Our efforts and achievements over the past year have laid the groundwork for accelerated progress on our core ambitions, including transformative regional investments and enhanced global representation and participation.
31 January 2023 marked the sixth anniversary of the establishment of the Africa Centers for Disease Control and Prevention (Africa CDC) by the Assembly of Heads of State and Government of the African Union. Reflecting on the past twelve months leading up to this anniversary, we can proudly highlight swift reactions to health emergencies, and investments in resilient systems, while noting areas for further action. Successes include upgraded and more efficient disease response; expanded partnerships; improved regional capacity in laboratory infrastructure; workforce development and progress towards local manufacturing and distribution of medical supplies. Major Africa CDC milestones for 2022 included the expansion of our mandate to become an autonomous health institution of the African Union; the authority to declare a Public Health Emergency of Continental Security; the launch of our Non-communicable Diseases (NCD), Injuries Prevention and Mental Health Promotion Strategy; expanded implementation of our Saving Lives and Livelihoods Initiative; the launch of our Framework for Antimicrobial Resistance; the Call to Action on Strengthening Public Health Emergency Operations Centres; and our successful in-person convening of the second annual international Conference on Public Health in Africa (CPHIA 2022).
Epidemiology and Disease Response
The May 2022 Mpox (Monkeypox) outbreak in non-endemic countries mainly in Europe and North America, was declared a public health emergency of international concern in July, and by the end of the year had spread to 110 countries. Since the beginning of 2022, Africa recorded more than 1250 confirmed cases and 226 deaths across eight endemic countries (Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Cote d’Ivoire, Liberia, Nigeria, the Republic of the Congo, and Sierra Leone), in environments with limited testing and vaccine availability, once more highlighting the inequities in global health response. Africa CDC worked with the Nigerian Centers for Disease Control (NCDC) and the African Society for Laboratory Medicine (ASLM) to train 20 Member States on diagnostics in June and provided test kits and sequencing support. We are grateful to the government of the Republic of Korea and the Korea Disease Control and Prevention Agency (KDCA) for their timely donation of 50,000 Mpox vaccine doses during my November 2022 visit. By the end of the year, five of the eight affected Member States had recorded no new cases over three months.
Ebola presented another major health threat with an April 2022 outbreak in the Democratic Republic of Congo, and in Uganda in September 2022. Africa CDC helped to quickly respond to both outbreaks and within 10 and 18 weeks respectively both were under control. Africa CDC provided technical support including epidemiologists and laboratory scientists, as well as community engagement teams. The combination of robust national responses and end-to-end support from the Africa CDC demonstrates the potential of close collaboration with Africa Union Member States. We also supported the Government of Uganda in convening a High-Level Emergency Ministerial meeting in October, bringing together 11 neighboring Member States to endorse key measures such as contact tracing, information sharing, simulation exercises, and joint training of first responders. We also supported the vaccine trials for the Sudan strain of the virus. The challenges of conducting trials at the tail end of an outbreak, such as the dearth of enrollable cases, highlight the need for rapid and flexible approaches before and during outbreaks.
While the worst waves of the COVID-19 pandemic on the continent appear to have receded, with infections and fatalities down from the most recent peaks of June 2022, Africa CDC continued to work throughout the year on Member States’ vaccine coverage (reaching 45% of eligible population by January 2023) and surveillance capacity, including through genomic sequencing. The Africa CDC Pathogen Genomics Initiative (Africa PGI) has supported more than 130,000 sequences covering most Member States and SARS-CoV-2 strains. Africa PGI is housed within Africa CDC’s Institute of Pathogen Genomics and supports African national public health institutions (NPHIs) with sequencing tools, training, lab and data infrastructure.
We are also applying our genome sequencing work to Malaria and other infectious diseases such as tuberculosis and HIV/AIDS. In September 2022, PGI co-hosted a training course on Malaria Genomic Epidemiology with 34 participants from 7 East African countries. I remain optimistic that successful 2021 pilot programs of the RTS,S Malaria vaccine in Ghana, Kenya, and Malawi will soon lead to a wider rollout supported mainly by African financing for procurement and delivery. An initial test of Africa’s commitment to contribute further to health financing has been set by GAVI’s commitment of nearly $160 million to vaccine access – a similar allocation from African actors would be a positive step in this direction.
We remain acutely aware of other disease threats affecting our continent – non-communicable diseases (NCDs) such as cancer, diabetes, and cardiovascular issues form a growing share of the continental disease burden and mortality. NCDs were responsible for 37% of deaths in Africa in 2019, and together with injuries and mental health issues, increased from 18% to 30% of disability-adjusted life years (DALYs) between 1990 and 2017. Furthermore, mental health conditions and NCDs are closely intertwined through shared risk factors, chronicity, and stigmatization. The launch of our NCD, Injuries Prevention and Mental Health Promotion Strategy demonstrates our effort to balance our focus and investments, and our commitment to providing technical support, funding advocacy, and peer review to improve national responses to disease threats.
To ensure that our Member States are always ready to rapidly detect any outbreak, and effectively coordinate response to health emergencies, Africa CDC facilitated a Call To Action: Strengthening Public Health Emergency Operations Centres in Africa, that was launched by H.E. President Hakainde Hichilema of Zambia. This Call was then followed by a high level meeting of ministers of health who agreed on steps to operationalize the Call To Action.
Partnerships
Our Africa PGI initiative is supporting broad collaboration with Member States. The initiative was launched in 2020 and is enabled by a $100 million, four-year PPP comprising support from the Bill & Melinda Gates Foundation, the US Centers for Disease Control, equipment and training from Illumina and Oxford Nanopore, and computing resources from Microsoft. Our $1.5 billion Saving Lives and Livelihoods Initiative with the Mastercard Foundation commenced implementation in Kenya in July, Ethiopia and Lesotho in August, and in November 2022 we rolled out activities including mobile vaccination sites, vaccine safety surveillance and risk communication across ten countries in Southern Africa.
In July 2022, the World Bank approved a $100 million support programme for Africa CDC to enhance our institutional technical capacity so that we can intensify our support to African Union Member States in preparing for, detecting, and rapidly responding to disease threats and public health emergencies. The grant is particularly timely as Africa changes her strategies for health security through the New Public Health Order and as we operationalize Africa CDC as an autonomous health institution of the African Union.
In December 2022, Africa CDC hosted the 2nd International Conference on Public Health in Africa (CPHIA 2022) in partnership with the Rwanda Ministry of Health at the Kigali Convention Centre in Rwanda. The conference welcomed more than 2500 in-person delegates from 90 countries and featured more than 30 sessions and 50+ side events on topics ranging from pandemic preparedness to vaccine production, non-communicable diseases, and strengthening NPHIs. One notable outcome was the signing on the sidelines of a memorandum of understanding between Africa CDC and Medicines Malaria Venture (MMV) towards African manufacturing of malaria medicines. The huge interest in the CPHIA, particularly in Africa, has clearly indicated that the continent has come of age to chart its own scientific and public health horizons.
Workforce and infrastructure
Recent Africa CDC health worker support efforts include our Institute of Workforce Development (IWD)’s establishment of a Clinical Community of Practice for COVID-19 and other diseases – including a webinar series that drew 9,000 participants from 50 African countries, and the roll-out of a virtual knowledge hub.
We have also rolled out a wide range of capacity development initiatives to support various African healthcare professionals. These include the Kofi Annan Global Health Leadership Programme in partnership with the Kofi Annan Foundation; the Global Nursing Leadership program in partnership with Harvard’s T.H. Chan School of Public Health; funded masters programs for epidemiologists and biostatisticians in partnership with EDCTP; and an $11.5 million grant from the Susan Thompson Buffett Foundation for capacity building in maternal and reproductive health epidemiology.
Our Takeaways
Despite its challenges, the past year has been a productive and exciting one for Africa CDC, with meaningful progress made on many of our core ambitions. Successfully implementing our vision of a New Public Health Order for Africa in 2023 and beyond entails a greater focus on larger and longer term resourcing for African healthcare systems, particularly through domestic financing of NPHIs; accelerating tangible investments in regional production of medical products to take advantage of agreements such as the Africa Continental Free Trade Area (AfCFTA); and a stronger regional leadership and global representation role for Africa CDC, especially in the coordination of public health emergency responses. As Africa’s public health agency, our regional leadership role and global participation should now be brought up to par with those of our counterpart organizations covering large regions such as the CDCs of the US, EU, and China. As the Africa CDC of tomorrow, we will have more active participation in global health financing and research decisions, on top of our well-developed coordination and collaboration roles across the continent. In 2023, we will thus work towards securing the policies, partnerships, and resource commitments to convert ambitious programme plans into tangible successes and continue to pursue greater self-reliance and self-advocacy in the pursuit of improved public health outcomes for all Africans and beyond.
