Exclusive: WHO makes push to limit Africa CDC’s power

Around 40 African health ministers gathered virtually Tuesday to discuss amendments to the statute of the Africa Centres for Disease Control and Prevention that would give it more autonomy.

During these closed discussions, about a dozen ministers called for that independence to be reined in — echoing points made in a document from the World Health Organization’s Regional Office for Africa. Devex obtained a copy of the document.

Sources familiar with the discussions referred to this briefing of ministers as the United Nations “lobbying” on what should be an African Union process, and if successful, it would block reform of Africa CDC and undermine its ability to respond to health crises and prevent pandemics.

A WHO spokesperson told Devex that while it is “not against” granting Africa CDC expanded powers, including the ability to declare and coordinate health emergencies, the suggested changes would constitute an “unprecedented arrangement” that requires “more discussion, further analysis and a full consideration of its implications.”

Africa CDC, which was launched in 2017, rose to prominence for its leadership during the COVID-19 pandemic. In a historic move in February, heads of state endorsed efforts to elevate it from a specialized technical institution to a public health agency with much more autonomy. The move would allow it to mobilize and respond rapidly to crises, removing bureaucratic overhead that results in delays and restraints on what it can do. But actualizing these changes is a multistep, ongoing process within the AU.

Reining in Africa CDC’s independence

Though WHO was not present at Tuesday’s gathering, WHO country offices briefed health ministers on their position in the lead-up to the meeting.

As its first point, WHO objected to granting Africa CDC the authority to declare regional health emergencies for the African continent. WHO wrote that it is in the “interests of Member States and all African countries that more discussion takes place before any final decision is made in respect of Africa CDC’s authority to declare ‘Public Health Emergency of Continental Security.’”

WHO wrote this decision would have “legal implications” and requires further analysis on how it would relate to the existing International Health Regulations and the mandated role of WHO.

Under the IHR, WHO Director-General Tedros Adhanom Ghebreyesus can declare a “public health emergency of international concern.” For example, he declared COVID-19 a PHEIC in January 2020, and next week he is convening an emergency committee to determine if the spread of monkeypox reaches that same threshold.

Having the Africa CDC also declare health emergencies could cause confusion among countries, WHO wrote in its briefing, and could lead to “duplicated roles.” WHO wrote that member states “do not broadly favor” regional declarations of emergencies and that these additional declarations could have a “significant associated risk” for international travel and trade.

The document also called for two of WHO’s regional offices to have representation on Africa CDC’s governing board — preferably one seat for its Regional Office for Africa and another for its Regional Office for the Eastern Mediterranean, even as observers. It highlighted the necessity of these seats to “strengthen coordination” between WHO and Africa CDC.

But placing WHO on the board wouldn’t be a reciprocal arrangement. Africa CDC is not a member of WHO’s board, nor are entities such as the European Union, but the AU attends its general meeting as an observer. Both the AU and Africa CDC are able to take the floor to speak about key decisions, according to a WHO spokesperson.

The briefing document also aimed to curb Africa CDC’s role in coordinating health emergencies.

“Such global coordination of health emergencies preparedness and response is currently conducted by WHO, under the IHR and in accordance with the WHO’s Constitution, and any potential for duplication of roles needs to be addressed,” the document said.

‘Willful disruption’

Africa CDC has worked to restructure the health architecture on the continent into what it has characterized as a “new public health order,” which calls for a strong role played by regional public health authorities in guiding priorities and “respectful” partnerships, among other ambitions.

A source familiar with the ministerial discussions said if ministers strip Africa CDC of the ability to declare emergencies and coordinate responses, they will have curbed its ability to mobilize resources and respond to health crises. The newly minted independence “means nothing” without these abilities. The source said that there are no international legal restrictions on Africa CDC declaring emergencies and that the continent would be better equipped than WHO to quickly report its own emergencies.

“This is killing an organization, without killing it. If not able to coordinate, then what is Africa CDC doing?” the source asked. “It's very sneaky and extremely disruptive to the health security agenda on the continent.”

WHO’s primary intervention for African nations during the pandemic was the delivery of vaccines through the international cooperative program COVAX, but those deliveries were marred by long delays, which left countries scrambling as COVID-19 cases overwhelmed hospitals. In this period, the African Union and Africa CDC stepped in to secure doses independently, which included the first deal for an African company — Aspen Pharmacare — to manufacture COVID-19 vaccines.

The source called this week’s briefing from WHO “hostile” and a “willful disruption” of an African Union process by the U.N., as well as an overstep of WHO’s mandate.

A second source familiar with the matter said the points in the briefing are "somewhat disingenuous" because during the World Health Assembly in May, WHO accelerated a U.S.-led reform process of the International Health Regulations, "which is the very same foundation that they argue must not be undermined” in the briefing to African health ministers. WHO is willing to reform its own organization’s structures but not those of Africa CDC, the person said.

The U.N. agency is making one point "at home in Geneva and contradictory points in Addis," the second source said, referring to WHO’s headquarters in Switzerland and the African Union’s headquarters in Addis Ababa, Ethiopia.

What is outlined in the briefing could also stifle the continent's ability to prepare for pandemics, the second source added. "The entire ideas and underlying assumptions of the reform is the ability to react, respond, and be prepared, which is now being undermined for the sake of technicalities, which is now the IHR considerations," the person said.

The ministers did not endorse the amendments this week but will reconvene next Tuesday. Following an endorsement, the health ministers will send the amendments to justice ministers. The final decisions on the statute are then placed before the AU executive council, which will act on behalf of the AU Assembly.

An ‘unprecedented arrangement’ needing further analysis

In an email to Devex, a WHO spokesperson wrote that a senior official in one of its country offices developed the brief to support his country’s health authorities but the note was not widely circulated.

“However, all WHO country offices are aware of our position on this and many had briefed their Member State counterparts,” she wrote.

The spokesperson said WHO is “very pleased” that Africa CDC was created and has supported the organization with funding and technical support, working in close collaboration on a variety of issues.

She noted that the AU invited WHO to be a member of a steering committee looking at the status of Africa CDC and “as such has solicited our opinion on the matter.” But the spokesperson added that the WHO representative who was part of that committee did not have the opportunity to contribute.

“WHO was called in late in the process and so we couldn’t contribute initially and then when we heard about the urgent meeting we then took the opportunity to share our opinion,” she said.

She said WHO was also approached by member states to comment on the amendments and assisting member states with technical advice is part of its mandate.

The spokesperson said that while WHO “fully supports” most of the amendments, some are too closely linked to the role of the U.N. agency.

She added that a “significant number” of countries agree that more discussion should take place before Africa CDC is able to declare emergencies, which would be an “unprecedented arrangement” that needs further analysis.

“We are not against this authority being given to Africa CDC but believe such an important change needs more discussion, further analysis and a full consideration of its implications. We note that no other region in the world is currently considering this approach, given increasing recognition of the interconnectivity among all regions,” she wrote, adding that WHO hopes “this misunderstanding can be resolved through fruitful discussions.”

Update, June 16, 2022: This article has been updated to reflect that the briefing of ministers was verbal in addition to written.