China - Africa cooperation for tropical diseases control: current status and future priorities

This review paper examines the growing implications of China's engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs. We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences. Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China's significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning. Strengthening China-Africa health development agenda towards collective commitment and investment in quality care delivery, effective programs coverage and efficiency, preparedness and emergency response is needed in transforming African health information systems, and local health governance structures and management in emerging epidemics. Furthermore, innovative evidence of operational joint solutions and strategies are critical in advancing healthcare delivery, and further enhancing Universal Health Care, and Sustainable Development Goals to attain global health improvements and economic prosperity.

In the world, one billion people are affected by tropical diseases, mainly people with low economic resources in rural and marginal urban regions. Being an important public health problem, prevention and control have been attempted. Achieving relevant progress in this regard. The objective is to show aspects related to the sanitary approach of tropical diseases. Based on the documentary review of virtual databases based on systematic analysis. The findings were grouped into: advances in the control of tropical diseases; tropical diseases from the prism of human rights; and challenges to consider for the maintenance of the control and extension of the prevention of tropical diseases. It is concluded that despite the complexity of the transmission of tropical diseases, great advances have been made in the control and prevention of some of them; that the principles of participation, non-discrimination and responsibility guarantee the human right to health in tropical diseases; that the progress achieved in the control and prevention of tropical diseases requires international support, consideration of environmental factors, timely health response, professional training, community participation and the promotion of research on the subject.

The COVID-19 pandemic exposed persistent weaknesses in global health governance, particularly in preparedness, equity, and accountability. The WHO Pandemic Agreement, adopted in May 2025, aims to address these systemic gaps through a binding international framework. To identify key challenges in global pandemic preparedness and health governance reported in the literature (2019-2024) through a systematic scoping review, and to evaluate how these challenges are addressed in the provisions of the WHO Pandemic Agreement via qualitative document analysis. Using Joanna Briggs Institute methodology and PRISMA-ScR guidelines, we systematically identified and thematically analyzed 52 peer-reviewed studies published between 2020 and 2024. The thematic results informed a qualitative document analysis of the WHO Pandemic Agreement text to assess the extent to which its provisions address the identified challenges. Persistent gaps in governance (limited enforceability, fragmented coordination), equity (inequitable access to medical countermeasures), capacity (technology transfer and financing), and accountability were identified. Health systems in low- and middle-income countries continue to face critical resource constraints and lack robust mechanisms to ensure accountability and continuous learning. Document analysis showed the WHO Pandemic Agreement addresses coordination and financing but offers limited advances in enforcement, technology transfer, and independent monitoring. The WHO Pandemic Agreement introduces important institutional and financing measures, but persistent gaps remain in enforcement, technology transfer, and inclusive implementation. Strengthening these domains is crucial to achieving equitable and resilient preparedness. By systematically linking evidence from the pandemic preparedness literature to Treaty provisions, this study offers a novel analytical framework for assessing how global health treaties respond to research-identified challenges.

Recently, there has been an increasing risk of importation of tropical diseases into China and the resultant re-transmission in the country with the in-depth implementation of the "Belt and Road" Initiative, which poses a serious threat to the national public health security. To effectively respond to the cross-border transmission risk of tropical diseases and facilitate the process towards tropical disease control and elimination in China and the countries along the "Belt and Road" Initiative, this article analyzes the current status and governance risks of major imported tropical diseases, cross-border joint prevention and control polices implemented for tropical diseases and challenges in the establishment of the joint prevention and control system for tropical diseases in China, and discusses the establishment and implementation path of the joint prevention and control system for tropical diseases in countries along the "Belt and Road" Initiative. This path covers the establishment of cross-border cooperation mechanisms, research and development and pilot production of Chinese public health products, and implementation of key cross-border tropical disease prevention and control projects. The establishment of this system will further improve Chinese prevention and control capabilities for key cross-border tropical diseases, build a demonstrative prevention and control model for tropical diseases, and promote international technical exchanges and cooperation of tropical diseases.

Neglected tropical diseases (NTDs) have long been overlooked in the global health agenda. The article is intended to generate information in consideration of the history of colonization of tropical countries with a special focus on tropical diseases especially common in the army during colonial wars and throughout the colonial era. Extreme poverty and warm tropical climates are the two most potent forces promoting the spread of neglected tropical diseases. European colonial doctors made valuable contribution towards understanding them and discovery these diseases. Large outbreaks of infectious and tropical diseases occurred in the Army throughout the colonial era, strongly influenced the formation of the Army Medical Services including provision for teaching and research. Subsequent improvements in prevention, diagnosis and treatment reduced the mortality from tropical diseases. Now in an era of “globalized” environment of interdependent trade, travel, migration, and international economic markets, many factors play an important role in the rise, emergence, and reemergence of tropical infectious disease, which necessitates a coordinated, global response. Many of the emerging and reemerging infectious diseases are also “neglected,” meaning they impact the world’s poorest and lack adequate funding and innovation for prevention and treatment, with some not adequately identified or studied. Although progress has been made in the management of neglected disease, there remains much work to be done. During the coming decade the global response will be able to further build on today’s successes, align with the new global health and development frameworks.

For decades, China has been unceasingly making headway on the modality and quality of educational collaboration. This educational collaboration comes through student exchange, joint initiatives (research) and special training programs for African educational officials, as well as other long- and short-term training of Africans in China. On the other hand, in the discourse about China-Africa relations, technology transfer is one of the less investigated subjects; however, technology transfers have existed in China-Africa cooperation in the form of knowledge sharing. The paper explores the following: (i) ‘what’ are transferred through knowledge sharing; (ii) the potential for cooperation in knowledge sharing between China and African countries that are core to economic development in the areas of agriculture, medical and knowledge sharing from China’s development experience. Chinese methods of teaching ‘how to develop’ based on its own experience may help fortify the independence of African nations and build win-win cooperation for long-term development.

3 - Global Health Governance and Tropical Diseases

BackgroundAs the 2014 Ebola virus disease outbreak (EVD) transitions to its post-endemic phase, its impact on the future of global public health, particularly the World Health Organization (WHO), is the subject of continued debate. Criticism of WHO’s performance grew louder in the outbreak’s wake, placing this international health UN-specialized agency in the difficult position of navigating a complex series of reform recommendations put forth by different stakeholders. Decisions on WHO governance reform and the broader role of the United Nations could very well shape the future landscape of 21st century global health and how the international community responds to health emergencies.DiscussionIn order to better understand the implications of the EVD outbreak on global health and infectious disease governance, this debate article critically examines a series of reports issued by four high-level commissions/panels convened to specifically assess WHO’s performance post-Ebola. Collectively, these recommendations add increasing complexity to the urgent need for WHO reform, a process that the agency must carry out in order to maintain its legitimacy. Proposals that garnered strong support included the formation of an independent WHO Centre for Emergency Preparedness and Response, the urgent need to increase WHO infectious disease funding and capacity, and establishing better operational and policy coordination between WHO, UN agencies, and other global health partners. The recommendations also raise more fundamental questions about restructuring the global health architecture, and whether the UN should play a more active role in global health governance.SummaryDespite the need for a fully modernized WHO, reform proposals recently announced by WHO fail to achieve the “evolution” in global health governance needed in order to ensure that global society is adequately protected against the multifaceted and increasingly complex nature of modern public health emergencies. Instead, the lasting legacy of the EVD outbreak may be its foreshadowing of a governance “shift” in formal sharing of the complex responsibilities of global health, health security, outbreak response, and managing health emergencies to other international structures, most notably the United Nations. Only time will tell if the legacy of EVD will include a WHO that has the full support of the international community and is capable of leading human society in this brave new era of the globalization of infectious diseases.

IntroductionThe theory of norm diffusion provides a fundamental framework for analysing the emergence, cascade and internalisation of norms in global health governance. As think tanks combine policy expertise with sharp...

8 - Global Health Governance and Tropical Diseases

This article examines how colonial legacies continue to structure global health financing and governance, perpetuating systemic inequities between the Global North and South, particularly African countries. Historical analysis reveals that colonial health systems were strategically designed to protect European interests while exploiting indigenous populations and establishing racially segregated frameworks whose structural biases persist in contemporary institutions. International financial architecture, particularly through bodies such as the International Monetary Fund (IMF) and World Bank, reinforces these asymmetries through governance mechanisms that privilege wealthy nations in decision-making and resource allocation. The COVID-19 pandemic exposed these entrenched disparities, as vaccine nationalism and disparate fiscal capacities widened the existing health gaps. Emerging digital health technologies now risk establishing new extractive relationships, as health data harvested from vulnerable populations flows to high-income countries without adequate benefit-sharing frameworks, a pattern identified as data colonialism. Addressing these interconnected challenges requires decolonising global health governance through fundamental reforms that redistribute power, ensure data sovereignty, and centre historically marginalised voices in shaping health priorities and financing mechanisms.

The United States presidential election of Donald Trump in 2016 was observed by global health commentators as posing dire consequences for the progress made in global health outcomes, governance, and financing. This article shares these concerns, however, we present a more nuanced picture of the global health governance progress narrative pre-Trump. We argue that Trump’s presidency is a displacement activity to which global health’s pre-existing inequalities and problems of global health security, financing, and reproductive health can be attributed. Unfettered access to sexual and reproductive rights, sustained financing of health system strengthening initiatives, affordable medicines and vaccines, and a human security-centred definition of global health security were already problematic shortfalls for global health governance. Trump no doubt exacerbates these concerns, however, to blame his presidency for failings in these areas ignores the issues that have been endemic to global health governance prior to his presidency. Instead of using Trump as a displacement activity, his presidency could be an opportunity to confront dependency on US financing model, the lack of a human-security centred definition of global health security, and the norm of restricting reproductive health. It is such engagement and confrontation with these issues that could see Trump’s presidency as being a catalyst for change rather than displacement as a means of preserving the uncomfortable status quo in global health. We make this argument by focusing on three specific areas of US-led global health governance: reproductive health and the ‘global gag rule’, health financing and the President’s Emergency Plan for AIDS Relief (PEPFAR), and pandemic preparedness and global health security.

BackgroundWith the promotion of national control programs on parasitic and tropical diseases in China, the National Institute of Parasitic Diseases (NIPD), Chinese Center for Disease Control and Prevention has gained significant experience in the global health arena through international cooperation over the last seven decades allowing a multilateral impact in the elimination of major endemic diseases.MethodsThe achievements of NIPD since 1950 has been analyzed with emphasis on the various stages that started with research and control of the endemic parasitic and other tropical diseases at the national level and progressed via international cooperation into a global presence.ResultsThe major achievements contributed by NIPD consist of (i) improving technical capability; (ii) promoting control and elimination of parasitic and tropical diseases; (iii) participating in global health governance and cooperation; and (iv) developing a cooperation model for technical assistance and global public health development. It is expected that NIPD’s experience of international cooperation will be essential for the dissemination of China's successful experience in global health governance, emergency response and development, with focus on malaria and neglected tropical diseases such as schistosomiasis, soil-borne and food-borne helminthiases and echinococcosis.ConclusionsNIPD’s new tasks will not only continue to promote national control of endemic parasitic infections and disease elimination programs in China, but also play a leading role in global health and disease elimination programs in the future.

Africa has 24% of the global disease burden, yet only 3% of the world's healthcare professionals [1]. The shortage of healthcare professionals in sub-Saharan Africa contributes to the weak domestic healthcare systems and impedes the achievement of the millennium development goals, such as reducing maternal and child mortality, treating noncommunicable chronic diseases or the eradication of pediatric HIV [2–4]. When using HIV prevalence as a proxy to signify burden of disease, it is blatant that there are an insufficient number of physicians trained per year to adequately meet the healthcare needs of the 10 sub-Saharan African countries afflicted most by HIV/AIDS (Table 1) [1].Table 1: Total physicians (per 100 000 population) and estimated lost investment in the 10 African Countries with the highest HIV/AIDS prevalence.One cause for this physician shortage is the emigration of well trained African physicians, a phenomenon popularly known as the healthcare ‘brain drain’ [5]. In a seminal economic analysis, Mills et al.[6] estimates that US$ 2.17 billion was lost by nine African countries in training physicians who then emigrated to Australia, Canada, the UK, and the USA (Table 1). Notably, the UK benefitted from the emigration of African healthcare workers by an estimated US$ 2.7 billion and the USA benefitted by US$ 846 million [6]. In an attempt to minimize this sink-source phenomenon, the World Health Assembly in 2010 adopted the Global Code of Practice on the International Recruitment of Health Personnel [7]. The resolution is a multilateral, voluntary framework that addresses the shortage of global health personnel by focusing on the migration of healthcare workers from resource-limited countries [7]. The code also calls on wealthy countries to provide financial assistance to source countries afflicted by the loss of qualified health workers [7]. We propose a solution to mitigate the healthcare brain drain by using a strategy known as human capital contracts (HCC) (first proposed by the Nobel Prize economist Milton Friedman) [8]. It works like this: an investor, such as a donor nation or global health initiative, covers the entire cost of a student's medical training [9]. In exchange, the student will work for the first 10 years of their medical career in a government or NGO sponsored health clinic in their respective country of medical education. Their medical license will be contingent on this obligatory national service. A multilateral ‘binding’ agreement between the African country and destination countries (i.e., Australia, Canada, the UK, and the USA) could prevent migration during the term period. For example, in Malawi, the College of Medicine (COM) (the country's only medical school) has graduated 372 students since 1991 [10]. Currently, the school anticipates 60 graduates per year with the intention to scale-up to 100 graduates per year [10]. The Malawian government subsidizes nearly 100% of students’ medical education, currently estimated to be US$ 32 952 per year [6]. In the case of Malawi, assuming a donor aims to triple the number of COM graduates from 60 to 180 students per year, it would cost an estimated US$ 6 million per year. Ironically, in order to tackle the physician shortage in Malawi, the United Nations Development Program (UNDP) is paying US$ 40 000 per year to attract foreign doctors [11]. It makes more sense for the UNDP to instead invest this aid into training Malawian physicians by way of a HCC. The benefits of training Malawian physicians, with stronger ties to their country, instead of importing foreign doctors are self-evident [12]. Our proposal has many advantages but we also acknowledge potential limitations. Without a concurrent increase in infrastructure capacity, African medical schools may not have the optimal environments for the increased class size. However, experience from Malawi and other African nations demonstrates that international partnerships with donors can improve medical school facilities by subsidizing construction of lecture halls, libraries, and computer labs [13]. In fact, The President Emergency Plan for AIDS Relief, through the creation of the Medical Education Partnership Initiative, committed US$ 130 million with the goal to train and support the retention of at least 140 000 new healthcare workers in Africa and included grants for medical school infrastructure development [1]. Another important consideration is the need to address quality of education. We propose coupling HCC with a mechanism of accreditation to ensure academic standards. Finally, donors of HCC will need to consider mechanisms to prevent increases in tuition (that surpass inflation) as medical schools may see this as an opportunity to increase revenue. Improving health equity vis-à-vis increasing access to healthcare is a well established intervention to achieve poverty reduction and attaining universal human rights [14]. Direct investment in medical education is an effective and well defined sector-wide approach to increase healthcare and public health capacity in Africa [15]. Financial support through the use of HCC could mitigate the ethical and economic consequences of emigration of African doctors, thereby stemming the healthcare brain drain. Acknowledgements Conflicts of interest All authors approve this manuscript. There are no conflicts of interest.

The Future of TDR: The Need to Adapt to a Changing Global Health Environment