By Kabaso Kabwe, PhD.

Global health in 2025 is facing monumental changes as Africa deals with the ramifications of
foundational U.S. policy changes of the Donald J. Trump administration. The withdrawal of the U.S.
from the World Health Organisation (WHO), where it is the largest donor will upset a key component
of technical expertise and coordination. Equally disruptive are the steep cuts to USAID, slashed by
83%, as announced by U.S. Secretary of State Marco Rubio on March 10, and the President’s
Emergency Plan for AIDS Relief (PEPFAR), a programme that has saved over 26 million lives globally
since 2003, with a profound impact in sub-Saharan Africa. Funding for Gavi, the Vaccine Alliance, and
pandemic preparedness is also under threat, leaving health systems across the continent grappling
with uncertainty.

These cuts, while not entirely unexpected, particularly given Trump’s “America First” doctrine, arrived
with a suddenness that has disrupted supply chains, HIV/AIDS treatment programmes, maternal and
child health services, reproductive health initiatives, and emergency response frameworks. Yet, amid
this turbulence, Africa stands at a crossroads, a moment not just of challenge, but an opportunity to
assert its agency, reimagine its health diplomacy, and forge a path toward resilience.

From dependency to leadership: The case for African agency

For decades, U.S. leadership has anchored Africa’s public health architecture. PEPFAR alone supported
almost all antiretroviral therapy in some African countries, such as Nigeria, where it funded
approximately 90% of the treatment burden, while USAID contracts bolstered thousands of health
initiatives. In Zambia, 75% of the total U.S. assistance is channelled to the health sector, with the
biggest portion going towards supporting the country’s HIV/AIDS response. South Africa, on the other
hand has long funded 90% of its HIV drug supply domestically, with PEPFAR contributing 17% to its
HIV programme channelled through NGOs to address gaps such as targeting key populations, rather
than core systems. Important to note is that while donor funds have delivered undeniable gains in
most countries, the reliance for many often comes at a cost as donor-driven priorities frequently
bypass local institutions, creating parallel systems that undermine national ownership.

The immediacy of these cuts, and lacking transition plans, has strained budgets and service delivery.
Yet, it has also ignited a well-known reckoning- Africa’s health future cannot hinge on fleeting external
support. Yet, dependency is not destiny. African countries must quickly adapt to the new landscape
by leveraging local innovation, strengthening regional institutions, and diversifying partnerships. The
challenge is to accelerate these efforts and institutionalise self-reliance in health governance.

Leveraging local innovation: Across the continent, countries are now looking to tap into homegrown
solutions to fill the void. Rwanda is exemplifying adaptability by reallocating funds and embracing
technology to sustain its healthcare initiatives. Its government has redirected 5 billion Rwandan francs
($3500) from short-term workshops to ensure the continuation of medical student training
programmes. Nigeria, facing the loss of its HIV funding, has allocated N700 billion ($456 million) to
combat HIV/AIDS, Tuberculosis, and Malaria, while also enhancing immunisation efforts nationwide.
In South Africa, the government is holding consultative processes with affected organisations, making
efforts to redeploy trained staff to fill gaps left by PEPFAR-funded personnel, and ensuring task-shifting
in hospitals and clinics. The 2025 national budget includes an extra 28.9 billion rand ($1.5 billion) set
out for health expenditures to cover the wages of around 800 recently qualified physicians as well as
9,300 medical staff in clinics and hospitals.

Additionally, the mRNA vaccine hub, established in 2022 with initial WHO backing and focused on
COVID-19 vaccines has the capacity for other diseases like HIV. Given the funding cuts, and South
Africa’s commitment so far to domestically fund its health system, the pivot to HIV sooner is a plausible
extension. These, and many innovations must be fully supported.

Strengthening regional institutions: Regional bodies should take on a greater role in addressing the
funding crisis. Drawn from lessons from the COVID-19 pandemic, the recently launched African
Epidemic Fund, a collaborative initiative between Africa CDC, the African Union Commission, and
AUDA-NEPAD will provide the Africa CDC with the flexibility to quickly allocate resources where they
are needed most. This is a great move that signals a broader shift toward self-sufficiency in health
financing and emergency preparedness. To guarantee that Africa leads and owns its health research,
development, and innovation, initiatives such as the African Health Research, Innovation, and
Development Alliance (AHRIDA), a ground-breaking pan-African movement for advocacy in health
research, development, and innovation (RD&I) that was introduced during the recently convened
Africa Health Agenda International Conference (AHAIC), are a welcome step. The AHAIC held in
Rwanda in March 2025 emphasised the need for public-private partnerships and technology-driven
solutions to strengthen health systems across the continent. Discussions highlighted the importance
of domestic resource mobilisation and reduced reliance on traditional funding streams to build
resilient healthcare infrastructures.

Diversifying Partnerships: While self-reliance is crucial, cooperation in global health is equally
essential. Africa should thus strategically diversify its partnerships. Collaborations between the Africa
CDC and ECDC have bolstered health security initiatives. China’s Belt and Road Initiative has expanded
healthcare infrastructure and India’s low-cost vaccine production offers a model for building local
pharmaceutical capacity building, among others. In addition, countries like Brazil and South Korea
provide alternative avenues for medical technology transfer and training. Africa must approach these
partnerships with clear priorities, ensuring alignment with its long-term health goals rather than
donor-driven agendas.

Challenges and a Bold Path Forward

While these initiatives underscore a collective shift towards self-reliance and innovation in Africa’s
healthcare landscape, aiming to build resilient systems capable of withstanding external funding
fluctuations, challenges abound. Political will varies across the countries, with corruption and
siphoning funds in some countries like Zambia, where audits have consistently revealed
misappropriation and procurement-related scandals. Debt burdens, averaging 65% of GDP in sub
Saharan Africa, limit investment, and brain drain of human resources for health remain a challenge.

The path forward thus demands boldness. African leaders must build on Rwanda’s 2025 AHAIC
conference, setting a 2030 vision for health sovereignty, doubling Africa CDC’s capacity, fast-tracking
initiatives like the African Medicines Agency’s rollout, and meeting the 2001 Abuja Declaration target
to allocate at least 15% of national budgets to the health sector. Civil society must hold governments
accountable while amplifying solutions. The U.S. retreat, and potentially other donors is a stark
reminder of external fragility, but Africa’s response rooted in ingenuity, unity, and resolve will prove
its capacity to lead. This flux should therefore not be a collapse but a call to rise, and the continent
should answer with strength.