If there were any doubts of what may happen when countries don't take prioritise epidemic preparedness, the covid-19 pandemic is still a fresh reminder. Its economic cost is estimated to be as high as $114 trillion. However, it is not just about money. Other long-term consequences may not be apparent at first, such as morbidity, mental health, economic losses and increased poverty rates.
However, one the lessons from the pandemic is the importance of collaboration. Unfortunately, the way countries, organisations and even individuals collaborated leaves much to be desired, unfortunately. Nevertheless, the saying "No one is safe, until everyone is safe", could not be truer.
Nonetheless, working together to achieve global health security requires frameworks that engender coordinated and seamless collaborations. One such framework was already in the works in West Africa even before the pandemic. In 2019, the 20th ordinary session of the Economic Community of West African States (ECOWAS) Assembly of Health Ministers adopted the Regional Strategic Plan for Public Health Emergency Preparedness and Response. The document committed to establishing a regional network comprising 15 National Public Health Institutions (NPHIs) in West Africa to strengthen and coordinate health security efforts across the region.
Learning on the go
NPHIs are set up to be learning organisations, using research and evidence to inform their response to infectious disease threats. They play crucial roles in responding to public health emergencies and mitigating the impact of health crises. By serving as centres of excellence for public health research, surveillance, and response, NPHIs are uniquely positioned to lead coordinated efforts to prevent, detect and control disease outbreaks. Importantly, they help preserve institutional knowledge gained from responding to disease outbreaks. Experts can be assembled from multiple disciplines to respond to an outbreak but without an NPHI, they all return to their respective organisations or agencies after the outbreak is over, losing the opportunity to preserve lessons that can be critical for future responses.
While some progress has been made in their establishment in West Africa (WA), challenges remain. Limited resources, capacity gaps, and competing priorities are barriers to the full functionality of these vital institutions. Learning from established NPHIs such as the Nigeria Centre for Disease Control and Prevention (NCDC) becomes an invaluable strategy for establishing and strengthening new NPHIs.
In March 2024, the West African Health Organization (WAHO), through the Reegional Center for Surveillance and Disease Control, in collaboration with the Africa Centres for Disease Control and Prevention (Africa CDC), the International Association of National Public Health Institutions (IANPHI), and the US Centers for Disease Control and Prevention (US CDC), organised the annual meeting of NPHI Directors and relevant senior Ministry of Health technical officers as well as development partners supporting NPHIs from the West African Region, in Abuja, Nigeria. The meeting provided a platform for peer learning and discussions on how to accelerate the functionality of NPHI networks across member states.
It takes a Village
Infectious diseases threats are unrelenting in their quest to grow, and sometimes, results in infecting humans, leading to illnesses and sometimes, death. Efforts to keep them at bay must also remain agile, and always evolving as conditions change. Like a village coming together to find strategies for addressing a common enemy, convenings such as the one in Abuja, are essential for regional, continental, and global health response. Experts also referred to this, encouraging representatives from the member states to share what is working in sustaining NPHIs in their countries, to enable others improve or start theirs.
Dr Virgil K. Lokossou, Ag Executive Director of ECOWAS Regional Centre for Surveillance and Disease Control, said establishing and strengthening NPHIs is a shared priority for WAHO, AfricaCDC and IANPHIs. Lokossou noted that "it reflects the spirit of cooperation and knowledge exchange that defines our collective pursuit of excellence in public health initiatives".
NCDC's DG, Dr Jide Idris, while stating the meeting's aim to "share lessons learned from both established national public health institutes and those in the nascent stages of development within West Africa," urged participants not to forget the consequences of Ebola and COVID-19 on health, which led to health system destruction, mass displacement, and destabilised economies.
However, it is important to be mindful of the context while replicating these learnings, noted Ellen Whitney, Director, U.S. Office, IANPHI. She hopes that the meeting empowers "member states of the West Africa region to walk away with a better understanding of the challenges and facilitators for establishing and strengthening national public health Institute's, learning from their peers who have successfully established a public health institute and how to build and strengthen their own within their country contexts". While the member states may not have all the necessary capabilities, organisations like the AfricaCDC are prepared to support them. Dr Raji Tajudeen Head, Division of Public Health Institutes and Research at AfricaCDC, said that it is one of their key agendas to support every member state to establish NPHIs and strengthen already existing ones.
Stronger together
Participants from Benin, Burkina Faso, Cabo Verde, Cote d'Ivoire, Gambia, Guinea, Guinea-Bisau, Liberia, Mali, Nigeria, Ghana, Senegal, Sierra Leone, and Togo attended the three-day workshop. The first session on day one set the tone with presentations and discussions that established an understanding of NPHIs. Haftom Taame, an Epidemiologist at Africa CDC presented an overview of Africa CDC NPHI framework and support towards NPHI establishment in West Africa. He shared their role in supporting the conceptualisation and ongoing revision of the NPHI development framework. He highlighted that NPHIs are one of the five key components of the new public health order.
Participating countries shared the status of NPHI development and key achievements, generating questions and feedback. While Senegal and Togo lack NPHIs, specialised institutions help coordinate public health interventions. Discussions also highlighted the need for legislative frameworks to shepherd the activities of NPHIs. NCDC had it bill signed into law in 2018. The countries also shared tips on domestic resource mobilisation, which is critical for maintaining health security initiatives. While NPHIs are important, there was an emphasis on the need for sub-national stakeholder engagement. While referring to themselves as the newest 'kid on the block', having recently launched their NPHI, Sierra Leone shared useful insights with other participants. Lessons from their history evolving from other agencies to lessons on domestic resource mobilisation with their Vice President's support. They also discussed how local businesses that generated a certain profit annually were required to contribute to health security, by being made aware of the effect a pandemic may have on their businesses.
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To increase learning during the workshop, participants worked in small groups to identify challenges and lessons learned in NPHI development, discussed possible ways to address these challenges, and developed roadmaps to accelerate NPHI development in the region. They delivered presentations and received feedback from their colleagues and other technical experts supporting the workshop.
As the host country with an NPHI, participants visited the National Reference Laboratory run by the Nigeria Centre for Disease Control to learn more.
Way forward
Beyond learning, these convenings help countries review the ever-present threats posed by infectious diseases, and remind each another of the need for working together, and the cost of not doing so. It also provides an opportunity for them to reaffirm their commitments to proactive data sharing and openness, which are critical if they are to meet the global 7-1-7 target.
Armed with these new insights and evidence, they may return to their respective countries and continue building political support for national and regional health security. Nigeria is fortunate to be experiencing a potential paradigm shift in its health sector, with health security clearly outlined in the new administration's four-point agenda to improve health for all. However, this will be meaningless if its neighbours do not prioritise health security.
After all, we are "only as strong as our weakest link".
