From PHEIC to PHECs: reclaiming Africa’s agency in global health security governance

TL;DR

Africa is reshaping global health governance by creating its own system for managing public health emergencies, reducing reliance on external bodies like the WHO.

Contribution

The paper introduces the Public Health Emergencies of Continental Concern (PHECs) as a decolonial and transformative mechanism for African health governance.

Findings

The PHECs mechanism was first used in 2024 to address mpox transmission in Africa.

The PHECs reflect a strategic withdrawal from and transformation of the WHO PHEIC system.

The PHECs aim to embed African-led governance through solidarity and regional financial instruments.

Abstract

In the wake of COVID-19 pandemic, the African Union elevated the Africa Centres for Disease Control and Prevention (Africa CDC) to autonomous status, empowering it to declare Public Health Emergencies of Continental Concern (PHECs). This mechanism was first operationalized in 2024 in response to sustained mpox transmission across multiple African countries, despite the World Health Organization’s (WHO) earlier lifting of the Public Health Emergency of International Concern (PHEIC). This article examines the PHECs as a decolonial intervention in global health governance. Applying the Critique, Reform, Withdrawal, and Transformation (CRWT) framework, I argue that the PHECs reflect both a strategic withdrawal from overreliance on the WHO PHEIC system and a transformative effort to embed African-led governance rooted in Pan-African solidarity. The article highlights mechanisms for sustaining Pandemic Prevention, Preparedness, and Response (PPPR), including tiered activation, cross-sectoral oversight, civil society engagement, and alignment with continental financial instruments. Invariably, the PHECs represent a critical reconfiguration of Africa’s role in global health—from recipient of external interventions to architect of regional norms, practices, and accountability. Its promise lies not in rejecting multilateralism but in recalibrating it, embedding regional expertise, political leadership, and operational autonomy within broader global frameworks.