The launch of the EU Health Emergency Preparedness and Response Authority (HERA): Improving global pandemic preparedness?

The crowded global health landscape has been joined by the European Union Health Emergency Preparedness and Response Authority (HERA). HERA will assume four broad areas of responsibility: horizon scanning for major health threats; research and development; support for capacity to manufacture drugs, vaccines, and equipment; and procuring and stockpiling key medical countermeasures. In this Health Reform Monitor article, we outline the reform process and describe HERA's structure and responsibilities, explore issues that arise from the creation of this new organisation, and suggest options for collaboration with existing bodies in Europe and beyond. The COVID-19 pandemic and other infectious disease outbreaks have shown the need to treat health as a cross-border issue, and there is now a broad consensus that greater direction and coordination at the European level is needed. This ambition has been matched with a considerable increase in EU funding to tackle cross-border health threats, and HERA can be used to deploy this funding in an effective manner. Yet this is contingent upon clearly defining its role and responsibilities vis-à-vis existing agencies to reduce redundancies.

Critical appraisal of the Coronavirus preparedness among countries using the global health security index

Introduction: This critical study was aimed to investigate the utility of the Global Health Security Index in predicting the current COVID-19 responses. Material and Methods: Number of infected patients, deaths, incidence and the death rate per 100,000 populations related to 55 countries per week for 26 weeks were extracted. The relationship of GHSI scores and country preparedness for the pandemic was compared. Results: According to the GHSI, the incidence rate in most prepared countries was higher than the incidence rate in the more prepared countries, and which was higher than the incidence rate in the least prepared countries. However, Prevention, Detection and reporting, Rapid response, Health system, compliance with international norms and Risk environment, as well as Overall, the incidence and death rate per 100,000 people have not been like this. Conclusion: Due to mismatch between the GHSI score and fact about COVID-19 incidence, it seems necessary to investigate the factors involved in this discrepancy. © 2022, Published by Frontiers in Health Informatics.

Securitising infectious disease outbreaks: The WHO and the visualisation of molecular life

Following its exceptional response to the 2003 severe acute respiratory syndrome (SARS) outbreak, the World Health Organization (WHO) gained new powers to securitise infectious disease outbreaks via the revised 2005 International Health Regulations (IHRs) and the ability to declare a Public Health Emergency of International Concern (PHEIC). This article investigates the declaration of a PHEIC in relation to the 2009 H1N1 flu pandemic, the 2014-16 Ebola outbreak, and the ongoing COVID-19 pandemic. It argues that the securitisation of these outbreaks was dependent upon global surveillance networks that utilised genetic technologies to visualise the molecular characteristics and spread of the pathogen in question. Genetic evidence in these cases facilitated the creation of a securitised object by revealing the unique and 'untypable' nature of the H1N1 and SARS-CoV-2 viruses and made visible the widespread prevalence of Ebola across the population of West Africa. The power of this evidence draws from a societal perception of science as producing objective 'facts' about the world that objectivise their objects of concern and empower political actors in the implementation of their security agendas. As a result, scientific evidence provided by genetic technologies now plays a necessary and indispensable role in the securitisation of infectious disease outbreaks.

Lack of Alignment Between WHO Joint External Evaluation and State Party Self-Assessment Scores Undermines Utility as Evaluation Tools for the Department of Defense.

The International Health Regulations 2005 (IHR) set standards for countries to detect and respond to public health threats such as COVID-19. The US Department of Defense engages with partner nations to build IHR-related health security capacities. In this article, we compare 2 elements of the IHR Monitoring and Evaluation Framework to determine if they align in a useful way. The version of the State Party Self-Assessment Annual Reporting (SPAR) tool used for this study is a self-assessment of 13 capacities, while the Joint External Evaluation (JEE) requires collaboration with international subject matter experts to evaluate 19 capacities. The SPAR indicators are scored separately from 0% to 100%, whereas the JEE uses a rank-ordered scale from 1 to 5 for variable numbers of indicators in each capacity. Using 2018-2019 data from the World Health Organization, we quantitatively and qualitatively evaluated the alignment of the SPAR and JEE scoring systems, using paired t tests for related capacities and 3 approaches to matching the scales. Whether using a simple, evenly divided scale for the SPAR or downscaling the SPAR scores to match with lower JEE scores, the paired t tests indicate that the JEE and SPAR scoring systems are not aligned. Many of the capacities in the JEE and SPAR are defined differently, pointing to one of the reasons for the discordance. We discuss implications for revision of the JEE and SPAR assessment tools along with ways in which the scores might be used for planning global health engagement capacity-building activities.

Global health governance responds to COVID-19: Does the security/access divide persist?

This paper evaluates global health responses to the COVID-19 pandemic through the 'two regimes of global health' framework. This framework juxtaposes global health security, which contains the threat of emerging diseases to wealthy states, with humanitarian biomedicine, which emphasises neglected diseases and equitable access to treatments. To what extent did the security/access divide characterise the response to COVID-19? Did global health frames evolve during the pandemic?Analysis focused on public statements from the World Health Organization (WHO), the humanitarian nonprofit Médecins Sans Frontières (MSF), and the American Centers for Disease Control and Prevention (CDC). Following a content analysis of 486 documents released in the first two years of the pandemic, the research yielded three findings. First, the CDC and MSF affirmed the framework; they exemplified the security/access divide, with the CDC containing threats to Americans and MSF addressing the plight of vulnerable populations. Second, surprisingly, despite its reputation as a central actor in global health security, the WHO articulated both regime priorities and, third, after the initial outbreak, it began to favour humanitarianism. For the WHO, security remained, but was reconfigured: instead of traditional security, global human health security was emphasised - collective wellbeing was rooted in access and equity.

Moving from assessments to implementation: promising practices for strengthening multisectoral antimicrobial resistance containment capacity.

BACKGROUND: Antimicrobial resistance (AMR) poses a global threat to human, animal, and environmental health. AMR is a technical area in the Global Health Security Agenda initiative which uses the Joint External Evaluation tool to evaluate national AMR containment capacity. This paper describes four promising practices for strengthening national antimicrobial resistance containment capacity based on the experiences of the US Agency for International Development's Medicines, Technologies, and Pharmaceutical Services Program work with 13 countries to implement their national action plans on AMR in the areas of multisectoral coordination, infection prevention and control, and antimicrobial stewardship. METHODS: We use the World Health Organization (WHO) Benchmarks on International Health Regulations Capacities (2019) to guide national, subnational, and facility actions that advance Joint External Evaluation capacity levels from 1 (no capacity) to 5 (sustainable capacity). Our technical approach is based on scoping visits, baseline Joint External Evaluation scores, benchmarks tool guidance, and country resources and priorities. RESULTS: We gleaned four promising practices to achieve AMR containment objectives: (1) implement appropriate actions using the WHO benchmarks tool, which prioritizes actions, making it easier for countries to incrementally increase their Joint External Evaluation capacity from level 1 to 5; (2) integrate AMR into national and global agendas. Ongoing agendas and programs at international, regional, and national levels provide opportunities to mainstream and interlink AMR containment efforts; (3) improve governance through multisectoral coordination on AMR. Strengthening multisectoral bodies' and their technical working groups' governance improved functioning, which led to better engagement with animal/agricultural sectors and a more coordinated COVID-19 pandemic response; and (4) mobilize and diversify funding for AMR containment. Long-term funding from diversified funding streams is vital for advancing and sustaining countries' Joint External Evaluation capacities. CONCLUSIONS: The Global Health Security Agenda work has provided practical support to countries to frame and conduct AMR containment actions in terms of pandemic preparedness and health security. The WHO benchmarks tool that Global Health Security Agenda uses serves as a standardized organizing framework to prioritize capacity-appropriate AMR containment actions and transfer skills to help operationalize national action plans on AMR.

The level of countries' preparedness to health risks during Covid-19 and pre-pandemic: the differential response to health systems building blocks and socioeconomic indicators.

The global health security (GHS) Index assesses countries' level of preparedness to health risks. However, there is no evidence on how and whether the effects of health systems building blocks and socioeconomic indicators on the level of preparedness differ for low and high prepared countries. The aim of this study was to examine the contributions of health systems building blocks and socioeconomic indicators to show differences in the level of preparedness to health risks. The study also aimed to examine trends in the level of preparedness and the World Health Organization (WHO) regional differences before and during the Covid-19 pandemic. We used the 2021 GHS index report data and employed quantile regression, log-linear, double-logarithmic, and time-fixed effects models. As robustness checks, these functional form specifications corroborated with one another, and interval validity tests confirmed. The results show that increases in effective governance, supply chain capacity in terms of medicines and technologies, and health financing had positive effects on countries' level of preparedness to health risks. These effects were considerably larger for countries with higher levels of preparedness to health risks. The positive gradient trends signaled a sense of capacity on the part of countries with higher global health security. However, the health workforce including doctors, and health services including hospital beds, were not statistically significant in explaining variations in countries' level of preparedness. While economic factors had positive effects on the level of preparedness to health risks, their impacts across the distribution of countries' level of preparedness to health risks were mixed. The effects of Social Development Goals (SDGs) were greater for countries with higher levels of preparedness to health risks. The effect of the Human Development Index (HDI) was greatest for countries whose overall GHS index lies at the midpoint of the distribution of countries' level of preparedness. High-income levels were associated with a negative effect on the level of preparedness, especially if countries were in the lower quantiles across the distributions of preparedness. Relative to poor countries, middle- and high-income groups had lower levels of preparedness to health risks, an indication of a sense of complacency. We find the pandemic period (year 2021) was associated with a decrease in the level of preparedness to health risks in comparison to the pre-pandemic period. There were significant WHO regional differences. Apart from the Eastern Mediterranean, the rest of the regions were more prepared to health risks compared to Africa. There was a negative trend in the level of preparedness to health risks from 2019 to 2021 although regional differences in changes over time were not statistically significant. In conclusion, attempts to strengthen countries' level of preparedness to health shocks should be more focused on enhancing essentials such as supply chain capacity in terms of medicines and technologies; health financing, and communication infrastructure. Countries should also strengthen their already existing health workforce and health services. Together, strengthening these health systems essentials will be beneficial to less prepared countries where their impact we find to be weaker. Similarly, boosting SDGs, particularly health-related sub-scales, will be helpful to less prepared countries. Moreover, there is a need to curb complacency in preparedness to health risks during pandemics by high-income countries. The negative trend in the level of preparedness to health risks would suggest that there is a need for better preparedness during pandemics by conflating national health with global health risks. This will ensure the imperative of having a synergistic response to global health risks, which is understood by and communicated to all countries and regions.

The Case for Integrating Health Systems to Manage Noncommunicable and Infectious Diseases in Low- and Middle-Income Countries: Lessons Learned From Zambia.

Noncommunicable diseases (NCDs) are the leading cause of death in the world, and 80% of all NCD deaths occur in low- and middle-income countries (LMICs). The COVID-19 pandemic has demonstrated that patients with NCDs are at increased risk of becoming severely ill from the virus. Disproportionate investment in vertical health programs can result in health systems vulnerable to collapse when resources are strained, such as during pandemics. Although NCDs are largely preventable, globally there is underinvestment in efforts to address them. Integrating health systems to collectively address NCDs and infectious diseases through a wide range of services in a comprehensive manner reduces the economic burden of healthcare and strengthens the healthcare system. Health system resiliency is essential for health security. In this article, we provide an economically sound approach to incorporating NCDs into routine healthcare services in LMICs through improved alignment of institutions that support prevention and control of both NCDs and infectious diseases. Examples from Zambia's multisector interventions to develop and support a national NCD action plan can inform and encourage LMIC countries to invest in systems integration to reduce the social and economic burden of NCDs and infectious diseases.

Global Health Security amid COVID-19: Tanzanian government's response to the COVID-19 Pandemic.

Several stakeholders assumed different responsibilities for global health security and safety during the COVID-19 pandemic. This study aims to highlight how the Tanzanian government, in collaboration with the international government, non-governmental organizations (NGOs), donor agencies, and stakeholders responded to the pandemic to improve health security and community well-being. This article analyzed secondary data sources from the World Health Organization's (WHO) country report and published reports from Tanzania's government to evaluate vaccine availability and health security. Findings from the data gathered indicate that the initial response from the Tanzanian government concerning the fight against the COVID-19 pandemic was rather abysmal due to the posture of the late President John Pombe Magufuli who at first downplayed the severity and seriousness of the COVID-19 pandemic. However, with the swearing-in of the new President, Samia Suluhu, there was a new approach and strategy instituted to deal with the pandemic which has resulted in the country making headway in containing the pandemic. Data gathered thus, indicate that, as of 11th February 2022, the total number of fully vaccinated individuals in the country as of 12th April 2022 stood at 3,435,513 from the total number of 2,205,815 reported on 11th February 2022. This study thus, concludes that there is a need for a strong stakeholder engagement with high-level political, community, and religious leaders and increased access to COVID-19 vaccination as well as a mass campaign to scale up vaccination activities with adequate resource mobilization and plan.

Do We Need to Protect the Entire World Population from Health Threats Through One Global Biomedical Surveillance and Response System? A Human Rights-Based Comment on the Proposed WHO Treaty on Pandemic Preparedness and Response

The World Health Organization (WHO) and its member States are currently in the process of negotiating a new multilateral treaty on pandemic preparedness and re-sponse. At the same time, the existing international legal framework regulating global health emergencies – the International Health Regulations (IHR) – are being revised. Overall, substantive proposals made so far for inclusion into the new treaty/revised IHR provide for a further centralisation of control over, and management of, the collectivity of all human bodies through increased digitally-based biomedical surveillance at WHO level to detect potential health threats in order to rapidly adopt, coordinate, and implement global medical and non-medical emergency countermeasures. This contribution shows that this substantive focus is driven by the Global Health Security (GHS) doctrine that has dominated WHO's, its member States', and its public-private partners' response to Covid-19. This is problematic because it will not only entrench the GHS doctrine further into international health law but also endorse and routinise many of the securitised global medical and non-medical coun-termeasures adopted in response to Covid-19 for responses to future health threats. (Emerging) evidence shows, however, that these countermeasures have been ineffective and resulted in far-reaching interferences with people's human rights in virtually every country around the world. By way of example, this is illustrated with an analysis of three GHS-in-formed medical and non-medical Covid-19 countermeasures: lockdowns, constant bio-surveillance, and the fast-track development, global promotion, distribution, and admin-istration of investigational vaccines. The contribution ends with a call on those responsible for the treaty negotiation and IHR revision processes to take due account of WHO's and its member States' human rights duties and responsibilities for human rights in these processes;and to question the exclusive focus on centrally managed, technocratic, biomedical ap-proaches to pandemic preparedness and response. © 2022, Duncker und Humblot GmbH. All rights reserved.

Leveraging Lessons Learned from Yellow Fever and Polio Immunization Campaigns during COVID-19 Pandemic, Ghana, 2021.

Ghana is a yellow fever-endemic country and experienced a vaccine-derived polio outbreak in July 2019. A reactive polio vaccination campaign was conducted in September 2019 and preventive yellow fever campaign in November 2020. On March 12, 2020, Ghana confirmed its first COVID-19 cases. During February-August 2021, Ghana received 1,515,450 COVID-19 vaccines through the COVID-19 Vaccines Global Access initiative and other donor agencies. We describe how systems and infrastructure used for polio and yellow fever vaccine deployment and the lessons learned in those campaigns were used to deploy COVID-19 vaccines. During March-August 2021, a total of 1,424,008 vaccine doses were administered in Ghana. By using existing vaccination and health systems, officials in Ghana were able to deploy COVID-19 vaccines within a few months with <5% vaccine wastage and minimal additional resources despite the short shelf-life of vaccines received. These strategies were essential in saving lives in a resource-limited country.

Global Health Security Index not a proven surrogate for health systems capacity to respond to pandemics: The case of COVID-19.

INTRODUCTION: Global Health Security borders on prevention, detection and response to public health threats like the novel coronavirus disease 2019 (COVID-19). Global Health Security Index (GHSI) of 2019 and 2021 revealed the world remains ill-prepared to deal with future pandemics, evident in the historic impact of COVID-19 on countries. As at 7th December 2022, COVID-19 has infected over 600 million people and claimed over six million lives, mostly in countries with higher GHSI scores. OBJECTIVE: Determine whether the GHSI scores of countries have a correlation with COVID-19 cases, deaths and vaccination coverage, while adjusting for country level dynamics. METHODS: This paper utilizes GHSI database of 195 countries. Data consists of 171 questions grouped into 37 indicators across six overarching categories on health security and COVID-19. Multivariate multiple regression analysis with robust standard errors was conducted to test the hypothesis that high GHSI ratings do not guarantee better COVID-19 outcomes like cases, deaths and vaccination coverage. Also, avplots STATA command was used to check outliers with potential negative effect on outcome and predictor variables. RESULTS: Global average GHSI score for all 195 countries was 38.9. United States of America recorded the highest GHSI score of 75.9 but also recorded one of the highest COVID-19 cases and deaths; Somalia recorded the worst GHSI score of 16.0 and one of the lowest COVID-19 cases and deaths. High GHSI scores did not associate positively with reduction in COVID-19 cases (Coef=157133.4, p-value=0.009, [95%CI 39728.64 274538.15]) and deaths (Coef=1405.804, p-value=0.047, [95%CI 18.1 2793.508]). However, high GHSI ratings associated with increases in persons fully vaccinated per 100 population (Coef=0.572, p-value=0.000, [95%CI.272.873]). CONCLUSION: It appears the world might still not be adequately prepared for the next major pandemic, if the narrative remains unchanged. Countries that recorded higher GHSI scores, counter-intuitively, recorded higher COVID-19 cases and deaths. Countries need to invest more in interventions towards attaining Universal Health Coverage (UHC) including integrated health systems and formidable primary health care to enhance preparedness and response to pandemics.

Continuing Contributions of Field Epidemiology Training Programs to Global COVID-19 Response.

We documented the contributions of Field Epidemiology Training Program (FETP) trainees and graduates to global COVID-19 preparedness and response efforts. During February-July 2021, we conducted surveys designed in accordance with the World Health Organization's COVID-19 Strategic Preparedness and Response Plan. We quantified trainee and graduate engagement in responses and identified themes through qualitative analysis of activity descriptions. Thirty-two programs with 2,300 trainees and 7,372 graduates reported near-universal engagement across response activities, particularly those aligned with the FETP curriculum. Graduates were more frequently engaged than were trainees in pandemic response activities. Common themes in the activity descriptions were epidemiology and surveillance, leading risk communication, monitoring and assessment, managing logistics and operations, training and capacity building, and developing guidelines and protocols. We describe continued FETP contributions to the response. Findings indicate the wide-ranging utility of FETPs to strengthen countries' emergency response capacity, furthering global health security.

COVID-19 Response Roles among CDC International Public Health Emergency Management Fellowship Graduates.

Since 2013, the US Centers for Disease Control and Prevention has offered the Public Health Emergency Management Fellowship to health professionals from around the world. The goal of this program is to build an international workforce to establish public health emergency management programs and operations centers in participating countries. In March 2021, all 141 graduates of the fellowship program were invited to complete a web survey designed to examine their job roles and functions, assess their contributions to their country's COVID-19 response, and identify needs for technical assistance to strengthen national preparedness and response systems. Of 141 fellows, 89 successfully completed the survey. Findings showed that fellowship graduates served key roles in COVID-19 response in many countries, used skills they gained from the fellowship, and desired continuing engagement between the Centers for Disease Control and Prevention and fellowship alumni to strengthen the community of practice for international public health emergency management.

Adapting Longstanding Public Health Collaborations between Government of Kenya and CDC Kenya in Response to the COVID-19 Pandemic, 2020-2021.

Kenya's Ministry of Health (MOH) and the US Centers for Disease Control and Prevention in Kenya (CDC Kenya) have maintained a 40-year partnership during which measures were implemented to prevent, detect, and respond to disease threats. During the COVID-19 pandemic, the MOH and CDC Kenya rapidly responded to mitigate disease impact on Kenya's 52 million residents. We describe activities undertaken jointly by the MOH and CDC Kenya that lessened the effects of COVID-19 during 5 epidemic waves from March through December 2021. Activities included establishing national and county-level emergency operations centers and implementing workforce development and deployment, infection prevention and control training, laboratory diagnostic advancement, enhanced surveillance, and information management. The COVID-19 pandemic provided fresh impetus for the government of Kenya to establish a national public health institute, launched in January 2022, to consolidate its public health activities and counter COVID-19 and future infectious, vaccine-preventable, and emerging zoonotic diseases.

Sustainable vaccine manufacturing in low- and middle-Income countries.

The sustainable manufacturing of vaccines in developing countries is critical to increasing equitable access to vaccines and pandemic preparedness globally. Sustainable manufacturing requires that organizations engaged in the development, production and supply of vaccines have viable business models and incentives to manufacture vaccine products. The expanding manufacturing capabilities and capacities of developing countries vaccine manufacturers (DCVMs) are increasingly positioning these organizations to meet the national and regional public health needs in developing countries; however, key industry challenges such as regulatory barriers, low prices and demand uncertainty for vaccine products, and limited R&D funding threaten the long-term viability of vaccine manufacturers. This study assesses the technical capabilities, manufacturing capacities, and aspirational plans of DCVMs, exemplifying the business models and strategies undertaken to sustainably manufacture vaccines in developing countries. The public health importance of a healthy vaccine industry which enables manufacturers is discussed throughout. Vaccine manufacturers reported diverse product portfolios and R&D pipelines and utilized an array of vaccine technology platforms. Large manufacturing capacities were reported, a critical factor in manufacturers achieving economies of scale and supplying large volumes of vaccine doses to the world's most populous regions. Partnerships and collaboration within the industry and with international organizations along the vaccine value-chain were cited with high frequency. Manufacturers also reported aspirational plans to enter new markets, acquire new technologies and invest in the development of novel and improved vaccines. As DCVMs aim to have an increasing impact on the global vaccine ecosystem, a coordinated multi-stakeholder approach is required alleviate critical industry barriers to ensure that all efforts produce vaccines are sustainable and enable developing countries to realize the public health benefit of vaccines.

A Global Health Law Trilogy: Transformational Reforms to Strengthen Pandemic Prevention, Preparedness, and Response.

This is a pivotal moment in the global governance response to pandemic threats, with crucial global health law reforms being undertaken simultaneously in the coming years: the revision of the International Health Regulations, the implementation of the GHSA Legal Preparedness Action Package, and the negotiation of a new Pandemic Treaty. Rather than looking at these reforms in isolation, it will be necessary to examine how they fit together, considering: how these reforms can complement each other to support pandemic prevention, preparedness, and response; what financing mechanisms are necessary to ensure sustainable health governance; and why vital norms of equity, social justice, and human rights must underpin this new global health system.

Can the Ebola experience in West Africa help to combat the COVID-19 pandemic? Testing the critical incident management systems model in the COVID-19 context

Purpose This study explored whether the critical incident management systems (CIMS) model can predict the EMS performance in the COVID-19 context. Past research has established the significance of early detection and response (ER) in the context of Ebola virus disease (EVD), prompting a question of whether the model can also be helpful in the COVID-19 context. Consequently, the authors assessed whether ER influences the impact of communication capacity (CC), reliable information channel (RC) and environment (EN) on COVID-19 EMS performance. Assessing these relationships will advance emerging infectious disease (EID) preparedness. Design/methodology/approach The authors employed standardized measurement instruments of the CIMS model (CC, ER, RC and EN) to predict the performance of COVID-19 EMS using structural equation modeling (SEM) in a study of 313 participants from frontline responders. Findings The results show that the relationship of ER and EN with COVID-19 EMS performance is positive, while that of EN on CC is negative. The relationship between EN and COVID-19 EMS performance was insignificant. Contrary to the hypothesis, CC was negatively significant to COVID-19 EMS performance due to poor communication capacities. Research limitations/implications The authors acknowledge some limitations due to challenges faced in this study. First, Data collection was a significant limitation as these questionnaires were built and distributed in June 2020, but the response time was prolonged due to the recurring nature of the pandemic. The authors had wanted to implore the inputs of all stakeholders, and efforts were made to reach out to various Ministry of Health, the local CDC and related agencies in the region via repeated emails explaining the purpose of the study to no avail. The study finally used the frontline workers as the respondents. The authors used international students from various countries as the representatives to reach out to their countries' frontline workers. Second, since the study was only partially supported using the CIMS model, future studies may combine the CIMS model with other models or theories. Subsequent research reassesses this outcome in other contexts or regions. Consequently, further research can explore how CC can be improved with COVID-19 and another future EID in the region. This may improve the COVID-19 EMS performance, thereby expanding the lesson learned from the pandemic and sustaining public health EID response. Additionally, other authors may combine the CIMS model with other emergency management models or theories to establish a fully supported theoretical model in the context of COVID-19. Practical implications The findings have practical implications for incident managers, local CDCs, governments, international organizations and scholars. The outcome of the study might inform these stakeholders on future direction and contribution to EID preparedness. This study unfolds the impact of lessons learned in the region demonstrated by moderating early detection and responses with other constructs to achieve COVID-19 EMS performance. The findings reveal that countries that experienced the 2013-2016 Ebola outbreak, were not necessarily more prepared for an epidemic or pandemic, judging by the negative moderating impact of early detection and response. However, these experiences provide a foundation for the fight against COVID-19. There is a need for localized plans tailored to each country's situation, resources, culture and lifestyle. The localized plan will be to mitigate and prevent an unsustainable EID management system, post-epidemic fund withdrawals and governance. This plan might be more adaptable and sustainable for the local health system when international interventions are withdrawn after an epidemic. Public health EID plans must be adapted to each country's unique situation to ensure sustainability and constantly improve EID management of epidemics and pandemics in emergency response. The high to moderate importation risk in African countries shows Africa's largest wind w of vulnerability to be West Africa (Gilbert et al., 2020). Therefore, they should be in the spotlight for heightened assistance towards the preparedness and response for a future pandemic like COVID-19. The West African region has a low capacity to manage the health emergency to match the population capacities. The COVID-19 outbreak in West Africa undoubtedly inflicted many disruptions in most countries' economic, social and environmental circumstances. The region's unique challenges observed in this study with CC and reliable information channels as being negatively significant highlight the poor maintenance culture and weak institutions due to brain drain and inadequate training and monitoring. This outcome practically informs West African stakeholders and governments on aspects to indulge when trying to improve emergency preparedness as the outcomes from other regions might not be applicable. Originality/value This study explored the relevance of the CIMS model in the context of the COVID-19 pandemic, revealing different patterns of influence on COVID-19 EMS performance. In contrast to the extant literature on EVD, the authors found the moderating effects of ER in the COVID-19 context. Thus, the authors contribute to the COVID-19 EMS performance domain by developing a context-driven EMS model. The authors discuss the theoretical and practical implications.