A laboratory technician prepares blood samples from volunteers for viral-genotyping at the government-run Ifakara Health Institute in Bagamoyo, 70 kms north of Tanzanian capital Dar es Salaam.Credit: Tony Karumba//AFP via Getty Images
Outbreaks of Ebola, COVID-19 and other infectious diseases in Africa have made clear the need for stakeholders to improve the continent’s capacity to detect, respond and plan during public health emergencies.
Before the World Health Organization (WHO) flagged COVID-19 as a major global threat and urged countries to step up screening at entry ports, many African countries had been using thermal scanners and handheld thermometers in response to previous Ebola outbreaks. These had already drawn public attention to disease prevention and were crucial in the forming public health emergency response plans in many African countries, which were quickly updated for COVID-19 response.
In May 2022, when cases of monkeypox began to emerge across Europe and beyond, within a short period, African countries also had to include screening for monkeypox on the list of national health priorities. Moeti Matshidiso, WHO Regional Director for Africa, told Nature Africa that the latest alert is a reminder of the need for African countries to continue to be vigilant and monitor health developments in other parts of the world.
She said the current approach is to continue to encourage national health ministries to be prepared to quickly respond to new and re-emerging outbreaks — while ensuring that current health priorities remain in focus.
“We support our member states to respond to more than 100 outbreaks in a year, each of different levels of severity in Africa. Countries must, at the same time, respond to a cholera outbreak, for example, COVID-19, and other diseases as well,” Matshidiso said.
Gains in disease surveillance
Outbreaks of diseases like Ebola have resulted in the improvement of surveillance in many African countries. This is evident in the sharp reduction in the number of confirmed cases of Ebola during the outbreaks of 2021and 2022. The focus of disease surveillance in Africa now is to ensure that suspected cases are quickly reported and isolated, followed by contract tracing.
This significant improvement is particularly marked in countries where disease outbreaks like Ebola had been of major concern. Surveillance has also improved across borders with countries working together to reduce the risk posed by movement.
Hervé Hien, director general of Burkina Faso’s National Public Health Institute, noted that Africa’s experience in the past five years — especially with Ebola and COVID-19 — brought about critical improvements in the continent’s public health sector. “It has opened our eyes to the link between health security and national security, and made us recognize the roles of infectious and non-infectious diseases in destabilizing our health system,” he said.
Growing collaboration, model achievements
With collaborations and networking between African countries becoming standard responses to public health emergencies a number of countries have emerged as hubs for control measures.
In South Africa, a genomic surveillance team has been spearheading genomic sequencing for SARS-CoV-2 in Africa. The country has published more sequences than any other African country since the pandemic began, in addition to being the first to identify new strains of the virus. This agility can also be adapted for other disease outbreaks.
Nigeria has also ramped up sequencing capabilities, and the African Centre of Excellence for Genomics of Infectious Diseases (ACEGID) has been providing genomic data for disease surveillance purposes, most recently, monkeypox.
Beyond genomic surveillance and disease testing, Ebola and COVID-19 drew attention to the need for Africa to reinforce its vaccine production capacity. Local production on the continent would ensure early access to vaccines. Production initiatives are at different stages. In South Africa, COVID-19 vaccines can now be produced. In a number of other countries including Ghana and Rwanda, the government is working with partners to establish mRNA vaccine production facilities.
In Senegal, where the Institut Pasteur, Dakar, has been producing and distributing vaccines for about 80 years, there has been an influx of new funds to finance a new vaccine manufacturing facility that is expected to significantly reduce Africa’s dependence on imported vaccines and support equal access, producing up to 300 million doses a year.
But challenges remain
Public health emergencies are driving attention to the state of health emergency preparedness on the continent, but also highlighting gaps in Africa’s public health preparedness, especially the issue of getting African governments to provide more funds to finance the numerous ambitious health preparedness initiatives. Despite the many lessons regarding the importance of disease surveillance, testing, public awareness and others, these efforts still heavily rely on donor funds in many African countries.
Oyewale Tomori, a professor of virology, noted that aside from South Africa, countries like Nigeria still heavily rely on donor funds and this, he said, is concerning. With the bulk of research on the continent still not funded by African governments, Tomori said Africa risks losing control of the research priorities and findings.
“If we put our own money into our research, we know who we will invite and we will have full control. But if you go to the Nigeria Centre for Disease Control (NCDC) lab, virtually every piece of equipment there was donated. What has the Nigerian government done?” he said.
African countries were reportedly reluctant to pay for COVID-19 vaccine doses manufactured in Africa and choosing instead to rely on donated doses thus putting the survival of the COVID-19 manufacturing line in South Africa at risk.
Robust planning and clarity in approaches and response
John Nkengasong, immediate past director of the Africa Centres for Disease Control and Prevention, said the continent needs to invest in manufacturing of diagnostics, pharmaceuticals and vaccines. This would strengthen national and continental institutions, expand Africa’s health workforce, and engage the private sector and traditional partners. “We have to be very deliberate to guarantee the health security of the continent,” he added.
Fiona Braka, team lead, emergency operations, at the WHO Regional Office for Africa, added that more disease awareness is needed among the general public, focusing on symptoms and how to prevent disease, Health workers also need training for case definition, and improved testing capacities.
Ahmed Ogwell Ouma, acting director of the Africa Centres for Disease Control (CDC) told Nature Africa that coming to terms with the highly connected nature of the world is vital. “Monkeypox is a good lesson. We need to prepare for every outbreak in every part of the world in the same way as we prepare for the ones that occur in many countries at the same time.
