Dr Jean Kaseya, Director-General of the Africa Centres for Disease Control and Prevention (CDC), discusses fighting Ebola amid conflict, rebuilding public trust and the much bigger challenge of strengthening health security across the continent. He is in conversation with Jamila Versi and Omar Ben Yedder.
Dr Kaseya ( above ) is a busy man – sitting at his headquarters in Addis Ababa, he has managed to squeeze us in between several meetings and a flight to Tanzania. Being Director-General of the Africa CDC, especially at this time, is clearly no easy feat.
Kaseya has led the organisation since April 2023, after a career spanning the WHO Meningitis Vaccine Project, Gavi and UNICEF. Now, with his focus firmly on the continent, he is juggling the difficult task of responding to outbreaks as they happen while trying to build the longer-term systems that might stop the next one from becoming a crisis.
That tension is particularly stark in the Democratic Republic of Congo (DRC). The current outbreak of Ebola has spread across six provinces, while health workers operating in the East have themselves come under attack.
In some communities, mistrust of outside responders runs deep; elsewhere, conflict and displacement have made basic surveillance and contact tracing extraordinarily difficult. Experts have also warned that the true scale of infection may be considerably higher than the official figures suggest.
There has been some progress. The African Health Security Index, published in July 2026, put the continent’s score at 41.2, up from 32.9 in 2021. But significant gaps remain, from vaccination and maternal and child mortality to epidemic preparedness.
And that is where Kaseya’s argument becomes bigger than Ebola. Africa CDC is increasingly pushing what it calls an agenda of ‘African health security and sovereignty’: stronger domestic financing, greater local manufacturing, better use of data and a larger African role in shaping the global health system.
We spoke to Kaseya about why the DRC outbreak has proved so difficult to contain, what mistrust has to do with it, and why he believes Africa ultimately needs to move “out of dependency” in health.
Ebola and security
As we go to press, the DRC has had over 6,000 cases of the Bundibugyo strain of the Ebola virus and more than 3,000 deaths, making it the deadliest Ebola outbreak in the country’s history.
What is making this Ebola outbreak so difficult to contain?
What makes this outbreak particularly difficult is that transmission is happening in areas affected by insecurity, displacement, high population mobility and fragile health services.
Response teams cannot move freely, and neither can patients, and that is the reason we see some patients coming late or dying in the community. Even my own teams have been attacked. [Attacks on medical health systems, ambulances and volunteers appear to be carried out by rebel groups as well as crowds of people.]
The message we are giving everyone is that the virus does not choose between rebels and the official army, or between one tribe and another.
It’s an opportunity for everyone to become humbler and say, how can we collaborate, at least to save our lives; because rebels are also human beings, they also want to live. And if a bullet cannot kill you, a virus can.
That is why we are requesting international partners to support what we call a “corridor of peace” – an agreement that would allow health teams to continue their work without being attacked. We need to see if everyone will agree to establish this corridor of peace.
What would that corridor of peace actually look like?
We have experience of this from several countries, including the DRC in 2018. Today, areas including Ituri and South Kivu are affected by both Ebola and attacks by armed groups. If neighbouring countries and the international community come together, they can help establish the space we need to continue operating safely.
In what other ways is political insecurity impacting the ability to tackle Ebola?
The political insecurity and lack of safe access to healthcare also create what we call ‘multiple opportunities for transmission’ before a case is detected.
More than 70% of deaths are occurring in the community rather than health centres, and more than 65% of new cases are coming from the community.
When you manage an outbreak, your contact list tells you how much control you have, and that contact list allows you to master the response. If you have a contact list of say, 4,000 people, and all cases are coming from your contact list, you are safe and you can at least control the outbreak.
But currently in the DRC, it’s a problem because we’ve got a lot of cases outside the contact list.
With around 6,000 confirmed cases, you would normally expect between 240,000 and 360,000 contacts. Now, we have only around 28,000.
That tells you there are a lot of people we are simply not reaching in the community. And when people are in the community, and you have more cases coming from the community, you are far from being able to achieve your target and control the outbreak, and that makes the context a little bit of a challenge.
It also means the real number of deaths is likely to be significantly higher than what has been reported.
There has been a lot of attention around vaccines, with the WHO announcing earlier this week that the new vaccine trials would begin in November. How much difference can they make
when insecurity is still such a major problem?
Vaccines are one part of the response. We have four candidate vaccines at different stages of development. For now, we are using Ervebo, the vaccine against the Zaire strain, because we have indications – not yet evidence – that it may offer some cross-protection against Bundibugyo.
We are now testing that through a clinical trial, while also vaccinating frontline workers. Maybe in the next three weeks we will be able to say if there is any cross-protection and then decide to extend the vaccination in other places, including where rebels are, but right now we are not doing any clinical trials where the rebels are. So the current work is happening in places such as Kisangani and Bunia.
How much have mistrust and misinformation complicated the response?
When I talk about taking a village-centred approach to these issues, it is not something coming from my office in Addis Ababa. When I travelled to Ituri in August, I told people: “I’m not bringing a solution to you. I’m coming to listen with humility. Tell me what we can do. Tell me what we did wrong.”
Many people are living in [internal] displacement camps without sanitation, water or enough food. They are already dying from violence, cholera, measles and malaria.
Then outsiders arrive and say: ‘Ebola is the emergency!’ People told me – we are dying every day from bullets because we are killed by rebels. Sometimes we are killed by cholera, by measles, and other diseases. And you are coming just because of Ebola!
For them, Ebola was not a big deal. For them, Ebola was mostly for us, because we were afraid of getting it. That is why they thought we came to them.
The second reason for mistrust is that we are living in a world that is interconnected, and every day these people hear about large amounts of money being announced, and they don’t see the effect of any of it – no new health centres, a lack of commodities, and if they have malaria, they must still pay if they go to the hospital.
Finally, they are unable to understand that after 19 years of Ebola, the world still hasn’t developed vaccines and therapeutics. There’s a feeling that, if Western people were affected, there would already be vaccines and medicines.
How do you overcome that?
You use people the community already trusts, and you use a village-centred approach, which is based around what we call the head of the village.
In the DRC, a village might be only 10 or 20 houses. The head of that village is chosen by the community. When that person speaks, people listen. So instead of outsiders simply arriving with instructions, you work through local leaders and other trusted people to explain, and they help sensitise and share the appropriate information.
Ultimately, what gets the DRC to the bottom of this outbreak: vaccines, better coordination or more money?
It is a combination of everything you are saying.
This is a huge outbreak, with the case-fatality rate approaching 50%, and as I said, there are many issues that are making this outbreak more complicated. This is why better coordination at the national level, but also on the ground, is key, and funding is critical. We need money that goes not to NGOs, but directly to activities on the ground.
And communities themselves must be part of the response.
That is why we are calling for the village-centred approach, where people within villages are responsible for sharing information and implementing measures such as safe burial.
And we are also thinking that by making progress in what we call the ‘medical countermeasures’, which means vaccines and therapeutics, that will also help. That’s why it’s a combination of so many factors that can help us defeat the virus.
Beyond Ebola
For Kaseya, responding to Ebola is only part of the job. The bigger question is how Africa should build health systems that are less vulnerable when the next crisis comes. Africa CDC has put what it calls ‘African Health, Security and Sovereignty’ at the centre of that agenda – an effort that has become more urgent as overseas aid has fallen.
How much have cuts in foreign aid changed the conversation around health sovereignty?
For a very long time, African countries did not invest enough in their health systems. Much of the funding came either from people paying out of pocket or from external support.
This external support was so critical because it was targeting things like surveillance, laboratories and health workers. But now that the aid has been cut, we see suddenly that these areas are not supported.
For me, the issue is not that the aid has been cut, but that it was cut suddenly. Because if we were informed that in the next five years our partners would be stopping their support for the African health system, action would have been taken; people could have begun investing – but nobody was informed.
But I also see it as a blessing, a blessing for African countries. It is forcing African countries to say: let us invest in our own health systems, so that if tomorrow we have another issue, we are well prepared to respond.
What other public health threats have been competing for the CDC’s attention and resources?
Every year, we have around 200 public health threats. Given that there are 365 days in a year, once you remove the weekends and public holidays, you could say that outbreaks are keeping us busy on a daily basis.
Some are huge, like Ebola, mpox, cholera, and measles. Others are smaller and can be controlled relatively quickly. But outbreaks are essentially part of our daily work.
Africa CDC is the public health agency of the continent; we are working in all areas. Responding to outbreaks is only one of the foundations of our work.
We are also working on digital health, health financing, local manufacturing of health products and putting in place some initiatives like the procurement mechanism for the continent.
But yes, when you have a major outbreak, and you see the magnitude of this outbreak, and particularly that it can spread to other countries or continents, you dedicate more time to it. An outbreak can destroy all your initiatives, everything you have built, but we move forward with building.
But if you are asking me on a personal level, I would say I am working at 200% – 100% for Ebola, and another 100% for everything else.
What does ‘African Health, Security and Sovereignty’ actually mean in practice?
There are five pillars. The first is reforming the global health architecture. Because we believe that we cannot continue to live in a world where we, as Africans, are facing people outside making decisions and then coming to impose their decisions. And that is why we are supporting this agenda, to see how Africa can become a contributor, a co-architect of the global health system.
The second pillar is pandemic prevention, preparedness and response.
The third is sustainable domestic financing, where we are pushing for African countries to invest more money in the health sector, and where we are pushing for international partners to be aligned with the funding under the leadership of the Ministry.
The fourth pillar is digital transformation – including ensuring that Africa owns and uses the data it generates. We don’t want to see African countries just generating data but not using it.
And the fifth and final one is local manufacturing. Africa still imports more than 90% of the health commodities we need. But that one is already changing; we are seeing more African countries manufacturing their products. We hope we are creating a big market for African manufacturers.
Where have you made the most progress?
You know, it takes time to develop a vision. And this vision doesn’t come from a lab; it comes from the conversations that you have, from the evidence.
Pandemic preparedness is one area. We have moved from around eight African countries with the capacity to do genomic sequencing [determining the building blocks of someone’s DNA].
A few years ago, only this number had that capacity. Today, we are at around 46 out of 54. And this is an amazing development, because it can help us detect and stop early outbreaks.
Today we are talking about Ebola, but what people don’t know is how many outbreaks we managed to detect early and stop.
We have also made huge progress in local manufacturing. In Algeria today, 82% of all the medicines they are using are produced nationally. We have also made huge progress by operationalising things across borders, for example through the African pooled procurement mechanism, and operationalising the African Medicines Agency for our regulatory aspect.
The biggest challenge remains sustainable financing. African countries are contributing more, but not yet at the level we need.
If governments want to make the biggest difference quickly, where should they start?
With better planning. Some countries have 20 or 30 different health plans that do not speak to each other. That creates enormous waste. I’ve told the leaders, by just planning properly, you can cut resource wastage by more than 20%.
Integrated planning, combined with digital systems that can help us stop fraud, can reduce that waste, improve procurement and address problems such as ‘ghost workers’ being paid from health budgets.
In the DRC, that is a huge issue – ghost workers represent a huge proportion of the budget, and they are paying people that don’t exist. If we use the money already in the system more efficiently, we create space to invest in everything else.
The President of Namibia [Netumbo Nandi-Ndaitwah] was telling me a few weeks ago that by putting in place the African pooled procurement mechanism linked to the digital agenda last year, they saved $200m. So the digital aspect is a crucial component, linked to sustainable financing and integrated planning, and it opens the door to all the other components.
How seriously are African leaders now taking the idea of health sovereignty?
Very seriously. It is increasingly part of the conversation among heads of state. And I believe this is the future for the continent.
If we implement these five pillars properly, you will see that my continent in the next 10 years will be out of dependency. That does not mean isolation. It does not mean we no longer need partners.
It means African countries should be able to provide perhaps 70 or 80% of what their health systems need themselves. Then we’ll welcome the external partners, but they will not come to dictate to us. They will be aligned with African priorities rather than dictate them. That is my hope. That is my dream.
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It is imperative that we Africans take control of our health systems
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