To address persistent health system challenges and avoid the same fate in future pandemics, African countries must take bold steps to repair their health systems and make them more resilient.
The Independent panel for Pandemic Preparedness and Response set up by the World Health Organization (WHO) released its second report in May 2022. Advising on how to reduce the current pandemic and better prepare for the next , the report is based on scientific research and the round of expert-discussion tables.
I contributed to this report, Transform or tinker? Inaction Lays the Groundwork for Another Pandemic, which recommends global and local actions. As different continents and countries are at different stages on the path to implementing these recommendations, African countries should extract actions relevant to them and integrate them into their health systems and epidemic preparedness plans.
The recommendations of this new report are based on those of previous reports by the panel. They looked at five aspects: equitable access to tools; health financing; WHO’s role in surveillance, detection and alert; political leadership; and preparation. The new report updates recommendations to fix a still broken public health system.
Five actions to fix the system
1. Make the tools accessible to everyone in the same way
The first action recommended by the panel is to stop the current COVID-19 pandemic through equitable access to health tools such as medical supplies.
In 2020 WHO launched the revolutionary Access to COVID-19 Tool Accelerator. This global collaboration aimed to accelerate the development, production and equitable access to COVID-19 tests, treatments and vaccines. It is now widely accepted that, when judged against equity and access, the accelerator has failed to live up to expectations. For example while the global vaccination coverage for the first dose of vaccine is 66%, for Africa this figure is 17.8%.
The panel recommends a comprehensive and independent evaluation of the Access to COVID-19 Tools Accelerator, involving civil society. The goal would be to learn from it and improve it. African experts should contribute, as the continent has suffered the most from inequitable access to COVID-19 medical products such as rapid tests and vaccines.
African governments should call for global intellectual property waiver policies for COVID-19 tests, treatments and vaccines and use them to build national pharmaceutical capacity. They should also push for a pre-negotiated platform to facilitate fair and timely access to medical products on the global market in times of emergency.
2. Make funding available
The second recommendation is to have a preparedness funding structure that “engages and serves every country”. Funds set aside for pandemic preparedness and response, primarily by G20 countries, were insufficient for the COVID-19 response. Dispersion has been slow and the scarcity of funds has forced low-income countries to more debt. Going forward, international pandemic financing should be based on ability to pay and prioritization of needs.
3. Strengthen the WHO
The panel also called for strengthening the authority and funding of the WHO through an increase in membership fees from member states. The aim would be to increase WHO’s monitoring and detection of new threats, leading to earlier warning. Differences in epidemiology and impact of COVID-19 clearly demonstrated that Africa’s health policy demands must be informed by local events and data rather than global trends. Therefore the WHO regional body needs more support to respond in a manner appropriate to the African context.
4. Improve political leadership
The report identified a lack of coordination between national governments, regional bodies, UN agencies and other stakeholders. The recommendations call for a UN political declaration on pandemic preparedness and the establishment of a UN Pandemic Preparedness Council. African countries should be represented in these bodies. Strengthen the authority of the African body of the WHO and the African Union to rapidly announce potential pandemic threats, investigate them and recommend interventions without country obstacle will expedite appropriate responses.
The report makes several suggestions to prepare for the next pandemic. At the global level, it recommends formalizing a periodic review of universal health coverage. And countries should conduct transparent reviews of their COVID-19 responses and learn lessons for future pandemics.
But COVID-19 has clearly shown that current clues preparedness, such as COVID-19 preparedness, did not distinguish between lack of preparedness and vulnerability. Africa was considered ill-prepared for COVID-19, but was actually less vulnerable due to many factors including outdoor demographics and lifestyle. Therefore, the readiness indices need to be revised to have a more comprehensive perspective of readiness, vulnerability and resilience.
The next pandemic is unlikely to be COVID. The world must prepare for new threats. The G7 aims to be able to develop a biological response to future pandemic threats within 100 days. But the experience of 10 years waiting for antiretrovirals against HIV and the difficulties of access COVID-19 vaccination shows that the wait will be well over 100 days for innovations from other continents to arrive in Africa. Therefore, African countries need to strengthen their basic public health interventions that protect against many different pathogens.
The superimposition of responses to a new disease on already weak health systems in Africa has further weakened them. Thus, in addition to public health, Africa’s preparedness plans must focus on health system strengthening and resilience.
The next pandemic
When acting on the panel’s recommendations, African countries should adapt them to address specific weaknesses in their health systems, such as the ability to produce medical supplies domestically.
African governments and institutions also need to improve medical supply and regulatory processes through already existing regional institutions and structures.
It is only by harnessing its recommendations that African countries will derive the greatest benefit and support from global initiatives.