Pathogens, Power and the Price of Aid: Why Africa Must Stand United
Nelson Aghogho Evaborhene argues that Africa must choose between fragmented dependency or sovereign cooperation.
As African countries consolidate post pandemic gains as envisioned in the New Public Health Order, now framed as Africa’s Health Security and Sovereignty Agenda, major donors are rewriting the global health rulebook. The United States’ retreat from the World Health Organization, Europe’s shift toward militarized spending, and Washington’s new bilateral requirements under the long term PEPFAR arrangement have created a market where data is currency, and the continent is expected to pay without guarantees. Demanding rapid specimen and genome sharing in exchange for health aid, with no binding assurances for access to countermeasures during emergencies, is not partnership. It is extraction dressed as cooperation.
Analysts have already flagged several loopholes in the emerging agreement. For instance, U.S.-led specimen sharing agreements tie aid to rapid provision of pathogen samples but contain vague terms like “developed primarily from” and “best efforts”, leaving no binding guarantee that African countries will gain timely access to vaccines, therapeutics, or diagnostics derived from their own data. Even if signatories comply fully, the U.S. prioritizes its domestic needs first. These conditions, set to persist for 25 years, are part of a wider transformation of global health policy under the America First Global Health Strategy, imposed just as the world attempts to build a fair multilateral system for pathogen access and benefit sharing.
The result is a dangerous gap. In May 2025 WHO member states adopted the Pandemic Agreement after 3 years of complex negotiations. While hailed as a “victory for public health, science, and multilateral action”, the Agreement cannot take effect until the pathogen access and benefit sharing system (PABS) annex under Article 12 is fully operational. Negotiations on PABS are expected to conclude by May 2026. The COVID-19 pandemic demonstrated why this framework is essential: when rules are unclear, equity disappears the moment a crisis begins.
African leaders understand these risks. In April 2024 they issued a joint warning that without a multilateral mechanism the continent would repeat the injustices of COVID-19. In August 2025 Africa CDC gathered national negotiators to sharpen a common position. Despite this clarity, fragmentation is rising fast. A recent report indicates that the U.S. government has begun its first round of negotiations for bilateral health agreements with 16 African countries. While it remains unclear how governments will respond, these new demands could undercut the African Union’s (AU) collective diplomacy at the precise moment when unified leverage is essential. Countries now face a dilemma: how to meet immediate needs without sacrificing continental leverage in global negotiations.
These pressures introduce significant uncertainty as health systems already under strain may be tempted to bypass continental and global coordination to secure quick aid. The consequences of reduced funding are severe. A modelling study in The Lancet HIV suggests that a 24% percent drop in global HIV financing combined with reduced PEPFAR engagement could lead to millions of new infections and almost 3 million additional deaths in low- and middle-income countries by 2030. Across Eastern and Southern Africa, reductions in funding have already triggered worker retrenchments, halted outreach programmes, and destabilised services.
Although these challenges have triggered continental introspection, including the Accra Reset and rising domestic investment in health, progress remains uneven. Many states still fall short of the Abuja target of allocating 15% of national budgets to health, and debt servicing continues to suffocate already narrow fiscal space. These pressures not only erode public trust but also create political incentives for governments to chase short term gains that satisfy electoral cycles rather than commit to long term continental and global priorities.
Even under these constraints, the pandemic proved that coordinated governance can deliver tangible gains. COVID-era investments expanded real capability across the continent. Over 70 percent of AU member states now have domestic sequencing capacity, and more than 170,000 SARS-CoV-2 genomes have been shared. The Pathogen Genomics Initiative (PGI), established in October 2020 by Africa CDC, has already demonstrated its value in enabling rapid detection of Mpox and supporting multiple outbreak responses. In November 2025, Africa CDC together with the African Society for Laboratory Medicine, and Member States launched the Africa Genome Archiving for Response and Insight (AGARI), a continent wide platform for genomic data sharing designed to accelerate public health decision making.
These efforts mark a significant step toward scientific self-reliance, but technical capability is insufficient without consolidated governance. In an era where data is power, leverage comes from authority. Africa CDC, the African Medicines Agency, and the African Union Commission must consolidate these under a continental PABS Secretariat or an equivalent regional body. At the same time, African negotiators must insist on its explicit inclusion within the PABS annex, with joint oversight by these continental institutions. Whether the Secretariat becomes operational first or is legally codified first is irrelevant. What matters is securing a body with binding authority under the Pandemic Treaty to coordinate pathogen access and benefit sharing and anchoring it in AU legal instruments to lock alignment with continental priorities.
Functioning as a regional hub, the Secretariat would integrate Africa’s scientific, regulatory, and manufacturing capabilities into the global PABS system. It could link the PGI, AGARI and RISLNET to global digital ledger systems, track pathogen sharing and benefit flows, and advocate for equitable access to vaccines, therapeutics, and diagnostics. This would ensure timely and transparent implementation of treaty obligations during emergencies.
By acting as the interface between Africa’s regional capacities and the global PABS framework, the Secretariat would foster local ownership and safeguard continental interests. Aligning its work with systems such as the Global Supply Chain and Logistics Network under the Pandemic Agreement, together with continental bodies like the AfCFTA, the Africa Medical Supplies Platform, the Africa Pharmaceutical Technology Foundation, and the Regional Economic Communities, would anchor Africa’s leadership in pandemic governance, equitable countermeasure distribution, and integrated value chains. This alignment also advances Agenda 2063 goals related to inclusive growth and industrial development.
Ultimately, this approach not only strengthens the continent’s health security, but also stabilizes the global system. WHO remains one of the few bodies capable of enforcing rules amid bilateral pressure. A united Africa therefore gives WHO a coherent regional bloc to negotiate as one, while WHO provides legitimacy and visibility to resist bilateral demands that would undermine African bargaining power. This is a strategic exchange, not charity.
Signs of continental resolve are already visible. Zimbabwe, speaking for 50 African countries during the PABS annex negotiations, insisted that all materials and sequence information must flow through WHO systems. The Elders have issued the same warning, cautioning that “parallel systems created through bilateral agreements should not undermine the foundations of global preparedness and response being built at the multilateral level.” Their message is unambiguous, and it reinforces the continent’s position.
But unity requires incentives. Early signatories should gain priority access to African-made countermeasures during crises. Alignment with continental regulatory frameworks should unlock faster review timelines. Membership should provide routes to pooled research funds, national allocations, and priority access to regional sequencing hubs. Technical teams can reinforce national regulators to ensure benefit sharing builds real, lasting capacity. Unity also demands credibility. Continental bodies must earn trust through transparency and accountability. Africa CDC’s situation reports during COVID-19 and Mpox built confidence through clarity and consistency.
The continent must also wield narrative power. During the COVID-19 TRIPS waiver campaign for instance, India and South Africa reframed a technical debate as a question of fairness and human lives. Even though the result was limited, the narrative shifted global expectations about the responsibilities of states during emergencies. Continental institutions, academia, civil societies and advocacy groups can apply that lesson by exposing the risks of unilateral agreements that require pathogen sharing without reciprocal benefit. Framing these issues as matters of sovereignty and equity strengthens continental influence in global negotiations and reinforces position in shaping fair, enforceable pandemic governance.
Recent experience underscores the urgency. South Africa’s rapid reporting of Omicron triggered travel bans instead of support. Accepting new aid conditions that repeat this dynamic would trap the continent in dependency. A united continent backed by strong institutions and pooled investment can force a fairer global system.
As geopolitics continue to erode collective action, the choice is absolute. Fragmented dependency or sovereign cooperation. In this new era, control over data, production, and scientific knowledge will define the future of global health. Africa must choose unity.
Nelson Aghogho Evaborhene is a PhD Fellow in Global Health Governance at the Centre for Interdisciplinary Study of Pandemic Signatures, Roskilde University.
Photo by Cardoso Lopes Lopes
