If the Covid-19 pandemic had struck five years earlier, Africa would have been in an even more precarious situation than it is today. The continent of almost 1.4bn people would have been without a public health agency to coordinate a multilateral response to the most serious health crisis in decades.
Fortunately, in 2016, the African Union (AU) established the Africa Centres for Disease Control and Prevention (Africa CDC), which aimed to emulate the Atlanta-based US equivalent as a coordinating body for public health.
However, it would take a lot of work to transform Africa CDC into an organisation that could meaningfully tackle Africa’s long list of public health concerns.
“I came here [Addis Ababa] five years ago and I didn’t have an office for almost a year,” says John Nkengasong, the outgoing director who oversaw the establishment of the specialised agency and has been lauded worldwide for his leadership role during the coronavirus pandemic.
“We had to create job descriptions, we had to write 300 individual applications. Therefore, in the first 18 months we were just doing things like that and providing minimum support to countries responding to Ebola and cholera outbreaks.”
Prior to setting up Africa’s public health body, the virologist spent 22 years at the US CDC where he worked in several roles, including chief of virology in Abidjan.
It was this experience and the role that Nkengasong played in setting up the African Society for Laboratory Medicine in 2011 that made him the ideal candidate to build the Africa CDC from scratch.
Following global recognition of his efforts – including being named as one of Time magazine’s Most Influential People of 2021 – the Cameroonian is now expected to serve as the head of the US President’s Emergency Plan for AIDS Relief (PEPFAR) if his nomination by President Joe Biden is confirmed by the Senate.
The Africa CDC that Nkengasong will leave behind has “matured significantly”, growing at an accelerated pace during Covid-19, he says.
“We were forced to ramp up very quickly. It is unfortunate that we have had such a devastating pandemic, but it has helped the Africa CDC move along very quickly.”
From the outbreak of coronavirus, the institution has been at the forefront of procuring and distributing tests, ventilators and vaccines across Africa. It has led the rallying cry for richer nations to distribute vaccines more equitably in poorer regions like Africa.
As a result, the central role played by the Africa CDC in combating the virus has elevated its status both internationally and among African leaders.
“The political leadership of the continent has taken notice of the Africa CDC because during this time we had a chance to brief heads of state and government about 15 times,” he says.
“Compared to how the AU responded to the Ebola outbreak, it is like day and night.”
Establishing credibility with member states and the donor community is a “key ingredient” for driving public health agencies forward, Nkengasong says. He has engaged tirelessly with the media over the last 18-months to make sure the world “understands what the Africa CDC is doing.”
Hurdles to overcome
Despite a coordinated response to Covid-19, Africa is still in the grip of a deadly pandemic that threatens to leave the continent at odds with the rest of the world if vaccine solutions are not found.
Nkengasong says that Africa will still have to rely on donations to meet the AU’s target of vaccinating 60% of Africa’s population by 2022. With only 4% of Africa currently fully vaccinated and 6% of the population with one inoculation, there is still a long way to go.
A manufacturing plant in Senegal with the capacity to produce 300m doses a year will not come online until 2023, while 400m Johnson and Johnson (J&J) vaccines being produced in South Africa will be distributed at the end of 2021 and continue throughout next year.
“My concern is that we have a crisis on our hands right now, we cannot wait until 2023,” he says.
“We are already in an endemic situation. The opportunity to do something meaningful where we can eliminate or control the pandemic is getting thin.”
Although most African countries have eased restrictions after they emerged from a third wave, seven countries – Algeria, Benin, Kenya, Tunisia, Egypt, Mauritius and Somalia – have slipped back into a fourth wave with more expected to follow.
Nkengasong urges richer nations “sitting on vaccines” to redistribute them quickly to Africa and other developing regions. Added to the J&J doses, Africa can meet its 60% vaccination target if bilateral and multilateral donors make good on previous pledges to supply the continent with millions of vaccines.
The failure of many partners to follow through on promises, Nkengasong says, has taught him to “interpret the pledges with care”. However, securing vaccines is only one issue that Africa must overcome to defeat Covid-19.
Political leadership and soft power
The Africa CDC director says that differences in vaccine rollout between each African country can also be explained by differences in “political leadership” and the use of “soft power”.
Morocco, for example, has vaccinated 54.5% of its population by going beyond donations from multilateral bodies like COVAX, a global partnership to equitably distribute vaccines.
The AU, which handles most of the donations being made to Africa, distributes COVAX vaccines to member states based on a formula that calculates the number of doses as a percentage of the overall population.
However, Morocco has also secured millions of Sinopharm vaccines from China, making it one of Africa’s most vaccinated nations.
The dangers of variants
A more worrying concern is the potential for Africa to be a hotbed for variants while the general population remains unvaccinated, Nkengasong says.
“If we are not able to defeat the pandemic everywhere in Africa then you don’t know what kind of variants will emerge, how they will emerge and with what capacity they have to resist antibodies that have been acquired because of vaccinations,” he says.
The flight bans that were implemented to and from Africa during the peak of the pandemic were mostly based on fears surrounding the emergence and transmission of dangerous variants and not on the number of cases on the continent.
Known African variants include the Eta variant from Nigeria and the Beta and C.1.2 variants from South Africa.
Recent research shows that comorbidities in Africa like HIV raise the possibility of Covid-19 mutating as the virus exists inside the host body for much longer than usual.
South Africa has 8.2m people living with HIV, the greatest number of people in the world. This, and other chronic health conditions, may help to explain why South Africa has already given rise to at least two deadly coronavirus mutations.
Triumphs and regrets
Looking back at his time at Africa CDC, Nkengasong says that he is most proud about putting “the structure and systems” in place to be able to deal with health threats going forward.
He regrets not being able to help set up national public health bodies in countries like the DRC that have cyclical bouts of diseases like Ebola.
Without a national health body, the DRC and partners can only respond to the crisis when there is an emergency, which he says is “not how you plan for the 21st century”.
With Nkengasong heading to the US having led Africa CDC with distinction through an unprecedented crisis, it will fall to his successor to continue the vital work of putting national systems and structures in place to strengthen Africa’s capacity to fight back against diseases and viruses.