HEALTH | DR OKEREKE | AU

Dr Ebere Okereke is a public health physician, specialising in global health security and health system strengthening. 

She is Senior Technical Adviser at the Tony Blair Institute for Global Change and honorary Senior Public Health Advisor to Africa CDC.

Ebere is currently on a career break from Public Health England (now UK Health Security Agency), where she led the UK-aid funded IHR strengthening programme, a technical assistance project aimed at sustainably strengthening public health systems in some African and Asian countries as well as with Africa CDC and WHO. 

She spoke to New Vision about Africa’s plan for a new public health order.

What does the new public health order for Africa entail?

The African Union adopted the policy Agenda 2063 about Africa we want to see, which was around developing a prosperous, secure peaceful and developing continent. 

Africa where opportunities for progress and improvement are high and equally available to everyone. Health is central just as the COVID-19 experience has shown. 

The new public health order is about putting the right public health systems, structures and people, at the centre of what we do as a continent. 

It is about strengthening our public health systems, with Africa CDC as the continental coordinator of the public health system. 

It is recommended that each member state of the African Union should have a national public health institution that takes responsibility for coordinating preparedness and responsible health security affairs.

Is AU taking over health ministries of countries?

No! It is not a replacement of ministries of health! Ministries of health have their responsibilities regarding the strategic directions and policy for governments. 

But the individual national public health institutions will work alongside ministries of health, specifically focusing on coordinating public health expertise to optimise their impact. 

It is about making sure that critical technical capacity is available for that country’s health priorities and enabling each country to play its part in a global public health system.

So, the first pillar is the national public health institution. Of course, your country is not going to have an institution without people. So, the next thing is having a trained public health workforce.

We have more public health institutions on the continent now and an increasing number of trained people, through programmes coordinated by national public health institutions and Africa CDC, for example, the Field Epidemiology Training Programmes. 

And we are actually seeing the dividend in how the continent has responded to the COVID-19 pandemic.

When we have institutions that coordinate national response and we have Africa CDC coordinating continental response, we improve our capacity to respond to and mitigate the more significant effects of epidemics.

The third pillar is about manufacturing for diagnostics, vaccines and drugs to meet our own health priorities. 

Look at today where we are at the back of a long queue for COVID-19 vaccinations! Only 6% of Africa’s population have been fully vaccinated, compared to over 70% in the European Union! 

That is an impact because we have under-resourced health systems that depend on the outside world for supplies. We only make 1% of the vaccines we need on this continent. 

We import over 80% of the therapeutics we need. At the beginning of the pandemic, we didn’t have enough diagnostic capacity to test people for COVID-19! 

We need to create a new public health order where we can manufacture some of these things for ourselves. 

We need to meet our own health needs so that a health crisis doesn’t cripple the entire continent.

The fourth pillar is about developing mutually beneficial trusted partnerships. 

I look at this in two ways: strengthening internal partnerships and collaboration within the continent. 

We have instruments like the African continental free trade agreement and African financial institutions focusing on development which encourage us to actually share with each other within the continent. 

We don’t have enough capacity, so we must optimise the impact of what we have. Scientists in Uganda should know about their colleagues in Zambia with who they can collaborate. 

The Conference for Public Health In Africa (CPHIA 2021) happening from 14-16 December this year aims to provide a forum for African public health professionals and institutions to learn about the capacity and expertise that is available on the continent to strengthen that internal collaboration.  

And then, externally, we do not want to always be the ones begging and waiting for partners from the global north to donate to us. 

We have experience and skills that our partners in the global north can also benefit from. We need a mutual exchange of knowledge and skills and, respect to underpin strong partnerships. 

How possible is this for Africa to play equal partner with the North now or soon, when we have failed for centuries?

I would not say we have failed; we have not succeeded YES, but things are changing and there is a will to see that change through. We are not starting from anything; we already have Africa CDC, at least 15 African countries already have National Public Health Institutions and many more are establishing the same - 22 countries will have national public health institutions in the coming months. With that infrastructure, we shall strengthen partnerships, build coordinated surveillance and laboratory systems. 

We are already moving in that direction. Yes, we do recognize that we do not have enough resources now, but we will get there.

African countries can adopt policies and sign binding resolutions but it always stops at that. Look at the Abuja Declaration of 2001 where AU countries pledged to allocate at least 15% of their annual budget to improve the health sector. How many have done it so far – 20 years later?

We recognize the challenge and are frustrated by the slow pace of change, but it doesn’t make it impossible for us and in public health we always recognize the opportunity to learn and to drive forward. And the COVID-19 pandemic opened many eyes; there is now a focus of attention from our political leaders to improve health security. 

Therefore, we need to build on the current momentum and recognise that there is no economic development without health security. 

The new public health order has to be at the centre of every decision we are making. And I’m glad African political leaders are beginning to recognize that in their priorities.

How do you rate Uganda’s commitment to the public health order and emergency?

I would not wish to comment on any single country, but Uganda is recognised as a science hub for the continent. 

It has a long-established history of strong research and science for health and, alongside that, established institutions that collect that expertise to inform the government’s response to the policy. 

Uganda has been at the forefront of the continental response especially in the areas of a public awareness campaign which is critical in this emergency. 

We encourage sharing of this expertise by working in partnership with neighbouring countries as part of the whole continent response and preparedness. 

No country can do this alone but some countries with more experience and expertise and can step up to move their region along. And Uganda is doing quite well in that space.

Uganda, as well most African countries, have been open to learning and improving as they go along. And the key thing is how we ensure that we are not in the same place when the next pandemic comes.

Are you predicting another pandemic?

There will be the next pandemic; that is inevitable. What we need to do is to ensure that we have a better place for it than this current one. 

And I think we have demonstrated the importance of cooperation. Uganda for example is close to DR Congo and has always had the opportunity to learn from DRC’s response to the Ebola outbreak and so have other countries across central, eastern and southern Africa! The same has been witnessed in West Africa, around how we are using the response to Ebola outbreak to prepare for other outbreaks like the Dengue fever and cholera outbreaks. 

How will the new public health order for Africa make it better for Uganda?

If governments across the continent adopt this new public health order, we would empower the national public health institutions to lead the public health system so that there is a single point of contact for example on how to respond to COVID-19.

Secondly, the ambition for the order to have more manufacturing on the continent instead of importing. Uganda has a strong science base so it would have a key role to play in the science and research required to support a manufacturing industry for drugs, diagnostics and vaccines for the continent. 

If we have these in Africa, the whole continent would be better prepared. 

And more importantly, it will help us learn how to collaborate as a continent; learning and networking with each other so there is a cross-fertilisation of expertise and experience. And that is in part, what the CPHIA 2021 aims to promote and foster.

Can you please take us through the roadmap towards this new public health order till 2063?

We are not planning it for 2063; it is already in motion now; we are already on the road to the new public health order! You have seen how the political mandate of the African Union was used very effectively to coordinate the response to the COVID-19 pandemic. We have also increased political will from all the heads of state across the continent in the response. 

Additionally, the Africa CDC as a convening public health institution for the continent is advocating for and supporting the development of national public health institutions, and a number of our countries have already put these institutions in place. 

We continue to build and promote these institutions to take that leadership role in each country. 

We are building on the spirit of Kofi Annan, developing the Kofi Annan global health leadership fellowship program hosted by Africa CDC to identify public health leaders across the continent who have the potential to be continental leaders for this new public health order. 

The first cohort is just about to complete the programme and we will be training more and more people to lead the public health systems for the new public health order. 

And I know that there are Ugandans on that fellowship program.

These days the AU heads of state summit always have a very clear agenda on public health and will continue to advocate because health is critical for development. It is a long way to go but it is not impossible.