Define global

The Africa CDC chief had trouble getting into Germany for the World Health Summit

Attendees from low-income countries often struggle to get visas to attend the conferences that discuss their future
The Africa CDC chief had trouble getting into Germany for the World Health Summit
Photo: World Health Summit
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The World Health Summit, a World Health Organization (WHO)-backed global health conference, is underway in Berlin, Germany.

The event, held from Oct. 16 to Oct. 18, is large and high profile. Around 400 speakers are listed on the official website, and among them are some of the world’s most prominent figures in global health. WHO’s head Tedros Adhanom Ghebreyesus, UN secretary-general António Guterres, and UNAIDS lead Winnie Byanyimia are expected to be in attendance. So are Bill Gates, Ayoade Alakija, who works on covid-19 access for the WHO, and Ahmed Ogwell Ouma (who goes by Ahmed Ogwell), the acting director of Africa’s Centers for Disease Control and Prevention (Africa CDC).

Except Ogwell almost didn’t make it to Berlin. At Frankfurt airport, he noted on Twitter, he was “mistreated.. by immigration personnel who imagine I want to stay back illegally.” His attendance at the summit—which is supposed to advance global health, with a specific focus of low-income countries—was in doubt. “I’m happier & safer back home in Africa. They invite you then mistreat you,” he wrote. Visas, he reflected, are like health emergencies and vaccinations: They leave Africa behind.

“Zero visa problems with speakers.”

Ogwell was eventually able to enter Germany, and check into the conference’s hotel in Berlin, according to Daniela Levy, a spokesperson for the summit, who said the organization only learned of the issues faced by Ogwell via Twitter. “[W]e had zero visa problems with speakers,” she added.

But the experience of some of the actual speakers or attendees might be different.“Ultimately these incidences don’t just happen to Dr. Ogwell. I too was asked whether I had a return ticket and implied that I would stay illegally in Germany—and these incidences happen very often to Black and brown people when traveling in Europe,” says Fifa Rahman of Matahari Global Solutions, a global health consultancy. “At the end of the day, no matter how many degrees we get or how prominent we become in global health, we are often disrespected at borders due to our skin color, and it does become a deterrent to us participating in these spaces,” she added.

Although many of the issues they focus on target countries in the so-called global south, international health conferences are overwhelmingly held in high-income countries, where delegates from Africa or Asia often face significant attendance barriers, both practical and psychological. “Visa issuance does not protect you from further subjection to indignity when you get to immigration. You may have a visa, but get there and just the way you are interrogated is dehumanizing and demeaning and undignified,” says Nadia Sam-Agudu, a professor of pediatrics in the Institute of Human Virology at the University of Maryland School of Medicine.

Beyond the cost of travel and accommodation, visas are often burdensome to obtain and expensive, even for those who manage to get them. Many visas are often denied or delayed, often leading to extra expenses to change tickets and other reservations.

“We keep hosting global health meetings in visa hostile countries,” says Madhukar Pai, the director of McGill University’s global health programs. Pai is outspoken in highlighting the power inequalities reflected by global health conferences and those who get to attend, and has frequently denounced the elitism of the field.

A legacy of colonialism

“Most of the people attending are from high income countries. They might be working in African countries, but they are from high income countries,” says Sam-Agudu, who holds an American passport, but says she has witnessed many colleagues from low-income countries being mistreated in the immigration process. “You have people not able to show up to present their work. They are not able to show up to collect the awards. They have to present virtually because they didn’t get a visa,” she says.

A look at the World Health Summit’s speakers list shows exactly this kind of imbalance. “Speakers and participants are from every region of the world and from every sector,” says Levy. “We have a strong participation from the global south including high profile speakers charting the narrative on public health and inclusivity. Everyone’s voice matters and we are mindful that discussions aren’t one-sided.”

Yet out of the 400 speakers listed, nearly 200 come from Germany, the US, Switzerland, and the UK, and another 50 belong to international organizations. Only 39 speakers come from African countries, and fewer than 20 from Asia. This is the norm for a global development conference, and the difficulty in traveling to the locations where such gatherings are held doesn’t help.

Changing the locations where these events are held could improve diversity in attendance, a conferences held in low- and middle-income countries often take ease of travel for attendants into account, says Sam-Agudu, who is on the board of five health conferences, including three AIDS-focused gatherings based in Africa. Yet this change would fundamentally reshape the power dynamics, and arguably the whole system, of global health. “Historically, we have to say, some of these global health conference and some of the oldest international health and tropical medicine organizations were not established necessarily to serve the interests of the people among whom the work was done,” she says.

Still, there is an understanding that in many cases the infrastructure of the global south doesn’t meet the standards required by high-level meetings, and that gathering in the rich centers of the world is inevitable. But the question is to whose standards do these conference cater? “There are many global south countries which can host big conferences and are safe and more importantly will enable meaningful participation of global south experts without being disrespected at borders,” says Matahari Global Solution’s Rahman

If international organizations want to embrace the principles of global health, says Sam-Agudu, they have to reconsider the way they organize their meetings, and the venues of their conferences. “If the organizing committees are not prepared to work on the inequity of simply attending conferences,” she asks, “how much more do you think they can work on inequity of health systems?”