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In this exclusive interview, Dr. Muhammad Ali Pate, Global Director, Health, Nutrition and Population (HNP) Global Practice of the World Bank and the Director of Global Financing Facility for Women, Children and Adolescents (GFF), spoke with Jide Akintunde, Managing Editor, Financial Nigeria Magazine – Africa’s premier development and finance journal – on the impact of Covid-19 and the World Bank’s response in Nigeria and other developing countries.  

Jide Akintunde (JA): This is a very stressful time for health professionals – both on the policy and healthcare sides. So, I would like to begin by asking: how are you doing?

Muhammad Ali Pate (MAP): Thanks for asking. It has been a tough period, from seeing the novel coronavirus starting as an outbreak in one place and rapidly expanding to the entire world within such a short period, to the tragic consequences on lives and livelihoods. But I am also encouraged by the resilient efforts of health workers across the globe who have been the warriors against the disease. Sadly, many of them lost their lives in this global fight against the virus.  

JA: The Covid-19 pandemic has been raging for six months. What have been the most unfortunate impacts of the disease?

MAP: We have all seen the tragedy unfold – more than 10 million people have been infected and half a million of them are dead, and the cases and deaths are still rising. These are not just numbers; they are individuals with families, loved ones, hopes, aspirations and stories yet untold.

In addition, we are seeing how the primary crisis of people being affected, particularly health workers, is leading to a secondary crisis characterized by disruptions in health service delivery for other life-threatening conditions. For example, immunizations, maternal and child health services, treatments of various ailments are being affected because health workers are diverted to Covid-19 care units or they are unable to be protected enough to continue to deliver those other services.

Estimates published in the premier medical journal, The Lancet, suggest that under a scenario in which Covid-19 causes similar disruptions as it happened in West Africa during the Ebola outbreak, almost 1.2 million children and 57,000 mothers could die within six months – an equivalent of 45 per cent increase in child mortality.  

We are also seeing the crisis having a broader and disproportionate impact on the poorest and marginalized sections of society in different countries across the wealth continuum. There have been job losses, loss of remittances, rising prices, and disruptions in services such as education and health care. Women, children, the disabled, health care workers, and displaced populations are being hit the hardest in this crisis.

The pandemic threatens to push between 71 million and 100 million people into extreme poverty. According to the latest World Bank forecasts, the global economy will likely shrink by 5.2 per cent this year, representing the deepest recession since the Second World War. This has major implications for poverty reduction.

JA: The novel coronavirus disease was viewed as an equal-opportunity infection, in terms of the geography of its spread. But as you have alluded to, empirical data has since established peculiar vulnerabilities, among people with prior health conditions, poor nutrition and even of a race. How does this reflect on the responses of the World Bank?

MAP: The Covid-19 pandemic is still unfolding. Even the wealthier and more advanced economies have struggled to contain the virus, and the numbers are still rising in many parts of the world. Therefore, it is likely that ultimately, the poorest countries and most vulnerable populations would be the hardest hit. With limited resources and lower government capacity, many of the poorest countries don’t have the health infrastructure necessary to prepare for disease outbreaks.

People with pre-existing conditions such as obesity, heart disease, and diabetes suffer more serious consequences of Covid-19, including more severe illness such as bilateral viral pneumonia. All these conditions require higher healthcare needs, such as the need for respirators.
 
The World Bank Group’s focus is to support all its client countries, especially the poorest and most vulnerable, to address these issues, including through existing health projects and a new facility. In mid-March, the World Bank approved a Covid-19 fast-track facility to support countries with emergency operations. By April 2, the Bank approved an initial $6 billion package for health support to countries as part of an overall plan of up to $160 billion for social and economic response to the crisis over the next 15 months.

The World Bank is currently assisting over 100 countries, which are home to 70 per cent of the world’s population, with their Covid-19 responses. We are helping them implement emergency health operations, protect the poorest households, save jobs and businesses, and get money to people who need it most. Fighting inequity in every form is at the core of the World Bank mission. The Bank’s unprecedented response in the Covid-19 crisis is the fastest, broadest and most substantive external support yet available to countries who need it most.

JA: There is also data – including rehiring of furloughed workers – indicating women may be particularly more vulnerable. And what affects women, impacts children. In what ways is the Global Financing Facility for Women, Children and Adolescents (GFF) channeling resources to fight the pandemic and its effects in these demographics?

MAP: The GFF is helping to ensure that safe and equitable delivery of essential health and nutrition services are available for women and children. While this is a central part of the Covid-19 response and recovery efforts, the facility also supports countries to build more resilient health systems.

The GFF took early steps to rally the support of global health and development leaders and urged immediate steps to protect essential services. Since then, it has been supporting its 36 partner countries to prioritize investments in essential services for women and children, strengthen frontline service delivery, and address constraints in demand for sexual and reproductive health, among other services.

For example, in Nigeria, the GFF is supporting policy dialogue and capacity building programmes for policymakers on service delivery. We are also providing data and analysis on the impact of Covid-19 on health services in the country. The data show that large service disruptions have the potential to leave 6.2 million children in Nigeria without oral antibiotics for pneumonia, almost five million children without DPT vaccinations, around 726,000 women without access to facility-based deliveries, and two million fewer women receiving family planning services. As a result, child mortality in Nigeria could increase by 18 per cent and maternal mortality by 9 per cent over the next year. Also, GFF estimates show that without mitigation, between 357,000 and 1,420,000 women could be unable to use contraception, resulting in 8,920 to 425,000 unintended pregnancies in Nigeria.

The GFF also supports countries through flexible financing. For example, as part of the World Bank-financed Nigeria State Health Investment project, the GFF has made funding available to support frontline primary health care facilities to manage the pandemic in the conflict-affected north-east region of the country. Historically, it has been extremely difficult to provide services in this region.  

JA: In Nigeria, the pandemic, so to speak, is out of control. There is very limited capacity for testing, isolating infected persons, treating them and tracing their contacts. Given the economic effects worsened by lack of safety nets for vulnerable people, the government is easing lockdown restrictions. This is likely the situation in many other low-income developing countries (LIDCs). Is it money that should be thrown at the pandemic in such countries?

MAP: First, we acknowledge the ongoing efforts by the Nigeria Centre for Disease Control (NCDC), Federal Ministry of Health, Presidential Task Force on Covid-19, as well as other government agencies both at federal and sub-national levels for their efforts. I believe they are trying their best and they deserve all our support. The pandemic has shown us that most countries around the world are overwhelmed by the response, but those with weak health systems are especially vulnerable.

From available information, the response in Nigeria has been hampered by fiscal challenges being faced by state governments. As you know, the main theater of operation for the response is at the sub-national level. It is where the testing, isolation and treatment of positive cases, contact tracing and other response activities take place. That’s why the World Bank is providing funds to support Covid-19 response at the sub-national level. This is being done through two projects: First, N100 million is being provided to each state from the ongoing Regional Disease Surveillance Systems Enhancement (REDISSE) project, which has been supporting the NCDC to build capacity for surveillance, preparedness and response to disease outbreaks. The funds will provide resources to states to implement time-bound, high impact priority activities such as ramping up testing, contact tracing, community engagement and risk communication.

The second project is part of the World Bank’s global Covid-19 emergency response facility and Nigeria is accessing $100 million from the fund and another $15 million grant from the Pandemic Emergency Facility (PEF). Once the project is effective, most of the project funds will provide further direct support to each of the 36 states and the Federal Capital Territory (FCT).

JA: What is the best-case scenario for Nigeria, and indeed the African continent, with regard to this pandemic and how can it be realized?

MAP: When compared to experiences in other regions, the best-case scenario is what is currently being experienced in Africa: a high level of asymptomatic or mildly symptomatic infection with fewer cases of severe infection and low mortality. Also, the health systems are not being overrun. Maintaining this trajectory until a vaccine and/or known therapeutics are available will be the best-case scenario.

Accordingly, there is a need to ramp up capacity for massive testing, isolating cases and contact tracing to bring the transmission under control by achieving a reproductive number (Ro) of less than one for the virus.

It is important to continue to strengthen primary health care systems to ensure better preparedness for the future, improve overall prioritization of health in public policies at federal and state levels and for Nigerian researchers to be appropriately funded to be involved in developing solutions for the world.

JA: There is great anticipation for vaccines against Covid-19 to be developed. How is the World Bank planning to ensure that there is a synchronized distribution of the vaccines around the world, so that the LIDCs don’t suffer from the pandemic much longer?

MAP: We believe fair and equitable access to vaccines is essential to altering the course of this devastating pandemic and allowing livelihoods and entire economies to be rebuilt. For every month that the pandemic is reduced, more than $375 billion in economic benefit is expected.

Financing and technical support to developing countries on vaccines and therapeutics are some of the key pillars of our Covid-19 support to countries. This broad, fast action is helping developing countries strengthen their pandemic response and health care systems. This is vital for the effective distribution and delivery of vaccines.

In February 2020, the World Bank Group co-convened together with the Coalition for Epidemic Preparedness and Innovations (CEPI) the first task force to discuss development of new tools for Covid-19, starting with vaccines. The Bank is now part of the Access to COVID-19 Tools Accelerator (ACT-A) alliance, to ensure global equitable access to Covid-19 diagnostics, therapeutics and vaccines for the poorest and most vulnerable countries.

The World Bank and the Global Fund are specifically co-convening the health systems strengthening pillar of the ACT-A to ensure that diagnostics, therapeutics and vaccines can be efficiently and effectively deployed to the health systems and local communities of countries once they are available. Without strong health systems, these tools will not reach the most vulnerable. Ultimately, however, it will be up to the countries, leaders and communities to step up to ensure the delivery of these tools.

JA: This is a very busy time for global and local health policymakers. While grappling with the current outbreak, there has been discussions on readiness for future outbreaks. What are the essential policies for future readiness?

MAP: More and better investments are necessary now to create stronger, more resilient health systems to save lives now and prevent reversals of recent progress in reducing maternal and child mortality. Efforts must also be made to ensure that everyone, everywhere, can access safe, quality and affordable health care. This means all countries across the globe must invest more and better in pandemic preparedness.

The World Bank response addresses both emergency containment and mitigation needs for Covid-19, including strengthening countries’ health systems to treat severe cases and save lives. This combined approach is also needed to help contain future pandemics, including the resurgence of Covid-19.

We have been supporting pandemic preparedness, especially in Africa for many years, including through the REDISSE project, the Africa CDC Project and the East Africa Laboratory Network. The new Health Emergency Preparedness and Response Multi-Donor Fund (HEPRF) is also a new tool that is responding to the urgency for stronger global health security and the need to help developing countries to be better prepared for disease outbreaks. The HEPRF will help guide critical health security investments now and in years to come.