From Covid to HIV: John Nkengasong, the African hero of modern pandemics

By Olivier Holmey
Posted on Friday, 8 July 2022 15:11

John Nkengasong, 60, has just taken over as director of PEPFAR, the US HIV program. © Africa CDC

At the helm of the Africa CDC, the Cameroonian-born scientist John Nkengasong coordinated the continent’s Covid-19 response. He has just taken over as head of the US AIDS programme, an organisation that is very active in Africa. According to him, whether it is Covid or AIDS, the fight is far from over.

“It is an extremely difficult decision,” Nkengasong says. At the end of May, as his colleagues were planning his farewell party, the virologist, his wife and their three children packed up their belongings. Goodbye Addis Ababa, hello Washington, where the headquarters of the US President’s Emergency Plan for AIDS Relief (PEPFAR) is located. This is a logical decision, almost a return to his roots for a man who has been involved in the fight against AIDS since 1988, under the guidance of Cameroonian immunology professor Peter Ndumbe.

“Nearly 500,000 people died from HIV last year in Africa. That’s a lot,” says Nkengasong. “The HIV pandemic – I use the word pandemic deliberately – is far from over.”

The choice to leave was nevertheless a difficult one, continues the man who has been coordinating the continent’s Covid-19 response since the beginning of 2020 as head of Africa CDC, the African Union’s public health agency. Although the coronavirus remains a major threat in Africa, the doctor has made the decision to go to Washington and fight against AIDS as head of the PEPFAR programme, which was created in 2003 under President George W. Bush and has since invested nearly $100bn in fighting the disease, mainly in Africa.

Lifelong vocation

Born into an English-speaking family in southwest Cameroon, Nkengasong was born in a village in the Lebialem department and began his education in the town of Kumba. Finding his way at an early age, he left to study virology at the University of Yaoundé, where he learned French.

In the late 1980s, he moved to Belgium, where he obtained a PhD from the prestigious Institute of Tropical Medicine in Antwerp before joining the US Centres for Disease Control and Prevention network in the mid-1990s. Assigned to Abidjan, he created one of the first laboratories on the continent capable of measuring the quantity of HIV in the bloodstream and sequencing the virus. Many researchers from Nigeria in particular were trained there.

Nkengasong was interested in hepatitis, the human T-lymphotropic virus, malaria and tuberculosis, but above all sought to understand and combat HIV. He has painful memories of the AIDS patients who came to the Treichville University Hospital in Abidjan in the 1990s.

“They were desperate, there was nothing we could do for them,” he recalls. “I saw them wandering around, their jaws hollowed out, suffering from diarrhoea. The younger generation did not experience that.”

At the time, there was a serious lack of treatment and funding, and the annual number of HIV victims was in the millions. Today, the virologist points out, much progress has been made: 77% of Africans who know they are HIV-positive are receiving treatment, according to the latest figures from the World Health Organisation. In the past 10 years, infections and deaths have been reduced by almost half, according to the WHO.

In the mid-2000s, Nkengasong became a US citizen, which cost him his Cameroonian citizenship, as his home country does not recognise dual citizenship. “I am a 100% naturalised American,” says this father of three, adding that he remains proud of his roots. He has not lost his accent.

In 2017, Nkengasong set down his bags in Addis Ababa, where he was called to take charge of the brand new Africa CDC. Created in the wake of the Ebola outbreak in West Africa, the organisation was established to help African Union member countries work together to tackle future health threats.

Modern-day African hero

Africa CDC’s beginnings were “very difficult,” Nkengasong recalls. Armed with only a laptop, he took charge of a team of a dozen epidemiologists and a handful of administrators, with a budget of only a few million dollars.

Under his leadership, however, Africa CDC proved its worth and became more independent. It now employs 220 people and is raising significant funds, most recently $1.5bn from the Mastercard Foundation.

From 2020 onwards, Nkengasong coordinated the continent’s response to the coronavirus pandemic. He is doing this with tenacity, despite a minimal budget, difficulties in supplying masks, screening tests and vaccines, and the irresponsible health policies of certain leaders, including Tanzania’s President John Magufuli, who denied the severity of the virus and then likely died from it. Previously unknown to the general public, Nkengasong is now one of the main faces of the fight against the pandemic on the continent.

In 2021, Nkengasong was reappointed to a second four-year term. Ngozi Okonjo-Iweala, the WTO director general, called him a “modern-day African hero” in Time magazine. His composure, pedagogy and voluntarism were praised.

The man who said he was “very worried” in March 2020 and foresaw an “imminent catastrophe” for the continent now explains that the worst has been avoided. He concedes, however, that the actual number of victims could be as high as 1 million, four times the official figures, and that the impact on African economies has been “severe”.

Despite this, he doggedly continues to belittle the work of field journalists who have obtained alternative data by interviewing ambulance drivers and gravediggers, notably in Somalia and the city of Kano, Nigeria. He considers these investigations to be anecdotal, as he believes that the press should rely on government information on the subject.

White House offer

In the early summer of 2021, the White House offered Nkengasong the opportunity to lead PEPFAR. At first he hesitated, as he had just started his second term, but the offer was too good to refuse. He finally accepted, much to the dismay of some of his peers. Some believe that he is deserting the fight against Covid and his choice is even seen as a disavowal of the continent’s public health structures, the very ones he helped to forge but which he is now abandoning in favour of a Western organisation. He denies this and says that the Africa CDC will be fine without him.

In September 2021, US President Joe Biden officially announced his choice. However, the Senate did not confirm his nomination until May of this year. Although he explains that this delay was due to scheduling problems, it hindered his actions within the Africa CDC, as his collaborators knew that he would not be able to complete the projects that he had undertaken.

Nkengasong was not only the Africa CDC’s first director, but also, since his swearing in ceremony on 13 June, PEPFAR’s first director of African origin. “I want to believe that the president chose me for my skills rather than because I come from Africa,” he says in response to those who view his appointment as merely symbolic.

What are his plans for the US programme? He wants to meet and take stock with his teams in Washington before making any announcements. Even if it means ignoring the darker side of PEPFAR, which has been accused in particular of serving as a tool for spreading US evangelical Christian beliefs in Africa, such as premarital abstinence.

However, he says he wants to go on an international tour as soon as he takes office so that he can meet the actors on the ground. The network of heads of state and ministers of health and finance that he has built up in recent years will no doubt open many doors for him.

His first destination may well be South Africa, the country hardest hit by AIDS. He also immediately made his mark on PEPFAR by announcing four new hires within his firm on 13 June. Notable among them are Jirair Ratevosian, who advised Biden on Covid-19 during the transfer of power last year and who will become Nkengasong’s chief of staff. So is Veronica Davison, a communications advisor who is extremely knowledgeable about Kenya.

As for the Africa CDC, Nkengasong refuses to make any predictions about who the agency’s board will appoint to replace him. He says he does not know if Ahmed Ogwell Ouma, his former deputy and now the agency’s acting director, intends to apply. Nkengasong will however have to collaborate with his former home, as the missions of both the Africa CDC and PEPFAR are to fight against HIV in Africa.

From one pandemic to the next, this discreet researcher is keeping a cool head. At just 60 years of age, and despite his growing responsibilities and visibility, he says: “I am not a public figure but a technician. In times of crisis you have to do what you have to do.”

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