SPOTLIGHT
T he centre of gravity in global health must shift towards the regions – to architects of solutions. Over the last two decades, global health initiatives saved millions of lives, and we honour those gains. But much of the investment was channelled vertically – highly effective against individual diseases, but insufficient for strengthening surveillance, laboratories, workforce, manufacturing and financing systems that keep countries safe between crises. The mandate of the Africa Centres for Disease Control and Prevention is to integrate those gains into resilient, country-owned systems, working with partners, not around them. Africa and elsewhere in the world – that have too often been considered passive recipients of aid rather than active I write as someone confronting daily the hard realities of outbreaks that respect no borders, economies destabilised by health shocks and communities demanding ownership of their resilience. I have seen how fragile the current arrangements are – and how exposed they leave Africa. But I have also seen the promise we hold if we claim our rightful place in reshaping the global health order. LESSONS FROM A BROKEN MODEL Recent emergencies such as Covid-19, mpox, cholera, Ebola and Marburg have revealed inequities in a system built on donor dependency and power asymmetry. Africa was at the end of the queue for life-saving tools. During Covid-19, high-income countries secured over 70% of available vaccines within the first year; Africa received less than 3% by mid-2021, with similar inequities in diagnostics, oxygen and protective equipment. Africa has faced mpox outbreaks for decades, but global attention mobilised only when cases reached Europe and North America. These crises also exposed fragile supply chains. Border closures, export bans and stockpiling left Africa unable to secure essential commodities. The rhetoric of ‘global solidarity’ gave way to vaccine nationalism, where access depended on purchasing power. Beyond inequitable access, the architecture itself was fragmented. Multiple overlapping initiatives with separate reporting requirements and vertical funding streams created duplication rather than coordination. Countries faced donor-driven agendas. Financing was reactive – surging during crises and disappearing when headlines faded – undermining sustainable systems. This so-called global health system is neither global nor fit for purpose. It leaves Africa disproportionately exposed to preventable loss of life and economic devastation.
Reimagining the global health architecture: An African roadmap for shared security Moving beyond an inequitable and broken global health system, Africa is reshaping health security through regional leadership, equity and innovation, as a resilient architecture emerges
AFRICA RISING: TAKING CHARGE OF ITS HEALTH FUTURE Africa has chosen to chart its own path. At the heart of this transformation is health sovereignty. Africa CDC is leading the scale-up of local manufacturing of vaccines, diagnostics and therapeutics, and the African Medicines Agency is being operationalised to ensure rigorous regulatory oversight across the continent. Scientific capacity is advancing rapidly. Africa’s
Jean Kaseya, director-general, Africa Centres for Disease Control and Prevention
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Health: A Political Choice – The Future of Health in a Fractured World
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