Epidemiological surveillance of emerging infectious diseases in sub-Saharan Africa and priorities for strengthening

Abstract

Emerging infectious diseases (EIDs), including Ebola, Lassa fever, cholera, coronavirus disease 2019 (COVID-19), Marburg virus disease, and mpox, continue to pose major global health threats, with sub-Saharan Africa experiencing a disproportionate share of morbidity and mortality. Effective epidemiological surveillance is important for early detection, rapid response, and outbreak preparedness; however, surveillance performance across the region remains inconsistent. This perspective article presents a narrative synthesis of peer-reviewed literature, policy documents, and regional surveillance reports to examine the current epidemiological surveillance landscape in sub-Saharan Africa. The analysis is organized around key domains influencing surveillance effectiveness, with selected regional and country-level experiences used to illustrate broader systemic patterns. Although notable progress has been made through facility- and event-based surveillance systems, the adoption of digital health tools (including mobile health applications, geographic information systems, and genomic surveillance), and strengthening of regional coordination mechanisms, such as the Africa Centers for Disease Control and Prevention and the Integrated Disease Surveillance and Response framework, substantial gaps remain. These include persistent underreporting, limited diagnostic and laboratory capacity, inequitable surveillance coverage among rural, nomadic, displaced, and conflict-affected populations, reliance on externally funded vertical programs, and the constraining effects of sociopolitical instability. Lessons from polio eradication initiatives and responses to Ebola, COVID-19, and cholera suggest the importance of community engagement, trust building, interoperable data systems, genomic data sharing, and integration of water, sanitation, and hygiene interventions. Strengthening epidemiological surveillance in sub-Saharan Africa likely requires sustained regional collaboration, context-appropriate digital innovation, investment in workforce capacity, integration of One Health approaches, and more sustainable domestic and pooled financing mechanisms. More resilient and equitable surveillance systems are essential for improving outbreak preparedness in the region and reinforcing global health security against transboundary and epidemic threats.