Two to four million additional Africans are likely to die annually as a result of the shock aid cuts by the United States and other key donors, according to Dr Jean Kaseya, who heads the Africa Centre for Disease Control and Prevention.

Kaseya heads to Washington next week to coincide with the end of US Congress’s reauthorisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) on 25 March.

Numerous PEPFAR projects have already been terminated in the past two months by Trump appointee Elon Musk’s Department of Government Efficiency (DOGE) and it is unclear what the Republican-dominated Congress envisages for the plan.

Kaseya said he planned to meet members of the Trump administration, PEPFAR officials and Members of Congress next week in a bid to restore US aid.

“It is a disaster,” Kaseya told a media briefing on Thursday, disclosing that some African countries relied on “external assistance” for 80% of their HIV and malaria responses.

‘Overnight, everything is gone’

“Overnight, everything is gone,” he said, noting that 30% of Africa’s health expenditure comes from official development assistance (ODA) – yet there had been a 70% cut in ODA this year from $81 billion to $25 billion.

Aside from the gutting of virtually all the US Agency for International Development (USAID) grants, major European donors have also cut ODA.

Earlier in the week, the World Health Organisation (WHO) reported that Kenya, Lesotho, South Sudan, Burkina Faso and Nigeria would run out of antiretroviral medicine for HIV within the next few months as a result of USAID cuts.

WHO Director-General Dr Tedros Adhanom Gebreyesus said that while the aid withdrawal was the right of the US administration it “has a responsibility to ensure that, if it withdraws direct funding for countries, it is done in an orderly and humane way to allow them to find alternative sources of funding.”

Kaseya reported that he has been travelling the breadth of the continent and internationally to secure three key pillars of support for health on the continent: increased domestic funding, “innovative financing” for outbreaks and “blended financing”.

The aid cut will “reverse two decades of health achievements in maternal, child health and infectious diseases”, warned Kaseya, adding that entire health systems “could collapse”.

Alongside the cuts is a surge in disease outbreaks – up 41% in the past two years.

The African health response is also hampered by countries’ debt servicing burden and dependence on imported medical countermeasures, said Kaseya.

Africa CDC projects an additional 39 million people will be pushed into poverty as part of the ODA cuts. The calculations are based on CDC modelling.

Kaseya has held several briefings with health ministers and African Union leaders to address the crisis, particularly focusing on alternative sources of funding.

Only two of the 55 member states – Botswana and Rwanda – spend 15% of their GDP on health – something that African states pledged to do in the Abuja Declaration back in 2001.

Only 16 countries have national health financing plans.

Kaseya said the Africa CDC is also trying to ensure that the health sector access to some of the $95 billion contributions made by the diaspora, including possibility via taxes.

With blended finance, Kaseya said private sector investment is needed “mostly in local manufacturing, electrification of health centres, connectivity, digital health and supply chain infrastructure”.

Mpox plateaus – but fall in testing is to blame

While mpox cases appear to have plateaued, this is due to challenges related to testing – particularly in the Democratic Republic of Congo (DRC) – rather than the disease being controlled, said Kaseya.

Conflict in eastern DRC and the loss of USAID funding that was covering the transportation of mpox samples to laboratories have led to a 16% drop in testing in the DRC over the past week alone. Less than a quarter of suspected cases were tested. Meanwhile, the turnaround time for testing has increased in many regions due to transport problems.

Image Credits: International AIDS Society, Witkoppen Clinic.