NAVIGATING HEALTH AND DISEASE IN AFRICA: Pertinent frameworks for Discovery and Recovery
By
Professor Nwadiuto Esiobu Florida Atlantic University, Boca Raton Fl. USA / Founder & President Applied Biotech Nigeria & USA
A think-Tank contribution to The African Development Institute (ADI) of the African Development Bank’s third G-CoP policy seminar on “Building Resilient Health Systems: Policies for Inclusive Health in Post-COVID-19 world, with a focus on Africa”, on 14:00 – 17:00 hours (Abidjan time) and 23 June 2020,
Just when the global disease burden report of 2013 for sub-Saharan Africa showed some progress in infectious and communicable disease control; the Ebola outbreak of 2014 and on-going COVID19 pandemic have exposed major vulnerabilities of the entire continent and its member countries. With only 17% of the world population, Africa bears a disproportionately high disease burden in communicable and non-communicable illnesses with a growing trend in chronic diseases from air pollution and poor nutrition. The overall status of health and disease on the continent is often ambiguous because there are no clear systems for measuring health. Health is not the absence of disease. It is an overall wellbeing of a well-nourished population that allows for optimal output, high cognition, and creativity of a people. The discovery of the underpinnings of health is intricately linked to the recovery from the burden of disease. The shock and multi-faceted devastation of COVID19 pandemic has brought wellness and healthcare system resilience into focus for many nations. This submission evaluates lessons learned by other countries from viral outbreaks such as Ebola and COVID19 and argues that any good policy framework should be versatile and robust enough to adequately respond to endemics, local outbreaks, regional epidemics and global pandemics. Policy frameworks that draws lessons from the past to shape the future and guard today are part of the best practices. Beyond engaging communities in high risk border areas and crowded urban slums and informal settlements, enabling public private partnerships that accelerates innovation to create a non-existent supply chain, continental or regional policies should ensure health and border security surveillance and develop broad bandwidth internet platforms to power modernized healthcare delivery systems to the most vulnerable. Proactively, before an outbreak, the continent must invest heavily in building laboratory capacity, a continental diagnostic and research and development center that will mine indigenous knowledge and develop context relevant solutions to Africa
The two questions from the Concept note that are examined herein are:
3. What are the lessons that can be learned from previous health epidemics such as Ebola, HIV/AIDS, etc., to accelerate an inclusive health system in Africa? 4. Are there examples elsewhere that African Countries should learn from to build an integrated health policy to foster a resilient and inclusive health system in post-COVID-19 Africa? What are the specific lessons to be learned to inform health sector policies to build more resilient and inclusive health systems in Africa post-COVID-19?
4. Are there examples elsewhere that African Countries should learn from to build an integrated health policy to foster a resilient and inclusive health system in post-COVID-
Learning from SARS
The Asia-Pacific region is learning from past pandemics. In a January 2020 report, titled “For the Future Towards the Healthiest and Safest Region” and published before the COVID-19 outbreak, WHO’s Western Pacific Regional Office said that the region has made considerable progress in strengthening health security systems over the last decade, building on lessons from the SARS epidemic, the H1N1 influenza pandemic and other real-life events – leading to the development and implementation of the Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies.
Frameworks for Discovery
- Fund and incentivize the building and modernization of Diagnostic Laboratory Capacity – infrastructure, skilled workforce and virtual
- Create Database of incidence and Prevalence of specific infectious diseases in African to permit predictions
- Develop satellite and remote sensing programs (eg with google) for an integrated and informed rapid response and prediction of outbreaks
Frameworks for Recovery
- Creating safety nets and systems for immediate response to the most vulnerable populations and weak links in the community – Food aid, treatment aid etc Nigeria’s neighborhood markets was an excellent intervention. Would be better to have a systematic map created long before an outbreak….
- After the West African Ebola regional outbreak and global scare of 2014, the US Government swiftly enacted the 21st Century Cures Act and signed it into law in 2016 with an initial budget of 900 million dollars to engage. This law was designed to accelerate medical product development and modify regulations to bring new innovations to patients faster. The US Food and Drug Administration (FDA) is the custodian of the Act and has leveraged Cures to modernize clinical trials, and review of novel medical products to admit remote testing and real-world evidence. Contextualizing this to the African scenario requires significant public -private partnership to serve a population with limited access to digital and tele medicine infrastructure
- The Cures Act also provided new authority to help FDA improve its ability to recruit and retain scientific, technical, and professional experts and it establishes new expedited product development programs. This is particularly pertinent to African countries where the dearth of highly skilled scientific and professional experts is more dire.
- Develop policy to strengthen and build local capacity in disease surveillance using metagenomics and invest in an AFROGENOBANK – a virtual database of genomic sequences of pathogens and of useful therapeutic bioresources and biodiversity.
- Mobilize communities to build coalitions towards protecting the vulnerable groups
- It Behooves Governments to partner with Private sector entities to leverage capacity for quick response
- Invest in creating local supply chains via PPP
- Prioritize funding infrastructure for Modernizing healthcare delivery
a. Telemedicine or Telemedicine
b. Virtual enabling solution companies to be supported
c. Internet bandwidth connectivity, especially for poor masses. Governments should subsidize or partner with private sector … in PPP?
d. New normal in hybrid care delivery - Proactive interventions
a. Infection Control and Prevention
b. Established Government programs during health and crisis times
c. Heatmap approach and analysis
d. Hygiene surveillance
e. Firm border control
f. Vaccination - Vaccination manufacturing and testing
• Fortify local institutions and insure their products and output
• Mandate stakeholder involvement in evaluating safety and data of any vaccine candidates from outside the continent
• Work actively with WHO to develop schedule. African policy on Vaccination against Infectious Diseases - Regional or continental accountability measures should be set up.
- Short Term policies
a. Enact laws that favor locally manufactured goods to stimulate supply chain growth
b. Example is the US BIO-Preferred laws which feeds into their circular economy. Here government preferentially procures by priority… all products that convert waste to wealth or that employ Life science renewable technologies to make a product or service.. www.biopreferred.gov
c. Create a dedicated system or institution for infectious diseases (such as the NIAID)
d. Formalize channels for engaging public health expertise from the Diaspora - Reactive systems
a. Critically review Crisis management structures and systems with the goal of identifying and creating Future epidemic management.
i. The FDAto modernize clinical trials and bolster domestic manufacturing through easing regulatory roadblocks but keeping the standards
ii. FDA steps up monitoring to ensure supply chains and national inventory (stockpiles) to avoid shocks
iii. Changed policy to include remote testing
Conclusion
Enact policies that foster inter-agency communications and nurture efficient communications (COVID19 is case in view)
- In an editorial, titled “Learning from Ebola: readiness for outbreaks and emergencies,” Margaret Chan, who was leading WHO then, wrote: “The Ebola outbreak has taught us many lessons, among them that the response to outbreaks and emergencies must start and end at ground level – which means that certain key capacities have to be in place before launching a response, including leadership and coordination, technical support, logistics, management of human resources and communications.”
- “It has also shown that the organizations working to contain outbreaks and emergencies must collaborate closely,”
- Long term preparedness disease surveillance and health screening are key to detection and referring potentially