What role will Africa CDC play in an ‘America First’ global health vision?

The U.S. State Department’s new “America First” global health strategy prioritizes direct agreements with country governments, the private sector, and faith-based organizations over working with multilateral organizations and nongovernmental organizations. Its release last week raised alarm within the Africa Centres for Disease Control and Prevention, a Pan-African public health organization that has long received U.S. support in areas such as outbreak response, provision of vaccines, and technical assistance. Africa CDC was explicitly mentioned in proposed U.S. legislation that also emphasized a shift to direct country agreements, or “compacts.” The bill noted the Pan-African public health organization couldn’t be a part of these arrangements. In a statement on Monday, Africa CDC’s committee of government leaders noted its concern about the U.S. “putting the AU and all its Organs, including Africa CDC, on the prohibiting list” and that this “carries serious diplomatic consequences.” But it seems their worries were quickly assuaged: an Africa CDC spokesperson told Devex on Wednesday that it has since received further clarification from the U.S. government about its future involvement and now considers “this matter closed.” Still, the situation raises questions about how multilateral global health agencies around the world will fit into the Trump administration’s “America First” focus. Country-to-country relationships This State Department’s “America First” global health strategy notes that while the U.S. “will start with a preference for bilateral relationships, the U.S. government will also engage in multilateral relationships for targeted purposes, such as when there’s not the ability to develop a bilateral relationship with a specific country for the purposes of surveillance.” It noted multilateral engagements will be limited and specific, with a “focus on identifying surveillance capabilities that the United States is not able to obtain through a bilateral relationship alone.” It said the U.S. aims to finalize many of its bilateral agreements with countries by the year’s end, with plans to start implementation next April. Before the release of this strategy, U.S. Rep. Brian Mast, a Republican from Florida who is chair of the House Foreign Affairs committee, introduced a bill that called for the creation of a “global health compact” model that also focused on these relationships between the U.S. government and partner countries. Mast put out a statement that his proposed legislation and the State Department’s strategy “operate in tandem.” The bill notes “a global health compact may not be entered into under this section with any of the following. ... The African Union or any affiliated entity of the African Union, including Africa CDC or affiliated multilateral funds.” A Republican senior aide with the House Foreign Affairs Committee told Devex that the text of the Congressional bill doesn’t prohibit the U.S. from working with Africa CDC in other ways, but says that for these bilateral global health compacts, the Africa CDC and any African Union-affiliated entities cannot be a party. The aide wished to remain anonymous to discuss intricate details. These health compacts are designed to create more efficient relationships with more transparency and accountability, the aide said, adding that one of the issues raised in terms of previous global health foreign aid is that many partner countries weren’t at the negotiating table. “Are we giving partner countries what they are asking from us, and are we getting what we ask in return?” the aide asked. The next step for the bill is a vote in the House of Representatives. If approved, it will then go to the Senate for another vote, and then go to President Donald Trump for his signature. Africa CDC’s role Africa CDC sees its role as crucial to supporting bilateral relationships. In its statement Monday, it called upon the U.S. to “promote collaboration” through regional and continental bodies to “better support the bilateral aspect of the America First Global Health Strategy.” An Africa CDC spokesperson told Devex on Wednesday that the concern by the AU committee of government leaders “was not about the legal scope, but rather about the perception that Africa’s continental public health institution might be excluded or singled out” and that “Africa’s public health agency must never be portrayed as ineligible or suspect.” “In subsequent meetings with senior U.S. government officials, this perception was fully clarified. We were assured — and this was also stated publicly at the launch of the U.S. Global Health Strategy — that the United States remains firmly committed to working with Africa CDC in implementing this strategy,” the spokesperson said. The Pan-African public health agency has reportedly hired Troy Fitrell, former acting U.S. assistant secretary of state for African affairs, as an adviser to help it navigate the changes underway within the Trump administration. Meanwhile, Africa CDC’s Director-General Dr. Jean Kaseya has also made a series of visits to Washington, D.C., this year, including visiting the State Department. China’s contributions The senior aide told Devex that another reason Africa CDC was excluded from the global compacts in the bill is that the U.S. government has expressed concern to it about contributions it receives from the Chinese government, and how this could impact data security. The “America First” global health strategy notes that “U.S. health foreign assistance has the potential to be an important counterweight to China, especially in Africa, a continent of strategic importance to U.S. national interests.” These strategic interests include the African continent's rapid population growth; that it’s home to several countries that are “hotbeds” of “Islamic extremism;” and that it’s home to several of the largest deposits of key minerals and rare earth elements “needed as inputs into advanced technologies that fuel critical military and commercial applications.” The Chinese government built Africa CDC’s new headquarters in Addis Ababa — funding the whole project, which includes a data center and reference laboratory named after Chinese scientist Dr. Wu Lien-teh. But the Africa CDC’s spokesperson said that the organization takes data protection “extremely seriously,” saying that the organization’s core IT infrastructure is hosted on Microsoft Azure Cloud, with services located exclusively in South Africa, in line with the AU’s Data Policy Framework. “We have developed a sovereign, African-owned digital health architecture including the OKAPI analytics platform and the federated clinical data repository to ensure that African data remain under African governance,” the Africa CDC’s spokesperson said.