Preparing Africa for the Next Pandemic: Strategies and Opportunities

Vaccine inequality at the height of the COVID-19 pandemic illustrated the importance of strengthening institutional capacity to handle future epidemics. By the end of December 2021, as the Global North had achieved vaccination rates of over 50% of the total population, Africa had only managed to vaccinate 11% of her 1.2 billion people. In preparation for the next pandemic, the continent must take significant actions to avoid such happening again.

In 2001, African leaders agreed under the Abuja Declaration to allocate 15% of their budgets towards healthcare. Two decades later, only six countries have managed to meet that commitment. Underfunding in the health sector remains a big challenge that negatively impacts the provision of health services, installation of healthcare assets, and proper remuneration of healthcare workers to limit ongoing brain drain. According to the World Health Organization (WHO), Africa carries 25% of the world’s disease burden, but its share of global health expenditures is less than 1%. Moreover, of the medicines consumed in Africa, just 1.8% are manufactured within the continent.

The struggling healthcare sector raises concerns about how the continent can handle the next pandemic or health emergency, which as history has shown us, is often around the corner.

Climate-related health emergencies are increasing

Over the last calendar year, conversations by policymakers have centered on addressing the effects of climate change. This stems from the fact that despite contributing just 3% of global emissions, African countries bear the biggest brunt of the climate crisis. While the focus is mainly on climate financing, there is a need to shift towards examining the impact of climate change on healthcare in the continent. The health sector is already literally feeling the heat from a fast-warming planet. According to the World Meteorological Organization (WMO), climate or water hazards are responsible for the deaths of nearly 734,000 people and $43 billion in economic losses between 1970 and 2021.

Worryingly, the fatality rates will continue rising primarily because climate-related health events are simultaneously increasing. This should light off alarm bells among policymakers. If the situation continues, the chances of witnessing an epidemic are very high, thus, the capacity to handle it when it occurs is crucial. The approach must also be specific since the health impacts vary according to geographic location. For example, water-borne diseases are likely to be more prevalent in urban informal settlements, while zoonotic diseases will impact rural areas more.

“Climate change is one of the greatest threats to humanity. The entire foundation of good health is in jeopardy with increasingly severe climatic events. In Africa, frequent floods and water- and vector-borne diseases are deepening health crises. Although the continent contributes the least to global warming, it bears the full consequences,” said Dr. Matshidiso Moeti, WHO Regional Director for Africa.

Therefore, more investment is required in constructing resilient and sustainable drainage, transportation, and waste disposal systems. As the focus shifts towards new forms of climate financing like debts-for-climate swaps, there is an opportunity for African countries to approach external creditors to have their debt obligations exchanged for solid commitments to invest in sustainable infrastructures. Moreover, while tree planting initiatives have the noble goal of increasing forest cover, it is more reasonable that climate financial flows into the continent go to other more pressing sectors, such as cleaning polluted rivers and constructing canals, drainage systems, and dams to cushion against floods.

Design alliances such as tripartite agreement between ARC, WAHO, IPD

Partnerships are crucial for strengthening epidemic preparedness in Africa. The 2014-2016 Ebola pandemic demonstrated the importance of coordinated responses to epidemics. When countries or organizations work together, much is achieved, In 2022, the African Risk Capacity Group (ARC), the Institut Pasteur de Dakar (IPD), and the West African Health Organization (WAHO) came together, under the leadership of AfriCatalyst, to sign a Memorandum of Understanding to establish a framework for collaboration in innovative finance and policy technical expertise to strengthen epidemic preparedness and response in the ECOWAS region and beyond.

Speaking during its launch, Ibrahima Cheikh Diong, United Nations Assistant Secretary-General and ARC Group Director General, said, “ARC welcomes this great Africa-led initiative supported by the BMGF as we continue to develop our Outbreaks & Epidemics risk insurance product to enable early containment of epidemic-prone diseases, and respond to public health emergencies.”

Meanwhile, Dr. Amadou Alpha Sall, CEO of Institut Pasteur de Dakar, praised the partnership’s potential. “The IPD-ARC-WAHO Alliance supported by the BMGF brings an innovative approach to dealing impact fully with epidemic and pandemic preparedness in West Africa and beyond.”

“WAHO is delighted with this partnership, which continues our strategy of prioritizing regional solutions to regional problems,” added Professor Stanley Okolo, WAHO Director General.

Collaboration on data sharing

The COVID-19 pandemic provided an opportunity to implement a data-centric approach to curbing the spread of the virus. The Africa Center for Disease Control (Africa CDC) worked closely with national governments to develop plans for immunization, utilizing data, that, while limited in scope, provided a helping hand for targeted actions. In preparation for the next epidemic, African countries must develop their epidemic intelligence, data collection and analysis systems, from early warning and detection to monitoring spread and compliance with enforcement measures. Sharing and harmonization of data sets regionally should also take precedence.

The World Health Organization has long been a leading advocate for data processes in Africa to combat the rise and spread of epidemics. In 1998, the WHO introduced the Integrated Disease Surveillance and Response (IDSR) framework to strengthen data collection, analysis, and use in African countries. The IDSR was to act like an early-warning system that could detect outbreaks at their initial stage and alert authorities to take action even before they leave. This strategy greatly assisted West African countries in dealing with Ebola and the Marburg virus.

Leveraging on continental frameworks

Diseases, unfortunately, do not know borders. African countries should work together even as they develop individual plans. Currently, there are various continental strategies, such as the Partnership for African Vaccine Manufacturing (PAVM), which aims to build institutional capacity to locally produce 60% of vaccines used in the continent by 2040. The private sector can also leverage on the Africa Medical Supplies Platform (AMSP), to procure medicines and other supplies from within the continent at competitive rates.

The African Continental Free Trade Agreement (AfCFTA) is another masterstroke. If fully implemented, Africa will be home to the world’s largest free trade area, with a market of more than 1.4 billion. Outside companies may find it easier to invest in the continent due to the free movement of goods, and this will integrate Africa further into the global supply chains. Knowledge transfer and cross-country partnerships between researchers, academia, and healthcare providers could also help strengthen resilience against the next pandemic.

In conclusion, Africa has done a commendable job in building capacity to handle future epidemics despite limited investment by governments in the healthcare sector. However, water-borne diseases and malaria remain a significant challenge, which is only estimated to grow as malaria-risk areas expand and flooding becomes more common and erratic. It is therefore critical that policymakers seek ways to attract more funding for health assets and sustainable infrastructure that puts the continent in the best position to handle extreme weather events when they happen.

Citations

Azevedo MJ. The State of Health System(s) in Africa: Challenges and Opportunities. Historical Perspectives on the State of Health and Health Systems in Africa, Volume II. 2017 Feb 3:1–73.

Ihekweazu, C. Building Africa’s capacity for pandemic and epidemic intelligence. The Brookings Institution. Retrieved September 22^nd, 2023 from https://www.brookings.edu/articles/building-africas-capacity-for-pandemic-and-epidemic-intelligence/

Umviligihozo G, Mupfumi L, Sonela N et al. Sub-Saharan Africa preparedness and response to the COVID-19 pandemic: A perspective of early career African scientists [version 3; peer review: 2 approved]. Wellcome Open Res 2020, 5:163 (https://doi.org/10.12688/wellcomeopenres.16070.3)