In the mid-1300s, humanity was struck by a deadly pandemic. Spread by fleas and flea-carrying rodents, the plague killed between 70 and 200 million people across the world over a period of about 20 years. Trade was slow and so was movement, and this defined the path of the bacteria that became so notorious that it was nicknamed The Black Death. In England, a quarter of the population died!
This wasn’t the first or last plague to strike humanity; the deadly smallpox, eventually defeated in 1978, struck in Mexico, spreading globally and leaving packed graveyards. Another major outbreak in 1918, coming from the battle fronts of the First World War, this time caused by a virus, killed between 50 and 100 million people.
However, humanity largely won the battle against this global enemy through major discoveries in vaccines, antibiotics, hygiene, and other medical advancements.
And there was relative calm.
But this was not to last long as the world witnessed the HIV pandemic towards the end of the 20th century and in quick succession, threats rose in the name of Ebola, swine flu, Zika virus, SERS and MERS, and currently Covid-19, which at the time of writing this article stands at more than 63 million cases and almost 1.5 million deaths globally in less than 12 months. It has been driven largely by globalisation and movement of people and goods in a highly interconnected world.
In 1969, the World Health Organisation Assembly, guided by the history of 20th century suffering and successes, and informed by the growing movement of people, noted that avoiding pandemics was not going to be the responsibility of a single country, but that of the whole world. The member states of WHO therefore adopted the International Health Regulations. This document, legally binding international law, was to achieve global collaboration to prevent, protect against, control, and provide a public health response to the international spread of diseases in a way that interferes with international traffic and trade.
Some 35 years later, and many gaps unattended on the International Health Regulations by Africa countries, the Ebola epidemic broke out in West Africa and became a big threat to the health, trade, and economy of the world. Guinea, Liberia, and Sierra Leone lost over 11,000 lives and $2.2 billion in GDP in one year. Actual total cost is estimated to be more than $53 billion.
Then 51 years later, the Covid-19 pandemic arrived in Africa. As I write this article, the continent has recorded more than two million cases and over 50,000 lives lost. In addition, the continent faces a recession estimated to be an economic contraction of 3.3 per cent, the first in 25 years, leaving many lives and livelihoods destroyed.
It’s clear that the future of Africa’s socio-economic development will be shaped by how well it prepares to prevent, protect against, control, and provide a public health response to current and future pandemics, epidemics, or outbreaks.
First and foremost, Africa must wake up to the reality that protecting its lives and livelihoods from the shocks of current and future health threats is one and the same thing as building universal health coverage – health security and universal health coverage are two sides of the same coin, as the World Health Organisation Director General, Dr Tedros Ghebreyesus, likes to say.
Currently, Africa remains the continent with the lowest universal health coverage, with only 43 per cent of its population achieving effective coverage of health services. Expanding universal health coverage to all, including its key component of financial protection, will mean that the services needed to keep pandemics at bay such as prevention of infectious diseases and other public health common goods will be available to everyone, everywhere across the continent. This will require investment in community health services, including early disease detection and control, with supportive health system infrastructure of laboratory capacity, health data management, and human resources and commodities in an equitable manner where all are included.
This will require Africa to invest more of its public resources in health, in line with previous commitments such as the popular Abuja Declaration to spend at least 15 per cent of governments’ general budget expenditure on health. This has to be seen as an investment in the continent’s future prosperity rather than merely expenditure. Furthermore, embedding community participation and ownership will only guarantee success and efficiency of these investments.
Secondly, Africa must realise that emergence and re-emergence of diseases is closely linked to climate change, which is causing displacement of people and encroachment of wild lands. This has brought humans face-to-face with new disease-causing pathogens to which they have not developed prior immunity; overpopulation resulting in food security challenges and resulting in consumption of wild animals; and emerging resistance of disease-causing pathogens to antibiotics.
Whereas investment in health may be seen as an individual country responsibility, save for the implementation of International Health Regulations requiring country collaboration, climate change is a global responsibility in which Africa must participate fully as the least contributing continent but one the most impacted because of its pre-existing vulnerabilities. Africa must pay more attention to the 2015 Paris Agreement than it has previously done to ensure accelerated implementation of commitments needed for a sustainable low carbon future.
Finally, the continent must examine its response to impending over-population. It is estimated that Africa will more than double its population by 2050 unless girl education and empowerment are accelerated and barriers to the advancement of girls and women are removed.
This unholy triad of poor access to health services, climate change threats, and overpopulation is my 21st century assignment to African leaders to help the continent escape from pandemics and accompanying social and economic deprivation.
Dr Githinji Gitahi, Group CEO Amref Health Africa and Co-Chair UHC 2030
This article was first published in a pullout in The EastAfrican newspaper on December 5, 2020.