunded health systems, weak governance, rapid increases in public debt, and large infrastructure deficits.
Given Africa’s precarious health institutions, and its shortage of doctors, health workers, medicine, and medical supplies, COVID-19 infections are likely to soar, sparking a humanitarian crisis that most likely will go unreported. The virus could spread widely in poorer areas with no water or sewage hook-ups, and in communities where low education levels, prevailing social habits, and skepticism toward government complicate containment efforts. If a cure for COVID-19 is not made widely available soon, the pandemic could devastate Africa.
Moreover, the prolonged halt to economic activity in the G20 countries (some of which are facing deep recessions) will cause global growth to decelerate sharply. That will hit African exports, the main engine of the continent’s growth, and worsen countries’ trade and current-account balances. Worker remittances and foreign direct investment will decline, too, as the pandemic throttles advanced economies.
In addition, lower prices for oil, natural gas, metals, and minerals will significantly undermine the fiscal position of many large African economies, especially Nigeria, South Africa, Algeria, Cameroon, Angola, the Democratic Republic of the Congo, Equatorial Guinea, Chad, the Congo, and Tanzania. That will force governments to make painful macroeconomic adjustments at the most challenging time.
Worse, Africa’s ability to use monetary and fiscal policies to mitigate the pandemic’s economic impact is limited. Whereas governments and central banks around the world have adopted robust and often unprecedented short-run stimulus measures, most African countries lack the policy space and capacity to do so, or are constrained by monetary arrangements that prevent them from implementing national strategies.
True, a few countries such as Morocco, Ghana, Mauritius, and Kenya have initiated national stimulus programs while also launching structural reforms to improve their medium-term fiscal outlook. But such policies would be more effective if they were designed and implemented at the continental level.
In the short term, Africa needs greater fiscal space to boost health expenditures, contain the spread of COVID-19, help the hardest-hit sectors, and stimulate domestic consumption, while the continent’s central banks should cut interest rates and channel liquidity to firms and households. But all spending measures should be implemented transparently, monitored by independent fiscal councils, and complemented by credible reform agendas that strengthen medium-term expenditure frameworks. To achieve these goals, African Union heads of state and government should hold an emergency virtual meeting to mobilize about 10% of the continent’s gross domestic product ($250 billion), including from central banks and development banks, and coordinate spending across borders.
Continent-wide measures should also be adopted to improve coordination of national tax policies, increase collection, and boost economic growth so that all countries can strengthen their national health systems. In particular, speeding up implementation of the African Continental Free Trade Area would provide additional fiscal space. A recent study has shown that a few easily implementable trade-policy actions – such as eliminating current bilateral tariffs and all non-tariff barriers on goods and services within the continent, and reducing the time it takes to cross borders – would generate $134 billion per year, or 4.5% of Africa’s GDP.
Second, Africa needs a special international financing facility aimed at enhancing its future productivity growth. Such an initiative would support emergency spending on health systems in budget-constrained countries while also boosting domestic demand. In addition, it would help to finance the construction of profitable infrastructure in competitive sectors, thus laying the foundations for future industrialization and growth.
This facility could initially be funded with an endowment of $1 trillion from institutional investors, regional development banks, the private sector, and G20 governments. It would allocate global savings to high-return projects that have a significant impact on economic development and employment. Such a facility would eventually generate self-sustaining public financing for Africa’s health and social sectors, reduce the widening gap between rich and poor, and make the continent an important contributor to global demand.
Third, existing monetary arrangements and financial-sector regulations that hamper external competitiveness – especially that of the 14 CFA franc zone countries whose currency is pegged to a strong euro – should be reformed to enable exchange-rate flexibility. Likewise, initiatives such as the US African Growth and Opportunity Act and the European Union’s Everything but Arms, under which imports from Africa are duty- and quota-free, should be open to all African countries without political conditionality.
Finally, a comprehensive new debt-relief scheme should be considered for African countries with good governance. The continent currently has a total external and domestic debt stock of $500 billion, and the median debt-to-GDP ratio has risen from 38% in 2008 to 54% in 2018. By causing a collapse in exports and terms of trade, the COVID-19 pandemic is pushing African countries into negative per capita growth. Given the continent’s financing needs and demographic growth, debt levels will quickly become unsustainable without debt forgiveness and policies to make Africa’s debt more transparent and better managed.
The COVID-19 pandemic is likely to impose heavy human, financial, economic, and social costs on Africa. But the crisis also creates an opportunity to re-examine the continent’s fiscal and economic-policy priorities, build stronger health and social sectors, and establish a global fund to support productive investment.
Célestin Monga, former Vice President and Chief Economist of the African Development Bank Group and former Managing Director at the United Nations Industrial Development Organization, is Senior Economic Adviser at the World Bank.