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

Episode Date: July 9, 2026

The ongoing Ebola outbreak in the Democratic Republic of Congo and Uganda has become the third-largest on record. And while the regional response is more robust than it was during the largest outbreak, in 2014-2016, the U.S. has now largely divested from global health initiatives under President Trump. So it raises the question: What role should the U.S. play in global health? And how do we build systems that protect our collective health even as political winds change? Flora speaks with John Nkengasong, virologist and founder of the Africa CDC, about Ebola, what it took to curb HIV/AIDS, and how to make global health initiatives more resilient. Dr. Jessica Bartley is senior director of psychological services for the U.S. Olympic and Paralympic Committee. Guest:  Dr. John Nkengasong has led public health initiatives in the United States and across Africa for over 30 years. He is also the executive director for higher education, collaboratives, and special initiatives at the Mastercard Foundation. Transcripts for each episode are available within 1-3 days at sciencefriday.com. Subscribe to this podcast. Follow our show on Instagram, TikTok, Facebook, and Bluesky @scifri and sign up for our newsletters. Got a science question that’s keeping you up at night? Call us: 877-472-4374 Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Hey, it's Flora and you're listening to Science Friday. An outbreak of the Bundy-Busjo 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 2014-216 outbreak that killed 11,000 people primarily in West Africa. The U.S. CDC has deployed some staff in 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 U.S. play? Here with me is Dr. John Kenghisang. 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 Ph.D. in Europe and worked on HIV-AIDS for the U.S. 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.

Thank you. Let's start with Ebola. What international response are we seeing and what do you think we should be seeing? 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 will call in this conversation Africa CDC, just convene a meeting of head of states in Africa to rally them around this outbreak because it's a serious health security threat. So we are seeing that.

At the global front, we are seeing the coalesing of assets and the WHO Geneva is leading that coordination. The UNICEF is leading that coordination, philanthropists like the Gates Foundation, the MasterCat 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 her this morning, early this morning at 7.30, and we're exchanging ideas on how it is going there. And really, this is the kind of leadership that we have been saying we want to see in the regions and we want to see in the countries. And this is a change, right? Because in 2014, the Africa CDC did not exist. 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, herd 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 their backyard. We need to do something. That said, do you think the U.S. should be playing a different role in this outbreak? 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 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 exercise 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 a global fund.

So look at where we are with the trajectory of that. There used to be of four million deaths a year. It's mostly in Africa. and today 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 U.S. 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 has been recognized. recognize 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. But the United States is pulling out of its leader of role in global health. Or do you see it differently? 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 dismanting of USAID was a terrible and unfortunate disaster

in the fight against diseases in global health, which I will keep repeating. GlobalHeart is not about helping others. It's about helping ourselves. 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? Absolutely. I was born in Cameroon, and the education system in Cameroon at that time was very forward-leaning. In other words, you just did 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 ways, 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 an elevation. fans and other while life was in then 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 um 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 uh the first thing that struck me was that there was no treatment for varro disease 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 it. 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. Tell me about your work in Cote d'Ivoire. 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, right? An African who had come in their study, did a postdoc, and end the confidence in Antwerp of all. I mean, a very conservative city. And so, yeah, I was very young. And I wanted to go back to Africa. I just wanted to. I was in dining, to go back to Africa.

Why? 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, okay, and this was the 90s. I mean, where you walked 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 Entebe to Kampala, you saw nothing by coffins.

the driving a business there was a coffin you drive like two hours you saw nothing by a coffin so I said to myself I need to go back and I remember reading in the library the Lancet a very prestigious America 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 me wife. Then I said, my God, I need to tell you something. I have applied for a position in Abidjan. He said, where is that? He said, where is there? He said, where is there?

He said, but you have a job here. You are the chief of a biology lab. You're publishing a lot of people who respect. I said, no. But anyway, fast forward. Was she okay with it? She was okay with it. She supported that. I went to Codivore and interviewed with the U.S. CDC 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 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 abandon building at the infectious disease unit, and then build a lab from scratch. That's the kind of challenge that I wanted to do. But I said, if we do, the U.S. 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 biology for HIV as a whole. Is this the kind of person you are, you see a big challenge and you're like, yeah, sign me up. Absolutely. In all my career, and I've just retired from the U.S. CDC after 30 years, I never work 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,

PEPFAR was created. That is the president's emergency plan for AIDS relief. 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 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 U.S. CDC at that time that I wanted to go back and build the Africa CDC from scratch. So I've never worked into a job that existed, except this job that I am in. You must have a lot of energy. 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? It's so interesting because even as a young person in your 20s, you were looking for the why, right? You were like going through, is it this, is it the bugs? Is it wildlife? I knew that you're always motivated by that. 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, you grew up with a lot of curiosity. You sit in the 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, why is that plane flying there?

Okay, how is it going to land? And there's all those kind of questions there. I mean, why are they vaccinating me? All the vaccines that you took. So you grew up in that curiosity of the main. And because of your circumstances, you are curious to solving the problem because you have to solve your own problems when you are poor. After the break, what should global health systems look like? Is there a better system? Stay with us.

Deaths from HIV-AIDS have decreased tremendously. What are the lessons that you take from that? And can they be applied to other pathogens or things too different? AIDS's its own story. Yeah, AIDS is its own story, but it has a general story. The general store 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 cuff 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.

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 for that is that you have to be resilient and do that and have a long haul of it. It can't be, because you have some problems, and some new problems were emerging, 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. It's a pandemic here or outbreak. We all write good reports, and then he ends with never again. 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 time. 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. I mean, we don't follow through. Is 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. It's seriously threatened.

After COVID, the COVID outbreak, there are about 30 pathogens. 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, okay, work on how do we set up workforce across the world? Like an army, right? 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, okay, across the world? So that we move away from accusation, Like, oh, the United States produced diagnostics or Europe and keep it for themselves and not share it with a developing world. That doesn't create trust at all. 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? 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 wheel 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-A yesterday if there was no political capital orchestrated by president. Bush. When I met him, when I was confirmed as the ambassador for the U.S. Global Aid Coordinator, I went to meet with him and with Laura. We sat down and asked him the question, President, why did you create a pepper? 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, this is 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, I mean, good public health resides on good politics there.

John, thank you so much for talking with me today. You're welcome. I appreciate it. Yeah, yeah, yeah. 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 Aireti, John Dancosky, and Kathleen Davis. Thank you for listening.

I'm Flora Lichten.