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In Bunia, in the Democratic Republic of Congo's Ituri Province, an Ebola outbreak is unfolding without the tools the world usually relies on to stop one. There's no vaccine. No approved treatment. And the strain behind it — Bundibugyo virus — doesn't even present the way Ebola usually does, making it harder for health workers to recognize and harder for communities to believe.

In this episode, Desmond sits down with Dr. Aimé Gilbert Mbonda Noula, a public health and emergency coordinator with the International Federation of Red Cross and Red Crescent Societies (IFRC), deployed in Bunia to support the response. Dr. Mbonda takes us inside what daily life looks like under an active outbreak layered on top of armed conflict — the door-to-door conversations correcting rumors, the safe and dignified burial teams working to stop transmission through the dead, and the moment in early June when a burial team was violently attacked after a community rumor spiraled out of control.

In this episode:

• What daily life looks like in Bunia under an active Ebola outbreak
• Why the Bundibugyo strain is uniquely difficult to detect, treat, and communicate about
• Inside the Red Cross's safe and dignified burial process
• What happened when a burial team was attacked — and how the response changed afterward
• Why misinformation is, in Dr. Mbonda's words, an outbreak of its own
• What international donors and policymakers need to understand right now

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When Yvette Raphael walked into a stakeholder meeting in Kigali in 2019 and asked Gilead's lead researcher, "What are you going to do differently?", she was doing her job. As co-founder of Advocacy for Prevention of HIV in Africa and chair of the Global Community Advisory Board for the PURPOSE 1 trial, Yvette has spent decades ensuring that women most affected by HIV are not just research subjects, but architects of the science designed to protect them.

In this episode, she tells the inside story of lenacapavir, Science magazine's 2024 Breakthrough of the Year, from the community trust-building that made the PURPOSE trials possible, to the moment at AIDS 2024 when results showing 100% efficacy brought a room of scientists to their feet.

But Yvette is clear: a breakthrough is only a breakthrough if it reaches the people who need it. With PEPFAR funding under threat and rollout decisions being made without community voices, she pulls no punches on what accountability from science, pharma, and governments must actually look like.

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The America First Global Health Strategy promises something African health advocates have demanded for decades: ownership. Through time-bound bilateral compacts, countries co-finance health programs with the US, gradually taking over as American funding tapers. By year five, they're supposed to own and sustain these systems themselves.

But what if ownership without authority is just dependency with a new face?

In this episode, we sit down with Nelson Aghogho Evaborhene, PhD fellow in Global Health Governance at Roskilde University, to unpack how these compacts actually work. Nelson has written several major analyses of the AFGH, and his conclusion is stark: these agreements transfer responsibility to African governments without transferring commensurate control over technology, data, procurement, or even the political conditions under which funding continues.

We explore Nigeria's $3 billion compact and its religious conditionalities, the South Africa precedent where funding was cut for political reasons despite strong performance, how bilateralism fragments the continental institutions Africa has been building, and why—even with full domestic financing—health systems remain vulnerable to collapse if they can't produce what they need.

Reading: Nelson's articles

Rebalancing Risk and Responsibility Under the America First Global Health Strategy

The America First Global Health Strategy and the Dilemma of Pan-Africanism

America First and the Fragmentation of Global Health: How Africa can Reimagine Its Agency

Protecting global health in the era of the America First Strategy

To support us, consider becoming a paid subscriber on Patreon or making a one-time donation via PayPal.

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