The Ebola outbreak in West Africa ended officially in June 2016. In January 2017, John Nkengasong began work as head of Africa’s new Centres for Disease Control (CDC).
“These kinds of agencies, the CDCs of the world, have always been the product of emergencies,” he said. The World Health Organisation was created in the wake of World War II. The United States CDC was formed in response to a malaria epidemic in 1947. That devastating Ebola outbreak, in which 11 323 people were killed — mainly in Guinea, Liberia and Sierra Leone — convinced African leaders that they needed their own public organisation to keep track of infectious diseases, and figure out how to contain them.
Now, as the world confronts the Covid-19 pandemic, that decision is paying off. “It’s the one thing people talk about as the major benefit of the Ebola outbreak,” said Nkengasong, a Cameroonian biologist with decades of public health experience.
He has spent most of his career at the CDC in the US, specialising in virology. Moving to Addis Ababa to take up his new job was initially something of a shock. At that stage, the Africa CDC was little more than an African Union resolution, and it was his job to build it, from the foundations up. He was in the job for only five months before the next crisis hit: another Ebola outbreak, this time in eastern part of the Democratic Republic of Congo (DRC). “I didn’t even have an office yet,” Nkengasong said.
Looking back, the new Ebola outbreak was a catalyst, forcing the Africa CDC to grow at speed. “We’ve come a long way, and quickly. We have responded to over 17 outbreaks in more than 15 African countries,” he said.
The Africa CDC’s largest response has been in the DRC, where 60-odd people are stationed to assist the government.
But there is no doubt that the novel coronavirus is the greatest test that this young institution has faced. Nkengasong is proud of its response.
He has barely slept for the past few months — “I’ve lost count of whether it’s a weekend or a work day” — and neither have his staff.
The Africa CDC identified the threat early. In the first week of February, it warned health ministers that this was serious, and identified a crucial weakness: only Senegal and South Africa had capacity to test for Covid-19, but neither of them had the reagents necessary to conduct the test. A training session in Dakar was hastily arranged, with medical professionals brought in from across the continent. Another one was held in Johannesburg a week later. By the end of the month, 43 African countries could test for Covid-19. “People don’t know the heroic effort that we did in three weeks,” said Nkengasong.
But there is still so much to be done. At the time of this interview, Nkengasong was preparing to brief the AU’s Peace and Security Council, hoping to persuade them to make more airlift capacity available to move supplies around the continent. “Quite honestly we cannot be complacent. We know that any region or country that has been complacent has had it very bad — the UK [United Kingdom], the French, the Italians.”
The Africa CDC is part of the AU system, which brings some major advantages, most notably that African leaders are more likely to take advice from their own experts. “[Heads of state] have reiterated that this response has to be African-led and African-owned,” said Nkengasong. “They are convinced they have an agency that is advising them properly.”
Although he is too diplomatic to mention it, sources in the Africa CDC suggested that this brings its frustrations, too; the agency cannot always move as swiftly as it would like to as major decisions need political buy-in, which can be slow and complex to obtain.
Nkengasong said this has not hindered Africa’s coronavirus response. “I think there’s a common understanding that this is a serious threat. It’s not been a difficult sell to the heads of state. It’s painful, of course.”
Nkengasong thinks that most African countries have responded well so far, but stresses that there is a long way still to go, and that the continent’s experience is likely to be different to that of other parts of the world, although it is too early to say whether that means better or worse. “There are many unknowns that make me extremely worried.”