The Ministers of Health of African Union Member States met in Addis Ababa, Ethiopia, on 27 April, under the facilitation of the Africa Centres for Disease Control and Prevention (Africa CDC) to drive this message home. 

“We need African opinion and voice to be heard because this is the only way for us to show that we are together,” said Dr Jean Kaseya, the Director General of Africa CDC, opening the meeting in Addis Ababa.

All AU members were represented at the meeting for the first time, and eight health ministers participated online.

“We decided to come and strengthen the voice for the continent and the world,” Dr Kaseya said.

The pandemic agreement is a potential international agreement currently being negotiated by the 194 member states of the WHO, including the US. It is intended to address some of the weaknesses in capacities and lack of international cooperation during the global response to COVID-19. 

Africa CDC is not a negotiator; it provides political, strategic, and technical support to negotiators.

Dr Mekdes Daba, Ethiopia’s new Minister of Health who took office in February 2024, said the ministers were meeting at a critical time in the global health governance where a pandemic had paused an administrative vacuum to our collective strengths, driving health experts to unforgivingly reflecting the world’s vulnerabilities.

“As we navigate these challenging times, we must learn from our past experiences and share the future of global health security,” Dr Daba said.

Slyvia Masebo, Zambia’s health minister, said the health of ‘our’ people in our respective countries is a core component of economic and social development, and our collective voices today should foster unity around this common purpose of achieving universal health coverage.

“Our voices today should lead to equitable access to pandemic-related health products, increased access to vaccines and diagnostics, ensuring that no one is left behind, tech transfer, local production capabilities, and strengthening of our health systems,” Masebo said.

Ministers of health eventually agreed that the current Pandemic Agreement should ensure equity.

In a 27 April communique, the ministers said multilateral pathogen access and benefit sharing system (PABS), which provides legal certainty for both users and providers and ensures improved access to pandemic-related health products, technologies with measures that establish regionally distributed production of pandemic-related health products, and measures that establish regionally distributed production of pandemic-related health products were required.

The ministers also called for the formulation of coherent national and regional strategies for emergency preparedness, response, and health workforce development, including community health workforce.  “Let us stand united in our commitment and ensure a fair and comprehensive pandemic agreement for the benefit of all our people and a healthier Africa,” said Masebo.

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b. Commitments to organize and resource technical support on the range of matters covered by the draft agreement, including all equity-related provisions, as well as pandemic prevention and public health surveillance, preparedness, readiness, and resilience, and health and care workforce through WHO coordinated mechanisms that are accountable to the Conference of Parties.

c. Appropriate safeguards and limitations that should be placed on the use and sharing of data and information provided by State Parties to WHO, such that the information shared should not be used to the detriment of the interests of the State Parties providing the information such as disproportionate travel or trade bans, devaluation of credit rating and/or sovereign bonds.

2. PANDEMIC PREVENTION, PREPAREDNESS AND RESPONSE (PPPR)
a. Formulate coherent national and regional strategies for emergency preparedness and response and health workforce development, including community health workforce.

b. Enact domestic laws providing for broad exemptions and limitations to intellectual property to address public health emergencies.

c. Increase supply chain diversification and logistics streamlining (continental, regional and national), including through initiatives with other Global South countries.

d. Make incremental steps, in line with respective capacities and nationally self-determined priorities, on PPPR competencies.

e. Operationalize various WHO coordinated mechanisms such as on coordinating R&D and technology transfer, in a manner that such mechanisms are accountable to the Conference of Parties and take guidance from the Conference of Parties in their operations.

3. PREDICTABLE, SUSTAINABLE FINANCING AND GOVERNANCE
a. Call for an International financing mechanism that is accountable to the Conference of Parties and enshrining explicit commitments to new, sustainable, and increased funding support from developed countries for country-level pandemic prevention, preparedness and response in developing countries, debt relief and debt restructuring mechanisms including debt for PPPR swaps.

b. Accelerate the operationalisation of the financing of the African Epidemic Fund.

AFRICA STANDS READY TO PLAY ITS PART AND COMMITS TO ENGAGE ACTIVELY IN THE ONGOING NEGOTIATIONS AND FINALISATION OF THE DRAFT PANDEMIC AGREEMENT.

Addis Ababa, 27 April 2024

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On 20 January 2024, Africa CDC sensitised Heads of State and Government from the Southern Africa Development Community (SADC) regarding the increase of cholera-related cases and deaths in the region.

Heads of State and Government then decided to organise an extraordinary summit hosted by the SADC Secretariat and led by President Lourenco from Angola as the Chair of SADC. This meeting was held virtually on 2 February 2024 to receive and consider a report on the status of the cholera outbreak in the SADC region. They expressed concern on the progress made in curbing the situation and the challenges that continue to hamper the effective fight against the recurrent outbreaks.

The extraordinary summit followed the meeting of the Committee of SADC Ministers of Health on 27 January 2024 and the SADC Executive Council (Ministers of Foreign Affairs) on 29 January 2024.

What We Know

The cholera situation in Africa is aggressive and more protracted in multiple countries. From January 2023 to January 24, 2024 (13 months), a total of 252,934 cases and 4,187 deaths (CFR 1.6%) have been reported from 19 African Union Member States. Over 72.5% of the total cases are reported from the SADC region.

Table 1: Reported Cholera cases and deaths in the SADC region from 1^st January 2022 to 24^th January 2024

*Source: Member States

1. The cholera situation is created and/or exacerbated by climate change. The climate outlook for the SADC region for the period between December 2023 and February 2024 projection increased chances of normal to above-normal rainfall in Angola, Botswana, DRC, Lesotho, Malawi, Mozambique, Namibia, South Africa, Tanzania, Zambia, and Zimbabwe.  

2. The overall performance results from the WHO Afro cholera readiness and preparedness survey conducted in 2023 indicated a limited capacity in Water Sanitation and Hygiene (WASH) infrastructure amongst the SADC countries. As the region continues to experience an increase in cholera outbreaks, more investments in cholera preparedness and readiness are urgently required.

3. The Director General of Africa Centers for Disease Control and Prevention (Africa CDC), H.E. Dr. Jean Kaseya, emphasised that cholera is not only a health sector problem. He advised adopting a multisectoral approach to eliminate cholera in the continent, considering the long-term investment in Water, Sanitation, and Hygiene facilities across Member States. He reiterated that the main driver for cholera outbreaks is limited access to water, hygiene and sanitation, which requires significant involvement of other sectors. 

Recommendations for Action

4. The Heads of State and Governments for the SADC region unanimously agreed on the following recommendations and action in addressing the Cholera outbreak in the region by urging Member States to:

a) Develop and implement regional solid and country multisectoral response plan that encompasses natural disasters and climatic effects on cholera re-emergence to control its spread effectively,

b) strengthen regional collaboration on cross-border outbreak risk assessment and public health surveillance to enhance early detection and prevention of outbreak-prone diseases,

c) jointly plan and implement synchronised cross-border cholera vaccination campaigns, as appropriate, and mobilise vaccines for affected and non-affected countries., and report to the council annually,

d) increase investment in the current cholera emergency response while long-term investment for a sustainable solution to the recurrent cholera crisis,

e) develop and implement climate-resilient water, sanitation and Hygiene (WASH) and Disaster Risk Reduction programmes to prevent future cholera outbreaks,

f) Accelerate local and regional manufacturing of cholera vaccines to scale up production and increase access to commodities such as Oral rehydration Solutions (ORS) and Cholera beds to improve control on the supply chain security and accelerate technology and knowledge transfer,

g) Increase investment in WASH infrastructure and provide efficient waste management and sustainable supply of clean water,

h) Increase budget allocation towards WASH Programmes and

i) Strengthen accountability tools for monitoring WASH interventions and local governments reporting on their WAS performance.

5. The SADC Summit commended the Africa CDC for technical and financial support towards the cholera response in the SADC region and recommended the AFRICA CDC to bring more epidemiologic data to facilitate the decision to Heads of State and Government to declare Cholera as a Public Health Emergency of Regional concern.

6. The Summit further designated His Excellency Mr Hakainde Hichilema, President of the Republic of Zambia, as the regional Cholera Champion to spearhead the fight against Cholera in the SADC region.

7. In response to this SADC Extraordinary Summit, the Director General of Africa CDC welcomes the recommendations from the Heads of State and Government and reiterates his commitment to work with the Member States and partners to urgently contain the ongoing Cholera outbreak by deploying personnel and resources in collaboration with the Ministries of Health.

8. The Africa CDC counts on the commitment of Member States to address the root cause of the recurrent cholera outbreaks to attain the goal of Cholera elimination by 2030.

Additional Resources:

 Communication and Public Information Directorate, Africa CDC, Email: Communications@africacdc.org | Ms. Ndahafa Nakwafila at: NakwafilaN@africacdc.org

Done on 02 February 2024

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The APHF met with the Africa CDC in July 2023 to discuss the implementation of its mandate, which includes coordinating resource mobilization and grants management for Africa CDC’s strategic priorities. These priorities are linked to the Director General’s five Flagship Programmes, which are focused on the following:

1. Healthcare worker protection – vaccination against vaccine preventable diseases with outbreak potential and provision of PPE for CHWs;
2. Strengthening primary healthcare (as essential foundation for PH surveillance and the frontline for pandemic preparedness and response), through digitisation and connectivity;
3. National Public Health Institutes (NPHIs) – all 55 AU Member States to have functional NPHI within the strategic cycle;
4. Laboratory capacity – every AU Member State to have atleast one national reference laboratory capable of diagnosing epidemic prone pathogens and with genomics capability, and
5. Manufacturing medical countermeasures – extending beyond vaccines to diagnostics and therapeutics.

During the discussions, H.E. Dr Jean Kaseya, the Director General of the Africa CDC reaffirmed Africa CDC’s commitment to the partnership with APHF. He emphasised the critical importance of sustainable financing to advance public health initiatives across the continent.

 The APHF will play a central role in mobilizing resources to support the Flagship Programmes and will join the Africa CDC Flagship Programme Development team to co-create initiatives and develop effective fundraising strategies.

Dr. Haufiku, Founder and Chairman of the Governing Council of APHF, commended the Africa CDC for their unwavering dedication to advancing public health across the continent. He also recognized the tremendous achievements made through collaborative initiatives, emphasizing the positive impact of joining forces for the greater good of the continent.

With its strong fiduciary accountability track record and access to diverse funding sources, the APHF is well positioned to achieve its mandate, and will work towards achieving the African Union’s New Public Health Order, for a safer, healthier, and  prosperous Africa in alignment with the African Union Agenda 2063.

END…./

For media inquiry:

1. Ndahafa Nakwafila | Senior Communication Officer | Policy, Health Diplomacy & Communication | Africa Centres for Disease Control and Prevention|

email: NakwafilaN@africaunion.org |Website: www.africacdc.org

• Eunice Chege | Communications Lead | Africa Public Health Foundation|

email: echege@aphf.africa | Website: www.aphf.africa

About Africa CDC

The Africa Centres for Disease Control and Prevention (Africa CDC) is a continental autonomous Public Health agency of the African Union which supports Member States in their efforts to strengthen health systems and improve surveillance, emergency response, prevention and control of diseases. Learn more at www.africacdc.org

About Africa Public Health Foundation The Africa Public Health Foundation exists to forge partnerships and mobilise resources to support critical public health initiatives across the continent, in support of the Africa Centres for Disease Control and Prevention (Africa CDC).

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Le CDC Afrique félicite le Fonds de lutte contre la pandémie pour le résultat du premier appel à propositions avec 19 subventions approuvées, ce qui est louable compte tenu des lacunes dans la réalisation de l’engagement initial de 1,6 milliard de dollars promis par les donateurs lors du lancement du Fonds. Le CDC Afrique note que seuls 9 % des pays africains (5 des 55 États membres de l’UA) représentant moins de 5 % de la population africaine bénéficieront de ce premier appel à propositions. Tout en félicitant les cinq pays et en s’engageant à les soutenir pour la mise en œuvre, le CDC Afrique reste préoccupé par l’impact limité de cette première allocation sur la préparation, la prévention et la réponse aux pandémies (PPPR) en Afrique en raison de sa taille limitée et de l’absence d’approche régionale.

Le CDC Afrique note que l’Afrique est la seule région à ne pas avoir de proposition régionale. En revanche, d’autres régions ont adopté une approche régionale afin de maximiser l’impact du Fonds de lutte contre la pandémie sur l’ensemble de leurs pays et de leurs populations : la région des Caraïbes avec 12 pays, l’Amérique du Sud avec 7 pays et l’Asie centrale avec 5 pays. Cet écart considérable s’explique par le fait que le Fonds pour la lutte contre les pandémies n’a pas reconnu le rôle vital qu’aurait pu jouer le CDC Afrique en tant qu’entité de mise en œuvre du Fonds, compte tenu de son rôle central dans le soutien aux initiatives sanitaires sur l’ensemble du continent.

Le fait d’avoir négligé l’inclusion du CDC Afrique, qui est la seule institution de santé publique du continent, a été un oubli regrettable. En conséquence, les lacunes de l’Afrique en matière de sécurité sanitaire ne sont pas suffisamment prises en compte, ce qui explique l’absence de propositions multi-pays/régionales émanant du continent.

Le CDC Afrique aimerait rappeler qu’en février 2023, elle a réitéré sa position en tant qu’observateur au Conseil du Fonds de lutte contre les pandémies, soulignant l’importance d’une représentation inclusive dans les structures de gouvernance, les équipes techniques et le Secrétariat du Fonds afin d’éclairer son travail crucial[1]. Le CDC Afrique souhaite également se faire l’écho de l’appel des chefs d’État et de gouvernement africain en faveur d’une meilleure représentation de l’Afrique dans toutes les instances multilatérales. Le CDC Afrique demande en outre une représentation équitable des pays africains et des organisations régionales dans les structures pertinentes afin de garantir des résultats justes et inclusifs. Par conséquent, le CDC Afrique exhorte une fois de plus le Fonds de lutte contre les pandémies à prendre des mesures décisives pour l’admission du CDC Afrique en tant qu’entité de mise en œuvre pour rejoindre celles identifiées en 2022. Pour aller de l’avant, le CDC Afrique plaide fortement pour une approche fondée sur l’équité, en mettant l’accent sur la transparence et le dialogue ouvert tout au long du processus de prise de décision. Le CDC Afrique, sous la direction de nos chefs d’État et de gouvernement, soutiendra activement les propositions régionales qui s’alignent sur son Plan stratégique 2023-2027 nouvellement adopté par le Conseil d’administration. Ces propositions seront guidées par les principes du Nouvel Ordre de la Santé Publique, qui promeut des partenariats respectueux et orientés vers l’action, favorisant une approche plus complète et inclusive de la lutte contre les menaces de maladies au niveau local et mondial.

[1] https://africacdc.org/news-item/statement-from-africa-cdc-on-the-pandemic-fund1/

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Africa CDC commends the Pandemic Fund for the outcome of the first call for proposals with 19 Grants approved, which is praiseworthy given the gaps in meeting the initial commitment of 1.6 billion dollars pledged by donors at the Fund’s launching. Africa CDC notes that only 9% of African countries (5 out of the 55 AU Member States) representing less than 5% of Africa’s population will benefit from this first call of proposals. While congratulating the five countries and committing to support them for implementation, Africa CDC remains concerned about the limited impact of this first allocation on pandemic preparedness, prevention, and response (PPPR) in Africa due to its limited size and lack of regional approach.

Africa CDC notes that Africa is the only region without a regional proposal. In contrast, other regions adopted a regional approach to maximize the impact of the Pandemic Fund on their entire countries and populations: Caribbean region with 12 countries, South America with 7 countries, and Central Asia with 5 countries. The considerable discrepancy stems from the Pandemic Fund’s failure to acknowledge the vital role that Africa CDC could have played as an Implementing Entity for the Fund, considering its central role in supporting health initiatives across the continent.

Overlooking the inclusion of Africa CDC, which is the sole continental public health institution, was an unfortunate oversight. As a result, Africa’s health security gaps remain inadequately addressed, leading to the absence of multi-country/regional proposals from the continent.

Africa CDC would like to recall that in February 2023, it reiterated its stance as an observer at the Pandemic Fund’s Board, emphasizing the significance of inclusive representation in the Fund’s governance structures, technical teams, and Secretariat to inform its crucial work[1]. Africa CDC would also like to echo the call from African Heads of State and Government for a better representation of Africa in all multilateral constituencies. Africa CDC further urges for equitable representation of African countries and regional organizations in the relevant structures to ensure fair and inclusive outcomes. Therefore, Africa CDC once again urges the Pandemic Fund to take decisive action for the admission of Africa CDC as an Implementing Entity to join the ones identified in 2022. Moving forward, Africa CDC strongly advocates for an equity-based approach, emphasizing transparency and open dialogue throughout the decision-making process. Africa CDC, under the guidance of our Heads of State and Government, will actively support regional proposals that align with the newly approved Africa CDC Strategic Plan 2023-2027 by the Governing Board. These proposals will be guided by the principles of the New Public Health Order, which promotes respectful and action-driven partnerships, fostering a more comprehensive and inclusive approach to combating disease threats locally and globally.

[1] https://africacdc.org/news-item/statement-from-africa-cdc-on-the-pandemic-fund1/

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Africa CDC is an observer at the Board of the Pandemic Fund, and we have emphasised the need for inclusive representation in the governance structures, and technical teams and the Secretariat to inform the important work of the Pandemic Fund. We are pleased to note that regional and gender balance at these three levels continues to improve as the Fund evolves.

As an integral part of the African approach to pandemic prevention, preparedness and response, the African Union and Africa CDC initiated Africa’s New Public Health Order, which aims to set the course for how Africa deals with its public health realities. The New Public Health Order is built on five pillars, four of which all relate to the high-impact priorities set out in the first round call of the Pandemic Fund, namely surveillance and early warning, laboratory systems and health workforce. Africa CDC is also an autonomous institution of the AU charged with the mandate for coordinating Africa’s disease prevention and control. Africa CDC is the convening platform for AU Member States on health security matters.

Africa CDC is convinced that the New Public Health Order brings the changes necessary for improved global preparedness and response to disease threats and health emergencies. One key aspect is regional strategies and action, based on mandates of regional institutions like Africa CDC. However, Africa CDC has not yet been accredited by the Pandemic Fund to be an Implementing Entity (IE) [2]. This has considerably constrained the ability of Africa CDC, in the context of the Pandemic Fund, to play its AU-mandated role as convenor and coordinator of health security in Africa.

To this end, Africa CDC is unable to participate in the first call for EOIs, indeed the First Call for Proposals as well. By its mandate, Africa CDC will await the outcome of the request to be an Implementing Entity so that it can play its rightful role of being a convenor and coordinator for health security in Africa.

Africa CDC once again urges all AU Member States to fully participate in the Pandemic Fund’s first Call for Proposals including the call for EOIs.

### End

[1] https://fiftrustee.worldbank.org/en/about/unit/dfi/fiftrustee/fund-detail/pppr

[2] https://www.worldbank.org/en/programs/financial-intermediary-fund-for-pandemic-prevention-preparedness-and-response-ppr-fif/funding-opportunities#implement

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