The world spends more than two trillion dollars every year on fighter jets, naval fleets, missile systems, and standing armies. These are serious investments against serious threats. No one disputes that. But political leaders have no serious standing architecture for a category of threat that, by any honest accounting, has already cost more in lives and economic output than all the military conflicts combined.
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COVID-19 will cost the global economy between sixteen and thirty-five trillion dollars before its full accounting is done. SARS cost forty billion dollars in a matter of weeks. Tuberculosis, still with us, still spreading — reduces global GDP by twelve billion dollars annually and cuts labor productivity by 30 percent in the populations it hits hardest. Yet pandemic preparedness and the pharmaceutical development that underpins it receive a fraction of what governments allocate to tanks and aircraft carriers.
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A nation that cannot protect the health of its people cannot protect anything else. Not its economy. Not its alliances. Not its sovereignty. This is not a rhetorical flourish; it is what happened during COVID-19. Which countries received vaccines first?
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Countries where clinical trials had been run. Countries where manufacturing had been scaled. Countries with the geopolitical leverage to have arrived at the table before the crisis, not during it. Everyone else waited for near expired drugs, or accepted doses from China and Russia, which were of lesser quality and came with geopolitical strings attached.
‘Health security is national security’
As Claver Gatete, the Executive Secretary of the United Nations Economic Commission for Africa, told African heads of state at the 2026 AU Summit: "Health is no longer a social service; it is a strategic economic sector. Health security is national security.”
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He was not speaking abstractly. He was speaking to a continent that watched, during COVID-19, as the global vaccine queue was organized not by need, but by geopolitical standing.
The mechanism behind this vulnerability is a structural and thoroughly documented market failure: global pharmaceutical companies are not investing in the vaccines and drugs that protect the world’s most exposed populations.
From 1975 through today, less than two percent of new drug approvals have targeted tropical and neglected diseases — which carry most of the global disease burden.
The reason is not malice. It is market. The United States market accounts for less than four percent of the global burden of disease, but it generates the returns that drive research and development investment globally.
The diseases we ignore are not in fixed locations. Drug-resistant TB cases in sub-Saharan Africa have surged seven hundred and forty-three percent since 1990.
Lassa fever, a hemorrhagic virus with no approved treatment anywhere in the world, is now estimated to infect between one and four million people annually across West Africa — a figure that reflects not a stable epidemic, but a surveillance gap so wide that we genuinely do not know how many people are dying. In Nigeria alone, the case fatality rate has risen to more than twenty-five percent in 2026.
RSV kills over one hundred thousand children under five every year, ninety-nine percent of them in low- and middle-income countries.
These diseases do not recognize borders, passport controls, or the clean categories that separate "global health” from "national security” in government budget lines. They spread. They destabilize. They hollow out the economic base of entire nations. And then, eventually, they arrive somewhere with a functioning news cycle, and the world notices.
If global pharmaceutical companies will not close this gap because market economics do not reward it, someone else must step in.
What Rwandan-owned Akagera Medicines is doing — and why it matters for Africa
We are developing therapeutics and vaccines for three programs, each of which represents a distinct and underappreciated security threat.
Tuberculosis remains the leading infectious disease killer in the world. Sub- Saharan Africa accounts for twenty-four percent of global TB cases and more than a third of TB deaths. A country absorbing a thirty-percent productivity loss from tuberculosis cannot build a stable economy, cannot maintain a professional military, cannot be a productive diplomatic partner. The disease does not weaken health systems in isolation; it weakens every system that depends on human capital.
The Lassa Fever virus infects millions with lethal efficiency, withparticularly brutal mortality in pregnant women, where fetal death and maternal death rates in the third trimester can exceed eighty percent. It has already appeared in returning travelers in North America and Europe. Phase 2 clinical trials for new treatments are now under way. The window to act before Lassa becomes the next COVID-19 is closing. Rwandan-owned Akagera Medicines, in collaboration with the NIAID’s Vaccine Research Center, is developing a vaccine to protect against Lassa Fever. If you wait for a Western pharmaceutical company to solve this, you will wait until Lassa is killing people in cities where political pressure to respond finally becomes unavoidable. By then, the cost of that delay will have been borne entirely by others.
On RSV and maternal-child health, WHO prequalified the first maternal RSV vaccine in March 2025. Gavi launched a design programme in November 2025. But meaningful access in the countries where children are dying remains years away. Every child who does not reach working age as a worker, a soldier, a citizen, a taxpayer — that a nation requires to function. Maternal and child health is workforce security. It is, in the most important sense, national security. Akagera Medicines is developing a targeted and potent RSV vaccine that will be affordable in low-income settings to protect these vulnerable populations.
President Hakainde Hichilema of Zambia and WHO Director-General Tedros Adhanom Ghebreyesus captured the stakes plainly when they wrote together in 2025 that Africa’s dependence on external suppliers placed African countries "at the back of the queue” when global demand surged. That queue is not a logistical inconvenience. It is a geopolitical condition, one that nations who focus on pharmaceutical sovereignty can undo.
The world needs countries like Rwanda to continue to lead
Rwanda has transformed its healthcare system by reducing infant mortality at world record rates, providing universal healthcare, and achieving WHO Maturity Level 3 and 4 regulatory status. These are not bureaucratic accomplishments. They are strategic investments in sovereignty. The continent currently imports seventy to ninety percent of its pharmaceuticals. That is not a health statistic. It is a sovereignty statistic.
Treat pharmaceutical development as the security investment it is. Fund the companies working where the burden is highest. Demand that global health institutions close the gap between prequalification and access. Build the regulatory and manufacturing ecosystems that mean the next pandemic will not find us vulnerable.
Economists who measure such things need to upgrade and innovate their analyses: The children dying of RSV in homes across this continent will not appear in a defense ministry’s risk assessment. The mothers lost to Lassa fever will not be counted in any GDP report. The young adults hollowed out by drug-resistant tuberculosis will not make the news. But their absence from their families, the workforce, and the future — will be felt in every institution that depends on a healthy, productive population to function. That is all of them. That is every institution. And that is why this work done by Rwanda and a few other nations, who "refuse to stand at the back of the queue,” matters.
The authors are board members, executives, and scientists of Rwandan-owned AKAGERA Medicines.