HARARE, Zimbabwe (AP) — A new and deadly Ebola outbreak in Congo and Uganda is the latest health emergency forcing African governments to break free of dependency on global donors like the United States as international support has been slashed in half over the past five years.
Shrinking assistance worsened by the Trump administration's sweeping cuts is colliding with Africa's fast-growing population of over 1.5 billion people. The Ebola outbreak of a strain with no approved therapeutics or vaccines comes days after a rare hantavirus outbreak on a cruise ship put officials on the continent on alert.
Africa faces "an equally dangerous threat" of funding, Dr. Jean Kaseya, director-general of the Africa Centers for Disease Control and Prevention, said while launching an initiative for African self-reliance in health financing earlier this year.
"Every time we have an outbreak, many countries start to ask for partners because they don't have in their budgets funding to respond, even to prepare for these outbreaks," he added during a briefing on the new Ebola outbreak.
But African nations know that must change.
The Africa CDC says the continent now faces "an unprecedented financing crisis."
It says official development assistance has dropped sharply, from about $26 billion in 2021 to around $13 billion in 2025, as wealthy nations turn attention instead to wider geopolitical issues like the Iran war and domestic pressures.
African leaders for years had pledged to better finance their own health systems, but commitments remained on paper. In 2001, countries committed to allocating at least 15% of national budgets to health, yet only Rwanda, Botswana and Cape Verde are on track out of Africa's 54 nations.
"The conversation was somehow theoretical because the donor system was still functioning," said Dr. Alex Ajangba, a health financing expert and co-editor of the new African Journal of Health Economics, Systems and Policy. "But now that cushion is gone."
He added: "What we are seeing here is not a temporary dip of donor funding that we will recover from."
Governments are accelerating efforts toward "health sovereignty," with aspirations to finance and manage systems with far less reliance on external aid.
Initiatives like Ghana's "Accra Reset" launched in September, and the Africa Health Security and Sovereignty Agenda, adopted by African leaders in February, aim to strengthen long-term resilience.
Health ministers are proposing domestic solutions, including higher taxes on tobacco, alcohol and sugary foods, pooled procurement of medicines to lower costs, expanding local pharmaceutical and vaccine manufacturing and tackling inefficiencies.
The need is stark. Africa imports more than 90% of its health commodities such as vaccines and medicines, while health emergencies — from mpox to cholera to Ebola — surged from 153 outbreaks to 242 between 2022 and 2024, according to the Africa CDC. It wants the continent to produce 60% of its vaccines by 2040.
"The word 'health sovereignty' has become a phrase that is used in almost every continental policy meeting right now," Ajangba said, warning it risks being just a "slogan."
Experts say the continent has plenty of wealth. Africa holds about 30% of the world's mineral reserves, including those essential to technology and renewable energy, yet much of that value is lost through opaque or weak contracts, illicit financial flows, debt burdens and limited local processing of minerals that are largely exported raw, Ajangba said.
The continent loses about $40 billion annually to illicit financial flows in an extractive sector that includes mining, gas and oil, according to the United Nations Economic Commission for Africa.
Aside from tackling those issues, another key pillar of African nations' transition away from aid dependency is co-financing, requiring countries to contribute more alongside donors.
Gavi, the global vaccine alliance, says lower-income countries contributed a record $302 million toward vaccines in 2025, and about $1 billion over the past five years.
"This creates predictability," Gavi chief executive Sania Nishtar told The Associated Press. "Reliance on aid for basic services does not."
But the shift can be contentious. The Trump administration has pushed co-financing as a key condition of the "America First" health deals it has agreed with nearly two dozen African nations. They reinvent aid to Africa by requiring countries to increase domestic spending within a specified time or risk losing support.
Some countries have rejected the proposed deals, outraged over U.S. requests for sharing of health data with no promises that nations will receive any benefit from it. Others criticize proposed swaps of health support for natural resources.
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Though most governments say Africa needs to move toward self-sufficiency, critics say some of the U.S. conditions place unrealistic pressure on already strained economies.
"They are being set up to fail," said Asia Russell, executive director of Health GAP, an international advocacy group. "When an administration says, 'If you don't hit these numbers, you're not going to get resources anymore,' that is extremely serious."
Many African countries are under mounting debt burdens. Already, about 40% are spending more on debt than health.
"Many of these countries have huge debt service and other challenges," said Jen Kates, a senior vice president at the nonprofit KFF, which focuses on health policy. "At the end of the day, it's going to be people who live in those countries who will feel the effects."
Africa's debt has surged to about $1.2 trillion, according to the African Export-Import Bank, forcing brutal trade-offs. Debt servicing consumes roughly 19% of government revenue in sub-Saharan African countries, according to the United Nations.
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