Reimagining the global health architecture: An African roadmap for shared security
The centre of gravity in global health must shift towards the regions – to Africa and elsewhere in the world – that have too often been considered passive recipients of aid rather than active 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.
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.
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 first continental Biosafety Level 3 laboratory is being established, and genomic sequencing has expanded to 44 countries, enabling real-time outbreak tracking. National public health institutes have nearly doubled to 25, with 19 more under development – anchoring preparedness and response in home-grown institutions.
These systemic advances are reinforced by new tools for equity and sustainability. The African Pooled Procurement Mechanism ensures Africa will never again have to beg for life-saving tools. The Africa Epidemic Fund provides a sustainable financing base for preparedness and response. They are supported by investments in a skilled workforce and modern data systems.
Africa has also pioneered new ways of managing emergencies. Empowered by a strong political and technical mandate, Africa CDC declared mpox a Public Health Emergency of Continental Security. We established the Incident Management Support Team, co-led with the World Health Organization, with 25 countries and 29 partners under one plan, one budget, one framework and one implementation model. This platform now coordinates the multi-country cholera response.
A strong, self-reliant Africa makes the entire globe safer in today’s interconnected world.
Financing that matches the ambition
Ambition without financing is only a slogan. That is why Africa is blending stronger domestic resources and aligning external support with national plans and innovative finance to attract private investment.
Health is not a liability; it is an investment. Healthy populations are the foundation of productivity, stability and growth. Every dollar invested in health yields dividends in resilience and prosperity.
Our Africa Epidemic Fund, as a predictable, rapid-response instrument, will disburse quickly against clear triggers, publish who receives funds and why, and uphold fiduciary integrity through the African Union’s financial controls and independent audits. Regions must have existing funding – not rely on ad hoc charity.
A roadmap rooted in regions
Global declarations do not detect outbreaks in rural clinics, deploy rapid response teams or build trust with local leaders. It is the work of regional institutions like Africa CDC to make global promises become practical action. We translate commitments into capacity and ensure that no member state stands alone.
The Lusaka Agenda on sustainable financing, the African Vaccine Manufacturing Accelerator, the APPM and our continental preparedness plans are not aspirations – they are blueprints in action.
I envision a future with Africa’s health security woven into our economic and social transformation. Where investments in public health laboratories also mean jobs, innovation and trade. Where young African scientists, digital entrepreneurs and community health workers stand on an equal footing with their peers across the world.
The global health architecture must become a system of shared security. Every outbreak contained in Africa is an outbreak prevented for the world. Every innovation scaled on our continent strengthens global defences.
To achieve this, we need courage – from global partners to trust regional leadership and African governments to put health financing at the heart of sovereignty. It takes courage to accept that equity is not charity, but enlightened self-interest.
Choosing a stronger future
I know this future is possible because I have seen innovators creating diagnostics in record time, ministers rallying in unity and leaders committing to finance Africa CDC directly.
Reimagining the global health architecture is not an academic exercise. It is survival and solidarity. For Africa, it means refusing to wait at the end of the queue for compassion. For the world, it means recognising that our destinies are inseparably linked.
I extend an invitation for partnership. Let us build a system no longer fragmented and fragile, but federated, fair and fit for the future. Let us centre regional institutions as engines of resilience. Let us place Africa at the core of global health security.
If we succeed, when the next pandemic arrives, history will remember that we built a foundation strong enough for all humanity to stand upon.
