From Response to Resilience: Practices and Prospects for China-Africa Public Health Cooperation

Africa bears a heavy burden of infectious diseases, and emerging and re-emerging infections continue to threaten regional and global health security, making stronger China-Africa public health cooperation increasingly important. This article reviews how the policy and conceptual framework supporting China-Africa public health cooperation took shape and traces the history of this cooperation across tropical disease control, health emergency response, and systematic technical collaboration on infectious disease control. Guided by China's 15th Five-Year Plan for National Health and responding to Africa's growing need for stronger public health systems, we propose six priority areas for future cooperation: infectious disease surveillance and early warning, laboratory networks, emergency preparedness and coordinated response, public health product access and local production, community public health services, and local adaptation of appropriate technologies. Future cooperation should remain demand-driven and emphasize technology transfer, workforce development, and sustainable capacity building, thereby strengthening resilience and making China-Africa public health cooperation more systematic and sustainable.

INTRODUCTION

Owing to its distinctive ecological and social conditions, the African continent harbors a wide diversity of pathogens. Although precise estimates of their overall share are lacking, resource-limited regions such as sub-Saharan Africa have consistently been high-risk zones for global infectious disease outbreaks and critical epicenters of emerging and re-emerging infectious diseases (1). Recent Ebola outbreaks in the Democratic Republic of the Congo, together with cross-border importations into Uganda, Kenya and Nigeria in 2026, again illustrate the persistent challenge that emerging and re-emerging infectious diseases pose to global health security (2-5). Africa's health burden also extends beyond infectious diseases: non-communicable diseases (NCDs) account for more than one-third of deaths in the WHO African Region, where premature NCD mortality remains high (6). In some countries, weak public health infrastructure, insufficient health resources, and limited disease prevention and control capacity underscore the long-term need for capacity building. Strengthening infectious disease control and pandemic preparedness, alongside broader health system strengthening, is therefore a shared imperative for China and Africa (7).

Drawing on core concepts and representative case studies, this article traces the historical trajectory of China-Africa public health cooperation since 2000 and the development of its framework. On this basis, it identifies key priorities for future collaboration, with the aim of informing efforts to further deepen China-Africa public health cooperation (Figure 1).

Figure 1.

China-Africa Public Health Cooperation: Foundation, Progress, and Future Priorities.

FORMATION OF THE CHINA-AFRICA PUBLIC HEALTH COOPERATION FRAMEWORK

The Forum on China-Africa Cooperation as the Cornerstone of Cooperation

The Forum on China-Africa Cooperation (FOCAC) is a key institutional cornerstone of China-Africa public health cooperation. Between its establishment in 2000 and 2024, FOCAC held nine ministerial-level meetings, gradually shaping a cooperation framework underpinned by three-year action plans and follow-up implementation mechanisms (8). In the forum's early years, health cooperation consisted mainly of dispatching Chinese Medical Teams (CMTs) and providing material assistance, without a dedicated public health agenda. Nevertheless, the Programme for China-Africa Cooperation in Economic and Social Development, adopted at the inaugural conference, already included the prevention and control of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), malaria, and other diseases (9).

The 2013 Ministerial Forum on China-Africa Health Development marked the beginning of the institutionalization of China-Africa public health cooperation (10). The 2015 Johannesburg Action Plan advanced this process by incorporating public health into its strategic framework, pledging support for epidemic prevention and control systems, including the Africa Centres for Disease Control and Prevention (Africa CDC), and committing to strengthen capacity building (11). The 2018 Beijing Summit emphasized strengthening the resilience of African public health systems (12), while the 2021 Dakar Conference called for stronger public health institutions, policy dialogue, and technical exchange (13). The 2024 Beijing Summit introduced the Partnership Action for Health within its broader framework, supporting the establishment and operation of the Africa CDC headquarters and subregional centers and strengthening public health technical cooperation and talent development (14). Overall, through sustained guidance and project arrangements, FOCAC has fostered the emergence and steady development of China-Africa public health cooperation, laying a solid foundation for jointly addressing infectious disease threats.

Visions as the Guide and Driving Force for Cooperation

The health cooperation visions proposed by China guide China-Africa public health cooperation and provide an important driving force for deepening it. In 2016, China proposed jointly building a Health Silk Road (HSR) to strengthen cooperation in epidemic reporting, disease prevention and control, medical assistance, and traditional medicine (15). In March 2020, as COVID-19 spread worldwide, China first proposed building a global community of health for all (16); on June 17 of the same year, at the Extraordinary China-Africa Summit on Solidarity Against COVID-19, China further called for a China-Africa community of health for all (17). The HSR expands the health dimension of the Belt and Road Initiative by integrating disease prevention and health system development with trade, economic exchange, and infrastructure connectivity, thereby deepening China-Africa health cooperation (18–19). China-Egypt cooperation on local vaccine production exemplifies this approach, combining joint pandemic response with capacity building for local manufacturing in Africa (20). The concept of a global community of health for all emphasizes the interdependence of national health security, joint responses to cross-border health threats, and support for Africa's disease prevention and response capacities (21). Related studies highlight the expansion of China-Africa health cooperation into public health infrastructure, health emergency response, and the provision of global public goods (22). Together, these visions encourage China and Africa to integrate health security into economic and cultural exchanges, positioning public health cooperation as essential to common development and reinforcing both sides' commitment to deeper cooperation.

Policies as New Support for Future Cooperation

The continued development of national policies has underpinned China-Africa public health cooperation. These policies address both the development of African health systems and the management of shared health risks through international collaboration (22–23). Previous research has identified a need for stronger strategic planning and interdepartmental coordination in health assistance, supported by needs assessments, policy alignment, and monitoring and evaluation (24–25). The Healthy China 2030 Planning Outline proposes implementing China’s global health strategy, explicitly including the China-Africa public health cooperation plan and support for building disease prevention and control systems (26). China’s 15th Five-Year Plan for National Health calls for strengthening health assistance abroad, expanding medical aid into public health, traditional medicine, and other fields, optimizing the structure and deployment of CMTs, and improving planning coordination as well as implementation monitoring and evaluation (27). The 2026 National Health Conference further emphasized deepening Belt and Road health cooperation and strengthening and innovating overseas health assistance (28). Together, these policies aim to align China's development strategy and technical strengths with Africa's health needs, translate cooperation objectives into concrete tasks through national planning and implementation mechanisms, and provide a consistent and systematic policy basis for sustained collaboration.

Anchored in these mechanisms and policies, China-Africa public health cooperation is demand-driven and context-specific rather than one-size-fits-all, aligning joint efforts with Africa’s strategic priorities. The Beijing Action Plan supports the Africa Health Strategy 2016-2030 and Africa CDC capacity building (14). In Tanzania, collaborative research adapted the "1-3-7" strategy into a localized "1,7" model that reflects local transmission patterns (29), while laboratory initiatives in Sierra Leone are aligned with the National Action Plan for Health Security (NAPHS 2018-2022) (30). These practices highlight the role of non-African partners in adapting technologies, managing facilities, and evaluating project outcomes, while ensuring that projects meet local needs and support Africa CDC priorities (31).

EVOLUTION OF PUBLIC HEALTH COOPERATION PRACTICES

Since 2000, China-Africa health cooperation has gradually expanded from medical aid into the broader field of public health, evolving from discrete initiatives into comprehensive measures. It has increasingly focused on system development, disease prevention and control technologies, and personnel capacity building.

Extending China's Infectious Disease Control Experience to African Settings

China-Africa cooperation on infectious disease control has drawn on China's technical expertise and experience in malaria control, with an emphasis on adapting these approaches to African settings. Since 2007, China has supported malaria and schistosomiasis control projects in countries and regions including Comoros (32), mainland Tanzania (33–34), and Zanzibar (35), helping to control transmission in these settings. The innovative 1,7-malaria reactive community-based testing and response (1,7-mRCTR) approach conducted in Tanzania reduced the odds of malaria infection by 66%, malaria prevalence in the intervention wards declined from 26.0% to 4.9% (36). Cooperation has also included support for national disease-control planning. In 2023, China CDC, together with WHO, supported Sierra Leone in developing its first National Viral Hepatitis Strategic Plan 2024–2030 (37).

Diversifying Support for Public Health Emergencies

Responding to major epidemics is an important component of China-Africa public health cooperation. From 2011 to 2012, experts from the China CDC were deployed to Nigeria, Namibia, and Ethiopia to take part in intensified immunization efforts to curb the spread of poliomyelitis (38). During the 2014–2015 Ebola outbreak in West Africa, China assisted affected countries by sending medical and public health experts, donating epidemic control supplies and funds, and supporting the construction of laboratories and other infrastructure. China subsequently participated in responses to yellow fever in Angola, plague in Madagascar, Ebola in the Democratic Republic of the Congo, and the global COVID-19 pandemic. The recurrence of Ebola in the Democratic Republic of the Congo in 2026 further underscores the long-term need for regional cooperation on public health emergencies.

Integrating Infrastructure Construction with Technological Cooperation

Combining infrastructure construction with technical cooperation has become an important pathway for deepening China-Africa public health cooperation, building health capacities that extend beyond individual emergency responses. In 2015, the China-supported Sierra Leone-China Friendship Biosafety Laboratory began operation, supporting local Ebola testing and subsequent infectious disease surveillance (39). This infrastructure-plus-technology approach strengthened Sierra Leone's capacity to combat infectious diseases ranging from Ebola to COVID-19 (30). The Africa CDC headquarters, funded and built by China, was completed and commissioned in 2023 and is expected to further strengthen Africa's public health prevention and control systems and capabilities (40).

Customizing Approaches to Public Health Workforce Development

Workforce development is an important foundation for strengthening African countries' capacity for independent development. China and Africa have gradually developed a multitiered model that addresses different levels of expertise and occupational needs. At the foundational level, short-term training programs held in China or abroad reach large numbers of participants and deepen their understanding of relevant strategies (41); at the intermediate level, technical cooperation projects provide on-the-job training and on-site practice, developing practice-oriented personnel through learning by doing; and at the advanced level, master's and doctoral degree programs in China train key personnel with professional research capabilities. However, workforce migration and weak retention in African health systems may undermine these training gains (42). Partnerships should therefore link training to funded employment, supportive working conditions, and continuing professional development, and should monitor whether trainees remain in national health services.

PRIORITY DIRECTIONS FOR FUTURE COOPERATION

The year 2026 marks the 70th anniversary of China-Africa friendship and cooperation (43) and the first year of China's 15th Five-Year Plan (44). Progress toward Healthy China offers further opportunities to deepen cooperation. Meanwhile, the entry into force of the amendments to the International Health Regulations (2005), the adoption of the WHO Pandemic Agreement, and ongoing changes in global health governance are placing new demands on national infectious disease capacities and international coordination (45). In this context, further research is warranted on how China and Africa can expand the scope of public health assistance in priority sectors while jointly advancing reform of global health governance. We propose the following six priority directions for future cooperation:

Infectious Disease Surveillance and Early Warning Capacity

Future cooperation should support Africa CDC and African countries in improving infectious disease surveillance systems, promote the integration of indicator-based and event-based surveillance, and enhance capacity for early outbreak detection and risk identification. Strengthening the use of information technology and big data analytics would promote standardized collection, integrated analysis, and early risk warning based on surveillance data. For example, community health workers could report unusual illness clusters by mobile phone for district-level verification and integration into existing surveillance systems (46).

Laboratory Networks

The China-funded Wu Lien-teh Laboratory Building at Africa CDC provides a platform for further laboratory cooperation. Since its inauguration in November 2023, the facility has supported joint laboratory training and technical exchange (47). Future collaboration could strengthen African public health laboratory networks through cooperation in pathogen detection, molecular diagnostics, genomic sequencing, and bioinformatics. Support for biosafety management, quality control, and personnel training could include on-site mentoring in specimen handling and molecular testing, helping laboratories build independent operational capacity (30).

Emergency Preparedness and Coordinated Response

Building on previous joint outbreak responses, cooperation should extend beyond post-outbreak response to sustained preparedness between emergencies. China and Africa could explore establishing a joint public health emergency expert team and conducting regular simulation exercises, with post-exercise reviews that specify corrective actions and responsible institutions (48). These activities could improve coordination in outbreak notification, cross-border collaboration, field epidemiological investigation, and laboratory testing.

Public Health Product Access and Local Production

Future cooperation could support access to priority public health products, such as diagnostic tests, vaccines, and laboratory consumables, in line with African countries' needs. Joint research and development, local evaluation and validation, and technology transfer could help adapt these products to local contexts and support local production where conditions allow. This would require training in production and quality management, stronger regulatory capacity, and robust quality assurance. Procurement arrangements and continued financial support would also be needed to sustain supply. However, local production does not necessarily improve access, which also depends on product pricing and distribution.

The 2024 memorandum of understanding between the United Nations Children's Fund (UNICEF) and China CDC provides a framework for technical cooperation with Africa CDC, including infectious disease surveillance and the evaluation and validation of public health products and services (49). Joint validation studies and staff exchanges could help tailor technologies to local service requirements. Multilateral collaborative innovation — encompassing joint research and development, local evaluation, and technology transfer — is essential for bridging the gap between product design and clinical application, thereby improving access to public health products and expanding local production for emerging infectious diseases.

Community Public Health Services

China's Patriotic Health Campaign offers practical experience in environmental sanitation, community mobilization, and infectious disease prevention (50). Drawing on this experience and on the needs of African community health systems, cooperation could address environmental sanitation, vector control, health education, immunization, and community-based infectious disease surveillance. Local governments, community health workers, and residents could jointly design sanitation and mosquito control pilots, adapting activities and health messages to local practices, languages, and available water and waste services (51). These efforts could help identify feasible and sustainable interventions suited to local socioeconomic conditions.

Local Adaptation of Appropriate Technologies

By deepening Belt and Road cooperation in the health sector, China and Africa should continue to advance joint malaria and schistosomiasis control. At the same time, cooperation should actively draw on China’s valuable experience in preventing and controlling infectious diseases such as HIV/AIDS, tuberculosis, and viral hepatitis; use paired Chinese-African teams to adapt malaria reporting and follow-up to national protocols and pilot their feasibility with local health workers (34); promote the effective translation and application of technologies; and advance the high-quality development of the HSR.

CONCLUSION

Since 2000, China-Africa public health cooperation has steadily expanded toward more systematic support for public health capacity. Across the six priorities outlined above, future cooperation should be driven by African countries' needs and priorities, with African institutions leading local implementation. Technology transfer and local adaptation should be combined with workforce development, sustained financing, and institutional support to maintain capacities beyond individual projects (52). Integrating response with preparedness is a critical pathway and core mechanism for building and demonstrating resilience. Sierra Leone’s transition from severe casualties during the 2014 Ebola outbreak to independent COVID-19 laboratory testing capacity in 2020 is a major achievement of China-Sierra Leone public health cooperation and a concrete demonstration of this resilience (30). Drawing on the experiences reviewed here, we conclude that future cooperation should reflect African countries' needs and priorities, emphasize technology transfer and local adaptation, and build sustainable local capacity to strengthen public health resilience and advance the health goals of the African Union's Agenda 2063. By strengthening African leadership in decision-making, coordinating cross-border responses, and ensuring equitable access to health technologies, China-Africa public health cooperation could contribute to more inclusive global health security governance.