Author: Jens Herpolsheimer
Type of publication: Article
Academic literature on the topic of West African regional responses to epidemics or pandemics, as well as regional health cooperation more generally, is rather limited. So far, only very few publications have touched upon the subject. The few exceptions in this regard include the publications discussed in the following. Adopting an institutional-legal perspective, Onzivu considers four “regional integration schemes” – the African Union, ECOWAS, the Association of South East Asian Nations (ASEAN), and the Caribbean Community (CARICOM) – to analyze the emergence and development of regional health policies out of regional economic cooperation efforts. With regard to ECOWAS, Onzivu, provides a short overview of the founding protocol of ECOWAS’ West African Health Organization (WAHO), from 1987, and a short analysis of regional capacities. Anaemene analyzes the links between regional integration, security, development and health diplomacy. Focusing on WAHO, Anaemene provides a very brief overview and analysis of the organization’s setup, before reflecting upon its achievements and challenges. Two additional publications were triggered by the experience of West African responses to the Ebola epidemic in the region. In an academic commentary, Bappah argues that ECOWAS played a leading and proactive role in response to the Ebola outbreak in 2014/15, but initially depended too much on member state institutions, which mostly lacked capacities for effective responses. Later, the process of regionalizing the response, most notably through the agency of WAHO, was to slow. Ifediora and Aning provide short overviews of the regional and international responses to the Ebola outbreak in West Africa, focusing in particular on the WHO, the African Union, and ECOWAS. The authors assess their respective takes on the emergency, reflecting a general lack of adequate resources and preparedness at all levels, and different degrees of ‘securitization’ of the crisis.
ECOWAS/WAHO responses to the Covid-19 pandemic
In response to the Covid-19 outbreak in China, WAHO started to prepare for potential consequences in West Africa already in January 2020. Since 13 January, it prepared and distributed a weekly Epidemiological Bulletin, including information on the Covid-19 outbreak, to regional health ministries, directors of national public health institutes (NPHIs), and partners. In addition, WAHO staff initiated weekly online meetings with NPHI directors and directors of national laboratory services to discuss situation updates, challenges, as well as country needs. They also put the so-called Regional Rapid Response Team on standby to allow in case of need for active communication and “real-time collaboration”. On 27 January, WAHO issued its first public statement on the “Outbreak of Novel Coronavirus in China”, to “inform the general public of ongoing measures to protect the region and what people should do to protect themselves”. The statement referred to the WHO risk assessment of the WHO for regions outside China as “moderate”, including West Africa, and highlighted first WAHO efforts, aiming at regional coordination towards the timely sharing of information, strengthen surveillance capacities in members states, and networking among laboratories to allow all West African states access to testing.
At the time, only one suspected case (fever detected at Abidjan airport, promptly isolated, and later tested negatively) existed in the ECOWAS region. Throughout February 2020, WAHO issued several public statements (1 February, 13 February, and 28 February), the WAHO Director General, Stanley Okolo, held a joint press briefing (17 February) with the Nigerian State Minister for Health, Olurunnimbe Mamora, and convened an emergency meeting of the Assembly of ECOWAS Health Ministers (14 February). Already on 1 February, WAHO had reported that the WHO had declared the Covid19 outbreak a “public health emergency of international concern” updating the WHO risk assessment outside China to “high” (being “very high” in China).
WAHO staff continued to work with member states towards strengthening airport surveillance, especially with regard to direct flights from and to China. Moreover, together with the Africa CDC, it began to support the increase of “regional reference laboratories” dedicated to testing for Covid-19 from two to five (WAHO 2020b). On 14 February, WAHO convened a “high-level regional coordination meeting” in Bamako, for the Assembly of ECOWAS Health Ministers to urgently discuss, coordinate and harmonize regional preparations and responses, especially “in terms of surveillance, case management, infection prevention and control, laboratory and risk communication”. Based on joint assessments of needs and challenges, WAHO staff was tasked to work towards developing common regional guidelines, and develop a strategic costed regional preparedness plan (based on member states’ priorities) for governments, partners, and the private sector to support.
In an effort to popularize the results of the ministerial emergency meeting, Okolo and Mamora held a joint press briefing on 17 February 2020, calling for collective action in West Africa. Referring to the first confirmed case in Africa, reported on 14 February in Egypt, Okolo argued to draw on lessons learned during the Ebola outbreak in 2014/15. He stated that testing capacities now were available in Nigeria, Ghana, Côte d’Ivoire, Sierra Leone, and Senegal. With the confirmed arrival of the virus in Africa, and subsequently in West Africa on 28 February, with a first confirmed case reported from Nigeria, WAHO dropped the reference “in China” from subsequent statements. Also in February, WAHO staff organized diagnosis training of laboratory personnel from Gambia, Ghana, Côte d’Ivoire and Nigeria in collaboration with the Pasteur Institute in Dakar, providing the participants with 100 test kits each, only Nigeria receiving 200.
Moreover, throughout February 2020, WAHO staff also engaged in several (previously scheduled) activities more or less explicitly involving Covid-19 (among other diseases). For example, it organized a twelve weeks field epidemiology training, starting in Gambia on 11 February. Between 12 and 14 February they held a workshop in Liberia, supporting the establishment of medical emergency teams, though this one was not specifically on the Coronavirus. During March 2020, WAHO staff sought to further strengthen individual capacities in member states to prepare and respond to the pandemic. It organized a simulation exercise in Abuja on 5 March, and rehearsed and practiced the deployment of the ECOWAS Regional Rapid Response Teams. It increased the procurement of critical supplies, such as diagnosis kits, specimen transportation kits, and personal protective equipment (PPEs). The ECOWAS Commission provided additional funds for an “emergency basis” of 50.000 test kits and equipment for member states. On 16 March, a technical working group of reference laboratories, on response to Coronavirus outbreak, met with the Africa Task Force for Novel Coronavirus (AFCOR), an effort of actors at the Africa CDC to coordinate support for laboratory testing and supply chains in member states.
ECOWAS / WAHO and continental coordination and ordering efforts
The accounts provided so far – of the emergence and functioning of WAHO and the ECOWASRCSDC, as well as the concrete efforts employed by ECOWAS actors in response to the Covid-19 pandemic – allow for several interesting observations regarding regional and interregional coordination, pointing to more general dynamics around efforts and ambitions to organize space, and potentially construct spatial order in Africa. First, agency in response to the crisis on behalf of ECOWAS has been most visible in the personality of the WAHO Director-General (DG), Stanley Okolo, and his staff, as well as to a lesser extent the ECOWAS Commission President, Jean-Claude Kassai Brou. At least publicly, these two figures have become the faces of regional responses to the Covid-19 pandemic, delivering public messages, answering at press conferences and in tv and newspaper interviews. In this, although in principal an ECOWAS institution, it appears that WAHO actors (specifically its DG and the Assembly of ECOWAS Health Ministers) have developed significant initiative and autonomy in their approach towards the Covid-19 pandemic. Actors at the ECOWAS Commission appear to have mainly sought to closely associate themselves with actions taken by WAHO.
Second, the ECOWAS-RCSDC, established specifically for the purpose of responding to situations like the current Covid-19 outbreak in West Africa, is nowhere mentioned in the available material documenting the ECOWAS responses. If active at all in response to Covid19, its actions have been completely subsumed under the WAHO efforts, more generally. Incipient research suggests that rather than becoming a more autonomous Specialized Agency of ECOWAS, the Center has become absorbed into the WAHO organization structure. Lack of visibility and leadership of the RCSDC may be explained by the position of Executive Director remaining vacant, which can be explained partly by a slow recruiting process at the ECOWAS Commission. However, it may also be explained by a lack of interest by the WAHO DG to see a stronger and more autonomous disease control center emerging, even if ultimately remaining under the formal authority of the WAHO DG. Another explanation would relate to efforts aiming to avoid institutional proliferation, which have also been at the heart of the creation of WAHO about 33 years ago. Further research into this direction might reveal interesting insights into dynamics among different West African regional actors.
Third, and closely related, the unclear state of operationalization of the ECOWAS-RCSDC also raises questions with regard to the inter-regional coordination and cooperation of West African regional health actors and the Africa CDC. As explained above, the RCSDC emerged in direct relation to the African Union’s initiative to establish regional branches of the Africa CDC. Therefore, another (admittedly speculative) possibility is that West African actors (in health or otherwise) are not too interested in empowering an institution somehow subordinate to its African Union counterpart, even less so with a similar agency (i.e. WAHO) already existing for a much longer time. In any case, with the RCSDC apparently out of the picture, the question emerges about the actual extent of coordination and cooperation between the Africa CDC and ECOWAS/WAHO. In the available material only very few references exist hinting at much interaction in that regard. Conversely, documentation on the website of the Africa CDC refers to cooperation with ECOWAS and WAHO only in three cases, two prior to the Covid-19 outbreak (in May and June 2019, respectively), and one with regard to the simulation exercise referred to above. At their extraordinary summit on 23 April 2020, ECOWAS heads of state called for the strengthening of cooperation between the Africa CDC and WAHO.
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