Channeling Nkrumah: The Quiet Promise of Pan-African Public Health
by Indira Martin, PhD
“It is clear that we must find an African solution to our problems, and that this can only be found in African unity.”
- Dr Kwame Nkrumah
Beyond the carefully curated negative imagery of human health in Africa and the diaspora, extraordinarily positive gains in public health are being quietly manifested on the continent and beyond. Fueled by epidemiologically experienced scientists and clinicians, Africa is coming into her rightful place as a global leader in innovative public health policy and practice. That this is being done with significant gaps in technology and other resources, makes this journey all the more spectacular.
One of the much heralded African success stories in the fight against the global covid-19 pandemic was Senegal who met the crisis with innovative approaches such as the development of a low-cost test for antibodies to the virus and the manufacture of low cost ventilators using 3D printing, as well as the engineering of medical robots to ease the human resource burden (1,2).
And there were numerous other examples of commendable pandemic responses throughout the continent- from Rwanda’s innovative use of ‘pooled testing’ to deliver free testing to its population (3); to Kenya’s repurposing of factories to manufacture masks (4). In the face of much global skepticism and controversy (5), the Malagasy Institute of Applied Research developed a herbal tonic containing extracts of the Artemisia plant known to be an effective treatment for malaria; this was submitted in capsule form to the Pan African Clinical Trials (6). Subsequent laboratory-based studies have supported a potential use for artemisins, the active ingredient in Artemisia, for the treatment of covid-19 disease (7,8).
Africa suffered unexpectedly low death rates from covid-19 and a similar case was seen in the Caribbean (9), defying doomsday computer models predicting Africa being overcome with covid-19 infections. Unexpectedly, African and Caribbean countries have fared better than the wealthier economies in the global North particularly in terms of death rates. We saw bungled public health responses for example in the US and UK, resulting in enormous death rates in the hundreds of thousands. We saw the unprecedented scene of Cuban doctors travelling to Europe to assist Italy in their fight against the pandemic (10).
There has been speculation as to why death rates were so low in Africa: some analysts have cited the youthfulness of African populations due to low life expectancy (11), or the counter-intuitive benefits of crowded living under impoverished conditions, or possibly prior infection with other coronaviruses which generally cause the common cold (12). Notwithstanding these circumstantial explanations for low African covid-19 fatalities, in the midst of this global panic elicited by covid-19, something powerful is quietly manifesting on the African continent. It seems that African scientists are reaping the benefits of years of experience dealing with public health threats (13).
Immediately preceding the global pandemic, one of Africa's finest scientists, Cameroonian Dr John Nkengasong, left his job as Chief of the International Laboratory Branch at the United States Centre for Disease Control (CDC) to become the founding director of a new public health organisation based in Addis Ababa, Ethiopia- the Africa CDC, founded in 2017 (14). This newborn child of the African Union immediately established the Journal of Public Health in Africa, under the leadership of distinguished virologist Dr Nicaise Ndembi as its first Editor-in-chief appointed in Nov 2019 (15). Promptly faced with the most serious of challenges in the covid-19 pandemic, under Dr Nkengasong's leadership the African CDC quickly sprang into action, leveraging global health networks to rapidly multiply diagnostic and clinical capacity throughout the continent (16).
These global health networks have been pivotal in forging connections across Africa and the diaspora, and builds on the work of many leaders in the public health arena. Almost a decade ago, I had the privilege as a young newbie public health lab director in the Bahamas, in participating in a Caribbean regional accreditation training program. The program, sponsored by the United States President’s Emergency Plan For AIDS Relief (PEPFAR) agreement with Caribbean states, was led by a contracted group of African scientists mostly out of South and East Africa called AFENET (African Field Epidemiology Network). The AFENET lead trainer, Dr Talkmore Maruta, is now a Senior Biosafety and Biosecurity Officer at the Africa CDC, coordinating implementation of the Biosafety and Biosecurity Initiative in the Africa region. He explains:
“Africa CDC strengthens the capacity and capability of Africa’s public health institutions as well as partnerships to detect and respond quickly and effectively to disease threats and outbreaks, based on data-driven interventions and programmes. [We are] currently leading the COVID-19 response”.
Africa CDC represents an official, state-sanctioned structure of pan-African public health in action. But there are many other diverse initiatives- born of both informal and formalised scientific networks- throughout the diaspora focused on the various facets of public health in African peoples.
In the case of cancer, the African Caribbean Cancer Consortium (AC3) of which I am a member, is a global pan-African network of scientists focused on cancers affecting the African diaspora, coordinated by Prof Camille Ragin based at the Fox Chase Cancer Center in Philadelphia, Pennsylvania, USA (17). A Jamaican by birth, Prof Ragin modestly states that:
"I established the African Caribbean Cancer Consortium (AC3) in order to build a collaborative research network of investigators who are committed to addressing the disproportionate body of scientific evidence generated from cancer research among populations of African Ancestry. This was fueled also by my motivation to contribute to the improvement of the health of Black people whose lives have continued to be disproportionately impacted by cancer. For me it was not enough to become a cancer researcher to test hypotheses that will reveal interesting findings. Rather I am passionate about generating scientific evidence that will yield greater impact in improving the health of Black individuals. I am humbled to have the opportunity to collaborate with so many like-minded investigators who are members of the AC3.”
Indeed, whereas it might be argued that there is a political bent to the networking that is occurring among African scientists throughout the diaspora, the fact remains that there are clear scientific reasons to investigate disease in the context of the unique and shared nuances in health experienced by Africans on the continent and beyond: such as genetic background, cultural similarities, and the common biological manifestations of racial disparity and/or a history of enslavement. With the objective clarity of the scientific lens we are able to reliably affirm a common bio-historical origin in Africa among diasporic Africans, and in so doing the science supports the pan-African politic of a united approach to matters affecting African health at home and abroad.
The 2001 Nassau Declaration of the governments of the Caribbean Community (Caricom) was made in my home country of the Bahamas, an archipelago in the Caribbean far away from the African continent and yet paradoxically inhabited by a majority of Africa's children- a solemn quirk of a history of enslavement. The Nassau declaration was simple but profound: The Health of The Nation is the Wealth of the Nation (18). But the biology of disease, if not the compulsion of Pan-african politics, dictates that in order to achieve maximal health in any nation inhabited by Africans, we must work together in common accord with others of our people from far flung corners of Earth, to collect data, devise models, and share resources, experiences and approaches. A pan-African public health model is a project born of pragmatism as much as it is one born of politic. Global African unity in health research and implementation is a logical imperative as much as it is a noble vision; the inevitable conclusion of reasoned, scientific distillation.
And in this quiet but compelling promise of pan-African public health, one can hear Dr Nkrumah's whisper on the wind...
I greatly thank my esteemed colleagues Prof Camille Ragin and Dr Talkmore Maruta for providing quotes for this article.
REFERENCES
1. https://apnews.com/article/66e8d6229ce8cfa535c3db2e821e7753
7. Anti-SARS-CoV-2 Potential of Artemisinins In Vitro
Ruiyuan Cao, Hengrui Hu, Yufeng Li, et al. (2020) ACS Infect Dis. Jul 31
Mathieu Gendrot, Isabelle Duflot, Manon Boxberger, Océane Delandre, Priscilla Jardot, Marion Le Bideau, Julien Andreani, Isabelle Fonta, Joel Mosnier, Clara Rolland, Sébastien Hutter, Bernard La Scola, Bruno Pradines
Int J Infect Dis. 2020 Oct; 99: 437–440.
11. Africa’s low COVID-19 mortality rate: A paradox? Yakubu Lawal (2021) Int J Infect Dis. 102: 118–122.
12. https://www.bbc.com/news/world-africa-53998374
14. https://africacdc.org/people/john-nkengasong/
16. https://www.devex.com/news/the-man-behind-africa-s-covid-19-response-98689
17. https://www.foxchase.org/blog/2017-02-14-camille-ragin-scientific-and-community-leader