It is almost a year since President Donald Trump signed an executive order suspending all foreign aid to Africa. Facing devastating consequences for healthcare systems, African governments, policy makers and the private sector are responding
The withdrawal of the US from global health had devastating and disruptive impacts across Africa. For decades, USAID underpinned national HIV responses, immunisation programmes, and maternal and reproductive health initiatives across the continent. And yet, even as the cuts disrupt the continent’s healthcare systems, there are silver linings of opportunity for 2026.
Speaking at the AU-EU Business Forum (AEBF2025), which took place in Luanda, Angola in late November 2025, this view was one shared by Dr Karim Bendhaou, Head of Africa Bureau at Merck, a leading German science and technology company. What he is seeing, he said, is a “tremendous shift” towards “co-creation,” and away from pure technical assistance and one-way technology transfer.
The statistics, however, are admittedly daunting – as the AEBF2025 health and pharma panel highlighted. Even before the abrupt and devastating cuts to USAID, the US agency for international development, Africa’s healthcare funding gap was put at $66 billion a year. Some 2025 estimates say aid has declined 70% compared to four years ago. And, according to the World Health Organisation (WHO), while 15% of national budgets should be directed towards health, average spending in Africa is 7%. For a continent which carries about 25% of the global disease burden, yet attracts just 1% of global health spending, underfunding remains a crisis, and an immediate challenge.
Africa carries 25% of the global disease burden, yet attracts just 1% of global health spending
However, it's not only US cuts that spurring change. In analysis from Dr Ebere Okereke, Associate Fellow at the Global Health Programme at the UK international affairs think-tank Chatham House, as Europe started cutting aid some years ago, African governments had already recognised that this cannot remain the foundation of health financing. She quotes Nigeria’s Co-ordinating Minister of Health and Social Welfare, Muhammad Ali Pate, who said in his speech at the Accra Health Sovereignty Summit last summer: “We cannot build healthier populations on the generosity of other nations. It is time to define our path rooted in sovereignty and aligned with local needs.”
This is vital, Okereke warns, because without alignment with national health planning and domestic priorities, the new donors appearing, such as China and the United Arab Emirates, could just “reproduce the same vulnerabilities that exist today”. Health assistance could be seen as becoming more overtly applied as a geopolitical bargaining tool. In addition, philanthropic funding also bypasses national systems.
Policy frameworks and practical approaches
Driven by aid cuts and public health crises but also the goal of economic integration under the African Continental Free Trade Area (AfCFTA), fortunately Africa today has in place institutions and technologies on which independence can be built. The African Centres for Disease Control and Prevention (Africa CDC), for one, is creating a platform for pooled procurement and leading efforts to build a continental ecosystem for manufacturing health products. Meanwhile, the African Medicines Agency is advancing the regulatory harmonisation essential for building viable regional pharmaceutical production
African innovation is actively tackling healthcare problems in practical ways. Across the continent, a new generation of entrepreneurs is harnessing technology to address deep-rooted health challenges. From drones delivering life-saving blood supplies to artificial intelligence (AI)-powered diagnostics in remote clinics, a vibrant healthtech sector is emerging. Technologies are helping to streamline patient management, predict disease outbreaks, and facilitate preventive care, greatly enhancing patient outcomes and reducing workloads for medical staff. Meanwhile, solar-powered hospitals and clinics are also providing consistent healthcare services, operating independently from unstable grids.
Nations are beginning to tackle the challenges in their own ways. Kenya, for example, has had an eHealth policy for over a decade, and is leading the way in developing frameworks for digital health interventions, such as defining national versus county roles. Spurred by high mobile-phone penetration, the digital health landscape has grown, increasing start-ups, and demand for telemedicine and other digital health tools. Yet technology alone is, of course, not enough. Governance, standards and interoperability matter – Kenya is working on putting those in place.
But today, as Merck's Dr Bendhaou sees it, health is no longer a cost but an investment
The big issues: resource mobilisation & sustainability of finance
Still, a vast amount remains to be done. Speaking on the health and pharma panel at the AU-EU Business Forum, Dr Benjamin Djoudalbaye, Head of Division, Public Health Policy Diplomacy and Communication, Africa CDC, pointed first and foremost to resource mobilisation.
"Without resources, there is nothing you can do," Dr Benjamin Djoudalbaye, Head of Division, Public Health Policy Diplomacy, Africa CDC.
A "critically important" second is innovation and institutional strengthening to advance local manufacturing and supply chain sovereignty. Success stories of speed, sovereignty and systems change are emerging, a major one driven by Afrigen Biologics and Vaccines, a private Cape Town-based biotech company behind launch of the WHO-backed mRNA Technology Transfer Hub. Since the pandemic, the continent has gone from zero mRNA manufacturing capacity to hosting technology hubs and modular factories that did not exist before COVID-19. By 2023, Afrigen successfully reverse-engineered an mRNA COVID-19 vaccine, trained scientists from multiple African countries and established protocols that could be transferred to other manufacturers.
Success stories of speed, sovereignty and systems change are emerging
At the industrial end of the spectrum, Germany’s BioNTech is investing heavily in African vaccine manufacturing, and has constructed modular mRNA vaccine facilities in Rwanda, Senegal, and is planning another in South Africa. It’s been helped by a €35 million European Commission grant, and a loan of up to €60 million from the European Investment Bank under GlobalGateway, Europe's strategy to engage the private sector in global development.
Beyond mRNA’s next-generation capabilities, China’s pharma giant Fosun is building a manufacturing facility in Côte d'Ivoire for antimalarial drugs and antibiotics, and its subsidiary Tridem Pharma operates across several Francophone African countries.
These are, indeed, tremendous achievements. However, more must now be done, to accelerate African production of vaccine, diagnostics, and therapeutics and in particular medical equipment. As Dr Amany Asfour, a medical doctor, entrepreneur and President of the Africa Business Council has pointed out, across the continent, there huge demand for medical products, and that is also a huge opportunity - in particular for European pharma companies, given the geographic proximity of the two continents.
Dr Amany Asfour, co-chair of the Business Declaration - delivered to the heads of state at the AU-EU Summit in November 2025 - is a passionate advocate for Africa's healthcare sovereignty - image by Azabache Films
Pragmatic and innovative approaches
To mobilise funds, many countries are introducing excise “sin” taxes on everything from tobacco to alcohol and airline tickets. Innovative financing mechanisms are also being explored. South Africa, for one, is pioneering a TB Social ImpactBond, linking financing to measurable health outcomes. Meanwhile, Africa CDC has been mandated by African Union Heads of State to champion ways that bring private sector funding to the table.
Yet everywhere the burden is falling on the individual, however poor. Solutions such as medical insurance are being pursued – in Morocco, for example, a major health financing reform, supported by the World Bank, has expanded mandatory health insurance, with coverage reaching 75% of the population.
Initiatives such as the African-led Lusaka Agenda are building on a new financing ecosystem and innovative financing models such as the G20’s New Compact for Africa, are helping African nations chart a path toward self-reliance in healthcare financing.
"We have to be pragmatic and ensure that he sustainability of finance is there," says Dr Karim Bendhaou, Head of Africa Bureau, Merck
The reasons are many – moral and social, but also geopolitical and economic. By increasing life expectancy by just one year can, after all, increase gross domestic product by 4 to 5%.
Looking ahead to the coming year, however, Africa must build build on these successes. It will require strong and transparent leadership and coordinated action at both national and international levels. The right partners will be vital. Today Africa has choices. It must make the right ones.