On Monday, US Secretary of State John Kerry signed an agreement with the African Union to help establish the African Centres for Disease Control and Prevention. Headquartered in Addis Ababa, Ethiopia, the African CDC will take on a role similar to the Centers for Disease Control and Prevention (CDC) in the United States, and work to prevent and respond to future disease outbreaks on the continent. According to the memorandum, the US CDC will provide technical assistance to help support a surveillance and response unit and an emergency operations center at the African CDC. It will also offer fellowships for African epidemiologists who will work at the new institution.
This is all very welcomed and exciting news.
In our increasingly globalized world, infectious pathogens, whether natural like Ebola or manmade like a resistant strain of tuberculosis, can jump international boundaries with a single plane trip. My blogs on the economic impact of Ebola (see here, here, and here) illustrate how the health of each global citizen, whether poor or rich, depends in part on the health of people in the rest of the world. The US CDC works to protect Americans from these threats. However, despite the success and relatively low cost of the US CDC (less than 9 percent of US budget for health care in 2015), it has few counterparts in the rest of the world and until this week had none in developing countries.
I particularly commend the African Union for recognizing this gap well before the outbreak of Ebola and requesting support from donors to create an African CDC. The idea was initially raised at the Special Summit of the African Union on HIV/AIDS, Tuberculosis and Malaria in July 2013. At the time, however, most observers (including some of us here at CGD) disregarded the proposal, perhaps because we thought the World Health Organization was already doing that job.
But the subsequent Ebola epidemic in Africa made it clear that the WHO in general, and its African region in particular, can barely fulfill their core responsibility to set standards and provide technical guidelines. They have neither the funding, the staff, nor the mandate to assure communicable disease surveillance or rapid outbreak response. Non-governmental agencies like Médecins Sans Frontières and Save the Children stepped in to fill the gaps, but were insufficient to hold back the Ebola epidemic. Ultimately, the affected countries looked to experts from the US CDC for core technical public health advice to manage their domestic epidemics. Some of this scrambling could have likely been avoided if an African CDC had existed.
That’s why I applaud the Obama administration’s commitment to support the creation of an African CDC, and I call on other donors to join in. Essential elements of the new institution must be strong, collaborative relationships with the US CDC as well as with the WHO in Geneva and OECD public health surveillance and control agencies. The African CDC needs surveillance capability not only against episodic outbreaks, but especially against the emergence of resistant strains of HIV, tuberculosis, malaria, and nosocomial (hospital-birthed) infections. Like the US CDC, it must also have a rapid response capability, including an arm similar to the US CDC’s storied Epidemic Intelligence Service. And I hope to see the US support conditioned on the new agency’s insulation from the patronage and corruption that have crippled the WHO Africa branch.
Creating and maintaining strong African Centres for Disease Control and Prevention can be expected to cost the US much less each year than the $5.4 billion it has spent this year on Ebola. And by knitting together the world community to address a threat to global public health that no country can adequately address alone, such an institution arguably contributes to international trust and collaboration on other more strategic topics.