How a continental approach helped Africa’s pandemic response

When the COVID-19 pandemic hit, the Africa Centres for Disease Control and Prevention was in its infancy. The crisis forced the agency to run before it fully began to walk, and experts say it has done so successfully — skillfully navigating the uncharted waters with limited resources. “It rose to the occasion. It became the sounding board for the heads of states … to be a thought leader in these times of need,” said John Mwangi, co-chair of the Africa Regulatory Network. While having a continental coordinating body didn’t prevent the failures of the international system — only about 4% of the population across the African continent is fully vaccinated for COVID-19 — experts told Devex the continent would have been much worse off without the Africa CDC. “It has come to serve its purpose during COVID-19,” said Dr. Margaret Agama-Anyetei, acting director of health and humanitarian affairs directorate at the African Union Commission. “Without Africa CDC leading, brokering, engaging, and supporting member states, I don't think the continent would have perhaps survived COVID to the extent it already has.” With its founding director now potentially departing the agency to head the United States’ global efforts on HIV/AIDS, even as the pandemic continues, there are questions about how the agency adapts going forward. Born from crisis The institution was born out of the massive West Africa Ebola outbreak between 2014 and 2016 that took over two and a half years to contain and resulted in over 11,300 deaths. That emergency response was disjointed, with countries tackling the outbreaks within borders independently. “If you really want to appreciate the Africa CDC, you have to look at what wasn't there during the Ebola crisis,” Agama-Anyetei said. Had the Africa CDC existed at that time, it likely would have rapidly deployed front-line responders and countries wouldn’t have scrambled to create their own proposals on how to respond, said Lolem Ngong, chief of staff at Amref Health Africa. In the wake of the crisis, African heads of state called for the creation of a new continental body to prevent that devastation from occurring again. Africa CDC was established in January 2016 and officially launched in Addis Ababa, Ethiopia, in 2017. Dr. John Nkengasong, a virologist from Cameroon with decades of public health experience, particularly in HIV, was placed at the helm. In this role, he advocates for a paradigm shift in how public health is managed, describing it as a “new public health order.” The agency is structured in a horizontal way, without divisions working on specific diseases to avoid the silos long existing in public health, Nkengasong said. Instead, there are divisions focused on broad areas such as disease surveillance and intelligence; laboratory systems and networks; information systems; and disease control that broadly target noncommunicable diseases, infectious diseases, endemic disease, research, and national public health institutes. “Regionalizing and strengthening regional public health agencies ... will actually take center stage in the lessons that we have learned from this pandemic.” --— Dr. John Nkengasong, head, Africa Centres for Disease Control and Prevention A continental response When the pandemic hit, laboratories across the continent didn’t have test kits. The Africa CDC organized the first sets of training. At that time, much of the medical equipment needed to confront the pandemic, such as personal protective gear, was in scarce supply. Africa CDC and its partners, including Strive Masiyiwa, a businessman and AU special envoy, African Export-Import Bank, and the United Nations Economic Commission for Africa, created the Africa Medical Supplies Platform, or AMSP, an online platform to connect medical commodity supplies with medical providers. In April 2020, the agency launched the PACT strategy, which had elements such as pooled procurement of diagnostics and the establishment of warehousing and distribution hubs. It launched the COVID-19 Response Fund to help finance the continental response, and deployed community health workers and epidemiologists to countries across the continent. It also helped countries build up the capacity to track variants of the coronavirus through a network of labs that can sequence genomes. Together with the same partners that established the AMSP, under the leadership of South African President Cyril Ramaphosa, who was then the chair of the AU, the African Vaccine Acquisition Trust was established as a vehicle for the AU to purchase vaccines. It brokered a deal with Johnson & Johnson for 400 million COVID-19 vaccine doses for African countries to purchase. Africa CDC also launched the Partnership for Vaccine Manufacturing, which aims to boost the production of vaccines in Africa. And throughout the pandemic, the Africa CDC has issued guidance to countries. “This dissemination of standards, guidelines, and strategies … That is really, probably, for me, one of the most important things that Africa CDC has done because I can't imagine where the continent would have gotten that unified leadership during the pandemic. You would have had 55 countries doing completely different things,” Ngong said. “When you look at the guidelines that they put out, they very, very, very much speak to the African context. And I think that's why people are more likely to listen to the guidance that comes from Africa CDC than any other entity,” she added. One of the other strengths of Africa CDC, according to Ngong, is the convening power it has to bring together African heads of state, ministers, and other partners to discuss health and create actionable plans. “It’s a testament to their ability to know who the right key players are within AU member states and being able to bring them to the table,” she said. It’s also been successful in partnering with the private sector. It announced a $1.3 billion partnership with the Mastercard Foundation in June and a $25 million vaccination deal with mobile network provider MTN in January, for example. “It is recognized as a credible institution to do business with,” Agama-Anyetei said. “Without Africa CDC leading, brokering, engaging, and supporting member states, I don't think the continent would have perhaps survived COVID to the extent it already has.” --— Dr. Margaret Agama-Anyetei, acting director of health and humanitarian affairs directorate, African Union Commission Strengthening health security As the agency looks forward, it is expected to undergo its first major structural transition, as U.S. President Joe Biden intends to nominate Nkengasong to head the U.S. President’s Emergency Plan for AIDS Relief. Nkengasong’s leadership of Africa CDC is seen by many as playing an instrumental role in the agency’s successes to date. “Dr. Nkengasong really has been behind the structure of Africa CDC from the very beginning. So, it is his leadership that really informs the structure,” Ngong said, adding that he has a “very inclusive style of leadership,” which makes others outside the agency invested in its success. When asked about a possible transition, Nkengasong said Africa CDC has a “very strong leadership team” to carry forward the agency’s vision in his absence. The agency is also working to decentralize. It is building up regional offices in Gabon, Nigeria, Egypt, Kenya, and Zambia. Nkengasong said one of the challenges the young agency faced during the pandemic was reaching out to all 55 member states, almost simultaneously, and receiving an influx of requests. Africa CDC doesn’t have country-level offices, by design, so the agency can help strengthen national public institutes, not duplicate them, he said. “That, of course, was a challenge and a drawback during this pandemic. But I believe that it is the right thing to do — that we continue to strengthen national public health institutes,” he said. And when all is said and done, just as the West Africa Ebola crisis prompted a moment of reflection, Nkengasong hopes the world will take the opportunity to “sit back and review our health security apparatus.” “Regionalizing and strengthening regional public health agencies ... will actually take center stage in the lessons that we have learned from this pandemic,” he said.