Financing pandemic prevention, preparedness and response: lessons learned and perspectives for future.

BACKGROUND: The attainment of global health security goals and universal health coverage will remain a mirage unless African health systems are adequately funded to improve resilience to public health emergencies. The COVID-19 pandemic exposed the global inequity in accessing medical countermeasures, leaving African countries far behind. As we anticipate the next pandemic, improving investments in health systems to adequately finance pandemic prevention, preparedness, and response (PPPR) promptly, ensuring equity and access to medical countermeasures, is crucial. In this article, we analyze the African and global pandemic financing initiatives and put ways forward for policymakers and the global health community to consider. METHODS: This article is based on a rapid literature review and desk review of various PPPR financing mechanisms in Africa and globally. Consultation of leaders and experts in the area and scrutinization of various related meeting reports and decisions have been carried out. MAIN TEXT: The African Union (AU) has demonstrated various innovative financing mechanisms to mitigate the impacts of public health emergencies in the continent. To improve equal access to the COVID-19 medical countermeasures, the AU launched Africa Medical Supplies Platform (AMSP) and Africa Vaccine Acquisition Trust (AVAT). These financing initiatives were instrumental in mitigating the impacts of COVID-19 and their lessons can be capitalized as we make efforts for PPPR. The COVID-19 Response Fund, subsequently converted into the African Epidemics Fund (AEF), is another innovative financing mechanism to ensure sustainable and self-reliant PPPR efforts. The global initiatives for financing PPPR include the Pandemic Emergency Financing Facility (PEF) and the Pandemic Fund. The PEF was criticized for its inadequacy in building resilient health systems, primarily because the fund ignored the prevention and preparedness items. The Pandemic Fund is also being criticized for its suboptimal emphasis on the response aspect of the pandemic and non-inclusive governance structure. CONCLUSIONS: To ensure optimal financing for PPPR, we call upon the global health community and decision-makers to focus on the harmonization of financing efforts for PPPR, make regional financing mechanisms central to global PPPR financing efforts, and ensure the inclusivity of international finance governance systems.

Characterising social contacts under COVID-19 control measures in Africa.

BACKGROUND: Early in the COVID-19 pandemic, countries adopted non-pharmaceutical interventions (NPIs) such as lockdowns to limit SARS-CoV-2 transmission. Social contact studies help measure the effectiveness of NPIs and estimate parameters for modelling SARS-CoV-2 transmission. However, few contact studies have been conducted in Africa. METHODS: We analysed nationally representative cross-sectional survey data from 19 African Union Member States, collected by the Partnership for Evidence-based Responses to COVID-19 (PERC) via telephone interviews at two time points (August 2020 and February 2021). Adult respondents reported contacts made in the previous day by age group, demographic characteristics, and their attitudes towards COVID-19. We described mean and median contacts across these characteristics and related contacts to Google Mobility reports and the Oxford Government Response Stringency Index for each country at the two time points. RESULTS: Mean reported contacts varied across countries with the lowest reported in Ethiopia (9, SD=16, median = 4, IQR = 8) in August 2020 and the highest in Sudan (50, SD=53, median = 33, IQR = 40) in February 2021. Contacts of people aged 18-55 represented 50% of total contacts, with most contacts in household and work or study settings for both surveys. Mean contacts increased for Ethiopia, Ghana, Liberia, Nigeria, Sudan, and Uganda and decreased for Cameroon, the Democratic Republic of Congo (DRC), and Tunisia between the two time points. Men had more contacts than women and contacts were consistent across urban or rural settings (except in Cameroon and Kenya, where urban respondents had more contacts than rural ones, and in Senegal and Zambia, where the opposite was the case). There were no strong and consistent variations in the number of mean or median contacts by education level, self-reported health, perceived self-reported risk of infection, vaccine acceptance, mask ownership, and perceived risk of COVID-19 to health. Mean contacts were correlated with Google mobility (coefficient 0.57, p=0.051 and coefficient 0.28, p=0.291 in August 2020 and February 2021, respectively) and Stringency Index (coefficient -0.12, p = 0.304 and coefficient -0.33, p=0.005 in August 2020 and February 2021, respectively). CONCLUSIONS: These are the first COVID-19 social contact data collected for 16 of the 19 countries surveyed. We find a high reported number of daily contacts in all countries and substantial variations in mean contacts across countries and by gender. Increased stringency and decreased mobility were associated with a reduction in the number of contacts. These data may be useful to understand transmission patterns, model infection transmission, and for pandemic planning.

Fighting COVID-19 and HIV through community mobilisation: lessons from an integrated approach to the Africa CDC Partnership to Accelerate COVID-19 Testing (PACT) initiative in seven countries.

Recent literature has shown how the HIV architecture, including community systems, has been critical for fighting COVID-19 in many countries, while sustaining the HIV response. Innovative initiatives suggest that fostering the integration of health services would help address the colliding pandemics. However, there are few documented real-life examples of community mobilisation strategies responding to COVID-19 and HIV. The African Union and Africa Centres for Disease Control and Prevention (Africa CDC) launched the Partnership to Accelerate COVID-19 Testing (PACT) in June 2020 with the goal of training and deploying one million community health workers across the continent. UNAIDS partnered with Africa CDC to implement the PACT initiative in seven countries, i.e. Algeria, Côte d'Ivoire, Gabon, Ghana, Madagascar, Malawi and Namibia. The initiative engaged networks of people living with HIV and community-led organisations to support two of its pillars, test and trace, and the sensitisation to protective measures against COVID-19 for the most vulnerable populations. It later expanded to improve access to COVID-19 vaccines. Based on the assessment of country projects, this article explains how PACT activities implemented by communities contributed to mitigating COVID-19 and HIV among vulnerable and marginalised groups. This article contributes to a better understanding of the impact of a community-based approach in responding effectively to emerging health threats and provides lessons from integrated COVID-19 and HIV community-led responses.

Psychosocial determinants of adherence to public health and social measures (PHSMs) in 18 African Union Member States during the early phase of the COVID-19 pandemic: results of a cross-sectional survey.

OBJECTIVE: The objective of this study was to gain a better understanding of the psychosocial and sociodemographic factors that affected adherence to COVID-19 public health and social measures (PHSMs), and to identify the factors that most strongly related to whether citizens followed public health guidance. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Nationally representative telephone surveys were conducted from 4-17 August 2020 in 18 African Union Member States. A total of 21 600 adults (mean age=32.7 years, SD=11.4) were interviewed (1200 in each country). OUTCOME MEASURES: Information including sociodemographics, adherence to PHSMs and psychosocial variables was collected. Logistic regression models examined the association between PHSM adherence (eg, physical distancing, gathering restrictions) and sociodemographic and psychosocial characteristics (eg, risk perception, trust). Factors affecting adherence were ranked using the Shapley regression decomposition method. RESULTS: Adherence to PHSMs was high, with better adherence to personal than community PHSMs (65.5% vs 30.2%, p<0.05). Psychosocial measures were significantly associated with personal and community PHSMs (p<0.05). Women and older adults demonstrated better adherence to personal PHSMs (adjusted OR (aOR): women=1.43, age=1.01, p<0.05) and community PHSMs (aOR: women=1.57, age=1.01, p<0.05). Secondary education was associated with better adherence only to personal PHSMs (aOR=1.22, p<0.05). Rural residence and access to running water were associated with better adherence to community PHSMs (aOR=1.12 and 1.18, respectively, p<0.05). The factors that most affected adherence to personal PHSMs were: self-efficacy; trust in hospitals/health centres; knowledge about face masks; trust in the president; and gender. For community PHSMs they were: gender; trust in the president; access to running water; trust in hospitals/health centres; and risk perception. CONCLUSIONS: Psychosocial factors, particularly trust in authorities and institutions, played a critical role in PHSM adherence. Adherence to community PHSMs was lower than personal PHSMs since they can impose significant burdens, particularly on the socially vulnerable.