In its newly launched Investment Case for Vaccine-Preventable Disease Surveillance in the African Region, 2020-2030, the World Health Organization (WHO) Regional Office for Africa’s highlights the drastic consequences that could be in store for the region, if countries do not invest in disease surveillance efforts – including a US$22.4 billion economic burden over the next decade.

The announcement was made at the high-level “Reaching the Last Mile Forum” in Abu Dhabi on 19 November, by Dr. Matshidiso Moeti, WHO Regional Director for Africa, to an audience of over 300 health leaders from across the globe.

Vaccine-preventable disease (VPD) surveillance is a critical component of the integrated disease control strategies and an effective way to detect and respond early to outbreaks – mitigating their impact on national security, the local economy and public health systems. Yet countries in the African Region still face major challenges in both the strategic planning and operation of their surveillance systems.

The WHO Investment Case makes the argument for increased domestic investment in VPD surveillance, under the overall umbrella of integrated disease surveillance and response, from countries in the African Region. As resources for VPD surveillance have declined markedly over the past two years – and domestic surveillance expenditure in the African Region remains low – funding for disease surveillance is urgently needed, now more than ever. 

During the launch announcement, Dr. Moeti called on governments to invest in strong disease surveillance systems that will ensure early detection and response to risks and outbreaks. “Strong surveillance is the backbone of a functioning health information system, empowering health workers with timely, quality evidence to inform decision-making. To curb the spread of life-threatening diseases, governments must invest in strong and functioning surveillance systems,” she stated.

With the African Region on the brink of polio eradication, VPD surveillance remains an issue yet to be prioritized by many health leaders. The Investment Case indicates that if current disease surveillance efforts are not maintained, there is a risk to reverse progress made, leading to more than 900,000 deaths.

“The fact that most countries in the African Region continue to rely on external funding for VPD surveillance is a strong indicator of the work that remains to be done,” said Dr. Richard Mihigo, Programme Manager for Immunization and Vaccine Development at the WHO Regional Office for Africa. “Governments have a central role to play to fill upcoming funding gaps and ensure immunization programmes and surveillance remain strong and vigilant.”

The Investment Case outlines WHO’s ambition for progress by 2030, including the need for increased domestic investment for surveillance activities as well as mobilization of international resources, in order to ensure strong disease surveillance. At least $470 million in operating costs will be needed over the next decade to reach this ambition. WHO predicts that the investment would save over 700,000 lives, prevent 20 million people from falling ill due to vaccine-preventable diseases, and save US$21 billion over 10 years – estimated to be a 44.6-fold return on investment.  

“Despite extraordinary progress boosting vaccine coverage around the world in the past two decades, one and a half million people are still dying from vaccine-preventable diseases every year,” said Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance. “Our biggest challenge in reducing the horrific toll these diseases still cause is finding the children who are still missing out on vaccines. That’s why improved vaccine-preventable disease surveillance systems are so important, helping health authorities to identify the areas where immunization coverage is weakest and protect those children who are currently being left behind.”

A private sector firm has already pledged $5 million over the next five years, beginning in 2020, to support and strengthen VPD surveillance efforts in the African Region. “We hope that this first pledge in support of the VPD surveillance investment case will be catalytic and will encourage other traditional and non-traditional donors to consider this critical area of work, including how the private sector and governments can work closely together to ensure we successfully bridge funding gaps,” said Elizabeth Ivanovich, Director of Global Health at the UN Foundation.

Dr Rebecca Martin, Director of the Center for Global Health at the US Center for Disease Control and Prevention, (CDC) issued a statement of support, adding: "CDC is strongly committed to global health security, helping to strengthen health systems that can prevent avoidable epidemics, detect threats early, and respond rapidly to outbreaks."

At the African Union Summit held in Addis Ababa in January 2017, African Heads of State endorsed the Addis Declaration on Immunization (ADI), pledging to ensure that everyone in Africa – regardless of who they are or where they live – receives the full benefits of immunization, and committing to increase political and financial investments in their immunization programmes. Commitment 5 of the ADI outlines the need for “attaining and maintaining high quality surveillance for targeted vaccine-preventable diseases.” Although Member States have endorsed these commitments and pledged to deliver on universal immunization coverage and high-quality surveillance, challenges remain in achieving immunization and surveillance targets.

“VPD surveillance is not only a valuable investment that will help countries reach immunization targets,” said Dr. Moeti, “it is a critical component of broader goals such as Universal Health Coverage and the Sustainable Development Goals and is absolutely essential to protecting all of our health security.”