The COVID-19 pandemic opened a 'Pandora's box' of never-ending problems putting enormous pressure on global health systems, exposing biases in global public health practices and disrupting global economies. There was also the loud warning about the need to reform and revitalise global health systems, which was difficult to ignore.
Today, Africa appears to be at a crossroads with an unprecedented opportunity to build resilient health systems that can withstand any health crisis, while also ensuring that the continent's voices are well represented in global health leadership.
To ensure that Africa builds back better, Africa Centers for Disease Control and Prevention (Africa CDC) developed the New Public Health Order for Africa in 2022, a roadmap to drive sustainable health outcomes and health security that is organised around five salient pillars -
- Strong African Public Health Institutions that represent African priorities
- Expanded Manufacturing of Vaccines, Diagnostics, and Therapeutics
- Investment in Public Health Workforce and Leadership Programs
- Increased Domestic Investment in Health
- Respectful, Action-Oriented Partnerships
This new public health order aims to strengthen African public-health systems and give Africa a stronger voice in the global health discourse. It came as no surprise then, that these five pillars were reiterated over and again at the second International Conference on Public Health in Africa (CPHIA 2022) which took place in Kigali in December 2022. The conference theme was, 'Preparedness for future Pandemic and Post-Pandemic Recovery: Africa at a Crossroad', and, from plenary to parallel to abstract-driven sessions and side events, delegates discussed Africa's most significant health challenges while also proposing solutions to building back better.
Here are five lessons from the conference on how to better navigate the crossroads and build back better.
- A continent confident in its ability
Africa's swift response to the COVID-19 pandemic was above expectations, particularly since the 2019 Global Health Security Index ranked many African countries as the least capable of dealing with any new health threat. The response capitalised on Africa's 'strengths' -- drawing from past experiences, leveraging previously used structures and swiftly adapting them to COVID-19. The restrictions placed on the exportation of essential medical supplies as well as the resulting shortage, prompted the local manufacturing of some of these essential medical commodities, such as masks, hand sanitisers, ventilators and mobile applications, to support patient treatment, management and contact tracing.
Africa's poor health indices have been among the worst in the world, owing largely to the under-investment in the continent's health sector, including its institutions, workforce, research, and manufacturing capacity. Building back better will require us to believe in our ability to guide the implementation of the solutions required to make a real and lasting change in global health security.
In his welcome address, Dr. Ahmed Ogwell Ouma, Acting Director of Africa CDC said, "It is time for a new way of doing things on the continent so that we can achieve our health security agenda. Our vision of that different way of doing things is the new public health order. A vision that takes Africa from always following others to an Africa that is confident in its own skin. A continent that sets its own agenda, develops its own internal capacity, establishes its own priorities, seeks indigenous solutins and uses domestic resources to initiate action."
- Fostering innovation and strengthening research capacity
Healthcare innovations were never more important than during the height of the pandemic, as it triggered scientific innovations that resulted in the rapid development of vaccines, medicines and diagnostics. Africa produces only 1% of its vaccines and must increase local vaccine and production of medicines, to ensure the continent's health security. However, for this to happen, we must take positive steps to strengthen our research capacity. Speaking during the plenary session on 'Increasing Local Production in Africa: Advocacy, Research & Development Capacity in Diagnostics, Therapeutics & Vaccine Manufacturing', Dr. Hassan Sefrioui, Director & Member of the Executive Board, MAScIR, identified political will, funding and the availability of raw material as enablers of local manufacturing of diagnostics in Africa. Without these, Africa might be unable to achieve the bold target of meeting up to 60 percent of its vaccine demand through regional manufacturing by 2040.
- Providing an enabling environment for the youth to thrive
Africa's youth make up over 65% of the continent's population, so it is important that they are given opportunities to lead and make decisions about the continent's public health. Delivering a keynote speech during the plenary session " Women in Health -- From Recipients to Providers to Leaders", Oyeronke Oyebanji, Policy and Partnerships Manager, CEPI, said that young people have the advantage of "energy" and the ability to go "over and beyond the call of duty". She therefore urged decision makers to "allow young people to lead and trust us to do this. Provide an environment so we can thrive; we have proven that we can do this."
To provide an enabling environment for the youth and ensure their full participation in the prevention and control of diseases in Africa, Africa CDC established a youth advisory team which, according to Dr Ouma, was formed to advise on the most effective ways to harness the energy and passion of the youth as Africa builds back better. "You, the youth, are not just the leaders of tomorrow, you are our present and you are our future," he stated.
- "Without gender equality there is no UHC"
The inequities in global health were exacerbated during the COVID-19 pandemic. Especially among women and girls who often had to navigate patriarchy, poverty and violence in order to access healthcare. These disparities are also observed among women in healthcare where, despite the majority of frontline workers being women, there are fewer women in leadership positions. "Women and young people have been pushed behind in leadership roles and this must change if we are to turn the crisis into opportunities and build sovereign and resilient health systems to ultimately achieve UHC," said Dr Magda Robalo, President, Institute of Global Health and Development.
To achieve UHC, the rights and dignity of women with disabilities must also be promoted and protected, said Dr Mary Muchekeza, Provincial Medical Director, Ministry of health and Child Care, Zimbabwe. Highlighting the immense gap in access to healthcare and education among women in this demographic as well as their vulnerability to gender-based violence, she called for policies that support women with disabilities to be more than just words on paper. "This is a call to the global health community to bring policies into life as indeed the life of any policy lies in its implementation," she added.
- We must tell our stories
In her popular TED talk titled, 'The Danger of a Single Story', Chimamanda Ngozi Adichie said, "If we hear only a single story about another person or country, we risk a critical misunderstanding". Africa must learn to fully tell her stories in full. The poor health indicators that are often reported are only part of the African story. The continent has made significant progress in public health and these stories must be told well. "As Africans we have not been very good at blowing our own trumpet said Dr Ouma. As public health professionals, we are so focused on the work that we are assigned to do that we don't pause to tell our own story, he added This must change at this crossroad". Being a story teller himself, he talked about some of Africa CDC's noteworthy feats, which were especially commendable because they were achieved between February and August 2020. These include,
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- Moving the continent from only 2 labs that could test for COVID-19 to every country on the continent being able to do the same from hundreds of laboratories.
- Building a network of labs that could do sequencing: first for the virus that causes COVID-19 and progressively any pathogen that we have wanted to sequence.
- Building the capacity of African professionals in all aspects of pandemic preparedness and response.
Implementing the new public health order
The world is more connected than it has ever been. COVID-19 threatened hard-fought gains against infectious diseases, and recent outbreaks serve as a reminder that Africa, like the rest of the world, is still vulnerable. Africa must build back better in order to improve African representation in the global health ecosystem, reverse the vast inequalities in global public health and mitigate the effects of future pandemics. To achieve this, countries must commit to working with the Africa CDC and partners to make Africa's New Pubic Health Oder a reality.
