Threats of public health emergencies: Time to set up epidemic preparedness fund

When the news broke out that Ghana has run out of childhood vaccines for children who needed them across the various health facilities in the country, it immediately became an issue of national concern, drawing reactions from various stakeholders and interest groups.

Among the interest groups that reacted to the situation and called out the government and the Ministry of Health to remedy the situation included the Parliament of Ghana, Paediatric Society of Ghana, Civil Society Organisations (CSOs), and many Public Health experts.

A number of public health experts raised an alarm that if the issue was not immediately addressed, it could have dire consequences on the health of the affected children.

Many were those who were surprised about the situation, wondering how the country allowed things to get to that point, knowing very well, the importance of the said vaccines and the health implications it could bring thereof.  

A section of the media even reported that due to the shortages of the childhood vaccines, some children had died from measles in some parts of Northern Ghana, which the Ministry of Health in a swift press conference in Accra on Tuesday, March 7, 2023, denied the said claims.

The sector Minister, Kwaku Agyeman Manu, at the said press conference said: "It is important to correct the erroneous impression that there have been deaths from Measles in Ghana recently. For the avoidance of doubt, there have been no deaths from the recently recorded spike in Measles cases. Indeed there have been no deaths since 2003 though we have recorded cases annually."

The Health Minister, however, assured Ghanaians that the government was working assiduously to get new stock of vaccines. But it did not happen immediately and stakeholders continued to mount pressure on the government.  

After many calls and sustained media pressure on the government to act on the vaccines shortages, the country on March 11, 2023, received some consignments of Measles vaccines, BCG vaccines and Oral Polio Vaccines. It brought some relief and joy to the parents whose children were due for vaccination but had to delay them due to the vaccine shortages. 

Vaccines are very critical in the health administration in the sense that they help prevent common diseases that used to seriously harm or even kill infants, children, and adults. Without vaccines, children are at risk of becoming seriously ill or even dying from childhood diseases such as measles, tetanus, diphtheria, and whooping cough. Most childhood vaccinations are completed between birth and six years.  

Why Epidemic Preparedness Fund? 

The childhood vaccines shortages that hit the country was just an indication of how frail our health system is, in terms of its response to any major public health emergency. It also shows the weakness in our preparedness and response to any public health threat.   

Experience from history has demonstrated the value of contingency planning to meet the exigencies of disasters. Although no abstract plans are ever likely to match specific circumstances that suddenly confront public health or disaster management, such plans provide a vital starting point. This is because without them, panic and paralysis may set in, in the event of any major public health emergency.

That is why health experts and advocates have over the years warned and called on the government, particularly the Ministries of Health and Finance to establish public health emergency fund that will help the country to respond effectively and efficiently to public health emergencies in the country.

The reason is that health financing is a core function of health systems that can enable progress towards Universal Health Coverage (UHC) by improving effective service coverage and financial protection. This is why the World Health Organisation’s (WHO) guidance on health financing policy is ultimately focused on strengthening health system resilience, health security and UHC.  

A carefully designed and implemented health financing policies can help to address shocks in the health system effectively and efficiently, including that of the childhood vaccines shortages.

For example, contracting and payment arrangements can incentivise care coordination and improve quality of care; sufficient and timely disbursement of funds to providers can also help to ensure adequate staffing and medicines to treat patients.

Epidemic fund long overdue

Contributing to the subject, the Head of the Department of Community Medicine of the University of Cape Coast’s (UCC) School of Medical Sciences (UCCSMS), Professor Kingsley K. Asare Pereko, said it was time for Ghana to set up epidemic preparedness and response fund, considering the threats of emerging diseases.

For him, the idea to set up epidemic preparedness and response fund in the country had been on the table for long and needed no further delays.

His conviction is based on the fact that there could not be any effective health response in times of outbreak of diseases when there was no preparation at all, pointing out that even the WHO had been advocating for countries to set up epidemic preparedness and response financing prior to the outbreak of the deadly COVID-19 pandemic.

Prof. Pereko, who is also the President of the Ghana Academy of Nutrition and Dietetics (GAND), even suggested that beyond the country-specific public health emergency funds, there was the need to have a regional epidemic fund to deal with outbreaks that may occur within the ECOWAS region.

“It is very, very important to set up the epidemic fund. When you set up the fund, before emergencies strike, you have some buffer to cushion yourself before external help comes,” he noted. 

In his opinion, resources played a critical role in times of disease outbreaks and failure to acquire the needed logistics or resources on time would only contribute to the escalation of the said outbreaks, hence compounding the problem and exposing more people to harm. 

Using the COVID-19 pandemic as an example, Prof. Pereko said, many countries, particularly African countries, were taken by surprise and had to wait on benevolent organisations and the developed world to provide them with free vaccines for their people.

“Even individually, when you do not have money and any of your child falls sick, it becomes dangerous because one cannot tell when external help will come. But if you have something on you, you can immediately act before you get external help,” he explained with an anecdote.

The Public Health expert also said nobody could predict when the next epidemic would break out, and that it was only prudent for the country to take a step ahead of any public health emergency. 

For Prof. Pereko, who is also the Country Coordinator for People’s Health Project Ghana, “the earlier the country set up its emergency or epidemic preparedness fund, the better for all of us,” charging CSOs to lead the campaign in getting the government’s attention to set up the fund.

He said the government could use taxation to feed the epidemic preparedness fund, pointing out that once the government makes the move and put structures in place to ensure transparency and accountability on how the fund would be used, benevolent individuals and corporate bodies would all contribute to its sustenance.

“If we talk to people very well, they will give. When COVID-19 came and government set up the Ghana Covid-19 Emergency Preparedness and Response Project, many individuals and corporate bodies willingly contributed to the fund because they knew what was at stake,” he observed. 

Threats of Viral Infections

Sharing his opinion, the President of the Ghana Association of Medical Laboratory Scientists (GAMLS), Dr. Abu Abudu Rahamani, said lessons from the COVID-19 pandemic together with emerging threats of other viral infectious diseases, called for a critical assessment of the country’s preparedness for any public health emergencies, particularly in the areas of diagnostics.

For him, when epidemic preparedness and response fund is set up, it would guarantee the availability and rapid deployment of medical materials and human resources to areas that needed services during times of disease outbreaks.

He expressed the concern that even though there are warnings that other possible epidemics could emerge anytime soon, many of the country’s district hospitals have  no microbiological testing capacity to conduct certain diagnostics test due to lack of infrastructure. 

In Dr. Rahamani’s view, it would be “disastrous” should the country fail to set up a dedicated fund for public health emergencies soon, adding that it would be wrong for the country to wait for an outbreak of a disease before marshaling efforts to contain it.

For him, even in the absence of epidemics, certain diseases in some parts of the country were seasonal which could be handled effectively when adequate preparation are made towards them.

Epidemic fund non-negotiable 

Madam. Eunice Joan Teah, the Central Regional Director in charge of Health Promotions at the Ghana Health Service (GHS), agrees with other experts who have called on the government to set up epidemic preparedness and response fund.

For her, “epidemic preparedness financing is something we cannot do without” as a nation. Her conviction is based on the fact that we live in a world where people’s lives are threatened on a daily basis by emerging and mutational diseases. 

“When epidemics occur; to respond to it needs logistics and that logistics cannot be mobilised within a short time if there is no allocated budget to work with. And if the logistics are not available, you and I know that the response will delay,” she explained.

For Ms. Teah, whether people would receive the needed care or logistical support during epidemics depended on how well a country had prepared itself for such unforeseen events. 

“Everybody’s life will be at stake should there be an outbreak of a disease without any preparation. This is because epidemics basically affect everything,” she noted, stressing that “…from where I stand as a health promotions specialist, I will say that all stakeholders need to have their hands on deck to ensure that we get a funding set aside towards public health emergencies.”

She said although it was the sole responsibility of the government to set up the epidemic preparedness and response fund and ensure it was used for that purpose, other actors, including the media, should play a key role in that regard.

Epidemic fund, a public health issue  

Adding to the conversation, the Executive Director of Ghana Non-Communicable Diseases Alliance (GhNCDA), Labram Musah, said any call on the government to set up epidemic preparedness fund “should be treated as a public health concern.”

“…for us civil society organisation and people working from the non-communicable diseases perspective, we think that it is a very good call for the government to set up epidemic preparedness fund. The government should look for revenue to ensure that we are able to reduce any eventualities that may come up during disease outbreaks,” he said.

For Musah, government could use proceeds from the Excise Duty tax to set up the epidemic preparedness fund, saying “A percentage of taxes on commodities such as tobacco, alcohol, and sugar beverages could be set aside to fund the epidemic preparedness fund.”

He believes that epidemic preparedness and response fund will play a major role in achieving universal health coverage (UHC) in Ghana. This is because the fund will ensure that all individuals and communities have access to the full spectrum of quality healthcare services without the risk of financial hardship.

Epidemic Fund and Universal Health Coverage (UHC)

For instance, the International Federation of Pharmaceutical Manufacturers & Association (IFPMA) and Speak Up Africa are working together to create an enabling environment to help countries in Africa to be able to achieve UHC. 

It for this reason they [IFPMA and Speak Up Africa] on May 22, 2023, launched the second edition of their flagship programme, the African Young Innovators for Health Award to find and nurture youth-driven health innovations that strive to accelerate efforts to advance UHC in Africa. 

The reason is that even though most African countries have UHC as a goal in their national health strategies, progress has been slow. 

Countries that will achieve their UHC targets by 2030 will eliminate preventable maternal and child deaths, strengthen resilience to public health emergencies, reduce financial hardship linked to illness, and fortify the foundations for long-term economic growth. 

The Africa Engagement Committee Chair of IFPMA, Dr. Karim Bendhaou during the launch of the awards said “Despite African countries across the continent strongly demonstrating their commitment to achieving UHC by 2030, progress toward reaching this goal has stalled, with the Covid-19 pandemic reversing many hard-earned gains.” 

In addition, he noted, “The Africa Young Innovators for Health Award provides an invaluable opportunity to leverage the ingenuity of Africa's growing youth population to find locally adapted solutions that help our communities have greater access to affordable and quality healthcare products and services.”  

The Director and Founder of Speak Up Africa, Yacine Djibo, also said “This programme provides young African health innovators the chance to learn from business, media, and legal experts to further develop their healthcare innovations, join a growing community of healthcare entrepreneurs, and strengthen the health ecosystem on the continent so that Africa’s biggest health challenges can be tackled.”

The African Young Innovators for Health Award offers four winners financial support totaling US$90, 000 to take their innovation to the next level, alongside a three-month business mentorship programme with leading business figures and strategic guidance on intellectual property rights from one of Africa’s top law firms.  

Action now! 

A stich in time, they say, saves nine. We cannot continue to be like the proverbial vulture that only sees the essence of making a home when it rains or about to rain and soon after the rains, forgets everything altogether until another rains come in and make him wet again. 

When epidemic preparedness and response systems are strengthened, disease outbreaks will be detected early for relevant institutions to respond on time to prevent devastating impacts on communities and the country. 

This article was produced with the support of Speak Up Africa's Media fellowship programme