Preparing for the next pandemic: A conversation with Africa CDC Director John Nkengasong

Initial dire predictions around the spread of the deadly COVID-19 pandemic in sub-Saharan Africa have not come to pass. The fragility of many of Africa’s health systems—including underfunded hospitals, low doctor-to-patient ratios, high disease burdens, and gaps in access to vital pharmaceuticals and medical supplies such as ventilators—at first portended devastating outcomes for Africa’s citizens.

To discuss the measures African leadership has taken to respond to the health implications of COVID-19 and how the continent can be better prepared for the next pandemic, on February 12, the Brookings Africa Growth Initiative hosted Africa Centres for Disease Control and Prevention (Africa CDC) Director Dr. John Nkengasong for a conversation. Vice President and Director of the Global Economy and Development Program Brahima Sangafowa Coulibaly gave opening remarks. Africa Growth Initiative Director and Senior Fellow Aloysius Uche Ordu moderated the conversation.

In his opening remarks, Coulibaly highlighted Africa’s vulnerabilities to COVID-19—especially lingering gaps in access to care (including medical staff and supplies) and low levels of human development. Contrary to many experts’ alarming predictions for the continent, he noted, Africa was not hit as hard as other regions of the world, partly due to efforts at the continental, national, and even individual levels of citizens who responded expeditiously to the lockdown and other measures. For more on the collective role of individuals in stemming the pandemic in Africa, see the Foresight Africa 2021 Chapter 6 essay, “Institutional resources for overcoming Africa’s COVID-19 crisis and enhancing prospects for post-pandemic reconstruction.”

After Coulibaly’s remarks, Nkengasong, a leading virologist with nearly 30 years of experience in public health, reflected on the region’s unique challenges and successes around the COVID-19 pandemic. He emphasized that unity among high-level political leadership paired with effective coordination across the continent were instrumental in mitigating the COVID-19 crisis. He added that clarity of action among ministers of health, adherence to the lockdown at the national level, and science-based public health messaging have also guided the continent’s successful response so far: “There were absolutely no opposing forces between politics and public health. Public health was allowed to guide the response,” he said.

Nkengasong and Ordu then explored many of the successes in the African response, including Africa CDC’s African Medical Supplies Platform and partnership with Swiss pharmaceutical company Novartis to facilitate rapid and affordable access to COVID-related supplies across African Union member states.

Further exploring the continent’s shared response, Nkengasong and Ordu discussed the African Union Commission’s COVID-19 Response Fund, which pools resources from African countries to finance pandemic response measures, as well as the Partnership to Accelerate COVID Testing (PACT) Initiative’s with Africa CDC to test over 20 million people. Emerging technological innovations such as the Africa Pathogen Genomics Initiative and the ability to increase genomic sequencing have allowed Africa CDC to begin understanding and combating emerging variants of COVID-19. Despite emerging inequity in vaccine distribution, Nkengasong highlighted that the African Vaccine Physician Taskforce has secured over 300 million doses of vaccine through the global COVAX effort. (For more on the rollout of vaccines in Africa, see Uwagbale Edward-Ekpu’s Foresight Africa 2021 viewpoint, “Navigating the complexities around a COVID vaccine in Africa.”)

Of course, the pandemic is not over: Variants continue to emerge and spread, vaccine rollouts in the developing world face a myriad of challenges, and cases and deaths continue to spike.   To combat these challenges, Nkengasong called for a new public health order in Africa, based on four key tenets. (For details on this new order, see Nkengasong’s Foresight Africa 2021 essay.)

First, he stressed that African leadership must strengthen the continent’s public health agencies and recognize that disease is not just a health threat—it is also an economic and security threat. To effectively combat disease, Africa must prioritize its local manufacturing capacity to produce medications, vaccines, and diagnostics, he said.

Second, Nkengasong advocated for investing in a well-trained, well-prepared public health workforce. While Africa currently has 1,900 epidemiologists on the continent, 6,000 are needed to effectively respond to COVID-19 and future pandemics, he explained.

Moreover, he argued, essential to strong public health agencies, local development of medicine and medical equipment, and an effective medical workforce is the ability to domestically finance efforts to combat health threats rather than rely on outside support. He and Ordu agreed that domestic resource mobilization must be central to that response. Moreover, as global inequity in COVID-19 vaccine distribution becomes more apparent, self-reliance has become a critical priority for Africa. Nkengasong called attention to the disparities between population share and vaccine doses purchased for low- and middle-income countries.  He stressed the importance of increased global collaboration on vaccine distribution because the threat of COVID-19 cannot be fully eliminated if only certain countries receive enough vaccines.

Nkengasong ended the conversation by stressing that innovation, solidarity of African leadership, and resilience of African citizens will be important moving forward in combating the COVID-19 pandemic. He shared his vision for Africa in 2030, which includes a strong network of public health institutions, multiple vaccine manufacturers, and substantial contributions from member states’ budgets to health security programs.

For more on all the different roles national public health institutions play in securing better public health outcomes, see Nigerian CDC Director-General Chikwe Ihekweazu’s Foresight Africa 2021 viewpoint, “Investing in national public health institutes for future pandemics: Lessons from Nigeria.”