What Matters in Global Health

NCDs Set to Overtake Infectious Diseases in Sub-Saharan Africa by 2030?

In a significant shift in public health trends, non-communicable diseases (NCDs) are projected to surpass infectious diseases as the leading cause of death in sub-Saharan Africa by 2030. This transition underscores the urgent need for comprehensive strategies to address the burgeoning NCD crisis in the region.

Historically, sub-Saharan Africa has grappled predominantly with infectious diseases such as HIV/AIDS, tuberculosis, malaria, and cholera. However, recent data indicates a rising prevalence of NCDs—including heart disease, diabetes, and hypertension—attributable to lifestyle changes, urbanisation, and increased life expectancy. The World Health Organization (WHO) reports that NCDs currently account for approximately 40% of deaths annually in Zimbabwe, with projections suggesting that NCDs will overtake communicable diseases as the leading cause of death or illness in sub-Saharan Africa by 2030.?

The escalation of NCDs is evident across various demographics, affecting not only the elderly but also younger populations. Factors such as sedentary lifestyles, unhealthy diets, tobacco use, and alcohol consumption contribute significantly to this trend. Dr. Johannes Marisa, a public health specialist in Harare and president of the Medical and Dental Private Practitioners of Zimbabwe Association, observes a "rapid change" with more children and young adults diagnosed with NCDs. He attributes this shift partly to increased screen time leading to reduced physical activity, as well as growing substance abuse and poor dietary habits.?

Various initiatives have been implemented to promote healthier lifestyles in response to the mounting NCD burden. In Zimbabwe, for instance, Finance Minister Mthuli Ncube introduced a 0.5% tax on sales of unhealthy foods—including doughnuts, pizza, and fried chicken—to encourage better dietary choices and mitigate the prevalence of NCDs.?

Community-driven efforts also play a pivotal role in combating NCDs. In Harare, the Commandos Fitness Club offers free exercise sessions in unconventional locations, such as cemeteries, to provide accessible fitness opportunities for residents. The club's coach, Joseph Nekati, was inspired to start the initiative after his mother's stroke in 2023. The group comprises individuals like 65-year-old Nelly Mutandwa, who manages her diabetes through regular exercise. Mutandwa emphasises the importance of physical activity, stating, "They are resting," referring to the graves, "I just don't want to join them ... ."?

The Kigali Declaration on Neglected Tropical Diseases (NTDs), launched in 2022, exemplifies a collaborative effort to address health challenges in the region. While primarily focused on NTDs, the declaration highlights the importance of comprehensive health strategies encompassing NCDs' prevention and management. The initiative aims to reduce the number of people requiring treatment for NTDs by 90% and eliminate at least one NTD in 100 countries by 2030.?

The impending shift from infectious to non-communicable diseases as the leading cause of mortality in sub-Saharan Africa necessitates a multifaceted approach. This includes policy interventions, community engagement, and individual commitment to healthier lifestyles. As the region stands at this critical juncture, proactive measures are essential to curb the rising tide of NCDs and ensure a healthier future for all.

Africa Takes Bold Steps Toward Vaccine Independence

In a landmark move to bolster Africa’s vaccine self-sufficiency, two significant agreements have set the stage for the continent to become a producer rather than a mere consumer of life-saving vaccines. These deals, backed by a $1.2 billion investment from Gavi, The Vaccine Alliance, mark a turning point in Africa’s efforts to strengthen its health security and manufacturing capabilities.

One of the agreements, signed at the 2nd Vaccine & Other Health Products Manufacturing Forum in Cairo, establishes Africa’s first end-to-end mRNA vaccine production platform. Led by Egypt’s EVA Pharma in collaboration with European biotech firms, the initiative is expected to produce up to 100 million doses annually. This development significantly enhances the continent’s ability to respond swiftly to infectious disease outbreaks and reinforces routine immunisation programs.

Another pivotal deal strengthens collaboration between Egypt’s Biogeneric Pharma and South Africa’s Afrigen, expanding expertise in homegrown mRNA vaccine technology. The move underscores Africa’s ambition to develop cutting-edge vaccines for diseases with a high burden on the continent. At the forum's closing, Dr Jean Kaseya, Director-General of Africa CDC, emphasized the significance of these efforts, declaring, “These agreements are proof that Africa is no longer just a buyer of vaccines—we are becoming producers. This is the future of health security on the continent.”

The agreements come as part of a broader push to accelerate vaccine production across Africa. Gavi’s African Vaccine Manufacturing Accelerator (AVMA), launched in mid-2024, aims to direct catalytic investments over the next decade toward African manufacturers. The goal is to prioritize vaccines like cholera and mRNA-based immunisations while ensuring that intellectual property rights remain on the continent. “This is about building a sustainable vaccine ecosystem in Africa,” said David Kinder, Gavi’s Director of Development Finance. “We are using our market power to drive investment where it’s most needed—ensuring Africa can produce its own vaccines, for its own people.”

Despite these promising strides, challenges remain. Africa’s vaccine demand is valued at over $1 billion annually, yet the continent contributes only 0.1% of the global supply. To address this imbalance, experts at the forum called for a pooled procurement mechanism modelled after Egypt’s successful Unified Procurement Authority. Such an initiative could ensure stable demand for African-made vaccines, fostering long-term sustainability.

Regulatory readiness is another hurdle, with African vaccine manufacturers needing to meet strict global quality standards. Progress is being made, however, with Egypt recently achieving WHO’s Maturity Level 3 for its vaccine and medicine regulatory system, following South Africa’s similar milestone in 2022. The establishment of the African Medicines Agency is expected to streamline regulatory approvals further and facilitate wider market access for African-produced vaccines.

The momentum for local vaccine production will continue in June 2025, with Africa’s first vaccine and biopharmaceutical manufacturing exhibition, Africa Excon, set to be held in Egypt. The event will highlight advancements in local production and attract further investment to sustain Africa’s vaccine ambitions.

As these developments unfold, the continent is moving beyond discussions of vaccine sovereignty to concrete action. Dr Kaseya captured this shift in his closing remarks: “We are no longer just talking about vaccine sovereignty—we are making it happen.”

Mass Firings Reshape U.S. Health Agencies Under RFK Jr.'s Leadership

In a dramatic shake-up of the U.S. public health sector, newly appointed Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. has initiated the termination of over 5,200 federal health agency employees. This sweeping move affects the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Advanced Research Projects Agency for Health (ARPA-H), among others, marking one of the most significant workforce reductions in the history of U.S. health agencies.

The firings were carried out swiftly, with agency supervisors delivering termination notices to employees across departments. At the NIH, 1,500 employees, including junior staff, research fellows, and recently converted permanent staff members, lost their jobs. At the CDC, 1,269 employees were dismissed, including members of the Epidemic Intelligence Service, a prestigious training program for young epidemiologists. Several division directors within the National Center for Emerging and Zoonotic Infectious Diseases, a critical unit for pandemic preparedness, were also let go.

The cuts were not limited to junior staff. Senior officials, including grants administration officers responsible for managing over $30 billion in research funding, were also affected. “This will decimate our ability to function as an institution,” said a senior NIH scientist who had to inform staff of their impending terminations while facing dismissal themselves. “Whatever the opposite of government efficiency is, this process will take us there.”

At ARPA-H, the agency was created just three years ago to fund high-risk, high-reward research, but the director and much of the core staff were removed. “I no longer have the opportunity to serve as the director of ARPA-H,” wrote Renee Wegrzyn, the agency’s now-former director, in a statement on LinkedIn.

HHS defended the decision, stating it was part of the administration’s broader effort to “restructure and streamline” the federal government. “This is to ensure that HHS better serves the American people at the highest and most efficient standard,” the department noted in an official statement.

The sweeping terminations have been met with widespread concern among scientists, public health officials, and policymakers. Many worry that the move will undermine critical health initiatives, including pandemic preparedness, infectious disease monitoring, and biomedical research funding. “This is indiscriminate, cruel, and is taking a wrecking ball to both the deep institutional knowledge of the agency and its future,” said a senior CDC scientist.

As the restructuring unfolds, the long-term impact on the nation’s public health and scientific research capabilities remains uncertain. Many fear that losing experienced personnel and institutional knowledge could set back years of progress in critical areas of public health policy and disease prevention.