Pandemic Proof: Expanding Africa CDC’s Role in Preparedness

DR JEAN KASEYA:
We are learning from COVID. And we saw that we didn't have access to vaccines, medicines, diagnostics, even gloves and syringes. We didn't have access to anything.

JAVIER GUZMAN:
You're listening to Pandemic Proof from the Center for Global Development. In this podcast, we explore policies and reforms to better prepare and respond to infectious disease threats like COVID-19, but also other nasty viruses, microbes and fungi that can throw our health, our communities and our economies into crisis. Join us as we envision ways to better protect our world in the future. I'm your host, Javier Guzman. Let's get started. Welcome back to Pandemic Proof. We're so grateful for your support during our first season and are thrilled to launch season two. We've heard the feedback and are excited to bring more cutting-edge conversations to you all. A few things are different this season. To start, I want to congratulate my colleague and former co-host Amanda Glassman on her new role at the Inter-American Development Bank. With this change, we're taking a slightly different approach to this season. I'll be your host for several episodes, but we will also feature a few of my colleagues here from CGD to host other episodes.

In total, we're planning to release six episodes over a year. We're keeping the same vision of Pandemic Proof. We'll still be digging into the key issues and exciting advancements in the field of pandemic preparedness and response. And this season, we're going deeper. We'll track progress, discuss solutions, and contend with the realities, opportunities, and challenges of strengthening pandemic preparedness and response in a post-COVID world. We have our eyes on several key milestones in the pandemic world this year. For starters, the Pandemic Fund is in its second year and is undergoing its second call for proposals. Gavi, the vaccine alliance, is gearing up for its next five-year strategic period, and defining its role in pandemic preparedness and response will be an important part of this process. Member states will take a call on whether to sign on to the pandemic accord at the upcoming World Health Assembly. And discussions are already underway about a very ambitious high-level meeting on antimicrobial resistance, which will take place at the United Nations General Assembly later this year.

Of course, we cannot forget the Africa Centers for Disease Control. They're leading the charge to strengthen preparedness and response on the African continent. But more on that in a bit. We are very excited about what's in store for season two. I encourage you to subscribe to the CGD podcast stream so you don't miss an episode. And as always, we would love to hear your feedback, so feel free to reach out to us. Now to kick off season two, I'm here with Dr Jean Kaseya, the director general of Africa Centers for Disease Control and Prevention, or Africa CDC, as it's known. But Africa CDC is a specialized health agency of the African Union, and it just celebrated its seventh anniversary in January. Importantly, the agency is also an autonomous institution of the African Union, a status that was given around two years ago. And that is important because it gives Africa CDC more independence, a more robust governance structure and the additional mandate of declaring public health emergencies of continental security.

As this young organization establishes its place on the African continent and in the broader global health architecture, is generating a lot of attention. The agency has taken very important steps to define the strategic plan for 2023 and '27. And it talks about implementing the new public health order, which basically focuses on one, strengthening public health systems and global health security. But also it has a very important element of a new way of partnering with multiple stakeholders. So the agency has already partnered with the global health organization, Gavi, the Vaccine Alliance, the Mastercard Foundation, and of course, several governments, including the United States and France. So at this critical point in time, Africa CDC needs to be very robust. And we know that it's facing the ever-increasing risk of public health emergencies. We know that in 2023 alone, the surveillance system recorded 166 public health events, including the first-ever Marburg virus disease outbreak in Equatorial Guinea and Tanzania.

Of course, talking also about the ongoing M-pox virus outbreak and emerging threats of malaria, drug resistance and many more. Doctor Kaseya was appointed director general of the Africa CDC in February 2023. He is a Congolese medical doctor with extensive experience in public health at the national and international levels. And I am happy to welcome him to Pandemic Proof. Thanks for being here with us today, Doctor Kaseya. How are you today?

DR JEAN KASEYA:
Thank you, Javier, for having me. I'm very fine. And thank you from Addis Ababa on behalf of my colleagues from Africa CDC.

JAVIER GUZMAN:
Last month marked the first anniversary of your appointment as Director General of Africa CDC, and we wanted you to reflect a bit on the most important achievements so far, as well as the challenges, especially thinking about pandemic preparedness and response on the African continent. Over to you, Dr Kaseya.

DR JEAN KASEYA:
I was appointed as the first Director General of Africa CDC in February 2023 by our African Head of State during the African Union Assembly. But I started effectively in April 2023. It means it will be next month that I will have one year in the office. But nevertheless, my action is director general. With support from the whole colleagues from Africa CDC, we can categorize that into three specific areas. The first one is to strengthen the governance of Africa CDC. Now we have the governing structures in place. When we talk about the governing structures, it means we have a technical one that we call advisory and technical council. We have a strategic one that we call the governing board, where we have ministers of health sitting with a number of other partners. And we have the committee of head of state. We have ten heads of state leading the agenda of Africa CDC at the continental level. The second one is when you have the vision, this vision must be translated into a strategic plan.

We developed and got approval for the new Strategic plan 2023-2027. And this is what we are implementing today, giving a clear vision based on the new public health order as you said, where Africa must be in the future. The thought success in terms of governance is the approval and operationalization of the new Organogram of Africa CDC. As you know, we moved from around 300 staff to 1000 staff, and this new organogram is showing the vision that we have for public health. And we can also say that one of the key successes in terms of putting in place strong mechanisms for accountability and transparency, because we are accountable vis a vis our member States and vis a vis our partners and our communities. This is the first area. The second one quickly is director general. We contributed to build the resilient health systems to ensure health security in Africa. During the last African Union assembly, we managed to pass a decision on the Continental Pool Procurement Mechanism and the expansion of the local manufacturing agenda in Africa.

This is something concrete. We managed to secure around 1.5 billion from Team Europe to support the agenda of local manufacturing in Africa, including 1 billion from Gavi for what we call the African Vaccine Manufacturing Accelerator, to support our vision of local manufacturing. Also, we built strong relationships and partnership with a number of partners. You know now we have what we call the Joint Emission Action Plan that we are implementing together with World Health Organization. We have areas including supporting the community health workers, including reinforcing the capacities of countries to have strong surveillance system. All of that contributed to that agenda, as I said, building the resilient health system. And the last one, we supported countries to respond to public health threats. You clearly said that in 2023, we had 166 public health events. Just from 1st January to date, we already have 30 public health events. We have an article that was released last week. The trend is going by increasing the number of public health events that we have in Africa.

What did I do as doctor general? I initiated the Southern African Development Community Summit of Heads of State about cholera outbreak that is affecting currently more than 15 countries in Africa. That summit took place in January 2024 with strong decisions, like the President of Zambia was appointed as champion. And we responded to a number of other outbreaks, monkeypox in DRC, dengue in West Africa and in number of other outbreaks.

JAVIER GUZMAN:
Well, clearly you are very busy. And I just wanted to follow on your point about the pooled procurement mechanism and also expanding regional vaccine manufacturing as a key component of the new public health order. What are the key priorities within these two big initiatives? One could say, can Africa CDC support the local vaccine manufacturing, get the procurement done, support the countries to respond to all these emerging threats? How are you going to prioritize all or what's the thinking there?

DR JEAN KASEYA:
No, I think this is a critical question. Let me put everything in the context, Javier. We are learning from COVID. And we saw that we didn't have access to vaccines, medicines, diagnostics, even gloves and syringes. We didn't have access to anything. In addition to that, in African countries, we are facing a number of issues, how to access quality medicines. We know this issue of fake medicines that is affecting our countries. Another one is the high cost of medicines. When we are procuring by our own self as countries, we are paying a lot of money. And also we have this issue of lack of local suppliers whoe can deliver quality product. Based on that, we decided to reflect on lessons that we have in Africa. And we submitted these decisions in the African Union Assembly that took place in February 2024. Three of the critical decisions that heads of state they made, the first one is to create the Continental Pool Procurement mechanism under the leadership of Africa CDC. This is a $50 billion per year market that was created, and that will change the way that Africa will deal with public health for the future.

The second one is to have an expansion of the local manufacturing. Because in the past Africa CDC was just responsible for vaccines. Now our heads of state, thanks to the wonderful job that Africa CDC is doing, they decided to expand our mandate not only to vaccines, but to all health commodities, including medicines, diagnostics and any health commodity. It means we are leading the agenda from A to Z to ensure that local manufacture will be a reality. And on top of that, because we need a strong voice. They gave us some champions. Like for the local manufacturing, the champion is the president of Kenya, President William Ruto. Now quickly, how do we think we can achieve that? You saw us almost two or three weeks ago we signed a memorandum of understanding with Unicef. Unicef is transferring now all capacity and capability that they have to Africa CDC in terms of procurement and supplying African countries. This is a game-changer. This is showing that we are serious with this agenda. Another one is we are bringing the political commitment.

We are bringing the convergence of all procurement policies and guidelines. And we are learning also from some experience that we have in Africa. You know, in Eastern Africa, we have a poor procurement mechanism under the United Nations Economic Commission for Africa UNECA, procuring for ten countries. We are learning from that. And UNECA is part of this pool procurement mechanism. The third component of the pool procurement mechanism is also Afreximbank. Because countries they will want to have access to quality medicines, sometimes they won't have funding for that. Then Afreximbank is there to guarantee the pre-financing. And countries they can see how to operate or to reimburse to Afreximbank later, but they have access to quality medicines. I think for now we are strong. We know where we are going and we know that this is a game changer in Africa.

JAVIER GUZMAN:
How do you see this role of regional institutions fitting within the evolving global health ecosystem? I mean, a lot of the conversation after COVID was, you know, we might have failed with Covax, we might have failed with some of the global institutions in terms of listening and making everyone part of the decisions. Now, a lot of attention is with the regional institutions and of course, Africa CDC. Now, you're saying Unicef Global is going to transfer some of the capabilities to Africa CDC regional. So how do you see these regional institutions, including Africa CDC, fitting within this global health ecosystem?

DR JEAN KASEYA:
I will talk about two different aspects. I will talk about Africa and I will talk about the global health architecture. In Africa. Africa CDC is the convening power. And with the extended mandate that we have, our heads of state, our member states wanted Africa CDC to become the public health agency in Africa. Not one, but the public health agency leading the agenda of health in Africa. For that, as I said, we develop the new strategic plan with involvement of all other partners. To achieve the vision, the objectives that we have in this strategic plan, we need to work with others. This is why we are building strong relationships in Africa with not only our Member States, but also UN agencies and others, with development partners like World Bank, private sector and philanthropists and a number of other partners, academia, CSOs and others. That one is helping to support the implementation of the strategic plan to move Africa in the next century. But when we talk about the global health architecture, we also understood that we cannot say Africa CDC can deliver 100% in Africa.

It's not true. We need to build relationship partnerships with others. We are working with philanthropies like Susan Buffett Foundation, Mastercard Foundation, Rockefeller Foundation, and a number of them. We are working with the private sector like Gavi, Global Fund. And we are working with developed countries, the US, the Team Europe for European countries and Japan and other partners like China and so many developed countries supporting us. We are also working with academia, with civil society organizations and a number of communities. It means we are working with everyone. But the reason we are doing that is to ensure that the health security in Africa will be preserved. When we preserve the health security in Africa, we are contributing to the global health security. And this is the question we are asking. It means today, Africa CDC becomes a key player for the global health architecture that is respected, that is heard by everyone.

JAVIER GUZMAN:
Thank you, Dr Kaseya One of the big points that has been discussed and will be very important in the future is what are the priority governance, operational and financial arrangements needed to set up the Africa Epidemics Fund? And this Africa Epidemics Fund, I know is a very big initiative as well. And a lot of hope has been put into it. Is there any update on those arrangements? Is there any traction? Do you think this will also fly? Or has this been prioritized now that you have other very important initiatives like the procurement mechanism and the local manufacturing?

DR JEAN KASEYA:
You know, we started with the vision. The vision was translated into the strategic plan. Then we moved to the governing structures for us to ensure that the governance of Africa CDC is in place. We moved to the organogram. It means human beings. People must implement this vision. The missing component we didn't discuss is funding. Africa CDC decided to put in place the African Epidemic Fund. And this African Epidemic Fund was approved by the African Union Assembly with heads of state in February 2022. And their decision, they said, we are putting in place this African Epidemic Fund to mobilize more resources for preparedness and response to disease threat in Africa. Now, it's important for our people of the population to know and our partners to know what is the main use, the main purpose of this funding of the African Epidemic Fund. African Epidemic Fund will provide funding for any activity and action to prevent the population of Africa from potential public health threats. This is the first mandate.

The second one is to ensure that our countries are well prepared to manage any potential public health threat. The third one is to respond to any public health emergency and also to recover from that. And the last one is to fund any activity related to health security on the continent. You see, it's broad. We are led by the agenda of pandemic preparedness, prevention and response. This is the purpose of this funding. Now, what is the governance that we are putting in place for that? We have the secretariat as head of states, they said Africa CDC. But the secretariat will hire a fund administrator and his team to manage this funding on daily basis and to report to the secretariat, then to report to another governance mechanism that we are putting in place that we call the Board of Trustee. Board of Trustee will comprise ministers of Health in Africa, donors and other key partners, because we need to ensure that we are transparent on the way we are approaching the use of this funding. Then where do we think this money will come from?

This is the financial arrangement we are talking about. First, we need to clearly say that the African Epidemic Fund will be aligned to the financial rules and regulations of the African Union. They upgraded the COVID-19 funds to African epidemic funds. It means today we still have money sitting under the Covi-19 fund. This money will be used by African Epidemic Fund. This is the first source. The second one, our head of state decided to allocate to Africa Epidemic Fund, 0.5% of the annual operational budget of the African Union. This is a major contribution that we are expecting. The third one is countries can voluntarily contribute. We hope that their contributions will also increase this envelope. We are also thinking about how to generate income with the investment of this money. And another area people they know that I like to talk about is innovative financing. We are thinking about a range of innovative financing that we can bring to make African Epidemic Fund well-funded, to support the agenda of pandemic preparedness prevention in Africa.

JAVIER GUZMAN:
What is the target? How much money do you think the Africa Epidemics Fund will need? And how are you doing against that target?

DR JEAN KASEYA:
We are at work on the, what we call a financial sustainability plan. We believe that if today the African Epidemic Fund can have $500 million, that one can help us to better support our countries and to invest this funding for the support that we need to provide to countries.

JAVIER GUZMAN:
OK. OK, thank you. We're coming to the end of this conversation. And I've got one final question for you. And then one question that we ask all the people who come to this podcast. But first, the final question for you specifically is about success. And if you can think of what success would look like for you as director general, what do you think of that?

DR JEAN KASEYA:
Let me tell you, I'm thinking about it every day, what I define as success. First, to see the agenda of local manufacturing becoming a reality. And I have to call local manufacturing the second independence of Africa. Because that one will ensure our health security. Will ensure economic growth. We are talking about $50 billion per year. Will ensure job creation. We will ensure innovation because the way to do that, more young people will come, like with the digital program, like with any kind of innovation around this local manufacturing. And it's also a tool for what we call global health diplomacy. Because a specific country manufacturing a specific product, it will be for the 54 countries in Africa. It means local manufacturing of health commodities will become an agenda of peace in Africa. This is the first one. The second one that I call success is having, in each country, a strong national public health institute leading the agenda of pandemic or outbreak preparedness, prevention and response.

This national public health institute will become the institutional memory. Today, we still have in Africa, many countries putting in place taskforce, ad-hoc committees when there is an outbreak because the National Public Health Institute is not strongly established. This national public health institute will be linked to what we call the Public Health Emergency Operational Center. Let me tell you that in Africa CDC, we have the biggest public operational center in the world that is helping us to monitor the situation every day in Africa. And will be supported by a network of laboratories in each region and a human health workforce capacitated who can effectively deliver the program. This is the second one. The third one I think I will call success, if I see another way to lead the governance of health sector in Africa with more resources, including domestic resources. Because Africa cannot just rely on funding from external partners. We need to start also to invest in our health sector.

The last one is the change in the global health architecture. We cannot continue like that. As we said, the voice of Africa must be heard and respected. And Africa must sit in the same table with all other partners for all global mechanisms that we have. This is why Africa CDC is a key supporter of the pandemic agreement that we have today. Because we believe that this pandemic agreement, if we finalize that, will also increase the role of Africa and Africa CDC in the global health architecture. These are the four pillars that I can define as success at the end of my terms in Africa CDC.

JAVIER GUZMAN:
Thank you, Dr Kaseya. You already answered then my final question, because my final question was if you could prioritize one change in the global architecture for pandemic preparedness and response, what would it be? But you clearly said you want the Africa CDC and the African continent to be at the table in the very important conversations that we need to take place for us all to be more secure. Anything else that you want to say? Just a closing remark.

DR JEAN KASEYA:
One word. One word about this question. We need equity. Equity is the starting point of everything. Equity will lead for more respect. Equity will lead for having access timely to all products, medicines, vaccines when we have outbreaks or pandemics. Equity means also having Africans sitting in all of this global mechanism and being part of the decisions that are impacting us. That is the keyword today, equity.

JAVIER GUZMAN:
I very much liked that ending. So, Dr Kaseya, it's been a pleasure to have you here. I wish you all the best. And hopefully, we can talk in three years to see how everything went. You have a very ambitious agenda, so we wish you all the best. Thank you.

DR JEAN KASEYA:
Thank you. Bye.

JAVIER GUZMAN:
Thanks for listening to Pandemic Proof from the Center for Global Development. Very special thanks to the CGD podcast team Morgan Pinkham, Stephanie Donohoe and son Izzy for making it happen. Pandemic Proof is available on the CGD podcast stream, so make sure you subscribe to the CGD podcast. And remember, you can check out all of our work on pandemic preparedness and beyond at cgdev.org or on X @cgdev That's c-g-d-e-v. Thanks.