Rethinking preparedness for re-emerging filovirus diseases in Africa: Integrating governance, policy, and health security innovation.

Abstract

Africa remains the epicenter of filovirus outbreaks, including Ebola virus disease (EVD) and Marburg virus disease (MVD), which continue to expose systemic weaknesses in epidemic preparedness and response systems. Despite the existence of national and regional policies, these deadly diseases continue to emerge across the continent, underscoring the urgent need for integrated strategies that align governance, policy, and health security innovation to strengthen resilience and mitigate the impact of future outbreaks. We reviewed the trajectory of EVD and MVD outbreaks in Africa from 1975 and 2025. Findings indicate that although the number of cases varied by country, the case fatality rate (CFR) has remained high for EVD and MVD. Recent outbreaks EVD occurred in Uganda (12 cases, 30% CFR), MVD in Tanzania (10 cases, 100% CFR), and Ethiopia (14 cases, 64% CFR). We posit that Africa's preparedness remains constrained by five interlinked barriers: governance gaps, policy inertia, fragile health systems, surveillance blind spots, and equity and trust deficits. This paper argues that sustainable epidemic resilience requires reframing preparedness as a governance and policy responsibility rather than a health sector issue. We propose embedding epidemic preparedness in national constitutions as a public good, establishing National Epidemic Preparedness Authorities, scaling Africa Centres for Disease Control and Prevention's Regional Integrated Surveillance and Laboratory Networks to achieve ≥90% genomic pathogen surveillance coverage by 2030, and developing an African epidemic preparedness index to monitor accountability. Strengthening governance, innovation, and domestic financing offers Africa a pathway from crisis response to enduring health security and self-reliance.