Leaders of the Africa Centres for Disease Control and Prevention (Africa CDC) held a five-hour meeting with Dr Susan Monarez, newly appointed head of the US CDC, and other US officials on Wednesday – for the first time since the US slashed funding to Africa’s health sector.

Discussion centred on health security, funding for Africa CDC and options for health financing on the continent, Dr Ngashi Ngongo, Africa CDC’s incident management head, told a media briefing on Thursday.

“From the [US] administration’s perspective, they would like to see more of health as a business, rather than something that functions on grants,” added Ngongo. 

African programmes worst affected by the US’s abrupt termination of funding are those dealing with maternal and child health, HIV, malaria and emergency preparedness and response, said Ngongo, speaking from Washington DC, where he and Africa CDC Director General Dr Jean Kaseya are meeting a range of US leaders.

Aside from Monarez, the meeting was attended by high-level officials from the White House, the US State Department’s Bureau of Global Health Security and Diplomacy, Health and Human Services (HHS), and an assistant secretary from the President’s Emergency Plan for AIDS Relief (PEPFAR).

“We made the point, which was accepted by our American counterparts, that global health security starts with what happens outside the US,” said Ngongo, adding that the Trump administration “remains committed to addressing health security”. 

This morning, @StateDeptGHSD hosted several meetings between USG leaders, @_AfricanUnion, and @AfricaCDC. We discussed our shared commitment to protecting the health of our people by advancing #GlobalHealth security and strengthening our partnerships. #USAfricaPartnership pic.twitter.com/DvKF7vXW0m

— Bureau of Global Health Security and Diplomacy (@StateDeptGHSD) March 26, 2025

‘Health as a business’

Ngongo said that the Trump administration is interested in “exploring how can we go into a partnership that translates into health as a business”, adding that private sector opportunities exist in the local manufacturing of medicines, digitalisation of health records and the electrification of clinics.

“On programmes, we discussed malaria, HIV, and also support in the area of systems for emergency preparedness and response, in particular surveillance, laboratory capacity strengthening, and the health workforce,” said Ngongo.

The aim of the meeting, he added, was “to make sure that we understand them and they also understand the priorities for Africa CDC”. Discussions with US government officials will continue in April around the World Bank’s spring meeting in Washington, he added.

A report published in The Lancet this week predicted that, across all low and middle-income countries, an anticipated 24% weighted average of international aid reductions plus discontinued PEPFAR support “could cause an additional 4·43–10·75 million new HIV infections and 0·77–2·93 million HIV-related deaths between 2025 and 2030”.

If PEPFAR support is “reinstated or equivalently recovered, this reduced to 0·07–1·73 million additional new HIV infections and 0·005–0·061 million HIV-related deaths”, the modelling study adds

“Unmitigated funding reductions could significantly reverse progress in the HIV response by 2030, disproportionately affecting sub-Saharan African countries and key and vulnerable populations,” the authors note.

Funding gap

Meanwhile, Africa CDC has a funding gap of $224 million – in part due to the US walking away from a pledge made to the continent by the Biden administration.

Official development assistance (ODA) for Africa has dropped from $81 billion in 2021 and to $25 billion 2025, yet there has been a 41% increase in disease outbreaks on the continent between 2022 and 2024. 

Lack of funds, weak health systems and conflict “risk the reversal of two decades of health achievement on the continent”, said Ngongo

“We are also concerned about the risk of another African pandemic, which … would translate into more crisis, with the economic vulnerability that will push more Africans into poverty,” said Ngongo.

“But it really doesn’t help to complain. We have to be proactive in terms of thinking that, if that is the new normal, if that is the direction that the world is taking, how do we remain fit in that context?”

Options include increasing domestic financing, a “solidarity levy” on all airline tickets sold on the continent, higher “sin taxes” on alcohol and tobacco and partnerships with the private sector.

“The European Union (EU) has already committed to imposing a minimal import levy on goods that are imported to Africa” to assist, he added.

“All that is on the backbone of the optimization of the use of resources to ensure that there is less corruption, there is less misuse and inefficiencies,” said Ngongo, adding “you cannot really leave your health in the hands of the partners”.

New mpox plan

An updated plan to address the ongoing mpox outbreak was recently completed by the Africa CDC’s Incident Management Support Team.

Its goals are to stop the human-to-human transmission, halve the burden of impact and strengthen the health system as part of countries’ epidemic preparedness and response.

“The response strategy is mainly community-centred under the leadership of community health workers,” said Ngongo.

It is a multi-sectoral approach that relies on strengthening co-ordination, digitalizing surveillance – which will assist with other diseases, and completing laboratory decentralisation.

“We need to vaccinate about 6.4 million people during the next six months on this second plan and on the case management, we target at least 80% of confirmed cases that need to be taken care of,” he added.

The total budget estimated is $429 million, of which a quarter will be for surveillance and a quarter for vaccination and logistics. 

Mpox cases rose by 22% increase over past week to 3,323 cases. Confirmed cases also rose from 381 to 925. The Democratic Republic of Congo (DRC), Burundi and Uganda account for 91% of all cases.

Surveillance was slightly improved in the DRC with 21 out of 26 provinces reporting (up from 19 the previous week) and testing up from 13% to 20% of suspected cases. There were 2,451 new cases in comparison to 2,183 the week before, with 312 confirmed cases in comparison to 150.

Sierra Leone, which has 114 confirmed cases, became the sixth country to start vaccinating people on Thursday.