Africa's top public health institution is warning of the risks of losing the gains made over the past two decades in epidemic preparedness and response. At the heart of the concern is a steep decline in external support.
"The next pandemic is not a question of if, but when," says Dr. Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC), sounding the alarm on the need for robust health security measures.
Official Development Assistance to Africa has decreased by 70% over the past few years, putting pressure on already fragile health systems. Africa CDC is particularly alarmed by the implications of recent reductions in global health funding, including cuts to US aid for major programmes such as PEPFAR, Gavi, and the US President's Malaria Initiative.
This contraction in funding coincides with a rise in disease outbreaks. Between 2022 and 2024, the continent witnessed a 40% increase in reported public health emergencies. Cholera is spreading in multiple countries, while mpox cases are growing in central and southern Africa.
Concerns also persist regarding the return of viral haemorrhagic fevers such as Ebola and Marburg, while climate shocks -- ranging from floods to heatwaves -- are fuelling new health risks, often in regions least equipped to respond.
Adding to the challenge is Africa's continued reliance on imported medical products. Over 90% of vaccines used on the continent are manufactured elsewhere. This dependence was starkly exposed during the COVID-19 pandemic and continues to limit Africa's ability to respond quickly and sustainably to disease threats.
The situation has been further complicated by the end of Gavi's support to Africa CDC's emergency operations. "The Gavi support was very useful in helping us to have an Emergency Operations Centre functioning 24/7," said Dr. Ngashi Ngongo, Manager of the Mpox Incident Management Support (IMST) team based in Kinshasa, Democratic Republic of Congo. "Unfortunately, that support has come to an end."
Dr. Ngongo outlined how the IMST has now entered its second phase, with a more ambitious and integrated plan to manage the ongoing mpox outbreak and prepare for future emergencies. The focus, he said, is on both scaling up current operations and building lasting systems. The strategy aligns with the "four ones" approach rooted in the IMST: one team (led jointly by Africa CDC and WHO), one plan, one budget, and one monitoring framework -- all coordinated with 28 partners.
This second-phase plan aims to stop human-to-human transmission in affected countries, halve mpox incidence in endemic areas, and strengthen national systems to withstand future outbreaks. It is deeply anchored in community-based action, with health workers playing a central role in case detection, contact tracing, and vaccination.
Digital tools for real-time surveillance are being scaled up, and the expansion of laboratory networks is underway to support decentralized testing. The goal is to boost testing coverage from around 50% to 80% and ensure that at least 8% of positive cases are genomically sequenced to track viral mutations. Meanwhile, vaccination campaigns aim to reach 6.4 million people across priority countries within six months.
Despite these efforts, the IMST faces a significant funding gap. Of the USD 429 million required for its full implementation, only a portion has been secured --leaving a shortfall of USD 224 million. Most of the available funding was pledged during the first continental mpox response plan, although some partners have indicated that previous commitments may no longer be fulfilled.
This situation reflects a broader challenge within Africa's health security architecture. However, work is ongoing to reverse the funding uncertainty. Furthermore, Dr. Kaseya has proposed a three-part strategy to enhance sustainability and reduce reliance on external donors.
He is calling on African Union Member States to increase their domestic funding for public health. Only two countries currently meet the Abuja target of allocating 15% of national budgets to healthcare. For Dr. Kaseya, domestic commitment is essential to safeguarding health systems against the volatility of international funding.
Second, Africa CDC is pursuing new financing models. These include the Africa Epidemics Fund, whose operational framework was launched in February 2025, as a pooled resource for emergency preparedness and rapid response. The agency is also exploring mechanisms such as an airline tax or regional solidarity levies to provide a more predictable stream of funding for outbreak management.
Third, Africa CDC is seeking greater collaboration with philanthropic organisations and the private sector. The aim is to attract long-term investment into critical infrastructure, including local vaccine production, digital health systems, and logistics networks. As part of this effort, Africa CDC is implementing the African Pooled Procurement Mechanism to lower costs and increase access to essential health commodities across the continent.
To galvanise broader support, Dr. Kaseya recently led a high-level diplomatic mission to the United States, Norway, and Denmark. In Washington, D.C., he and his team met with U.S. lawmakers, USAID, the U.S. Centers for Disease Control, and major philanthropic institutions, including the Gates and Rockefeller Foundations. These engagements focused on reaffirming Africa CDC's central role in global health security and appealing for continued support despite ongoing budgetary pressures in donor countries.
"An investment in Africa's public health is an investment in global stability," said Dr. Kaseya during his visit to the U.S. "Africa's progress cannot be reversed by temporary budget constraints in partner countries."
"What may seem like a major setback could, in fact, be a defining opportunity. Africa CDC is leveraging global funding cuts to champion sustainable health financing fuelling domestic investment, unlocking innovative funding streams, and building resilient systems for Africa's future," says Dr. Ngongo.
In Europe, discussions with government and development officials in Norway and Denmark highlighted a shared interest in strengthening health systems. While new financial commitments have yet to materialise, both countries signalled strong political support for Africa CDC's long-term objectives.
Throughout these engagements, Dr. Kaseya emphasised that Africa is not seeking charity, but partnerships. "We are asking for solidarity and co-investment," he said. "What we are building is a firewall that protects not only Africa but the world."
Dr. Ngongo adds that it really doesn't help to complain. "We have to be proactive in terms of thinking that, if this is the new normal -- if that is the direction the world is taking -- how do we remain fit in that context? What are the adjustments we need to make on our side to turn this challenge into an opportunity for Africa? That's the angle we have taken: to turn what may seem like a setback into an opportunity. This is why we're moving ahead with a new strategy -- one that prioritises increased domestic resource mobilisation, explores innovative financing like solidarity levies and sin taxes, and brings in private sector investment. We see this not only as a challenge, but also as a moment to reshape the future of health financing on the continent."
Back in Kinshasa, the IMST continues to operate under constrained conditions. Yet Dr. Ngongo remains focused on the opportunity to strengthen Africa's preparedness. "We want to ensure that when this (mpox) outbreak ends, we leave behind stronger systems -- better surveillance, decentralised labs, and community-led response mechanisms."
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Africa CDC's efforts to build a strong war chest to fund outbreak responses and fight diseases across Africa received a boost from two African heads of state on March 14.
President of Angola, João Manuel Gonçalves Lourenço, took over the rotating African Union (AU) chairmanship at the opening of the 38th Ordinary Session of the AU Assembly of Heads of State and Government on February 15.
"I strongly commend the remarkable efforts of the Africa CDC in advancing the continent's public health agenda, tying it closely to economic growth and job creation, and ensuring the safety and wellbeing of all Africans," President Lourenço said.
Africa CDC plays a key role in strengthening Africa's capacity to respond effectively and rapidly to emerging health threats, he said.
"The fundamental role that this institution has played has set a commendable standard in disease surveillance, prevention, and control, contributing immensely to continental and global health security. I reaffirm my commitment to providing continuous and sound support to Africa CDC, empowering you to fully discharge its essential mandate," President Lourenço said.
Ethiopian Prime Minister Abiy Ahmed, who also visited Africa CDC on the same day, called on AU members to intensify their collective support in elevating the Africa CDC as a premier public health institution. "It is incumbent upon us to strengthen this institution in collaboration with partners. I call upon fellow African leaders to join efforts in establishing our continental public health agency as a premier institution, fully committed to advancing health across the continent," Prime Minister Abiy Ahmed said.
