Global Health Security: How Fragmenting Western Aid Budgets Are Reshaping Health Sovereignty in Africa

As Western governments reduce foreign aid, that imbalance is becoming increasingly difficult to ignore. The question is no longer simply how Africa will replace lost funding, but how the current situation will redefine health as an issue of sovereignty and foreign policy. At stake is a broader renegotiation of who sets Africa’s health priorities, who finances them, and how international partnerships support them.

For more than three decades, external donors financed vaccination campaigns, disease surveillance, HIV treatment, maternal health programmes, and emergency outbreak responses across the continent. This support saved millions of lives, yet it also created long-term dependence on external financing, imported medical products, and donor-driven priorities. It is imperative that Africa reconsider its approach to health funding by building domestic resilience to protect its health sovereignty.

A Global Health Financing Model Under Strain

The current funding crisis reflects a broader shift in international politics. The United States has suspended large portions of foreign aid, while several European governments have also reduced development assistance as resources shift toward domestic priorities, defence, migration, and geopolitical competition. These cuts come as African countries continue responding to recurring outbreaks of Ebola, mpox, cholera, Marburg virus disease (MVD), and malaria while managing rising debt that limits public spending.

This is more than a humanitarian funding crisis. It exposes a longstanding weakness in the global health system. Critical aspects of Africa’s health security—including financing, procurement, and pharmaceutical supply chains—remain vulnerable to political decisions made outside the continent. The COVID-19 pandemic demonstrated these risks as African countries experienced delayed access to vaccines, diagnostics, and therapeutics. Those vulnerabilities remain today, with Africa continuing to import more than 90% of its supplies in medicines, vaccines, diagnostics, and other essential medical products.

Within this changing funding environment, the Africa Centre for Disease Control and Prevention (Africa CDC) has evolved beyond its original mandate of disease surveillance and emergency response. Representing 55 member states, it increasingly serves as the African Union's principal public health institution, coordinating preparedness, supporting regional policy alignment, and strengthening Africa's voice in global health governance. Instead of viewing declining foreign aid solely as a crisis, the organization is using this moment as an opportunity to advance a broader agenda centred on health sovereignty.

The expanding role of Africa CDC reflects both necessity and strategic choices as new funding realities place greater responsibility on African governments and regional institutions. With this increased responsibility come possible risks; without sustainable domestic financing and stronger national health systems, greater institutional responsibility could reveal itself as short-term substitution for lost external funding rather than a durable shift toward health sovereignty.

Greater African ownership does not mean isolation from the international health system. Health sovereignty should not be equated with self-sufficiency. For African governments and institutions such as Africa CDC, the goal is to strengthen their ability to set health priorities and exercise greater control over health systems, while maintaining international partnerships. This approach allows cooperation with donor nations to reinforce African-defined priorities rather than determine them. In this sense, health is no longer viewed solely as a development issue, but increasingly as a strategic asset linked to economic resilience, political stability, diplomatic influence, and regional security.

The Path to a New Framework

Advancing this vision will depend on progress across three interconnected priorities. First, governments should increase domestic investment. As external assistance becomes less predictable, greater domestic investment offers African governments an opportunity to strengthen health sovereignty by reducing their exposure to shifting donor priorities and exercising greater control over how health resources are allocated. Although African leaders committed through the Abuja Declaration to allocate 15% of national expenditure to health, only three countries currently meet this target.

Second, health financing should be more diversified to make health systems more resilient. Africa CDC has proposed expanding health insurance, introducing solidarity levies, mobilizing diaspora investment, and strengthening public-private partnerships to reduce dependence on traditional aid. One proposal is to explore how voluntary mechanisms—such as diaspora health bonds and direct health insurance contributions—could leverage a portion of the US$95 billion sent home annually to support national health priorities. Public-private partnerships can similarly combine public resources and priorities with private capital and expertise; South Africa’s Biovac Institute, for example, uses such a model to support domestic vaccine production.

Finally, Africa should produce more of what its healthcare systems need. Investments in pharmaceutical manufacturing, laboratory capacity, and disease surveillance are strategic tools for economic resilience and political autonomy. Still, greater self-reliance does not eliminate the need for international partnerships. During the 2026 Bundibugyo Ebola outbreak, for instance, the World Bank’s Pandemic Fund provided $220.6 million in emergency aid to support regional containment and cross-border coordination. This demonstrates that strengthening African health systems is an investment in global security, not just an African priority.

Health Sovereignty Requires More Than Financing

Rising debt, limited fiscal capacity, corruption, procurement inefficiencies, and the misallocation of public resources continue to undermine health systems in many African countries. Simply replacing donor funding with domestic financing will not strengthen health security, unless governments also improve transparency, accountability, and institutional capacity. International partnerships will therefore remain essential, but they must reinforce African priorities rather than determine them.

The real test is not whether aid will decline—that trend is already underway—but whether African governments can pair greater ownership of health with stronger governance. Health sovereignty will ultimately depend not only on who finances health systems, but on how transparently, effectively, and accountably those resources are managed. In an increasingly fragmented world, the countries best prepared for the next pandemic are not those that receive the most aid, but those that build institutions capable of thriving when it is no longer guaranteed.

By Raquel Jakac

Editor’s Note: This article is part of the Emerging Leaders Series, featuring exceptional early-career international relations professionals whose fresh perspectives shape debates on critical global priorities.