Protecting populations through stronger health security
A heavy and persistent burden
Recurrent, overlapping and interconnected emergencies continue to threaten health, disrupt services and deepen vulnerabilities across the Region.
For the African Region, the period 2025-2026 was not a year of isolated outbreaks set against a calm baseline; the baseline was recurrent emergency. The Ebola virus disease (EVD) outbreak in Bulape, followed by the Bundibugyo Ebola virus disease (BVD) outbreaks in the Democratic Republic of the Congo and Uganda, unfolded in parallel with cholera, mpox, Marburg, meningitis, dengue, floods and humanitarian crises. These were among more than 120 public health emergencies recorded each year in the Region, 80% of them outbreaks and the remaining 20% humanitarian crises (1).
In 2025, more countries were affected by cholera than in any of the previous three years, with 245 472 cases, including 5344 deaths – a case fatality ratio (CFR) of 2.2% – recorded in 24 countries (2), reversing progress towards the 2030 cholera elimination targets. Between July 2025 and June 2026, mpox continued to spread, reaching 21 306 confirmed cases and 121 deaths – a CFR of 0.6% – in 30 countries, despite the lifting of its PHEIC status in 2025. Other outbreaks were equally significant, including Lassa fever, dengue, Rift Valley fever and diphtheria, alongside climate-related events such as floods and cyclones affecting East and Southern Africa.
In September 2025, the 2024 amendments to the International Health Regulations (IHR) entered into force in 46 African Member States. Furthermore, the hantavirus cluster aboard a cruise ship in May 2026 drew 23 IHR National Focal Points across four continents into a coordinated response — a clear demonstration of IHR compliance. Preparedness capacities are strengthening as countries respond with growing independence, and the response itself is more agile: the Ebola outbreak in Bulape was controlled within 88 days. The current BVD outbreak, however, is a stark reminder of how much more complex it is to manage public health emergencies that overlap with armed conflict.
The Region’s contribution to the “ protect health” mission of the Fourteenth General Programme of Work (GPW14) centres on preventing, preparing for, detecting and responding to health emergencies to ensure that a shock in one community is not replicated as a catastrophe across many. These efforts share one unifying logic with the rest of the report: capacity built for an emergency is built to last. Drawing on the primary health care platform that delivers routine care, the workforce mobilized for an outbreak, the laboratory network that sequences a poliovirus and the surveillance system that catches an event early all continue to serve the population once the emergency has passed.
This chapter sets out how this was possible, across six result areas: strengthened emergency preparedness; collaborative surveillance and early warning, rebuilt under the 2024 IHR amendments; faster outbreak control, with a workforce that became deployable across borders within hours and left permanent capacity behind; a polio infrastructure that now protects the Region against far more than polio; a One Health response to antimicrobial resistance that has kept today’s medicines effective and continuity of essential health services.
Against the landscape set out in Chapter 1, the WHO Regional Office for Africa worked with Member States to build capacity that would last. The institutional reforms that underpinned this response are explored in Chapter 5, the financing on which it depends is carried in Chapter 6, and the resilience agenda it feeds is detailed in Chapter 7.
01Countries are prepared to tackle public health threats and prevent cross-border spread of pathogens
This section reports on the Region’s contribution to the prepare and respond functions of the “ protect health” mission: putting in place the legal frameworks and preparedness capabilities needed to identify and prevent high-risk hazards, measuring preparedness capacities, and identifying the priorities that protect health and limit the socioeconomic consequences of emergencies.
Key results
State Party self-assessment annual reporting (SPAR) was completed in full for the ninth consecutive year: the regional core-capacities average rose from 42% in 2018 to 51% in 2025, with the largest gain in the surveillance domain. The details of IHR implementation in Africa are set out in the Region’s first annual IHR report.
41 of 47 Member States (87%) completed a second-round Joint External Evaluation (JEE) of IHR core capacities, with 10 countries achieving level 3 (developing capacity) or higher in 2025, compared with just one in 2016; only three countries remained at the lowest level of capacity (level 1) in 2025, down from 27 in 2016. Forty-one countries used their JEE results to develop national action plans for health security (NAPHS), and US$ 225 million in Pandemic Fund resources was mobilized to strengthen IHR core capacities.
Eleven more countries (bringing the total to 35) identified their hazard risk profiles using the Strategic Toolkit for Assessing Risks (STAR) during the reporting period. An innovative Preparedness Data Exchange (PDX) — an AI-enabled Integrated Preparedness Intelligence system serving as an all-hazards early-warning platform integrated with anticipatory and predictive action — was developed and now covers all 47 countries.
By June 2026, 19 countries (up from five in 2023) had identified their Priority Areas for Multisectoral Interventions (PAMI), a prerequisite for cholera elimination and preventive vaccination; 24 454 867 doses of oral cholera vaccine were delivered in 11 countries, and 2 332 368 people were vaccinated against mpox in 17 countries. For EVD, 52 010 vaccine doses were delivered to the Central African Republic to support preventive vaccination of health and front-line workers, while 48 090 doses were delivered to the Democratic Republic of the Congo to support outbreak-response vaccination.
Country spotlight
Ghana
domesticated the 2024 International Health Regulations amendments inside its universal health coverage legislation, in a single legislative package rather than two separate processes. The Region is now actively promoting this model, as it aligns the legal basis for health security with the legal basis for health financing, ensuring that both preparedness obligations and the funding to meet them are written into law.
02All 47 Member States transform their surveillance and laboratory systems for faster detection
This section reports on the Region’s contribution to the prevent and detect functions of the “ protect health” mission: the surveillance and early-warning capacity, built under the IHR amendments, on which everything else rests. The practical payoff shows up where it matters most — in how quickly events are now detected.
Key results
The strategic toolkit for assessing risks was applied in 11 additional countries, a 13% increase compared to 2024. The Region also developed the AI-enabled Preparedness Data Exchange, which links hazard, preparedness and health-system data, accompanied by the first expert consultation on AI for health emergencies to be held in Africa.
All Member States now have sequencing capacity. Sequencing output has grown accordingly: for COVID-19, from fewer than 5500 sequences in 2020 to more than 183 500 in 2025; for mpox, from fewer than 500 sequences in July 2024 to more than 2700 in November 2025.
The completeness of integrated disease surveillance and response rose from 70% in 2024 to 94% in 2025 across 46 Member States, with timeliness ranging from 55% to 66%; the centralized integrated disease surveillance and response platform is now in use in 40 Member States (85%), with 24 countries trained in advanced outbreak analytics, collaborative analytics and modelling.
The Emergency Preparedness and Response Laboratory Unit of the WHO Regional Office for Africa significantly advanced the strengthening of laboratory systems and diagnostic capacity across the Region, through targeted laboratory assessments, rapid diagnostic scale-up, quality-assurance initiatives and expanded genomic surveillance.
03Faster responses to public health emergencies, leaving behind stronger national capacities
During the reporting period, July 2025 to June 2026, WHO supported Member States across the African Region to respond rapidly to public health emergencies by drawing on national, regional and global capacities. This support was aligned with the priorities of the Protect pillar of GPW14, the Regional Strategy for Health Security and Emergencies 2022– 2030, and the WHO Emergency Response Framework. It focused not only on containing outbreaks and reducing the health impact of emergencies, but on ensuring that response investments also strengthened national systems, sustained essential health services and improved readiness for future shocks.
Africa accounted for an estimated 45% of the global humanitarian caseload, with about 134 million people in need in 2025 (3). Following a record 167 million Africans who faced acute food insecurity in 2025, an estimated 120 million people are projected to experience crisis-level food insecurity across the continent in 2026 (4). Within the Region, 18 countries were classified as fragile, conflict-affected and vulnerable, with 11 Health Clusters in response mode, meaning that outbreak control, humanitarian health coordination and continuity of essential services had to be managed together, particularly in areas affected by conflict, displacement, food insecurity and climate shocks.
Key results
Additional data for July 2025 to June 2026 indicate that H3 package implementation increased from 50% to 83%, while the Health Resources and Services Availability Monitoring System tracked 26 354 service-delivery units across 9865 health facilities.
There were 1300 AVoHC-SURGE deployments in 2025 – 1218 national and 82 international – alongside 489 additional responders trained in eight countries, and 40 African institutions now active in the Global Outbreak Alert and Response Network (GOARN).
The multi-country cholera response achieved measurable gains despite continued transmission risk. Cholera remained widespread, with more than 245 000 cases and 5238 deaths reported across 24 countries during 2025–2026; integrated response actions nonetheless drove the reported case fatality ratio down from 2.01% to 1.14% by the end of 2025. Between the third and fourth quarters of 2025 alone, the case fatality ratio fell from 2.46% to 1.57% and deaths fell by 65%, despite continued transmission. Nearly 30 million oral cholera vaccine doses were administered, integrated with surveillance, case management, water, sanitation and hygiene (WASH) and community-level interventions. Cholera was successfully contained in Chad (8), Namibia, Rwanda, the United Republic of Tanzania, Kenya, the Republic of the Congo, Zambia and Angola, with significant reductions in cases reported in South Sudan.
In fragile, conflict-affected and vulnerable settings, implementation of the H3 Essential Health Services Package increased service availability from about 50% to more than 80%, with several countries reaching at least 90% coverage. WHO and its partners supported the continuity of essential services through 9865 health facilities in 18 fragile settings, reaching more than 23 million people in 2025 (6).
National and regional surge capacity also expanded significantly: through African Volunteers Health Corps (AVoHC)-SURGE, more than 2600 responders were trained across 32 countries, and 26 countries activated national rosters.
The mpox response moved from emergency control to transition and integration. Following sustained regional and continental effort, the WHO Director-General determined on 5 September 2025 that the mpox upsurge no longer constituted a PHEIC (7). The Democratic Republic of the Congo subsequently declared the end of its national outbreak, and the continental mpox Incident Management Support Team was deactivated, bringing to a close a response of nearly two years.
Regional logistics capacity underpinned the speed of the emergency response. The annual report records nearly US$ 5 million in life-saving commodities moved through the Nairobi and Dakar hubs in 2025; draft RC76 data further indicate 218 inbound shipments valued at more than US$ 4 million, 240 outbound deployments valued at US$ 9.39 million, and emergency procurement exceeding US$ 9 million across 24 countries through 377 purchase orders that were issued between July 2025 and June 2026.
WHO AFRO Regional Director’s visit of the Mpox treatment centre in Bujumbura, Burundi -March 2026
Response spotlight
The mpox response demonstrated that sustained regional coordination can move large multicountry emergencies from escalation to control. The joint WHO–Africa CDC continental response aligned surveillance, laboratory support, vaccination, clinical care, risk communication, partner coordination and country support within a single operational framework. This contributed to a 61.5% reduction in cases from earlier peaks and supported the delivery of more than 1.17 million vaccine doses across affected countries. Testing coverage improved from 57% in 2024 to 66% in 2026, reflecting strengthened laboratory capacity (12).
The lifting of the mpox PHEIC in September 2025, the closure of the national mpox emergency response in the Democratic Republic of the Congo, and the deactivation of the continental Incident Management Support Team (IMST) marked a transition from emergency response to sustained surveillance, readiness and integration into routine systems.
Country spotlights
Democratic Republic of the Congo
The Ebola virus disease outbreak in Bulape Health Zone, Kasai Province, illustrated how an emergency can help strengthen longer-term resilience. Declared on 4 September 2025 and officially over on 1 December 2025, the outbreak resulted in 64 cases, 45 deaths and 19 survivors, with a case fatality ratio of 70.3%.
The response combined early deployment, surveillance, contact tracing, vaccination, case management, infection prevention and control, logistics, community engagement and health facility strengthening. WHO mobilized approximately US$ 6 million, deployed 112 personnel, supported the verification of more than 3300 alerts, monitored over 2300 contacts, supported the vaccination of more than 45 000 people, established two Ebola treatment centres and mobilized more than 150 metric tonnes of supplies and logistics equipment (13). The treatment infrastructure included a 40-bed Ebola treatment facility and a 32-bed infectious disease treatment module.
Beyond the outbreak, the response left behind assets for the local health system. Investments in water supply, solar power, treatment capacity and logistics strengthened Bulape General Hospital, including a 2.5 km water pipeline, water storage capacity of more than 20 000 litres (14) and solar power support.
These investments supported the outbreak response and will continue to support future emergency readiness and routine care.
This experience shows the value of a response-to-resilience approach. The same investments that helped stop transmission also strengthened water, power, treatment, logistics and workforce capacity in the affected district. This should become standard practice after major outbreaks.
Ethiopia
Ethiopia’s first Marburg virus disease outbreak was contained in less than three months through strong national leadership and rapid WHO support (15). The Ministry of Health and the Ethiopian Public Health Institute activated national and regional public health emergency operations centres (PHEOCs), strengthened surveillance and contact tracing, designated treatment centres, deployed a mobile laboratory in Jinka and engaged communities. WHO supported all response pillars, including coordination, laboratory diagnostics, case management, infection prevention and control, safe and dignified burial, logistics and risk communication.
The outbreak resulted in 14 confirmed cases, including nine deaths and five recoveries, with five additional probable deaths (16). WHO activated its emergency response within 24 hours, deployed 36 experts and repurposed 28 staff to reinforce field operations. The response was further enabled by Ethiopia’s prior investments in public health preparedness, including strengthened laboratory capacity, disease surveillance systems, a trained surge workforce and established coordination mechanisms through the PHEOC. Supported through initiatives such as the Ethiopian Pandemic Multi-Sectoral Prevention, Preparedness and Response Project and the AVoHC-SURGE programme, these capacities enabled early detection, rapid scale-up of diagnostics, timely deployment of responders and continuity of essential health services.
Floodwaters Contaminate Medical Supplies at Chókwè Rural Hospital, Mozambique –February 2026
Mozambique
As climate change increases the frequency and intensity of floods and other extreme weather events, climate-related emergencies are becoming a recurrent health security risk, requiring stronger preparedness, surveillance and continuity of essential services. In Mozambique, WHO supported the government-led response to floods that affected more than 720 000 people across six provinces and Maputo City. Support included coordination at national, provincial and district levels, prepositioning of essential supplies, strengthened disease surveillance, and deployment of rapid responders and a medical coordinator to sustain care in accommodation centres.
As the response shifted to recovery in Gaza Province, WHO supported efforts to restore and sustain health services in affected areas. The floods affected 100 health centres, including 20 that were flooded and 23 that were temporarily closed, while 710 health workers were directly affected (17). WHO deployed a health emergency officer and Health Cluster coordinator, shipped 9 tonnes of essential medicines and supplies for cholera prevention and treatment, and supported daily digital reporting from more than 160 health units to strengthen early detection and reduce the risk of secondary outbreaks.
04Resilience: continuity of essential health services protected populations during emergencies
The Region does not return to a quiet baseline between emergencies. As the regional outlook shows, more than 120 public health emergencies are recorded each year, four in five of them disease outbreaks, and during the reporting period many occurred concurrently rather than in sequence. Recurrent emergencies have become the operating environment, not the exception. Resilience is therefore reported here as a result in its own right.
This persistent burden coincided with a period of financial contraction, and the evidence is consistent: weak systems cannot be resilient (18). Systems absorb shocks through the everyday capacities already in place before the shock – governance, financing, workforce, information and service delivery – rather than through structures raised after the event (19). A 2026 scoping review of health system resilience in Africa identified the same foundations, while also highlighting trusted community engagement and adaptable infrastructure as additional pillars or resilience (20). In a period of financial contraction, the implication is practical: the Region neither needs nor can afford a parallel emergency architecture.
The Region’s answer is therefore to ensure that every response delivers a double dividend. In Bulape, for example, the Ebola response left more than 20 000 residents with improved access to safe water, solar power and a rehabilitated emergency operations centre after the outbreak had ended – a double win under the Region’s Framework for sustaining resilient health systems to achieve universal health coverage and promote health security, 2023–2030 (21). Communities carry that resilience: the engagement built during a response is what sustains detection and care between them. Recovery feeds preparedness, and preparedness strengthens the next response. It is that loop, rather than the speed of any single activation, that turns a sequence of responses into a system that grows stronger over time. For ministers, the conclusion is concrete: in a contraction, the cheapest preparedness available is the capacity that the last response has already paid for. The priorities below make that principle standard practice.
05Polio infrastructure now protects the Region against far more than polio
This section reports a result that lies at the heart of the “ protect health” mission and extends well beyond it. Africa remains free of indigenous wild poliovirus, and despite a 30% reduction in global polio financing during the reporting period, the Region still drove transmission down for a third consecutive year. This progress was sustained through country-led emergency operations centres under direct Ministry of Health leadership and the rapid deployment of response teams within 72 hours of every confirmed outbreak. The infrastructure built to find and stop poliovirus – surveillance networks, laboratories and rapid-response teams – has become a shared backbone for detecting and responding to many other threats.
Key results
Nine circulating vaccine-derived poliovirus type 2 outbreaks were interrupted within two to three campaign rounds in Burundi, the Republic of the Congo, Gambia, Ghana, Guinea-Bissau, Liberia, Mauritania, Sierra Leone and Uganda. Mozambique has recorded no virus detection since early 2024.
Fifty-three synchronized supplementary immunization activities were implemented across 17 priority countries, with 80% of targeted districts achieving high-quality coverage; more than 2400 surge personnel were deployed.
Forty-six of the Region’s 47 Member States now operate environmental surveillance systems, while 16 accredited laboratories process more than 100 000 specimens annually.
Polio-funded surveillance and laboratory networks now support the detection of measles, yellow fever, mpox and cholera, and polio rapid-response teams were deployed in support of the mpox response in the Democratic Republic of the Congo.
06Antimicrobial resistance was met with One Health governance, surveillance and stewardship
This section reports the Region’s response to the slowest-moving emergency within the “ protect health” mission. When the antibiotics that a clinic depends on stop working, ordinary medicine becomes dangerous again: a caesarean section, a child’s pneumonia or a routine surgical procedure can once again become life-threatening. During the reporting period, the Region shifted from awareness to action, strengthening the governance, surveillance and stewardship needed to slow antimicrobial resistance through a One Health approach linking human, animal and environmental health. This ties antimicrobial resistance to health security preparedness.
The Regional Office convened the Region’s One Health response through collaboration with the quadripartite partners, the Food and Agriculture Organization (FAO), the World Organisation for Animal Health (WOAH), WHO and the United Nations Environment Programme (UNEP), as well as the African Union, including Africa CDC and the African Union Inter-African Bureau for Animal Resources (AU-IBAR). It delivered training on costing and budgeting, the Tracking Antimicrobial Resistance Country Self-assessment Survey (TrACSS) and the Global Antimicrobial Resistance and Use Surveillance System (GLASS), and produced country and regional profiles to support evidence-informed decision-making. The Regional Office also conducted the Region’s first simulation exercise for antimicrobial resistance-related outbreaks; led the continental awareness week; and provided specialized technical support on antimicrobial stewardship and antimicrobial use to countries. This included an assessment of stewardship core elements across 26 health facilities in Sierra Leone that generated a replicable model. It sustained the regional evidence base by publishing analyses of resistance trends and national action plan implementation, and by contributing peer-reviewed evidence on surveillance, laboratory capacity, health care-associated infections and the role of vaccines (22–30).
Key results
Country spotlight
Antimicrobial resistance has long been treated as a laboratory concern, easy for a health ministry under pressure to defer. In 2025, the United Republic of Tanzania hosted the African continental World Antimicrobial Resistance Awareness Week, convened jointly by the quadripartite organizations and African Union institutions. In doing so, it helped move antimicrobial resistance from the margins of policy discussion to the centre of the regional health security agenda. The choice of host matters: By placing its national platform behind a continental awareness initiative, the Government of the United Republic of Tanzania signalled to Member States that antimicrobial resistance requires coordinated governance across the human, animal and environmental health sectors, and that the surveillance data now flowing from all 47 Member States enrolled in the Global Antimicrobial Resistance and Use Surveillance System are there to be acted upon.
All 47 Member States are now enrolled in the GLASS, and 33 are reporting resistance data to inform clinical and public health decisions.
The 2025 TrACSS platform achieved a 100% regional submission rate, strengthening accountability for implementation of national action plans.
Seventeen Member States strengthened their capacity to develop costed and budgeted national action plans on antimicrobial resistance, while five institutionalized antimicrobial stewardship and antimicrobial use monitoring programmes.
07Chapter 3 references (29)
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