Public health emergency fund needed to achieve ‘One Health’

At least, 1,469 individuals have died in multiple disease out­breaks that have plagued Ghana in the last two years. The diseases; COVID-19, Marburg virus disease (MVD), Monkeypox (Mpox) a nd Lassa fever (LF) have something in common. They are all zoonotic.

While scientists trace the sources of transmission of MVD and the SARS-COV-2 viruses responsible for the COVID-19 pandemic to species of bats, Mpox and Lassa fever viruses are said to be linked to rodents.

The World Health Organisation (WHO) defines zoonotic diseas­es as infectious diseases shared between animals and humans and that the most common infectious diseases across the globe are traced to the zoonotic origin.

It is estimated that 60% of known infectious diseases and up to 75% of new or emerging in­fectious diseases are zoonotic and about 2.5 billion cases of illness and 2.7 million deaths recorded annually attributed to zoonoses.

While COVID-19 had claimed 1,462 lives in the country as of March 10, 2023, four persons had died from Mpox out of the total 116 cases recorded in the last year, and two people lost their lives to MVD.

This year, Ghana has already recorded one casualty from Lassa fever, a 40-year-old trader who plied her trade at the Agbogbloshie market in the Greater Accra Region.

At least 13 others are said to be under monitoring and treatment at various health facilities and a total of 59 contacts so far traced to the confirmed cases.

According to health experts, fa­tality rate of these highly-infectious diseases could be as high as 90 per cent depending on early detection, diagnosis, and treatment mecha­nisms available.

Prior to COVID-19, about 100 billion dollars had been lost to zoo­notic diseases globally with ‘poorer’ countries being worst affected, according to a 2020 United Na­tions Environmental Programme (UNEP) report.

Emerging zoonotic diseases, according to the WHO, have potentially more serious health and economic impacts than ‘conven­tional’ ones and this is evident in outbreaks like Ebola in 2014 and the COVID-19 pandemic, which has had ravaging effects on world economies.

Although no nation anywhere in the world is ever fully prepared to handle such health emergencies, commitment to actions that address or mitigate health security risks determine the extent of impact of outbreaks on a population.

According to the 2019 Glob­al Health Security (GHS) Index, which assesses a country’s ability to prevent, detect and respond to health emergencies, the US is the “most prepared” nation (scoring 83.5 out of a 100 percent score) to respond to health emergencies.

It is followed by the UK (77.9), the Netherlands (75.6), Australia (75.5) and Canada (75.3). Much of Europe, Russia, the Middle East, Asia, Central and South America are described as “more prepared” scoring between 66 and 34.3, while majority of countries ranked “least prepared” to deal with pandemics are in Africa.

Of the 195 member countries of the WHO which were assessed, Gha­na placed 105th, scoring 35.5 points, way below the average global score of 40.2 points, an indication that the country’s health system is functioning well below standards and that gaps exist in guaranteeing health security.

Ghana is vulnerable to the effect of zoonotic diseases as approximate­ly 46% of the population is engaged in agriculture.

This means that there is a high interconnection between the human, animal, and environmental ecosystem which increases the risk of zoonotic disease transmission.

It is for this reason that the country, in 2016, adopted the “One Health” concept to promote a holis­tic approach to responding to possible public health threats such as high-impact infectious diseases emerging at the inter­face between humans, animals and the environment.

“One Health” embraces a collaborative, multi-sectoral, and trans-disciplinary approach (working at the local, region­al, national, and global level) to achieving optimal health outcomes, recognising the in­terconnection between people, animals, plants and their shared environment.

However, seven years down the line, little has been done to fully operationalise the concept as the country continues to grapple with emerging zoonot­ic infectious diseases.

A study on the state of Ghana’s public health emergen­cy preparedness and response capacity by Franklin Asie­du-Berkoe et al (November, 2022), identified inadequate funding as a major gap in insti­tutionalising the model.

“There is an over-depen­dence by Ghana on external donor funding for running the public health system. The Central Government provides funding during outbreaks but donor partners are the main sources of financial support before, during and after public health emergencies.

They have been unfailing in their support so far, but there are concerns of sustainability should these donor partners reduce or withdraw their sup­port in the future,” the research established.

Ghana’s Medium Term Develop­ment Framework

(2022-2025) makes provision for the establishment of a Public Health Emergency Fund (PHEF) in readiness for health emergencies and increase the country’s preparedness ratings regarding emerging threats but with barely two years to the elapse of the document, that prom­ise is yet to see light of day.

To address the funding gap, the government now has the option of expanding the existing COVID-19 Health Recovery Levy, 2021 (Act 1068), which imposes a one-percent levy on the supply of goods, services and imports, to a dedicated fund for emergency preparedness and response.

In an interview, the Risk Commu­nication Officer of the Veterinary Services Directorate, Dr Benjamin Sasu, said the absence of a dedicated fund for public health was a major impediment to building a resilient healthcare system for the country.

He said active surveillance, mon­itoring and availability of resources and logistics were central to detecting early signals of viruses migrating from animals to humans for early control interventions but as things stand now, financial constraints high­ly militate against that.

“The animal ecosystem plays an integral role in public health and can­not be put on the back burner. We are invading the animal ecosystem with rapid urbanisation, our waste management is poor, and generally, we have poor attitudes relating to animals.

We are highly at risk of picking up viruses, bacteria and other agents from animals either through consumption or how we relate to them and the danger is that while an animal having a virus may live longer, it is often lethal when it transmits it to humans,” and that, he explained, could be the reason many zoonotic diseases had high fatality rate in humans.

Dr Sasu said it was long overdue for a Public Health Emergency Fund (PHEF) to ensure increased and sustained investment across all levels for “one health” in the shortest time possible and promote better response to epidemics in the country.

Health experts caution that the trend of emerging zoonotic diseas­es remains unpredictable and a ma­jor threat to global health security owing to their epidemic potential, high case fatality ratio and the absence of specific treatment and vaccines to control the spread of most of these diseases.

The next wave of an epidemic or pandemic may be upon us and while animals provide many bene­fits to people, they could represent a major public health problem.

Lessons from COVID-19, Ebo­la, and other such diseases should serve as notice that emerging zoo­notic infectious diseases are here to stay and so there is the need for coordination in human, animal and plant health to be reinforced to promote “one health.”

Ghana stands the risk of being overwhelmed by a future epi­demic, if the government fails to take immediate steps to establish a dedicated budget for prepared­ness and response to public health emergencies.

BY ABIGAIL ANNOH