## A New Public Health Order for Africa

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**Canonical URL:** [A New Public Health Order for Africa](https://www.imf.org/-/media/files/publications/fandd/article/2021/december/nkengasong.pdf)

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### Current COVID-19 situation and health-system constraints
- As of November 3, 2021, there were 8.5 million confirmed cases and over 218,000 COVID-19 fatalities across the continent.
- Less than 3 percent of the population is fully vaccinated in Africa.
- Africa has about 3 million health care workers.
- Doctor-to-population ratios cited:
  - 3 doctors per 10,000 people in Africa.
  - nearly 30 for the Americas.
  - more than 40 for Europe.
- The pandemic has overwhelmed health systems and diverted scarce resources from concurrent epidemics and an already high disease burden related to rapid population growth; infectious and noncommunicable diseases; high maternal morbidity; and environmental, climatic, and ecological changes.

### Homegrown, regional responses and key actions taken
- Lessons from the 2014–16 Ebola virus outbreak highlighted needs for stronger surveillance and governance systems, better national pandemic management capacity and capability, and more predictable funding; coordination, communication, and collaboration through the African Union were crucial.
- Africa Centres for Disease Control and Prevention (Africa CDC) coordinated the African Union’s continental response strategy; the strategy was released less than six weeks after the first confirmed case on the continent.
- Pan-African Partnership to Accelerate COVID-19 Testing (launched April 2020 by the African Union Commission and Africa CDC):
  - Increased the number of countries with testing capacity from 2 to 43 in just three months.
  - Procured more than 90 million test kits and trained thousands of lab workers.
- African Union partnerships (Africa CDC, United Nations Economic Commission for Africa, African Export-Import Bank) created a medical supplies platform as a one-stop shop for procurement to improve bargaining power and support African manufacturers.
- AUC and Africa CDC launched the Trusted Travel Platform to simplify verification of COVID-19 test results and travel documentation; the system could also be used for the African Continental Free Trade Area.
- The African Vaccine Acquisition Trust was established to complement initiatives such as COVAX and has secured enough vaccine doses to cover one-third of the African population.

### The case for regionalization and the "new public health order"
- Regional institutions provide roles beyond backstopping countries: they can innovate, adapt responses to regional needs, and secure political support.
- Africa CDC’s five core focus areas for mid- to longer-term health security:
  - Strong regional institutions to guide priorities, coordinate policies and programs, and drive standard-setting and disease surveillance.
  - Local production of vaccines, therapeutics, and diagnostics to reduce procurement costs and increase response speed.
  - Investment in the public health workforce and leadership programs.
  - Strong, high-level partnerships, including between donors and governments, the public and private sectors, and public health institutions.
  - A greater role for regional organizations in pandemic governance via decentralizing institutions and including regional representatives in key agencies to ensure regional specificities and needs are considered in planning central mechanisms such as surveillance systems.

### Funding needs and global financing considerations
- A new public health order requires more predictable, long-term funding.
- Funding for national public health institutes differs widely, but a starting budget of at least $20 million is required.
- “Tens of billions of dollars” will be needed to train nurses, physicians, epidemiologists, and other health care workers.
- Continental manufacturing of vaccines, diagnostics, and therapeutics will require up-front investments in infrastructure, materials, and staff.
- These calculations exclude additional global-level funding needs (support for World Health Organization; access to vaccines, diagnostics, and therapeutics; global surveillance and alert systems; rapid surge funding for early response activities).
- Domestic funding increases are necessary but insufficient for low- and many lower-middle-income countries in the foreseeable future; financing must be bolstered by favorable financing options, strong partnerships, investments in preparedness and response, and a backstop fund for surge expenses.
- Both the Independent Panel for Pandemic Preparedness and Response and the G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response recommend a global fund.
- The G20 panel estimates that it will cost at least $75 billion over the next five years to fill gaps in pandemic prevention and preparedness.

### People-centered health systems and concluding policy orientation
- A fundamental rethink toward people-centered, inclusive health systems is required; equity begins by regionalizing health systems so regions can respond when crises hit.
- Translating lessons from COVID-19 into a new public health order can lessen the effects of future pandemics on lives and livelihoods.

*John Nkengasong, "A New Public Health Order for Africa", Finance & Development, December 2021.*

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_Source: https://www.imf.org/-/media/files/publications/fandd/article/2021/december/nkengasong.pdf_