Meet Africa’s trailblazing science hero and frontline warrior against Covid
Africa CDC director Dr John Nkengasong is likely to head the $7bn US HIV/Aids Pepfar programme
If John Nkengasong had followed his youthful impulse to study wildlife conservation, perhaps fewer African species would be threatened today. Instead, the esteemed virologist and public health trailblazer has spent his life protecting people from viruses.
During the Covid-19 pandemic, Nkengasong has been the voice of medical science on the continent, the Anthony Fauci of Africa.
The first director of the Africa Centres for Disease Control and Prevention, his prescience of a pending disaster in the early days of Covid-19 and swift response have likely saved thousands of lives.
A modern-day African hero and one the 100 Most Influential People of 2021.TIME magazine
Nkengasong says being vaccinated saved him. He and his wife got infected in August after being fully inoculated in April. “Without that, I wouldn’t be here, because even with the breakthrough infection the severity of the attack was unbearable.”
He is fighting day and night to get Covid-19 vaccines to Africa, which has been hit by a “vaccine famine”.
The continent has struggled to secure the life-saving doses after wealthy countries grabbed millions more than they needed, manufacturing countries, like India, suspended exports and donors failed to meet commitments.
“We are not winning the battle in Africa,” Nkengasong has warned repeatedly. “We need to vaccinate at speed and at scale.”
Nkengasong was on holiday in the US over Christmas 2019 when he heard about a new virus in Wuhan.
“It occurred to me that it was going to be a serious threat to the whole world. The first thing I did was call Addis Ababa to activate the Emergency Operations Centre,” says Nkengasong, who persisted when his staff pushed back that “it is far away, and we have Ebola going on”.
In January 2017, that emergency centre had served as Nkengasong’s office when he started as Africa CDC director in Addis without a desk or secretary and even, in the heat of an Ebola outbreak, interrupted internet. “I was in the corridors for almost a year, but you don’t need an office to practise public health,” he says.
Three years on, when the world had only a few hundred confirmed cases of Covid-19, Nkengasong called on African countries to prepare to fight the virus. He raised the alarm with ministers of health and in a commentary in the journal Nature Medicine.
Covid-19 would spread rapidly given global connectivity, he warned. “More than 60% of air traffic to Ethiopia is from China. There are four or five flights a night and the planes are always full.”
I saw an opportunity that I could create things from scratch and that has become my passion.
His first step was organising training in Covid-19 testing for scientists from 16 countries at Senegal’s Institut Pasteur in Dakar. When a key substance needed for the diagnostic test was unavailable in Africa, he ordered the reagent from Germany and tracked it from airport to airport, hoping it would land in time.
The package did and the training went ahead, just days before Africa’s first case of Covid-19 was confirmed on February 14 in Egypt.
Africa owes award-winning scientist and former Cameroonian minister of health Victor Anomah Ngu for influencing the young Nkengasong at the University of Yaoundé to chase viruses rather than pursue his initial interest in wildlife or etymology.
“I was 22 after graduation and I knocked at his lab to ask for advice. He was such a gigantic figure that my heart was racing in my chest,” he says.
His white-coated hero gave him a chair and told the young biologist: “I think that virology is more exciting. I didn’t know what that was, so I went and looked it up,” says Nkengasong, his face lighting up at the memory.
And that was how he got immersed into the world of viruses, variants and vaccines.
In 1988 he joined the laboratory of renowned scientist and research champion Peter Ndumbe, and a young Belgian man came knocking on his lab door one lunchtime.
Nkengasong says: “I was doing experiments and he was impressed because the culture in Cameroon at the time was to work two shifts, morning to noon and then break for lunch. It was very odd to see a young man all by himself in the lab.”
That microbiologist was Peter Piot, later to become the executive director of UNAids. He arranged for Nkengasong to go to the Institute of Tropical Medicine in Belgium to do a masters in virology. This he followed with a PhD in the medicine department of the University of Brussels.
“We were investigating new strains of HIV. Back then nobody was so scared of variants,” says Nkengasong, who became head of the institute’s virology lab.
His disciplined routine triggered another career move in 1994, this time back to Africa.
“I had a habit of doing my experiments in the morning and then I would go to the library at lunchtime to read the latest scientific journals,” says Nkengasong, of an era when there was no internet.
In a small reading room, he opened the Lancet journal and saw a job advertised for the head of the virology lab at the US CDC station in Abidjan, Ivory Coast.
“I was eager to go back to Africa, so I did something that was unusual,” he says. Without speaking to his wife, he wrote an application and faxed it in. When he got home and told her, she was sceptical.
About two weeks later, the then director of the US CDC station in Ivory Coast, Alan Greenberg, invited Nkengasong to meet the team in Brussels and subsequently to visit Abidjan.
“Guess what, when I arrived there, there was no laboratory! They showed me an abandoned building behind their compound that they wanted to demolish to set up a lab. I remember Alan Greenberg saying: ‘I know you see a dilapidated building, but I see a virology lab. What do you see?’” Greenberg was so passionate about this vision that Nkengasong just nodded.
When he got offered the job, however, his “mind was spinning”. Why leave when he was running a successful lab in Antwerp and publishing papers in high-impact journals?
But says Nkengasong: “I saw an opportunity that I could create things from scratch and that has become my passion.”
When Nkengasong landed in Abidjan, he designed and built a lab from the ground up, which became a state-of-the-art HIV research centre in Africa, visited by scientists like Fauci.
“Fighting (viruses) without diagnostics is almost like piloting a plane without a rudder system; you fly blind, you crash,” says Nkengasong, who has been passionate about building a laboratory network across Africa.
But his vision was even bolder. His centre became one of the first to overturn the prejudice in the 1990s that Africans could not take antiretroviral treatment, by doing research that proved they could.
Piloting ARV treatment successfully, running clinical trials on preventing mother-to-child HIV transmission and mapping HIV variants were among its cutting-edge achievements.
Nkengasong has co-authored more than 250 peer-reviewed publications during his career and won major accolades for his work.
In 2001, after civil war erupted in Abidjan, Nkengasong and his team had to be evacuated to the US CDC headquarters in Atlanta for their safety.
“That is what I call episode two of starting from scratch,” says Nkengasong.
He needed to set up a laboratory network across Africa to support the US President’s Emergency Plan for Aids Relief (Pepfar) goals of treating two million people with ARVs and prevent 7-million HIV infections — and to deliver results from day one.
“In the first years I would come to work every day expecting to get fired,” Nkengasong laughs.
Instead, the Pepfar laboratory programme has been recognised as a “signature achievement” of its programme.
The Pepfar programme, which Nkengasong helped to build nearly 20 years ago — and to which he returns as the head if the US Senate confirms President Joe Biden's intended nomination — has delivered HIV/Aids treatment to more than 18-million people in 50 countries.
He helped set up the African Society for Laboratory Medicine in 2011, and Cameroon and Senegal have knighted Nkengasong, who has received many awards for his contributions.
By 2014, Nkengasong was acting deputy director-general of the US CDC Centre for Global Health when Ebola flared up in West Africa.
“The sheer images, of corpses littered on the streets of Liberia, of Guinea, people abandoned. Personally, it was devastating,” says Nkengasong of the two-year epidemic that claimed more than 11,000 lives.
This acted as a catalyst for him to return to Africa and to apply for the post of director of the Africa CDC, set up by the AU to tackle outbreaks and promote health security.
The sheer images, of corpses littered on the streets of Liberia, of Guinea, people abandoned. Personally, it was devastating.
On May 9 2016, after a day of waiting for an interview which was delayed, Nkengasong almost walked away because his flight was booked for that night. “I called my wife and she said: ‘No, you are already there, just change your flight’ so I stayed ... The rest is history.”
In January 2017, Nkengasong moved to Addis Ababa to build a public health agency that existed only in name.
“I was running around to define a job description and there was no structure,” says Nkengasong, who had to craft this with a skeleton team.
“We were expected to be operational the day after the launch, but setting it up was not like buying stock for a supermarket,” says Nkengasong.
“With a name like the Africa CDC, expectations were high. For example, when Ebola (erupted) in the DRC in May, people were asking what we were going to do?
“In Ethiopia, students were sitting exams and the internet was suspended to prevent cheating, and I was supposed to coordinate a response. Luckily, I was travelling to DC, and I got internet on the international flight,” he says.
Initially he had a team of about 10 epidemiologists, with two advisers from the US CDC and one from the China CDC.
Africa has only about 1,900 epidemiologists and needs about 6,000 to fight public health threats, says Nkengasong. “It is like going to a gunfight with a knife.”
From the start of Covid-19, he has been fighting for resources. First for diagnostic tests. Next PPE. Now for vaccines.
He has briefed African ministers of health more than a dozen times — who united in implementing early lockdowns to slow the spread of Covid-19 — and provided the public with weekly updates.
“I have not been sitting in an office. I have been in the field every two weeks,” says Nkengasong who has travelled to countries like the DRC, Rwanda and SA.
In African cities, he has seen lines of people wanting to get vaccines. “I thought there was a soccer match going on (at the Tangier sport stadium in Morocco), but it was people registering online to get the vaccine,” he said.
As one of the WHO director-general’s special envoys for Covid-19, Nkengasong, with the WHO regional director for Africa Dr Matshidiso Moeti, is urging countries to redirect their surplus doses to the continent — without further delay.
I thought there was a soccer match going on at the Tangier sport stadium in Morocco, but it was people registering online to get the vaccine.
This could be achieved by “just swapping the order in which (Africa) is in the queue for vaccine delivery” or through donations, he says. About 5% of Africans have been fully vaccinated compared to a global average of roughly 33%.
By Friday, 215 000 Covid-19 deaths had been reported in Africa. More than 8.4 million infections had been reported, which serological surveys have shown to be lower than the true number.
Until the third wave surged around July, most countries were coping better than had been expected. But the aggressive Delta variant and rocketing infections overwhelmed some countries, and deaths have soared.
Africa runs the risk of becoming the “continent of Covid-19” unless access to vaccines in the next quarter accelerates dramatically with developed countries releasing doses they do not need.
The pandemic has exposed Africa’s over-dependence on the rest of the world for health security again — an estimated 12-million Africans died needlessly from 1997 to 2007 waiting for life-saving ARVs to become affordable on the continent — turbocharging initiatives to manufacture locally, with Nkengasong at the helm.
He has been tirelessly driving these efforts so Africa will be ready with its own life-saving diagnostics and vaccines when the next pandemic hits.
As more and more African countries enter their fourth wave, seven at last count, the Africa CDC will be hosting the first international conference on public health in Africa in mid-December.
This may be Nkengasong’s swan song before he departs to the US to head up Pepfar, the first leader from Africa to lead the $7bn US government programme. But, as his track record shows, Africa’s health security will be a priority for him wherever he is.
AFRICA UNITES VS COVID-19
- February 22 2020: Emergency meetings of ministers of health who endorse Africa Joint Continental Strategy for Covid-19.
- April 21: Launch of the Partnership to Accelerate Covid-19 Testing by the AU and the Africa CDC, with the aim of testing 10-million Africans in six months, a target that was met.
- June 18: Launch of the African Medical Supplies Platform, the first time Africa has pooled its purchasing power to order medical equipment, PPE, diagnostic tests and vaccines.
- June 24-25: Some 3,000 experts and political leaders meet to discuss a vaccine strategy to develop and manufacture vaccines in Africa.
- September 10: Launch of the Covid-19 genome sequencing laboratory network by the Africa CDC and WHO to help track variants.
- December 3: The Africa Infodemic Response Alliance is launched to combat misinformation around COVID-19 pandemic and emergencies.
- January 14 2021: Then-president of the AU, Cyril Ramaphosa, announces that its Covid-19 Africa Vaccine Acquisition Task Team has secured a provisional 270-million J&J vaccine doses for Africa.
- August 7 2021: The first J&J shipments purchased by AU countries and their taxpayers are delivered to Mauritius.