The SARS-CoV-2 pandemic has revealed that Africa needs a new public health order to be resilient, to adapt, and to cope with 21st-century disease threats.
The new order will need strengthened continental and national public health institutions; local manufacturing of vaccines, therapeutics, and diagnostics; attraction, training, and retention of a public health workforce; and fostering of respectful local and international partnerships.
Infectious diseases remain a great threat to Africa’s aspiration to achieve its 2063 developmental blueprint: “Agenda 2063: The Africa We Want.” Health, as a development issue, continues to have a significant impact on the economic and social security of countries and regions across Africa.
Africa’s underlying burden of endemic diseases is the largest in the world. Infectious diseases play a particularly severe role on the continent. Every year they account for over 227 million years of health life lost and produce an annual productivity loss of over $800 billion (World Health Organisation Regional Office for Africa, 2019). Moreover, outbreak-prone diseases are an increasingly devastating force. Of the estimated 10 million deaths per year resulting from infectious diseases, the majority occur in Africa.
The SARS-CoV-2 pandemic has clearly shown how infectious diseases are a serious threat to health, global economies, and security.
Economically, the SARS-CoV-2 pandemic is forecast to cause a 5.2% contraction in global gross domestic product and to a 2.8% contraction in Sub-Saharan Africa in 2020 (World Bank, 2020). The SARS-CoV-2 pandemic has underlined the datum that disease does not respect boundaries. While we seek to flatten the epidemiological curve of SARS-CoV-2 globally, the virus has also “flattened the world.” It has shown us that we are more connected than we thought, that we are vulnerable regardless of where we live, and that we have tremendous shared responsibilities and vast inequalities.
In the midst of this, Africa has learned how fragile international cooperation can be when the world is collectively threatened and challenged by a common disease threat. For instance, the ease with which Africa was shoved out of the SARS-CoV-2 diagnostics market exposed how easily global cooperation and international solidarity can collapse (Nkengasong, 2020). Similarly, Africa could find itself at the end of the queue for access to any available vaccines against SARS-CoV-2 with the rise of global protectionism and vaccine nationalism (Callaway, 2020).
One of the greatest lessons learned by Africa is the urgent need to invest in its healthcare systems as a critical instrument to secure its economic development as it implements the African Continental Free Trade Area Agreement and other flagship projects of Agenda 2063. About 50 years ago, Julian Tudor-Hart proposed the principle of the inverse care law, stating that the availability of good medical or social care tends to vary inversely with the need of the population served (Hart, 1971).
This principle vastly prevails in Africa today, and a new public health order must aim to deconstruct this law. Here, we provide a historical perspective of where Africa is coming from and where it might be heading to understand why we need a new public health order to fight the inverse care law.
We propose that the new public health order must stand on four pillars: strengthened public health institutions; local manufacturing of vaccines, therapeutics, and diagnostics; a strengthened public health workforce; and respectful local and international partnerships.
