Large-scale protracted outbreaks can be prevented through early detection, notification, and rapid control. We assessed trends in timeliness of detecting and responding to outbreaks in the African Region reported to the World Health Organization during 2017–2019. We computed the median time to each outbreak milestone and assessed the rates of change over time using univariable and multivariable Cox proportional hazard regression analyses. We selected 296 outbreaks from 348 public reported health events and evaluated 184 for time to detection, 232 for time to notification, and 201 for time to end. Time to detection and end decreased over time, whereas time to notification increased. Multiple factors can account for these findings, including scaling up support to member states after the World Health Organization established its Health Emergencies Programme and support given to countries from donors and partners to strengthen their core capacities for meeting International Health Regulations.

Experience gained from responding to major outbreaks may have influenced the early COVID-19 pandemic response in several countries across Africa. We retrospectively assessed whether Guinea, Liberia, and Sierra Leone, the three West African countries at the epicentre of the 2014-2016 Ebola virus disease outbreak, leveraged the lessons learned in responding to COVID-19 following the World Health Organization's declaration of a public health emergency of international concern (PHEIC). We found relatively lower incidence rates across the three countries compared to many parts of the globe. Time to case reporting and laboratory confirmation also varied, with Guinea and Liberia reporting significant delays compared to Sierra Leone. Most of the selected readiness measures were instituted before confirmation of the first case and response measures were initiated rapidly after the outbreak confirmation. We conclude that the rapid readiness and response measures instituted by the three countries can be attributed to their lessons learned from the devastating Ebola outbreak, although persistent health systems weaknesses and the unique nature of COVID-19 continue to challenge control efforts.

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This study describes risk factors associated with mortality among COVID-19 cases reported in the WHO African region between 21 March and 31 October 2020.Average hazard ratios of death were calculated using weighted Cox regression as well as median time to death for key risk factors. We included 46870 confirmed cases reported by eight Member States in the region. The overall incidence was 20.06 per 100000, with a total of 803 deaths and a total observation time of 3959874 person-days. Male sex (aHR 1.54 [95% CI 1.31, 1.81]; p<0.001), older age (aHR 1.08 [95% CI 1.07, 1.08]; p<0.001), persons who lived in a capital city (aHR 1.42 [95% CI 1.22, 1.65; p<0.001) and those with one or more comorbidity (aHR 36.37 [95% CI 20.26, 65.27]; p<0.001) had a higher hazard of death. Being a healthcare worker reduced the average hazard of death by 40% (aHR 0.59 [95% CI 0.37, 0.93] p=0.024). Time to death was significantly less for persons ≥60 years (p=0.038) and persons residing in capital cities (p<0.001). The African region has COVID-19 related mortality similar to that of other regions, and is likely underestimated. Similar riskfactors contribute to COVID-19 associated mortality as identified in other regions.

Monitoring and evaluation (M&E) is an essential component of public health emergency response. In the WHO African region (WHO AFRO), over 100 events are detected and responded to annually. Here we discuss the development of the M&E for COVID-19 that established a set of regional and country indicators for tracking the COVID-19 pandemic and response measures. An interdisciplinary task force used the 11 pillars of strategic preparedness and response to define a set of inputs, outputs, outcomes and impact indicators that were used to closely monitor and evaluate progress in the evolving COVID-19 response, with each pillar tailored to specific country needs. M&E data were submitted electronically and informed country profiles, detailed epidemiological reports, and situation reports. Further, 10 selected key performance indicators were tracked to monitor country progress through a bi-weekly progress scoring tool used to identify priority countries in need of additional support from WHO AFRO. Investment in M&E of health emergencies should be an integral part of efforts to strengthen national, regional and global capacities for early detection and response to threats to public health security. The development of an adaptable M&E framework for health emergencies must draw from the lessons learned throughout the COVID-19 response.