‘Our Loss is World’s Gain’; African Leaders on Nkengasong’s Confirmation to Head PEPFAR
Dr John Nkengasong at one of the weekly Africa CDC media briefings that became a centrepiece of African Union response during the COVID pandemic.

African leaders have applauded the US move to appoint John Nkengasong as head of the U.S. President’s Emergency Plan for AIDS Reliefs (PEPFAR) – saying he’ll reinvigorate the programme that has been a flagship for the global battle against the AIDS pandemic for nearly decades. 

But they also said the loss of Nkgengasong as head of the African Union’s Centers for Disease Control (Africa CDC), would be a blow to the Organization that he built from a virtual unknown into a full-fledged AU health agency during his five-year tenure. 

“The reward for good work is more work. Our ‘loss’ is the ‘world’s’ gain,” said Ifedayo Adetifa, Director-General of the Nigeria Centre for Disease Control (NCDC), reacting to Nkengasong’s Senate confirmation.

Prof Christian Happi, Director of the African Center of Excellence for the Genomics of Infectious Diseases (ACEGID) said the HIV/AIDS ecosystem is now “looking forward to a more impactful PEPFAR” under Nkengasong’s leadership.

Nkengasong will “bring immense skills to the important challenge of ending AIDS”, added Charlotte Watts, Chief Scientific Advisor, UK Foreign Commonwealth and Development Office.

But Aggrey Aluso Odhiambo, Health and Rights Program Manager at the Open Society Initiative for Eastern Africa, also lamented the loss to Africa CDC – attributing its meteoric rise on the public health scene to Nkengasong’s transformative leadership. 

“I hope your successor will sustain the Africa CDC vision of an African new public health order,” he said.

Long road to finding an Africa CDC replacement 

Nkengasong before the US Senate during hearings on his PEPFAR nomination.

Nkengasong’s appointment reflects his “public health statesmanship and technical coordination of the African Union’s response to the COVID-19 pandemic as head of the Africa CDC, said  Moussa Faki Mahamat, Chairperson of the African Union Commission. 

The Africa CDC experience “will stand him in exceptionally good stead as he gears up to lead PEPFAR,a key programme in fighting the global HIV/AIDS pandemic,” Mahamat added. 

During the pandemic, Nkengasong became the public face of Africa’s response to a wave of crisis on the continent – beginning with woefully inadequate access to basic PPE for doctors and nurses to be followed by the dire shortage of vaccines on the continent – the most severe anywhere – in the initial months of vaccine rollout.  

Now, as the focus shifts to the longer-term tasks associated with rebuilding health systems and routine services, Nkengasong’s departure will leave a gap, his colleagues acknowledge, that will be difficult to fill.  The search for his replacement is expected to take several months. 

Confirmation last Thursday 

The US Senate last Thursday confirmed Nkengasong by voice vote to head PEPFAR with the title of “Ambassador at Large, Coordinator of United States Government Activities to Combat HIV/AIDS Globally”. 

“HIV/AIDS remains a serious threat globally,” he tweeted following the Senate confirmation, describing PEPFAR as a “hugely impactful” programme.

Nkengasong’s PEPFAR leadership journey officially began on 4 January 2022 when his nomination was officially received in the Senate and was referred to the Committee on Foreign Relations.

On March 15, the committee held a hearing, the outcome of which was favourable; that paved the way for the Senate’s consideration and confirmation. 

With his exit from Africa CDC imminent, he told Health Policy Watch in March that the next priorities for Africa CDC should be leveraging gains made during the period of COVID-19 response to further strengthen systems across the African Union’s 55 member states, so as to also be better positioned to fight future pandemics. 

“The continent has been extremely innovative in developing platforms that are continuously being used to fight this COVID pandemic, but we need to focus our energy on developing them to fight other diseases,” he said.

PEPFAR’s long history of involvement in Africa 

PEPFAR has a long history of involvement in Africa, dating back to its inception in 2003 by the late president George W Bush, at the height of the HIV/AIDS pandemic. Africa, as the pandemic epicenter at the time, also became the biggest beneficiary of PEPFAR investments, which globally amount to over $100 billion to date. The plan claims it has saved 21 million lives, prevented millions of HIV infections, and is now supporting countries end the HIV epidemic altogether – all while significantly strengthening global health security.

In Nkengasong’s opening testimony before the US Senate on Tuesday, March 15, 2022, the Cameroonian-born virologist who also holds US citizenship, said he will draw upon his three decades of experience with research and public health to advance PEPFAR’s mission.

“If confirmed, I would be stepping into this role at a critical moment when the world is confronted with dual global pandemics.  We have seen how COVID-19 has affected some progress in our HIV efforts with devastating results. But we have also witnessed how the health systems and institutions built and strengthened by PEPFAR’s investments have been central to the COVID-19 response,” he told senators.

PEPFAR under Nkengasong – integrated health systems approach

As Director of the Africa CDC, Nkengasong underlined that PEPFAR’s investments in health systems over the past 19 years helped strengthened—and in some cases, helped establish—the fundamental health infrastructure, including laboratories, surveillance systems, and human resources, in the countries it supports. 

While previous HIV prevention, treatment and control efforts were premised upon building ‘vertical’ systems as semi-independent entities, the goal has now shifted, Nkengasong also said. PEPFAR’s future efforts must now ensure that these HIV services and systems are well integrated into national health systems, sustainably financed, and resilient to respond not only to HIV/AIDS but also other diseases.  

“For this to happen, it is my belief that we need to capitalize on the capacity and experience of those in the countries where we work, coming to the table with a deep respect for their perspectives and needs, taking account of their insights, their knowledge of local contexts, and their reservoirs of expertise. 

For such systems to be sustainable and keep infectious disease in check, we must act collectively to support the capabilities of local leaders and regional institutions and work in respectful partnership and accountability with them,” he said.

See our previous Health Policy Watch story on Nkengasong and Africa CDC here: 

Nkengasong’s PEPFAR Prospects and Hopes for Africa CDC 


Image Credits: Paul Adepoju.

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