Dr. Solomon Zewdu & Dr. Zameer Brey Bill and Melinda Gates Foundation
Moderator: Tian Johnson
Complied by: Anna Matendawafa – with inputs from Wilfred Gurupira & Maaza Seyoum
Webinar Recordings & Supplementary Materials:
Date: 17 September 2020
Dr. Solomon ZewduHe is the Deputy Director for the Africa office of the Bill and Melinda Gates Foundation, where he shapes continental health nutrition, disease eradication, and development investments. Prior to moving to the Continental platform, he served as a deputy director in Ethiopia. He has created significant opportunities with system based investments built on concurrently identifying and aligning the Foundation’s priorities with the Ethiopians’ health system transformation plan and the donor community. Given his emergency planning and response background, Dr. Zewdu also serves as Bill and Melinda Gates Foundation COVID-19 coordinator for the African continent to inform the shaping of critical COVID-19 and related investments on the continent.
Dr. Zameer Brey,Dr. Zameer Brey, has worked in senior leadership positions where his core role as a change agent and turnaround specialist. Currently, he is the TV program lead in South Africa for the Bill and Melinda Gates Foundation, part of the global health team. He has previously served as the acting General Manager of the South African Medical Association process analyst for the Western Cape Department of Health as an internal consultant to the Faculty of Health scientists’ deanery at UCT. Dr. Zameer Brey has been involved in consulting with the National Department of Health in higher education ministries. His expertise centers on improving efficiency, quality and leveraging innovation to drive patient centered approaches.
QUESTION AND ANSWERS
*This section contains a transcribed account of the Question and Answer Session
Some of the initial feedback we’ve gotten from the Foundation is that you’re managing it through your common strategy. But the reality to many us on the ground is we don’t see this, these issues being addressed. It’s so we part of the work that we’ve been doing is we’ve been tracking anti-vaxxer sentiments amongst political leadership. And there’s a constant flow of anti-vaxxer, anti-Gates, a sentiment that is really in my mind goes beyond just the Foundation’s work. It sets back an entire sector because it planted seeds of confusion and doubt. And it impacts how we can then target potential anti-vaxxers, who might be sitting on the fence, and it almost pushes them over to the other side. What has your experience been? So perhaps in Africa, and then specifically in South Africa been around responding to this? And of course, we know that there’s a group that you will just never be able to engage with them change their point of view because they firmly believe it. And that’s their right. But what work have you been doing to at least more aggressively or strategically deal with this? With this movement of hatred, misinformation, specifically and meaningfully impacting our ability as advocates to get on with the important work of supporting and creating communities that are excited about research, and understand and begin to take ownership of research that is happening in their communities?
Dr. Solomon ZewduA tremendously important question. As you know, and you preface this by saying that you’ve already talked to our communications people, and we do have a pretty robust communications team that follows the disinformation and misinformation which seems to have increased, like you said, over the past few months, that you know, and the overall strategy is, as far as I know, it from my position, and there’s also an additional conversation that needs to take place with the folks that are tasked to manage this would be we try and create as much evidence we try and make as much transparency as we can. And that’s the approach. Of course, as you said, there are some people that you cannot potentially reason with, and whatever you do, whatever you say, whatever you provide, as evidence won’t trickle down. Anyone makes an impact, for those that are slightly confused, those that are looking to understand, the sentiments and you know, what is the fact out there as opposed to a lot of opinions that have been tossed around our policies that make sure that we don’t run away from it but even present opportunities such as these to be able to come and discuss it openly. There’s no secret; there’s no secret lab out there that’s doing all sorts of crazy stuff; what we do is open what we produce as available sources of the public good. So to some degree, the idea is to show that there’s no ill intent. And if there’s any misinterpretation or anything to our various capacities, you know, and there are people that can articulate this a lot better than I do, some of my bosses, we are available. We don’t shy away from engagements; we do not shy away from the misinformation and disinformation that we see as long as they come within the realm or the parameters of decency, and inquiry and there are some which are ugly, which don’t particularly make sense. So fueling the fire on some of those things, that doesn’t particularly make it productive. But at the end of the day, our attempt for both myself is and Zameer being part of this conversation, although it’s a very charged environment, it’s about vaccines, and it’s about it’s not just about vaccines anymore, It’s also about therapeutics, and, you know, a general sense of why do you even care? Why would you put all this money in a continent like Africa? What’s good? What’s the interest in there? And I think I saw something in the chat as well, somebody that that that posted that? Um, and my, my answer would be, why not? I mean, this is where the need is the greatest. Again, my personal opinion would be, you know, I’d rather have somebody care than not care because we know what not caring does. As long as it’s done in the right way, as long as it’s not imposing particular interest on an unwelcoming community or unwilling community and you’re trying to convince them otherwise, as long as you’re working in partnership, as long as you can find your champions and your advocate in the space. You’re able to convince them to take over the agenda as their agenda, work in partnership; it’s a win-win situation. But the main idea here is, we don’t run away from it. We don’t want to create a void in which things fester. And they come out, and they become tremendously unrealistic sometimes. But the idea is, the evidence is there, we’ll generate as much evidence as we can, and present them, the transparency should be there. Again, this is a two-way street if the message is not being communicated in the right way. And there are suggestions on how we can do this better. And there’s a, you know, an amazing group that we can tap into, how can we do it better as a narrative that we continue to have, you know, how do things resonate? How are they made context-specific? How do they resonate with, with the individuals that we’re trying to help and not come on and impose our will, on how to do things, you know, poverty is poverty, illness is an illness, treatment is treatment. So there are these principles. But you know, how you engage and how you bring that topic forward and get acceptance is a very nuanced skill. So we’re open; we want to communicate completely be transparent. But also seek your advice on how best we can get this done. And South Africa has got some tremendous pool of civil society organizations that have a massive impact. This is a place where we can learn from and hopefully capitalize on the rest of the continent, and eventually the globe. So I’ll stop here and maybe yield to Zameer to add anything. Dr. Zameer Brey You set me up well, comrades; this is a report I would want to share with you if you allow me to, which is our goalkeeping report, which was just published three days ago. There’s a statistic in there that just gives me goosebumps, and that’s the statistic that we stand to lose 25 years of progress in a vaccine is in 25 weeks. And that’s, that’s how quickly the world could be, at a threat that is multiple folds bigger than the COVID. And we should be in mind that the anti-Vax kind of sentiment is not restricted per se to COVID vaccination. What’s a very concerning trend if colleagues haven’t seen in South Africa that despite lockdown levels decreasing, immunization has not recovered. In the best situations, they are 20% lower than last year; in the worst, which are in some of the meters, we’ve seen almost 40% reduction in children’s immunizations for measles. The reality here is that that potentially leads to the risk of massive outbreaks that would compromise the most vulnerable the youngest in our population is also a survey that came out last week that put South Africa in the lowest in I believe, on in terms of appetite for vaccination. This is not a phenomenon that South Africa; what challenges that South Africa health system needed to deal with substantively previously? There was always a small percentage that we’re going not to use vaccines for various reasons. That proportion seems to be increasing at quite an alarming rate. And I think that the way we will address this, to try our level best to present, as Solomon is alluded to, to present the data in a transparent way to provide the evidence in an accessible way. And I think that you know, the point around making sure the data is accessible is essential. Because I believe that what we should do is we could have the number of credible voices that have come to the fore, individuals who have an amazing ability to articulate very complex concepts to the general public. I mean, we’ve seen, you know, people like Professor slim carry people like the professor, you know, Shabir Madhi connect to the public in a way, you know, that public health folks haven’t kind of done before. I think that we should try as a community to cultivate champions who can speak with credibility and get voices from the community who can relate to and understand individuals’ concerns and translate what that evidence is saying in a way that becomes accessible for communities. You describe that the people sitting on the fence are waiting for that kind of guidance. Hopefully, they haven’t completely blocked off on the idea that vaccines are bad, etc. what we will need to do as part of this response, related to COVID. Still, I think it’s a broader issue around vaccines, is to connect with local organizations who have a deep understanding of why this anti-vaccine sentiment has come about why it’s growing, and how to stymie that. In some ways, it’s almost an answer; I think Solomon and I are looking to this group to help us unpack because I think you probably have a better understanding of, you know, what some of those challenges are?
One of the issues certainly is that, as you say, it’s not just confined to COVID. These are issues we faced with HIV vaccine trials; a lot of the TB work as well. It is crucial to almost to amp up that kind of investment in groups and community groups who can then take these complex concepts to critical mass. We also do a lot of work with social media influences and work on social media to ensure that critical concepts are communicated. Another common thread in the questions here is understanding civil society’s perception that the Foundation is particularly excited about investing in African groups and movements. However, this is usually done according to some of the group’s comments via international NGOs or via the North, so you can find groups in Africa funded via Zurich or by an NGO in New York. Could you perhaps share some of your thoughts on the Foundation’s political principles of directly investing in local organizations, not necessarily having that funding go through organizations in the global North? I imagine there’s a thinking behind that if that is indeed the case, but I will give you the space to respond to those comments, which was submitted by both Yvette and Uma.
Dr. Solomon Zewdu
So yes, can I mean, this is a great example of our own evolution and our maturity process. As you can imagine, Foundation is 15 years old, in comparison to organization that had been around for quite some time, we still have an adolescent making a lot of mistakes and still learning. Are there is an intentional movement in our strategy to actually start really looking at how do we build continental capacity to actually take on some of these works that were being done by international NGOs. It’s not a light switch, as you can imagine, we can just say, okay, you know, a few months ago, we had all these international NGOs that were in the space, you know, moving and shaking things. But now we want to make sure that we shifted over, it goes through a whole process of actually trying to understand, who do we pick? Who do we align with? How do we bring organizations on board for our own, you know, limitations, as well as the public as a foundation, there has to be some rules and regulations by which we engage in civil societies or private sector or government and things like that. So just to let you know that, yes, you know, you absolutely right now, international NGOs have dominated the space, and it felt like, sometimes, depending on how well the international NGO has managed it, it feels even in an imposition, as opposed to assistance, you know, you can continuously swimming against the tide. They come with money, funded, fully funded, and they’ll basically come in and try and tell you what’s best for you. That has been recognized. And we recognize that quite effectively. And we want to make sure without really undermining the value of international NGOs, that we continue to actually start striking a balance. To let you know, we are going through our, you know, Africa strategy development process right now, where our young gofers, we’ve been beefing up our presence on the continent. And one of the major things that we, you know, are tackling right now is how do we do not just partnership and capacity or doing good getting the work done? But actually, how do we even build the capacity on the continent? What is it that we need to get to what need to do? And how do we need to design differently, you know, that to make sure that we harness the existing capacity on the continent, in everything, and development and implementation in RND, in institutions that are, homegrown as well as continental the grown. So this is work in progress. And it’s a very good reflection of our own maturity phase, and we’re starting to understand that we need to get closer to the problem that we’re trying to solve. And we need to use local solutions to bring about the change that we want. And once we get those things in place, we do understand that we’ll be able to move the needle a lot faster than we were able to do it in the past. Some of these resentments about, vaccine and things like that, I’m assuming that if the vaccine was built in your backyard, and you knew about the process from start to end, you will have a lot less resistance when it’s deployed out as opposed to being done somewhere and in the North, where you have no concept on how it was developed and ended up coming in your backyard. And it’s trying to immunize your children or the adults for the COVID state. But we very much cognizant that we want to make sure that we start tapping into the Continental capacity, where it’s there, leverage it or if it’s not there, try and build it.
Dr Zameer Brey
If I can just add and kind of hold on, you know, some of that I think that a very focused attempt that we’re undertaking is tracking the funding flows from the foundation perspective. And so it’s not something that was traditionally looked at, but with the applicant information and our current leadership with Luma, Solomon and others is making sure that we can follow the dollars that leave the Foundation. And so often what was happening previously is that even the dollars that were landing on the continent would have been being diverted back to Northern institutions. And, and so that’s a metric that we are, increasingly looking at. And, and they are obviously, as Solomon says that, this is going to be a journey of making sure that we tie and move more and more investments we appropriate to be made on the continent for all of the reasons that we listed. You know, previously, I think, another metric that we are looking at is making sure that we are a lot more mindful around diversity, equity and inclusion when we make these investments, whether that’s gender or race. And, and I think this is also part of the Foundation’s own kind of journey, to make sure that you’re more intentional in that regard. With a COVID response, I can say that for the South African ones, in fact, all of the South Africa specific investments, are all with local institutions. And there was, a couple of these investments within multinational organizations that we considered. But I’m pleased to say that, we’ve been able to go the route of investing locally. And I think that I want to give two examples. So one is, about two or three years back, there was a project that the Africa team undertook, to say that there are few partners that are so important to our overall strategy as the Foundation. And we see ourselves working with them long term, that we need to invest in based on building their capacity. And we were quite fortunate that two of the organizations were based in South Africa. In fact, I think it was a Treatment Action Campaign and the Aurum Institute at the time. And what was nice about those investments is they didn’t have a specific in investment outcome, the style, but rather, what do you need as an organization to build your organization for sustainability. And so it was giving some flexibility, to the organization to be able to do that, and my understanding and feedback on that, is that those investments were particularly well received. Now, you know, it’s not a common investment for us to make. But just to say, I think there is, you know, some precedence in US recognizing that, I think that the the last example, I just want to share with a colleague, and as I do, Belinda is on from the Boland community advisory board. And she’ll know that, in fact, set up the South Africa TB vaccine initiative was set up with significant funding from the Gates Foundation, has world class research infrastructure to be able to test and do research on TB vaccines, so much so that probably at least two in every three vaccines globally are tested through the site. But what was, I think, particularly noteworthy about this is that the investment, the science, engagement with the community, combined from the government meant that this became a national asset, and actually attracted significant more investment from other donors to invest in this, you know, kind of world class capacity in a way. And so the dependency on the Gates Foundation, you know, really kind of waned over time. And I think it’s a good example of a initial investment that then become sustainable, beyond that that kind of seed funding period. And we have the confidence that there are going to be many, many more examples that come from the continent of this kind of investment.
In closing, I just wanted to get your thoughts on, do you feel that the levels of historical investment in the health space, has COVID been a distraction? And has COVID taken away attention, in your view from what Belinda is also raising? You know, access to HIV, access to TB? I know you touched on it briefly in terms of access, but after COVID, do you think we’d be in a better and even just saying after COVID sounds ridiculous at this stage in life and the once we’ve adapted to a world where COVID exists? And it is part of our reality? Do you believe that the investments that we’re making now in terms of the COVID response will further strengthen the research sector in general, as we almost hopefully fall back into into people accessing treatment, prevention options, care, etc, etc, at a very local level? And then the last question, and before we wrap up is, could you specifically speak to your experience, then with TAC and Aurum in terms of you almost stepped out of the traditional donor partner box, and you said, you ought to give us direction in terms of how you want this investment to roll out? And once you did that, at the end of the day, I’m imagining now, it’s quite a while after the effects. What has the takeaway been? And has that impacted how you granted the going force? Or was that an interesting experience and you kind of fell back into you know, normal practices of grant-making, where the agenda is pretty much set in the terms of work set and people bid etc.
Dr Solomon Zewdu
Both very important questions and highly critical. Yes, has COVID been damaging, it has, it took all of our attention away. And we chased about a disease that pathetically made us feel like if we tackle that one, all the other problems that we had, were just gonna stand there and wait for us, which is, which is an unfortunate way of thinking of it, and how we got so distracted and why we went all out for on COVID it will be, you know, topic of discussion to move forward for many years to come. But it has been a distraction, and has been damaging, and the whole discussion about how do we make sure that whatever has happened has happened, you know, compromising your economy, compromising routine services, the TB inference in the in the chats, definitely. And it has been some robust conversations along the line of saying, you know, in when you envy and the response space, usually, there’s the slogans that you use, or these, you know, quotations that you use, you know, rebuild better dual, dual purpose, investment and things like that. So we’ve been talking about these for months now and all over the continent, and I have the opportunity to kind of look across 55 member states and look at all of the agencies that are on the continent and have these dialogues from the EU, to Africa, CDC, to Waho, to Wits University, you know, all of these think tanks and all of these decision makers that are out there, and we have been Cognizant and would but we’re also caught into this COVID frenzy, rightfully so because it was a massive killer. We’ve never seen a pandemic before none of us. Even I’m probably senior and in this group, haven’t seen a pandemic because the last one was the 1980s. It was 100 years ago, and none of us knew how to handle this. So we went all out with the way we knew how to best do it, which was you know, just just go ahead and tackle it and, and contain it was it containable? You know, this the jury’s still out, because it’s all over the place. Now. What do we what did we drop in the process of chasing after COVID, you know, maternal child health, neonatal, and newborn health, TB, malaria, HIV, you name it, everything that we’re tackling for decades under the MDGs. were put on the on the backburner, rightfully so because we’re had a much bigger thing to deal with. But you know midstream, about, you know, a few months back, you know, everybody started realizing that this is COVID. Like he said, Tian is here to stay. I mean, vaccine will come and we’ll take these a couple of years to get to potentially, you know, herd immunity, even after the vaccine. So, it will be in the background. I think the new reality will have COVID in the background, my eight-year-old daughter talks about you know, I have was born, and I just survived the era of COVID. So it’s become part of our existence. So that, for me, was a distractive factor, and rightfully so we all went out all out. But now how to recover back from that. And we’d minimize the damage. other situations, you know, the TB treatment that that is falling, the HIV treatment that is falling, the maternal child health unit and mortality rates are climbing, how do we go back to making sure that we bring those as a priority? Because one thing that’s unique for the lower to middle-income countries, Africa and South Asia, is that we are tackling multiple things at the same time. You know, when you look at the North, basically, there’s no malaria to worry about, there’s no cholera to worry about, you know, measles, of course, because of, you know, immunization, you know, anti-vaxxer movements can actually flare-up. But there are all these old foes that we know exist on the continent, and will not fade away, because we’re tackling COVID by itself. So right now, it’s a balancing act that we have to go through, and one of those vulnerable things in there as well. It’s not just diseased, but it’s also our economy. So we have to go back and make sure that we don’t, you know the unemployment rate has gone up all over the continent, you know, and we were on lockdown and things like that. So the impact of COVID needs to be better appreciated, and better managed as we move forward. So the long answer to your very crisp question was, yes, it has been disruptive, and it has come at an expense about grant-making moving forward. Your second question, the grant-making forward, you know, we won’t go back from the processes that we learned, you know, we learned these, we these lessons, because there was a need to learn them. And moving forward, our investments are really looking at this new way of doing business, this new way of actually bringing impact on on the continent and the places that we want to bring impact globally, or the programs that we want to bring impact globally on so we won’t go back. This journey will take us to one of the slogans you know, building better that will put us in that position where we’re kind of stuck thinking about, you know, we wouldn’t be in the predicament that we are, it with COVID if we had planned it differently. If we had invested in health systems more robustly for had invested on local capacity more robustly, there wouldn’t be that massive frenzy, will we really be scared about the massive infection rates and the massive death counts that that really drove are impulsive, no impulsiveness tackle COVID and kind of almost put everything else on the back burner. We can’t afford to do that again. So moving forward. And it’s my personal belief, and you know, as we build our presence on the continent, and we also increase our bandwidth engaged in being, you know, proactive, I think more of the, how do we do this together? How do we get a solution locally? How do we say to get solutions from the people that are actually living the issue, breathing the issue, sleeping the issue, as the way we’re going to engage? And I think I find myself, you know, well-positioned to be able to make that statement because I am part of the team that comes up with the strategies and the planning process as well. So that would be my, my, my feedback to you.
Dr. Brey, any final remarks ?
Dr Zameer Brey
I mean, I would just say that you know, I would concur fully with what Solomon has said around kind of that we’ve taken the health system has taken a big hit around COVID. I will say that I think there’s a very specific role for civil society to play in trying to extract what has happened and work from a health system perspective, and keep those in place. So how did we get, you know, very rapid regulatory approvals and some of the products? How did we get? You know, that’s the space to open up with health. How did you? How did we get, you know, some of those realizations of the pharmaceutical guidelines which, looking back, we should wonder, you know, where they necessarily to start with, but I won’t say the window is, I feel like that window is beginning to close. And so if there isn’t a voice and advocacy around making sure that those things stay in place. I would say that not only did the health system and these priorities, diseases taken a knock, but we also lost what, what was beneficial to the health service overall. And just to you know, thank the colleagues here for a fantastic discussion. I’ve certainly learned A lot and apologies that we didn’t get through all of the questions; I guess the sign of a robust debate. And, you know, we look forward to building this relationship. So thanks.
Dr Solomon Zewdu
Now put a plugin I mean, I wanted to say that, you know, hold us accountable. You know, we all work in service of the vulnerable. And it was a question in there that said, What do you mean by vulnerable unless we are true to what we’re trying to change, and we’re held accountable, and we’re being challenged, we want to accomplish what we set out to do. So before it gets to the point where it becomes misinformation, disinformation and antagonistic. And, and help us be our eyes and ears and our counsel telling us, you go on the wrong path here, you might be thinking that you’re doing goodwill here, but you’re not being accepted, you’re not being received well. So this only one this two-way street is generated, do we will feel like we reached the community would reach them, we made an impact because our work is shifting more and more and more our way of thinking it’s no longer a theory of change. Upstream designing, it’s about the impact and working our way back. Our CEO tells us all the time, what impact you want to bring about, I want you to think that way. And the impact is that the country and the community and the people that we want to, you know, benefit. So I just wanted to say that, you know, let’s make sure that you know, when we open these forums of conversation, we don’t come in like this big elephant in the room or gorilla. We come in just like anyone else. And we are here to learn and be here to receive and to better program to your second point.