Global health security starts locally, build universal coverage

Dr Ebere Okereke

Dr Ebere Okereke. Public health physician specialising in global health security and health systems strengthening.

Photo credit: Pool

Dr Ebere Okereke is a public health physician specialising in global health security and health systems strengthening, senior health advisor at the Tony Blair Institute for Global Change, and a senior public health advisor at Africa CDC. She talks to Nation.Africa about health security.

What’s the future of globalisation after the Covid-19 pandemic?

Globalisation means that the rich and poor are interdependent on each other for access to services, and so in the words of the World Health Organization’s (WHO) Dr Tedros Ghebreyesus, we are not safe until everyone is safe. The pandemic explicitly revealed the inequities in global health and access to resources. It highlighted risks to the world as a consequence of those imbalances. Decision making, resources and access to tools for health protection are concentrated in high income countries, thus disadvantaging poorer ones. This is particularly concerning because the risks from emerging public health threats increase with climate change and are primarily felt in low resource regions and countries.

The future of globalisation must therefore address the current power and resource imbalances by increasing equitable partnerships.

In a continent of finite resources, what are Africa’s global priorities?   

The future of global health for Africa must be driven from the bottom up by full and effective involvement of the civil society in determining priorities and developing culturally competent strategies to implement them. Civil society engagement should be closely followed by increased domestic financing for health programmes, hence moving away from donor dependence and shifting from externally-determined priorities. 

Resources may be finite but we can make different decisions on how to utilise the resources we do have. Health is an investment that is necessary for development and economic growth.

What are the gaps, challenges and inequities from the current global health ecosystem?

Africa is underrepresented in global health discourse since the global health system is significantly skewed in favour of the Global North. Africa’s absence or under-representation in key decision-making means that we have less power to influence major outcomes. For example, only 3 per cent of WHO collaborating centres (WCCs) which support public health system strengthening and generate evidence necessary for health policy are in Africa. Nearly 80 per cent of all WCCs are based in just 22 countries, 13 of which are high-income countries.

Most research into the solutions for global health priorities are defined, funded, implemented and managed by countries in the west, thus Africa’s needs may be peripheral or secondary.

The absence of an African health manufacturing industry means that we are reliant on others for our vaccines, therapeutics, diagnostics and health solutions, creating a scenario where we were at the end of the queue for these essential products. This is a health security risk for the continent.

What should Africa do to be less vulnerable in future pandemics?

We have already started that journey through the coordination between the African Union (AU) and Africa CDC. The priorities are summed up in the New Public Health Order for Africa which calls for increased investment in:

•             National Public Health Institutions

•             Effective trained public health leaders and workforce

•             Health technology – diagnostics, therapeutics, vaccines and other health solutions

•             Increased domestic financing for health

•             Trusted partnerships: within countries, between countries, across the globe, between public private and philanthropic actors

Beyond health systems, to prevent pandemics, we must address climate change, create peace to reduce forced movement of people, focus on food security and educate our citizens, particularly women and girls.

Does Africa stand a chance to change its health infrastructure and disease burden for the better in the long-run?               

A Martin Luther King quote, often used by former US President Barack Obama, states: ‘The arc of the moral universe is long but it bends towards justice’. This saying can be applied to the journey towards improved health outcomes, disease burdens and life expectancy across the continent. The move is generally in the right direction, but it is slow, precarious and requires continued focus and committed investment. Over time, childhood health outcomes continue to improve as HIV, TB and Malaria death rates decline. Despite the pause due to the pandemic, the general direction of life expectancy and disease burden across the continent is positive. There are pockets of excellence as well as challenges. Covid-19 will only have a positive impact if we learn the lessons and translate the investment in the pandemic response into sustainable routine health systems and improved preparedness. Ultimately, the best protection from disease is universal health coverage.

Africa was left behind in terms of access to Covid-19 vaccines, drugs and even various therapies. What preparation should we put in to be ready for the next pandemic?     

Preparation started even before Covid-19 with the creation of Africa CDC, whose mandate is to coordinate the public health system for the continent. Africa CDC proved its value with the speed with which it was able to coordinate all AU member states to agree on a continental strategy for pandemic response before the first coronavirus case was confirmed on the continent.

The AU and Africa CDC have now moved forward by creating the Partnerships for African Vaccines Manufacturing (PAVM) and setting a goal to increase domestic manufacturing of vaccines from 1 per cent of Africa’s current consumption to 60 per cent of our needs by 2040. PAVM is creating an ecosystem for vaccine manufacturing that will also be relevant to the production of therapeutics and diagnostics. 

The now ratified Africa Medicines Agency will have a continuing role to consolidate the innovations and investments emerging from the pandemic into a sustainable benefit for the continent.

Solutions created in response to the pandemic such as the Partnership to Accelerate Testing (PACT), the African Vaccine Acquisition Task Force (AVATT), the African Union Trusted Travel Portal and the AU Covid-19 Response Fund should be leveraged to address broader public health priorities. Innovative partnerships between the public and private sector should be enhanced and supported by increased domestic health financing. This is not only for the next infectious disease outbreaks but also to address the growing burden of non-communicable diseases such as hypertension, diabetes and cancer.

How do we build resilient systems that can outlast the Covid-19 era?

Universal Health Coverage (UHC) is fundamental to resilient health systems. It is the foundation for health security as it can provide the architecture for disease surveillance and rapid response. UHC is built on good quality health services which in themselves engender trust. That requires sustained investment informed by local and shared priorities, and the avoidance of vertical programmes that can be less efficient. We need to make Covid-19 response systems the routine – from surveillance, electronic health records, logistics and vaccines. The emergency health workforce should become part of the universal health system by applying lessons learned from the pandemic to other health priorities.

Underpinning all this is increased domestic finance for public health systems.

Explain how strong institutions underpin Africa’s New Public Health Order?    

Strong regional and continental global institutions, equipped with effective systems, structures and skills to coordinate public health responses, are pivotal to the New Public Health Order as prescribed by Africa CDC.

This was recognised by the AU, leading to the proposal to create an African public-health organisation in 2013, which was then established as Africa CDC in 2017. Ecowas established the West African Health Organization (Waho) in 1987, focusing primarily on health-policy harmonisation but increasingly adopting a regional public health coordination role. The value of these public-health institutions has been increasingly recognised in response to cross-border health security threats.

But most important is the role that national public health institutions play in coordinating and optimising use of resources to prevent and detect public health threats. National institutions are closest to areas of need as every pandemic starts as one case in one town/village/city/community. 

The presence and operation of such institutions enables quick response and feeds into the regional and then global architecture. National Public Health Institutes (NPHIs) improve the completeness and quality of information through surveillance that informs not only the local response but also the global one to prevent the next pandemic.