Politics of disease control in Africa and the critical role of global health diplomacy: A systematic review

The study addresses how political dynamics shape disease control in Africa and explores how global health diplomacy (GHD) can mitigate the continent’s triple burden of communicable diseases, rising NCDs, and nutritional disorders. Contextually, Africa bears 25% of the global disease burden but accounts for less than 1% of global health expenditures and manufactures under 2% of its medicines, leaving many without essential services. Frequent infectious outbreaks occur amid fragile health systems and socioeconomic disparities. The review’s purpose is to analyze the politics of epidemics and health system responses, and to assess how GHD can support cooperative strategies, preparedness, and integration of health into broader human security and development agendas.

The review synthesizes historical and contemporary literature on disease control politics and GHD in Africa. It highlights early 20th-century colonial responses to sleeping sickness around Lake Victoria and the proliferation of European scientific expeditions and experimental therapies. Contemporary analyses cover major communicable and vector-borne disease outbreaks (e.g., Ebola, COVID-19, yellow fever, Rift Valley fever, cholera, plague, measles, chikungunya, H1N1), their socioeconomic impacts, and critiques of WHO’s response during the 2014–2016 Ebola crisis. It also summarizes the growing NCD burden projected to surpass communicable and maternal/child causes by 2030, and widespread nutritional deficiencies and undernutrition in sub-Saharan Africa. The review incorporates AU and REC regional integration efforts, AU political commitments (e.g., Abuja Declaration, Ouagadougou, Libreville, Luanda commitments), the rise of the Global Fund, calls for integrated approaches to neglected tropical diseases (NTDs), and the WHO Global Vector Control Response (2017–2030). It examines the establishment and role of Africa CDC, China–Africa health cooperation, and the maturation of GHD, including global commitments (e.g., G20 on UHC, IHR, FCTC). Finally, it discusses the vertical vs horizontal program debates, proposing integration of broader macro-dimensions (human security, Health in All Policies, good governance/poverty alleviation, climate change) with WHO health system building blocks.

Systematic review conducted per PRISMA guidelines. Databases searched up to June 15, 2020: Medline/PubMed, Web of Science, Scopus, OVID/Embase, and Google Scholar, using MeSH and keywords: “Politics,” “disease control,” “epidemics/endemics,” and “global health diplomacy,” focused on Africa. Grey literature included reports from WHO, UN, AU, and African government websites; WHA annual reports (2007–2019) were screened for regional initiatives and targets. Inclusion criteria: English-language publications with African context addressing infectious diseases, NCDs, health threats, politics of health, and disease control. Exclusions: non-English and non-African context. Screening and quality assurance were independently performed by two reviewers (VKC, KSR). Search results: 3337 total records; after duplicates/irrelevant removal, 134 remained; title/abstract screening: 86; full-text assessed: 46; manual/grey literature added: 8; total included: 54 (28 journal articles, 5 books, 13 reports, 8 online sources). WHA resolutions were categorized into communicable diseases, NCDs, and strengthening primary health care for analysis.

- African health systems remain fragile, struggling with frequent epidemics and a triple burden: communicable diseases, rising NCDs, and nutritional deficiencies. - Politics of disease control involves negotiating divergent interests among state and non-state actors; cooperative partnerships and GHD are essential for effective responses. - Major outbreaks since 2000 include Ebola, COVID-19, yellow fever, Rift Valley fever, cholera, plague, measles, chikungunya, and H1N1, which have overwhelmed systems and impacted economies; WHO’s response to Ebola drew criticism for coordination and prioritization issues. - Africa bears 25% of the global disease burden but <1% of health expenditures and manufactures <2% of its medicines; over half the population lacks access to essential services. - NCDs: WHO projects a 27% increase in NCD deaths in the African Region by 2030 (≈28 million additional deaths), potentially surpassing deaths from communicable, maternal, perinatal, and nutrition-related causes; in some countries (Mauritius, Namibia, Seychelles), >50% of adult deaths are NCD-related. - Nutrition: Sub-Saharan Africa accounted for 36% of the world’s chronically undernourished under-5 children (2018); undernourished people increased from 195M (2014) to 237M (2017); protein-energy malnutrition caused an estimated 209,000 deaths in the region (2016). - WHO Global Health Estimates (2016) show leading causes of death include lower respiratory infections, HIV/AIDS, diarrhoeal diseases, ischaemic heart disease, malaria, TB, and stroke. - AU and RECs have made multiple political commitments (e.g., Abuja Declaration; commitments on UHC, NTDs, maternal/child health), yet health has not been consistently prioritized across AU agendas and funding allocations. - Africa CDC (launched 2017) enhances continental capacity for surveillance and outbreak response; supported by AU members and international partners (e.g., US, China, World Bank, Kuwait, Japan). - GHD has risen in prominence, with African states engaging in IHR, FCTC, and G20 commitments toward UHC, emergency preparedness, antimicrobial resistance, and NCD prevention. - Vertical disease programs risk fragmenting systems; balanced approaches integrating vertical initiatives with horizontal system strengthening and Health in All Policies are needed. - Authors propose augmenting WHO’s six building blocks with four macro-dimensions: human security, Health in All Policies, good governance/poverty alleviation and human development, and climate change action. - Policy recommendations for the AU: (i) leverage GHD to navigate global health governance; (ii) strengthen preparedness and response; (iii) address health–human security linkages (e.g., climate-driven food/water insecurity); (iv) mobilize resources and train health officials in diplomacy.

The findings demonstrate that disease control in Africa is deeply political, shaped by resource scarcity, competing priorities, and multi-actor negotiations. Fragile systems and the intertwined burdens of communicable diseases, NCDs, and malnutrition necessitate coordinated, cross-sectoral action. GHD offers mechanisms to align diverse stakeholders, secure resources, and embed health within broader development and human security agendas. The evidence supports shifting from predominantly vertical, disease-specific programs to balanced strategies that strengthen core health system functions while maintaining targeted interventions. Integrating human security, Health in All Policies, governance/poverty alleviation, and climate resilience into system design can enhance preparedness, reduce inequities, and improve outcomes. Regional institutions (AU, RECs, Africa CDC) are pivotal in harmonizing strategies, leveraging WHA resolutions and global commitments (IHR, FCTC, UHC), and building diplomatic capacity to negotiate partnerships and funding, thereby addressing the political determinants of health and advancing SDG health targets.

Africa has progressed socioeconomically but remains challenged by recurrent epidemics and a growing NCD burden amid fragile health systems. Prioritizing health within AU and REC agendas, and strategically employing global health diplomacy, can catalyze partnerships, funding, and policy coherence to strengthen systems. Emphasis should shift toward Health in All Policies, addressing social determinants, gender-sensitive programming, endemic NTDs, and climate change. Developing a cadre of trained global health diplomats, upgrading infrastructure, and deploying digital health solutions can improve access and resilience, enabling progress toward UHC and SDG health targets, particularly during and after the COVID-19 era.

The interdisciplinary literature is sparse, with limited data across many African countries; numerous undocumented national strategies (successful or failed) could not be captured. As a literature review, it may miss on-the-ground activities. Existing epidemic-focused studies often center on a few NTDs, with few publications spanning all domains of politics, health, and diplomacy in the African context.