分类： health

An ongoing Ebola outbreak originating in the Democratic Republic of the Congo (DRC) has spread faster and wider than initial assessments projected, international health officials have warned, with cases already detected in neighboring Uganda and multiple provinces across the unstable Central African nation. As of Tuesday, official counts put suspected cases in the DRC at more than 513, with 131 recorded fatalities in the country and one additional death in Uganda. But new analysis from the London-based MRC Centre for Global Infectious Disease Analysis suggests official numbers are likely far lower than the actual caseload, with researchers warning that substantial under-detection could mean the total number of infections has already surpassed 1,000. The true size of the outbreak remains uncertain, the study added, noting that current confirmed figures understate the outbreak’s real scale.

The World Health Organization (WHO) representative to the DRC, Dr. Anne Ancia, told the BBC that expanded on-the-ground investigations have confirmed the virus has reached multiple new regions, including the conflict-affected province of South Kivu and Goma, eastern DRC’s largest population center home to roughly 850,000 residents that is currently controlled by Rwandan-backed armed groups. The outbreak’s epicenter remains DRC’s Ituri province, a chronically insecure region marked by widespread forced population displacement that has severely complicated response efforts. “The more we are investigating this outbreak, the more we realise that it has already disseminated at least a little bit across border and also in other provinces,” Ancia explained. Chronic instability across multiple affected provinces pushes residents to move frequently, raising the risk of further transmission, she added.

The Red Cross echoed the WHO’s warning, noting that all the conditions that allow Ebola to escalate rapidly—delayed case identification, low community awareness, and strained health systems—are already present in the current outbreak. DRC President Félix Tshisekedi called for calm and urged citizens to maintain vigilance following an emergency crisis meeting on the outbreak Monday evening. WHO Director-General Tedros Adhanom Ghebreyesus, who declared the outbreak a Public Health Emergency of International Concern (PHEIC) last week, said he is deeply alarmed by both the size and acceleration of the epidemic.

Health investigators believe the outbreak had been circulating for several weeks before it was first officially detected on April 24. Complicating response efforts further, there is no approved vaccine for the specific viral strain driving the current outbreak: the rare Bundibugyo strain, which has only caused two recorded outbreaks previously, with roughly a third of infected patients dying from the disease. The WHO is currently evaluating whether existing antiviral treatments developed for other Ebola strains may offer some protection against Bundibugyo.

Neighboring and regional countries have already implemented emergency precautions to slow cross-border spread. Rwanda has closed its entire border with the DRC, while Uganda has advised citizens to avoid traditional greetings including hugs and handshakes, and multiple other African nations have tightened entry screenings and prepped health facilities to handle potential cases.

International fallout from the outbreak has already spread beyond Africa: an American citizen, identified as missionary doctor Peter Stafford, developed Ebola symptoms over the weekend and is being evacuated to Germany for treatment. The U.S. Centers for Disease Control and Prevention (CDC) confirmed it is also coordinating the evacuation of at least six other American citizens who had potential exposure to the virus.

WHO and partner humanitarian organizations are currently working alongside DRC government officials and local community leaders to contain transmission, urging residents to follow public health safety guidelines and seek immediate care at the nearest health facility if they develop any Ebola symptoms.

Ebola is a viral infectious disease that begins with flu-like symptoms including fever, headache, and fatigue. As the infection progresses, patients often develop vomiting and diarrhea, which can progress to organ failure; some patients also experience internal and external bleeding. The virus spreads through direct contact with infected bodily fluids such as blood or vomit. The 2014-2016 West African Ebola epidemic, caused by the Zaire strain for which an approved vaccine now exists, remains the largest outbreak of the virus since its discovery in 1976, with more than 28,600 confirmed infections and 11,325 recorded deaths across multiple countries including Guinea, Sierra Leone, the United States, the United Kingdom, and Italy.

KINSHASA, Democratic Republic of Congo — A fast-escalating rare Ebola outbreak in eastern Democratic Republic of Congo has already claimed at least 131 lives and sparked over 500 suspected infections, Congolese health officials confirmed Tuesday, as the top leader of the World Health Organization (WHO) issued urgent warnings over the outbreak’s alarming scale and accelerating spread.

Health experts and humanitarian aid workers report the virus circulated undetected for several weeks after the first fatality, and delays in identifying and responding to the crisis have severely complicated efforts to contain transmission. Congolese Health Minister Samuel Roger Kamba told reporters the country has recorded 513 suspected cases and 131 deaths to date, noting that all fatalities are still under investigation to confirm linkage to the current outbreak. These figures represent a dramatic jump from just one day prior, when authorities reported 300 suspected cases, underscoring how much remains unknown about the full scope of the crisis.

WHO Director-General Tedros Adhanom Ghebreyesus stated he is “deeply concerned about the scale and speed of the epidemic”, and announced the U.N. health agency would convene its emergency committee later the same day to assess the outbreak and coordinate a global response. Tedros outlined key factors driving fears of further spread: transmission in densely populated urban centers, deaths of frontline healthcare workers, high volumes of population movement through the affected region, and critical shortages of targeted vaccines and treatment options.

The outbreak, formally confirmed on May 14, is caused by the Bundibugyo variant, a rare strain of Ebola for which no fully approved vaccines or specific therapeutics currently exist. Just three days after confirmation, on May 17, the WHO declared the event a Public Health Emergency of International Concern (PHEIC), the highest level of global health alert.

Confirmed cases have already been documented across five locations: Bunia, the rebel-held North Kivu provincial capital of Goma, Mongbwalu, Butembo, and Nyakunde. The outbreak has also crossed an international border, with one confirmed case and one death recorded in Uganda in an individual who traveled from the affected Congolese region.

In Ituri province’s capital of Bunia, one American physician has tested positive for the virus, according to Dr. Jean-Jacques Muyembe, medical director of the DRC’s National Institute of Bio-Medical Research. Dr. Peter Stafford, who was treating patients at a local hospital when he developed symptoms, works for the international medical organization SERVE. Three other SERVE staff members, including Stafford’s wife, were working at the same facility but have not reported any symptoms to date.

The chain of delayed detection stretches back to April 24, when the first recorded Ebola fatality occurred in Bunia. The victim’s body was subsequently transported for burial to the Mongbwalu health zone, a heavily populated gold mining region, a movement that health minister Kamba says directly fueled the outbreak’s rapid escalation.

When a second person fell ill on April 26, samples were shipped to the national capital Kinshasa for testing. Congolese officials report that samples were initially screened only for Zaire ebolavirus, the more common circulating strain, and returned a false negative result. Local authorities therefore ruled out Ebola and took no immediate containment action. It was not until May 5, when WHO was alerted to an unexplained cluster of 50 deaths in Mongbwalu—including four local health workers—that officials ordered expanded testing, leading to the formal confirmation of the outbreak on May 14.

Matthew M. Kavanagh, director of the Georgetown University Center for Global Health Policy and Politics, says the false negative result left global and local responders playing catch-up with a deadly pathogen. He criticized the former Trump administration’s decision to withdraw U.S. membership from the WHO and slash global health foreign aid funding, cuts that he says weakened the very early warning surveillance systems designed to detect these outbreaks before they grow out of control.

The U.S. State Department rejected criticism on Monday, noting that Washington had moved quickly to deploy support and already committed $13 million in emergency assistance to the outbreak response.

Esther Sterk, a representative for the humanitarian medical organization Medecins Sans Frontieres (Doctors Without Borders), told the Associated Press that the situation remains deeply worrying and is evolving much faster than initial projections. She added that delayed detection is not an uncommon challenge for Ebola outbreaks, as the disease shares early symptoms with many other common tropical illnesses.

Ebola is a highly contagious viral pathogen spread through direct contact with infected bodily fluids, including blood, vomit, and semen. While infections are rare, the disease causes severe illness that is frequently fatal. During the 2014-2016 West African Ebola epidemic that killed more than 11,000 people, many transmissions occurred during traditional funeral practices that involve close contact with deceased victims’ bodies.

Dr. Craig Spencer, an associate professor at Brown University School of Public Health who survived an Ebola infection he contracted while working in Guinea in 2014, notes that Ebola disproportionately harms those who care for the sick, a dynamic he describes as the “disease of compassion.” Common symptoms of infection include fever, headache, muscle pain, weakness, diarrhea, vomiting, abdominal pain, and unexplained bleeding or bruising.

Rising caseloads and severe symptoms have fueled growing panic among residents in Bunia’s neighborhoods. Noëla Lumo, a Bunia resident who previously lived through an Ebola outbreak in Beni, says she understands the threat firsthand and has already begun production of homemade protective cloth masks to distribute to her community.

The affected region of eastern DRC already faces overlapping crises that complicate the outbreak response. Mongbwalu is located in a remote part of Ituri province, more than 620 miles from Kinshasa, with poorly maintained road networks that slow the movement of medical supplies and response teams. Eastern DRC has been grappling with a years-long humanitarian crisis and ongoing violence from armed rebel groups, which have killed dozens of people and displaced thousands in Ituri alone over the past year. According to U.N. data, Ituri is home to more than 273,000 internally displaced people out of a total provincial population of just 1.9 million.

A U.N. official based in Bunia, speaking on condition of anonymity due to restrictions on speaking to media, confirmed that all U.N. staff in the region have been ordered to work remotely, avoid close physical contact with others, and stay away from crowded public spaces to reduce their risk of infection.

A deadly Ebola outbreak in the Democratic Republic of the Congo has claimed nearly 120 lives, and public health teams are facing unusual challenges because the outbreak is driven by Bundibugyo virus, one of the rarest Ebola species, with no licensed specific treatments or vaccines ready for deployment. Unlike the more common Zaire Ebola species, for which multiple vaccines and therapeutics have been developed and approved, Bundibugyo virus has no candidate interventions even advanced enough to enter human clinical trials, leaving frontline responders to rely on foundational, decades-old outbreak control measures. “There’s nothing even close to ready for clinical trials,” explained Dr. Celine Gounder, an infectious disease specialist and epidemiologist who treated patients during the devastating 2014–2016 West African Ebola epidemic. “And so that means responders, healthcare workers and other aid workers are really back to the basics.”

What makes this outbreak unusual is the specific pathogen at its center. Bundibugyo virus was first formally identified in 2007 by the U.S. Centers for Disease Control and Prevention’s Special Pathogens Branch, then led by Dr. Tom Ksiazek, now a virologist and veterinarian at the University of Texas Medical Branch. To date, this marks only the third recorded Bundibugyo outbreak, with all previous events occurring in the same Congo River basin region where the current outbreak is unfolding.

Like all known Ebola viruses, Bundibugyo spreads through direct close contact with the bodily fluids of infected people—living or deceased. These fluids include blood, sweat, feces, and vomit, meaning healthcare workers and family members caring for sick patients face the highest risk of infection. “So very often we see doctors and nurses among the first to be infected and to die,” noted Gounder, who serves as editor-at-large for public health at KFF Health News.

Based on limited data from the two prior small outbreaks, experts believe Bundibugyo virus may have a slightly lower mortality rate than the more widespread Zaire Ebola virus, the species responsible for most large Ebola outbreaks. Even so, the estimated 30% or higher mortality rate remains a major public health threat, though precise estimates are hard to calculate given the limited number of recorded infections. “I think a 30%-plus mortality rate is still quite scary, but it’s hard to say with a lot of precision because we don’t have a lot of experience,” Gounder said.

Without targeted treatments or vaccines, clinical care for infected patients is limited to supportive care, a strategy that has proven effective at reducing death rates in past outbreaks. In the two previous Bundibugyo events, early identification of initial cases allowed rapid response teams to implement core control measures: providing frontline staff with full personal protective equipment, identifying and isolating exposed contacts, and delivering aggressive supportive care including intravenous or oral fluid replacement to manage dehydration, a common complication of Ebola infection. Proper supportive care “reduces mortality significantly,” Ksiazek confirmed.

Today, public health teams are leaning on these same proven core strategies to contain the current outbreak. Response efforts focus on active case finding, prompt isolation of infected people, contact tracing to stop secondary transmission, and public education to help communities avoid exposure. As during the 2014–2016 West African epidemic, promoting safe burial practices is a top priority, since traditional funeral rites that involve close contact with deceased bodies have historically been a major driver of Ebola spread. Experts also emphasize that consistent access to high-quality personal protective equipment for healthcare workers remains non-negotiable for stopping transmission.

While the absence of a vaccine is certainly a setback, experts point out that basic public health tools have successfully stopped every previous Ebola outbreak in the DRC, which has now weathered 17 separate Ebola events in its history. “Of course, it’s problematic because vaccines are some of our best tools for combating infectious diseases,” said Lina Moses, an epidemiologist and disease ecologist at Tulane University. “But other public health tools — public education, contact tracing, quick testing — still work. It’s important to keep in mind that every single Ebola outbreak that has occurred in the (Democratic Republic of the Congo) — we’re on our 17th now — has been stopped.”

This reporting was contributed by Associated Press Southern Africa reporter Mogomotsi Magome from Johannesburg. The AP Health and Science Department receives funding support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation, with the AP retaining full editorial control over all content.

In an ongoing public health crisis centered in the northeastern Democratic Republic of the Congo, a rare strain of Ebola has sparked an outbreak that the World Health Organization has now designated a Public Health Emergency of International Concern (PHEIC), with fatalities topping 100 and cases already spreading into neighboring Uganda. What follows is a comprehensive chronological breakdown of how the under-recognized crisis unfolded, marked by early challenges in identifying the unusual pathogen behind the spread of disease.

Between April 24 and 27, the first suspected case of the mysterious illness – a local health worker – fell ill and died in Bunia, the capital of Congo’s Ituri Province. According to Congo’s health minister, the worker’s body was subsequently transported to the nearby mining hub of Mongbwalu. While Congolese officials cite April 24 as the date of death, the Africa Centers for Disease Control and Prevention (Africa CDC) records the death occurring on April 27, following the onset of severe hemorrhagic symptoms characteristic of filovirus infections like Ebola.

On April 28, the Africa CDC confirmed that a close contact of the initial suspected victim had also died after developing matching disease symptoms. Just two days later, on April 30, on-site testing of patient samples in Bunia returned negative results for Zaire ebolavirus – the strain responsible for nearly all previous large Ebola outbreaks in Congo. The WHO notes that three Ebola species are known to trigger major outbreaks: Zaire, Sudan, and the far less common Bundibugyo virus. It would take a full two additional weeks for public health authorities to confirm that the rarer Bundibugyo strain was the actual cause of the outbreak.

By May 5, the WHO was formally notified of a “high-mortality” outbreak of unknown origin in Mongbwalu, with multiple health workers already counted among the deceased. Local preliminary reports placed the death toll at roughly 50 by this point. Congolese health officials later noted that the movement of the first victim’s contagious remains to Mongbwalu likely sparked the local transmission chain there, as bodies of Ebola victims carry extremely high infection risk.

On May 11, a 59-year-old Congolese man with Ebola-typical symptoms of fever and body aches checked into a hospital in Kampala, Uganda’s capital, located roughly 434 miles from Ituri Province. Ugandan health authorities confirmed he had crossed the border from Congo to seek care. A WHO rapid response team deployed to investigate the expanding outbreak in Mongbwalu and the nearby Rwampara health zone on May 13, as transmission continued to accelerate. The following day, 13 blood samples from suspected Ebola cases in Rwampara were sent for official analysis at a national laboratory in Kinshasa, Congo’s capital. That same day, the cross-border patient from Congo died in the Kampala hospital, and his remains were returned to Congo for burial.

May 15 marked a turning point in the crisis: laboratory analysis from Kinshasa confirmed the presence of Bundibugyo virus in eight of the 13 Rwampara samples. Posthumous testing of the Ugandan patient’s sample also returned positive for the rare strain, for which no licensed vaccine or specific antiviral treatment currently exists. The Congolese Ministry of Health officially declared an Ebola outbreak, with the Africa CDC reporting 246 suspected cases and 65 fatalities. Within days, those numbers jumped to more than 300 suspected cases and over 100 confirmed deaths. Ugandan officials confirmed their country’s cases were limited to two people, both of whom had entered Uganda from Congo. This outbreak marks the 17th major Ebola event in Congo since the virus was first discovered in the country in 1976.

On May 17, the WHO formally designated the cross-border outbreak in Congo and Uganda a PHEIC, the United Nations health agency’s highest level of public health alert. The WHO emphasized that the outbreak does not meet the criteria for a pandemic classification like that applied to COVID-19, and explicitly advised against countries closing their borders to Congo or Uganda. Even so, the agency urged all nations sharing a land border with the two affected countries to immediately strengthen routine disease surveillance and ensure frontline health workers receive specialized training to identify, triage and manage Ebola cases.

The following day, Congolese health officials confirmed that an American doctor working in Bunia had tested positive for the virus. Dr. Jean-Jacques Muyembe, medical director of Congo’s National Institute of Bio-Medical Research, confirmed the case was counted among the infections in Bunia, where the doctor had been treating patients at a local hospital, according to his employing organization.

This reporting was a collaborative effort by Associated Press writers based across the African continent: Monika Pronczuk in Dakar, Senegal, Evelyne Musambi in Nairobi, Kenya, and Rodney Muhumuza in Kampala, Uganda.

The World Health Organization (WHO) has formally designated an ongoing Ebola outbreak in the eastern region of the Democratic Republic of Congo (DRC) as a Public Health Emergency of International Concern (PHEIC), marking a major escalation of global response to a dangerous and uniquely challenging public health crisis.

Unlike more common Ebola variants that global health systems have experience addressing, this outbreak is driven by the Bundibugyo strain – an extremely rare subtype that has not triggered a major outbreak in more than 10 years. Only two previous Bundibugyo outbreaks have ever been recorded, with the virus claiming the lives of roughly one-third of all confirmed cases in those events. This rarity has created multiple layers of barriers to containment and treatment: standard initial Ebola diagnostic tests are calibrated to detect more common strains, leading to initial false negatives that delayed detection, and no officially approved vaccine or targeted antiviral treatment exists for this specific variant. While experimental vaccines are currently in development, researchers note that existing vaccines for the Zaire Ebola strain may offer partial cross-protection, though this has not been formally confirmed for widespread use.

Compounding these biological challenges is the outbreak’s location in an unstable conflict zone. Over a quarter of a million people have been displaced from their homes in the affected Ituri province, and porous, poorly monitored borders with neighboring countries have created constant risk of cross-border spread. The outbreak was not detected early after its initial emergence: the first documented case was a nurse who first developed symptoms on April 24, meaning the virus circulated undetected for multiple weeks before authorities were alerted. That nurse later died in Bunia, Ituri’s capital, and her body was transported back to Mongwalu – one of two gold-mining towns that have recorded the majority of confirmed cases. Congolese Health Minister Samuel Roger Kamba explained that widespread community transmission accelerated after the nurse’s funeral, where dozens of people were exposed to the infected body during traditional mourning practices. This mirrors patterns seen in past Ebola outbreaks across Africa, where funeral customs have repeatedly fueled spread.

Delayed reporting also stemmed from widespread misinformation in affected communities: many residents initially attributed the mysterious illness to witchcraft or a supernatural curse, leading sick people to seek care from traditional healers and prayer centers instead of formal medical facilities. This allowed transmission to continue uninterrupted for weeks. As of current reports, cases have been confirmed across three Ituri locations (Mongwalu, Rwampara, and Bunia) as well as Goma – the largest city in eastern DRC, home to 850,000 people and currently under the control of AFC-M23 rebel forces. The Goma case involves a woman who traveled to the city after her husband died of Ebola in Bunia. Alarmingly, two Congolese travelers who entered Uganda from the DRC have already died of Ebola in Kampala, Uganda’s capital, marking the first cross-border fatalities linked to the outbreak.

Contrary to widespread public speculation, WHO officials stress that this PHEIC declaration does not signal an impending COVID-19-style global pandemic. The overall risk of Ebola spread outside of East Africa remains categorized as minimal, with the greatest danger concentrated in the Great Lakes region of central Africa. Still, global health bodies are sounding the alarm about significant regional spread risks. The Africa Centres for Disease Control and Prevention (Africa CDC) has highlighted high risk of transmission to neighboring Uganda, Rwanda, and South Sudan, and is coordinating with officials from all four countries to strengthen cross-border surveillance and response capacity.

Neighboring nations have already implemented urgent precautionary measures. Rwanda, which shares a border with Goma, has ramped up entry screening for all travelers coming from the DRC, and has restricted entry for non-resident Congolese nationals coming from affected areas. In Uganda, President Yoweri Museveni has postponed the annual Martyrs’ Day pilgrimage – a major Christian event that draws thousands of Congolese visitors each year – to prevent large-scale gathering that could fuel transmission.

On the ground in the DRC, multiple response efforts are underway, but political fragmentation threatens to slow progress. The Congolese national government has deployed specialized health teams equipped with personal protective equipment to Bunia, and has launched a public awareness campaign alongside a toll-free hotline (151) for residents to report suspected symptoms. Public health officials have issued core guidance for residents: seek immediate medical care at the first sign of symptoms, avoid contact with bodies of people who died with suspected Ebola or dead wild animals, avoid eating raw or undercooked meat, and maintain physical distancing in public spaces. The WHO and medical humanitarian organization Médecins Sans Frontières (MSF) have also deployed personnel and resources to set up dedicated Ebola treatment centers and coordinate the overall response. In Goma, AFC-M23 rebel officials say they have activated their own response mechanisms in partnership with local health facilities to contain spread, but political tensions mean the Congolese national government is unlikely to collaborate with the rebel administration, creating a critical coordination gap that could hinder containment efforts.

Africa CDC Director Dr. Jean Kaseya says current public outreach efforts are focused on addressing the key risk factors that have driven spread so far, including educating communities on safe funeral practices, universal basic hygiene, and proper sanitation, as well as ensuring frontline health workers have access to adequate protective equipment to avoid infection while caring for patients.

A new, lethal Ebola outbreak spanning the Democratic Republic of Congo and Uganda has laid bare the growing vulnerability of African health systems, as plummeting international donor assistance forces the continent to confront a long-deferred reckoning: ending decades of dependency on foreign aid for public health emergency response.

According to the Africa Centers for Disease Control and Prevention (Africa CDC), the continent is grappling with an unprecedented health financing crisis. Official development assistance for health has been cut in half over just four years, plummeting from roughly $26 billion in 2021 to a projected $13 billion in 2025. Wealthy nations have redirected global health resources to prioritize geopolitical conflicts and domestic economic pressures, with sweeping cuts implemented during the Trump administration worsening the funding shortfall. The shrinking budget crisis arrives as Africa’s population has surpassed 1.5 billion and disease outbreaks are surging: the Africa CDC recorded a jump from 153 public health emergencies across the continent in 2022 to 242 in 2024, ranging from mpox and cholera to this latest Ebola strain, which has no approved vaccines or targeted treatments.

For decades, African governments signed pledges promising to increase domestic investment in public health, but few have followed through on those commitments. In the 2001 Abuja Declaration, 54 African nations committed to allocate a minimum of 15% of their national budgets to the health sector. Today, only three countries — Rwanda, Botswana, and Cape Verde — are on track to meet that target. Dr. Jean Kaseya, director-general of the Africa CDC, framed the funding gap as a threat as dangerous as any emerging pathogen, noting that “every time we have an outbreak, many countries start to ask for partners because they don’t have in their budgets funding to respond, even to prepare for these outbreaks.”

Dr. Alex Ajangba, a health financing expert and co-editor of the *African Journal of Health Economics, Systems and Policy*, explained that prior commitments to self-reliance remained theoretical as long as donor funding was available. “But now that cushion is gone,” he said, adding that the current drop in foreign assistance is not a temporary dip, but a permanent shift.

Against this backdrop, the concept of “health sovereignty” has moved to the center of continental policy, with African governments accelerating efforts to build self-sufficient health systems that rely far less on external aid. Recent initiatives, including Ghana’s September 2024 Accra Reset and the continent-wide African Health Security and Sovereignty Agenda adopted by leaders in February 2025, aim to strengthen long-term public health resilience. Proposed domestic solutions include new targeted taxes on tobacco, alcohol, and sugary beverages to generate health revenue, pooled bulk procurement of medicines to cut costs, expanding local pharmaceutical and vaccine manufacturing, and eliminating systemic inefficiencies that drain limited budgets.

Currently, Africa imports more than 90% of its critical health commodities, including vaccines and prescription drugs. The Africa CDC has set an ambitious target to produce 60% of the continent’s vaccines domestically by 2040. Still, experts warn that health sovereignty risks becoming little more than a empty policy slogan without meaningful structural and financial reform.

A key barrier to expanding domestic health investment is the paradox of Africa’s natural resource wealth: the continent holds roughly 30% of the world’s total mineral reserves, including critical minerals essential for global technology and renewable energy development, but most of the economic value of these resources never reaches national governments or public budgets. Opaque and weak contracting, massive illicit financial flows, crippling national debt burdens, and the export of raw minerals with limited local value processing drain hundreds of billions of dollars from African economies annually. The United Nations Economic Commission for Africa estimates the continent loses roughly $40 billion each year to illicit financial flows alone in the extractive sector.

To bridge the funding gap, global health bodies and African governments are increasingly turning to co-financing models, which require recipient nations to contribute a growing share of health funding alongside donor contributions. Gavi, the global vaccine alliance, reports that lower-income African nations contributed a record $302 million toward domestic vaccine purchases in 2025, and have contributed roughly $1 billion total over the past five years. “This creates predictability,” Gavi chief executive Sania Nishtar told the Associated Press. “Reliance on aid for basic services does not.”

But the shift toward new financing models has become contentious, particularly as the Trump administration has made co-financing a non-negotiable condition for “America First” health agreements with nearly two dozen African nations. The deals restructure U.S. aid to require countries to increase domestic health spending within set deadlines, or lose all U.S. support entirely. Some nations have rejected the agreements outright, pushing back against U.S. demands for access to domestic health data with no guarantees that African nations will share in any commercial benefits derived from that data. Other critics have condemned proposals that would swap health aid commitments for access to African natural resources.

While most African leaders agree that long-term self-sufficiency is a necessary goal, critics argue that many of the U.S. conditions place unfair, unrealistic pressure on economies already strained by debt and underdevelopment. “They are being set up to fail,” said Asia Russell, executive director of global health advocacy group Health GAP. “When an administration says, ‘If you don’t hit these numbers, you’re not going to get resources anymore,’ that is extremely serious.”

Mounting national debt burdens already make dramatic increases in domestic health spending nearly impossible for many nations. Africa’s total sovereign debt has surged to roughly $1.2 trillion, according to the African Export-Import Bank, forcing governments to make devastating trade-offs between public health and debt repayment. For roughly 40% of African countries, annual debt servicing costs exceed total national health spending. The United Nations reports that debt repayment consumes an average of 19% of total government revenue across sub-Saharan Africa. Jen Kates, senior vice president of global health policy nonprofit KFF, noted that “at the end of the day, it’s going to be people who live in those countries who will feel the effects” of underfunded health systems. The Associated Press receives financial support from the Gates Foundation for coverage of global health and development in Africa, and maintains full editorial control over all content.