Africa has gained nine points out of one hundred in five years in its capacity to detect and contain an epidemic. This measurable leap, where the continental average score rises from 32.4 to 41.5 out of 100 between 2021 and 2026, according to the Africa Health Security Index, says something real about what targeted investments can produce. But the index itself notes that the recent decline in American and European funding is not yet reflected in these figures, which makes the progression more fragile than it appears.
The essentials
- The average score for pandemic preparedness in Africa advances from 32.4 to 41.5 out of 100 between 2021 and 2026, a 28% gain in five years (Africa Health Security Index 2026, NTI/Science for Africa Foundation).
- South Africa illustrates the effect of targeted biosecurity investments: its score in this pillar rises from 6 to 54 in five years.
- External funding remains important, particularly in low-income countries, but the exact share of this funding in continental progress is not established by the Index. The recent withdrawal of American and European aid is not yet reflected in the 2026 data.
- Africa CDC and the African Union are calling on member states to increase sustainable domestic financing to consolidate these gains.
28% gain in five years, progress to decode
Nine points out of one hundred in five years, across a continent of 54 states with highly unequal health capacities, constitutes a measurable result. The Africa Health Security Index 2026, led by NTI and the Science for Africa Foundation, evaluates six dimensions: prevention, detection, response, health system, international standards, and risk environment. African progress touches each of these, but unevenly.
Post-Covid investments have produced measurable effects. The 2020 pandemic had highlighted deep gaps: under-equipped laboratories, fragmented epidemiological surveillance systems, absent health command chains in several countries. In response, donors—the United States via PEPFAR and USAID, the European Union via several instruments including EU4Health, HERA, and Global Health EDCTP3—injected targeted funds on early detection and training of public health personnel. The 2026 figures measure the overall evolution of capacities since 2021, resulting from investments and reforms by states, regional organizations, and partners, without isolating any particular funding wave.
South Africa’s case is the most striking. Its biosecurity score rises from 6 to 54 in five years. This is a structural transformation, not a statistical side effect: the country invested in its reference laboratories, strengthened its genomic surveillance network, a direct legacy of its capacity to sequence the Omicron variant in November 2021, and professionalized its rapid response teams. South Africa proves that a middle-income country can build a solid health architecture when investments accumulate over several years.
But this success story carries its own warning. South Africa has a tax base, scientific institutions, and a capacity for governance that the majority of continental countries do not possess. Generalizing its case to sub-Saharan Africa as a whole would be misleading.
The limits of the score
The figure of 41.5 is that of a photograph taken before the landscape changed. The index itself signals this: the withdrawal of American and European funding, begun in 2025, is not yet reflected in 2026 data.
This time lag is important to understand. Preparedness scores measure installed capacities, laboratories that exist, validated protocols, trained personnel. They do not measure the flow of funding that allows them to function. A laboratory built with USAID funds can display a high score in 2026 while lacking reagents in 2027 if operating budgets do not follow.
This is what development economists call the one-off investment trap: you build, you train, you measure capacities, and you leave. The capacity exists on paper but depends on an external flow to remain operational. The Africa Health Security Index 2026 photographs capacities; it does not guarantee their durability.
Recent signals are not reassuring. The American administration reduced PEPFAR commitments in 2025. The revision of the European financial framework reduced EU4Health by 1 billion euros, while maintaining European funding for global health initiatives. These recent reductions in public aid risk affecting health capacities, but their pace and precise impact on operating expenses are not established by this source.
The wager of fragile progress: what Norberg does not resolve alone
Johan Norberg, in his work on long-term material progress, documents with rigor how real gains—life expectancy, access to care, reduction in infant mortality—can be measured and celebrated. His argument is that progress is real, cumulative, and that catastrophism erases its reality. The Africa Health Security Index 2026 partially proves him right: 28% in five years is a fact, not an illusion.
Norberg himself acknowledges, in Peak Human, that progress remains fragile where institutions do not consolidate it. His optimism bumps up against a constraint that African data makes visible: a score that progresses on external financing differs from a score that progresses on indigenous institutional capacity. The first can reverse; the second tends to accumulate.
Daron Acemoglu and Simon Johnson, in their reading of relationships between institutions and technology, offer a useful counterpoint. Their thesis establishes that technological and health gains consolidate only where institutions distribute benefits durably. On the African continent, the challenge lies as much in institutional architecture as in financing: only this architecture transforms one-off investment into permanent capacity. Without it, each wave of aid produces reversible progress.
The two readings do not exclude each other. They jointly define the condition of African health progress: it is real (Norberg is right), and it is conditional on institutional consolidation that external financing alone cannot produce (Acemoglu and Johnson are also right).
The capacities and limits of Africa CDC
The institution that best embodies the attempt at African institutional consolidation is Africa CDC, the African Centre for Disease Control and Prevention, based in Addis Ababa. Created in 2017 under the auspices of the African Union, it gained strength during the Covid-19 pandemic and now plays a coordination role among national health authorities.
Africa CDC has real assets. It coordinated vaccine purchases through the AVAT mechanism during the pandemic, developed regional epidemiological surveillance capacities, and built a network of reference laboratories. Its director general, Jean Kaseya, presented the African Epidemic Fund as a mechanism aimed at increasing the autonomy and speed of Africa CDC financing.
But Africa CDC itself depends on external funding for a large part of its operating budget. The African Union, which hosts it, struggles to collect contributions from its member states. Several continental countries are in arrears on their dues. The institution is strong in coordination and standards; it is more fragile in autonomous financing capacity.
The gap between institutional ambition and precise budgetary reality clarifies the conditions for success. Africa CDC can become the pivot of pandemic preparedness provided that member states increase their contributions, which assumes a political decision that current figures do not allow one to take for granted.
The same tension runs through European health systems, where dependence on old institutional architectures weakens adaptive capacity. The challenge of institutional consolidation in health is not unique to Africa.
States that finance their own resilience
A few African countries have begun to internalize the logic of sovereign financing in health. Rwanda is the most documented case. The country has strengthened several preparedness capacities, but no recent national budget line explicitly dedicated to the overall improvement of these capacities is documented. Its score in the 2026 index progresses at a more regular pace than the continental average, and its trajectory is less exposed to the shock of donor withdrawal.
Ghana followed comparable logic with its health emergency preparedness fund, created in the wake of the Ebola epidemic. Kenya strengthened its National Centre for Epidemiological Surveillance with national budget lines.
These examples do not represent the African norm. But they show that the transition from external dependence to sovereign financing is possible, and that it follows an identifiable path: explicit political decision, protected budget line, strong national institution. This path demands time, and it demands that external donors continue to ensure the transition, rather than withdrawing abruptly.
Timing is determining. If the withdrawal of American and European aid occurs before states have consolidated their autonomous financing capacities, the decline in funding threatens the durability and extension of capacities, without allowing one to assert that they can no longer function.
The solidity of progress by 2032
By the horizon of 2032, the Africa Health Security Index will publish what will be, for this post-Covid investment cycle, the consolidation balance sheet. Two trajectories are plausible.
In the first, Africa CDC has succeeded in convincing its member states to increase their contributions. A dozen countries have established sovereign preparedness funds. Laboratories built with external funds operate on national budgets. The continental score crosses 50 out of 100, for the first time in a preparedness zone qualified as “adequate” by international standards. This trajectory assumes a political decision in the next two or three years, a short timeline.
In the second, the withdrawal of external funding has intensified, but the general absence of organized transition is not established. Many are the states whose health budgets do not allow them to compensate for this withdrawal. Laboratories operate at reduced capacity. Epidemiological surveillance loses sensitivity. The continental average score could plateau or progress more slowly, without the installed capacities having disappeared, they would simply be underutilized.
A next epidemic will reveal the gap between the score and actual capacity.
Between the two, the signals that will allow one to read the trajectory are readable. The first: the level of collection of member state contributions to the African Union, published each year. The second: the number of countries that create a national budget line dedicated to pandemic preparedness in their budget laws for 2026-2028. The third: Africa CDC’s capacity to raise bonds on regional capital markets, independent of bilateral donors.
These signals do not demand imaginary future figures. They demand a political decision in the present. This is what the score of 41.5 cannot measure, and what African leaders and their international partners still have the capacity to steer.
Sources
- Africa Health Security Index 2026, NTI & Science for Africa Foundation
- Johan Norberg, Peak Human, johanmorberg.se
- Daron Acemoglu & Simon Johnson, Power and Progress (2023), on the institutional conditions for the diffusion of technological gains
- Africa CDC, annual activity reports, africacdc.org
- African Union, AVAT mechanism (African Vaccine Acquisition Trust), official documentation
