Nature | Editorial

Highway to health

Africa has an ambitious and welcome plan for a continent-wide centre for disease control — but if the agency is to live up to its promise, it will need substantially better resources.


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In light of the ongoing Ebola epidemic in West Africa, it is entirely sensible that the African Union intends to set up a pan-continental organization to guard against the ravages of infectious disease. The African Centres for Disease Control and Prevention (ACDC), as the agency is called, will be modelled not on the massive US CDC, but on the smaller European Centre for Disease Prevention and Control (ECDC). Although the goal is excellent and the effort should be cautiously welcomed, the plans for the African agency are woefully inadequate. In terms of funds and staff — at least initially — it will be in no position to achieve its lofty ambitions.

There is no exact definition of a CDC other than a public-health agency, often with a focus on infectious diseases. The US CDC was created in 1946 with around 400 staff members and an annual budget of some US$10 million (worth $120 million today), largely to tackle malaria in the US south. It now has a staff of 15,000 and a whopping $7-billion annual budget, covering the entire spectrum of health issues — from detecting and responding to infectious-disease outbreaks worldwide, to control and prevention of non-communicable diseases, bioterrorism, workplace injuries and environmental health threats.

The past 15 years have seen a proliferation of CDCs and equivalent organizations worldwide, in part because of awareness of the need to improve responses to infectious-disease threats, prompted in particular by the 2003 epidemic of severe acute respiratory syndrome (SARS). But their organizational models are diverse. The Public Health Agency of Canada — created in 2004 after SARS outbreaks revealed weaknesses in the country’s response — is a smaller version of the US CDC, with 2,400 employees and a budget of Can$633 million (US$517 million).

The ECDC is different. Unlike the US and Canadian organizations, the Stockholm-based agency has no in-house laboratories. It acts instead as a coordinator, drawing on a network of research labs and national health-protection bodies to reinforce disease surveillance and response. The highly respected agency has a relatively modest budget of €60 million (US$64 million), and 300 staff members.

The ACDC, to be based for now in Addis Ababa, would coordinate national resources and labs, as well as pan-African networks including the African Field Epidemiology Network and the African Network for Drugs and Diagnostics Innovation. It would focus on infectious diseases. But the similarities with the ECDC end there.

“That Africa wants to assume political ownership of its response to public-health emergencies can only be welcomed.”

The ACDC’s budget for July 2015 to December 2016 calls for just US$6.9 million, and the centre would initially have just 11 staff members, including management and 5 epidemiologists. These resources are hopelessly inadequate to tackle the agency’s long list of stated ambitions, which include not only helping to prevent, detect and respond to disease outbreaks, but also strengthening health systems and conducting regional and national risk assessments. The African Union has declined to say what funding it hopes the ACDC will attract beyond this start-up phase. Its backers need to commit funding now for at least five to ten years — experts say that $60 million and 300 staff members would be the absolute minimum needed.

That Africa seems to want to assume political ownership of its response to public-health emergencies, rather than relying largely on outside agencies and support, can only be welcomed. Yet there is a risk that the creation of this skeletal agency might provide an excuse for complacency and inaction by politicians in Africa and globally. And the underlying problems that leave many countries vulnerable to disease outbreaks will not be solved by an African health agency alone, however robust and however desirable.

As the Ebola epidemic has cruelly highlighted, what Africa lacks most are proper health systems and labs. There is a drastic shortage of health-care workers, with only a few dozen physicians per million people. Yet there are no serious national or international plans to reinforce public-health capacities.

An alphabet soup of organizations involved in global health and disease detection and prevention has developed over the past 20 years, yet proved incapable of reacting promptly when the Ebola threat emerged. These groups’ often overlapping and duplicated efforts must be better coordinated to prevent and mitigate future health crises. But there is a danger that with concern over Ebola fading, governments will lapse back into old habits, and that the stark lessons of the epidemic will not be taken fully on board.

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This article originally said that the ACDC would need a minimum of $300 million and 60 staff members — this should have read $60 million and 300 staff. The text has been corrected.

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