US aid cuts threaten Ghana’s child immunisation gains

Accra, Ghana – Ghana was among the first countries in Africa to introduce the RTS,S malaria vaccine into its routine immunisation programme. In Ghana, Kenya and Malawi, the vaccine was associated with a 13 percent reduction in mortality among children eligible for vaccination, with roughly one in eight deaths averted.

But keeping those gains will require more than the vaccine itself. Health workers still have to reach children, trace those who miss doses and get vaccines safely to communities.

The suspension of United States Agency for International Development (USAID) programmes left Ghana facing an estimated $156m funding gap across affected programmes, including a projected $78.2m shortfall in health. The health funding supported programmes including malaria prevention, maternal and child health, nutrition, family planning and human immunodeficiency virus (HIV) services.

The disruption has also raised concerns about the systems that keep routine immunisation running.

A study examining donor withdrawal in northern Ghana found that 75 percent of the districts surveyed reported vaccine delays or irregular supplies. The study also found constraints affecting cold-chain equipment, delivery kits and transport fuel.

Nana Owusu Ensaw, municipal director of health for Akuapim North, said Ghana should use the funding shock to rethink how it pays for healthcare.

“The $78m health funding gap after USAID programme closures is significant, but it is also a chance to rethink healthcare financing in Ghana. The Ghana Medical Trust Fund, or MahamaCares, is already expanding access to specialised care,” Ensaw said.

“The private sector must also step up. With the right partnerships, Ghana can become a medical tourism hub by investing in diagnostics, telemedicine and specialist care. Banks and financial institutions have a critical role to play. They must support these health tourism initiatives with tailored financing packages to attract more players into the sector. We have the talent and the will. Now we need the investment to match.”

John Yabani, the medical director of Banahene Specialist Hospital, said private providers were also prepared to play a larger role.

“Ghana’s healthcare sector is at a pivotal moment. As a specialist hospital, we have already been investing in medical tourism and positioning ourselves to attract patients from across West Africa and the diaspora. The private sector is ready to step in and complement government efforts. With the right support from financial institutions, we can help build a health system that is resilient, self-sufficient and truly world-class.”

But private investment cannot immediately replace the public health infrastructure needed to deliver routine vaccinations, particularly in remote communities.

Not everyone sees the loss of donor funding only as a setback.

A government official who spoke to Al Jazeera on condition of anonymity said he had long been uncomfortable with African countries relying on Western governments to finance basic healthcare.

“For me, this USAID cut is a perfect opportunity for us to put our house in order and utilise our resources to take care of our citizens,” he said.

George Kwame Egeh, cofounder and director of operations at the Humserve Africa Foundation, which provides surgical aid and immunisation support to deprived communities, said his organisation had long advocated greater use of local funding.

“We have always used internally generated funding from colleagues and corporate Ghana to support all health interventions,” Egeh said. “We believe that civil society organisations (CSOs) can step in and fill the gap that the USAID cuts are creating.”

For immunisation programmes, however, replacing donor money is not simply a matter of finding another funding source. Health workers still have to travel to remote communities, trace children who miss doses, maintain cold-chain equipment and organise outreach services.

In the Oti Region, where many communities are rural, hard to reach and close to Ghana’s borders, the concern is particularly acute.

A 2025 study of routine immunisation in Ghana’s Eastern and Oti regions found basic antigen coverage in Oti of 85.3 percent, while coverage for the national schedule was 62.1 percent.

Mark Appiah, chairman of the Oti Regional Health Committee, told Al Jazeera he was concerned that financing pressures could erode those gains.

“Funding pressures could affect outreach, defaulter tracing, transportation, supervision and immunisation campaigns, all of which are essential to maintaining these gains,” he said.

“A child should not lose protection against a preventable disease because the health system is experiencing a financing problem.”

Appiah said the committee was focusing on domestic resource mobilisation, community participation and targeted support for hard-to-reach communities. He also called for an Oti Regional Health Development and Resource Mobilisation Framework to build structured partnerships with businesses, development partners and NGOs.

For families in communities that can be difficult for health teams to reach, those systems can determine whether a child receives a vaccine or misses a dose.

In northern Ghana, Rahinatu, a mother whose child has benefitted from routine immunisation, said the funding gap had created real challenges for her community.

“But I am optimistic the government will figure a homegrown solution as soon as possible to get things back on track for us,” she said.

Her hope comes as Ghana faces a longer-term shift in how it finances vaccines.

Ghana is in an accelerated transition from Gavi, the Vaccine Alliance, support and is expected to take full responsibility for financing its immunisation programme from 2030.

At the same time, Gavi is facing its own funding pressures. The alliance’s 2026–2030 strategy aims to strengthen the financial sustainability of immunisation programmes and increase countries’ domestic contributions as they transition from Gavi support.

That puts Ghana under pressure from two directions: the immediate disruption caused by the withdrawal of US funding and the longer-term need to take on a greater share of immunisation costs.

Ghana has begun looking for ways to do that. The government has removed the cap on funding from the National Health Insurance Scheme, while it is also backing efforts to develop local vaccine manufacturing capacity.

As health ministers and senior officials from the World Health Organization (WHO) African Region’s 47 member states meet in Addis Ababa for the 76th session of the WHO Regional Committee for Africa, Ghana’s experience points to a difficult question facing many countries: how quickly can governments build greater financial independence without allowing the health services that children rely on today to weaken?

“No child in Oti Region should be denied life-saving immunisation because of where that child lives or because of a temporary financing gap.”