Health

Every September, heads of state and ministers meet in New York for the opening of the UN General Assembly. This year one meeting was meant to agree a political declaration on preparing for pandemics. On 25 September it failed. The United States said it could not support the text, and Italy and the European Union also objected. African governments, speaking together through Burundi, supported it. The text now goes to a vote before the end of the year.

Two days earlier, the United States brought a group of countries together outside the World Health Organization. That meeting raised about $3 billion to fight Ebola in the Democratic Republic of the Congo (DRC). African governments together gave $110 million, less than 4% of the total. Africa CDC asked that every dollar be tracked from promise to payment.

A group set up by Ghana's President John Mahama, called the Accra Reset, also published a plan. It proposes merging several global health funds and handing their work to African governments over five to ten years. It records that outside money for health in Africa fell by almost 70% between 2021 and 2025.

The Ebola outbreak in the DRC is the largest the country has ever had. By 23 September, WHO had confirmed 7,890 cases and 3,799 deaths, most of them in Ituri province in the east. This type of Ebola, called Bundibugyo, has no approved vaccine or treatment. Trials of possible vaccines began in August and September.

At the same time, the money that paid for much of Africa's health care is shrinking. Global aid for health fell to about $38 billion in 2025, less than half its level in 2021. The Global Fund raised $12.6 billion against a target of $18 billion. Gavi lost its US pledge and cut a third of its staff.

The United States now sends much of its health money through separate deals with individual countries, which it calls "America First" health agreements. Thirty-five countries have signed, 24 of them in Africa. Each government must pay a share of the cost, on average 39%, and that share rises each year. Several deals also give US agencies access to patient records, disease tracking systems and samples of viruses.

Africa is short of health workers, yet many trained ones cannot find a job. WHO expects the region to be short of 5.85 million health workers by 2030. It also counts 943,000 trained nurses, midwives and doctors with no job in 2024. Many leave for Europe and North America, where nurses earn about seven times more. Hiring all of them would cost about $7.8 billion a year.

In 2001, African governments promised in Abuja to spend 15% of their budgets on health. Few have done so. In 2023, South Africa spent 16.9% and Namibia 15%, while Nigeria spent 4.3% and the DRC 4%.

Kenya signed its US deal in December 2025. The deal totals $2.48 billion, and Kenya pays $850 million of that. A Kenyan court suspended the deal because of the way it shares health data. A higher court later let it continue, and its final ruling is due on 30 October. Kenyan law already says health data must be kept in Kenya.

Other governments have pushed back. Zimbabwe ended talks in February 2026 and Ghana turned down a deal in April. Zambia's negotiators objected to sharing data for 25 years in return for five years of money. On 25 September, Zambia said the United States had agreed to replace those terms.

Nigeria has the largest deal, $5.05 billion, and has promised to pay 59% of it. That is a big promise from a government that spent 4.3% of its budget on health in 2023. Mozambique pays under 4% of its deal and Malawi under 7%, so both will struggle as US money falls away.

The DRC is fighting Ebola with a health budget that took 4% of government spending in 2023. Its US deal asks it to pay a quarter of $1.2 billion. Neighbouring Uganda has already ended its own outbreak.

Africa makes about 0.1% of the world's vaccines, and the African Union wants Africa to make 60% of what it needs by 2040. Some firms are building that capacity, including Biovac in South Africa and EVA Pharma in Egypt. The African Medicines Agency, a new continental regulator based in Rwanda, started work in October 2025.

When health money comes through one-to-one deals, each government negotiates alone. A small country has little power to refuse data terms or payment schedules. If 24 African governments agreed the same basic rules, they would be much harder to ignore.

Governments are also negotiating rules on sharing virus samples and data at WHO, with a decision due in May 2027. Until then, the one-to-one deals are setting those rules in practice, one country at a time.

Money for pandemic preparedness mostly goes to disease tracking, testing and research, which protect the whole world from diseases that cross borders. What catches an outbreak early is a trained nurse in a staffed rural clinic, and that gets the least. The world raised $3 billion for Ebola in a few weeks. Nobody has called a meeting to put Africa's 943,000 idle health workers into jobs.