THE GLOBAL FUND’S WAMBO.ORG HELPS COUNTRIES PROCURE PERSONAL PROTECTIVE EQUIPMENT AND COVID-19 DIAGNOSTIC TESTS
Download PDF The global demand for personal protective equipment (PPE) to curb the spread of COVID-19, ventilators, and testing supplies continues to outstrip the supply. At the onset of the pandemic, three countries produced about 40% of the global supplies of PPE. With the pandemic, at least 47 countries implemented some form of export restrictions on those items. The increased…Article Type:
Supplies of some products remain limited
ABSTRACT The Global Fund has stepped up to help recipient countries access COVID-19 products, including diagnostic tests and PPE. It extended the use of wambo.org, an online procurement platform, to include COVID-19 products that countries could purchase using grant funding, domestic resources, and funds from other partners. The platform promotes increased transparency, competitive pricing, visibility of transactions, and ensures access to quality-assured products. However, product options and quantities on wambo.org remain limited. Countries have also turned to other procurement channels such as the Africa Medical Supplies Platform for the African region.
The global demand for personal protective equipment (PPE) to curb the spread of COVID-19, ventilators, and testing supplies continues to outstrip the supply. At the onset of the pandemic, three countries produced about 40% of the global supplies of PPE. With the pandemic, at least 47 countries implemented some form of export restrictions on those items. The increased demand accompanied by limited production led to widespread shortages, and prices skyrocketed globally.
The World Health Organization (WHO) estimated that prices for surgical masks increased six-fold, while those of N95 masks trebled. United Nations Children’s Fund (UNICEF) estimated that prices for specific PPE increased steeply in some instances (by more than 20 times).
The Global Fund then intervened to assist recipient countries access PPE needed for COVID-19 prevention—surgical face masks, gloves, gowns, face shields, goggles, and aprons—and diagnostic testing kits which included tests as well as the materials needed to run them. The Secretariat made COVID-19 products available to Principal Recipients (PRs) through wambo.org, an online platform developed by the Global Fund Secretariat in 2016, to help countries procure health commodities. Wambo.org allows PRs to search for, compare quality and prices, and purchase quality-assured products.
Originally wambo.org only allowed the purchase of HIV, tuberculosis (TB) or malaria-related commodities with Global Fund grants. Then as of November 2019, the Board allowed countries to use domestic resources to purchase commodities on wambo.org in what is commonly referred to as the wambo.org pilot.
This article explores the use of wambo.org by Global Fund recipients as well as other approaches countries have used to secure COVID-19 products. Information is taken from a review of Global Fund documents and interviews with key informants from Global Fund recipient countries. Informants requested anonymity since they are not their countries’ official spokespersons.
Board approves extension of wambo.org pilot to include COVID-19 products
The wambo.org platform started offering PPE and diagnostic tests with non-Global Fund financing after Board approval on 7 July 2020. The decision allowed countries to procure COVID-19 products using the Global Fund emergency COVID-19 funding, domestic funding, or funding from other partners. Grant funds included $500 million in grant flexibilities and an additional $500 million made available through the COVID-19 Response Mechanism (C19RM). Countries have used 20% of the C19RM funds to procure diagnostic tests; and used the remaining 80% to support other aspects of the COVID-19 response and to mitigate the impact of COVID-19 on HIV, TB and malaria programs.
PPE and diagnostic tests now available on wambo.org
The wambo.org platform currently includes PPE and diagnostic tests. So far, the Global Fund has signed a cooperation agreement with UNICEF to make selected items on UNICEF’s PPE catalog available to PRs. Currently, only 15 items from the UNICEF catalog are available on wambo.org. These include disposable aprons, face shields, gloves (examination and surgical), medical masks, and respirators (N95 masks).
The WHO led the creation of the WHO Diagnostics Consortium, to address global market shortages of diagnostic tests and promote equitable access. The Consortium has secured commitments from five manufacturers. The Global Fund and UNICEF are the lead procurers of automated COVID-19 molecular tests: the Global Fund procures automated diagnostic tests from Cepheid and Abbott, while UNICEF procures them from Thermo Fisher and Roche (Figure 1). The diagnostic testing kits include the reagents, consumables and controls. The WHO procures manual COVID-19 diagnostic tests from BGI and Thermo Fisher. The Global Fund made Abbott and Cepheid COVID-19 diagnostic tests available on wambo.org. The distribution of diagnostic tests is based on a WHO allocation model, where each country has been assigned a specific number of diagnostic tests based on availability.
According to the most recent Global Fund COVID-19 Situation Report, published on 9 September 2020, 73 countries have collectively procured 1.7 million diagnostic tests so far, although it is not clear if they have all been purchased through wambo.org. This accounts for about 85% of the two million diagnostic testing kits that the Global Fund had secured through volume agreements with the manufacturers.
Table 1: Diagnostics Consortium shipping update for COVID-19
Source: Presentation from the ACT-Accelerator Diagnosis Partnership biweekly meeting held on 03 September 2020
In early September 2020, the Global Fund added dexamethasone products to the COVID-19 module on wambo.org. This addition follows guidance by the WHO, published on 2 September 2020, that strongly recommends systemic corticosteroids such as dexamethasone for the treatment of critically ill patients with severe COVID-19 symptoms. The Global Fund has also announced that it will make antigen-detecting rapid diagnostic tests (Ag-RDTs) available on wambo.org once the tests receive WHO quality assurance approval, which is expected shortly. The cost of each test is estimated at $5 and will deliver results in 10 to 30 minutes.
The platform improves transparency, competitive pricing and visibility of procurement of PPEs and tests
According to the Global Fund, wambo.org helps countries benefit from the Global Fund’s economies of scale for health products and increases transparency and visibility of procurement transactions. This increased transparency is critical as concerns grow over the misuse of COVID-19 funds, in countries such as Brazil, Kenya, Somalia, South Africa, and Zimbabwe, among others. In the alleged misuse of funds in Kenya, the national procurement agency, the Kenya Medical Supplies Authority (KEMSA), bought PPE at double their actual price.
The platform also helps safeguard countries against the purchase of low-quality products; the Global Fund indicated that wambo.org only lists products that are deemed to be of appropriate quality. There have been concerns about poor quality PPE in some countries due to the lack of strict quality control measures and procedural loopholes in quality assurance amid the COVID-19 pandemic.
Limited supply of COVID-19 products available on wambo.org
Several Global Fund Observer sources noted that their countries were using wambo.org to procure PPE and COVID-19 diagnostic testing kits using Global Fund funding. However, the sources noted that product quantities on the wambo.org platform were limited. This is especially true for the Abbott and Cepheid diagnostic tests. One country indicated that although it had secured funding for around one million COVID-19 tests, they had obtained only about 300 000 tests. Indeed, the Global Fund notes a global shortage of the diagnostic tests in its COVID-19 diagnostics guidance. The manufacturers channel most of the supplies to the United States and European countries that easily outbid the orders by low- and middle-income countries (LMICs). Manufacturers including Thermo Fisher, Cepheid, Roche, and Abbott, supplied only 20% of their total testing production to LMICs, according to Devex.
Before the COVID-19 pandemic, in January 2020, the wambo.org had registered 125 buyers from 65 countries. Some sources from countries that were not using wambo.org queried whether the Secretariat would require them to start using it. Some countries have already established their preferred system of procurement, where they have existing relationships with manufacturers and suppliers.
For now, the use of wambo.org remains optional; some countries have opted to procure COVID-19 products from other channels with Global Fund grant funding, instead of wambo.org.
Use of domestic resources to procure wambo.org COVID-19 products
None of the countries we talked to used domestic resources to procure the items on wambo.org. For the diagnostics, the Global Fund pointed out that they had made sufficient funds available through the C19RM.
Some sources told Aidspan that their countries opted to source PPE from local manufacturers, where possible, as they got lower prices compared to those on wambo.org and shorter lead times. The average waiting time for orders of PPE on wambo.org is three months (depending on the mode of delivery). Deliveries by air take between one to three months while those by sea freight take between three to five months. The sources expressed confidence in the ability of local manufacturers to meet the demand. The quality of locally made supplies was approved by the national regulatory authorities.
The same sources reported that purchasing PPEs with domestic resources on wambo.org threatens local manufacturing capacity in their countries, noting that a decrease in local demand and production due to imports would result in fewer jobs and reduce workers’ incomes. As a result, these countries would lose not only jobs but also tax revenue.
The United Nations Conference on Trade and Development (UNCTAD) explained that face masks, gloves, and gowns for health workers are relatively easy to produce thus LMICs should not face shortages of these items. Some countries manufactured their supplies, including testing kits, PPE, and ventilators. For instance, Kenya and Nigeria have been producing PPE including face masks and disposable coveralls. In early September, Ethiopia announced that it planned to start producing testing kits for domestic use and exporting them to the African region. As a result, the Ethiopian government halted the import of testing kits.
LMICs have to address the challenges of a lack of resources (capital, technology, and skills), low quality and standards, weak enabling policy frameworks, inadequate infrastructure, small markets, and unstable demand if they are to produce pharmaceuticals or vaccines.
When LMICs produce PPE, they can trade in their regions. A source pointed out that increased trading of PPE in the region will promote the spirit and objectives of the newly signed African Continental Free Trade Agreement (AfCFTA) as countries would trade among themselves rather than with American, Asian and European countries.
One suggestion on how to incentivize countries to channel domestic resources to wambo.org is to include more suppliers from the African continent on the platform. For a supplier to be listed on the wambo.org platform, it must be prequalified by the WHO; however, the prequalification process is lengthy and costly.
African countries developed an alternative platform
The use of wambo.org, especially when using domestic funds, remains optional for Global Fund recipient countries. Some countries used alternative channels to procure PPE and diagnostics instead of wambo.org (or used those channels together with wambo.org). The African Union (AU) launched Africa Medical Supplies Platform (AMSP) in June 2020 to help African countries access critical medical equipment for the COVID-19 response. The platform has made key COVID-19 products, such as diagnostic kits, PPE, and clinical management devices like ventilators and oxygen concentrators, available to the 55 African states and the 15 members of the CARICOM (Caribbean Community and Common Market). It is not clear how the prices and quality compared to those of wambo.org.