How to Highway to health

In light of the ongoing Ebola epidemic in West Africa, it is entirely understandable that the African Union intends to establish a pan-continental organization to combat the ravages of infectious disease.

The African Centers for Disease Control and Prevention (ACDC), as the agency is called, will largely be based not on the US CDC, but on the smaller European Centers for Disease Prevention and Control (ECDC). Although the goal is excellent and the effort should be cautiously welcomed, the African Agency’s plans are grossly inadequate. In terms of money and staff – at least initially – it will not be in a position to achieve its high ambitions.

The CDC has no precise definition other than a public-health agency, often focused on infectious diseases. The US CDC was created in 1946 with approximately 400 staff members and an annual budget of some US$10 million (worth $120 million today), primarily to combat malaria in the US South.

It now has a staff of 15,000 and an annual budget of $7 billion, covering the full spectrum of health issues – from detecting and responding to infectious-disease outbreaks around the world, from non-communicable diseases, Bioterrorism, to the control and prevention of workplace injuries. environmental health hazards.

The past 15 years have seen a proliferation of CDC and equivalent organizations around the world, partly due to increased awareness of the need to improve response to infectious-disease threats, particularly severe acute respiratory syndrome (SARS) in 2003. ) was induced by the pandemic.

But their organizational models are diverse. Canada’s Public Health Agency – after disclosing weaknesses in the country’s response to the SARS outbreak in 2004 – is a smaller version of the US CDC, with 2,400 employees and a budget of CAN$633 million (US$517 million). .

ECDC is different. Unlike the US and Canadian organizations, the Stockholm-based agency does not have any internal laboratories. It acts as a coordinator rather than drawing on a network of research laboratories and national health-protection bodies to strengthen disease surveillance and response. The highly regarded agency has a relatively modest budget of €60 million (US$64 million) and 300 staff members.

ACDC, which is based in Addis Ababa for now, will coordinate national resources and laboratories as well as a pan-African network including the African Region Epidemiological Network and the African Network for Drugs and Diagnostics Innovation. It will focus on infectious diseases. But the similarities with ECDC end there.

Africa’s desire to assume political ownership of its response to public-health emergencies can only be welcomed.

ACDC’s budget for July 2015 to December 2016 calls for only US$6.9 million, and the center will initially have only 11 staff members, including management and 5 epidemiologists.

These resources are hopelessly insufficient to tackle the agency’s long list of stated ambitions, which include not only helping to prevent, detect, and respond to disease outbreaks, but also strengthen health systems and address regional and national risks.

Evaluation is also included. The African Union has declined to say what kind of funding ACDC expects beyond this start-up phase. Its proponents now need to have funding for at least five to ten years – experts say $60 million and 300 staff members will be the bare minimum needed.

It is only welcome that Africa wants to assume political ownership of its response to public-health emergencies, rather than relying largely on external agencies and support.

Yet there is a risk that the creation of this skeletal agency could provide an excuse for complacency and passivity by politicians in Africa and globally. And the underlying problems that leave many countries vulnerable to disease outbreaks will not be solved by an African health agency alone, no matter how strong and desirable.

As the Ebola epidemic has brutally exposed, Africa lacks most of all proper health systems and laboratories. There is a severe shortage of health care workers, with only a few dozen doctors per million people. Yet there is no serious national or international plan to strengthen public-health capabilities.

An alphabet soup of global health and organizations involved in disease detection and prevention has evolved over the past 20 years, yet has proved unable to respond quickly to the emergence of the Ebola threat.

The often overlapping and repeated efforts of these groups should be better coordinated to prevent and reduce future health crises. But there is a danger that governments will fall back into old habits, with concerns about Ebola disappearing, and that the lessons will not be fully learned from the pandemic.

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