Ambassador John Nkengasong: Lessons Learned in Tackling Global Health Inequities

At the ASCP 2024 Annual Meeting in Chicago, Ambassador John Nkengasong, a trailblazer in global health, delivered the prestigious Dr. Paul Farmer Keynote Address. Amb. Nkengasong currently serves as the U.S. Global AIDS Coordinator and Senior Official of the Bureau of Global Health Security and Diplomacy. He is well-known for his impactful leadership with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Africa CDC, where he advanced efforts to combat infectious diseases and strengthen health systems across the African continent.

Reflecting on his career, Amb. Nkengasong emphasized three key lessons from the global HIV/AIDS response: the need for strong political leadership, the transformative power of innovation, and the importance of partnerships. These lessons align closely with the work the American Society for Clinical Pathology (ASCP) has been doing for more than 15 years in global health. As we look ahead, we can see how these pillars offer a path to sustained progress and equitable healthcare worldwide.

Political leadership: The driving force behind global health success

Amb. Nkengasong opened his keynote by highlighting the critical role of political leadership in tackling global health crises. He pointed to PEPFAR as one of the most successful examples of bipartisan U.S. government intervention in global health. Established in 2003 by the George W. Bush administration, PEPFAR has been instrumental in reducing AIDS-related deaths by 68 percent and new HIV infections by 42 percent since 2004. In total, the program has saved 25 million lives and prevented 5.5 million babies from being born with HIV.

Despite these monumental achievements, Amb. Nkengasong emphasized that PEPFAR’s work is far from complete. Originally conceived as an emergency response to the HIV/AIDS crisis, the program must now transition to a long-term, sustainable model that ensures continued treatment and viral suppression for people living with HIV (PLHIV) and achieves an AIDS-free generation. This transition includes reaching the ambitious 95-95-95 goals by 2030: 95 percent of PLHIV knowing their status, 95 percent receiving treatment, and 95 percent achieving viral suppression.

Amb. Nkengasong also underscored the importance of political will in achieving health equity. He warned that the absence of strong political leadership could undo the progress made by programs like PEPFAR and the Global Fund. This is especially relevant today, as PEPFAR faces political challenges that threaten its future funding. Amb. Nkengasong called for a clean five-year reauthorization of the program, stressing that only sustained political support can ensure continued progress.

ASCP’s role in PEPFAR’s success

ASCP has been a key partner in advancing PEPFAR’s objectives. Since 2004, ASCP has collaborated with the Centers for Disease Control and Prevention (CDC) to respond to the HIV/AIDS epidemic, providing technical assistance, training, and mentorship to laboratory professionals in 14 countries. ASCP has led over 740 training workshops, equipping more than 10,000 laboratory professionals with the skills needed to improve molecular diagnostics, strengthen laboratory quality management, and enhance biosafety. These efforts directly support PEPFAR’s goals of improving healthcare delivery and reducing health inequities.

Dr. Lee Hilborne, Past President of ASCP and a driving force in the organization’s global health initiatives, reflected on the significance of this partnership: “When we started our efforts in global health, the first person at CDC I met was Dr. Nkengasong. It was clear that he had a vision to change the world for the better. That he did.”

ASCP, in collaboration with CDC and other partners, played a vital role in co-developing the Strengthening Laboratory Management Toward Accreditation (SLMTA) program. “When we conceived the notion of SLMTA (March 25, 2007), we knew that the person we needed to engage was John. John sent the proposal to the WHO, and the WHO shared it with WHO-AFRO.  After that, the rest is history,” Dr. Hilborne says. SLMTA has improved laboratory quality in more than 56 countries and helped over 400 laboratories achieve ISO accreditation, with ASCP staff and volunteers playing a pivotal role as faculty, mentors, advisors, and collaborators.

“Honestly, I have nothing but good memories from our PEPFAR work. Professionally I think this was among the most meaningful things I have done. It may seem cliché but in some ways, I see the PEPFAR initiative and personally our initial work as a reminder that ‘one person (and organization) really can change the world.’  I think in this case there are likely millions of people alive today who would not be had it not been for the efforts of ASCP staff and volunteers. What could be more meaningful than that?” Dr. Hilborne reflects.

Innovation: Harnessing technology and data to close the gap in health equity

The second major lesson Amb. Nkengasong shared was the importance of innovation, particularly the role of technology and data in addressing global health disparities. He highlighted recent advancements in HIV treatment, including gene-editing technologies like CRISPR, and the potential of artificial intelligence (AI) to revolutionize healthcare in low- and middle-income countries (LMICs).

Amb. Nkengasong stressed that to fully leverage these innovations, it is crucial to democratize access to technology and data in LMICs. He called for local developers to be involved in creating context-specific solutions, as well as for investments in start-ups focused on innovative health technologies. He also emphasized the need for proper regulations and standards to ensure the ethical and accurate use of health data.

One example of innovation that Amb. Nkengasong highlighted is DataPathology, a MedTech start-up that applies AI and image processing to pathology. By using AI to analyze biopsy samples, DataPathology has reduced diagnostic times from weeks to just a few days—an essential improvement for patients in LMICs, where timely diagnoses are often the difference between life and death.

ASCP’s leadership in digital pathology and innovation

ASCP has long been at the forefront of integrating technology into pathology and laboratory medicine. Through its Partners for Cancer Diagnosis and Treatment in Africa initiative, ASCP has deployed whole slide imaging and telepathology systems in resource-limited settings, enabling remote consultations and faster diagnoses. This program has provided more than 10,000 patients across 30 countries with access to life-saving diagnostic services, significantly reducing the delay in cancer diagnoses.

By leveraging innovation and data, ASCP is helping to close the gap in health inequities, ensuring that patients in LMICs have access to the same high-quality diagnostic services available in high-income countries.

Transformative partnerships: Collaborating for maximum impact

The third and perhaps most impactful lesson from Amb. Nkengasong’s keynote is the power of partnerships in driving global health improvements. He pointed to the Go Further Partnership, a collaboration between PEPFAR, UNAIDS, and the George W. Bush Institute, as a prime example of how public-private partnerships can make a significant impact on global health outcomes. The Go Further Partnership aims to reduce cervical cancer incidence among women living with HIV, who are six times more likely to develop the disease. Since its launch, the initiative has provided cervical cancer screening to more than 5.5 million women, with a 79 percent treatment rate for pre-invasive lesions.

Amb. Nkengasong stressed that partnerships like Go Further are essential for addressing complex health challenges that no single organization can tackle alone. By leveraging the strengths of different partners—including governments, non-governmental organizations (NGOs), and private companies—these initiatives can maximize their reach and impact.

ASCP’s work building transformative partnerships

ASCP has been a leader in forming partnerships that drive meaningful change in global health. Through the Partners for Cancer Diagnosis and Treatment in Africa Initiative, ASCP has worked with local hospitals, governments, academic institutions, and NGOs to establish histology laboratories and implement telepathology services. Additionally, as a founding member of the Coalition for Implementation Research in Global Oncology (CIRGO) initiative, ASCP has awarded more than $1,000,000 to cancer researchers in LMICs and provided mentorship for their research. These partnerships have not only expanded access to diagnostic services but have also provided critical training to local pathologists, building the long-term capacity of healthcare systems.

By engaging partners across sectors, ASCP has been able to expand its reach and deepen its impact, providing critical diagnostic services to thousands of patients in underserved regions. These partnerships exemplify the kind of transformative collaborations that Amb. Nkengasong advocated for in his keynote.

The path forward: Sustaining the momentum

As Amb. Nkengasong concluded his keynote, he reiterated that the fight against HIV/AIDS—and global health inequities more broadly—is ongoing. The challenges of political instability, emerging diseases, and funding uncertainties require sustained leadership, innovation, and collaboration. Amb. Nkengasong’s call for a clean five-year reauthorization of PEPFAR is just one example of the continued political commitment needed to drive progress.

ASCP is proud to stand at the forefront of this fight, leveraging its technical expertise, innovative solutions, and strong partnerships to reduce health inequities. Through its Center for Global Health, ASCP mobilizes its members to provide technical assistance and mentorship to laboratory professionals in LMICs, empowering them to deliver high-quality diagnostic services.

Get involved: Join ASCP’s global health efforts

Active ASCP members interested in engaging in ongoing global health work through ASCP’s Center for Global Health, either from clinical or anatomic pathology disciplines, are invited to complete this interest form. Ideas for future collaborations or partnerships in global health work should be directed to: GlobalHealth@ascp.org.

Reflecting on the impact of ASCP’s global health work, Dr. Hilborne remarks: “From personal experience, it’s an opportunity to have one of the most rewarding experiences in your life. We are so fortunate to have selected an incredible profession, and we are members of an organization that believes in transformational change.”