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Dr. When John Nkengasong took over as the first head of Africa’s new Centers for Disease Control in 2017, parts of the continent had just emerged from a war. devastating Ebola epidemic. Less than three years later, Covid-19 struck.

Dr. Nkengasong is now working to bring together the governments of a large and diverse continent to anticipate and combat public health threats and make them less dependent on international institutions such as the World Health Organization or the Red Cross. It has helped Africa speak with one voice, especially about what he calls the “vaccine shortage” as rich countries are destroying Africa by buying millions of doses they don’t need.

Perhaps Ebola was a sign that something bigger was on the way and that something turned out to be Covid-19. He also thinks that Covid-19 could be a harbinger of something worse: a virus as contagious as the Delta variant but with the high mortality rate of Ebola.

The African CDC was launched in response to the Ebola epidemic, with funding from the African Union and several other donors. Dr. When Nkengasong arrived, there was no office, staff, or even internet at one point for months; The Ethiopian government had shut it down to prevent people from cheating on university entrance exams.

But he says: “We can do public health under the tree. It’s really does not matter. The issue is concepts. Are you committed to solving inequality and health security issues?”

(This talk has been edited and shortened for clarity.)

What was it like when Covid-19 first hit the continent?

I was off in December 2019 and we started hearing stories about the virus in Wuhan. I called Addis Ababa and said “Activate our Emergency Operations Center”. I got an initial reaction from my own staff. They said, “Well, this thing is happening far away. Ebola continues in North Kivu.” They said, “We’re already very busy.” I said, “Please, just do it, because I know this is coming.”

The continent started well. We positioned ourselves. we mixed it up. We trained people. It may sound silly, but in our first practice sessions in South Africa and Senegal, everyone went home with a pack of 100 tests.

How are things going now? And how do you see the future trajectory of the virus in Africa?

An emergency is where your house burns down. You run around, you call 911, they sprinkle water on them. That stage is over. We are now at a stage where your house is burned down. How to build a new house?

I think this virus is winning. We are not winning as a continent. Today we have more than seven million cases with close to 180,000 deaths. And death rates are rising dramatically across the continent. Vaccination rates are very, very low. We are about 2.5 percent of the fully vaccinated population, and this is a continent of 1.2 billion.

What about vaccines for African countries? Does Covax – the alliance backed by the United Nations – come as promised?

The story of access to vaccines and the role Covax must play is what I call a moral tragedy.

The purpose and the design were excellent, excellent, but the execution – even the people who run Covax will admit that it didn’t deliver on its promise.

The countries that financed or committed to Covax were developed countries. So they promised. I’m not sure they necessarily give money. But then they bought the vaccines, all the vaccines. So even with the money Covax had, there was nowhere to buy the vaccine.

We are not saying donate to us. do not do that to give vaccinates us. We’re just saying that Africa should come forward with 400 million doses of vaccine – they paid for it! I think you can start solving a lot of problems just by changing the order in which we queue for vaccine delivery.

What is the state of Africa’s public health infrastructure?

Governments have not invested enough in their public health needs.

All of the architecture – public health architecture and health safety architecture – has been designed since the Second World War in such a way that Africa has so much dependence on the outside world.

There are about three million healthcare workers in Africa. This is almost nothing. So you clearly see the negligence. And our health security architecture was designed when the African population was less than 300 million. Where are we today? We are 1.2 billion people aiming to reach 2.5 or 2.4 billion in the next 30 years.

No human could survive importing 99 percent of their vaccines and 100 percent of their diagnoses. It doesn’t make sense. We need 6,000 epidemiologists. We currently only have about 1,900 on the continent.

Are people hesitant to get vaccinated?

It should still be a battle won or lost at the community level. Incorrect information remains a serious problem.

But when I look at trends, what’s going on on the continent, I get very encouraged. I was in Morocco and there were long queues of young people at the Tangier sports stadium. When I approached them, I thought it was a football game but they were people who signed up online to get the vaccine. We’ve seen similar scenarios in Kigali in Nairobi.

So vaccine hesitancy is no longer a problem. The real challenge now is the vaccine shortage, not vaccine hesitancy.

What is your target for vaccination in Africa by the end of 2021?

It was to reach at least 25 to 30 percent by the end of the year. But this will depend on many factors. Are countries with safe vaccines ready to release them?

At the pace we are doing, we are moving very consciously towards the continent’s endemicity of this virus, there is no doubt about it. It is now concentrated in big cities, but soon it will spread to remote areas and will be very, very difficult to get out.

You worked at the US Centers for Disease Control for many years. What was it like going back to Africa?

I grew up in Cameroon. You go and you think you’ll come back, and then life carries you from one end of the world to the other and you move on.

I remember when I got the job, my colleagues were like, “John, maybe you’re going through a midlife crisis? Why would you leave Atlanta, quit your job and start something you really don’t know?” But I had to do it.

I didn’t have an office for almost a year. I had a big director name, but there was no place to sit and work.

Was it easy? Not at all.

The moment you say you have a CDC, the expectations are high. Borrowing a name, especially from a well-known CDC like the USCDC, put pressure and anticipation on our shoulders very, very early.

Does public health need to be decolonized in Africa?

Shirley Chisholm said if they don’t give you a chair around the table, go there with a folded chair. Do not ask permission to do what is rightfully yours.

Think about it, the first conference on public health in Africa will be organized by the Africa CDC later this year.

Why is this important? It provides a platform for African public health professionals to interact, share experiences and learn from each other.

The second is that we invest in our own public health schools and believe in our own public health schools.

Learning a lesson is what Africa is doing now; We do not have a vaccine, we have to produce a vaccine.

If we continue this journey driven by a new public health order, we will fight it in a very, very different way when the next pandemic hits.