When Dr John Nkengasong took the post of first chief of the new African Centers for Disease Control in 2017, part of the continent had just emerged from a devastating Ebola outbreak. Less than three years later, the Covid-19 struck.
Dr Nkengasong is now trying to bring together governments from a large and diverse continent to anticipate and combat threats to public health and make them less dependent on institutions like the World Health Organization or the International Committee of the Red Cross. He has helped Africa speak with one voice, especially on what he calls “vaccine famine”, with rich countries buying millions of doses they don’t need while Africa is short.
Maybe Ebola was a signal that something bigger was looming, he says, and something turned out to be Covid-19. He also believes Covid-19 could be the harbinger of something worse to come: a virus as contagious as the Delta variant but with the high fatality rate from Ebola.
The Africa CDC was launched in response to the Ebola outbreak, with funding from the African Union and other donors. When Dr Nkengasong arrived, for months there was no office, no staff and even at one point no internet; the Ethiopian government had shut it down to prevent people from cheating on college entrance exams.
But, he says, “We can do public health under the tree. It doesn’t really matter. The trick is the concepts. Are you committed to solving the issues of inequity and health security? “
(This conversation has been edited and condensed for clarity.)
What was it like when Covid-19 first hit the continent?
In December 2019, I was on leave and we started hearing stories about the virus in Wuhan. I called Addis Ababa and said, “Activate our emergency operations center. I received a first setback from my own staff. They said, “Well, this thing’s going on far away. We have Ebola underway in North Kivu. They said, “We are already too busy. I said, “Please do it, because I know it will come. “
The continent has started well. We had positioned ourselves. We have scrambled. We have trained people. It might sound silly, but in the first few training sessions we did in South Africa and Senegal, everyone went home with a pack of 100 tests.
How is it going now? And how do you see the future trajectory of the virus in Africa?
An emergency is when your house is on fire. You run everywhere, you call 911, they come to sprinkle water. This phase is over. We are now in a phase where your house is on fire. How to build a new house?
I think this virus is gaining ground. As a continent, we are not winning. Today we have over seven million cases with almost 180,000 deaths. And death rates are all increasing very dramatically across the continent. Immunization rates are very, very low. We are about 2.5% of the population fully vaccinated, and it is a continent of 1.2 billion people.
What about vaccines for African countries? Covax – the alliance backed by the United Nations – is coming to fruition as promised?
The story of access to vaccines and the role Covax was supposed to play is what I call a moral tragedy.
The intention and design was perfect, excellent, but the execution – even the people who run Covax will admit he broke his promise.
The countries that fund Covax, or that have pledged funds, were developed countries. So they got involved. I’m not sure they necessarily donated money. But then they bought the vaccines, all the vaccines. So even with the money Covax had, there was nowhere to get vaccines.
We’re not saying, donate to us. Not to give us vaccines. We are simply saying, let Africa come up with its 400 million doses of vaccine – which it has paid for! By simply swapping the order in which we are in the queue for vaccine delivery, I think you can start to solve a lot of problems.
What is the state of public health infrastructure in Africa?
Governments have not invested enough in their own public health needs.
The whole architecture – public health architecture and health security architecture – has been designed, since World War II, in such a way that it has created a lot of dependencies, Africa vis-à-vis the outside world.
Africa has around three million health workers. It is almost nothing. So you clearly see the neglect. And our health security architecture was designed when Africa’s population was below 300 million. Where are we today? We are 1.2 billion people, aspiring to reach 2.5 billion or 2.4 billion in the next 30 years.
No people will survive by importing 99% of their vaccines and 100% of their diagnoses. That does not make sense. We need 6,000 epidemiologists. We currently only have about 1,900 on the continent.
Are people reluctant to get vaccinated?
It has yet to be a battle won or lost at the community level. Misinformation continues to be a serious problem.
However, when I look at the trends, what is happening on the continent, I am very encouraged. I was in Morocco, and at the Tangier stadium there were long lines of young people. When I approached them, I thought there was a football game, but they were people signing up online to get the shot. We have seen similar scenarios in Kigali, in Nairobi.
The reluctance to vaccinate is therefore no longer the problem. Vaccine starvation is the real challenge now, not vaccine hesitation.
What is your vaccination goal in Africa by the end of 2021?
It was expected to reach at least 25 to 30 percent by the end of the year. But that would depend on many factors. Are the countries that have obtained vaccines ready to distribute these vaccines?
At the rate we are doing it, we are heading very willingly towards the endemicity of this virus on the continent, there is no doubt about that. Now it’s concentrated in the big cities, but it’s going to spread to remote areas soon, and it’s getting very, very difficult to track down.
You worked for the United States Centers for Disease Control for many years. What was it like going back to Africa?
I grew up in Cameroon. You go and you think you’ll come back, and then life carries you from one part of the world to another and you just keep moving on.
I remember when I took the job my coworkers said to me, “John, are you maybe going through a midlife crisis? Why would you want to leave Atlanta and quit your job, and start something you really don’t know? But it was in me that I had to do this.
For almost a year, I didn’t have an office. I had a great director’s name, but there was no place to sit and work.
Was it easy? Not at all.
By the time you say you have a CDC, the expectations are very high. In particular, borrowing a name from a renowned CDC like the USCDC put a lot of pressure and expectations on our shoulders very, very early on.
Should we decolonize public health in Africa?
Shirley Chisholm said if they don’t give you a chair around the table, go with a folded chair. Do not ask permission to do what is in your right.
Imagine, the first public health conference in Africa will be organized by Africa CDC at the end of this year.
Why is this important? It provides a platform for African public health experts to interact, share experiences, learn from each other.
Second, we invest in our own schools of public health and believe in our own schools of public health.
Learning a lesson is what Africa is doing now; we don’t have vaccines, we have to produce vaccines.
If we continue on this journey of a new order of public health, when the next pandemic strikes, we will fight it in a very, very different way.