When Dr. John Nkengasong took the job as the first head of Africa’s new Centers for Disease Control in 2017, part of the continent had just come out of a devastating Ebola outbreak. Less than three years later, Covid-19 struck.
dr. Nkengasong is now trying to bring together the governments of a vast, diverse continent to anticipate and fight threats to public health and make them less dependent on international institutions such as the World Health Organization or the Red Cross. He has helped Africa speak with one voice, especially on what he calls “vaccine famine,” where rich countries buy up millions of doses they don’t need while Africa falls short.
Perhaps Ebola was a signal that something bigger was on the way, he says, and that something turned out to be Covid-19. He also thinks Covid-19 could be a harbinger of something worse to come: a virus as contagious as the Delta strain, but with the high death rate from Ebola.
The Africa CDC was created in response to the Ebola outbreak, with funding from the African Union and some other donors. When Dr. Nkengasong arrived, for months there was no office, no staff, and at one point, no internet at all; the Ethiopian government had shut it down to prevent people from cheating on university entrance exams.
But, he says, “We can put public health under the tree. It doesn’t really matter. It’s about the concepts. Are you committed to solving inequality and health security problems?”
(This conversation has been edited and shortened for clarity.)
What was it like when Covid-19 first hit the continent?
In December 2019 I was on leave and we heard stories about the virus in Wuhan. I called Addis Ababa and said, “Activate our Emergency Operations Center.” I was initially given a push from my own staff. They said, “Well, this is happening in the distance. We have Ebola in North Kivu.” They said, “We’re too busy already.” I said, “Please, just do it, ’cause I know this will come.”
The continent started well. We had positioned ourselves. We scribbled. We have trained people. It will sound ridiculous, but in the first training sessions we did in South Africa and Senegal, everyone went home with a pack of 100 tests.
How are you now? And how do you see the future trajectory of the virus in Africa?
In the event of a disaster, your house is on fire. You run around, you call 911, they come to sprinkle water. That phase is over. We are now in a phase where your house burns down. How to build a new house?
I think this virus is winning. As a continent we don’t win. Today we have more than seven million cases with nearly 180,000 deaths. And death rates are all rising very dramatically across the continent. The vaccination rate is very, very low. We are fully vaccinated with about 2.5 percent of the population, and this is a continent of 1.2 billion people.
What about vaccines for African countries? Will Covax – the alliance backed by the United Nations – come through as promised?
The story of access to vaccines and the role Covax should play is what I call a moral tragedy.
The intent and design was perfect, excellent, but the execution – even the people who run Covax will admit it didn’t deliver on its promise.
The countries financing Covax, or committed financing, were developed countries. So they promised. Not sure if they gave money per se. But then they bought the vaccines, all the vaccines. So even with the money Covax had, there was nowhere to get a vaccine.
We don’t say, donate to us. do not donate we do the vaccines. We’re just saying, let Africa come forward with their 400 million doses of vaccines – what they paid for! By just swapping the order in which we line up for vaccine deliveries, I think you can start solving a lot of the problems.
What is the state of public health infrastructure in Africa?
Governments have not invested enough in their own public health needs.
The entire architecture – public health architecture and health security architecture – has been designed since the Second World War in such a way that a great deal of dependence, Africa, on the outside world has arisen.
Africa has about three million health workers. That’s almost nothing. So you can clearly see the negligence. And our health security architecture was designed when Africa’s population was less than 300 million. Today, where are we? We are 1.2 billion people and aim to go to 2.5 or 2.4 billion in the next 30 years.
No people will survive importing 99 percent of their vaccines and importing 100 percent of their diagnostics. There is no point. We need 6,000 epidemiologists. We currently only have about 1,900 on the continent.
Do people hesitate to get vaccinated?
It still has to be a battle won or lost at the community level. Misinformation remains a serious problem.
But when I look at the trends, what’s happening on the continent, I’m very encouraged. I was in Morocco and in the Tangier sports stadium there were long lines of young people. When I approached them, I thought there was a football game going on, but it was people who registered online to get the vaccine. We have seen similar scenarios in Kigali, in Nairobi.
So hesitation about vaccines is no longer the problem. Vaccine starvation is now the real challenge, not vaccine hesitation.
What is your goal for vaccinations in Africa by the end of 2021?
By the end of the year it should be at least 25 to 30 percent. But that would depend on many factors. Are countries that have secured vaccines ready to release those vaccines?
At the pace that we are doing, we are very consciously moving towards endemism of this virus on the continent, there is no doubt about it. Now it’s concentrated in major cities, but it’s going to spread to remote areas quickly, and it’s going to be very, very hard to wash away.
You worked for the US Centers for Disease Control for many years. What was it like going back to Africa?
I grew up in Cameroon. You go away and you think you’re going to go back, and then life takes you from one part of the world to another and you just carry on.
Understanding Vaccine and Mask Mandates in the US
- Vaccine Rules. On August 23, the Food and Drug Administration gave full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and older, paving the way for an increase in mandates in both the public and private sectors. Private companies increasingly require vaccines for employees. Such mandates are: legally permitted and have been confirmed in legal proceedings.
- Mask Rules. The Centers for Disease Control and Prevention recommended in July that all Americans, regardless of vaccination status, wear masks in indoor public places in areas with outbreaks, a reversal of the guidance it offered in May. Find out where CDC guidelines apply and where states have their own masking policies. The battle over masks has become controversial in some states, with some local leaders defying state bans.
- College and universities. More than 400 colleges and universities are demanding that students be vaccinated against Covid-19. Nearly all of them are in states that voted for President Biden.
- schools. Both California and New York City have introduced vaccine mandates for educators. A survey published in August found that many U.S. parents of school-aged children are opposed to mandatory vaccines for students, but were more in favor of mask mandates for students, teachers and staff who have not received their injections.
- Hospitals and Medical Centers. Many hospitals and major health systems require workers to receive a Covid-19 vaccine, citing the increasing caseload fueled by the Delta variant and persistently low vaccination coverage in their communities, even within their workforce.
- New York City. Evidence of vaccination is required from employees and customers for indoor meals, gyms, performances and other indoor situations, although enforcement will not begin until September 13. Teachers and other education workers in the city’s vast school system must have at least one vaccine dose by Sept. 27, without the option of weekly testing. City hospital employees should also receive a vaccine or be tested weekly. Similar rules apply to employees in New York State.
- At the federal level. The Pentagon announced it would aim to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “by mid-September.” President Biden announced that all civilian federal employees would be required to be vaccinated against the coronavirus or undergo regular testing, social distancing, mask requirements and restrictions on most travel.
I remember when I took the job, my coworkers said, ‘John, are you maybe going through a midlife crisis? Why would you leave Atlanta and quit your job and start something you really don’t know about?” But it was in me that I had to do that.
I had no office for almost a year. I had a big name as a director, but there was no place to sit and work.
Has it been easy? Not at all.
The moment you say you have a CDC, the expectations are very high. Borrowing a name from a reputable CDC like the USCDC in particular put a lot of pressure and expectation on our shoulders very, very early on.
Should public health in Africa be decolonized?
Shirley Chisholm said if they don’t give you a seat around the table go there with a folded chair. Do not ask permission to do what you are entitled to.
Imagine, at the end of this year, the first public health conference in Africa will be hosted by Africa CDC.
Why is that important? It provides a platform for African public health experts to interact, share experiences and learn from each other.
Second, is that we invest in our own public health schools and believe in our own public health schools.
Learning a lesson is what Africa is currently doing; we don’t have vaccines, we have to produce vaccines.
If we continue on this journey, driven by a new public health order, when the next pandemic hits, we will fight it very, very differently.