ARUSHA, Tanzania – In the bustling corridors of the East African Community headquarters in Arusha this January, a document of quiet significance was unveiled. The Regional Pandemic Prevention, Preparedness, and Response Policy Framework represents something rare in regional geopolitics: a genuine admission of collective vulnerability and a commitment to shared action . Its launch was accompanied by words that, for once, were not mere diplomatic flourish. “We have learnt that pandemic preparedness is not the responsibility of the health sector alone,” said Andrea Aguer Ariik Malueth, the EAC Deputy Secretary General. “It requires a whole-of-government and whole-of-society approach” .
The framework is ambitious. It seeks to build a regional disease surveillance network grounded in the “One Health” approach—recognising that pathogens do not respect the boundaries between human, animal, and environmental health . It aims to expand vaccination programmes, harmonise regulatory standards, pool procurement of essential medicines, and strengthen local manufacturing capacity, including vaccine production at a regional centre in Kigali . It is, on paper, a comprehensive blueprint for a healthier, more resilient East Africa.
But the distance between a policy framework and a functional health system is measured in lives. And as 2026 unfolds, that distance yawns perilously wide.
The Funding Chasm and the Refugee Health Crisis
Barely one week after the EAC’s optimistic launch in Nairobi, the International Rescue Committee (IRC) issued a devastating assessment from Uganda. Severe humanitarian funding cuts, the agency warned, are pushing the country’s refugee health system to the brink of collapse .
Uganda hosts nearly two million refugees, primarily fleeing conflict in South Sudan and the Democratic Republic of Congo. It operates one of the most progressive refugee policies in the world, granting freedom of movement and the right to work. But that generosity now rests on a foundation of sand. The IRC reported that more than six disease outbreaks were recorded in refugee settlements across Uganda in 2025, while stock-outs of essential medicines reached 30 percent . Acute malnutrition has risen from 5.4 percent to 7.8 percent across twelve of Uganda’s fourteen refugee locations, putting thousands of children at risk of irreversible developmental harm and death .
The mathematics of survival are brutally simple. The UN High Commissioner for Refugees estimates that supporting one refugee in Uganda costs approximately $16 per month. Current funding allows for just $5 per refugee per month . With only six percent of required funding secured for 2026, Elijah Okeyo, IRC Uganda country director, warned of further clinic closures, suspended programs, and preventable deaths .
The Forgotten Crises: Sudan, DRC, and South Sudan
The humanitarian outlook for Eastern Africa in 2026 is, by any measure, grim . Across the region, conflict, climate shocks, and disease have converged into a self-perpetuating cycle of crisis, while international response falters under the weight of donor fatigue and competing global priorities.
In Sudan, more than two years of war have devastated the health system. Nearly 12 million people have been displaced. Famine has been declared in multiple locations. Among children screened by Médecins Sans Frontières (MSF) in Tawila, more than 70 percent were acutely malnourished. In Nyala, 26 percent of pregnant women were acutely malnourished—one of the worst maternal nutrition crises MSF has encountered globally . Cholera spreads unchecked. Sexual violence is systematically deployed as a weapon of war. Aid has itself been weaponised, with both sides blocking access to desperate populations .
In eastern Democratic Republic of Congo, the thirty-year conflict shows no sign of abating. In just six months, MSF treated more than 3,600 people for violence-related injuries, 80 percent of them civilians. Eighty-five percent of health facilities lack essential medicines. Forty percent of health workers have fled . Sexual violence remains endemic: nearly 28,000 survivors sought care at MSF facilities in the first half of 2025 alone—an average of 155 each day .
South Sudan presents its own tableau of collapse. Fighting in 2025 reached its worst levels since the 2018 peace agreement, displacing 320,000 people. MSF facilities have been directly targeted: eight separate attacks forced hospital closures, and the Pieri and Lankien facilities were hit by airstrikes . For the second consecutive year, nationwide stockouts of malaria drugs occurred during peak season, despite malaria being the leading cause of death. South Sudan allocates just 1.3 percent of its national budget to health—far below the 15 percent target set in the Abuja Declaration .
The Neglected Epidemic: Kala-Azar’s Deadly Surge
Even as the world’s attention remains fixed on high-profile emergencies, neglected diseases are claiming lives in silence. Cases of kala-azar (visceral leishmaniasis) have more than doubled in Kenya, from 1,575 in 2024 to 3,577 in 2025 . Spread by sandflies, the disease carries a 95 percent fatality rate if untreated, causing fever, severe weight loss, and enlargement of the spleen and liver.
The outbreak is a direct consequence of climate change. “Climate change is expanding the range of sandflies and increasing the risk of outbreaks in new areas,” said Dr Cherinet Adera, a researcher at the Drugs for Neglected Diseases Initiative in Nairobi . Prolonged drought followed by rains creates ideal breeding conditions, while malnutrition weakens immunity in already vulnerable populations.
Yet diagnostic and treatment capacity remains dangerously inadequate. In Mandera county, a hotspot for the parasite, only three facilities can diagnose and treat the disease . Harada Hussein Abdirahman, a 60-year-old grandmother, spent nearly a year being misdiagnosed with malaria and dengue fever by a local pharmacist while her condition deteriorated. “I thought I was dying,” she told AFP. “It is worse than all the diseases they thought I had” .
For migrant workers at a quarry in Mandera, the disease proved fatal. At least two died; others fled back to their villages, their fates unknown. “We did not know about the strange disease causing our colleagues to die,” said Evans Omondi, who had travelled hundreds of miles from western Kenya seeking work .
The Rising Tide of Non-Communicable Diseases
Amid the acute emergencies, a slower-moving catastrophe is unfolding. Non-communicable diseases (NCDs)—diabetes, hypertension, cardiovascular disease, kidney disease—now account for an estimated 30 to 45 percent of all deaths in East Africa . This is the “double burden” that health systems designed for infectious disease are ill-equipped to handle.
The Novo Nordisk Foundation has partnered with Kenya’s Ministry of Health, the NCD Alliance of Kenya, and the Science for Africa Foundation to develop a nationally endorsed NCD Research Agenda focused on cardiometabolic diseases . The initiative aims to identify service-delivery bottlenecks and strengthen regional research capacity so that African-led science can inform policy and practice.
“Africa’s NCD burden is intensified by a persistent gap between research and implementation,” said Dr Evelyn Gitau, Chief Scientific Officer at the Science for Africa Foundation . The goal is to move from evidence to action—to ensure that knowledge generated in African institutions translates into better outcomes for African patients.
The Sovereignty Imperative: From Policy to Action
The theme of implementation—or the lack thereof—runs like a thread through every discussion of health in East Africa. At a civil society webinar convened ahead of the African Union Heads of State Summit, experts delivered a blunt message: Africa’s health challenge is no longer a lack of policy frameworks, but a failure of execution .
Rosemary Mburu, Executive Director of WACI Health, challenged the traditional conception of independence. “Health sovereignty isn’t about isolationism,” she said. “It’s about shifting the power dynamic toward stronger, respectful, and mutually reinforcing partnerships” .
That shift requires domestic resource mobilisation. Official Development Assistance to Africa has contracted by 70 percent over the past four years, even as disease outbreaks have surged by 41 percent . Total health spending across many African nations averages just $17 per person per year. The minimum required for essential services is $60 . As Dr Penninah Iutung of AHF put it: “We cannot beg our way out of a $43 per person deficit” .
Pooled procurement offers one pathway to greater efficiency and sovereignty. When countries buy medicines together, they gain stronger bargaining power and secure better prices. Yet progress has been slowed by weak coordination and a lack of trust among nations. “Years of discussion must now give way to concrete action,” said Dr Julius Simon Otim of the EAC Secretariat .
Local Solutions: Nairobi’s Urban Health Initiative
Amid the litany of crises, there are signs of hope rooted in local initiative. Nairobi Governor Sakaja Johnson has signed a landmark five-year agreement with the Kenya Medical Research Institute (KEMRI) to transform the capital into East Africa’s leading urban health research and disease surveillance hub .
The partnership will establish a premier urban health research institute—the first of its kind in East Africa—alongside a Nairobi Urban Disease Surveillance Hub designed to enhance early detection and rapid response to public health threats . The agreement covers everything from infectious disease surveillance to water quality monitoring, maternal and child nutrition, and clinical trials.
“Through this partnership, we will detect diseases early and respond on time, without delay,” Sakaja said. “That is how modern cities protect their people” .
Conclusion: The Cost of Inaction
Eastern Africa enters 2026 facing overlapping medical, political, and climatic emergencies. Humanitarian needs are rising as assistance shrinks. Ministries of health are losing access to critical supplies. Preventable diseases are claiming preventable deaths.
The new EAC pandemic framework is a necessary step, but it is only a first step. Its success will be measured not in policy documents signed, but in vaccines delivered, outbreaks contained, and lives saved. The cost of inaction is not abstract. It is measured in the hollow eyes of malnourished children in Darfur, in the untreated wounds of rape survivors in eastern Congo, in the misdiagnosed fevers of grandmothers in Mandera.
As MSF’s assessment of the region’s humanitarian outlook concluded: “This is not a lack of information, but a lack of action. The consequences are unfolding daily in hospital wards, displacement camps, and communities struggling to survive” . Behind every statistic is a person. And for millions across East Africa, the most basic right—the right to health—remains a distant promise, awaiting the courage to make it real.
