Many private-sector investors are considering health in Africa. Maybe that’s no surprise; the African Development Bank says the Continent could almost double its GDP if health were better. Robert Appelbaum, though, thinks that many are interested in what Africa might export as well as the potential unlocked at home.

Appelbaum has advised multinational pharma companies through the most difficult episodes of the past three decades including the disputes over HIV medicines patents and the transfer of technology to African producers. He also provides legal and business counsel to billionaires who are household names. “Today, investors are looking at the African Continental Trade Agreement (AFCTA) and the commercialisation of African drugs and devices for use across the world,” he told me. “The AFCTA is making Africa into a legitimate manufacturing hub for the full gamut of manufacture from API [active pharmaceutical ingredients] through to fill and finish, whereas in the past we have been in the business of fill and finish,” he added.

The day before we spoke I had been to see the Biomedical Research Institute at Stellenbosch. It houses a network of 26 BSL-3 — highly secure — laboratories to handle infectious diseases samples. There are probably a third as many BSL-3 labs at Stellenbosch alone as there in all of China. The Biobank in the same facility has space for up to seven million samples and provides an exceptionally rapid way of looking back at the evolution of disease outbreaks. It was designed to allow another seven million to be stored when needed. To give an idea of how massive this is, the largest biobank in China can hold 10 million samples and the largest human biobank in Europe can keep 20 million. Maybe the most impressive statistic is that the Stellenbosch institute was completed for about €65 million, a fraction of what it would have cost in Europe.

Cost is not Africa’s only advantage: it has the kind of frugal innovation that hard-pressed European and American health systems need. “There is a huge amount of work taking place — more in devices and technology than in drug discovery. Africans are very innovative at creating for ourselves what does not already exist,” Appelbaum said. These are exactly the areas in which slow first-world innovation is holding back medicine: commissions on antimicrobial resistance assumed point-of-care diagnostics would by now have been able to differentiate between viral and bacterial illnesses and between different kinds of infectious bacteria. They cannot.

Pre-history gives Africa another advantage. As humans spread across the globe from Africa, we lost genetic diversity. It’s said that today there is more genetic diversity within Mozambique than between people in South Asia and people in Europe. In that vast genetic storehouse are hidden undiscovered clues to resisting and treating disease — clues that can be transformed into prevention, diagnosis and treatment by health innovators. As Africans have more access to health services, those genetic assets and liabilities will become more and more evident and accessible. This is a key aspect of the African Human Genome project and of South African agreements with commercial entities such as Illumina and MGI.

To spot the real life implications of these genetic patterns, to find population clusters and to identify possible genetic outliers, a country needs easy, secure access to massive numbers of records. The United Kingdom sees this as a competitive advantage for its four national health services while France’s La poste, the nation’s post office, is bringing together over 40 million patients’ referrals, visit reports and test results. These and other developed world efforts, though, are having to retrofit national analytical frameworks onto multiple old data systems and to pry data loose from academics and care systems with strong proprietorial instincts. African countries are building new national data systems from the bottom up with integration and analysis as part of the original design. Appelbaum thinks that Africa may again leapfrog over Western competitors, just as it did by introducing modern mobile telephony and mobile payment systems while legacy system owners slowed down adoption in Europe and the Americas.

Many think that Oracle has already honed in on the opportunity. It has partnered with the Tony Blair Institute to introduce vaccine tracking systems in Ghana, Rwanda and Sierra Leone and to promote them Continent-wide. Given the vast effort that Oracle continues to put into developing a nationwide repository of health records in the USA and the Gulf states, many see its efforts in Africa as a test run for much broader and more ambitious national health databases. African countries are not waiting. Kenya’s Afya Yangu platform is already operational in a third of the nation’s counties and provides portable individual records including medical history, prescriptions, lab results, and appointments for three million users. South Africa faces some of the same challenges as Europe in unifying or supplanting existing systems but its Health Patient Registration System has registered over 57 million patients across more than 3,000 facilities as a foundation for portable electronic health records. Africa’s health data is a vast opportunity which governments will need to use as the basis for investment.

Private sector health investors are indispensable to Africa, Appelbaum thinks. In the US and Europe, they find far more R&D than governments and foundations combined; that must be the pattern in Africa if the Continent is to not just meet its own health needs but to develop innovations for the world.

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Yet today, we find ourselves dismantling these hard-won achievements. Extraordinary cuts to disease prevention, research, and surveillance programs signal a large-scale reversal of a successful strategy of containment and elimination. Such an irresponsible pivot risks opening the door for vaccine-preventable diseases, drug-resistant infections and new pandemics to reemerge with devastating force. If we continue down this path, the consequences will be felt not just in developing nations, but across the industrialized world, where health systems already are under strain.

It could take years to regain the high ground we currently hold against infectious diseases; many countries may never get there again. While pursuing modernization and efficiencies in the global health system is vital, randomly eliminating or suppressing funding and institutions we rely on to develop the pipeline of new vaccines, therapeutics, and practices to fight tomorrow’s pathogens only weakens us further. Our most dangerous disease threats constantly evolve, probe our weaknesses, and exploit natural opportunities to strike.

The attack on America’s preeminent medical research institutions and the innovations they fuel severely undermines our ability to counter disease while degrading the very talent we need to protect us: the next generation of scientists and medical researchers.

Many prominent health leaders are sounding the alarm, but until a coalition of the informed begins to take shape, we may as well be screaming into the wind. Unless a concerted effort is made to change course, the infrastructure, jobs, institutional knowledge, and recruitment of future health experts that constitute one of humanity’s greatest achievements may be dismantled. Surely by now we have learned that research and disease prevention is dramatically less costly than deploying the vast resources necessary to respond to a new outbreak.

Here’s one path forward: U.S. health communicators, advocates, and leaders should coordinate framing the issues to state and congressional lawmakers who stand to lose the most from the current health funding policy direction. Many of the places contributing the most to America’s competitive advantage in biomedical research are in conservative districts that receive funding from the NIH and other public sources.

Similarly, emerging diseases often pose the highest threat to people battling chronic diseases or living in areas underserved by health services, which means all of us are affected, regardless of economic status or ideological belief. People at every level of the health system—from practitioners to patients, researchers to drugmakers—should be energized to speak with one voice and let policymakers know that retreat in the face of defeatable disease threats is the wrong direction for the U.S.

Disease is humanity’s greatest enemy, and it constantly hovers at our doorstep. Do we pretend not to hear it knocking, or do we recognize its dangers and act?

That’s exactly the moment we are facing now. Our situation is complicated by the fact that our most important defenses – biomedical research and disease prevention infrastructure – are being demolished before our eyes. It will take real courage to act, but we must marshal our resources, defying the ambivalence and dismissiveness that make us more vulnerable to looming infectious disease threats. This is no time to retreat.

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A Changing Landscape: Opportunities in U.S.-India Health Ties

India’s rapidly evolving health sector and the U.S.’s unparalleled expertise in innovation and investment create a powerful synergy. India, already a global leader in pharmaceuticals, supplies 40% of generics to the U.S. and has emerged as a hub for cutting-edge manufacturing and research. Meanwhile, U.S. companies view India as a gateway to growth, with its burgeoning middle class, aging population of over 100 million, and a health market projected to reach $638 billion by 2025, growing at a 22% compound annual growth rate. The results of U.S. elections will directly influence health policies, including tariffs, trade agreements, and investment incentives, shaping the pace of collaboration between the two nations. Multinationals must navigate these shifts carefully, balancing policy changes with market potential.

Emerging Trends in the US-India Health Partnership

Reshaping the Pharmaceutical Supply Chain: With the U.S. increasing tariffs on Chinese imports and emphasizing domestic resilience, India has an unprecedented opportunity to fill the gap. Proposed legislation like the U.S. BIOSECURE Act positions India as a vital partner in contract manufacturing and research, doubling opportunities for Indian CDMOs and CROs. 

Incentivizing Innovation and Local Production: India’s Production Linked Incentive (PLI) and Make in India initiatives are revolutionizing domestic manufacturing. These schemes offer MNCs financial incentives to produce locally, reducing costs and enhancing access. U.S. companies like Pfizer and GSK have already capitalized on India’s pro-business policies, paving the way for others to follow.

Digital Health Revolution: India’s National Digital Health Mission and growing investments in telemedicine present lucrative opportunities for U.S. firms. Collaborating with India’s thriving tech ecosystem could help MNCs expand their digital health solutions, from AI-driven diagnostics to telehealth platforms, addressing unmet needs in rural and underserved markets.

Medical Devices as the Next Frontier: India’s recent ₹500 crore initiative to strengthen its medical devices sector aligns with U.S. expertise in advanced technologies. Partnerships in this space could make India a global exporter of high-quality medical devices, with MNCs playing a pivotal role in innovation and scale.

Why India is Unmissable for Multinationals

India’s health sector is undergoing a profound transformation, bolstered by government-led reforms and a favorable FDI regime. The allowance of 100% foreign direct investment through automatic routes in health and related sectors has already attracted global giants. Regulatory relaxations, such as waiving clinical trial requirements for drugs approved in select countries, make India an even more attractive destination for innovation. Additionally, India’s ambitious BIO-Ride Scheme aims to bridge the gap between research and commercialization, enhancing the country’s reputation as a biomanufacturing powerhouse. These developments, coupled with the expanding talent pool, provide multinationals with access to skilled professionals and cutting-edge research.

While the U.S.-India health partnership offers immense promise, challenges such as regulatory hurdles, intellectual property concerns, and geopolitical shifts must be addressed. Multinationals must adopt a strategic approach to align their goals with India’s priorities, from affordability to local capacity building. The future of health lies in the strength of the U.S.-India relationship. Together, the two nations can drive transformative change, addressing global health challenges through innovation, policy alignment, and mutual investment. Multinationals that recognize and act on this potential will not only unlock significant growth but also play a defining role in shaping the health landscape for generations.

As the post-election dust settles, one thing is clear: the U.S.-India health partnership is not just a bilateral opportunity—it’s a global imperative.

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As the world gradually recovers from the shockwaves of the COVID-19 pandemic, the spectre of another potential public health crisis looms ominously on the horizon. A recent report in The Lancet on the risks of avian influenza H5N1 at mass gatherings is a critical reminder that our vigilance against infectious diseases must remain steadfast, especially as we approach a summer filled with major religious, cultural, and sporting events.

Mass gatherings have always been fertile ground for spreading infectious diseases, serving as hubs for international transmission. From the annual Hajj pilgrimage to the bustling celebrations of Kumbh Mela, these events draw millions of people from around the globe, creating perfect storm conditions for pathogen spread. The resurgence of avian influenza, particularly the H5N1 strain, poses a renewed threat that demands immediate and focused attention.

The Silent Spread of H5N1

H5N1, also known as Highly Pathogenic Avian Influenza, has been on the radar of global health authorities since its emergence in 2004. Despite not currently transmitting easily from person to person, recent reports of mild or asymptomatic human cases in the USA, China, Vietnam, and Europe are alarming. The first human case in the USA was reported in 2022 in Colorado, linked to direct poultry exposure. Similarly, England has documented 298 cases since October 2021. This underscores the virus’s persistence and the potential for rapid, widespread outbreaks if left unchecked.

Lessons from History: Preparedness Pays Off

Historical precedents demonstrate the critical importance of proactive public health measures. The past decade has seen mass gatherings successfully navigate Zika, Ebola, and COVID-19 threats through meticulous planning and surveillance. For instance, the 2015 Africa Cup of Nations in Equatorial Guinea proceeded safely amidst the Ebola outbreak, thanks to stringent health protocols and international cooperation.

The ongoing efforts to prevent outbreaks at events like the Tokyo 2020 Olympics and various religious gatherings highlight the effectiveness of preparedness. Yet, these successes should not breed complacency. The ever-evolving nature of viral pathogens necessitates continuous vigilance and adaptation of our health strategies.

The One Health Approach: A Unified Front Against Zoonotic Diseases

The interconnectedness of human, animal, and environmental health underscores the need for a comprehensive One Health approach. Mass gatherings often involve the consumption of animal products and, in some cases, live animal sacrifice. This creates multiple avenues for zoonotic transmission, particularly with avian influenza viruses.

Countries hosting mass gatherings must implement rigorous screening and testing protocols for poultry and other animals to mitigate these risks. This includes mandatory surveillance of imported animals and those used in religious rituals. Wastewater surveillance can also provide early detection of viral presence, allowing for swift intervention.

Bridging Knowledge Gaps: Research and Surveillance

Mass gatherings present unique opportunities for real-time research and data collection. Understanding the transmission dynamics of H5N1 and other zoonotic pathogens is crucial for developing targeted interventions. Enhanced surveillance, using advanced diagnostic platforms, can identify and monitor emerging threats, filling critical knowledge gaps.

The Path Forward: International Cooperation and Vaccine Development

Ultimately, the global community must unite in the face of these emerging threats. Developing and distributing effective vaccines for H5N1 and its variants will be pivotal in safeguarding public health. Collaborative efforts involving organisations like the WHO, FAO, and OIE are essential for a coordinated response.

A Two-Year Effort to produce a global pandemic treaty misses its deadline. On Friday, May 24, Tedros Adhanom Ghebreyesus, the director general of the World Health Organization, announced that the negotiators from the group’s 194 member nations couldn’t reach a consensus in time for the World Health Assembly, which started this week.

The goal had been to draft a document that could be adopted at the meeting and then sent to countries for ratification. However, the sticking points—including the willingness of richer countries to share vaccines and treatments with less well-off countries in the Global South—could not be resolved in time.

What Next?

Scientists predict the next pandemic could occur soon, perhaps in two years or twenty. Still, the message is clear: proactive surveillance and preparedness are not optional. They are imperative. By learning from past experiences and embracing a unified approach, we can protect millions of lives and ensure that mass gatherings are celebrated safely worldwide.

Christopher Nial is a senior partner at FINN Partners. He specialises in global public health and the intersection between climate change and public health. With over 30 years of experience, he is passionate about leveraging public health strategies to save lives.

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Doctors still struggled to keep me alive as my fever spiked to 105 degrees Fahrenheit and my resting heart rate hovered around 175. I had multiple intravenous bags of quinine dripped into me, a routine treatment that brought with it the unfortunate risk of sudden cardiac arrest due to my infection while on Larium, a controversial and, in hindsight, ineffective antimalarial drug.

It’s a massive understatement to say malaria sucks, but I am among the lucky ones who get to say it at all. Malaria remains one of the greatest public health threats facing humanity, infecting 241 million people each year and inflicting incalculable damage on the economic prospects of endemic countries. If my description of malaria sounded bad, how could a 4-year-old kid battle the disease without most of the resources I had in Kinshasa? Most of the 500,000 people killed yearly by malaria are children under 5 – a vicious toll on future generations.

That’s why this week’s announcement by the WHO approving the use of a second malaria vaccine is astoundingly good news. Since the introduction last year of Mosquirix, the first-ever malaria vaccine brought to market by GSK last year, health officials have been trying to balance the limitations of the vaccine – both in efficacy and supply – with the high cost and urgency to get it distributed. With the approval of R21/Matrix-M, developed by the Serum Institute of India, Oxford University and Novavax, comes the potential for greater price competition and sufficient supply.

The news couldn’t come soon enough. As climate change expands the habitat of malaria-carrying mosquitos, two issues are rapidly emerging. First, regions that have been malaria-free for decades – or have never experienced malaria – will be in the projected range of vector-borne diseases within a matter of years. These include North America and parts of Europe. At the same time, the overuse of prophylactic medications, such as chloroquine-based drugs, is fueling increased resistance in regions such as Southeast Asia.

Second, malaria primarily afflicts rural communities in many areas where malaria is endemic. No longer. Researchers are now tracking new forms of malaria that are settling in densely populated urban areas. This is a potential tectonic shift in the threat that vector-borne disease poses to sustainable economic development and health system resilience. Seasonal outbreaks may crash worker productivity, shutter universities, and overwhelm hospitals.

The two approved malaria vaccines may help prevent the worst-case scenario looming in our future, but they are not solutions by themselves; they are part of a Swiss Army knife of tools that public health officials are deploying to contain malaria. Some, like insecticide-treated bed nets, provide trusted, low-cost and accessible interventions for low-income populations worldwide. Other theoretical options, such as genetically modifying male mosquitos or making humans “invisible” to the insects, may prove more effective in grabbing headlines than protecting communities. But with more volatile weather patterns and increased resistance fueling a surge in malaria mosquitos, nothing should be off the table or dismissed out of hand.

Why is malaria prevention more than a feel-good development story? The answer to that question lies in a simple calculus. Most of the potential for future economic growth will come from markets in the Global South. Several countries in Africa, Latin America and Southeast Asia represent a surge in young, increasingly educated and upwardly mobile consumers. The rise of megacities and other large urban centers can focus economic productivity, but such concentration also dramatically increases the impact of widespread, uncontrolled disease outbreaks.

The implications for the business community are clear. As we saw with COVID-19, the potential for disease outbreaks to cause prolonged economic disruption is high. And the ripple effects are extensive. Vector-borne diseases such as malaria are not the same as the next pandemic threat, of course. Thankfully we have a variety of tools to prevent and treat malaria.

The imperative now is to make sure we apply a greater sense of urgency and policy support to fund the research and mitigation programs that are necessary to protect vulnerable populations today, as well as the growth markets of tomorrow. This requires the global business community to become vocal champion for public health initiatives that help blunt a future where disease-carrying mosquitos can derail the economic vitality of the next generation of consumers.

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