African policymakers face a dilemma when it comes to COVID-19. The first hope is to prevent the virus from gaining a foothold at all, and many African states have significant experience of managing infectious disease outbreaks. The establishment of the Africa Centre for Disease Control highlights the hugely increased focus on public health in recent years.

But capacities to track, test and isolate vary wildly, notably between neighbours with porous and poorly controlled borders and, in most cases, sustained national-level disease control is difficult. Initial clusters of COVID-19 cases are already established in many places, but a lack of testing capacity makes it hard to know the full extent of transmission.

It is not obvious what African states should do as a response. Lack of information about COVID-19 means the proportion of asymptomatic or mild cases is not known, still less the ways in which this is influenced by human geography and demographics.

Africa is an overwhelmingly young continent with a median age under 20. But it also faces chronic malnutrition, which may weaken immune responses, and infectious diseases such as malaria, TB and HIV are widespread which could worsen the impact of COVID-19, particularly if treatment for these diseases is interrupted.

Complex and unknown

Ultimately, how all these factors interact with COVID-19 is complex and remains largely unknown. Africa may escape with a relatively light toll. Or it could be hit harder than anywhere else.

What is clear, however, is that cost of simply following the rest of the world into lockdown could be high. Africa is relatively rural but has higher populations living in informal settlements than anywhere in the world. Many live in cramped and overcrowded accommodation without clean water or reliable electricity, making handwashing a challenge and working from home impossible.

And the benefits appear limited. The goal of lockdowns in most places is not to eliminate the virus but to accept the economic and social costs as a price worth paying in order to ‘flatten the curve’ of infection and protect healthcare systems from being overwhelmed. But this logic does not hold when many of Africa’s healthcare systems are barely coping with pre-coronavirus levels of disease.

Africa suffers in comparison to much of the rest of the world in terms of access to quality and affordable healthcare, critical care beds and specialist personnel. For example, in 2017, Nigeria had just 120 ICU beds for a country of 200 million, equating to 0.07 per 100,000 inhabitants compared to 12.5 per 100,000 in Italy and 3.6 per 100,000 in China.

The pandemic’s ruinous economic impacts could also be more acute for Africa than anywhere else. The continent is highly vulnerable to potential drops in output and relies heavily on demand from China and Europe. Many states are already facing sharply falling natural resource revenues, and investment, tourism and remittances will suffer - all on top of a high existing debt burden.

Analysis by the World Bank shows that Africa will likely face its first recession in 25 years, with the continental economy contracting by up to 5.1% in 2020. Africa will have scant financial ammunition to use in the fight against COVID-19 with currencies weakening, food prices rising, local agri-food supply chains disrupted and food imports likely to decrease as well. A food security emergency appears a strong possibility.

So, although several states have imposed national lockdowns and others closed major urban centres, lockdowns are difficult to manage and sustain, especially in places where the daily hustle of the informal sector or subsistence agriculture are the only means of survival and where the state has neither the trust of the population nor the capacity to replace lost earnings or meet basic needs.

Of course, this is not simply a binary choice between lockdown or no lockdown - a range of intermediate options exist, such as some restriction on movement, curfews, shutting places of worship, banning only large gatherings, or closing pubs, schools and borders.

A significant number of African states have so far taken this middle path. This will not prevent the virus from spreading nor, in all probability, be enough to ensure adequate healthcare for all Africans infected with COVID-19. But it may help slow the spread and buy invaluable time for African states and partners to prepare.

How this time is used is therefore of paramount importance. Popular trust in the state is low in many African countries so strategies must empower communities, not alienate them. Africa’s experience of previous epidemics and long traditions of collective resilience and community-based crisis response - which persist in many places – are significant strengths.

The right messages must be carried by the right messengers, and policies - including cash transfers and food distribution - implemented sensitively. If not, or if responses become militarized, public consent is unlikely to be sustained for long.

On 10 January 2020, Chinese scientists released the sequence of the COVID-19 genome on the internet. This provided the starting gun for scientists around the world to start developing vaccines or therapies. With at least 80 different vaccines in development, many governments are pinning their hopes on a quick solution. However, there are many hurdles to overcome. 

Vaccine development

Firstly, vaccine development is normally a very long process to ensure vaccines are safe and effective before they are used. 

Safety is not a given: a recent dengue vaccine caused heightened disease in vaccinated children when they later were exposed to dengue, while Respiratory Syncytial Virus vaccine caused the same problem. Nor is effectiveness a given. Candidate vaccines that use novel techniques where minute fragments of the viruses’ genetic code are either injected directly into humans or incorporated into a vaccine (as is being pursued, or could be pursued for COVID-19) have higher risks of failure simply because they haven’t worked before. For some vaccines, we know what levels of immunity post-vaccination are likely to be protective. This is not the case for coronavirus. 

Clinical trials will have to be done for efficacy. This is not optional – regulators will need to know extensive testing has taken place before licencing any vaccine. Even if animal tests are done in parallel with early human tests, the remainder of the process is still lengthy. 

There is also great interest in the use of passive immunization, whereby antibodies to SARS-CoV-2 (collected from people who have recovered from infection or laboratory-created) are given to people who are currently ill. Antivirals may prove to be a quicker route than vaccine development, as the testing requirements would be shorter, manufacturing may be easier and only ill people would need to be treated, as opposed to all at-risk individuals being vaccinated.

Vaccine manufacturing

Developers, especially small biotechs, will have to make partnerships with large vaccine manufacturers in order to bring products to market. One notorious bottleneck in vaccine development is getting from proof-of-principle to commercial development: about 95 per cent of vaccines fail at this step. Another bottleneck is at the end of production. The final stages of vaccine production involve detailed testing to ensure that the vaccine meets the necessary criteria and there are always constraints on access to the technologies necessary to finalize the product. Only large vaccine manufacturers have these capacities. There is a graveyard of failed vaccine candidates that have not managed to pass through this development and manufacturing process.

Another consideration is adverse or unintended consequences. Highly specialized scientists may have to defer their work on other new vaccines to work on COVID-19 products and production of existing products may have to be set aside, raising the possibility of shortages of other essential vaccines. 

Cost is another challenge. Vaccines for industrialized markets can be very lucrative for pharmaceutical companies, but many countries have price caps on vaccines. Important lessons have been learned from the 2009 H1N1 flu pandemic when industrialized countries took all the vaccines first. Supplies were made available to lower-income countries at a lower price but this was much later in the evolution of the pandemic. For the recent Ebola outbreaks, vaccines were made available at low or no cost. 

Geopolitics may also play a role. Should countries that manufacture a vaccine share it widely with other countries or prioritize their own populations first? It has been reported that President Trump attempted to purchase CureVac, a German company with a candidate vaccine.  There are certainly precedents for countries prioritizing their own populations. With H1N1 flu in 2009, the Australian Government required a vaccine company to meet the needs of the Australian population first. 

Vaccine distribution

Global leadership and a coordinated and coherent response will be needed to ensure that any vaccine is distributed equitably. There have been recent calls for a G20 on health, but existing global bodies such as the Coalition for Epidemic Preparedness Innovations (CEPI) and GAVI are working on vaccines and worldwide access to them. Any new bodies should seek to boost funding for these entities so they can ensure products reach the most disadvantaged. 

While countries that cannot afford vaccines may be priced out of markets, access for poor, vulnerable or marginalized peoples, whether in developed or developing countries, is of concern. Developing countries are at particular risk from the impacts of COVID-19. People living in conflict-affected and fragile states – whether they are refugees or asylum seekers, internally displaced or stateless, or in detention facilities – are at especially high risk of devastating impacts. 

Mature economies will also face challenges. Equitable access to COVID-19 vaccine will be challenging where inequalities and unequal access to essential services have been compromised within some political systems. 

The need for global leadership 

There is an urgent need for international coordination on COVID-19 vaccines. While the WHO provides technical support and UNICEF acts as a procurement agency, responding to coronavirus needs clarity of global leadership that arches over national interests and is capable of mobilizing resources at a time when economies are facing painful recessions. We see vaccines as a salvation but remain ill-equipped to accelerate their development.

While everyone hopes for rapid availability of safe, effective and affordable vaccines that will be produced in sufficient quantities to meet everyone’s needs, realistically, we face huge hurdles. 

The World Health Organization (WHO) declared the spread of COVID-19 to be a Public Health Emergency of International Concern (PHEIC) on January 30 this year and then characterized it as a pandemic on March 11.

Declaring a PHEIC is the highest level of alert that WHO is obliged to declare, and is meant to send a powerful signal to countries of the need for urgent action to combat the spread of the disease, mobilize resources to help low- and middle-income countries in this effort and fund research and development on needed treatments, vaccines and diagnostics. It also obligates countries to share information with WHO.

Once the PHEIC was declared, the virus continued to spread globally, and WHO began to be asked why it had not yet declared the disease a pandemic. But there is no widely accepted definition of a pandemic, generally it is just considered an epidemic which affects many countries globally.

Potentially more deadly

The term has hitherto been applied almost exclusively to new forms of flu, such as H1N1 in 2009 or Spanish flu in 1918, where the lack of population immunity and absence of a vaccine or effective treatments makes the outbreak potentially much more deadly than seasonal flu (which, although global, is not considered a pandemic).

For COVID-19, WHO seemed reluctant to declare a pandemic despite the evidence of global spread. Partly this was because of its influenza origins — WHO’s emergency programme executive director said on March 9 that ‘if this was influenza, we would have called a pandemic ages ago’.

He also expressed concern that the word traditionally meant moving — once there was widespread transmission — from trying to contain the disease by testing, isolating the sick and tracing and quarantining their contacts, to a mitigation approach, implying ‘the disease will spread uncontrolled’.

WHO’s worry was that the world’s reaction to the word pandemic might be there was now nothing to be done to stop its spread, and so countries would effectively give up trying. WHO wanted to send the message that, unlike flu, it could still be pushed back and the spread slowed down.

In announcing the pandemic two days later, WHO’s director-general Dr Tedros Adhanom Ghebreyesus reemphasised this point: ‘We cannot say this loudly enough, or clearly enough, or often enough: all countries can still change the course of this pandemic’ and that WHO was deeply concerned ‘by the alarming levels of inaction’.

The evidence suggests that the correct message did in fact get through. On March 13, US president Donald Trump declared a national emergency, referring in passing to WHO’s announcement. On March 12, the UK launched its own strategy to combat the disease. And in the week following WHO’s announcements, at least 16 other countries announced lockdowns of varying rigour including Austria, Belgium, Canada, Czech Republic, Denmark, Finland, France, Germany, Hungary, Netherlands, Norway, Poland, Portugal, Serbia, Spain and Switzerland. Italy and Greece had both already instituted lockdowns prior to the WHO pandemic announcement.

It is not possible to say for sure that WHO’s announcement precipitated these measures because, by then, the evidence of the rapid spread was all around for governments to see. It may be that Italy’s dramatic nationwide lockdown on March 9 reverberated around European capitals and elsewhere.

But it is difficult to believe the announcement did not have an effect in stimulating government actions, as was intended by Dr Tedros. Considering the speed with which the virus was spreading from late February, might an earlier pandemic announcement by WHO have stimulated earlier aggressive actions by governments?

Declaring a global health emergency — when appropriate — is a key part of WHO’s role in administering the International Health Regulations (IHR). Significantly, negotiations on revisions to the IHR, which had been ongoing in a desultory fashion in WHO since 1995, were accelerated by the experience of the first serious coronavirus outbreak — SARS — in 2002-2003, leading to their final agreement in 2005.

Under the IHR, WHO’s director-general decides whether to declare an emergency based on a set of criteria and on the advice of an emergency committee. IHR defines an emergency as an ‘extraordinary event that constitutes a public health risk through the international spread of disease and potentially requires a coordinated international response’.

In the case of COVID-19, the committee first met on January 22-23 but were unable to reach consensus on a declaration. Following the director-general’s trip to meet President Xi Jinping in Beijing, the committee reconvened on January 30 and this time advised declaring a PHEIC.

But admittedly, public recognition of what a PHEIC means is extremely low. Only six have ever been declared, with the first being the H1N1 flu outbreak which fizzled out quickly, despite possibly causing 280,000 deaths globally. During the H1N1 outbreak, WHO declared a PHEIC in April 2009 and then a pandemic in June, only to rescind both in August as the outbreak was judged to have transitioned to behave like a seasonal flu.

WHO was criticized afterwards for prematurely declaring a PHEIC and overreacting. This then may have impacted the delay in declaring the Ebola outbreak in West Africa as a PHEIC in 2014, long after it became a major crisis. WHO’s former legal counsel has suggested the PHEIC — and other aspects of the IHR framework — may not be effective in stimulating appropriate actions by governments and needs to be reconsidered.

When the time is right to evaluate lessons about the response, it might be appropriate to consider the relative effectiveness of the PHEIC and pandemic announcements and their optimal timing in stimulating appropriate action by governments. The effectiveness of lockdowns in reducing the overall death toll also needs investigation.

Almost four years since it was established, the China-led Asian Infrastructure Investment Bank (AIIB) has approved 49 projects and proposed 28. The AIIB claims to be more efficient and less bureaucratic than traditional multilateral development banks (MDB’s) which has threatened the existing model of multilateral development finance. At the same time, China’s increased role in previously Western-led economic institutions, such as the WTO and IMF, has raised questions over the future of the international trade order. How will a rising China shape the international institutional order? Where are there opportunities for potential collaboration and what areas pose challenges? And how should other states and international organizations respond?

Attendance at this event is by invitation only. 

Julia Gillard, you became the first female prime minister in Australian history in 2010, what have been the challenges and opportunities for you as a woman working in politics? Have the obstacles women face in positions of power changed over the years, and if so, how? 

I want to start positive and say I’m a huge advocate for people going into politics – particularly women. I believe there’s no better way of putting your values into action than going into politics but I’m not going to pretend that there’s no gender bit.

There still is a gender bit and I experienced that personally. A disproportionate focus on appearance, a disproportionate focus on family structures – for example the fact that I didn’t have kids – and the gendered insults becoming the go-to weapon when politics got turbulent, which inevitably happens, as governments make decisions that not everybody agrees with.

In terms of politics past and politics present, I think a lot has changed for the positive. There are more women in politics now which means more role models for other women. There’s been more of an attempt to have the system offer flexibilities for work and family life too. In Australian politics, famously, the non-members bar was replaced by a childcare centre, so that’s giving you a sense that there has been progress. We’ve also just hit the stage where our Senate is now 50 per cent men and 50 per cent women.

But I do think that there’s a new toxicity for women that’s been introduced through social media – through the fact that it’s anonymous and people can say anything and the kinds of revolting material many women politicians receive. I think that there’s a new coarseness in our traditional media too which means things will be said about people in politics today, especially women, which would not have been put in the pages of respectable newspapers 10 or 20 years ago.

So, it’s a mixed picture, where there has been major steps forward but there are still some huge issues to resolve.

Following this year’s elections, there are now a record number of female members of parliament in Australia, yet some argue that women are still underrepresented across the major political parties, and over the past 20 years, the country has fallen from 15th in the world to 50th for gender diversity in its parliament.

Given some of the recent experiences of women in Australian politics, do you think the major political parties are doing enough to address gender diversity in their ranks? 

I certainly think on the Labor side of politics important changes have happened in our political party and the benefit of those changes has showed. I’m of that generation of Labor women that fought for an affirmative action target and we had that adopted as a Labor party rule in the early 1990s. It started at 30 per cent, and it’s gone up over time, and the benefit of that now is that the Labor Party is almost at 50-50 per cent men and women, coming off a very low base in the early 1990s where we were at 14 per cent men and women. 

The Conservative side for politics hasn’t embraced a target or quota as of yet. They have done some things, through mentoring and networking and training, but that hasn’t seen as significant a shift in the gender diversity in their ranks. They’ve moved slowly from when they were 13 per cent women to now where they’re in the mid-20 per cent. 

Of course that doesn’t mean the work within Labor is done: we’ve got to keep delivering to the affirmative action target, having women come through for all of the ministries, the Cabinet and for all of the portfolios and to make sure that we’re embracing the full diversity of women too. Australia is a very multicultural society and there is more to do to make sure that women – and men – in the Australian parliament represents that diversity. 

During your premiership, you delivered a famous speech on misogyny and sexism and described there being 'gender wars' in Australian politics. How far has Australia addressed its problems regarding everything from unconscious bias to gender stereotypes? Do you think social attitudes in Australia to women in leadership are changing?

I don’t think these issues are particularly an Australian problem. When I left politics, people kept asking me about my experiences and it became convenient for them to say ‘That’s Australia and its macho culture and Crocodile Dundee and all of that.’ I was always quick to point out, actually, a number of the insults hurled at me were first hurled at Hillary Clinton when she originally put her name forward to be considered as a candidate for US president. So this is not an Australian problem – it’s a global problem. 

I can see progress in Australia though. When I was prime minister, the sort of fashionable analysis by the press was that nothing, in my experience, had anything to do with gender – I was just being treated like every prime minister had always been treated.

Today, there is a very lively debate about sexism in Australian politics and about how women can feel excluded from these structures with various conservative women making complaints about bullying within their political party. So the preparedness to report issues due to the understanding of gender is now much higher and I’m a big believer that you never solve a problem unless you start talking about it so I’m glad we’re talking about it now.

From the implementation of ‘womenomics’ in Japan, to gender-responsive budgeting in Indonesia, countries around the world are making progress towards addressing gender issues, yet, structural and cultural barriers that prevent women’s economic, political and social participation remain.

What are the biggest barriers that women face around the world and do you think enough is being done to address these barriers?

I think so much is context-specific that it’s hard to say, but I would say, in some parts of the world, unequal access to education is the fundamental barrier.

Now that’s not true in the UK or in Australia, where the statistics tell you that disproportionately graduates today are women and not men, but if we look at many of the poorer parts of the world, like in sub-Saharan Africa and other places, there are 260 million children out of school – and the face of a child most likely to miss out is a female face. So there still needs to be a lot more progress on things such as equal access to education around the world. 

In many parts of the developed world, there is actually an assault now on long-held rights around women’s reproduction so I think that is another foundation stone – and then really it comes to a set of issues and barriers around the world of work and full access to every level of work.

Much of this is what we research at the Global Institute for Women’s Leadership because we continue to see workplaces and organizations that have a very traditional view of what merit looks like. It’s a sort of male-defined view of the world and it is one that is not inclusive of women. We are still seeing the unequal sharing of domestic labour which has ramifications for women’s engagement in the world of work and their ability to achieve leadership within it too. 

With a broad brush, I would point to all of this, but the most pressing problems that women continue to face varies from place to place.

Globally, increasing numbers of women are being elected to political office, from the first female president of Slovakia to the first female mayor of Tunis. This comes at a time of record numbers of female ministers in Egypt and Jordan as well as gender-balanced cabinets in 10 countries worldwide – six of which were achieved in 2018 alone.

Do you think women’s rights and gender equality are benefitting from more female representation in politics and how are female voters responding, if at all, to this increase in the number of women holding political office?

I think, even if women didn’t bring new policy perspectives to the world of politics, I would still be an advocate of gender equality in politics because I believe merit is equally distributed between the sexes.

If you see women being represented at less than 50 per cent then that’s got to mean that there are women of merit who didn’t get there – who should’ve gotten there. I think it’s important to make that point otherwise we’re saying ‘Women should only be there if, when they are there, they do this, this and this’. We don’t tend to put that ‘if’ in sentences about men.

But I do think the evidence shows that more women, being involved in politics, does diversify the public policy agenda. That doesn’t mean that a male politician couldn’t focus his career and advocacy on childcare or domestic violence or combating sexual assault or furthering women’s reproductive rights. But I think the evidence shows that there is a lived experience that women bring to politics that enables them to mobilize around a set of issues that are of particular concern to women.

On the role model effect, I think the evidence shows that, if women and girls do see role models, they are more likely to think that that is a pathway open to them. One of the things that does slightly concern me is whether that evidence is now retrospective evidence and whether the prospective evidence is going to be – because of the toxicity of social media – more women thinking about the real-world threats that being in politics presents for them. And so the role modelling effect will work in reverse because it will show how women are treated in politics is more of a negative than a positive.

I certainly hope this doesn’t happen and young women are encouraged to go into politics. That’s where we still have to shine a light on the positive aspects of what working in politics has to offer.

Despite all of the progress we are seeing, women are still faced with gender-based discrimination and gender-based violence, virtually and physically, with 40 per cent of women and girls living in countries which fail to guarantee basic standards of gender equality. What do you think needs to happen to ultimately realize women’s rights and gender equality globally? Are you hopeful this will be achieved in the future?

Yes I’m an optimist overall. People like to quote the great Martin Luther King quote ‘The moral arc of the universe bends towards justice.’ I believe that but I think sometimes the imagery of the arc as if it’s always in a forward movement hides the nitty-gritty struggle that is there beneath. 

Inevitably, at some points, it feels like there’s more of a backlash against women than a forward movement. But, over time, I’m an optimist that the forward movement wins through. 

I do believe we can reach a stage where societies are generating societies where women can live their lives free from the threat of sexual violence or discriminatory treatment based on gender.