Hayley Severance, Deputy Vice President, Global Biological Policy and Programs, Nuclear Threat Initiative (NTI), walks us through the newly launched Africa Health Security Index (AHSI): its origin and purpose; its key African and other partners; what it reveals about significant progress in Africa since 2021 (surveillance, countermeasures) and what it reveals about glaring problems (biosafety/biosecurity, finance). The challenge now is to get the AHSI in front of senior African decision makers, and to engage with the Trump administration, among others, at this moment when the Bundibugyo Ebola outbreak is raging.

Aurélia Nguyen, Dep. CEO of CEPI (Coalition of Epidemic Preparedness Innovations) shares her unusual personal and career story, including working with Andrew Witty at GSK, and with Seth Berkley at GAVI during Ebola in West Africa 2014-2015 and later during the COVID-19 pandemic when she managed the COVAX facility. "It was incredibly difficult." CEPI's 3.0 strategy focuses on viral families; technologies and platforms; and networks to rapidly conduct clinical trials and begin manufacturing. CEPI swung rapidly into action with the advent of the Bundibugyo Ebola outbreak in Ituri, DRC. It struck a promising $50 million partnership with the Department of State in support of its work to accelerate development of four vaccine candidates. Clinical trials are beginning and will advance in the fall in the hot zone in eastern DRC. Mistrust and insecurity require intensive community engagement. Even with US and EU support, CEPI still strives to fill an estimated $130 million gap over the next 6-9 months. Her biggest worry? Cases have doubled in just 23 days. We are not yet able to gauge the true scale of the outbreak. 

Samaritan’s Purse (SP) has a well-established hospital and deep community ties in DRC's Ituri province. Vice President Ken Isaacs describes how SP pivoted during the unfolding Ebola outbreak, launching Ebola treatment centers. Humanitarian assistance reaches close to 200,000. Health workers have been very vulnerable to infection. "We have lost three." Expansion of international staff requires coping with the possibility of a 21-day isolation period before returning home. "What they need are Ebola fighters." Addressing malaria is essential. There is not yet a clear path to take care of international staff that get sick. If the U.S. facility in Kenya served a wide array of international Ebola fighters, that would be well received.

Dr. Chikwe Ihekweazu, Executive Director, WHO Health Emergencies Programme, spent several weeks in the hot zone in eastern Congo, mobilizing the international response to the late-discovered Ebola outbreak. Establishing community trust and confidence is the single most urgent challenge across all activities. At the six-week point, the response is scaling. However, "We have to be humble." "We are nowhere yet where we want to be." There is now a high-level UN figure in eastern Congo charged with addressing the complex security challenges. The absence of advanced US technical expertise in the deliberations and response, following the US withdrawal from WHO, is "strange." "Everyone pays a price." 

In this episode of the CommonHealth Live! series, J. Stephen Morrison sits down with Representative Ami Bera (CA-06) to discuss the future of U.S. global health security strategy in an era of redefined alliances, geopolitical competition, and the rise of transformative but disruptive technologies such as AI. 

What is the future of global health assistance under the new structure created by the U.S. Health Memorandums of Understanding (MOUs)? How is this model reshaping the role of the State Department and the CDC in global health, and how is it playing out in the context of the unfolding Ebola outbreak? How durable is this compact model, and does it align with long-term strategies Congress is pursuing in other foreign assistance domains, including for critical minerals under the DOMINANCE Act? As the United States pursues a more robust industrial policy in the name of stronger national security, how can it maintain reasonable channels for cooperation with China in the highly interdependent bioeconomy?  

Dr. Gerald Parker, an acclaimed biodefense/One Health expert and high-ranking official across several administrations, experienced New World screwworm (NWS) as a boy in Texas while assisting his veterinarian father treat pets invaded by the parasite. Michaela Simoneau, CSIS Fellow, joined the conversation. In the late 1950s, the scaled introduction of sterile male flies — 50 million per week — was a brilliant scientific discovery, combined with a public private partnership with the ranching community. NWS was cleared from the United States by 1966, and from Mexico and Central America by 2006. The barrier began to decay in this decade, a function of migration, illicit cattle trafficking, a decline in the effectiveness of the sterile flies, Covid interruptions, and complacency and bureaucratic inertia. NWS has now arrived in Texas and New Mexico. The race is now fully on to restore control. We need an "Operation Warp Speed" mentality to advance multiple technological innovations, diplomacy, financing, a massive expansion of flies — perhaps as high as one billion per week.

Jamie Bay Nishi, the dynamic CEO of the American Society of Tropical Medicine and Hygiene (ASTMH), is absorbed with the question: how do we navigate all the changes in government policy and programs and hold the global health community together? That includes philanthropies, universities, and companies. OMB’s proposed “Regulation for Federal Financial Assistance,” a 400-page document, would expand political oversight and weaken the authority of scientific advisory groups, changes that would alter the scientific research enterprise and create uncertainties. A 45-day period for comment is too little time to understand what is in the document and the ramifications if its proposed actions were enacted. It could further stigmatize collaboration with China. The June 3 White House Executive Order to reclassify the federal workforce will weaken career protections of GS-15 workers, leaving them open to firing at-will. CDC’s overseas country offices are to transition to a fee-for-service model, as part of the America First Global Health Strategy. This will not be sufficient to guarantee a sustainable work force, which requires a reliable surge capacity in CDC headquarters at Atlanta and stable expert in-country staff. It is incumbent upon Congress to change the funding scheme for CDC overseas experts and its surge capability.

Declan Walsh, the acclaimed New York Times Africa correspondent, visited the hot zone of the Ebola outbreak in Ituri Province in the Democratic Republic of the Congo (DRC) from May 22 to June 12, the "perfect petri dish." How to explain the "enormous lag" in acknowledging the outbreak and responding to it? "It all boils down to two factors, conflict and gold."  Will the outbreak grow exponentially or burn out? Insecurity will dominate, but it is not at all certain how that is to be managed. Things have begun to go better in expanding testing and treatment capacities, while contact tracing lags, at just over 50%. There are worries that the outbreak is spreading already from Ituri into North Kivu province, potentially into areas controlled by the Allied Democratic Forces (ADF), the Uganda-origin Islamist armed group. Interest is rising inexorably in seeking a cease-fire, given the acute vulnerability of health and emergency assistance providers. The United States is now coming in strong with over $700m in investments, but on a parallel track, separate from the incident management mechanism run by WHO and the Africa CDC, which is stirring some tensions with Congolese authorities. The U.S. effort to create a treatment unit on a remote air base in Kenya has generated considerable protests and political challenges for Kenyan President Ruto.

Dr. Salim Abdool Karim, the renowned South African epidemiologist, chairs the Africa CDC Emergency Consultative Group. In that role, he just completed a visit to Bunia, capital of Ituri province in the Democratic Republic of Congo, site of the dangerous Ebola outbreak. His focus included laboratories, test centers, isolation units, along with PPE, safe, dignified burials, contact tracing, the WHO/Africa CDC Incident Management Team, and security challenges. The United States has made major commitments, but US experts and US-funded groups operate outside the IMT. The moment you arrive in Buria, it is very obvious you are inside a conflict zone. Care providers—true heroes—are rushing in. They are "fire fighters running into the fire."

Two years since the launch of the African Vaccine Manufacturing Accelerator (AVMA), a financial mechanism that invests in commercially viable manufacturing efforts on the continent, what progress has been made in the effort to produce 800 million vaccines in Africa by 2035? Where are there opportunities for strengthening access to routine immunizations for vulnerable populations, including the 6.7 million zero-dose children in the region, along with those living in fragile and conflict-affected areas? And how can the AVMA, which was developed in response to the region’s challenges in securing access to Covid-19 vaccines during the global pandemic, help build countries’ resilience in the face of current and future disease outbreaks?

Please join the CSIS Bipartisan Alliance for Global Health Security for a broadcast conversation with Katherine E. Bliss, Director and Senior Fellow, Immunizations and Health Systems Resilience, with the CSIS Global Health Policy Center, Farrah Losper, Chief Commercial Officer at Biovac and Chairperson of the Board of the African Vaccine Manufacturing Initiative, Folake Olayinka, Director of Immunization, Africa CDC, Shanelle Hall, Principal Advisor to the Director General, Africa CDC, and David Kinder, Head of Development Finance at Gavi, the Vaccine Alliance, regarding the progress of the AVMA and contributions to the immunization landscape in the Africa region.