During the reporting period, significant progress was made in strengthening the mpox response across the continent. The lessons learned and challenges identified during the joint mpox continental intra-action review (IAR), which took place successfully in December 2024 in Addis Ababa have guided the development of the action plan for the response to the mpox epidemic in January and February 2025.

Country support is ongoing through country visits including DRC, Uganda and Burundi, weekly deep dives with priority countries, experience sharing between countries and technical support by continental IMST pillars. Support has been provided to some countries, remotely or on-site, to conduct the intra-action review. The Financial Tracking Mechanism (FTM) continues to provide a comprehensive assessment of financing, including pledges, commitments, and disbursements. Strengthening decentralization
of laboratory diagnostic capacities is ongoing. Guidelines and technical documents have been developed/updated and shared with countries, such as updated guidelines on infection prevention and control and clinical management, SOPs for data cleaning and
standardization, and infodemic management guides. Harmonized and Integrated mpox data from surveillance, laboratory, and treatment centers set up in DRC. Risk communication and community engagement have reduced the stigma of mpox patients and increased acceptance of vaccination against mpox. Through coordinated efforts a total of 1.4 million doses of vaccines have been allocated to 12 countries, among which 7 countries have already received 687,780 doses and 5 countries are currently vaccinating (DRC, Rwanda, Uganda, Central African Republic and Nigeria).

However, despite these accomplishments, challenges such as poor decentralization of the response at sub national level, data incompleteness and timeliness in many countries, slow progress in the decentralization of laboratory capacity, low testing coverage, passive surveillance and the low vaccination coverage hamper the response. In addition to that, the funding freeze from the USG has further weakened response capacities, particularly for sample transportation, laboratory testing, and vaccine deployment. The conflict in Eastern DRC has worsened disease control efforts, leading to increased migration of affected populations into neighboring countries. Given this crossborder movement, the risk of further regional spread is very high.

Moving forward, priorities include the ongoing development of a Response and Legacy plan to guide response efforts from March to August 2025. The intensification phase of this plan, from March to May 2025 will ensure the control of human-to-human transmission of mpox, while the second phase from June to August 2025 will concentrate on resilience and Legacy of the response.

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The NCDs, Injuries and Mental Health Division under the Africa CDC convened the Continental Consultative Meeting on Cervical
Cancer Elimination from 27 to 29 November 2024 in Addis Ababa, Ethiopia. The meeting brought together representatives from 22 African Union Member States, partners, donors, academia, civil society and the private sector to accelerate efforts towards eliminating cervical cancer in Africa by 2030. Some of the key partners included the World Health Organization, UNAIDS, GAVI, Unitaid, Jhpiego, African Organization for Research and Training in Cancer (AORTIC), Elekta Foundation, International Centre for Advanced
Public Health, MSD and Roche.

The consultative meeting provided a platform to review progress, share best practices, develop an accelerated roadmap, and establish a Continental Technical Working Group (TWG) and agree on countries to host three Centers of Excellence (CoE) to support implementation.

1.1 Background
Cervical cancer is the fourth most common cancer among women globally, with the African Region disproportionately affected.
In 2020, approximately 90% of global cervical cancer deaths occurred in low- and middle income countries, with Africa facing significant challenges in the prevention, screening, and treatment. Despite its preventability, cervical cancer remains a leading public health issue due to limited awareness, inadequate funding, and access inequalities. Aligned with WHO’s global strategy, Africa CDC’s initiatives aim to accelerate Member States’ efforts towards achieving the 90-70-90 targets by 2030:

• Vaccinate 90% of girls by age 15 with the HPV vaccine.
• Screen 70% of women by age 35 and again by age 45 using a high-performance test.
• Treat 90% of identified cervical disease cases (90% of women with precancer treated, and 90% of women with invasive cancer managed).

Africa CDC’s strategy for NCDs, Injuries prevention and control and Mental health promotion (2023-2027) highlights the need
for strengthening health systems, integrating NCD prevention into primary care, mobilizing funding, and establishing CoE to serve as hubs for capacity building, research and innovations in the area of NCDs prevention and control on the continent.

Africa CDC’s strategy for NCDs, Injuries prevention and control and Mental health promotion (2023-2027) highlights the need for strengthening health systems, integrating NCD prevention into primary care, mobilizing funding, and establishing CoE to serve as
hubs for capacity building, research and innovations in the area of NCDs prevention and control on the continent.

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Overview
The cross-border RCCE readiness training for Eastern Africa was conducted from 15-19 April 2024 in Mombasa, Kenya. The training was attended by Ministry of Health staff across public health emergency response pillars, including Surveillance, Case Management, Infection Prevention and Control (IPC), RCCE and Points of Entry, from the seven African Union (AU) member states (MS); Ethiopia, Kenya, Rwanda, Somalia, South Sudan, Tanzania and Uganda. Participants from Red Cross and Red Crescent National Societies, WHO and UNICEF from these seven countries also participated. A total of 53 participants attended the training, alongside 11 facilitators.
This report has been authored by the RCCE training facilitation team, consisting of the Collective Service (IFRC, UNICEF and WHO), UKHSA-PHRST, Africa CDC, READY Initiative and IOM. It synthesizes key insights collected from the plenary discussions during the training sessions and data gathered throughout the planning, implementation, and evaluation phases. Finally, this report outlines recommendations and proposed next steps for regional and country-level stakeholders, aiming to guide future efforts in enhancing cross-border outbreak readiness in RCCE.

Background
Lessons learned around RCCE in outbreak responses in East and Southern Africa recognise the need to learn from and strengthen national and cross-border collaboration in the face of frequent public health emergencies. In October 2023, One Health partners conducted a Simulation Exercise in the Mandera region between Ethiopia, Kenya, and Somalia to test cross-border readiness. One of the key recommendations from this workshop was that current and future agreements, plans, and SOPs on One Health Emergency Preparedness and Response (EPR) in all three countries should include RCCE for cross-border situations.

In response to cholera outbreaks in the Eastern Africa Region, Africa CDC hosted a Cross-Border Coordination, Collaboration, and Communication workshop in Kampala, Uganda, in October 2023 with participants from Ethiopia, Kenya, South Sudan, and Uganda including IPC/WASH, Cross border/PoE, RCCE and Surveillance focal points from these MS. Participants noted frequent delays in implementing RCCE activities in outbreaks and the need to improve cross-border community engagement and trust for a coordinated response. Recommendations for RCCE responses included the need for training on rapid qualitative assessments to better understand community concerns and the collection and sharing of community feedback, including across borders.

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Antimicrobial resistance (AMR) has emerged as a leading cause of death in the African region, surpassing fatalities from malaria, HIV, and TB. In response to this critical threat, the region has adopted the AMR Global Action Plan and the African Union Framework for Antimicrobial Resistance Control 2020 – 2025, which is tailored to meet the specific needs of African nations through a coordinated approach. While most countries in the region have developed and prioritized National Action Plans (NAPs) to tackle AMR, the overall response remains inadequate given the magnitude of the threat, which endangers human, animal, environmental, aquatic, and plant health.

Africa bears a significant burden of infectious diseases, accounting for approximately 95% of malaria deaths, 70% of people living with HIV, and 25% of TB deaths globally. In 2019, AMR was
linked to approximately 55,000 deaths from HIV, 30,000 from malaria, and 255,000 overall. Major drivers of AMR in the region include the overuse and misuse of antimicrobials in human and food systems, migration, suboptimal vaccination rates, and environmental contamination from hospital and pharmaceutical effluents. Additionally, there is a lack of access to quality-assured antimicrobials and diagnostics, compounded by inadequate knowledge about AMR. Unlike high-income countries, where indiscriminate antimicrobial use is the primary factor driving AMR, African countries face additional challenges, including a lack of access to clean and safe water, poor Water, Sanitation, and Hygiene (WASH) programs, inadequate infection prevention measures, and suboptimal vaccinations for preventable diseases. One in three hospitals in the region lacks clean, safe running water, and one in eight people defecate openly due to inadequate sanitation. Investments in WASH, infection prevention, and biosecurity could save approximately 700,000 lives annually.

Addressing AMR in Africa requires a comprehensive, multi-sectoral approach involving the entire society. Sustainable access to antimicrobials, including antibiotics, vaccines, and therapeutics, is crucial, as lack of access leads to more morbidity and mortality than AMR itself. Support for the region should focus on preventing infections, strengthening health and food systems, developing human resources, ensuring sustainable access to diagnostics and therapeutics, and investing in laboratory infrastructure to support
surveillance and data generation.

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From April 11-13, 2024, a ‘High-Level Emergency Regional Meeting on Mpox in Africa’ was convened by Africa CDC in collaboration with the Democratic Republic of Congo (DRC) and multiple other partners, including CEPI, WHO, UNICEF, INSP, and US Government among others. This report highlights key findings from 9 technical sessions.
The high-level ministerial meeting brought together over 05 Ministers of Health and delegates from 11 AU Member States (1)
To share the latest research and insights on Mpox, including its epidemiology, transmission, and prevention strategies (2)
To review and enhance existing response frameworks and collaboration mechanisms among affected countries (3)
To foster partnerships and coordinate efforts with international health organizations and donors for effective outbreak response and management including vaccination and, (4)
To develop a comprehensive action plan for Mpox surveillance, control, and prevention across the continent.

The high-level emergency meeting recognized the need for timely, accurate, and quality information on mpox situation in Africa to inform decision-making, program interventions, monitoring, and evaluations for the fight against mpox in Africa. The Ministers of Health of Angola, Benin, Burundi, Cameroon, Central African Republic, Congo, Democratic Republic of Congo, Gabon, Ghana, Liberia, Nigeria, Uganda, and partners emphasized the urgent need for strengthened preparedness and response to mpox in the African Union Member States, highlighting the need for cross-border integrated disease surveillance and a coordinated regional approach. It called for partners to harmonize support and interact with the African Taskforce for mpox coordination to fulfill mandates.

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Article (23) of the Africa CDC Statute states that “In the execution of its strategic work plan, the Africa CDC will network and harness public health assets in each region including through its Regional Coordinating Centers (RCCs). The coordination and support of the RCCs is to ultimately bring into reality an ‘Africa CDC without walls’ that supports the continent at the point of need, rather than from a centralized, distant location.” Therefore, engagement with key regional partners (Member States, Regional Economic Communities, Donors, and health partners) will ensure better alignment, standardization, and harmonization of approaches to fully harness each region’s different public health efforts and capacities.
In light of this, the Eastern and Southern Africa Regional Coordinating Centers (RCCs) hosted a high-level side event during the International Conference on Public Health in Africa (CPHIA 2023) on 29th November 2023. The event, titled ‘The Role of Regional Structures in Strengthening Health Systems and Enhancing Health Security in Africa,’ emphasized the necessity of strengthening health systems in African Member States through targeted programs and effective collaborations. It also explored the pivotal role played by the Africa CDC’s Regional Coordinating Centers in enhancing health system resilience.

Introduction:

The side event commenced with the screening of an insightful video illustrating the progress in implementing the Saving Lives and Livelihood Program. Dr Lul Riek, Regional Director, Southern Africa RCC and Acting Regional Director, Eastern Africa RCC, commenced the proceedings by articulating the objectives of the side event, followed by the formal introduction of esteemed dignitaries.

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Africa has a high disease burden which not only poses a threat to the health of its people but also impedes its progress towards achieving the Goal 1.3 Healthy and well-nourished citizens of the African Union (AU) Agenda 2063.
Africa is also the youngest continent in terms of population, with approximately 60% of Africans being under the age of 25 and 40% of the population reportedly being aged 15 years and younger. By 2030, up to 42% of the world’s youth are projected to be African.

Acknowledging this, the Africa Centres for Disease Control and Prevention (Africa CDC) has been engaging African youth through initiatives such as the AU COVID-19 Vaccination Bingwa Initiative and the Africa CDC’s inaugural Youth Advisory Team for Health (YAT4H). Another key element of Africa CDC’s youth engagement efforts is its Youth Pre-Conference, an annual event that brings together young people from across the African continent to discuss and strategise on issues related to health.
From 25 to 26 November 2023, Africa CDC convened the 2nd Youth Pre-Conference in Lusaka, Zambia, on the margins of the 3rd International Conference on Public Health in Africa (CPHIA 2023). The theme of the Pre-Conference was “Youth Leadership for a Safer and Healthier Africa”. It aimed to continue and intensify the conversation on youth engagement at Africa CDC and in public health on the African continent. It also provided a platform to showcase examples of youth leadership in innovating public health solutions on the continent and to network across countries and regions.

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I am delighted to present the Africa Centres for Disease Control and Prevention (Africa CDC) Annual Report 2023, encapsulating the efforts undertaken by Africa CDC over the past year – our second year of autonomy. This period was marked by significant health challenges for the continent, including prolonged Cholera outbreaks in Southern Africa, 2022-2023 Ebola Virus outbreak in Uganda, Marburg virus disease outbreaks in Equatorial Guinea and Tanzania, natural disasters, and the ongoing COVID-19 pandemic.
The achievements detailed in this Annual Report are attributed to the dedication and bravery of our 361 staff, as well as the robust partnerships and unprecedented
support from our donors. We also commend the strong leadership demonstrated by Africa Union Heads of State and Government, committed Ministers of Health, and other national stakeholders. In 2023, notable governance milestones were reached, including the establishment, and convening of meetings for the new Advisory and Technical Council, as well as the constitution of the new Governing Board for Africa CDC.

Key strategic advancements in 2023 included the approval of the 2023 – 2027 Strategic Plan for Africa CDC by the Governing Board. Additionally, there was a strategic realignment of the Saving Lives and Livelihoods initiative, a partnership of $1.5 billion between Africa CDC and Mastercard Foundation, to prioritize the vaccination of high-risk populations, integrate COVID-19 response into routine immunization and primary health care, and proactively prepare for potential future pandemics on the continent. The approval of the African Vaccine Manufacturing Accelerator (AVMA) and the implementation of PAVM’s strategic priorities also took precedence, focusing on vaccine manufacturing and supply chain capabilities in Africa. The 3rd Conference on Public Health in Africa (CPHIA 2023) was hosted in Lusaka, Zambia demonstrating the power of a united Africa to break barriers in global health.
As we execute our Africa CDC 2023 – 2027 Strategic Plan, we will concentrate on ensuring that Africa CDC is adequately equipped and staffed with the necessary technical expertise to fulfill its mandate at continental, regional, and country levels.

We have established internal mechanisms to empower our staff, provide training and career growth opportunities, and offer essential support. Furthermore, we are committed to maintaining a robust governance and accountability framework, promoting efficient financial management, accountability, and transparency,
alongside the Africa CDC financial sustainability plan to secure sufficient, predictable, and sustainable funding.
While there are still considerable challenges ahead in recovering from pandemic-related disruptions to health service delivery and access, these, are opportunities to integrate innovative approaches adopted to sustain services during the pandemic into future strategies.
I extend an invitation to all our national, regional, and global partners to join us in realizing this strategic vision and building “The Africa We Want”.
I express gratitude to our Member States and partners for their unwavering support for the 2030 global health sector strategies, which I believe provide a solid foundation for recovery from setbacks and better preparation for future health shocks.

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In May 2023, Africa CDC and AUDA-NEPAD convened sixty experts from across the continent and the globe to discuss concrete solutions for strengthening the impact and efficiency of the African clinical trials ecosystem, with the goal of speeding access to new lifesaving technologies in line with public health priorities. This meeting—rooted in aspirations of Africa’s Agenda 2063 and informed by the World Health Assembly clinical trials resolution—built upon discussions forged at the 2019 Pan African Clinical Trials Alliance meeting and in the sidelines of the 2022 Grand Challenges Annual Meeting. It was designed to:
• Diagnose and develop a collective vision for strengthening the African clinical trial ecosystem to drive more impact.
• Co-design a roadmap to drive efficiency and optimal impact for clinical trial pipelines in line with global initiatives on clinical trials.
• Identify priority funding, areas of harmonization in policy and practices, and opportunities for meeting participants to contribute to strengthening the ecosystem.

Participants agreed that despite the strengths and assets within the current clinical trial ecosystem, it is not equipped to effectively manage a global health product pipeline that is expected to grow in both complexity and size. A lack of overall coordination and ecosystem-wide weaknesses mean that individual investments in areas such as capacity strengthening and retention, digital infrastructure, trial design, and network strengthening have often yielded transactional gains that cannot be sustained over time.
Over three days, meeting participants examined all aspects of the clinical trial ecosystem and proposed concrete solutions, ultimately agreeing that there is an urgent need to reconfigure how coordination happens and how information, data, processes, and tools are shared and reported. They examined the opportunity to improve coordination across the continent to build more predictability for researchers, clinical trial funders, and sponsors; a stronger clinical trials workforce; more streamlined and efficient systems for collaboration; harmonized ethics and regulatory reviews; and better responsiveness to the needs of African research centers.

Participants together developed a shared vision for the African clinical trial ecosystem and developed several priority solutions that would enable this vision. They ultimately agreed that a coordination mechanism was needed to enable increased efficiency and impact and recommended that this mechanism be housed at Africa CDC and managed in partnership with AUDA-NEPAD, WHO AFRO, and AVAREF.
This mechanism should foster collaboration across funders and research sponsors, research networks and centers, industry partners, and community representatives, and that its mandate should include evaluation of the pipeline of clinical trials in line with African public health and research priorities, aligning on financing needs and mechanisms, building cohesive capacity strengthening partnerships, and driving evaluation of the impact of these changes on the clinical trial ecosystem. Participants prioritized a set of solutions that should be coordinated through this mechanism, including those that would strengthen clinical trial networks, advance innovative clinical trial design, harness digital innovations and efficiencies,
ensure sufficient capacity and capacity strengthening across the ecosystem, standardize policies and practices, and ensure effective engagement of communities and the public.
In the coming months, Africa CDC and AUDA-NEPAD will continue to engage with the African clinical research ecosystem and African Member States to shape and refine this coordination role, including through the evolution of a ten-year execution roadmap.

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I am delighted to introduce the Competency Frameworks for Vaccine Manufacturing and Research and Development Competency Frameworks, which have been prepared through collaborative efforts with key stakeholders in the industry,  supported by Africa Centres for Disease Control and Prevention (Africa CDC). The Competency Frameworks are essential tools for ongoing assessment of training needs, the development of curricula and transparency of course offerings.

Established in 2021 by the African Union (AU), the Partnerships for African Vaccine Manufacturing (PAVM) set to deliver a bold goal of enabling the African vaccine manufacturing industry to develop, produce, and supply over 60 percent of the total continental vaccine demand by year 2040, up from the current less than 1 percent. Interim goals have also been set to achieve 10 percent by 2025 and 30 percent by 2030. The Framework for Action (FFA),a guiding document of PAVM, outlines critical strategies and interventions to enable the development and foster the growth of a sustainable vaccine manufacturing industry in Africa.

The African vaccine research, development, and manufacturing sector currently employs approximately 3,000 Full-time Employees (FTEs), which is markedly insufficient compared to the 12,500 FTEs required to realize Africa’s 2040 ambitions. This shortfall represents a significant challenge in scaling up vaccine manufacturing and the development of R&D talent across the continent.

The Frameworks delineated in this report are not merely theoretical constructs. They serve as pragmatic tools in our journey towards self-reliance in vaccine manufacturing in pursuit of vaccine self-sufficiency. These Frameworks, among other applications, underpin the development of tools for assessment of vaccine manufacturing and vaccine R&D needs. These assessment tools, to be rolled out by Africa CDC, are designed to map training needs and guide initiatives for talent development. Moreover, they provide consistency in nomenclature and enhance transparency in educational program offerings. As such, we hope they will become invaluable resources for training providers, vaccine manufacturers and research institutions.

I wish to extend my profound gratitude to the Secretariat of the PAVM and to all the dedicated individuals and organizations involved in formulating these frameworks. I am equally indebted to the esteemed experts whose insights and expertise assure these Frameworks’ integrity and relevance.

As we embark on this noble endeavour, I call upon all stakeholders to unite. Together, we can bolster talent development and research and development capabilities on the continent. May these competency frameworks be instrumental in achieving the aim of having the African vaccine manufacturing industry develop, produce, and supply over 60 percent of the total vaccine doses required on the continent by 2040.

Looking ahead to the New Deal and the New Public Health Order for Africa, we must strive for a continent that is self-reliant not only in vaccine production but in all aspects of healthcare provision.

H.E. Dr Jean Kaseya

Director General, Africa Centres for Disease Control and Prevention (Africa CDC)

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