Staying the course in 2025

There is a moment in any relationship when intentions become commitments. For PATH in Africa, 2025 was that moment—not once, but repeatedly, across a year that tested every assumption about how global health partnerships should work.

The context demands honesty.

International aid to Africa hasdeclined by 70 percent since 2021, falling from US$80 billion to just $24 billion. The continent faces a $66 billion annual health care funding gap. Organizations like ours have had to make difficult choices about scope and scale. And yet, within those constraints, we discovered that partnerships built on genuine respect could still deliver.

To understand 2025, it is essential to understand what came before.

In 2001, PATH’s Malaria Vaccine Initiative entered into a partnership with GSK to develop a vaccine scientists had been working on since the late 1980s. The goal was audacious: create the world’s first malaria vaccine for young children in sub-Saharan Africa.

With support from the Gates Foundation, PATH provided technical and project management expertise, while GSK led the scientific aspects. But crucially, the work was anchored in African research institutions.

The Phase 3 clinical trial involved 15,459 children across 11 research centers in seven African countries: Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique, and Tanzania. The Clinical Trials Partnership Committee, which oversaw this work, was led by African research scientists. This was not an afterthought. It was the architecture.

When baby Lusitana in Malawi became the first child in the world to receive the RTS,S vaccine through routine immunization in April 2019, it represented years of collaboration between PATH, GSK, the World Health Organization (WHO), UNICEF, Gavi, the Global Fund, and Unitaid.

But fundamentally, it was a story of African scientists, health workers, and families trusting a process built with them, not merely for them.

By the time the pilot concluded in 2023, more than 6 million doses had been administered. Deaths among vaccine-eligible children fell by 13 percent. Severe malaria hospitalizations dropped by 22 percent. With Gavi’s support and Bharat Biotech’s manufacturing partnership, 12 African countries are expected to have introduced RTS,S through routine immunization by the end of 2025.

I share this history because it sheds light on what 2025 was about. The partnerships we cultivated this year were extensions of a philosophy that has guided PATH for decades: African institutions lead, we provide technical support, funders enable, and communities remain at the center.

The year began in Lilongwe at the 74th Health Ministers’ Conference of the East, Central and Southern Africa Health Community (ECSA-HC). I was invited to speak about what technical partners can offer beyond funding.

What struck me was the clarity with which African health leaders articulated what they did not want: relationships that substitute external expertise for local capacity, that create dependency, that leave systems weaker when projects end. They were asking for something different.

I outlined PATH’s framework for effective collaboration, which includes a shared vision and mutual understanding, complementary capabilities with clear roles, local presence and community trust, data integration and interoperability, and sustainable financing.

Articulating these principles in that room felt like making a promise.

Four months later, we returned to Malawi. The symmetry was not lost on me.

The 4th Southern Africa Regional Ministerial Steering Committee Meeting brought together ministers of health and senior representatives from ten African Union member states in Lilongwe, under the theme “One Region, One Health, One Future.”

The same country where baby Lusitana had received the world’s first routine malaria vaccination was now hosting conversations about the next chapter of African health coordination.

Hon. Khumbize Chiponda, MP, then Malawi’s Minister of Health, opened the meeting on behalf of Vice President Dr. Michael Biswick Usi. Hon. Dr. Elijah Muchima, Zambia’s Minister of Health and Chair of the Africa Centres for Disease Control and Prevention (Africa CDC) Governing Board, reminded delegates that the theme was “not merely a slogan. It is a strategic imperative.”

Dr. Jean Kaseya, Director General of the Africa CDC, urged African nations to lead their own health transformation.

Under the leadership of Dr. Lul Riek, Regional Director of the Africa CDC’s Southern Africa Regional Coordinating Centre, the Southern Africa Regional Steering Committee structure has become a vital platform for aligning regional priorities. Dr. Riek was recognized at the meeting for his instrumental role in operationalizing the center and advancing regional public health coordination.

PATH’s participation in the “Respectful Partnerships for Health” panel allowed us to demonstrate our framework in action—not as abstract principles, but as operational guidance for navigating shared public health challenges.

The gathering adopted Africa CDC’s “Green Book” vision for health financing reform and endorsed implementation of the Continental Immunization Strategy. These are the spaces where continental frameworks meet national realities. Our role is to contribute expertise that accelerates the progress of African institutions that have already prioritized these areas.

In August, PATH joined continental leaders in Lusaka on the eve of the 75th Session of the WHO Regional Committee for Africa. Speaking alongside Africa CDC leadership, the WHO Africa region director, Gavi’s CEO, and ministers of health, I emphasized what had become evident: Nobody can do this alone.

The conversation acknowledged difficult truths but was not without hope. Africa CDC shared that some African countries now mobilize over $1.4 billion annually in additional domestic health financing. The network of National Public Health Institutes has expanded from a handful before COVID-19 to 45 functional institutes today.

Africa is building capacity that does not depend on external funding cycles.

September brought formalization. During the last week of the 80th Session of the United Nations General Assembly in New York, PATH and ECSA-HC signed a Memorandum of Understanding (MOU) consolidating years of collaboration. Dr. Ntuli Kapologwe, ECSA-HC Director General, described the partnership’s foundation as being based on the alignment between PATH’s technical capabilities and ECSA-HC’s regional coordination across member states.

That same week, we co-hosted a ministerial event on noncommunicable diseases that produced concrete commitments.

The Democratic Republic of the Congo’s Minister, Roger Kamba, outlined targets to achieve 50 percent coverage of noncommunicable diseases by 2030. Kenya, Tanzania, and Uganda announced a joint procurement initiative for noncommunicable disease medicines.

These outcomes emerged because the right people were in the room and African leaders drove the agenda. Our role was facilitation.

The 4th International Conference on Public Health in Africa drew nearly 20,000 participants from more than 72 countries, under a theme that captured the continental mood: “Moving Toward Self-Reliance to Achieve Universal Health Coverage and Health Security.”

PATH arrived with purpose.

We presented research on financing responses to shifts in donor funding across ten African countries. Alongside Africa CDC and partners, we launched the Africa Regional Immunization Advocacy Strategy (2025–2030) and the Africa Regional MNCH Advocacy Strategy (2025–2030). These frameworks are designed to sustain political commitment and domestic investment in the health priorities that matter most for women and children.

When Dr. Jean Kaseya and I signed our three-year MOU renewal, Acting Deputy Director General Dr. Raji Tajudeen articulated what made it meaningful. Partners, he said, must commit to “moving away from partnership that is just serving paperwork.”

The five-pillar framework we agreed upon covers digital health, primary care, surveillance, workforce development, and climate adaptation. It is a work plan, not a wish list.

Standing in that hall, I felt how the moment connected backward to everything that had been built and forward to everything that was yet to be finished.

Throughout 2025, our teams extended partnership into emerging challenges. When mpox required a rapid response, PATH collaborated with Africa CDC and national authorities on surveillance and diagnostics. Our SAFEStart+ initiative with Unitaid is accelerating the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B across nine countries.

In November, PATH supported the launch of Africa’s first regulatory framework for AI in mental health at the G20 Social Summit, with the South African Health Products Regulatory Authority (SAHPRA) and Wellcome leading a groundbreaking approach to ensuring innovation serves people safely.

I want to resist overstating what we accomplished. The MOUs we signed are foundations, not finished buildings. The strategies we helped develop require years of implementation to have an impact. The scope of our work has changed because funding has contracted.

And yet, 2025 demonstrated something important. When external financing fluctuates, relationships built on mutual respect remain stable. When global attention shifts, African institutions with strengthened capacities continue to advance their priorities.

The journey from baby Lusitana’s first vaccination in 2019 to the ReSCO meeting in Lilongwe in 2025 tells a story. It is a story of staying the course. Of partnerships that outlast funding cycles. Of the conviction that African scientists, health workers, and communities can lead, and that our role is to support that leadership rather than substitute for it.

The work ahead is implementation: translating patient agreements into improved health outcomes for communities.

That is where partnerships will be put to the test. That is where they must prove their worth.