This interview is part of COVID-19 vaccines: The road to recovery and beyond, a series that includes a broad array of voices leading the historic global effort to develop, distribute, and provide equitable access to COVID-19 vaccines, including the Africa CDC; CEPI; Gavi, the Vaccine Alliance; Moderna; and Pfizer.
Africa has had a long history of disproportionate struggle with deadly viruses. The COVID-19 crisis seems to have further illuminated the need for the continent to have a coordinated approach to meet pandemic threats head-on. Dr. John Nkengasong, the first-ever director of the Africa CDC, is a strong believer of a joint continental strategy being the “North Star” on which to guide pandemic response.
Some groups of countries have long had a centralized public-health unit, but the Africa CDC is the first of its kind in Africa. Established in 2016, the Africa CDC was officially launched under the African Union (AU) in 2017 to support the health systems of 55 member states and directly respond to disease threats.
Since the COVID-19 pandemic began, Africa has experienced more than five million cases and more than 140,000 deaths,
heightening the relevance of the Africa CDC and giving it major prominence. Leading the fast mobilization of heads of state around a continent-wide response to the pandemic, the Africa CDC is setting the groundwork for the first public-health order in Africa, possibly changing the face of its public-health landscape for a long time to come.
Since Africa relies heavily on imported vaccines to beat COVID-19 and most other infectious diseases, Dr. Nkengasong is also an advocate for homegrown manufacturing. In a virtual conference held in April 2021 by the Africa CDC, there was an aspiration set to manufacture 60 percent of the continent’s needed vaccines locally by 2040.
Nkengasong thinks that the COVID-19 crisis may accelerate that goal.
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Dr. John Nkengasong
Dr. Nkengasong took some time to speak with McKinsey’s Sunny Sun on what it will take to deploy a continent-wide vaccine rollout, increase vaccine manufacturing within Africa, and enhance coordination across borders further. The outcomes could help Africa better control its response to COVID-19 and any future infectious diseases and improve the health security of the continent. What follows is an edited excerpt of their conversation.
McKinsey: You talk about a continent-wide approach to combating COVID-19. How has the creation of the Africa CDC driven this approach? What challenges did the pandemic present and what was the response to them?
John Nkengasong: The Africa CDC is the backbone of the continent-wide mobilization among AU member states. I’ve always maintained that its creation was one of the greatest innovations of African leadership. Members watched in disbelief as the 2014 to 2016 West Africa Ebola epidemic threatened the health and economic security of 1.2 billion people on the continent. It ultimately claimed 11,299 lives.
By January 2019, the Africa CDC had responded to nine disease outbreaks in seven AU member states. During the 2018 to 2019 Ebola outbreak in the Democratic Republic of Congo and Uganda, 48 healthcare experts were sent out to train over 820 local health and community workers on infection prevention and cross-border screenings.
Thankfully, this framework was in place—because Ebola was at no imaginable level equivalent to what we’re facing with COVID-19.
The power of a joint continental strategy
People often think of Africa as a homogeneous block of people, which is not the case. Coordinating efforts and bringing 55 member states into alignment is a challenge in itself. But we faced it head-on because we had no choice. The first cases of COVID-19 in Africa were reported in Egypt on February 14, 2020. Within one week, we were able to convene an emergency meeting with most of the ministers of health from across the continent in the Ethiopian capital of Addis Ababa.
When leaders left Addis Ababa on February 22, there was clarity of action on what each member state would do when they got home and COVID-19 hit—because it wasn’t a matter of
if but when it would strike throughout the continent. This joint continental strategy became the North Star on which to guide the pandemic response across Africa and still underpins our ability to respond to COVID-19 today.
McKinsey: The COVID-19 crisis has likely strengthened support for Africa’s new public-health order. Can you talk about the order’s different components and goals?
John Nkengasong: The concept behind a new public-health order for Africa is the recognition that health is central to our developmental process—that infectious diseases are critical and can easily undermine our agenda.
There are four key elements that make up Africa’s public-health order. One is strengthening our own public-health institutions with an empowered Africa CDC that connects with the national public-health institutes in all 55 member states. This creates a health-security apparatus that can consistently respond to disease outbreaks. Two is the need for local manufacturing of diagnostics, pharmaceuticals, and vaccines. With the COVID-19 crisis, we had no diagnostics or vaccines. The continent was literally exposed. Three is a competent public-health workforce. Without it, there’s absolutely nothing we can achieve in the spirit of strengthening our health defenses on the continent. And four is engaging with the private sector for innovations that can drive our health- and economic-security agendas.
What the COVID-19 pandemic has done is bring the new public-health order to life much faster, since issues we were discussing in theory, such as a severe lack of manufacturing, the desperation over diagnostics, the slow vaccine acquisition, and shortage of health workforce, have now come to the fore. For example, our ability to deploy health responders has been ad hoc at best. In April 2020, we had to hire a military plane in Cameroon, take it to the Democratic Republic of Congo, transport 28 health responders, and drop them in Niger, Burkina Faso, Cameroon, and Mali. We had to pull epidemiologists from the Ebola response in North Kivu. Clearly, we can’t guarantee the health security of a large continent of 1.2 billion people like this. We need a more comprehensive strategy.
McKinsey: How has the response to COVID-19 shifted from the first wave to the most recent developments?
Africa CDC and its growing role
John Nkengasong: When we look at the surge of cases in India in April, you have to factor in the prospect of that happening in Africa, which is a real concern. The way we can prepare ourselves is to revise our strategy around the communities: supporting and educating them on ownership, engagement, and leadership.
During the first wave of COVID-19, the focus was on testing. But now, we’ve adjusted our strategy to better monitor, prevent, and treat the disease. Based on learnings from India, monitoring means that we look at how we increase our ability to track variants more rigorously on the continent. Monitoring also means bettering surveillance, looking more carefully at the communities, finding any pockets of infection—and squashing them. We are not in the same situation that India was in, but the time to prepare—such as working to scale up our oxygen supply—is now.
To better support our strategy, we’ve also created the African Medical Supplies Platform to supply countries with vaccines, along with the equipment needed to maintain them, and to help governments with strategies on how to distribute limited vaccine supplies.
But it’s not just about providing the country with the supplies to properly store and handle vaccines, such as a cold-chain setup and vaccination accessories. You also need to pay attention to risk communication throughout the health event to encourage informed decision making and maintain trust. Deploying a vaccination plan if the communities aren’t fully engaged and the risk communication is not fully addressed is not ideal. The Africa CDC has put out a simple equation: “Vaccines plus vaccinations equal saved lives and economies.”
The Africa CDC has put out a simple equation: ‘Vaccines plus vaccinations equal saved lives and economies.’
McKinsey: On the vaccine front, how would you define the access challenges that exist in Africa? And how are you working to remedy them through partnerships?
John Nkengasong: Access to COVID-19 vaccines in Africa has been sluggish at best. If we continue at this pace, we will not achieve the Africa CDC target of vaccinating 60 percent of Africa’s population by the end of 2022. Our hope is that some countries that have acquired a lot of COVID-19 vaccines will donate surplus doses to African nations sooner rather than later.
In the area of vaccination acquisition, there’s COVAX, managed by WHO, Gavi, and CEPI. We have also established the African Vaccine Acquisition Task Team because COVAX will only cover 20 to 30 percent of our needs, and we need to vaccinate 60 percent of our population. That’s a 30-percentage-point gap that needs to be filled. There are also individual, bilateral, and multilateral deals that various African countries are engaged in.
We also need more partnerships to help with building vaccination centers—which includes redesigning workflows, repurposing existing hospitals and facilities, and setting up clinics within arenas—so we can vaccinate at scale and with speed. That said, the World Bank and other institutions and foundations are working with African countries to allocate additional resources. We are beginning to see a whole coalition of different partners coming in to support individual member states to roll out vaccinations.
McKinsey: Another pandemic response could be the manufacturing of domestic vaccines for COVID-19 and other infectious diseases. What would it take for Africa to manufacture its own vaccines?
Manufacturing vaccines in Africa
John Nkengasong: In a sense, you could say we are at war with the pandemic. And if we are at war, we need to use everything we have. Africa has the capacity and the ability to vaccinate. For instance, in the middle of this crisis, Ethiopia has been able to vaccinate 12 million children with measles vaccines. It is doable; we just need the vaccines. So we need to look at how we can manufacture vaccines from home.
In the spring of 2021, we held a summit with some of the top researchers, business leaders, civil-society groups, and heads of state on how to bring vaccine manufacturing to Africa. We vowed to achieve an ambitious aspiration for the continent to manufacture at least 60 percent of our routinely used vaccines by 2040.
Currently, we only manufacture 1 percent. A continent that holds 1.2 billion people shouldn’t be having to import 99 percent of its vaccines. We need to apply ourselves in a very deliberate manner in order to achieve that goal.
It starts by mobilizing enough financial resources to make manufacturing happen on the continent, which is an uphill climb. We need to look inward at the African Development Bank or Afreximbank and see these efforts as an investment in our people and in the next generation of Africans. When the history of the COVID-19 pandemic is written, I want Africa to be remembered for doing the right thing.
Then we need to get the right partnerships for intellectual-property transfer on the continent so that we can begin to develop and achieve these ambitious vaccine-manufacturing targets. What’s also important is strengthening our regulatory processes on the continent and launching groups like the African Medicines Agency, which contributes to the approved regulation of medicines in a timely fashion.
Probably the most critical aspect in the area of manufacturing is the launch of the Partnerships for African Vaccine Manufacturing in April 2021 by the AU to drive the agenda on vaccine manufacturing for the continent. It will also support five regional production sites over the next ten to 15 years, secure financial partnerships, and work on developing African universities as hubs for vaccine research and development.
In the history of infectious diseases, vaccines have always been central in turning the tide. Africa should learn from this experience in that you cannot mortgage your health security to external factors. Africa needs to be in full control of its vaccine security.
Coronavirus vaccines progress: What’s next?
McKinsey: As you lead the continent through the COVID-19 pandemic, what have been your biggest challenges to date? And what have you learned so far?
John Nkengasong: When working hard to supply countries with a vaccine in a timely fashion, the greatest challenge for me has been managing the gap between knowing what we need and not having what we need. For instance, in 2020, we knew that the central pillar to responding to any infectious disease was acquisition of diagnostics. But we didn’t have the diagnostics. It was very frustrating because it’s impossible to fight a disease that we can’t diagnose. Identifying the gaps and finding the necessary supplies has been extremely challenging.
Another tough situation is when countries are looking to you to tell them where to get the vaccines. It’s been heartbreaking to hear countries say to me at times, “John, we have the money to buy the vaccines. We have the money to buy the diagnostics. Just tell us where to go get them.” And you’re sitting there as the leader of a public-health agency, and you truly don’t know the answer.
But it’s also been very rewarding to see the countries that have expressed real solidarity, coming together to work across geographic areas. For instance, there’s the cross-country work ECOWAS [Economic Community of West African States] is doing, led by Professor Stanley Okolo, on evidence-based health policies and how they are vital in achieving continued improvement in health outcomes.
Also, Nigeria has been a strong advocate for vaccine equity, led by the director general of the Nigeria Centre for Disease Control, Chikwe Ihekweazu, who’s committed to multilateral deals with WHO, COVAX, and the AU to get vaccines not only for his country but also across the continent.
Examples like these have encouraged us to say that we can truly implement our new public-health order, which hinges on strengthening our own regional- and public-health agencies and institutions across the continent. I don’t think there’s any moment in the history of fighting diseases in Africa that has seen the same degree of coordination, collaboration, and cooperation as fighting the COVID-19 pandemic has.
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