Take as Directed

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.

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.

Keith Humphreys, a leading expert on addiction psychiatry, based at Stanford University, unpacks his January article in Science examining the steep reduction in overdoses deaths—between May 2023 and the end of 2024—in the United States and Canada. It likely stemmed from a supply shock, linked to steps taken by China to disrupt the supply of fentanyl and precursor chemicals. Underneath, US-China diplomacy was essential. This story was lost during the 2024 US presidential election cycle. Subsequently, President Trump’s overt threats to China, including the imposition of a 20% tariff tied to fentanyl, changed the negotiating context. Some progress followed on October 30 when Presidents XI and Trump met on the margins of the APEC summit in South Korea.

Dr. Chris Murray, IHME, co-chairs the Lancet Commission on 21st Century Global Threats to Health, which will launch its report in February at the Munich Security Conference. It is the “Commission of Commissions,” a novel, highly ambitious three-year effort to forecast what are to be the biggest, most costly problems by taking a broadened non-traditional view. It focuses on 16 factors plus hypertension, each forecast to exact over one billion life years over the next 75 years. These include the familiar big three – pandemics, climate, and conflicts – but includes other factors that rank surprisingly high: education, inequality and low economic growth, obesity, tobacco, and AMR. A wildcard such as malicious use of AI has to be taken into account. “We excluded meteors” and mirror life, the latter too early to include. The Commission calls for a rolling, annualized review, and for higher investment by governments in both promising innovative technological solutions and building better threat-ready health systems.