Cape Town, South Africa will host the 18th World Congress on Public Health (WCPH) from September 6–9, 2026, convening more than 2,000 public health professionals, policymakers, and advocates from around the world. The Congress is organised by the World Federation of Public Health Associations (WFPHA) in partnership with the Public Health Association of South Africa (PHASA).

It is the first time the World Congress on Public Health has been held in Southern Africa, and its first return to African soil in nearly three decades, a reflection of Africa’s growing voice in global health.

With its breathtaking landscapes and rich cultural heritage, Cape Town provides a fitting setting to confront today’s most pressing global health challenges under the Congress theme: “Health Without Borders: Equity, Inclusion, and Sustainability.”

The programme features plenaries, World Leadership Dialogues (WLD), symposia, workshops, poster sessions, and oral presentations - formats designed to foster substantive, cross-disciplinary discussions.

Why This Matters

Africa faces an unprecedented surge in health emergencies even as foreign aid declines sharply. The Congress arrives at a pivotal moment, placing the continent at the centre of global public health conversations and decision-making.

For Africa, hosting the Congress will strengthen partnerships, attract investment in health research and infrastructure, and amplify African perspectives in global health governance, reinforcing the continent’s readiness to move from crisis response to solution leadership.

Register to attend the 18th World Congress on Public Health — Cape Town, September 6–9, 2026

“Africa is not a real market”

This statement made during a keynote plenary at the World Health Summit Regional Meeting (WSRM2026), titled “Manufacturing Health in Africa: Sovereignty, Scale and Supply Chains” reflected the recognition that manufacturing alone will not secure Africa’s health sovereignty. There is need for coordinated market systems to sustain it.

The COVID-19 pandemic fundamentally reshaped conversations around health manufacturing and supply chains across Africa. As countries struggled with delayed access to vaccines, diagnostics, medicines, and other important medical supplies, the pandemic exposed the risks of relying heavily on external markets during global emergencies, and brought a recognition that health manufacturing is a matter of sovereignty and resilience, beyond it being an industrial ambition of countries on the continent.

Speaking during the panel, Dr Omar Albush, representing the Principal Secretary for Public Health, Kenya, described manufacturing as a “strategic imperative” tied to both health security and national resilience. “Health security is not charity. It is sovereignty,” he said, emphasising that no country can say it has achieved health security, if it cannot reliably produce and procure health products, in addition to strengthening last mile delivery its population depends on. He noted that Kenya strives to position itself as a leader in this transformation, guided by a presidential directive to achieve 50% local manufacturing of essential health products and technologies by the end of 2026. However, as countries accelerate manufacturing ambitions, panelists repeatedly cautioned that factories alone cannot sustain a manufacturing ecosystem.

For decades, Africa has operated as a supplied market, one where external institutions such as Gavi and UNICEF aggregate demand, negotiate prices with manufacturers, and coordinate distribution on behalf of countries. While these donor-backed procurement mechanisms have expanded vaccine access across the continent, they have enabled a market structure heavily dependent on external purchasing decisions rather than coordinated continental ownership.

Vandana Shah, Vice President, Health Systems Strengthening at the Global Health Advocacy Incubator, identified a conflict at the heart of the agenda. As countries transition from Gavi support, they tend to lose the pooled procurement advantages that previously guaranteed pricing stability, demand consistency and must now buy on their own terms. Meanwhile, procurement systems across the continent are often designed to prioritise the cheapest available product, putting African manufacturers who have not yet achieved the volumes needed to compete on price at a disadvantage. As Shah said, “the market has been shaped by multilateral financing, which brought consistency, but not country-level ownership.”

However, as Shah identified the procurement logic problem, others on the panel challenged a fundamental assumption. Dr. Tala Jallow, Director, African Pooled Procurement Mechanism (APPM), pushed the discussion further by challenging the idea that Africa lacks a viable health products market:

“We have the market...but we have been focused on fragmentation that we don’t have a sense of direction sometimes. One of the things that we are doing with the African pool procurement mechanism is, first, a market shaping tool. We need to leverage our continental purchasing power to be able to shape our market”

~ Dr. Tala Jallow

This reframed one of the central assumptions surrounding Africa’s manufacturing ambitions. Although African countries collectively spend billions annually on medicines, vaccines, and other health products, procurement systems remain fragmented across national borders, with differing regulations, purchasing laws, and market priorities limiting manufacturers’ ability to scale sustainably.

Through the African Pooled Procurement Mechanism (APPM), Africa CDC hopes to aggregate continental purchasing power, support African manufacturers, and create more predictable demand for locally produced health commodities.

Dr. Tala also stressed that efforts to harmonise regulatory pathways through institutions such as the African Medicines Regulatory Harmonization and the African Medicines Agency are intended to ensure that regulation becomes “an enabler for market access” rather than a barrier.

She pointed to the evolution of antiretroviral (ARV) medicines as an example; “when ARVs started, they cost around $175 per patient yearly. Now it’s less than $30 because we kept the market going, scaling up, increasing the volumes....but if we start the conversation by talking about how the prices of African manufacturers is going to be very high, we are killing the market before it even succeeds.”

Why This Matters

When African countries cannot reliably produce and purchase their own health products, the consequences are measured in lives lost, due to outbreaks that spiral because of delays in accessing medical countermeasures. The conversations at the World Health Summit Regional Meeting in Nairobi made clear that the path forward must go beyond building factories. It will require building the market conditions that make those factories viable, sustainable, oriented toward African health needs, with distribution channels that ensure products reach their markets.

Proof of concept already exists in some African countries. Egypt now sources 80% of its health products domestically. Ethiopia has shifted to over 40% local manufacturing. Rwanda is constructing an end-to-end pharmaceutical ecosystem from the ground up, anchored by continental partnerships and long-term vision. These examples show that deliberate policy, sustained political will and coordinated investment can move the needle.

The African region is a large, yet fragmented market, with manufacturers ready to scale. What is now required, is for procurement and distribution to become strategic tools, leveraging on existing mechanism such as the African Continental Free Trade Area (AFCTA) and others. Until that shift happens, manufacturing in Africa will remain an aspiration that remains unfulfilled.

Convened annually by the World Health Organization, the World Health Assembly, will bring together ministers of health, diplomats, researchers, multilateral agencies, civil society organisations, and global health leaders in Geneva, Switzerland, for its seventy-ninth session (WHA79).

Holding from May 18–23, 2026, delegations from all WHO Member States gather during the Assembly to shape policies and priorities that influence health systems across the globe.

What to Expect at the Seventy-ninth World Health Assembly

This year’s Assembly convenes against a backdrop of shifting donor commitments and mounting pressure on health systems, with high-level debates, technical sessions, and strategic roundtables tackling the world’s most urgent public health challenges.

Proceedings from the Assembly will be webcast live in six official languages — Arabic, Chinese, English, French, Russian, and Spanish — expanding access to audiences around the world.

Why This Matters

The Assembly is where global health policy is made. Resolutions adopted here set the direction for WHO’s work, shape donor financing, and bind Member States to commitments on pandemic preparedness, disease elimination, and access to medicines.

For African countries, the stakes are higher this year. With traditional donor flows contracting and the continent pushing for local vaccine manufacturing, stronger primary healthcare, and a louder voice in global health governance, WHA79 is a chance to convert long-standing positions into binding outcomes.

What gets negotiated in Geneva over six days will shape health budgets, supply chains, and policy choices across African capitals for years to come.

Africa Health Dispatch: Live from Geneva

Africa Health Watch will be on the ground in Geneva, bringing timely insights and on-the-ground reporting through our Africa Health Dispatch series.

Through these updates, we will follow key conversations as they unfold, unpacking what global decisions and debates mean for African health systems, institutions, and communities.

For more information, visit the World Health Assembly official page for proceedings and explore related events through the WHA79 side events page.

Nigeria has achieved some of the most ambitious malaria control campaigns globally. In 2023, nearly 29 million children were reached through Seasonal Malaria Chemoprevention – the highest number anywhere in the world, protecting children during the peak transmission season. Yet despite this achievement, the country still carries the heaviest malaria burden globally, accounting for roughly 27 percent of all cases.

This exposes a clear paradox. Nigeria can mobilise at an extraordinary scale when a campaign demands it. What it has not yet cracked is the same reliability, accountability, and coordination when it comes to routine care. Across nearly 1,900 health facilities surveyed in northern states, more than half reported stockouts of the malaria treatments needed by patients, not because the medicines were unavailable in the country, but because distribution failed to get them to the point of care.

Delivery failures are not neutral. They fall hardest on the most under-resourced and hardest-to-reach communities – the people most likely to be turned away from care because treatments are out of stock. As such, strengthening delivery systems is not only an efficiency issue, but an equity imperative that needs to be addressed with utmost urgency.

Nigeria already has much of what it takes to combat malaria. The challenge now is translating the efficiency of campaign logistics into everyday system discipline. Achieving this is arguably the quickest and highest-return investment the country can make in malaria today, especially as external health financing contracts and Nigeria, like other high-burden countries, faces growing pressure to do more with what it already has. That makes this the moment to use remaining support to strengthen delivery systems while it still exists. Once that support declines further, the cost of fixing broken logistics will rise significantly.

The question, then, is how Nigeria can make this shift.

Technology has a role to play. Today, one of the biggest constraints in Nigeria’s health supply chain is the difficulty of finding capable logistics providers. The country is home to many qualified providers able to deliver across the country, to the very last mile. Yet they often remain invisible to governments, donors, and manufacturers trying to move health products efficiently. This consistently results in a persistent mismatch between demand and supply, particularly during periods of heightened need.

Centralising this market – using technology to create a single, accessible space where buyers and logistics providers can find each other – therefore becomes important. Platforms like the Logistics Marketplace are beginning to address this by making qualified providers visible and streamlining procurement. Governments, global health partners, humanitarian agencies, and manufacturers can more easily identify, assess, and engage capable providers, turning existing capacity into capacity that is actually used.

But visibility at the system level is only part of the solution. The greater test is whether technology improves decision-making at the point of care. The goal should not be simply to track shipments, but to ensure that the person running a rural clinic knows what they have, what they are about to run out of, and how to trigger a resupply before patients are turned away. Without that level of visibility and agency at the frontline, digital tools risk becoming reporting mechanisms that serve the top of the system rather than the point of care.

Partnership with the private sector is equally central to closing this gap. Like in many other sectors, private logistics networks already move the majority of goods across Nigeria. Integrating this existing capacity into health delivery naturally becomes a practical way to extend reach without building parallel infrastructure. This must be structured so that integration is accountable, transparent, and performance-driven. Poorly designed collaborations carry risks, including inefficiency and diversion.

Senegal offers a lesson on how such partnerships could work. It was the first country to launch the “Zero Malaria Starts With Me” campaign, explicitly integrating the private sector into its response, and achieved a 73 percent reduction in malaria cases and a 13 percent decline in deaths between 2000 and 2019. Its progress was driven by strong national ownership, reliable data systems, and deliberate use of private sector capacity, including logistics. This is a model for what Nigeria could look like with stronger coordination between government and private logistics providers.

Rwanda also offers a complementary lesson on what is possible when delivery systems are treated as core infrastructure. Between 2016 and 2022, malaria incidence fell from 409 cases per 1,000 people to 76, while deaths dropped by more than 89 percent. These gains were not primarily driven by new drugs or major increases in funding, but by deliberate investment in delivery systems. Rwanda trained 30,000 community health workers to diagnose and treat malaria at home, built a reliable last-mile supply chain, and introduced data visibility so managers could act before shortages occurred. As a result, facility-level stockouts fell from around 10 percent to just 1 percent over five years. The lesson is that delivery system investment, not just health product investment, drives outcomes.

These successes are replicable in Nigeria, though we must not underestimate the intricacies of the country. Running reliable last-mile delivery across a country of more than 200 million people, with Nigeria’s geographic and infrastructure variation, is comparable to managing a commercial distribution network across multiple countries. But that level of complexity is not beyond reach. Nigeria already has the people, partners, and underlying capacity required – it now needs to coordinate them more effectively to deliver a reliable system.

Why This Matters

Nigeria's ability to reach nearly 29 million children through seasonal malaria chemoprevention demonstrates that the country can operate at scale. But the persistence of stockouts across more than half of surveyed health facilities in northern states shows that campaign-level ambition has not yet translated into routine system reliability — and it is the most underserved communities that bear the cost of that gap.

The experiences of Rwanda and Senegal suggest that this is a solvable problem. Both countries achieved significant reductions in malaria cases and deaths not by introducing entirely new tools, but by investing in delivery infrastructure, frontline capacity, and structured partnerships with the private sector. Nigeria already has many of these building blocks in place. The challenge is one of coordination, accountability, and sustained attention to the systems that move treatments from warehouses to the point of care.

With external health financing contracting, the window to make these investments is narrowing. Strengthening delivery systems now, while support still exists, is both the most practical and most equitable step Nigeria and other high-burden African countries can take to protect any malaria gains already made — and to ensure they last.

Prof. Lukoye Atwoli, International President of WHSRM 2026, pulled the conversation away from comfort. “One of the unspoken intentions of this convening” he said “is to make people a little uncomfortable by having difficult conversations.”

With over 3,000 participants, the scale of the gathering was evident, but for Atwoli, the convening’s significance also lay in the specific actions that would follow.

Prof. Axel R. Pries, President of the World Health Summit, followed by situating that responsibility within a wider shift. He emphasised that Africa’s health sovereignty can only be built through partnerships within countries, across regions and between sectors. He pointed to the need to move beyond fragmented, under-resourced arrangements toward more coordinated, sustainable and transparent systems that deliver at scale.

The Regional Director for WHO AFRO, Dr. Mohamed Janabi, brought the point down to practice. He noted that the summit showed what alignment can look like when governments, institutions and regions work together. For the first time, three WHO regions – AFRO, EMRO and Europe – came together around a shared agenda, reinforcing the idea that health threats do not respect borders and cannot be addressed in isolation.

“Telling people to wash hands means little if water is kilometres away,” he said, pointing to work in the Democratic Republic of Congo where partners installed water infrastructure, upgraded laboratories and strengthened local health facilities during an outbreak. The result was not just containment, but a more resilient system left behind.

By the time Deputy President of the Republic of Kenya, Prof. Kithure Kindiki took the floor, that message had settled into something firmer:

“The message from Nairobi 2026 is simple and direct. Africa’s health future will not be given to us. It will be built by us. It will require political courage, institutional discipline, sustained investment and an unshakable conviction that African lives matter equally on the global stage.”

His remarks brought together the key issues raised over the three days. Domestic financing, local manufacturing, and stronger institutions were no longer treated as aspirations but were presented as conditions for progress.

The summit also surfaced tangible signs of movement. Two stand out: the launch of a continental immunisation strategy and the establishment of a high-level ministerial committee on global health architecture reform.

What stood out in Nairobi was not the scale of the problem, but the direction of the response.

Whether that direction holds will depend on what follows — in how governments translate commitments into policy, institutions coordinate investment, and systems deliver in practice, not just on paper.

The conversation, moderated by AMREF Health Africa CEO, Dr Githinji Gitahi, began by highlighting the issue of trust. “Many Africans”, he noted, “still do not trust products made on the continent. It’s almost like the ones that are imported are more superior to the ones that we manufacture here and that narrative must change by creating globally acceptable quality products across the continent that are trusted.

Setting the tone for the session, Ibrahima Socé Fall, CEO of Institut Pasteur de Dakar (IPD), pushed back against the idea that sovereignty can simply be declared:

“Sovereignty cannot be just a slogan. We need to create the ecosystem. We need to be able to produce vaccine from end to end, starting with technical expertise, the talent and the workforce needed, this is the minimum requirement”

His point speaks to a deeper challenge facing African health systems. The shift from dependence on imported vaccines and diagnostics to building integrated, self-sustaining manufacturing capacity is complex. The COVID-19 pandemic exposed the risks of that dependence, as global supply chains faltered and African countries found themselves at the back of the queue for life-saving products.

Fall pointed to Senegal’s experience as proof that progress is possible, while acknowledging how complex the path remains. At Institut Pasteur de Dakar, he noted, the organisation has expanded beyond its long-standing yellow fever vaccine production to invest in a vaccine research centre, clinical trials, and new candidates for diseases such as Marburg, Lassa fever and Rift Valley fever.

However, supply chains remain fragile and largely controlled from outside the continent. Africa still lacks a coherent market for its own products. Procurement systems dominated by global actors such as Gavi and UNICEF leave little room for African manufacturers to grow at scale.

Fall called for a continental approach. Countries need to align production with their comparative advantages and build a market that can sustain the industry over time.

From Kenya, Biovax Institute’s Richard Oduor reinforced the scale of the gap. Africa currently produces less than one percent of the vaccines it uses. Closing that gap would need more than infrastructure. It requires building capabilities across the entire value chain, from early-stage research and drug substance manufacturing to formulation, packaging, regulation and distribution.

For Biovax, the strategy is practical. Start where capacity already exists, such as fill and finish, then gradually build backward into more complex stages through technology transfer. Even this approach depends on sustained financing, strong negotiation capacity, and the ability to attract skilled talent back to the continent.

The session made one thing clear: Africa’s vaccine manufacturing ambitions will not be won in laboratories alone. They will be won in procurement rooms, policy conversations, and the long-term commitment to train and retain the scientists the continent is already producing. What remains missing is the coordinated architecture — the markets, financing, and political will — that turns isolated progress into continental self-reliance. Sovereignty, as Fall reminded the room, cannot be a slogan.

The session, “Trust in Science: Advancing Quality Health Information in the Age of Digital Health,” which was hosted by Nature Commission brought together Mercy Korir (Willow Health), Vivianne Ihekweazu (Nigeria Health Watch), Rebecca Ivic (University of Alabama), Nancy Booker (Aga Khan University), Ozge Tuncalp (Institute of Tropical Medicine, Antwerp), Ben Johnson (Nature Commission), and Jacqueline Kitulu (World Medical Association).

Discussions reiterated how the health information landscape is quickly shifting. Digital platforms and artificial intelligence have expanded access to health information, but they have also made it harder to distinguish evidence from distortion.

Traditional gatekeepers of health information such as journals, ministries, and academic institutions no longer determine how information reaches the public. Today, social media platforms, messaging apps, and algorithm-driven feeds increasingly shape what people see, share, and believe.

Examples were made visible across African contexts.

Vivianne Ihekweazu, the managing director of Nigeria Health Watch described how digital platforms have transformed health communication, but also created a space where people often rely on peer networks and online sources over trained health professionals when making decisions.

During the COVID-19 pandemic, misinformation influenced health behaviours, including the use of unverified remedies and vaccine hesitancy in some communities. Those patterns have continued to shape how people engage with health systems long after the emergency phase ended.

“False information travels around the world as the truth is tying its shoes,”

said Mercy Korir of Willow Health, capturing the speed at which misinformation now moves compared to verified evidence.

For Jacqueline Kitulu, president of the World Medical Association, the issue is not only technical but ethical. “We are surrounded by health information, but much of it is unverified, misinterpreted, or deliberately misleading,” she said. “Patients have a right to reliable, evidence-based health information.”

Responses to this shift are beginning to take shape. Rebecca Ivic of the University of Alabama highlighted ongoing work to develop global indicators for assessing the quality of health information, while Booker, Tuncalp, and Johnson stressed the need for stronger governance frameworks and greater accountability in how evidence is produced, communicated, and acted upon.

The session closed with a clear consensus: no single intervention will fix the problem. Building trust requires working across multiple layers simultaneously — accurate information, relatable communication, stronger health literacy, and, importantly, coherence between what people encounter online and what they hear from health workers in clinics and communities.

For Africa, the urgency is clear. Health systems are already overstretched, and misinformation routinely outpaces the public health responses designed to counter it. In this environment, rebuilding trust in health information is not a secondary concern — it is as fundamental to survival as the care itself.

Over the past two decades, countries across Africa have made real progress. Expanded use of bed nets, improved diagnostics, effective treatments, seasonal prevention, and more recently malaria vaccines have saved millions of lives. According to the World Health Organization (WHO), malaria interventions have prevented over two billion cases and millions of deaths globally since 2000, with Africa accounting for the majority of those lives saved.

However, World Malaria Day presents us with an opportunity to ask a longer‑horizon question: what kind of progress will be needed to truly end malaria as a public health threat? Three observations stand out as essential in helping us guide our reflection and action;

(1) Strategies designed for control are not designed for permanence.

(2) Elimination is fundamentally about equity, reaching those who are consistently left out.

(3) Innovation must be understood broadly, as a portfolio of tools and approaches shaped and led by countries themselves to address malaria in a systemic way.

To truly eliminate malaria in Africa, one additional move is needed: beyond technical progress, we must work with our communities to understand and communicate that we are moving past the era of control toward permanently interrupting transmission. It is possible to eliminate malaria. This shift in mindset must be shaped with our communities.

The limits of strategies designed for control
Control has been highly effective at reducing deaths, particularly among children. But it relies on continuous repetition. Bed nets must be replaced, medicines restocked, prevention campaigns repeated year after year. Yet the most recent global data show that malaria cases and deaths remain heavily concentrated in the African region, which still accounts for around 94–95 percent of global malaria deaths, despite widespread coverage of core tools.

These patterns suggest that while control saves lives, it does not always interrupt transmission permanently. Elimination changes the way the problem is framed, shifting attention from managing malaria season after season to breaking the chain of transmission itself, reducing long‑term dependence on repeated interventions.

Malaria elimination is about equity
Malaria increasingly persists in the same places: remote rural areas, border communities, informal settlements, and regions where health systems face chronic constraints. WHO and partner analyses show that a relatively small number of high‑burden countries account for the majority of global malaria cases, even as national tool coverage improves.

Elimination refocuses attention on these remaining gaps. Beyond national averages, success takes into account whether transmission continues anywhere, and why. In that sense, elimination is also about equity, prioritising children and communities who are consistently hardest to reach and sometimes last to benefit. This requires deeper involvement of our communities, not only as recipients of interventions but as active partners and leaders in elimination efforts.

Country-led innovation is a game changer.
Innovation in malaria spans a broad portfolio: the roll‑out of new malaria vaccines now introduced in multiple African countries, next‑generation insecticide‑treated nets, improved diagnostics, enhanced surveillance systems, and approaches that seek to address malaria transmission at its source, alongside more precise delivery strategies.

According to WHO, the combined impact of new tools and improved delivery approaches saved more than a million lives globally in recent years alone, even as emerging challenges such as insecticide and drug resistance threaten existing gains. The core issue here is addressing the challenge in countries across Africa is not the use of any single tool, but how countries assemble the right mix of interventions for their national contexts.

Innovation is also about robust institutions. New approaches must be evaluated rigorously, regulated transparently, and shaped by national priorities. Community engagement is central to this process, and an integral part of how those decisions are made. Trust, governance, and leadership are as essential as technical effectiveness.

Across Africa, scientists, regulators, and public health institutions are already strengthening this capacity, building evidence, reinforcing regulatory oversight, and developing frameworks to govern innovation responsibly at the country level.

Why this matters

Taken together, these observations point in the same direction. Bed nets, treatment, preventive therapies, and vaccines remain indispensable. They are the reason millions of children are alive today. But relying on these tools alone keeps the global response oriented around containment. Complementing them with sustained investments aimed at elimination, stronger health systems, responsible innovation, regional coordination, and community leadership, opens the possibility of a different outcome. Centering community leadership and ownership alongside these investments strengthens the possibility of a different, lasting outcome.

Elimination is demanding. It requires long‑term commitment, cooperation across borders, and the patience to invest even when results are not immediate. But malaria has endured for centuries in part because it adapts to the spaces we leave unattended. Ending it will require sustained attention of a different kind, deliberate, collaborative, and forward‑looking.

World Malaria Day is a moment to reflect on whether we are ready to make that turn.

In 2000, Sierra Leone recorded 1,682 maternal deaths per 100,000 live births — the highest maternal mortality ratio in the world. By 2023, that figure had fallen to 354. Dr. Kenneth came to Abuja, Nigeria, not to celebrate that number, but to propose that West Africa builds the system behind it together.

Presenting the Freetown Charter, Dr. Kenneth was deliberate about what drives change. “The buzzword is not the technology. It is not the digitalisation that is going to save lives. Make no mistake, it is actually the decisions that we make and the actions that we take that change things. But digital and innovative technology can position us in such a way that we act fast in response, remain accountable and accurate, and make progress in a very short time.”

Sierra Leone’s journey illustrates exactly that. During the Ebola crisis, the country developed an electronic case-based disease surveillance system, shifting from aggregate to real-time reporting. That system was later adapted for maternal and child health. Every death is now reported immediately. Every week, a national review call connects leadership, specialists, district officers, UN partners, and regulatory bodies. A midwife’s absence, an unsigned supply document, a delayed referral —failures that once went undetected now surface within hours.

The data has also driven direct clinical decisions. When supply chain data flagged heat instability in oxytocin stocks, Sierra Leone switched to heat-stable carbetocin, reducing deaths from postpartum bleeding. When data revealed high anaemia rates, the country shifted from iron and folate to multiple micronutrient supplements. “Data must lead to action,” Dr. Kenneth told delegates.

The Freetown Charter proposes seven priority areas: Data governance and surveillance, Digital infrastructure and interoperability, Contextual and Innovation, Human capacity & workforce, Accountability & Performance, Data Sovereignty & Ethics, and Sustainable Financing. Its targets include institutionalising maternal and child death audits, adopting digital tracking tools across health facilities, and developing AI-based tools by 2030.

“This will not be the end, but the beginning of a collective effort to strengthen health systems across the region”

~ Dr. Satti Kenneth, Chief Medical Officer, Sierra Leone

Sierra Leone’s experience offers an early indication that the Charter’s ambitions are not merely aspirational, but actionable.

Drug resistance in West Africa is spreading and the region’s data systems are not keeping pace. Drug resistance is spreading across West Africa’s borders faster than the region’s surveillance systems can detect it.

This was the central concern raised during the session on West African Health Organisation's (WAHO) Regional Malaria Elimination Framework. A recurring call from health experts was for a regional network that allows Member States to share drug resistance data in real time. Strengthening monitoring committees to track both drug and insecticide resistance was seen as equally urgent. The reasoning was straightforward: resistant strains spread across borders faster than national surveillance systems can detect them. Without coordinated, cross-border data exchange, one country’s emerging resistance problem becomes a regional challenge.

Delegates stressed the need to translate these technical recommendations into ministerial-level resolutions to ensure formal adoption and accountability across Member States. Not recommendations that sit in a report - but commitments that bind governments to action.

“Each country already has its own national strategic plan. Our role as ECOWAS is to support, coordinate, and harmonise efforts across Member States.” said a WAHO Representative.

The conversation moved from data systems to the people those systems are meant to protect. Delegates emphasised the role of communities in malaria control - and specifically on who communities trust. Traditional and religious leaders, they argued, are central to health communication. Their formal integration into malaria strategies was strongly supported, with delegates noting that community acceptance of interventions, from bed-nets to vaccines, often hinges on endorsement from these figures.

Community health workers received similar attention. Already embedded at the front lines of care, they were recognised as essential actors in malaria surveillance. Delegates called for strengthened training and for malaria monitoring responsibilities to be formally incorporated into their roles, a practical step that costs relatively little but extends the reach of the entire framework.

Delegates called for the framework to explicitly address how gender shapes malaria exposure, healthcare access, and caregiving responsibilities. Urging that programming account for the different ways men and women experience and respond to malaria.

Private sector inclusion is also critical for the success of the framework, the experts emphasised. As private channels supply much of the region’s medicines, delegates raised concerns about the quality of medicines and the need for stronger regulatory compliance, noting that substandard and falsified medicines accelerate resistance. They called for local manufacturers to be engaged as active partners producing and supplying quality-assured medicines and commodities, reducing the region’s dependence on external suppliers.

Dr Monique Murindahabi, Global Health Expert and Consultant, presented a regional framework designed to move countries from fragmented control efforts to coordinated elimination by 2030.

Developed through expert consultations in Conakry in March 2025, the framework positions governance, data, commodities, innovation, and financing as interconnected levers for impact rather than isolated interventions.

At the centre is Pillar One: Governance and Coordination, which Dr Murindahabi described as the foundation of progress. While political commitment already exists through the African Leaders Malaria Alliance, she stressed that the real test lies in implementation. She called for stronger regional coordination mechanisms and cross-border collaboration, given that malaria does not respect national boundaries.

“Cross-border coordination is essential. Without harmonised cross-border collaboration and notification systems, malaria elimination will not be possible”

~ Dr Monique Murindahabi

Pillar Two: Data Systems, Surveillance, and Resistance focuses on strengthening regional intelligence. Although countries have improved use of District Health Information Software 2 (DHIS2) platforms, she called for a real-time ECOWAS malaria dashboard and stronger integration of national data systems. She also warned of rising drug and insecticide resistance, urging expanded molecular surveillance, digital tools such as geospatial mapping, and improved cross-border reporting.

Pillar Three: Treatment and Community Health Systems, Dr Murindahabi emphasised safeguarding first-line therapies while preparing for resistance through diversified treatment options. She emphasised community health workers as the backbone of early detection and response. “Community systems remain the first point of care and must be fully strengthened,” she said, also calling for better integration of private sector and traditional health actors.

Pillar Four: Manufacturing, Supply Chains, and Pooled Procurement addresses efficiency and equity in access to commodities. Dr Murindahabi proposed a regional pooled procurement system to reduce costs and prevent stock imbalances across countries. She also pointed to emerging innovations such as Nigeria’s planning model for malaria commodities and discussions on local manufacturing of mosquito nets as opportunities for regional scale-up.

Pillar Five: Research, Innovation, and Capacity Strengthening, calls for better use of existing laboratories, stronger regional research networks, and improved collaboration between academic institutions.

Pillar Six: Community Engagement and Behaviour Change focus on trust and ownership. Dr Murindahabi stressed that even effective interventions fail without community acceptance, urging engagement of traditional and religious leaders, alongside civil society, to drive uptake. “Elimination depends on communities understanding and owning the response,” she said.

The final pillar, Financing and Strategic Partnerships, highlights the need for increased domestic investment while leveraging regional and global partnerships. She called for innovative financing approaches and better integration of malaria into broader health financing systems.

Across all seven pillars, three principles were emphasised: strong governance, data-driven decision-making, and accountability. Dr Murindahabi concluded by stating that a malaria-free ECOWAS region is achievable, but only through coordinated action, sustained investment, and regional solidarity.

Malaria claims the lives of children under five nearly every minute with sub-Saharan Africa bearing the heaviest burden.

This sobering reality hung over the Health Experts Meeting in Sierra Leone, where WAHO presented two consequential documents: a Regional Malaria Elimination Framework and an account of how its budget is evolving. Together, they told one story. Ambition is not the problem. Money is.

The malaria framework, co-created with experts at a meeting in Conakry in March 2025, is structured around seven pillars: governance and coordination, surveillance and data systems, treatment and community health, supply chain and commodities, research and innovation, community engagement, and financing.

Dr. Monique Murindahabi, a WAHO consultant, who led the presentation was direct. “Malaria does not respect borders. We cannot talk about elimination if neighbouring regions do not align their policies.” Cross-border case notification, harmonised drug resistance protocols, pooled procurement, and a real-time regional disease dashboard are among the framework’s centrepieces.

The African Leaders Malaria Alliance (ALMA) has already committed to elimination by 2030, however, participants pushed back on timelines.

On commodities, Dr. Murindahabi was equally explicit. “If we are serious about elimination, we must ensure that when a case arrives at a health facility, it is tested and treated. Commodities must therefore be available at all health facilities.”

Commodities, however, are only one part of the equation. The question of financing soon followed.

Dr Aruba Fallah, WAHO’s Director for Administration and Finance highlighted during his presentation that the WAHO’s approved budget has grown from roughly $47 million in 2018 to $71.6 million in 2025, a trajectory that looks healthy until you examine what is funding it. In 2018, external partners dominated, and by 2023, ECOWAS’s community levy had grown to surpass partner contributions, a sign of growing ownership.

However, the 2024 and 2025 figures are alarming. USAID, the African Development Bank, and Germany’s KfW — once pillars of WAHO’s external funding — have dramatically reduced from the ledger. In 2025, KfW accounted for 41% of remaining external funds, with USAID contributing just 2%.

Against that backdrop, Dr. Fallah set out an ambitious target.

"We have a projection to double our budget from $47 million in 2018 to $100 million in 2026… So there is a strong need for domestic resource mobilisation to achieve this"

~Dr. Aruba Fallah

The ambition is clear, but with ECOWAS covering just 26% of WAHO’s budget and traditional donors retreating, the path to $100 million runs through domestic resource mobilisation — a conversation the region can no longer defer.

This makes what comes next consequential.

“A malaria-free ECOWAS region is possible,” Dr. Murindahabi told delegates. “It is an achievable goal with political will, adequate investment, and regional solidarity.”

That solidarity must now be financial. Without it, West Africa’s boldest public health ambition risks becoming its most expensive unfulfilled promise.

At a webinar hosted by the World Health Organization Regional Office for Africa, researchers, clinicians, and care providers came together to examine what dementia means for Africa. While it is often viewed as a condition of old age, experts emphasised that its roots begin much earlier, calling for a shift in how the region understands dementia and responds to it.

Dementia is often mistaken for a normal part of ageing, which can make it easy to overlook in its early stages. In reality, it is not an inevitable part of growing older. It describes a group of conditions that affect memory, thinking, and the ability to carry out everyday activities, with Alzheimer’s and vascular dementia accounting for the majority of cases.

An estimated 57 million people were living with dementia globally in 2021, reflecting a growing but often under-recognised public health challenge. That number is projected to rise to 78 million by 2030 and reach 139 million by 2050, driven by ageing population and shifting disease patterns. More than 60% of cases are in low-and middle-income countries, where health systems are often least equipped to respond and where the gap in available care remains significant.

As this burden continues to grow, there is increasing attention at the global policy level. The political declaration of the fourth high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being, situates dementia within the broader NCD and mental health agenda, reflecting its growing recognition as a public health priority.

These realities were at the centre of a recent webinar hosted by the World Health Organization Regional Office for Africa, titled “Dementia in the African Region: Strengthening Policy on Integrated Care and Community Support for Older People.”

Dr Rwafa Madzvamutse, Regional Advisor for Mental Health at the World Health Organization Regional Office for Africa, in her presentation drew attention to the multiple and often intersecting factors shaping dementia risk in Africa. Beyond age, factors such as poorly managed HIV, harmful alcohol use, and nutritional deficiencies are increasingly recognised as contributors to cognitive decline.

Dr Madzvamutse also pointed to existing global frameworks, including the WHO Global Action Plan on the Public Health Response to Dementia, Action Plan on the Decade for Healthy Aging and broader mental health and healthy ageing strategies which provide a roadmap for countries to respond. However, it was noted that translating these commitments into practical, context-specific action remains uneven across Africa.

“57 million people worldwide live with dementia. This is as of 2021 we're expecting an exponential increase and that is up to 80 million by the end of the decade. 1 in 12 adults over sixty-five live with dementia, depending on the region. I am looking at the global data and over 60% of people who live with dementia actually live in low-and middle-income countries”

~ Dr Rwafa Madzvamutse

Insights from Nigeria and Kenya

Offering a practical perspective, Ekezie Ralueke Oluchukwu, a dementia care coach and founder of Blue Torch Home Care Ltd, shared how community-based care is being delivered in Nigeria. Founded in 2012, Blue Torch Home Care was established in response to the growing need for home-based support for older adults. Its model centres on integrating family involvement, community engagement, and professional care, recognising that for many people, care happens primarily at home.

Mr Oluchukwu emphasised that Blue Torch Home Care places strong emphasis on cultural context. Engagement with community leaders, use of familiar social structures, and culturally responsive care practices have helped improve acceptance and uptake of services. In settings where stigma and misconceptions remain, this approach has been critical in opening conversations and encouraging early support. While challenges like late diagnosis, workforce shortages, and financial barriers persist, Blue Torch’s model offers a glimpse of what is possible when care is designed around people’s lived realities and adapted to local contexts.

Additional evidence from rural eastern Uganda also shows how these challenges are unfolding across communities. Presenting findings from a three-year study, Dr Stephen Ojiambo Wandera, a gerontologist, population scientist and a member of the Technical Advisory Group for the UN Decade of Healthy Ageing, highlighted that about 12% of older adults were living with probable dementia, with prevalence increasing significantly with age and disproportionately affecting women.

Beyond age, the data pointed to a convergence of risk factors that are both widespread and, in many cases, preventable. More than half of the older adults studied were socially isolated, while rates of moderate to severe depression were strikingly high. Hypertension was also common, yet many participants were unaware of their status, showing gaps in routine screening and access to care.

In response to these diagnostic and system gaps, tools such as the Informant Dementia Severity Assessment (IDEA) are being used in Uganda, particularly in rural and resource-limited settings.

The tool, which assesses domains such as memory, orientation, verbal fluency, and visuospatial ability, is administered in local languages by trained health workers and is used to define cognitive impairment, with studies showing it to be effective in identifying dementia in community settings where low literacy and limited diagnostic capacity remain major challenges.

WHY THIS MATTERS

The discussion from the webinar shows that dementia in Africa is a social and systems challenge, beyond being seen as a clinical condition. Data from global policy tracking and the WHO Global Dementia Observatory proves that no African country currently has a fully implemented national dementia plan, with only a few, such as South Africa, Ghana, Kenya, and Ethiopia, having drafts that are yet to be operationalised.

Without a national plan, responses to dementia remain fragmented and underfunded. Care is often informal, falling largely on families and communities rather than being supported through structured health systems. This gap is becoming more concerning as Africa’s population ages and the burden of dementia rises. Projections suggest a sharp increase in the coming decades, which will place further strain on already limited care.

From April 27–29, 2026, global health leaders, policymakers, researchers, and advocates will convene in Nairobi, Kenya, for the World Health Summit Regional Meeting 2026, placing Africa at the center of conversations shaping the future of health systems worldwide.

The 2026 Regional Meeting, hosted by the Aga Khan University in Kenya, marks the second time the convening will be held in East Africa and on the African continent, signaling a growing recognition of the region’s role in shaping global health discourse.

Key Theme: Reimagining Africa’s Health Systems: Innovation, Integration, and Interdependence

The meeting will bring together more than 2,000 participants from over 50 countries and will span high-level plenaries, ministerial and leadership roundtables, technical sessions, youth forums, and community dialogues, creating space for both formal deliberation and cross-sector exchange.

Why This Matters

As African health systems navigate complex challenges ranging from emerging health threats to longstanding structural gaps, this meeting comes at a critical moment. With support from institutions such as the Africa Centres for Disease Control and Prevention and the WHO Regional Office for Africa, the convening reflects a broader shift toward more inclusive and regionally grounded global health conversations.

For Kenya, hosting the meeting presents an opportunity to reaffirm its leadership in health system transformation and universal health coverage. More broadly, it offers a platform to amplify Africa’s collective voice in shaping global health policy and priorities.

Africa Health Dispatch: Live from Nairobi

Africa Health Watch will be on the ground, bringing timely insights through our Africa Health Dispatch series.

Through this coverage, we will track key conversations as they happen, moving beyond headlines to unpack what they mean for health systems across the continent.

Readers can expect:

• Real-time updates from major plenaries and high-level sessions

• Key takeaways from discussions across core thematic areas

• Voices and perspectives from policymakers, experts, and emerging leaders

• Contextual analysis connecting global conversations to African realities

By sharing real-time updates, the Africa Health Dispatch keeps readers connected to the conversations unfolding on the ground.

Register to attend the World Health Summit Regional Meeting 2026

Speaking for parliamentarians from 11 African countries, Hon. Lilani Brinkman, a Namibian Member of Parliament, framed preventable maternal deaths as a leadership issue, not just health. “We already know what works, Midwives can provide 90% of all essential reproductive, maternal and newborn, child and adolescent health services”. She argued for countries to invest in recruiting, training and retaining them, “because investing in midwives, is investing in saving lives.” she said, pointing to workforce investment as one of the known solutions to accelerate progress.

Brinkman presented joint parliamentary commitments to achieving Every Woman, Every Newborn Everywhere targets. They pledged to advocate for dedicated financing to ensure life-saving maternal and newborn commodities reach underserved populations. They also resolved to strengthening regional collaboration through pooled procurement and market-shaping mechanisms to improve affordability and expand access.

Central to the commitments, Hon. Brinkman recommended achieving the Abuja Declaration target of allocating at least 15 percent of national budgets to health. She cautioned against returning home without action.

“We cannot continue to gather in conferences, speak passionately, and then return home unchanged. This must be the turning point.”

~ Hon. Lilani Brinkman

In his closing speech, the Principal Secretary, State Department for Medical Services Kenya, Dr. Ouma Oluga, shifted attention to what he described as the most critical weakness in maternal and newborn health systems. This is the widening gap between what is planned and what is implemented on the ground. “Preventable maternal and neonatal deaths is the greatest indictment of any healthcare system and the best indicator of health system performance,” he said, noting that “we must do everything to reverse these trends.”

He called for building stronger accountability systems across governments, health workforce, and development partners, urging a shift away from process-driven financing toward measurable impact. “In the past, we have done health financing for reports, not for results. Conference after conference, we’ve presented very good reports of the work that we’ve done, even when we have not made actual progress and this has left a gap” Oluga noted.

The conversations at IMNHC 2026 emphasised that reducing maternal and newborn deaths will depend less on new strategies and more on execution. The discussions pointed toward aligning political commitment with measurable delivery where financing follows impact, data drives accountability, and partnerships reinforce national priorities. If this momentum continues beyond Nairobi, the conference may help turn shared ambition into real improvements in care and survival for women and children across Africa.

Presenting the global overview of maternal and newborn health, Dr Allisyn Moran, Unit Head for Sexual, Reproductive, Maternal and Newborn Health at the World Health Organization, outlined the scope of the challenge. “In 2023, we had 4.5 million deaths, and we still have 4.5 million deaths of women during pregnancy and childbirth, as well as newborns and stillbirths,” she said, noting that “progress has really not accelerated since 2015/2016.”

She reminded delegates of the 90-90-80-80 targets introduced in 2023, which focus on antenatal care, skilled birth attendance, early postnatal care, and access to emergency services.

“These targets have been the driving force behind the different work that’s been going on at country level, Yet, we’re still far from the targets that we were hoping to achieve by 2030”

~ Dr Allisyn Moran

On the importance of equity and quality, Dr Allisyn stressed that coverage alone is not enough, highlighting the need for strong health systems, a skilled workforce, reliable commodities, and actionable data as essential building blocks for progress.

Building on this, Dr Gagan Gupta, Unit Lead, Maternal and Newborn Health, UNICEF, shared early EWENE-CSA 2026 findings. He noted that although many countries have strengthened policies and data systems, these gains have yet to translate into real improvements for maternal and newborn outcomes. “The progress is mixed,” he explained. “We have strong frameworks on paper, but coverage of essential services and reductions in mortality remain frustratingly slow.” This message points to a critical disconnect between planning and implementation, showing that policy advances alone are not enough without effective delivery on the ground.

Dr Gupta further noted gaps in financing and implementation identified in the report. “Countries said that they have a maternal and newborn health plan, but only 15% of them have it fully financed,” he said, adding that high-impact interventions such as emergency obstetric care and care for small and sick newborns “are very much underfunded and under prioritised.”

Despite these challenges, Dr Gupta acknowledged policy gains.

“We have seen major gains in policy shifts. Last time we reported, 59% of countries said they had moved to eight antenatal care visits. Now, 83% of countries have made that shift. Similarly, the proportion of countries with a birth companion policy has increased from 54% to 78%, and for postnatal care, a marked improvement has been noticed,” he said.

Ahead of the 2026 World Health Assembly where the final report will be presented, the focus is shifting from what must be done to how quickly and equitably commitments can be turned into measurable improvements for women and newborns.

Despite years of global commitments, from maternal health action plans to universal health coverage agendas, progress has remained uneven. Speakers pointed to systems that are not delivering at scale, with inefficiencies, fragmented planning, and weak coordination undermining progress.

In his speech, Africa CDC Director General, Dr Jean Kaseya, emphasised that Africa is at a defining moment, shifting the conversation away from technical fixes to something more political and urgent.

“Africa is facing its own defining moment. We are confronted with an unacceptable maternal neonatal mortality rate...It’s not just a health issue… For me, it’s a justice issue, a development issue, a sovereignty issue. A continent that cannot protect its mothers and children cannot claim full sovereignty over its future”

~ Dr Jean Kaseya

Kaseya proposed a “New Deal” for maternal and child health in Africa. It was a call for system-wide transformation rather than incremental change, tied to a broader continental vision of health security and sovereignty, built on domestic financing, stronger primary healthcare systems, digital infrastructure, and local manufacturing of essential commodities.

The shift from commitment to execution was echoed in the opening remarks delivered on behalf of Kenya’s President, Dr William Ruto, by Cabinet Secretary for Health, Hon. Aden Duale, who positioned the country as a testing ground for what accelerated delivery could look like.

“We are rolling out the Rapid Results Initiative to accelerate reductions in maternal and newborn morbidity and mortality,” he said. “The RRI is about urgency… tracking results in real time, and delivering measurable change where it matters most.”

Duale pointed to Kenya’s expanding Social Health Authority, investments in primary healthcare, and a growing digital health system as examples of how policy is being translated into practice particularly by reducing financial barriers and improving access to care.

Together, the messages from the opening plenary reflected a broader shift in African health policy. Maternal and newborn health is no longer being framed solely as a sectoral issue, but as a test of governance, financing, and state capacity. From universal health coverage to domestic resource mobilisation, from digital systems to local manufacturing, the agenda outlined in Nairobi ties maternal survival to the continent’s wider push for health sovereignty.

Yet, as African countries face persistent gaps in financing for health security, new bilateral arrangements with external partners are raising questions about equity, legal clarity and access to these benefits.

The importance of PABS is most evident in Africa’s experience during the COVID-19 pandemic. When South African scientists shared data on the Omicron variant of SARS-CoV-2 within days of its detection, the discovery gave the world a crucial head start in understanding the virus. Yet the region faced immediate travel bans, while access to vaccines and other medical countermeasures remained constrained. For many African policymakers, the PABS system is meant to prevent a repeat of that imbalance, ensuring that countries providing critical outbreak information are not left waiting at the back of the queue for vaccines, diagnostics, and treatments.

However, as negotiations over the PABS annex continue, the absence of an operational multilateral framework is creating space for bilateral agreements and other arrangements outside the PABS framework. In several African countries, new bilateral health agreements that include provisions on surveillance, data sharing, and research collaboration are being pursued. Some of these arrangements do not include binding benefit-sharing commitments, and without such safeguards there is a risk of reproducing the very imbalance the PABS system is intended to address.

Africa’s Role in Global Pathogen Surveillance

According to a diplomatic official familiar with the negotiations, Africa is often at the centre of global discussions on infectious disease, accounting for 25% of the global disease burden. As a result, pathogen samples and genomic sequence data generated on the continent are highly valuable for global research and pharmaceutical development. Early access to such data can provide countries with an important scientific advantage in developing countermeasures and strengthening national preparedness.

This strategic importance also shapes the implications of new U.S bilateral partnerships emerging across parts of Africa. While these agreements can bring much-needed financial and technical support to national health systems, they may also create uneven exchanges. Countries providing outbreak information could enable external partners to gain early access to pathogen data that supports research and development, without binding obligations to share the vaccines, diagnostics, or treatments ultimately developed from that information.

The emergence of these bilateral arrangements has intensified the importance of ongoing negotiations over the Pathogen Access and Benefit-Sharing (PABS) system. The framework is intended to establish a multilateral mechanism linking access to pathogen materials and genetic sequence data with more predictable benefit-sharing obligations, including access to vaccines, diagnostics, and treatments resulting from their use.

During the fifth session of the Intergovernmental Working Group negotiating the Pandemic Agreement, some member state blocs signalled that they were unwilling to compromise the PABS annex simply to meet the Seventy-Ninth World Health Assembly deadline. While acknowledging progress in the current draft, they argued that significant gaps remain, particularly around legal clarity, enforceability, and the rights and obligations of both providers of pathogen materials and users of the system. Speaking on behalf of the Group of Equity and the African, Eastern Mediterranean and South-East Asia regions, Indonesia cautioned:

“Legal certainty cannot be something we simply hope to settle down the road...we understand the pressure of timelines, but we should also be clear on the choices and decisions in front of us. We are aiming for an annex by May that can deliver a functioning PABS system in totality, but if we cut too many corners now, we will pay for it later in credibility and implementation”

Negotiators’ emphasis on legal clarity is essential, the diplomatic official noted, but even a robust PABS framework can only succeed if countries have the capacity to detect, report, and share pathogen data in a timely manner. African countries continue to face gaps in laboratory infrastructure and workforce capacity, and in some cases, pathogen samples must travel across borders before they can be analysed in certified laboratories, delaying outbreak detection and response.

At the same time, several African countries have recently signed bilateral memoranda of understanding with the United States that include provisions related to surveillance cooperation and specimen sharing. These agreements are emerging in parallel to ongoing negotiations on the PABS system. While some of these MoUs are now publicly available, the specific provisions governing specimen sharing have not been fully disclosed.

The diplomatic official also highlighted workforce shortages as another structural constraint. According to the World Health Organization (WHO) Health Workforce Support and Safeguards List 2023, 55 countries, including many in Africa, have critical health worker shortages, defined as fewer than 49 health workers per 10,000 population, and require priority safeguards against active international recruitment. Despite these protections, large numbers of trained professionals continue to migrate to high-income countries, leaving already strained health systems with limited personnel to support surveillance, diagnostics, and outbreak response.

Without sustained investment in surveillance networks, laboratories, and public health institutions, early detection of outbreaks will remain difficult regardless of the international rules governing pathogen sharing.

Why This Matters

Africa’s contribution to global pathogen surveillance is invaluable, but without a robust PABS framework, there is a risk that countries sharing critical outbreak information could be left behind when vaccines, diagnostics, or treatments are distributed. Bilateral arrangements may offer short-term support, but they cannot replace a legally binding, multilateral system designed to ensure more equitable access to pandemic countermeasures.

At the same time, national capacity remains essential. Laboratories, surveillance networks, and trained health workers are the backbone of effective outbreak detection and response. Persistent gaps in these systems, alongside the migration of health professionals, continue to limit Africa’s ability to detect and respond to emerging health threats quickly. Ultimately, a functioning PABS system must be matched by stronger national health infrastructure. Without sustained investment in laboratories, surveillance systems, and the health workforce, the inequities seen during COVID-19 could easily be repeated in future pandemics.

The study, led by the Bandim Health Project, aims to examine the health impacts of the hepatitis B vaccine on infants who receive it at birth compared to those following Guinea-Bissau’s current immunisation schedule, which begins at six weeks. Researchers involved argue that the trial does not remove existing vaccines as half of the children receive an additional hepatitis B vaccine at birth that is not yet part of the national program. Critics, however, insist that not extending a proven, life-saving intervention to all enrolled newborns in a high-prevalence country is unethical under standard global ethical frameworks. Beyond the specifics of this trial, the debate points to a wider concern in Africa about how ethical decisions are made, especially when studies are designed and financed by external partners.

In Guinea-Bissau, the hepatitis B virus poses a serious risk, particularly for infants. Babies exposed at birth are more likely to develop chronic infection, increasing their chances of liver disease or cancer later in life.

The World Health Organization recommends that newborns receive a hepatitis B vaccine within 24 hours of birth. Administered on time, the dose has been shown to prevent an estimated 70–95% of mother-to-child transmission, and more than 115 countries have incorporated it into their national immunisation schedule. Guinea-Bissau, however, currently administers the vaccine at six weeks, with plans to introduce the birth dose by 2028.

It is within this gap between global recommendation and national policy that the current trial has taken shape. Instead of using available resources to expand immediate protection for newborns, the study randomise access to the birth dose, giving some babies the vaccine at birth while others continue the routine six-week schedule, a design intended to aid researchers observe how the timing of vaccination affects health outcomes. This approach has raised ethical concerns, as international research standards emphasise that interventions already proven to be safe and effective must be incorporated thoughtfully, with clear scientific justification and measures to reduce potential harm.

Beyond science, the Guinea-Bissau controversy has reignited debates around global health ethics, double standards in clinical research, and whether trials that would undergo strict regulatory review in high-income countries are more easily advanced in low-resource settings and questions about whether this particular study met the scientific and ethical safeguards required under the relevant national oversight frameworks.

Ethics Is Not One-Size-Fits-All

The controversy surrounding the hepatitis B vaccine study in Guinea-Bissau draws attention to a fundamental reality, that ethical approval in global health research cannot be entirely procedural. Beyond clearance, it must consider local epidemiology, historical experience, mutual agreements, and asymmetries between sponsors and host communities, including differences in resource and decision-making power that affect community participation and access to benefits.

A similar concern surfaced during the COVID-19 pandemic, when a study on ethics review in public health research identified perceived inequities and mistrust despite full regulatory compliance, suggesting that procedural approval alone does not address questions of equity and community perspectives in research ethics.

Africa’s research history also provides important lessons. From the 1996 Pfizer trial of the antibiotic drug Trovan in Kano to HIV prevention trials later stopped in Cameroon, some studies that had initially received ethical approval were subsequently criticised for failing to adequately reflect local realities or ensuring equitable benefit. These experiences show that a study considered acceptable elsewhere cannot be applied in a higher-risk setting without careful adaptation to the local context.

Regional Safeguards: African Institutions as Ethical Gatekeepers

If ethics must align with local realities, then the question becomes institutional: who sets the standards of what is acceptable?

Across Africa, regional bodies are taking ownership of research oversight, using their authority to define acceptable standards and safeguard local interests. One example is the African Vaccine Regulatory Forum (AVAREF) which provides a platform for joint ethics and regulatory review of vaccine and clinical trial applications, bringing national regulators and ethics committees together to strengthen technical scrutiny and harmonise standards.

This expanding institutional role extends beyond AVAREF. In response to an enquiry from Africa Health Watch on its role in ethical oversight, the West African Health Organization (WAHO) emphasised that, under its ECOWAS mandate, it serves as a convening and harmonising body, rather than a passive observer. Through the West African Network of National Ethics Committees, WAHO supports alignment of national reviews with shared standards and facilitates joint assessments when research protocols raise concerns, helping to reduce the risk of sponsors exploiting regulatory gaps in individual countries.

At the continental level, the Africa CDC has also clarified its role. During a briefing, Director General Jean Kaseya stressed that for any clinical study to take place, authorisation must be granted by the host country. He also noted that Africa CDC’s role is limited to providing regulatory and ethical review support rather than replacing national authorities. In a separate Africa CDC weekly press briefing, Dr. Mosoka Papa Fallah, Acting Director of the Science and Innovation Directorate, outlined plans to establish an independent continental platform of African scientists and ethicists to advise on complex or contested studies.

“We are working on a concept to have this continental body of prominent African scientists and ethicists that will be around from multiple countries. Whenever countries have an issue or need an external opinion to guide and advise them on ethics or the scientific rigor for any study, they can consult. We are working internally...... In the couple of coming weeks or so, we'll launch it. It will be an independent body of scientists that can always be available to Africans to review studies that are coming up”.

~ Dr. Mosoka Papa Fallah

Together, these responses signal a shift in Africa’s research landscape, with regional and continental bodies increasingly taking ownership of ethical oversight and providing guidance to ensure studies are conducted responsibly within the continent.

Why This Matters

Countries across Africa are at an important inflection point in how research is conducted and governed. As clinical trials expand and external research bodies continue to seek research partnerships in high-burden settings across the African continent, the tension between advancing science and protecting participants is becoming more visible. In settings where resources are limited, and disease burden is high, ethical standards cannot quietly bend under the weight of urgency or scarcity.

Regional bodies such as WAHO and Africa CDC are well placed to further strengthen their roles in supporting national regulatory and ethics review systems for clinical trials. Alongside these institutions, the African Vaccine Regulatory Forum (AVAREF) provides a valuable platform for joint ethics and regulatory assessments, bringing national regulators and ethics committees together to review complex trial protocols and share expertise. Through regional coordination, technical guidance and platforms for independent scientific exchange, they can help promote more consistent standards and reinforce the principle that research conducted in African countries is shaped with local leadership and aligned with regionally defined priorities.

The Accra Reset at Davos opened with a call for “A New Bandung Spirit”, an idea that progress happens when countries act together at the right scale, at the opportune moment, and with the right balance of incentives.

Speaking to this vision, Ghana’s President, H.E John Dramani Mahama, framed Africa’s approach to global governance as practical and urgent. While the post-independence era has delivered important gains, it has also left the continent vulnerable to aid dependence, shifting geopolitical interests, and limited control over the value of its own resources. He described this as a “triple dependency trap” where countries rely on external actors for security decisions, depend on donors to sustain health and education systems, and supply the world’s critical minerals while capturing little of their value.

For Mahama, the Accra Reset is meant to move beyond rhetoric. He presented it as a practical blueprint for advancing African sovereignty, structured around five core pillars:

(i) investing in skills: digital, green energy, and manufacturing skills that match real jobs.

(ii) building together: regional industrial and digital platforms that create economies of scale.

(iii) negotiating as one: pooling bargaining power on minerals, trade, and climate finance.

(iv) producing at home: from vaccines to semiconductors, ensuring Africa controls critical supply chains.

(v) holding governments accountable to their citizens, with Mahama explaining that Africa cannot credibly demand global investment while tolerating corruption, waste, and systems that fail to work.

Former Nigerian President, Olusegun Obasanjo, chairman of the Guardians Circle of the Accra Reset, agreed that Africa’s triple dependency has fostered a dangerous habit that trains countries to negotiate from fear, plan from scarcity, and implement amid constant disruption.

“Sovereignty is not a flag that we have come to wave. Sovereignty is discipline. It is the ability to make choices and carry them through... It is the ability to coordinate regionally, mobilise capital, incentivise resources and implement at scale that lead to sustainable development and growth. If you cannot execute, you cannot be sovereign. If you cannot coordinate, you will be divided, if you cannot negotiate, you will be prized, packaged and positioned by others....”

~ H.E Olusegun Obasanjo

Echoing the call for action, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus explained that Africa loses more to illicit financial flows than it receives in aid. He stressed that countries must mobilise domestic resources, combining short-term measures like taxes on alcohol, tobacco, and sugary drinks with long-term solutions such as social health insurance and community-based systems to strengthen sovereignty.

Turning Vision into Action

Drawing on the Global Fund’s 24-year partnership with African countries, Executive Director Peter Sands, reflected on how country-led strategies have long enabled governments and communities to set priorities and drive delivery. “What’s changed,” he said, “is both the ambition and the global context. The Accra Reset is an opportunity to accelerate self-reliance while leveraging the benefits of global scale.” He also highlighted three key executional challenges that must be navigated: maintaining the benefits of global scale; protecting hard-won gains against major disease during the transition; and ensuring the push for sovereignty is not misread as a signal for donors to withdraw prematurely, particularly in conflict-affected settings where external support remains lifesaving.

Sands concluded on a note of partnership, reaffirming the Global Fund’s long-term commitment to Africa, noting that the goal remains eventual self-reliance. “You have had the Global Fund as a partner for 24 years and we will continue to be your partner until you do us out of a job, and we will celebrate when that day happens.”

From the perspective of delivery, Dr. Sania Nishtar, CEO of GAVI stressed that countries must be empowered to make real decisions at the local level, while global institutions streamline and simplify operations, not add layers of complexity. Her experience leading Gavi’s reforms, such as Gavi Leap showed that giving governments discretion over resources and merging overlapping programs at the last mile can turn ambition into tangible results for communities.

In his closing remarks, President Mahama formally announced the establishment of the global Secretariat of the Accra Reset, a permanent political and strategic hub to ensure continuity between Heads of State and the Guardians Circle. He also launched a high-level panel on global health governance and confirmed Ghana’s commitment to co-host a technical Secretariat with a North partner under the North-South Dialogue. This framework will coordinate policy exchanges on investments, critical minerals, AI, digital infrastructure, and skills development, with partners including India, Indonesia, South Korea, and Singapore, reflecting a renewed Bandung-inspired approach to cross-regional cooperation.

Why This Matters

The Accra Reset and the drive for health sovereignty are unfolding against a backdrop of deep shifts in global health and foreign policy. The United States, historically one of the largest funders of many global health initiatives, formally withdrew from the World Health Organization on 22nd January 2026, weakening multilateral health coordination and introducing new risks for pandemic preparedness and vaccine collaboration. At the same time, the U.S. is increasingly favouring bilateral agreements with African countries over multilateral support, raising questions about how health priorities are set and how accountability is maintained.

These shifts make the push for health sovereignty urgent and tangible. With official development assistance (ODA) models changing and countries navigating bilateral deals often shaped by donor priorities rather than negotiated with national interests fully at their centre, Africa’s ability to set its own health priorities is no longer just a matter of equity. It is central to building resilient systems that can deliver for communities, safeguard progress, and ensure that Africa is driving its own future.