Nairobi, Kenya · 19 February 2025
The United Nations Children's Fund (UNICEF) issued an alert on 19 February 2025 warning that multiple disease outbreaks are creating a cascade of public health emergencies for children across Eastern and Southern Africa. According to the agency, 17 of the region's 21 countries are grappling with one or more simultaneous disease outbreaks, overwhelming fragile health systems and threatening decades of progress in child survival.
UNICEF Regional Director for Eastern and Southern Africa Etleva Kadilli described the situation in stark terms:
"The alarming frequency of public health emergencies and disease outbreaks in the region is disrupting vital safety nets for children and depriving them of their right to a safe and nurturing environment. Global and regional stakeholders must come together to fortify protection systems offered by families, communities, and state services to ensure every child can thrive, even in the face of multiple challenges."
A Convergence of Crises
The simultaneous emergencies spanned an extraordinary range of pathogens and transmission modes:
| Disease Category | Key Outbreaks | Affected Countries (Examples) |
|---|---|---|
| Cholera / AWD | Active transmission, high mortality | Angola, Burundi, DRC, South Sudan, Zambia, Zimbabwe |
| Mpox | Ongoing transmission, cross-border risk | Burundi, Uganda |
| Viral Haemorrhagic Fevers | Marburg (Tanzania), Sudan virus (Uganda) | Tanzania, Uganda |
| Vaccine-Preventable Diseases | Polio, measles, diphtheria | Multiple countries across the region |
Cholera remained the most widespread threat, affecting at least 12 countries. The region recorded some of the highest global numbers of cholera and acute watery diarrhoea deaths. In Angola, a severe outbreak began in early January 2025 and intensified through February.
The Immunisation Gap
A significant portion of the emergencies stemmed from outbreaks of vaccine-preventable diseases — polio, measles, and diphtheria. UNICEF attributed this resurgence to a systemic failure:
"Years of stagnating and declining immunization rates across many countries in the region have resulted in a resurgence of these preventable diseases."
This warning echoed concerns raised by WHO and UNICEF throughout 2024, when multiple countries reported immunisation coverage below the 95% threshold needed for herd protection against measles. The COVID-19 pandemic's disruption of routine immunisation services, compounded by funding shortfalls and health worker shortages, created an immunity debt that is now being collected in the form of outbreaks.
Climate as a Threat Multiplier
UNICEF and WHO emphasised that these outbreaks did not occur in isolation. Three intersecting drivers fuelled the simultaneous emergencies:
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Climate shocks: Frequent floods and droughts disrupted water, sanitation, and hygiene (WASH) infrastructure, directly contributing to the spread of waterborne diseases like cholera. Extreme weather events also displaced populations, concentrating people in areas with limited health services.
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Conflict and displacement: Large-scale violence, particularly in the Democratic Republic of the Congo, and instability in Sudan triggered significant population movements. Displacement heightened the risk of cross-border disease transmission and disrupted routine immunisation services.
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Systemic vulnerabilities: Fragile health systems, compounded by funding shortfalls, limited the ability of many nations to sustain routine immunisation and mount effective responses to the surge in outbreaks.
The Response Architecture
Throughout early 2025, UNICEF and WHO coordinated regional responses focused on:
- Strengthening disease surveillance across borders, including enhanced event-based surveillance and cross-border data sharing
- Expanding vaccination campaigns for cholera, measles, polio, and other outbreak-prone diseases
- Improving WASH infrastructure in health facilities and communities, particularly in cholera-affected areas
- Ensuring continuity of routine immunisation services even in conflict-affected and displaced settings
- Scaling up mpox response in Burundi and Uganda, including vaccination of high-risk contacts
Kadilli stressed that the response must go beyond immediate outbreak containment: "In addition to investing in essential infrastructure and services, promoting routine immunization, and addressing the social determinants of health, sustained funding for protection efforts must continue to be prioritized to support the overall well-being of children in the region."
The Broader Regional Picture
The UNICEF alert came at a moment of extraordinary epidemiological complexity in the WHO African Region. In the first quarter of 2025 alone, the region was responding to:
- Sudan virus disease in Uganda (declared 30 January)
- Marburg virus disease in Tanzania (declared 20 January, ended 13 March)
- Cholera across 16–18 countries (rising from 16 in February to 18 in March)
- Meningitis in Nigeria (825 suspected cases, 74 deaths from October 2024 through mid-March 2025)
- Lassa fever in Sierra Leone (January–March)
- Measles in the Central African Republic
- Dengue fever in Comoros
A Call for Sustained Investment
The UNICEF alert's underlying message was that outbreak response alone is insufficient. The simultaneous nature of these emergencies reflects structural weaknesses that require long-term investment: in health workforce training, in cold chain and supply chain systems, in surveillance infrastructure, and in the social determinants of health — water, sanitation, nutrition, and education.
For the children of Eastern and Southern Africa, the stakes are immediate. Every cholera outbreak that closes a clinic, every measles cluster that spreads through an unvaccinated school, every haemorrhagic fever that triggers a district-wide quarantine — each erodes the fragile gains made in child survival over the past two decades. The 17-country alert was not a forecast of what might happen. It was a description of what was already underway.
Sources:
- UNICEF, "Multiple disease outbreaks heighten public health emergencies for children across Eastern and Southern Africa," 19 February 2025.
- Xinhua, "UNICEF raises alarm over frequent health crises in eastern, southern Africa," 20 February 2025.
- ReliefWeb, UNICEF Eastern and Southern Africa Region Humanitarian Situation Report No. 1, January–June 2025.
- WHO African Region, Monthly Regional Cholera Bulletins (January–March 2025).
- WHO African Region, Emergency Preparedness and Response.
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Institutional Research Desk · Foresight Institute of Research and Translation
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