Senior Adviser to the Brown Pandemic Center, Professor of the Practice of Health Services, Policy and Practice at the Brown University School of Public Health
Dr. James, an internationally recognized thought leader in biosecurity, global health, and pandemic preparedness, is a Senior Advisor to the Pandemic Center and a Professor of the Practice of Health Services, Policy and Practice.
Dr. James has served as Member of Parliament and Shadow Minister of Health in South Africa, and most recently held positions at Columbia University as Senior Research Scholar at the Institute for Social and Economic Research and Policy and as Chair of the Center for Pandemic Research. Wilmot co-chairs the National Framework sub-working group of the G7-led Global Partnership’s Signature Initiative to Mitigate Biological Threats in Africa; is Academic Chair of the World Economic Forum’s Biosecurity Readiness through Intelligence, Data, and Global Engagement (BRIDGE); chairs the Climate-Health Impacts Advisory Committee of the London based Wellcome Trust; chairs one of the selection panels for the Schmidt Science Fellows Post-Doctoral Program; and serves on the Advisory Board of Resolve to Save Lives. Dr. James will use his extensive experience to address public health and national security challenges in his role as senior advisor to the Pandemic Center.
In December 2024, a group of scientists did something rare: published a warning against building a technology that some of them had spent years working toward. Even more eye-popping, this came at least a decade before the tech is even possible.
The warning concerned mirror bacteria: hypothetical synthetic organisms built from mirror-image forms of the proteins, amino acids, DNA, and other biomolecules used by life on earth.
In an analysis published in Science, we and 36 colleagues—including two Nobel Laureates and 16 members of national academies from around the world—argued that such organisms could be built within the next 10 to 30 years and could pose an extraordinary threat if they were.
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While the immediate effects of the US cuts in health aid are being felt primarily by the Global South, the associated risks extend worldwide.
Last week, global leaders gathered for the World Health Assembly in Geneva to address the reality that the global health landscape is being reshaped by dramatic shifts in funding, priorities, and leadership.
Chief among these is the United States’ decision to slash foreign aid and withdraw from the World Health Organization (WHO). Despite spending only 0.24% of its gross national income on foreign aid, the United States has been the largest donor to global health programmes, providing one-third of the international assistance in global health. This is not just a US issue – other countries have also signalled reductions in foreign health aid, and Argentina also recently announced it will withdraw from the WHO.
These dramatic shifts have forced the WHO to plan a reduction in staff by nearly 50%, triggering massive restructuring. Non-government organisations (NGOs) are laying off large numbers of staff worldwide. While other donors and philanthropies are stepping in, they cannot fill the void alone.
Meanwhile, the shock to the system is already resulting in lives lost. According to the WHO, countries such as Haiti, Kenya, Lesotho, South Sudan, Burkina Faso and Nigeria may run out of HIV antiretroviral medications within months.
The vacuum left by the US threatens irreparable damage to global health institutions, with the WHO bearing a disproportionate burden. The organisation must view this crisis as an opportunity to develop into an entity that is leaner with greater agency to carry out its most essential, life-saving tasks.
The World Health Organization (WHO) is in a moment of crisis. The decision by the US to withdraw from the organisation leaves the WHO with a deficit of about 15% of its total funding through the end of 2025 and 45% projected for 2026-27.
Without US funding, there has been immediate disruption to controlling the mpox outbreak. Now is the time for global health leaders, philanthropic organisations and other high-income nations to step up and fill the void left by the funding withdrawal.
The viral zoonotic disease mpox (formerly known as monkeypox) has periodically affected African nations since its discovery in 1958.
Historically, it remained confined to specific regions, primarily within central and west Africa. However, the outbreak that began in 2022 marked a significant escalation, with cases spreading beyond usual endemic regions. By mid-2022, the virus had reached multiple continents, prompting the World Health Organization (WHO) to declare a public health emergency of international concern in early May, 2022. Unlike previous outbreaks, the 2022-2023 epidemic saw a significant number of cases in Europe and the Americas.
Now is the time to continue the momentum towards achieving African vaccine sovereignty. We must work to both increase the continent’s vaccine manufacturing capacity and then develop strategies to promote their uptake.
Five years to the day after the World Health Organization first referred to Covid-19 as a pandemic, the US National Institutes of Health slashed grant funding for projects that aim to understand vaccine hesitancy and promote vaccine uptake. The Covid-19 pandemic and more recent outbreaks of mpox, Marburg and Ebola underline the importance of regionalised vaccine manufacturing to ensure access to vaccines for people in Africa. Yet, without research to inform strategies to improve trust in vaccines and promote their uptake, the gains in manufacturing will not translate to lives saved.
Defunding research that aims to improve vaccine uptake is another historic mistake in what has become a sad litany of health science reversals by the Trump administration. In January 2025, before the funding cuts were announced, leading vaccine researchers from around the world published an article calling for countries to measure the social and behavioural reasons that people choose to get vaccinated or not and to use this information to design approaches to improve vaccine uptake. Heeding this call is now more important than ever to ensure that the vaccines produced in Africa are taken up by those who can benefit from them – otherwise what is the point?
We must work to both increase African vaccine manufacturing capacity and develop strategies to promote their uptake once they are made. Currently, only 1.1% of Africa’s vaccine supply is produced locally. This overdependence on foreign vaccine supplies leaves African people vulnerable. This challenge is heightened by the inequity in access to foreign supplies, a disparity that became especially evident during the Covid-19 pandemic. While the Covid vaccination campaign was the largest and fastest in history, Africa faced significant challenges in access and distribution. By November 2022, almost two years after high-income countries began vaccinating their citizens, only 25% of the people in Africa had been fully vaccinated against Covid-19.
At the beginning of the pandemic, initiatives such as the Covax facility, a global Covid-19 vaccine procurement mechanism, signalled positive steps towards global solidarity for equitable vaccine access. Although this effort was highly commendable, the reality was very different. Gavin Yamey, the director of Duke University’s Center for Policy Impact in Global Health who was involved in the early discussions about Covax, declared that “rich countries behaved worse than anyone’s worst nightmares”. Wealthy countries were first in line to receive vaccines because they were able to place orders for multiple candidates in their early stages of development. Hoarding of these vaccines led to what World Health Organization (WHO) director-general Tedros Ghebreyesus called “vaccine apartheid”, as booster doses of the Covid-19 vaccine were widespread in high-income countries before people in low-income countries had even received a first dose.
Once vaccines are available on the African continent, how can policymakers be sure that the regulatory process for their approval, technical expertise to run clinical trials, and health workforce to administer vaccines are in place to be able to ensure that vaccines reach those who need them? For example, the response to the current mpox public health emergency of international concern has been plagued by delays in authorisation for the vaccine and limited data on the effectiveness of these vaccines in children.
The ongoing challenges with vaccine access in Africa continue to cause preventable loss of life even though it is well established that early access to vaccines in an outbreak can stop a virus in its tracks. Strengthening vaccine manufacturing capacity on the continent will ensure long-term health security across the continent. Promising efforts are already under way that must be supported and expanded, particularly in light of uncertainties surrounding US funding for global health. As of late 2024, there were five African vaccine suppliers in four countries – South Africa (Aspen Pharmacare and Biovac), Senegal (Institut Pasteur de Dakar), Morocco (Marbio) and Egypt (Vacsera) – with scaled facilities that are close to commercialisation. A further 20 suppliers across the continent are in development or awaiting technology transfer.
In 2021, the African Union announced its goal of supporting the African vaccine manufacturing industry to produce more than 60% of the vaccine doses required on the continent by 2040. The Partnerships for African Vaccine Manufacturing was created under the Africa CDC in 2021 to achieve this goal and was expanded in 2024 to include all health products under a new name, the Platform for Harmonized African Health Products Manufacturing. As of June 2024, there are 25 active vaccine projects across the continent. Initiatives such as the WHO’s mRNA technology transfer hub and those supported by the Coalition for Epidemic Preparedness Innovations (Cepi) also have been working to increase African vaccine manufacturing, and fostering vaccine sovereignty.
In 2024, major African-led initiatives were launched to accelerate African vaccine manufacturing. The African Vaccine Manufacturing Accelerator received a $1.2-billion investment, through reallocated Covid-19 funds from other country’s governments and philanthropies, to expand vaccine manufacturing on the continent, Afreximbank pledged $2-billion in support of African Health Products Manufacturing, and regulatory bodies from seven African countries signed a memorandum of understanding to promote a strong, harmonised regulatory system on the continent.
Countries including Rwanda are also setting a strong example. Leveraging a tremendous amount of preparation and partnerships with the private sector and global public health organisations such as Cepi, just 10 days after the outbreak was declared, Rwanda implemented clinical trials of the Sabin mpox vaccine.
Achieving self-reliance in vaccine production in Africa is possible. In combination with continued efforts to understand and promote vaccine uptake, we need whole-of-government approaches that support the growth of vaccine manufacturing on the continent. The ministries of health and finance must work together to develop strategic approaches for preferential procurement practices of regionally produced vaccines. There needs to be harmonisation of the regulatory bodies on the continent with the WHO’s prequalification process – an approval process required for vaccines to be bought by UN agencies such as Unicef – so that safe and effective vaccines can reach populations in need and at scale.
Now is the time to continue the momentum towards achieving African vaccine sovereignty. These efforts will save lives if people have the confidence and trust to take them. DM
Margaret Dunne is a doctoral candidate in the Department of Epidemiology; Thokozani Liwewe a medical doctor and global health professional working with the Ministry of Health, Malawi, and a Game Changers Fellow; Alice Im is a research assistant; Andrea Uhlig is a research associate; Carly Gasca is a project director; and Wilmot James is a professor and senior adviser – all at the Pandemic Center in Brown University’s School of Public Health, Providence, Rhode Island.
A disruption of current HIV/Aids mitigation programmes in southern Africa will lead to decreased access to critical treatments and preventive therapies, which will in turn lead to increased mortality and mother-to-child transmission.
For decades, the United States has been a critical player in supporting the response to HIV/Aids in southern Africa. However, recent shifts in US policy as mandated by executive orders from the second Trump administration threaten to disrupt life-saving humanitarian aid programmes, posing profound danger to pan-African public health and economic stability, in addition to global health security.
Southern Africa has long been the epicentre of the global HIV/Aids pandemic, with Botswana, South Africa and neighbouring countries experiencing some of the highest infection rates in the world – in several cases exceeding 20% of the total adult population.
Botswana, for example, has an adult HIV prevalence rate of about 23% (for reference, any country with HIV infection rates above 1% is determined a Generalized HIV Epidemic per the Joint United Nations Programme on HIV/Aids); South Africa, the most affected country worldwide by case volume, has an estimated 7.7 million people, people living with HIV/Aids, of which 5.9 million are on antiretroviral therapy.
