10 8 6 4 Regional averages 2 0 1995-2000 2000-2005 2005-2010 2010-2017 SUPPORT 2FOR PUBLIC HEALTH: Preparing for the next pandemic 22 FORESIGHT AFRICA Building a new public health order for Africa— and a new approach to financing it “One lesson we learned from the Ebola crisis is that the best way to minimize the damage from an outbreak is not to have one at all. Preparedness is key. But preventing future pandemics won’t happen automatically. It requires collabora- tive effort to catch-up on years of underinvestment in our health systems. The technical know-how for building strong health systems to prevent diseases alre- ady exists. The challenge is to match that know-how with plain old vision–good governance and global cooperation.” Ellen Johnson Sirleaf, Former President of Liberia & Nobel Peace Prize Laureate In the early autumn of 2020, Africa rises. With limited local manufac- received positive press about its turing capacity, Africa is particular- response to the SARS-CoV-2 (also ly vulnerable to such dynamics. known as COVID-19) pandemic. Given the fragility of many of the Thankfully, as of this fall, Africa had continent’s health systems, many counted just about 1.5 million cases had initially feared that the impact and 40,000 deaths43—far, far fewer of SARS-CoV-2 would be devastat- than other, often richer, regions of ing.40 Indeed, Africa has the larg- the world.44 Public health experts est burden of endemic diseases in largely attributed Africa’s success the world,41 and SARS-CoV-2 could so far to favorable socio-economic, abolish decades of progress in the demographic, and environmental fight against these diseases by dis- factors, but also to rapid and de- rupting health care provision and termined political action. Indeed, access to medications.42 In addi- many African countries were quick tion, as the world races for access to introduce containment mea- to critical diagnostics, pharmaceu- sures, such as lockdowns.45 The ticals, and vaccines, protectionism continent has also been approach- John 40 “Africa Is Woefully Ill-equipped to Cope with COVID-19,” The Economist, March 26, 2020. Nkengasong 41 John Nkengasong and Sofonias K. Tessema, “Africa Needs a New Public Health Order to Tackle Infectious Disease Threats,” Cell 183, no. 2 (2020): 296-300. 42 Britta L. Jewell et al., “Potential Effects of Disruption to HIV Programs in Sub-Saharan Africa Caused Director, Africa Centres by COVID-19: Results from Multiple Mathematical Models,” Lancet HIV 7, no. 9 (2020): e629-e640. for Disease Control 43 “Coronavirus Disease 2019 (COVID-19): Africa CDC Dashboard,” Africa CDC, accessed January 1, 2021. and Prevention 44 Anne Soy, “Coronavirus in Africa: Five Reasons Why COVID-19 Has Been Less Deadly than Elsewhere,” BBC, October 7, 2020. 45 @JNkengasong John Nkengasong and Sofonias K. Tessema, “Africa Needs a New Public Health Order to Tackle Infectious Disease Threats,” Cell 183, no. 2 (2020): 296-300. 23 TOP PRIORITIES FOR THE CONTINENT IN 2021 ing the crisis largely as a bloc: Even before the ing vulnerabilities it exposes. To address this first case was confirmed in sub-Saharan Africa, multidimensional threat, Africa requires a new the health ministers of the member states of the public health order, including: African Union held an emergency meeting to pre- pare for the pandemic and, fewer than six weeks 1. A strengthened Africa CDC and national pub- after the first reported case on the African conti- lic health institutions (NPHIs). Africa CDC, nent in Egypt on February 14, released the Joint through its Secretariat and Regional Collabo- Africa Continental Strategy on COVID-19. rating Centers, provides national NPHIs with guidance on priorities and programs, inte- grates efforts, and drives standard-setting and surveillance. (For more on the role of national The African approach to NPHIs, see the viewpoint on page 27). COVID-19 has been anchored 2. Local production of vaccines, therapeutics, in collaboration and solidarity. and diagnostics that contributes to supply security, drives down procurement costs, and increases the speed of response to a lo- cal threat.50 Such initiatives should be driven The African approach has been anchored in by strong private sector partners, with public collaboration and solidarity. Successes include support for the required capability building the Partnership to Accelerate COVID-19 Testing and other enablers, but also for the negoti- (PACT), launched by the African Union Commis- ation of contracts that are sufficiently large sion (AUC) and the Africa Centres for Disease and long-term for the initiative to attract the Control and Prevention (Africa CDC) in April required funding. An example of such a pub- 2020, which enabled Africa, initially shoved aside lic-private partnership is the South African when global demand for diagnostics rose,46 to Biovac Institute.51 increase the number of countries with testing capacity from two to 43 in three months,47 pro- 3. Investment in public health workforce and cure more than 90 million test kits,48 and train leadership programs. A sufficiently large, thousands of lab workers. Similarly, a shared ef- well-prepared health workforce is key to any fort among the AU, Africa CDC, UNECA, and the of the activities mentioned above. But the African Export-Import Bank to create the Africa gaps are significant. For example, Africa re- Medical Supplies Platform led to pooled pro- quires 25,000 frontline epidemiologists and curement of critical medical supplies, increasing has about 5,000.52 countries’ access to vital personal protective equipment regardless of the size of their market. 4. Action-oriented partnerships—including be- The most recent example is the Trusted Travel tween the public and private sector, donors Platform launched by AUC and Africa CDC in Oc- and governments, and with public health in- tober 2020. The platform includes information stitutions. Respectful partnerships are those on the latest travel restrictions and entry require- that respect African-originated and -defined ments and simplified health-related immigration health priorities and solutions, and ensure that processing for travellers and port officials, which health programs are aligned with continental will protect lives and livelihoods and help pre- priorities such as the Agenda 2063. pare for the implementation of the African Conti- nental Free Trade Area (AfCFTA).49 This new public health order requires more pre- dictable, long-term funding overall, joint priori- However, if we only look at SARS-CoV-2-related ty-setting, and stronger mechanisms to manage morbidity and mortality, we miss a large part the allocation of funds in line with continental of the pandemic’s impact and of the underly- aspirations. 46 John Nkengasong, “Let Africa into the Market for COVID-19 Diagnostics,” Nature 580 (2020): 565. 47 Pascale Ondoa et al., “COVID-19 Testing in Africa: Lessons Learnt,” Lancet Microbe 1, no. 3 (2020): e103-e104. 48 Giulia Paravicini, “African Countries Secure 90 Million Coronavirus Test Kits for Next Six Months,” Reuters, June 4, 2020 49 “’Travel Pass’ to accelerate AfCFTA implementation,” The Herald, October 28, 2020. 50 Stanley Plotkin et al., “The Complexity and Cost of Vaccine Manufacturing - An Overview,” Vaccine 35, no. 33 (2020): 4064-4071. 51 David R. Walwyn and Adolph T. Nkolele, “An Evaluation of South Africa’s Public–Private Partnership for the Localization of Vaccine Research, Manufacture and Distribution,” Health Research Policy and Systems 16, no. 1 (2018): 30. 52 Stanley Plotkin et al., “The Complexity and Cost of Vaccine Manufacturing - An Overview,” Vaccine 35, no. 33 (2020): 4064-4071. 24 FORESIGHT AFRICA FIGURE 2.1 THE TRAJECTORY OF COVID-19 IN AFRICA AND THE REST OF THE WORLD In defiance of early predictions that COVID-19 would severely affect sub-Saharan Africa due to weak health systems and challenges to social distancing, it seems that Africa has fared much better than the rest of the world in fighting the disease: To date, sub-Saharan Africa has had substantially fewer cases and deaths per million from COVID-19 than the rest of the world. The trajectory of the pandemic has also differed in Africa, with no substantial peaks or increases, unlike in North America and Europe, which have the highest death tolls per million inhabitants and are shown on a separate axis below. Over the past year, How easy or difficult Visual Key Cases Deaths Recoveries how often have you or your family was it to obtain medical care gone without medical care? you needed Sub-Saharan Africa 1000 134127 Rest of the world 1 2 42366 Never Very easy Just once or twice Easy 1000 1 2 Several times Difficult Many times Very difficult 5000 2000 Always Total deaths per million inhabitants North America and Europe and Central Asia on a separate axis 3 4 500 1,000 Total deaths per million (North America and ECA) Total deaths per million (North Right away Very well After a short time Fairly well 3 4 400 800 After a long time Fairly badly Never received care Very badly 300 600 How long did it take you How is the government 200 400 to receive the medical care handling improving that you needed basic health services 100 200 Total deaths per million (excl. North America and ECA) Total deaths per million (excl. 0 0 Mar 1 May 1 Jul 1 Sep 1 Nov 1 Jan 12 Visual Key North America Europe & Central Asia (ECA) Funding in the tens of billions of dol- and international organizations. Beyond 53,54 Sub-Saharan Africa lars is required to train the nurses, training, a better equipped medical sys- South Asia physicians, and other cadres needed tem requires local manufacturing ca- Latin America & Caribbean to close the gap in the availability of pacity, which, in turn, needs significant East Asia & Pacific trained health care professionals pre- upfront investment.