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Dear Colleagues,
In what was once again a very busy global health policy week – even if we stay away from the ongoing genocidal & nihilistic horror in the Middle East and elsewhere – we’ll first come back on World TB Day (24 March) ( rather dire commemoration this year, sadly…), and then cover the Second Global Conference on Air Pollution and Health in Cartagena, Colombia (25-27 March), a G20 Health Working group meeting in South-Africa (where among others, UHC and – especially for Rob Yates – PUBLIC financing made a much needed comeback) and the Nutrition for Growth Summit in Paris (27-28 March).
A major chunk of the newsletter is then again dedicated to “Trump 2.0” disruption updates (this week among others with some more focus on PEPFAR’s major troubles, and a not entirely unexpected shock decision on GAVI ) & related analysis on global health governance & financing reform. A number of reform-related reads went viral again, certainly including a Geneva Health Files guest essay by Olusoji Adeyi on ‘Sunset strategies’. We also already want to draw your attention to a recent (and complementary?) quote via IDS : “… These financial cuts are undoubtedly a significant setback for international development. However, should it also be seen as a moment to rethink the funding model for development and humanitarianism…. Can it be opportunity to disband with the term ‘aid’ altogether and reframe it for what it is – an investment in tackling our shared global challenges?” We certainly hope so.
Among the reports and papers of the week, in addition to dire modelling in the Lancet HIV on ‘the impact of an international HIV funding crisis on HIV infections and mortality in LMICs’ and new UN reports warning that decades of progress in reducing child deaths and stillbirths are at risk, we also already want to flag here a few more uplifting reads such as Ingrid Robeyn’s ‘Why Economic Inequality Should be Central to Strategies for the Future’ and a new paper on NCD ‘quick buys’.
Speaking of the latter, I particularly enjoyed WHO’s press release which emphasized these (25) public health measures can improve people’s health within a single political cycle (i.e. 5 years). Now we still have to find ‘quick fix’ public health measures for the increasing number of non-democracies in the world which tend to have rather different “political cycles”, including Orban-style illiberal ones (not to mention the “kakistrocacies with chainsaw characteristics”)
Meanwhile, over here in the EU we all have to become ‘preppers’ now, apparently: ‘ready for anything’ ! Also by 2030 (within one political cycle, dare I say! 😊). Built not just on a changed geopolitical environment, but also on a Boulevard of Broken SDG dreams.
Enjoy your reading.
Kristof Decoster
We already flagged a few related reads last week, among others WHO’s urgent call for action to address worldwide disruptions in tuberculosis services putting millions of lives at risk (20 March).
Some more:
(21 March) “Tuberculosis (TB) and HIV are intricately linked, and they present profound challenges for global health. In 2023, 1.25 million people lost their lives to TB, including 161 000 people living with HIV. As the leading life threating comorbidity of HIV infection, TB accounted for nearly one third of all deaths among people living with HIV in 2023…..”
“UNAIDS is advancing the targets set at the 2023 UN High-Level Meeting on TB, where global leaders committed to addressing these issues. UNAIDS is working to incorporate these targets into the next Global AIDS Strategy, advocating for the global community to commit to ensuring that 90% of people living with HIV access HIV and TB testing and treatment services as needed, and that 95% of people living with HIV receive preventive TB therapy. … …. On World Tuberculosis Day (24 March) and in this critical moment, UNAIDS urges the donor community to maintain their support for the global TB and HIV response….”
Peter Sands; https://www.forbes.com/sites/petersands/2025/03/23/long-seen-as-the-pandemic-of-the-poor-tb-is-a-threat-to-us-all/
Sands prefers a Global Health Security framing in this op-ed for World TB Day.
“Despite being preventable and curable, tuberculosis (TB) remains a persistent health threat across the world. TB is now the number one infectious disease killer worldwide, causing 1.25 million deaths in 2023. As a respiratory infection prone to drug resistance, TB poses a persistent threat to global health security. …. …. Progress against the disease rebounded quickly after the disruptions caused by COVID-19, but recent reductions in development assistance for health pose a serious threat to sustaining this momentum. Many of the most affected countries face significant gaps in funding for tests and treatments. Yet any let-up in the fight against TB will only increase the costs and risks….”
PS: “….In addition to this health security imperative, there is also a compelling economic argument for investing to defeat TB…..”
https://www.dw.com/en/india-tuberculosis-outbreak-infectious-disease/video-72017599
“Despite government pledges to eradicate tuberculosis by 2025, India has over 2 million cases of the infectious disease each year. … …. The government set an ambitious goal to eliminate TB infections by the end of 2025, but experts say this goal is unachievable. Critics argue that authorities have failed to grasp the urgency of the crisis due to low government spending and shortage of medicines…..”
· And a link: WB (blog) – Why is the fight against tuberculosis far from over? The answer in four charts ( by Emi Suzuki & Ana Florina Pirlea)
“The WHO’s Second Global Conference on Air Pollution and Health Accelerating action for clean air, clean energy access and climate change mitigation serve[d] as a crucial platform for experts, policymakers, and stakeholders from around the globe to converge and address the interlinked issues of air quality, energy production, and public health. It [will] highlight policy solutions for air pollution and lack of energy access and catalyse evidence-based, multi-sectoral actions in cities, countries and regions…..”
Check out the key objectives of the conference.
And the concept note.
Primer published ahead of the conference. “On Tuesday, the Colombian coastal city [will] host the second WHO Air Pollution and Health conference 25-27 March, where global leaders are poised to call for an ambitious goal of cutting deaths from air pollution by 50% in 2040.”
“… But unlike some other disease challenges, there are ready, affordable, solutions that largely require political will to implement. (WHO’s) Neira has a ready list of WHO’s top priorities for the conference at her fingertips: “We need to work together urgently to scale up transitioning from coal-fired power to renewable energy,” she says, while also. “expanding public and sustainable transport, establishing low-emission zones in cities and promoting clean energy for cooking, and solar power in healthcare facilities.” “
“… while ambitious, this year’s conference goal also provides a clear target for countries to aim for – after the WHO’s inaugural Conference on Air Pollution and Health failed to do so. …
“… As another reflection of growing awareness, nearly 50 million health professionals, patients, advocates, and individuals signed a call ahead of this week’s conference for urgent action to reduce air pollution. ….”
PS: “Notably, no US government officials will be attending the conference – reflecting the Trump Administration’s recent decision to withdraw from WHO and as well as from multilateral global climate and environmental efforts where the US was previously a leader.”
PS: “Countries that are unable to pledge to halve air pollution deaths within just 15 years will also be encouraged to make commitments to reducing pollution’s impacts more incrementally to at least meet one of WHO’s “interim air quality” goals, on the path to cleaner air. ….”
PS “… In the two days leading up to Thursday’s session on high level policy commitments, the conference will feature dozens of technical sessions on the latest science……”
“Three air pollutants – black carbon, methane, and ozone – are responsible for nearly half of global temperature increases so far. Reducing these emissions, which only remain in the atmosphere for a few weeks to decades, could serve as the “emergency brake” critical to halting runaway climate change, said experts Monday on the eve of the second WHO Air Pollution and Health Conference..”
PS: “Two leading super pollutant gases, methane and nitrous oxides (N2Ox), are formally recognized in the Paris climate agreement as powerful greenhouse drivers with a climate forcing potential that is 80, and 270, times more than CO2 respectively in the next 20 years. But black carbon is ignored, leading to a fragmented approach…..”
“…Reducing these pollutants could avoid four times more warming by 2050, as opposed to decarbonization policies alone – and also prevent some 2.4 million deaths a year from air pollution. Yet emissions of super pollutants, including methane, are currently on the rise….”
PS: “…. What CAF, Wellcome and the Climate and Clean Air Coalition want to foster is a more coordinated super-pollutants “movement” that cuts across sectors…..”
https://healthpolicy-watch.news/make-our-lungs-healthy-again/
“The 3-day conference will explore an array of evidence about the adverse effects of air pollution on everything from newborn health to brain health and ageing …. The conference is the first on the topic to be convened by WHO since 2018. It takes place at a time when the evidence about the adverse effects of air pollution on everything from newborn health to brain health and aging continues to mount – or even snowball. ….”
“…. Sessions Tuesday and Wednesday are covering relatively “new” topics for the health sector such as: impacts of air pollution on agriculture; new knowledge on wildfires and dust storms; as well as opportunities for the health sector to reduce its own emissions through shifting to renewable energy and climate resilient health facility design…..”
And re a new World Bank report: “ … Meanwhile, a new World Bank report, to be released Thursday, estimates that some 2 million deaths annually from outdoor air pollution would be avoided if the number of people exposed to deadly PM2.5 pollution particles above 25 micrograms per cubic meter was halved by 2040. But investments in clean air strategies would need to increase from $8.5 billion to nearly $14 billion annually to meet that 2040 goal, said World Bank analyst, Sandeep Kohli. At the same time, with the costs of air pollution amounting to over $8 trillion annually, or some 10% of global GDP today, the economic gains would be immediate and significant. “
“In the most optimized strategy of integrated action in the energy, transport, waste and industry, reducing air pollution emissions across a range of sectors would yield between $1.9 and $2.4 trillion over the coming 15 years – (in 2021 dollar terms) as well as reducing deaths from outdoor air pollution alone, by about 2 million annually – from about 6.2 million to 4.2 million deaths annually, according to the new World Bank Report, Accelerating Access to Clean Air for a Livable Planet…..”
PS: As for the high-level portion of the meeting Thursday: there, “ countries will make national commitments to reduce air pollution – in line with the stated conference goal of reducing deaths from air pollution by one-half by 2040. “
“The number of children dying globally before their fifth birthday declined to 4.8 million in 2023, while stillbirths declined modestly, still remaining around 1.9 million, according to two new reports released today by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Since 2000, child deaths have dropped by more than half and stillbirths by over a third, fuelled by sustained investments in child survival worldwide. In 2022, the world reached a historic milestone when child deaths dropped slightly below 5 million for the first time. However, progress has slowed and too many children are still being lost to preventable causes…..”
“…. Decades of progress in child survival are now at risk as major donors have announced or indicated significant funding cuts to aid ahead. Reduced global funding for life-saving child survival programmes is causing healthcare worker shortages, clinic closures, vaccination programme disruptions, and a lack of essential supplies, such as malaria treatments. These cuts are severely impacting regions in humanitarian crises, debt-stricken countries, and areas with already high child mortality rates. Global funding cuts could also undermine monitoring and tracking efforts, making it harder to reach the most vulnerable children, the Inter-agency Group warned. …”
PS: “… Even before the current funding crisis, the pace of progress on child survival had already slowed. Since 2015, the annual rate of reduction of under-five mortality has slowed by 42 per cent, and stillbirth reduction has slowed by 53 per cent, compared to 2000–2015…..”
“… Better access to quality maternal, newborn, and child health care at all levels of the health system will save many more lives, according to the reports. This includes promotive and preventive care in communities, timely visits to health facilities and health professionals at birth, high-quality antenatal and postnatal care, well-child preventive care such as routine vaccinations and comprehensive nutrition programmes, diagnosis and treatment for common childhood illnesses, and specialized care for small and sick newborns….”
PS: “The two reports—Levels & Trends in Child Mortality and Counting Every Stillbirth—are the first of a series of important global data sets released in 2025. UN maternal mortality figures will be published in the coming weeks.”
Via Devex: https://www.devex.com/news/devex-dish-nutrition-for-growth-summit-faces-funding-headwinds-109724 (26 March)
On the agenda: “…. As for what’s on the agenda: Today will see the launch of the Global Compact on Nutrition Integration, a SUN Movement and United Kingdom-led effort to mobilize and implement commitments to integrate nutrition across sectors that may not have traditionally prioritized it, such as trade, climate resilience, and global health. Tomorrow, the two-day summit itself kicks off. Friday will feature a series of events around enlisting the support of multilateral development banks, hosted by Finance in Common — a network of public development banks — with the support of the French development agency AFD. ….”
“More countries are turning to prenatal vitamins to reduce health problems for pregnant women and newborns. Funding at the Nutrition for Growth summit could bring them to more women in poorer countries.”
“Multiple micronutrient supplements, or MMS — more commonly known as prenatal vitamins — are about to have their moment. For years, researchers and advocates have been pressing for more uptake in MMS, a combination of up to 15 essential vitamins and minerals given to pregnant women in the form of powders or pills. MMS improves the health of mothers and reduces the risk that the baby will be stillborn, born early, or have a low birth weight — problems that affect millions of mothers and babies annually because women lack essential nutrients during pregnancy.”
“Now those efforts are getting a financing boost at the Nutrition for Growth summit in Paris this week, where governments, philanthropies, and development banks are gathered to make political and financial pledges for various interventions to prevent and treat malnutrition. The event marks the culmination of a months-long global MMS fundraising effort. On Thursday, the Children’s Investment Fund Foundation, the Eleanor Crook Foundation, the Gates Foundation, and Kirk Humanitarian will announce more than $250 million in contributions to MMS. Kirk Humanitarian, a U.S. philanthropy, announced its $125 million piece of that commitment last year. They’re calling on other donors to join them in raising $1 billion by the United Nations General Assembly in September.”
PS”…. in 2021, the WHO added MMS to its model essential medicines list, as an antenatal supplement for pregnant women. Across the global south, policymakers look to the WHO’s list when determining what interventions to prioritize and purchase. “What we have seen is after the WHO onboarded MMS in the essential medicines list, countries have been busy taking it up at national level now and updating their essential medicines lists…..”
PS: another critical development: “…. the gradual improvement in the affordability and availability of MMS, which meant countries could actually buy it. This follows a sustained campaign by the global nutrition community to encourage broader manufacturing of MMS, including by producers in the global south. In 2023, Kirk Humanitarian partnered with the Indonesian company Dexa Medica to expand production of MMS. A year later, the Bangladeshi government approved local production of MMS. With the support of international NGOs, South Africa and Nigeria are also preparing for production. All of which, Mwangi said, has added up to a situation where “it’s very affordable now for a country to procure.” In fact, UNICEF prices MMS at less than two cents per tablet. The Copenhagen Consensus, which looks to prioritize global health solutions, declared MMS one of the 12 best investments for global development in 2023. And there is evidence that MMS is more cost-effective in many settings than IFAS (supplements containing iron and folic acid supplementation)…..”
https://www.sanews.gov.za/south-africa/sa-hosts-second-g20-health-working-group-meeting-kzn
South-Africa [hosted] the second meeting of the Group of 20 Health Working Group (G20 HWG) this week. The meeting kicked off on Wednesday, 26 March 2025, at the Capital Zimbali Resort in Ballito, KwaZulu-Natal. “The three-day meeting [will] focus on the theme “Accelerating Health Equity, Solidarity, and Universal Coverage.” ….. The event will include several side events that provide a platform for delegates to engage in bilateral and multilateral discussions on various critical issues, including strengthening health systems and promoting equitable access to health services.” “Key issues for discussion during the meeting and side events include financial protection for universal health coverage (UHC) and maintaining health financing amid a challenging global economy.”
For some more detail, see Health Minister Motsoaledi to Deliver Keynote at G20 Health Working Group Meeting in KwaZulu-Natal
“The G20 Health Working Group will concentrate on several key issues, including: • Strengthening investments and advancing universal health coverage (UHC); • Bridging the equity gap to improve access to essential healthcare; • Responding to the global health financing emergency amid economic volatility; • Promoting financial protection mechanisms to ensure sustainability in healthcare systems; • Tackling the burden of non-communicable diseases (NCDs) through equity-focused approaches.”
According to the Department of Health, one of the key aims of this meeting is to build consensus on urgent actions to address systemic inequities, especially in lower- and middle-income countries.”
PS: “A significant side event at the meeting will focus on the elimination of cervical cancer, with a dedicated session bringing together experts from public health institutions, donor agencies, and civil society. This event will explore policy innovations, vaccine access, and funding models to eliminate cervical cancer as a public health threat by 2030.”
And: “The outcomes of this G20 Health Working Group meeting will feed into the G20 Leaders’ Summit, expected to be held in South Africa later this year. These meetings will shape the international health policy agenda for years to come….”
Links:
Important speech.
Quotes: “We are witnessing a concerning trend: declining global health budgets simultaneously with rising costs. This is particularly acute in the Global South, where many nations are burdened by unsustainable debt servicing. These debt repayments are cannibalising health budgets, leaving millions without access to essential health services.”
“Crucially, we implore all G20 members to champion increased public financing of health systems. This is not merely a budgetary issue; it is a fundamental investment in our collective future….”
More or less chronologically. We dedicate extra sections to GAVI &PEPFAR, below.
From late last week. “The threat hanging over South African HIV/AIDS researchers for the past week has become a reality: The Trump administration this afternoon began terminating or putting on hold their grants from the U.S. National Institutes of Health (NIH). The cuts appear in part linked to an escalation of NIH efforts to terminate grants, at least some of which the government has decided have components of diversity, equity, and inclusion (DEI).”
“… “This is the Night of the Long Knives,” says Glenda Gray, the head of South Africa’s Medical Research Council, referring to a Nazi purge of perceived German enemies in 1934. … Gray notes that South Africa, which has more people living with HIV than any country, has played a pivotal role in clinical trials that have shaped international guidelines about the most effective ways to use anti-HIV and TB drugs. The trials have also helped lead to approvals of new drugs by the U.S. Food and Drug Administration…”
· See also Bhekhisa - Trump ends SA’s HIV and TB research grants
“Cancellation letters, which end hundreds of millions of rands of South African universities’ US-government funded HIV and TB research grants with immediate effect, started to roll in over the weekend. …. Fears are rife that the Trump administration might stop all US government grants, which holds devastating implications for South Africa. Some experts estimate that as much as 70% of the country’s HIV and TB research is funded through the US government’s National Institutes of Health.”
https://www.statnews.com/2025/03/24/susan-monarez-trump-pick-cdc/
“Monarez was the agency’s acting director, and previously had a top role at ARPA-H.”
“After the chaotic withdrawal of President Trump’s previous nominee to lead the Centers for Disease Control and Prevention, the president selected the CDC’s acting director, Susan Monarez, to lead the agency. Monarez is a longtime biosecurity expert with ties to former President Biden’s flagship health initiative, the Advanced Research Projects Agency for Health. “
· Related read: Stat – Marty Makary and Jay Bhattacharya confirmed by Senate as FDA commissioner and NIH director
“Trump’s health team is taking shape as key picks advance.”
https://www.propublica.org/article/nih-funding-climate-change-public-health
“It’s unclear whether the guidance will impact active grants, but it appears to halt opportunities for future studies. One climate health expert said the directive would have a “devastating” impact on much-needed research.”
“The National Institutes of Health will no longer be funding work on the health effects of climate change, according to internal records reviewed by ProPublica. The guidance, which was distributed to several staffers last week, comes on the back of multiple new directives to cut off NIH funding to grants that are focused on subjects that are viewed as conflicting with the Trump administration’s priorities, such as gender identity, LGBTQ+ issues, vaccine hesitancy, and diversity, equity and inclusion.”
“Grant terminations halt research on improving vaccinations and preventing future pandemics .”
· See also Nature News – Exclusive: NIH to cut grants for COVID research, documents reveal
“Studies on climate change and South Africa are also on the latest list of grants to be terminated, according to updated documents obtained by Nature.”
PS: “Under the new directive, it’s unclear whether the NIH plans to shut down long COVID research, including its $1.6 billion RECOVER initiative, which aims to find the root causes and treatments for the disease. The Trump administration appears to be deprioritizing long COVID: this week, the HHS will close its Office of Long COVID Research and Practice, which coordinates the US government’s response to the disease, according to e-mail correspondence that Nature has obtained……”
· See also NYT - H.H.S scraps studies of vaccines and treatments for future pandemics
“Federal officials cited the end of the pandemic in halting the research. But much of the work was focused on preventing outbreaks of other pathogens. “
· And a link: Guardian - Trump administration at ‘war’ with mRNA technology: scientists alarmed vaccine skeptics could kill research
https://healthpolicy-watch.news/civil-society-organisations-face-backlash-after-trump/
“Civil society organisations (CSOs) globally face investigation, restrictions and harassment in dozens of countries after US President Donald Trump claimed that the US Agency for International Development (USAID) was run by “radical left lunatics” and Elon Musk claimed that several grantees supported terror organisations…..”
“This is according to a recent survey carried out by the EU System for an Enabling Environment (EU SEE), which documents the experiences of 54 organisations, and draws on information from two global surveys involving almost 1000 CSO respondents…..”
“…. The abrupt halting of US foreign aid is disrupting “critical human rights, democracy, gender equality and health programmes, leaving vulnerable communities without essential support”, the survey found. …. ….. Over two-thirds (67%) of surveyed organizations have been directly impacted by the termination of USAID, with 40% of them losing 25-50% of their budgets….”
PS: “…. The Global Aid Freeze Tracker, reports that the health and protection sectors have been worst hit, with particularly significant disruptions in HIV, malaria, and protection services. The second most affected category is governance, particularly anti-corruption activities, followed by projects offering economic and livelihood support for vulnerable populations, especially women and children…..”
https://www.devex.com/news/ousted-usaid-health-lead-says-us-fumbled-uganda-s-ebola-response-109726
(26 March) “The acting assistant administrator for global health at USAID (N Enrich), who was put on administrative leave, said Ebola response activities were not approved and no funds were made available.”
(27 March) “Sweeping plan would consolidate authorities, create a new agency for a ‘Healthy America’”.
· Link: NYT - Trump Administration Abruptly Cuts Billions From State Health Services
“States have been told that they can no longer use grants that were funding infectious disease management and addiction services.”
· Link: Devex - What's the status of all the lawsuits against Trump's aid freeze?
“ As the legal challenges mount, and many move on from an initial emergency phase, here's a look at the cases challenging the legality of the Trump administration's dismantling of foreign aid…. …. after an initial flurry of efforts in the courts to immediately put a stop to the administration's actions, many of these cases are now moving toward more in-depth deliberations, with long-term decisions likely months or years away….”
https://www.nytimes.com/2025/03/26/health/usaid-cuts-gavi-bird-flu.html
(26 March) Another major shock came on Wednesday. “A 281-page spreadsheet obtained by The Times lists the Trump administration’s plans for thousands of foreign aid programs.”
“The Trump administration intends to terminate the United States’ financial support for Gavi, the organization that has helped purchase critical vaccines for children in developing countries, saving millions of lives over the past quarter century, and to significantly scale back support for efforts to combat malaria, one of the biggest killers globally. The administration has decided to continue some key grants for medications to treat H.I.V. and tuberculosis, and food aid to countries facing civil wars and natural disasters. Those decisions are included in a 281-page spreadsheet that the United States Agency for International Development sent to Congress Monday night, listing the foreign aid projects it plans to continue and to terminate. The New York Times obtained a copy of the spreadsheet and other documents describing the plans.”
“…. In all, the administration has decided to continue 898 U.S.A.I.D. awards and to end 5,341, the letter says. It says the remaining programs are worth up to $78 billion. But only $8.3 billion of that is unobligated funds — money still available to disburse. Because that amount covers awards that run several years into the future, the figure suggests a massive reduction in the $40 billion that U.S.A.I.D. used to spend annually…..”
PS: “The terminated grant to Gavi was worth $2.6 billion through 2030. Gavi was counting on a pledge made last year by President Joseph R. Biden Jr. for its next funding cycle. ….”
“… By Gavi’s own estimate, the loss of U.S. support may mean 75 million children do not receive routine vaccinations in the next five years, with more than 1.2 million children dying as a result…. Dr. Sania Nishtar, Gavi’s chief executive, said that she hoped the Trump administration would reconsider the decision to end its support…”
PS: “according to Sania Nishtar, the organization has not received a termination notice from the U.S. government (yet), and Congress has approved $300 million for the organization’s activities this year…..”
· See also HPW - US Plans to End Support to Global Vaccine Alliance, Gavi
“The US covers 13% of Gavi’s budget….”
· Related tweet Andrew Green: “It's not at all clear that the administration actually has the authority to do this, since Congress allocates spending. But Congress has shown no interest in asserting this authority, so it will fall to the courts to determine if this plan can move forward. In the interim, people will suffer.”
PS: via Devex - The USAID awards the Trump administration killed — and kept | Devex
With some better news for the Global Fund, it seems:
“At the top of the list of terminations sent to Congress is a cut in funding to Gavi, the Vaccine Alliance — an organization that purchases vaccines for millions of children across the world. An award to the Global Fund, on the other hand, was spared.”
“While Gavi was on the termination list, the Global Fund to Fight AIDS, Tuberculosis and Malaria was spared, with $13.4 billion on the ledger from 2017 until 2027 — although all that funding has already been obligated. ….”
J Ratevosian; https://www.thinkglobalhealth.org/article/pepfar-misses-reauthorization-deadline-whats-next-global-hiv-fight
One of the must-reads of the week (26 March) “The expiration of PEPFAR's authorization could mark a pivotal shift in the HIV/AIDS response.”
In this analysis, Ratevosian explains what the expiration of PEPFAR’s authorization implies (against also the broader backdrop of Trump 2.0 re global health).
“As of March 25, 2025, however, PEPFAR's congressional reauthorization has expired, raising key questions about its future. Prior to 2024, bipartisan support had secured five-year reauthorizations in 2008, 2013, and 2018. Last year, Congress allowed only a one-year authorization as political strife engulfed PEPFAR. Without reauthorization, PEPFAR sits in purgatory—even though Congress appropriated funding through the end of September via the continuing resolution that passed this month. The expiration of its authorization introduces deep uncertainty about its long-term future, meaning that officials could now terminate or significantly curtail PEPFAR at any time.
Health ministries, implementing partners, and community-based organizations across PEPFAR-supported countries must try to deliver lifesaving care without the stability that long-term U.S. commitments once provided. At the same time, structural questions remain about how the State Department will operate PEPFAR amid reported proposals to create a new U.S. Agency for International Humanitarian Assistance. The question now is not just whether PEPFAR will continue, but also how it must evolve to remain effective in a drastically reshaped foreign aid landscape. ….”
A few excerpts:
“…. PEPFAR's programs will not disappear overnight, but the most immediate consequence of no reauthorization is instability. The work can continue under the annual appropriation of funds from Congress—though without a long-term legislative framework, PEPFAR officials lose their ability to secure cofinancing arrangements, make long-term strategic investments, or plan sustainability partnerships with governments and local actors. …. “ “ …. Governments and implementing organizations now need to adjust to an unpredictable, year-by-year funding process. This instability makes it harder to secure long-term procurement contracts with drug companies for essential medicines, develop multiyear cofinancing commitments, or scale up emerging HIV prevention technologies. “
“… Congressional reauthorization also provided key oversight mechanisms that have long shaped PEPFAR's priorities and ensured accountability. ….”
“ …. Without these safeguards, funding decisions now rest solely with the executive branch, increasing the risk that shifting political priorities could disrupt the balance across treatment, prevention, and broader health system investments. ….”
“Another consequence of PEPFAR's lapsed reauthorization is the expiration of key provisions governing how the United States supports the Global Fund to Fight AIDS, Tuberculosis, and Malaria. For years, these provisions have set guardrails on U.S. contributions, ensuring that funding is allocated to promote transparency, accountability, and burden-sharing among donor countries. Without these restrictions, U.S. financial commitments to the Global Fund could shift, potentially altering how monies are distributed between bilateral and multilateral HIV programs—and weakening U.S. leverage to improve the Global Fund's performance and priorities. ….”
“… The coming months will shape the future of PEPFAR….”
A Green; https://www.devex.com/news/why-pepfar-has-bigger-problems-than-reauthorization-109705
Analysis from Monday. “Even if its authorization is allowed to expire tomorrow, PEPFAR will survive. Instead, the program faces a much bigger problem as a result of cuts to USAID, which administered the majority of PEPFAR services.”
“Congressional authorization for the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, is all but certain to expire tomorrow. But that is far from the main threat to PEPFAR’s survival…. “
“PEPFAR's biggest problem isn't authorization expiration; it's the dismantling of USAID…..”
Or in the words of a tweet by A Green himself: “The bigger problem? It's impossible to determine just how much of PEPFAR is actually functional at the moment. But faults are emerging….”
A few excerpts:
“cfr Coester ( who also serves as co-chair of the Global AIDS Policy Partnership, an advocacy coalition focused on U.S. global HIV policy): “Right now, she said, “The most important thing is to have a greater understanding of what work is actually functioning right now than it is about reauthorization.”
“At the same time, she said there are practical and political implications if PEPFAR’s authorization is allowed to expire. On the practical front, the current PEPFAR legislation has eight time-bound requirements that will lapse tomorrow. Among these are guidance on how PEPFAR funds are spent and how much the United States will contribute to the Global Fund to Fight AIDS, Tuberculosis and Malaria. “Those requirements will not be requirements if it’s not reauthorized,” Kates said, although Washington can still follow the provisions if it chooses….”
“Politically, “PEPFAR reauthorization is about Congress having a say and a role in the future of the program,” Coester said. “By not reauthorizing, they’re sort of giving up that opportunity.” Congressional engagement with the reauthorization process also sends a signal about the health of the program….”
PS: whether PEPFAR will survive the ongoing disruptions? “….. One of the program’s architects, Ugandan physician Peter Mugyenyi, told Devex that is not something that should be taken for granted. Mugyenyi, who advised former President George W. Bush’s administration as it developed PEPFAR, sees the failure to reauthorize the program as yet another signal of just how much it is now in jeopardy.”
Another informative read on the state of affairs re PEPFAR, as the week was kicking off.
“America’s most celebrated global health program is on life support, former U.S. government officials and global health advocates say. President Donald Trump’s decision to suddenly halt and then terminate most U.S. foreign aid, and GOP concerns that organizations receiving government grants to combat HIV and AIDS were performing abortions, have key congressional Republicans broaching what was once unthinkable: ending PEPFAR, the program President George W. Bush created to combat HIV and AIDS in the developing world…”
With among others, a few quotes on how MAGA republicans now look at PEPFAR (and frame some of its ‘flaws’, in nutty MAGA eyes).
https://healthpolicy-watch.news/pepfar-reauthorisation-expires-with-no-clear-path-for-renewed-aid/
(25 March) “The US Congress’s one-year reauthorisation of the President’s Emergency Plan for AIDS Relief (PEPFAR) expire[d] on Tuesday (25 March) and there is no clarity about its future – other than that it is likely to be slashed.”
“….The only inkling of what a reformed and slashed PEPFAR might look like is contained in a throwaway reference to PEPFAR in a leaked plan on US foreign aid reform that is being circulated by Trump aides, as reported by Politico. ….”
PS: “Jean Kaseya will be in Washington this week to lobby for the resumption of aid, and plans to meet members of the Trump administration, PEPFAR officials and Members of Congress in a bid to restore US aid. However, he said that there were also urgent continental efforts to get more domestic resources to fill the huge gaps left by the termination of USAID grants.”
PS: “Former PEPFAR chief-of-staff Ratevosian, Beyrer and four other Duke University colleagues have written a policy proposal that would see countries achieving 50% co-financing for HIV within five years. A key aspect of their proposal is that funding should move to places where the epidemic is getting worse and scale up HIV prevention by rolling out the long-acting pre-exposure prophylaxis (PrEP) injectable lenacapavir to five million most at-risk people…..”
PS: some more detail on the ‘dismal prospects’: “But influential conservatives have long sought to curtail PEPFAR. The Heritage Foundation, which authored the conservative Project 2025 blueprint for Trump’s administration, argued in 2023 that PEPFAR should be “restructured as a development rather than an emergency assistance program”. Except in cases of rape or maternal transmission, HIV/AIDS is “primarily a lifestyle disease (like those caused by tobacco) and as such should be suppressed through education, moral suasion, and legal sanctions,” according to the foundation. It also claimed that “as with any venereal disease, education and abstinence could end the AIDS epidemic” – although this approach has failed miserably in both the US and Africa. While PEPFAR projects can continue – in theory – as long as congressional appropriations (funding) are available, a much scaled-down version is likely to emerge that may well follow the Heritage Foundation’s proposals.”
With some key reads here, but more also in the next Global Health Governance & Financing section.
https://www.devex.com/news/kenyan-govt-internal-memo-warns-of-domino-effect-of-us-health-cuts-109719
“Kenya’s Ministry of Health sent a briefing to President William Ruto to warn of a “domino effect that imperils every link in the healthcare chain.”
“Kenya’s health system is reeling from the Trump administration’s abrupt halt of U.S. foreign aid — a move that has left health facilities underfunded, health workers unemployed, data management systems vulnerable, and placed vital programs, from HIV treatment to malaria prevention, in jeopardy, according to an internal government briefing (from 10 March).”
PS: “The authors — which included 46 people from a variety of government entities — called for urgent, coordinated measures to “fortify Kenya’s health system and guarantee the uninterrupted delivery of lifesaving HIV and health services, even under severe funding constraints.” They said the country needed to “reimagine” health financing, reduce external donor dependency, create a dedicated health contingency fund, fast-track budget disbursements, conduct a rapid fiscal analysis, strengthen public-private partnerships, incentivize private sector engagement, develop co-financing models, improve accountability frameworks, invest in local pharmaceutical manufacturing, review the national insurance benefits package to expand coverage for “critical conditions and commodities,” and explore health bonds, targeted levies, and insurance schemes, among other efforts. They also called for better harmonizing of the work of national policymakers and local health authorities and for the Kenyan government to engage diplomatically with the U.S. government, which would include requests for American technical assistance during Kenya’s transition period.”
Winnie Byanima spoke to reporters in Geneva on Monday. “The sudden halt to US foreign aid funding has been "devastating", the UNAIDS chief said Monday, warning that without more funding, millions more will die and the global AIDS pandemic will resurge.”
“…. without more funding, "there will be an additional... 6.3 million AIDS-related deaths" in the next four years. At the last count, in 2023, some 600,000 AIDS-related deaths were registered globally, she pointed out. "So you're talking of a 10-fold increase." “
“At the same time, Byanyima said her agency expected to see "an additional 8.7 million new infections". "You're talking of losing the gains that we have made over the last 25 years. It is very serious." “
“Looking further ahead than the next four years, if aid funding is not restored, "in the longer term, we see the AIDS pandemic resurging, and resurging globally," Byanyima said. "Not just in the countries where now it has become concentrated, in low-income countries of Africa, but also growing amongst what we call key populations in Eastern Europe, in Latin America," she said. "We will see a... real surge in this disease. We'll see it come back, and we'll see people die the way we saw them in the '90s and in the 2000s." “
· See also Reuters – There could be 2,000 new HIV infections every day due to USAID cuts, says UNAIDS
· And via UN News – UNAIDS chief warns of ‘real surge’ in deaths unless US restores funding
“Amid continuing uncertainty about the impact of deep US funding cuts to humanitarian work worldwide, the head of the UN agency coordinating the fight against HIV-AIDS warned that an addition 6.3 million people will die in the next four years, unless support is reinstated.”
PS: “And in a direct appeal to President Donald Trump, the UNAIDS chief noted that just as President George W Bush had introduced the groundbreaking PEPFAR initiative, the new White House incumbent could also be part of the “prevention revolution”, involving injectable HIV injections that are required just twice a year to provide protection. “The deal is that an American company is enabled to produce and to license generics across the regions to produce millions and roll out this injectable to those who really need it,” she insisted….”
“New modelling analysis suggests that proposed funding cuts by major donor countries to foreign aid could undo decades of progress made to end HIV/AIDS as a public health threat and new infections and deaths could surge back to levels not seen since the early 2000s.”
“The study estimates there could be between 4.4 million to 10.8 million additional new HIV infections by 2030 in low-and-middle income countries (LMICs) and between 770,000 to 2.9 million HIV-related deaths in children and adults by 2030. The greatest impact from potential funding cuts could be in sub-Saharan Africa and among vulnerable populations, including people who inject drugs, sex workers, men who have sex with men, and children.”
“The authors argue that long-term, strategic planning and international cooperation are crucial for establishing sustainable health systems and country-led HIV treatment and prevention programmes; they call for the global community to unite to advocate for continued support for HIV programmes.”
· Related coverage via the Guardian – Aid cuts predicted to cause 2.9 million more HIV-related deaths by 2030 – study
Somewhat more uplifting message here. “….those on the frontline don’t have the luxury to wait for the dust to settle and are beginning to lay the groundwork for a sustainable HIV response without US support at its centre.”
Excerpt: “…. the alarmism in Geneva feels too distant from reality for frontline actors like Florence Riako Anam, the executive director of the Global Network of People Living with HIV, an organisation with offices in the Amsterdam and Cape Town. Riako Anam, who is based in Kenya, says she doesn’t have the luxury of waiting for the US to come around. “We need our treatment now,” she tells Geneva Solutions. Riako Anam says African governments and civil society have entered “emergency response mode” reminiscent of Covid-19. Her network has been working with health ministries to see public health workers redeployed to cover simple tasks like filling prescriptions, transferring patients to operational clinics and convincing political leaders to shoulder the treatment costs. Nigeria, South Africa, Uganda and Kenya have taken steps in that direction….”
PS: “Experts and campaigners alike are most concerned about the impact on prevention….”
Boston University - School of Public Health
Resource. “ Brooke Nichols has launched online tracking tools that capture estimated increases in mortality and disease spread for HIV/AIDS, tuberculosis, malaria, and other diseases as a result of the near-total freeze in US foreign aid funding and programming. ….”
C Kenny; https://www.cgdev.org/blog/usaid-shutdown-where-next
(24 March) Not mincing words here: “... Some members of the administration are floating foreign assistance reorganization proposals. While there is surely a lot that could be done to make US foreign assistance more effective, I hope Congress focuses on the far more urgent task of ensuring the foreign assistance funding it has already appropriated can be legally and responsibly spent. At the moment, the system to accomplish that is collapsing, still functioning at all thanks only to court-ordered remedies.”
Kenny concludes: “…. it is worth noting what is preventing the further dismantling of capacity, and further collapse in the ability of USAID to follow legal mandates on spending levels, reporting, and oversight: it is the judicial system, not administration leadership. The payments that have been made are because of a judge, not because of a waiver. Looking forward, the number of active USAID solicitations for contracts and grants rounds to zero. And the administration wants to reduce staffing to 300 or fewer employees…..”
“It is ridiculous to talk about a reform agenda when on the current trajectory there will be nothing left to reform. I hope members of Congress who were misled by the waiver process refuse to entertain discussion of a new aid architecture until the foundations of that architecture are clearly secured: a staffed and operational aid delivery system that can meet legal commitments including the responsible expenditure of appropriated funds.”
https://www.devex.com/news/has-usaid-spending-been-cut-by-less-than-we-thought-109699
(21 March) “Figures from the Center for Global Development, based on leaked lists of terminated and retained programs, place USAID spending cuts at around 34% — way lower than estimates based just on the number of canceled programs…..”
“…. CGD calculated the sectors worst affected, finding that some sectors potentially lost all funding. …. “The estimates suggest that potentially all awards were terminated in sectors including private sector competitiveness, higher education, and political competition and consensus building,” the CGD blog said. …. “Other sectors were cut by potentially 90 percent or above, including infrastructure, good governance, basic education, family planning, civil society, conflict mitigation, and trade and investment.” …. Other sectors, particularly food, health, and humanitarian aid, seem to have seen relatively fewer cuts. These reductions appear to line up with recent proposals for a new, narrower, focus on U.S. aid, which appears to have gained some support among Republicans in recent days. …. One recently leaked memo, for example, outlined plans for a U.S. Agency for International Humanitarian Assistance within the Department of State, and advocates for it to focus chiefly on these areas…..”
By Justin Sandefur and Charles Kenny; https://www.cgdev.org/blog/usaid-cuts-new-estimates-country-level
(26 march). And by now, CGD has come up with updated estimates.
“Last week, we published an estimate of cuts to USAID programs at the sectoral level based on two leaked documents covering cancelled and retained awards. Since then, a new version of the terminated and retained awards list was shared with Congress. Using that updated list, we revise our earlier sectoral estimates using the same approach as previously, and also estimate the scale of cuts to USAID country programs. ….”
“The country analysis suggests a number of country programs may have been effectively closed down, particularly in Central and East Asia but also in West Africa, Central Europe, and the Americas. In absolute dollar value, by far the largest cut is to the Ukraine program, followed by Ethiopia and the Democratic Republic of the Congo. …. … The largest absolute dollar cut at the country level is $1.4 billion in Ukraine assistance. Ethiopia, the DRC, Colombia, South Africa, Palestine, Bangladesh, Kenya, Afghanistan, and Tanzania all see cuts over $200 million. Liberia sees the largest cut as a percentage of its economy, estimated at 1.6 percent of GNI. Afghanistan, Palestine, and Somalia are all over 1 percentage point. In terms of the existing USAID program, our data suggest in some cases country cuts may be equal to 95 percent or more of the value of programs including the following countries where programs were previously above $100 million: Madagascar, Georgia, El Salvador, Senegal, Nepal, Indonesia, Liberia, and the Philippines.”
“…The updated sectoral analysis suggests that the total cuts may have been in the region of 38 percent of contract values measured by FY24–25 obligations, as compared to our estimate of 34 percent last week. The sectoral results remain broadly similar….”
“Disease surveillance programs worldwide are suddenly in limbo.”
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00222-1/fulltext
“A global survey released on March 5, 2025, highlights the potentially devastating impacts of the US Government's funding decisions. Ed Holt reports.”
“… On March 5, 2025, the volunteer organisation TB Community Coordination Hub released the results of a survey of technical staff, tuberculosis (TB) activists, and community health-care workers in 31 countries on how recent foreign-aid cuts and stop-work orders from the US Government had affected their operations. ….”
https://news.un.org/en/story/2025/03/1161366
“….children, refugees and displaced people worldwide are paying the price for the deep-seated funding crisis that has engulfed the international aid sector, made worse by pronounced cuts in Washington, the UN children’s and refugee agencies said [last week] on Friday. “
S Osendarp, L Haddad et al; https://www.nature.com/articles/d41586-025-00898-3?linkId=13661656
“The sudden withdrawal of almost half of global funding for nutrition suddenly will have dire consequences for decades.”
“The impacts of these cuts will be dire. To illustrate, here we assess their scale. Altogether, we estimate that reductions of $290 million in donor funding for severe acute malnutrition (see ‘Nutrition funding collapse’) will cut off treatment for 2.3 million children in low- and middle-income countries (LMICs). This would lead to 369,000 extra child deaths a year that would otherwise have been prevented…..”
“…. Although shocking, the number of deaths might be an underestimate, because the aid cuts threaten a huge array of nutrition-supporting programmes, including health, agriculture, school feeding and water and sanitation. Soon we might see many more millions of children around the world developing wasting, stunted growth and micronutrient malnutrition…..”
“… This unprecedented crisis requires the world to rethink aid to nutrition, as well as to prioritize and expand financing options. We call for governments, donors and funders to take the (four) following steps….”
“…. Government officials from Sweden, Norway and the Netherlands told The Associated Press that a combined $15 million they contributed for joint development work overseas has been parked at the U.S. Agency for International Development for months. After the Republican administration and Musk’s Department of Government Efficiency cut USAID’s funding and the bulk of its programs, the Europeans asked whether their money would be funneled to projects as expected or refunded. They have gotten no response….”
https://genevasolutions.news/global-news/the-capitol-rioter-surveying-international-geneva
“Confidential documents reveal the political ideologies of those behind the controversial survey distributed to organisations in Geneva. Meanwhile, unease grows in Geneva, as the UN Refugee Agency considers laying off up to 6,000 employees.”
“The architects of the questionnaire are Peter Marocco and Andrew Veprek – Trump loyalists and close associates of Stephen Miller, instigator of the White House’s draconian immigration policy ….”
PS: And re the UN: “ Geneva’s anxiety is matched in New York. Diplomats and international civil servants had initially hoped that the US president would limit himself to a few symbolic gestures. In an opinion piece that breaks with his usual measured response, Richard Gowan, director of UN affairs at the International Crisis Group in Manhattan, can hardly hide his alarm: “Two months later (since Trump took office – ed.), UN insiders admit that the new administration has done far more harm to the institution than they had expected. And they worry that it will do even greater damage before long.” “
I Bharali, G Yamey et al; https://www.brookings.edu/articles/navigating-us-global-health-aid-cuts-what-can-past-donor-exits-teach-us/
“Five key lessons from past donor exits may inform how the sudden aid freeze could impact recipient countries.”
1. Some countries are more vulnerable to backsliding after transition …. 2. The strength of the health system is critical ….. 3. Sudden, poorly planned exits cause disease resurgence …. 4. Relying on just a few donors is risky …. 5. Donors may make decisions based on strategic interests
Bharali et al then describe the “new normal of strategic bilateral donor assistance”.
“If these trends in donor exits persist, aid-receiving countries must accelerate progress toward wholly financing their healthcare systems to preserve health gains achieved over the past decade. For example, the Nigerian government recently announced its plans to absorb 28,000 health workers formerly employed by USAID. Previous research suggests that with proper planning and prioritization, the incremental healthcare costs could be covered by domestic resources from expected economic growth in lower-middle-income countries. However, some low-income countries and fragile and conflict-affected states will continue to need external aid in the near term. In addition to domestic resource mobilization, health policymakers have also identified improving the efficiency of health spending as a potential high-impact intervention that can mitigate the effects of donor exits.”
By Helen Clark, Rajat Khosla; Devex;
“Amid aid cuts, to sustain women’s, children’s, and adolescents’ health, the global health community must pivot to self-reliance, innovative funding, and global south leadership.”
(25 March) Resource. “Starting on January 20, 2025, as part of a larger foreign aid review, the Trump administration began to take several steps to defund and dismantle most of the U.S. global health response, rendering its future uncertain. To better understand the U.S. global health response, as it was before this date, here are key facts to know….”
(PS: as Andrew Harmer noted on Bluesky, KFF is not to be confused with the KLF from the ‘90s 😊)
Some key reads, in no particular order though.
https://healthpolicy-watch.news/african-leaders-meet-us-government-over-health-funding-cuts/
“Leaders of the Africa Centres for Disease Control and Prevention (Africa CDC) held a five-hour meeting with Dr Susan Monarez, newly appointed head of the US CDC, and other US officials on Wednesday – for the first time since the US slashed funding to Africa’s health sector.”
“Discussion centred on health security, funding for Africa CDC and options for health financing on the continent, Dr Ngashi Ngongo, Africa CDC’s incident management head, told a media briefing on Thursday. “From the [US] administration’s perspective, they would like to see more of health as a business, rather than something that functions on grants,” added Ngongo. “
“African programmes worst affected by the US’s abrupt termination of funding are those dealing with maternal and child health, HIV, malaria and emergency preparedness and response, said Ngongo, speaking from Washington DC, where he and Africa CDC Director General Dr Jean Kaseya are meeting a range of US leaders.”
“Ngongo said the business perspective resonates with African health officials, given efforts already underway in the African region to produce vaccines and other health supplies locally…”
PS: “Meanwhile, Africa CDC has a funding gap of $224 million – in part due to the US walking away from a pledge made to the continent by the Biden administration…..”
Re Geneva. “The longtime epicenter of global public health, peacemaking and diplomacy is being squeezed by budget cuts that could redefine its identity.”
“…. Geneva’s problems didn’t start under the current American president. The global turn towards isolationism has been gaining momentum for years, and Switzerland’s pivot away from strict neutrality — central to the country’s efforts to pitch itself as the world’s impartial arbiter — started in the early 2000s. In light of Trump’s “America First” agenda, however, Geneva is now in the uncomfortable position of representing a liberal order that’s no longer ascendant. “The idea of international cooperation, of being a globalist, used to be a cool thing to be and say, but in most countries, national interest has become way more important,” says Joost Pauwelyn, a professor in international trade law at the Graduate Institute in Geneva. “That’s not good for Geneva.”…”
PS: “…. Within multilateral institutions, the expectation is not that international Geneva will disappear, but that power dynamics will shift as other authoritarian-minded countries step in to fill the gap left by the US…..”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00589-6/fulltext
“Countries with long health legacies from nuclear testing are leading calls for new assessments as global nuclear tensions rise. John Zarocostas reports from Geneva.”
“A group of Pacific island states with painful nuclear legacies, spearheaded by the Marshall Islands, Samoa, and Vanuatu, is behind a diplomatic initiative to renew WHO's mandate to investigate the effects of nuclear war on global health. The move reflects mounting concerns at the prospect of nuclear war and its consequences for humanity and the planet. The draft proposal, also cosponsored by Fiji, the Federated States of Micronesia, Burkina Faso, Peru, Guatemala, Iraq, and Kazakhstan, aims to provide the WHO Director-General with a renewed mandate at the upcoming World Health Assembly (May 19–27). The mandate would enable updated WHO reports on the effects of nuclear war on health and health services (previously published in 1983 and 1987) and the Health and Environmental Effects of Nuclear Weapons report (published in 1993)….”
PS: “… In February, during a session of the WHO Executive Board, North Korea and Russia opposed the Pacific-led initiative. However, with the text now “almost agreed“, diplomats are hopeful of securing broad support for adoption at the World Health Assembly.”
T J Bollyky & Y Huang ; https://www.foreignaffairs.com/china/coming-global-health-crisis?utm_campaign=tw&utm_content=&utm_medium=social&utm_source=twitter
“America Is Retreating, and China Won’t Fill the Void.”
“ A U.S. retreat on global health, if sustained, will indeed open the door for China to exploit the abrupt, chaotic withdrawal of U.S. programs in some strategic regions. China is already providing replacement funding in Southeast Asia, and it may do the same in Latin America. But in most of the places that U.S. aid targets, including those at the greatest risk from disease, China will not step in. China’s leaders are focused on using aid to build influence with strategic partners; they have no desire to take up the U.S. role in preventing, detecting, and responding to the world’s most dangerous diseases. Without sustained support for either international institutions or health programs in the world’s poorest countries, the result will be a vacuum in global health that will make everyone less safe. The greatest risk to Americans is not that China will supplant the United States as the world’s leader in global health. It is that no one will.”
A few excerpts:
“ Tensions [between China & WHO] continued after the pandemic. In 2023, China reportedly balked at a 20 percent increase in its WHO contributions. The same year, Tedros allegedly rejected China’s preferred candidate for the post of assistant director general and instead promoted a senior WHO staff member. China has been lukewarm toward a proposed new pandemic treaty, a WHO priority, sending low-ranking officials to the negotiations and adopting what one Chinese observer characterized to us as a “not opposing but not hoping to happen” stance. …. …. Since Trump once again promised to withdraw the United States from the WHO in January, China has seemed reluctant to fully replace the U.S. role. In February, it signaled that it planned to oppose a scheduled increase in member dues that would bring contributions more in line with each country’s GDP. Although China will become the WHO’s largest contributor of assessed funding after the United States withdraws, member state dues accounted for just 12 percent of the organization’s budget in 2023. Beijing is unlikely to make up most of the U.S. contribution, the majority of which consists of voluntary funding. China’s reluctance to fill the financial hole left by the United States will likely extend to other multilateral institutions, too. ….”
“… Many individual countries, like international organizations, will seek China’s help to replace U.S. funding, but recent trends in Beijing’s bilateral aid suggest that most are unlikely to get it. In 2023, China’s bilateral health development assistance—funds that flow directly to recipients rather than through international organizations—declined to its lowest level since 2010. And as its overall spending has fallen, China has concentrated its dollars less on the greatest threats to global health and more on advancing its national interests. To that end, much of China’s recent health assistance has targeted countries participating in its Belt and Road Initiative. This has meant shifting its earlier support from malaria control aid projects in Africa to infrastructure-driven investments in Southeast Asia and Latin America. China’s aid in Africa has not vanished entirely: it continues to contribute to some high-visibility health projects, such as the newly completed headquarters and a high-security laboratory for the Africa Centers for Disease Control and Prevention in Addis Ababa. Beijing Genomics Institute, the Chinese genomics research giant, has provided low-cost gene sequencing technology to some African countries for infectious disease surveillance, as part of its efforts to, in its own words, “seize the commanding heights of international biotechnology competition.” But the trend is unmistakable. Fifteen years ago, four of the top five recipients of Chinese health aid were African countries; today only one is……”
By Olusoji Adeyi; Geneva Health Files;
This one went viral, as mentioned in the intro.
“Starting with a thought experiment, in the year 2030: ….. They all agree on one thing: an era had ended and another was beginning, as the African Union launched its African Responsibility and Accountability Pact for Health (ARAPH)……”
Adeyi then came back to today’s situation, focusing on Global Fund & GAVI. He considers three options which the primary financiers of GAVI & GF might consider. Keep the status quo; merge GAVI & GF; Set a sunset date and begin transition.
And clearly prefers option 3. Read why. And he argues: “… These matters are sufficiently important to urge that wealthy countries and the Gates Foundation publicly state whether they are for or against sunsetting GAVI and the Global Fund over an explicit transition period.”
A Demeshko, Tom Drake et al; https://www.cgdev.org/publication/new-era-global-health-can-african-countries-agree-new-compact-external-donors
Must-read.
First zooming in on Health Financing in African countries in 2025, then focusing on Africa CDC’s role in health financing.
“Africa CDC plays a key role in reshaping health financing across the continent in line with its Health Economics Programme (HEP) vision…..”
And: “…. In response to this, Africa CDC will be working with the Center for Global Development in the coming months to explore the potential for a New Compact between countries and donors based on three principles: Locally led, evidence-informed prioritisation: Countries are empowered to set their own health priorities based on evidence, ensuring that external funding aligns with national needs rather than donor-driven agendas. Domestic-first resource allocation: Governments take ownership of financing essential health services, with external aid supplementing these efforts rather than replacing them. Consolidated supplementary aid: Donors collaborate to provide "top-up" funding for services that would otherwise remain unfunded, complementing domestic efforts and reducing fragmentation.”
(18 March) Update on the HIIP. “ Yesterday the Health Impact Investment Platform (HIIP) held its inaugural Steering Committee meeting, marking a significant milestone in advancing innovative financing for global health. As the Platform’s highest decision-making body, the Committee – consisting of representatives from the World Health Organization (WHO), the European Investment Bank, and the Islamic Development Bank – reviewed progress, endorsed key governance and operational priorities, and provided strategic guidance on HIIP’s efforts to expand primary health care (PHC) services in low- and middle-income countries. ….”
As a reminder: “The HIIP was unveiled during the Summit for a New Global Financing Pact in Paris in 2023, and is a landmark partnership between WHO, multilateral development banks and beneficiary countries. Amid a US$ 371 billion annual health financing gap for health-related Sustainable Development Goals (SDGs) and a US$ 31.1 billion annual funding requirement for pandemic preparedness, the Platform innovates multilateral solutions to increase the share of development funding going to the health sector. Integrating technical expertise, financial resources and local knowledge into impactful, country-driven investments in vulnerable communities, the Platform has mobilized over US$ 30 million of investment for WHO to support countries in developing prioritized investment plans for potential support from MDBs and donors….” “ The Platform aims to use these plans to generate over US$1.5 billion funding for low- and middle-income country governments to build resilience against pandemic threats and the climate crisis.”
PS: a bit of an anticlimax, that US $30 million so far…
https://www.devex.com/news/unaids-faces-dicey-future-as-us-slashes-40-of-its-budget-109707
“UNAIDS Executive Director Winnie Byanyima said they will have to make some painful decisions.”
“….. According to Angeli Achrekar, deputy executive director of UNAIDS programs, the U.S. government provides funding to UNAIDS through the U.S. Agency for International Development and the U.S. Centers for Disease Control and Prevention. It’s the funding from USAID that’s been terminated, which totals $50 million in core funding or flexible funds and roughly $40 million in non-core funding or earmarked funding. That’s around 40% of UNAIDS’ total revenue.”
“… UNAIDS Executive Director Winnie Byanyima said they are now looking at restructuring the joint U.N. program. ….”
“Apart from the U.S., other donors are also cutting their overall aid budgets, which may have implications for UNAIDS in the long run….”
“… She said they continue to engage with donors, the U.S. included, and are looking at raising more non-core funds. UNAIDS is also looking at different scenarios in the wake of dwindling resources, making sure it can continue playing its role in the fight against HIV and AIDS, including providing critical data for countries and international initiatives such as PEPFAR, policy setting, and getting countries to agree on ambitious targets and holding them accountable to achieving those targets.”
S Muhula et al ; https://newsroom.amref.org/blog/2025/03/health-for-all-not-for-some-revamping-the-global-health-architecture-for-equitable-access/
Interesting recap from the AHAIC 2025 conference of a few weeks ago, with focus on a plenary session.
“At the Africa Health Agenda International Conference (AHAIC) 2025, a critical plenary session titled Health for All, Not for Some examined how Africa can assert its role in shaping global health policies, financing models, and partnerships to achieve sustainable, inclusive health systems…..”
“Moving Forward: Key Takeaways : The plenary session clarified that Africa must take proactive steps to reframe the global health architecture in its favor. Three actionable recommendations emerged: (1) Enhance Domestic Health Financing: Governments must increase budget allocations to health and explore sustainable financing mechanisms such as taxation on unhealthy products, strategic public-private partnerships, and innovative funding models tailored to Africa’s unique needs. Strengthening financial accountability will be key to ensuring long-term success. (2) Invest in local manufacturing and research… …. (3) Unify Africa’s negotiating power: African nations must leverage their collective strength in global health decision-making, advocating for policies that reflect the continent’s priorities. A cohesive, well-coordinated African bloc will be better positioned to drive structural reforms in global health governance, ensuring equitable access to funding, technologies, and medical innovations…..”
· See also P4H- Rethinking Sustainable Health Financing in Africa: From Dependence to Partnership
“The Africa Health Agenda, emphasized at the AHAIC 2025 conference, highlights the urgent need for African nations to shift towards proactive health strategies and sustainable, locally-led financing in response to declining external support and rising health challenges. …”
https://www.cidrap.umn.edu/mpox/african-leaders-take-stock-health-cuts-chart-path-forward
As flagged at an Africa CDC briefing from last week, “After hearing from African leaders and getting their buy-in, public health leaders agreed on a three-part plan to address the health cuts, which include enhanced domestic financing, innovative financing plans, and addressing financing gaps with other measures such as raising private-sector capital and local manufacturing of health-related products. Examples of innovative financing plans might include, for example, a levy on airline tickets, targeted taxes on high-consumption products such as mobile phones, or a minimal import levy on goods entering Africa. …..”
· PS: via Pandemic Action Network’s newsletter:
“Currently, only two countries are on track to meet the Abuja Declaration target of investing 15% of GDP in health (Rwanda and Botswana) and only 16 African countries have a national health financing plan in place. Jean Kaseya asked, “If you don’t have a plan, how can you advocate to get more funding?!””
“…. This crisis comes at the worst possible time. Health systems were already under immense strain from ageing populations, rising chronic disease rates, and COVID-19 aftereffects. Without predictable foreign aid, low- and middle-income countries (LMICs) must now take urgent action—strengthening domestic revenue, enhancing governance, and creating environments that attract investment and healthcare innovation…..”
(WHO’s) Clarke then offers a Practical Guide to Fast-Tracking Domestic Reforms.
“Bangladesh’s Anti Corruption Comission (ACC) has filed two cases against Saima Wazed, director of WHO’s South East Asia Regional Office (SEARO), for fraud, forgery and misuse of power in connection with her campaign to become the WHO’s top official in the South East Asia region. The charges against Wazed, who took office a Regional Director in January 2024 following her election by SEARO member states, are the culmination of an ACC investigation that began in January 2025, as reported by Health Policy Watch. …”
PS: “ Role of WHO Regional office leadership – under scrutiny: The role and position of WHO’s Regional Office leadership could become all the more important as the agency comes under under increased pressure to improve efficiency, transparency and overall performance in the wake of the announced United States withdrawal – the agency’s largest financial backer. Reinforcing the leadership and prowess of the agency’s six regional and 152 country offices was core to the “transformation” initiative launched by WHO Director Genera Tedros Adhanom Ghebreyesus in July 2017, just after he took office. Now facing a financial crisis, shifting more staff, as well as some core areas of expertise, to WHO regional centers and country offices could also serve as an inportant cost-saving measure since generous “post adjustments” based on location, are usually much lower for international staff in regions than in Geneva’s headquarters. At the same time, to fill any enhanced role and mission, WHO’s regional offices need leadership acting professionally and above any single set of vested interests…..”
· Related quote from Kent Buse who led a campaign to increase transparency in RD selection process. Among others in 2024, he wrote to the chair of the WHO EB and to the three regional committees with elections that year.
“ While I can’t comment on any corruption charges, what I can say is that two of the reforms our campaign advocated might have raised concerns about her candidacy if implemented. Among our recommendations were the introduction of a more rigorous vetting process—ideally conducted by an independent professional HR firm—to scrutinise candidates’ credentials and experience, and greater transparency in campaign financing. Even at the time, questions were being raised about the BD government’s health-related agreements with regional countries. We also called for integrity to be a guiding principle in the selection process, specifically referencing the Nolan Principles for standards in public life. Nepotism would clearly fall within that framework.” Prof Kent Buse, Monash University Malaysia
Rebecca F Grais on behalf of SAGE and RITAG; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00577-X/fulltext
“….. The normative function underpinning the global immunisation structure—comprising the Immunization, Vaccines and Biologicals department at WHO, the Strategic Advisory Group of Experts on Immunization (SAGE), the Regional Immunization Technical Advisory Groups (RITAGs), and the National Immunization Technical Advisory Groups—plays a vital role in ensuring that vaccine policies are informed by scientific data and contextual realities. Together they produce WHO Vaccine Position Papers that serve as global public goods, providing updated and harmonised guidance to support national immunisation programmes. These structures are essential to help countries to maintain the credibility and effectiveness of vaccination strategies. Amid rapid transformations in global health governance, it is imperative that these support mechanisms are not only preserved, but reinforced. ….”
They conclude: “ Although discussions on reform are necessary and should continue, they must not come at the cost of dismantling the frameworks that have enabled global health progress. We urge global health stakeholders to recognise and protect this crucial normative function of WHO, ensuring that technical guidance for immunisation, including policies and strategies, remains a cornerstone of its mandate. Without this guidance, the world risks losing one of the most effective tools for disease prevention, ultimately jeopardising decades of progress vaccines have contributed to global health.”
S van Teutem et al; https://ourworldindata.org/foreign-aid-domestic-overseas
“In many countries, a substantial share of aid is spent domestically on hosting refugees, offering student scholarships, and administrative costs.”
“… In 2023, 22% of total foreign aid for all Development Assistance Committee (DAC) countries was spent at home. The DAC countries are a group of 32 high-income countries; from this point onwards, we’ll refer to them as “rich donor countries”. In this article, we’ll look at how aid money spent at home varies across countries and categories, how this has changed over time, and what this means for the amount of money available for support overseas….”
https://thetricontinental.org/newsletterissue/women-gender-inequality-poverty/
“In the month of International Working Women’s Day, we explore how debt-austerity regimes and climate change impact women farmworkers across the Global South.”
Clearly, not just relevant for the UK. “New polling reveals people across Britain overwhelmingly would prefer the very richest to pay more in tax, rather than see cuts to public spending, as new analysis shows the UK’s wealthiest continue to amass even greater fortunes.”
PS: “… It comes as new analysis by Oxfam, Patriotic Millionaires UK and Tax Justice UK finds that the wealth of all UK billionaires soared by £11 billion last year – the same amount the UK Government has recently cut from the international aid and social security budgets combined.”
“The organisations are calling for a two per cent wealth tax on those with net assets of over £10 million, which could raise an estimated £24 billion tax revenue each year - £460 million every week and would only apply to 0.04 per cent of the population - around 20,000 people….”
Ali Mohamed (Kenya’s Special Envoy for Climate Change); https://www.climatechangenews.com/2025/03/24/its-time-for-shipping-to-launch-first-global-tax-on-a-polluting-sector/
“Decarbonising the seas is a strategic imperative for a sustainable trade system that can also generate climate finance for vulnerable countries.” ….. “Kenya is a frontline casualty of the climate crisis. Escalating temperatures, unpredictable rainfall, and prolonged droughts are slashing food production, depleting water resources, and destabilising our economy. Our coastal ecosystems, vital to the “blue economy”, are besieged by rising sea levels, coral bleaching, and accelerating erosion. …. A proposed carbon levy on the shipping industry offers a transformative opportunity, one Kenya urgently supports, to deliver climate finance where it’s most needed while decarbonizing a critical global sector…..”
PS: “The Global tax on shipping emissions faces choppy waters despite growing support: The shipping industry, a linchpin of global trade, stands poised to pioneer a new era of climate finance. At the UN International Maritime Organisation (IMO), governments are nearing agreement on a carbon levy on shipping emissions, with a decision slated for April 2025 at the Marine Environment Protection Committee (MEPC) 83 summit in London. If enacted, this would be the first universal tax on an international polluting sector, a precedent-setting move. The World Bank estimates this levy could raise $60 billion annually, channeling vital funds into climate adaptation and mitigation for vulnerable nations like Kenya.” “ Kenya endorses this initiative unequivocally. It aligns with our national commitment to cut emissions and advance sustainable development, and it amplifies our role as co-chair of the Global Solidarity Levies Task Force, which champions levies on under-taxed, high-emission sectors. ….”
Ellen Johnson Sirleaf & Helen Clark; https://foreignpolicy.com/2025/03/26/trump-who-covid-anniversary-pandemic-treaty-cdc-usaid-funding/
Important viewpoint. “ Trump’s WHO withdrawal and cuts to research and aid are making it harder to prepare for the next pandemic.”
First with a dire assessment of the current impact on PPPR due to Trump 2.0 & other recent aid trends, then offering a number of important recommendations for what they call most likely the ‘post-aid’ era – including on the need for transitional planning by donors, models such as taxation schemes & global public investment, as well as on the pandemic treatment negotiations & IHR amendments implementation.
https://afripoli.org/pandemic-preparedness-in-african-countries-status-quo-and-the-way-forward
“While the World Health Organization (WHO) provides a standardized blueprint, post-pandemic preparedness responses across African nations vary significantly. Countries prioritizing health system strengthening—such as South Africa, Nigeria, Ghana, and Senegal—appear relatively better prepared for pandemics. In contrast, nations with greater socio-economic and political challenges—including the Democratic Republic of Congo, Liberia, Guinea, Ethiopia, and Sierra Leone—focus on securitization while struggling with resource constraints and weak health policies. Notably, those most susceptible to pandemics often lack the necessary frameworks for effective response…..”
“African nations rely heavily on external partnerships for crisis response. While these collaborations facilitate resource mobilization and knowledge exchange, they often suffer from power imbalances, conflicting priorities, and neglect of local scientific evidence. In the light of the above, African stakeholders must foster a relational approach that emphasizes context-specific strategies, equitable partnerships, and increased health financing. Additionally, expedited reviews of global health partnership and strengthening African agency in global health governance are recommended to prevent extractive or unethical research practices targeting vulnerable African states and refugee populations…..”
“The first tool of its kind from the UK Health Security Agency (UKHSA) lists 24 types of viruses and bacteria where a lack of vaccines, tests and treatment, changes due to the climate crisis or growing drug resistance pose a biosecurity risk. ….. The pathogen families on the list cause many diseases not currently seen in the UK. However, climate change could change how and where they spread, said Dr Isabel Oliver, UKHSA’s chief scientific officer, while a large outbreak overseas could have “major impacts globally, including socioeconomic impacts”.”
“…. Oliver said UKHSA’s scientists had considered “not just the fact that some of these families have got high potential to cause pandemics or epidemics, but also where there are currently gaps in the availability of either diagnostics, vaccines and therapeutics, or where there are evolving and growing changes around antimicrobial resistance, or where there is a significant sensitivity to climate change, that might mean that this threat evolves or changes more rapidly”. “ ….She said one of UKHSA’s concerns, reflected in the tool, was “the change in the distribution of mosquitoes and ticks that can carry viruses that cause adverse health effects to humans” linked to climate and environmental change.”
“The document, which will be updated regularly, does not indicate which pathogens UKHSA considers most likely to cause the next pandemic, Oliver stressed, but those most in need of increased scientific investment and study.
· See also the Telegraph – UKHSA unveils Britain’s first priority pathogens list
“New database identifies 24 viral, bacterial and fungal diseases that leave Britain vulnerable to future outbreaks.”
Blagovesta Tacheva, Garrett Wallace Brown et al; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-025-01103-w
“This is the first published study examining whether, and to what degree, innovative financing could effectively support the financing needs of the global pandemic prevention, preparedness and response (PPPR) agenda…”
After zooming in on four different innovative health financing instruments – the IFFIm, the PEF, the Gavi Ebola APC, and the Gavi COVAX AMC, they conclude:
“Our findings reveal a set of innovative financing tools shrouded in unsubstantiated claims to success and effectiveness that look to have underwhelming promise of ‘value for money’ in global health. This stems from evidence suggesting design flaws, inadequate application, lack of transparency, private sector profiteering and associated opportunity costs. Thus, contrary to popular claims, they may not be the ‘silver bullet’ for bridging PPPR financing gaps and addressing costly, complex and multifaceted PPPR interventions.”
https://www.nature.com/articles/d44148-025-00090-9
“Teams in Uganda and South Africa worked through a single weekend to confirm the strain and trace the disease’s genetic origins.”
“Testing has confirmed that an initially unidentified illness that killed more than 50 people in northwest Democratic Republic of Congo was malaria, the country's National Public Health Institute (INSP) said late on Monday…..”
· Via Pandemic Action Network’s newsletter: “WHO and Africa CDC have finalised the second joint mpox continental response plan, calling for $429,595,970 to strengthen response efforts on the continent for the next six months…..”
· And via Cidrap News: Sierra Leone launches mpox vaccination amid rising cases
“In mpox outbreak developments, cases are still trending upward, with Uganda, Burundi, and the Democratic Republic of the Congo (DRC) reporting the most cases over the past week, Ngongo said. He added the Central Africa Republic (CAR) reported its first case, after going 6 weeks with no new cases.
In a positive development, the region saw the case-fatality rate drop a bit, from 1.8% to 1.5%, which he said is due to better care-seeking and improved quality of case management….”
“In a weekly health emergencies update, the World Health Organization (WHO) African regional office said Sierra Leone’s rapid rise in cases is concerning, due to the concentration of cases in Freetown, the country’s capital, with most cases among young adults, students, and business people. It said high mobility, social interactions, and closed environments such as schools are driving the spread of the virus, which has been identified as the global clade 2 strain.;..”
On the new Mpox plan for the coming 6 months: “He said the goal is to halve the mpox burden in endemic areas and strengthen the health systems in affected and at-risk countries. Part of the plan included enhanced contact tracing, with a goal of identifying at least 20 primary contacts for each patient and 200 secondary contacts. A vigorous vaccine push is also part of the strategy, with a goal of immunizing 6.4 million more people over the next 6 months, he said, adding that the region needs $224 million in new support for the next phase of the response.”
· Related: Lancet Profile - Yap Boum II: coordinating the mpox response in Africa
Recommended read.
“With just 5 years to go before the 2030 deadline for the Sustainable Development Goals, a new paper from WHO/Europe identifies 25 interventions that can help countries accelerate progress towards their health commitments. The paper [was] being published in the “Lancet Regional Health – Europe” on 24 March and launched at a virtual event…..”
“The “quick buys” are proven and cost-effective interventions that can deliver public health impact within 5 years. Developed by WHO/Europe noncommunicable disease (NCD) experts, the paper adds the dimension of time to the Organization’s established NCD “best buys”…..”
· For the paper, see the Lancet Regional Health : Quick buys for prevention and control of noncommunicable diseases (by Gauden Galea, M McKee, D Stuckler et al)
“Despite their established effectiveness, uptake of the WHO best buys for tackling non-communicable diseases (NCDs) has been uneven and disappointing. Here we introduce the “quick buys”, an evidence-based set of cost-effective interventions with measurable public health impacts within five years. ….”
“Just 25 public health measures can improve people’s health within a single political cycle.”
G Seidman et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00508-2/fulltext
“A considerable portion of the growth in clinical studies in Africa needs to come from research on non-communicable diseases (NCDs). In 2023, 80% of global clinical trials focused on NCDs, whereas less than half of trials in Africa did so. Nonetheless, Africa has the disease burden and research infrastructure to initiate more trials in NCDs…..”
They sketch some benefits of such trials.
And then argue, “… Governments and funders can take four concrete steps that will incentivise a pipeline of NCD studies for research funders to realise these benefits. ….”
“The World Health Organization (WHO) today launched new guidance to help all countries reform and strengthen mental health policies and systems. Mental health services worldwide remain underfunded, with major gaps in access and quality. In some countries, up to 90% of people with severe mental health conditions receive no care at all, while many existing services rely on outdated institutional models that fail to meet international human rights standards.”
“The guidance provides a clear framework to transform mental health services in line with the latest evidence and international human rights standards, ensuring quality care is accessible to all.”
“…. The guidance identifies five key policy areas requiring urgent reform: leadership and governance, service organization, workforce development, person-centred interventions, and addressing social and structural determinants of mental health.”….”
Simon Matthew Graham et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00074-9/fulltext
« An injury is any harm or damage to the body that disrupts its normal structure or function, whether accidental or intentional. Injuries can arise from various causes, including road traffic collisions, falls, drowning, burns, poisoning, and acts of violence—whether self-inflicted or directed at others. The Global Injury Group was established in August, 2024, with funding from the global health programme of the UK's National Institute for Health and Care Research and the Medical Research Council. This equitable partnership is a collaboration of researchers across high-income countries (HICs) and low-income and middle-income countries (LMICs) with the shared vision of improving care of the injured via research. ….”
« … The Global Injury Group hosted its inaugural research summit in Cape Town, South Africa, in January 2025, bringing together injury care experts from across sub-Saharan Africa. The summit featured representation from low-income (Malawi), lower-middle-income (Tanzania), and upper-middle-income (South Africa) countries, fostering a diverse and inclusive dialogue. During the summit, we identified key priority areas to guide our future research (panel)…..”
H Walls, M McKee & D Balabanova; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00520-3/fulltext
“The 2023 Lancet Series on the commercial determinants of health highlighted how commercial organisations shape health policies, both positively and negatively. Some negative actions, such as spreading misleading narratives and lobbying to delay legislation, are legal but ethically questionable. Others, such as bribery, tax evasion, and complicity in smuggling, are illegal. Many actions fall into a grey zone between these extremes. Yet governments give commercial organisations considerable power, enabling them to shape regulations and exploit intellectual property rules. We argue that when commercial organisations exploit these powers in ways that harm human and planetary health, they display “the abuse of entrusted power for private gain”, as defined by Transparency International; yet with a few exceptions, these actions are rarely labelled as corruption…..”
“…There is a strong case for calling out some corporate actions as corruption. …” (listing a number of examples).
They conclude: “….Moving beyond euphemisms such as unethical business practices and explicitly calling out corruption would allow society to play a more active part in safeguarding population and planetary health, addressing the structural conditions that enable corporate actors to behave as they do. Those in public health must advocate for greater scrutiny and accountability of corporate practices harming public health, broadening the definition of corruption to hold companies accountable, and collaborating with journalists and civil society to expose corporate malfeasance.”
“Last week, anti-choice campaigners emboldened by current US politics met in New York at the same time as UN delegates gathered to address the widespread inequalities women face. The battle to protect rights has never felt more urgent.”
T Mofokeng ( United Nations Special Rapporteur on the Right to Health) et al ; https://www.thinkglobalhealth.org/article/defending-global-right-choose
“Academics and UN bodies should strategize to counter the renewed threat to women's rights.”
With among others some suggestions for CSW (Commission on the Status of Women).
Quote: “….the CSW should evolve into a more binding body that moves beyond political rhetoric to actively hold countries accountable for their international commitments…..”
“A roundup of the discussions, declarations, and tidbits at the 69th session of the Commission on the Status of Women. “
Excerpts:
“.... There was some relief that the U.S. delegation did not torpedo the adoption of a political declaration reaffirming the Beijing Declaration and Plan of Action, the 30-year-old landmark blueprint for advancing women’s equality and rights. And on Friday, the delegates overcame reservations by Washington’s ally, Argentina, to adopt a program of priorities to advance the cause of women over the coming years. But Washington sent a strong signal that it plans to leverage its financial and diplomatic muscle to reverse a range of progressive U.N. policies, from access to sexual and reproductive health and rights to quotas tailored to achieve gender parity in U.N. institutions…..”
“…. While several delegations expressed frustration that the final declaration made no explicit mention of women's sexual reproductive health and rights, they appeared relieved that the U.S. had not blown up the entire process. … … “It’s been a weird CSW,” said Ishaan Shah, a U.K.-based advocate with the Young Feminist Caucus. “People are not really addressing the elephants in the room, obviously now the U.S., but also this growing move to authoritarianism, the right-wing underfunding, aid cuts, that sort of thing. “There is definitely this undertone of depleted funding, lack of resourcing, and growing anti-rights, anti-gender movement,” he added. “I think it’s been quite somber in that sense.”….”
“In almost every election in Europe in recent years, a discreet but increasingly powerful force has been at play to help bolster the far right. Much like the architects behind “Project 2025”, a set of ultra-conservative networks are waging a campaign to dismantle progressive European policies and replace them with traditionalist Christian values – leaving little room for feminists, LGBTQ+ activists and other marginalised groups.”
(Kigali) “The Africa Centres for Disease Control and Prevention (Africa CDC), Regional Economic Community (REC) representatives and other stakeholders convened for a consultative workshop to strengthen coordination between regional pooled procurement mechanisms (PPMs) and the African Pooled Procurement Mechanism (APPM), as well as to discuss the modalities for the establishment of a joint information sharing platform. Co-hosted by the East African Community (EAC) and the University of Rwanda/EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management (UR/EAC RCE-VIHSCM), the workshop aimed to align the efforts of Africa CDC and the RECs to create a holistic, coordinated, and synergistic approach to pooled procurement…..”
Adam R. Houston & Stan Houston; https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004359
The Houstons flagging a problem.
“….In October 2024, the global stockpile of oral cholera vaccine (OCV) ran dry yet again, leaving no unallocated doses for new or worsening outbreaks. This underscores the ongoing shortfall of tens of millions of doses, driven by growing need, with both cases and deaths increasing globally in recent years, and lack of supply, with only one manufacturer currently serving the global stockpile. Meanwhile, however, pharmaceutical companies are reaping profits from a booming parallel market for OCV for a much lower-risk population: travelers from high-income countries (HICs). The current situation, where a tourist from a HIC at essentially zero risk of dying from cholera has more ready access to vaccines than a resident of the endemic country they will visit, exemplifies the chasm between commercial priorities and global health needs…..”
https://www.gavi.org/vaccineswork/new-study-suggests-ebola-could-be-cured-pill
“A new antiviral pill has been shown to be effective at treating Ebola in monkeys, potentially transforming the way we can control a disease that kills up to 90% of those infected.”
“The drug, obeldesivir, is an oral pill that doesn’t require refrigeration, meaning it could be distributed quickly and easily. Currently the only approved treatments are monoclonal antibody infusions, which require hospital administration……” “…. Obeldesivir was originally approved to treat COVID-19 during the pandemic. In a study last week in Science Advances, researchers describe how they used the antiviral to treat macaques infected with Ebola virus….”
“But someone needs to pay for it—and aid budgets are being slashed.”
“Vaccines are an important new tool to stop children in poor countries falling sick and dying of malaria. Though not perfect, they are a useful and cost-effective supplement to existing interventions like bed nets and anti-mosquito sprays. A successful rollout in the countries worst affected by the disease, all of which are in Africa, could save up to 1m lives over the next five years. Yet that probably will not happen. The main reason, as rich countries slash their aid budgets, is that nobody wants to pay for it. …. … Manufacturers say they can make enough shots to vaccinate all eligible children in the worst-affected countries. GSK, a British pharmaceutical company, will be able to produce 15m doses a year of RTS,S from 2026. India’s Serum Institute, which makes R21, says it can churn out 100m doses a year, rising to 200m if needed.”
“But most of the current capacity remains unused, even though African governments have begun routine rollouts of the vaccines. Gavi, an alliance which funds vaccines in poor countries, plans to spend $1.1bn on malaria over the next five years, jabbing 50m children. That could avert 170,000 deaths, save families money on hospital bills and free up resources to fight other illnesses….” “ At that rate it would take another decade to vaccinate all children under three in the countries at greatest risk from malaria. The Centre for Global Development (CGD), an American think-tank, reckons the same goal could be achieved by 2027 at an extra cost of $3.5bn over five years, which is less than Americans spent on costumes at Halloween in one.”
“Gavi’s ambition is bound by the generosity of the governments and philanthropists which fund it. Donors were supposed to meet in Brussels in March to pledge contributions for the next five years, with a target of $9bn for all diseases. The summit has now been postponed until June. …. … Historically nearly a quarter of Gavi’s routine funding has come from Britain, which is slashing foreign aid to pay for an increase in defence spending, which has taken a chainsaw to it. Seth Berkley, who led Gavi until 2023, says that an American retreat would be “very hard” and a British one “devastating”. He hopes that Gavi’s strong reputation might protect it. Last time it asked for money, in 2020, it raised more than it expected. Canada recently pledged C$675m ($470m) for the current funding round….”
PS: “… One way for Gavi to save money in the short run, according to CGD, would be to prioritise R21, which is a third of the price of RTS,S. Sania Nishtar, Gavi’s chief executive, says that encouraging a diversity of manufacturers is important to encourage competition and ensure security of supply. In the long term, that is likely to hold true. Yet in the short term it will mean buying fewer doses of the vaccine….. Without Gavi’s support, more children will die.”
Sharon Friel; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00494-5/fulltext
“A recent Lancet Editorial asserts that philanthropy in health is here to stay. Are these private actors altering the evolution of global and national institutions in ways that undermine planetary health equity—the equitable enjoyment of good health in a stable system? As UN agencies and governments rush to ameliorate harms from the withdrawal of the US Government from WHO, the UN Framework Convention on Climate Change (UNFCCC), and the Paris Agreement, powerful private actors are embedding themselves further into global climate and health governance….”
Friel is no fan. Neither am I.
“Handbook outlines practical ways faith organisations can ‘speak truth to power’ to help protect planet.”
“Christians around the world are being encouraged to take legal action against polluters and those who finance them. In a new climate justice handbook, the World Council of Churches sets out practical ways faith organisations can help protect young people and future generations from the climate crisis. Drawing on Christian teachings on stewardship and justice, it presents strategic litigation as a tool to “create hope and hold responsible parties accountable”…..”
“Tackling climate crisis will increase economic growth, OECD research finds. Third of global GDP could be lost this century if climate crisis runs unchecked, says report.”
“Taking strong action to tackle the climate crisis will increase countries’ economic growth, rather than damage their finances as critics of net zero policies have claimed, research from the world’s economic watchdog has found. Setting ambitious targets on cutting greenhouse gas emissions, and setting out the policies to achieve them, would result in a net gain to global GDP by the end of the next decade, according to the Organisation for Economic Co-operation and Development (OECD), in a joint report with the UN Development Programme. The calculation of the net gain, of 0.23% by 2040, would be even greater in 2050, if it included the benefit of avoiding the devastation that not cutting emissions would wreak on the economy….
“By 2050, the most advanced economies would enjoy an increase of 60% in GDP per capita growth, while by the same date lower income countries would experience a 124% rise from 2025 levels. In the shorter term, there would also be benefits for developing countries, with 175million people lifted out of poverty by the end of the decade, if governments invest in cutting emissions now. By contrast, a third of global GDP could be lost this century, if the climate crisis were allowed to run unchecked…..”
Harini Arumugasamy et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00459-3/fulltext
« …. We were intrigued by the recent Editorial emphasising philanthropy for health. Philanthropists contribute to substantial funding, and often dictate policies, research directions, and interventions based on their own priorities rather than the needs articulated by local communities and governments…. …. Global health funding and policy decisions should prioritise leadership from affected regions. Initiatives such as the Centers for Disease Control and Prevention and the south Asian-led vaccine manufacturing initiatives are steps in this direction. WHO should be strengthened to lead independent, locally informed strategies rather than relying on a few billionaires or governments from high-income countries for funding….”
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00116-0/fulltext
Among others with a call for papers. (by July 31)
“…. The shrinking of development assistance from high-income countries presents an opportunity for the rise of participatory implementation science based in and led by low-income and middle-income countries (LMICs), dismantling the dominance of high-income countries in funding and research agenda-setting. …. …. In light of these considerations, we invite contributions on how implementation science could be refocused to improve equity and move towards decolonisation of global health. ….”
Mark G Shrime; https://gh.bmj.com/content/10/3/e019159
Editorial by the new Editor-in-chief. On what the focus of BMJ GH will be now - 9 years into its existence.
“ BMJ Global Health must remain committed to the quest for equity on which it was founded. And we must expand our understanding of where these problems exist and how they manifest….” Do read what this entails.
Michael J A Reid et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00049-X/fulltext
“The Lancet Global Health Commission on AI and HIV is being launched to provide strategic recommendations on responsible AI adoption. The Commission will use epidemiological and economic modelling to predict AI's potential impact across diverse, high HIV-burden settings, inform digital infrastructure development, and ensure AI models are trained on locally relevant data….”
“… While acknowledging AI's transformative potential, its limitations and barriers to scale-up in high HIV-burden, low-income and middle-income countries (LMICs) must also be recognized….”
https://www.thelancet.com/series/clinical-trials
“The landscape of clinical trials has undergone significant changes, as highlighted in the current Series of six papers published in The Lancet Global Health. The WHO guidance provides a comprehensive framework to enhance clinical trial infrastructure, focusing on patient and community engagement, especially for under-represented populations. Key barriers identified include poor trial design, lack of inclusivity, inadequate infrastructure in low and middle-income countries, and inefficient approval processes. The guidance advocates for risk-proportionate approaches and aims to support local policymakers. The Series aims to strengthen the clinical trial ecosystem, emphasizing ethical research, stakeholder collaboration, and quality improvement through strategic investments. This initiative seeks to promote equity, efficiency, inclusion, and engagement in clinical trials, ultimately improving global health outcomes.”
Ingrid Robeyns; https://www.tandfonline.com/doi/full/10.1080/19452829.2025.2479028
“In this article, I develop and defend the claim that we, humanity, will not be able to get significantly closer to a world in which there is ecologically sustainable human development if we do not tackle economic inequalities head-on. This implies that we should focus not only on poverty but also on the entire distribution of income and wealth, including extreme wealth concentration. For national and international policymaking, this means that reducing economic inequality must be one of the central priorities rather than assuming that it is indirectly covered by other social goals such as poverty reduction or formal equality of opportunities, or assuming that it is a problem that will solve itself over time under globalised neoliberal capitalism.”
https://sdg.iisd.org/news/un-report-calls-for-making-development-cooperation-fit-for-purpose/
“To make international development cooperation “fit for purpose in today’s context,” the report calls for rationalizing national-level architectures by supporting developing country efforts to strengthen country-owned and country-led coordination platforms, bringing together all partners, and by enhancing the use of country systems and results frameworks. It also recommends supporting regional platforms and approaches by strengthening regional knowledge sharing and cooperation and improving coordination of regional development banks with other actors.”
“The UN Secretariat has issued the UN Secretary-General’s analysis of key trends and challenges in international development cooperation. It highlights the need to strengthen country ownership and leadership, reduce fragmentation, address resource allocation, strengthen alignment with country needs and priorities, and enhance effectiveness, among other actions.”
PS: “…Dated 3 January 2025, the report informed the discussions at the UN Development Cooperation Forum, which convened from 12-13 March, and will feed into the Fourth International Conference on Financing for Development (FfD4), taking place from 30 June to 3 July 2025 in Seville, Spain…..”
“Since reclaiming power in 2021, the Taliban have systematically denied Afghan girls and women their rights to education, employment, and freedom of movement. Now, as internal divisions shake the regime, there is a real chance that the ban on girls’ education may finally be lifted.” Let’s hope so.
“…. With the Taliban in disarray, the international community – especially Muslim-majority countries – must capitalize on internal divisions to pressure the regime to reverse the ban on girls’ education. …. The apparent split within the Taliban comes at an opportune time. United Nations human rights officials are considering classifying gender apartheid, defined as “inhumane acts committed within the context of an institutionalized regime of systematic discrimination, oppression, and domination by one group over another or others, based on gender, and committed with the intention of maintaining that regime,” as a crime against humanity. Such a move would represent a milestone in the fight against the systemic oppression of women in Afghanistan and beyond…..”
“Arab Group formally nominates Palestinian diplomat, setting stage for clash with U.S. and Israel.”
PS: “ The prospect of a Palestinian campaign has fueled anxiety across the wider U.N. system, which is facing unprecedented U.S. budget cuts that have already forced the elimination of thousands of jobs. There are also U.S. laws on the books that would trigger a withdrawal of U.S. funding to U.N. agencies in the event it recognizes Palestine as a full-fledged member state…..”
https://rsc-src.ca/en/protecting-our-collective-future-renewing-canadas-role-in-global-health
“…. An Expert Panel was jointly convened by the Royal Society of Canada (RSC) and the Canadian Academy of Health Sciences (CAHS) to provide strategic insights and advice on Canada’s role in global health over the next two decades…..”
“…. the Panel identified seven key findings. The first four findings set out “what” issue areas require priority attention and where Canada’s leadership could make a substantial contribution. Importantly, each issue area embodies domestic-global interconnectedness by recognizing that health in Canada cannot be provided, protected or promoted without engaging in global cooperation. The remaining three findings concern “how” Canada can effectively take forward these priority issue areas through clear strategy, targeted investments in research and innovation systems, and capacity building to support Canadian leadership.”
· Related: the Conversation - Why it’s a critical time for Canada to renew its commitment to global health co-operation (by Kelley Lee & Tim Evans)
https://www.reuters.com/world/us-suspends-financial-contributions-wto-trade-sources-say-2025-03-27/
“The United States has paused contributions to the World Trade Organization, three trade sources told Reuters, as U.S. President Donald Trump's administration ramps up efforts to cut government spending. The Trump administration is retreating from global institutions it sees as at odds with his "America First" economic policies…..”
The US is the top contributor to WTO: “The Geneva-based trade watchdog had an annual budget of 205 million Swiss francs ($232.06 million) in 2024. The United States was due to contribute about 11% of that based on a fees system that is proportionate to its share of global trade, according to public WTO documents.”
Nelson A Evaborhene et al https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00324-1/fulltext
“…. The intersection of global health diplomacy and geopolitics presents a unique challenge, requiring us to balance national security priorities with pressing transnational health issues. As we navigate this complex landscape, the need for genuine, collaborative global health solutions has never been more crucial. We must prioritise public health, even as geopolitical forces attempt to reshape our collective efforts….”
Yiwen Zhang et al; https://gh.bmj.com/content/10/3/e017321
“…. We collected reports from 12 globally representative think tanks, covering the period from 15 June 2007 to 31 December 2022… …. Globally, think tank discussions on health governance norms centre on four primary areas: the global economy and trade, responses to infectious diseases and public health crises, cooperation and aid in global health governance, and the social impacts of health norms. Regionally and temporally, think tanks in the USA, East Asia, Europe and parts of the Global South prioritise health governance norms differently, with these priorities evolving over time in response to varying levels of development and the specific Public Health Emergencies of International Concern (PHEIC) encountered. Moreover, think tanks underscore the pivotal role of the World Health Organization (WHO) and the United Nations (UN) in shaping global health governance, as these international organisations are central to managing health emergencies, setting global standards and coordinating international cooperation.”
“Europe is restructuring its development aid, shifting from traditional grants to investment-driven funding while cutting budgets and prioritizing defense, raising concerns about the future of global development.”
“While the majority of attention is directed at the United States dismantling of its foreign aid apparatus, Europe is going through its own overhaul — one that started long before President Donald Trump took office. Recent rhetoric from the Trump administration telling Europe to defend itself has pushed the continent into budgetary action, but the continent has been rethinking its development strategy for years. In addition to cuts across the board, European development funding is shifting from ODA grant-based programs to investment-focused projects that explicitly benefit European countries and European banks.”
““[Overseas Development Assistance] is the form our international cooperation took in the 1960s and 50s,” said Rémy Rioux, the CEO of the French Development Agency, or AFD. “What will happen now is just consistent with what the world has become, and we need a new architecture. We need to turn from assistance to investment, sustainable, inclusive investment.”
By Sanjeev Gupta and Charley Ward; https://www.cgdev.org/blog/what-would-revive-demand-imfs-resilience-and-sustainability-facility
“…It has been almost two and half years since the IMF launched the Resilience and Sustainability Facility (RSF) to help low-income and vulnerable middle-income countries address long-term structural challenges related to climate change and pandemic preparedness. While the RSF saw a strong initial uptake, demand peaked in 2023 and has since tapered off (Figure 1). Between October 2022 and May 2024, the IMF approved 18 RSF arrangements. However, only four additional arrangements have been approved since then (the IMF Board also recently supported Egypt’s request for an RSF arrangement). This trend contradicts the IMF’s Interim Review of the RSF, which stated that demand for the RSF remains “high.” As a result, a significant portion of the resources pledged to the RSF will remain unutilized, even as financial needs continue to grow in many low- and middle-income countries (LMICs). This blog post argues that the IMF needs to implement reforms to the RSF’s architecture to enhance its attractiveness to potential users….”
PS: “… Substantial resources pledged by wealthy countries to the Resilience and Sustainability Trust (RST), which finances the RSF, remain largely unused. To date, these countries have committed to recycling SDR 34.8 billion ($45.56 billion) to the RST, of which the IMF has committed SDR 8.47 billion ($11.09 billion) to borrowing countries (Figure 2). Actual disbursements by the IMF are even lower than these commitments. While last year’s Interim Review called for “$10 billion of…near-term fundraising,” the RST’s current resources are more than sufficient to meet its current financing needs…..”
“… Two key features of RSF eligibility and program design are inhibiting its uptake by countries. First, access to an RSF program requires that a country concurrently maintain an upper credit tranche (UCT) IMF program. Second, the RSF imposes relatively low access limits on its funds…..”
C Kenny; https://www.cgdev.org/blog/how-development-finance-institutions-can-help-time-aid-austerity
“…. private sector investment vehicles funded by official development assistance (ODA) have been rapidly expanding over the past decade. But while these development finance institutions (DFIs) have grown, they are no replacement for grant aid. That’s especially true in the poorest countries, where they have largely failed to deliver: despite a considerable increase in the subsidy rate on its lower-income investments (subsidies that suck up ODA), the World Bank Group’s DFI, IFC, only invests about eight percent of its financing in low-income countries, a share that is shrinking. European DFIs are investing ever less in low-income countries as well—down to 12 percent by 2023. In particular, the role of international private finance in infrastructure, health, and education in low-income countries remains (extremely, increasingly) marginal.”
“… In short, development finance institutions control a large amount of ODA as capital, which is of limited use to the poorest countries where aid cuts most threaten development prospects. Nonetheless, they could play a very valuable role in shoring up ODA flows to the poorest countries if they stopped absorbing ODA and instead focused on what they are good at: large-scale, profitable investments in richer developing countries. Those profits could then be used to shore up ODA to the poorest countries, with the added benefit that some of the investments DFIs make might also count toward climate finance targets without absorbing (yet) more ODA….”
P4H; .
(as flagged in a previous newsletter): “The World Bank report Budget Execution in Health: From Bottlenecks to Solutions explores challenges in health budget execution and offers practical solutions for policymakers. It examines financial management trends, policy responses, and a structured approach to improving budget implementation. Drawing on case studies and data analysis, the report provides insights for Ministries of Finance, Health, and local governments to enhance efficiency and ensure resources effectively support health services. The findings aim to foster collaboration among key stakeholders, promoting a more adaptive and results-driven approach to health financing.”
· Related comment via LinkedIn (by Dr. Sara Al Dallal): “ Health budgets are designed to deliver essential care, yet in many low- and middle-income countries, execution challenges leave funds unspent. A new WHO-World Bank report highlights that, on average, 13% of health budgets in LICs remain unused—equivalent to an annual loss of $4 per capita. The problem? Budget execution bottlenecks, from unpredictable fund flows to procurement delays. The solution? Strengthening public financial management, improving fund allocation, and enhancing accountability…..”
“Knowledge sharing to improve policy dialogue and technical capacity.”
“The Health Systems Flagship Program integrates a comprehensive suite of features designed to enhance countries’ capacity to strengthen health systems. More than just a training course on essential health system topics, the Flagship Program is conceived as a convening space for key stakeholders in the health arena to come together and find collective responses to their most pressing health system performance challenges. The program aims to enhance the impact of ongoing or upcoming strategies or reforms, in the long term, and at a system level. Both at a country and regional levels, the program is intended to generate a sense of collective ambition and shared approaches towards achieving the UHC 1.5 billion agreed target…..”
Jessamy Bagenal; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00566-5/fulltext
“On March 13, 2025, the UK Government announced that it was disbanding NHS England, the arm's length government body overseeing health-care delivery in England……”
Irene Papanicolas et al; JAMA;
Via Stat: “In most high-income countries around the world, the number of avoidable deaths (avoidable thanks to preventative measures or treatments) has been decreasing over the past decade. But in the U.S., that number is increasing, according to a study published yesterday in JAMA Internal Medicine. ….” Research on the period between 2009 and 2021.
“One year after the first infections were reported, it's still unclear how H5N1 virus jumped into U.S. cattle—and why it keeps doing so.”
Olushayo Oluseun Olu (WHO) et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00019-1/fulltext
Comment related to a new study in the Lancet Global Health – Evaluation of a decentralised model of care on case isolation and patient outcomes during the 2018–20 Ebola outbreak in the Democratic Republic of the Congo: a retrospective observational study (by P M Barks et al)
N Denticco; Geneva Health Files
Making the link with ‘One Health’ in the pandemic treatment negotiations. “…. global health scholar, and a strident critic of the system, Nicoletta Dentico skillfully lays out the regulation of Glyphosate (a contested herbicide) in the European Union, contrasting it with the bloc’s position on health and environment matters in Geneva, notably in the context of the Pandemic Agreement negotiations.”
“The number of conflicts disrupting or halting the mining of critical minerals, like copper and lithium, is putting the energy transition required to combat climate change at risk, researchers warn in a new study.”
“The new research from the Institute of Development Studies (IDS) shows that there were over 36,000 mineral mining-related conflict events across 4,293 locations worldwide between 2015 and 2022— up to seven times higher than previously recorded. The conflict events, between the local populations and the mining companies and government ranging from verbal disputes to outbreaks of violence, pose a huge risk to clean energy transition worldwide…..”
“Cooling demand as a result of record temperatures was a significant driver of power generation last year, according to the International Energy Agency.”
· Related: Economic growth is increasingly decoupling from energy emissions, IEA says
“Global heating over this millennium could exceed previous estimates due to carbon cycle feedback loops. This is the conclusion of a new study by the Potsdam Institute for Climate Impact Research (PIK). The analysis shows that achieving the Paris Agreement’s aim of limiting global warming to well below 2°C is only feasible under very low emission scenarios, and if climate sensitivity is lower than current best estimates. The paper is the first to make long-term projections over the next 1,000 years while accounting for currently established carbon cycle feedbacks, including methane.”
“Our study demonstrates that even in emission scenarios typically considered ‘safe’, where global warming is generally considered to remain below 2°C, climate and carbon cycle feedbacks, like the thawing of permafrost, could lead to temperature increases substantially above this threshold,” says PIK scientist Christine Kaufhold, lead author of the paper published in Environmental Research Letters. “We found that peak warming could be much higher than previously expected under low-to-moderate emission scenarios.” “… Most studies are too short-term to capture peak warming, as they end by 2100 or 2300. The team used PIK’s newly developed Earth system model CLIMBER-X to simulate future climate scenarios over the next millennium under three low-to-moderate emissions trajectories – pathways that align with recent decarbonisation trends.”
· Coverage via New Scientist - Even moderate CO2 emissions could lead to 7°C of warming by 2200
“There's a small chance of very high warming even with moderate future emissions, according to a computer model exploring what could happen in the next thousand years.”
M Fritz et al; https://www.sciencedirect.com/science/article/pii/S0016328725000552
“The concept of ‘sustainable welfare’ conceptualizes welfare and wellbeing within planetary limits…..”
“Caring about the future is linked to supporting social-ecological transformation; Caring about the future corresponds with active political engagement; Unconcern for the future is related to rejection of sustainable welfare; Future orientations are weakly correlated with social positions, but linked to political orientations.”
Methodologically, applying Bourdieu’s relational approach in Sweden.
K J Cloete et al ; https://www.nature.com/articles/s41591-025-03594-x
“Conflict zones are plagued by air pollution from warfare-related activities, which exacerbates public health challenges, especially for vulnerable populations and the environments they live in.”
https://www.kcl.ac.uk/news/people-from-disadvantaged-backgrounds-have-covid-19-symptoms-for-longer
“People from disadvantaged backgrounds are more likely to experience COVID-19 symptoms for longer, new research suggests.”
“... The findings were published today in BMJ Public Health. … …. The inequalities in recovery were not explained by pre-existing health conditions but instead linked to broader social disadvantages. Financial and employment instability during the pandemic further contributed to poorer outcomes, suggesting that the impact of COVID-19 extended beyond physical health to economic and social wellbeing.”
“A Phase 3 trial for the tuberculosis vaccine known as M72/AS01E is running a year ahead of schedule and has already recruited 90% of the 20,000 people it needs, according to Dr Alemnew Dagnew, who leads its clinical development. The vaccine aims to prevent adolescents and adults already infected with latent TB from developing pulmonary TB. In countries with high TB burden, vast numbers of people have latent TB, which means that they are infected with the TB bacteria but not symptomatic or infectious. People with latent TB do not generally develop TB disease unless their immune systems are compromised.”
“The trial scientists initially thought it would take two years to recruit all the study participants at the 54 trial sites spread across South Africa, Kenya, Zambia, Malawi and Indonesia. “We started the trial last year in March, and we have already enrolled more than 90% of the participants, which is huge progress, and we are hoping to have full enrollment in the coming weeks,” Alemnew told Health Policy Watch this week. “It’s one year ahead of our projection.””
“Alemnew works for the Gates Medical Research Institute (Gates MRI), which is funding the trial alongside a contribution from Wellcome Trust…..”
by D Weiss et al. With the latest global high-resolution maps of malaria prevalence, incidence, and mortality.
“From 1990 to 2019, global death rates from influenza declined significantly overall but rose in older adults and those living in certain regions, Zhejiang University researchers in China reported this week in Epidemiology & Infection…..”
“Less than 2% of human genomes analysed so far have been those of Africans. Yemaachi Biotech’s Africa Cancer Atlas aims to fill the research gap.”
https://hsph.harvard.edu/news/healthy-eating-in-midlife-linked-to-overall-healthy-aging/
“Maintaining a healthy diet rich in plant-based foods, with low to moderate intake of healthy animal-based foods and lower intake of ultra-processed foods, was linked to a higher likelihood of healthy aging—defined as reaching age 70 free of major chronic diseases and with cognitive, physical, and mental health maintained, according to a new study by researchers at Harvard T.H. Chan School of Public Health, University of Copenhagen, and University of Montreal. The study is among the first to examine multiple dietary patterns in midlife in relation to overall healthy aging.”
“Studies have previously investigated dietary patterns in the context of specific diseases or how long people live. Ours takes a multifaceted view, asking, how does diet impact people’s ability to live independently and enjoy a good quality of life as they age?” said co-corresponding author Frank Hu, Fredrick J. Stare Professor of Nutrition and Epidemiology and chair of the Department of Nutrition at Harvard Chan School.
The study was published on March 24 in Nature Medicine.
· See Nature Medicine - Optimal dietary patterns for healthy aging
· Link: JAMA Forum - Can a New Commission Make America Healthy Again? (by L Gostin et al)
“ On February 13, 2025, President Donald Trump issued an executive order establishing the Make America Healthy Again (MAHA) commission, a government-wide initiative focused on decreasing chronic diseases. The MAHA commission is chaired by Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr and is directed to produce a Make Our Children Healthy Again assessment within 100 days, followed by a strategy within 180 days…..”
“Author Anna Fielder discusses her book “Going Into Labour” and explores how capitalism shapes the experience and practice of childbirth.”
Meike J. Schleiff , S Dalglish et al; https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004377
“Global public health champions breastfeeding and sets global norms recommending that women breastfeed exclusively on demand for six months and continue up to two years and beyond [1]. Yet in our experience, it is difficult to meet these norms while working as global health professionals, let alone pursuing career advancement and leadership roles for which women are already in the minority. This situation must change: solutions are available. Without them women are professionally disadvantaged and excluded from making their highest potential impact….”
“Despite substantial privilege, we have struggled to breastfeed while working in diverse global health settings including international organisations, academia and civil society organizations around the world. While we come from different geographic regions – Africa, south Asia, Europe, and North and South America – each with varying cultures and laws, we have all faced challenges including unsanitary conditions, lack of infrastructure, insensitive managers and colleagues, and unyielding workloads that did not accommodate the hours of daily labor required to breastfeed, chestfeed or express milk. We believe these experiences are shared by many; constructive and frank conversation and remedial actions at organisational and systemic levels are needed.”
“… We outline a list of barriers and burdens we have collectively faced while breastfeeding as well as actionable recommendations for diverse global health organisations that would alleviate these issues…”
“A review and meta-analysis of five randomized controlled trials (RCTs) indicates that mass biannual azithromycin distribution significantly reduces mortality in children ages 1 to 5 years in high-mortality settings, researchers reported yesterday in the Journal of Antimicrobial Chemotherapy. The five RCTs were conducted in five countries in sub-Saharan Africa (Burkina Faso, Ethiopia, Malawi, Niger, and Tanzania)…..”
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0003890
By Laura van der Krogt et al.
V A Goodyear et al; https://www.bmj.com/content/388/bmj-2024-082569
“Supporting the healthy development of children requires an approach to smartphone and social media use underpinned by age appropriate design and education, argue Victoria Goodyear and colleagues.”
Also making the link with a Rights based approach to smartphone and social media use.
“The Court held that the public good outweighs the profits of a company, considering that the drug is not available at an affordable price in India.”
“The Delhi High Court on Monday dismissed an interim injunction application filed by Swiss pharmaceutical giant F Hoffmann-La Roche AG against Indian drugmaker Natco Pharma Limited alleging that the latter company was unauthorisedly manufacturing its drug Risdiplam, an oral medicine for Spinal Muscular Atrophy (SMA). …. In what could be a significant ruling, the Court has held that the public good outweighs the profits of a company, considering that the drug is not available at an affordable price in India. …..”
· See also TWN – IP: Delhi High Court clears path for generic risdiplam availability in India
“The Delhi High Court’s judgment decision of 24 March 2025 paves the way for the introduction of generic risdiplam, offering a potentially more affordable treatment for a rare disease called Spinal Muscular Atrophy (SMA)…..”
By Hector Castro and Javier Guzman https://www.cgdev.org/blog/can-managed-entry-agreements-help-lmics-navigate-rising-cost-medicines
“The skyrocketing cost of high-cost, innovative medicines is straining healthcare budgets worldwide. In 2021, global pharmaceutical spending hit $1.4 trillion, with oncology drugs alone accounting for over $185 billion—a staggering 70 percent increase since 2016. For low- and middle-income countries (LMICs), where health budgets are already stretched thin and essential health services remain out of reach for many, these escalating costs pose an even greater challenge. To address this, high-income countries have increasingly turned to managed entry agreements (MEAs)—deals between pharmaceutical companies and healthcare payers designed to provide access to high-cost medicines while managing financial risks and clinical uncertainties. Now, countries such as Thailand, Costa Rica, Colombia, Peru, and Brazil have passed regulations or expressed interest in using MEAs for expensive medicines…..”
“But are MEAs a realistic solution for LMICs? Can they offer financial sustainability while ensuring equitable access to life-saving treatments? This blog explores the potential of MEAs, their feasibility in LMICs, and what lessons can be drawn from high-income countries where these agreements have already been tested…..”
In somewhat related news: Reuters: Novo licenses Chinese biotech's obesity drug candidate for up to $2 billion
“Danish drugmaker Novo Nordis has secured the global rights to develop, manufacture and sell China-based United Laboratories International's weight-loss drug candidate in a deal worth up to $2 billion. …. “ “As part of the agreement with a United Lab unit announced on Monday, Novo will make an upfront payment of $200 million and up to $1.8 billion upon the completion of certain development and sales milestones for the drug candidate, UBT251.”
“Big Pharma keeps pushing for weaker pollution standards despite proven risks to human and environmental health”
https://www.bmj.com/content/388/bmj.r605
“Since Brexit the UK government has flouted its own guidelines and initiatives by plugging NHS staffing gaps with staff from outside the EU. Sally Howard reports.”
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004327
By Priya Das et al.
https://www.tandfonline.com/doi/full/10.1080/17441692.2025.2480646
By Hansjörg Dilger et al.
https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-025-00659-z
By Karl Blanchet & Daniela Fuhr.
AJ Tatem et al ; https://theconversation.com/global-population-data-is-in-crisis-heres-why-that-matters-251751
“… For centuries, census and household surveys have been the backbone of population knowledge. But we’ve just returned from the UN’s statistical commission meetings in New York, where experts reported that something alarming is happening to population data systems globally. Census response rates are declining in many countries, resulting in large margins of error…..”
https://www.bmj.com/content/388/bmj.r589
“A growing tendency in official data to ask a person for their gender identity rather than their sex is having serious consequences in some areas of healthcare such as missed cancer screenings and mistakes in blood testing.”
“An independent, government commissioned report into the collection of accurate data and statistics on biological sex concluded that public bodies should collect distinct data on both sex and gender identity to ensure that nationally held data are accurate and clear. The report, published by the Department for Science, Innovation, and Technology, sets out a timeline of how survey data have been collected since the 1960s….”
“The Africa Centres for Disease Control and Prevention (Africa CDC) has launched the Africa Public Health Podcast, a powerful platform designed to elevate African voices in public health, tackle misinformation, and drive resilience to the continent’s evolving health challenges…..”
https://www.thelancet.com/journals/langlo/issue/current
The editorial & some other articles were already flagged above. But do check out the full issue.
Eg: Emerging resistance to dolutegravir: implications for the treatment and prevention programme in South Africa (Comment linked to a new study in the Lancet GH).
Michelle Amri , Jesse Bump et al ; https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004384
“This study investigates the operationalization of health equity and associated challenges faced by directors of policy and planning and those in related positions in the African Region. The results of this study demonstrate that health equity is generally a priority for policymakers in practice and is operationalized in four ways: (i) targeting priority groups, (ii) focusing on the entire population; (iii) through procedural justice; and (iv) operationalizing population health data….”
“… Four main domains of challenges for incorporating health equity emerged relating to: (i) understanding health equity, (ii) governance, (iii) resources, and (iv) lack of data. ….”
Anna M Anderson et al ; Nature Medicine;
“Despite bringing great strengths and facing substantial health inequities, disabled people remain underserved by health research; addressing this requires multi-level actions spanning all areas of research.”
https://katribertram.wordpress.com/2025/03/22/should-we-abolish-the-nobel-peace-prize/
“Reflections on megalomanic egos and absurd bucket lists.”
PS: “In global health, the sector I work in, the Nobel Peace Prize also plays a role. Médecins Sans Frontières (Doctors Without Borders) was awarded the prize in 1999. I’ve along the years heard many (also inner-circle insider) anecdotes that the prize is an obsession (and I’m explicitly using the word obsession, because that’s always the storyline I’ve heard) for some people, especially some philanthropists….. Reading the above interviews of Bolton and Budde, I was again reminded of the anecdotes I had heard in global health. We have many global health prizes these days, and there have apparently been bitter battles to secure these – not to mention year-long efforts to get the big one: the Nobel Peace Prize. Nearly always (but not exclusively), the people craving these awards are white, male leaders.”
Bertram concludes: “… I hope the Nobel Peace Prize Committee (members of which are appointed by the Norwegian Parliament) keep these awards to people with integrity – and at least some degree of humility. I don’t think the prize should be abolished, but I do think we should question whether anyone who has this prize on their bucket list (and as an obsession) is fit to lead – in any sector.”
“Aid to Africa? From 1980-2018, sub-Saharan Africa lost a staggering $1.3 trillion to illicit financial flow- annually $88.6 billion =3.7% of Africa GDP. Why not stop this. Instead it finances agriculture, health, education, research, social care and jobs.”
“Within 8 yrs how things have changed; In 2017 central govt announced-Modi govt cuts ties with Bill and Melinda Gates Foundation on immunisation https://business-standard.com/article/economy-policy/modi-govt-cuts-ties-with-bill-and-melinda-gates-foundation-on-immunisation-117020800294_1.html… And now the man is being welcomed into Parliament.”
“I completely understand the importance of talking about recent and ongoing cuts to global health 'initiatives' and related aid funding. However, we have to see this in the broader context of how countries make sure their citizens have access to even the most basic health services: According to latest data, approximately 4.5 billion people do not have access to essential health services. 4.5 billion! While restoring international funding for global health priorities, such as the 'Big 3' infectious diseases (i.e. HIV, TB and malaria) is essential, we must urgently identify sustained ways for all countries to ensure access to the most basic of health services for over half the world's population. We can't keep talking about 'global health' as though it is somehow different to the fundamental health of the world's population.”
“I am deeply disturbed by news reports that the U.S. Administration is considering withdrawing its support for Gavi. If true, and if Congress allows this to happen, the impacts will be devastating, including possibility of hundreds of thousands, if not millions, of preventable.”
“The speed at which American universities & companies are giving up on DEI is a dead giveaway that they were never serious to begin with.”