Nkengasong eyes big job at PEPFAR, but Africa CDC may miss him

Just how will the Africa Centres for Disease Control (Africa CDC) run after its famed leader John Nkengasong leaves? The answer may not be apparent, but the Cameroonian-American virologist, who has recently become the face of Africa’s campaign for vaccine equity, could be departing the organisation soon.

On Monday, US President Joe Biden nominated Dr Nkengasong as the next ambassador-at-large and coordinator of the US government activities to combat HIV/Aids globally. He will, once approved, oversee the massive $7 billion programme known as the US President’s Plan for Aids Relief (PEPFAR).

As the largest ever programme dedicated to fighting the Aids pandemic, PEPFAR has been the US government’s focal point for supplying HIV management drugs to poor countries, most of which are in Africa, as well as coordinating awareness campaigns meant to help save lives.

No definitive leader

But PEPFAR has been controversial too, having no definitive leader since February when Deborah Leah Birx left the post, and sometimes accused of having no local feel in areas it has operated in despite pumping nearly $90 billion into programmes since 2003, when it was launched under President George W. Bush.

It has been under the leadership of Dr Angeli Achrekar, who has been the acting US Global Aids coordinator.

In 2017, under President Donald Trump, PEPFAR irked activists after ‘narrowing’ down the focus of areas it would increase budgetary allocations for Aids programmes. Trump had decided to slash its overall budget, demanding a more focused approach.

Various countries across Africa and other poor regions were picked from the crowd as being in need of the most urgent attention. Activists argued the move risked derailing successes elsewhere.

When talk of the nomination of Dr Nkengasong first emerged last week, activists said they were ready for someone who has a deeper understanding of Africa’s health woes. Winnie Byanyima, the Ugandan diplomat who heads the UNAids programme, said it was an “excellent choice”.

“A long-time leader in fighting Aids and great collaborator,” she said of the man who, incidentally, had been among the founding bureaucrats of PEPFAR. Dr Nkengasong had been co-chair of PEPFAR’s Laboratory Technical Working Group.

Crucial voice

“He is a crucial voice for global health equity at a time when decisive action is needed to shore up HIV services and tackle Covid-19 around the world,” said Chris Collins, president and CEO of Friends of the Global Fight Against Aids, Tuberculosis and Malaria, a non-profit organisation that campaigns for transparent programmes to manage these diseases.

“The Biden administration’s intention to nominate Dr Nkengasong demonstrates its commitment to a strong and effective PEPFAR programme, focused on accelerated progress against the HIV epidemic.”

In particular, the virologist is seen as a man who understands how effective responses to pandemics can save lives. Collins argued the approach for HIV/Aids must be seen in terms of human rights and prioritising those who have been marginalised or discriminated against.

New brains needed

Since 2003, PEPFAR has assisted about 18 million people in 50 countries to cope with HIV/Aids. Activists say the programme needed new brains to deal with upcoming challenges, as witnessed under both the Trump administration and in times of other pandemics like Covid-19.

“John is exceptionally well qualified to confront those challenges, including increasing PEPFAR’s impact in the face of Covid-19 and building a foundation for pandemic preparedness and global health equity,” said Mitchell Warren, the executive director for AVAC, the Global Vaccine Alliance.

“He is a highly accomplished scientist and administrator, known and respected in both the global North and South, with a strong commitment to global health equity,” he said.

More collaboration with Africa

The African Union has not yet commented on the nomination, but some AU officials told the Nation that they hoped he brings the much needed collaboration between US and African health practitioners on the Aids project.

PEPFAR, activists say, must work with local governments and partners, rather than impose its policies on recipients of its aid. Dr Nkengasong, Mr Warren argued, brings his important knowledge of Africa and contacts to help PEPFAR retune its programmes.

Dr Nkengasong has been director of the Africa CDC since 2017, when the continental body decided to establish its own scientific institution to predict, plan and deal with emerging infectious diseases.

It was part of lessons learnt after the deadly Ebola epidemic in West Africa that killed more than 11,300 people between 2013 and 2016 in Guinea, Sierra Leone and Liberia.

Vaccine equity

In times of Covid-19, Dr Nkengasong has been vocal in demanding vaccine equity. He has been serving as one of the special envoys for the World Health Organization. Last week, he lampooned the UK for discrediting vaccine certificates issued by African countries to those vaccinated, ironically from jabs partly donated by the UK.

“This message doesn't really speak to solidarity and cooperation that we all believe are the cornerstone and ingredients for us to emerge from this pandemic together,” Dr Nkengasong said of the UK's red-listing of Africa, warning it could discourage people from taking vaccines.

Dr Nkengasong has more than three decades of experience in virology and infectious disease control. He was acting deputy director at the Center for Global Health of the US Centres for Disease Control and Prevention.

He had also served as the chief of the International Laboratory Branch, Division of Global HIV/Aids and Tuberculosis at the CDC, and associate director for laboratory science at the same US agency.

If confirmed by Congress, Dr Nkengasong will be the first person of African origin to hold the position. But it could now leave the Africa CDC with big shoes to fill.

Dr Nkengasong’s deputy at the Africa CDC is a Kenyan, Dr Ahmed Ezra Ogwell Ouma, who earlier this year ran for the post of AU commissioner of health, humanitarian affairs and social development. But the election for this post was postponed.