[AUDIO LOGO] FLORA LICHTMAN: Hey, it’s Flora, and you’re listening to Science Friday. An outbreak of the bundibugyo 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 2014-2016 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 Nkengasong. He has 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.

JOHN NKENGASONG: Thank you.

FLORA LICHTMAN: Let’s start with Ebola. What international response are we seeing, and what do you think we should be seeing?

JOHN NKENGASONG: 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 17th 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 played 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 to rally them around this outbreak because it’s a serious health security threat. And so we are seeing that.

At the global front, we are seeing the coalescing of assets, and the WHO Geneva is leading that coordination. The UNICEF is leading that coordination. Philanthropies 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 7:30, and I was– we were exchanging ideas on how it is going there. So I really– this is the kind of leadership that we have been saying we want to see in the regions and want to see in the countries.

FLORA LICHTMAN: And this is a change because in 2014 the Africa CDC did not exist.

JOHN NKENGASONG: 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 a 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. We need to do something.

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

JOHN NKENGASONG: Oh, 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 of 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. They used to be about 4 million deaths a year. It’s mostly in Africa, and today we look at where we are, about 600,000 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 led, 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, it took just 30 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.

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

JOHN NKENGASONG: Yeah. 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 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.

FLORA 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? Nkengasong.

JOHN NKENGASONG: I was born in Cameroon, and the education system in Cameroon at that time was very forward leaning. In other words, if you just need to study and do well 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 endangered. I wanted to solve the problem.

So I was struggling with myself, and it’s very typical when at that age where you’re 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 1988. That’s how I joined HIV Yes.

FLORA LICHTMAN: Tell me about your work in Cote d’Ivoire.

JOHN NKENGASONG: So I had spent like 10 years at the Institute of Tropical Medicine in Belgium and actually became the chief of the virology lab at the age of 33. And this is an African–

FLORA LICHTMAN: That’s pretty young, right?

JOHN NKENGASONG: Yeah, an African who had come in there, studied, did a postdoc, and end the confidence in Antwerp of all, a very conservative city. And so, yeah, it was very young and– but I wanted to go back to Africa. I just wanted to. I was in dire need to go back to Africa.

FLORA LICHTMAN: Why?

JOHN NKENGASONG: 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. So remember this is the peak of HIV, and this was the ’90s, where you walk down the streets of Nairobi or Entebbe you saw people with sunken jaws. You didn’t need a lab test to 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, I saw nothing but coffins. The thriving business there was coffins. You mean you drive 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 medical journal, and I saw that a position had been advertised at the US CDC field station in Abidjan.

And I 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– and then I said, my God, I need to tell you something. I’ve applied for a position in Abidjan. He said–

FLORA LICHTMAN: By the way.

JOHN NKENGASONG: He said where is that. I said Cote d’Ivoire. Said but you have a job here. You are the chief of a virology lab. You are publishing. A lot of people respect you. I said no but– but anyway fast forward–

FLORA LICHTMAN: Was she OK with it.

JOHN NKENGASONG: She was OK with it. She supported that. I went to Cote d’Ivoire and interviewed with the US CDC folks, and they gave me a one year contract. And I took the contract. And when I came back, I explained to my wife, she said are you OK. You have a permanent job here, and you want to go take a contract for one year.

I like it because it was you needed to knock down an abandoned 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 US CDC 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 sub-region, 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.

FLORA LICHTMAN: Is this the kind of person you are? You see a big challenge and you’re like, yeah, sign me up?

JOHN NKENGASONG: Absolutely. In all my career– and I just retired from the US CDC after 30 years– I never walk into a job that existed. So I always took a job that I thought– I had to create that job. Then fast forward when I moved to the CDC headquarters in Atlanta, PEPFAR was created. That is the President’s Emergency Plan for AIDS Relief, but there were no laboratories.

So I shoved 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– the Ebola hit West Africa, and I saw the disaster that it had created in Africa. I told Dr. Frieden, who was the director of the US CDC at that time, that I wanted to go back and build the Africa CDC from scratch. So I’ve never walked into a job that existed except this job that I am in.

FLORA LICHTMAN: You must have a lot of energy.

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

FLORA LICHTMAN: It’s so interesting because even as a young person in your 20s, you were looking for the why. You were like going through is it this. Is it the bugs? Is it wildlife?

JOHN NKENGASONG: I knew that–

FLORA LICHTMAN: You’re always motivated by that.

JOHN NKENGASONG: I was very curious about– yes, about the whys and about research and answering questions. When you are born out of poverty because I was born from a family that was very poor, 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 shade the sun. You look at that. You ask questions like why is that plane flying there. How is it going to land? And there’s all those kind of questions there.

Why are they vaccinating me? They made all the vaccines that you took, so you grew up in that curiosity, because of your circumstances, you are curious to solving the problem because you have to solve your own problems when you are poor.

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

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

JOHN NKENGASONG: 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 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. So it took us at least 25 years to bend the curve in HIV/AIDS from where we are having millions of deaths to now that we have about close to 650,000 deaths a year, but it took us 25 years.

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 other diseases 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.

So what does this mean for global health security? We are extremely transactional in global health security. We have what we call– are called the pandemic memory loss. It’s a pandemic or outbreak. We all write good reports, and then it ends with never again we’ll ever.

Of course, that is not true. 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 you give you a report now because we say all the right things but we don’t even do it and we don’t follow through. Is that cycle of panic and neglect with them.

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. It’s seriously threatened.

After COVID, the COVID outbreak, there are about 30 pathogens that have been out there that are threatening to jump into human species. Can we for once just come together and say let’s build a defense system where we truly work on how do we set up workforce across the world that would– like an army. Every country has its own army.

Where is our army to fight diseases? That is a serious threat to all of us. Where are we producing diagnostics 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 share it with the developing world. That doesn’t create trust at all.

FLORA LICHTMAN: How do we build that system though. 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?

JOHN NKENGASONG: Public health is political. It has always been. That is– 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, why did you create PEPFAR.

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 Condi 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 $15 billion. 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. Good public health resides on good politics there.

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

JOHN NKENGASONG: You’re welcome. Thank you having me.

FLORA LICHTMAN: I appreciate it.

JOHN NKENGASONG: Yeah, yeah, yeah.

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

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