High-level meeting on resilience and response to Ebola and emerging and re-emerging health threats, 26 March 2021
Remarks by WHO Regional Director for Africa, Dr Matshidiso Moeti
Messieurs les Ministres de la santé de la République de la Guinée, Republique Démocratique du Congo, Honourable Minister of Sierra Leone,
United States Secretary of State, Mr Blinken,
My DG, Dr Tedros,
John Nkengasong, Director of the Africa CDC, dear colleague and friend,
Rebecca Martin, our Moderator and Director of the US CDC for Global Health,
Mesdames et Messieurs les chefs des institutions partenaires,
Ladies and gentlemen:
I’m really pleased to join you for this important discussion on the threat of emerging and re-emerging infectious diseases and how we can build resilience in African countries.
I add my thanks to the US Government amd other co-coveners for the initiative to bring us all together for this important discussion.
John has really presented the history and recent events in the Region and I’d just like to add that, every three days an acute public health event is reported to WHO in the African Region and 80% of these are infectious diseases and most are of zoonotic origin. Some such as Ebola and Marbug are being reported more frequently (it’s been very well illustrated by John) in the context of population growth, increased mobility and travel, expanding human-animal contact and also climate change.
Apparentl recurrences of diseases like dengue might also be linked to increased awareness and the availability of better diagnostics and laboratory facilities in the countries.
We know also that currently, 11 African countries are also dealing with complex humanitarian crises, including the situation in the eastern part of the DRC, in the Tigray Region in Ethiopia, in the Sahel and several others. In here, we find the situation of when outbreaks occur much more complex to respond to so we need to be aware of operating in that complex humanitarian context.
Outbreaks and health emergencies often spill over across national borders – this can happen very rapidly, as we have seen with COVID-19, so cross-border collaboration is important, not only during the course of an outbreak when we need to respond but as an ongoing part of health development in contiguous districts in neighbouring countries.
Often solutions exist beyond the health sector, for example, preventing outbreaks of diseases like cholera, by improving access to clean water and sanitation.
The impacts of infectious diseases are wide ranging and really do require a multisectoral response and the COVID-19 pandemic has demonstrated this very clearly.
There are the direct health impacts of ill health and lives lost and the disruptions to other essential services that threaten and often set back gains that have been made over decades in child survival through routine immunization, in the control of malaria, HIV and other diseases.
Border closures have exacerbated food insecurity and stay-at-home orders have impacted education and livelihoods. The socio-economic impacts have hit the most vulnerable the hardest, and particularly, I would like to emphasize the impact on women and girls.
The pandemic has pushed Africa into recession for the first time in 25 years, with risks of long-term impacts, both on the continent and for global health security, rolling back hard-earned progress in key areas of development on the continent.
The COVID-19 pandemic, and before that numerous outbreaks including of Ebola, have proved without doubt that there are enourmous, multi-faceted benefits to investing in epidemic and outbreak preparedness, starting with averting needless and preventable deaths and illness.
The return on investment is hugely significant. For example, more than 3.6 billion dollars was spent on the response to the Ebola epidemic in West Africa, and the economic impact is estimated at 53 billion dollars. By contrast, our region-wide estimate to dramatically improve preparedness in Africa in the next three years is a fraction of this cost, at eight billion US dollars.
We see that preparedness really does pay off. Investments in Ebola preparedness for example, equipped countries to quickly detect and respond to threats, like COVID-19. This included strengthening their incident management systems, the infection prevention and control practices, surveillance, rapid response, laboratory capacities, community mobilization, among other critical areas.
The Ebola epidemic in West Africa was a turning point. It really did demonstrate that the world and in particular many low- and middle-income countries, were not ready.
It triggered wide-ranging reforms, and incentivization of research leading to innovations, such as Ebola vaccines and therapeutics, which Guinea and the Democratic Republic of the Congo have deployed to quickly contain the spread of outbreaks. And I am really happy to see that in both countries, we are now counting down having seen the last patients over several weeks.
The WHO Health Emergencies Programme was reformed in the wake of the West Africa epidemic, and as a result, our support to countries is now faster, more coordinated and more effective – outbreaks are detected more quickly, from a regional median of about 17 days in 2016 to less than 24 hours in 2020 and they are also contained faster, from a median of 418 days in 2016 to 103 days in 2020, with notably the exception of the tenth Ebola outbreak in the DRC and the ongoing COVID-19 pandemic.
Through our WHO country teams, we are close advisers to ministries of health supporting them technically and supporting their coordination of partners and we use our convening role to coordinate health partners not only at the national level but also subnationally at the provinicial level, and of course we work closely with partners like the CDC on coordination at the regional and continental level and at global levels.
We provide countries with tailored policy and technical guidance, training of health-care workers, and procurement of supplies, along with significant capacities to repurpose our staff who work in multiple programs to emergency response operations when needed, and also to deploy additional experts.
Governments report outbreaks to WHO, which coordinates and manages implementation of the International Health Regulations, and we assist in building country IHR capacities. There is no doubt that this needs transforming and we have high expectations of the ongoing discussions on strengthening the IHR including on aspects of governance and accountabilities.
Almost all African countries have undergone external evaluation of their IHR capacities and 30 of them have developed costed roadmaps to address the most critical gaps. Now, what’s needed is a strategy for resource mobilization, both domestic and international, including through prioritizing areas of intervention that will have the greatest impact.
The USA is a longstanding partner of WHO in strengthening health security in Africa. We have worked together over the decades with US CDC to build Integrated Disease Surveillance and Response, which is now implemented in almost all African countries. With US government institutions, universities and the Bill & Melinda Gates Foundation among others, we have contributed to kicking wild poliovirus out of Africa, and advancing other priorities.
Turning then to the way forward for our collective action to build resilience against emerging and re-emerging infectious diseases:
Firstly, significantly more domestic and international investment in preparedness is needed, to translate high-level commitments into action, and to implement national action plans, and integrate preparedness into work to strengthen health systems and build their resilience.
We have witnessed the impacts of infectious threats across development sectors, and have seen the significant contribution that they in turn can bring to epidemic and pandemic preparedness. So multisectoral action will be a critical as a component, including emphasizing links at the animal–human–environmental interface through the One Health approach. Partnership with the international organizations that support these different sectors is vital and it must be different including within the continental and global platforms whose improvement is currently under discussion.
We also need to mobilize supportive voices, networks, capacities and actions in civil society and our communities and also the private sector.
Together with the African Union, the Africa CDC and regional economic communities, we can support countries in strengthening national institutions such as public health institutes, as has already been inducated by John, emergency operations centres as well as the regulatory capacities for biosecurity.
Working with regional technical capacities, including academic institutions and professional associations, we can continue to strengthen expert networks to be deployed to support emergency preparedness and response.
At the inter-country, regional and continental levels, we should together enhance and sustain cross-border collaboration, including having in place mechanisms to share information across border districts, and strengthening laboratory networks for sample referrals. We in WHO also have laboratory networks, which we are working to bring together with what is being put in place by the Africa CDC.
We should also grow collaborative platforms, such as the COVAX and the UN Supply Portal, linking these to the extraordinary work done by the African Union in response to COVID-19, so that these mechanisms can spring quickly into action when they are needed.
Addessing global supply challenges and potential market distortions is being dramatically demonstrated to need innovation, resolve, solidarity and ongoing candid dialogue even as we speak.
In closing, while capacities to prevent, detect and respond to infectious threats have dramatically improved in recent years, the COVID-19 pandemic has confirmed that investments in preparedness must find their place in national development and in national security in all of our countries. We will see the benefits of these investments in saving lives and building resilience in our health systems, economies and societies and we in WHO in the African Region and I speak also for our global colleagues, look forward very much to the strengthened partnership as we undertake to do this on behalf of the African people.
Thank you very much for your attention.