Filling the funding void would mitigate infectious outbreaks and build resilience in Africa

Countries across Africa are facing more frequent and concurrent infectious disease outbreaks, straining pandemic surveillance and control systems amid cuts to aid. These challenges warrant empowered leadership from the Africa Centres for Disease Control and Prevention (Africa CDC), rapid capacity building, and new financing initiatives.

The Africa CDC recently recommended maintaining mpox as a public health emergency of continental security owing to intense spread and the emergence of a new highly transmissible clade Ia variant.1 Mpox remains uncontrolled in 22 countries, with weekly cases tripling between August 2024 and February 2025.1 Vaccine supplies, surveillance systems, and health services are insufficient, exacerbating the risks to public health.

Concurrent outbreaks of Ebola, Marburg, measles, cholera, and other diseases add further strain to fragile health systems. In January 2025, Tanzania reported a Marburg outbreak with 100% case fatality rate.2 Also in January a new disease outbreak in the Democratic Republic of the Congo (DRC) affected over 1000 people, causing around 60 deaths.3 After ruling out Ebola and Marburg, tests have confirmed malaria. Simultaneously, conflict in eastern DRC recently displaced 1.2 million people, heightening the risk of new outbreaks.4

These challenges are seriously compounded by the suspension of foreign aid by the US government, disrupting outbreak control activities. The 90 day freeze on the President’s Emergency Plan for AIDS Relief and the President’s Malaria Initiative is predicted to double new HIV infections and put 20 million people at risk of losing access to life saving HIV medications. It would also derail efforts to prevent 14.9 million malaria cases and 100 000 malaria deaths in 2025.67 The USAID freeze and stop work orders are likely to escalate polio, tuberculosis, unwanted pregnancies, and unsafe abortions, and to deteriorate child health—causing irreversible harm. But surveillance systems to document these consequences are diminished by the reduced aid, thus silencing the voices of those affected.8

We need to fill this governance space. The Africa CDC is prepared to lead this transition but needs to double its staff to cope with ongoing outbreaks and further scale-up to implement its strategic plan for 2023-27. The plan supports the five regional collaborating centres to lead emergency response, mitigation, and epidemiological surveillance and to increase regional vaccine production to 60% of its needs by 2040.910 Mobilising regional teams at the point of new outbreaks is more cost effective and sustainable than bringing in overseas experts. Africa has many talented people with experience in infectious disease research, diagnostics, and surveillance, but capacity building is needed at all levels, including community engagement.

To accomplish this, Africa needs regional and international funding amounting to less than 1% of the EU’s 2024 military defence investments.11 Supporting response systems for disease outbreaks aligns with the EU’s Global Health Strategy (2022),12 but the EU has made little effort to compensate for the collapse in US leadership.13 Instead, EU member states have redirected €2bn from development funds to migration related activities, cutting aid budgets by 7.48% for 2025-27.14 Rising nationalism and security priorities overshadow the development agenda. In 2022, EU countries and development assistance committee members allocated just 0.37% of their gross national incomes to official development assistance, far below the 0.7% sustainable development goal 17 target.15 Recently, the UK exacerbated this downward trend by reducing its official development assistance to 0.3% of its gross national income.16

The “global south” needs to gradually transition away from dependence on development assistance by allocating more domestic resources to essential health services and outbreak response.17 Most African governments fall short of the Abuja declaration goal to invest 15% of national budgets in health,17 and many countries spend more on debt interest payments than on education or health with aid shifting from grants to loans.15

Despite dire consequences, recent shifts may open opportunities for more equitable partnerships that allow local universities to prioritise south-south collaboration and challenge power imbalances to empower local scientists, build capacity, and align funding with local needs.18 Equitable and sustainable north-south academic partnerships, however, remain crucial for ensuring transparency and data sharing, preserving global cooperation, and enabling evidence based policy making and response.

Immediate actions can be taken to mitigate disease outbreaks, improve surveillance, and promote equitable partnerships. African Union member states must increase domestic financing for health and research and development in line with the Abuja and Lusaka declarations,19 with concrete plans for increased independence. The EU must adhere to its strategy and commit to sustainable investment in pandemic prevention, preparedness, surveillance, and outbreak response in Africa.12 Commitments must also be secured from the drug industry to enable tech transfer and ensure access to affordable lifesaving medication and vaccines to mitigate imminent threats.

Establishing and extending global academic networks can build sustainable capacity and ownership for African universities and organisations prioritising local impact and needs. Local efforts should also involve training more community health workers and expanding public health messaging to encourage vaccination and other essential health services for disease prevention, while countering health misinformation and disinformation.

Philanthropists and high income countries can invest in the newly created African Epidemic Fund as a vehicle for funding to rapidly support countries with high flexibility and accountability.4 Serious discussions about debt relief are needed as many countries in the global south spend more on debt interest payments than on their education or health systems.15