U.S. Africa Pandemic Health Force

Today marks a sobering milestone: the world has been embroiled in the fight against the deadly novel coronavirus for six months. Worldwide infections have surpassed 10 million and COVID-19 related deaths have risen above 500,000. The virus is spreading across the globe at an alarming rate, upending economies and straining health capacity. In Africa, COVID-19 threatens to overwhelm under-resourced health systems and reverse hard-won gains on U.S. priorities like maternal and child health, HIV/AIDS, and malaria. We cannot accept this. COVID-19 has shown us that the world is inextricably connected—if the virus thrives anywhere unabated, no one will be safe. Now, more than ever, the United States must reassert itself as a bastion of global health, for the sake of human life everywhere.

The United States bears a legacy of investing in health and improving health outcomes—particularly in Africa. Life-saving programs like the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. President’s Malaria Initiative (PMI) have helped to turn the tide against HIV/AIDS and malaria, respectfully. A concerted U.S. investment could lead the world’s response to the COVID-19 pandemic by supporting Africa to create a technology-driven community health worker platform – a “U.S.-Africa Pandemic Health Force”. 

Community health workers (CHWs) have emerged as the backbone of effective healthcare delivery in Africa, administering vital services to communities in the greatest need. For the rural poor, CHWs are often the only source of essential care. Community health has been shown to be more effective and cost-efficient than facility-based care across a range of interventions, including vaccinations, neonatal care, family planning, as well as specific interventions for malaria, HIV/AIDS, and tuberculosis. Estimates show that investment in CHWs in sub-Saharan Africa can yield an economic return of up to $10:1. [1]

Similar to the West Africa Ebola outbreak in 2014, COVID-19 presents the opportunity for the U.S. to use technology to transform community health services. The U.S. has championed data-driven approaches through its focus on mobile-health solutions, health information systems, and improved surveillance. The use of technology to monitor and support CHW performance increases health impact and return-on-investment, while creating an early-warning system to identify and contain future pandemics.

Failure to act and safeguard global health will be catastrophic. COVID-19 has the potential to reverse decades of U.S. Government-supported health gains across Africa. Current models predict that COVID-19 could infect as many as 1 billion people in Africa, with 3.3 million deaths, if further action is not taken.[1] By disrupting primary health systems, COVID-19 could cause a 45% increase in deaths among children under 5 (e.g. from malaria, mother to child transmission of HIV, etc.) and a 39% increase in maternal deaths across Africa. It is estimated that COVID-19 could cause malaria deaths in Africa to double, reversing decades of U.S. leadership and investment.[2] Interruption of HIV services across sub-Saharan Africa could result in 550,000 incremental deaths from HIV – a 2.2-fold rise in HIV mortality.[3] These numbers illustrate the disastrous indirect effects of COVID-19 in Africa, which threaten to undermine $3 billion in annual U.S. investments in malaria and HIV/AIDS control efforts.

The economic impact of the pandemic on Africa is equally grim. A World Bank report predicts sub-Saharan Africa will suffer its first recession in 25 years as a consequence of coronavirus, noting that the region’s economy could shrink by as much as 5.1%. Additionally, the African Union reports that nearly 20 million jobs on the continent are “threatened with destruction”.

The investment case for CHWs is clear: Support for CHWs will ensure that Africa can effectively respond to the COVID-19 pandemic now, build resilience to identify and contain future pandemics, while accelerating progress towards ambitious U.S.-supported targets on malaria and HIV reduction in the medium-term. 

If we invest $2 billion[4] per year to train, equip, and support 1 million CHWs across sub-Saharan Africa, projections show that a U.S-Africa Pandemic Health Force can avert up to 1 billion additional COVID-19 infections, 3.3 million COVID-related deaths, and save the lives up of up to 1.2 million children and 57,000 mothers – all before the end of 2021.[5]

Our battle against COVID-19 has just begun. We must mitigate the economic burdens and cost of human life by proactively doing the smart thing—the right thing. Establishing a U.S.-Africa Pandemic Health Force now could have one of the most impactful and durable contributions not only to the COVID-19 response efforts, but also for future pandemic preparedness.

We cannot simply hope for the best. We must prepare for success. That is the only we will prevail.

Sources

[1] United Nations Economic Commission for Africa (UNECA). (April 2020). “COVID-19 in Africa: Protecting Lives and Economies.” Web: https://www.uneca.org/publications/covid-19-africa-protecting-lives-and-economies. 

[2] World Health Organization. (April 2020). “The potential impact of health service disruptions on the burden of malaria: a modelling analysis for countries in sub-Saharan Africa.”

[3] World Health Organization. (May 2020). “The cost of inaction: COVID-19-related service disruptions could cause hundreds of thousands of extra deaths from HIV.”

[4] "Closing the $2 Billion Gap," a joint report between USAID + Financing Alliance for Health. The report documents the cost of deploying the 1 million additional CHWs that Africa needs to bring healthcare within reach of every person + carry out surveillance is about $3.1B annually. This is based on a validated costing of $3000 per year to hire, train and equip each CHW. Africa governments + donors currently spend about $1.1B, leaving a $2B annual gap.

[5] Global Financing Facility. (April 2020). “Press Release: GFF leaders warn of emerging secondary global health crisis from disruptions in primary health care due to COVID-19.” Web: https://www.globalfinancingfacility.org/gff-leaders-warn-emerging-secondary-global-health-crisis-disruptions-primary-health-care-covid-19.