All nations must guarantee PPE for health workers

With solidarity, justice, and cooperation we can overcome challenges posed by Covid-19

Thierry Allafort-Duverger

The United States Agency for International Development (USAID) has recently told aid organisations running international programmes financed by the agency that it will not fund the purchase of personal protective equipment — filter and surgical masks, medical gloves and gowns, etc.

This announcement turns the slogan ‘America First’ into ‘America Only’ as, at a time of equipment shortages, it is no longer just a question of requisitioning supplies and US companies’ production lines to fulfil domestic requirements, but also preventing international humanitarian organisations dependent on US funding from protecting their personnel.

As Médecins Sans Frontières (MSF) receives no money from the US government, USAID’s announcement does not affect us. Sadly, however, our experience of providing assistance in dozens of so-called limited-resource countries, notably in Africa and the Middle East, makes us all too aware of the challenges of protecting health workers and facilities.

Embroiled in the hunt for masks since the pandemic first broke out, we are up against an ultra-competitive market that lacks a mechanism to regulate the allocation of resources in a clear, transparent and fair manner.

Due to this capricious market and the shortages we see everywhere, we are unable to give our medical teams working in the field assurances that we will be able to protect them beyond the next few weeks.

Not alone in this

We are not alone in this: many other medical aid organisations across the world are also managing the protection of staff and their essential work against this same background of shortages and just-in-time distributions.

While this weakness in the supply chain is linked, of course, to the unprecedented demand for PPE, we also see that it is largely caused by a lack of transparency about the global stocks actually available and the criteria for their distribution. For while the pandemic is global, not every country finds themselves in the same position.

At first glance, it could be argued that protecting health workers and facilities in countries with limited resources is a secondary priority. How do the 120,000 cases officially registered in Africa compare to the millions of cases in Europe and the United States?

Why should we reserve for a relatively unscathed continent the equipment that the most badly affected countries continue to have a desperate need for?

First, assuming that Africa will be spared the ravages of the epidemic because of the relative youth of its population or its climate is to gamble as much on the present as it is on the future. The reality is that the lack of large-scale testing makes it impossible to know how many cases there are in Africa already.

Number of ICU beds

Tracking the number of intensive care beds occupied — the principal indicator of the severity of the situation in Europe or in the US — is irrelevant in the many countries that have very little intensive care capacity.

We do not know the true extent of the transmission of the virus in Africa but we do know how its poison spreads. Extremely infectious, coronavirus is the perfect example of a disease that spreads like wildfire in medical settings where neither staff nor patients have the necessary equipment to protect themselves from each other.

Even if they are asymptomatic, infected health workers transmit the virus to patients they examine, perform surgery on, or deliver the babies of. Similarly, symptomatic or not, infected patients transmit the virus to health workers they consult and other patients they come in contact with.

Ebola experience

Our experience with Ebola shows us there are two major risks in contexts such as these — the risk of health centres becoming breeding grounds for the virus, and the risk of health services essential to the population suddenly closing down.

Take the maternity unit MSF assists in Peshawar, Pakistan where approximately 8,000 women were cared for in 2019. After two staff members were found to be infected with the virus in mid-April, all medical services had to be suspended. Or Chad, where, despite being in the throes of a measles epidemic, vaccinating against it is no longer authorised.

Or Aden, in Southern Yemen, where MSF has been admitting increasing numbers of patients to its surgical units because most of the hospitals in the city closed out of fear. And, in Kenya’s capital city Nairobi, emergency room and ambulance services supported by MSF now only treat critical cases because of the shortage of protective equipment.

Therefore personal protective equipment for health workers must be seen as a common good and its availability must be guaranteed in the long-term. The World Health Organisation (WHO) is attempting to set up a system based on an assessment of each country’s requirements and a dedicated supply chain.

These commendable efforts, however, will continue to be obstructed by the lack of transparency regarding the true availability and allocation criteria of the equipment. The global market is currently a jungle, and the law of the jungle benefits the most powerful, with strong states and speculators able to accrue far more than what they need.

If this is to change a mechanism must be imposed on nations and industries requiring them to provide full visibility with respect to the actual state of the protective equipment supply chain at global, regional and national level, and transparency in disclosing how it is allocated.

We must resist the impulse to protectionism and curb the worst excesses of the market for it is only with solidarity, justice, and cooperation that we can overcome the huge challenges that we face due to this pandemic.

Thierry Allafort-Duverger is the Director General of Médecins Sans Frontières