Preparing Africa for next pandemic: Lessons from Europe

•Good start but accountability gap undermines potential of pandemic treaty, says WHO

Different continents are in a race to be better prepared for next pandemic. The ongoing COVID-19 pandemic caught the entire continents ill prepared, including the Americas and Europe.

With the threat of the predicted Disease X looming large, the European Health Union plans to build the foundation in a European Union (EU) in which the Member States detect, prepare and respond collectively to future health threats and crises. The European Commission initiated the European Health Union, during the COVID-19 pandemic.

Director-General of the of the Directorate-General for Health and Food Safety, Sandra Gallina, noted in her editorial, published in the European Centre for Disease Prevention and Control journal, that the EU Health Security Framework was reinforced “to make use of the lessons learned and, recognise the limitations of our collective response to the pandemic at EU level.” Thus, to learn from experiences and to further strengthen the EU’s preparedness and resilience towards cross-border health threats and other crises, a reinforced EU Health Security Framework was initiated. Together, the European Medicines Agency (EMA), the European Health Emergency Preparedness and Response Authority (HERA) and the European Centre for Disease Prevention and Control (ECDC) are in the forefront to protect the health of the Europeans.

The mandates for both EMA and ECDC have recently been reinforced, while HERA was established in 2021 to further strengthen Europe’s capacity to prevent, detect and respond rapidly to cross-border health crises. EMA’s new role will enable it to improve access to medicines and medical devices between EU countries. ECDC’s strengthened mandate further enhances the Centre’s capacity to provide the robust and independent scientific expertise needed to support prevention, preparedness and response planning to prevent and control serious cross-border health threats.

What can be expected in the future? Maarit Kokki and ECDC Director Andrea Ammon described in their editorial how ECDC plans to operate under its new mandate. The EU Health Task Force (EUTHF), to be established and coordinated by ECDC, is one example of what to expect from the agency: in disease outbreak situations, the EUTHF will provide hands-on support to EU countries and third countries. Moreover, to give assistance in their preparedness and response planning. An Enhanced Emergency Capacity will be created consisting of EUTHF public health experts from EU/EEA countries as well as ECDC experts and fellows from the ECDC fellowship programme. During their deployment, experts will support outbreak investigations or preparedness and response activities.

EMA’s Executive Director, Emer Cooke, explained in her editorial how the extended mandate has enabled implementation tools that will help manage medicine shortages in future public health emergencies. For example, a new executive body, the Medicine Shortages and Safety Steering Group (MSSG), has been set up to respond broadly to medicine supply problems caused by public health emergencies or other major events. It will also coordinate rapid action across the EU where necessary.

Its Director-General, Pierre Delsaux outlines the role of HERA as another building block of the EU Health Emergency Framework. During a public health crisis, the Emergency Framework Regulation allows HERA to enter a crisis mode, which can be triggered by example, a declaration of a public health emergency at EU level. In this mode, HERA can take required actions that ensure adequate and timely access to and provision of medical countermeasures relevant to emergencies in Europe. If and when the emergency framework is not activated, HERA works in preparedness mode together with EU countries, ECDC and EMA as well as international partners on activities such as intelligence gathering and threat assessment and promoting advanced research and development of medical countermeasures, to only name a few.

Although the organisations have their separate tasks, the framework is built for close and efficient collaboration. Emer Cooke described how ECDC would provide epidemiological data to EMA to help forecasting the needs of medicines and to gather specific data from countries and supply-chain stakeholders. These forecasts will be important for HERA to build EU manufacturing capacities and stockpiles. In addition, to launch emergency procurements and emergency deployment of medical counter measures such as vaccines.

One example where all the new tools were applied, is the 2022 mpox (formerly monkeypox) outbreak mainly affecting the community of men who have sex with men (MSM) in Europe: ECDC Epidemic Intelligence picked up the signals of an outbreak, with next steps including contacting EMA, who would then act as an advisor for HERA. Here, the role of EMA was to help identify the available, both authorised and unauthorised treatments as well as vaccines for mpox.

A common insight from the editorials is the need for multi-sectoral collaboration and cross border coordination in order to effectively face future health threats.

In addition, authors noted it is imperative that lessons learned are not only listed but also acted on. Kokki and Ammon stated: “To ensure this, continuous political will and sustained investment in public health at national and at EU level are needed.”

As the key players of the EU Health Security Framework, ECDC, EMA and HERA will together contribute to better preparedness for and to respond quickly to future cross-border health threats in the EU as well as build resilience to overcome these new challenges together.

Meanwhile, last week, Japan saw record numbers of people dying from COVID-19, the United States announced plans to end its COVID-19 emergency declaration in May and the World Health Organisation (WHO) said that for now, COVID-19 will continue to be classified as a Public Health Emergency of International Concern (PHEIC), the organisation’s highest level of alert. As the enter the fourth year of the pandemic, global response remains inconsistent, hampered by inequitable access to health technologies and continues to put a huge burden on overburdened health workers and health systems.

Last week, the intergovernmental negotiating body (INB), the entity tasked with drafting and negotiating a pandemic treaty, published its “zero draft” for countries to consider before negotiations officially kick off at the end of this month. The Panel for a Global Public Health Convention (GPHC) lauds the INB’s recognition that equity must prevail at every level of decision-making to adequately and justly tackle global health threats. In particular, the draft analyses the challenges of COVID-19 and aims to ensure that the global supply of lifesaving tools, like vaccines, therapeutics and diagnostics, are predictably and equitably shared during a crisis.

While the Panel strongly supports the INB’s commitment to equity, there are worrying gaps in its effort to ensure accountability mechanisms are agreed from the start. Accountability is one of the most sparingly used terms in the treaty, and when it is used, it’s clear that real decisions on compliance will be kicked down the road. Principles and concrete mechanisms for accountability must be reflected in a treaty, and not left solely to the International Health Regulations (IHR), which have so far not held countries to account.

The Panel for GPHC represents an independent coalition of former heads of state and global leaders working to strengthen the world’s ability to prevent, prepare, and respond to infectious disease outbreaks before they become widespread pandemics. The Panel was founded in 2020 in response to the emergence of the COVID-19 pandemic with the aim of bridging critical gaps in the global public health architecture and policy frameworks by promoting a new global public health treaty or convention in an effort to ensure another pandemic of such magnitude does not happen again.

Pandemic preparedness is making global headlines this year – from ongoing measles outbreaks in South Africa, to the closure of the Ebola outbreak in Uganda, to the much-anticipated initial draft of a pandemic treaty, released this week in Geneva.

The Panel for a Global Public Health Convention, an independent coalition of former heads of state, including Former President of Ghana John Dramani Mahama, and other global leaders, argue in the below press statement that to deliver welcome ambitions on ensuring equity during a global health crisis, concrete accountability mechanisms for pandemic preparedness and response are needed in a treaty. Unfortunately, accountability is one of the most sparingly used terms in the treaty, and when it is used, it’s clear that real decisions on compliance will be kicked down the road.

As the Panel says, “Countries must know what they are responsible for and who they are responsible to before the treaty is finalized, not after. The world must wake up, as global health security is only as strong as its weakest link.”

The Chair of the Panel, Barbara Stocking (Former Chief Executive, Oxfam; Former Chair, Independent Panel of Experts to Assess WHO’s Response to the Ebola Outbreak) spoke to journalists on the historic conversations taking place around a new Pandemic Treaty, as well as shared insights on where the world stand a year after the World Health Assembly (WHA) agreed to kick-start the process, where it is headed, and critically, what is being left out.