Amid shifting politics, can we build stable global health systems?

Virologist, policymaker, diplomat: Dr. John Nkengasong discusses the current Ebola outbreak, and how public health is inherently political.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:02Flora Lichtman?

  Hey, it's Flora and you're listening to Science Friday. An outbreak of the bundiboujo virus in eastern Congo and Uganda has become the third-largest Ebola outbreak on record. The Africa CDC warned that if the virus is not halted, it could become even more deadly than the 2014 to 2016 outbreak that killed 11,000 people, primarily in West Africa. The US CDC has deployed some staff and funding, but generally, the Trump administration has divested in foreign public health, leaving WHO dismantling USAID. So the question we're asking is, what role should the US play? Here with me is Dr. John Kengasong.

• 0:45Flora Lichtman?

  He has a one-of-a-kind perspective, and let me just run through a bit of his bio. John was born in Cameroon. He got his PhD in Europe and worked on HIV/AIDS for the US CDC at a field station in Cote d'Ivoire and then in Atlanta, and was the founding director of the Africa CDC. There are very few people in the world who have led and thought as deeply about public health initiatives across the continent of Africa as John, so I'm very, very glad to have him here with us today. Thank you for being here.

• 1:20Speaker 01

  Thank you.

• 1:21Flora Lichtman?

  Let's start with Ebola. What international response are we seeing? And what do you think we should be seeing?

• 1:30Speaker 01

  What we are seeing with respect to this current Ebola outbreak in the Democratic Republic of Congo, commonly called DRC, is African leadership, where the country Congo itself is leading an extraordinary response, supported by their own resources, the assets that they've accumulated over the years. Remember, this is the 17 or so outbreak in that country. We are also seeing the regional WHO, World Health Organization, and the Africa Centers for Disease Control and Prevention, playing an extraordinary role. The Africa Centers for Disease Control, which we call in this conversation Africa CDC, just convened a meeting of head of states in Africa

• 2:15Speaker 01

  to rally them around this outbreak because it's a serious health security threat. And so we are seeing that. At a global front, we are seeing the coalescing of assets. And the WHO Geneva is leading that coordination. The UNICEF is leading that coordination. Philanthropists like the Gates Foundation, the Mastercard Foundation are supporting. So we are seeing a multi-layered response to this outbreak. But again, what is important and pleasing to me is the leadership that the government of the Congo is exercising. I just spoke with the Minister of Health this morning, early this morning at seven thirty. And we were exchanging ideas on how it is going there. So I really, this is the kind of leadership

• 2:58Speaker 01

  that we have been saying we want to see in the regions and want to see in the countries.

• 3:03Flora Lichtman?

  And this is, this is a change, right? Because in 2014, the Africa CDC did not exist.

• 3:09Speaker 01

  Absolutely. In disease outbreaks, when you do that call and how you do the call is so important. So that is the extra advantage of having regional authorities, health authorities that can look at their backyard and say, hey, look, there's fire in my backyard and I need to do something with it, rather than wait for an organization in Geneva to say, look, it looks like you have fire in your backyard and we need to do something.

• 3:34Flora Lichtman?

  That said, do you think the US should be playing a different role in this outbreak?

• 3:38Speaker 01

  The United States has always been a champion, a leader in global health with a distant second. And that has made the world a better place. It has created trust. Trust is what connects all of us as humanity. And that leadership is, has been recognized at several levels. Where we are today with respect to the control of HIV/AIDS because the leadership the United States exercised when President Bush went to Congress. And said, I want to create an emergency response plan for the world. And he created the PEPFAR and then the Global Fund. So look at where we are with the trajectory of that. There used to be about four million deaths a year.

• 4:21Speaker 01

  It's mostly in Africa and today, look at where we are, about six hundred thousand deaths and could do more. Polio, we are where we are with polio and aiming at elimination or eradication because of the leadership of the United States. We are here today because smallpox was eradicated, eliminated because the United States, especially the US CDC, showed a lot of leadership there. So the point I'm making is that when the United States have learned, the world has been in a good place. And that leadership role is, it has been recognized abundantly. And it's not protecting others, it's protecting all of us because we are all very, very interconnected. Let me use COVID as an example. When COVID showed up in Wuhan,

• 5:04Speaker 01

  it took just thirty days for the whole world to be affected. And it created serious economic harm to everybody in the world, including the United States. So the point I'm making is that this is absolutely not the time for the United States to pull out of that leadership role in global health.

• 5:22Flora Lichtman?

  But, but the United States is pulling out of its leadership role in global health. Or do you see it differently?

• 5:27Speaker 01

  Yeah, the United States, of course, is very clear that it has pulled out of the World Health Organization, which I don't think that is a wise decision. The dismantling of USAID was, was a terrible and unfortunate disaster in the fight against diseases in global health, which I will keep repeating, global health is not about helping others, it's about helping ourselves.

• 5:53Flora Lichtman?

  I want to talk a little bit about, you mentioned HIV and AIDS. And that is such an amazing story and I know a huge part of your career. I want to go back in time even before that and just hear a little bit about your trajectory. How did you grow up? How did you find your way to science?

• 6:10Speaker 01

  Absolutely. I was born in Cameroon and

• 6:15Speaker 01

  The education system in Cameroon at that time was very forward leaning. In other words, you just need to study and do well in your, in secondary school and high school and you get a scholarship to continue studying. But when I graduated, I just, I wasn't sure what to do. I wanted to do entomology because I've read somewhere that insects were affecting, can affect plants in a whole variety of way and I wanted to solve a problem. I was looking for a problem to solve. Then I abandoned that. Then I wanted to do wildlife because I read somewhere that there was elephants and other, wildlife was in danger. I wanted to solve the problem. So I was struggling with myself and it's very typical when, at that age, where you're

• 6:59Speaker 01

  still trying to define yourself. Then I met a professor and he said, virology is exciting. And I've never heard about virology. So I started reading, what is virology? And I said, oh boy, this is something interesting because the first thing that struck me was that there was no treatment for viral diseases. None. We can treat it, but you just cannot cure it. So that became a problem that I thought at that age that I wanted to be part of. I started working on hepatitis B at the medical school and then I had a scholarship to go to Belgium at the Institute of Tropical Medicine after just one year and started my HIV career in nineteen eighty-eight. That's how I joined HIV, yes.

• 7:42Flora Lichtman?

  Tell me about your work in Cote d'Ivoire.

• 7:45Speaker 01

  So I had spent like ten years at the Institute of Tropical Medicine in Belgium and actually became the chief of the virology lab at the age of thirty-three. And this is

• 7:57Flora Lichtman?

  That's pretty young, right?

• 7:58Speaker 01

  An African who had come in their study, did a postdoc and had the confidence in Antwerp of all, I mean, a very conservative city. And so, yeah, I was very young and that, I wanted to go back to Africa. I just wanted to, I was in need to go back to Africa. Because I thought the need was there because I was based in Belgium, but my work was mainly in the DRC and Cameroon, Gabon, in Kenya.

• 8:25Speaker 01

  So that remember this is the the peak of HIV, okay? And this was the nineties. I mean, where you walk down the streets of Nairobi or Entebbe, you saw people with sunken jaws. You didn't need a lab test to know that this was an HIV patient or young people there. When I visited Uganda for the first time from the airport in Entebbe to Kampala, you saw nothing but coffins. The thriving business there was coffins. You mean, you drive like two hours, you saw nothing but coffins. So I said to myself, I need to go back. And I remember reading in the library, the Lancet, a very prestigious American journal. And I saw that a position had been advertised at the USCDC field station in Abidjan.

• 9:07Speaker 01

  And I a photocopy that advert, I wrote my application, attached my CV and faxed it to the address that was there. Then I went home and told my wife that I mean, then I said, my God, I I need to tell you something. I have applied for a position in in Abidjan. He said, where is that? He said, where is that? He said, Cote d'Ivoire. He said, but you have a job here. You are the chief of a virology lab. You are publishing a lot of people respect. I said, no, but but anyway, fast forward.

• 9:37Flora Lichtman?

  Was she okay with it?

• 9:38Speaker 01

  She was okay with it. She supported that. I went to Cote d'Ivoire and interviewed with the USCDC folks. And they gave me a one year contract. And I took the contract. And when I came back and explained to my wife, she said, are you are you okay? I mean, you have a permanent job here and you want to go take a contract for one year. I liked it because it was you needed to knock down and or abandon building at the infectious disease unit and then build a lab from scratch. That is the kind of challenge that I wanted to do. But I said, if we do, the USCDC is very resource and I love the scientists there. I said, if we actually do it right, the lab can serve the whole region and the subregion.

• 10:21Speaker 01

  And that became a platform, fast forward, by the time I left, it became a regional platform for treating HIV patients and for conducting virology for HIV as a whole.

• 10:31Flora Lichtman?

  Is this the kind of person you are? You see a big challenge and you're like, yeah, sign me up.

• 10:36Speaker 01

  Absolutely. In all my career, and I've just I've just retired from the USCDC after thirty years. I never walked into a job that existed. So I always took a job that I had to create that job. Then fast forward, when I moved to the CDC headquarters in Atlanta, PEP5 was created, that is a President's Emergency Plan for Aid to Live. But there were no laboratories. So I showed my hand up, I said I wanted to start creating. So I created a whole new branch in Atlanta and got that accredited. And that is the lab that was used in training Africans that came from all over the countries that we were supporting. Then when Ebola hit West Africa, and I saw the disaster that it had created in Africa,

• 11:18Speaker 01

  I told Dr. Frieden, who was the director of the US CDC at that time, that I wanted to go back and build the African CDC from scratch. So I've never walked into a job that existed, except this job that I am in.

• 11:30Flora Lichtman?

  You must have a lot of energy.

• 11:31Speaker 01

  Yeah, a lot of curiosity of what is the problem? Once I know the why, the how, I don't care about the how. I know I'll find a way to do the house. Yeah, it's always the why. Why am I doing this job?

• 11:47Flora Lichtman?

  It's so interesting because even as a young person in your twenties, you were looking for the why, right? You were like going through, is it this? Is it the bugs? Is it wildlife?

• 11:57Speaker 01

  I knew that--

• 11:58Flora Lichtman?

  You're always motivated by that.

• 11:59Speaker 01

  I was very curious about, yes, about the whys and about research. I mean, and answering questions. I mean, when you are born out of poverty, because I was born from a family that was very poor, and you grew up with a lot of curiosity. You sit in a village and you see a plane up there flying. That is the closest you saw a plane was a plane flying in the skies. And you are looking, you put your hand on your forehead to shed the sun. You look at that, you ask questions of why is that plane flying there? Okay, how is it going to land? And there's all those kind of questions. I mean, why are they vaccinating me? I mean, all the vaccines that you took. So you grew up in that curiosity of, I mean,

• 12:42Speaker 01

  because of your circumstances, you are curious to solving the problem. Because you have to solve your own problems when you are poor.

• 12:49Flora Lichtman?

  After the break, what should global health systems look like? Is there a better system? Stay with us.

• 13:01Speaker 02

  And from the Alfred P. Sloan Foundation, working to enhance public understanding of science, technology, and economics in the modern world.

• 13:14Flora Lichtman?

  Deaths from HIV/AIDS have decreased tremendously. What are the lessons that you take from that? And are they, can they be applied to other pathogens? Are things too different? AIDS is its own story.

• 13:26Speaker 01

  Yeah, AIDS is its own story, but it has a general story. The general story of HIV/AIDS is that we have to show resilience in fighting a disease. Diseases are very difficult to fight, very difficult to fight. So it's not transactional. It shouldn't be politicized, I mean, because it takes time. It took us years to get to where we are with polio. It took us years and decades to eradicate smallpox, right? So it took us at least 25 years to burn the cough in HIV/AIDS, from where we are having millions of deaths to now that we have about close to 650,000 deaths a year, right? But it took us 25 years.

• 14:08Speaker 01

  The United States government invested more than $100 billion over the last 25 years in fighting HIV/AIDS in the world. They saved 25 million lives. So the point is, what do we learn from that? Is that you have to be resilient and do that and have a long haul of it. It can't be, because you solve some problems and some new problems will emerge, right? So what does this mean for global health security? We are extremely transactional in global health security. We have what we call the pandemic memory loss. If a pandemic hit or outbreak, we all write good reports and then it ends with never again. Whatever, of course, that is not true.

• 14:52Speaker 01

  If you go back to the reports we all wrote and published in The Lancet and New England Journal after the outbreak in 2014, you can take those reports, change the dates, and change the countries and it'll give you a report now. Because we say all the right things, but we don't even do it. I mean, we don't follow through. It's that, that cycle of panic and neglect. So the point of HIV is that can we deliberately step back and say, this is our world now. This is our humanity. Our humanity is threatened. Is seriously threatening. After Covid, the Covid outbreak, there are about thirty pathogens that are out there that are threatening to jump into human species.

• 15:33Speaker 01

  Can we for once just come together and say, let's build a defense system where we truly, okay, work on how do we set up workforce across the world that would, like an army, right? Every country has its own army. Where is the army to fight diseases? That is a serious threat to all of us. Where are we producing diagnostics, okay, across the world? So that we move away from accusation like, oh, the United States produced diagnostics or Europe and kept it for themselves and not sharing with the developing world. That doesn't create trust at all.

• 16:06Flora Lichtman?

  How do we build that system, though? I mean, it feels like public health, global public health is so political and it feels so vulnerable because as we see, a new administration comes in, different priorities. What is a better system?

• 16:20Speaker 01

  Public health is political. It has always been, right? I mean, we, the scientists, can invent the tools, can know exactly how are you affected, who is affected, why are you affected, where are you affected? So we can do all of that and describe it. But if there's no political will behind that, it doesn't go anywhere. And diplomatic will. So two things, political will, diplomatic will. Let me substantiate that. We will still be dealing with HIV/AIDS today if there was no political capital orchestrated by President Bush. When I met him, when I was confirmed as the ambassador for the US Global AIDS Coordinator, I went to meet with him and with Laura, we sat down and I asked him the question, President,

• 17:05Speaker 01

  why did you create PEPFA? And he said, I believe in God and to whom much is given, much is required. And the United States has been blessed and they could solve that problem because Condoleezza Rice came to me, I'm quoting him, and said, there's a whole continent that is going to be eliminated by HIV/AIDS. Then he laughed. He said, I went to Congress and ambushed them. They didn't know I was coming to ask for fifteen billion dollars. So that is the political capital and leadership that existed around the 2000. So that is all political and diplomacy there. So it's always been. I mean, good public health resides on good politics there.

• 17:42Flora Lichtman?

  John, thank you so much for talking with me today.

• 17:44Speaker 01

  You're welcome.

• 17:45Flora Lichtman?

  I appreciate it.

• 17:46Speaker 01

  Yeah, yeah, yeah.

• 17:47Flora Lichtman?

  This conversation was recorded at Aspen Ideas Health. Special thanks to Tanya Bauer and Katie Taylor for their help. This episode was produced by Rasha Aridi, John Dankosky, and Kathleen Davis. Thank you for listening. I'm Flora Lichtman.