Nkengasong's bittersweet departure from Africa CDC

United States President Joe Biden is reportedly nominating Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, to head the U.S. President’s Emergency Plan for AIDS Relief, a $7 billion operation. The U.S. government initiative has been without a permanent leader since February 2020. The Cameroonian virologist would be the first person from the African continent to head the program.

This would be a homecoming, in one sense, for Nkengasong, who was one of the founding leaders of PEPFAR, which launched in 2003. He left the U.S. in 2016 when he was appointed to serve as the founding director of the Africa CDC.

The New York Times reported the nomination late Tuesday, citing “several sources familiar with the matter,” saying Biden is expected to announce the nomination in the coming days.

He would be taking the helm at PEPFAR during a critical time. A report out this week on the United Kingdom aid cuts said the "world is sleepwalking towards a new AIDS emergency and says that urgent action is needed to get the HIV response back on track."

‘An excellent choice’

Many members of the health community rejoiced at the news.

Winnie Byanyima, executive director of UNAIDS, tweeted: "Thrilled! An excellent choice. A long time leader in fighting #AIDS and great collaborator."  

Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition described Nkengasong as “someone who is accomplished and trusted in the global North and South” and “exactly what PEPFAR and the world need right now.”

“He is the connective tissue that can realize the needs of the people PEPFAR is meant to serve, with experience and action to accomplish the huge challenge ahead: to maintain the urgency and impact in ending the AIDS pandemic, to respond to COVID-19, and to build sustainable health infrastructure for the long-term," he said.

PEPFAR has a tradition of meaningfully engaging with civil society, and this appointment is seen as a continuation of this collaboration, said Tian Johnson, founder of NGO African Alliance for HIV Prevention.

"We will support him to gain a deeper and urgent appreciation of the critical role of Civil Society in the AIDS response and reflect on the many historical successes of PEPFAR that were achieved as a result of accountability, respect, and meaningful engagement with Civil Society," he said.

At PEPFAR, Nkengasong would "no doubt bring his Africa experience to ensure greater equity and health justice for our continent and for all around the world," said Dr. Ayoade Olatunbosun-Alakija, co-chair of the African Union’s African Vaccine Delivery Alliance, in an email to Devex.

She added that this appointment is strategic in that it addresses "agitation from so many of us for high level global health leadership positions for those from [low-income countries] who understand and can therefore navigate the complexities and unique challenges faced by those most in need from the Global South.”

“We’re happy to see the world beginning to respond to decolonisation and the unequal balance of power in global leadership,” she said.

A leader in responding to both HIV and COVID-19

Nkengasong is an innovator in the field of HIV. In the 1990s, he built in Côte d'Ivoire, at the field station of the U.S. Centers for Disease Control and Prevention, one of the most sophisticated HIV labs in sub-Saharan Africa.

This was one of the first laboratories in Africa to culture the HIV virus and to map out its genetic subtypes extensively. It also led to the efforts to start describing antimicrobial resistance to HIV treatment and examined strategies for reducing the transmission of HIV from mother to infant. Côte d'Ivoire was one of the first African nations to pilot the rollout of HIV drugs under his leadership.

He then went on to work for PEPFAR, working to develop its laboratory program to strengthen laboratory capacity across Africa. His program was the largest and most funded program within the U.S. CDC’s HIV division.

He left PEPFAR to serve as the founding director of Africa CDC. The agency rose to prominence during the pandemic as a highly trusted institution working to coordinate the continent’s COVID-19 response.

This included bringing COVID-19 diagnostic tools to countries when there was none, setting up a network of labs to expand genomic sequencing, creating a pooled procurement platform for the purchase of vaccines, and deploying community health workers and other responders to countries in need.

His leadership has earned him numerous accolades, such as making Time magazine’s list of the 100 most influential people of this year, which referred to him as a modern-day hero.

Africa CDC’s fate

While offering their congratulations to both Nkengasong and PEPFAR, some expressed concerns about the transition in leadership amid a pandemic. Nkengasong has been a tireless advocate for vaccine equity across the continent, which has fully vaccinated only less than 4% of the population.

Peter Kamalingin, director of Oxfam International's Pan Africa Programme, told Devex this move would be great for Nkengasong, and PEPFAR is an important player in providing access to medicines across the African continent.

But he said Nkengasong offered critical leadership not just on vaccine equity, but on the importance of investing in the long-term health security of countries across the continent. Kamalingin expressed concern that there could be a loss in momentum in these fights if Nkengasong leaves, as the African Union leadership works to replace him.

“I think that it is going to be a challenge now, for us at this point in time, in the middle of the raging pandemic, for Africa — the stakeholders, the AU, and the member states to quickly, secure, strong leadership, a strong successor, not only to maintain, but actually to expand that momentum, that initiative, that leadership that Dr. Nkengasong was providing,” he said.

Nkengasong’s leadership through these uncharted waters during the pandemic has been “very inspirational,” he said, adding that it will be important for the African Union to quickly find a successor with the important combination of skill sets that Nkengasong has — both technical capacity and passion.

“He was shifting the conversation. He was rallying the continent and the member states,” he said. “As we celebrate the move of Dr. Nkengasong to PEPFAR, we must quickly make sure that we don't have a gap in leadership."

While the Africa CDC will no doubt be "severely impacted" by Nkengasong's departure, one person does not make an institution, Olatunbosun-Alakija said.

“This is a good day for Africa. It’s paradoxical but our loss is PEPFAR’s gain, and his promotion and recognition is past due,” she wrote to Devex.

"It would be unfair to place the fate of Africa CDC on John’s shoulders. He has set the agency on course and brought the visibility and profile needed to show that Africa CAN," she said.  

Updated: May 6, 2022: This article has been updated to reflect that PEPFAR has been without a permanent leader since February 2020.