A united call for new public health order for Africa: the inaugural International Conference on Public Health in Africa (CPHIA 2021)

By mid-December 2021, around 8.9 million cases of COVID- 19 and nearly 225,000 deaths had been reported across Africa, a picture less grim than had been predicted by international public health experts.¹ While Africa’s response to the COVID-19 pandemic has been challenging, there are critical lessons which have been learned. COVID-19 should be a stimulus to strengthen health systems in Africa, and a call to invest in public health institutions, local manufacturing of medical interventions for Africa’s health security.^2,3

Unlike previous disease outbreaks, during the COVID-19 pandemic, Africa has been a key player in the acquisition of scientific knowledge that has guided the global response.¹ An excellent example is the discovery of Omicron, a new variant of concern (VOC) by African researchers in November 2021.⁴

Recalling the Heads of State and Government’s Declaration in July 2013 at the African Union Special Summit on HIV/AIDS, tuberculosis (TB) and Malaria in Abuja, Nigeria, in which African leaders recognized the need for an Africa Centres for Disease Control and Prevention (Africa CDC) to conduct life-saving research on priority health problems and to serve as a platform to share knowledge and build capacity in responding to public health emergencies and threats in Africa.

Africa CDC continues to play a critical continental coordination role that has allowed for strong collaboration and best use of available resources in African countries to respond to the COVID- 19 pandemic.⁵ Some key initiatives established include the Africa Task Force for Coronavirus (AFTCOR) that leads response efforts across the continent; Partnerships for African Vaccine Manufacturing (PAVM) for local production of over 60% of vaccines by horizon 2040; African Vaccine Acquisition TRUST (AVAT), Consortium for COVID-19 Vaccine Clinical Trials (CONCVACT) established to convene the diverse organizations working across the continent under one umbrella, to help accelerate progress on planned and future COVID-19 vaccine trials that take place in African nations; Africa Collaborative Initiative to Advance Diagnostics (AFCAD) to enable all African Union Member States to achieve equitable access to health, Africa Pathogen Genomics Initiative (PGI) which is supporting surveillance of new variants of SARS-CoV-2 across the continent; Africa Medical Supplies Platform (AMSP) which is a pool procurement mechanism that ensures quick access by Member States to COVID-19-related diagnostics, medicines and other medical supplies from vetted manufacturers, suppliers and procurement partners at competitive or discounted prices.⁵ Under the leadership of Dr. John Nkengasong the Africa CDC has a vision of a New Public Health Order for Africa that will secure its future and guarantee its development, allowing for health systems that can adequately respond to infectious disease threats. This new public health order will necessitate strengthened national public health institutions, strengthened public health workforce and leadership, expanded manufacturing of vaccines, diagnostics and therapeutics, and respectful action-oriented partnerships, and engagement of the private sector.⁶

Against this backdrop, final preparations were underway for the inaugural Conference on Public Health in Africa (CPHIA) 2021 which was held virtually from 14-16 December 2021, hosted by Africa CDC.⁷

Co-chaired by Professors Agnes Binagwaho and Senait Fisseha, the CPHIA 2021 International Organising Committee was privileged to have many of Africa’s leading scientists, epidemiologists and public health experts onboard. The conference aimed to create a unique platform where African leaders, researchers, policymakers and stakeholders can share perspectives and research findings in public health, while ushering in a new era of strengthened scientific collaboration and innovation across the continent. This conference provided an opportunity to discuss gains and losses and examine how to develop systems better able to prepare and respond to the next public health emergencies and threats in Africa.

With seven scientific plenaries, eleven parallel sessions, and eight abstract driven sessions, CPHIA 2021 had 232 African policymakers, scientists, public health experts, data experts, and civil society representatives who presented the latest learnings and research from the COVID-19 pandemic, as well as the actions needed to better guard against current and future health crises. In addition, 40 parallel side events were also hosted by various health institutions and agencies.

CPHIA 2021 brought together over 12 000 public health stakeholders from across the continent and the world, to share scientific findings; collaborate on research and implementation; and chart a shared course towards a more secure future for Africa. There was strong support and political commitment to CPHIA and the AU New Public Order as seen with the opening and closing ceremonies which included African Heads of State and leaders of Government, as well as key leaders of regional and international health agencies.

Some of the key findings from CPHIA 2021 deliberations include the following:

• It is time for a new paradigm in Africa that can achieve a truly equitable and effective health system for Africa.

• Africa needs to rethink the architecture of its National Public Health Institutes (NPHIs), leveraging on the resources already invested in our Ministries of Health to help us prevent and respond to future pandemics.

• Africa needs to invest in the development of an adequate health workforce, with systems that ensure that public health professionals are well compensated and protected.

• Africa needs to build state of the art science infrastructure and create conducive environments that can generate good science and also allow for building institutional capacity for health research across the continent.

• Within the research environment, models of cross-collaboration are essential to retaining skills on the continent by ensuring world class facilities and enabling environments for career growth of young scientists and public health professionals.

• International intellectual property rules can present a significant barrier to equitable global health response as observed with the various technologies needed to make COVID-19 vaccines, a few richer countries that house some of these manufacturers still not consented to a temporary waiver. It is important to ensure that the incentive to invent remains, this should be protected. However, how this innovation is shared is just as critical.

• Technology transfer is a key element of building capacity in the global South. The WHO supported mRNA hub led by Afrigen Biologicals in South Africa is key to establishing the technology needed for building vaccine manufacturing capacity in Africa.

• African leaders need to view health as an investment which can have big returns. Africa has a rapidly growing population that is projected to reach 2.4 billion by 2050. A healthy workforce is essential to further economic development.

There was an overwhelming consensus that it is time for change – Africa must stand up, Africa must unite, and Africa must put in place the necessary systems for it to safeguard the health of its people. Africa’s aspiration for all of its citizens to be “healthy and well-nourished” as outlined by Agenda 2063 shall be tested by gains made in the spheres of global health security and diplomacy. Lessons that have been learnt from the ongoing COVID-19 pandemic, such as multi-sectoral collaboration to address the widening health inequalities shall be essential to defining the nature of longterm investments in health, and health systems that are essential, resilient and ultimately cost-effective. Despite the immeasurable human cost and unintended economic implications, COVID-19 has created a unique opportunity for the African continent to build a new public health order – one that can secure Africa’s future and guarantee its continued development.

‘We do not need to be scared of the future of our continent, and do not need to be scared of the work it will take to get there – success will be ours if we define our future together’ - Dr Michele Sidibe, African Union special Envoy for the African Medicines Agency (AMA).

This historic inaugural conference with participation and endorsement from multiple global health leaders and agencies, repositioned Africa as a continent collectively taking charge of its future, to ensure an Africa where access to health is a reality of for all.

“Together we will create a new benchmark for collective efforts and participation as we advance public health practice, education, training and research in Africa, for Africa.” – H.E. Moussa Faki Mahamat, Chairperson, African Union Commission.

It is planned that CPHIA will become the seminal annual public health conference in Africa, bringing together the brightest minds in public health on the continent, to discuss pertinent issues relevant to public health in Africa. We look forward to welcoming you all to Kigali, Rwanda for CPHIA 2022 from 13-15 December 2022.

Funding Statement

Funding: none.