Dr Margaret Agama-Antyetei: the African Union boss shaping a continent’s response to the pandemic

As acting director for Health, Humanitarian Affairs, and Social Development at the African Union, Dr Margaret Agama-Anyetei is a key architect of the continent’s health policy landscape. Here, she tells Maya Prabhu how a collision with the pandemic has both helped and hindered her mission.

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Dr Margaret Agama-Antyetei

 

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In late February 2020, Dr Margaret Agama-Anyetei boarded a flight from Addis Ababa, where the African Union is headquartered, to Victoria Falls, where the 6th Africa Regional Forum on Sustainable Development was being convened. She noticed, with surprise, that a fellow passenger was wearing a face-mask. “I thought – that’s pretty strange. She must be very scared of this thing that’s going on in Asia”.

The ‘thing in Asia’ was, of course, an obscure new sickness – a coronavirus outbreak that Dr Agama-Anyetei had imagined would flare and fade in a few months, the way SARS had in 2003. In Zimbabwe, the threat of infection was apparently distant enough to be notional to the 3,000 conference participants gathered at the resort on the banks of the Zambezi.

“You have two or three meetings at the same time; you start very early and end very late. If you go to have a shower you take your laptop with you.”

It was early in a new decade, and the Forum’s gaze was locked on a future that seemed to be hurrying closer. In her opening address, United Nations Deputy Secretary-General Amina Mohammed warned that the world was falling behind on the 2030 target for the Sustainable Development Goals, and the continent urgently needed “enhanced action” to meet the African Union’s Agenda 2063. “2020 is an opportunity for all of us to chart a different course and kick-start a Decade of Action to deliver the SDGs,” she said.

But within days, as news of COVID-19’s accelerating spread filtered in, it was clear that that Decade of Action had already turned an unexpected corner. “It was on the return flight to Addis that I realised how serious this pandemic was,” Dr Agama-Anyetei recalls. “Being a doctor myself, and just understanding how respiratory diseases work, knowing that the test was a point-in-time test, knowing that there was still some movement, as limited as it was – there was no way it wasn’t going to hit Africa sooner or later.”

Dr Agama-Anyetei and I meet via Zoom one March afternoon, about two years after it did hit. It was also two years, approximately, after she first entered lockdown in her Addis Ababa home. “My children are grown men, so I actually was locked down alone,” she says. It might have been lonely if it wasn’t so busy. As the African Union’s Acting Director for Health, Humanitarian Affairs, and Social Development, Dr Agama-Anyetei plays a vital role in shaping the health policy landscape for the entire continent – a position which meant she watched the impending crisis from an uncomfortingly wide angle.

“At that time, I’d been to over 45 member states. So I had a pretty good picture of what exists on the continent [in terms of health systems preparedness]. With the logistics chains compromised because of the border closures, the supply chain issues – you’re just waiting for the bad news.” Neither the capacity to produce medicines and medical products or technologies, nor the capacity to regulate them, was “where it was supposed to be,” she knew. Meantime, even strong, well-resourced health systems in the West were cracking under the pandemic’s strain. “Clearly, Africa was going to be in trouble.”

That must have been terrifying, I suggest. “Looking back, you don’t really have time to be terrified,” she reflects. Her team adapted quickly to a new, fully-online working world; her portfolios: health, nutrition and population, “were moving, virtually – that was satisfying.” But without the braking friction of physical presence, of venues and commutes, the work day slipped into a semi-hysterical kind of boundlessness. Presidents, suddenly more mobile in a world of Zoom gatherings, showed up to meetings that would usually have been experts-only; their illustrious presence demanded a cascade of further attendees. “It was this initial madness,” Dr Agama-Anyetei recalls. “You have two or three meetings at the same time; you start very early and end very late. If you go to have a shower you take your laptop with you.”

Even amid that focused frenzy – which remained only temporarily at fever pitch: at some point Dr Agama-Anyetei legislated tea breaks, lunch breaks and sensible evenings for her team – there was a separate, irrepressible, private part of Margaret that did find scope for panic. “As a mum, I was thinking about my two sons. I was thinking about my elderly mum.” Her sons both live in South Africa; her eldest is a doctor. She knew his risk of infection was high.

She comforted herself with the knowledge that South Africa had one of the continent’s strongest health systems. “Thankfully, they have the resources to take care of their health personnel, even though, of course, many died, and may they rest in peace.” What remained troubling, she said, was their delayed access to the vaccine. “I didn’t care about myself – it took a while before I got vaccinated – I was more worried about him.”

She diagnoses the problem flatly: “Once our borders closed and supply chains narrowed, Africa had to wait. It just had to join the queue.” Across the continent the pandemic had cracked open a “Pandora’s box” of health system weaknesses, she says; the many lapses between policy and implementation became freshly compromising. A paucity of necessary supplies, including PPE, was one concern. A rising tide of counterfeit medicines was another.

Fake drugs are not a new problem. According to WHO, 42% of all cases of fake medicines reported between 2013 and 2017 were found in African markets; the BBC reports that in 2017 an Interpol-led operation in seven West African countries seized more than 420 tonnes of illicit pharmaceuticals. “People are dying, babies are dying just because some malaria medicines are fake. Women are dying after childbirth because the oxytocin they are being given to stop bleeding is fake,” says Dr Agama-Anyetei. It’s a large part of why she’s been working for years to bring the African Medicines Agency (AMA), intended to strengthen and harmonise medical regulation across the continent, into existence.

But the threat of COVID-19 boosted the market for “quacks and fake people who want to make a quick buck”. Did the pandemic make the need for the AMA more urgent than ever? “Certainly,” says Dr. Agama-Anyetei.

Crucially, she isn’t the only person to think so. COVID-19 occasioned an exciting shift on the continent. “Very few people can say they don’t know somebody who died of COVID,” she explains. “People started paying attention to what we were saying about some of these issues. So at the policy level, there was a complete change in thinking, and opportunity space opened up, and interest scaled up. And so: things change.”

Things changed in decisive ways: in October 2021, the AMA treaty, adopted in February 2019, became “one of the fastest treaties ratified in the history of the Union” according to Dr Agama-Anyetei. In November 2021, it entered into force, establishing the AMA as the second specialised health agency of the AU. The first, the Africa CDC, was founded as recently as 2016, but proved itself as a vital voice for health on the continent during the pandemic, helping to build a crucial bank of trust among Africa’s leadership.

“Treaties in the AU don’t usually get ratified very quickly,” Agama-Anyetei underscores. “It was really understanding how the politics works, and then, of course, riding on the back of COVID, and riding on the back of the efforts of the Africa CDC; understanding how to position it as an important agenda. And we did it in two and a half years.”

Today, the AMA is “a baby just born,” says Dr Agama-Anyetei. It needs a home – and encouragingly, there is no shortage of applicants. “That’s another first!” she says. “We had 13 member states offering to host the headquarters. That’s a huge number. That’s the level of interest currently being expressed to host this agency.”

But if a groundswell of African political commitment to health means there’s optimism in this pandemic moment, then Dr Agama-Anyetei has had her share of disappointment too. “I think, for me, it’s that nagging reminder that there’s no equity,” she says. “And perhaps that those who shout the loudest about equity do so only when it suits them.”

On the day we speak, the vaccination ticker for the African continent hovers at 10%. That she and her sons number among the vaccinated is a personal comfort – she began to sleep better, she says, when her doctor son received his dose of Johnson & Johnson – but the wider facts are disillusioning. “There was an ability to produce this vaccine, to make sure that everyone, everywhere got access to it. But the opportunity was not taken.”

“For me,” she adds, “it jeopardises the entire SDG discussion, even though really nobody is saying it. Because how are you going to achieve the SDGs and have an equitable and equal world, if when the opportunity came the world was reminded how unequal and how inequitable it actually is?”  

So, I ask – how do we move forward from here? “Africa is not yet written off because of COVID, even though we are still not at the level of vaccination we would have loved to be at,” she tells me, her tone buoyant, cheerful even. “So you look forward for the opportunity, and what you can do. And you don’t get bogged down in what’s not going to change.”

Provided Africa’s leaders remain “seized of the matter”; provided administrations don’t mistake COVID-19 for a purely epidemiological matter, neglecting its social and economic ramifications, there are major strides to be taken. The pandemic might have put a kink in the course, but for Dr Agama-Anyetei, our strange decade still promises to be a decade of action.