A new Africa Health Security (AHS) Index, released today against the backdrop of a devastating Ebola disease outbreak, reveals significant gaps in critical health infrastructure despite important progress in health security capacity in recent years.
The AHS Index spotlights how African governments and partner investments in the aftermath of the COVID-19 pandemic have paid off. The continent is nearly 30% more prepared than it was five years ago, according to the Index, yet an average score of only 41.5 out of 100 reveals gaps that could allow crises to become catastrophes at a time when threats and risk factors continue to escalate.
Developed by a coalition of African and global research organizations and public health and security experts, the AHS Index assessed all 54 African countries based on answers to 190 questions. These questions benchmark health security alongside other factors critical to preventing, detecting, and responding to outbreaks, including the strength of each country’s health systems, commitment to global norms, and the local political and risk environment. The Index was designed by the coalition to meet African priorities and equip leaders with evidence to address current and future risks.
The Index findings show that progress is real and broad-based with 52 out of 54 countries showing improved scores by at least one point. The continent-wide averages improved in all top-level Index categories except risk environment. However, despite these gains, some underlying indicators declined.
“The AHS Index is a game changer for an exceptionally diverse continent with wide differences in national incomes, climate, governance, and social conditions. It measures our unique strengths and strategic opportunities and provides the evidence base for African controlled health investments and policy decisions,” said Judith Omumbo, head of partnerships and resource mobilisation for the Science for Africa Foundation, a co-lead of the AHS Index. “It can guide domestic policy priorities and international collaboration opportunities, ensuring that countries in Africa lead, rather than follow, in global health security initiatives.”
The Index also found improvements in biosecurity and biosafety capacity across Africa, but capacity in those areas still remains alarmingly low. The average biosecurity score is 14.9, the biosafety average 18.2, and the dual-use research of concern average is 1.9 out of 100. Lab infrastructure is expanding, but it is outpacing safety and security oversight mechanisms.
“The measurable increase in capacity is the result of dedication, hard work, and investment in the health security of Africa over recent years, but much more is needed. Substantial gaps remain that can mean the difference between a small outbreak and an international pandemic. Investments made today will determine Africa’s capacity to address the health threats of tomorrow,” said Dr. Wilmot James, senior adviser to the Brown University Pandemic Center and a former Member of Parliament and Shadow Minister of Health in South Africa. “Recent declines in overseas development assistance underline the need for governments to prioritize resources and strengthen the systems that address health emergencies.”
Other findings include:
Biosurveillance capacity is growing: 53 out of 54 countries had increased biosurveillance capacity, though progress varied by region. Wastewater and environmental surveillance has expanded to 52 countries and genomic sequencing capacity in 48 countries, but programs vary in maturity.
Medical countermeasure development is outpacing deployment: Capacity for life-saving medical countermeasures (MCM) such as vaccines and therapeutics rose across all five regions. However, countries have better capacities to develop MCM (average score: 56.5 out of 100) than to deploy them (20.7 out of 100). Similarly, while 85 percent of countries have an agency to approve new MCMs, only 22 percent have public plans to handle supply surges during emergencies.
Climate-related health security capacity is improving: Access to water and sanitation infrastructure to better manage risks linked to climate change has increased, and countries have more capacity to prevent, detect, and rapidly respond to zoonotic diseases with more legislation, surveillance, data sharing, and emergency response planning.
Regional health security infrastructure is strengthening, but unevenly: In response to regional capacity building efforts, the number of countries meeting field epidemiologist staffing thresholds nearly doubled: Fifty-two countries now have Emergency Operations Centres, and 36 have animal health emergency agreements. However, only eight countries are tracking dangerous pathogen facility locations.
National health security financing commitments show signs of strain: The average score dipped from 52.5 to 50.5 out of 100. Eighteen countries no longer show evidence of active financing commitments, although seven new countries do.
“African governments have made measurable progress in health security capacity, and the data show it,” said Christine E. Wormuth, president and CEO of the Nuclear Threat Initiative. “Growing biological risks and a challenging security environment expose countries to outbreaks, accidents, and deliberate threats. Strengthening public health is both a national and regional security priority.”
Based on the assessments, the report also highlights key actions governments, multilateral organizations, regional entities, funders and the private sector can take today to ensure continued progress in the face of rising threats, including:
Additional quotes from Index leads:
“Measuring health capacity matters because what gets measured gets done. The Africa Health Security Index equips policymakers with the data they need to act and will help countries understand and strengthen capacity across the region,” said Peter Babigumira Ahabwe, an epidemic intelligence analyst in Uganda’s National Public Health Institute and chair of the expert advisory group behind the Index. “This is a cross-sectoral tool with value for every policy domain.”
“More frequent outbreaks, climate change, unstable funding for health systems, and security risks all increase vulnerability,” said Dr. Jake Jordan, vice president for Global Biological Policy and Programs at NTI. “The data is telling us that stronger, sustained investment and broad-based partnerships matter more than ever. Governments increasingly understand the assignment—but need more resources to complete it.”
“The Africa Health Security Index represents a collaborative approach to measuring preparedness—grounded in data and built for action,” said Dr. Jennifer Nuzzo, director of the Brown University Pandemic Center. “With multiple years of data, it helps countries identify gaps, track progress over time, and gives donors and policymakers the evidence they need to prioritize investments and strengthen health systems.”
“The Africa Health Security Index allows countries to measure capacities and make their own decisions about where and how to fill health security gaps using different financing solutions. I am excited about how this new regional approach can further empower regional leaders across health, financing, security, and other relevant sectors,” said Dr. Elizabeth Cameron, senior adviser to the Brown University Pandemic Center. “This effort adds an important new element to the global architecture for pandemic preparedness monitoring, linking to other important efforts to fund the highest priority gaps, track pandemic spending across sectors, and showcase economic returns on investment, including the Pandemic Fund and the High Level Independent Panel.”
“Robust data collection and validation, and a transparent, comparable methodology across countries underpins the Africa Health Security Index,” said Elly Vaughan, principal, global health at Economist Enterprise. “Countries should use the data to identify and close gaps, and share progress publicly, to enable cross-border learning. Everyone has a role to play in strengthening health security.”
About the AHS Index
The AHS Index is co-led by the Nuclear Threat Initiative (NTI), the Brown University Pandemic Center, Economist Enterprise, and Science for Africa Foundation, in collaboration with University of the Witwatersrand (Johannesburg, South Africa), and University of Tunis El Manar (Tunis, Tunisia). Funding was provided by the Gates Foundation.
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