Africa: From emergency to resilience – what it will take to sustain smallpox control in Africa
For the first time since the creation of the Africa Centers for Disease Control and Prevention (CDC), the agency has used its expanded mandate under the revised 2022 statute to Mbox announced Public Health Emergency for Continental Security (PHECS) in August 2024. The Public Health Emergency for Continental Security (PHECS) is a continental alert that enables Africa CDC to coordinate a unified response, mobilize resources, and support Member States to contain cross-border threats. The announcement reflects the worsening outbreak. As of August 13, 2024, At least 12 African countries have reported smallpox outbreaks, with 2,863 confirmed cases and 517 deaths, while suspected cases have exceeded 17,000.
But the bigger question has always been what happens when the emergency tag is removed. By January 22, 2026, the landscape had changed. Based on the recommendations of the Africa CDC Emergency Advisory Group Announce the lift From the smallpox case to the PHECS case, citing continued improvements in surveillance, laboratory capacity, clinical care, risk communication, and regional coordination. The results were measurable. Between peak transmission periods In early 2025 and late 2025, suspected cases decreased by 40% and confirmed cases by 60%, and the mortality rate among suspected cases decreased from 2.6% to 0.6%. But raising the PHECS test is not a signal to relax.
It is a delivery of emergency engineering that is made through Incident management support team (IMST) for sustained state-led control through National Institutes of Public Health (National Health Institutions) and Ministries of Health, as an integral part of routine surveillance and primary care. This transformation is a real test for The new public health system in AfricaAnd whether the continent can maintain essential capabilities such as finance, workforce, laboratories, genomics, supply chains, and responsible leadership, once the pressure of the emergency eases.
According to the Africa CDC, the response has been secured 1 billion US dollars In government and donor pledges and the expansion of genetic sequencing through Supported by the European Union A partnership aimed at enhancing laboratory diagnostics and improving sequencing capacity. Partners like Coalition for Epidemic Preparedness Innovations (CEPI) It also supported vaccine research and clinical evaluation during the outbreak, helping to generate evidence about the effectiveness of vaccines and enhancing Africa’s preparedness for future smallpox outbreaks. The question now is whether these gains will become routine infrastructure rather than one-off mobilizations.
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Why are biocollections important and why can’t surveillance be reduced?
Mbox It is not a single, unified threat. Different viral groups and subgroups can differ in transmission patterns and outcomes. Clade International Investment Bank This led to an outbreak in several countries that began in 2022, while branches Ia and Ib led to increasingly widespread outbreaks in the Democratic Republic of the Congo and other African countries, with Clade Eb It was discovered outside Africa. The point is that surveillance must remain sensitive enough to detect the spread of zoonoses and shifts in human-to-human transmission, especially in settings where testing, sample transport, and cold chain logistics remain fragile. Community alerting, rapid access to testing, and cross-border event-based surveillance must not be weakened. If sample transportation, cold chain, and last-mile logistics are given less priority, delays will widen, and the virus could spread undetected in hard-to-reach areas.
Defining the strategic pivot and why vigilance is still important
From August 2024 to January 2026, Africa’s response was based on speed. Rapid intervention teams, emergency funding, and central coordination It has been prepared To stop transmission of infection and reduce deaths. the Post-PHECS It should be built on tolerance, incorporating smallpox into routine surveillance, laboratories, infection prevention and control, and targeted vaccination where risks remain higher. In practical terms, this means switching from Africa led by Centers for Disease Control and Prevention IMST A model of national ownership through national public health institutions and ministries of health, supported by clear performance indicators and predictable local funding. It is often a particularly vulnerable stage in the fight against an outbreak DowngradeWhen political attention shifts and funding becomes less certain.
During the acute phase, countries and partners It pledged more than one billion US dollars To support the response. The danger now lies in donor fatigue and domestic budget shortfalls. Member States should convert emergency spending into routine budget lines for surveillance, laboratory systems, infection prevention and control, and targeted vaccination. This sustainable investment is especially critical in hotspot areas and border towns, where population movement can accelerate cross-border movement. Without coordinated surveillance and joint outbreak response between neighboring countries, gains made during the emergency phase could be quickly eroded, delaying recovery.
Risk communication, trust, and the future research agenda
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Once the official emergency designation is lifted, perceived risks could decline faster than biological risks. Therefore, the transition roadmap should place risk communication and community engagement (RCCE) at the centre, and clearly articulate that this is a shift from emergency response to sustainable control and recovery, not the end of the threat. vaccination It remains a central phase, but this longer phase depends on stronger evidence about the duration of protection, priority populations, and vaccine performance as the virus evolves. Therefore, research and monitoring must continue, especially in high-burden settings and among vulnerable groups.
The coming months will test whether Africa can maintain the infrastructure built during an emergency without having to issue a continental ultimatum. The Africa CDC has pointed to lessons learned from the smallpox response It will be institutionalized And other epidemic diseases, including cholera, diphtheria, measles and polio, are taking hold Epidemic prevention, preparedness and response Agenda (PPPR). If Member States fund these capacities and integrate them into everyday systems, Africa will not only respond faster to the next outbreak, but will also prevent further outbreaks.
