Protestors gathered outside USAID headquarters in Washington DC.

Governments have been advised to impose ‘sin taxes’ on tobacco, alcohol and other unhealthy products to offset the severity of cuts to official development assistance (ODA), World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus told a tuberculosis meeting on Thursday.

This comes as US President Donald Trump formally requested his country’s Congress to cancel previously approved budget allocations amounting to $9.4 billion on Tuesday. 

Should Congress agree, this would officially endorse the cuts already made to the US Agency for International Development (USAID) and US President’s Emergency Plan for AIDS Relief grants by Elon Musk’s Department of Government Efficiency (DOGE). It would also cement cuts to UN agencies including the WHO, UN Children’s Fund (UNICEF), UN Development Program (UNDP), and the UN Population Fund (UNFPA),.

“In the past few months, I have spoken to many ministers, and the impact on their  programmes of the sudden cuts in official development assistance is severe,” Tedros told a WHO Town Hall meeting on tuberculosis.

“We are seeing treatment interruptions, clinics closed, health workers losing their jobs, disruptions and more – not just for TB, but for malaria, HIV, neglected tropical diseases, vaccinations, maternal and child health, sexually transmitted infections, family planning and so on.”

The WHO’s advice to countries trying to raise domestic resources to offset the cuts is to start immediately with the “sin taxes” while, in the longer-term, implementing social health insurance and community-based health insurance, Tedros added.

‘Reject rescission package’

Meanwhile, the Global Health Council urged US Congress to reject the rescission package, describing it as “a systematic effort to diminish the longstanding role of the United States as a global health leader” that puts lives at risk.

The One Campaign also called on Congress “to reject rushed attempts to override their previous decisions and to continue supporting smart, effective international assistance programs.”

One Campaign added that the rescissions package “gives scant detail about the nature and impact of the proposed cuts. When lifesaving assistance is at stake, Congress needs real details. For example, the package cuts nearly a billion dollars from health and infectious disease funding which deserves more explanation than 11 vague sentences.”

Trump claims the cuts are aimed at “wasteful foreign assistance spending” to “eliminate programs that are antithetical to American interests”.

Speaking in the US Senate on Thursday, Democratic Senator Dick Durbin asked “why in the world would we cut such low cost but impactful programmes?”

“If there were international programmes that were ineffective, and I admit such work can be difficult and with mistakes, the place to fix them is through the regular appropriations process, not the wholesale gutting of a complete programme like USAID.”

While the US Congress has 45 days to consider the proposal.

Gutting of USAID

USAID staff offload emergency supplies.

The Trump administration wants to rescind $500 million of the USAID’s global health programs for “activities related to child and maternal health, HIV/AIDS, and infectious diseases”, claiming that this would not reduce treatment but “eliminate programs that are antithetical to American interests and worsen the lives of women and children, like ‘family planning’ and ‘reproductive health,’ LGBTQI+ activities, and ‘equity’ programs.”

Projections from March indicated that up to 29,000 health workers had lost or were at risk of losing their jobs in Uganda alone due to cuts in foreign assistance. Other African countries severely affected by the US cuts include Ethiopia, Nigeria, and the Democratic Republic of Congo.

“As Uganda’s health workers and Ministry of Health were mounting an effective, coordinated response to contain the Ebola outbreak, the sudden freeze of US foreign assistance created serious challenges,” said Irene Atuhairwe, Seed Global Health’s Country Director in Uganda.

“Health workers lost their jobs, and contact tracing and surveillance efforts had to be scaled back. With limited resources and reduced staffing, health officials were forced to narrow their efforts, potentially increasing the risk of further spread,” added Atuhairwe.

“Diseases like Ebola don’t stay within borders. It takes just one infected traveller boarding a plane or crossing borders for a local outbreak to go global. The very abrupt cuts to foreign assistance have made all of us less safe.”

There were more than 50 USAID-funded staff dedicated to outbreak response in Uganda, but that number has been reduced to just six, who are now responsible for preparedness and response efforts for Ebola, Marburg virus, mpox, and bird flu.

The Trump administration also wants to rescind $400 million of the $6 billion appropriated for HIV programmes, namely the PEPFAR grants administered via USAID.

Numerous African HIV treatment programmes receiving PEPFAR grants through USAID have had to scale down or close because their grants have been terminated, potentially affecting 20 million people.

Also on the rescinding chopping block is $2.5 billion in USAID development assistance to “end extreme poverty and promote resilient, democratic societies”, and $496 million for international disaster assistance in response to natural disasters, conflicts, and other emergencies.

Trump wants to rescind  $1.7 billion from the Economic Support Fund for “countries of strategic importance to the US”, claiming this has been used “to fund radical gender and climate projects.” However, it has largely assisted countries transitioning to democracy and for Middle East peace talks.

Trump also wants to jettison the entire $125 million allocated to the Clean Technology Fund, as it invests in “climate-friendly projects in developing countries that do not reflect America’s values or put the American people first”. 

The fund provides low-cost finance for “promising low-carbon technologies in developing countries”, including “renewable energy, energy efficiency, sustainable transport, and green industry projects.”

International organisations and programmes

The entire $437 million allocated to international organisations and programmes is up for rescission, which would eliminate funding for the UNICEF, UNDP, UNFPA and the Montreal Protocol, which regulates ozone-depleting substances. 

“Eliminating these programs will do real harm,” said Global Health Council President and CEO, Elisha Dunn-Georgiou. 

“These are not fringe initiatives. They make the world safer, healthier, and more just. When the US invests in equitable, inclusive, and evidence-based global health programs, we don’t just improve lives abroad – we strengthen public health security, global cooperation, and America’s reputation as a principled and effective leader.”

The council urged people to “push back against efforts to politicise public health”, noting that “these proposed cuts are about ideology, not money. And they put lives at risk.”

Image Credits: Reuters Youtube, USAID Press Office.

Ambassador Amma Twum-Amoah (left) and Dr Delese Mimi Darko.

CEO of Ghana’s Food and Drugs Authority (FDA) Dr Delese Mimi Darko has been appointed the inaugural Director-General of the African Medicines Agency (AMA) by the agency’s Conference of State Parties (CoSP) at a meeting in Rwanda this week.

Darko has a “wealth of experience and a distinguished track record in regulatory excellence”, according to a media release from the African Union.

Darko has been CEO of Ghana’s FDA since 2017, currently chairs the WHO African Vaccines Regulatory Forum and serves on several international and local committees related to medicines and regulation.

“The appointment of the Director General is an important step toward the operationalisation of AMA,” said Ambassador Amma Twum-Amoah, the AU’s Commissioner for Health, Humanitarian Affairs and Social Development. 

“The AMA has been established to harmonise and strengthen regulatory systems for medical products across Africa. We are confident that under Dr Darko’s leadership, the agency is poised to accelerate its efforts in coordinating and standardising regulatory practices, facilitating joint assessments and inspections, and fostering a harmonised approach to medicines regulation that will ultimately benefit all African citizens,” added Twum-Amoah.

Dr Francine Dekandji, Chad’s Minister of State of Health and chairperson of the CoSP, said that AMA “is crucial for ensuring that medical products on our continent meet international standards of quality, safety, and efficacy”. 

The CoSP also elected a new Bureau to guide its future work and endorsed an additional member to the AMA Governing Board. 

Establishing the agency has been a slow process in the evolution of the harmonisation of the regulation of medicines on the continent.

“The appointment of Dr Darko as the Director General of the AMA represents an important milestone for the organization. The depth of her scientific and regulatory experience will be invaluable in shaping the future of medicine regulation in Africa,” said David Reddy, Director General of the International Federation of Pharmaceutical Producers and Manufacturers Associations (IFPMA).

“By supporting national regulatory authorities across the continent, the AMA has real potential to help facilitate faster access to quality medicines, contribute to tackling substandard and falsified medicines, and support medical innovation.”

Bunmi Femi-Oyekan and Zainab Aziz, co-chairs of the Africa Regulatory Network at IFPMA, both offered their congratulations.

“Under her leadership, the AMA can make important progress in its mission to strengthen initiatives to harmonise medicines regulation and promote cooperation and reliance of regulatory decisions,” said Femi-Oyekan.

Aziz described her appointment as “a crucial step toward a fully functional agency that has the potential to transform access to quality-assured medicines across Africa and foster a more predictable, efficient regulatory environment for innovation”. 

Image Credits: African Union.

Few countries have submitted new climate commitments – fewer yet track health benefits of action, including reduced urban air pollution. Portrayed here, a street view in Beijing.

Most countries’ climate action plans refer to the health benefits of adaptation and mitigation strategies, such as reduced air pollution, but few actually track them. And as World Environment Day is observed Thursday, global climate commitments remain extraordinarily weak. 

Only 21 countries out of the 195 parties to the UN Paris Agreement have submitted updated national climate action plans (Nationally Determined Commitments) through the year 2035 – nearly four months after the plans were due. 

This is according to the latest report by Climate Action Tracker, which monitors submission of the reports to UN Climate Change.

Only 21 countries have so far submitted new national climate commitments due in February, according to Climate Tracker data. The United States has since renounced its targets.

Of those few countries that have submitted, most refer to the health benefits of mitigation strategies, such as reduced air pollution in general terms, while others make reference to health adaptation strategies. 

But there continues to be a lack of clear tracking systems to monitor progress in achieving the desired health outcomes, according to a recent analysis by the Global Climate and Health Alliance (GCHA), a global network that mobilises the health community towards climate action.

The GCHA looked in depth at 11 countries’ national climate plans in different regions of the world and at diverse economic development levels – from Botswana to Panama, Japan and the United Kingdom.

The assessment looked at a set of eight criteria, including references to health benefits from mitigation efforts, related financial commitments, and health sector adaptation initiatives.

Eight criteria used for evaluating health-related NDC commitments and targets.

Under the Paris Agreement, all countries are required to develop NDCs, which outline steps to reduce emissions and adapt to climate impacts. These plans are updated every five years.

This year, governments are submitting their third round, which details emission reduction targets for 2035.

As of the February 10 deadline, only 13 of the 195 parties to the agreement had submitted their 2035 NDC targets.

Since then, there have been just eight additional submissions, bringing the total to 21.

Ambitious NDC commitments would help health 

Countries analysed in the GCHA report included Botswana, Brazil, Canada, New Zealand, Japan, Panama, Switzerland, United Arab Emirates, United States, United Kingdom and Uruguay.

Notably, most national pledges acknowledge the health benefits of mitigation strategies aimed at improving air quality. However, only the United Kingdom’s NDC includes specific monitoring efforts for air quality. 

Some recent submissions are noteworthy for the health benefits that they may reap – even if they are not explicitly measured at all. For instance, Kenya’s NDC, submnitted in May, includes an ambitious pathway to 100% renewable energy and a 35% reduction in greenhouse gas emissions by 2035, even though the country contributes less than 0.1% to global GHGs.  

Those commitments would reduce the health impacts from outdoor air pollution, related to vehicle emissions as well as unsustainable waste burning, including of plastics.  Improved access to electricity at household level would similarly reduce air pollution from biomass burning very significantly. But air pollution is not mentioned as a benefit of the NDC actions. 

Summary of Kenya’s NDC commitments: They would yield far-reaching benefits to health, even if these are not explicitly measured.

Weak commitments contrast with temperature rises 

The NDCs are all the more critical this year, insofar as in 2024, global surface temperatures surpassed 1.5°C above pre-industrial levels for the first time, making it the warmest year on record. Several multilateral studies have warned that surpassing this mark would have catastrophic effects on both human health and the environment. However, by scaling up interventions, up to 1.9 million premature deaths could be prevented annually.

Although CO2 has been the primary focus of climate mitigation efforts, experts at the Second WHO Global Air Pollution and Health Conference in Cartagena, Colombia, urged the adoption of integrated strategies to also target super pollutants, which significantly contribute to global warming, but also disappear from the atmosphere within weeks or a few years, as compared to the centuries for CO2. Reducing emissions of super pollutant gases and particles, including methane, black carbon and ozone, can thus yield quick gains for slowing temperature rise. 

“These actions involve setting targets to reduce climate impacts on health and highlighting the co-benefits of climate action, such as in the forestry, water, and energy sectors. These would help facilitate inter-ministerial coordination, which remains a challenge in many countries’ climate plans,” Fabio Aleina, a senior consultant on climate adaptation and co-author of the GCHA report, told Health Policy Watch in an interview.

In 2024, global average surface temperatures rose 1.5C above the 1850-1900 pre-industrial mark for the first time in history.

Action to mitigate air pollution

Last year, the first-ever UN Climate Change global stocktake, a process to evaluate parties’ collective progress towards the goals of the Paris Climate Agreement, called for more ambitious emission reduction targets  spread out across the economy.

Recent NDC submissions such as Kenya’s show that countries are indeed diversifying strategies to curb emissions, including commitments to more sustainable management of waste, waters, forest and ecosystems, which can yield multiple cascading health benefits over time. 

The plan aims to increase tree cover through afforestation while reducing deforestation to curb emissions from the dominant AFOLU (combined agriculture, land use change and forestry) sector, as well as integrating other nature-based solutions for better ecosystem management.

The UK government has also placed significant focus on decarbonising the transport sector, a step expected to result in significant reductions in air pollution. For its industries, the UK will continue using the Best Available Techniques (BAT) framework to ensure the adoption of sustainable methods that reduce pollution to air, water and soil.

Brazil, the host of COP30 in November, places a strong focus on combating deforestation as a central strategy in its NDC. This has direct implications for reducing wildfires linked to widespread destruction of natural ecosystems, indigenous communities, and related livelihoods, as well as big surges in hospital admissions for respiratory and cardiovascular illness. 

Brazil’s climate plan also mentions transitioning away from fossil fuels. But it remains silent about new oil extraction plans, muddying its climate pledges with recent approvals for new offshore oil drilling near the sensitive Amazon River mouth, despite warnings from expert advisors.  The Senate recently passed legislation, dubbed the “devastation bill”, that severely curtails the Environment Ministry’s regulatory powers by allowing companies to self-license projects, or avoid environmental reviews altogether, including for road and dam construction.

The Brazilian NDC also lacks explicit reaffirmation of a zero deforestation by 2030 pledge, that was a hallmark of the 2021 UN Climate Conference (COP26).

Other nations take varied approaches 

Brazil’s NDC has targeted deforesation, while other countries take varied approaches.

New Zealand’s climate plan addresses several super pollutants, but its emission reduction target of 51–55% below gross 2005 levels by 2035 has been described as “shockingly unambitious,” as it only represents a 1% increase from its 2030 goal.

Japan remains heavily dependent on fossil fuels for electricity, which increases air pollution risks. In 2021, 80,000 deaths were attributed to air pollution (PM2.5) in Japan, with fossil fuels contributing to 31% of these deaths.

The United Arab Emirates NDC enhances transparency, through the development of a national monitoring system for greenhouse gases and air pollutants. Panama’s NDC emphasises renewable energy and active transportation, while Uruguay’s climate plan highlights fiscal incentives to promote electric mobility and sustainable transport.

In North America, Canada, an early mover towards the phase out of coal-fired electricity by 2030, is implementing regulatory measures to make its fuel less polluting and ensure a growing supply of zero-emission vehicles. 

The United States’ climate plans also showed a commitment to significantly cut emissions, including methane reductions and other super pollutants.

However, the US commitment to international climate agreements has seen a 180 degree about-face under new President Donald Trump, whose “drill baby drill” slogan has become a rallying cry for the fossil fuel industry.  On his first day in office, Trump issued an executive order to initiate the process of withdrawing the US from the 2015 Paris Agreement, that sent the 1.5C° benchmark for limiting global warming.

The outlook for climate action is notably more positive for its northern neighbor under Canada’s newly-elected Prime Minister Mark Carney.

Fabio Aleina, Co-author of the GCHA Report

Even so, the broader emission reduction targets of the NDCs submitted so far fall short of the goal to limit global warming, with the UK as the exception, as its target is deemed compatible with the 1.5°C limit.

“What makes the UK’s approach worth emulating by other high-emitting countries is its top-down approach. This collaboration is essential, as health outcomes and indicators can vary from one part of the country to another, making it important to involve local governments in aligning strategies with these indicators,” says Aleina. For instance, local authorities in the UK work with the government to ensure that legal limits for pollutants like nitrogen dioxide are met.

Growing climate finance gap

The US directly funded 8% of global climate finance in 2024.

The World Bank estimates that halving the global population exposed to average annual PM2.5 levels above 25 micrograms/cubic meter of air (25µg/m3) by 2040 would require increased annual investments in clean air from $8.5 billion in 2020 to $13.9 billion in 2040. That would save some two million lives annually from outdoor air pollution in the worst polluted cities and locations on earth. The WHO guideline limit is 5 µg/m3.

However, financial commitments to climate action have been disappointing over the years, with the US – one of the major contributors to climate finance – exiting key climate agreements, further straining resources.This reduction in funding particularly affects countries’ conditional climate targets, which are emission reduction efforts dependent on external financial support.

“The US exit could have a significant impact,” says Aleina. Notably, in 2018, following US President Donald Trump’s first attempt to withdraw from the Paris Agreement, the International Energy Agency reported a 1.7% increase in global CO2 emissions from energy-related sources, reversing three years of consistent declines.

“Without the corresponding financial commitment, countries might continue to struggle to improve their climate ambition,” says Aleina.

With nearly 90% of the parties to the Paris Agreement yet to submit their national climate plans, United Nations (UN) climate chief Simon Stiell has extended the deadline to September, just ahead of the NDC Synthesis Report, which will be released before COP30 in Belem, Brazil. 

“From the conversations I’ve been having, countries are taking this extremely seriously,” said Stiell  in February. “So, taking a bit more time to ensure these plans are first-rate makes sense.”

Image Credits: Markus Winkler/Unsplash, Climate Tracker , Global Climate and Health Alliance , Kenya NDC – 2031-2035, EC/Copernicus , Dirk Erasmus/Unsplash , Carbon Brief .

A health facility in Sopore in Kashmir’s Baramulla district. Mental health facilities are scarce in Kashmir.

SRINAGAR, India – Areeba* tucks a strip of tiny blue pills into the back of her mathematics textbook before heading to class. It’s become second nature.

“Half when I can’t sleep. One if I can’t walk,” says the 22-year-old university student, her voice calm, as if describing a cold remedy. “I don’t really want to take them, but it’s the only way to get through the day.”

Across Kashmir, India’s northernmost and politically volatile region, young people are self-medicating to cope with anxiety, sleeplessness and depression. The strains of decades-long conflict, repeated lockdowns, and recent flare-ups–including a drone strike and extended power blackouts during cross-border tensions in May–have left many struggling to find mental health care.

While India’s National Mental Health Mission has expanded services across several states, Kashmir remains critically underserved. With limited access to therapists, trained counsellors or psychiatrists, antidepressants, sedatives and illicit narcotics have become people’s primary coping mechanisms and are often obtained without prescription or follow-up.

Panic attack in the dark

Zubair Iqbal, a 20-year-old undergraduate in Sopore, recalls the night of 9 May vividly: “It was around 9pm. I had packed my bag for a flight to Delhi the next morning. “But because of the tension with Pakistan, it got cancelled. My mother came and said, ‘Zubair, come downstairs – we’ll eat in the blackout’.”

Iqbal was puzzled when the power went out, then heard what felt like “a thousand thunderstrikes.”

“My brother said it was just thunder, but I knew it wasn’t. It was a drone attack.”

He collapsed inside the house. “My legs were shaking. I couldn’t see properly. My heart was racing. I thought I was dying.”

The next day, he asked his father if he could see a doctor.

“My father said, ‘We won’t travel 40 kilometres to Srinagar for this. It’s nothing–you were just scared. Let’s go to the peer sahib (faith healer).’ I wanted to cry.”

Instead, Iqbal looked online for the name of an antidepressant, then went to a local pharmacy and bought it over the counter.

Hidden in plain sight

A clinical psychologist in downtown Srinagar, who requested anonymity because of workplace restrictions, says Zubair’s experience is typical.

“Because of the conflict and some of the highest unemployment rates in India – female unemployment here is 53.6% – symptoms of trauma are normalized,” she says.

She sees over 100 patients a day, many adolescents.

“Every other teenager between 15 and 18 reports some mental health concern. Many fear the schools will close again if the war escalates. Others worry their parents will lose their jobs. But very few actually seek therapy.”

Her observations reflect existing data. A 2015 survey by humanitarian group Médecins Sans Frontières (MSF) found that 1.8 million adults in Kashmir’s valley – about 45% of the population – experienced significant mental distress. Almost one in five people showed symptoms of post-traumatic stress disorder. Meanwhile, 41% of women and 26% of men showed symptoms consistent with depression, according to the study.

According to government Census figures from 2011, there were just 41 psychiatrists for the entire Jammu and Kashmir region, home to 12.5 million people. 

Mental health experts believe that the number has barely doubled in the past 14 years, leaving much of the population without access to specialized care.

Médecins Sans Frontières teams raise awareness about mental health in Kashmir.

‘We were just trying to survive’

Kubra Aziz, 24, lives in Uri, a village just 3km from the Line of Control, the heavily militarized border with Pakistan. She fled with her family to Baramulla during recent shelling in May.

“We left at night,” she recalls. “My cousin, who has a history of mental illness, began hyperventilating.”

They took shelter in a local college, where Kubra says her cousin screamed all night.

“The next morning, I took her to the district hospital, but the psychiatrist was on leave.”

That, she says, is routine: “Even when there’s a doctor, they may have 1000 patients. They’re overwhelmed. Misdiagnoses are common.”

In the absence of therapy, many Kashmiris turn to pills and substances – prescribed or not.

“Most people either buy psychiatric medication from pharmacies or turn to charas, tobacco, or anything that numbs the brain,” Kubra says.

One young man, Nadeem*, left Kashmir for Saudi Arabia three years ago.

“I was unemployed and addicted to hash. My family thought leaving Kashmir would help,” he says.

He quit drugs after moving abroad, but returned home recently amid renewed violence.

“The stress is back. I’m trying to hold on. But I don’t know how long I’ll last.”

A 2022 report from Kashmir’s only government-run drug de-addiction centre showed a 2,660% increase in patients since 2016. Doctors say most patients are not recreational drug users, but they are self-medicating trauma.

“I plan to leave again,” Nadeem says. “People from age 10 to 40 are trapped in addiction. Just look at the schoolkids.”

No therapists in schools

Residents of Kashmir seek health at one of the health facilities in the region during recent conflict between India and Pakistan.

Aman Bhat, a 17-year-old high school junior in Budgam district, says his missionary-run school has no mental health services.

“We don’t have a counsellor,” Bhat says. “If someone is anxious or depressed, there’s no one to talk to. Mental health is something we don’t even have words for here. We say, ‘My heart feels heavy.’ That’s it.”

Many of his classmates chew tobacco to manage stress. “What else can they do?”

In villages, Bhat notes, “We don’t have real hospitals like other parts of India. What do we have?”

Learning from Gujarat

Despite the scale of Kashmir’s mental health crisis, the region lacks community-based support models proven successful elsewhere in India, such as the Atmiyata program, which means “shared compassion” in Marathi.

Atmiyata was launched in Mehsana district of Gujarat in 2017 which comprises of 645 villages. Atmiyata Mitras – trained community volunteers – identify people in distress and provide up to six sessions of basic, evidence-based counselling in homes or local temples.

Volunteers use smartphones to screen culturally relevant films about unemployment, alcoholism, domestic violence, and other root causes of mental distress – issues that are difficult to talk about.

When symptoms exceed what a volunteer can handle, Mitras guide patients through India’s District Mental Health Programme, even accompanying them to clinics.

Because mental health and poverty are often intertwined, Mitras also help families apply for disability pensions, job schemes and social benefits.

What Kashmir needs now

“If the recent trauma in Kashmir has taught us anything, it’s that medication alone is not the answer,” says Dr Sameena Qadri, a South Asia-based public health psychiatrist. 

“Antidepressants and sedatives offer short-term relief. But without therapy, follow-up care and social support, the root causes remain untouched.”

This conversation is urgent as global leaders prepare for the UN High-Level Meeting (HLM) on Non-Communicable Diseases (NCDs) and Mental Health on 25 September. The meeting aims to ensure that 150 million more people worldwide gain access to affordable mental health care by 2030.

The HLM zero draft includes the target of 80% of public primary health care (PHC) facilities having essential mental health medicines and technologies available by 2030.

“These targets sound ambitious,” Qadri says. “But they must be grounded in places like Kashmir, where the mental health crisis is visible in pharmacies, schools and homes.”

She advocates for a multi-tiered, district-wide care system, with trained community volunteers delivering support and referring severe cases. She also calls for mobile mental health clinics and tele-psychiatry.

“School-based counselling is essential, especially in conflict zones. Children grow up with trauma and no outlet. Without care, we risk losing a generation.

“These aren’t luxuries,” she says. “They’re urgent needs.”

Call for global partnerships

“We need partnerships between governments, civil society and global health organizations to scale community care. The most vulnerable can’t wait for a perfect system. They need access now,” Qadri urges.

“Mental health is not a luxury. It’s dignity. You can’t talk about peace or sustainable development while millions suffer in silence.”

Kubra agrees: “We always talk about peace. But how can there be peace when people are breaking inside, and no one hears them?”

Until models like Atmiyata are adapted to Kashmir and scaled, young Kashmiris will continue to medicate their distress in silence – behind schoolbooks, in back-alley pharmacies and bedrooms darkened by blackout curtains, both literal and emotional.

*Not their real names.

 

Image Credits: MSF, Arshdeep Singh.

Dr Louisa Dunn, an investigator on the TB PRACTECAL clinical trial, consults with a patient.

In Nukus, Uzbekistan, 34-year-old surgical nurse Dilaram was devastated when she was diagnosed with drug-resistant tuberculosis (DR-TB). 

But instead of facing the standard treatment, including nearly 15,000 pills to be taken over two years and painful injections causing severe side effects, she could enrol in TB-PRACTECAL, the MSF-led clinical trial testing an all-oral, six-month regimen for DR-TB. 

After completing treatment with virtually no side effects, she returned to work and to caring for her two young daughters. This trial transformed her TB treatment journey and recovery. 

This profound revolution in her treatment journey is not a coincidence.  It is a result of years of dedicated clinical research, shaped by experiences of people like her and driven by significant contributions and efforts from public and non-profit organisations working closely with people affected by TB in low-resource settings.

TB-PRACTECAL, a landmark clinical trial led by Médecins Sans Frontières (MSF), not only identified an all-oral, six-month regimen for DR-TB,  but it is also the first clinical trial for which the detailed costs, €33.9 million, were published in the journal PLOS Global Public Health. 

This stands in stark contrast to the opaque norms of pharmaceutical research and development (R&D), where there is no transparency about what it costs to develop new medicines although high drug prices are often justified based on high R&D costs.

This moment is more than a medical milestone. It marks a critical step toward accountability in medical innovation and demonstrates  to all stakeholders that transparency in R&D is both possible and essential. 

When costs are hidden, governments—and organisations like MSF that purchase medical products—lose the leverage to negotiate affordable prices. We therefore ask: what does the pharmaceutical industry have to hide? If their costs are truly high, why not publish them? They refuse because transparency would undermine their ability to charge whatever prices they like, even for lifesaving TB medicines.

Costs of TB-PRACTECAL clinical trial

TB-PRACTECAL was a phase 2b-3 adaptive trial, which means it was designed to test how well different treatments work and confirm those results in a larger group of people, while also adapting the study design over time based on early results. 

The trial tested three new regimens for DR-TB against the standard of care. The total cost of €33.9 million was further broken down into 27 cost categories, enabling a detailed analysis of the key cost drivers of the trial.

Current estimates for the full R&D costs of developing a new drug range from €40 million to €3.9 billion, depending on the methodology used. Estimates for phase 2 and phase 3 pharmaceutical clinical trials alone range between €4.7 and €133 million. 

While the overall cost of TB-PRACTECAL fits within this range, several factors pushed its cost higher. These include the fact that it was both a phase 2b and phase 3 trial combined, it included multiple sub-studies, ran for a long duration of five years, and required significant investment in health facilities and infrastructure to carry out the trial. Medicine costs were also high. The cost of Bedaquiline alone made up 46% of all medicine expenses.

Breakdown of the cost of the TB-PRACTECAL trial.

Why transparency matters

The TB-PRACTECAL trial was conducted in resource-limited settings in South Africa, Uzbekistan, and Belarus – countries with a high prevalence of DR-TB. In 2022, the trial confirmed that a shorter, all-oral regimen using bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) could treat patients in six months or less, with significantly higher cure rates and fewer side effects compared to the previous 18–24 month regimens that relied on painful injections and caused severe side effects. 

After publication of the trial results, the World Health Organization (WHO) recommended the regimen as the preferred treatment for rifampicin-resistant TB. It has since been adopted for use in 40 countries. Sustained advocacy by TB activists and MSF played a crucial role in pushing for price reductions of key newer drugs, including bedaquiline and pretomanid, making broader rollout of this regimen possible.

Historically, pharmaceutical companies have justified sky-high drug prices under the pretext of recouping R&D expenses without ever disclosing the actual costs. For life-threatening diseases like TB, this secrecy costs lives.

MSF and TB activists witnessed this with bedaquiline, a core drug that is now an essential part of all DR-TB regimens. Although it was developed with substantial public funding, the pharmaceutical company Johnson & Johnson charged an exorbitant price, citing the need to recoup high R&D costs and sustain future innovation. 

Academic research showed that public investment in bedaquiline was up to five times greater than private investment. Civil society and health advocates used this information to successfully push for a price reduction. 

This transparency marked a turning point in the fight for access to this medicine and demonstrated the critical role of R&D cost transparency in enabling affordable access. The justification of high prices due to high R&D costs is a recurring argument from the pharmaceutical industry that MSF has encountered repeatedly when addressing the high cost of lifesaving medicines. 

This can no longer remain an evidence-free zone, which is why MSF chose to play its part by publishing the detailed cost breakdown of the TB-PRACTECAL trial.

We are calling on all funders and implementers of clinical trials – governments, product-development partnerships (PDPs), philanthropic organisations, academics, institutions, and pharmaceutical companies – to publicly disclose their R&D costs. MSF has developed a Clinical Trial Cost Reporting Toolkit to support publishing clinical trial costs, building on our own experiences.

Medicines shouldn’t be a luxury

Every year, 1.3 million people die of tuberculosis, making it the world’s deadliest infectious disease, disproportionately affecting people in low- and middle-income countries. Countries like India, which bear the world’s largest burden of TB and DR-TB, need timely access to the latest WHO-recommended treatments at affordable prices. However, exorbitant pricing has long stood in the way of widespread implementation of these regimens.

Without generic competition, national TB programmes struggle to widely implement updated WHO guidance on treatments that rely on newer, and often more expensive drugs.

The global community cannot afford another delay like the one we saw with bedaquiline, where people with DR-TB in low- and middle-income countries were left behind for over a decade. To truly end TB, we need to dismantle the barriers of cost, control, and corporate secrecy that continue to undermine access.

What needs to change

At MSF, we do not accept funding from pharmaceutical companies. From the front lines of conflict to work done with communities battling epidemics, our work is rooted in compassion, equity, and medical ethics. 

We took a big step to openly share our trial costs because we believe that when public resources are used, the public deserves accountability.

We urge the global health community to support transparency in medical R&D. We ask all stakeholders to recognize that transparency is not a threat but a lifeline. Without it, access to care remains a privilege for the few; with it, it becomes a shared responsibility to protect the many.

Six years ago, the World Health Assembly adopted the transparency resolution that urges all member states to “take appropriate measures to publicly share information on the net prices of health products”.  

All governments must take urgent steps to enact legislation mandating the disclosure of disaggregated R&D costs, including clinical trial costs, especially where the R&D has received public funding.

We will keep speaking out against systems that put profits ahead of people—because no one should be left to suffer, or die, from a disease that could be treated, simply due to hidden costs. Secrets cost lives.

Farhat Mantoo is the Executive Director of Médecins Sans Frontières (MSF) South Asia, with over two decades of leadership experience in humanitarian operations across Asia, Europe, and East Africa.

Bern-Thomas Nyang’wa is the Medical Director of Médecins Sans Frontières (MSF) Netherlands. He was the Chief Investigator of TB-PRACTECAL and has extensive TB clinical, programmatic and research experience.

 

Image Credits: Oliver Petrie/ MSF.

An oil rig operates off the coast of Denmark.

Over 30 health organizations representing 12 million doctors, nurses, and public health professionals globally have pledged to no longer work with advertising agencies that partner with the fossil fuel industry, citing conflicts of interest and the resulting health effects from industry disinformation campaigns.

The organizations span five continents and include prominent groups such as Médecins Sans Frontières, The Lancet, the World Organisation of Family Doctors, and the Yale Centre on Climate Change and Health.

For decades, oil and gas companies have employed PR and lobbying tactics strikingly similar to those of the tobacco industry: seeding doubt about established science, creating front groups, and pushing misleading narratives to stall regulation despite overwhelming evidence that fossil fuel pollution harms human and planetary health.

Yet many of the same PR and advertising agencies employed by health groups to promote healthy habits, vaccinations, and cancer prevention have continued partnering with fossil fuel companies, spreading misleading messages that downplay or deny these health harms and delay action needed to curb emissions.

“The same PR firms spreading fossil fuel disinformation are also working with health organizations—a clear conflict of interest for health,” said Shweta Narayan, Campaign Lead at the Global Climate and Health Alliance (GCHA). “Fossil fuels are making us sick, and the companies behind them are spending millions on advertising and PR to cover it up.”

Air pollution from fossil fuel combustion causes more than five million premature deaths annually. Burning oil and gas has been linked to increases in respiratory illnesses, cardiovascular diseases, cancers, and adverse pregnancy outcomes.

“As health professionals guided by humanitarian values, we have a responsibility to speak out when public health is under threat,” said Dr Maria Guevara, international medical secretary for Médecins Sans Frontières. “Fossil fuels are at the heart of a growing global health crisis, and the PR and advertising firms that help obscure this reality undermine efforts to protect lives.”

Cutting ties 

Royal Dutch Shell headquarters in The Hague, Netherlands.

The health sector often relies on professional advertising and PR services for public health messaging, including cancer awareness, infectious disease prevention, and vaccine uptake.

In 2020, the World Health Organization hired Hill+Knowlton to fight COVID-19-related disinformation. Scientists and environmental groups have widely criticised the company for its oil and gas portfolio, including clients ExxonMobil, Shell, Chevron and Saudi Aramco.

Edelman, the world’s largest PR company with over $1 billion in revenue, exemplifies this contradiction and the scale of the challenge.

The company assembled a task force of global health and pharmaceutical companies, including Novo Nordisk, GSK, and Roche to “accelerate the transition to net zero health systems” in India and China—a campaign hailed as groundbreaking public-private collaboration.

Yet Edelman won the bidding war for Shell’s worldwide public relations account in 2024, extending their decades-long relationship in a deal worth tens of millions—one of the agency’s most lucrative contracts. In March, Shell abandoned a key climate target for 2035 and weakened another goal for 2030.

While Edelman publicly states it “believes climate change is the biggest crisis we face as a society,” the firm creates “innovative promotional campaigns” for Shell, including a video game where users imagine themselves as engineers “keeping the lights on.”

The Climate Investigations Center describes Edelman as “the dominant PR firm for trade associations that promote an anti-environmental agenda.”

“Just like health leaders once stood up to Big Tobacco and its advertising, it’s time to stand up to Big Oil,” said Jeni Miller, GCHA executive director. “Organisations are demonstrating that they won’t help spread fossil fuel disinformation, and will use every tool they have, including their ad and PR dollars, to protect people’s health and the planet.”

Building on healthcare’s trusted voice

Ipsos Global Trustworthiness Index 2024.

With doctors and nurses consistently ranked among the world’s most trusted professions, advocacy groups believe their voices are essential to reframing fossil fuels as a health crisis rather than just a climate issue.

“We are trusted voices in the community,” said Dr Viviana Martinez Bianchi, president-elect of the World Organization of Family Doctors. “We are uniquely positioned to inform, explain, and speak about the equity implications. We can counteract this disinformation and mobilize public understanding and action.”

The decision to cut ties with these PR firms aligns with a broader movement to place health at the heart of climate policy and counteract the “commercial determinants of health,” where corporate practices from sectors like tobacco, ultra-processed food, and fossil fuels shape conditions for disease.

“We see the effects first-hand in vulnerable populations,” Bianchy explained, citing patients with asthma exacerbations, cardiovascular conditions, and poor respiratory health, all linked to pollution exposure.

Decades of scientific studies have linked fossil fuel activities to rising rates of asthma, heart disease, heat-related illness, infectious disease spread, and mental health stress during climate-related disasters—evidence that health professionals say has forced them to act.

“We, the health community, have a duty to warn humanity about the profound health harms from burning fossil fuels and to act on that knowledge,” said Edward Maibach, Director of the George Mason University Center for Climate Change Communication. “We must refuse to work with any marketing agency that works with fossil fuel companies.”

Industry disinformation campaigns

Plastic waste sorting
Over 30 metric tonnes of plastic are burned each year, mostly in lower and middle income countries, leaving millions exposed to toxic air pollutants.

For over fifty years, fossil fuel companies have run multi-billion-dollar campaigns to misinform, lobby, and confuse the public about the climate crisis, varying their messaging strategy by region and audience.

In the global North, these tactics focus on “greening” the gas industry by positioning fossil fuels as climate solutions.

The playbook includes shifting blame to individuals through concepts like the personal carbon footprint, which British Petroleum popularised in 2004 with a calculator that encouraged people to tally up how their morning commute, grocery runs, and vacation flights were heating the planet.

The industry also championed plastic recycling, rolling out blue bins across American driveways while chemical giants like Chevron, DuPont, and Exxon knew the technology to recycle at scale did not exist.

Plastics are now a key justification used by nations and companies to pursue higher fossil fuel production, even though only 9% of plastic ever produced has been recycled. The technology to recycle complex polymer plastics at scale still does not exist decades later.

In the global South, fossil fuel-producing nations and companies promote oil as essential for economic and sustainable development, according to Vivek Parekh, an analyst with London-based climate risk think tank Influence Map.

Saudi Arabia made this argument while trying to block the climate resolution at last week’s World Health Assembly, saying: “As an oil producing sector, we are aware of our role in [energy] transformation, but can’t ask developing countries to pay the price for transformation when they are not responsible for the problems.”

Saudi delegate explains their take on the WHO Climate Change and Health action plan in WHA debate.

“The fossil fuel industry dominates the lobbying landscape,” Parekh said. “What we see is the industry’s attempt to weaken and obstruct climate policy, despite clear economic, health and climate benefits.”

At major UN climate conferences, fossil fuel lobbying groups have dramatically outnumbered health organizations. Nearly 2,500 fossil fuel lobbyists attended COP28 in Dubai—more than delegates from the ten most climate-vulnerable nations combined.

At November’s plastic treaty negotiations, 220 fossil fuel and chemical industry lobbyists descended on Busan, forming the largest single delegation and outnumbering host South Korea’s 140 representatives as well as the European Union and its 27 member states.

The oil giants got what they came for, successfully derailing what was meant to be the final treaty adoption session by opposing any caps on plastic production.

This strategy has led UN Secretary-General António Guterres to call fossil fuel companies the “godfathers of climate chaos.”

“It’s an almost comical conflict of interest that Big Oil’s spin doctors are also in charge of communications for the UN climate talks,” Dr. Geoffrey Supran, a Harvard researcher who studies fossil fuel disinformation tactics, told environmental news website DeSmog.

Despite some victories, including a Dutch court upholding The Hague’s ban on fossil fuel advertising and Energy Australia apologizing for greenwashing, greater transparency is needed as the industry’s activities continue undermining climate action.

“We can’t be neutral,” added Dr. Jemilah Mahmood, executive director of Malaysia-based Sunway Centre for Planetary Health. “Our Hippocratic Oath goes beyond just treating disease to preventing it.” Like the tobacco industry, she argued, fossil fuel companies “manipulate the truth,” leaving marginalized communities polluted and vulnerable to health risks.

Image Credits: CC, IPSOS, SweepSmart.

Mahmoud Ali Youssouf, chairperson of the African Union Commission, and Bill Gates, chair of the Gates Foundation.

Philanthropist Bill Gates announced on Monday that the majority of the $200 billion he plans to donate over the next 20 years will be spent in Africa.

The focus will be “on partnering with governments that prioritise the health and wellbeing of their people”, Gates told government leaders, diplomats and partners during an address at the African Union headquarters in Addis Ababa, Ethiopia.

“By unleashing human potential through health and education, every country in Africa should be on a path to prosperity – and that path is an exciting thing to be part of,” Gates said.

He called on  primary healthcare (PHC) to be prioritised, emphasizing that this “has the greatest impact on health and wellbeing.”

 “With primary healthcare, what we’ve learned is that helping the mother be healthy and have great nutrition before she gets pregnant, while she is pregnant, delivers the strongest results. Ensuring the child receives good nutrition in their first four years as well makes all the difference.”

Gates singled out Ethiopia, Rwanda, Zimbabwe, Mozambique, Nigeria, and Zambia for showing bold leadership that harnesses innovation, from expanding frontline health services to deploying advanced tools against malaria and HIV, and safeguarding PHC.

 “I’ve always been inspired by the hard work of Africans even in places with very limited resources.” He added, “The kind of field work to get solutions out, even in the most rural areas, has been incredible,” said Gates

Gates also spoke about the transformative potential of artificial intelligence, noting its relevance for the continent’s future. 

Drawing a parallel to the continent’s mobile banking revolution, he said that “Africa largely skipped traditional banking and now you have a chance, as you build your next generation healthcare systems, to think about how AI is built into that.”  

He pointed out that Rwanda is using “AI-enabled ultrasound to identify high-risk pregnancies earlier, helping women receive timely, potentially life-saving care.”

 “In Ethiopia and Nigeria this week, Gates will see first-hand the state of health and development priorities in the wake of foreign aid cuts, and he will affirm his and the foundation’s commitment to supporting Africa’s progress in health and development over the next 20 years,” according to a media release from the Gates Foundation.

Image Credits: African Union.

Flavour additives are designed and packaged to appeal to young people, hooking the next generation on tobacco and nicotine products.

As the world observes ‘No Tobacco Day’, the World Health Organization (WHO) has called on governments to ban all flavours in tobacco and nicotine products, including cigarettes, pouches, hookahs and e-cigarettes – which are playing an increasing role in hooking young people to tobacco products.

Over 50 countries have banned flavoured tobacco, but manufacturers are getting around it with online sales of various types of flavours that can be added to cigarettes, e-cigarettes and other tobacco products, according to a series of new WHO policy briefs on the issue.

Examples of common tobacco and nicotine flavour accessories.

Flavours like menthol, bubble gum and cotton candy are particularly popular amongst youth. And because they mute the harshness of tobacco and nicotine, they make those products more attractive to use.

Paired with flashy packaging and social media-driven marketing, flavours have also increased the appeal to young people of nicotine pouches, heated tobacco, and disposable vapes. Some 8 million people a year die prematurely from tobacco-related deaths.

The accessories market offers a work-around to countries’ bans on flavoured tobacco and nicotine products.

Different types of flavours are designed and packaged to appeal to young women, children, and other target groups.

“Flavours are fuelling a new wave of addiction, and should be banned,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “They undermine decades of progress in tobacco control. Without bold action, the global tobacco epidemic, already killing around 8 million people each year, will continue to be driven by addiction dressed up with appealing flavours.”

Flavour accessories remain largely unregulated, WHO notes.

“We are watching a generation get hooked on nicotine through gummy bear-flavoured pouches and rainbow-coloured vapes,” said Dr Rüdiger Krech, WHO Director of Health Promotion. “This isn’t innovation, it’s manipulation. And we must stop it.”

Image Credits: Chemist 4 U/Flickr, WHO , Arom-Team.com.

Air pollution remote sensor India
Remote sensing equipment and camera capturing real-world emissions data of vehicles in India as they drive by.

New research shows how 310 premature deaths and 230 new children’s asthma cases can be prevented every day over the next 15 years if governments act against polluting vehicles and accelerate the move to electric vehicles.

Pollution from fossil-fuel vehicles is most lethal for two age groups, those above the age of 65 and those under five, a new study shows.

Five countries, China, the United States, Indonesia, India, and Mexico, are estimated to have the most road transport-attributable cases for children and older people in 2023. For lower-income countries, transitioning to cleaner transport is difficult for most countries, particularly as several are dumping grounds for heavily polluting vehicles from richer countries. 

In 2023, there were 251,500 new asthma cases in children linked to nitrogen dioxide (NO2) from road transport.  Back in 2015, tailpipe emissions were linked to 385,000 fine particulate matter (PM2.5) and ozone- (O3) related deaths globally, with road transport accounting for 64% of these mortalities.

Among those who conducted the research are the International Council on Clean Transportation (ICCT), widely known for exposing Volkswagen’s diesel emissions cheating scandal, along with George Washington University and the University of Colorado Boulder. 

The authors say this study fills a crucial gap in existing literature and provides important evidence needed to support governments at all levels.

They provide a detailed analysis of how different policies could improve health outcomes across more than 180 countries and 13,000 urban areas. The study warns that vehicle pollution could cause up to 1.9 million premature deaths and 1.4 million new cases of asthma in children by 2040 unless strong policy action is taken now.

At its core, the science is straightforward: vehicle exhaust releases tiny particles (PM2.5) and gases like nitrogen dioxide (NO₂) and volatile organic compounds (VOCs), which then react in sunlight to form ground-level ozone — a harmful pollutant. These pollutants penetrate deep into the lungs and bloodstream. In young children, these trigger asthma. In older adults, it raises the risk of heart and lung diseases and early death.

The report suggests a pathway to save these millions of lives and asthma cases in children. The report emphasises that no single policy is enough. A combination of interventions is needed to tackle the crisis. 

Saving the most lives

Accelerating the switch to electric vehicles could cut air pollution and save many lives.

The best case scenario they evaluated would mean a country adopting and enforcing modern vehicle emission standards (like Euro 6 and eventually Euro 7), accelerating the transition to electric vehicles (EVs), phasing out older, more polluting vehicles, and ensuring that the electricity grid becomes cleaner, so that EVs don’t simply shift pollution from roads to power plants.

The largest gains from adopting this mix would be visible in low and middle-income countries (LMICs) that are yet to adopt Euro 6 equivalent standards. Currently, richer nations are dumping polluting vehicles in LMICs.

Implementing the best standards in these countries could achieve 56% and 63% of the total benefits of all identified measures combined for avoidable premature deaths and new paediatric asthma cases, respectively.

Halving air pollution by 2040

China, India and the USA are among the five hotspot countries portrayed here, in terms of avoidable deaths in top ten urban areas. Row a) is PM2.5- and ozone-attributable premature deaths and (b) NO2-attributable new paediatric asthma cases. Yellow labels show cumulative share of avoidable burden from the top ten urban areas, and brown data labels show their corresponding share of population from applicable age groups in the region.

The newly peer-reviewed study released this month aligns with the WHO’s 15-year goal to cut air pollution-linked deaths by half. On 26 May, all WHO regions endorsed this plan at the World Health Assembly in Geneva. The World Bank’s assessment is that if it’s business-as-usual, there will be a rise of 21% in the number of people who are exposed to PM 2.5 levels above [the WHO annual guideline] of five micrograms per cubic meter.

While the goal is a reduction in vehicular emissions, the report highlights the pathway for the next 15 years would be combining Euro 6 (and eventually Euro 7) and ambitious electric vehicle (EV) policies. This could avoid an additional 323,000 (39%) premature deaths and an additional 419,000 (100%) new paediatric asthma cases cumulatively worldwide from 2023 to 2040, compared to focusing on EVs alone (EV). 

But for countries that have already adopted Euro 6/VI-equivalent standards, an ambitious EV transition is vital to achieve further emissions reductions.

The new report, an updated version of a study first reported by Health Policy Watch here, identifies the most vulnerable countries by various criteria. 

Five hotspot countries 

The global hotspots for these impacts are not surprising given the density of population and vehicles. China, India, Indonesia, the United States, and Mexico together account for the largest number of avoidable deaths and new asthma cases linked to nitrogen dioxide from road transport.

Roads account for 93% of carbon emissions from Indian transport, compared with 84% in the US and 81% in China. 

“India ranks among the top five countries with the highest number of premature deaths and pediatric asthma cases from road transport emissions, with COPD and NO₂-related asthma posing major health burdens,” Amit Bhatt, ICCT India’s managing director told Health Policy Watch.
“Children under five and adults over 65 are especially vulnerable, underscoring the need for targeted policies. Though urban youth under 20 make up just 33% of the population, they account for up to 68% of avoidable NO₂-related asthma cases, highlighting the urgent need for city-level interventions. Accelerating EV adoption and ensuring a clean power grid offer India significant health and environmental gains.”

Populous middle-income countries, namely China, India, Pakistan and Indonesia, the report says, have the highest potential avoidable health impacts. These countries lead in avoidable premature deaths and ‘years of life lost.’ China, Egypt, Indonesia and India have the most avoidable new paediatric asthma cases.

Poor countries, those with lower social development indices, are likely to experience increases in new paediatric asthma cases due to growth in populations under 20 years old and changes in exposure. 

Cities are especially critical. Although urban areas house only a third of the world’s children, they account for 68% of avoidable pediatric asthma cases. 

This makes city-level action, like low-emission zones, public transport electrification, and walkable infrastructure, crucial in the fight for clean air.

Image Credits: ICCT, Ernest Ojeh/ Unsplash, ICCT.

Africa needs 6.4 million mpox vaccines in the next few months to address the outbreak, which is now concentrated in Sierra Leone, according to the Africa Centres for Disease Control and Prevention (Africa CDC).

Three-quarters of Africa’s confirmed new mpox cases are in Sierra Leone, all concentrated in high-density areas in all districts, with 648 confirmed cases in the past week. Yet the country only has around 10,000 vaccine doses.

Meanwhile, Ethiopia reported its first three cases this week: parents and their baby who were diagnosed in Moyale, a town in the Oromia district near the border with Kenya.

“Given also the proximity of Somalia, and knowing all the challenges that are there, we need to be really very bold and aggressive to control this outbreak at the source so that it doesn’t expand further,” according to Dr Ngashi Ngongo, Africa CDC’s mpox incident manager.

The 16,915 confirmed cases for the first five months of this year are almost as many as the total for the entire 2024.

Mpox vaccinations are being carried out in seven countries, and while the Africa CDC has appealed for more vaccine donations, the 1.5 million LC16 vaccines from Japan are estimated to finally arrive over the weekend.

Nineteen African countries have active mpox cases, and 2,836 new suspected cases were reported in the past week. 

Meanwhile, 20 countries have cholera outbreaks affecting some 127,409 people, and addressing this is on the agenda of the African Heads of State meeting on 2 June, according to Ngongo

Seventeen member states have measles outbreaks, seven have dengue in seven member and four have Lassa fever.