Ebola in Uganda. Marburg in Tanzania. Cholera in Angola. War in Goma in the Democratic Republic of Congo (DRC) that escalated the risk of multiple disease outbreaks – and then the United States decision to halt foreign aid for 90 days and order grantees to stop all work.

“This is not the kind of week we like,” Dr Jean Kaseya, Director General of Africa Centres for Disease Control and Prevention (Africa CDC) told a media briefing on Thursday.

“I was shaking, to be honest with you, when there was this US pause regarding the [Marburg] response in Tanzania,” Kaseya admitted. “And if we talk about mpox, we have a pledge of $500 million from the US. We got around 60% from what the US committed, and we are waiting for this 40%.”

However, Kaseya expressed gratitude that the US had exempted “life-saving humanitarian assistance” from the 90-day pause. The US State Department has defined humanitarian assistance as “core to life-saving medicine, medical services, food, shelter, and subsistence assistance, as well as supplies and reasonable administrative costs as necessary to deliver such assistance”. 

Africa CDC is waiting to engage with the US about its financial assistance once the appointment of the US Secretary for Health and Human Services (HHS) is finalised and the head of the US CDC is appointed. Trump’s HHS pick, Robert F Kennedy Jr is currently in Senate confirmation hearings.

Uganda reports Ebola – and maybe DRC too

Uganda announced an Ebola outbreak on Thursday, following the death on Wednesday of a 32-year-old male nurse in Kampala after five days of illness.

Uganda has set up an incident management team and is tracing 45 contacts, mostly people working in Mbale Hospital in eastern Uganda and Abubakar Islamic Hospital in Kampala.

Kaseya said that there was also a possible Ebola outbreak in DRC where seven out of 12 suspected cases had died. Samples from five of the cases have been sent to a laboratory in Kinshasa for diagnosis.

Conditions in war-torn Goma ripe for epidemic

Kaseya expressed deep concern about people in Goma, the capital of DRC’s North Kivu province, which was taken over by Rwandan-backed M23 rebels this week.

Hundreds of people have reportedly died and the city is without water, electricity and the internet. 

However, Kaseya said there was a high risk of multiple health outbreaks in the heavily congested city, home to up to three million people including almost one million who have fled fighting elsewhere.

“We are talking about an area where so many people are together. Health infrastructure is broken. Access to basic services, even water and sanitation, doesn’t really exist. In addition to mpox, we have cholera outbreaks, measles and other diseases. I’m calling on our leaders to stop this unnecessary war that already killed 300 people. The guns cannot kill all of us, but outbreaks can.”

Kaseya said he did not know whether Goma’s health laboratory had been affected, and if it had been destroyed in fighting this would affect the country’s disease surveillance.

The rebels control the airport, so the L16 mpox vaccines donated by Japan that recently arrived in the DRC’s capital, Kinshasa, can’t reach Goma at present.

Meanwhile, mpox continues to dominate the outbreak statistics on the continent with almost 10,000 suspected cases reported in the past week along with 85 deaths. The one bright spark, however, is that Burundi has finally agreed to start vaccinating its citizens after months of scepticism.

Africa CDC is also supporting Angola to address a cholera outbreak that had already killed 51 people and infected around 1200 people. Some 2000 cholera vaccines will reach  Angola on 7 February. 

‘Difficult times’

“We are facing a very difficult moment. Western countries are decreasing their aid budgets,” said Kaseya, noting that in 2023, the US gave Africa in $8 billion in assistance, mostly for health and humanitarian assistance. 

“African countries are facing a tough economic situation. Projection from Africa CDC shows that we can expect two to four million additional deaths per year by 2025, which will push 39 million people into poverty, and reverse even the gain in mortality almost comparable to what we had 25 years ago,” said Kaseya.

“All of these conditions can lead one day to a pandemic from Africa. And if there is a pandemic from Africa, all of us in the world will be affected.”

African leaders are meeting on 14 February at the invitation of Rwandan President Paul Kagame to discuss more sustainable financing for health.