Strengthening policy to foster more equitable responses to future health crises

When a region is hit by health crisis upon health crisis, governments, scientists, researchers and the medical community must work together to manage immediate impacts on people’s health as well as the longer-term collateral damage. In West Africa — where countries have experienced a series of infectious disease outbreaks including cholera, measles, yellow fever and Ebola in the last decade alone — one group in particular has led an intense effort to address how the COVID-19 pandemic has impacted some of the region’s most vulnerable people, including women and children.  

The West African Network of Emerging Leaders in Health Policy and Systems (WANEL) recently concluded an IDRC-supported three-year project studying the collateral effects of COVID-19 and developing strategies that can help address future epidemics and pandemics. With a focus on 15 West African countries, their findings will help policymakers from across the region learn from the past to better prepare for the health challenges of the future. 

Managing health emergency responses in West Africa

The question at the heart of WANEL’s research is: how can we prevent collateral effects like excess mortality and morbidity, anxiety, fear, food insecurity and lack of income from harming populations during future disease outbreaks?  

 To achieve this, their research aimed to:  

• build a strong base of research networks  
• support emerging researchers across 15 West African countries 
• strengthen research capacities  
• generate powerful evidence to directly inform policies  
• create environments that encourage policymakers and researchers to work together  
• provide solutions that lead to better health and societal outcomes 

Collateral effects of a public health crisis

Health crises like the COVID-19 pandemic have lasting effects. While Africa experienced only 1.3% of global COVID-19 cases, the impacts were felt disproportionately by vulnerable populations. Some of the most significant collateral effects reported include:  

• The disruption of essential health services (health facility closures, diversion of resources to COVID-19 response), resulting in delayed access to life-saving care for non-COVID conditions. These disruptions are likely to have contributed to the region’s very high excess COVID-19 mortality rate (beyond what other similar size populations experienced), estimated at 480,000 deaths in West Africa from 2020-2021 — far above the estimated 13,000 deaths officially attributed to COVID-19 during that time. 
• Mental health and social harms, including anxiety and depression associated with quarantine, social separation and loss of family relations among affected individuals. 
• Economic and livelihood losses, especially among informal workers affected by curfews and lockdowns, which reduced productivity and income and increased vulnerability. 
• Increased household vulnerability, as reflected in rising food insecurity, hunger, domestic violence, abuse and suicide, partly driven by income loss, confinement measures and broader social stress. 
• Educational disruption due to school closures and reduced quality of learning, contributing to a slowdown in progress in mean years of schooling. 

Overall, in West Africa, COVID-19 reduced life expectancy, slowed the rate of the Human Development Index growth, impacted the mean years of schooling and reduced national income per capita. In addition, COVID-19 response widened the inequality gap for women in almost all these areas.

This highlights that when responding to disease outbreaks, it is critical for control measures to do no harm. Policymakers must consider economic realities, social inequalities, health structures and population dynamics to understand where vulnerabilities exist. Collaboration across sectors, policies that reduce gender inequality, and systems-thinking approach can further decrease collateral effects. 

Case study: The Guinea experience 

One component of WANEL’s work included a deep dive into the collateral effects of COVID-19 in Guinea. Its findings paint a clear picture: COVID-19 may affect everyone, but it disproportionately impacts women.

For example, governments failed to develop economic support programs tailored to the needs of women in the informal sector. Women make up a significant proportion of the workforce in Guinea, and the resulting loss of income impacted them severely. They were also largely excluded from social safety nets and faced fewer work opportunities overall due to containment measures and travel restrictions. Women in Guinea also faced difficulties accessing government financial aid and health services due to gender-specific barriers.

The Guinea study demonstrates that during epidemics and pandemics, government interventions must take a more gender-sensitive approach. This study has laid the groundwork for discussions on how interventions can be more gender transformative — as a result, the Ministry of Women’s Promotion, Children and Vulnerable Persons in Guinea allocated funds to 40 women’s groups in its 2023 action plan. 

From strength to strength 

By working together with multisectoral actors at all levels and across countries, the work done by WANEL supports governments and policymakers in better formulating and implementing evidence-based and inclusive responses to pandemics. Key recommendations include: 

• Incorporating a policy framework grounded in the following principles: that epidemic responses should be people-centred, do no harm, advance equity and social justice and be guided by context-sensitive evidence, systems-thinking, multisectoral collaboration and social trust. This is critical to inform more appropriate response strategies to outbreaks, prevent increased vulnerabilities and enhance the resilience of health systems. 
• Adopting integrated epidemic responses that anticipate, monitor and address collateral effects, while promoting positive long-term system gains. This is essential to reduce unintended harm, strengthen learning and adaptation and improve preparedness, equity, and health system resilience. 

This important work will help influence policies so that vulnerable populations are not disproportionately impacted by future epidemics and pandemics.