A new and deadly Ebola outbreak in Congo and Uganda has become the last health emergency which pushes African governments to reduce their dependence on international donors such as the United States, in a context in which foreign support has been reduced by half in the last five years.
The decrease in aidaggravated by the extensive cuts promoted by Donald Trump’s administration, coincides with the rapid growth of the African population, which already exceeds 1.5 billion people. The Ebola outbreak, corresponding to a strain without approved vaccines or treatments, occurs just a few days after an unusual hantavirus outbreak on a cruise ship put health authorities on the continent on alert.
Africa faces “an equally dangerous threat” related to financing, the director general of the Africa Centers for Disease Control and Prevention (Africa CDC), Jean Kaseya, warned at the beginning of the year during the launch of an initiative aimed at boosting the continent’s health self-sufficiency.
“Every time we have an outbreak, many countries start asking their partners for help because they do not have funds in their budgets to even prepare for these outbreaks,” Kaseya explained during a hearing on the new Ebola outbreak.
However, African countries are aware that this situation must change.
Africa has been promising more investment in health for years
Africa CDC maintains that the continent is now experiencing “an unprecedented funding crisis.”
According to the organization, the official help development has fallen sharply: from around $26 billion in 2021 to around $13 billion expected by 2025, as rich countries focus their attention on geopolitical conflicts and internal problems.
Although African leaders have been promising for years to strengthen financing for their health systems, many of those commitments have not materialized. In 2001, countries agreed to allocate at least 15% of their national budgets to health, but currently only Rwanda, Botswana and Cape Verde are moving towards that goal among the 54 African countries.
“The debate was somewhat theoretical because the donation system was still working,” explained Alex Ajangba, a health financing expert and co-editor of the African Journal of Health Economics, Systems and Policy. “But now that cushion is gone.”
Ajangba added that the current situation is not “a temporary drop in international funding from which we will recover.”
“Health sovereignty” gains weight in Africa
African governments initiatives are now accelerating to achieve greater “health sovereignty”with the aim of financing and managing their health systems with less dependence on foreign aid.
Projects such as the “Accra Reset” promoted by Ghana or the African Agenda for Security and Health Sovereignty, approved by African leaders in February, seek to strengthen the continent’s long-term resilience.
Among the proposed measures are increasing taxes on tobacco, alcohol and sugary drinks, making joint purchases of medicines to reduce costs, expanding local production of vaccines and drugs and improving the efficiency of the health system.
The need is urgent: Africa imports more than 90% of health products such as vaccines and medicines, while public health emergencies – from mpox to cholera to Ebola – increased from 153 outbreaks in 2022 to 242 in 2024, according to Africa CDC. The organization aims for the continent to produce 60% of its vaccines before 2040.
A continent rich in resources but economically limited
Experts recall that Africa has about 30% of the world’s mineral reserves, including essential resources for technology and renewable energy. However, much of that wealth is lost through unfavorable contracts, illicit financial flows, debt, and lack of local processing of raw exported raw materials.
According to the United Nations Economic Commission for Africa, the continent loses about $40 billion a year due to illicit financial flows linked to extractive sectors such as mining, oil and gas.
Another key to reducing international dependence is co-financing. The global alliance for vaccines Gavi assures that low-income countries contributed a record amount of 302 million dollars in 2025 and around 1 billion over the last five years.
The new conditions of the United States
The Trump administration has promoted health agreements based on co-financing with several African countries. These pacts force governments to increase national health spending within specific deadlines under the threat of losing international support.
Some countries have rejected the American proposalsespecially due to the demands related to the exchange of health data without clear guarantees of benefit for the participating countries. Criticism has also arisen of possible exchanges of health aid for access to natural resources.
Although there is consensus on the need to move towards greater self-sufficiency, several experts believe that some of the conditions imposed by Washington generate excessive pressure on already weakened economies.
Debt limits health spending
Many African countries also face a growing debt burden. Nearly 40% already allocate more resources to paying debt than to healthcare.
The continent’s total debt stands at about $1.2 trillion, according to the African Export-Import Bank, while debt service consumes about 19% of public revenue in sub-Saharan Africa, according to the United Nations.