Opinion: Here are some of the top priorities for a new Africa CDC chief

The African Union is currently recruiting for the new director general of the Africa Centres for Disease Control and Prevention to replace founding director Dr. John Nkengasong, following his appointment as U.S. global AIDS coordinator and special representative for global health diplomacy. The chatter across the global health community has been whether Africa can find another leader of Nkengasong’s global stature and competence to lead Africa CDC in its next phase and tackle pressing challenges. Having had the privilege of working with many African public health leaders, the talent is there — we just need to find it. Nkengasong positioned Africa CDC as the leading public health institution for the continent. With the backing of political leaders across the continent and the support of the leadership of the AU commission, he gave the continent a unified and respected technically sound and politically astute voice in global health. His leadership of the institution and the continent in response to the ongoing COVID-19 pandemic has been lauded across the globe, and trust in his steering of the institution resulted in the development of many partnerships with global health players and donors. He articulated the now well-known New Public Health Order for Africa — a framework for public health engagement for the continent that calls for investment in public health institutions, workforce, health products including vaccines therapeutics and diagnostics, and trusted partnerships. In September 2022, under the leadership of Africa CDC acting director, Dr. Ahmed Ouma Ogwell, the AU adopted the New Public Health Order, with the inclusion of an additional pillar — increased domestic financing — as an official position for the union. Nkengasong’s parting gift to his successor was to have Africa CDC’s status within the Africa Union elevated to that of an autonomous public health agency, giving it more flexibility and agility to deliver on its mandate to protect the health of the continent’s 1.4 billion people. The incoming director general will need to … invest inward … establishing the organizational culture required to be both an emergency responder and a strategic forward-looking public health agency. --— The published job description and person specification for the director general post clearly outlines the qualifications and experience that applicants should demonstrate to be considered for the job. It is vital the recruitment process gets the balance right, and selects a person who will straddle the space between public health expertise, and political and diplomatic competence. The new director general will have to constructively challenge the power imbalance of the current global health system — made stark by the inequitable response to the ongoing COVID-19 pandemic — to achieve better outcomes for African citizens. Whatever the appointee’s professional credentials as a scientist and public health expert, he or she will need to have a clear understanding of, and ability to influence and navigate through the Africa Union political leadership and commission, and global health politics. They will be tasked with leading Africa CDC through its consolidation phase as it becomes an established autonomous agency, expected to deliver on its early promises and successes. The new director general will face a number of significant challenges including establishing the systems required for an autonomous AU agency that is no longer reliant on AU offices for human resources management, financial systems, and strategic communications. They will have to navigate the fine line of an autonomous agency that remains an AU institution and under its political jurisdiction. A priority for the incoming director general will be to drive forward initiatives to strengthen the African public health ecosystem. Africa CDC’s success will be determined by its support for the development and strengthening of public health systems at national level, increasing the number of countries with functional national public health institutions, or NPHIs, from the current less than a dozen fully established NPHIs. In addition, they will need to accelerate the development and operationalization of Africa CDC’s Regional Collaborating Centers to bring coordination closer to the nation states. Beyond NPHIs, Africa CDC will need to effectively champion the research and academic institutions — public and private — that will develop the scientific evidence and workforce needed to inform public health policy and to deliver on the New Public Health Order for Africa. A particularly sensitive priority for the incoming director general will be to develop the processes for implementation of the AU ambition for an autonomous Africa CDC to have the responsibility to declare public health emergencies of continental security. This will require constructive engagement with the World Health Organization in Geneva, and particularly with WHO’s Regional Office for Africa, a relationship that could currently be described as sensitive. With the ongoing review of the International Health Regulations – IHR 2015 – and the development of the pandemic treaty, it is imperative that both institutions find a way to work together to represent the interests of the continent. Both institutions are needed. As the global financial downturn continues and the COVID-19 pandemic becomes yesterday’s news in some quarters, the generous flow of donor funding that Africa CDC has experienced in recent years, primarily aimed at supporting the COVID-19 pandemic response and broader emergency preparedness and response capabilities, could slow down, with donors requiring greater evidence of impact and long-term sustainability. Africa CDC will need to persuade AU member states to fund it better and to invest in their own national public health institutions. The incoming director general will need to look beyond their organization to strengthen the public health system on the continent. They will also need to invest inward, recruiting a larger skilled workforce, upskilling the existing workforce, and establishing the organizational culture required to be both an emergency responder and a strategic forward-looking public health agency. It’s a tough job but the right person is out there and given the right recruitment process, I am confident they will be found.