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UNGA Decoded
Dr. Ahmed Ogwell Ouma on African health leadership
00:24:55
The COVID-19 pandemic revealed stark inequalities in the global health architecture. As the virus spread, a handful of mostly wealthy countries proved to have the money, the private sector relationships, and the power to be first in line for vaccines,...
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- [00:04]
Michael Igoe
Welcome to UNGA Decoded. I'm Michael Igoe, senior reporter at devex. For the next couple weeks, my colleagues and I are going to bring you inside the biggest global development gathering of the year. Skip the travel, the traffic and the security lines and join us for candid conversations with people at the leading edge of global development, global health and humanitarian assistance. This is UNGA Decoded.
- [00:38]
Dr. Ahmed Agwel Uma
If you look at all the mechanisms that are being put together to respond to what may be another pandemic, the same systems are still being used. And this in my view, will be a very big loss to opportunity.
- [00:57]
Michael Igoe
The COVID 19 pandemic revealed stark inequalities in the global health architecture. As the virus spread, a handful of mostly wealthy countries proved to have the money, the private sector relationships and the power to be first in line for vaccines, treatments and supplies. And global health institutions struggled to even the playing field. Health leaders on the African continent have taken that lesson to heart. And one institution at the forefront of a new vision for African health security is the Africa Centers for Disease Control. Rajkumar, editor in Chief of Devex, spoke to Dr. Ahmed Agwel Uma, second in command at Africa CDC, about how the continent's quest for greater self reliance is unfolding and what a more regional approach to preparing for pandemics might look like. Here's their conversation.
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Rajkumar
What are some of the lessons you think Africa CDC has learned as an organization from the pandemic?
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Dr. Ahmed Agwel Uma
Three big things. One is when an outbreak is very big, the inequity translates into Africa being on its own. When the outbreak is small, smallpox, Lhasa fever, yellow fever, then it's not interesting enough for others. Therefore Africa is still on its own. This is one lesson. Second is we have learned that if we come together, we can actually be able to find local solutions. And for us, as local solutions have come in the form of our heads of state having keen interest and therefore participating very regularly in meetings at the heads of state level and asking very pertinent questions, giving us very concrete direction and advice, our ministers leading the implementation at country level and they will come together, learn from one another. Our technical colleagues have been exceptional both at country level and at Africa CDC level. Sieve through all the data, generate analysis and then use that evidence to be able to design the way responses will be. You'll notice that during the pandemic we didn't follow what others were saying. We generated our own evidence and using it, we delivered some very concrete technical advice that were implemented at country level. Third, if we don't secure our supply chain, then we cannot be able to respond to any outbreak, small or big. So the need for local manufacturing became very urgent. The urgency may be going down because the acute phase of the pandemic is passing, but the facts still remain that we must secure our supply chain for everything we need, from countermeasures to therapeutics to diagnostics and vaccines, we must secure the supply chain. So whether we'll be manufacturing under license or doing R and D to come up with our own novel owned products on the continent, that has to happen so that the next one does not catch. I mean, look in the. We were in the middle of the COVID pandemic, monkeypox, the numbers were growing. And we were saying, the numbers are growing, we need to refocus on this. Even those who are listening were not responding until monkeypox was exported.
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Rajkumar
Many of the health leaders I talked to point to just that, monkeypox as an example of us not having learned the lessons of COVID that look, this hit us and we still didn't respond correctly to it. We still didn't get ahead of it. We still didn't secure the supplies of vaccine needed for the continent where the burden was much higher. Right. So I guess, I wonder, as you talk to people here, right, you're in general assembly, you're meeting with lots of other leaders, is the general sentiment that, okay, we've learned some lessons, we know what to do, we're going to start working toward these things like supply chains that are more robust and secure, or is there not yet a consensus that this is what we need to do?
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Dr. Ahmed Agwel Uma
The consensus is that we must do things differently. There's consensus around that. So there is appreciation that the systems didn't work. Where there's still no very concrete agreement is how do we fix that? For us, how we fix that is very clear. And we've captured that in the new public health order. Strengthening institutions on the continent, strengthening workforce so that they are fit for purpose, securing supply chain, improving domestic resources, not just money, but also expats, infrastructure, bringing in the private sector capacity. So domestic resources need to be part of the game. And finally is, although our ambition is to do it on our own, we don't want to do it alone. Then you bring a broad group of partners who see the priorities of the continent from our lens. So we define the priorities and the partners are able to help. But here, if you look at all the mechanisms that are being put together to respond to what may be another pandemic, the same systems are still being used. And this, in my view, will be a very big lost opportunity if we do not address the planning for a possible pandemic, planning for the next big outbreak, to use infrastructure that is not currently being used. A good example is regional approach. For us as Africa cdc, we are looking at this as a continent. We need to strengthen those. Because if you regionalize it, then you are able to define priorities differently for different regions. That way, if monkeypox or any other outbreak comes on the continent of Africa, we define it as a priority and we respond properly to it. Not to wait for the whole world to agree that it is a priority because that will take time. So those old methods and mechanisms are fine, but they are not going to address specific regions priorities because they are not global in nature.
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Rajkumar
And it sounds like soon you will have the authority to declare public health emergencies on the continent. Right? As the agency becomes fully autonomous. Is that still on track to happen?
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Dr. Ahmed Agwel Uma
Absolutely. The decision was already made in July. The amended Statute of Africa CDC in Article 3e gives the authority of declaring a public health emergency of continental security to Africa cdc. And operationalizing that is what we are doing. And yes, we'll do it by the end of the year. And we will then be in a position to be able to declare an emergency here on the continent of Africa.
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Rajkumar
Without having to go through the AU for their approval. You can do it on your own?
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Dr. Ahmed Agwel Uma
Absolutely. That is a technical decision. The ramifications will be looked at very carefully. The one thing that I think many do not appreciate is that we take this responsibility very seriously of declaring a public health emergency on the continent. We take it very seriously. We will put together a group of experts who will use the IHR as the template of what you need to consider and go through to make that declaration. And we will do that in the context of appreciating that any public health emergency that is declared has socioeconomic ramifications and we'll take all that into consideration. But it remains an Africa CDC mandate, it remains a technical assessment, and it remains a public health imperative. If you don't declare, you delay and public health is affected and eventually the economic ramifications will come. So we will do it and we'll put in place the measures by the end of the year so that any. The next outbreak that is major and fits the criteria that we will have defined will be declared by Africa citizen.
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Rajkumar
And what about beyond new outbreaks, new pandemics, thinking about things like TB and malaria and hiv, where there's been some real backsliding during, During The COVID pandemic is the new structure of Africa cdc. The fact that it is fully autonomous and that you're just operationalizing that now, will we see real world changes in what that means for the fight against those diseases and others NCDs, or is it really mostly about these big questions of declaring a public health emergency on the continent?
- [10:20]
Dr. Ahmed Agwel Uma
The new Africa CDC, call it Africa CDC 2.0, is going to address all disease entities on the continent. So, yes, the older pandemics like HIV are going to be part of that. The older disease burdens that we have, like malaria and TB are going to be part of that. NCDs, environmental health, including climate change effects, are going to be part of that. Because the mandate is for disease prevention and control. So we will handle the full range of disease threats on the continent, whether they are acute or whether they are more chronic. We will be able to handle that. Second is that the statute gives us the leeway to be able to engage beyond health to bring on the table all those players that we feel are required for a response that is going to be positive for public health. So in this way we are expanding the capacity and capability of Africa CDC to be able to handle that large bracket, if you want, of responsibilities that has been granted by the new statute.
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Jenny Leigh Ravelo
Who says the end of the COVID 19 pandemic is in sight? But with waves of infection still expected in the near future, how are health systems going to cope? What's going to happen to initiatives that were formed during the pandemic like covax? And how is the world preparing for the next global health emergency? I'm Jenny Leigh Ravelo, senior global health reporter for devex, and every Thursday we bring you answers to these questions and other exclusive news and insights on everything global health in our free weekly newsletter, Devex Checkup. Visit devex.comnewsletters to subscribe.
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Rajkumar
What about the new Africa Medicines Agency? What's this latest status on it? How will it work with Africa cdc? Give us a sense of where you see that fits into the architecture.
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Dr. Ahmed Agwel Uma
The African Medicines Agency is very complementary to Africa CDC's work because our responsibility of responding to disease threats will need concrete response from health products and we don't want to go into regulation. And that is why the African Medicines Agency has been set up. So the agency will be ensuring that we have what we need for response and it will grow the manufacturing enterprise on the continent because as a regulator, they will be providing that clearance that this particular product is good to use. And with that kind of ability on the continent, it Means that we can grow our manufacturing sector effectively. At the moment, Rwanda was chosen to host the secretariat of the headquarters of the African Medicines Agency. They are proceeding with that. It's very good. When we regionalize preparedness and response, we must regionalize manufacturing and therefore we must regionalize regulatory processes as well. And this is where the African Medicine Agency becomes very important. Attached to that is securing the market. Right now, the way that particularly the vaccines market is designed, the buyers are few and they control a large proportion of the market of vaccines, for example, that come to the continent. And we want to ensure that any manufacturer that is going to be setting up on the continent of Africa has a fair chance of having access to the African market. And that is why our Africa Continental Free Trade Area Secretariat in Accra is very key. And we are working with them to ensure that that market is secured in a way that is positive for any enterprise of manufacturing health products that is set up on the African continent. So as AMA expands and occupies a space that is designed to occupy, the enterprise of manufacturing on the continent will also find a very strong ally and a way of getting into the market much faster than it is now.
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Rajkumar
I don't know, maybe here in New York, but have you been meeting with some of the pharmaceutical companies? I'm curious what their reaction is. We've heard different plans from different companies about setting up their own facilities. I think Moderna is setting up a facility, I believe, in Kenya, your home country. What is your sense in talking to the pharmaceutical industry? Are they moving too, at the kind of pace that you would like to see?
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Dr. Ahmed Agwel Uma
So here, and even before here, as we speak, to manufacturers who are already on the ground and those who potentially want to come to set up. Three things are of concern that keep on appearing. One is the regulatory and policy environment within each and every country. And we've been challenged to try and address that in the coming months and years with Africa Medicines Agency. So that if a manufacturer is setting up an enterprise in Country X, this business of going and you have to register in each and every country for your product to be accessible there, we are trying to address that through internal mechanisms where registration by one national regulatory authority with endorsement from the African Medicines Agency, should be able to suffice registration in another country within the continent. We are working on that with the Africa Continental Free Trade Area Secretariat. So this is one thing that is coming up, the policy environment.
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Rajkumar
And presumably the pharmaceutical companies would be very supportive of that.
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Dr. Ahmed Agwel Uma
Absolutely, they should be, because it makes life easier for them. Secondly is market how do they access the market? And our regional economic blocs already have a free movement of goods. And ecowas, they will have some defined goods that can move freely within a particular market. And health products are one of those east of the Community, the Southern Africa Development Community are doing the same. Central Africa, the same. So what we are trying to do now to address that concern of market is already our heads of states have given us very clear direction. In May, when they met, they said to all those who are purchasing vaccines that 30% of vaccine should be purchased from enterprises on the continent so as to build that capacity of local manufacturing. So those directions give us the opportunity to ensure that the market is available for those who are going to manufacture here in Africa. And as we speak with them and they express that concern, we want to translate that into something that is more concrete. Some protocols that are in place, agreements that are in place that when they manufacture, then we buy from them. And then finally is the challenges of the supportive services to manufacture. Do you have electricity? Do you have water? Do you have the technical staff who can be able to be employed to do this work? So, so as Africa cdc, what we are doing is we are focusing as a priority on human capacity. We want to build that in all areas, from R and D to technical work, to the management part of the whole manufacturing enterprise. And we are doing that systematically. And we are also speaking to Africans in the diaspora that you have all this knowledge. Let's transfer the knowledge to people who are local on the continent. You don't have to leave where you were, but that knowledge we wanted back.
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Rajkumar
How do you imagine that might work? Are you thinking about scientists, research scientists coming back to the continent, training their counterparts?
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Dr. Ahmed Agwel Uma
Yes, exactly. This will be purely capacity building. And because they have the knowledge, we don't expect them to have the infrastructure, but they have the knowledge. So they build the capacity of those who are back in Africa. And with that capacity being built, then enterprises that are being set up for manufacturing on the continent will have the human capacity that they need. Apart from working with the diaspora, we are also getting experts from Africa to go elsewhere in Africa. Tim has just come back from Egypt from four or so countries. And we want to utilize the sharing of knowledge and opportunities on the continent. And if we don't have enough capacity on the continent, then we send them outside of the continent. Again, we sent, I think, 54 virologists to go to South Korea. We have the Institute for Virus, the International Vaccines Institute, where we are training vaccinologists to be able to Come back and then set up smaller groups, then expand those. So we'll be training using facilities on the continent. We'll be inviting diaspora experts to come and train, and then we'll also be sending our experts outside of the continent when it is so necessary.
- [19:54]
Rajkumar
It sounds very aligned with the University for Global Health Equity in Rwanda. The same kind of ethos. Right. Can you bring the education, highest global standards, but bring it back to where it's needed instead of having people just travel all over the world?
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Dr. Ahmed Agwel Uma
And we want to do that in a structured way. We don't want every country to do the same thing. So when we are developing that capacity, we are also speaking with our member states so that some countries do one type of product, other countries do another type of product. That way there is no overt competition within the African market, within the African countries that are putting up their own enterprises. So we train them, but we are also guiding through discussion and agreement negotiation, what product which country is going to produce so that we have enough market for all the different manufacturing enterprises that are going to be set up.
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Rajkumar
Yeah, I mean, you can see a lot of progress at the existence of the Africa CDC and how it's grown. And now this new phase is a real step forward for the health system strengthening on the continent.
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Dr. Ahmed Agwel Uma
A very big step. Not just a step, but a very big step. Three years ago, we were not thinking like this, but circumstances of the pandemic have shown us that we must think in this direction and ensure continent is actually ready for the next big outbreak even before a pandemic comes. The value in that kind of training is going to go beyond health, beyond health security. It will translate into other sectors as well. We expect the colleagues in agriculture will see it in the same way. We expect the colleagues within the climate change movement will see it in the same way. We expect politicians are going to see it in the same way. We are willing in the health security space, Africa cdc, African Medicines Agency, to lead that path where Africa can start doing things on its own. But of course, in collaboration with Friends of Africa.
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Rajkumar
Now you have been in the chair as acting director. What do you expect to happen from here? Will you be Acting Director General at some point? Or do you think that your role is going to be filled? Give us a sense of the latest on that process. Many of us, of course, listening to this, know John Nkengasong, your predecessor and now at pepfar, he played such a key role in the development of this agency. What will happen for that important position?
- [22:23]
Dr. Ahmed Agwel Uma
So two trucks here, the current Acting responsibilities that I have means that I must guide Africa CDC to continue to do what it's been doing and do even more. My ambition is we do better because now we have autonomy. So that track will continue. The second track is the process of getting the new structure to be operationalized where our Director General is going to be recruited and the rest of the system as well. Now that process is in the hands of the commission, the Africa Union Commission, not in the hands of Africa cdc. It is not our responsibility at the moment to do that. It is in the hands of the Commission who will midwife the process. And then after that, the policy organs of Africa CDC will take over. The governing board, does all the interviews and recommends that to the committee of Heads of States and government, who then make their recommendations to the Africa Union Assembly. So within the commission, there is a process that's going on. I'm not privy to that because it is their responsibility, not mine. And I may be an interested party anyway, so I will not get involved into the details of that. But these two processes will go hand in hand together so that there is no, no gap between the responsibilities that I have now before a substantive Director General is then recruited. How long that will take is not something that I will be able to know. It is a commission that can be able to answer that.
- [24:00]
Rajkumar
Well, it sounds like we might see you in the same chair with a new title soon. Or maybe an entirely different title down the road. Let's see. It's been such a pleasure to get to talk talk with you, Dr. Aman Ogawel Oma. And thank you for all the good work you're doing at Africa cdc.
- [24:16]
Dr. Ahmed Agwel Uma
Thank you for having me.
- [24:19]
Michael Igoe
Thanks for listening to UNGA Decoded. We'll be bringing you more interviews from the UN General assembly throughout the next week. If you enjoyed today's episode, please do share it with friends, family and colleagues. And you can also leave us a rating or a review on Apple Podcasts. If you've been to UNGA and have some thoughts, or if you just want to share some feedback on this episode, we'd love to hear from you. You can find us on social media Evex and at Alterig.