Covid shows that Africa must ensure its own health security, says head of Africa CDC

Embracing new ways of doing public health "is an imperative for Africa’s security and economic survival" say Christian Happi and John Nkengasong in an article for the science journal Nature.


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The Covid-19 pandemic reveals the urgent need for Africa to achieve self-sufficiency in health security, argue leading African health experts Christian Happi and John Nkengasong in the 6 January 2022 edition of science journal Nature.

The fact that Africa is struggling to vaccinate its population when developed countries are giving booster doses to their own citizens shows that it is imperative for the continent to guarantee its own health security, they say.

African leaders face a stark choice, they say – the continent must either embrace new ways of doing public health or risk failure in confronting the infectious-disease threats of the 21st century and achieving the ambitious development goals of the African Union’s Agenda 2063.

The authors, who are respectively the director of the African Centre of Excellence for Genomics of Infectious Diseases (ACEGID) and outgoing director of the Africa Centres for Disease Control and Prevention (Africa CDC), propose five steps that could achieve this objective.

Africa’s remarkable response to Covid-19

In the early months of the Covid-19 pandemic, Africa’s response was “remarkable”, say Happi and Nkengasong.

Africa has made “astonishing gains” in surveillance and public health responsiveness and been “a key player in the acquisition of scientific knowledge that has guided the global response” to Covid-19, they say.

From the convening of an emergency meeting of African health ministers just days after the first report of Covid-19 in Africa to set up a joint strategy, through the immediate measures taken by African countries to curb the spread of the virus, and ongoing meetings at continental level to coordinate the response, the continent’s response has been rapid and collaborative.

These actions, they say, “stand in contrast to the inflexibility seen in other parts of the world”.

In a recent interview with African Business, Nkengasong, who is expected to join the US government as ambassador-at-large and coordinator of United States Government Activities to Combat HIV/AIDS Globally at the Department of State, described the central role of Africa CDC, which was formed in 2016, in combating the virus.

“Compared to how the AU responded to the Ebola outbreak, it is like day and night,” he said.

The rapid response and coordinated actions taken across the continent, argue Happi and Nkengasong, were at least partly responsible for the relatively low mortality rate seen in Africa.

The figure of 8.9m cases of Covid-19 and some 225,000 deaths across Africa at the time of writing on 13 December 2019 contrasts strongly with early predictions that up to 70m Africans could be infected by June 2020, with more than 3m people dying.

Africa’s Covid response confounds the critics

When Covid-19 struck in early 2020, the first thought when it came to Africa was one of dread. There were headlines such as “African countries are at severe risk”, and “Bill Gates warns the coronavirus could hit Africa worse than China,” argues Hannah Ryder.  

With this kind of international consensus, by March 2020, experts were confounded by the early lack of cases in Africa. Headlines appeared such as France24’s “Africa’s low coronavirus rate puzzles health experts”.

Some explanations suggested that African countries were under-reporting or under-testing, but they were at best derived from analysis in one country. 

What was often not mentioned was that fast, decisive action was the key commonality of Africa’s initial response. Almost 70% of African countries closed borders and instituted social distancing before detecting 10 cases. The majority of African countries introduced mask-wearing policies, at least in capital cities, well before many European countries or American states.

Abridged from “Does Covid-19 offer a new way of looking at African risk?”, by Hannah Ryder, African Business, March 2021.

Happi and Nkengasong also point out the important contribution that Africa has made to genomics during the pandemic: South African researchers were responsible for identifying both the Beta and Omicron variants of the virus.

Shortcomings of multilateralism

However,  despite Africa being a “key player in the acquisition of scientific knowledge that has guided the global response”, the continent now lags behind the rest of the world:

“Around 47% of people have been fully vaccinated globally, and many countries in the world are giving a further (booster) dose to their citizens. Yet Africa is still struggling – it has achieved full coverage in only about 7% of eligible people.”

This should be a “stark reminder to African leaders of the fragility of international cooperation and multilateralism”, say the authors.

In April 2020, Nkengasong spoke to African Business at a time when African countries were experiencing problems in purchasing tests and other equipment to fight the pandemic. Rather than a lack of funds or political will, Africa’s shortfall was triggered by richer nations outcompeting the developing world in their ability to purchase materials, he said.

“We’ve learned that when the world is challenged with access to limited commodities then global solidarity collapses,” he declared.

While multilateralism will always be crucial for responding to epidemics and pandemics, ultimately “Africa’s dependence on the outside world sustains a lack of confidence in Africa – both within and outside the continent,” say Happi and Nkengasong in the Nature article.

Five steps for action

Africa’s move towards self-reliance must be based on five steps, say the authors:

  • Invest in health and disease. Happi and Nkengasong say African leaders must honour their commitments to allocate at least 15% of their annual budgets to the health sector. (For details of the way the pandemic has laid bare the lack of investment in African health systems see “Coronavirus exposes neglect of Africa’s health systems”)
  • Build regional control and capability. The authors call for national public-health institutions to be strengthened and the empowering of the Africa CDC and its five Regional Collaborating Centres.
  • Accelerate translational research and development. Currently, Africa imports 70-90% of its drugs and there is almost no biotechnology sector, say Happi and Nkengasong. Governments, philanthropists and the private sector must provide sustainable funding for research and development, with a focus on diagnostics, therapeutics and vaccines for infectious and non-communicable diseases.
  • Invest in early-warning systems. The Sentinel Initiative, which is led by Happi, is an example of a promising programme, say the authors. To be effective in the long term, such schemes must be integrated into Africa’s public-health institutions. 
  • Build centralised governance. An African Pandemic Preparedness and Response Authority, as proposed by the African Union in October 2021, could empower the Africa CDC to coordinate pandemic responses across borders. 

Embracing this way of doing public health “is an imperative for Africa’s security and economic survival,” say Happi and Nkengasong. “It will also benefit the world – as so powerfully demonstrated in November 2021 by the discovery of the Omicron variant.”

John Nkengasong is featured by our sister publication New African as one of its 100 Most Influential Africans of 2021.

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