Dr. John Nkengasong - Executive Director, Higher Education, Collaboratives, and Strategic Initiatives, Mastercard Foundation
Former Director, Africa CDC (2017-2022), and former Ambassador at Large, U.S. Global AIDS Coordinator and Senior Bureau Official for Global Health Security and Diplomacy (2022 to 2025).
The quiet days between Christmas and the New Year in 2019 were meant for recharging. As director of Africa CDC, the African Union's public health agency, I was on holiday in the US, exhausted after months fighting a complex Ebola outbreak in the Democratic Republic of Congo. But as the holiday festivities faded, a new, disturbing news surfaced: an unknown respiratory infection from Wuhan, China, was spreading.
I realized immediately that this was serious. As cases spread rapidly to Thailand and Hong Kong, I summoned the team back to work at HQ in Addis Ababa. But more daunting than the pathogen was the responsibility we bore: coordinating a response for 55 African Union member states and 1.5 billion people through an institution never tested on such a scale. Early projections warned of staggering scenarios of up to 200 million African deaths.
Before the first African case was detected, we were mobilizing. We mapped the 10 African countries with direct flights from China and prioritized training each country’s medical laboratory staff. We assembled working groups led by African experts on laboratory medicine, public health, data sciences and genomics. Young epidemiologists who'd been fighting Ebola in DRC deployed to West Africa as COVID spread. This was African expertise responding to an African crisis.
When WHO offered Africa just about 2 million COVID tests for a continent of 1.4 billion people, we knew we had to act alone. When vaccines became available and Africa had to wait for its turn while wealthy nations stockpiled doses, we knew the pattern. This wasn't malice - it was national self-preservation. But it meant Africa needed a different strategy, one based on African resources and African trust.
History seemed poised to repeat itself. After three decades working on HIV/AIDS, I'd watched antiretroviral drugs take 10 years to reach Africa after becoming available in the West. Twelve million people died in that gap. We were determined not to repeat that experience.
The pivotal moment came through a partnership with the Mastercard Foundation. Reeta Roy, the Foundation’s President and CEO, asked us a question that transformed everything: would US$1 billion enable a meaningful pandemic response? And what would such a response look like? The answer was clear - it would mean the ability to purchase vaccines, distribute them across the continent, strengthen Africa CDC's capacity, and support local vaccine manufacturing. On this basis, the Foundation committed US$1.5 billion to Saving Lives and Livelihoods, the largest-ever partnership between a philanthropic organization and an African institution.
That commitment both funded our response and dramatically shifted how the world saw Africa CDC. Before, I'd sit in donor meetings trying to figure out how to raise money. After the Mastercard Foundation's investment, everything shifted. The World Bank, which had previously offered us US$10 million as part of a regional grant before the pandemic, suddenly came asking if US$100 million would be enough. The United Kingdom followed with £20 million. By the time I left Africa CDC, we'd mobilized about US$1.8 billion.
What the Mastercard Foundation’s team understood – and what made this partnership work - was trust. They believed in African leadership and African institutions. Over the next four years, the Saving Lives and Livelihoods program delivered 57 million vaccine doses to member states, supported the training and deployment of 37,000 health workers and enabled the creation of 23,000 jobs across 25 African nations. That scale was possible because Africa CDC was trusted to make decisions and act quickly.
Beyond the immediate pandemic response, Saving Lives and Livelihoods helped lay the foundation for Africa's long-term health security. Genomic sequencing laboratories expanded from about two to over 46 countries, creating data-sharing networks that connect national systems into a continental early warning system. Programs like African STARS Fellowships at the Centre for Epidemic Research Institute at Stellenbosch University are developing the next generation of health leaders across Africa's universities, while Institut Pasteur Dakar is training the continent's vaccine manufacturing workforce. And in 2022 Africa CDC gained greater independence and responsibility when it was established as an autonomous African Union agency - underscoring its significance as Africa’s leading public health institute.
As the Saving Lives and Livelihoods program reaches its planned conclusion this December, Africa faces a critical decision: Does the continent outsource its health to global capitals, or does it own it? My vision - forged during my time at Africa CDC - is for an African-led ‘new public health order.’ A continent of 1.5 billion people cannot rely on others for its citizens' health or tie it to political outcomes in Western capitals. Africa cannot build sovereignty on aid budgets that shift with electoral cycles. One of the key foundations for African health sovereignty is being strengthened through genomic networks, expanded vaccine manufacturing capacity, and newly trained leadership. With recent investments accelerating the growth of African organizations, the continent now has a cohort of institutions capable of supporting Africa CDC’s response to future pandemics. The challenge is now political: will African governments treat this infrastructure as a permanent strategic priority to be invested in for the long run?
If and when the next pandemic arrives, it will find either a continent prepared to continue to lead its own response, or one that has let this opportunity pass. What happens next depends on the choices African governments make now.
