Professor Nana Poku is one of the world’s leading experts in research and policy on the political economy of health and HIV/AIDS in sub-Saharan Africa. With an impressive career spanning over three decades, Professor Poku has led The United Nations Commission on HIV/AIDS and Governance in Africa at the Economic Commission for Africa and worked in various capacities with global bodies such as the World Health Organization (WHO), World Bank, United Nations Development Programme and UNAIDS.
Since July 2019 he has served as the Vice-Chancellor and Principal of the University of KwaZulu-Natal and in June will assume a role as the new Chair of the Frontline AIDS Board of Trustees. On World AIDS Vaccine Day, our Global Head of the Non-Profit and Social Impact Practice, Arabella Chichester, sat down with Professor Poku to discuss his career so far, his new role with Frontline AIDS and the impact of the COVID-19 pandemic on the global fight against HIV and AIDS.
Firstly, thank you for taking the time to speak with me today. What are you most proud to have been a part of during your career?
I am not usually one to regret or to a re-play of proud moments, as there is far too much great work to be done! However, I can say that it is immensely gratifying to have had a role over the past three decades in galvanising the unprecedented international response to the AIDS pandemic particularly for Africa. My colleagues and I worked incredibly hard, with the kind of focus and determination that the pandemic warranted. In the process, we were able pioneer the provision of complex medication in a resource limited setting at a time when most in the western world felt it would be impossible for low- and middle-income countries to get HIV and AIDS treatments because of the costs and complexities inherent in the medication.
I was also fortunate to be at the centre of the development of a global health architecture able to confront HIV and AIDS. Amongst other impacts, this led to the establishment of the Global Fund and the only Global Commission on HIV and AIDS - the United Nations Commission on HIV/AIDS Governance in Africa - which I had the honour of leading. The work of the Commission was pivotal in WHO’s acceleration of HIV treatment in the developing world.
I have no doubt that 2020 was a challenging year for the fight against AIDS – can you please tell me how has the COVD-19 pandemic impacted efforts?
Given the scale, speed and urgency of the COVID-19 pandemic, it could hardly have not been impacted. The problem is compounded because even before COVID-19 struck, the fight against AIDS had lost its position as a uniquely urgent global crisis. We can see that AIDS must now fight for political prioritisation and scant resources with other large global issues, not least climate change.
Generally, it will be some time before we know the full effects of the COVID-19 pandemic on the AIDS response and the dynamics of HIV. Undoubtedly lockdown measures will have had both negative and positive impacts, such as reduced sexual health clinic visits, but also a reduction in risky social interactions. However, the largest impacts will likely be negative, owing primarily to diverted health budgets and highly stressed health systems. Globally, there will be a long ‘tail’ of postponed procedures and operations, which will in all probability continue to apply pressure on health budgets and health care systems overall.
COVID-19 has shown us how quickly an effective vaccine can be developed. What does this mean for the development of vaccinations for AIDS and other diseases?
I think we were all astonished by how quickly a safe and effective vaccine could be developed by scientific and medical establishments in several parts of the world. The potential of mRNA—that is, genetically encoded vaccines to combat not only infectious diseases but also non-communicable ones such as cancer—has been with us for a number of years, but the COVID vaccine has been a real breakthrough. We could be on the verge of a very exciting new chapter in medicine and human health. Currently, an extended human trial is underway on a malaria vaccine that has to date shown 77% efficacy. What a transformative exciting development that would be!
What must be done to ensure that everyone has access to HIV prevention and treatment?
Under current conditions, it is going to be very difficult to prevent a retrenchment of treatment programmes, let alone secure the badly needed extension for the 12 million people not currently covered. That makes HIV testing and locally appropriate prevention strategies crucial. As we battle to extend the reach of lifesaving antiretrovirals, we must also ensure that we reverse the tide of new infections. On prevention, we have learned the hard way that generic, culture-blind approaches determined remotely do not work. Hence, why I am delighted to be working with Frontline AIDS!
We were so pleased to work with you on your recent appointment. What exactly attracted you to the role with Frontline AIDS?
Frontline AIDS has a unique role as a partnership network, placing resources where they are most needed and best applied, with local expertise and knowledge. There is no one technique, or programmatic response that will work across the variety of communities worst affected by AIDS. As marginalised populations are most at risk, it matters greatly that Frontline AIDS concentrates on those communities and on utterly fundamental matters such as accessible sexual and reproductive health clinics, prevention programmes and HIV testing.
This is certainly very important work. In your new role as Chair of the Frontline AIDS board of trustees, what would you like to achieve?
The board can play an important role in assisting the executive by reviewing and renewing the organisation’s strategy and its means to implement it in an ambitious but sustainable manner. I am enthusiastic about enlarging and strengthening Frontline AIDS’ partnership network, with a particular view to the various means by which local organizations can succeed in preventing the spread of HIV.
Are you hopeful that the world can achieve an AIDS free future?
We can certainly reduce AIDS to the extent that it is no longer a global public health emergency. However, extending and maintaining treatment programmes on the scale required is going to take political and financial commitment beyond the current generation of leaders. This would be the case even if we quickly reverse the still serious deficiencies in our prevention efforts. Rates of infection are dropping, but not fast enough to place an AIDS-free future on the horizon.
That said, the past year has shown us just how much we can achieve by working together, and so it is up to all of us to play our part in reducing the global burden and ensuring that no one should go without prevention or treatment for HIV.