3 global health leaders outline their health security visions

CANBERRA — Olubunmi Eyitayo Ojo has been instrumental in establishing the Nigeria Centre for Disease Control. Now deputy director of disease surveillance and epidemiology at

NCDC, Ojo is looking ahead to further improve the West African country's capacity to respond to health threats.

Within Africa and the Pacific, leaders are emerging to encourage greater action on the issue of health security within their regions. At the 2019 Global Health Security conference in Sydney, Australia, last month, the message was clear that the world needs to do more to prepare for global epidemics and pandemics.

Devex caught up with Ojo and several other global health leaders about how they are working to improve engagement and build global health security capacity and support within their countries.

Communication is one critical piece of preparing her country and working with 36 subnational jurisdictions, Ojo told Devex.

“On our website, we have a lot of information and use social media for sharing insights — Twitter, WhatsApp, and more,” she explained. “We also have a dedicated toll-free line where people can share information. We engage the press regularly to provide information and help people in Nigeria to become familiar with the [N]CDC. And we don’t hide information — transparency and trust are important.”

In providing accessible health security information to communities, NCDC produces material in local languages and uses pictorials to ensure it is getting the message to all communities.

Showing that they have the capacity to prepare and respond to an epidemic event within their own borders is also important — both for its citizens and external health organizations, Ojo noted.

“In Nigeria, we’re on top of things,” Ojo said. “We have a plan in place and if overseas partners want to come in, they support our plans. It is important for everyone in our country to know we are in control.”

Better utilizing resources

Working with funding and resources limitations is a key challenge in global health security — both in lower- and high-income countries. In the Cook Islands, Secretary for the Ministry of Health Dr. Josephine Herman is trying to better utilize resources and networks to improve capacity and response.

Herman returned to the Cook Islands — where she formerly worked as director of public health — after 10 years away to take up the role in June 2018. She expected more progress than what she was met with, she told Devex, highlighting the need for smarter use of resources to support the development of health security in her country — including better use of diaspora networks connected via web conferencing to share their medical knowledge.

“We’ve got systems in place and now it’s about fine-tuning them and making us more agile, mobile, and quicker in response,” she said. “It’s not easy, but better use of technology at hand is important in building something important — our capacity to respond.”

Utilizing partnerships will also be crucial, she said. As part of the upcoming 13th Pacific Health Ministers Meeting to be hosted by French Polynesia in August, Herman will be looking to engage partners such as Australia, New Zealand, and France on issues of health security.

“This will not be a talkfest,” Herman said. “It is a decision-making forum, and health security is on the agenda. We have the basic requirements to do some infection control, but I don’t think it is currently robust enough to give me the confidence to say today we would be ready for an Ebola-like outbreak. But that is what we always have in the back of our minds. We need to ensure we are working together, and our ministers are confident with the direction from the meeting.”

Global health, public health, and health security — the distinctions

While budgets can be a sticking point, they can’t be ignored either. For Ojo, it is important to engage various areas of the government — including inviting the ministry of finance, policymakers, and other members of the government to the table.

“It is important to advocate to ensure everyone knows what we are doing and why,” she said.

But being clear on what exactly is being requested is also important. This is something Dr. John Nkengasong, director of the Africa Centers for Disease Control and Prevention, says the health security sector has yet to properly define.

“I still am struggling with a basic definition of what we are talking about — and that is important,” he told Devex. “If we are going to mobilize resources, we are mobilizing resources from people who are meant to be stakeholders but are not part of our daily conversation. The clarity with which we present this to other stakeholders is important. Otherwise, we continue to talk among ourselves.”

The fine distinction between global health, public health, and health security, he said, has to be developed and defined in short, succinct, and crystalized ways.

“If we define global health security in terms of the impact of diseases or a disease outbreak on mobility or mortality, that is one way of defining health security. In that case, you have to say HIV/AIDS is the greatest health security threat for all of Africa. If instead, we say we’re looking at a disease that has the possibility of impacting mobility and mortality as well as destabilize and disrupt social services globally, we can distinguish from HIV.”

But this “tight” definition has yet to be cemented, something Nkengasong said needs to happen in order to see progress.

A clearer definition will also shed more light on what money will buy. According to Nkengasong, this is more important than a joint external evaluation, a voluntary process to assess country capacities to prevent, detect, and respond to public health risks, which he said acts like a “laundry list” of health security needs and can do more harm in asking for support.

Being clearer on the definition of health security, Nkengasong said, will enable money to be directed to establish a system that can quickly respond to threats before creating harm to health, social, and economic systems.

Knowns and unknowns

Leaders consider capacity building a critical element for the development of sustainable systems in Nigeria and the Cook Islands.

“When staff are well trained, there is a risk they may move on,” Ojo said, explaining this was part of business as usual for any organization, including the health sector. “And that is why capacity building should always be part of the strategy. Training on the job and other opportunities for growth needs to be built into the system. And this helps make the system sustainable.”

Herman, meanwhile, is already planning her own succession: “I am very clear in thinking about who is going to step up into this role following myself so we don’t miss a step in terms of where we are planning to take the Cook Islands.”

With regards to building capacity to respond to health threats, thinking about what is known rather than unknown is where preparedness should lie.

“If I invest in appropriate human capacity to deal with diseases on a daily basis, we can take care of the knowns,” Nkengasong said. “But this also means people are trained to know something is unknown. And that is important for preparedness. In the end, money is helpful to fight outcomes, but it is not the most important — building human capacity is.”