Africa, with a population of approximately 1.3 billion and significant economic growth, still faces persistently high extreme poverty, particularly in sub-Saharan Africa. The continent carries 25% of the global disease burden but receives less than 1% of global health expenditure, leaving over half the population without access to essential health services. While traditional communicable diseases remain a significant concern, sub-Saharan Africa has experienced an epidemiological transition towards non-communicable diseases (NCDs) in recent decades. Infectious disease outbreaks have become increasingly frequent and widespread. The political nature of responses to these outbreaks, often impacting marginalized groups, necessitates examination. Politics, broadly defined as influencing government actions and policies, involves conflict and cooperation stemming from diverse interests and scarce resources. This review aims to understand the politics of disease control in Africa and the critical role of global health diplomacy (GHD) in addressing these challenges.

A systematic literature review was conducted using databases such as Medline/PubMed, Web of Science, Scopus, OVID, and Google Scholar. Keywords included "Politics," "disease control," "epidemics/endemics," and "global health diplomacy" in the African context. WHO reports, UN documents, and World Health Assembly (WHA) resolutions were also included. The review followed PRISMA guidelines, screening 3337 initial results to select 54 records (journal articles, books, reports, and online sources). The review focused on studies published in English and relating to the African context, discussing infectious or chronic NCDs or health threats, and the politics of health and disease control. Studies not meeting these criteria were excluded. The definition of 'politics' employed encompassed the interactions of diverse actors influencing health outcomes during disease outbreaks, considering both infectious and chronic NCDs.

The study employed a systematic literature review following PRISMA guidelines. A comprehensive search was conducted across multiple databases (Medline/PubMed, Web of Science, Scopus, OVID, Google Scholar) up to June 15, 2020. The search strategy used various combinations of MeSH keywords and Boolean operators to identify studies on the "politics of disease control" and the "role of GHD" in Africa. The search also included WHO reports, UN documents, and WHA resolutions. All articles published in English and focusing on the African context, addressing infectious or chronic NCDs, and exploring the politics of health and disease control were considered. Articles in other languages or not focused on Africa were excluded. The grey literature included reports from the UN, WHO, AU, and African government websites. Two reviewers independently screened the documents and evaluated the suitability for the review. A total of 54 studies were included, consisting of journal articles, books, reports, and online sources. Annual WHA reports (2007-2019) were also reviewed to identify initiatives and targets for the African region, categorized into communicable diseases, NCDs, and primary healthcare strengthening.

The review highlights several key findings: The politics of disease control in Africa are deeply intertwined with the continent's fragile health systems and the limited deployment of GHD tools. A modified framework of WHO's health system building blocks, incorporating a conducive macro-environment, is proposed, focusing on the politics of disease control, the rise of African diplomacy, and GHD's role in strengthening health systems. Historical perspectives reveal how early 20th-century sleeping sickness outbreaks underscored the involvement of European governments and institutions in Africa's health challenges. Currently, Africa grapples with a "triple burden": communicable and vector-borne diseases (with notable outbreaks of COVID-19, Ebola, Zika, and others), chronic NCDs, and nutritional deficiencies. The inadequate response to the 2014 Ebola outbreak highlighted limitations in coordination between WHO and local/regional actors. The WHO's shift in priorities from infectious diseases to NCDs resulted in insufficient funding for rapid interventions. The rise of African diplomacy for disease control is observed through the AU's collaboration with WHO, yet health remains a secondary concern in the AU's agenda, as indicated by funding allocation and the limited number of health-focused summits. Although initiatives like the Global Fund and GVCR aim to bolster disease control efforts, challenges remain in implementing comprehensive approaches. The COVID-19 pandemic further underscores the need for stronger health systems and a prioritization of health in policy. The establishment of the African CDC and various health research institutes represents progress, but additional investment and coordination are necessary. The review emphasizes the increasing importance of GHD, the collaboration among public and private actors to address global health challenges, and the G20's commitment to UHC. However, Africa’s reliance on vertical programs needs to shift toward horizontal approaches, reinforcing health systems and integrating interventions. Beyond WHO's health system building blocks, the study stresses the importance of human security, Health in All Policies (HiAP), good governance, and climate change mitigation in building resilient health systems. The conclusion underscores the need for stronger political commitment, increased funding, and improved partnerships to enhance disease control in Africa.

The findings address the research question by demonstrating how political factors, weak health systems, and limited GHD deployment hinder effective disease control in Africa. The significance of the results lies in highlighting the need for a paradigm shift, integrating health into broader development agendas and leveraging GHD for stronger partnerships and funding. The relevance to the field is significant because the study offers a comprehensive framework for improving disease control, emphasizing the interplay between politics, health systems, and diplomacy. This interdisciplinary approach provides valuable insights for policymakers, researchers, and global health actors.

This review underscores the urgent need for the AU to prioritize health challenges in Africa. Adapting GHD principles can attract more funding and foster collaborations to tackle the triple burden of disease. The focus should shift from vertical programs to HiAP for improved health equity and policy accountability. Training a cadre of global health diplomats could enhance negotiation and policymaking skills. GHD can be transformative, particularly in the context of COVID-19 and its aftermath. Addressing social determinants of health, gender-sensitive initiatives, endemic NTDs, and climate change are crucial for both short-term and long-term success. Strengthening health systems and securing targeted funding through successful GHD implementation are essential steps toward achieving UHC and SDG health targets in Africa.

This review, while being the first of its kind in this interdisciplinary area, has limitations. The limited number of studies specifically addressing the intersection of politics, health, and diplomacy in Africa constrained the breadth of evidence. Data paucity from various African nations prevented capturing a more comprehensive picture. As a literature review, the study could not account for undocumented activities or specific national strategies. Research publications covering all aspects of this interdisciplinary area are scarce.