NIH director Jay Bhattacharya
Dr Jay Bhattacharya, seen here testifying before the Senate Health Committee, will now also serve as acting director of the CDC.

Dr Jay Bhattacharya, the director of the National Institutes of Health, will take on an additional role in the Administration of US President Donald Trump as acting director of the Centers for Disease Control and Prevention (CDC), long seen as a leading reference point for public health policy not only in the US but worldwide. 

Bhattacharya succeeds Dr Jim O’Neill, a science and tech investor who has been acting CDC director since August 2025.  O’Neill, who lacks any medical or research experience, is now being tapped to oversee the National Sciences Foundation in what critics described as a “musical chairs leadership shakeup for science agencies.”

Bhattacharya, meanwhile, will lead both NIH and CDC until President Trump appoints a permanent director for the latter – reflecting the tightening grip of a small coterie of Health Secretary Robert F Kennedy Jr and Trump confidantes around the leading US health policy, science and research institutions.

A permanent appointee to head the CDC would require Senate confirmation. Susan Monarez, the first Senate-confirmed CDC director under the Trump administration, led the agency briefly in 2025, before being ousted by Kennedy Jr just 29 days into her tenure.

In Senate testimony about her firing, Monarez told the Senate Health Committee members that she refused Kennedy’s requests to “replace evidence with ideology,” in pre-approving vaccine recommendation changes and in firing career public health officials.

Musical Chairs: Jim O’Neill (center) sworn in as Deputy HHS Secretary in June, 2025. In August he became Acting CDC Director. Now he is to lead the National Science Foundation.

Bhattacharya will have to balance managing the nation’s premier biomedical agency headquartered in Bethesda, Maryland, with running the federal public health agency, in Atlanta, Georgia. But the geographic distance is not the only challenge the incoming director faces.

Now positioned to reduce US vaccine schedules

The CDC vaccine advisory committee, also hand-picked by Kennedy, has made clear that its recommendations aim to reduce the number of shots American children should get, with the committee’s most recent recommendations dropping six common vaccines. The changes made good on Kennedy’s promises to reverse decades of US vaccine policy. 

As CDC’s acting director, hand-picked by Kennedy and a close ally, Bhattacharya is positioned to oversee further rollbacks in vaccine schedules, although the NIH director has stated he does support vaccinations for major childhood diseases. 

“The measles epidemic [is] best solved by parents vaccinating their children for measles,” he said during a Senate hearing in early February. The US has seen a resurgence in measles cases in the past year, fueled by misinformation and falling vaccination coverage. South Carolina reported nearly a thousand cases since October.

Along with the festering vaccine debate, the CDC has also seen mass layoffs as well as closures of departments that monitor infectious disease trends, support mental health, and manage tobacco and substance use prevention. 

Kennedy and his team claim that they have acted to reduce what they term “bureaucratic bloat” and conflicts of interest in the nation’s medical agencies. But some critics, including Dr James Alwine, speaking on behalf of  the alliance ‘Defend Public Health’,  argue that the movement championed by Kennedy is a new form of conflict of interest. 

“They promote ‘Medical Freedom,’ which is simply underwriting the largely unregulated multi-billion dollar wellness industry,” Alwine , an emeritus professor of cancer biologist at the University of Pennsylvania, said in a statement to Health Policy Watch.

“And the negative results of [this] movement are appearing as vaccine hesitancy rises, with increased cases of measles, whooping cough, flu, tetanus, mumps, and more. Children are suffering and dying.”

COVID-19 contrarian

HPV vaccine
Vaccine policy has been at the center of the Trump Administration’s public health controversy.

Bhattacharya rose to prominence during the COVID-19 pandemic as an outspoken critic of the US management of the pandemic – particularly state-mandated shutdowns, as well as CDC  recommendations regarding vaccination and public use of masks.  A Stanford economist and physician, Bhattacharya co-wrote the Great Barrington Declaration, which argued for minimal COVID restrictions to boost ‘natural’ herd immunity.

The declaration was embraced by the Trump Administration and conservative news outlets. But critics pointed out that achieving herd immunity for COVID-19 without vaccines is both unethical and improbable. 

Bhattacharya will have to contend with an agency gutted of its top leadership after conflicts with Secretary Kennedy over vaccine recommendations. 

“I resigned because CDC leaders were reduced to rubber stamps, supporting policies not based in science and putting American lives at risk,” said Dr Debra Houry, a career CDC official and former CDC Chief Medical Officer, during Senate testimony on her resignation in September 2025.

“Secretary Kennedy censored CDC science, politicized its processes, and stripped leaders of independence.”

Image Credits: C-SPAN, HHS Photo by Amy Rossetti, National Cancer Institute on Unsplash.

Speakers at the panel on extreme heat and the future of outdoor work at Mumbai Climate Week. First from right is Dr Radhika Khosla, Associate Professor at the University of Oxford, and fourth from right is Dr Soumya Swaminathan, former WHO chief scientist.

MUMBAI, India – Air pollution and heat are much worse together for human health than each of them alone, said Dr Soumya Swaminathan, former chief scientist at the World Health Organization, speaking at this week’s Mumbai Climate Week (MCW).

Heat and air pollution were among the key regional priorities during the three-day event that brought global climate conversations to a climate-vulnerable region.

“There is work done in California which shows that on the days when you have the highest heat and high air pollution, the deaths which occur on those days are three times more than when you have either heat or high air pollution,” Swaminathan said at a session on extreme heat and outdoor labour.

In South East Asia, climate change is leading to more extreme heatwaves, and the region’s very high levels of air pollution exacerbate related health impacts, worsening cardiovascular and respiratory symptoms, and increasing premature mortality. Swaminathan stressed, however, the need for more research on the synergies.

Bringing climate conversation to the global south

Mumbai is one of the few cities in the global south to host a climate week.
Shishir Joshi, Project Mumbai.

Mumbai’s Climate Week, which ended on Thursday, was the first of its kind to be staged in South East Asia. Modelled after more well-established events in New York City and London, it was organised by the local non-profit Project Mumbai, in collaboration with several dozen Indian and international partners. Those included well-known philanthropies such as the Clinton Global Initiative, as well as other finance, industry, UN agencies. The Climate Group, which organises the New York climate week was also a partner.

The goal was to bring climate dialogue that often happens in the developed world to the global south, and provide a platform to diverse voices across India and other developing countries, said Shishir Joshi, CEO and founder of Project Mumbai speaking to Health Policy Watch ahead of the event.

The organizers selected Mumbai due to its position as India’s financial capital, its range of urban challenges, and its active civil society. The densely populated urban metropolis of over 18 million people is struggling with extreme heat, rainfall, flooding as well as worsening air quality.

The event received the support of the Indian government and the regional Maharashtra government. The latter launched its ‘Be Cool’ initiative to scale up cooling solutions across the state’s cities, supported by the United Nations Environment Programme (UNEP).

The week revealed “the strength of a collaborative, philanthropic effort for change,” Joshi said, but added that the week was also a platform for, “citizen-led action … While deep dive conversations on the three thematic areas are the primary focus of the climate week, our effort is also to ensure that citizens feel they do have a voice and a voice which can be heard.”

Attention given to heat’s impact on workers

Outdoor workers are often exposed to a disproportionate amount of heat.

Roughly half of India’s workforce, or an estimated 231.5 million workers are outdoor workers, according to one recent analysis. They labour in agricultural fields, at construction sites, in markets, and as delivery workers in urban areas.

These workers are increasingly on the front lines of rising heat and air pollution, among other climate extremes.

Yet related health impacts may go unnoticed for a long time. “A lot of them experience chronic exhaustion, kidney stress, and declining productivity before there is a medical emergency. That means the true burden of heat still remains quite invisible,” said Dr Radhika Khosla, an associate professor at the University of Oxford, who also appeared on the panel on outdoor workers.

Nearly 62% of India’s female workers are employed in agriculture and are thus by extension, primarily outdoor workers.

Of those women not engaged in agriculture, about 40% are home-based workers, mostly engaged in artisanal food production and sewing or textile work. And they are also at risk, said Renana Jhabvala, President of SEWA Bharat, a national federation of informal women workers.

“Their homes’ roofs are usually aluminum sheets, and the temperatures are almost 8-10° C higher than what it is outside,” she said, adding that the related impacts on health and productivity are also often invisible.

Experts said what is needed is to scale up cheap and locally available solutions like cooling paints, low-cost roofs that don’t overheat, increasing green cover and shade across cities, along with access to public water dispensers and toilets.

Workers applying reflective paint to a roof in South Africa.

Global North players made their presence felt

Former US Secretary of State Hillary Clinton.

An occupational health insurance initiative being piloted by the Clinton Global Initiative (CGI) demonstrates another approach. The insurance scheme provides compensation for lost work days due to heat. So far, some 500,000 have been enrolled in India, said former US Secretary of State Hillary Clinton, who discussed the initiative during a fireside chat at the MCW.

“We are very focused on climate, health and women, and that combination is important, because women are on the front lines of climate change,” Clinton said. “Women, especially in the Global South, and obviously here in India, are very often working outdoors and now in extreme heat. India will be the model for the rest of the global south because of this CGI commitment.”

Finance remains an issue

Yet, typically it is women workers, and women climate advocates, who find it harder to access finance for available climate solutions, Clinton observed.

Speakers at the session on climate finance expressed optimism about India’s prospects. In the centre in black is Clarisa De Franco of Allied Climate Partners.

Unlocking finance more broadly was another key theme at the sessions, taking place in India’s financial capital with major international banks such as HSBC, British International Investment, IDFC First, and others partnering both in the event and its panels.

What is really needed is more “blended finance” – e.g. combination of public and private investments in climate projects – because neither the public nor the private sector can meet all of the looming needs on its own, said Clarisa De Franco, of Allied Climate Partners, a philanthropy that mobilizes investments for climate projects in the Global South.

But the panelists also expressed optimism for India’s prospects of mobilizing more climate investment as the region is regarded as an attractive option for international investment overall.

Image Credits: Unsplash/Previn Samuel, By arrangement, Mario Spencer/Unsplash, HABVIA , By Arrangement.

Air pollution worsens a range of serious mental health disorders, according to the latest research.

Breathing in air with high levels of pollution worsens a range of serious mental health conditions, such as schizophrenia, depression, and anxiety disorders, according to emerging research.

A 2026 study, published in the journal Environmental Research, reviewed 25 existing studies on air pollution’s impact on anxiety disorders and found that while long-term exposure is the most dangerous, even short-term exposures worsen anxiety disorders.

The finer the air pollutants, the higher the danger, according to a 2023 study published in Environment International involving over 1.7 million people in Rome, Italy.

“Long-term exposure to ambient air pollution, especially fine and ultra-fine particles, was associated with increased risks of schizophrenia spectrum disorder, depression, and anxiety disorders,” the 2023 study found.

Currently, nearly 99% of the world’s population breathes in air exceeding the World Health Organization’s (WHO) clean air guidelines.

While air pollution’s impact on depression is reasonably well known, more is being understood about its impact on other mental health disorders. Research on a link between air pollution and bipolar disorder has currently produced mixed results.

“A growing evidence base links exposure to air pollution to a variety of mental health disorders, including anxiety, depression, and schizophrenia, as well as risk for suicide. Evidence also points towards the risk being higher for more disadvantaged communities,” said Pallavi Pant, an environmental health scientist at Health Effects Institute (HEI).

Pant cautioned that this area of research is currently limited but very active.

Also read: More Evidence That Air Pollution is Linked to Higher Risk of Dementia

Air pollution’s role in worsening mental health disorders

Air pollution has been linked to a large number of dementia deaths in research.

Air pollution kills an estimated 8.1 million people every year, according to the State of Global Air Report 2024, which is brought out annually by HEI in collaboration with the Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Disease project.

The links between high levels of air pollution and higher rates of dementia and other cognitive impairment, post-partum depression, and even schizophrenia relapse were established by a study in World Psychiatry published in 2024.

“Higher levels of specific air pollutants were associated with a higher risk of dementia or cognitive impairment, cognitive disorders, post-partum depression (class II), and schizophrenia relapse,” according to the 2024 study, which looked at 32 existing global studies on air pollution and mental health disorders.

Higher temperatures also affect mental health. “Temperature increase was associated with an increase in suicidal behaviour, suicide or mental disorders-related mortality; and hospital access due to suicidal behaviour or mental disorders, or mental disorders only,” the 2024 study noted.

“What happens when high temperatures and poor air quality intersect? That is an area that remains understudied, Pant said.

The biological mechanisms of how air pollution affects mental health disorders are still not well understood, “but evidence points towards inflammation playing an active role,” Pant explained.

“Some studies also indicate greater risks for children and adolescents- exposure during critical windows of development, including development of the brain, can increase the risk of psychiatric disorders,” she added.

Also read: Air Pollution ‘Kills a Child Every Minute’

Disadvantaged communities hit hardest

Most of the air pollution deaths are in low- and middle-income countries.

A report released last year by the US non-profit advocacy group, Physicians for Social Responsibility Pennsylvania, looked at the role physicians can play in low-income neighbourhoods where air pollution levels tend to be worse, and the mental and emotional toll on communities is high.

“Physicians can work as advocates for their patients’ health. They can use their influence as trusted professionals to promote policies that will decrease air pollution and increase access to mental health resources,” said Laura Dagley, a nurse who wrote the report.

“We have learned from research that air pollution itself has physiological impacts on the brain and other organs in the body, but what I learned from my time working with these communities is the mental health implications from the erosion of their sense of place and home,” Dagley added.

 “Many felt they were living in sacrifice zones, or that their lives were not considered important enough by industry or politicians to care about the health impacts.”

Such communities often also tend to have poorer access to resources.

Limited research from the global south

Nearly 99% of the world breathes in polluted air. World’s most polluted countries are in Africa and Asia.

The world’s most polluted countries are in the developing world, particularly in Asia and Africa, but evidence about the health impact is sparse from these regions.

Most studies are from high-income countries in North America, Western Europe, and increasingly, from China and other Asian countries. Studies from Africa and South Asia are still relatively scarce, Pant said.

Dagley said that physicians can also play a role in filling this data gap: “A lot of the research we have showing mental health impacts has come from medical records, combined with air pollution data.”

Image Credits: Unsplash, State of the Global Air report 2025, IQAir.

Thousands of people claim that exposure to Roundup has given them cancer.

Monsanto has reached a provisional $7.25 billion settlement with US law firms representing clients who claim that exposure to its pesticide, Roundup, caused them to develop non-Hodgkin lymphoma (NHL).

The settlement was filed in the St Louis Circuit Court in Missouri on Tuesday and still needs court approval, according to an announcement from Bayer, which bought Monsanto in 2018.

It covers plaintiffs who allege exposure to Roundup before 17 February and currently have a medical diagnosis of NHL, or who receive a medical diagnosis within 16 years following the final approval of the agreement.

“Monsanto is taking the Roundup-related actions solely to contain the litigation, and the settlement agreements do not contain any admission of liability or wrongdoing,” according to the company statement.

“Indeed, leading regulators worldwide, including the US EPA [Environmental Protection Agency] and EU regulatory bodies, continue to conclude based on an extensive body of science, that glyphosate-based herbicides – critical tools that farmers rely on to produce affordable food and feed the world – can be used safely and are not carcinogenic.”

However, the World Health Organization’s International Agency for Research on Cancer (IARC) classified glyphosate as “probably carcinogenic to humans” back in 2015.

IARC made its decision based on “limited evidence of carcinogenicity in humans for non-Hodgkin lymphoma. The evidence in humans is from studies of exposures, mostly agricultural, in the USA, Canada, and Sweden published since 2001. In addition, there is convincing evidence that glyphosate also can cause cancer in laboratory animals.”

Right to appeal

The Roundup settlement proposal comes as Bayer is preparing to appeal against $1.25 million awarded by ​​the Missouri Circuit Court to NHL patient John Durnell, who sued the company for its failure to warn customers that Roundup could cause cancer.

The company stated in court papers in the Durnell case in April last year that it faced claims from “more than 100,000 plaintiffs across the country that … seek to hold Monsanto liable for not warning users that glyphosate, the active ingredient in Roundup, causes cancer”. 

It has settled around 130,000 claims but still faces around 67,000 active claims, many of which are based on state requirements about cancer warning labels.

Bayer argues that the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) is responsible for issuing cancer warnings and that this is a federal decision that should  supercede state law warning claims.

“For decades, EPA has exercised its authority under FIFRA to find that Monsanto’s Roundup product line and its active ingredient, glyphosate, do not cause cancer in humans,” Bayer states in the court papers.

“Consistent with that understanding, EPA has repeatedly approved Roundup’s label without a cancer warning. FIFRA prohibits Monsanto from making any substantive change to an EPA-approved label unless it first obtains EPA’s permission.”

Trump support

Bayer, which donated $1 million to Donald Trump’s presidential inauguration, successfully lobbied the Trump administration for support to ensure that the Supreme Court would hear its appeal against the Durnell award.

Last year, Solicitor General D. John Sauer filed a brief with the Supreme Court, supporting Monsanto’s argument that federal law was responsible for cancer warnings, and urged the Supreme Court to review the company’s case.

“A positive ruling on the question before the Supreme Court should largely foreclose present and future claims based on state label-based warning theories – including the pending appeals, as well as opt-outs from the class,” said Bayer, which noted that “a favorable ruling by the Supreme Court would provide essential regulatory clarity.”

However, the Trump administration’s intervention has angered “Make America Healthy Again” (MAHA) supporters.

“President Trump specifically promised to address the harms from pesticides. This move to support the Supreme Court in hearing Bayer’s case for federal preemption of state laws that protect our safety could not stray further from that promise he made to American citizens,”  said Kelly Ryerson, co-executive director of American Regeneration and a MAHA leader.

Manipulation of science

Meanwhile, a scientific paper written 25 years ago, claiming that glyphosate posed little risk to people, has finally been withdrawn after it was found that the authors relied solely on Monsanto studies and did not acknowledge that Monsanto staff had assisted in writing the paper.

The study by Gary Williams, Robert Kroes and Ian Munro was published in 2000 in the journal, Regulatory Toxicology and Pharmacology, but only retracted last December.

Making the announcement, journal co-editor Martin van den Berg cited several problems, including the “authorship of this paper, validity of the research findings in the context of misrepresentation of the contributions by the authors and the study sponsor and potential conflicts of interest of the authors”.

Image Credits: Pesticide Action Network.

During winter, snow renders roads in Kashmir impassable.

In the high Himalayas of  Kashmir, winter does not arrive quietly. It rolls in across mountain ridges in dense sheets of snow, swallowing roads, sealing off valleys and transforming steep passes into walls of white. 

Entire communities become temporarily cut off from the outside world. In some villages, the only link to the nearest hospital disappears for weeks.

For most residents, winter is a season of endurance. But for pregnant women, it can become a countdown measured not in weeks, but in weather forecasts.

Officially, the region of Jammu and Kashmir records one of India’s lowest maternal mortality ratios: 47 deaths per 100,000 live births, nearly half the national average. 

Public health indicators suggest improvement over the past decade, with institutional deliveries increasing and antenatal coverage expanding. But statistics do not climb mountains.

Across remote districts near the Line of Control, the de facto border dividing India and Pakistan, childbirth is shaped as much by geography as by policy. Villages sit at high altitudes. Roads are narrow and vulnerable to landslides. Within hours, snowfall can block the only route linking a community to a district hospital.

When that happens, ambulances stop running. Helicopter evacuations depend on clear skies and administrative clearance. Primary health centres, already short of specialists and equipment, become the only point of care.

Every autumn, families in snowbound belts quietly begin preparing for a decision that has become routine: relocate pregnant women to lower-altitude towns before the snow closes in or remain behind and hope there are no complications.

For those who can afford to move, childbirth becomes an economic burden. For those who cannot, it remains a medical gamble.

Leaving before the snow seals the valley

Pregnant Kashmiri women living in isolated areas often need to move closer to health facilities when their due date looms as winter snowstorms can make it impossible to get maternal health services.

In Machil, a remote Himalayan border village in north Kashmir, the nearest district hospital lies more than 60 kilometres away in Kupwara.

In summer, the drive can take several hours along winding mountain roads carved into steep slopes. In winter, heavy snowfall can render the route impassable for days and sometimes weeks. 

For 67-year-old Abida Khan, winter no longer brings beauty: “I have seen women suffer because they couldn’t reach a hospital in time,” she told Health Policy Watch.

Her daughters and daughters-in-law now leave the village weeks before their due dates. The family arranges temporary accommodation in Kupwara or Srinagar, absorbing the costs as best they can.

“If complications happen at night during heavy snowfall, what can we do?” she asked. 

In previous winters, residents say they waited days for helicopter evacuations that were delayed due to poor visibility. In such conditions, childbirth becomes dependent on timing and luck rather than medical preparedness. 

Local health workers say they routinely advise families to shift pregnant women out of Machil before peak winter. But relocation requires savings, something many households that are reliant on small-scale farming or daily wages struggle to accumulate.

Migration for childbirth

Nearly 200 kilometres away, in Kangan market in central Kashmir’s Ganderbal district, Faqir Mohammad stands outside an electrical shop, weighing whether to buy a room heater he cannot afford. 

The heater is intended for a rented room where his pregnant wife, Rasheeda Begum, now lives with their two children, far from their home in Buglinder village in the remote Tulail Valley of Gurez. 

Tulail lies in a high-altitude belt that remains snowbound for months. Once heavy snowfall begins, roads close and air evacuations become uncertain.

“We have no choice,” Rasheeda told Health Policy Watch from the cramped rented room. “Every winter, doctors tell our husbands to shift the pregnant women out of Gurez. It is out of compulsion, not comfort.”

She is expecting her third child. Her first two deliveries, both at home, were uncomplicated. But this time, early snowfall warnings pushed the family to leave in November.

 “Our monthly expense is nearly ₹20,000 [$220],” Faqir said. “The rent alone is ₹4,000 [$40]. I don’t earn that much.” 

To manage costs, he borrowed ₹1 lakh [$1,100] from his brother-in-law, a sum that will take months, perhaps years, to repay.

“I am mentally disturbed with all this financial burden and the harsh cold,” said a woman twho asked not to be named. “But staying back would be more dangerous.”

She recalled a tragedy in her village nearly a decade ago when a woman died because the helicopter couldn’t travel for three days during a snowstorm. 

“They kept her in the medical room until she lost her breath. That memory scares all of us.”

Structural gaps in care

Even outside winter, maternal healthcare in remote belts faces systemic constraints.

There is no ultrasound facility in the entire Gurez–Tulail region.  Rasheeda must travel around 120km for a single scan, and pay about ₹1,000 [$10]  excluding transport.

“We don’t have specialists, tests, transport, nothing,” she told Health Policy Watch.

Such limitations reflect wider staffing shortages. Reporting by Kashmir Times found that hundreds of consultant posts are vacant across Jammu and Kashmir’s health department, leaving tertiary hospitals overstretched and peripheral centres understaffed.

Previous coverage by Health Policy Watch reported that dozens of primary health centres and hundreds of sub-centres in the region lack reliable electricity, a critical requirement for conducting safe deliveries and emergency procedures.

A doctor in north Kashmir, speaking on condition of anonymity, said terrain magnifies existing shortages: “There are areas we simply cannot reach in winter. Even in summer, these terrains are difficult. During snowfall, ambulances get stuck. If a woman develops complications at night, response time becomes critical.”

He added that while referral systems exist on paper, implementation falters when roads close or communication lines fail.

Some families incur large debts while renting rooms near hospitals if a woman is due to give birth during winter.

Conflict and climate pressures

In frontier towns near the Line of Control, residents say periodic cross-border shelling adds another layer of unpredictability to maternal care.

In villages near Uri, families described how an escalation in shelling has forced temporary evacuations in the past. Pregnant women were shifted to safer areas with limited facilities, disrupting routine check-ups and antenatal monitoring.

“When there is firing or roads close, where do we go?” asked Nadeem from Buzgaow. “We cannot abandon our homes for months. But we cannot reach hospitals either.”

Weather patterns, too, have grown less predictable. Residents report sudden heavy snowfall arriving earlier in the season, complicating planning. In high-altitude regions already vulnerable to isolation, even minor shifts in snowfall timing can determine whether a woman delivers near a fully equipped hospital or in a basic facility without specialist support.

Choice between debt and danger

For women in Kashmir’s snowbound valleys, childbirth often becomes a negotiation between financial survival and physical safety. Temporary migration means rent, heating, food and transport costs in unfamiliar towns. Many families depend on livestock or seasonal agricultural income. Months away from home disrupt livelihoods.

“We left our home, borrowed money and separated our family just to survive childbirth,” Shazada Akhter from Kupwara told Health Policy Watch. “What else can a mother do?”

Back in Machil, as the first snow settles across the mountains, Abida Khan watches the road disappear beneath fresh drifts.

“We pray the winter passes without emergency,” she said.

The region’s maternal mortality statistics suggest progress. But in villages perched along fragile mountain routes, safe delivery still depends on clear skies, open roads and borrowed funds.

For pregnant women in Kashmir’s high Himalayas, winter remains the single most decisive factor in whether childbirth is routine or perilous.

Image Credits: Rutpratheep Nilpechr/ Unsplash, Welt Hunder Hilfe, Safina Nabi.

Fatioma, 30, a pregnant refugee who fled conflict in Sudan, sits with her daughter in front of their shelter in a camp in Adre, Chad.

Over 60% of maternal deaths in 2023 took place in countries and territories experiencing conflict or institutional and social fragility, according to a World Health Organization (WHO) technical brief published on Tuesday.

“In 2023, an estimated 260,000 women died from causes related to pregnancy and childbirth. Around 160,000 of those deaths occurred in settings experiencing conflict or institutional fragility,” Jenny Cresswell, WHO sexual and reproductive health scientist, told a media briefing in Geneva on Tuesday.

“The majority of women dying in pregnancy today are not dying because we lack medical solutions. They are dying because of structural weaknesses in health systems, often rooted in conflict, crisis and instability,” Cresswell added.

The maternal mortality ratio in conflict-affected countries was 504 maternal deaths per 100,000 live births in 2023, according to the report.

In fragile settings, it was 368 deaths per 100,000 and countries not affected by these challenges, it was 99 per 100,000. 

The cost of disrupted services

“The overwhelming majority of these deaths can be prevented,” Cresswell stressed. “That gap is not a coincidence. It is the cost of disrupted services, damaged hospitals, health workers fleeing violence, interrupted supply chains, and women unable to reach quality care safely or quickly enough at the time that this is needed. 

“This means that women are dying from preventable maternal causes in conflict settings, such as haemorrhage or excessive bleeding relating to childbirth, hypertensive disorders such as pre-eclampsia, infections and complications relating to unsafe abortion.”

A 15-year-old girl living in a country or territory affected by conflict in 2023 had a 1 in 51 lifetime risk of eventually dying from a maternal cause, in comparison to a 1 in 593 risk for  a 15-year-old girl living in a country not affected by conflict or institutional and social fragility.

Around 10% of women of reproductive age lived in the 17 countries and territories classified as experiencing conflict by the World Bank, where 21% of all live births, and 55% of all maternal deaths occurred. 

The 20 countries and territories classified as experiencing institutional and social fragility were home to just 2% of all women of reproductive age, 4% of all live births and 7% of all maternal deaths.

Progress is possible

But progress is possible, as the report shows.

The MMR in Ethiopia decreased from 267 to 195 maternal deaths per 100 000 live births between 2020 and 2023.  But pregnant women in the areas affected by conflict, drought and displacement – particularly the Tigray, Amhara, Afar and Oromia regions – faced “significant challenges” to get essential maternal health services.

These included a lack of ambulances, restrictions on vehicle movements at night, and health workers fleeing from conflict-affected areas. 

In response, the WHO, United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA), with funding support from the Bill & Melinda Gates Foundation, launched the Service Delivery Innovations in Conflict-Affected Areas (SDI) project in Amhara, Oromia and Afar, in collaboration with Ethiopia’s Ministry of Health and Regional Health Bureaus.

This resulted in three ambulances and six mobile health service teams being deployed to underserved and remote communities. Twenty-four maternity waiting homes, six neonatal intensive care units and four maternity wards were renovated, and 24 midwives were trained and deployed.

“Since the SDI project began in 2022, the number of deliveries attended by skilled health workers increased from 12,790 to 17,620 in 2024,” according to the report.

“The number of women and girls receiving at least four antenatal care visits rose from 15,636 in 2022 to 23,228 in 2024”, while the number of women receiving postnatal care visits within seven days of delivery increased from 17,611 in 2022 to 21,730 in 2024”.

Off track

“The world is committed to reducing maternal mortality globally to fewer than 70 deaths per 100,000 live births by the year 2030, but at current rates, we are off track,” said Cresswell.

“We must protect maternal health in fragile settings. That means investing in primary health care, protecting health workers and facilities, ensuring emergency obstetric services remain functional during crisis,” she added. “No woman should lose her life, giving life.”

The WHO report also recommends “improving data collection on maternal and newborn mortality at the subnational level, particularly in settings where humanitarian access is restricted, can help identify and address inequities and track progress towards ending preventable maternal deaths.”

Additional reporting by Elaine Fletcher.

Image Credits: Nicolò Filippo Rosso/ WHO.

A doctor at a diistrict hospital in Ifakara, Tanzania treating a malaria patient.

Every $1 invested in the Medicines for Malaria Venture (MMV) between 2000 and 2023 yielded $13 in monetised health benefits, according to a study published in The Lancet Global Health this week.

MMV is a not-for-profit product development partnership (PDP) that works with public and private sector partners to discover, develop and deliver accessible and affordable medicines to treat, prevent and eliminate malaria. 

Since its launch in 1999, it has brought 19 malaria medicines to the market that have treated or protected more than 1.3 billion people worldwide. 

The total investment received by MMV was $2.3 billion over the 23-year study period, and the antimalarial drugs developed and launched with the support of MMV averted an estimated 1.6 million deaths and 87 million disability-adjusted life-years (DALYs). The cost of delivery is estimated to be $785 million. 

“This analysis demonstrates that funds invested in MMV are working extraordinarily hard,” said Dr Lesong Conteh, from the London School of Economics and Political Science (LSE), the study’s corresponding author.

“Every dollar produces outsized and sustained benefits for malaria-affected regions. In a constrained funding environment, identifying investments that consistently deliver is critical.” This evidence also underscores the vital role that investing in the PDP model plays in generating global health returns beyond any single organisation. “

The study was conducted by experts from the LSE and Imperial College London, in collaboration with Cambridge Economic Policy Associates. 

Malaria kills almost 600,000 people annually (2023 figures), 95% in Africa. Among the most affected are newborns and pregnant women.

A new Novartis anti-malarial drug designed for newborns and babies under 5kg, which was developed with MMV, was launched late last year in Ghana. 

Meanwhile, new treatments for pregnant women have just entered Phase 3 trials.

However, progress against the parasite is stalling, in part because a lack of resources and the parasite’s ability to mutate to develop resistance to antimalarial drugs. 

Growing resistance to artemisinin, the standard drug of care, is a huge challenge that highlights the need for new products.

The WHO forecasts an additional 78 million cases of malaria over the next five years in the absence of new treatments, which could result in 80,000 more deaths each year.

Climate-driven extreme weather events and conflict are also increasing the risk of malaria.

Image Credits: Peter Mgongo.

Social connection and healthy foods are key ingredients of Blue Zone Communities.

It’s a cold winter morning in Davos, but the pictures on the screen are aglow with warmth  – a 100-year-old man cuddling an infant; ancient women with faces wrinkled in laughter; aged men sharing a flask of local red wine;  and an extended family gathered around a Mediterranean meal of chickpeas, cheeses, salads and seafood. 

These are everyday scenes from the world’s best known “Blue Zone” communities – far-flung regions of the world with huge cultural, economic and geographic differences that share something deeply in common. 

In these Blue Zone communities, longevity is common and chronic disease is less prevalent, explained Dan Buettner Jr, executive vice president of the Blue Zones Initiative, at a session of the Davos Alzheimer’s Collaborative during the 2026 World Economic Forum (WEF). 

What are blue zones?

Centenarian women in Okinawa, Japan which has the longest healthy life expectancy in the world.

The term Blue Zones refers to “geographically demographically defined places of longevity,” explained Buettner, at the session in the DAC “Brain House”, which hosted a series of WEF side events  that zeroed in on the growing relevance of brain health to global health and economic policy. 

“These are longevity hotspots, places even at 10 times the rating we get in the United States.”

People in Blue Zone communities maintain the “longest disability free life expectancy in the world, seven good years longer than most Americans,” alongside “one-fifth the rate of dementia and a sixth the rate of cardiovascular disease,” he said.

Perhaps most striking is that wealth is not the driver: “Four out of five of these places are places that are at or below the poverty line, so they don’t have big pharmacies, billion-dollar health systems, big health plans, and yet they’re getting what we’re talking about right here.”

Dan Buettner maps out some of the world’s outstanding Blue Zones.

Flipping through scenes as diverse as Okinawa, Japan; Sardinia, Italy; Ikaria, Greece; Costa Rica and Loma Linda, a community of Seventh Day Adventists in Southern California, Buettner talked about their differences – but also what they still have in common. 

Sardinia, noted for its high number of centenarians, largely relies on a plant-based diet and strong social fabric.  Loma Linda, a tightly-woven community of Seventh-Day Adventists, emphasises a diet straight from the Bible, leading to a longer, healthier life. People in the Nicoya Peninsula in Costa Rica and Ikaria in Greece, a relatively poor Aegean Sea island, also have a high likelihood of reaching age 100, with a focus on natural movement, community connection, and celebrating life.

“Take Nicoya Peninsula, Costa Rica,” said Buettner.  There is abject poverty, and yet, according to the World Health Organization, if you can reach age 50 here, you have the highest likelihood of making it to 100 anywhere else on planet Earth. 

“And again, we see communities that are well connected, families that are nearby, people who are engaged in a purpose and a mostly vegetarian diet with lots of beans, beans, beans. So this idea that you have to be elite in order to afford good, whole food that’s healthy for you, is a myth.”

Even more revealing is the mindset of the people who live in the Blue Zones. Of the hundreds of centenarians in diverse communities surveyed, “not a single one pursued health, not a single one pursued fellowship or purpose or love for all of them, ensued as a byproduct of where they lived, that’s environment, and who they lived with, the culture, the rituals, the lifestyle,” Buettner observed. 

Those insights flip conventional wellness culture on its head. Longevity is less about individual discipline and more about the visible architecture of communities – the spaces where people move, as well as the foods most available for people to consume – and the invisible architecture of social connectivity.

Lessons from longevity hotspots

People in Blue zones consume healthy homemade foods, generally mostly vegetarian.

Across diverse regions of the world, patterns repeat with surprising consistency. Their lifestyles are not extreme; they are embedded.

“They all lived in environments and had hobbies, were they able to move a little bit every day, as opposed to the sedentary life that we have,” Buettner said. Social rituals matter just as much: “It is about the ritual of a glass of red wine over a healthy meal with friends… and of course, it all sits on a bedrock of connection.”

Purpose also plays a measurable role. “Purpose is good for four to six years of added life expectancy.”

The takeaway is clear: health is not pursued. It emerges from what Buettner calls the “Power Nine” best practices of Blue Zones, including: moving naturally, managing stress, eating a plant-heavy diet, living in a well-networked community with social rituals, and having a sense of purpose.

“None of these people was pursuing health or longevity or long life,” Buettner observed. “Ït ensued as a byproduct of where they lived, the culture that they belong to.”

Asked what people truly need in life, one 98-year-old grandmother offered a simple formula, Buettner recalled: “We all need four things: someone to love, something to do, some way to give back, and something to look forward to.”

He believes communities that deliver those essentials can transform public health. “If we can give that to people… they will do the transformation for us.”

Designing communities for brain health

Left to right: Jochem Reiser, UTMB, Dan Buettner, Blue Zones Project; Amy Dittmar, Rice University

“For decades, Blue Zones have shown real-world evidence that everyday environments supporting movement, connection, purpose and lifelong learning can prevent cognitive decline, dementia and preserve independence,” said Rice University’s Provost, Amy Dittmar, who moderated the discussion at the DAC Brain House in Davos. 

But after years of studying natural Blue Zones, researchers have begun asking a harder question: can such conditions be recreated in places where they haven’t emerged organically?

If Blue Zone communities could also be engineered, then the implications for healthier minds and dementia prevention could be enormous.

“Healthy neighborhoods lead to healthy neurons,” added Buettner, summing it all up.

Buettner believes they can, but only by shifting the focus away from the individuals and to the community settings. 

“Individual discipline is a muscle, and muscles always fatigue,” he said. “It’s hard to always make the right choice.”

Instead, success depends on structural change. “You don’t rely solely on individual discipline. You have to set people up for success. You empower them… with the invisible hand that nudges all of us all day long around food systems, tobacco and the built environment.”

When these elements align, Buettner argues, “you can literally engineer the effect of living in a Blue Zone anywhere in the world.”

To test out his theories, Buettner’s initiative has already linked up some 90 communities around the United States in a network of Blue Zone project communities. 

Communities in the network engage to promote healthier foods, more physical activity and ‘natural’ mobility via walking paths and bicycle lanes, as well as fora for social connectivity. 

Taken together the strategies mean that “when you step out of your door for your life mindlessly, you’re being inundated with a few more choices that are the healthy choices and they’re the easy choice,” as Buettner describes it.

Landmark collaboration 

New UTMB- Galveston partnership with the nationwide netework of Blue Zone projects.

But if Blue Zone communities can be engineered, can their health benefits also be measured more conclusively by researchers?  That question is now driving a landmark collaboration between Buettner and the University of Texas Medical Branch (UTMB) at Galveston, Texas.

UTMB is now partnering with the City of Galveston as well as Buettner’s Blue Zone network of some 90 US cities, to study the physical and human ecology of Blue Zones, and how they can improve help, said Jochem Reiser, President of UTMB at the session.  

“One of the biggest pushbacks we have got… is, where is the scientific evidence?” said Reiser. “Everybody believes it, but what’s the evidence?”

“We are going to create a research institute that studies the biological and the genetic underpinnings of Blue Zone,” Reiser explained. The effort aims to “define biomarkers and spark innovation as well as extending research beyond laboratories to “have impact in the communities.”   

Rice is also a part of the action, Dittmar observed, noting that the two universities are also collaborating in the context of the Rice Brain Institute – an interdisciplinary hub uniting experts in engineering, natural sciences and social sciences to advance brain health.   

Mapping longevity in Galveston

The new UMTB partnership is focusing first on the city of Galveston, Texas, a diverse coastal community seen as an ideal testing ground.

Buettner described the project’s ambition: “What we’re looking to do is to take a deeper clinical  dive into how environment and lifestyle can be expressed in the human body, whether it’s biometrics, whether it’s epigenetics.”

The approach breaks new ground. “What if we baseline people not with a program, a lifestyle program, but with an environment, and then had them just live their lives in that environment and then show that their lifestyle shifted?” Buettner asked.

Reiser sees Galveston as a microcosm. “We have a mix of people from all kinds of backgrounds… We also have centenarians, and we have people who die early. So we will study all of that.”

The UMTB collaboration also includes what Buettner called a “brain trust” compact with UTMB that will link their research and science powerhouse… with the Blue Zone Project’s international network of longevity experts and community experts to further advance the science of implementing lessons of the Blue Zones.”

Ultimately, the work aims to scale the insights “for everyone, whether they live in a Blue Zone project city or not.”

The added value of prevention

While the innate appeal of the Blue Zones is longer, healthier and happier lives, a stark financial reality is also a driver. 

“We spend seven times more on health care than any other nation, arguably not getting a very good return on investment,” Buettner warned. 

“Of that $4 trillion a year, which represents 20% of the American GDP, the predominance of it is spent on chronic disease, preventable chronic disease, and a fraction is spent on prevention. 

“And that [prevention part] is typically spent on diets, supplements, exercise, medication – short term wins, long term failures. Why is that? It’s because individual discipline is a muscle, and muscles always fatigue.

“The puck is moving,” Buettner said. With rising labor costs, inflation, and growing disease burden, the current system is “utterly unsustainable.”

“You’re a single mother, you’re a firefighter, you’re a nurse. Crap happens. It’s hard to always make the right choice. 

“But if you can get to a tipping point of people, places and policy, you can make the healthy choice, the easy choice, you can literally engineer the effect of living in a Blue Zone anywhere in the world.” 

Image Credits: Health Policy Watch .

African Union leaders sign an agreement with Rwanda’s Ministry of Health to establish the African Medicines Agency’s first headquarters in the capital, Kigali, in June 2023.

The African Medicines Agency (AMA) called on the 24 African member states that are yet to ratify the AMA Treaty to “act without delay” at a meeting on the sidelines of last week’s African Union assembly in Addis Ababa.

AMA aims to improve African countries’ capacity to regulate medical products, which will improve access to quality, safe and efficacious medical products on the continent. It will do so by harmonising regulatory requirements and practices across the national medicines authorities (NMRAs) of the AU member states. 

However, since the AMA Treaty was signed in 2019, it has only been ratified by 31 of the 55 AU member states, which is “leaving gaps in protection against substandard and falsified medical products and limiting the benefits of a unified African regulatory system”, according to a media release from the agency on Monday.

Ratification by 15 states enabled AMA to be established, with headquarters in Kigali, and in June last year, Ghana’s Dr Delese Mimi Darko was appointed AMA Director General.

Darko briefed the meeting last week, stressing that AMA wants to be universally ratified,  achieve WHO Listed Authority status and be financially self-reliant by 2030. 

“Over the past five years, we have moved from a treaty on paper to a living institution,” said Darko, who stressed that AMA is “already working hand‑in‑hand with member states that have ratified to strengthen regulatory systems, streamline joint assessments and increase reliance on shared expertise.”

Boost from Seychelles

At the meeting, Sebastien Pillay, Vice President of Seychelles, reaffirmed his country’s political support and committed $200,000 to AMA, doubling the seed fund contribution of $100,000 required of state parties. 

Tunisian Health Minister Dr Mustapha Ferjani reinforced the foundational importance of regulation, highlighting that “today, a single truth imposes itself: Africa’s health sovereignty depends on regulatory sovereignty. 

“Let us all ratify, and equip AMA with the capacity to act—with resources, skills, clear procedures, and effective governance. Our people deserve it, our health security demands it, and our sovereignty depends on it.” 

Ambassador Amma Twum‑Amoah, AU Commissioner for Health, Humanitarian Affairs and Social Development, described AMA as “a shared continental asset integral to delivering on the African Health Strategy 2030 and Agenda 2063, and the commitments our Member States have made to protect the health and wellbeing of their people.”

She affirmed that the Commission “firmly believes that universal ratification, full implementation and sustainable financing of the African Medicines Agency are achievable within this political cycle.”

 

Image Credits: Rwanda Ministry of Health.

Adapting to a much hotter world will include changing the design of buildings, moving away from glass high-rises.

Extreme heat will rise rapidly as the 1.5°C threshold is crossed, potentially causing half the world’s population to live in extreme heat by 2050, 

Shiny, glass-facade buildings are a symbol of modernisation and growth, but such buildings are dangerously vulnerable in a rapidly warming world, as they trap solar heat and will face much greater heat stress over their lifetime than expected, according to a new study from Oxford University. 

This disconnect between modern aesthetics and thermal reality is emblematic of a wider adaptation gap. While glass towers lock in high energy demand, the report’s findings focus on the more urgent scale of human exposure, tracking how billions in the most vulnerable communities will be forced to navigate a world of unprecedented heat.

Almost half the world’s population, almost four billion people, will be living with extreme heat by 2050 if the world reaches 2°C of global warming above pre-industrial times, according to the report, a global gridded dataset published in Nature Sustainability.

By population exposure, six countries – India, Nigeria, Indonesia, Bangladesh, Pakistan and the Philippines – will have the largest populations affected by the extremes. 

As absolute heat intensity surges, 20 countries, primarily in Africa, South America, and Southeast Asia, are estimated to see the greatest absolute change in heat intensity. The hottest countries are predicted to be Central African Republic, Nigeria, South Sudan, Laos, and Brazil.

Paradoxically, colder climates will see the largest relative change. Compared to the 2006–2016 period, a 2.0°C rise would more than double “uncomfortably hot days” in Canada and Austria, with Ireland seeing a staggering 230% increase.

The hottest 20 countries.

What are CDDs and HDDs?

The study’s results are measured in ‘cooling degree days’ and ‘heating degree days’ metrics commonly used in climate research and weather forecasting to estimate whether cooling or heating is needed to keep people within safe temperatures. 

Cooling Degree Days (CDDs) and Heating Degree Days (HDDs) are simple measures of how much heating or cooling buildings need. They compare outdoor temperatures to a reference temperature (often around 18°C). For example, a day with a mean outdoor temperature of 30 °C has 12 CDDs. Adding up all such days over a year gives the annual CDD value. A value of 3,000 CDD means that, over the year, temperatures are persistently high enough to create very large heat exposure. 

“In practical terms, 3,000 CDD signals that cooling is no longer optional or occasional — it becomes a central issue for building design, energy use, and health,” Jesus Lizana, one of the report’s authors, told Health Policy Watch. 

While the 18°C reference point helps policymakers and engineers to improve standards, ‘safety’ for the average citizen in the Global South is a far more complex equation. For a street vendor in Kolkata or the construction worker in Lagos, extreme heat isn’t just a matter of energy demand, but it’s a biological limit. 

Crossing the 1.5°C threshold means setting new public safety standards, for instance, based on wet-bulb temperatures, where humidity and heat combine to make outdoor labour life-threatening. These new standards need to ensure that adaptation strategies protect those without the luxury of living in glass buildings and air conditioning. 

The danger is 2030 not 2050 

The report’s most urgent finding is that the threat is not decades away. The most significant shifts in adaptation requirements occur in the early stages of warming, as we cross the 1.5° warming threshold.

“If we pass 1.5° around 2030 – which is likely – India will have an average CDD of 3,078. By 2050, it will have an (annual) average CDD of 3,248,” Radhika Khosla, of the Smith School of Enterprise and the Environment and an author of the report, told HPW. 

In comparison, a decade ago, between 2006 and 2016, when the world had warmed by 1 degree, India already had 2,864 CDDs annually. 

“Our study shows that India will continue to have the largest affected population globally, and that the number of extremely hot days it faces will rise exponentially as we pass 1.5°,” Khosla says. 

Global South: Hot, hotter 

The Central African Republic is predicted to see the greatest increase in heat intensity.

Countries in South Asia and Africa are more used to extreme heat, and 18°C days are usually a rarity in the countries mentioned in South and Southeast Asia, Africa and South America. But Khosla says that doesn’t mean its impacts will be any less acute, particularly when we are talking about a significant increase in the number of “dangerously hot days”.

In the authors’ assessment, while some Indian cities already have heat action plans to improve responses when temperatures rise, implementation needs accountability as the impacts of heat intersect across development priorities, such as healthcare, energy access, productivity, and education. 

In Africa, the Central African Republic and Nigeria face an even steeper challenge, the authors point out. They will need to adapt to ever more extreme heat while building reliable energy grids, all while dealing with life-threatening heat. 

“It is worth remembering that these countries are responsible for only a fraction of the emissions that have caused climate change, raising important questions of climate justice and adaptation finance,” Khosla adds.

What should policymakers do?

The warning is clear that the adaptation to higher temperatures needs to be sped up. Most increases in CDDs occur before reaching the 1.5° threshold across the top 20 countries, indicating that the most significant shifts in adaptation requirements occur in the early stages of warming – before 2030, rather than in a steady progression. 

This dataset provides a basis for incorporating new climate data into sustainability planning and development policy. For buildings, CDD is a useful metric to estimate and design the increased demand for cooling while ensuring it is sustainable – for instance, how to deliver more air conditioning but with lower emissions and power consumption. 

“This research adds to the body of evidence that heat exposure in vulnerable communities is accelerating, in some cases faster than many have predicted,” says Luke Parsons of The Nature Conservancy. 

Low-income nations with relatively higher social vulnerability are usually the least equipped to face some of the largest increases in extreme heat. 

“Unless we move to rapidly limit global warming, we are on track to see major impacts in the short and long term,” he says.

Rethink glass high-rises

Policy-makers need to rethink architecture, such as these glass buildings that characterise Dubai, to prepare for heat.

More visibly, this means that the glass high-rise buildings designed today will face much greater heat stress than expected. Building standards need to be updated to avoid locking in high energy use, overheating risks and costly retrofits later. 

“This is especially relevant for glass-facade high-rises, which have become symbols of growth but often perform poorly in hot conditions. Large glass areas trap solar heat, increasing cooling demand and vulnerability during heatwaves,” Jesus Lizana told HPW. 

Inclusive adaptation requires looking past the shiny skyscrapers to the neighbourhoods where most people actually live. In dense, low-income urban areas, the ‘Urban Heat Island’ effect can make local temperatures several degrees hotter than official weather station readings. 

Real adaptation, for the majority, looks like ‘cool roofs’ for informal housing, greater urban tree canopies to provide natural shade, and improving the energy grid to prevent the power outages that turn modest homes into ovens. The Oxford data shows that the most vulnerable communities are already on the clock.

The glass high-rise is emblematic of a larger disconnect: a modernisation strategy that prioritises aesthetics over global warming reality. For the billions living in informal housing or working outdoors, adaptation cannot be a luxury. 

The message for the Global South is clear. Policy choices made today must be built for the 1.5°C reality of 2030, not the cooler world of the past.

Image Credits: Erika Plepyte/ Unsplash, Shashi Yadav/ Unsplash.