Opinion: Africa, it’s time to take charge of our health agenda

For decades, to be African meant to be underprivileged, overlooked and subdued by the powers that be. While the “Africans Rising” narrative that began to take shape in the early- to mid-2000s introduced the world to a different version of the continent, one characterized by hope, political stability and equitable economic growth and development, the reality is that while a lot may have changed, much remains the same — including in the field of global health.

Just recently, UNAIDS Executive Director Winnie Byanyima tweeted about her experience at the Geneva Airport on her way to attend the International AIDS Conference in Canada. Not only were her documents scrutinized repeatedly but also Byanyima was almost denied permission to board her flight. “I board last,” she wrote, calling her treatment “Unjust, racist!”

Hers is not an isolated case. Numerous nonwhite delegates were denied access to the AIDS conference by having their visa applications delayed or rejected, perpetuating the cycle of conference inequity that bars individuals from the global south from meaningful participation in discussions that — ironically — often focus on global health issues affecting populations in low- and middle-income countries.

Passport and visa privilege in global health is real, but it is just one small example of the neocolonial patterns that persist in the field.

A recent Devex article on the World Health Organization’s position against the autonomy of the Africa Centres for Disease Control and Prevention is another example of the reality of global health inequity.

While Africa CDC has now received the greenlight to begin the transition from a specialized technical institution of the African Union to an independent public health agency by the end of this year, WHO had at the time argued that empowering Africa CDC to declare regional health emergencies was an unprecedented arrangement that could result in confusion among countries and lead to duplication of roles between WHO and Africa CDC.

Many groups that advocate for greater global south representation argue that this position reflects the belief that Africa is not ready — or capable of — taking charge of its own health agenda. At worst, they say it smacks of the kind of patronization and status quo that Africa and the rest of the global south must reject.

It is in part because of this status quo that 20.5% of Africa’s population is fully vaccinated against COVID-19, significantly lower than the global average of about 64%. It is because of the same status quo that WHO only recently declared the monkeypox outbreak a public health emergency of international concern, yet African countries have been containing outbreaks of the disease since 1970.

It is no coincidence that despite recording over 2,100 monkeypox cases and 75 deaths in 11 countries, Africa still does not have a single dose of the monkeypox vaccine, which WHO stockpiled and only mobilized in response to the outbreaks in Europe and North America. The tools to detect and prevent the outbreak have been available — just not to Africa.

For too long, African countries’ efforts to take charge of our own health agenda have been curtailed, either by factors beyond our control or by self-sabotage through poor governance and lack of accountability. As a result, we have been reminded time and again that our lives are not as valuable as the lives of citizens from wealthier regions, but we have a chance to write our own narrative.

We surprised the world with our quick response to mitigating the impact of COVID-19. And now, our unprecedented cooperation through the leadership of the African Union, its agencies and member states are marking a new era of collaboration and African unity as exemplified by increased autonomy for Africa CDC, the planned creation of the African Pandemic Preparedness and Response Authority, or APPRA, and setting up of the African Medicines Agency — a specialized health agency of the AU tasked with improving regulatory harmonization of medicines.

These are all significant milestones in Africa’s journey toward achieving a “New Public Health Order” for the continent, which calls for regional collaboration to bolster African manufacturing capacity for vaccines, diagnostics and therapeutics; strengthening public health institutions; expanding the public health workforce; and engagement with the private sector and other partners.

The tide is turning, and we are on the cusp of change. Africa, it is time to claim the seat we have historically been denied at the global health decision-making table. The decisions we make as a continent today will either deliver us from the litany of woes that have been visited upon our people for decades, or resign us to the tyranny of false promises, empty slogans, and indignity that will surely follow if we sit back and accept the status quo.