Jubilant and exhausted members of the INB pose after marathon pandemic agreement talks finally result in unity.

World Health Organization (WHO) member states are very close to agreeing on the entire pandemic agreement – and may even have been able to clinch a deal on Saturday had they not been exhausted after negotiating from Friday morning right through until  9am on Saturday morning, according to sources.

Anne-Claire Amprou, co-chair of the Intergovernmental Negotiating Body (INB), told Associated Press  that “we have an accord in principle” – and indeed they almost do.

By sunrise on Saturday morning, the entire draft pandemic agreement had been agreed on – bar the vexing question of whether technology transfer related to the production of pandemic products should always be voluntary, reported by Health Policy Watch.

Several negotiators also need to get new mandates from their principles before they regroup at the final formal talks on Tuesday where the text expected to be approved for presentation at the World Health Assemby (WHA) next month.

The one outstanding issue involves whether technology transfer for producing pandemic-related health products shall be both “voluntary” and on “mutually agreed terms”, according to a footnote in Article 11.

Thirty legal experts argue in a letter sent to negotiators earlier in the week that the use of “voluntary” will undermine countries’ “sovereign right … to implement legislation within their jurisdiction, and equity in pandemic preparedness and response”.

Several countries have laws allowing non-voluntary measures under exceptional circumstances, including the United States Defense Production Act, and Germany’s Act on the Protection of the Population in Case of an Epidemic Situation of National Significance, passed in 2020 in response to the COVID-19 pandemic.

The INB Bureau proposed on Wednesday that the footnote should read: “For the purposes of this Agreement, transfer of technology refers to an agreed process where technology is transferred on mutually agreed terms. This understanding is without prejudice to and does not affect the measures that Parties may take in accordance with their domestic or national laws and regulations, and compliant with their international obligations”.

Brazil has since proposed a compromise, which reads:  “For the purposes of this agreement, ‘as mutually agreed’ means willingly undertaken and on mutually agreed terms, without prejudice to the rights and obligations of the Parties under other international agreements.”

This compromise appears likely to have struck the right note with member states and it looks as if Tuesday will see text of the entire agreement “greened” to show total agreement – positive news for global pandemic prevention, preparedness and response after three long and tough years of negotiations.

Image Credits: Thiru Balasubramaniam.

Half of the world’s population has no access to any kind of oral care and lives with untreated oral disease every day, according to Dr. Habib Benzian, a dentist and professor of epidemiology and health promotion at New York University.

“There’s no other disease group that affects so many people,” Benzian said.

In fact, oral health issues impact 3.5 billion people globally.

Benzian spoke on the most recent episode of Global Health Matters with Dr. Garry Aslanyan, alongside Bulela Vava, a dentist and president of the Public Oral Health Forum in South Africa. The discussion centred around the World Health Organization’s new global oral health strategy and action plan for 2023 to 2030. The plan calls for everyone to have access to essential oral health services—prevention, care, and rehabilitation—by 2030. However, the vision remains far from being realised.

Why the gap?

Benzian and Vava pointed to several barriers. One is the historical professionalisation of oral health as a separate field, which has led to its exclusion from broader health systems. Another is the framing of oral health as a private responsibility rather than a public health issue, keeping it out of many government-funded healthcare programs. There is also a widespread complacency and a lack of awareness that oral diseases affect overall health and should be taken seriously.

What needs to change?

Advocacy, the speakers agreed. Benzian noted that oral health professionals are often trained in clinical settings and focus on treating individual patients rather than driving systemic change. Yet, as Aslanyan said, the real challenge is for “us all to see our role not only as providers of care, but as mobilisers of community agency.”

Listen to more Global Health Matters podcasts on Health Policy Watch >>

Image Credits: TDR Global Health Matters.

Negotiators pose at the final meeting of the Intergovernmental Negotiating Body in Geneva

By sunrise on Saturday morning, the entire draft pandemic agreement had been agreed on – bar the vexing question of whether technology transfer related to the production of pandemic products should always be voluntary.

Negotiators talked into the early hours of Saturday morning, trying to find a way around the deadlock, according to sources close to the process.

Formal talks at the 13th meeting of the Intergovernmental Negotiating Body (INB) will resume on Tuesday, according to the World Health Organization (WHO).

“INB13 ends on Tuesday with several pieces to resolve. Several members states  have to clarify various positions with the capitals,” a WHO spokesperson told Health Policy Watch.

The negotiations were due to finish on Friday in time for a draft agreement to be prepared for the World Health Assembly (WHA) next month.

The standoff involves whether technology transfer for producing pandemic-related health products shall be both “voluntary” and on “mutually agreed terms”, according to a footnote in Article 11. 

Thirty legal experts argue in a letter sent to negotiators earlier in the week that the use of “voluntary” will undermine countries’ “sovereign right … to implement legislation within their jurisdiction, and equity in pandemic preparedness and response”.

Several countries have laws allowing non-voluntary measures under exceptional circumstances, including the United States Defense Production Act, and Germany’s Act on the Protection of the Population in Case of an Epidemic Situation of National Significance, passed in 2020 in response to the COVID-19 pandemic.

Insisting solely on voluntary measures will “defeat two principles that guide the Pandemic Agreement’s core objective: respect for the sovereign right of States to implement legislation within their jurisdiction, and equity in pandemic preparedness and response”, the experts note.

‘Voluntary’ – or bust?

However, the pharmaceutical industry has said that dropping “voluntary” is a no-no for them, and European nations that host large pharma companies – most notably Germany and Switzerland – have also dug in their heels on this issue.

The European pharmaceutical industry is facing tariff threats from the United States, and earlier this week, the European Federation of Pharmaceutical Industries and Associations (EFPIA) issued a “stark warning” to European Commission President Ursula von der Leyen that, “unless Europe delivers rapid, radical policy change then pharmaceutical research, development and manufacturing is increasingly likely to be directed towards the US”.

Knowledge Ecology International’s Jamie Love proposes using a caveat “without prejudice” to overcome the deadlock.

Various proposals have been made to accommodate differing positions. Knowledge Ecology International’s Jamie Love told negotiators on Friday morning that it “would make sense to say [Article 11] is without prejudice”, and does not affect the measures that parties may take in accordance with their own laws.

This is in line with what the INB Bureau proposed on Wednesday, namely that the footnote should read: “For the purposes of this Agreement, transfer of technology refers to an agreed process where technology is transferred on mutually agreed terms. This understanding is without prejudice to and does not affect the measures that Parties may take in accordance with their domestic or national laws and regulations, and compliant with their international obligations”.

However, there are other proposals on the table too, according to Third World Network. These involve:

  • Modifying the footnote;
  • Removing the footnote and using language from the Framework Convention on Tobacco Control (FCTC), Article 22 “as mutually agreed” after each mention of “transfer of technology” in the text;
  • Removing the footnote and using the whole FCTC text from Article 22, with slight adjustment for clarity;
  • Removing both the footnote and “as mutually agreed”, and using “consensual” and “reporting procedure”:
  • Removing the footnote and rephrasing.

Hopefully, negotiators will find a way to agree on one of these options to enable an agreement by Tuesday.

Racing against time

WHO Deputy Director-General Dr Mike Ryan said that the WHO Secretariat “will do whatever it takes to get them more time”.

“The reality is we’re against that time now if you consider that many member states will have to consult their capitals … before the [WHA] meeting in May,” Ryan told the WHO’s global media briefing on Thursday.

“The Assembly is, classically, a meeting of ministers of health and it often involves heads of state… so the people who will make the agreement at the Assembly are at a higher level. So the sooner negotiations can be concluded, the sooner we can prepare that process.” 

While negotiators “don’t have to have every ‘i’ dotted, they don’t have to have every comma agreed”, the text still needs to be subjected ao a legal scope, Ryan explained. 

“The member states will have to make a judgement themselves of how close they are. The negotiators downstairs [in the WHO headquarters in Geneva] are not WHO negotiators. The negotiators are … 192 sovereign states [excluding the US, which pulled out of the talks], and they will decide what happens next, and we will facilitate whatever they wish. 

“We will obviously offer them advice around timelines and what’s realistic and what can be done in advance of the Assembly. I’m always someone who’s very reticent to admit that you won’t make it and then add on more time, because in my world, work fills time, and if you make more time, the work will just stretch out to fill that time.”

However, he acknowledged that “there are real issues”, with single words having political, ideological and legal meanings. 

“The great thing we should celebrate is that there are currently over 190 member states in a basement, trying to find a way to work together, trying to find language that will protect eight and a half billion people from the next pandemic. 

“We should be celebrating the very fact that they’re in the room, given everything else that’s happening around the world, geopolitically and geo-economically.”

Image Credits: WHO.

The US Environmental Protection Agency is set to halt requirements for a majority of major polluters to report their emissions.

The federal agency responsible for protecting the environment in the United States will stop requiring most polluters to report their emissions of carbon dioxide, methane and other greenhouse gases that cause climate change.

The upcoming policy shift by the Environmental Protection Agency (EPA), first reported by ProPublica on Thursday, will effectively render the second-largest greenhouse gas emitter in the world, and largest historical emitter, blind to the pollution caused by its factories, fossil fuel industry and chemical plants.

The Greenhouse Gas Reporting Program, a publicly accessible database tracking US emissions since 2010, is widely used by lawmakers across the country to make policy decisions on health and environmental considerations of polluting facilities in local communities and to hold companies accountable for damages. The program currently tracks an estimated 90% of US emissions.

The EPA will cut reporting requirements for 40 out of 41 sectors currently required to submit emissions data, according to documents reviewed by ProPublica. The single sector that will remain under reporting obligations is known as Subpart W, and covers facilities involved in onshore and offshore production, processing, transmission, storage, and distribution of oil and natural gas products.

Only 2,300 of the 8,000 facilities currently required to report emissions will still be subject to the reporting requirements after the rule change. The rollback will make public scrutiny of heavy polluters more difficult as emissions that are not tracked cannot be regulated. It is likely to primarily benefit the petrochemical and energy-intensive manufacturing industries, such as cement, glass, iron and steel, by reducing compliance costs.

The program is also the source of a vast majority of the data submitted by the US to the United Nations on its emissions trajectory required under the Paris Climate Agreement, which Trump exited on his first day in office. 

The move comes as countries around the world try to move in the opposite direction and reduce emissions as weather threats intensified by climate change drive increasingly severe floods, storms and droughts globally. Trump’s withdrawal from the Paris agreement saw the US  join Iran, Libya and Yemen as the only countries on the planet that are not part of the accord. 

Why?

Lee Zeldin, Trump’s EPA chief, has declared that his agency is “driving a dagger straight into the heart of the climate change religion.”

The motivation for the move, while reflecting the Trump administration’s position that the federal government should not be involved in fighting or studying the effects of climate change on the US and the world, is not immediately clear. The primary beneficiaries, however, will be large industrial polluters.

The move was first hinted at in a press release posted by the EPA on 12 March, when Lee Zeldin, the agency’s administrator, announced that his agency was “reconsidering” the emissions reporting programme as part of a set of 31 policy reviews in “the greatest and most consequential day of deregulation in the history of the United States.”

“The Greenhouse Gas Reporting Program is another example of a bureaucratic government program that does not improve air quality,” Zeldin said at the time. “Instead, it costs American businesses and manufacturing millions of dollars, hurting small businesses and the ability to achieve the American Dream.”

The move to gut emissions reporting is directly referenced in Project 2025, the behemoth 900-page far-right policy blueprint underpinning many actions taken by the Trump administration in its early months. The document echoes Zeldin’s critique that it is a burden on small businesses, advising the EPA to “remove” it.

Yet to qualify for mandatory reporting requirements, businesses must emit at least 25,000 metric tons of carbon dioxide equivalents per year – a high threshold that excludes the vast majority of what may be considered “small businesses.”

This is equivalent to 58,000 barrels of oil consumed or nearly 14,000 tonnes of coal burned, according to the EPA’s own Greenhouse Gas Equivalencies Calculator. At the average price of $80.53 per barrel for Brent crude oil in 2024, those barrels would be worth about $4.7 million.

The regulation was designed with this high threshold specifically to protect small businesses from onerous reporting requirements. 

Eliminating reporting as emissions rise

A Carbon Brief analysis of President Trump’s climate and energy policies estimated his re-election would add new emissions equivalent to the annual output of the world’s 140 least polluting nations by the end of the decade.

One plausible benefit of the elimination of the programme is to limit public scrutiny of emissions amid plans by the Trump administration and Project 2025’s policy paper to vastly increase US emissions.

An analysis of plans published by the Trump administration conducted by Carbon Brief found his re-election was likely to add four billion tonnes of US emissions by 2030, equivalent to the combined annual emissions of the European Union’s 27 member-states and Japan, or 140 of the world’s smallest emitter nations.

“Put another way, the extra 4GtCO2e from a second Trump term would negate – twice over – all of the savings from deploying wind, solar and other clean technologies around the world over the past five years,” the analysis found.

Project 2025 meanwhile proposes a similar trajectory. A separate analysis found the policy proposals outlined would increase US emissions by 2.7 billion tonnes above its current trajectory by 2030. Ross Vought, the architect of Project 2025, is in Trump’s cabinet and leads the Office of Personnel Management (OPM).

An analysis by Energy Innovation Policy & Technology, a non-partisan energy and climate policy think tank, found Project 2025’s policies would “significantly increase” US emissions.

Regardless of the stated justifications, the policy shift clearly aligns with the broader agenda of the administration that the federal government should have nothing to do with studying or funding climate change initiatives.

In what Zeldin termed the “most momentous day in the history of the EPA” in March when he first mentioned eliminating the GHG Reporting Program, his agency announced the rollback of 31 separate regulations on climate.

These included revising measures “throttling the oil and gas industry,” safety standards for mercury and toxic air that “improperly targeted coal-fired power plants,” and slashing national standards set by the EPA that control the discharge of pollutants in wastewater from industrial facilities produced during extraction operations like drilling, fracking, and production, among an array of other measures softening rules on pollution of all kinds.

“We are driving a dagger straight into the heart of the climate change religion,” Zeldin said in March. “We are living up to our promises to unleash American energy, lower costs for Americans, revitalize the American auto industry.”

The EPA has not responded to a request for comment from Health Policy Watch at the time of publication. 

Lobbyists in control

An ExxonMobil plant towers over the landscape outside Chicago, Illinois. Lobbyists who recently represented the fossil fuel giant are now key figures gutting the Trump era EPA.

The political appointees who have tasked the EPA with rolling back reporting requirements have direct and recent ties to America’s petrochemical industry, public records show.

Abigale Tardif, the Principal Deputy Assistant Administrator at the EPA’s Air and Radiation Office, was identified by ProPublica as the appointee who instructed the agency’s staff to draft the regulation that would eliminate emissions reporting.

Tardif was still listed as a lobbyist on the website of the American Fuel and Petrochemical Manufacturers (AFPM) – an industry group including Chevron, ExxonMobil, and Koch Industries that spent over $27 million lobbying in 2024 – when her appointment was announced.

She previously worked as a lobbyist for the Ohio-based Marathon Petroleum, which is a member of AFPM, according to public records. Her lobbying portfolio included pushing for the repeal of Biden-era tailpipe emissions standards as well as “unspecified air regulations on refineries and petrochemical plants along with vehicle fuel economy standards,” according to public quarterly disclosure reports seen by Politico.

Aaron Szabo, who is awaiting confirmation as assistant administrator to the office, was also confirmed to be present at the meeting by ProPublica. His recent work includes lobbying for the American Chemistry Council, which includes fossil fuel titans such as Chevron, ExxonMobil and Shell, and the American Petroleum Institute, among others, public records show.

Combined, just three of the clients represented by Tardif and Szabo – the American Petroleum Institute (API), American Chemistry Council (ACC) and American Fuel and Petrochemical Manufacturers (AFPM) – spent over $56 million on lobbying in 2024 alone.

Zeldin, the EPA chief, received over $410,000 from the oil and gas industry during his runs for Congress and governor of New York, public records show. He was a frequent opponent of all types of climate action during his time in Congress.

On Tuesday, Zeldin said his EPA supports “clean beautiful coal” following a Trump administration executive order prohibiting federal agencies “discriminate” against coal and waiving crucial air-pollution regulations on plants across the country – effectively granting the industry both increased pollution rights and freedom from public scrutiny.

Climate purge across US government 

Trump is cutting $4 million in federal funding for climate change research at Princeton University, saying the work promoted “exaggerated and implausible climate threats” and increased “climate anxiety” among young Americans.#HeadInTheSandwww.bostonglobe.com/2025/04/09/n…

— Climate Risk Economics (@climateeconomics.bsky.social) 2025-04-10T08:10:42.362Z

The plan to stop tracking emissions that cause climate change is part of a wider assault on climate science and discourse that began the day Trump retook the White House.

Beyond the EPA, mentions of climate are being targeted across every government website, grant program and policy.

The Trump administration has gutted government support for scientific research in the US and abroad that contains the word “climate” at all. This ban on referencing the climate crisis in research includes grants issued by federal agencies, research within those agencies, as well as outside academic institutions.

One environmental scientist who did not want to be named told The Guardian their previously awarded grant from the Department of Transportation for climate-adaptation research had been withdrawn, until they renamed it to remove the word “climate.”

“I still have the grant because I changed the title,” the scientist said. “I was told that I needed to do so before the title of the grant was published on the US DoT website in order to keep it. The explanation was that the priorities of the current administration don’t include climate change.”

Over $20 billion in grants for climate research have been terminated, including $4 million to Princeton University cancelled on Monday, which the White House accused of promoting “exaggerated and implausible climate threats” that increase “climate anxiety” in young Americans. 

Princeton was running programs with the National Oceanic and Atmospheric Administration (NOAA) focused on forecasting weather models for water access and extreme weather events, modeling climate risks and predictions to advance adaptation strategies for a world on track for 3.1C warming by 2100 – catastrophic warming by all model predictions.

“Its focus on alarming climate scenarios fosters fear rather than rational, balanced discussion,” the Department of Commerce said in a press release announcing the funding cuts to Princeton. 

It added one of the research programs “suggests that the Earth will have a significant fluctuation in its water availability as a result of global warming. Using federal funds to perpetuate these narratives does not align with the priorities of this Administration and such time and resources can be better utilized elsewhere.”

US military drops ‘climate change crap’

The Pentagon has seen a similar purge despite its long history of climate security planning. The US military has cancelled more than 90 studies related to climate change impacts on national security in the US and abroad. 

“The Department of Defense does not do climate change crap,” US Defense Secretary Pete Hegseth declared on social media, a statement later confirmed as “Fact check true” by an official Pentagon account.

This dramatic shift contradicts the military’s own long-standing position. The Department of Defense has officially recognized climate change as a “threat multiplier” since at least 2010, noting it can exacerbate existing security threats. In 2014, the Pentagon released a Climate Change Adaptation Roadmap that called climate change an “immediate risk to national security.”

“Today, no nation can find lasting security without addressing the climate crisis. We face all kinds of threats in our line of work, but few of them truly deserve to be called existential. The climate crisis does,” then-Secretary of Defense Lloyd Austin stated in 2021.

US lobbying efforts have historically resulted in military activities being exempted from landmark UN climate agreements. The Kyoto Protocol contained no requirements for military emissions reporting, and the 2015 Paris Agreement makes armed forces emissions reporting optional – exemptions that have also benefited other major military powers like China and Russia.

Meanwhile, the US Department of Defense has become by far the world’s largest single institutional consumer of fossil fuels. A 2023 report found the United States and United Kingdom armed forces emitted at least 430 million tons of CO₂ since the Paris accord was signed — more than the UK’s total emissions in 2022. Ninety percent of those emissions were attributed to the US military.

If the planet’s militaries were a country, they would have the fourth-largest national carbon footprint, exceeding that of Russia. 

“We are stripping away support for these studies to restore the warrior ethos and refocus our military on its core mission of deterring, fighting and winning wars,” Pentagon spokesperson John Ullyot said in a statement. “Climate zealotry and other woke chimeras of the Left are not part of that core mission.”

Image Credits: Gadge Skilmore, Richard Hurd.

Africa CDC headquarters
Africa CDC’s head office in Addis Ababa, Ethiopia.

Amid bleak global economic and development aid trends, Africa’s Centres for Disease Control and Prevention (Africa CDC) is piloting innovative financing solutions and doubling down on efforts to get member states to invest more domestic funds in health.

A week ago, Africa CDC launched a new financing guide for member states and on Friday the continental body announced that it was starting to implement the first phase, which will focus on “updating national health financing plans in 30 countries, piloting innovative revenue mechanisms, and launching transparency dashboards”. 

The strategy urges governments to allocate at least 15% of national budgets to health, as agreed by the 2001 Abuja Declaration, which was adopted during another crisis: the HIV and tuberculosis pandemics.

Its proposals on innovative financing include “solidarity levies on airline tickets, alcohol, and mobile services, while exploring how Africa’s US$95 billion in annual diaspora remittances can support national health priorities”, according to the body. 

Finally, it proposes blended financing to “unlock public and private capital for critical investments in infrastructure, digital health, and local production of vaccines and medical supplies”.

Phase 2 (2026–2030) will scale successful approaches and aims to ensure that at least 20 countries can finance 50% or more of their health budgets through sustainable domestic sources.

“Africa cannot continue outsourcing its health security,” said Dr. Jean Kaseya, Director General of Africa CDC. “This strategy is not about aid—it’s about ownership. We are building a future where Africa invests in its people, drives its own health agenda, and responds to crises with speed, strength, and self-reliance.”

Mpox continues to rise

Professor Yap Boum of the Incident Management Support Team

Meanwhile, at the Africa CDC briefing on Thursday, Professor Yap Boum, the Africa CDC’s deputy head of the Incident Management Support Team, reported that Uganda’s mpox outbreak is continuing to spread, increasing by 30% in the past week (from 190 to 247 confirmed cases).

Boum attributed the spread of Clade 1b to complex sexual networks, including sex workers with multiple daily clients.

“Mpox, specifically the Clade 1b strain, is sexually transmissible. Yesterday, Uganda’s incident manager informed us that there are sex workers who have up to 10 clients per day,” said Boum.

“Sexual networks remain the key driver of the outbreak [in Uganda], with cases spreading in slums, semi-urban, and urban areas. Last week, Mbarara City and Masaka City accounted for 50% of daily incidence,” Boum noted.

Unlike the Democratic Republic of Congo (DRC), however, Uganda is managing to test all its suspected mpox cases, 60% of which have been positive.

Uganda has also faced Ebola and Crimean-Congo hemorrhagic fever (CCHF) outbreaks in the past month.

While mpox cases in the DRC decreased slightly over the past week, the burden is likely underestimated because of challenges with testing, which has been adversely affected by the withdrawal of US funding and conflict in North and South Kivu.

Kinshasa was also affected by torrential rains in the past week that resulted in the Limete Health Center and other health facilities being submerged under water, damaged roads and power and water outages across multiple health facilities in Kinshasa.

However, testing in the DRC has risen over the past week from 18.4% of suspected cases to 21.7%, largely as a result of decentralised laboratory services. Three new Gene Xpert testing machines have been deployed and 26 laboratories are now functional.

Image Credits: Africa CDC .

Dr Tedros Adhanom Ghebreyessus

Health services worldwide have been “severely disrupted” by the United States slashing aid, and the World Health Organisation (WHO) is radically reducing its operations following the US withdrawal from the global body – but there has been no formal engagement between the WHO and the White House.

WHO Director-General Dr Tedros Adhanom Ghebreyessus revealed this at a press conference on Thursday, reporting that three-quarters of the over 100 countries had reported “severely disrupted” services, a quarter had closed health facilities and a quarter were charging patients more for services.

The US owes the WHO $260 million in membership fees for 2024-25. The Biden administration failed to pay fees last year and the US is liable for this year’s fees as it is obliged to give a year’s notice of its withdrawal form the body. 

But there has been no formal engagement between the WHO and the White House since Trump issued an executive order on 20 January withdrawing from the WHO, said Tedros.

“I hope there will be some formal engagement, or a very honest and candid dialogue for the US to come back to the World Health Organisation. It’s in the best interest of the US to stay in WHO. It’s a health security that keeps the US safe and the rest of the world safe,” he added.

Ongoing talks between the remaining 192 WHO member states on a pandemic agreement, expected to conclude this week, would “set the rules of the game” in a future pandemic to ensure that the world is safer, added WHO Deputy Director-General Dr Mike Ryan.

“The great thing about an international rules-based system is we all agree how the game is played, and we really do need to play a better game in the next pandemic, and this is the way to do it,” added Ryan.

The US has pointedly removed itself from the pandemic agreement negotiations, erroneously claiming that a pandemic agreement will infringe on its soverignty.

Prioritise the poorest

In response to the loss of US aid, countries are “revising budgets, cutting costs and strengthening fundraising and partnerships,” said Tedros, reporting on efforts by South Africa, Nigeria and Kenya to increase their domestic allocations to health.

He advised countries to prioritise their poorest citizens, protecting them from being impoverished by additional health spending, and to resist cutting public health spending, instead improving efficiency.

“Absorb as much of the impact as possible through efficiency gains in health systems, including.. improving procurement, minimising overheads, pooling purchasing of goods and services, and using health technology assessment to guide decisions on which services and products provide the biggest health gains,” Tedros advised.

Countries can also increase revenue by introducing or increasing taxes on products that harm health, including tobacco, alcohol and sugary drinks, he added.

Unpaid WHO membership fees

Dr Mike Ryan

The WHO is in the midst of intense reprioritisation following the loss of around a quarter of its budget. It faces a gap of $2,5 billion for the 2025/27 period, according to a recent Health Policy Watch report.

Ryan, who chairs the WHO prioritisation committee, said that the pain being experienced at WHO was a “ha’penny space” in “the hierarchy of suffering”.

“However, we recognise that we’re in a situation where, with the advice and with cooperation with our member states, we need to contract the amount of money we absorb as an organisation to do the work we do,” said Ryan.

“We’re approaching that very, very responsibly in terms of cost containment, resource mobilisation” and prioritisation of activities, he said.

“We have to have a new budget on the table for the World Health Assembly [next month]… and there will have to be a new set of priorities, and obviously an organisational design that can deliver that.”

Aside from $260 million hole left by the US withdrawal, other member states owe the WHO $193 million in unpaid membership fees (called “assessed contributions”), according to a report compiled for the World Health Assembly next month.

The voting privileges of Afghanistan, Central African Republic, Comoros, Dominica, Lebanon, Sierra Leone, Somalia, South Sudan, Sudan, Venezuela and Yemen remain suspended as a result of unpaid fees.

Algeria, Bolivia, Cameroon, Grenada, Iran, Myanmar, Panama and Saint Lucia may also lose their voting rights as a result of unpaid fees for 2024 and 2025.

Gaza blockade

A child forages in Gaza rubble.

Tedros also condemned Israel’s “complete blockade” of Gaza since the breakdown of the ceasefire on 2 March, in which it has prevented all food and medicine from entering into Gaza.

“In the past week, 75% of UN missions within Gaza have been denied or impeded. This blockade is leaving families hungry, malnourished, without clean water, shelter and adequate health care, and increasing the risk of disease and death,” said Tedros.

During the ceasefire, WHO had been able to resupply the health system and its warehouses but those supplies “will run out in two to four weeks unless the siege is lifted”, he added.

“Some 180,000 doses of routine childhood vaccines, enough to protect 60,000 children under the age of two, have not been allowed to enter leaving newborns and young children at risk,” said Tedros.

“Since the breakdown of the ceasefire, almost 400,000 people are estimated to have been displaced again with no safe place to go, and almost 1500 people have been killed, including 500 children,” said Tedros.

“The health system is only functioning partially and is overwhelmed. Meanwhile, healthcare continues to be attacked. On the 23 March, the Israeli army attacked a medical and emergency convoy, killing 15 health and humanitarian workers.”

On Wednesday, WHO assisted in evacuating 18 patients and 29 companions to Norway, Malta, Luxembourg and Romania but “more than 10,000 other patients are still awaiting evacuation” for medical treatment.

“WHO calls for the urgent lifting of the aid blockade, the protection of healthcare and embedded humanitarian access across Gaza, the immediate resumption of daily medical evacuations, the release of hostages still detained in Gaza, and above all, a ceasefire,” Tedros concluded.

Image Credits: UNICEF/UNI501989/Al-Qattaa.

A technician works on production of medicines.

Patients will face costlier medicine and European and Indian drug companies face billion-dollar losses if US President Donald Trump’s threat issued late Tuesday of “a major tariff on pharmaceuticals” produced outside his country is realised.

However, amid chaos on the financial markets, Trump back-pedalled on Wednesday and announced a 90-day pause on all tariffs except for China – where he announced a 125% tariff on Chinese goods.

Trump’s threat was made a few hours after major European pharmaceutical companies met with European Commission (EC) President Ursula von den Leyen, urging her to negotiate with the US or they would face supply chain issues, according to Euro News.

The European Federation of Pharmaceutical Industries and Associations (EFPIA) issued a “stark warning to President von der Leyen that unless Europe delivers rapid, radical policy change then pharmaceutical research, development and manufacturing is increasingly likely to be directed towards the US,” in a statement on Tuesday.

Eighteen EFPIA member companies identified “as much as 85% of capital expenditure investments (approximately €50.6 billion) and as much as 50% of R&D expenditure (approximately €52.6 billion) potentially at risk” in an industry survey. 

“This is out of a current combined total of €164.8 billion in investments planned for the period 2025-2029 in the EU-27 territory. Over the next three months, companies that responded estimate that a total of €16.5 billion ie. 10% of the total investment plans is at risk,” the federation noted.

‘Little incentive to invest in Europe’

“In addition to the uncertainty created by the threat of tariffs, there is little incentive to invest in the EU and significant drivers to relocate to the US,” the federation warned, noting that the US “now leads Europe on every investor metric from availability of capital, intellectual property, speed of approval to rewards for innovation.

They called on von der Leyen to develop a competitive EU market that “rewards innovation”, stronger intellectual property provisions, and “policy coherence across environmental and chemical legislation to secure a resilient manufacturing and supply chain of medicines in Europe”.

“Europe needs to make a serious commitment to invest in a world-class pharmaceutical ecosystem, or at best, risk being reduced to a consumer of other region’s innovation.”

Pharma giants Bayer, Novartis, Novo Nordisk, Roche and Sanofi are based in Europe. Their shares all tumbled by around 5%, while US pharma companies’ shares fell by 3-6 %, according to Reuters. Shares in the UK-based AstraZeneca and GSK also lost value.

Costly to relocate

The share price of US pharmaceutical giants including Pfizer, Johnson & Johnson, Eli Lilly, Bristol-Myers Squibb, Gilead and AbbVie also lost value. These have significant European manufacturing capacity, based primarily in Ireland and it would be costly to relocate.

Han Steutel, head of the German Association of Research-Based Pharmaceutical Companies (VFA), said that moving production to the US could cost billions of dollars and take five to 10 years to set up.

“It will be devastating for patients if medication is no longer available as they cannot easily switch from one drug to another, like with other commodities,” Steutel told CNBC.

‘We are a global industry in terms of research and development and production,” said Steutel. “Unlike with generic companies, the active [pharmaceutical] ingredients for patented drugs are solely produced in Europe or the US,” he said.

“If a company has a plant producing this in Europe it’s not going to set up another plant in the US or vice versa because it would just make the production process inefficient,” he noted.

Huge losses for Indian companies

​​However, 90% of API for US medicines are manufactured outside that country – by 2021, mostly in India (48%), followed by Europe (22%) and China (13%). 

Indian companies face potentially huge cost increases from tariffs on pharmaceutical products as the US is their biggest market – worth $8.7 billion in 2024, according to the Pharmaceuticals Export Promotion Council of India.

Some 45% of US generics are made in India and tariffs would cause price hikes that would affect both patients and companies outside the US.

However, given Trump’s last-minute flip-flop on tariffs, uncertainty is only certain element of the US’s global trade war.

Image Credits: AMR Industry Alliance.

Rain falls on a camp in Khan Younis where some of the 1.9 million Palestinians displaced by the violence shelter.

Heads of six UN agencies including the World Health Organization, UNICEF, and the World Food Programme issued a desperate warning that blockades of aid, food, medicine and life-saving supplies to Gaza since Israel resumed its attack on the enclave show “utter disregard for human life.”

“For over a month, no commercial or humanitarian supplies have entered Gaza,” the agency chiefs wrote in a joint statement with the Office for the Coordination of Humanitarian Affairs (OCHA), UN Relief and Works Agency (UNRWA), and UN Office for Project Services (UNOPS) on Monday.

“More than 2.1 million people are trapped, bombed and starved again, while, at crossing points, food, medicine, fuel and shelter supplies are piling up, and vital equipment is stuck,” the letter continues, calling on world leaders to “act – firmly, urgently and decisively – to ensure the basic principles of international humanitarian law are upheld.”

Since Israel broke the ceasefire in March, the humanitarian situation has dramatically deteriorated. The letter authored by UN leaders is the latest alarm sounded by humanitarians as Israel’s military enforces a blockade on essential food and medicine while its troops press deeper into Gaza. 

The Ministry of Health in Gaza reports that at least 50,523 Palestinians have been killed and 114,776 injured since the war began, including 1,163 deaths and 2,735 injuries since the escalation of hostilities three weeks ago. A study published in The Lancet in January found the statistics published by Gaza’s Health Ministry likely underestimate the true death toll by as much as 40%, placing the total deaths at 61,000 four months ago. 

Approximately 1.9 million Palestinians—nearly everyone in the territory—have been displaced by the fighting, most several times. Much of the territory has been leveled into uninhabitable rubble, with entire cities like Rafah, once home to hundreds of thousands of people, effectively deleted from the map.

“We are witnessing acts of war in Gaza that show an utter disregard for human life,” the UN leaders wrote. “Protect civilians. Facilitate aid. Release hostages. Renew a ceasefire.”

Israel launched the offensive in response to Hamas’s October 7, 2023 surprise attack on over a dozen Israeli communities on the periphery of the Gaza enclave, during which militants killed 1,200 people, mostly civilians. 

Another 251 Israelis and foreign nationals were taken hostage.  Over 100 hostages, mostly women and children, were released in an initial week-long truce in November, while several more were rescued alive and the bodies of others found in Gaza by the Israeli military. 

Israel’s UN mission in Geneva, responding to the UN agencies’ letter, did not refer directly to the humanitarian crisis or its blockade, blaming “the terrorist organization Hamas” as the “first and foremost cause of suffering in the Gaza Strip… cynically seeking to maximize civilian harm as a matter of strategy.”

“All international organizations” should “uniformly call for the immediate and unconditional release of the 59 hostages” still held by Hamas, the mission said.  Among the 59 hostages still held captive in Gaza, only 24 are believed by Israel to be alive.

Humanitarian progress reversed

As food stocks in #Gaza run out, WFP's various assistance programmes are gradually shutting down.◼️All WFP-supported bakeries are closed◼️Last food parcels were distributed this week◼️Hot meals continue, but supplies are running lowWe urgently need aid to enter Gaza.

— World Food Programme (@wfp.org) 2025-04-04T11:40:34.396Z

During the ceasefire, UN and humanitarian agencies made vital progress in Gaza after Israel temporarily ended its blockade – a practice that violates international humanitarian law’s prohibition on collective punishment of civilian populations. Aid workers rushed to alleviate the most urgent crises, treating malnourished children, rehabilitating hospitals, and replenishing critical food and medicine stocks.

“The latest ceasefire allowed us to achieve in 60 days what bombs, obstruction and lootings prevented us from doing in 470 days of war: life-saving supplies reaching nearly every part of Gaza,” the joint UN agency letter stated.

UNICEF began repairing critical wells and water points to increase safe drinking water access. Now that progress has been wiped away by renewed fighting and blockades.

“While this ceasefire offered a short respite, assertions that there is now enough food to feed all Palestinians in Gaza are far from the reality on the ground, and commodities are running extremely low,” the agency chiefs warned.

All 25 UN subsidized bakeries that were opened during the last reprieve have now closed due to a lack of cooking gas and flour. WFP reports approximately 5,700 tons of food stocks remain in Gaza—enough to support its operations for a maximum of two weeks.

With 91 percent of Gaza’s population facing crisis-level food insecurity, families are struggling amid unprecedented destruction and constant displacement, WFP said on Monday.

Health system on the brink

Latest data on Gaza’s health system according to the World Health Organization.

Gaza’s health infrastructure, already in ruins, now faces total collapse. The fragile system is overwhelmed by casualties, particularly among children, while essential medicines and supplies rapidly dwindle.

“The partially functional health system is overwhelmed. Essential medical and trauma supplies are rapidly running out, threatening to reverse hard-won progress in keeping the health system operational,” the joint letter states.

The situation is particularly dire for pregnant women and children. An estimated 55,000 women are pregnant in Gaza, with one-third facing high-risk pregnancies. Around 20% of the 130 babies born each day are pre-term, underweight, or born with complications, needing advanced care that is rapidly diminishing.

“Gaza continues to be one of the most dangerous places to be a child and where pregnancy is clouded by fear due to ongoing violence, displacement and lack of medical access,” WHO reported over the weekend.

Médecins Sans Frontières warns that the month-long siege has forced their teams to ration medications and turn patients away. Critical medications including pain killers, anesthetics, pediatric antibiotics, and medicines for chronic conditions are running out.

“The Israeli authorities have condemned the people of Gaza to unbearable suffering with their deadly siege,” says Myriam Laaroussi, MSF emergency coordinator in Gaza. “This deliberate infliction of harm on people is like a slow death; it must end immediately.”

“UNICEF has thousands of pallets of aid waiting to enter the Gaza Strip,” said UNICEF Regional Director for the Middle East and North Africa Edouard Beigbeder. “Most of this aid is lifesaving – yet instead of saving lives, it is sitting in storage. It must be allowed in immediately. This is not a choice or charity; it is an obligation under international law.”

As the blockade continues and bombs fall, UNRWA chief Philippe Lazzarini echoed UNICEF’s concerns for Gaza’s youth, who represent nearly half of the territory’s population.

“The ceasefire at the beginning of the year gave Gaza’s children a chance to survive and be children,” said Lazzarini, citing a new UNICEF report which found an average of 100 children have been killed or injured in Gaza every day since the war began.

“The resumption of the war is again robbing them of their childhood,” Lazzarini added. “The war has turned Gaza into a ‘no land’ for children.”

Humanitarian workers in the crosshairs

More aid workers have died in Gaza than any conflict since data recording began.

The joint UN statement comes on the heels of a bloody incident near Gaza’s southern border in Rafah on 23 March, when Israeli forces shot dead 15 Palestinian emergency workers, before burying their bodies in a shallow grave along with the crushed remains of their vehicles.

A video released by the Palestine Red Crescent Society, obtained from the cell phone of one of the victims of the attack, contradicted initial Israeli military claims that the emergency vehicles were not properly marked. The footage, published by the New York Times, clearly showed ambulances with lights and emergency signals on when they came under fire.

“During [the] day and at night, it’s the same: external and internal lights are on. Everything tells you it’s an ambulance that belongs to the Palestinian Red Crescent,” the sole survivor of the incident, Munther Abed, told the BBC. “All the lights were on until we came under direct fire.”

The Palestine Red Crescent released a video made by a paramedic before he was killed by Israelis in Gaza, and called the deaths of 15 rescue workers “a full-fledged war crime.” Israel has said it is investigating, but Red Crescent officials called on the UN for an independent investigation.

— The New York Times (@nytimes.com) 2025-04-07T18:23:22.084Z

The world looked on as aid workers in Gaza have been killed at a rate unprecedented in modern humanitarian operations, making this the deadliest conflict for UN workers in the history of the organization founded after World War II.

Since 2023, 411 aid workers have been killed in the Occupied Palestinian Territories—more than eight times the total killed in the previous two decades combined. The recent period represents approximately 89% of all recorded aid worker deaths in the region’s history, including all previous conflicts with Israel, according to an International Aid Worker Security Database.

WHO has recorded 670 attacks on healthcare workers or facilities in Gaza and another 754 in the West Bank since the war began. Israel accuses Hamas of militarizing Gazan schools, healthcare facilities and hospitals, including the holding of numerous hostages in at least one hospital in the first stages of the war.

The toll on journalists is equally unprecedented in modern warfare. Between 147 and 232 journalists have been killed in Gaza since October 7, 2023—more than in the U.S. Civil War, World Wars I and II, the Korean War, the Vietnam War, the wars in Yugoslavia, and the post-9/11 war in Afghanistan combined—according to the Brown Institute for the Costs of War.

“What is happening here, it defies decency, it defies humanity, it defies the law,” said Jonathan Whittall, head of OCHA’s office for the Occupied Palestinian Territory. “It really is a war without limits.”

A mother and newborn at a health center in the Patna district of Bihar, India. International aid cuts threaten progress on maternal health.

Maternal mortality rates have dropped by 40% since 2000, largely due to improved access to essential health services. But WHO officials warn that the recent, deep cuts to international aid could be as disruptive as the COVID-19 pandemic, if not more so, to a woman’s chances of surviving pregnancy and childbirth.

And in 2023, more than a quarter million women still died from pregnancy and childbirth complications, according to a report on global maternal mortality released on Monday, World Health Day, which focused on maternal and newborn health.

That’s a death every two minutes. 

“This is not just a medical failure,” said Dr Pascale Allotey, director of the WHO Department of Sexual and Reproductive Health and Research, at the report’s launch. “It’s a failure of society.”

The report by UNICEF, WHO and the UN Population Fund (UNFPA) comes as the dismantling of most of USAID’s international health programmes, and other cuts to health and humanitarian aid send shockwaves through global health, forcing countries to roll back vital services for maternal, newborn and child health, the WHO said. 

Without urgent action, fading attention, funding cuts, and humanitarian crises will jeopardize pregnant women in conflict settings – and make the persistent tragedy of maternal mortality “alarmingly high,” warned WHO officials convened at a press conference last week. 

International aid cuts could mirror COVID-19 chaos

Maternal mortality ratios 2000-2023 by SDG region.
Maternal mortality ratios by region. The COVID-19 pandemic caused an upsurge in deaths, particularly in 2021.

This year’s report is also the first to delve into how the pandemic affected deaths from pregnancy-related conditions.

“I hate to use the term ‘surviving’ pregnancy,” said Dr Bruce Aylward, WHO assistant director general for Universal Health Coverage and life course at a press conference. “But that’s what our reality is.”

The pandemic “shocked” health systems, said Aylward, meaning that many women could not access needed care for their pregnancies and deliveries.

As a result, more than 40,000 more women died in pregnancy and childbirth in 2021 (322,000) as compared to 2020 (282,000), the report concludes, as the pandemic was gathering steam in low-income regions such as Africa and South Asia.  

The upsurge in deaths was partly linked to direct complications caused by COVID-19 during pregnancy, but not only that. There were also widespread interruptions to maternity services – due to the competing demands of the pandemic on hospital beds and healthcare workers, limitations on travel, and other factors limiting access to hospitals and primary healthcare services. 

Severe bleeding, infections, preeclampsia and eclampsia, delivery complications, and unsafe abortions are the largest drivers of maternal mortality. 

Yet the spike in deaths during the pandemic was temporary. In 2022, the global MMR and number of maternal deaths were lower than they had been in the three years immediately prior to the COVID-19 pandemic, the report notes. 

Whether the disruptions now being experienced as a result of the broad funding cutbacks in international health assistance led by the United Strates, but also including the United Kingdom, will be as short-lived, remains to be seen.  

Aid crisis threatens to reverse decades of progress

To date, aid cuts have already led to facility closures and loss of health workers, while also disrupting supply chains for supplies and medicines for the pregnancy complications, WHO said in a joint statement with UNICEF. 

“Global funding cuts to health services are putting more pregnant women at risk, especially in the most fragile settings, by limiting their access to essential care during pregnancy and the support they need when giving birth. The world must urgently invest in midwives, nurses, and community health workers to ensure every mother and baby has a chance to survive and thrive,” UNICEF Executive Director Catherine Russell, said in the press statement. 

She added, “When a mother dies in pregnancy or childbirth, her baby’s life is also at risk. Too often, both are lost to causes we know how to prevent.”

Lead author Dr Jenny Cresswell also predicted a rise in unsafe abortions as one consequence of the recent funding cuts – which target reproductive health services, in particular.

“Any sudden disruptions will eventually lead to adverse outcomes,” she said.

US international assistance also “underpins” WHO’s ability to collect and analyse country data, and more importantly, support the “basic ability of a woman to survive during pregnancy,” Aylward noted at last week’s briefing. 

“The American people have been incredibly generous in the past 25 years – and share in the credit for progress so far. It makes a real difference” Aylward. This progress is now “at risk of disappearing.” 

And the most economically fragile countries are also the ones with the least ability to rapidly adjust to the abrupt funding halt, and are consequently at highest risk, he concluded.

Huge global disparities – particularly in conflict zones

The report gathers data from 195 countries and territories, with a third of all countries having “very low” maternal mortality ratios (MMR). No country was rated as having an “extremely high” ratio for the first time, defined as the number of deaths per 100,000 live births. 

In 2000, nearly a million women died from pregnancy-related conditions. In 2023, maternal morality had declined to 260,000.  That represents a 40% decline in the rate of maternal deaths, as compared to live births per 100,000 population. 

And while the WHO pointed to these significant improvements since 2000,  “there is a huge unfinished agenda in which a quarter million women die trying to give life,” said Aylward. 

The burden is not equal. Lower and middle income countries and countries caught in conflict are the places where the vast majority of maternal deaths occur – nine in ten in fact.  

Sub Saharan Africa did see the largest improvements over the past two decades. Even so, some 70% of maternal deaths still occur in that region, noted Cresswell. Globally, Chad, the Central African Republic (CAR), Nigeria, and Somalia face the highest burden of maternal mortality – along with Afghanistan. 

Conflict zones are especially vulnerable to high rates of maternal mortality. Countries in conflict – such as Afghanistan, Somalia, and CAR – accounted for three in ten deaths. 

The maternal mortality ratio is “significantly higher” in conflict-affected areas (504 deaths per 100,000 live births) compared to non-conflict of non fragile settings (99 per 100,000 live births), the report notes. 

Persistent social and economic inequalities underline uneven progress between regions. Post-2015, progress stalled in five regions: North Africa and Western Asia, Eastern and South-Eastern Asia, Oceania (excluding Australia and New Zealand), Europe and North America, and Latin America and the Caribbean.

“We cannot be complacent,” said Cresswell. 

Skilled health workers at the center of solutions

“This is not just a medical failure – it is a failure of society,” said Dr Pascale Allotey of the WHO, referring to maternal mortality. A child is tested for malnutrition by a WHO healthcare provider.

The most important factor in healthy pregnancy outcomes is having a skilled attendant at the time of childbirth – most deaths occur around the time of delivery. 

Part of the remarkable progress seen in the past two decades is attributable to the upsurge in midwifery programs, as well as in programmes targeted at reducing unsafe abortions, a major cause of complications. 

“Having a skilled health worker in place is key, and we have seen positive progress, particularly in Sub Saharan Africa,” said Cresswell. “There is still work to be done. There are still too many women who are delivering without a skilled health provider.”

Also imperative is improved access to family planning services, and preventing underlying health conditions like anaemias, malaria and noncommunicable diseases that increase pregnancy risks, the report notes. 

Allotey, from the department of sexual and reproductive health, also emphasized the role of access to comprehensive information throughout pregnancy. This means generally making sure girls stay in school and receive the knowledge and resources to protect their health.

“There are a whole range of preventive measures to make sure that women are safe,” she said. These include making sure the pregnancies are wanted, and therefore mothers are able to access better care, as well as political commitments.

In recent years, increased political support from African nations has begun to “move the needle” on maternal and child health. 

This year’s World Health Day theme “Healthy beginnings, hopeful futures,” aims to raise awareness on maternal and child health because “it is not okay for a woman to die trying to give birth,” said Aylward. 

“While this report shows glimmers of hope, the data also highlights how dangerous pregnancy still is in much of the world today – despite the fact that solutions exist to prevent and treat the complications that cause the vast majority of maternal deaths,” said Dr Tedros Adhanom Ghebreyesus, Director General of WHO. 

Image Credits: BMGF, WHO, Twitter.

Wearing green for go: INB co-chair Precious Matsoso, WHO’s Dr Tedros Adhanom Ghebreyessus and Mike Ryan at the INB opening.

Countries keep increasing their military budgets yet seem unwilling to prepare for an “invisible enemy” – a pandemic-causing pathogen that can be more damaging than a war, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyessus warned at the start of the final negotiations for a pandemic agreement on Monday.

The COVID-19 pandemic killed up to 20 million people and wiped $10 trillion from the global economy, while the 1918 influenza epidemic killed up to 50 million people – and First World War killed 15-22 million people, Tedros pointed out. 

WHO member states have a mere five days to reach consensus on the pandemic agreement if they are to present it to the World Health Assembly (WHA) next month – yet three ‘big ticket’ items and a myriad of process questions are still on the table.

Articles on how to share information about dangerous pathogens – the Pathogen Access and Benefit-Sharing (PABS) system; technology transfer (purely voluntary or not) and the pandemic preparedness responsibilities of member states (including ‘One Health’ measures) are still lacking agreement.

READ: What’s New in the Pandemic Agreement

Waning political will

The opening day coincided with International Health Day and the WHO’s 77th anniversary, and WHO and INB staff wore green to signify all systems go for the talks.

Tedros, hastily tying his green tie, urged all countries to “find a balance in protecting their people from both bombs and bugs” as the next pandemic is an “epidemiological certainty”.

While the talks at the Intergovernmental Negotiating Body (INB) could continue beyond this week and after the WHA, there is widespread consensus that member states’ already-waning political will to nail down a treaty will simply fizzle out.

The pandemic agreement has also been the target of a systematic misinformation campaign based on the incorrect claim that it will enable the WHO to undermine countries’ sovereignty. 

Right-wing parties and organisations, including a significant portion of US President Donald Trump’s Republican Party, have bought into various anti-WHO conspiracies as they have sought to blame the WHO for everything that went wrong during the COVID-19 pandemic.

Several influential countries have swung to the right, including Germany, the Netherlands and France, and this has also undermined support for the agreement as these right-wing parties typically opposed COVID-19 lockdowns and vaccine mandates, and have seen the pandemic agreement as an attempt to enforce these.

Growing health threats

The talks come amid serious and growing health threats. Disease outbreaks in Africa have increased by 41% between 2022 and 2024. Yet the continent has experienced a 70% loss in official development assistance (ODA), from $81 billion in 2021 plummeting to $25 billion in 2025 – largely as a result of US funding cuts – and ODA covers 30% of the continent’s health spending.

Dr Jean Kaseya, head of the Africa Centres for Disease Control and Prevention (Africa CDC), warned last week that the continent no longer has the means to adequately monitor outbreaks – including the mpox outbreak in central Africa.

The reduction in aid means fewer trained health workers, less equipment and medical countermeasures – vaccine, medicines and diagnostics, said Kaseya.

“It means we are, all of us, at risk. Our message to our colleagues from Western countries is:  ‘You are not protected, because if there is a pandemic coming from Africa, you will be affected’,” he added.

Ironically, however, the US also poses a risk to the rest of the world as it has dismantled vast areas of its health system, including cutting 2,400 posts at the Centers for Disease Control and Prevention (CDC), which monitors disease outbreaks – amid a serious and ongoing outbreak of H5N1 in cattle and a measles outbreak. In addition, the US’s radical aid cuts have also weakened global disease surveillance and response – including or mpox and Ebola.

Stakeholders’ pleas

IFPMA’s Grega Kumer.

Various stakeholders spoke in support of the pandemic agreement – with some caveats – on Monday, with several underlining that enough progress has been made to close the deal.

Grega Kumer, representing the International Federation of Pharmaceutucal Manufacturers and Associations (IFPMA), stressed the need for entrenched intellectual property rights and the voluntary transfer of technology and know-how during a pandemic (Article 11). 

“The significance of including both ‘voluntary’ and ‘on mutually agreed terms’ for tech transfer is paramount as it facilitates the sharing of technologies and expertise in a manner that respects the interests and agreements of all parties involved,” said Kumer.

Various other parties have pointed out that even the US and Germany have laws that allow their governments to enforce compulsory tech transfer during crises such as wars and pandemics.

Oxfam’s Mogha Kamal-Yanni told the INB that “technology transfer cannot be left to the whim of pharmaceutical companies”. 

“We see the clear evidence of the failure of voluntary action in the fact that, four years since the establishment of the mRNA hub in South Africa and despite several attempts to get companies to share the mRNA technology, not a single one agreed,” she said.

“Let’s hope that on Friday, we celebrate your hard work resulting in an agreement that is fair and that protects all people everywhere, and proves that the multilateral system works,” said Kamal-Yanni.

Spark Street Advisors CEO Nina Scwalbe

Spark Street Advisors CEO Nina Schwalbe said: “As currently drafted, the pandemic agreement secures important gains, including on research and development, equitable access to pandemic countermeasures and a One Health approach to pandemic threats. 

“While not all policy goals have been achieved, this potentially historic agreement lays essential groundwork for equitable, collective preparedness and response now and can be strengthened through additional protocols in the future,” said Schwalbe, also speaking for the Pandemic Action Network, the Panel for a Global Public Health Convention, Helen Clark, the co chair of the Independent Panel for Pandemic Preparedness and Response, and various members of the Global Preparedness Monitoring Board.

“We urge you, member states, to stay laser focused on the end goal and find room to give and take to reach agreement… We are counting on you to pull together and get this agreement.”