U.S. withdrawal from WHO and aid programs: implications and opportunities for Africa’s global health security

Abstract

The United States has long played a central role in global health through its engagement with the World Health Organization (WHO) and through major bilateral programs, including the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Agency for International Development (USAID). These investments have contributed to health infrastructure development, disease surveillance, and the expansion of treatment and prevention programs across Africa. The recent U.S. withdrawal from WHO and the freezing of USAID funding raise concerns for infectious disease control, healthcare delivery, and global health security, particularly in settings with high dependence on external financing. This commentary argues that the U.S. withdrawal, while disruptive, should not be understood solely as a setback, but as an opportunity for African governments to assume greater ownership of their health systems and exercise leadership through deliberate political and policy choices. These include increased domestic health financing, stronger institutional governance, and enhanced regional coordination. The paper outlines pathways for sustaining donor-built infrastructure, expanding local pharmaceutical and diagnostic manufacturing, and aligning public–private partnerships with national health priorities. By strengthening domestic capacity and regional cooperation, African governments can reduce vulnerability to external funding shocks, improve outbreak preparedness, and play a more active role in shaping global health security agendas.

Introduction

The United States has played a pivotal role in global health for decades through its engagement with multilateral institutions, particularly the World Health Organization, and through major bilateral initiatives such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development. PEPFAR, launched in 2003 and coordinated by the U.S. Department of State, is implemented primarily through agencies including USAID and the U.S. Centers for Disease Control and Prevention, with USAID playing a central role in health systems strengthening, service delivery, supply chains, and laboratory capacity development across low- and middle-income countries (LMICs).

Through these mechanisms, U.S. investments have supported HIV/AIDS treatment and prevention, vaccine delivery, disease surveillance, and emergency response across Africa [1]. PEPFAR alone has saved more than 25 million lives [2], primarily through declines in HIV-related mortality achieved by the scale-up of antiretroviral therapy, prevention of mother-to-child transmission, and broader health system investments supported by the program. Beyond disease-specific outcomes, PEPFAR and USAID funding contributed to the establishment of molecular laboratory networks, initially designed for HIV viral load testing, and the deployment of platforms such as GeneXpert—a cartridge-based molecular diagnostic system used for rapid detection of tuberculosis and other pathogens. These investments also included the provision of basic laboratory infrastructure, such as hematology and chemistry analyzers, in secondary and tertiary hospitals, alongside workforce training and quality assurance systems. Collectively, these capacities were later leveraged during the COVID-19 pandemic and continue to support diagnostics for Mpox and other infectious diseases.

In parallel, the United States has been a major contributor to WHO-led initiatives, providing approximately 20% of the organization’s assessed and voluntary budget since 2022 and offering technical support for pandemic preparedness, disease surveillance, and immunization programs [1]. Through this support, WHO has coordinated global surveillance systems, facilitated real-time data sharing, and deployed rapid response mechanisms to contain outbreaks. The recent U.S. decision to withdraw from WHO and freeze USAID funding therefore marks a significant turning point. Reduced financial and technical support threatens the continuity of treatment programs, constrains laboratory operations, and weakens disease surveillance systems that are critical for early outbreak detection.

The implications extend beyond immediate programmatic disruptions. Delays in surveillance, laboratory confirmation, and coordinated response increase the risk that localized outbreaks escalate into wider epidemics, particularly in settings where health systems rely heavily on external financing for routine operations. In African countries with high donor dependence, funding freezes may translate into reduced testing capacity, slower information flow, and delayed emergency responses, thereby amplifying disease transmission and undermining global health security.

More fundamentally, this moment exposes the structural reliance of many African health systems on donor support. This commentary argues that the current disruption, while posing serious risks, also creates an opportunity for African governments to assume greater ownership of health governance and security. By shifting from aid dependency toward domestically led financing, stronger institutions, and enhanced regional coordination, African countries can work toward more resilient and autonomous health systems.

Health sovereignty and the political economy of global health governance

Discussions of health sovereignty have a long intellectual and political history in global health and development. Since at least the 1970s, many post-colonial states have articulated demands for greater control over health policy, financing, and priority-setting, often in relation to broader debates on self-reliance, primary health care, and economic development. These claims have persisted across successive development paradigms, even as the institutional context of global health has changed.

At the same time, historical efforts to advance health sovereignty have encountered significant structural constraints. Prior scholarship has shown that sovereignty in global health is not exercised in isolation, but is continuously negotiated within institutional, financial, and geopolitical arrangements that shape national policy space. For example, Walker’s work highlights how sovereignty claims are often expressed through, rather than outside of, global health institutions, where donor priorities, technical standards, and performance frameworks mediate national decision-making [3]. Earlier analyses similarly demonstrate how narratives of scarcity and efficiency have limited domestic autonomy while justifying external intervention across different phases of development policy [4].

In African health systems, these dynamics have been reinforced by debt burdens, donor conditionality, constrained fiscal space, and uneven institutional capacity. Over time, health financing has become closely tied to vertical programs and external accountability mechanisms, particularly in disease-specific areas such as HIV, tuberculosis, and malaria. While these arrangements have delivered important gains, they have also shaped national planning processes, workforce deployment, and monitoring systems in ways that can fragment governance and narrow domestic priority-setting.

U.S. influence within global health extends beyond bilateral assistance and includes substantial governance and agenda-setting roles within multilateral institutions. This influence operates through voting power and board representation in organizations such as the World Bank and the World Health Organization, as well as through leadership in vertical initiatives that shape global norms and financing priorities. In addition, U.S. engagement within regional financing mechanisms including contributions to the African Development Fund of the African Development Bank has implications for concessional lending priorities in the health sector. These institutional relationships complicate simple narratives of donor withdrawal and highlight the depth of interdependence within contemporary global health governance.

Within this context, health sovereignty should be understood not as disengagement from global institutions, but as a gradual rebalancing of decision-making authority, financing, and accountability. Advancing sovereignty requires strengthening domestic fiscal capacity, enhancing regulatory and planning institutions, and renegotiating relationships with external actors in ways that align global engagement with national priorities. The current period of funding uncertainty therefore presents both risks for health system stability and an opportunity for African governments to reassess how autonomy might be incrementally expanded within existing global structures.

Impact on global health security

Global health security relies on collective action to detect, prevent, and respond to infectious disease threats [5]. For more than seven decades, the World Health Organization (WHO) has played a central coordinating role in this effort, supporting international surveillance, outbreak response, and disease control. Through this multilateral framework, the global community has achieved the eradication of smallpox, substantial progress toward polio elimination, and major advances in the control of malaria, measles, and HIV. The withdrawal of the United States from WHO risks weakening this cooperative architecture at a time when transnational health threats are increasing.

The use of a global health security framing has been instrumental in mobilizing political attention and resources for outbreak preparedness, particularly following major epidemics [6]. In Africa, this framing has supported investments in laboratory networks, early warning systems, and cross-border coordination. However, scholars have also noted that security-oriented approaches can be analytically limiting when they prioritize emergency response and external threat containment over sustained investment in routine health systems and domestic capacity [7]. These tensions are especially relevant in settings where health sovereignty and long-term system strengthening are central policy objectives.

Africa’s vulnerability to health security threats reflects both epidemiological exposure and structural conditions that constrain response capacity. Over the past decade, the continent has experienced recurrent outbreaks of Ebola, Marburg virus disease, yellow fever, cholera, Rift Valley fever, and, most recently, COVID-19. Rapid urbanization, environmental change, deforestation, population mobility, and food insecurity have increased opportunities for zoonotic spillover and cross-border transmission. At the same time, reliance on external financing, fragmented health governance, limited fiscal space, and unequal access to vaccines and medical countermeasures have shaped the ability of countries to respond effectively during global emergencies.

The U.S. withdrawal from WHO and reductions in global health funding raise concerns not only about immediate outbreak response but also about the longer-term balance between security-driven interventions and health system resilience. Addressing global health security in Africa will therefore require approaches that integrate preparedness with domestic capacity building, public accountability, and regional cooperation, ensuring that security investments reinforce rather than undermine sovereignty-oriented health strategies.

Effects on disease surveillance and vaccine equity

Disease surveillance remains a central component of outbreak preparedness and response. The World Health Organization plays a coordinating role in global surveillance by supporting data sharing, laboratory networks, and the rapid mobilization of technical expertise. A key mechanism is the Global Outbreak Alert and Response Network (GOARN), a partnership of more than 250 institutions that has supported countries in detecting and responding to outbreaks of Ebola, Zika virus, cholera, and COVID-19. Sustained coordination through such platforms has helped reduce delays in outbreak confirmation and response, particularly in resource-constrained settings.

The U.S. withdrawal from WHO and the freezing of USAID funding risk weakening these surveillance and response mechanisms. Reduced financial and technical support may create gaps in routine testing, reporting, and cross-border coordination, increasing the likelihood that outbreaks are detected later in some countries than in others. This uneven capacity can widen disparities between countries, as those with greater domestic resources maintain surveillance systems while donor-dependent countries face constraints. Within countries, disruptions to centralized laboratories and reporting systems may also exacerbate subnational disparities, particularly affecting rural or underserved populations that rely on referral networks for diagnostic confirmation.

Vaccine equity represents a related and closely connected concern. WHO has coordinated global initiatives such as the COVID-19 Vaccines Global Access (COVAX), which delivered more than two billion COVID-19 vaccine doses to LMICs [8]. Through collaboration with the Global Alliance for Vaccines and Immunization (GAVI) and the Coalition for Epidemic Preparedness Innovations (CEPI), WHO supported regulatory approval, safety monitoring, and distribution mechanisms intended to promote more equitable access during the pandemic. These arrangements illustrated the role of multilateral coordination in mitigating disparities in vaccine availability across regions.

However, reductions in donor support threaten the sustainability of such mechanisms. Constraints on financing and coordination may deepen inequities across disease areas, as attention and resources remain concentrated on high-profile epidemic threats while routine immunization programs and preparedness for other infectious diseases receive less support. Over time, these dynamics risk prolonging outbreaks and reinforcing uneven access to countermeasures.

Taken together, weakened surveillance and constrained vaccine coordination do not simply reduce overall system effectiveness; they redistribute risk across countries, populations, and disease priorities. Addressing these challenges will require not only restoring technical capacity but also strengthening the governance and financing arrangements that underpin equitable surveillance and vaccine access within the global health system.

Health infrastructure and emergency preparedness

U.S. funding has been instrumental in building Africa’s health infrastructure. PEPFAR established molecular labs for HIV viral load testing, later adapted for COVID-19. GeneXpert machines procured for tuberculosis now diagnose multiple pathogens, including HIV in infants and Mpox. Hospitals were equipped with hematology and chemistry analyzers, while laboratory networks adopted quality management systems.

These investments built human capacity and enabled genomic sequencing, enhancing Africa’s ability to track variants and prepare for pandemics. Withdrawal of support could derail HIV programs, leaving patients without access to treatment or viral load monitoring, while weakening emergency preparedness and reversing health gains.

Turning crisis into opportunity for Africa

The withdrawal of the U.S. from global health partnerships and the freezing of USAID funding presents a critical moment for Africa. Rather than a setback, this juncture offers an opportunity for the continent to strengthen leadership, innovate, and advance health sovereignty. It is a time for decisive action, not despair. It serves an opportunity for African governments to reimagine health systems, reduce external dependency, and invest in sustainable, locally driven solutions. The opportunities outlined below are what African governments and regional policymakers can leverage on to reimagine the health of the continent within existing political, fiscal, and institutional constraints.

Policy autonomy and health sovereignty

Reductions in external financing and influence raise questions about how health priorities are defined, financed, and governed within African health systems. Policy autonomy is relevant not only as a normative concept, but as a practical condition that shapes governments’ capacity to align resource allocation, institutional arrangements, and accountability mechanisms with nationally articulated health objectives.

Primary healthcare, maternal and child health, and the control of endemic infectious diseases have long been reflected in national health strategies across the continent. However, empirical analyses of global health financing suggest that the translation of these priorities into sustained investment has often been uneven. External funding arrangements have frequently emphasized disease-specific interventions, short funding cycles, and performance indicators linked to donor reporting requirements. These dynamics can influence budgeting, administrative attention, and service delivery in ways that do not always correspond to broader system-level priorities, even where governments formally endorse them.

From this perspective, renewed attention to primary care, endemic disease control, and foundational health system functions should be understood less as a redefinition of priorities than as an effort to address persistent misalignments between policy commitments and the financing and governance structures that support implementation. Greater policy autonomy may expand governments’ capacity to recalibrate these relationships by strengthening domestic decision-making over resource allocation, procurement, and regulatory oversight. This includes creating space to integrate emerging approaches such as digital health systems and context-specific research agendas within existing service delivery frameworks rather than as parallel or externally driven initiatives.

At the same time, historical efforts to exercise greater health sovereignty have faced well-documented constraints, including limited fiscal space, institutional capacity gaps, debt obligations, and continued dependence on external financing [3, 4]. Expanding policy autonomy therefore involves incremental changes to governance and financing arrangements rather than abrupt shifts. Diversifying funding sources, strengthening public financial management, and aligning institutional incentives with national priorities can gradually widen domestic policy space. Under these conditions, policy autonomy functions as an enabling framework through which subsequent strategies such as domestic financing reforms, public–private partnerships, and regional coordination can be more coherently designed and sustained [9].

Indigenous solutions and domestic financing strategies

The U.S. withdrawal from WHO and reductions in global health funding underscore the need for African governments to strengthen indigenous solutions and expand domestic financing for health. While external assistance has played an important role in building health system capacity, greater reliance on domestic resources is central to reducing vulnerability to funding shocks and enhancing policy autonomy.

One potential mechanism for supporting long-term public investment is the use of sovereign wealth funds, which are state-owned investment vehicles typically financed through natural resource revenues or fiscal surpluses [10]. Several African countries operate such funds, although their application to social sector financing has been uneven, reflecting differences in governance arrangements, legal mandates, and competing fiscal priorities. Where appropriately structured, sovereign wealth funds could support strategic health investments, including pharmaceutical manufacturing and infrastructure, but their effectiveness depends on transparency, insulation from political interference, and alignment with national development strategies.

Regional financing institutions also play an increasingly important role. Organizations such as the African Export–Import Bank and the African Development Bank have supported vaccine and drug manufacturing through concessional loans and blended finance mechanisms. These institutions offer opportunities to complement domestic budgets, particularly for capital-intensive investments, although they do not substitute for sustained public financing.

Evidence suggests that scope exists for increasing domestic health spending, although feasibility varies across countries. Public revenue as a share of gross domestic product remains below global averages in many African economies, and health expenditure often falls short of regional and international benchmarks. Importantly, this reflects not only revenue constraints but also allocation choices, as health competes with other sectors for limited fiscal space. Historical commitments, such as the Abuja Declaration’s 15% health budget target, illustrate that underinvestment in health is frequently a matter of political prioritization rather than absolute resource scarcity.

Innovative financing instruments have been proposed to supplement traditional public funding. Health bonds, for example, could be issued to finance clearly defined projects such as laboratory infrastructure or manufacturing capacity, with repayment linked to future government revenues. Diaspora investment funds may mobilize capital from expatriate populations, but their viability depends on credible governance frameworks, transparent use of proceeds, and investor confidence. Without these conditions, such instruments risk limited uptake or unsustainable borrowing costs.

National health insurance schemes are frequently cited as pathways to sustainable financing, yet experience across Africa highlights persistent challenges. These include difficulties enrolling informal-sector populations, weak contribution compliance, limited fiscal subsidies for vulnerable groups, and political resistance to mandatory payments. Where insurance expansion has made progress, it has typically relied on incremental implementation, cross-subsidization through general taxation, and strong political commitment to equity. These experiences suggest that insurance schemes are most effective when embedded within broader public financing systems rather than treated as standalone solutions.

Regional initiatives illustrate both the promise and complexity of domestic financing strategies. The Partnership for African Vaccine Manufacturing, supported by the African Development Bank, aims to enable Africa to produce up to 60% of its vaccine needs by 2040 [11]. Achieving this goal will require sustained public investment, regulatory harmonization, and predictable demand through pooled procurement. Taken together, these approaches indicate that strengthening domestic financing and indigenous innovation is a long-term governance challenge that hinges on political commitment, institutional capacity, and regional coordination.

Building of processing industries in Africa

Developing processing industries will strengthen both economic and health resilience. Local manufacturing of vaccines, medicines, and diagnostics can reduce aid dependency and create jobs. Agro-processing can enhance food security, indirectly improving health outcomes. Developing local processing industries can create jobs, boost intra-African trade, and strengthen economic resilience. Investing in pharmaceutical manufacturing, vaccine production, and medical technology will reduce dependency on imports while improving public health security. Expanding agro-processing industries ensures food security and supports health through better nutrition. Strengthening industries in diagnostics, protective equipment, and biomedical research can position Africa as a global health innovator [11].

Governments can support this shift by providing incentives for local manufacturing, investing in infrastructure, and strengthening trade agreements under African Continental Free Trade Agreement (AfCFTA). For example, Ethiopia’s industrial parks have attracted pharmaceutical investments, while South Africa’s Biovac Institute is expanding vaccine production. By adding value to Africa’s raw materials, industrialization can sustain healthcare systems and drive economic independence [12].

Public–private partnerships and manufacturing initiatives

Public–private partnerships (PPPs) have become an increasingly prominent feature of health system financing and industrial policy in many African countries, particularly in sectors requiring substantial capital investment such as pharmaceutical manufacturing, diagnostics, and laboratory infrastructure. In contexts of constrained public resources, PPPs are often proposed as mechanisms to mobilize additional capital and technical expertise. Their contribution to health system resilience and sustainability, however, depends on how they are designed, governed, and embedded within publicly led health strategies.

When appropriately structured, PPPs can support governments in sustaining and scaling infrastructure that was initially established through donor financing. In practice, this may involve transitioning laboratory systems, diagnostic platforms, or pharmaceutical facilities into mixed-financing arrangements in which governments retain ownership, regulatory authority, and procurement control, while private partners contribute operational capacity, maintenance, or technology transfer. Such arrangements may help prevent the deterioration of health infrastructure following reductions in external funding, particularly where public financing alone is insufficient to cover recurrent costs.

Recent manufacturing initiatives illustrate both the potential and the limitations of PPPs. Rwanda’s collaboration with BioNTech to establish local mRNA vaccine manufacturing capacity demonstrates how governments can convene private actors to support technology transfer and workforce development within a nationally defined regulatory framework [13]. Similarly, Nigeria’s Health Sector Investment Fund reflects an effort to mobilize blended public and private capital to support domestic pharmaceutical production and health infrastructure. These initiatives highlight the importance of state leadership in defining priorities, managing risk, and aligning private investment with public health objectives, rather than relying on market incentives alone.

At the regional level, the Partnership for African Vaccine Manufacturing (PAVM), endorsed by the African Union and supported by the African Development Bank, represents a coordinated effort to expand vaccine manufacturing capacity across the continent. The initiative emphasizes regulatory harmonization, technology transfer, workforce development, and the creation of predictable demand through pooled procurement mechanisms. While private manufacturers are integral to implementation, PAVM relies fundamentally on sustained public investment, regional governance arrangements, and long-term purchasing commitments from governments. Its experience underscores that manufacturing scale-up is primarily a public policy and coordination challenge, with private participation operating within a publicly defined framework.

Though PPPs are unlikely to serve as primary financing mechanisms for UHC, which remains dependent on public revenue mobilization, risk pooling, and redistribution. However, PPPs may contribute indirectly to UHC objectives by lowering the cost of essential medicines and diagnostics through local production, improving supply reliability, and expanding service infrastructure. These effects can reduce input costs for publicly financed insurance schemes and service delivery systems, provided that governments retain strong purchasing power, enforce price regulation, and integrate PPP outputs into national health financing arrangements.

The effectiveness of PPPs in addressing current financing and capacity gaps is therefore shaped by political and institutional conditions. Governments must retain agenda-setting authority, manage long-term fiscal risks, and ensure accountability through transparent contracting and regulatory oversight. In settings with limited regulatory capacity, PPPs are most likely to be effective when narrowly targeted, time-bound, and embedded within broader public-sector-led strategies for health system strengthening. Under these conditions, PPPs can complement domestic financing efforts and contribute to stabilizing health systems during periods of external funding volatility, without displacing public responsibility for health.

Governance, accountability, and institutional reform

Effective responses to reduced external health financing depend not only on resource mobilization, but on the strength of governance and institutional coordination at national and regional levels. Regional institutions play a critical role in this landscape, particularly where health threats, supply chains, and regulatory challenges transcend national borders.

Institutions such as the Africa Centres for Disease Control and Prevention (AfCDC) and the African Medicines Agency (AMA) provide platforms for coordinating cross-border disease surveillance, regulatory harmonization, and emergency response. Their effectiveness, however, depends on sustained political commitment and predictable domestic financing from African governments. Without such support, regional coordination risks remaining aspirational rather than operational. Strengthening regional laboratory networks and research institutions can further reduce fragmentation, build technical expertise, and support more timely and coordinated outbreak detection and response [13].

Institutional reform at the national level is equally important. Sustainable health financing requires strengthening public financial management systems, improving budget execution, and ensuring that health allocations translate into operational capacity [14]. Weak accountability mechanisms, delayed fund releases, and fragmented procurement processes have historically undermined health system performance even where nominal funding increases occurred. Strengthening audit functions, parliamentary oversight, and transparent procurement systems can help address these challenges.

Digital health tools can contribute to accountability when integrated into routine governance processes. Electronic procurement platforms, logistics management information systems, and facility-level reporting dashboards can improve transparency and efficiency, provided they are linked to decision-making authority and oversight mechanisms. Similarly, efforts to reduce inefficiency should focus on targeted expenditure reviews, procurement rationalization, and reductions in administrative fragmentation rather than generalized expenditure cuts.

Taken together, governance and institutional reform are best understood as incremental and politically mediated processes. Strengthening regional coordination, improving accountability, and enhancing institutional capacity are essential for ensuring that domestic and regional investments in health deliver sustained and equitable outcomes in a context of declining external support.

Feasibility, political commitment, and pathways for reform

The feasibility of the reforms outlined above, ultimately depends on political choices as much as technical capacity. Health system strengthening, domestic financing, and preparedness for health emergencies are not merely technocratic exercises; they reflect decisions about how public resources are allocated and whose priorities are advanced. Across the continent, commitments to strengthen health systems have repeatedly been articulated but inconsistently realized.

The Abuja Declaration of 2001, in which African Union member states committed to allocating at least 15% of national budgets to health, remains a prominent example. More than two decades later, only a small number of countries have consistently approached or met this target. This gap reflects not only fiscal constraints, but competing political priorities, institutional fragmentation, and the persistence of external financing that has, in some cases, reduced pressure for domestic resource mobilization. Similar patterns can be observed across subsequent reform initiatives, where ambition has outpaced implementation.

Recent efforts, including the Lusaka Agenda, signal renewed recognition of the need for country-led priority setting, sustainable financing, and stronger alignment between global and national health agendas. However, translating such commitments into action requires confronting long-standing structural and political obstacles. These include limited fiscal space, debt burdens, weak public financial management systems, and resistance from vested interests that benefit from existing allocation patterns.

Pathways to reform are therefore likely to be incremental rather than transformative in the short term. Evidence from prior reforms suggests that progress is most feasible when technocratic leadership within ministries of health and finance is supported by broader coalitions, including professional associations, academic institutions, civil society organizations, and regional bodies. Regional institutions, such as Africa CDC and the African Union, can help lower political costs by coordinating norms, pooling resources, and reinforcing peer accountability.

External shocks such as pandemics or abrupt funding withdrawals may also open policy windows by exposing vulnerabilities and increasing political demand for domestic solutions. Whether such moments lead to durable change depends on governments’ willingness to translate crisis awareness into sustained investment and institutional reform. In this sense, the current reconfiguration of global health financing presents not only a technical challenge, but a test of political commitment to health as a development priority.

Conclusion

The U.S. withdrawal from WHO and cut in global health funding threatens global health security and poses serious risks for Africa’s healthcare systems, surveillance, and emergency preparedness. However, this turning point also creates opportunities. Africa can seize the moment to reduce dependency, strengthen local innovation, and pursue health sovereignty.

By investing in pharmaceutical production, industrializing health-related industries, and expanding public-private partnerships, Africa can mobilize the resources needed for resilient systems. Regional institutions such as Africa CDC and AMA can coordinate cross-border health governance, while institutional reforms will enhance accountability and sustainability. Policy autonomy will allow governments to prioritize local needs and design context-driven strategies.

This is not simply a crisis of lost funding, it is a call to action. Africa now has the chance to lead, innovate, and secure health sovereignty, ensuring both continental resilience and a stronger contribution to global health security. African governments and policymakers now face a critical responsibility to lead this transition, translating policy autonomy into concrete investments, institutional reform, and regional cooperation that can secure sustainable health systems and strengthen global health security.

Author contributions

JON conceptualize the commentary, made a draft, and final review EAO made a initial draft, and final review FEO made final review, PO, TD, KCO, MT, NE, did literature review and initial draft, DAA, AO, JO, made the first draft, JON, EAO, FEO, BOA reviewed the final draft for submission.

Funding

Not applicable.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Competing interests

The authors declare no competing interests.