Africa: ‘Your Health Security in Somebody’s Hands is Dangerous,’ Warns Top Africa CDC Advisor #CPHIA2025

Durban, South Africa — What if Africa could use its industrial strength to protect its people’s health by producing medicines locally?

The future of Africa’s health security depends on local manufacturing, which has the potential to revolutionize access to life-saving medicines and vaccines. This is not only an economic opportunity, but also a key move toward health independence but also an important step toward health sovereignty. The foundation for creating a sustainable, end-to-end pharmaceutical ecosystem in Africa depends on coordinated investments, innovation, and political will.

In this exclusive interview at the 4th International Conference on Public Health in Africa (CPHIA) in Durban, South Africa, Principal Advisor to the Director General of Africa CDC and Continental Incident Manager for the Mpox response in Africa, Dr. Ngashi Ngongo, shared his vision for a self-reliant, healthier Africa capable of addressing its own health challenges. Africa CDC is the leading public health institution on the continent and is an autonomous agency of the African Union. The body is responsible for ensuring the health of over 1 billion people on the continent and coordinating cross-border outbreak responses.

“African manufacturing can transform both health security and development on the continent,” Ngongo said. He said that many people tend to focus solely on the health aspect, yet the benefits go far beyond and considering the other aspects of African development in general.

Dr. Ngongo said that health security depends on access to “medical countermeasures” – diagnostic tests, vaccines, and medicines – yet Africa currently produces less than 1% of the vaccines it uses and less than 5% of diagnostic tests. “Africa is almost 100% dependent on what happens outside of Africa,” he said, adding that this dependence leaves the continent vulnerable in times of crisis.

He recalled the COVID-19 pandemic in which Africa was left behind when wealthier nations blocked vaccine exports. “When your life is in somebody’s hands, that is very dangerous,” he said. “The Western countries produced for themselves first, and Africa was left to wait.”

This experience, he said, prompted African leaders to declare that “never again” should the continent be so dependent on others.

“They decided that at least 60% of what we use in Africa must be produced in Africa,” said Dr. Ngongo. “That just gives you an idea that if you don’t control the products you need, they are being controlled by someone else, then you can’t ensure your health security. That’s your health security in somebody’s hands.”

Health is one of the strongest sectors of any economy.

Beyond improving access to essential health products, local manufacturing would also help retain economic value within the continent. According to Dr. Ngongo, “health is one of the strongest sectors of any economy. But then, if the most important sector of the economy is dependent on other countries, what does that mean?. It means that most of your money is going out of Africa to go and give to those companies that are producing in their countries,” he said.

“By doing local manufacturing in Africa, we are solving two major problems, addressing health security and expanding our economy to create jobs,” he said.

Dr. Ngongo said that strengthening local production would also enhance the social determinants of health, from poverty reduction to education and better living conditions. “If we do local manufacturing in Africa, it will boost the economy, improve social determinants of health, reduce poverty, and get more educated people,” he said. “All that together contributes to both health security and the development of the continent.”

Africa Targets 60% Local Production of Health Products by 2040

Dr. Ngongo said that for Africa to truly strengthen its health security and achieve self-reliance, it must build a complete and sustainable African manufacturing ecosystem rather than rely on partial solutions offered by external partners.

“What we need is the African manufacturing ecosystem,” he said. “That’s the most important milestone – the ecosystem.”

He said that for too long, African countries have been limited to “fill and finish” – the final stage of pharmaceutical manufacturing, where a drug is aseptically filled into its final container (like vials, syringes, or cartridges), sealed, and prepared for distribution. “In reality, they do most of the job there in their countries,” he said. “They just bring them to you already conditioned in big containers for you to take them in vials. We say no – we need the entire end-to-end process to be controlled by Africans.”

According to Dr. Ngongo, this end-to-end model begins with research and discovery, an area where Africa must build its own capacity to ensure its health priorities are addressed. “If you don’t have research capacity and the diseases are African diseases, they might not be a priority for others,” he said, citing Lassa fever as an example. “The Lassa fever is found in West Africa, Nigeria, and so on… It isn’t in Europe or the United States,” he said. “Then why shouldn’t Europeans and Americans focus on Lassa fever research? They’ll put COVID first, knowing they’re going to get it. They’ll put Mpox first, knowing they’re going to get it. Therefore, we should begin with research.”

He outlined five key pillars needed to make local manufacturing work: research, infrastructure, talent, financing, and regulation.

“We need to strengthen research, build the right infrastructure, and develop talent,” he said. “Even if you produce, you need money to be able to produce – that’s why financing is critical.”

Dr. Ngongo pointed to the partnership between Gavi and the African Vaccine Manufacturing Accelerator (AVMA) as a major step forward. “We had to advocate big time for Gavi to support African manufacturing,” he said. “That’s why they allocated 1.2 billion dollars to help African manufacturers invest and build capacity, so that African manufacturers that don’t have enough funding and financing, then they can go and take advantage of that money to be able to invest and build the capacity for them to produce. That is key.”

However, he warned that regulatory capacity remains a major bottleneck.

“We only have seven countries out of 55 that have reached level three maturity to register products,” he said. Because of this, African manufacturers often rely on the WHO’s pre-qualification process, which he described as “heavy, lengthy, cumbersome, and expensive.” To change that, he welcomed the establishment of the African Medicines Agency (AMA), whose role will be to oversee the pre-qualification and regulation of African products. “It’s taking shape,” he said, noting that the African Union and Africa CDC are supporting the agency’s development.

Perhaps the most important factor, Dr. Ngongo stressed, is market demand. “Market, market, market – that’s critical,” he said emphatically. Without strong local demand, he warned, manufacturers cannot sustain production. “If you have all this machinery producing for just a thousand people, the cost will be high. But if you’re producing for hundreds of millions, the price drops and investment becomes viable.”

“If we are 1.5 billion in Africa, can you imagine if we are selling for 500 million because we are producing high volumes, and the average cost will be much lower? That is Africa’s challenge at the moment,” he said.

He cited the example of Senegal’s Institut Pasteur, which developed a COVID-19 diagnostic test but struggled to sell it because African countries did not buy it. “They couldn’t sell it because there was no continental mechanism to bring countries to buy together,” he said.

That gap, he said, is now being addressed through the African Pooled Procurement Mechanism (APPM) – a structure created by African Union Heads of State to coordinate joint purchasing. “If Kenya, DR Congo, Nigeria, and others buy together through Africa CDC, we can pull all their demand, negotiate lower prices, and support our local manufacturers,” he explained…” That is why that market, market, market is critical. If we don’t create a market on the continent, we are going to kill everything that we are producing. People will invest, they won’t get a return on investment, they will close.”

Africa’s Health Products Set Global Standard

To ensure the quality and safety of locally manufactured medical products, Dr. Ngongo said that the African Medicines Agency (AMA) will play a central role. “When you pre-qualify a drug, you check that the product meets the required standard,” he said.

He said that AMA will assess African manufacturers for quality before production begins, and then re-examine products in the laboratory to ensure they meet international benchmarks before approving them for use. “Only when they are approved by AMA can they produce,” he said. “Once the product comes out, AMA takes it again, examines it, and if it meets the required standard, that’s when it’s approved for use in Africa – and even beyond.”

Dr. Ngongo said that this regulatory framework will also benefit smaller nations that lack their own testing capacity. “With AMA, countries like Lesotho that don’t have big laboratories won’t have to repeat the same regulatory process,” he said. “AMA will do it on their behalf.”

He also pointed out that many fake medicines circulating in Africa are imported, not locally made. “That’s why we say we need to control our own production, because at least we’ll be producing from the manufacturers that we have control and assurance of the quality,” he said.

Dr. Ngongo added that Africa would continue its collaboration with the World Health Organization (WHO) to promote global confidence in African-made products. “We have made it clear that African products are not only for Africans,” he said. The same way we buy from India, Europe, and America, they should also be able to buy from Africa.”

He said discussions between the AU and WHO in Addis Ababa were aimed at ensuring that products approved by AMA would also receive WHO pre-qualification, making them exportable. It has health benefits, but it also has economic benefits – and those benefits will be much higher if our products are also used outside Africa,” Dr. Ngongo said.

Sustaining Preparedness

Dr. Ngongo said the African CDC is leveraging domestic resources and innovative financing to maintain outbreak preparedness despite declining global health funding. Its Green Paper on Financing lays out a clear strategy based on four key principles. “The Green Paper” represents a strategic framework aimed at rethinking and advancing Africa’s health financing and pharmaceutical manufacturing in a new era.

“It has four main pillars: increasing domestic resources, promoting innovative financing, engaging the private sector, and addressing what we call the African cancer,” he said.

He said that the first pillar focuses on increasing domestic health investment. “Our governments need to allocate more resources to health within their national budgets,” he said. “Twenty years ago, through the Abuja Declaration, African countries committed to allocating at least 15% of their budgets to health. But only Rwanda and Botswana have reached that target – others are still far below, some even below 7%.”

To revive that commitment, he said, President Paul Kagame was appointed as the AU Champion for Domestic Health Financing, and Africa CDC recently convened a Heads of State meeting in Addis Ababa to push leaders to look inward. “We told them the situation is not good. We need to stop looking outward and first fulfill our own 15% commitment,” he said. However, Dr. Ngongo acknowledged that fiscal constraints make it difficult for some countries to meet that goal. “Many are dealing with wars, conflicts, and multiple outbreaks at once – Ebola, cholera, Mpox, measles, and polio,” he said. “You can’t just say, ‘increase to 15%,’ if there’s no money to do so.”

That’s why the second pillar focuses on innovative financing, he said.

He said Africa CDC is exploring new mechanisms such as health-related taxes and solidarity levies. “In the West, the average tax rate per country is around 35%, while in Africa it’s only about 15%,” said Dr. Ngongo. “If we raised that to even 30%, we could double our revenue.” He added that African countries should also ensure foreign investors contribute fairly. “Those running many of the businesses in Africa are not Africans,” he said. “They’re heavily taxed in their own countries, but in Africa, they often get it for free. That’s not fair – we need to raise taxes and ensure everyone contributes.”

Dr. Ngongo pointed to examples like UNITAID, which began as a small air ticket levy in France and Britain to fund global health.

“We’re exploring a similar model,” he said. “We’ve met with the CEO of Ethiopian Airlines, and he was very open to the idea of adding a small health levy on tickets. Those who can afford to travel can also afford to contribute.”

Africa CDC strongly supports health taxes, he said. “Health tax is an excellent idea that we fully support for two reasons,” he said. “It’s a way of raising money, but it also discourages unhealthy behaviors.”

He said taxes on tobacco, alcohol, and sugary drinks can both generate funds and reduce the burden of non-communicable diseases.

“By taxing them, we get money to care for those who fall sick, while also discouraging people from consuming products that harm their health,” he said. “It becomes a form of prevention.”

The Africa CDC’s approach to influencing hesitant member states is to encourage positive competition rather than impose directives, according to Dr. Ngasji. The member states are sovereign, he said. “We can only offer advice.”

The third pillar, he said, involves private sector engagement through public-private partnerships (PPPs). “Health is often seen as an expenditure, but we are changing that narrative; health is an investment,” he said. “We want African private sector players to invest in local manufacturing, such as producing antimalarials. The market is huge – millions of Africans need these drugs.” He said that by inviting African investors rather than relying only on external partners, the continent can build jobs, expand tax revenue, and reinvest profits locally. “If our private sector invests, they make money here, they create jobs here, and they pay taxes here,” he said. “It’s all connected.”

Corruption – the African cancer – needs to be addressed.

The fourth pillar, he said, addresses “the African cancer” by improving efficiency, governance, and accountability in health financing, ensuring that funds are utilized effectively for the continent’s long-term health. He said Africa CDC is now taking concrete steps to help governments strengthen their systems and reduce financial leakages.

“We are recruiting 10 specialists in public finance management who will be posted as our experts within governments,” said Dr. Ngongo. “Their role is to help governments relook at their financial management systems, close loopholes where corruption exists, and improve how health budgets are handled so that more money is kept, and ultimately, has more impact on health.” He said managing resources effectively is as important as mobilizing new funds. He explained that it’s not just about finding more money. “It’s about making sure the money we already have delivers real results for our people,” he added.

Hopes for CPHIA 2025

Dr. Ngongo said the conference was not just about discussions, but about “moving towards self-reliance to achieve universal health coverage and health security.”

He said that across the continent, leaders such as Presidents Nana Akufo-Addo, Paul Kagame, and Cyril Ramaphosa have been pushing a continental movement around health sovereignty, a vision Africa CDC fully supports. “For us at Africa CDC,” he said, “health sovereignty requires important building blocks, and the first one is money. You cannot be sovereign if you are eating from my pocket. If I close the tap, you cry.”

According to Dr. Ngongo, the conference aimed to provide Africans with local solutions and practical examples of what has already worked. “We want to hear from countries that have done something that works so that others can learn from them. Everything shouldn’t be just theory,” he said.

He pointed to Ghana, which introduced a 2.5% VAT levy to finance universal health coverage, as a model worth replicating. DR Congo, he added, has created new taxes on imports and mandatory medical insurance for workers to raise nearly $1.2 billion annually for health coverage. In Rwanda, they’ve really, really mobilized the community to make a small contribution. This is built on a culture rooted in the Ubuntu spirit – “I support you, you support me” – giving more than 90% of citizens access to free care.

“These are not theories,” he said. “They are real examples that show what works when countries think outside the box.”

He further explained that local manufacturing was another pillar under discussion.

Africa CDC hopes to encourage collaboration so countries “don’t all produce the same product.” He said, “If everyone manufactures paracetamol, who will buy it? But if Zambia makes the cholera vaccine and Kenya provides syringes and needles, both can benefit.”

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