Articles Archives – Africa CDC

How to prepare for the next inevitable Ebola outbreak: lessons from West Africa

Thomas Ngbonga — Sat, 19 Oct 2024 05:15:43 +0000

Henry Kyobe Bosa, Neema Kamara, Merawi Aragaw, Misaki Wayengera, Patrick D. M. C. Katoto, Chikwe Ihekweazu, Mosoka P. Fallah, Moussa Douno, Robert Kwame Agyarko, Placide Mbala, Mamadou Souncalo Traoré, Ambrose Talisuna, James Bangura, Henry G. Mwebesa, Abdoulaye Bousso, Obasanya Joshua, James Sylvester Squire, Tolbert Nyenswah, Thelma V. Nelson, Justin Maeda, Olushayo Oluseun Olu, Yonas Tegegn Woldemariam, Benjamin Djoudalbaye, Alain Ngashi Ngongo, Tajudeen Raji, Francis Chisaka Kasolo, Ibrahima Socé Fall, Ahmed Ouma Ogwell, Jane Ruth Aceng & Jean Kaseya

Many lessons have been learned 10 years after the Ebola virus disease outbreak in West Africa, but urgent work is now needed to prevent another outbreak.

The West African Ebola virus disease (EVD) outbreak in 2014 emerged in a region in Africa that had previously not reported any EVD outbreak. Subsequently, the outbreak rapidly spread and was protracted in the three Mano River basin countries (Guinea, Sierra Leone and Liberia), with spillover cases in Nigeria, Senegal and Mali and, for the first time, importation into Europe and the USA. It became the most extensive and protracted EVD outbreak in history, followed by the 2018 outbreak in the Democratic Republic of the Congo (DRC). For the first time, cases were reported in urban centers, underscoring the urban spread of the disease. Its devastation had a far-reaching impact on lives in the three largely affected countries for years to follow. A total of 28,616 cases and 11,310 deaths were reported from Guinea, Sierra Leone and Liberia, with an additional 36 cases reported from Italy, Mali, Nigeria, Senegal, Spain, the UK and the USA.

Five years later, in 2021, Guinea experienced another outbreak that was controlled swiftly, much the same way as in Uganda in 2022. The DRC, which had the largest number of EVD cases and deaths, experienced a protracted outbreak in 2018–2020 and another episode in 2021, despite the country’s decades-long experience with EVD outbreaks. In this historical context, we propose a strategic overhaul of intervention methodologies, emphasizing the need for a more adaptive and globally integrated approach to health crisis management. This revised strategy must account for the complexities introduced by rapid urbanization and the intricate web of international travel, and recognize the critical importance of global cooperation and innovation in health emergency readiness and response.

The genetic conservation of the Ebola viruses and their actual source, natural reservoirs and wildlife-to-human spillover dynamics remain elusive, which makes the prediction and prevention of EVD more challenging. However, since its first detection in 1976, the virus has not undergone any major selected mutations. This presents an opportunity for sustained investment in and development of vaccines, therapeutics and diagnostics that remains on course. A key lesson from the EVD outbreak in West Africa is that in addition to weaknesses in health systems and other challenges highlighted in Table 1, slow and unpredictable funding was a major contributing factor to the inability to respond to the initial outbreaks rapidly. If the response to EVD had been effectively initiated just 2 months earlier, this could have averted fatalities by up to 80% in Sierra Leone and Liberia.

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The pandemic agreement: Achieving an African win for health security inequity

Thomas Ngbonga — Sat, 25 May 2024 11:45:28 +0000

The coronavirus disease 2019 (COVID-19) pandemic has tested the resilience of global health systems and exposed their frailty and disparities across health systems worldwide, particularly in Africa. As pandemic responses kicked in, the introduction and deployment of COVID-19 vaccines, therapeutics, and diagnostics were woefully inadequate, and in the aftermath demonstrated a clear need for reform. Particularly in the earlier days of the disease and vaccine introduction, the response was characterised by vaccine nationalism, a lack of transparency in data sharing, and an overall lack of inclusivity and Global South integration in global response mechanisms. As a result of these and other inequities, the global health community raised concerns about global health security frameworks, such as the inability of the International Health Regulation (IHR) to prepare countries for a global health emergency. Criticisms centred, inter alia, around the IHR’s limitations on timely investigation of public health emergencies, an insufficiently robust compliance system, scarcity of resources, and conflicting advice.

Cognisant of these gaps in the IHR, the World Health Organization (WHO) formed an Intergovernmental Negotiating Body (INB) to draft a new legally binding Pandemic Agreement and to facilitate the conclusion of member state negotiations by the upcoming 77th World Health Assembly (WHA) in May 2024. Underlining the Agreement are notions that this new agreement should fill policy gaps in the IHR and ensure equity worldwide. At the time of writing, WHO member states have been engaging in textual negotiations over crucial issues of the Pandemic Agreement, including what has been referred to as the ‘heart of the political bargain’ of the Agreement, that is, pathogen access and benefit sharing (PABS), as well as Research and Development (R&D) conditionalities, financing and technology transfer. During the two rounds of negotiations, the member states agreed on various issues such as governance mechanisms, compliance and implementation, workforce, and R&D, among others. However, they failed to reach consensus on critical issues such as PABS, pandemic prevention and one health, and pandemic financing. The WHO announced that the member states will continue the negotiation on the articles to reach into agreement before the 77th WHA.

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Sero-epidemiological assessment of SARS-CoV-2 vaccine responsiveness and associated factors in the vaccinated community of the Casablanca-Settat Region, Morocco

Thomas Ngbonga — Thu, 02 May 2024 12:42:51 +0000

Sayeh Ezzikouri, Raji Tajudeen, Hind Majidi, Soad Redwane, Safaa Aqillouch, Mohammed Abdulaziz, Merawi Aragaw, Mosoka Papa Fallah, Senga Sembuche, Serge Batcho, Patrick Kabwe, Elizabeth Gonese, Oumaima Laazaazia, Mohcine Elmessaoudi-Idrissi, Nadia Meziane, Abdelhakim Ainahi, M’hammed Sarih, Ahmed E. Ogwell Ouma & Abderrahmane Maaroufi

Abstract

Assessing the prevalence of SARS-CoV-2 IgG positivity through population-based serological surveys is crucial for monitoring COVID-19 vaccination efforts. In this study, we evaluated SARS-CoV-2 IgG positivity within a provincial cohort to understand the magnitude of the humoral response against the SARS-CoV-2 vaccine and to inform evidence-based public health decisions. A community-based cross-sectional seroprevalence study was conducted, involving 10,669 participants who received various vaccines (two doses for BBIBP-CorV/Sinopharm, Covishield vaccine, and Pfizer/BioNTech, and one dose for Johnson & Johnson’s Janssen COVID-19 vaccine). The study spanned 16 provinces in the Casablanca-Settat region from February to June 2022, during which comprehensive demographic and comorbidity data were collected. We screened samples for the presence of IgG antibodies using the SARS-CoV-2 IgG II Quant assay, which quantifies antibodies against the receptor-binding domain (RBD) of the spike (S) protein, measured on the Abbott Architect i2000SR. The overall crude seroprevalence was 96% (95% CI: 95.6–96.3%), and after adjustment for assay performance, it was estimated as 96.2% (95% CI: 95.7–96.6). The adjusted overall seroprevalences according to vaccine brands showed no significant difference (96% for BBIBP-CorV/Sinopharm, 97% for ChAdOx1 nCoV-19/Oxford/AstraZeneca, 98.5% for BNT162b2/Pfizer-BioNTech, and 98% for Janssen) (p = 0.099). Participants of older age, female sex, those with a history of previous COVID-19 infection, and those with certain chronic diseases were more likely to be seropositive among ChAdOx1 nCoV-19/Oxford/AstraZeneca and BBIBP-CorV/Sinopharm vaccinee groups. Median RBD antibody concentrations were 2355 AU/mL, 3714 AU/mL, 5838 AU/mL, and 2495 AU/mL, respectively, after two doses of BBIBP-CorV/Sinopharm, ChAdOx1 nCoV-19/Oxford/AstraZeneca, BNT162b2/Pfizer-BioNTech, and after one dose of Janssen (p < 0.0001). Furthermore, we observed that participants vaccinated with ChAdOx1 nCoV-19/Oxford/AstraZeneca and BBIBP-CorV/Sinopharm with comorbid chronic diseases exhibited a more pronounced response to vaccination compared to those without comorbidities. In contrast, no significant differences were observed among Pfizer-vaccinated participants (p > 0.05). In conclusion, our serosurvey findings indicate that all four investigated vaccines provide a robust humoral immune response in the majority of participants (more than 96% of participants had antibodies against SARS-CoV-2). The BNT162b2 vaccine was found to be effective in eliciting a strong humoral response compared to the other three vaccines. However, challenges still remain in examining the dynamics and durability of immunoprotection in the Moroccan context.

More at https://www.nature.com/articles/s41598-024-58498-6

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Establishing Regional Centers of Excellence: Capacity Assessment of Fully-Established National Public Health Institutes in Africa

Thomas Ngbonga — Thu, 02 May 2024 12:38:58 +0000

Haftom Taame Desta^*, Nicaise Ndembi, Fai Karl, Howard Nyika, Grace Merekaje, Emmanuel Idigbe, Killian Songwe, Joshua Obasanya, Placido Cardoso, Ngashi Ngongo, Raji Tajudeen, Jean Kaseya

Africa Centers for Disease Control and Prevention (Africa CDC), African Union

Abstract

Introduction: By linking key components of public health functions such as surveillance, laboratory capacity, emergency response, communications, and public health research, NPHIs shorten the response time to public health emergency response and provides focused and centralized leadership and coordination mechanism for public health.

Objective: The main objective of the assessment was to describe the capacities of fully established NPHIs and identify potential Centres of Excellence for Health Information System, Emergency Response Coordination, Workforce Development and Public Health Research in each geographic regions of Africa.

Method: We assessed capacity of 12 fully established NPHIs in Africa from May to August 2023 using a tool focused on Corporate Governance, Health Information Management System, Public Health Workforce Development, Public Health Emergency Response Coordination and Public Health Research.

Result: The assessment findings showed that NPHIs of DRC, Ethiopia, Liberia, Burkina Faso, South Africa, and Mozambique scored 71%, 93%, 91%, 90%, 91.3%, 88.4% for Health Information Management System; Burundi, Rwanda, Burkina Faso, Nigeria, Mozambique, and South Africa scored 71%, 90%, 86%, 81%, 90.5%, and 85.7% for Work Force Development; Burundi, Ethiopia, Liberia, Burkina Faso, South Africa and Mozambique scored 67%, 94%, 98%, 92%, 78.4%, and 70.6% for Emergency Response coordination; and Burundi, Ethiopia, Rwanda, Liberia, Morocco, South Africa, and Mozambique scored 92%, 92%, 92%100%,100%, 91.7%, and 91.7% for Public Health Research respectively. The mean score of the potential regional centers of excellence at 95% CI is 87% [72-102], 84.5% [67,101], 70.6% [27,140] and 91.7% [89,99] for Health Information Management System, Workforce Development, Emergency Response Coordination, and Public Health Research respectively.

Conclusion: The most common challenges all NPHIs faced include inadequate infrastructure and resources to carry out their mandates, fragmented health information systems, dependence on external funding for programmes, high staff turnover, and lack of career development plans. Addressing these challenges require sustained political commitment, increased funding for public health, improved infrastructure, and resources, strengthened partnerships and collaborations, and the development of effective policies and strategies to support the functions of NPHIs.

More at https://www.fortunejournals.com/articles/establishing-regional-centers-of-excellence-capacity-assessment-of-fullyestablished-national-public-health-institutes-in-africa.html

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Lusaka Call-to-Action 2022: A Call to Strengthen Public Health Emergency Operation Centers in Africa

Thomas Ngbonga — Thu, 02 May 2024 12:32:56 +0000

Published online by Cambridge University Press: 16 April 2024 Womi-Eteng Oboma Eteng, Wessam Mankoula, Merawi Aragaw, Ibrahima Sonko, Mathew Tut, Dennis Kibiye, Lul Riek and Ahmed Ogwell Ouma

Abstract

In July 2022, on the sidelines of the 41st Ordinary Session of the Executive Council of the African Union and the 4th Mid-Year Coordination Summit in Lusaka, Zambia, Heads of state and government, and leaders of delegations of African Union Member States called on member states, African Union through Africa CDC, and partners to recognize, prioritize, and accelerate the establishment and strengthening of public health emergency operation centers (PHEOCs) in the context of health security and in line with Africa’s new public health order. Implementing the declaration requires a multi-dimensional approach that spans across governance, operational capabilities, partnerships, workforce development, and sustainable financing. African countries are increasingly plagued by public health emergencies, acutely characterized by high morbidity and mortality outcomes. Effective coordination and improved management of the situation requires the implementation of public health emergency operation centers (PHEOCs) running according to minimum common standards.¹ The PHEOC concept represents a nascent best practice in the spectrum of actions required to establish a comprehensive emergency management program and is critical to the fulfillment of the International Health Regulations² (2005) obligations by member states. Its implementation integrates traditional public health services into an emergency management model. Functional PHEOCs are typically well-equipped, physical (and more recently, virtual), tech-savvy hubs within which emergency management resources are co-located and directed. These hubs provide a platform for joint risk assessment, planning, coordination, and the dissemination of crucial information and resources essential for effective emergency management. Where fully implemented, PHEOCs mitigate common setbacks in emergency situations such as lack of clear leadership, delayed decision making, mismanagement of response resources, poor communication, ineffective coordination, and duplication of efforts by the various responding jurisdictions. Coordination of public health response to the coronavirus disease (COVID-19) pandemic was widely reported as suboptimal,^{Reference Lanyero, Edea and Musa3,Reference Kapucu and Hu4} a situation that robust, interlinked, and pretested PHEOCs systems could avert by ensuring better coordination of information and resources across sectors and the communities being served. The veritable use of PHEOCs in coordinating preparedness and response efforts remains illusional without political commitment. Commendably, Heads of State and Government of the African Union (AU) have consistently demonstrated strong public health leadership by championing various initiatives and embracing public health instruments to tackle health threats on the continent. In recent past, AU Heads of State and Government have championed the establishment of the Africa Centers for Disease Control and Prevention (Africa CDC), one fast-tracked by the 2014–2016 Ebola crisis in West Africa. The Africa CDC as a continental public health institution was instrumental in mounting a coordinated continental response for the COVID-19 pandemic. AU Heads of State and Government also ensured the continuous improvement of preparedness and response to infectious disease threats and other emergencies on the continent as evidenced by their championing of multiple public health initiatives, including domestic financing, nutrition, HIV/AIDS, malaria, and climate change. The African Health Strategy 2030, which provides direction on improving health on the continent,⁵ and the Agenda 2063,⁶ a continental framework for inclusive growth and sustainable development over a 50-year period, collectively define public health as a critical pillar of the continent’s development agenda. More at https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/lusaka-calltoaction-2022-a-call-to-strengthen-public-health-emergency-operation-centers-in-africa/09EBC27FEF1EC10E98272FD20E3C7705

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Tackling the twin threats of pandemics and climate change: an agenda for action

Thomas Ngbonga — Fri, 15 Mar 2024 08:08:48 +0000

Ending fossil fuel dependence is a prerequisite for a healthier world and future generations. The direct health impact of climate change driven by fossil fuel emissions is already devastating. The triple planetary pollution crisis, biodiversity loss, and climate change exacerbate the impact. The World Health Organization (WHO) predicts that between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year. World leaders are taking actions to address climate change. Given the interconnectedness nature of climate change on health, and growing pandemics effecting the most vulnerable communities, there is no better time than now, to recognize “health as the human face of climate change”, and, crucially to set out clear targets to tackle these issues systematically and underscoring the imperative for collective action.
Governments must also adapt to a warming world by investing in climate- and pandemic-resilient health systems and supply chains —not only at the domestic level but also regionally and globally.
There are many ways in which health and climate interweave. There is no doubt that Africa is the continent most vulnerable to climate change. Climate change is increasing the vulnerability of our ecosystems, accelerating the spread of diseases, and reshaping the trajectory of Africa’s future.
First, climate change is making future pandemics more likely due to the increasing frequency, geographic spread, and severity of infectious diseases. Zoonotic diseases comprise more than 60% of new infectious diseases — and three-quarters of emerging pandemic threats to humans. There has been a 63% increase in the number of zoonotic outbreaks in Africa in the decade from 2012-2022 compared to the previous decade; a significant proportion (32%) have been zoonotic diseases. A modelling study predicts that by 2070, there will be increased cross-species viral transmission risk with geographical range shifts for 3,139 mammal species.

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African Global Health: an initiative committed to achieving Health Sovereignty in the Global South

Thomas Ngbonga — Fri, 15 Mar 2024 08:04:21 +0000

The COVID-19 pandemic has played a crucial role in accelerating the shift in healthcare. Indeed, the pandemic has been an unprecedented global health crisis that has shaken the foundations of healthcare systems worldwide. It has exposed vulnerabilities in health systems, especially in Africa, and underscored the critical need for sovereign health systems to address the continent’s unique challenges.
The concept of sovereign health systems has recently gained prominence in global health discourse by focussing on the right to self-determination and independence of control over its health systems, Policies and Programs. It is imperative for the health system to remain sensitive to the local cultural norms, the social and the economic context, and in recognition of the global nature of health challenges. It should be capable of implementing informed and
prioritized choices, to provide accessible, equitable, high-quality healthcare services to its citizens. In Africa and the broader Global South, achieving sovereignty in healthcare has been a long-standing goal.

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Empowering Africa’s healthcare future: the crucial role of human capital development in bio- and pharmaceutical manufacturing

Thomas Ngbonga — Fri, 15 Mar 2024 07:54:26 +0000

Introduction
Africa, a continent of immense potential and diversity, has long grappled with complex healthcare challenges. The COVID-19 pandemic has accentuated the urgency of fortifying the continent’s healthcare infrastructure. The Africa Union has since set a target to manufacture 60% of vaccines used on the continent locally by 2040, and established the Partnership for African Vaccine Manufacturing (PAVM) to carry out this mandate. At the heart of this transformation lies the imperative of human capital development in bio- and pharma-manufacturing.

The recently unveiled African Union’s Bio-manufacturing Workforce Development Workshop Report 2023 and the United Nations Economic Development in Africa Report 2023 spotlight the critical role of a skilled and adaptable workforce. Additionally, the commitment of BRICS member states, Africa CDC, and WHO to collaborate with the business sector on pandemic prevention, preparedness, and response underscores the importance of a robust pharmaceutical industry and workforce. The Framework for Action (FFA)5 further cements the need for strategic collaboration.

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Public health emergencies in war and armed conflicts in Africa: What is expected from the global health community?

Thomas Ngbonga — Tue, 12 Mar 2024 07:39:35 +0000

War and armed conflicts, in any form, threaten public health. Outbreaks of diseases have the propensity to cripple the growth of a nation, especially when they are transitioning in a conflict setting.
Diseases can often debilitate a country that is marred by conflict and facing developmental challenges. It is, thus, necessary to make global health an essential aspect of peacekeeping and peacebuilding. More often than not, countries that are experiencing conflict are more susceptible to diseases, which can prolong the achievement of peace in the region. In addition to the direct effects of conflict on human and infrastructure loss, conflict-affected communities are also highly vulnerable to enormous public health threats including, but not limited to outbreaks, gender-based violence, mental and psycho-social problems, maternal and child health issues and nutritional problems.2 Wars and armed conflicts disrupt the health system and essential life-saving services are often jeopardised or not prioritised. Basic human needs such as access to safe water, food and shelter are highly compromised during conflicts and wars—leading to further desperation and threat in the conflict-affected communities. Consequently, conflict-affected communities make forced decisions to migrate internally or cross international borders—risking their lives and well-being.
Moreover, global communities in general and African people specifically have been affected by the bi-directional interplay between war and climate change—wars and armed conflicts cause environmental degradation, and climate change in turn, aggravates armed conflicts.

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Climate change and malaria, dengue and cholera outbreaks in Africa: a call for concerted actions

Thomas Ngbonga — Sat, 09 Mar 2024 07:17:47 +0000

Climate is rapidly changing and bringing extensive direct and indirect adversities to public health globally, either by increasing the seriousness and frequency of public health emergencies or causing new, unanticipated problems. Nearly half (approximately 3.6 billion) of the global population is highly susceptible to the impacts of climate change as they live in regions with high vulnerability to climate change, including Africa. Between 2030 and 2050, it is estimated that climate change will take the lives of an additional 250 000 people per year due to infectious diseases, undernutrition, diarrhoea and heat stress—of which the majority will be in low-income countries, including Africa. By the year 2030, climate change will cause direct damage to health systems—causing a loss of an estimated US$2–4 billion.

With its population expected to double to 2.5 billion people by 2050, Africa has been disproportionally affected by the impacts of climate change. Africa contributes only 4% of the global carbon emissions; however, 7 out of the 10 countries most vulnerable to the impacts of climate change globally are located in Africa. High- income and upper middle- income countries contribute to 87% of global carbon emissions but are less vulnerable to the impacts of climate change.

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