In an article for BMJ Global Health in February 2024 a group of authors from Africa CDC consider the role that their organisation played during the COVID-19 pandemic and the lessons that can be identified from the experience. They recognise that the African continent has been “highly affected by recurrent emerging and re-emerging public health threats” such as Ebola, Marbug, and Mpox. However, despite, or perhaps due to “decades of recurring outbreaks”, the continent’s public health emergency management system is “characterised by a limited capacity to prevent, detect, and respond to the outbreak”. So, how does Africa CDC see a way forward for the continent?
Africa CDC
The authors state that the 2014-2016 Ebola Viruse Disease outbreak in West Africa was a “catalyst” to accelerate commitments leading to the establishment of a continental public health agency.
“It exposed the weakness of health systems in affected countries and the challenges of mounting well-coordinated regional and continental responses.”
Thus, African Heads of State and Government officially launched Africa CDC in January 2017 with the aim of strengthening public health institutions’ capacity to “prevent, detect, control, and respond quickly and effectively to disease threats”. Africa CDC is “mandated to oversee and support the implementation of the New Public Health Order”. This comprises 5 key elements:
- Strengthened public health institutions
- Strengthened public health workforce
- Expanded manufacturing of vaccines, diagnostics, and therapeutics
- Increased domestic resources for health security
- Respectful and action-oriented partnerships
Learning from COVID-19
While they recognise that the “acute phase” of the COVID-19 pandemic has been declared over by WHO, the authors emphasise the “challenging” effect it continues to have on the health system. Although there are continued reports of global cases and deaths, “testing capacity and case detection are not getting due attention in Africa”.
“Thus, it is critical to reactivate the interventions and capitalise on the lessons learnt thus far to address the ongoing burden and prepare for future pandemics.”
The authors highlight the critical role of “high-level political will and commitment” in discussions about pandemic preparedness and response. During the pandemic, Africa CDC convened the first high-level emergency meeting of Ministers of Health with a “clear roadmap” on 22 February 2020, a week after the first case was reported in Africa. This “pivotal moment” gathered the African Union Member States to “fight against the looming threat”, which was “complemented” by “continuous engagement”.
Pandemic preparedness reportedly began “when the outbreak was still mostly confined to China”, but initial preparations revealed that “laboratory capacity was still inadequate”; only two countries (South Africa and Senegal) were able to diagnose SARS-CoV-2 in February 2020. Between March and April 2020, laboratory experts from Member States were trained and test kits were supplied to “dramatically” improve detection capabilities. Other “bottlenecks” were targeted by Africa CDC, such as “critical medical supplies for the response” and “bridging the lockdown with air transport”.
Key initiatives
Two key developments are highlighted in the editorial: the African Vaccine Acquisition Trust (AVAT) and African Medical Supplies Platform (AMSP). The former was established in response to a need for pooled procurement to ensure equitable access to vaccines.
“This special-purpose vehicle serves as a central entity for negotiating, procuring, and paying vaccines and acts as the interface between AU Member States and the vaccines manufacturers.”
The latter, AMSP, is a not-for-profit initiative that was launched by the AU as an “immediate, integrated, and practical” response to the pandemic. The goal was to “facilitate access to an African and global base of vetted manufacturers”. This ensured that Member States purchased “certified medical equipment” with “increased cost-effectiveness and transparency”.
Partnerships against pandemics
The authors identify another “critical lesson”: “the role of respectful and action-oriented partnerships with international agencies, partners, and philanthropies”. Africa CDC offers an opportunity for the “cocreation of exemplary partnerships” to “boost the capacity” of Member States to respond to health threats. An example of a partnership is between Africa CDC and the Mastercard Foundation: Saving Lives and Livelihood (SLL).
“The SLL programme was spectacular in purchasing and delivering vaccines, enhancing vaccine uptake, and strengthening the capacity of Member States and public health institutes, thereby contributing substantially to the mitigation of the pandemic’s impact on the lives and livelihoods of African people.”
Fragility = opportunity
As they identify the “fragility of the health system”, particularly the public health surveillance system, the authors recognise an opportunity to build “digital health systems” and “establish electronic data management and visualisation systems” to guide “informed decision-making and response”. They suggest that, during the transition out of the acute phase of the pandemic, “sustaining digital health investments is critical”.
“Learning from the COVID-19 pandemic, countries need to invest more in health informatics workforce, information technology infrastructure, and data quality improvement initiatives to prepare for the future pandemic.”
National Public Health Institutes (NPHIs)
The role played by National Public Health Institutes (NPHIs) during the pandemic response is described as “spectacular”. They coordinated essential public health functions. Additionally, with lessons from the Ebola outbreak and now the COVID-19 pandemic, Africa CDC is supporting Member States to establish an NPHI with a “functional” public health emergency operation centre (PHEOC). This is a “physical hub to coordinate response activities” for public health emergencies. The authors recommend that Member States “prioritise the establishment and strengthening” of NPHIs and the “sustainability and functionality of their PHEOCs”.
Preparing for the future
“Learning from the hard-fought gains during the COVID-19 pandemic is critical as we prepare for the future pandemic.”
The article concludes with a reminder that “high-level political commitment” and “cocreated respectful, action-oriented partnerships” are “remarkable” to effective and timely responses. The authors demand agility and flexibility of African health systems to “accommodate their respective countries’ and the continent’s emerging and evolving needs”. Furthermore, digital health interventions and NPHI coordinating roles should be “sustained” through “increased investment in the health workforce and resources”.
Sustaining and building on Africa’s efforts during the pandemic is a topic of interest for many of our attendees at the Congress in April so do get your tickets to hear from experts in this subject, including representatives of Africa CDC, and don’t forget to subscribe for more global health perspectives.
