Congolese doctor Jean Kaseya: "We face a serious risk of a pandemic from Africa."

The collapse of USAID, the US aid agency and the world's largest donor, along with the withdrawal of funds from other European countries, has placed Africa in a mirror reflecting its level of dependence on foreign aid , especially in health care. Now, the cuts usher in a new era, in which African governments are being forced to redefine their priorities, according to Congolese doctor Jean Kaseya, director of the African Union's Centers for Disease Control and Prevention (CDC).

For Kaseya (Kinshasa, 54), as for many African experts and leaders, this crisis is both an opportunity to distance themselves from external agendas . He is optimistic, but also aware that the short-term consequences are already catastrophic. “The sudden cuts are a bad decision by Western countries because they are not prepared for the transition,” he said on the sidelines of the Mo Ibrahim Foundation's annual conference, held last weekend in Marrakech. He warns that the lack of healthcare resources increases the risk of a new pandemic, this time originating in Africa.

Question: The West has turned off the development aid tap. There are estimates that millions of lives will be lost, but in Africa, it's also seen as an opportunity to become independent of the foreign agenda. Is this realistic?

Answer: In a crisis, you can decide to cry, but you can also decide to see it as an opportunity. Africa is severely affected by the aid cuts, but above all, by the suddenness of the decision. In Africa, between 30% and 40% of the population pays for their healthcare out of pocket because they don't have health insurance. The second source of health funding is external support. It's key because it funds critical programs, especially for HIV , tuberculosis, malaria, and mental and child health. The [African] governments decided to outsource these programs.

Q. And what do African governments finance?

A. The national budget is the third source of funding, which was partly used to pay the salaries of health workers, but which did not contribute to investing in the health system.

P. Until the cuts came.

A. The cuts were abrupt, but the feeling that the aid system was coming to an end was increasingly present. The starting point for me was the outbreaks of monkeypox and the Marburg virus. I saw that some of our partners, who had previously come forward proactively to provide support, failed to do so.

Q. How can Africa fill the donor gap?

A. We still have middle-income countries that contribute less than 5% to their healthcare systems and could do more. We must maximize the money to dedicate to healthcare. For example, the Democratic Republic of Congo has decided to allocate 2.5% of citizens' salaries to the healthcare system. In South Africa, they decided to impose a tax on tobacco and sugar. Healthcare wasn't the priority area for many governments, which did fund other areas, including the military. But now we have to say: let's reallocate some funds to healthcare. From my conversations with heads of state, I think things are moving in African countries.

Q. There are, however, countries, such as Kenya, where taxes have sparked strong protests among the younger, more hopeless generation.

A. It can't be a top-down decision. People need to be involved and know that the money raised by taxing sugar, for example, will be used for health. We need to involve the population in management; we can't continue with the poor governance we previously had in Africa. The aid cuts show us that we need to improve our governance. We have to combat corruption and fraud and make the most of the little money still coming in from external partners; we don't need more than 30% of what we're receiving in foreign aid.

Q. What do you mean when you talk about improving governance?

A. When the ministers we meet with are asked about the healthcare resources they need, most of them are unable to answer this question because external partners tell them, "We have money for you." That's the problem. Some countries were told, "Don't worry about the vaccine, or HIV. We have to rethink the system and invest in health." And then we have to tell our partners, "If you want to come to my country to invest or provide support, align yourself with my vision."

Some countries were told: don't worry about the vaccine, or about HIV. We need to rethink the system and invest in health.

Q. That's in the medium term, but while key treatments, for example, antiretrovirals, are being discontinued.

A. Obviously. In South Africa, for example, the government isn't acting quickly enough, and in this vacuum, many people are going to suffer greatly.

Q. There's a lot of talk about the next pandemic. Do funding gaps and the climate crisis increase the risk?

A. We face a significant risk of a pandemic originating in Africa. First, we see a 41% increase in outbreaks from 2022 to 2024 in Africa. And even in 2025, the first quarter will double what we had in 2024. Monkeypox, cholera, Marburg, Ebola, measles…

Q. To what do you attribute this?

A. The first reason is the lack of basic products. We don't have medicines, we don't have vaccines, we don't have diagnostics. The second reason is the lack of adequate human resources. The third reason is the lack of a digital system, because if countries and regions aren't connected, you don't know what's happening. If there's an outbreak somewhere, but you have the information, you can contain it and delay the onset of a pandemic. But if you don't know, this outbreak will continue.

Q. Didn't we learn anything from the COVID pandemic?

A. As outbreaks increase, we continue to rely on medical products from other countries. And with aid cuts, we're reducing our ability to purchase essential products and pay our health workers, and thus, we're moving toward a pandemic. That's why we're accelerating the local manufacturing program for diagnostics, vaccines, and treatments.