The case for regionalization
The examples mentioned show that regional institutions have an important role to play that goes beyond backstopping countries. They can innovate and help adapt responses to regional needs, and are close enough to decision-makers to secure the required political support—all important elements of success.
Our work at Africa CDC is guided by the need for a new public health order for Africa and a focus on five core areas for the continent’s 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 drive down procurement costs and increase response speed;
- Investment in the public health workforce and leadership programs;
- Strong, high-level partnerships, including between donors and governments and the public and private sectors and with public health institutions; and
- A greater role for regional organizations in pandemic governance, by decentralizing institutions and through regional representatives in key agencies to ensure that the specificities and needs of each region are considered in the planning of central mechanisms such as surveillance systems.
This new public health order requires more predictable, long-term funding. Funding needed for national public health institutes differs widely based on size, function, and country, but a starting budget of at least $20 million is required. Most important, 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 also require up-front investments in infrastructure, materials, and staff.
These calculations do not include the additional funding needs identified on a global level. For example, support for global institutions such as the World Health Organization; access to vaccines, diagnostics, and therapeutics; global surveillance and alert systems; and rapid surge funding for (early) response activities.
While there should be more domestic funding, it will not be sufficient for the needs of low- and many lower-middle-income countries, at least not in the foreseeable future. It must be bolstered by favorable financing options, supported by strong partnerships and investments in pandemic preparedness and response, and backstopped by a fund that can pay for surge expenses as needed.
