During the pandemic, the UK and other rich nations have relied on African doctors and nurses to shore up their health services.
Now the continent’s chief health leader is hoping to put the brain drain into reverse with a plan to persuade African expats to return.
Dr John Nkengasong, the head of the Africa Centres for Disease Control and Prevention (Africa CDC), said they were planning a programme to attract scientists, doctors and nurses back from the diaspora.
“The leadership of the continent must invest in strengthening health systems,” Nkengasong said, in an interview with the Observer. “We need a very deliberate programme that facilitates Africans in the diaspora to come back to the continent and do a rotation. A Ghanaian or Nigerian in London doesn’t just wake up in the morning and think, ‘I’m going to go to Nigeria for a year.’ That person needs lodging, basic transportation. They have responsibilities, a job.”
He said the Africa CDC would soon put forward a package of measures to the African Union commission to create a regional health treaty to govern the pandemic response, which would include support for expatriates.
Research by the House of Commons library last year showed that 2.5% of NHS England’s 1.35 million staff were African. The largest proportion were the 10,494 from Nigeria, with a further 4,780 from Zimbabwe, 3,395 from Ghana and 2,895 from Egypt.
Nigeria has about 72,000 registered doctors, but only 35,000 were practising in the country in 2021, according to Abba Moro, a Nigerian senator.
The Africa CDC set up seven working groups allowing doctors and scientists working in richer countries to give regular advice remotely.
“They have been extremely useful during this pandemic,” Nkengasong said. “We need to formalise it and facilitate the return to the continent to support the public need.”
Africa seems to have suffered less severely from Covid and its variants than other continents. About 10 million people are estimated to have been infected but that is probably an undercounting, Dr Nkengasong said, and about 220,000 people have died.
“That’s relatively low for a continent of 1.3 billion,” he said. “We saw India was overwhelmed by Covid in May, you couldn’t hide it. We’ve not seen a scenario in Africa where people are dying on the streets.
“I think there is a puzzle of why many more people have been infected in Africa, but it has not translated into many deaths. That is a research question we need to investigate, and also how many deaths we are missing.
“We have to be prepared for variants to emerge that will be more challenging than what we are dealing with.”
Africa CDC has been instrumental in creating the Sentinel network of labs to track the virus using genomic sequencing that led to the detection of the Omicron variant in Botswana in November.
“We have the infrastructure in place to detect early, prevent and respond,” he said. “Take west Africa – there’s a lot of public health assets there. The Noguchi [Medical Research] Institute in Nigeria is a state-of-the-art facility. The Pasteur Institute in Cote d’Ivoire, the Pasteur Institute in Senegal, the Medical Research Council in the Gambia – but they were not talking to each other. The whole concept of this new public health order is to use as much in the region as you can.”
He added that in 2018 he was contacted by public health officials in Sierra Leone about a suspected monkeypox case, asking for help to find someone at the US CDC to test for the disease. “I said no, if you send that to Cote d’Ivoire, I know they have the primers to help you do that.”
That mindset of Africans always needing help from richer western nations is far too widespread, he said.
“People see the continent as a place to go, do a few projects, gather the data, publish it, do a few clinical trials and get out. That is not global health. It should be an equal partnership, recognising that the principal investigators should come from the developing countries.”
The pandemic provided an example of the limits of western help, he said, with the WHO’s Covax programme. The Gavi alliance, which directs the programme, had pledged 2bn doses of vaccines to 144 poorer countries in 2021, but managed about 900m. Earlier this month, poorer nations rejected 100m doses that were close to expiring. There have been heated debates about whether western countries were hoarding vaccines.
“Covax represents the best mechanisms of global cooperation,” Nkengasong said. “But look at what happened. It’s a good example of where good intention is not matched by reality. The promissory note that African countries would get vaccines at the same time didn’t happen.
“And what we did, under the leadership of President Ramaphosa, we established the African Vaccine Acquisition Task Team and we were able to acquire 400m doses of the Johnson & Johnson vaccine.”
So far Africa CDC has launched 12 pandemic initiatives, he said. As well as genomic surveillance and vaccines, there are plans to secure diagnostics and testing kits, and medical supplies.