Africa CDC publishes its first list of priority pathogens

The Africa Centres for Disease Control and Prevention released its first ranking of epidemic-prone diseases of highest concern to the continent. The ranking, published on Sunday, is aimed at helping Africa CDC and the health sector across the continent determine where to allocate resources aimed at preparedness, such as pre-positioning of health countermeasures, as well as setting the research agenda for the development of vaccines and drugs. The pan-African public health agency ranked each pathogen by risk trajectory, epidemic potential, disease severity, and how well the continent is prepared for an outbreak. When examining the mean score, experts found Ebola, cholera, and COVID-19 had the highest risk trajectory and epidemic potential. The lowest ranking in this category were plague, rabies, and anthrax. Ebola, COVID-19, Crimean-Congo hemorrhagic fever, Marburg, and an “unknown disease” ranked highest in mean score in disease severity, whereas chikungunya, poliovirus, mpox, and dengue fever ranked lowest. Measles, COVID-19, and Ebola ranked highest for preparedness and available medical countermeasures, whereas the continent is least prepared for outbreaks of an unknown disease, plague, and Crimean-Congo hemorrhagic fever. To develop the list, Africa CDC worked with the European Centre for Disease Prevention and Control, or ECDC. They formed a planning team, which met weekly between November 2021 and May 2022. A consultative group was formed with different divisions of Africa CDC, as well as the U.K. Health Security Agency, U.S. Centers for Disease Control and Prevention, and ECDC. The teams examined the top most frequently reported types of outbreaks between 2020 and 2021 — and narrowed their list down to the 18 most frequently reported outbreaks. The examined factors included the probability the pathogen would circulate among African populations in the next 5 years; the probability that the risk of this disease would increases in the next 5 years; transmissibility; how many regions of the continent have high numbers of people susceptible to the pathogen; and the probability of a cross-border outbreak. While this was a continental assessment, regional assessments might provide different results, the agency wrote. It also noted that the survey of experts was small — they reached out to 49 experts but only 14 responded to their online questionnaire, and some of the pathogens had wide variations in responses. The agency acknowledged it may need to move toward a larger sample size to give the ranking “more power.” It plans to undertake this ranking every one to two years. The agency noted caution should be applied when interpreting final results due to some of these shortcomings. Some organizations have been waiting for this ranking to ensure their activities align with Africa CDC’s priorities. For example, researchers from Panther, an initiative launched in December to hasten the pace at which clinical trials are rolled out on the continent, told Devex they have been waiting for this priority list of pathogens to determine the directions their own teams take.