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Trade & Investment

‘Africa CDC proved itself during the pandemic,’ says John Nkengasong

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.

Massive growth

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.

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Technology & Information

Global solidarity collapses over access to coronavirus testing kits and vaccines, says Africa CDC director

In all the best-case scenarios where countries succeed in dramatically decreasing transmission rates of Covid-19, testing has been shown as the single most important tool in the fight against the deadly virus. Despite contributions from Chinese billionaire Jack Ma and sustained efforts from a variety of continental bodies, Africa has a severe lack of testing kits.

Rather than a lack of funds or political will, Africa’s shortfall is triggered by richer nations outcompeting the developing world for critical equipment, says John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC).

“The companies that produce the tests are finding it very difficult to meet global demand because of the competition that exists in the form of Western countries buying all the tests. We’ve learned that when the world is challenged with access to limited commodities then global solidarity collapses,” he says.

Test, test, test

As the African Union’s specialised agency for strengthen­ing the response of member states to infectious diseases, Africa CDC has been instrumental in coordinating the fight against the virus on the continent. Shortly after the first African case was announced in Egypt on 14 February, the institution procured testing kits from a company in Berlin and had them shipped to Senegal.

Despite distribution of thousands more across the African continent since that initial shipment, access to the crucial equipment varies wildly from country to country and breaks down among economic lines. South Africa, which currently has the most cases in Africa, has conducted more than 150,000 tests for a population of 58m whereas Nigeria has conducted around 10,000 for a population of over 200m.

While the African Union said that it planned to distribute one million tests from late April, Nkengasong estimates that Africa requires a further 15m over the next three months. This seems ambitious given the competition surrounding the equipment.

The softly-spoken Cameroonian with more than 20 years’ experience at the US Centres for Disease Control and Prevention warns that Africa must learn from its reliance on “trickle-down technology” from more developed nations.

“Lesson one is that because of our dependency on the diagnostic technologies from the West, we are in a very vulnerable position with respect to the health situation,” he says.

“That has to change almost immediately. We need diagnostic companies on the continent which can manufacture these tests like Singapore, Thailand and others. It is not that difficult. The gene sequences are known. Yet there is not one company on the continent which produces diagnostics.”

Vaccine race

The greater concern in the long-term fight against Covid-19 is access to vaccines. While scientists are not yet sure whether recovered patients will develop long-lasting immunity to the virus, it is generally accepted that vaccines will play a pivotal role in returning the world to normal. Numerous companies are working on vaccines around the world; none of them are in Africa.

Africa’s unequal access to testing kits may serve as a grim warning for when a vaccine is finally produced. Failure to secure the preventative measure would cause untold economic and social disruption, with African nations foreseeably forced to continue lockdowns well past those of richer nations.

“What we have observed for diagnostics should give us a sense of how access to vaccines may look like and that concerns me,” says Nkengasong.

“We as Africans have to stand up and make sure our voice is heard. We are in a world of 7bn people and Africa is a continent of 1.3bn people. If there are vaccines in the next 15 to 18 months, Africa should be a factor in that and we should not have to wait for a trickle-down effort.”

Global cooperation

Nkengasong hopes that global health institutions like the Norway-based Coalition for Epidemic Preparedness Innovations (CEPI) will “play the role they are designed for” and champion the equitable distribution of a vaccine once it has been created.

However, recent events cast doubt on global cooperation. President Donald Trump’s withdrawal of US funding to the World Health Organisation (WHO) over accusations that it was too lenient with China during the initial outbreak of the virus has damaged the multilateral response to Covid-19.

Some European countries are also beginning to take a more critical stance towards China, believing that the government lied about the true scale of the crisis.

Overseeing the health response of the world’s poorest continent, Nkengasong is well aware of the dangers of retreating to isolationism.

“We are in for a global crisis, a global war against this virus,” he says. “This is the time to focus on the enemy. The enemy here is coronavirus. What we ought to do is express global solidarity.”

Unique response

Africa has responded in a unique manner, formulating a response at the continental level, he says. Eight days after the first reported case in Africa, the head of the African Union Commission summoned all health ministers to an emergency meeting in Addis Ababa where they agreed on the joint strategy of coordination, collaboration and communication.

Many African governments acted quickly to shut down borders and implement lockdowns. Some countries, like Niger and Lesotho, had implemented a lockdown even before any cases were confirmed, which stood in stark contrast to other responses around the world.

“African leaders have not underestimated the enemy,” Nkengasong says. “We must recognise that this is a deadly virus. Countries which have underestimated the virus will pay the price.”

Nevertheless, Africa has around 25,000 cases at time of writing and the increases show no signs of stopping.

It remains to be seen whether Africa will be spared the devastation witnessed in Europe and North America as a result of the extraordinary measures put in place. The fact that there is only around six months of Covid-19 data makes any conclusive judgements difficult.

Indeed, it is unclear why West Africa and North Africa seem to be worse hit then East Africa, Central Africa and Southern Africa (excluding South Africa). Such questions will need to be answered by conclusive studies when the pandemic is over, Nkengasong says.

One thing that can be determined is the importance of best practice. By combining Africa’s most rigorous testing and tracing regime with a total lockdown, South Africa has managed to reduce the daily growth of cases from 31% to just 5% at the time of writing.

This example of “flattening the curve” should be mirrored across the continent, he says.

Yet if Africa’s efforts to stop the virus from spreading are not successful, the continent will be in real danger. Africa’s relatively undeveloped health systems are unable to cope with a dramatic increase in cases. Ten African countries are without even a single ventilator which can make the difference between life and death for severely affected patients.

This begs the question of where Africa will secure equipment which is in such high global demand.

“I’ll be honest with you, we have very few ventilators,” Nkengasong says.