Prof. Nicaise Ndembi is the Deputy Director General of the International Vaccine Institute (IVI) and Regional Director for Africa. A virologist whose early research helped shape global HIV drug resistance policy, Prof. Ndembi has been at the forefront of Africa’s pandemic preparedness and response architecture, from the evolution of the Africa Centres for Disease Control and Prevention (Africa CDC) to the continent’s ambitious push for vaccine manufacturing and research & development sovereignty.
He also serves as an Associate Professor at the Institute of Human Virology, University of Maryland School of Medicine, and as a Research Professor in the Department of Viral Infection and International Public Health at Kanazawa University School of Medicine, where he earned his doctorate in virology.
Before joining IVI in 2025, Prof. Ndembi was Principal Advisor to the Director General of Africa CDC, where he spearheaded the Partnerships for African Vaccine Manufacturing, establishing a framework for regional vaccine production and self-reliance. He also served as Deputy Incident Manager for the Mpox–Marburg Continental Preparedness and Response Plan for Africa.
Prof. Ndembi has authored and co-authored over 300 peer-reviewed papers and book chapters. He is the Editor-in-Chief of the African Journal for AIDS and Infectious Diseases (AJAID).
Over a virtual coffee with Vaccines Beat’s editorial team spanning Houston, Lisbon, and Africa, he reflects on his scientific journey, the transformation of Africa’s health security landscape, and why the continent must now take ownership of its research and development agenda.
From HIV Origins to Drug Resistance and Policy Formulation
For Prof. Ndembi, his scientific calling is rooted in equity and urgency. Multiple factors are contributing to the rise of emerging infectious diseases in Africa, with more than 200 disease outbreaks reported every year.
“It is why Africa needs a coordinated strategy to develop, finance, manufacture and deliver vaccines across the continent,” he says.
As an African scientist, he was motivated by the need for Africa to have a voice in the HIV response.
“My inspiration stems from supporting what we can bring to the continent,” he adds.
Antiretroviral drugs to treat HIV became available in the mid-1990s. However, the initial pricing of these medications made them largely inaccessible in many low-income countries. While death rates declined significantly in wealthier nations, access to treatment in parts of Africa remained limited. It is estimated that between 1997 and 2007, millions of Africans died during a period when life-saving therapies were not yet widely available across the continent.
Ensuring equitable access to diagnostics, therapeutics, vaccines, and other medical countermeasures became Prof. Ndembi’s mission.
“My goal was to contribute to the science and find ways to make it accessible so that these drugs could actually reach the people who needed them,” he recalls. “I pursued a PhD in molecular virology, in part because there was scepticism at the time about whether Africans could adhere to antiretroviral therapy (ART).”
Demonstrating adherence, he explains, is not just about counting pills. It involves measuring drug levels in the blood and monitoring viral fitness, evolution and dynamics over time. Coming from a background studying HIV evolution and simian viruses -transmission from monkeys and chimpanzees to humans in Central Africa- he was well-positioned to explore the origins of HIV.
“So it was natural for me to apply the concept of viral evolution to HIV drug resistance,” he says.
In the early phase of his career, Prof. Ndembi focused on drug resistance. He published extensively, showing that treatment could not rely on a single drug or a fixed-dose combination indefinitely in low and middle-income countries.
“If one drug fails, how do we transition to another and optimize the regimen?” he explains. “That challenge became my inspiration.”
Africa CDC: From Ebola to COVID-19 and Beyond
The 2014–2015 Ebola Virus Disease (EVD) outbreak in West Africa served as a turning point, accelerating efforts to establish a continent-wide public health institution. The crisis exposed significant weaknesses in national health systems and underscored the profound economic and social consequences that infectious disease outbreaks can generate.
In response, African heads of state formally launched the Africa Centres for Disease Control and Prevention (Africa CDC) on January 31, 2017, tasking it with strengthening public health institutions across the continent to better detect, prevent, control, and respond swiftly and effectively to health threats.
The founding of Africa CDC in 2017, along with the appointment of Ambassador Dr. John Nkengasong, represented what Prof. Ndembi describes as a transformative shift in Africa’s public health landscape.
Established by the African Union, Africa CDC was designed to facilitate faster, more coordinated responses across member states, working in partnership with the World Health Organization (WHO).
Yet, the scale of public health demand remains substantial. According to reports, Africa experienced more than 200 outbreaks in 2024, with a similar estimate in 2025.
As in many parts of the world, the COVID-19 pandemic marked a defining period for the continent. However, Africa did not receive COVID-19 vaccines until approximately six months after the pandemic began, underscoring persistent challenges related to equity and timely access to essential medical countermeasures.
Among the flagship initiatives was the Partnerships for African Vaccine Manufacturing (PAVM), with an ambitious goal: to manufacture 60% of Africa’s vaccines locally by 2040.
“Africa previously produced only one vaccine antigen, yellow fever at the Institut Pasteur in Dakar,” Prof. Ndembi notes. “By 2030, we aim to produce eight more antigens locally.”
Today, more than 25 vaccine manufacturing initiatives are underway across the continent, representing a critical step toward Africa health sovereignty and New Public Health Order.
The Eight Enablers: Financing, Human Capital Development, R&D, and the Engine of Innovation
The Framework for Action recommends that the African vaccine manufacturing ecosystem focus on strengthening eight enablers, which will require it to roll out eight bold programs. Initially, a collaborative pooled-procurement mechanism can help ensure consistent and sustainable vaccine supply by leveraging economies of scale. A deal preparation facility will help attract the significant investments needed. Meanwhile, ongoing efforts in technology transfer, regulation, research and development, and infrastructure will continue to build a supportive environment for long-term success.
Prof. Ndembi notes that very few countries in Africa spend more than 1% of their GDP on R&D, fewer than ten out of fifty-five African countries, covering 1.5 billion people. With global funding cuts affecting pandemic preparedness, domestic investment has never been more urgent. Financing, he emphasizes, is equally critical.
“They need to find better ways to mobilize resources for research. Without strong research ecosystems, intellectual property ownership and meaningful technology transfer remain out of reach,” he mentions. “R&D is the engine for local manufacturing.”
Human capital development forms another bold program. He cites South Korea’s transformation as an example: within two decades, the country went from producing 5% of its vaccines to 50–60%, driven by strategic financing, human capital development, and strong R&D and regulatory systems.
“When we talk about producing 60% of Africa’s vaccines locally by 2040, we need the people behind it,” he says. “Ultimately, biotechnology will drive innovation and manufacturing,” he concludes. “That’s the core model.”
Regulatory Harmonization and AMA
Fragmented regulatory systems remain a major challenge for Africa’s health agenda. In this context, the African Medicines Agency (AMA) is intended to strengthen national regulatory systems and support more consistent oversight of medical products. By advancing regulatory harmonisation and fostering cooperation among national regulatory authorities (NRAs) of African Union member states, the AMA aims to facilitate more timely and equitable access to quality, safe, and efficacious medicines across the continent.
However, 31 African countries have ratified the AMA Treaty, with major economies such as Nigeria and South Africa still pending. An advocate of regulatory harmonization in the region, Prof. Ndembi notes that there are still some challenges to overcome.
“The remaining 24 countries are all supportive,” he notes, “but there are still national legislative processes to overcome before having the benefits of a unified African regulatory system and that’s essential for the continent’s health sovereignty.”
ACHIEVE Africa: Owning the R&D Agenda
ACHIEVE Africa (Accelerating Health Innovation, Equity, and Development of Vaccines and Biologics) is a regionally connected and globally relevant initiative and perhaps the most transformative initiative led by Prof. Ndembi. It aims to build the continent’s end-to-end research and development ecosystem for vaccines and therapeutics.
“R&D capability exists on the continent, but it is unevenly distributed and often disconnected from product development,” he says. “The ultimate question is: how many technology transfers or intellectual property outcomes have actually been generated over years?”
Over the past decade, substantial investment has been directed toward research and development in Africa. However, the translation of research findings into practical applications has at times been limited. Lately, there has been growing recognition of the need to strengthen pathways that connect research more directly to implementation, innovation, and societal impact.
“There needs to be a paradigm shift – R&D that leads to manufacturing,” Prof. Ndembi emphasizes, adding that many current initiatives are attempting to close that gap.
He also highlights the lack of domestic investment and claims Africa’s gross expenditure on R&D, as a proportion of GDP, stands at about 0.5% compared to world average of 2.2%. Without sufficient resources from member states, Africa cannot drive its own research priorities. To achieve genuine leadership, he believes all regional stakeholders must work together.
“Right now, we don’t fully own the R&D agenda. When funding comes from external sources, priorities are dictated externally, not by the continent,” he says.
ACHIEVE Africa aims to unify leading institutions across North, West, Central, East, and Southern Africa regions. Its goals include conducting gap analyses, building infrastructure through a hub and spokes twinning capabilities enhancement model, and defining product pipelines for priority diseases.
Currently, less than 5% of global clinical trials take place in Africa, despite the continent bearing the highest burden of infectious diseases.
“We need clinical trial–ready centers compliant with international standards,” he underscores.
By the end of its five-year program, ACHIEVE Africa aims to advance at least two vaccine candidates and one biologic toward manufacturing, and to progress two new intellectual properties (IPs) through non-GMP development and pre-clinical animal studies.
“It really unifies the continent,” he says. “Rather than funding several projects across the continent, funders can invest in ACHIEVE Africa and undertake clinical trials across different regions.”
Marburg, Cholera, emergency preparedness and response
Prioritization and risk ranking of epidemic-prone disease is important to inform strategic planning and help effective resource allocation to manage prevention/mitigation
and response actions to health emergencies.
Historical modelling suggests that the frequency and severity of epidemics caused by wildlife zoonoses –driven by human activities and their environmental impact– are increasing. Such modelling estimates that the probability of a future zoonotic-spillover event resulting in a pandemic of COVID-19 magnitude or larger is between 2.5% and 3.3% annually. In other words, there is a 22%–28% chance that another outbreak of the magnitude of COVID-19 will occur within the next 10 years and a 47%-57% chance that it will occur within the next 25 years
Turning to Marburg virus disease (MVD), Prof. Ndembi highlights a rare but highly fatal viral hemorrhagic fever, with mortality rates up to 88%. Recent years have seen MVD emerge or cause outbreaks in areas (Ethiopia, Rwanda, Equatorial Guinea, Tanzania, Ghana and Guinea) where it was not previously detected, indicating a widening geographical range.
“Marburg today… but that’s also the same question we can ask about cholera,” he says, broadening the discussion to other persistent public health threats.
Last year alone, Africa recorded 6,000 cholera deaths, a vaccine-preventable disease. Yet, for over a decade, vaccine supply has consistently fallen short of demand.
Without public health prioritization and pooled funding -potentially involving organizations like the Coalition for Epidemic Preparedness Innovations (CEPI), among others- manufacturers may hesitate to invest. Nevertheless, promising vaccine candidates exist for both Marburg and Lassa fever.
“We really ought to put funding in place to move these candidates beyond phase 1 or phase 2,” he insists, emphasizing the need for strategic investment in pandemic preparedness.
Beyond Vaccines: Water, Sanitation and One Health
On cholera prevention, Prof. Ndembi emphasizes that vaccines alone are not enough. Outbreak response often falls solely under Ministries of Health, while water and sanitation are managed by other ministries.
“We should start earlier,” he says, advocating for multisectoral coordination under the One Health approach, which integrates health, water, energy, and environmental sectors.
One Health is a collaborative, multisectoral, and transdisciplinary framework that works at local, regional, national, and global levels. It aims to achieve optimal health outcomes by recognizing the interconnections between people, animals, plants, and their shared environment. The approach focuses on preventing, predicting, and responding to threats such as zoonotic diseases, antimicrobial resistance, and environmental degradation.
Vaccine Hesitancy: Engagement Not Assumptions
Vaccine hesitancy is rising across the globe, with more people postponing or declining recommended immunisations despite their availability. This increases community vulnerability to infectious diseases, contributing to recurring outbreaks that strain resources and result in preventable deaths.
Understandably, vaccine hesitancy is receiving unprecedented global attention. Yet, knowledge gaps remain, particularly in Africa. A recent article in Human Vaccines & Immunotherapeutics notes that: “The vast majority of research on this topic has been conducted in high-income countries. Little is therefore known about the nature and causes of vaccine hesitancy in Africa, and evidence-based interventions in the region to address it are also limited.”
“Despite conducting only 5% of global clinical trials, Africa consumes a disproportionately high share of vaccines for immunization programs,” Prof. Ndembi says. “I cannot explain why.”
During COVID-19, Africa CDC conducted in-person surveys across 15 countries with over 15,000 participants.
“Africans wanted the COVID-19 vaccine -almost 80% or more,” he asserts.
Prof. Ndembi draws a distinction between strong childhood immunization uptake (above 80% in most countries) and the more complex dynamics surrounding adult outbreak vaccines. However, he points out that delayed access of the COVID-19 vaccine -six to eight months after the global rollout- eroded trust.
“People would say, ‘If I survive for eight months, I can survive another eight months,’” he remembers. “That’s when vaccine acceptance dropped, turning into hesitancy. Primarily due to lack of access, misinformation, and disinformation,” he concludes.
