US Shrinks Childhood Vaccine Schedule; Drops Six Common Vaccines from CDC Recommendations 06/01/2026 Sophia Samantaroy Among the core vaccines no longer recommended for all children are those that protect against rotavirus, RSV, influenza, meningococcal disease, hepatitis A, and hepatitis B. HHS Secretary Robert F Kennedy Jr makes good on promise to reduce the number of recommended vaccines. US health officials announced Monday an overhauled version of the vaccines recommended to infants and adolescents, shrinking the number of diseases for which vaccines should be administered from 17 to 11. The decision follows a December 5, 2025 directive from President Donald Trump to the US Centers for Disease Control and Prevention (CDC) to review the US childhood vaccine schedule in comparison to those of wealthy, peer-nations, citing Denmark, Germany and Japan in particular. The revisions now mean that the US will go from being one of the developed nations with the highest number of diseases covered – to one of the lowest – according to HHS’s own analysis. In fact, only Denmark recommends fewer jabs – for just 10 diseases in total. Greece and Ireland recommend immunization for 16 diseases and five countries recommend immunization against 15 diseases, including Australia, Canada, Denmark, Ireland, Spain and the United Kingdom. Japan recommends childhood immunization against 14 different diseases. A table from HHS’s assessment of the US vaccine schedule in comparison to other wealthy nations. The table shows the number of doses for each type of vaccine recommended. The “# Mandated” row uses the example of New York state. The “18-19” number in the bottom right reflects the number of shots a child could receive if they take a yearly COVID-19 and flu shot. Some vaccines are duplicated, such as the measles, mumps, rubella combined vaccine (MMR). “A” reflects the new CDC guidance that these shots be only for high-rish patients or at the bequest of caregivers. The US has no childhood federal vaccine mandate – these vary by state. Among the core vaccines CDC will no longer recommend for all children are those that protect against rotavirus, influenza, meningococcal disease, hepatitis A, and hepatitis B (HBV). The CDC also dropped a relatively new recommendation for newborns to be vaccinated against Respiratory Syncytial Virus (RSV) – if their mothers had not been previously vaccinated. RSV is the single largest cause of childhood hospitalizations in the US today, burdening the healthcare system with 80,000 hospitalizations a year. And the new CDC policy reduces the number of recommended doses against HPV – a key cause of cervical cancer – from two to one. This is contrary to the two-dose advice of most other developed nations and the World Health Organization. WHO’s cervical cancer elimination strategy calls for a dramatic reduction in cases by 2030, largely through mass immunization programs. Another key point of concern for US public health experts is the removal of any broad recommendation for vaccination against hepatitis B – a leading cause of liver disease and a vaccine that almost every other developed country includes for newborns or infants. Instead, the updated recommendation urges caregivers to consult with their physicians if their child falls into a “high risk” category. Already in December 2025, the CDC in recommended to delay administration of the hepatitis B (HBV) vaccine for infants by six months. The Department of Health and Human Services Secretary Robert F Kennedy Jr’s longtime skepticism about the HBV vaccine played a central part of his Senate confirmation hearing where Senator Bill Cassidy (R-LA), a medical doctor and liver specialist, credited the vaccine with saving some 90,000 children’s lives in the US since 1991. Despite the reassurances that Kennedy provided at that time to the Senate Confirmation Committee to follow well-established evidence on immunization’s benefits, the HHS Secretary, who built his career around vaccine hesitancy, has now made good on his previous record as a vaccine skeptic. Changes announced Monday following a brief review U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. conducts the swearing-in ceremony of Jim O’Neill as the Department’s Deputy Secretary Monday, June 9, 2025 at the Hubert H. Humphrey Building in Washington, D.C. (Source: HHS by Amy Rossetti) The changes were announced abruptly Monday by acting Centers for Disease Control and Prevention Director Jim O’Neill. He directed the public health agency to move forward immediately on the new CDC recommendations. The Trump Administration’s health leadership has argued that the change will increase transparency and rebuild trust in health institutions. “After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent. This decision protects children, respects families, and rebuilds trust in public health,” Kennedy said in the statement. But the overhaul also is an unprecedented departure from the evidence-based process the US previously used to decide its vaccine schedule. Normally an independent federal advisory panel of experts would review studies and data for each vaccine before publishing recommendations. In this instance, CDC director O’Neill issued the changes in a memorandum responding to a request by Trump for such a review only a month ago – and with the underlying analysis based on a comparison of schedules in other nations. The comparisons between the seemingly high number of actual shots, or jabs, US children previously received as compared to those of other nations is also somewhat misleading – insofar as annual flu and COVID-19 vaccines up until the age of 18 are included in the US count of previous recommendations – totaling about 35 or 36 more shots across 18 years. But in November, the CDC last year already stated that COVID vaccination for children, while recommended, should be a matter of “individual decision-making.” And WHO’s own recommendations for COVID-19 vaccination of children were already reversed post-pandemic, advising only one dose for never-vaccinated children with co-morbidities. In 2010, the CDC did adopt a universal recommendation for annual childhood sesasonal flu vaccination. That went further than the current WHO recommendation which recommends prioritizing seasonal flu vaccine for “health workers, individuals with comorbidities and underlying conditions, older adults and pregnant women,” adding only that “Depending on national disease goals, capacity and resources, epidemiology, national policies and priorities, and disease burden, countries may consider additional (sub)populations for vaccination, such as children.” Concerns that hospitalizations, deaths may increase View this post on Instagram A post shared by Jessica Malaty Rivera, MS | Making Science Make Sense (@jessicamalatyrivera) “Fewer vaccinations (specifically for rotavirus, COVID-19, influenza, RSV, meningococcal disease, hepatitis A and hepatitis B) will result in an increase in disease, disability, and death, wrote epidemiologist and infectious disease specialist Jessica Malaty Rivera in a post. “Please ignore this unscientific nonsense and follow the @ameracadpeds schedule alongside your pediatrician.” Prior to the vaccines and therapeutics that prevent RSV, for instance, the virus accounted for over one in four hospitalizations among young children in the US. Other physicians and health experts criticized the shift for causing confusion and for ignoring decades of vaccine studies demonstrating safety and efficacy. “Know this: Even as our government shifts its recommendation language, I would never forgo the RSV, hepatitis A & B, or meningitis vaccines for my own kids,” said Dr Scott Hadland, a pediatrician and chief of adolescent medicine at Harvard. “This is health policy malpractice at the highest level and must be reversed before children and families suffer,” said Dr George C Benjamin, executive director of the American Public Health Association. Attempt to bring US “in-line” with other wealthy countries The 33-page CDC policy document argues that in light of falling vaccination rates across the US and the lack of trust in public health institutions, the US should therefore cut back on the number of recommended vaccines. “Bringing the U.S. pediatric immunization schedule in line with the consensus of peer nations while keeping non-consensus vaccines available for high-risk groups and populations and/orthrough shared clinical decision-making is a balanced approach to reform and restore trust in public health,” the document says. Traditionally, the US has recommended slightly more vaccines, on average, than “peer” nations. However, the US also continues to face surges of measles, hepatitis A, RSV, and other infectious diseases. The other problem with policy decisions based on comparisons with other high income countries experts say, is that the US has a far larger, and more sickly, population that often lacks access to primary healthcare. “Many high-income countries have universal coverage and paid family leave that make it easier to get care and stay safe when kids get sick,” said Dr Uché Blackstock, a physician and health equity advocate in a social media post. “You cannot copy the [vaccine] list without copying the supports,” Blackstock said. Denmark and Japan’s healthier population, more robust healthcare systems, surveillance, testing, and social support mean there is less of a reliance on vaccines. “We have fragmented insurance, we’ve got millions uninsured, we don’t have a national health registry and we’ve got enormous gaps in the continuity of care,” said Dr. Jake Scott, an infectious disease specialist at Stanford University School of Medicine. “And we use broader vaccine recommendations because our system can’t reliably identify and follow up with every person at risk.” Assessment downplays risk of rotavirus, meningococcal disease, HPV A screen capture of the CDC website with the burden of rotavirus on the US Of the vaccines being cut from the list, RSV and rotavirus pose a significant burden to the healthcare system. Prior to the RSV maternal vaccine and monoclonal antibodies, up to 80,000 children were hospitalized with the virus. Nearly all children were infected with rotavirus prior to the vaccine. It caused 20-60 deaths each year, according to the CDC. “Reasonable people can reach different conclusions about recommending the rotavirus vaccine for all children,” says the assessment. The assessment also argued that low rates of meningococcal disease warranted an end of recommendations. “Considering the low incidence of meningococcal disease in the U.S., the meningococcal vaccine should not be part of the consensus recommended vaccine schedule.” These low rates are due in large part to vaccinations. Still covered by health insurers? The vaccines dropped from the CDC’s recommendations should still be covered by health insurance systems – the new CDC policy also states. But it is unclear whether health insurers in the US’s fragmented public health system will in fact guarantee continued access for all of those who would like to get a shot – once the actual CDC recommendation has been removed. The authors of the new CDC policy are Dr Tracy Beth Høeg, a Danish-American physician and Food and Drug Administration director of the Center for Drug Research and Evaluation, and Martin Kulldorff. They are self-described in the assessment as “one of the most pro-vaccine scientists in the country” – however, they garnered significant attention during the COVID pandemic for their anti-COVID-19 vaccine stances. Kulldorff’s bio continues in the assessment: “In early 2021, he was one of the first public health scientists to publicly oppose Covid vaccine mandates and it is hard to imagine a policy doing more harm to the trust in vaccines and public health.” Image Credits: European Union, Quinn Dombrowski, HHS , Amy Rossetti, CDC. UN Agencies, Aid Groups Protest Israel’s Move to Bar Many NGOs from Gaza as Winter Exacerbates Dire Conditions 06/01/2026 Elaine Ruth Fletcher Gaza tent camp surrounded by mud from unusually heavy winter storms; new Israeli restructions on NGO activities would further impede humanitarian efforts, UN and partner agencies charge. Senior United Nations officials and humanitarian leaders have urged Israel to reverse plans to withhold registration from more three-dozen international NGOs providing humanitarian relief in war-torn Gaza and the Israeli-occupied West Bank – warning that the move would severely undermine life-saving aid in a moment of acute humanitarian need. Israel said last Thursday that some 37 international NGOs operating in Palestinian areas it controls, including the internationally renowned Médecins Sans Frontières, had not complied with a deadline to meet “security and transparency standards” now required by Israel for re-licensing in 2026. The NGOs are contesting new Israeli rules requiring them to disclose personal information on local Palestinian staff. For those NGOs that don’t comply, Israel has said it “will enforce” a ban on their activities in 2026. The government approved the new registration rules in March 2025 – in the wake of Israeli government allegations that two former MSF staff members were involved with Hamas or other armed groups. MSF has denied knowingly hiring people with military ties. In a related move, Israel last week also cut off water and electricity to the now vacant Jerusalem facilities of UNRWA, the UN Palestinian Refugee Agency, under legislation approved by the Knesset, or Parliament to close down the UN agency’s operations in areas under Israeli control. On Monday, seven European countries, including Spain, Ireland and Norway, condemned the move calling it a violation of international law with “grave humanitarian consequences.” Joint UN Agency statement decries move In a joint statement 31 December, the Inter-Agency Standing Committee (IASC), which represents about 20 heads of UN agencies and major humanitarian organisations, said that international NGOs collectively deliver nearly $1 billion in assistance each year in the occupied Palestinian territory and are “central to humanitarian operations,” particularly in Gaza. “Humanitarian access is not optional, conditional or political,” the statement said. It warned that restricting NGO operations during winter, amid continued food insecurity and recent flood-related displacement, risks undoing fragile gains made since the October 2025 Israeli-Hamas ceasefire – and would have “devastating” consequences for Gaza’s civilian population. The signatories included the UN emergency relief coordinator Tom Fletcher, the World Health Organization’s Dr. Tedros Adhanom Ghebreyesus, as well as the heads of the UN Refugee Agency (UNHCR); the UN Development Pogramme (UNDP); UNICEF, the UN Childrens Agency; the World Food Programme; and leaders of major civil society groups such as Oxfam, Save the Children, Mercy Corps and Caritas Internationalis. MSF condemns “cynical” attempt to block aid A pregnant Palestinian mother, Donia Alouf, and her 1 year-old son, Ahmed, who was diagnosed with malnutrition, receive treatment in an MSF-supported Gaza city clinic. COGAT, the Israeli Defense Ministry agency coordinating Gaza humanitarian aid, has said that the new registration process is designed to prevent the misuse of humanitarian aid by Hamas, which it claims has exploited aid frameworks for to divert funds and recruit local aid employees for its own military purposes. COGAT also contended that the revocation of the licenses to the 37 NGOs will not substantially affect aid delivery, claiming that the affected organizations had not provided substantial aid to Gaza since the ceasefire began on October 10. And before the ceasefire, their combined contribution amounted to only a small proportion of total aid, Israel said. Médecins Sans Frontières (MSF), one of the most prominent organisations affected by Israel’s registration decision, contested Israel’s claims. An MSF press statement noted that the organization currently supports one in five hospital beds in Gaza and assists one in three mothers during childbirth. “In the last year, MSF teams have treated hundreds of thousands of patients and delivered hundreds of millions of litres of water,” said Pascale Coissard, MSF emergency coordinator for Gaza, in a 22 December statement. “In 2025 alone, we carried out almost 800,000 outpatient consultations and handled more than 100 000 trauma cases, and if we obtain registration, we plan to continue strengthening our activities in 2026.” Describing the move as a “cynical and calculated attempt” at political control, MSF said that blocking its activities and those of other NGOs that refused to register their Palestinian staff would exact a “terrible cost” after Gaza’s health system has been decimated. Only about half of the enclave’s 36 hospitals are functioning, and those only partially. International organizations say new Israel’s rules potentially endanger staff A toddler plays with dolls in MSF’s burn unit in Nasser hospital, Gaza, in May 2025. She was severely burned in an Israeli airstrike that struck her family’s tent in the Al-Mawasi humanitarian zone, which also killed her mother and two siblings. The healing process was hindered by a lack of proper nutrition and protein for the child, unavailable due to the Israeli halt to most humanitarian aid between March and late May. MSF said Israel’s core demand, that the NGO’s share personal information about Palestinians employees, is especially dangerous in Gaza where humanitarian workers have been intimidated, detained, attacked and killed. Some 15 MSF colleagues have reportedly been killed by Israeli forces. “Demanding staff lists as a condition for access to territory is an outrageous overreach,” MSF said, adding that there is no clarity on how such sensitive data would be used or shared. The organization said Israeli authorities had ignored repeated requests for meetings and instead accused MSF in the media of harbouring alleged militants – an allegation MSF rejects. “MSF would never knowingly employ anyone involved in military activities, which contradicts our core values and ethics,” the organization said. “Denying medical assistance to civilians is unacceptable under any circumstances, and it is appalling to use humanitarian aid as a tool of policy or collective punishment.” Israel’s moves on UNRWA follow in the wake of allegations that surfaced in 2024, charging that some 19 UNRWA employees participated in the 7 October Hamas attacks on Israeli communities, and UNRWA facilities were also used for Hamas weapons storage and other military activities. UNRWA has denied most of the claims, while acknowledging that an internal UN investigation led to the termination of nine UNRWA employees where “evidence obtained … – if authenticated and corroborated – might indicate that the staff members may have been involved.” Meanwhile, Palestinian nationalists who are also critics of Hamas note that the pressures on local aid workers to filter food, funds or other forms of aid can be intense – particularly as the militant group has now regained control over the roughly 50% of Gaza that lies within the “yellow line” to which Israel withdrew in October. A chilling update from the ground in Gaza: Two of my friends, who have been running independent food drives via international crowdfunding, were stopped and interrogated by Hamas militants. After proving their transparency and showing that all funds are used for food and aid for… pic.twitter.com/d55tKopGHM — Hamza (@HowidyHamza) January 5, 2026 Shelter crisis deepens amid winter storms Tents and ruined buildings in Gaza surrounded by mud. The curbs on the activities of the NGOs comes as housing and sanitary conditions in Gaza continue to deteriorate amidst a series of heavy winter storms, particularly for hundreds of thousands of displaced people living in makeshift shelters, according to the end December update of the UN Office for the Coordination of Humanitarian Affairs (OCHA). The unusually heavy rainfall has flooded tents and caused already unstable buildings to collapse – forcing displaced families to move yet again in search of safer ground. Seawater inundation has rendered shelters uninhabitable in coastal areas such as Al Mawasi in Khan Younis, while heavy winds have destroyed or severely damaged many tents. As of 30 December, humanitarian partners have provided emergency shelter assistance to more than 80,000 Gazan households, distributing tens of thousands of tents, tarpaulins and bedding items. Despite these efforts, more than one million Gazans out of a population of 2.1 million still need urgent shelter support, OCHA said. According to Gaza’s Hamas-controlled Ministry of Health, at least 17 people died in December due to the collapse of storm- and flood-damaged buildings, while three children died of hypothermia. WHO, MSF and other partners have reported consistently high rates of respiratory infections, warning that winter conditions are driving further illness, particularly among young children. Sewage, waste and public health risks A Palestinian boy walks past tents during a break in the rain in Jabalya, North Gaza. Waste mixed with floodwaters increases exposures to infectious diseases. Flooding has also intensified Gaza’s long-running sewage and solid waste crisis – and along with that infectious disease risks related to sewage exposure. The UN Water, Sanitation and Hygiene (WASH) Cluster reports that damaged infrastructure, fuel shortages and restrictions on the entry of equipment are limiting the ability to manage wastewater and storm runoff. Recent rains raised water levels in inland lagoons such as Wadi Gaza and Sheikh Radwan, heightening the risk of overflow and sewage contamination on land, as well as into the sea. The Palestinian Water Authority says it has been forced to rely on short-term measures because critical equipment such as pumps, pipes and electromechanical components has been denied entry by Israel. Solid waste management remains severely constrained. Since 7 October 2023, Hamas miiltants first invaded Israeli communities on the Gaza periphery in the opening salvo of the war, an estimated $66 million in damage has been recorded to waste management systems, including the destruction of more than 200 collection trucks and widespread damage to facilities. Gaza’s two main landfills remain inaccessible, forcing municipalities to rely on overcrowded temporary dumping sites. Waste generation far exceeds collection capacity in northern Gaza, where only about 60 per cent of daily waste is collected. This has resulted in continued accumulation of solid waste in densely populated areas, exacerbating public health and environmental risks. While a recent analysis found that famine conditions in Gaza have been pushed back, acute food insecurity and malnutrition remain critically high, and aid officials warn that progress remains fragile. “Needs are growing faster than aid can get in,” UN Secretary-General António Guterres declared in a late December press briefing, stressing that predictable and unimpeded access for humanitarian actors is essential to address the immense challenges faced. “We need more crossings, the lifting of restrictions on critical items, the removal of red tape, safe routes inside Gaza, sustained funding, and unimpeded access – including for NGOs,” Guterres said. “And we cannot lose sight of the rapidly deteriorating situation in the West Bank,” he added referring to escalating Israeli settler violence, land seizures, demolitions and displacement as well as intensified restrictions on movement – affecting Palestinian access to vital health and social services as well as livelihoods. Against that landscape, the prospect of new Israeli bans on international NGOs threatens to further erode an already strained response. “Allowing humanitarian aid is not a favour,” MSF said. “It is an obligation under international law.” Image Credits: MSF , Palestinian Water Authority , Nour Alsaqqa/MSF, Palestinian Water Authority , OCHA . US EPA dismisses WHO Cancer Agency Determination that Widely Used Herbicide is ‘Probably Carcinogenic’ 05/01/2026 Sophia Samantaroy Over 70 million tons of atrazine is applied to US soil each year. The chemical is now deemed a ‘probable’ carcinogen to humans. The US Environmental Protection Agency has dismissed a recent finding that atrazine, the second most widely-used herbicide in the United States, is “probably carcinogenic to humans” by the World Health Organization’s cancer review agency. Atrazine is used extensively in the US on crops like corn, sorghum, and sugarcane. However, over 60 countries have banned the chemical due to its endocrine-disrupting properties and tendency to contaminate groundwater. In a new classification, published in the January, 2026 issue of The Lancet Oncology, the International Agency for Research on Cancer (IARC) ranked atrazine as probably carcinogenic to humans based on what it described as “limited evidence” for cancer in humans and “sufficient evidence for cancer in experimental animals.” The agency’s findings are independent assessments that guide national regulatory authorities worldwide in the promulgation of rules around chemicals used in agriculture, food systems and occupational settings. The IARC assessment was the first in nearly three decades. In 1998 the organization said the compound was not classifiable as to its carcinogenicity to humans. Since the IARC findings were initially released in late November, the US Environmental Protection Agency (EPA), as well as chemical producers in China and elsewhere, have pushed back against the new classification. Both used almost identical terms in describing the determination as “flawed” and “inconsistent with scientific consensus.” Hormone disruptor, cancer risk of atrazine Atrazine has been linked to non-Hodgkin’s lymphoma Atrazine’s cancer links include evidence of oxidative stress, hormone disruption, immune suppression, and actual tumor growth, IARC found in its abbreviated evaluation of atrazine and two other compounds. In particular, IARC pointed to animal studies that showed tumor growth in the mammary glands and uterus of female rats, reduced estrogen and testosterone in both male and female rats, and induced cell death and division. The most recent study IARC cites, from 2024, also concluded that male rats also experience oxidative stress and severe hormone disruption. In humans, only a handful of studies have been published so far. However, IARC noted that two case-control studies that reported “strong positive associations between exposure to atrazine…and translocation-positive NHL [non-Hodgkin’s Lymphoma]” among exposed farm workers. Links to other human cancers did not show “consistent positive findings.” Beyond its cancer inks, atrazine exposure is also associated with birth defects, reproductive harm, and hormone disruption, in papers not cited by IARC – an agency that focuses almost exclusively on cancer risks. US regulators and manufacturers push back The US EPA said IARC’s findings used a “deeply flawed approach to its cancer assessments” In a 21 November statement, Syngenta, the agrochemical company that produces most of the US’s atrazine, said: “[c]urrent scientific evidence clearly demonstrate[s] that atrazine is safe when applied in accordance with registered label instructions.” Syngenta is owned by the Chinese state-operated company Sinochem. Speaking to Health Policy Watch just a few days after the Syngenta statement, EPA used identical terms, arguing that IARC’s findings “stir up fear” by also including “very hot beverages, red meat, working the night shift and hairdressing in the same classification.” “This announcement on atrazine is just another example of the World Health Organization International Agency for Research on Cancer (IARC) using a deeply flawed approach to its cancer assessments on multiple levels,” the EPA added. The EPA spokesperson complained, in particular, that the two-page article published so far is just a brief summary of the full review, which is only due to be published later this year, according to IARC. “[F]or IARC to roll out these “findings” and unnecessarily stir up fear when IARC has said it will not be publishing any of its detailed science until late 2026 or 2027 is irresponsible and lacks transparency. Currently, there is no opportunity for anyone to meaningfully review how IARC has reached its conclusions,” said the EPA’s press office. “In contrast, atrazine has been extensively studied by EPA across multiple administrations, including having five meetings of independent Scientific Advisory Panels peer review the cancer potential of atrazine between 2009-2011,” EPA said. “As a reminder, IARC also has a long history of being severely misguided in its findings,” the EPA spokesperson said, citing past IARC findings on red meat and night shift work, among other factors, as possible or probable causes of cancer. In 2015 IARC concluded that red meat was a possible cause of cancer and processed meat is a probable cause. Those findings have since been echoed by the American Institute for Cancer Research, which in 2021 concluded “there is strong evidence that eating high amounts of red meat increases the risk of colorectal cancer.” The US Department of Agriculture’s most recent dietary guidelines also suggest reducing red meat consumption. The US CDC concluded in a 2021 report that there is “high confidence” that persistent night shift work that results in circadian disruption can cause human cancer. Environmental groups welcome IARC re-evaluation Latest estimates of atrazine use from the US Geological Survey, 2019 Separate EPA reviews in 2003 and 2018 concluded that available evidence does not support a relationship between atrazine exposure and human cancers. IARC cites one new animal study from 2024, while re-evaluating older data in a new light. For pesticide experts like Dr Jennifer Sass, a senior scientist at the Natural Resources Defense Council (NRDC), IARC’s re-evaluation was welcome – correcting industry bias in previous evaluations. . “With atrazine, there’s hormone disruption, there’s oxidative stress, there is indication of tumors in human and animal studies,” said Sass. “IARC gathered a solid expert array of people from different disciplines, including industry people. They didn’t second-guess or overinterpret the data. “The EPA needs to take another look at their assessment to account for the carcinogenicity,” said Sass. Canada, Australia and Brazil also use atrazine extensively Atrazine, also known under brand names such as Aatrex®, Aatram®, Atratol®, and Gesaprim® is the second most widely-used pesticide in the US after glyphosate – also known as Roundup®. Glyphosate also was designated as a probable carcinogen in humans by IARC in 2015, in a ruling that continues to trigger controversy between the US and trading partners that have banned the chemical. Across the US’s corn belt, up to 60 million pounds of atrazine is applied to treat US crops each year. Atrazine also is flushed from soil into streams or groundwater aquifers where it can contaminate drinking water supplies, according to the US Centers for Disease Control and Prevention. A 2017 analysis of EPA tap water data found that nearly 30 million Americans across 28 states have tap water that contains atrazine. Drinking water in these areas had atrazine levels three to seven times higher than the federal limit of three parts per billion during spikes due to run-off in spring and summer, according to another major research and advocacy non-profit, Environmental Working Group. “Because the EPA has been sweeping the evidence on cancer under the rug for the time it has been on the market for 50 years, they’re not monitoring for atrazine in the water. The drinking water standard should be zero, because it’s a carcinogen,” said Sass. But the US is not alone in its reliance on the chemical, which is typically applied to unplanted fields so as to kill any other weeds or plants before crops are planted. Canada, Australia, Brazil and China also use atrazine to increase crop yields. In the decades prior to IARC’s classification, 60 countries banned the use of atrazine. These include 27 European Union countries, most Middle Eastern countries, and even many African countries. However, in many lower-and-middle income countries where atrazine is banned, the chemical is often smuggled in illegally. The European Union banned atrazine in 2004 and most EU countries have since banned glyphosate as well. Mexico, which exports tens of billions of dollars of agricultural products to the US, had attempted to ban glyphosate. But in 2024 it postponed the ban indefinitely following pressure from industry and the US, citing the lack of an effective alternative. As international assessments increasingly flag risks associated with such chemicals, the US remains an outlier among high-income countries in continued widespread use. “We were all told for a long time that weed killers aren’t harmful to people because their mechanism of toxicity targets photosynthesis. We all believed them,” said Sass. “Because of that, we didn’t have proper food monitoring. We didn’t have proper drinking water monitoring. The people exposed to atrazine occupationally, whether by mixing it, loading it, applying it, manufacturing it, need to take the proper precautions because of how toxic it is. EPA stance contrasts sharply with MAHA rhetoric about healthier foods EPA’s pro-pesticide stance under the new US administration of President Donald Trump contrasts sharply with the healthy foods rhetoric of the “Make America Healthy Again” (MAHA) movement, critics also said. “Despite the rhetoric of MAHA, there will be no robust review of the dangers of pesticides by the Trump Administration,” said Sylvia Wu, of the Washington DC-based Center for Food Safety. “Instead, a toxic poison like atrazine will continue to contaminate our lands and waters, making our children sick for decades to come,” said Wu. Wu was responding, in particular, to another recent US Fish and Wildlife’s (FWS) statement that atrazine does not pose an extinction risk to any US endangered species. The Center for Food Safety sued the EPA in 2020 when the agency moved to reapprove atrazine, along with a host of other pesticides and herbicides, as part of a routine evaluation. “The public trust has been steamrolled by agrochemical interests,” said Sass of the Natural Resources Defence Council. “The EPA has fast-tracked the approval of their poisons, which is not only a violation of the public’s trust, but also of the mission of the EPA.” “Using modern farming methods, we do not need weed killers like atrazine. We simply don’t have to kill every weed to grow our crops. It. We don’t have to be so scorched earth in our farm practices,” Sass argued. “I look forward to the day that the US catches up to other countries in keeping American families safe from chemicals.” Image Credits: Akshat Jhingran , Waldemar Brandt , AP/Sierra Club, USGS. Near-Zero Change in Delhi’s Peak Air Pollution Levels Over Past Decade – But Big Change in Public Outrage 05/01/2026 Chetan Bhattacharji Delhi air pollution during peak days in mid-November 2025 – an annual public health crisis that remains unresolved. The latest ten-year data shows almost no change. Can the momentum of outrage finally push officials to take high-impact measures to lower pollution this year? It’s Delhi 2026. Since 2016, there’s been near-zero improvement in the city’s air pollution during the annual peak pollution period of October to December, a new analysis by the Center for Research on Energy and Clean Air (CREA) reveals. This period also usually sees peak coverage and public outrage about the crisis. In 2025, average levels for those peak months even inched up a notch over the year before to 177 micrograms/cubic meter (µg/m³) of PM2.5 – despite a slight decline in the annual average levels in 2025 as compared to 2024 (96 µg/m³ in 2025 versus 105 in 2024). This means average levels in the peak pollution months were over 35 times the WHO’s annual average guideline of 5 µg/m³ and 11 times the peak 24 guideline limit of 15 µg/m³. And that’s if questions over the robustness of the latest government monitoring data are ignored for the moment. For nine of these last 10 years, opposition-led the Aam Aadmi Party was in power in Delhi, while Narendra Modi’s BJP party has been in power at the national level during the entire time. Near-zero improvement in Delhi’s peak pollution months since 2016. In 2025, Delhi also elected a BJP-led state government, which means the BJP is now in power at the national, state and municipality level – a ‘triple engine sarkar’, as the Hindustan Times framed it, referring to the Hindi term for “government.” Indeed, the BJP not only controls Delhi, but also the governments of two key bordering states, Haryana and Uttar Pradesh – which generate smoke from crop waste burning that contributes to the capital’s autumn smog crisis. That’s also why the new Delhi government, led by Chief Minister Ms Rekha Gupta, was expected to be uniquely placed to reduce pollution when she assumed office. Yet, as the peak season began, there was little indication of a significant shift in strategy. Unprecedented outrage against air pollution Public outrage against air pollution in Delhi and northern India has escalated to a level not seen in many years. It’s been characterised by a mix of anger and cutting humour – reels, memes and so on – against the government and the crisis. There were other aspects. Multiple protests, including the one on 9th November where police detained several demonstrators, including parents, among others, demanding clean air for their children. Multiple groups have been created on various social media and messaging apps. Some TV anchors and journalists, seen to be close to the ruling establishment since 2014, took many by surprise by pivoting and questioning official inaction and apathy. View this post on Instagram A post shared by Newslaundry (@newslaundry) India’s air pollution is “a metaphor for the challenges facing the nation more broadly.… if India cannot solve a problem that manifestly and acutely affects its elite, the prospects for solving the larger challenges confronting the country remain slim,” observed Arvind Subramanian and Devesh Kapur, in their book, A Sixth of Humanity, published last October. India’s environment minister Bhupender Yadav held a series of meetings on Delhi’s pollution, including one where he directed officials to “ensure visible improvement” in the air quality across Delhi and its neighbourhood “within one week.” That was mid-December. By the end of the month, there was no improvement. In fact, this December saw the worst pollution since 2018. Delhi’s environment minister and chief minister held several meetings, extensively posted policy action and photo ops on social media. There have been some positive steps, like distributing electric heaters to gatekeepers at various residential areas, curbs on categories of polluting vehicles, and stricter enforcement of OCEMS, online continuous emissions monitoring systems, at thousands of factories. Gaps in pollution control Along with the global “embarrassment” mentioned in A Sixth of Humanity, critical technical gaps remain. Firstly, misplaced focus on PM10: The government’s focus remains on spraying water to control dust because it continues to prioritise controlling PM10 particulate matter pollutants rather than the finer PM2.5 ones. PM2.5 is dangerous because it is small enough to enter the bloodstream and, so, is more lethal, whereas the body’s defenses can often stop the larger PM10 particles. In theory, watering down dust may help, but in practice, there hasn’t been much improvement. As this clip shows there’s simply too much pollution. And this water mist barely tackles PM2.5. ⚪️ Installs anti smog guns on top of 13 high rise buildings in Delhi to tackle pollution.pic.twitter.com/CJQWH18SYt — Mediterranean Voice (@mediterranvoice) December 26, 2025 Secondly, lack of political will: At a national level, there’s a lack of political will to stop the practice of farmers burning the residue of the paddy harvest in the three states north of Delhi and upwind of the city – Punjab, Haryana and Uttar Pradesh. This contributes almost 10% of the pollution in October and November in Delhi and the neighbourhood, according to a government (IITM) study, but on certain days and hours, it can be much higher. Thirdly, pseudo-science over evidence: There has been a reluctance among decision-makers to fully embrace scientifically evidence-based action. So a lot of time, taxpayers’ money, and effort over the years have gone into what may be described as pseudo-science, like smog towers, or action taken against scientific advice, like cloud-seeding trials. Fourthly, flawed monitoring of vehicular pollution: The Delhi government has, in a well-intentioned move, made pollution-under-control (PUC) certificates mandatory for all vehicles. However, the old PUC regime is flawed, and it needs to be replaced as it doesn’t check for key pollutants like PM2.5 and nitrogen oxides, which are major contributors to Delhi’s pollution. But to give credit where credit is due: a new panel has been formed by the national government with external experts on curbing vehicular pollution, which contributes more than a third of the capital’s air pollution levels. Many vehicles in Delhi are highly polluting, contributing more than a third to ambient air pollution levels. Battle against air pollution, 2026 There have been political missteps, too. One example: In early July, after public protests pressured the Delhi government to quickly roll back stricter enforcement of limits on old, polluting vehicles, the same government also successfully petitioned the Supreme Court to reverse a previous ban on firecrackers during the annual Diwali festival of lights, arguing that certain brands of so-called “green firecrackers” would not pollute. They were wrong. And the ensuing smoke was a factor in 2025’s post-Diwali pollution being the worst in years; and the chief minister repeatedly came in for criticism for comments she made on pollution. In 2026, can the public’s pressure, and even the government’s momentum, for clean air action be sustained or will it, as in the past, fizzle out when Delhi’s peak pollution season tapers off? Republished, with slight adaptation, from the original ‘What Am I Breathing’ Substack by Chetan Bhattacharji, a senior correspondent for Health Policy Watch from Delhi. Image Credits: Chetan Bhattacharji, Centre for Research on Energy and Clean Air. 2025: A Brutal Year for Global Health 28/12/2025 Editorial team This has been a brutal year for global health, with shock cuts in development aid to countries most in need; a knock-on budget crisis for United Nations (UN) agencies; widespread humanitarian crises, extensive disease outbreaks, and mounting climate-related health challenges. Health Policy Watch (HPW) has provided daily coverage of developments, and our reporters were often the first to break news on a range of issues despite our small and under-resourced newsroom. Development aid plunge Chaos followed the immediate “pause” of all development aid from the United States as soon as Donald Trump became president in January. The “pause” included the US President’s Emergency Plan for AIDS Relief (PEPFAR), which funded three-quarters of HIV and tuberculosis programmes worldwide, including lifesaving antiretroviral medicine to 20.6 million people in 2024. Within weeks, clinics across Africa closed, and patients were turned away as there was no money for staff or medicine. Although US Secretary of State Marco Rubio later issued a limited waiver for “lifesaving” programmes, this was narrowly focused and ideological. Influenced by the Heritage Foundation’s view that HIV is a “lifestyle disease”, the Trump administration stopped funding HIV measures aimed at “key populations” most vulnerable to infection – including sex workers and men who have sex with men. DOGE’s Elon Musk brandishing a chainsaw given to him by Argentinian President Javier Milei (right) after cutting US government programmes and global development aid, resulting in deaths and chaos. Within two weeks of Trump assuming the presidency, his appointee, Elon Musk and a new Department of Government Efficiency (DOGE) had also dismantled the US Agency for International Development (USAID). Musk declared that “USAID is a criminal organisation. It’s time for it to die.” USAID was hugely influential, and its closure affected almost every country in the world – from Albania to Zambia. As USAID had administered 60% of PEPFAR funds, in many instances, there was no one left to provide goods and services for those projects covered by Rubio’s waiver. Reporting on this issue was led by HPW Deputy Editor Kerry Cullinan. WHO slashes staff The WHO headquarters in Geneva has been in upheaval all year over how to rearrange the organisation’s budget to make up the 25% cut. The US withdrawal from the World Health Organization (WHO) on Trump’s first day in office, and its reduced support for other UN agencies. unleashed mass layoffs and restructuring. The WHO is slashing its staff by around a quarter – aiming to shed about 2,371 staff by mid-2026 – many at the end of this year – with ripples across Geneva. This has affected WHO’s ability to respond to health emergencies across the world. HPW Editor-in-Chief Elaine Fletcher was often the first to report on the various developments, with an inside track to staff reactions, including the WHO Staff Association decision to challenge the fairness and legitimacy of the restructuring process and the mounting rage of lower-level staff as HPW highlighted data suggesting that low- and mid-level personnel will bear the brunt of cuts, while high-ranking executives, whose real costs far exceed their published salaries, remain largely protected. UNAIDS has also been forced to retrench 55% of its head office staff and cut its country offices by almost half after the US ceased to fund it, a move that affected 40% of its budget. The agency warned that the brupt funding cuts have resulted in “perilous risks” for the global HIV response that threaten the health and well-being of millions of people throughout the world. “It feels like the ground has been ripped out from under our feet,” a Mozambican woman with HIV told UNAIDS, which reported at the year’s end that over two million women and girls have been “deprived of essential health services”, and millions of people at high risk of acquiring HIV have lost access to “the most effective prevention tools available” – pre-exposure prophylaxis (PrEP). Gavi, the vaccine alliance, has pared down its staff by a third, which will also affect global vaccination efforts. Disease outbreaks surge – so does anti-vax activities Mosquitoes, which can carry dengue virus, thrive at warmer temperatures. Climate change is fueling dengue cases globally. Amid the chaos in global health funding, diseases have surged. Africa has experienced large outbreaks of cholera, measles, Lassa fever and mpox, while deadly Ebola and Marburg have also affected several countries. By 10 December, Africa CDC had recorded over 300,000 cholera cases, over 140,00 measles cases and almost 134,000 mpox cases this year. Over the past year, both Latin America and the Caribbean saw record-breaking cases of the mosquito-borne dengue fever, with almost one-fifth of cases (about 45 million infections a year) attributable to climate change, Sophia Samantaroy covered issues from the Americas. Measles has also surged in the US and Canada amid the rise of anti-vaccine misinformation. This has been fueled by the appointment of vaccine sceptic Robert F. Kennedy Jr. as US Health and Human Services Secretary. So far, Kennedy and his appointees have cancelled mRNA research, restricted access to COVID-19 vaccines and made Hepatitis B vaccines non-mandatory for infants. In an exclusive article for HPW, Dr Demetre Daskalakis, former Director of the US CDC’s National Center for Immunizations and Respiratory Diseases, describes how the “wall protecting science from political interference in the US has fallen”. Humanitarian crises multiply Some 42,000 Gazans will need prolonged rehabilitation care and support due to war-related trauma injuries and amputations. Conflict and humanitarian crises – particularly in Gaza, Sudan and Ukraine – inflicted heavy casualties on citizens and health workers, with ongoing and unprecedented attacks on health facilities. HPW coverage of the conflict in Gaza included Israel’s blockade of Gaza, the resulting famine, Israeli attacks on WHO’s warehouse and efforts by Israel to secure the release of hostages being held by Hamas. This coverage was also led by Editor-in-Chief Elaine Fletcher. HPW has also consistently reported on the humanitarian crisis in Sudan, including the attack on a maternity hospital in El Fasher in which more than 460 people died. Climate change is ‘needlessly killing millions’ Climate change is claiming millions of lives annually through extreme heat, air pollution, wildfires and the spread of deadly infectious diseases, according to the ninth annual Lancet Countdown report, the most comprehensive assessment to date of the links between climate change and health, published in October. “We’re seeing millions of deaths that are occurring needlessly every year because of our persistent fossil fuel dependence, because of our delay in mitigating climate change, and our delays in adaptation to the climate change that cannot be avoided,” said Marina Romanello, executive director of the Lancet Countdown at University College London, describing this year’s report as “a bleak and undeniable picture of the devastating health harms reaching all corners of the world.” Breaching the 2015 Paris Agreement, a legally binding global treaty adopted in 2015 to combat climate change by limiting global warming to well below 2°C (ideally 1.5°C) above pre-industrial levels, is now unavoidable, according to scientists. The world is heading for 2.8°C of warming by century’s end under current policies, according to a UN assessment. Climate change protest Global greenhouse gas emissions rose 2.3% to a record 57.7 gigatons of CO2 equivalent in 2024, the largest annual increase since the 2000s. Land use change and deforestation account for 53% of the overall increase, while fossil fuel production continues to expand in direct contradiction of climate pledges. The US is the worst emitter, yet Trump withdrew the US from the Paris Agreement on Day One of his presidency. Domestically, the US Environmental Protection Agency (EPA) has committed to rolling back 31 climate, air and water pollution, and emissions regulations that will negatively affected citizens’ health. The EPA has also announced that it will no longer require most polluters to report their emissions of carbon dioxide, methane and other greenhouse gases that cause climate change. Stefan Anderson led HPW reporting on climate change. The impact of air pollution Disease burden from air pollution. Meanwhile, 90% of people on the planet breathe dangerously unhealthy levels of air pollution every day, and millions fall ill every year with a range of respiratory and cardiovascular diseases as well as cancers, leading to at least seven million deaths each year. Air pollution is the number one killer across South Asia, accounting for 2.7 million deaths, of which 2.1 million are in India alone. There is growing evidence of the impact of air pollution on a range of medical conditions including strokes, diabetes, heart disease and lung cancer. Significant sources of the deadly fine particulate matter (PM 2.5) come from fossil fuels in vehicles, power plants and other industrial facilities, and burning coal, wood, dung and agricultural residues for cooking. India-based Chetan Bhattacharji, led reporting on air pollution. Women’s rights The ‘Green Tide’: Argentinians demanding the legalisation of abortion. HPW has covered the backlash against sexual and reproductive rights, and women’s rights through stories on US anti-rights groups mobilising in Africa, the rollback of abortion rights in Argentina, the impact of intimate partner violence on children, efforts to enable access to menstrual products for girls and women, female genital mutilation, and several articles on women under Taliban rule in Afghanistan. Disha Shetty and Munija Mirzaie contributed several articles on this topic. New world order? In the final few months of the year, the Trump administration sought to turn the chaos its funding cuts caused into opportunities for the US by signing bilateral health agreements with several African countries that promote American business opportunities – and also enable US access to African minerals. This approach is detailed in the America First Global Health Strategy published in September, that “uses global health diplomacy and foreign assistance to make America safer, stronger, and more prosperous”. Driven by former DOGE official Brad Smith, these bilateral Memorandums of Understanding (MOUs) compel countries that receive US aid to fight HIV, tuberculosis and malaria to immediately share all information about “pathogens with epidemic potential” and give the US the right to share this information with other entities, including US pharmaceutical companies. The MOUs directly undermine the WHO negotiations on a pathogen access and benefit-sharing (PABS) system underway in Geneva, placing African countries in a particularly difficult position. Unlike past PEPFAR agreements, the MOUs cut out the involvement of community groups, except faith-based service providers, some of which are known to be against contraception and any recognition of LGBTQ people. Civil society groups have described the MOUs as “extractive” and over 50 organisations issued a letter calling on African heads of state and government to demand “equity and sovereignty” in the new bilateral agreements. However, in a positive reaction to plummeting aid, several African countries have allocated more money to health while several continental efforts are building Africa’s independence. At the Africa Health Sovereignty Summit, Ghana’s President John Mahama announced the formation of the Presidential High-Level Task Force on Global Health Governance in response to the 40% reduction in development aid in the past two years. “The world has changed, but global health governance has not kept pace with the changing world. At this moment, we’re called to redesign the architecture that has, for far too long, excluded Africa’s voices, excluded Africa’s needs and innovations,” said Mahama. Dr Muhammad Ali Pate, Nigeria’s Coordinating Minister of Health and Social Welfare. Writing for HPW, Nigerian Health Minister Muhammad Ali Pate Africa argues that Africa “can redefine its role in global health – emerging as a producer, innovator, and equal partner in shaping both the health of its people and the well-being of the world”. Pate argues that this can be achieved by countries investing in health “with the same urgency it devotes to infrastructure, defence, or governance”; enhancing South–South cooperation and collaboration; and forging a continental alliance that harnesses shared expertise, resources, and innovation for collective health security. HPW was proud to be a media partner at the Conference of Public Health in Africa 2025, where African researchers discussed how best to build solidarity between countries on the continent. Other Health Policy Watch team members and contributors include Maayan Hoffman (who also coordinates our social media), Arsalan Bukhari, Felix Sassmannshausen, Rahul Basharat Rajput, Kate Okorie, Abdullahi Jimoh, Edith Magak and Roisa Kerry. We are deeply grateful to our donors and media collaborations that have supported HPW to remain afloat during this difficult year and provide an important platform of engagement for the Global South and North that is free of charge. But most of all, we are grateful to all our readers for your engagement and interest. Please consider donating to HPW to ensure our ongoing survival. May 2026 be a more positive one for global health! Image Credits: Guilhem Vellut, WHO/EMRO , Markus Spiske/ Unsplash, Health Ministry of Nigeria. Escalating DR Congo Conflict Exacerbates Refugee Flight; Gaza Famine Threat Eases 22/12/2025 Editorial team Thousands of Congolese families are fleeing intense fighting in eastern DRC and crossing into Burundi in search of safety. UNHCR, the UN Refugee Agency, has said it is “deeply alarmed” by the worsening humanitarian situation in Burundi, which has reached a crisis point following a rapid influx of refugees and asylum-seekers fleeing a new wave of violence in the eastern part of the Democratic Republic of the Congo (DRC). Since early December, over 84,000 Congolese have crossed into neighbouring Burundi, fleeing escalating clashes in DRC’s South Kivu region where M-23 militias continue to make major inroads against government forces. Congolese refugees and asylum-seekers in Burundi now number more than 200,000m, said UNHCR’s Representative in Burundi, Brigitte Mukanga-Eno. Thousands of people crossing the border on foot and by boats each day have overwhelmed local resources, creating a major humanitarian emergency that requires immediate global support, Mukanga-Eno told reporters in Geneva on Friday. Women and children are particularly affected, arriving exhausted and severely traumatized, bearing the physical and psychological marks of terrifying violence. “In Burundi, transit centres and informal sites where new arrivals are hosted have far surpassed capacity, in some cases by nearly 200 per cent,” while “acute water and sanitation shortages are increasing the risk of outbreaks of life-threatening diseases, including cholera and Mpox,” Mukanga-Eno said. Across the border in the DRC’s South Kivu, violence, drone attacks and bombardments have forced more than 500,000 Congolese from their homes, many “displaced several times this year alone.” Speaking at an end year press briefing in Geneva, UNHCR, WHO and other UN agencies also warned that as 2025 draws to a close, humanitarian needs in Africa, the Middle East, and worldwide “remain staggering” and recent gains against famine in Gaza since a US-brokered cease-fire between Hamas and Israel last October are “extremely fragile.” In a separate press release, WHO meanwhile declared that “attacks on health care in Sudan are becoming deadlier and more widespread.” Gaza – famine threat rolled back, but hunger remains Famine averted by hunger crisis remains critical according to December IPC report and early 2026 projections.. On a more positive note, the threat of famine in Gaza has eased somewhat since the October cease-fire opened the gates to more aid – but hunger remains a constant threat for most Gazans. The latest Integrated Food Security Phase Classification (IPC) analysis for Gaza confirms that no areas of the Strip are currently classified in famine, but UN officials described this welcome progress as “extremely fragile.” “At least 1.6 million people – or 77 per cent of the population – are still facing high levels of acute food insecurity in the Gaza Strip,” including “over 100,000 children and 37,000 pregnant and breastfeeding women projected to suffer acute malnutrition,” said four UN agencies, including WHO and UNICEF, in a press release Friday, which coincided with release of the latest IPC report, containing a snapshot of the situation today as well as projections for 2026. All four Gaza governorates are still described as facing Phase 3 or 4 hunger conditions marked by “large food consumption gaps, high levels of acute malnutrition, and an elevated risk of mortality.” While “the ceasefire has improved some deliveries of food,” UN agencies said “most families are still grappling with severe shortages,” with “more than 730,000 people” displaced and “heavily reliant on humanitarian assistance,” the UN agencies said. “Gaza’s children are no longer facing deadly famine, but they remain in grave danger,” UNICEF’s Lucia Elmi warned at the Geneva press briefing. She added: “Food is now in markets, but many families simply cannot afford to buy it. Health facilities are barely functioning, clean water and sanitation services are scarce, and winter is bringing increasing suffering to displaced people huddling in makeshift shelters. These fragile gains could vanish overnight if fighting resumes. We need sustained humanitarian access, restored basic services, and above all, lasting peace.” Only 50% of Gaza health facilities functioning even partially Palestinian’s in Gaza’s Deir al Balah receive winterization assistance – an estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Only fifty per cent of Gaza’s health facilities are partially functional, and that “much more is needed to address the vast health needs,” warned WHO’s Tarik Jašarević, also speaking at the Geneva press event. Access constraints facing Gazan Emergency Medical Teams have, however, eased, with denial rates decreasing to about 20 per cent, compared with 30 – 35 per cent before the ceasefire, according to the Health Cluster. There are 343 EMT staff in Gaza, including 73 international staff and 270 national staff, OCHA stated, in a related press release on Friday. Since the cease-fire there has also been an increase in the number of medical evacuations. But more than 18,500 patients, including 4100 children, still are awaiting evacuation, Jašarević added. According to the Palestinian Ministry of Health, more than 1000 patients had died while awaiting medical evacuation between July 2024 and November 2025. Last week, at least ten Gazans reportedly died due to heavy rains, underscoring the life-threatening conditions that families were facing in Gaza, Jašarević said. That included three children who died of hypothermia in a context of cold temperatures and lack of medical infrastructure and medicine, said Ricardo Pires, for United Nations Children’s Fund (UNICEF), citing other reports. The severe storm conditions affected nearly 55,000 households, and forced the evacuation of 370 families from shoreline sites, said OCHA, the UN Office for Coordination of Humanitarian Affairs, in a separate press statement. An estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Sudan North Darfur’s strategic capital of El Fasher (Al Fashir), has been beseiged by the RSF for over a year while 650,000 people fleeing the war have clustered in Tawila (red dotted line) and other areas of the region, like Nyala, which also come under periodic attack. Meanwhile, WHO issued a stark warning over the increase of attacks on health care in Sudan, saying they are “becoming deadlier and more widespread, cutting off access to lifesaving services and placing health workers and humanitarian operations at serious risk.” The latest incident occurred on 14 December when nine health workers were killed and 17 injured in an attack on a hospital in Dalanj, a town in South Kordofan state, WHO said. Dalanj is a key administrative and health hub for surrounding communities, where health workers provide critical referral care. Earlier this month, on 4 December, a kindergarten and the Kalogi Rural Hospital in South Kordofan were also hit, with 114 people killed – including at least 60 children – and 35 injured. Health staff were treating casualties when the attack occurred at the hospital, which serves as a key referral health facility for surrounding rural communities. Evacuations of injured patients to Abu Jebaiha Hospital took place amid ongoing fire. In Nyala, South Darfur, at least 70 health workers were detained, alongside around 5000 civilians, over the past few months according to reports in early December. This incident followed multiple attacks on health facilities in El Fasher in October 2025, including targeted attacks on a maternity hospital that killed more than 460 patients, their families and other civilians, and the abduction of six health workers from El Fasher and surrounding localities in November 2025. Since the conflict began in April 2023, WHO has verified 201 attacks on health care in Sudan, resulting in 1858 deaths and 490 injuries,” with 2025 accounting for “more than 80% of all deaths from attacks on health care verified by WHO in complex humanitarian emergencies globally.” “Health workers have been providing health services with exceptional courage and dedication under extremely challenging conditions,” said WHO in a press release. WHO called “for an immediate halt to attacks on civilians, health workers, health facilities and humanitarian operations in Sudan,” and urged “safe, rapid and unimpeded humanitarian access in line with international humanitarian law.” See related story here: ‘Beyond Horrific’ Conditions in Sudan’s El Fasher; Gaza Swamped by Flooding Image Credits: © UNHCR/Bernard Ntwari, IPC , OCHA , Google Maps . New Flu Strain Sweeping Europe Says WHO; but Vaccines Remain Effective, ECDC Finds 19/12/2025 Felix Sassmannshausen Hans Henri Kluge, the WHO/Europe Regional Director, emphasised that vaccines save lives in the midst of a new flu strain surging early. Sudden fever, a severe cough and acute respiratory distress are the familiar onset symptoms of seasonal flu, which has affected WHO’s European Region with unusual intensity and speed this year. As the Northern Hemisphere enters winter, health systems are struggling to manage an epidemic driven by an aggressive, genetically mutated influenza strain A(H3N2) subclade K. But a new report by the European Centre for Disease Prevention and Control (ECDC), published on Friday, concluded that current seasonal influenza vaccines remain effective against this new strain of the virus. Health experts urge vulnerable groups to get vaccinated. The current influenza outbreak is dominated almost entirely by the A(H3N2) subclade K, which now accounts for up to 90 per cent of all confirmed cases in the region, according to data from WHO’s European Regional Office (EURO). Subclade K marks a “notable evolution in influenza A(H3N2) viruses,” having undergone genetic drift and displaying several amino acid changes in the hemagglutinin protein (the “key” the virus uses to unlock and enter human cells). Due to these slight changes, antibodies acquired from previous infections or older vaccines may not recognise the virus as effectively. “Flu comes around every winter, but this year is a little different,” stated Hans Kluge, WHO Regional Director for Europe, in a press release on Wednesday. Although there is no evidence that it causes more severe disease, Kluge explained that the small genetic variation in the virus places “enormous pressure on our health systems because people don’t have built-up immunity against it.” Flu season gains early momentum A(H3N2) subclade K is fuelling a flu surge across the WHO/Europe region, with protection stalling as most countries fail to meet critical vaccination targets. With the new strain spreading quickly, the current influenza season began approximately four weeks earlier than in previous years. High or very high activity is now being reported in at least 27 of the 38 countries being monitored by the WHO European Region. These countries range from EU Member States such as Ireland and Slovenia to Kyrgyzstan and Montenegro. “This is expected to cause a significant burden in terms of morbidity and mortality, as observed in past years, and target groups should be vaccinated rapidly,” said Bruno Ciancio, an ECDC senior expert, in response to a query from Health Policy Watch. WHO data shows that the strain has been detected in more than 34 countries globally over the last six months. While it is most prevalent in the European and Western Pacific regions, its expansion has also been confirmed in the WHO South-East Asia region. Since October, A(H3N2) subclade K sequences have been reported in Nepal, India and Thailand, as well as in the WHO African and Eastern Mediterranean Regions. Vaccines remain primary shield against severe illness Vaccinations remain effective and a key protection against the new strain, experts emphasize, based on preliminary findings. With cases expected to continue rising, likely peaking in late December or early January, protecting the most vulnerable is paramount. Public health authorities are emphasising urgently that vaccination is the most important protective measure for vulnerable groups, including adults aged 65 and over, pregnant women, people with chronic conditions and healthcare workers. Although recent reports suggest that subclade K shows “reduced reactivity” to current vaccines, it remains effective in preventing severe health outcomes, the ECDC concluded. “The current influenza vaccine is not perfectly matched to circulating strains, including H3N2. However, the primary aim of vaccination is to prevent severe disease, and effectiveness against severe outcomes is expected to be preserved,” explained ECDC expert Ciancio. According to the preliminary data published by the ECDC for this flu season, vaccine effectiveness in preventing influenza cases that require medical attention at the primary care level ranges from 52% in children (ages 0–17) and 57% in adults (ages 18–64). For the critical group of individuals aged 65 and older, it was not possible to estimate vaccine effectiveness separately, due to the low number of influenza cases so far considered in the study. ECDC experts emphasized, moreover, that the findings rely on small sample sizes from nine participating countries and have low statistical precision (e.g. wide confidence intervals). Efficacy could fluctuate as the season progresses. According to a ECDC analysis released only this week, vaccines significantly cut hospital admission rates in the last 2024-25 flu season. The modeling study found that seasonal vaccines were 70-75% effective at preventing hospital admissions among children aged 2-17 years and 30-40% effective in adults. Using computer simulations, the analysis estimated that vaccination programmes prevented 26-41% of flu-related hospitalisations among adults aged 65 and over across European Union (EU) countries between August 2024 and June 2025. Low vaccination rates remain public health concern To protect the vulnerable and to reduce transmission, a multilayered approach following the WHO playbook is essential. Within the EU, only Denmark, Portugal, and Ireland met the 75 percent target for older adults during the reporting period. The ECDC projects that a 75% vaccination rate can prevent up to three-quarters of flu-related hospitalisations, significantly reducing the strain on public health systems. Influenza vaccination rates for high-risk groups in other EU countries remained below WHO targets in the past seasons, as ECDC data from the most recent available season (2021-2022) shows. The overall median influenza vaccine coverage for adults aged 65 years and older was only 43 percent. The scale of the challenge is huge. Recent interim data from Germany’s Robert Koch Institute (RKI) for the 2024-25 season found that flu vaccination coverage among German adults aged 60+ declined from 39.7-34.5% since 2020-21, the first year of the COVID pandemic, reaching its lowest level in over 17 years. And at the same time, a severe flu season can strain hospital staff and capacity in already overburdened health systems. Combating the flu requires a multi-layered approach, experts underline. Slowing transmission requires proactive public health and social measures alongside vaccination, says WHO. These steps, proven effective during the COVID-19 pandemic, include staying home if unwell, wearing a mask in public if symptomatic, maintaining regular hand hygiene, and improving indoor ventilation. European health systems have “decades of experience managing influenza,” said Kluge, striking a note of optimism alongside the WHO warning. “We have safe vaccines that are updated annually, and we have a clear playbook of protective measures that work.” Image Credits: European Union, WHO/Europe , World Health Organization, European Union. Cervical Cancer in India: Early Marriage, Poor Screening and Gender Inequality Fuel a Preventable Killer 19/12/2025 Arsalan Bukhari Though largely preventable, cervical cancer continues to kill thousands of Indian women each year. MUMBAI, India – Cervical cancer kills more than 75,000 women in India each year, according to figures recently disclosed in Parliament – yet it is one of the most preventable cancers. In India, low human papillomavirus (HPV) vaccination coverage, limited access to routine screening and deep-rooted social behaviours – such as early marriage and low condom use – drive late diagnosis and high mortality. Globally, cervical cancer is the fourth most common cancer among women, with an estimated 660,000 new cases and 350,000 reported deaths in 2022, accoridng to WHO. Public health experts say these factors increase exposure to HPV, the underlying cause of nearly all cervical cancer cases, while allowing the disease to progress silently for years before detection. For Neha, a 29-year-old hotel worker in the city of 12.5 million, India’s largest, the statistics reflect a deeply personal loss. My two cousins died from cervical cancer,” she told Health Policy Watch. “What frightens me most is how silent it is. People seem completely normal for years, and then you discover they have had cancer for a long time only when they are close to dying. Early marriage and rising HPV exposure A wedding procession in India, where early marriage remains common. Doctors say nearly all cervical cancer cases are caused by persistent infection with high-risk types of HPV, one of the most common sexually transmitted infections worldwide. Mumbai physician, Dr Sonali Roy told Health Policy Watch that HPV exposure in India is closely tied to early marriage, low awareness and limited access to vaccination and screening, particularly in rural areas. “In some villages, girls are married as young as 14 or 15,” Roy said. These marriages often do not last, and women may remarry multiple times. Each marriage increases exposure to HPV, especially when condoms are rarely used and sexual health awareness is very low. Early marriage often leads to early sexual debut, repeated pregnancies and limited agency over reproductive health decisions, experts say all of which raise the risk of persistent HPV infection. The biological vulnerability of the cervix during adolescence further increases susceptibility to the virus. Unlike many high-income countries, India has yet to roll out a nationwide HPV vaccination programme, despite repeated recommendations from public health experts and the World Health Organization (WHO). While some states have launched pilot projects, coverage remains patchy and largely urban, leaving millions of girls unprotected before sexual debut. Routine cervical cancer screening also remains uneven across Indian states, with weak outreach in rural areas and among informal urban settlements, where health services are often overstretched. Evidence from research HPW vaccine introduction; India and South-East Asia lag behind most other regions of the world in routine HPV vaccination. Research supports the link between early sexual debut, multiple partners and higher HPV infection risk. A 2019 study reviewing medical records of 349 women who tested positive for high-risk HPV found that women who began sexual activity at a younger age or had multiple sexual partners faced a significantly higher risk of infection with HPV types 16 and 18, the two strains responsible for the majority of cervical cancer cases globally. The study found that about one in five women was infected with HPV 16, while nearly 9% were infected with HPV 18 – the types of HPV most likely to cause cervical cancer. Women who reported their first sexual intercourse at age 19 or younger were significantly more likely to be infected with HPV 16 than those who became sexually active later. The risk rose sharply with multiple partners. Women who reported more than three lifetime sexual partners were four times more likely to be infected with HPV 18 than women who had fewer partners. Public health researchers caution that these findings reflect structural conditions rather than individual behaviour. “In many cases, women do not have the power to negotiate when to marry, when to have sex or whether protection is used, ” said a health researcher. Men refuse to use protection With fewer than one in 10 Indian men using condoms, women bear the health consequences of preventable HPV infections. Even when women understand the risks, many say they have little control over prevention. A 27-year-old woman from the East Mumbai suburb of Kurla, who spoke on condition of anonymity, told Health Policy Watch that her partner refuses to use condoms.“He says it affects his pride,” said Priya (not her real name). This is common, even in cities like Mumbai, India’s modern financial center. She said stigma is far stronger in rural areas, where access to contraception is limited and social scrutiny is intense. Many women end up with these infections simply because men refuse to use protection. Her account echoes broader national trends. A 2021 report found that fewer than one in 10 men in India use condoms, making male sterilisation and barrier contraception among the least-used family planning methods in the country. Female sterilisation remains the dominant form of contraception, often placing the burden of reproductive health entirely on women. By comparison, a 2025 Zipdo educational report estimated that around 45% of sexually active people worldwide used a condom during their last sexual encounter. Priya recalled a close friend who had part of her cervix surgically removed after an early cancer diagnosis. Doctors later told her that consistent condom use would likely have prevented the HPV infection that led to the disease. Screening gaps Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. In India, the absence of a structured nationwide screening system has meant that many women are diagnosed only at advanced stages of the disease when treatment is more expensive and survival rates drop sharply. Under India’s National Programme for Prevention and Control of Non-Communicable Diseases and Ayushman Bharat, its health insurance for vulnerable families, women aged 30 to 65 are supposed to be screened for cervical cancer at primary health centres using visual inspection with acetic acid, a low-cost test known as VIA. Coverage, however, remains extremely low. Only about 2% of eligible women are currently being screened, with wide variations across states based on education levels and rural–urban divides. Health workers cite multiple barriers, including staff shortages, limited training, lack of privacy at health centres and social stigma around gynaecological examinations. For many women, domestic responsibilities and daily wage work also make preventive care a low priority. Cancer means financial ruin Doctors perform a surgical procedure on a woman patient. For some women, barriers go beyond awareness and access. A woman living on the rural outskirts of Mumbai, nearly 87 kilometres from the city centre, told Health Policy Watch that fear of financial ruin often outweighs concern about infection itself. “May God save us from expensive diseases. Unfortunately, cancer is one,” said Afshana, not her real name. “Even though we have a five lakh cover [around $5,500 annually] under Ayushman Bharat [insurance plan], we often end up going to private hospitals because services are lacking.” Her experience reflects broader systemic gaps. A 2024 NITI Aayog review of Health and Wellness Centres linked to Ayushman Bharat, India’s flagship government insurance scheme, found significant shortfalls in cancer screening delivery. While most centres had initiated screening for noncommunicable diseases, fewer than 10% had completed a full annual round. Cervical cancer screening was “yet to be operationalised,” according to the report, while oral cancer screening was carried out only selectively. The review also found that many auxiliary nurse-midwives, staff nurses and medical officers had not received adequate training to conduct screenings or manage referrals. Although most centres met basic infrastructure standards and provided essential medicines free of charge, service delivery continued to lag behind national goals for early detection and prevention. A preventable tragedy Cervical cancer is widely regarded as one of the most preventable forms of cancer. HPV vaccination, regular screening and timely treatment of precancerous lesions have dramatically reduced incidence and mortality in countries that have invested in these measures. Public health experts warn that without urgent action, India risks continuing to lose tens of thousands of women each year to a disease that can largely be stopped. “Cervical cancer is not just a medical issue,” Roy said. “It is a reflection of gender inequality, weak health systems and the failure to prioritise women’s health.”For women like Neha, the cost of that failure is already painfully clear. “If they had found it earlier, my cousins might still be alive,” she said. “No one should die from something that can be prevented.” Image Credits: Saiyan Mondal/Pexels, Gurpreet Singh/ Unsplash, Han J et al, eClinicalMedicine, Vol. 84June 2025, Deon Black/ Unsplash, Bermix Studio/Unsplash, Richard Catabay/Unsplash. Malawi’s New Government Faces National Hunger, Dwindling Aid and Soaring Debt 18/12/2025 Dingaan Mithi Almost a quarter of Malawians face malnutrition until the next harvest in March. This story was originally published by The New Humanitarian. Just a few months into his new term, President Peter Mutharika is grappling with a triple crisis: a deep-seated food emergency, diminishing aid, and soaring debt. With over four million Malawians – 22% of the population – facing the threat of acute malnutrition until the next harvest in March, Mutharika last month declared a nationwide state of disaster. But the $119 million humanitarian response is underfunded. Although crucial to staving off the risk of hunger-related deaths, it has so far raised only $26 million from Malawi’s aid partners – roughly 21% of the amount required. The trigger for Malawi’s food emergency has been a 20% drop in maize yields last year as a result of drought and localised flooding. The harvest failure hit small-scale farmers especially hard – the backbone of food production. The problem is not just food availability, but also its affordability. Reduced farm output, a severe foreign exchange shortage, plus perennial fuel scarcities, have pushed Malawi’s inflation rate to around 28% – the highest in Africa. Even though Monica Jasteni runs a small fish business in her home area of Salima, in central Malawi, the 34-year-old mother of four is struggling. “The money I make is not enough [to buy the food we need],” she told The New Humanitarian. “I try to persuade my children to go to school without eating, telling them that they’ll have food after school, because things are difficult.” She supplements what she makes from selling fish by also farming. But as she can’t afford irrigation, her small plot is susceptible to dry spells. An unsustainable debt burden The experience of Jasteni – trying to make ends meet, yet failing – is why a coalition of 50 civil society organisations is demanding urgent action by the government. “The hunger crisis is a huge national emergency,” said Amon Lukhele, national coordinator of the Civil Society Social Protection Network (CSSPN). “We are calling upon the government to act now to protect the poorest households before the hunger situation worsens.” CSSPN wants the government to accelerate implementation of its National Social Protection Policy, a safety net programme that aims to provide relief to the most vulnerable. But Mutharika, elected in September, has inherited public finances in a critical state. That has put pressure on what spending the government can afford, and the speed with which remedial programmes can be rolled out. Malawi is heavily debt-distressed. Its total debt burden is around $9.25 billion – an unsustainable 86% of GDP. It also faces a looming debt service obligation of $1.8 billion. That affects not only economic growth, but also the provision of essential social services. As a result, Malawi spends more on debt servicing than it does on health. The closure of the US Agency for International Development – a key health donor – has only made the government’s budget calculations even harder. Yet opportunities have been squandered. In 2006, Malawi had its debt cancelled under the Highly Indebted Poor Country Initiative (HIPC). But 19 years down the line, after years of heavy borrowing, it is back in arrears – and has been forced to swallow two painful currency devaluations, in 2022 and again in 2023. “Too much debt erodes Malawi’s capacity to strengthen food security,” said Mavuto Bamusi, a prominent political analyst and anti-corruption campaigner. “Debt repayments to lenders, especially the IMF [International Monetary Fund], are taking out a lot of money that could have been used for agricultural commercialisation.” Malawi needs to urgently restructure its debt, and find domestic and international support for reforms to revive its economy after years of mismanagement, analysts suggest. Joseph Mwanamvekha, the new finance minister, has announced new reform measures to stabilise the economy, and combat the food crisis. They include a commitment to improve public debt management and fiscal discipline, strict expenditure controls, and management of the wage bill. Getting food security right This is the fifth time in a decade Malawi has declared a food-related state of disaster. It not only signifies a deepening cycle of climate volatility, but also reflects the deep structural issues around food security. The agricultural sector is central to Malawi’s economy, accounting for almost a quarter of GDP and employing three quarters of the population – mostly through subsistence farming. But productivity gains have stagnated over the past decade, with an over-reliance on maize leading to soil degradation and micro-nutrient deficiencies in people’s diets. Successive governments have implemented input subsidy programmes, providing cut-price fertiliser and seeds. But historically they have suffered from logistical bottlenecks leading to late input deliveries, as well as targeting problems, fraud, and political interference. Mutharika’s government is trying again. He has launched the 2025/2026 Farm Input Subsidy Programme (FISP) aimed at 1.1 million farming households. Each will receive two 50kg bags of subsidised fertiliser plus a 5kg pack of seed of their choice. Political commentators suggest this will be a defining test for his administration. The goal for Mutharika is to deliver on his election campaign promises to provide farm inputs on time – and nationwide – avoiding favouring political constituencies. The rollout of digital registries and e-vouchers, backed by the World Bank, may help fix some of those problems. Yet the FISP will reach only a fraction of Malawi’s farming households. It also doesn’t fully address the problem of farmers’ preference for drought-vulnerable maize at a time of worsening climate volatility. Dominic Nyasulu, the national coordinator at the National Youth Network on Climate Change, argues that the new government needs to reframe food security policies to promote drought tolerant crops such as millet and sorghum – crops that were traditionally grown before the commercialisation of maize. “This country has potential to defeat hunger, but our policies need to be reformed in view of extreme weather events and other climate impacts,” said Nyasulu. Tamani Nkhono-Mvula, a Malawian agriculture and food security expert, said a more far-reaching change will come with irrigation. Only 4% of farming land is currently irrigated. The drawbacks are that it is expensive, there is a lack of rural financing, water management has historically been a problem, and women farmers are particularly disadvantaged. The lack of government capacity is also a significant drawback, as is access to commercial markets, according to 2021 evaluation of a World Bank irrigation and rural development project. However, Nkhono-Mvula argues that the potential “for Malawi to feed itself is there – the leadership just needs to be transformative”. The New Humanitarian puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world. Image Credits: Fatsani Gunya/ The New Humanitarian. Two More WHO Officials Cut from Senior Leadership Team Move into Other Roles 16/12/2025 Elaine Ruth Fletcher WHO Director General’s former Senior Leadership Team – which he slashed from 11 to six positions as part of a major reshuffle in May 2025. Two more senior WHO officials, Bruce Aylward and Ailan Li, who were among those dropped from WHO’s Senior Leadership Team during the first phase of an Agency shake-up, have now been appointed to leading roles elsewhere in the organisation, according to a memo from Director General Tedros Adhanom Ghebreyesus. Li, a Chinese national and former assistant director-general for UHC/Healthier Populations at WHO Headquarters in Geneva, has been appointed as WHO Representative to the Kingdom of Thailand, Tedros announced, in a message seen by Health Policy Watch. Aylward, formerly assistant director-general for the Division of Universal Health Coverage/Life Course, was appointed director of the WHO-World Bank Global Preparedness Monitoring Board in August, and will now also be coordinating the work on the UN80 Initiative, Tedros confirmed in the message, emailed to all staff on Friday. The new appointments complete the sweep of WHO’s 17 former senior management officials, now reduced to 12 as part of major cost-cutting moves triggered by the withdrawal of the United States from the organisation in January. The US retreat left a gaping $1.7 billion budget gap for the upcoming 2026-27 budget period. That has now been reduced to $1.05 billion due to a projected 25% reduction in WHO’s workforce next year. Three of six ADGs cut from senior leadership ranks actually left WHO Dr Mike Ryan addresses a meeting of WHO pandemic negotiators in one of his last public appearances before retiring. The new senior leadership team includes four assistant director generals at headquarters, a Chef de Cabinet and Chief Scientist, as well as Tedros himself. The directors of five WHO Regional Offices (not including the head of the Pan American Health Organisation, counted separately) also hold an equivalent ranking, for total of 12 such posts. Of the six ADGs who were cut from team in May, three have actually left the organisation, including Samira Asma, formerly ADG for Data, Analytics and Delivery, now with the Susan Thompson Buffett Foundation; Jérome Salomon, ADG for Universal Health Coverage who left WHO in September; and Health Emergencies Executive Director Mike Ryan, who retired in September. The recent appointments mean that three others, including Li, Aylward and former ADG for External Relations Catherine Boehme have now moved into other roles, with Boehme serving as “Officer in Charge” of WHO’s South-East Asia Regional Office (SEARO). Tedros placed SEARO’s Regional Director, Saima Wazed on leave on 11 July, after the Bangladeshi government filed two cases against her for alleged fraud, forgery and misuse of power, also issuing a warrant for her arrest. No return date has so far been announced. See related story: Controversial WHO Regional Director Placed on Leave Former HQ Directors also named to lead WHO country offices In his message Friday, Tedros also named a number of other former department directors and team heads at headquarters to head country offices in the global organisation, including: Indrajit Hazarika, formerly Senior Public Health Officer, of Country Strategy and Support at HQ, as WHO Representative to the Republic of Angola. Ann Maria Lindstrand, formerly Unit Head, Essential Programme on Immunisation in the Health Emergencies Division, as WHO Representative to the Republic of Cabo Verde. Dr Pavel Ursu, formerly Director of the Department of Delivery for Impact at headquarters in Geneva, as WHO Representative to the Federal Republic of Nigeria. Dr Michel Yao, formerly the Director of the Department of Strategic Health Operations, will become the WHO Representative to the Republic of Senegal. In 2021, Yao as well as another senior WHO official, were named in an alleged cover-up of allegations of sexual abuse brought against WHO field staff and consultants responding to an Ebola outbreak in the Democratic Republic of Congo. They were later cleared by an UN investigations panel. Nedret Emiroglu, a former Director for Country Readiness Strengthening in the Health Emergencies Division, was meanwhile named to head the WHO Secretariat for the Intergovernmental Working Group (IGWG), which is negotiating further provisions of the WHO Pandemic Agreement approved in May – most notably a proposed system for Pathogen Access and Benefit Sharing (PABS). Staff Reductions to date WHO workforce, headquarters, country offices and regions, in 3rd Quarter 2025, a reduction of over 500 staff in comparison with December 2024. In a press briefing last week, Tedros publicly acknowledged that the organisation plans to reduce WHO staff worldwide by an estimated 2371 positions by mid-2026, shedding about 25% of the workforce, which numbered 9,466 at the end of December 2024, and just under that as of 1 January. Around 1,089 staff are being shed through what WHO described as “natural attrition.” This includes retirements, early retirement, and the non-renewal of short-term staff contracts that expire. In addition, another 1,282 long and short-term posts have been abolished outright, according to statements at the presser and the earlier briefing to WHO member states. That should bring WHO’s global staff headcount down to about 7,360 professional and administrative positions by mid-2026. In terms of sheer numbers, professional staff at low and mid-level are among those hit hardest by the staff cuts.. Of those cuts, some 505 staff had left WHO by end September, WHO human resource records show; that count was confirmed by a WHO spokesperson. “A large number of staff are exiting at the end of December, three-months notice while notified in September,” the spokesperson told Health Policy Watch. “And another large number will leave in June 2026, i.e. the ones with reassignment rights.” In terms of D1 and D2 directors, whose numbers nearly doubled in the first six years of Tedros’ administration, costing the organisation nearly $100 million annually, some 21 Directors’ positions had been eliminated as of 30 September. That brings the number of directors worldwide down from a peak of 188 at end 2024 to 167 in Q3 2025. WHO Directors – 3rd Quarter 2025 – versus December 2024. That still leaves another 30 D1 and D2 posts to be eliminated by June 2026, mostly at headquarters. The massive reorganisation announced in April and May, slashed the number of departments and directors at headquarters by more than half – from 76 to 34 positions). The reason those reductions haven’t yet been reflected in the HR records is simple, WHO says. “Some directors who are sitting on positions that have been abolished have up to 6 months reassignment [rights] plus a 3-month notice period,” a WHO spokesperson said, “hence they still appear in the Q3 report. The target remains for June 30, 2026.” How will cuts translate into budget savings? Despite the painful plans to cut more 2,371 staff worldwide by June 2026, a projected funding gap remains of $1.05 billion, according to the director general’s last report to member states in November. The $1.7 billion funding gap for 2026-27 has been reduced to $1.05 billion, according to current projections. And the degree to which cuts in rank-and-file, as well as high level positions, will lead to actual savings remains to be seen. WHO’s November reports to member state did not offer any detailed analysis of projected savings that would be gained through the reductions by staff grade or office location. Even less detail provided on the status, conditions and costs of non-staff contract holders – about which there is no reporting even of pay grades or geographic base, let alone gender and age. That’s despite the fact that WHO’s non-staff’s headcount of 7582 (full-time equivalents) in 2024 was approaching that of actual staff numbers (9466) for that year. WHO officials say that the lack of more detailed reporting on non-staff contracts, is linked to legal and ethical issues. “WHO does not systematically capture, aggregate or publish individual-level information (such as grade equivalence, age, gender or demographic background) for non-staff contractual arrangements,” a WHO spokesperson told Health Policy Watch. “Doing so would raise legal, ethical and data-protection concerns, as WHO is not the employer of these individuals and does not have a mandate to collect or process such personal data beyond what is strictly required for contractual and financial compliance.” This table in WHO’s bi-annual HR report is the sole data available on non-staff contracts. It notes full-time equivalents for part-time engagements (consultants and APWs). Presuming that most Special Service Agreements (SSAs) are full-time, total estimated full time equivalent contracts numbered nearly 7600 in 2024. At the highest levels of WHO staff, meanwhile, some directors whose departments at headquarters were abolished remained in the organisation as a heads of unit, which typically carries a top-level professional grade of P6. In the UN grading system, the salaries of D1 directors and P6 professionals are virtually identical. And some former department heads now running units have even clung to their old titles, regardless of the formalities. Signature of a former director – (phone number and email have been erased to protect privacy). In an email invitation to colleagues for a late November reception at the WHO canteen, the former Director of the Department of Public Health and Migration (PHM), who is now technically a unit head, couldn’t resist signing the invite with his old title as well: “Head of Special Initiative on Health and Migration (Director). Division of Universal Health Coverage and Healthier Populations.” Observed one WHO staff member: “This kind of thing is all over the place. As for cost reduction, NADA!” Image Credits: WHO HR database , WHO , WHO Workforce Data, December 13 2024, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
UN Agencies, Aid Groups Protest Israel’s Move to Bar Many NGOs from Gaza as Winter Exacerbates Dire Conditions 06/01/2026 Elaine Ruth Fletcher Gaza tent camp surrounded by mud from unusually heavy winter storms; new Israeli restructions on NGO activities would further impede humanitarian efforts, UN and partner agencies charge. Senior United Nations officials and humanitarian leaders have urged Israel to reverse plans to withhold registration from more three-dozen international NGOs providing humanitarian relief in war-torn Gaza and the Israeli-occupied West Bank – warning that the move would severely undermine life-saving aid in a moment of acute humanitarian need. Israel said last Thursday that some 37 international NGOs operating in Palestinian areas it controls, including the internationally renowned Médecins Sans Frontières, had not complied with a deadline to meet “security and transparency standards” now required by Israel for re-licensing in 2026. The NGOs are contesting new Israeli rules requiring them to disclose personal information on local Palestinian staff. For those NGOs that don’t comply, Israel has said it “will enforce” a ban on their activities in 2026. The government approved the new registration rules in March 2025 – in the wake of Israeli government allegations that two former MSF staff members were involved with Hamas or other armed groups. MSF has denied knowingly hiring people with military ties. In a related move, Israel last week also cut off water and electricity to the now vacant Jerusalem facilities of UNRWA, the UN Palestinian Refugee Agency, under legislation approved by the Knesset, or Parliament to close down the UN agency’s operations in areas under Israeli control. On Monday, seven European countries, including Spain, Ireland and Norway, condemned the move calling it a violation of international law with “grave humanitarian consequences.” Joint UN Agency statement decries move In a joint statement 31 December, the Inter-Agency Standing Committee (IASC), which represents about 20 heads of UN agencies and major humanitarian organisations, said that international NGOs collectively deliver nearly $1 billion in assistance each year in the occupied Palestinian territory and are “central to humanitarian operations,” particularly in Gaza. “Humanitarian access is not optional, conditional or political,” the statement said. It warned that restricting NGO operations during winter, amid continued food insecurity and recent flood-related displacement, risks undoing fragile gains made since the October 2025 Israeli-Hamas ceasefire – and would have “devastating” consequences for Gaza’s civilian population. The signatories included the UN emergency relief coordinator Tom Fletcher, the World Health Organization’s Dr. Tedros Adhanom Ghebreyesus, as well as the heads of the UN Refugee Agency (UNHCR); the UN Development Pogramme (UNDP); UNICEF, the UN Childrens Agency; the World Food Programme; and leaders of major civil society groups such as Oxfam, Save the Children, Mercy Corps and Caritas Internationalis. MSF condemns “cynical” attempt to block aid A pregnant Palestinian mother, Donia Alouf, and her 1 year-old son, Ahmed, who was diagnosed with malnutrition, receive treatment in an MSF-supported Gaza city clinic. COGAT, the Israeli Defense Ministry agency coordinating Gaza humanitarian aid, has said that the new registration process is designed to prevent the misuse of humanitarian aid by Hamas, which it claims has exploited aid frameworks for to divert funds and recruit local aid employees for its own military purposes. COGAT also contended that the revocation of the licenses to the 37 NGOs will not substantially affect aid delivery, claiming that the affected organizations had not provided substantial aid to Gaza since the ceasefire began on October 10. And before the ceasefire, their combined contribution amounted to only a small proportion of total aid, Israel said. Médecins Sans Frontières (MSF), one of the most prominent organisations affected by Israel’s registration decision, contested Israel’s claims. An MSF press statement noted that the organization currently supports one in five hospital beds in Gaza and assists one in three mothers during childbirth. “In the last year, MSF teams have treated hundreds of thousands of patients and delivered hundreds of millions of litres of water,” said Pascale Coissard, MSF emergency coordinator for Gaza, in a 22 December statement. “In 2025 alone, we carried out almost 800,000 outpatient consultations and handled more than 100 000 trauma cases, and if we obtain registration, we plan to continue strengthening our activities in 2026.” Describing the move as a “cynical and calculated attempt” at political control, MSF said that blocking its activities and those of other NGOs that refused to register their Palestinian staff would exact a “terrible cost” after Gaza’s health system has been decimated. Only about half of the enclave’s 36 hospitals are functioning, and those only partially. International organizations say new Israel’s rules potentially endanger staff A toddler plays with dolls in MSF’s burn unit in Nasser hospital, Gaza, in May 2025. She was severely burned in an Israeli airstrike that struck her family’s tent in the Al-Mawasi humanitarian zone, which also killed her mother and two siblings. The healing process was hindered by a lack of proper nutrition and protein for the child, unavailable due to the Israeli halt to most humanitarian aid between March and late May. MSF said Israel’s core demand, that the NGO’s share personal information about Palestinians employees, is especially dangerous in Gaza where humanitarian workers have been intimidated, detained, attacked and killed. Some 15 MSF colleagues have reportedly been killed by Israeli forces. “Demanding staff lists as a condition for access to territory is an outrageous overreach,” MSF said, adding that there is no clarity on how such sensitive data would be used or shared. The organization said Israeli authorities had ignored repeated requests for meetings and instead accused MSF in the media of harbouring alleged militants – an allegation MSF rejects. “MSF would never knowingly employ anyone involved in military activities, which contradicts our core values and ethics,” the organization said. “Denying medical assistance to civilians is unacceptable under any circumstances, and it is appalling to use humanitarian aid as a tool of policy or collective punishment.” Israel’s moves on UNRWA follow in the wake of allegations that surfaced in 2024, charging that some 19 UNRWA employees participated in the 7 October Hamas attacks on Israeli communities, and UNRWA facilities were also used for Hamas weapons storage and other military activities. UNRWA has denied most of the claims, while acknowledging that an internal UN investigation led to the termination of nine UNRWA employees where “evidence obtained … – if authenticated and corroborated – might indicate that the staff members may have been involved.” Meanwhile, Palestinian nationalists who are also critics of Hamas note that the pressures on local aid workers to filter food, funds or other forms of aid can be intense – particularly as the militant group has now regained control over the roughly 50% of Gaza that lies within the “yellow line” to which Israel withdrew in October. A chilling update from the ground in Gaza: Two of my friends, who have been running independent food drives via international crowdfunding, were stopped and interrogated by Hamas militants. After proving their transparency and showing that all funds are used for food and aid for… pic.twitter.com/d55tKopGHM — Hamza (@HowidyHamza) January 5, 2026 Shelter crisis deepens amid winter storms Tents and ruined buildings in Gaza surrounded by mud. The curbs on the activities of the NGOs comes as housing and sanitary conditions in Gaza continue to deteriorate amidst a series of heavy winter storms, particularly for hundreds of thousands of displaced people living in makeshift shelters, according to the end December update of the UN Office for the Coordination of Humanitarian Affairs (OCHA). The unusually heavy rainfall has flooded tents and caused already unstable buildings to collapse – forcing displaced families to move yet again in search of safer ground. Seawater inundation has rendered shelters uninhabitable in coastal areas such as Al Mawasi in Khan Younis, while heavy winds have destroyed or severely damaged many tents. As of 30 December, humanitarian partners have provided emergency shelter assistance to more than 80,000 Gazan households, distributing tens of thousands of tents, tarpaulins and bedding items. Despite these efforts, more than one million Gazans out of a population of 2.1 million still need urgent shelter support, OCHA said. According to Gaza’s Hamas-controlled Ministry of Health, at least 17 people died in December due to the collapse of storm- and flood-damaged buildings, while three children died of hypothermia. WHO, MSF and other partners have reported consistently high rates of respiratory infections, warning that winter conditions are driving further illness, particularly among young children. Sewage, waste and public health risks A Palestinian boy walks past tents during a break in the rain in Jabalya, North Gaza. Waste mixed with floodwaters increases exposures to infectious diseases. Flooding has also intensified Gaza’s long-running sewage and solid waste crisis – and along with that infectious disease risks related to sewage exposure. The UN Water, Sanitation and Hygiene (WASH) Cluster reports that damaged infrastructure, fuel shortages and restrictions on the entry of equipment are limiting the ability to manage wastewater and storm runoff. Recent rains raised water levels in inland lagoons such as Wadi Gaza and Sheikh Radwan, heightening the risk of overflow and sewage contamination on land, as well as into the sea. The Palestinian Water Authority says it has been forced to rely on short-term measures because critical equipment such as pumps, pipes and electromechanical components has been denied entry by Israel. Solid waste management remains severely constrained. Since 7 October 2023, Hamas miiltants first invaded Israeli communities on the Gaza periphery in the opening salvo of the war, an estimated $66 million in damage has been recorded to waste management systems, including the destruction of more than 200 collection trucks and widespread damage to facilities. Gaza’s two main landfills remain inaccessible, forcing municipalities to rely on overcrowded temporary dumping sites. Waste generation far exceeds collection capacity in northern Gaza, where only about 60 per cent of daily waste is collected. This has resulted in continued accumulation of solid waste in densely populated areas, exacerbating public health and environmental risks. While a recent analysis found that famine conditions in Gaza have been pushed back, acute food insecurity and malnutrition remain critically high, and aid officials warn that progress remains fragile. “Needs are growing faster than aid can get in,” UN Secretary-General António Guterres declared in a late December press briefing, stressing that predictable and unimpeded access for humanitarian actors is essential to address the immense challenges faced. “We need more crossings, the lifting of restrictions on critical items, the removal of red tape, safe routes inside Gaza, sustained funding, and unimpeded access – including for NGOs,” Guterres said. “And we cannot lose sight of the rapidly deteriorating situation in the West Bank,” he added referring to escalating Israeli settler violence, land seizures, demolitions and displacement as well as intensified restrictions on movement – affecting Palestinian access to vital health and social services as well as livelihoods. Against that landscape, the prospect of new Israeli bans on international NGOs threatens to further erode an already strained response. “Allowing humanitarian aid is not a favour,” MSF said. “It is an obligation under international law.” Image Credits: MSF , Palestinian Water Authority , Nour Alsaqqa/MSF, Palestinian Water Authority , OCHA . US EPA dismisses WHO Cancer Agency Determination that Widely Used Herbicide is ‘Probably Carcinogenic’ 05/01/2026 Sophia Samantaroy Over 70 million tons of atrazine is applied to US soil each year. The chemical is now deemed a ‘probable’ carcinogen to humans. The US Environmental Protection Agency has dismissed a recent finding that atrazine, the second most widely-used herbicide in the United States, is “probably carcinogenic to humans” by the World Health Organization’s cancer review agency. Atrazine is used extensively in the US on crops like corn, sorghum, and sugarcane. However, over 60 countries have banned the chemical due to its endocrine-disrupting properties and tendency to contaminate groundwater. In a new classification, published in the January, 2026 issue of The Lancet Oncology, the International Agency for Research on Cancer (IARC) ranked atrazine as probably carcinogenic to humans based on what it described as “limited evidence” for cancer in humans and “sufficient evidence for cancer in experimental animals.” The agency’s findings are independent assessments that guide national regulatory authorities worldwide in the promulgation of rules around chemicals used in agriculture, food systems and occupational settings. The IARC assessment was the first in nearly three decades. In 1998 the organization said the compound was not classifiable as to its carcinogenicity to humans. Since the IARC findings were initially released in late November, the US Environmental Protection Agency (EPA), as well as chemical producers in China and elsewhere, have pushed back against the new classification. Both used almost identical terms in describing the determination as “flawed” and “inconsistent with scientific consensus.” Hormone disruptor, cancer risk of atrazine Atrazine has been linked to non-Hodgkin’s lymphoma Atrazine’s cancer links include evidence of oxidative stress, hormone disruption, immune suppression, and actual tumor growth, IARC found in its abbreviated evaluation of atrazine and two other compounds. In particular, IARC pointed to animal studies that showed tumor growth in the mammary glands and uterus of female rats, reduced estrogen and testosterone in both male and female rats, and induced cell death and division. The most recent study IARC cites, from 2024, also concluded that male rats also experience oxidative stress and severe hormone disruption. In humans, only a handful of studies have been published so far. However, IARC noted that two case-control studies that reported “strong positive associations between exposure to atrazine…and translocation-positive NHL [non-Hodgkin’s Lymphoma]” among exposed farm workers. Links to other human cancers did not show “consistent positive findings.” Beyond its cancer inks, atrazine exposure is also associated with birth defects, reproductive harm, and hormone disruption, in papers not cited by IARC – an agency that focuses almost exclusively on cancer risks. US regulators and manufacturers push back The US EPA said IARC’s findings used a “deeply flawed approach to its cancer assessments” In a 21 November statement, Syngenta, the agrochemical company that produces most of the US’s atrazine, said: “[c]urrent scientific evidence clearly demonstrate[s] that atrazine is safe when applied in accordance with registered label instructions.” Syngenta is owned by the Chinese state-operated company Sinochem. Speaking to Health Policy Watch just a few days after the Syngenta statement, EPA used identical terms, arguing that IARC’s findings “stir up fear” by also including “very hot beverages, red meat, working the night shift and hairdressing in the same classification.” “This announcement on atrazine is just another example of the World Health Organization International Agency for Research on Cancer (IARC) using a deeply flawed approach to its cancer assessments on multiple levels,” the EPA added. The EPA spokesperson complained, in particular, that the two-page article published so far is just a brief summary of the full review, which is only due to be published later this year, according to IARC. “[F]or IARC to roll out these “findings” and unnecessarily stir up fear when IARC has said it will not be publishing any of its detailed science until late 2026 or 2027 is irresponsible and lacks transparency. Currently, there is no opportunity for anyone to meaningfully review how IARC has reached its conclusions,” said the EPA’s press office. “In contrast, atrazine has been extensively studied by EPA across multiple administrations, including having five meetings of independent Scientific Advisory Panels peer review the cancer potential of atrazine between 2009-2011,” EPA said. “As a reminder, IARC also has a long history of being severely misguided in its findings,” the EPA spokesperson said, citing past IARC findings on red meat and night shift work, among other factors, as possible or probable causes of cancer. In 2015 IARC concluded that red meat was a possible cause of cancer and processed meat is a probable cause. Those findings have since been echoed by the American Institute for Cancer Research, which in 2021 concluded “there is strong evidence that eating high amounts of red meat increases the risk of colorectal cancer.” The US Department of Agriculture’s most recent dietary guidelines also suggest reducing red meat consumption. The US CDC concluded in a 2021 report that there is “high confidence” that persistent night shift work that results in circadian disruption can cause human cancer. Environmental groups welcome IARC re-evaluation Latest estimates of atrazine use from the US Geological Survey, 2019 Separate EPA reviews in 2003 and 2018 concluded that available evidence does not support a relationship between atrazine exposure and human cancers. IARC cites one new animal study from 2024, while re-evaluating older data in a new light. For pesticide experts like Dr Jennifer Sass, a senior scientist at the Natural Resources Defense Council (NRDC), IARC’s re-evaluation was welcome – correcting industry bias in previous evaluations. . “With atrazine, there’s hormone disruption, there’s oxidative stress, there is indication of tumors in human and animal studies,” said Sass. “IARC gathered a solid expert array of people from different disciplines, including industry people. They didn’t second-guess or overinterpret the data. “The EPA needs to take another look at their assessment to account for the carcinogenicity,” said Sass. Canada, Australia and Brazil also use atrazine extensively Atrazine, also known under brand names such as Aatrex®, Aatram®, Atratol®, and Gesaprim® is the second most widely-used pesticide in the US after glyphosate – also known as Roundup®. Glyphosate also was designated as a probable carcinogen in humans by IARC in 2015, in a ruling that continues to trigger controversy between the US and trading partners that have banned the chemical. Across the US’s corn belt, up to 60 million pounds of atrazine is applied to treat US crops each year. Atrazine also is flushed from soil into streams or groundwater aquifers where it can contaminate drinking water supplies, according to the US Centers for Disease Control and Prevention. A 2017 analysis of EPA tap water data found that nearly 30 million Americans across 28 states have tap water that contains atrazine. Drinking water in these areas had atrazine levels three to seven times higher than the federal limit of three parts per billion during spikes due to run-off in spring and summer, according to another major research and advocacy non-profit, Environmental Working Group. “Because the EPA has been sweeping the evidence on cancer under the rug for the time it has been on the market for 50 years, they’re not monitoring for atrazine in the water. The drinking water standard should be zero, because it’s a carcinogen,” said Sass. But the US is not alone in its reliance on the chemical, which is typically applied to unplanted fields so as to kill any other weeds or plants before crops are planted. Canada, Australia, Brazil and China also use atrazine to increase crop yields. In the decades prior to IARC’s classification, 60 countries banned the use of atrazine. These include 27 European Union countries, most Middle Eastern countries, and even many African countries. However, in many lower-and-middle income countries where atrazine is banned, the chemical is often smuggled in illegally. The European Union banned atrazine in 2004 and most EU countries have since banned glyphosate as well. Mexico, which exports tens of billions of dollars of agricultural products to the US, had attempted to ban glyphosate. But in 2024 it postponed the ban indefinitely following pressure from industry and the US, citing the lack of an effective alternative. As international assessments increasingly flag risks associated with such chemicals, the US remains an outlier among high-income countries in continued widespread use. “We were all told for a long time that weed killers aren’t harmful to people because their mechanism of toxicity targets photosynthesis. We all believed them,” said Sass. “Because of that, we didn’t have proper food monitoring. We didn’t have proper drinking water monitoring. The people exposed to atrazine occupationally, whether by mixing it, loading it, applying it, manufacturing it, need to take the proper precautions because of how toxic it is. EPA stance contrasts sharply with MAHA rhetoric about healthier foods EPA’s pro-pesticide stance under the new US administration of President Donald Trump contrasts sharply with the healthy foods rhetoric of the “Make America Healthy Again” (MAHA) movement, critics also said. “Despite the rhetoric of MAHA, there will be no robust review of the dangers of pesticides by the Trump Administration,” said Sylvia Wu, of the Washington DC-based Center for Food Safety. “Instead, a toxic poison like atrazine will continue to contaminate our lands and waters, making our children sick for decades to come,” said Wu. Wu was responding, in particular, to another recent US Fish and Wildlife’s (FWS) statement that atrazine does not pose an extinction risk to any US endangered species. The Center for Food Safety sued the EPA in 2020 when the agency moved to reapprove atrazine, along with a host of other pesticides and herbicides, as part of a routine evaluation. “The public trust has been steamrolled by agrochemical interests,” said Sass of the Natural Resources Defence Council. “The EPA has fast-tracked the approval of their poisons, which is not only a violation of the public’s trust, but also of the mission of the EPA.” “Using modern farming methods, we do not need weed killers like atrazine. We simply don’t have to kill every weed to grow our crops. It. We don’t have to be so scorched earth in our farm practices,” Sass argued. “I look forward to the day that the US catches up to other countries in keeping American families safe from chemicals.” Image Credits: Akshat Jhingran , Waldemar Brandt , AP/Sierra Club, USGS. Near-Zero Change in Delhi’s Peak Air Pollution Levels Over Past Decade – But Big Change in Public Outrage 05/01/2026 Chetan Bhattacharji Delhi air pollution during peak days in mid-November 2025 – an annual public health crisis that remains unresolved. The latest ten-year data shows almost no change. Can the momentum of outrage finally push officials to take high-impact measures to lower pollution this year? It’s Delhi 2026. Since 2016, there’s been near-zero improvement in the city’s air pollution during the annual peak pollution period of October to December, a new analysis by the Center for Research on Energy and Clean Air (CREA) reveals. This period also usually sees peak coverage and public outrage about the crisis. In 2025, average levels for those peak months even inched up a notch over the year before to 177 micrograms/cubic meter (µg/m³) of PM2.5 – despite a slight decline in the annual average levels in 2025 as compared to 2024 (96 µg/m³ in 2025 versus 105 in 2024). This means average levels in the peak pollution months were over 35 times the WHO’s annual average guideline of 5 µg/m³ and 11 times the peak 24 guideline limit of 15 µg/m³. And that’s if questions over the robustness of the latest government monitoring data are ignored for the moment. For nine of these last 10 years, opposition-led the Aam Aadmi Party was in power in Delhi, while Narendra Modi’s BJP party has been in power at the national level during the entire time. Near-zero improvement in Delhi’s peak pollution months since 2016. In 2025, Delhi also elected a BJP-led state government, which means the BJP is now in power at the national, state and municipality level – a ‘triple engine sarkar’, as the Hindustan Times framed it, referring to the Hindi term for “government.” Indeed, the BJP not only controls Delhi, but also the governments of two key bordering states, Haryana and Uttar Pradesh – which generate smoke from crop waste burning that contributes to the capital’s autumn smog crisis. That’s also why the new Delhi government, led by Chief Minister Ms Rekha Gupta, was expected to be uniquely placed to reduce pollution when she assumed office. Yet, as the peak season began, there was little indication of a significant shift in strategy. Unprecedented outrage against air pollution Public outrage against air pollution in Delhi and northern India has escalated to a level not seen in many years. It’s been characterised by a mix of anger and cutting humour – reels, memes and so on – against the government and the crisis. There were other aspects. Multiple protests, including the one on 9th November where police detained several demonstrators, including parents, among others, demanding clean air for their children. Multiple groups have been created on various social media and messaging apps. Some TV anchors and journalists, seen to be close to the ruling establishment since 2014, took many by surprise by pivoting and questioning official inaction and apathy. View this post on Instagram A post shared by Newslaundry (@newslaundry) India’s air pollution is “a metaphor for the challenges facing the nation more broadly.… if India cannot solve a problem that manifestly and acutely affects its elite, the prospects for solving the larger challenges confronting the country remain slim,” observed Arvind Subramanian and Devesh Kapur, in their book, A Sixth of Humanity, published last October. India’s environment minister Bhupender Yadav held a series of meetings on Delhi’s pollution, including one where he directed officials to “ensure visible improvement” in the air quality across Delhi and its neighbourhood “within one week.” That was mid-December. By the end of the month, there was no improvement. In fact, this December saw the worst pollution since 2018. Delhi’s environment minister and chief minister held several meetings, extensively posted policy action and photo ops on social media. There have been some positive steps, like distributing electric heaters to gatekeepers at various residential areas, curbs on categories of polluting vehicles, and stricter enforcement of OCEMS, online continuous emissions monitoring systems, at thousands of factories. Gaps in pollution control Along with the global “embarrassment” mentioned in A Sixth of Humanity, critical technical gaps remain. Firstly, misplaced focus on PM10: The government’s focus remains on spraying water to control dust because it continues to prioritise controlling PM10 particulate matter pollutants rather than the finer PM2.5 ones. PM2.5 is dangerous because it is small enough to enter the bloodstream and, so, is more lethal, whereas the body’s defenses can often stop the larger PM10 particles. In theory, watering down dust may help, but in practice, there hasn’t been much improvement. As this clip shows there’s simply too much pollution. And this water mist barely tackles PM2.5. ⚪️ Installs anti smog guns on top of 13 high rise buildings in Delhi to tackle pollution.pic.twitter.com/CJQWH18SYt — Mediterranean Voice (@mediterranvoice) December 26, 2025 Secondly, lack of political will: At a national level, there’s a lack of political will to stop the practice of farmers burning the residue of the paddy harvest in the three states north of Delhi and upwind of the city – Punjab, Haryana and Uttar Pradesh. This contributes almost 10% of the pollution in October and November in Delhi and the neighbourhood, according to a government (IITM) study, but on certain days and hours, it can be much higher. Thirdly, pseudo-science over evidence: There has been a reluctance among decision-makers to fully embrace scientifically evidence-based action. So a lot of time, taxpayers’ money, and effort over the years have gone into what may be described as pseudo-science, like smog towers, or action taken against scientific advice, like cloud-seeding trials. Fourthly, flawed monitoring of vehicular pollution: The Delhi government has, in a well-intentioned move, made pollution-under-control (PUC) certificates mandatory for all vehicles. However, the old PUC regime is flawed, and it needs to be replaced as it doesn’t check for key pollutants like PM2.5 and nitrogen oxides, which are major contributors to Delhi’s pollution. But to give credit where credit is due: a new panel has been formed by the national government with external experts on curbing vehicular pollution, which contributes more than a third of the capital’s air pollution levels. Many vehicles in Delhi are highly polluting, contributing more than a third to ambient air pollution levels. Battle against air pollution, 2026 There have been political missteps, too. One example: In early July, after public protests pressured the Delhi government to quickly roll back stricter enforcement of limits on old, polluting vehicles, the same government also successfully petitioned the Supreme Court to reverse a previous ban on firecrackers during the annual Diwali festival of lights, arguing that certain brands of so-called “green firecrackers” would not pollute. They were wrong. And the ensuing smoke was a factor in 2025’s post-Diwali pollution being the worst in years; and the chief minister repeatedly came in for criticism for comments she made on pollution. In 2026, can the public’s pressure, and even the government’s momentum, for clean air action be sustained or will it, as in the past, fizzle out when Delhi’s peak pollution season tapers off? Republished, with slight adaptation, from the original ‘What Am I Breathing’ Substack by Chetan Bhattacharji, a senior correspondent for Health Policy Watch from Delhi. Image Credits: Chetan Bhattacharji, Centre for Research on Energy and Clean Air. 2025: A Brutal Year for Global Health 28/12/2025 Editorial team This has been a brutal year for global health, with shock cuts in development aid to countries most in need; a knock-on budget crisis for United Nations (UN) agencies; widespread humanitarian crises, extensive disease outbreaks, and mounting climate-related health challenges. Health Policy Watch (HPW) has provided daily coverage of developments, and our reporters were often the first to break news on a range of issues despite our small and under-resourced newsroom. Development aid plunge Chaos followed the immediate “pause” of all development aid from the United States as soon as Donald Trump became president in January. The “pause” included the US President’s Emergency Plan for AIDS Relief (PEPFAR), which funded three-quarters of HIV and tuberculosis programmes worldwide, including lifesaving antiretroviral medicine to 20.6 million people in 2024. Within weeks, clinics across Africa closed, and patients were turned away as there was no money for staff or medicine. Although US Secretary of State Marco Rubio later issued a limited waiver for “lifesaving” programmes, this was narrowly focused and ideological. Influenced by the Heritage Foundation’s view that HIV is a “lifestyle disease”, the Trump administration stopped funding HIV measures aimed at “key populations” most vulnerable to infection – including sex workers and men who have sex with men. DOGE’s Elon Musk brandishing a chainsaw given to him by Argentinian President Javier Milei (right) after cutting US government programmes and global development aid, resulting in deaths and chaos. Within two weeks of Trump assuming the presidency, his appointee, Elon Musk and a new Department of Government Efficiency (DOGE) had also dismantled the US Agency for International Development (USAID). Musk declared that “USAID is a criminal organisation. It’s time for it to die.” USAID was hugely influential, and its closure affected almost every country in the world – from Albania to Zambia. As USAID had administered 60% of PEPFAR funds, in many instances, there was no one left to provide goods and services for those projects covered by Rubio’s waiver. Reporting on this issue was led by HPW Deputy Editor Kerry Cullinan. WHO slashes staff The WHO headquarters in Geneva has been in upheaval all year over how to rearrange the organisation’s budget to make up the 25% cut. The US withdrawal from the World Health Organization (WHO) on Trump’s first day in office, and its reduced support for other UN agencies. unleashed mass layoffs and restructuring. The WHO is slashing its staff by around a quarter – aiming to shed about 2,371 staff by mid-2026 – many at the end of this year – with ripples across Geneva. This has affected WHO’s ability to respond to health emergencies across the world. HPW Editor-in-Chief Elaine Fletcher was often the first to report on the various developments, with an inside track to staff reactions, including the WHO Staff Association decision to challenge the fairness and legitimacy of the restructuring process and the mounting rage of lower-level staff as HPW highlighted data suggesting that low- and mid-level personnel will bear the brunt of cuts, while high-ranking executives, whose real costs far exceed their published salaries, remain largely protected. UNAIDS has also been forced to retrench 55% of its head office staff and cut its country offices by almost half after the US ceased to fund it, a move that affected 40% of its budget. The agency warned that the brupt funding cuts have resulted in “perilous risks” for the global HIV response that threaten the health and well-being of millions of people throughout the world. “It feels like the ground has been ripped out from under our feet,” a Mozambican woman with HIV told UNAIDS, which reported at the year’s end that over two million women and girls have been “deprived of essential health services”, and millions of people at high risk of acquiring HIV have lost access to “the most effective prevention tools available” – pre-exposure prophylaxis (PrEP). Gavi, the vaccine alliance, has pared down its staff by a third, which will also affect global vaccination efforts. Disease outbreaks surge – so does anti-vax activities Mosquitoes, which can carry dengue virus, thrive at warmer temperatures. Climate change is fueling dengue cases globally. Amid the chaos in global health funding, diseases have surged. Africa has experienced large outbreaks of cholera, measles, Lassa fever and mpox, while deadly Ebola and Marburg have also affected several countries. By 10 December, Africa CDC had recorded over 300,000 cholera cases, over 140,00 measles cases and almost 134,000 mpox cases this year. Over the past year, both Latin America and the Caribbean saw record-breaking cases of the mosquito-borne dengue fever, with almost one-fifth of cases (about 45 million infections a year) attributable to climate change, Sophia Samantaroy covered issues from the Americas. Measles has also surged in the US and Canada amid the rise of anti-vaccine misinformation. This has been fueled by the appointment of vaccine sceptic Robert F. Kennedy Jr. as US Health and Human Services Secretary. So far, Kennedy and his appointees have cancelled mRNA research, restricted access to COVID-19 vaccines and made Hepatitis B vaccines non-mandatory for infants. In an exclusive article for HPW, Dr Demetre Daskalakis, former Director of the US CDC’s National Center for Immunizations and Respiratory Diseases, describes how the “wall protecting science from political interference in the US has fallen”. Humanitarian crises multiply Some 42,000 Gazans will need prolonged rehabilitation care and support due to war-related trauma injuries and amputations. Conflict and humanitarian crises – particularly in Gaza, Sudan and Ukraine – inflicted heavy casualties on citizens and health workers, with ongoing and unprecedented attacks on health facilities. HPW coverage of the conflict in Gaza included Israel’s blockade of Gaza, the resulting famine, Israeli attacks on WHO’s warehouse and efforts by Israel to secure the release of hostages being held by Hamas. This coverage was also led by Editor-in-Chief Elaine Fletcher. HPW has also consistently reported on the humanitarian crisis in Sudan, including the attack on a maternity hospital in El Fasher in which more than 460 people died. Climate change is ‘needlessly killing millions’ Climate change is claiming millions of lives annually through extreme heat, air pollution, wildfires and the spread of deadly infectious diseases, according to the ninth annual Lancet Countdown report, the most comprehensive assessment to date of the links between climate change and health, published in October. “We’re seeing millions of deaths that are occurring needlessly every year because of our persistent fossil fuel dependence, because of our delay in mitigating climate change, and our delays in adaptation to the climate change that cannot be avoided,” said Marina Romanello, executive director of the Lancet Countdown at University College London, describing this year’s report as “a bleak and undeniable picture of the devastating health harms reaching all corners of the world.” Breaching the 2015 Paris Agreement, a legally binding global treaty adopted in 2015 to combat climate change by limiting global warming to well below 2°C (ideally 1.5°C) above pre-industrial levels, is now unavoidable, according to scientists. The world is heading for 2.8°C of warming by century’s end under current policies, according to a UN assessment. Climate change protest Global greenhouse gas emissions rose 2.3% to a record 57.7 gigatons of CO2 equivalent in 2024, the largest annual increase since the 2000s. Land use change and deforestation account for 53% of the overall increase, while fossil fuel production continues to expand in direct contradiction of climate pledges. The US is the worst emitter, yet Trump withdrew the US from the Paris Agreement on Day One of his presidency. Domestically, the US Environmental Protection Agency (EPA) has committed to rolling back 31 climate, air and water pollution, and emissions regulations that will negatively affected citizens’ health. The EPA has also announced that it will no longer require most polluters to report their emissions of carbon dioxide, methane and other greenhouse gases that cause climate change. Stefan Anderson led HPW reporting on climate change. The impact of air pollution Disease burden from air pollution. Meanwhile, 90% of people on the planet breathe dangerously unhealthy levels of air pollution every day, and millions fall ill every year with a range of respiratory and cardiovascular diseases as well as cancers, leading to at least seven million deaths each year. Air pollution is the number one killer across South Asia, accounting for 2.7 million deaths, of which 2.1 million are in India alone. There is growing evidence of the impact of air pollution on a range of medical conditions including strokes, diabetes, heart disease and lung cancer. Significant sources of the deadly fine particulate matter (PM 2.5) come from fossil fuels in vehicles, power plants and other industrial facilities, and burning coal, wood, dung and agricultural residues for cooking. India-based Chetan Bhattacharji, led reporting on air pollution. Women’s rights The ‘Green Tide’: Argentinians demanding the legalisation of abortion. HPW has covered the backlash against sexual and reproductive rights, and women’s rights through stories on US anti-rights groups mobilising in Africa, the rollback of abortion rights in Argentina, the impact of intimate partner violence on children, efforts to enable access to menstrual products for girls and women, female genital mutilation, and several articles on women under Taliban rule in Afghanistan. Disha Shetty and Munija Mirzaie contributed several articles on this topic. New world order? In the final few months of the year, the Trump administration sought to turn the chaos its funding cuts caused into opportunities for the US by signing bilateral health agreements with several African countries that promote American business opportunities – and also enable US access to African minerals. This approach is detailed in the America First Global Health Strategy published in September, that “uses global health diplomacy and foreign assistance to make America safer, stronger, and more prosperous”. Driven by former DOGE official Brad Smith, these bilateral Memorandums of Understanding (MOUs) compel countries that receive US aid to fight HIV, tuberculosis and malaria to immediately share all information about “pathogens with epidemic potential” and give the US the right to share this information with other entities, including US pharmaceutical companies. The MOUs directly undermine the WHO negotiations on a pathogen access and benefit-sharing (PABS) system underway in Geneva, placing African countries in a particularly difficult position. Unlike past PEPFAR agreements, the MOUs cut out the involvement of community groups, except faith-based service providers, some of which are known to be against contraception and any recognition of LGBTQ people. Civil society groups have described the MOUs as “extractive” and over 50 organisations issued a letter calling on African heads of state and government to demand “equity and sovereignty” in the new bilateral agreements. However, in a positive reaction to plummeting aid, several African countries have allocated more money to health while several continental efforts are building Africa’s independence. At the Africa Health Sovereignty Summit, Ghana’s President John Mahama announced the formation of the Presidential High-Level Task Force on Global Health Governance in response to the 40% reduction in development aid in the past two years. “The world has changed, but global health governance has not kept pace with the changing world. At this moment, we’re called to redesign the architecture that has, for far too long, excluded Africa’s voices, excluded Africa’s needs and innovations,” said Mahama. Dr Muhammad Ali Pate, Nigeria’s Coordinating Minister of Health and Social Welfare. Writing for HPW, Nigerian Health Minister Muhammad Ali Pate Africa argues that Africa “can redefine its role in global health – emerging as a producer, innovator, and equal partner in shaping both the health of its people and the well-being of the world”. Pate argues that this can be achieved by countries investing in health “with the same urgency it devotes to infrastructure, defence, or governance”; enhancing South–South cooperation and collaboration; and forging a continental alliance that harnesses shared expertise, resources, and innovation for collective health security. HPW was proud to be a media partner at the Conference of Public Health in Africa 2025, where African researchers discussed how best to build solidarity between countries on the continent. Other Health Policy Watch team members and contributors include Maayan Hoffman (who also coordinates our social media), Arsalan Bukhari, Felix Sassmannshausen, Rahul Basharat Rajput, Kate Okorie, Abdullahi Jimoh, Edith Magak and Roisa Kerry. We are deeply grateful to our donors and media collaborations that have supported HPW to remain afloat during this difficult year and provide an important platform of engagement for the Global South and North that is free of charge. But most of all, we are grateful to all our readers for your engagement and interest. Please consider donating to HPW to ensure our ongoing survival. May 2026 be a more positive one for global health! Image Credits: Guilhem Vellut, WHO/EMRO , Markus Spiske/ Unsplash, Health Ministry of Nigeria. Escalating DR Congo Conflict Exacerbates Refugee Flight; Gaza Famine Threat Eases 22/12/2025 Editorial team Thousands of Congolese families are fleeing intense fighting in eastern DRC and crossing into Burundi in search of safety. UNHCR, the UN Refugee Agency, has said it is “deeply alarmed” by the worsening humanitarian situation in Burundi, which has reached a crisis point following a rapid influx of refugees and asylum-seekers fleeing a new wave of violence in the eastern part of the Democratic Republic of the Congo (DRC). Since early December, over 84,000 Congolese have crossed into neighbouring Burundi, fleeing escalating clashes in DRC’s South Kivu region where M-23 militias continue to make major inroads against government forces. Congolese refugees and asylum-seekers in Burundi now number more than 200,000m, said UNHCR’s Representative in Burundi, Brigitte Mukanga-Eno. Thousands of people crossing the border on foot and by boats each day have overwhelmed local resources, creating a major humanitarian emergency that requires immediate global support, Mukanga-Eno told reporters in Geneva on Friday. Women and children are particularly affected, arriving exhausted and severely traumatized, bearing the physical and psychological marks of terrifying violence. “In Burundi, transit centres and informal sites where new arrivals are hosted have far surpassed capacity, in some cases by nearly 200 per cent,” while “acute water and sanitation shortages are increasing the risk of outbreaks of life-threatening diseases, including cholera and Mpox,” Mukanga-Eno said. Across the border in the DRC’s South Kivu, violence, drone attacks and bombardments have forced more than 500,000 Congolese from their homes, many “displaced several times this year alone.” Speaking at an end year press briefing in Geneva, UNHCR, WHO and other UN agencies also warned that as 2025 draws to a close, humanitarian needs in Africa, the Middle East, and worldwide “remain staggering” and recent gains against famine in Gaza since a US-brokered cease-fire between Hamas and Israel last October are “extremely fragile.” In a separate press release, WHO meanwhile declared that “attacks on health care in Sudan are becoming deadlier and more widespread.” Gaza – famine threat rolled back, but hunger remains Famine averted by hunger crisis remains critical according to December IPC report and early 2026 projections.. On a more positive note, the threat of famine in Gaza has eased somewhat since the October cease-fire opened the gates to more aid – but hunger remains a constant threat for most Gazans. The latest Integrated Food Security Phase Classification (IPC) analysis for Gaza confirms that no areas of the Strip are currently classified in famine, but UN officials described this welcome progress as “extremely fragile.” “At least 1.6 million people – or 77 per cent of the population – are still facing high levels of acute food insecurity in the Gaza Strip,” including “over 100,000 children and 37,000 pregnant and breastfeeding women projected to suffer acute malnutrition,” said four UN agencies, including WHO and UNICEF, in a press release Friday, which coincided with release of the latest IPC report, containing a snapshot of the situation today as well as projections for 2026. All four Gaza governorates are still described as facing Phase 3 or 4 hunger conditions marked by “large food consumption gaps, high levels of acute malnutrition, and an elevated risk of mortality.” While “the ceasefire has improved some deliveries of food,” UN agencies said “most families are still grappling with severe shortages,” with “more than 730,000 people” displaced and “heavily reliant on humanitarian assistance,” the UN agencies said. “Gaza’s children are no longer facing deadly famine, but they remain in grave danger,” UNICEF’s Lucia Elmi warned at the Geneva press briefing. She added: “Food is now in markets, but many families simply cannot afford to buy it. Health facilities are barely functioning, clean water and sanitation services are scarce, and winter is bringing increasing suffering to displaced people huddling in makeshift shelters. These fragile gains could vanish overnight if fighting resumes. We need sustained humanitarian access, restored basic services, and above all, lasting peace.” Only 50% of Gaza health facilities functioning even partially Palestinian’s in Gaza’s Deir al Balah receive winterization assistance – an estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Only fifty per cent of Gaza’s health facilities are partially functional, and that “much more is needed to address the vast health needs,” warned WHO’s Tarik Jašarević, also speaking at the Geneva press event. Access constraints facing Gazan Emergency Medical Teams have, however, eased, with denial rates decreasing to about 20 per cent, compared with 30 – 35 per cent before the ceasefire, according to the Health Cluster. There are 343 EMT staff in Gaza, including 73 international staff and 270 national staff, OCHA stated, in a related press release on Friday. Since the cease-fire there has also been an increase in the number of medical evacuations. But more than 18,500 patients, including 4100 children, still are awaiting evacuation, Jašarević added. According to the Palestinian Ministry of Health, more than 1000 patients had died while awaiting medical evacuation between July 2024 and November 2025. Last week, at least ten Gazans reportedly died due to heavy rains, underscoring the life-threatening conditions that families were facing in Gaza, Jašarević said. That included three children who died of hypothermia in a context of cold temperatures and lack of medical infrastructure and medicine, said Ricardo Pires, for United Nations Children’s Fund (UNICEF), citing other reports. The severe storm conditions affected nearly 55,000 households, and forced the evacuation of 370 families from shoreline sites, said OCHA, the UN Office for Coordination of Humanitarian Affairs, in a separate press statement. An estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Sudan North Darfur’s strategic capital of El Fasher (Al Fashir), has been beseiged by the RSF for over a year while 650,000 people fleeing the war have clustered in Tawila (red dotted line) and other areas of the region, like Nyala, which also come under periodic attack. Meanwhile, WHO issued a stark warning over the increase of attacks on health care in Sudan, saying they are “becoming deadlier and more widespread, cutting off access to lifesaving services and placing health workers and humanitarian operations at serious risk.” The latest incident occurred on 14 December when nine health workers were killed and 17 injured in an attack on a hospital in Dalanj, a town in South Kordofan state, WHO said. Dalanj is a key administrative and health hub for surrounding communities, where health workers provide critical referral care. Earlier this month, on 4 December, a kindergarten and the Kalogi Rural Hospital in South Kordofan were also hit, with 114 people killed – including at least 60 children – and 35 injured. Health staff were treating casualties when the attack occurred at the hospital, which serves as a key referral health facility for surrounding rural communities. Evacuations of injured patients to Abu Jebaiha Hospital took place amid ongoing fire. In Nyala, South Darfur, at least 70 health workers were detained, alongside around 5000 civilians, over the past few months according to reports in early December. This incident followed multiple attacks on health facilities in El Fasher in October 2025, including targeted attacks on a maternity hospital that killed more than 460 patients, their families and other civilians, and the abduction of six health workers from El Fasher and surrounding localities in November 2025. Since the conflict began in April 2023, WHO has verified 201 attacks on health care in Sudan, resulting in 1858 deaths and 490 injuries,” with 2025 accounting for “more than 80% of all deaths from attacks on health care verified by WHO in complex humanitarian emergencies globally.” “Health workers have been providing health services with exceptional courage and dedication under extremely challenging conditions,” said WHO in a press release. WHO called “for an immediate halt to attacks on civilians, health workers, health facilities and humanitarian operations in Sudan,” and urged “safe, rapid and unimpeded humanitarian access in line with international humanitarian law.” See related story here: ‘Beyond Horrific’ Conditions in Sudan’s El Fasher; Gaza Swamped by Flooding Image Credits: © UNHCR/Bernard Ntwari, IPC , OCHA , Google Maps . New Flu Strain Sweeping Europe Says WHO; but Vaccines Remain Effective, ECDC Finds 19/12/2025 Felix Sassmannshausen Hans Henri Kluge, the WHO/Europe Regional Director, emphasised that vaccines save lives in the midst of a new flu strain surging early. Sudden fever, a severe cough and acute respiratory distress are the familiar onset symptoms of seasonal flu, which has affected WHO’s European Region with unusual intensity and speed this year. As the Northern Hemisphere enters winter, health systems are struggling to manage an epidemic driven by an aggressive, genetically mutated influenza strain A(H3N2) subclade K. But a new report by the European Centre for Disease Prevention and Control (ECDC), published on Friday, concluded that current seasonal influenza vaccines remain effective against this new strain of the virus. Health experts urge vulnerable groups to get vaccinated. The current influenza outbreak is dominated almost entirely by the A(H3N2) subclade K, which now accounts for up to 90 per cent of all confirmed cases in the region, according to data from WHO’s European Regional Office (EURO). Subclade K marks a “notable evolution in influenza A(H3N2) viruses,” having undergone genetic drift and displaying several amino acid changes in the hemagglutinin protein (the “key” the virus uses to unlock and enter human cells). Due to these slight changes, antibodies acquired from previous infections or older vaccines may not recognise the virus as effectively. “Flu comes around every winter, but this year is a little different,” stated Hans Kluge, WHO Regional Director for Europe, in a press release on Wednesday. Although there is no evidence that it causes more severe disease, Kluge explained that the small genetic variation in the virus places “enormous pressure on our health systems because people don’t have built-up immunity against it.” Flu season gains early momentum A(H3N2) subclade K is fuelling a flu surge across the WHO/Europe region, with protection stalling as most countries fail to meet critical vaccination targets. With the new strain spreading quickly, the current influenza season began approximately four weeks earlier than in previous years. High or very high activity is now being reported in at least 27 of the 38 countries being monitored by the WHO European Region. These countries range from EU Member States such as Ireland and Slovenia to Kyrgyzstan and Montenegro. “This is expected to cause a significant burden in terms of morbidity and mortality, as observed in past years, and target groups should be vaccinated rapidly,” said Bruno Ciancio, an ECDC senior expert, in response to a query from Health Policy Watch. WHO data shows that the strain has been detected in more than 34 countries globally over the last six months. While it is most prevalent in the European and Western Pacific regions, its expansion has also been confirmed in the WHO South-East Asia region. Since October, A(H3N2) subclade K sequences have been reported in Nepal, India and Thailand, as well as in the WHO African and Eastern Mediterranean Regions. Vaccines remain primary shield against severe illness Vaccinations remain effective and a key protection against the new strain, experts emphasize, based on preliminary findings. With cases expected to continue rising, likely peaking in late December or early January, protecting the most vulnerable is paramount. Public health authorities are emphasising urgently that vaccination is the most important protective measure for vulnerable groups, including adults aged 65 and over, pregnant women, people with chronic conditions and healthcare workers. Although recent reports suggest that subclade K shows “reduced reactivity” to current vaccines, it remains effective in preventing severe health outcomes, the ECDC concluded. “The current influenza vaccine is not perfectly matched to circulating strains, including H3N2. However, the primary aim of vaccination is to prevent severe disease, and effectiveness against severe outcomes is expected to be preserved,” explained ECDC expert Ciancio. According to the preliminary data published by the ECDC for this flu season, vaccine effectiveness in preventing influenza cases that require medical attention at the primary care level ranges from 52% in children (ages 0–17) and 57% in adults (ages 18–64). For the critical group of individuals aged 65 and older, it was not possible to estimate vaccine effectiveness separately, due to the low number of influenza cases so far considered in the study. ECDC experts emphasized, moreover, that the findings rely on small sample sizes from nine participating countries and have low statistical precision (e.g. wide confidence intervals). Efficacy could fluctuate as the season progresses. According to a ECDC analysis released only this week, vaccines significantly cut hospital admission rates in the last 2024-25 flu season. The modeling study found that seasonal vaccines were 70-75% effective at preventing hospital admissions among children aged 2-17 years and 30-40% effective in adults. Using computer simulations, the analysis estimated that vaccination programmes prevented 26-41% of flu-related hospitalisations among adults aged 65 and over across European Union (EU) countries between August 2024 and June 2025. Low vaccination rates remain public health concern To protect the vulnerable and to reduce transmission, a multilayered approach following the WHO playbook is essential. Within the EU, only Denmark, Portugal, and Ireland met the 75 percent target for older adults during the reporting period. The ECDC projects that a 75% vaccination rate can prevent up to three-quarters of flu-related hospitalisations, significantly reducing the strain on public health systems. Influenza vaccination rates for high-risk groups in other EU countries remained below WHO targets in the past seasons, as ECDC data from the most recent available season (2021-2022) shows. The overall median influenza vaccine coverage for adults aged 65 years and older was only 43 percent. The scale of the challenge is huge. Recent interim data from Germany’s Robert Koch Institute (RKI) for the 2024-25 season found that flu vaccination coverage among German adults aged 60+ declined from 39.7-34.5% since 2020-21, the first year of the COVID pandemic, reaching its lowest level in over 17 years. And at the same time, a severe flu season can strain hospital staff and capacity in already overburdened health systems. Combating the flu requires a multi-layered approach, experts underline. Slowing transmission requires proactive public health and social measures alongside vaccination, says WHO. These steps, proven effective during the COVID-19 pandemic, include staying home if unwell, wearing a mask in public if symptomatic, maintaining regular hand hygiene, and improving indoor ventilation. European health systems have “decades of experience managing influenza,” said Kluge, striking a note of optimism alongside the WHO warning. “We have safe vaccines that are updated annually, and we have a clear playbook of protective measures that work.” Image Credits: European Union, WHO/Europe , World Health Organization, European Union. Cervical Cancer in India: Early Marriage, Poor Screening and Gender Inequality Fuel a Preventable Killer 19/12/2025 Arsalan Bukhari Though largely preventable, cervical cancer continues to kill thousands of Indian women each year. MUMBAI, India – Cervical cancer kills more than 75,000 women in India each year, according to figures recently disclosed in Parliament – yet it is one of the most preventable cancers. In India, low human papillomavirus (HPV) vaccination coverage, limited access to routine screening and deep-rooted social behaviours – such as early marriage and low condom use – drive late diagnosis and high mortality. Globally, cervical cancer is the fourth most common cancer among women, with an estimated 660,000 new cases and 350,000 reported deaths in 2022, accoridng to WHO. Public health experts say these factors increase exposure to HPV, the underlying cause of nearly all cervical cancer cases, while allowing the disease to progress silently for years before detection. For Neha, a 29-year-old hotel worker in the city of 12.5 million, India’s largest, the statistics reflect a deeply personal loss. My two cousins died from cervical cancer,” she told Health Policy Watch. “What frightens me most is how silent it is. People seem completely normal for years, and then you discover they have had cancer for a long time only when they are close to dying. Early marriage and rising HPV exposure A wedding procession in India, where early marriage remains common. Doctors say nearly all cervical cancer cases are caused by persistent infection with high-risk types of HPV, one of the most common sexually transmitted infections worldwide. Mumbai physician, Dr Sonali Roy told Health Policy Watch that HPV exposure in India is closely tied to early marriage, low awareness and limited access to vaccination and screening, particularly in rural areas. “In some villages, girls are married as young as 14 or 15,” Roy said. These marriages often do not last, and women may remarry multiple times. Each marriage increases exposure to HPV, especially when condoms are rarely used and sexual health awareness is very low. Early marriage often leads to early sexual debut, repeated pregnancies and limited agency over reproductive health decisions, experts say all of which raise the risk of persistent HPV infection. The biological vulnerability of the cervix during adolescence further increases susceptibility to the virus. Unlike many high-income countries, India has yet to roll out a nationwide HPV vaccination programme, despite repeated recommendations from public health experts and the World Health Organization (WHO). While some states have launched pilot projects, coverage remains patchy and largely urban, leaving millions of girls unprotected before sexual debut. Routine cervical cancer screening also remains uneven across Indian states, with weak outreach in rural areas and among informal urban settlements, where health services are often overstretched. Evidence from research HPW vaccine introduction; India and South-East Asia lag behind most other regions of the world in routine HPV vaccination. Research supports the link between early sexual debut, multiple partners and higher HPV infection risk. A 2019 study reviewing medical records of 349 women who tested positive for high-risk HPV found that women who began sexual activity at a younger age or had multiple sexual partners faced a significantly higher risk of infection with HPV types 16 and 18, the two strains responsible for the majority of cervical cancer cases globally. The study found that about one in five women was infected with HPV 16, while nearly 9% were infected with HPV 18 – the types of HPV most likely to cause cervical cancer. Women who reported their first sexual intercourse at age 19 or younger were significantly more likely to be infected with HPV 16 than those who became sexually active later. The risk rose sharply with multiple partners. Women who reported more than three lifetime sexual partners were four times more likely to be infected with HPV 18 than women who had fewer partners. Public health researchers caution that these findings reflect structural conditions rather than individual behaviour. “In many cases, women do not have the power to negotiate when to marry, when to have sex or whether protection is used, ” said a health researcher. Men refuse to use protection With fewer than one in 10 Indian men using condoms, women bear the health consequences of preventable HPV infections. Even when women understand the risks, many say they have little control over prevention. A 27-year-old woman from the East Mumbai suburb of Kurla, who spoke on condition of anonymity, told Health Policy Watch that her partner refuses to use condoms.“He says it affects his pride,” said Priya (not her real name). This is common, even in cities like Mumbai, India’s modern financial center. She said stigma is far stronger in rural areas, where access to contraception is limited and social scrutiny is intense. Many women end up with these infections simply because men refuse to use protection. Her account echoes broader national trends. A 2021 report found that fewer than one in 10 men in India use condoms, making male sterilisation and barrier contraception among the least-used family planning methods in the country. Female sterilisation remains the dominant form of contraception, often placing the burden of reproductive health entirely on women. By comparison, a 2025 Zipdo educational report estimated that around 45% of sexually active people worldwide used a condom during their last sexual encounter. Priya recalled a close friend who had part of her cervix surgically removed after an early cancer diagnosis. Doctors later told her that consistent condom use would likely have prevented the HPV infection that led to the disease. Screening gaps Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. In India, the absence of a structured nationwide screening system has meant that many women are diagnosed only at advanced stages of the disease when treatment is more expensive and survival rates drop sharply. Under India’s National Programme for Prevention and Control of Non-Communicable Diseases and Ayushman Bharat, its health insurance for vulnerable families, women aged 30 to 65 are supposed to be screened for cervical cancer at primary health centres using visual inspection with acetic acid, a low-cost test known as VIA. Coverage, however, remains extremely low. Only about 2% of eligible women are currently being screened, with wide variations across states based on education levels and rural–urban divides. Health workers cite multiple barriers, including staff shortages, limited training, lack of privacy at health centres and social stigma around gynaecological examinations. For many women, domestic responsibilities and daily wage work also make preventive care a low priority. Cancer means financial ruin Doctors perform a surgical procedure on a woman patient. For some women, barriers go beyond awareness and access. A woman living on the rural outskirts of Mumbai, nearly 87 kilometres from the city centre, told Health Policy Watch that fear of financial ruin often outweighs concern about infection itself. “May God save us from expensive diseases. Unfortunately, cancer is one,” said Afshana, not her real name. “Even though we have a five lakh cover [around $5,500 annually] under Ayushman Bharat [insurance plan], we often end up going to private hospitals because services are lacking.” Her experience reflects broader systemic gaps. A 2024 NITI Aayog review of Health and Wellness Centres linked to Ayushman Bharat, India’s flagship government insurance scheme, found significant shortfalls in cancer screening delivery. While most centres had initiated screening for noncommunicable diseases, fewer than 10% had completed a full annual round. Cervical cancer screening was “yet to be operationalised,” according to the report, while oral cancer screening was carried out only selectively. The review also found that many auxiliary nurse-midwives, staff nurses and medical officers had not received adequate training to conduct screenings or manage referrals. Although most centres met basic infrastructure standards and provided essential medicines free of charge, service delivery continued to lag behind national goals for early detection and prevention. A preventable tragedy Cervical cancer is widely regarded as one of the most preventable forms of cancer. HPV vaccination, regular screening and timely treatment of precancerous lesions have dramatically reduced incidence and mortality in countries that have invested in these measures. Public health experts warn that without urgent action, India risks continuing to lose tens of thousands of women each year to a disease that can largely be stopped. “Cervical cancer is not just a medical issue,” Roy said. “It is a reflection of gender inequality, weak health systems and the failure to prioritise women’s health.”For women like Neha, the cost of that failure is already painfully clear. “If they had found it earlier, my cousins might still be alive,” she said. “No one should die from something that can be prevented.” Image Credits: Saiyan Mondal/Pexels, Gurpreet Singh/ Unsplash, Han J et al, eClinicalMedicine, Vol. 84June 2025, Deon Black/ Unsplash, Bermix Studio/Unsplash, Richard Catabay/Unsplash. Malawi’s New Government Faces National Hunger, Dwindling Aid and Soaring Debt 18/12/2025 Dingaan Mithi Almost a quarter of Malawians face malnutrition until the next harvest in March. This story was originally published by The New Humanitarian. Just a few months into his new term, President Peter Mutharika is grappling with a triple crisis: a deep-seated food emergency, diminishing aid, and soaring debt. With over four million Malawians – 22% of the population – facing the threat of acute malnutrition until the next harvest in March, Mutharika last month declared a nationwide state of disaster. But the $119 million humanitarian response is underfunded. Although crucial to staving off the risk of hunger-related deaths, it has so far raised only $26 million from Malawi’s aid partners – roughly 21% of the amount required. The trigger for Malawi’s food emergency has been a 20% drop in maize yields last year as a result of drought and localised flooding. The harvest failure hit small-scale farmers especially hard – the backbone of food production. The problem is not just food availability, but also its affordability. Reduced farm output, a severe foreign exchange shortage, plus perennial fuel scarcities, have pushed Malawi’s inflation rate to around 28% – the highest in Africa. Even though Monica Jasteni runs a small fish business in her home area of Salima, in central Malawi, the 34-year-old mother of four is struggling. “The money I make is not enough [to buy the food we need],” she told The New Humanitarian. “I try to persuade my children to go to school without eating, telling them that they’ll have food after school, because things are difficult.” She supplements what she makes from selling fish by also farming. But as she can’t afford irrigation, her small plot is susceptible to dry spells. An unsustainable debt burden The experience of Jasteni – trying to make ends meet, yet failing – is why a coalition of 50 civil society organisations is demanding urgent action by the government. “The hunger crisis is a huge national emergency,” said Amon Lukhele, national coordinator of the Civil Society Social Protection Network (CSSPN). “We are calling upon the government to act now to protect the poorest households before the hunger situation worsens.” CSSPN wants the government to accelerate implementation of its National Social Protection Policy, a safety net programme that aims to provide relief to the most vulnerable. But Mutharika, elected in September, has inherited public finances in a critical state. That has put pressure on what spending the government can afford, and the speed with which remedial programmes can be rolled out. Malawi is heavily debt-distressed. Its total debt burden is around $9.25 billion – an unsustainable 86% of GDP. It also faces a looming debt service obligation of $1.8 billion. That affects not only economic growth, but also the provision of essential social services. As a result, Malawi spends more on debt servicing than it does on health. The closure of the US Agency for International Development – a key health donor – has only made the government’s budget calculations even harder. Yet opportunities have been squandered. In 2006, Malawi had its debt cancelled under the Highly Indebted Poor Country Initiative (HIPC). But 19 years down the line, after years of heavy borrowing, it is back in arrears – and has been forced to swallow two painful currency devaluations, in 2022 and again in 2023. “Too much debt erodes Malawi’s capacity to strengthen food security,” said Mavuto Bamusi, a prominent political analyst and anti-corruption campaigner. “Debt repayments to lenders, especially the IMF [International Monetary Fund], are taking out a lot of money that could have been used for agricultural commercialisation.” Malawi needs to urgently restructure its debt, and find domestic and international support for reforms to revive its economy after years of mismanagement, analysts suggest. Joseph Mwanamvekha, the new finance minister, has announced new reform measures to stabilise the economy, and combat the food crisis. They include a commitment to improve public debt management and fiscal discipline, strict expenditure controls, and management of the wage bill. Getting food security right This is the fifth time in a decade Malawi has declared a food-related state of disaster. It not only signifies a deepening cycle of climate volatility, but also reflects the deep structural issues around food security. The agricultural sector is central to Malawi’s economy, accounting for almost a quarter of GDP and employing three quarters of the population – mostly through subsistence farming. But productivity gains have stagnated over the past decade, with an over-reliance on maize leading to soil degradation and micro-nutrient deficiencies in people’s diets. Successive governments have implemented input subsidy programmes, providing cut-price fertiliser and seeds. But historically they have suffered from logistical bottlenecks leading to late input deliveries, as well as targeting problems, fraud, and political interference. Mutharika’s government is trying again. He has launched the 2025/2026 Farm Input Subsidy Programme (FISP) aimed at 1.1 million farming households. Each will receive two 50kg bags of subsidised fertiliser plus a 5kg pack of seed of their choice. Political commentators suggest this will be a defining test for his administration. The goal for Mutharika is to deliver on his election campaign promises to provide farm inputs on time – and nationwide – avoiding favouring political constituencies. The rollout of digital registries and e-vouchers, backed by the World Bank, may help fix some of those problems. Yet the FISP will reach only a fraction of Malawi’s farming households. It also doesn’t fully address the problem of farmers’ preference for drought-vulnerable maize at a time of worsening climate volatility. Dominic Nyasulu, the national coordinator at the National Youth Network on Climate Change, argues that the new government needs to reframe food security policies to promote drought tolerant crops such as millet and sorghum – crops that were traditionally grown before the commercialisation of maize. “This country has potential to defeat hunger, but our policies need to be reformed in view of extreme weather events and other climate impacts,” said Nyasulu. Tamani Nkhono-Mvula, a Malawian agriculture and food security expert, said a more far-reaching change will come with irrigation. Only 4% of farming land is currently irrigated. The drawbacks are that it is expensive, there is a lack of rural financing, water management has historically been a problem, and women farmers are particularly disadvantaged. The lack of government capacity is also a significant drawback, as is access to commercial markets, according to 2021 evaluation of a World Bank irrigation and rural development project. However, Nkhono-Mvula argues that the potential “for Malawi to feed itself is there – the leadership just needs to be transformative”. The New Humanitarian puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world. Image Credits: Fatsani Gunya/ The New Humanitarian. Two More WHO Officials Cut from Senior Leadership Team Move into Other Roles 16/12/2025 Elaine Ruth Fletcher WHO Director General’s former Senior Leadership Team – which he slashed from 11 to six positions as part of a major reshuffle in May 2025. Two more senior WHO officials, Bruce Aylward and Ailan Li, who were among those dropped from WHO’s Senior Leadership Team during the first phase of an Agency shake-up, have now been appointed to leading roles elsewhere in the organisation, according to a memo from Director General Tedros Adhanom Ghebreyesus. Li, a Chinese national and former assistant director-general for UHC/Healthier Populations at WHO Headquarters in Geneva, has been appointed as WHO Representative to the Kingdom of Thailand, Tedros announced, in a message seen by Health Policy Watch. Aylward, formerly assistant director-general for the Division of Universal Health Coverage/Life Course, was appointed director of the WHO-World Bank Global Preparedness Monitoring Board in August, and will now also be coordinating the work on the UN80 Initiative, Tedros confirmed in the message, emailed to all staff on Friday. The new appointments complete the sweep of WHO’s 17 former senior management officials, now reduced to 12 as part of major cost-cutting moves triggered by the withdrawal of the United States from the organisation in January. The US retreat left a gaping $1.7 billion budget gap for the upcoming 2026-27 budget period. That has now been reduced to $1.05 billion due to a projected 25% reduction in WHO’s workforce next year. Three of six ADGs cut from senior leadership ranks actually left WHO Dr Mike Ryan addresses a meeting of WHO pandemic negotiators in one of his last public appearances before retiring. The new senior leadership team includes four assistant director generals at headquarters, a Chef de Cabinet and Chief Scientist, as well as Tedros himself. The directors of five WHO Regional Offices (not including the head of the Pan American Health Organisation, counted separately) also hold an equivalent ranking, for total of 12 such posts. Of the six ADGs who were cut from team in May, three have actually left the organisation, including Samira Asma, formerly ADG for Data, Analytics and Delivery, now with the Susan Thompson Buffett Foundation; Jérome Salomon, ADG for Universal Health Coverage who left WHO in September; and Health Emergencies Executive Director Mike Ryan, who retired in September. The recent appointments mean that three others, including Li, Aylward and former ADG for External Relations Catherine Boehme have now moved into other roles, with Boehme serving as “Officer in Charge” of WHO’s South-East Asia Regional Office (SEARO). Tedros placed SEARO’s Regional Director, Saima Wazed on leave on 11 July, after the Bangladeshi government filed two cases against her for alleged fraud, forgery and misuse of power, also issuing a warrant for her arrest. No return date has so far been announced. See related story: Controversial WHO Regional Director Placed on Leave Former HQ Directors also named to lead WHO country offices In his message Friday, Tedros also named a number of other former department directors and team heads at headquarters to head country offices in the global organisation, including: Indrajit Hazarika, formerly Senior Public Health Officer, of Country Strategy and Support at HQ, as WHO Representative to the Republic of Angola. Ann Maria Lindstrand, formerly Unit Head, Essential Programme on Immunisation in the Health Emergencies Division, as WHO Representative to the Republic of Cabo Verde. Dr Pavel Ursu, formerly Director of the Department of Delivery for Impact at headquarters in Geneva, as WHO Representative to the Federal Republic of Nigeria. Dr Michel Yao, formerly the Director of the Department of Strategic Health Operations, will become the WHO Representative to the Republic of Senegal. In 2021, Yao as well as another senior WHO official, were named in an alleged cover-up of allegations of sexual abuse brought against WHO field staff and consultants responding to an Ebola outbreak in the Democratic Republic of Congo. They were later cleared by an UN investigations panel. Nedret Emiroglu, a former Director for Country Readiness Strengthening in the Health Emergencies Division, was meanwhile named to head the WHO Secretariat for the Intergovernmental Working Group (IGWG), which is negotiating further provisions of the WHO Pandemic Agreement approved in May – most notably a proposed system for Pathogen Access and Benefit Sharing (PABS). Staff Reductions to date WHO workforce, headquarters, country offices and regions, in 3rd Quarter 2025, a reduction of over 500 staff in comparison with December 2024. In a press briefing last week, Tedros publicly acknowledged that the organisation plans to reduce WHO staff worldwide by an estimated 2371 positions by mid-2026, shedding about 25% of the workforce, which numbered 9,466 at the end of December 2024, and just under that as of 1 January. Around 1,089 staff are being shed through what WHO described as “natural attrition.” This includes retirements, early retirement, and the non-renewal of short-term staff contracts that expire. In addition, another 1,282 long and short-term posts have been abolished outright, according to statements at the presser and the earlier briefing to WHO member states. That should bring WHO’s global staff headcount down to about 7,360 professional and administrative positions by mid-2026. In terms of sheer numbers, professional staff at low and mid-level are among those hit hardest by the staff cuts.. Of those cuts, some 505 staff had left WHO by end September, WHO human resource records show; that count was confirmed by a WHO spokesperson. “A large number of staff are exiting at the end of December, three-months notice while notified in September,” the spokesperson told Health Policy Watch. “And another large number will leave in June 2026, i.e. the ones with reassignment rights.” In terms of D1 and D2 directors, whose numbers nearly doubled in the first six years of Tedros’ administration, costing the organisation nearly $100 million annually, some 21 Directors’ positions had been eliminated as of 30 September. That brings the number of directors worldwide down from a peak of 188 at end 2024 to 167 in Q3 2025. WHO Directors – 3rd Quarter 2025 – versus December 2024. That still leaves another 30 D1 and D2 posts to be eliminated by June 2026, mostly at headquarters. The massive reorganisation announced in April and May, slashed the number of departments and directors at headquarters by more than half – from 76 to 34 positions). The reason those reductions haven’t yet been reflected in the HR records is simple, WHO says. “Some directors who are sitting on positions that have been abolished have up to 6 months reassignment [rights] plus a 3-month notice period,” a WHO spokesperson said, “hence they still appear in the Q3 report. The target remains for June 30, 2026.” How will cuts translate into budget savings? Despite the painful plans to cut more 2,371 staff worldwide by June 2026, a projected funding gap remains of $1.05 billion, according to the director general’s last report to member states in November. The $1.7 billion funding gap for 2026-27 has been reduced to $1.05 billion, according to current projections. And the degree to which cuts in rank-and-file, as well as high level positions, will lead to actual savings remains to be seen. WHO’s November reports to member state did not offer any detailed analysis of projected savings that would be gained through the reductions by staff grade or office location. Even less detail provided on the status, conditions and costs of non-staff contract holders – about which there is no reporting even of pay grades or geographic base, let alone gender and age. That’s despite the fact that WHO’s non-staff’s headcount of 7582 (full-time equivalents) in 2024 was approaching that of actual staff numbers (9466) for that year. WHO officials say that the lack of more detailed reporting on non-staff contracts, is linked to legal and ethical issues. “WHO does not systematically capture, aggregate or publish individual-level information (such as grade equivalence, age, gender or demographic background) for non-staff contractual arrangements,” a WHO spokesperson told Health Policy Watch. “Doing so would raise legal, ethical and data-protection concerns, as WHO is not the employer of these individuals and does not have a mandate to collect or process such personal data beyond what is strictly required for contractual and financial compliance.” This table in WHO’s bi-annual HR report is the sole data available on non-staff contracts. It notes full-time equivalents for part-time engagements (consultants and APWs). Presuming that most Special Service Agreements (SSAs) are full-time, total estimated full time equivalent contracts numbered nearly 7600 in 2024. At the highest levels of WHO staff, meanwhile, some directors whose departments at headquarters were abolished remained in the organisation as a heads of unit, which typically carries a top-level professional grade of P6. In the UN grading system, the salaries of D1 directors and P6 professionals are virtually identical. And some former department heads now running units have even clung to their old titles, regardless of the formalities. Signature of a former director – (phone number and email have been erased to protect privacy). In an email invitation to colleagues for a late November reception at the WHO canteen, the former Director of the Department of Public Health and Migration (PHM), who is now technically a unit head, couldn’t resist signing the invite with his old title as well: “Head of Special Initiative on Health and Migration (Director). Division of Universal Health Coverage and Healthier Populations.” Observed one WHO staff member: “This kind of thing is all over the place. As for cost reduction, NADA!” Image Credits: WHO HR database , WHO , WHO Workforce Data, December 13 2024, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
US EPA dismisses WHO Cancer Agency Determination that Widely Used Herbicide is ‘Probably Carcinogenic’ 05/01/2026 Sophia Samantaroy Over 70 million tons of atrazine is applied to US soil each year. The chemical is now deemed a ‘probable’ carcinogen to humans. The US Environmental Protection Agency has dismissed a recent finding that atrazine, the second most widely-used herbicide in the United States, is “probably carcinogenic to humans” by the World Health Organization’s cancer review agency. Atrazine is used extensively in the US on crops like corn, sorghum, and sugarcane. However, over 60 countries have banned the chemical due to its endocrine-disrupting properties and tendency to contaminate groundwater. In a new classification, published in the January, 2026 issue of The Lancet Oncology, the International Agency for Research on Cancer (IARC) ranked atrazine as probably carcinogenic to humans based on what it described as “limited evidence” for cancer in humans and “sufficient evidence for cancer in experimental animals.” The agency’s findings are independent assessments that guide national regulatory authorities worldwide in the promulgation of rules around chemicals used in agriculture, food systems and occupational settings. The IARC assessment was the first in nearly three decades. In 1998 the organization said the compound was not classifiable as to its carcinogenicity to humans. Since the IARC findings were initially released in late November, the US Environmental Protection Agency (EPA), as well as chemical producers in China and elsewhere, have pushed back against the new classification. Both used almost identical terms in describing the determination as “flawed” and “inconsistent with scientific consensus.” Hormone disruptor, cancer risk of atrazine Atrazine has been linked to non-Hodgkin’s lymphoma Atrazine’s cancer links include evidence of oxidative stress, hormone disruption, immune suppression, and actual tumor growth, IARC found in its abbreviated evaluation of atrazine and two other compounds. In particular, IARC pointed to animal studies that showed tumor growth in the mammary glands and uterus of female rats, reduced estrogen and testosterone in both male and female rats, and induced cell death and division. The most recent study IARC cites, from 2024, also concluded that male rats also experience oxidative stress and severe hormone disruption. In humans, only a handful of studies have been published so far. However, IARC noted that two case-control studies that reported “strong positive associations between exposure to atrazine…and translocation-positive NHL [non-Hodgkin’s Lymphoma]” among exposed farm workers. Links to other human cancers did not show “consistent positive findings.” Beyond its cancer inks, atrazine exposure is also associated with birth defects, reproductive harm, and hormone disruption, in papers not cited by IARC – an agency that focuses almost exclusively on cancer risks. US regulators and manufacturers push back The US EPA said IARC’s findings used a “deeply flawed approach to its cancer assessments” In a 21 November statement, Syngenta, the agrochemical company that produces most of the US’s atrazine, said: “[c]urrent scientific evidence clearly demonstrate[s] that atrazine is safe when applied in accordance with registered label instructions.” Syngenta is owned by the Chinese state-operated company Sinochem. Speaking to Health Policy Watch just a few days after the Syngenta statement, EPA used identical terms, arguing that IARC’s findings “stir up fear” by also including “very hot beverages, red meat, working the night shift and hairdressing in the same classification.” “This announcement on atrazine is just another example of the World Health Organization International Agency for Research on Cancer (IARC) using a deeply flawed approach to its cancer assessments on multiple levels,” the EPA added. The EPA spokesperson complained, in particular, that the two-page article published so far is just a brief summary of the full review, which is only due to be published later this year, according to IARC. “[F]or IARC to roll out these “findings” and unnecessarily stir up fear when IARC has said it will not be publishing any of its detailed science until late 2026 or 2027 is irresponsible and lacks transparency. Currently, there is no opportunity for anyone to meaningfully review how IARC has reached its conclusions,” said the EPA’s press office. “In contrast, atrazine has been extensively studied by EPA across multiple administrations, including having five meetings of independent Scientific Advisory Panels peer review the cancer potential of atrazine between 2009-2011,” EPA said. “As a reminder, IARC also has a long history of being severely misguided in its findings,” the EPA spokesperson said, citing past IARC findings on red meat and night shift work, among other factors, as possible or probable causes of cancer. In 2015 IARC concluded that red meat was a possible cause of cancer and processed meat is a probable cause. Those findings have since been echoed by the American Institute for Cancer Research, which in 2021 concluded “there is strong evidence that eating high amounts of red meat increases the risk of colorectal cancer.” The US Department of Agriculture’s most recent dietary guidelines also suggest reducing red meat consumption. The US CDC concluded in a 2021 report that there is “high confidence” that persistent night shift work that results in circadian disruption can cause human cancer. Environmental groups welcome IARC re-evaluation Latest estimates of atrazine use from the US Geological Survey, 2019 Separate EPA reviews in 2003 and 2018 concluded that available evidence does not support a relationship between atrazine exposure and human cancers. IARC cites one new animal study from 2024, while re-evaluating older data in a new light. For pesticide experts like Dr Jennifer Sass, a senior scientist at the Natural Resources Defense Council (NRDC), IARC’s re-evaluation was welcome – correcting industry bias in previous evaluations. . “With atrazine, there’s hormone disruption, there’s oxidative stress, there is indication of tumors in human and animal studies,” said Sass. “IARC gathered a solid expert array of people from different disciplines, including industry people. They didn’t second-guess or overinterpret the data. “The EPA needs to take another look at their assessment to account for the carcinogenicity,” said Sass. Canada, Australia and Brazil also use atrazine extensively Atrazine, also known under brand names such as Aatrex®, Aatram®, Atratol®, and Gesaprim® is the second most widely-used pesticide in the US after glyphosate – also known as Roundup®. Glyphosate also was designated as a probable carcinogen in humans by IARC in 2015, in a ruling that continues to trigger controversy between the US and trading partners that have banned the chemical. Across the US’s corn belt, up to 60 million pounds of atrazine is applied to treat US crops each year. Atrazine also is flushed from soil into streams or groundwater aquifers where it can contaminate drinking water supplies, according to the US Centers for Disease Control and Prevention. A 2017 analysis of EPA tap water data found that nearly 30 million Americans across 28 states have tap water that contains atrazine. Drinking water in these areas had atrazine levels three to seven times higher than the federal limit of three parts per billion during spikes due to run-off in spring and summer, according to another major research and advocacy non-profit, Environmental Working Group. “Because the EPA has been sweeping the evidence on cancer under the rug for the time it has been on the market for 50 years, they’re not monitoring for atrazine in the water. The drinking water standard should be zero, because it’s a carcinogen,” said Sass. But the US is not alone in its reliance on the chemical, which is typically applied to unplanted fields so as to kill any other weeds or plants before crops are planted. Canada, Australia, Brazil and China also use atrazine to increase crop yields. In the decades prior to IARC’s classification, 60 countries banned the use of atrazine. These include 27 European Union countries, most Middle Eastern countries, and even many African countries. However, in many lower-and-middle income countries where atrazine is banned, the chemical is often smuggled in illegally. The European Union banned atrazine in 2004 and most EU countries have since banned glyphosate as well. Mexico, which exports tens of billions of dollars of agricultural products to the US, had attempted to ban glyphosate. But in 2024 it postponed the ban indefinitely following pressure from industry and the US, citing the lack of an effective alternative. As international assessments increasingly flag risks associated with such chemicals, the US remains an outlier among high-income countries in continued widespread use. “We were all told for a long time that weed killers aren’t harmful to people because their mechanism of toxicity targets photosynthesis. We all believed them,” said Sass. “Because of that, we didn’t have proper food monitoring. We didn’t have proper drinking water monitoring. The people exposed to atrazine occupationally, whether by mixing it, loading it, applying it, manufacturing it, need to take the proper precautions because of how toxic it is. EPA stance contrasts sharply with MAHA rhetoric about healthier foods EPA’s pro-pesticide stance under the new US administration of President Donald Trump contrasts sharply with the healthy foods rhetoric of the “Make America Healthy Again” (MAHA) movement, critics also said. “Despite the rhetoric of MAHA, there will be no robust review of the dangers of pesticides by the Trump Administration,” said Sylvia Wu, of the Washington DC-based Center for Food Safety. “Instead, a toxic poison like atrazine will continue to contaminate our lands and waters, making our children sick for decades to come,” said Wu. Wu was responding, in particular, to another recent US Fish and Wildlife’s (FWS) statement that atrazine does not pose an extinction risk to any US endangered species. The Center for Food Safety sued the EPA in 2020 when the agency moved to reapprove atrazine, along with a host of other pesticides and herbicides, as part of a routine evaluation. “The public trust has been steamrolled by agrochemical interests,” said Sass of the Natural Resources Defence Council. “The EPA has fast-tracked the approval of their poisons, which is not only a violation of the public’s trust, but also of the mission of the EPA.” “Using modern farming methods, we do not need weed killers like atrazine. We simply don’t have to kill every weed to grow our crops. It. We don’t have to be so scorched earth in our farm practices,” Sass argued. “I look forward to the day that the US catches up to other countries in keeping American families safe from chemicals.” Image Credits: Akshat Jhingran , Waldemar Brandt , AP/Sierra Club, USGS. Near-Zero Change in Delhi’s Peak Air Pollution Levels Over Past Decade – But Big Change in Public Outrage 05/01/2026 Chetan Bhattacharji Delhi air pollution during peak days in mid-November 2025 – an annual public health crisis that remains unresolved. The latest ten-year data shows almost no change. Can the momentum of outrage finally push officials to take high-impact measures to lower pollution this year? It’s Delhi 2026. Since 2016, there’s been near-zero improvement in the city’s air pollution during the annual peak pollution period of October to December, a new analysis by the Center for Research on Energy and Clean Air (CREA) reveals. This period also usually sees peak coverage and public outrage about the crisis. In 2025, average levels for those peak months even inched up a notch over the year before to 177 micrograms/cubic meter (µg/m³) of PM2.5 – despite a slight decline in the annual average levels in 2025 as compared to 2024 (96 µg/m³ in 2025 versus 105 in 2024). This means average levels in the peak pollution months were over 35 times the WHO’s annual average guideline of 5 µg/m³ and 11 times the peak 24 guideline limit of 15 µg/m³. And that’s if questions over the robustness of the latest government monitoring data are ignored for the moment. For nine of these last 10 years, opposition-led the Aam Aadmi Party was in power in Delhi, while Narendra Modi’s BJP party has been in power at the national level during the entire time. Near-zero improvement in Delhi’s peak pollution months since 2016. In 2025, Delhi also elected a BJP-led state government, which means the BJP is now in power at the national, state and municipality level – a ‘triple engine sarkar’, as the Hindustan Times framed it, referring to the Hindi term for “government.” Indeed, the BJP not only controls Delhi, but also the governments of two key bordering states, Haryana and Uttar Pradesh – which generate smoke from crop waste burning that contributes to the capital’s autumn smog crisis. That’s also why the new Delhi government, led by Chief Minister Ms Rekha Gupta, was expected to be uniquely placed to reduce pollution when she assumed office. Yet, as the peak season began, there was little indication of a significant shift in strategy. Unprecedented outrage against air pollution Public outrage against air pollution in Delhi and northern India has escalated to a level not seen in many years. It’s been characterised by a mix of anger and cutting humour – reels, memes and so on – against the government and the crisis. There were other aspects. Multiple protests, including the one on 9th November where police detained several demonstrators, including parents, among others, demanding clean air for their children. Multiple groups have been created on various social media and messaging apps. Some TV anchors and journalists, seen to be close to the ruling establishment since 2014, took many by surprise by pivoting and questioning official inaction and apathy. View this post on Instagram A post shared by Newslaundry (@newslaundry) India’s air pollution is “a metaphor for the challenges facing the nation more broadly.… if India cannot solve a problem that manifestly and acutely affects its elite, the prospects for solving the larger challenges confronting the country remain slim,” observed Arvind Subramanian and Devesh Kapur, in their book, A Sixth of Humanity, published last October. India’s environment minister Bhupender Yadav held a series of meetings on Delhi’s pollution, including one where he directed officials to “ensure visible improvement” in the air quality across Delhi and its neighbourhood “within one week.” That was mid-December. By the end of the month, there was no improvement. In fact, this December saw the worst pollution since 2018. Delhi’s environment minister and chief minister held several meetings, extensively posted policy action and photo ops on social media. There have been some positive steps, like distributing electric heaters to gatekeepers at various residential areas, curbs on categories of polluting vehicles, and stricter enforcement of OCEMS, online continuous emissions monitoring systems, at thousands of factories. Gaps in pollution control Along with the global “embarrassment” mentioned in A Sixth of Humanity, critical technical gaps remain. Firstly, misplaced focus on PM10: The government’s focus remains on spraying water to control dust because it continues to prioritise controlling PM10 particulate matter pollutants rather than the finer PM2.5 ones. PM2.5 is dangerous because it is small enough to enter the bloodstream and, so, is more lethal, whereas the body’s defenses can often stop the larger PM10 particles. In theory, watering down dust may help, but in practice, there hasn’t been much improvement. As this clip shows there’s simply too much pollution. And this water mist barely tackles PM2.5. ⚪️ Installs anti smog guns on top of 13 high rise buildings in Delhi to tackle pollution.pic.twitter.com/CJQWH18SYt — Mediterranean Voice (@mediterranvoice) December 26, 2025 Secondly, lack of political will: At a national level, there’s a lack of political will to stop the practice of farmers burning the residue of the paddy harvest in the three states north of Delhi and upwind of the city – Punjab, Haryana and Uttar Pradesh. This contributes almost 10% of the pollution in October and November in Delhi and the neighbourhood, according to a government (IITM) study, but on certain days and hours, it can be much higher. Thirdly, pseudo-science over evidence: There has been a reluctance among decision-makers to fully embrace scientifically evidence-based action. So a lot of time, taxpayers’ money, and effort over the years have gone into what may be described as pseudo-science, like smog towers, or action taken against scientific advice, like cloud-seeding trials. Fourthly, flawed monitoring of vehicular pollution: The Delhi government has, in a well-intentioned move, made pollution-under-control (PUC) certificates mandatory for all vehicles. However, the old PUC regime is flawed, and it needs to be replaced as it doesn’t check for key pollutants like PM2.5 and nitrogen oxides, which are major contributors to Delhi’s pollution. But to give credit where credit is due: a new panel has been formed by the national government with external experts on curbing vehicular pollution, which contributes more than a third of the capital’s air pollution levels. Many vehicles in Delhi are highly polluting, contributing more than a third to ambient air pollution levels. Battle against air pollution, 2026 There have been political missteps, too. One example: In early July, after public protests pressured the Delhi government to quickly roll back stricter enforcement of limits on old, polluting vehicles, the same government also successfully petitioned the Supreme Court to reverse a previous ban on firecrackers during the annual Diwali festival of lights, arguing that certain brands of so-called “green firecrackers” would not pollute. They were wrong. And the ensuing smoke was a factor in 2025’s post-Diwali pollution being the worst in years; and the chief minister repeatedly came in for criticism for comments she made on pollution. In 2026, can the public’s pressure, and even the government’s momentum, for clean air action be sustained or will it, as in the past, fizzle out when Delhi’s peak pollution season tapers off? Republished, with slight adaptation, from the original ‘What Am I Breathing’ Substack by Chetan Bhattacharji, a senior correspondent for Health Policy Watch from Delhi. Image Credits: Chetan Bhattacharji, Centre for Research on Energy and Clean Air. 2025: A Brutal Year for Global Health 28/12/2025 Editorial team This has been a brutal year for global health, with shock cuts in development aid to countries most in need; a knock-on budget crisis for United Nations (UN) agencies; widespread humanitarian crises, extensive disease outbreaks, and mounting climate-related health challenges. Health Policy Watch (HPW) has provided daily coverage of developments, and our reporters were often the first to break news on a range of issues despite our small and under-resourced newsroom. Development aid plunge Chaos followed the immediate “pause” of all development aid from the United States as soon as Donald Trump became president in January. The “pause” included the US President’s Emergency Plan for AIDS Relief (PEPFAR), which funded three-quarters of HIV and tuberculosis programmes worldwide, including lifesaving antiretroviral medicine to 20.6 million people in 2024. Within weeks, clinics across Africa closed, and patients were turned away as there was no money for staff or medicine. Although US Secretary of State Marco Rubio later issued a limited waiver for “lifesaving” programmes, this was narrowly focused and ideological. Influenced by the Heritage Foundation’s view that HIV is a “lifestyle disease”, the Trump administration stopped funding HIV measures aimed at “key populations” most vulnerable to infection – including sex workers and men who have sex with men. DOGE’s Elon Musk brandishing a chainsaw given to him by Argentinian President Javier Milei (right) after cutting US government programmes and global development aid, resulting in deaths and chaos. Within two weeks of Trump assuming the presidency, his appointee, Elon Musk and a new Department of Government Efficiency (DOGE) had also dismantled the US Agency for International Development (USAID). Musk declared that “USAID is a criminal organisation. It’s time for it to die.” USAID was hugely influential, and its closure affected almost every country in the world – from Albania to Zambia. As USAID had administered 60% of PEPFAR funds, in many instances, there was no one left to provide goods and services for those projects covered by Rubio’s waiver. Reporting on this issue was led by HPW Deputy Editor Kerry Cullinan. WHO slashes staff The WHO headquarters in Geneva has been in upheaval all year over how to rearrange the organisation’s budget to make up the 25% cut. The US withdrawal from the World Health Organization (WHO) on Trump’s first day in office, and its reduced support for other UN agencies. unleashed mass layoffs and restructuring. The WHO is slashing its staff by around a quarter – aiming to shed about 2,371 staff by mid-2026 – many at the end of this year – with ripples across Geneva. This has affected WHO’s ability to respond to health emergencies across the world. HPW Editor-in-Chief Elaine Fletcher was often the first to report on the various developments, with an inside track to staff reactions, including the WHO Staff Association decision to challenge the fairness and legitimacy of the restructuring process and the mounting rage of lower-level staff as HPW highlighted data suggesting that low- and mid-level personnel will bear the brunt of cuts, while high-ranking executives, whose real costs far exceed their published salaries, remain largely protected. UNAIDS has also been forced to retrench 55% of its head office staff and cut its country offices by almost half after the US ceased to fund it, a move that affected 40% of its budget. The agency warned that the brupt funding cuts have resulted in “perilous risks” for the global HIV response that threaten the health and well-being of millions of people throughout the world. “It feels like the ground has been ripped out from under our feet,” a Mozambican woman with HIV told UNAIDS, which reported at the year’s end that over two million women and girls have been “deprived of essential health services”, and millions of people at high risk of acquiring HIV have lost access to “the most effective prevention tools available” – pre-exposure prophylaxis (PrEP). Gavi, the vaccine alliance, has pared down its staff by a third, which will also affect global vaccination efforts. Disease outbreaks surge – so does anti-vax activities Mosquitoes, which can carry dengue virus, thrive at warmer temperatures. Climate change is fueling dengue cases globally. Amid the chaos in global health funding, diseases have surged. Africa has experienced large outbreaks of cholera, measles, Lassa fever and mpox, while deadly Ebola and Marburg have also affected several countries. By 10 December, Africa CDC had recorded over 300,000 cholera cases, over 140,00 measles cases and almost 134,000 mpox cases this year. Over the past year, both Latin America and the Caribbean saw record-breaking cases of the mosquito-borne dengue fever, with almost one-fifth of cases (about 45 million infections a year) attributable to climate change, Sophia Samantaroy covered issues from the Americas. Measles has also surged in the US and Canada amid the rise of anti-vaccine misinformation. This has been fueled by the appointment of vaccine sceptic Robert F. Kennedy Jr. as US Health and Human Services Secretary. So far, Kennedy and his appointees have cancelled mRNA research, restricted access to COVID-19 vaccines and made Hepatitis B vaccines non-mandatory for infants. In an exclusive article for HPW, Dr Demetre Daskalakis, former Director of the US CDC’s National Center for Immunizations and Respiratory Diseases, describes how the “wall protecting science from political interference in the US has fallen”. Humanitarian crises multiply Some 42,000 Gazans will need prolonged rehabilitation care and support due to war-related trauma injuries and amputations. Conflict and humanitarian crises – particularly in Gaza, Sudan and Ukraine – inflicted heavy casualties on citizens and health workers, with ongoing and unprecedented attacks on health facilities. HPW coverage of the conflict in Gaza included Israel’s blockade of Gaza, the resulting famine, Israeli attacks on WHO’s warehouse and efforts by Israel to secure the release of hostages being held by Hamas. This coverage was also led by Editor-in-Chief Elaine Fletcher. HPW has also consistently reported on the humanitarian crisis in Sudan, including the attack on a maternity hospital in El Fasher in which more than 460 people died. Climate change is ‘needlessly killing millions’ Climate change is claiming millions of lives annually through extreme heat, air pollution, wildfires and the spread of deadly infectious diseases, according to the ninth annual Lancet Countdown report, the most comprehensive assessment to date of the links between climate change and health, published in October. “We’re seeing millions of deaths that are occurring needlessly every year because of our persistent fossil fuel dependence, because of our delay in mitigating climate change, and our delays in adaptation to the climate change that cannot be avoided,” said Marina Romanello, executive director of the Lancet Countdown at University College London, describing this year’s report as “a bleak and undeniable picture of the devastating health harms reaching all corners of the world.” Breaching the 2015 Paris Agreement, a legally binding global treaty adopted in 2015 to combat climate change by limiting global warming to well below 2°C (ideally 1.5°C) above pre-industrial levels, is now unavoidable, according to scientists. The world is heading for 2.8°C of warming by century’s end under current policies, according to a UN assessment. Climate change protest Global greenhouse gas emissions rose 2.3% to a record 57.7 gigatons of CO2 equivalent in 2024, the largest annual increase since the 2000s. Land use change and deforestation account for 53% of the overall increase, while fossil fuel production continues to expand in direct contradiction of climate pledges. The US is the worst emitter, yet Trump withdrew the US from the Paris Agreement on Day One of his presidency. Domestically, the US Environmental Protection Agency (EPA) has committed to rolling back 31 climate, air and water pollution, and emissions regulations that will negatively affected citizens’ health. The EPA has also announced that it will no longer require most polluters to report their emissions of carbon dioxide, methane and other greenhouse gases that cause climate change. Stefan Anderson led HPW reporting on climate change. The impact of air pollution Disease burden from air pollution. Meanwhile, 90% of people on the planet breathe dangerously unhealthy levels of air pollution every day, and millions fall ill every year with a range of respiratory and cardiovascular diseases as well as cancers, leading to at least seven million deaths each year. Air pollution is the number one killer across South Asia, accounting for 2.7 million deaths, of which 2.1 million are in India alone. There is growing evidence of the impact of air pollution on a range of medical conditions including strokes, diabetes, heart disease and lung cancer. Significant sources of the deadly fine particulate matter (PM 2.5) come from fossil fuels in vehicles, power plants and other industrial facilities, and burning coal, wood, dung and agricultural residues for cooking. India-based Chetan Bhattacharji, led reporting on air pollution. Women’s rights The ‘Green Tide’: Argentinians demanding the legalisation of abortion. HPW has covered the backlash against sexual and reproductive rights, and women’s rights through stories on US anti-rights groups mobilising in Africa, the rollback of abortion rights in Argentina, the impact of intimate partner violence on children, efforts to enable access to menstrual products for girls and women, female genital mutilation, and several articles on women under Taliban rule in Afghanistan. Disha Shetty and Munija Mirzaie contributed several articles on this topic. New world order? In the final few months of the year, the Trump administration sought to turn the chaos its funding cuts caused into opportunities for the US by signing bilateral health agreements with several African countries that promote American business opportunities – and also enable US access to African minerals. This approach is detailed in the America First Global Health Strategy published in September, that “uses global health diplomacy and foreign assistance to make America safer, stronger, and more prosperous”. Driven by former DOGE official Brad Smith, these bilateral Memorandums of Understanding (MOUs) compel countries that receive US aid to fight HIV, tuberculosis and malaria to immediately share all information about “pathogens with epidemic potential” and give the US the right to share this information with other entities, including US pharmaceutical companies. The MOUs directly undermine the WHO negotiations on a pathogen access and benefit-sharing (PABS) system underway in Geneva, placing African countries in a particularly difficult position. Unlike past PEPFAR agreements, the MOUs cut out the involvement of community groups, except faith-based service providers, some of which are known to be against contraception and any recognition of LGBTQ people. Civil society groups have described the MOUs as “extractive” and over 50 organisations issued a letter calling on African heads of state and government to demand “equity and sovereignty” in the new bilateral agreements. However, in a positive reaction to plummeting aid, several African countries have allocated more money to health while several continental efforts are building Africa’s independence. At the Africa Health Sovereignty Summit, Ghana’s President John Mahama announced the formation of the Presidential High-Level Task Force on Global Health Governance in response to the 40% reduction in development aid in the past two years. “The world has changed, but global health governance has not kept pace with the changing world. At this moment, we’re called to redesign the architecture that has, for far too long, excluded Africa’s voices, excluded Africa’s needs and innovations,” said Mahama. Dr Muhammad Ali Pate, Nigeria’s Coordinating Minister of Health and Social Welfare. Writing for HPW, Nigerian Health Minister Muhammad Ali Pate Africa argues that Africa “can redefine its role in global health – emerging as a producer, innovator, and equal partner in shaping both the health of its people and the well-being of the world”. Pate argues that this can be achieved by countries investing in health “with the same urgency it devotes to infrastructure, defence, or governance”; enhancing South–South cooperation and collaboration; and forging a continental alliance that harnesses shared expertise, resources, and innovation for collective health security. HPW was proud to be a media partner at the Conference of Public Health in Africa 2025, where African researchers discussed how best to build solidarity between countries on the continent. Other Health Policy Watch team members and contributors include Maayan Hoffman (who also coordinates our social media), Arsalan Bukhari, Felix Sassmannshausen, Rahul Basharat Rajput, Kate Okorie, Abdullahi Jimoh, Edith Magak and Roisa Kerry. We are deeply grateful to our donors and media collaborations that have supported HPW to remain afloat during this difficult year and provide an important platform of engagement for the Global South and North that is free of charge. But most of all, we are grateful to all our readers for your engagement and interest. Please consider donating to HPW to ensure our ongoing survival. May 2026 be a more positive one for global health! Image Credits: Guilhem Vellut, WHO/EMRO , Markus Spiske/ Unsplash, Health Ministry of Nigeria. Escalating DR Congo Conflict Exacerbates Refugee Flight; Gaza Famine Threat Eases 22/12/2025 Editorial team Thousands of Congolese families are fleeing intense fighting in eastern DRC and crossing into Burundi in search of safety. UNHCR, the UN Refugee Agency, has said it is “deeply alarmed” by the worsening humanitarian situation in Burundi, which has reached a crisis point following a rapid influx of refugees and asylum-seekers fleeing a new wave of violence in the eastern part of the Democratic Republic of the Congo (DRC). Since early December, over 84,000 Congolese have crossed into neighbouring Burundi, fleeing escalating clashes in DRC’s South Kivu region where M-23 militias continue to make major inroads against government forces. Congolese refugees and asylum-seekers in Burundi now number more than 200,000m, said UNHCR’s Representative in Burundi, Brigitte Mukanga-Eno. Thousands of people crossing the border on foot and by boats each day have overwhelmed local resources, creating a major humanitarian emergency that requires immediate global support, Mukanga-Eno told reporters in Geneva on Friday. Women and children are particularly affected, arriving exhausted and severely traumatized, bearing the physical and psychological marks of terrifying violence. “In Burundi, transit centres and informal sites where new arrivals are hosted have far surpassed capacity, in some cases by nearly 200 per cent,” while “acute water and sanitation shortages are increasing the risk of outbreaks of life-threatening diseases, including cholera and Mpox,” Mukanga-Eno said. Across the border in the DRC’s South Kivu, violence, drone attacks and bombardments have forced more than 500,000 Congolese from their homes, many “displaced several times this year alone.” Speaking at an end year press briefing in Geneva, UNHCR, WHO and other UN agencies also warned that as 2025 draws to a close, humanitarian needs in Africa, the Middle East, and worldwide “remain staggering” and recent gains against famine in Gaza since a US-brokered cease-fire between Hamas and Israel last October are “extremely fragile.” In a separate press release, WHO meanwhile declared that “attacks on health care in Sudan are becoming deadlier and more widespread.” Gaza – famine threat rolled back, but hunger remains Famine averted by hunger crisis remains critical according to December IPC report and early 2026 projections.. On a more positive note, the threat of famine in Gaza has eased somewhat since the October cease-fire opened the gates to more aid – but hunger remains a constant threat for most Gazans. The latest Integrated Food Security Phase Classification (IPC) analysis for Gaza confirms that no areas of the Strip are currently classified in famine, but UN officials described this welcome progress as “extremely fragile.” “At least 1.6 million people – or 77 per cent of the population – are still facing high levels of acute food insecurity in the Gaza Strip,” including “over 100,000 children and 37,000 pregnant and breastfeeding women projected to suffer acute malnutrition,” said four UN agencies, including WHO and UNICEF, in a press release Friday, which coincided with release of the latest IPC report, containing a snapshot of the situation today as well as projections for 2026. All four Gaza governorates are still described as facing Phase 3 or 4 hunger conditions marked by “large food consumption gaps, high levels of acute malnutrition, and an elevated risk of mortality.” While “the ceasefire has improved some deliveries of food,” UN agencies said “most families are still grappling with severe shortages,” with “more than 730,000 people” displaced and “heavily reliant on humanitarian assistance,” the UN agencies said. “Gaza’s children are no longer facing deadly famine, but they remain in grave danger,” UNICEF’s Lucia Elmi warned at the Geneva press briefing. She added: “Food is now in markets, but many families simply cannot afford to buy it. Health facilities are barely functioning, clean water and sanitation services are scarce, and winter is bringing increasing suffering to displaced people huddling in makeshift shelters. These fragile gains could vanish overnight if fighting resumes. We need sustained humanitarian access, restored basic services, and above all, lasting peace.” Only 50% of Gaza health facilities functioning even partially Palestinian’s in Gaza’s Deir al Balah receive winterization assistance – an estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Only fifty per cent of Gaza’s health facilities are partially functional, and that “much more is needed to address the vast health needs,” warned WHO’s Tarik Jašarević, also speaking at the Geneva press event. Access constraints facing Gazan Emergency Medical Teams have, however, eased, with denial rates decreasing to about 20 per cent, compared with 30 – 35 per cent before the ceasefire, according to the Health Cluster. There are 343 EMT staff in Gaza, including 73 international staff and 270 national staff, OCHA stated, in a related press release on Friday. Since the cease-fire there has also been an increase in the number of medical evacuations. But more than 18,500 patients, including 4100 children, still are awaiting evacuation, Jašarević added. According to the Palestinian Ministry of Health, more than 1000 patients had died while awaiting medical evacuation between July 2024 and November 2025. Last week, at least ten Gazans reportedly died due to heavy rains, underscoring the life-threatening conditions that families were facing in Gaza, Jašarević said. That included three children who died of hypothermia in a context of cold temperatures and lack of medical infrastructure and medicine, said Ricardo Pires, for United Nations Children’s Fund (UNICEF), citing other reports. The severe storm conditions affected nearly 55,000 households, and forced the evacuation of 370 families from shoreline sites, said OCHA, the UN Office for Coordination of Humanitarian Affairs, in a separate press statement. An estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Sudan North Darfur’s strategic capital of El Fasher (Al Fashir), has been beseiged by the RSF for over a year while 650,000 people fleeing the war have clustered in Tawila (red dotted line) and other areas of the region, like Nyala, which also come under periodic attack. Meanwhile, WHO issued a stark warning over the increase of attacks on health care in Sudan, saying they are “becoming deadlier and more widespread, cutting off access to lifesaving services and placing health workers and humanitarian operations at serious risk.” The latest incident occurred on 14 December when nine health workers were killed and 17 injured in an attack on a hospital in Dalanj, a town in South Kordofan state, WHO said. Dalanj is a key administrative and health hub for surrounding communities, where health workers provide critical referral care. Earlier this month, on 4 December, a kindergarten and the Kalogi Rural Hospital in South Kordofan were also hit, with 114 people killed – including at least 60 children – and 35 injured. Health staff were treating casualties when the attack occurred at the hospital, which serves as a key referral health facility for surrounding rural communities. Evacuations of injured patients to Abu Jebaiha Hospital took place amid ongoing fire. In Nyala, South Darfur, at least 70 health workers were detained, alongside around 5000 civilians, over the past few months according to reports in early December. This incident followed multiple attacks on health facilities in El Fasher in October 2025, including targeted attacks on a maternity hospital that killed more than 460 patients, their families and other civilians, and the abduction of six health workers from El Fasher and surrounding localities in November 2025. Since the conflict began in April 2023, WHO has verified 201 attacks on health care in Sudan, resulting in 1858 deaths and 490 injuries,” with 2025 accounting for “more than 80% of all deaths from attacks on health care verified by WHO in complex humanitarian emergencies globally.” “Health workers have been providing health services with exceptional courage and dedication under extremely challenging conditions,” said WHO in a press release. WHO called “for an immediate halt to attacks on civilians, health workers, health facilities and humanitarian operations in Sudan,” and urged “safe, rapid and unimpeded humanitarian access in line with international humanitarian law.” See related story here: ‘Beyond Horrific’ Conditions in Sudan’s El Fasher; Gaza Swamped by Flooding Image Credits: © UNHCR/Bernard Ntwari, IPC , OCHA , Google Maps . New Flu Strain Sweeping Europe Says WHO; but Vaccines Remain Effective, ECDC Finds 19/12/2025 Felix Sassmannshausen Hans Henri Kluge, the WHO/Europe Regional Director, emphasised that vaccines save lives in the midst of a new flu strain surging early. Sudden fever, a severe cough and acute respiratory distress are the familiar onset symptoms of seasonal flu, which has affected WHO’s European Region with unusual intensity and speed this year. As the Northern Hemisphere enters winter, health systems are struggling to manage an epidemic driven by an aggressive, genetically mutated influenza strain A(H3N2) subclade K. But a new report by the European Centre for Disease Prevention and Control (ECDC), published on Friday, concluded that current seasonal influenza vaccines remain effective against this new strain of the virus. Health experts urge vulnerable groups to get vaccinated. The current influenza outbreak is dominated almost entirely by the A(H3N2) subclade K, which now accounts for up to 90 per cent of all confirmed cases in the region, according to data from WHO’s European Regional Office (EURO). Subclade K marks a “notable evolution in influenza A(H3N2) viruses,” having undergone genetic drift and displaying several amino acid changes in the hemagglutinin protein (the “key” the virus uses to unlock and enter human cells). Due to these slight changes, antibodies acquired from previous infections or older vaccines may not recognise the virus as effectively. “Flu comes around every winter, but this year is a little different,” stated Hans Kluge, WHO Regional Director for Europe, in a press release on Wednesday. Although there is no evidence that it causes more severe disease, Kluge explained that the small genetic variation in the virus places “enormous pressure on our health systems because people don’t have built-up immunity against it.” Flu season gains early momentum A(H3N2) subclade K is fuelling a flu surge across the WHO/Europe region, with protection stalling as most countries fail to meet critical vaccination targets. With the new strain spreading quickly, the current influenza season began approximately four weeks earlier than in previous years. High or very high activity is now being reported in at least 27 of the 38 countries being monitored by the WHO European Region. These countries range from EU Member States such as Ireland and Slovenia to Kyrgyzstan and Montenegro. “This is expected to cause a significant burden in terms of morbidity and mortality, as observed in past years, and target groups should be vaccinated rapidly,” said Bruno Ciancio, an ECDC senior expert, in response to a query from Health Policy Watch. WHO data shows that the strain has been detected in more than 34 countries globally over the last six months. While it is most prevalent in the European and Western Pacific regions, its expansion has also been confirmed in the WHO South-East Asia region. Since October, A(H3N2) subclade K sequences have been reported in Nepal, India and Thailand, as well as in the WHO African and Eastern Mediterranean Regions. Vaccines remain primary shield against severe illness Vaccinations remain effective and a key protection against the new strain, experts emphasize, based on preliminary findings. With cases expected to continue rising, likely peaking in late December or early January, protecting the most vulnerable is paramount. Public health authorities are emphasising urgently that vaccination is the most important protective measure for vulnerable groups, including adults aged 65 and over, pregnant women, people with chronic conditions and healthcare workers. Although recent reports suggest that subclade K shows “reduced reactivity” to current vaccines, it remains effective in preventing severe health outcomes, the ECDC concluded. “The current influenza vaccine is not perfectly matched to circulating strains, including H3N2. However, the primary aim of vaccination is to prevent severe disease, and effectiveness against severe outcomes is expected to be preserved,” explained ECDC expert Ciancio. According to the preliminary data published by the ECDC for this flu season, vaccine effectiveness in preventing influenza cases that require medical attention at the primary care level ranges from 52% in children (ages 0–17) and 57% in adults (ages 18–64). For the critical group of individuals aged 65 and older, it was not possible to estimate vaccine effectiveness separately, due to the low number of influenza cases so far considered in the study. ECDC experts emphasized, moreover, that the findings rely on small sample sizes from nine participating countries and have low statistical precision (e.g. wide confidence intervals). Efficacy could fluctuate as the season progresses. According to a ECDC analysis released only this week, vaccines significantly cut hospital admission rates in the last 2024-25 flu season. The modeling study found that seasonal vaccines were 70-75% effective at preventing hospital admissions among children aged 2-17 years and 30-40% effective in adults. Using computer simulations, the analysis estimated that vaccination programmes prevented 26-41% of flu-related hospitalisations among adults aged 65 and over across European Union (EU) countries between August 2024 and June 2025. Low vaccination rates remain public health concern To protect the vulnerable and to reduce transmission, a multilayered approach following the WHO playbook is essential. Within the EU, only Denmark, Portugal, and Ireland met the 75 percent target for older adults during the reporting period. The ECDC projects that a 75% vaccination rate can prevent up to three-quarters of flu-related hospitalisations, significantly reducing the strain on public health systems. Influenza vaccination rates for high-risk groups in other EU countries remained below WHO targets in the past seasons, as ECDC data from the most recent available season (2021-2022) shows. The overall median influenza vaccine coverage for adults aged 65 years and older was only 43 percent. The scale of the challenge is huge. Recent interim data from Germany’s Robert Koch Institute (RKI) for the 2024-25 season found that flu vaccination coverage among German adults aged 60+ declined from 39.7-34.5% since 2020-21, the first year of the COVID pandemic, reaching its lowest level in over 17 years. And at the same time, a severe flu season can strain hospital staff and capacity in already overburdened health systems. Combating the flu requires a multi-layered approach, experts underline. Slowing transmission requires proactive public health and social measures alongside vaccination, says WHO. These steps, proven effective during the COVID-19 pandemic, include staying home if unwell, wearing a mask in public if symptomatic, maintaining regular hand hygiene, and improving indoor ventilation. European health systems have “decades of experience managing influenza,” said Kluge, striking a note of optimism alongside the WHO warning. “We have safe vaccines that are updated annually, and we have a clear playbook of protective measures that work.” Image Credits: European Union, WHO/Europe , World Health Organization, European Union. Cervical Cancer in India: Early Marriage, Poor Screening and Gender Inequality Fuel a Preventable Killer 19/12/2025 Arsalan Bukhari Though largely preventable, cervical cancer continues to kill thousands of Indian women each year. MUMBAI, India – Cervical cancer kills more than 75,000 women in India each year, according to figures recently disclosed in Parliament – yet it is one of the most preventable cancers. In India, low human papillomavirus (HPV) vaccination coverage, limited access to routine screening and deep-rooted social behaviours – such as early marriage and low condom use – drive late diagnosis and high mortality. Globally, cervical cancer is the fourth most common cancer among women, with an estimated 660,000 new cases and 350,000 reported deaths in 2022, accoridng to WHO. Public health experts say these factors increase exposure to HPV, the underlying cause of nearly all cervical cancer cases, while allowing the disease to progress silently for years before detection. For Neha, a 29-year-old hotel worker in the city of 12.5 million, India’s largest, the statistics reflect a deeply personal loss. My two cousins died from cervical cancer,” she told Health Policy Watch. “What frightens me most is how silent it is. People seem completely normal for years, and then you discover they have had cancer for a long time only when they are close to dying. Early marriage and rising HPV exposure A wedding procession in India, where early marriage remains common. Doctors say nearly all cervical cancer cases are caused by persistent infection with high-risk types of HPV, one of the most common sexually transmitted infections worldwide. Mumbai physician, Dr Sonali Roy told Health Policy Watch that HPV exposure in India is closely tied to early marriage, low awareness and limited access to vaccination and screening, particularly in rural areas. “In some villages, girls are married as young as 14 or 15,” Roy said. These marriages often do not last, and women may remarry multiple times. Each marriage increases exposure to HPV, especially when condoms are rarely used and sexual health awareness is very low. Early marriage often leads to early sexual debut, repeated pregnancies and limited agency over reproductive health decisions, experts say all of which raise the risk of persistent HPV infection. The biological vulnerability of the cervix during adolescence further increases susceptibility to the virus. Unlike many high-income countries, India has yet to roll out a nationwide HPV vaccination programme, despite repeated recommendations from public health experts and the World Health Organization (WHO). While some states have launched pilot projects, coverage remains patchy and largely urban, leaving millions of girls unprotected before sexual debut. Routine cervical cancer screening also remains uneven across Indian states, with weak outreach in rural areas and among informal urban settlements, where health services are often overstretched. Evidence from research HPW vaccine introduction; India and South-East Asia lag behind most other regions of the world in routine HPV vaccination. Research supports the link between early sexual debut, multiple partners and higher HPV infection risk. A 2019 study reviewing medical records of 349 women who tested positive for high-risk HPV found that women who began sexual activity at a younger age or had multiple sexual partners faced a significantly higher risk of infection with HPV types 16 and 18, the two strains responsible for the majority of cervical cancer cases globally. The study found that about one in five women was infected with HPV 16, while nearly 9% were infected with HPV 18 – the types of HPV most likely to cause cervical cancer. Women who reported their first sexual intercourse at age 19 or younger were significantly more likely to be infected with HPV 16 than those who became sexually active later. The risk rose sharply with multiple partners. Women who reported more than three lifetime sexual partners were four times more likely to be infected with HPV 18 than women who had fewer partners. Public health researchers caution that these findings reflect structural conditions rather than individual behaviour. “In many cases, women do not have the power to negotiate when to marry, when to have sex or whether protection is used, ” said a health researcher. Men refuse to use protection With fewer than one in 10 Indian men using condoms, women bear the health consequences of preventable HPV infections. Even when women understand the risks, many say they have little control over prevention. A 27-year-old woman from the East Mumbai suburb of Kurla, who spoke on condition of anonymity, told Health Policy Watch that her partner refuses to use condoms.“He says it affects his pride,” said Priya (not her real name). This is common, even in cities like Mumbai, India’s modern financial center. She said stigma is far stronger in rural areas, where access to contraception is limited and social scrutiny is intense. Many women end up with these infections simply because men refuse to use protection. Her account echoes broader national trends. A 2021 report found that fewer than one in 10 men in India use condoms, making male sterilisation and barrier contraception among the least-used family planning methods in the country. Female sterilisation remains the dominant form of contraception, often placing the burden of reproductive health entirely on women. By comparison, a 2025 Zipdo educational report estimated that around 45% of sexually active people worldwide used a condom during their last sexual encounter. Priya recalled a close friend who had part of her cervix surgically removed after an early cancer diagnosis. Doctors later told her that consistent condom use would likely have prevented the HPV infection that led to the disease. Screening gaps Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. In India, the absence of a structured nationwide screening system has meant that many women are diagnosed only at advanced stages of the disease when treatment is more expensive and survival rates drop sharply. Under India’s National Programme for Prevention and Control of Non-Communicable Diseases and Ayushman Bharat, its health insurance for vulnerable families, women aged 30 to 65 are supposed to be screened for cervical cancer at primary health centres using visual inspection with acetic acid, a low-cost test known as VIA. Coverage, however, remains extremely low. Only about 2% of eligible women are currently being screened, with wide variations across states based on education levels and rural–urban divides. Health workers cite multiple barriers, including staff shortages, limited training, lack of privacy at health centres and social stigma around gynaecological examinations. For many women, domestic responsibilities and daily wage work also make preventive care a low priority. Cancer means financial ruin Doctors perform a surgical procedure on a woman patient. For some women, barriers go beyond awareness and access. A woman living on the rural outskirts of Mumbai, nearly 87 kilometres from the city centre, told Health Policy Watch that fear of financial ruin often outweighs concern about infection itself. “May God save us from expensive diseases. Unfortunately, cancer is one,” said Afshana, not her real name. “Even though we have a five lakh cover [around $5,500 annually] under Ayushman Bharat [insurance plan], we often end up going to private hospitals because services are lacking.” Her experience reflects broader systemic gaps. A 2024 NITI Aayog review of Health and Wellness Centres linked to Ayushman Bharat, India’s flagship government insurance scheme, found significant shortfalls in cancer screening delivery. While most centres had initiated screening for noncommunicable diseases, fewer than 10% had completed a full annual round. Cervical cancer screening was “yet to be operationalised,” according to the report, while oral cancer screening was carried out only selectively. The review also found that many auxiliary nurse-midwives, staff nurses and medical officers had not received adequate training to conduct screenings or manage referrals. Although most centres met basic infrastructure standards and provided essential medicines free of charge, service delivery continued to lag behind national goals for early detection and prevention. A preventable tragedy Cervical cancer is widely regarded as one of the most preventable forms of cancer. HPV vaccination, regular screening and timely treatment of precancerous lesions have dramatically reduced incidence and mortality in countries that have invested in these measures. Public health experts warn that without urgent action, India risks continuing to lose tens of thousands of women each year to a disease that can largely be stopped. “Cervical cancer is not just a medical issue,” Roy said. “It is a reflection of gender inequality, weak health systems and the failure to prioritise women’s health.”For women like Neha, the cost of that failure is already painfully clear. “If they had found it earlier, my cousins might still be alive,” she said. “No one should die from something that can be prevented.” Image Credits: Saiyan Mondal/Pexels, Gurpreet Singh/ Unsplash, Han J et al, eClinicalMedicine, Vol. 84June 2025, Deon Black/ Unsplash, Bermix Studio/Unsplash, Richard Catabay/Unsplash. Malawi’s New Government Faces National Hunger, Dwindling Aid and Soaring Debt 18/12/2025 Dingaan Mithi Almost a quarter of Malawians face malnutrition until the next harvest in March. This story was originally published by The New Humanitarian. Just a few months into his new term, President Peter Mutharika is grappling with a triple crisis: a deep-seated food emergency, diminishing aid, and soaring debt. With over four million Malawians – 22% of the population – facing the threat of acute malnutrition until the next harvest in March, Mutharika last month declared a nationwide state of disaster. But the $119 million humanitarian response is underfunded. Although crucial to staving off the risk of hunger-related deaths, it has so far raised only $26 million from Malawi’s aid partners – roughly 21% of the amount required. The trigger for Malawi’s food emergency has been a 20% drop in maize yields last year as a result of drought and localised flooding. The harvest failure hit small-scale farmers especially hard – the backbone of food production. The problem is not just food availability, but also its affordability. Reduced farm output, a severe foreign exchange shortage, plus perennial fuel scarcities, have pushed Malawi’s inflation rate to around 28% – the highest in Africa. Even though Monica Jasteni runs a small fish business in her home area of Salima, in central Malawi, the 34-year-old mother of four is struggling. “The money I make is not enough [to buy the food we need],” she told The New Humanitarian. “I try to persuade my children to go to school without eating, telling them that they’ll have food after school, because things are difficult.” She supplements what she makes from selling fish by also farming. But as she can’t afford irrigation, her small plot is susceptible to dry spells. An unsustainable debt burden The experience of Jasteni – trying to make ends meet, yet failing – is why a coalition of 50 civil society organisations is demanding urgent action by the government. “The hunger crisis is a huge national emergency,” said Amon Lukhele, national coordinator of the Civil Society Social Protection Network (CSSPN). “We are calling upon the government to act now to protect the poorest households before the hunger situation worsens.” CSSPN wants the government to accelerate implementation of its National Social Protection Policy, a safety net programme that aims to provide relief to the most vulnerable. But Mutharika, elected in September, has inherited public finances in a critical state. That has put pressure on what spending the government can afford, and the speed with which remedial programmes can be rolled out. Malawi is heavily debt-distressed. Its total debt burden is around $9.25 billion – an unsustainable 86% of GDP. It also faces a looming debt service obligation of $1.8 billion. That affects not only economic growth, but also the provision of essential social services. As a result, Malawi spends more on debt servicing than it does on health. The closure of the US Agency for International Development – a key health donor – has only made the government’s budget calculations even harder. Yet opportunities have been squandered. In 2006, Malawi had its debt cancelled under the Highly Indebted Poor Country Initiative (HIPC). But 19 years down the line, after years of heavy borrowing, it is back in arrears – and has been forced to swallow two painful currency devaluations, in 2022 and again in 2023. “Too much debt erodes Malawi’s capacity to strengthen food security,” said Mavuto Bamusi, a prominent political analyst and anti-corruption campaigner. “Debt repayments to lenders, especially the IMF [International Monetary Fund], are taking out a lot of money that could have been used for agricultural commercialisation.” Malawi needs to urgently restructure its debt, and find domestic and international support for reforms to revive its economy after years of mismanagement, analysts suggest. Joseph Mwanamvekha, the new finance minister, has announced new reform measures to stabilise the economy, and combat the food crisis. They include a commitment to improve public debt management and fiscal discipline, strict expenditure controls, and management of the wage bill. Getting food security right This is the fifth time in a decade Malawi has declared a food-related state of disaster. It not only signifies a deepening cycle of climate volatility, but also reflects the deep structural issues around food security. The agricultural sector is central to Malawi’s economy, accounting for almost a quarter of GDP and employing three quarters of the population – mostly through subsistence farming. But productivity gains have stagnated over the past decade, with an over-reliance on maize leading to soil degradation and micro-nutrient deficiencies in people’s diets. Successive governments have implemented input subsidy programmes, providing cut-price fertiliser and seeds. But historically they have suffered from logistical bottlenecks leading to late input deliveries, as well as targeting problems, fraud, and political interference. Mutharika’s government is trying again. He has launched the 2025/2026 Farm Input Subsidy Programme (FISP) aimed at 1.1 million farming households. Each will receive two 50kg bags of subsidised fertiliser plus a 5kg pack of seed of their choice. Political commentators suggest this will be a defining test for his administration. The goal for Mutharika is to deliver on his election campaign promises to provide farm inputs on time – and nationwide – avoiding favouring political constituencies. The rollout of digital registries and e-vouchers, backed by the World Bank, may help fix some of those problems. Yet the FISP will reach only a fraction of Malawi’s farming households. It also doesn’t fully address the problem of farmers’ preference for drought-vulnerable maize at a time of worsening climate volatility. Dominic Nyasulu, the national coordinator at the National Youth Network on Climate Change, argues that the new government needs to reframe food security policies to promote drought tolerant crops such as millet and sorghum – crops that were traditionally grown before the commercialisation of maize. “This country has potential to defeat hunger, but our policies need to be reformed in view of extreme weather events and other climate impacts,” said Nyasulu. Tamani Nkhono-Mvula, a Malawian agriculture and food security expert, said a more far-reaching change will come with irrigation. Only 4% of farming land is currently irrigated. The drawbacks are that it is expensive, there is a lack of rural financing, water management has historically been a problem, and women farmers are particularly disadvantaged. The lack of government capacity is also a significant drawback, as is access to commercial markets, according to 2021 evaluation of a World Bank irrigation and rural development project. However, Nkhono-Mvula argues that the potential “for Malawi to feed itself is there – the leadership just needs to be transformative”. The New Humanitarian puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world. Image Credits: Fatsani Gunya/ The New Humanitarian. Two More WHO Officials Cut from Senior Leadership Team Move into Other Roles 16/12/2025 Elaine Ruth Fletcher WHO Director General’s former Senior Leadership Team – which he slashed from 11 to six positions as part of a major reshuffle in May 2025. Two more senior WHO officials, Bruce Aylward and Ailan Li, who were among those dropped from WHO’s Senior Leadership Team during the first phase of an Agency shake-up, have now been appointed to leading roles elsewhere in the organisation, according to a memo from Director General Tedros Adhanom Ghebreyesus. Li, a Chinese national and former assistant director-general for UHC/Healthier Populations at WHO Headquarters in Geneva, has been appointed as WHO Representative to the Kingdom of Thailand, Tedros announced, in a message seen by Health Policy Watch. Aylward, formerly assistant director-general for the Division of Universal Health Coverage/Life Course, was appointed director of the WHO-World Bank Global Preparedness Monitoring Board in August, and will now also be coordinating the work on the UN80 Initiative, Tedros confirmed in the message, emailed to all staff on Friday. The new appointments complete the sweep of WHO’s 17 former senior management officials, now reduced to 12 as part of major cost-cutting moves triggered by the withdrawal of the United States from the organisation in January. The US retreat left a gaping $1.7 billion budget gap for the upcoming 2026-27 budget period. That has now been reduced to $1.05 billion due to a projected 25% reduction in WHO’s workforce next year. Three of six ADGs cut from senior leadership ranks actually left WHO Dr Mike Ryan addresses a meeting of WHO pandemic negotiators in one of his last public appearances before retiring. The new senior leadership team includes four assistant director generals at headquarters, a Chef de Cabinet and Chief Scientist, as well as Tedros himself. The directors of five WHO Regional Offices (not including the head of the Pan American Health Organisation, counted separately) also hold an equivalent ranking, for total of 12 such posts. Of the six ADGs who were cut from team in May, three have actually left the organisation, including Samira Asma, formerly ADG for Data, Analytics and Delivery, now with the Susan Thompson Buffett Foundation; Jérome Salomon, ADG for Universal Health Coverage who left WHO in September; and Health Emergencies Executive Director Mike Ryan, who retired in September. The recent appointments mean that three others, including Li, Aylward and former ADG for External Relations Catherine Boehme have now moved into other roles, with Boehme serving as “Officer in Charge” of WHO’s South-East Asia Regional Office (SEARO). Tedros placed SEARO’s Regional Director, Saima Wazed on leave on 11 July, after the Bangladeshi government filed two cases against her for alleged fraud, forgery and misuse of power, also issuing a warrant for her arrest. No return date has so far been announced. See related story: Controversial WHO Regional Director Placed on Leave Former HQ Directors also named to lead WHO country offices In his message Friday, Tedros also named a number of other former department directors and team heads at headquarters to head country offices in the global organisation, including: Indrajit Hazarika, formerly Senior Public Health Officer, of Country Strategy and Support at HQ, as WHO Representative to the Republic of Angola. Ann Maria Lindstrand, formerly Unit Head, Essential Programme on Immunisation in the Health Emergencies Division, as WHO Representative to the Republic of Cabo Verde. Dr Pavel Ursu, formerly Director of the Department of Delivery for Impact at headquarters in Geneva, as WHO Representative to the Federal Republic of Nigeria. Dr Michel Yao, formerly the Director of the Department of Strategic Health Operations, will become the WHO Representative to the Republic of Senegal. In 2021, Yao as well as another senior WHO official, were named in an alleged cover-up of allegations of sexual abuse brought against WHO field staff and consultants responding to an Ebola outbreak in the Democratic Republic of Congo. They were later cleared by an UN investigations panel. Nedret Emiroglu, a former Director for Country Readiness Strengthening in the Health Emergencies Division, was meanwhile named to head the WHO Secretariat for the Intergovernmental Working Group (IGWG), which is negotiating further provisions of the WHO Pandemic Agreement approved in May – most notably a proposed system for Pathogen Access and Benefit Sharing (PABS). Staff Reductions to date WHO workforce, headquarters, country offices and regions, in 3rd Quarter 2025, a reduction of over 500 staff in comparison with December 2024. In a press briefing last week, Tedros publicly acknowledged that the organisation plans to reduce WHO staff worldwide by an estimated 2371 positions by mid-2026, shedding about 25% of the workforce, which numbered 9,466 at the end of December 2024, and just under that as of 1 January. Around 1,089 staff are being shed through what WHO described as “natural attrition.” This includes retirements, early retirement, and the non-renewal of short-term staff contracts that expire. In addition, another 1,282 long and short-term posts have been abolished outright, according to statements at the presser and the earlier briefing to WHO member states. That should bring WHO’s global staff headcount down to about 7,360 professional and administrative positions by mid-2026. In terms of sheer numbers, professional staff at low and mid-level are among those hit hardest by the staff cuts.. Of those cuts, some 505 staff had left WHO by end September, WHO human resource records show; that count was confirmed by a WHO spokesperson. “A large number of staff are exiting at the end of December, three-months notice while notified in September,” the spokesperson told Health Policy Watch. “And another large number will leave in June 2026, i.e. the ones with reassignment rights.” In terms of D1 and D2 directors, whose numbers nearly doubled in the first six years of Tedros’ administration, costing the organisation nearly $100 million annually, some 21 Directors’ positions had been eliminated as of 30 September. That brings the number of directors worldwide down from a peak of 188 at end 2024 to 167 in Q3 2025. WHO Directors – 3rd Quarter 2025 – versus December 2024. That still leaves another 30 D1 and D2 posts to be eliminated by June 2026, mostly at headquarters. The massive reorganisation announced in April and May, slashed the number of departments and directors at headquarters by more than half – from 76 to 34 positions). The reason those reductions haven’t yet been reflected in the HR records is simple, WHO says. “Some directors who are sitting on positions that have been abolished have up to 6 months reassignment [rights] plus a 3-month notice period,” a WHO spokesperson said, “hence they still appear in the Q3 report. The target remains for June 30, 2026.” How will cuts translate into budget savings? Despite the painful plans to cut more 2,371 staff worldwide by June 2026, a projected funding gap remains of $1.05 billion, according to the director general’s last report to member states in November. The $1.7 billion funding gap for 2026-27 has been reduced to $1.05 billion, according to current projections. And the degree to which cuts in rank-and-file, as well as high level positions, will lead to actual savings remains to be seen. WHO’s November reports to member state did not offer any detailed analysis of projected savings that would be gained through the reductions by staff grade or office location. Even less detail provided on the status, conditions and costs of non-staff contract holders – about which there is no reporting even of pay grades or geographic base, let alone gender and age. That’s despite the fact that WHO’s non-staff’s headcount of 7582 (full-time equivalents) in 2024 was approaching that of actual staff numbers (9466) for that year. WHO officials say that the lack of more detailed reporting on non-staff contracts, is linked to legal and ethical issues. “WHO does not systematically capture, aggregate or publish individual-level information (such as grade equivalence, age, gender or demographic background) for non-staff contractual arrangements,” a WHO spokesperson told Health Policy Watch. “Doing so would raise legal, ethical and data-protection concerns, as WHO is not the employer of these individuals and does not have a mandate to collect or process such personal data beyond what is strictly required for contractual and financial compliance.” This table in WHO’s bi-annual HR report is the sole data available on non-staff contracts. It notes full-time equivalents for part-time engagements (consultants and APWs). Presuming that most Special Service Agreements (SSAs) are full-time, total estimated full time equivalent contracts numbered nearly 7600 in 2024. At the highest levels of WHO staff, meanwhile, some directors whose departments at headquarters were abolished remained in the organisation as a heads of unit, which typically carries a top-level professional grade of P6. In the UN grading system, the salaries of D1 directors and P6 professionals are virtually identical. And some former department heads now running units have even clung to their old titles, regardless of the formalities. Signature of a former director – (phone number and email have been erased to protect privacy). In an email invitation to colleagues for a late November reception at the WHO canteen, the former Director of the Department of Public Health and Migration (PHM), who is now technically a unit head, couldn’t resist signing the invite with his old title as well: “Head of Special Initiative on Health and Migration (Director). Division of Universal Health Coverage and Healthier Populations.” Observed one WHO staff member: “This kind of thing is all over the place. As for cost reduction, NADA!” Image Credits: WHO HR database , WHO , WHO Workforce Data, December 13 2024, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Near-Zero Change in Delhi’s Peak Air Pollution Levels Over Past Decade – But Big Change in Public Outrage 05/01/2026 Chetan Bhattacharji Delhi air pollution during peak days in mid-November 2025 – an annual public health crisis that remains unresolved. The latest ten-year data shows almost no change. Can the momentum of outrage finally push officials to take high-impact measures to lower pollution this year? It’s Delhi 2026. Since 2016, there’s been near-zero improvement in the city’s air pollution during the annual peak pollution period of October to December, a new analysis by the Center for Research on Energy and Clean Air (CREA) reveals. This period also usually sees peak coverage and public outrage about the crisis. In 2025, average levels for those peak months even inched up a notch over the year before to 177 micrograms/cubic meter (µg/m³) of PM2.5 – despite a slight decline in the annual average levels in 2025 as compared to 2024 (96 µg/m³ in 2025 versus 105 in 2024). This means average levels in the peak pollution months were over 35 times the WHO’s annual average guideline of 5 µg/m³ and 11 times the peak 24 guideline limit of 15 µg/m³. And that’s if questions over the robustness of the latest government monitoring data are ignored for the moment. For nine of these last 10 years, opposition-led the Aam Aadmi Party was in power in Delhi, while Narendra Modi’s BJP party has been in power at the national level during the entire time. Near-zero improvement in Delhi’s peak pollution months since 2016. In 2025, Delhi also elected a BJP-led state government, which means the BJP is now in power at the national, state and municipality level – a ‘triple engine sarkar’, as the Hindustan Times framed it, referring to the Hindi term for “government.” Indeed, the BJP not only controls Delhi, but also the governments of two key bordering states, Haryana and Uttar Pradesh – which generate smoke from crop waste burning that contributes to the capital’s autumn smog crisis. That’s also why the new Delhi government, led by Chief Minister Ms Rekha Gupta, was expected to be uniquely placed to reduce pollution when she assumed office. Yet, as the peak season began, there was little indication of a significant shift in strategy. Unprecedented outrage against air pollution Public outrage against air pollution in Delhi and northern India has escalated to a level not seen in many years. It’s been characterised by a mix of anger and cutting humour – reels, memes and so on – against the government and the crisis. There were other aspects. Multiple protests, including the one on 9th November where police detained several demonstrators, including parents, among others, demanding clean air for their children. Multiple groups have been created on various social media and messaging apps. Some TV anchors and journalists, seen to be close to the ruling establishment since 2014, took many by surprise by pivoting and questioning official inaction and apathy. View this post on Instagram A post shared by Newslaundry (@newslaundry) India’s air pollution is “a metaphor for the challenges facing the nation more broadly.… if India cannot solve a problem that manifestly and acutely affects its elite, the prospects for solving the larger challenges confronting the country remain slim,” observed Arvind Subramanian and Devesh Kapur, in their book, A Sixth of Humanity, published last October. India’s environment minister Bhupender Yadav held a series of meetings on Delhi’s pollution, including one where he directed officials to “ensure visible improvement” in the air quality across Delhi and its neighbourhood “within one week.” That was mid-December. By the end of the month, there was no improvement. In fact, this December saw the worst pollution since 2018. Delhi’s environment minister and chief minister held several meetings, extensively posted policy action and photo ops on social media. There have been some positive steps, like distributing electric heaters to gatekeepers at various residential areas, curbs on categories of polluting vehicles, and stricter enforcement of OCEMS, online continuous emissions monitoring systems, at thousands of factories. Gaps in pollution control Along with the global “embarrassment” mentioned in A Sixth of Humanity, critical technical gaps remain. Firstly, misplaced focus on PM10: The government’s focus remains on spraying water to control dust because it continues to prioritise controlling PM10 particulate matter pollutants rather than the finer PM2.5 ones. PM2.5 is dangerous because it is small enough to enter the bloodstream and, so, is more lethal, whereas the body’s defenses can often stop the larger PM10 particles. In theory, watering down dust may help, but in practice, there hasn’t been much improvement. As this clip shows there’s simply too much pollution. And this water mist barely tackles PM2.5. ⚪️ Installs anti smog guns on top of 13 high rise buildings in Delhi to tackle pollution.pic.twitter.com/CJQWH18SYt — Mediterranean Voice (@mediterranvoice) December 26, 2025 Secondly, lack of political will: At a national level, there’s a lack of political will to stop the practice of farmers burning the residue of the paddy harvest in the three states north of Delhi and upwind of the city – Punjab, Haryana and Uttar Pradesh. This contributes almost 10% of the pollution in October and November in Delhi and the neighbourhood, according to a government (IITM) study, but on certain days and hours, it can be much higher. Thirdly, pseudo-science over evidence: There has been a reluctance among decision-makers to fully embrace scientifically evidence-based action. So a lot of time, taxpayers’ money, and effort over the years have gone into what may be described as pseudo-science, like smog towers, or action taken against scientific advice, like cloud-seeding trials. Fourthly, flawed monitoring of vehicular pollution: The Delhi government has, in a well-intentioned move, made pollution-under-control (PUC) certificates mandatory for all vehicles. However, the old PUC regime is flawed, and it needs to be replaced as it doesn’t check for key pollutants like PM2.5 and nitrogen oxides, which are major contributors to Delhi’s pollution. But to give credit where credit is due: a new panel has been formed by the national government with external experts on curbing vehicular pollution, which contributes more than a third of the capital’s air pollution levels. Many vehicles in Delhi are highly polluting, contributing more than a third to ambient air pollution levels. Battle against air pollution, 2026 There have been political missteps, too. One example: In early July, after public protests pressured the Delhi government to quickly roll back stricter enforcement of limits on old, polluting vehicles, the same government also successfully petitioned the Supreme Court to reverse a previous ban on firecrackers during the annual Diwali festival of lights, arguing that certain brands of so-called “green firecrackers” would not pollute. They were wrong. And the ensuing smoke was a factor in 2025’s post-Diwali pollution being the worst in years; and the chief minister repeatedly came in for criticism for comments she made on pollution. In 2026, can the public’s pressure, and even the government’s momentum, for clean air action be sustained or will it, as in the past, fizzle out when Delhi’s peak pollution season tapers off? Republished, with slight adaptation, from the original ‘What Am I Breathing’ Substack by Chetan Bhattacharji, a senior correspondent for Health Policy Watch from Delhi. Image Credits: Chetan Bhattacharji, Centre for Research on Energy and Clean Air. 2025: A Brutal Year for Global Health 28/12/2025 Editorial team This has been a brutal year for global health, with shock cuts in development aid to countries most in need; a knock-on budget crisis for United Nations (UN) agencies; widespread humanitarian crises, extensive disease outbreaks, and mounting climate-related health challenges. Health Policy Watch (HPW) has provided daily coverage of developments, and our reporters were often the first to break news on a range of issues despite our small and under-resourced newsroom. Development aid plunge Chaos followed the immediate “pause” of all development aid from the United States as soon as Donald Trump became president in January. The “pause” included the US President’s Emergency Plan for AIDS Relief (PEPFAR), which funded three-quarters of HIV and tuberculosis programmes worldwide, including lifesaving antiretroviral medicine to 20.6 million people in 2024. Within weeks, clinics across Africa closed, and patients were turned away as there was no money for staff or medicine. Although US Secretary of State Marco Rubio later issued a limited waiver for “lifesaving” programmes, this was narrowly focused and ideological. Influenced by the Heritage Foundation’s view that HIV is a “lifestyle disease”, the Trump administration stopped funding HIV measures aimed at “key populations” most vulnerable to infection – including sex workers and men who have sex with men. DOGE’s Elon Musk brandishing a chainsaw given to him by Argentinian President Javier Milei (right) after cutting US government programmes and global development aid, resulting in deaths and chaos. Within two weeks of Trump assuming the presidency, his appointee, Elon Musk and a new Department of Government Efficiency (DOGE) had also dismantled the US Agency for International Development (USAID). Musk declared that “USAID is a criminal organisation. It’s time for it to die.” USAID was hugely influential, and its closure affected almost every country in the world – from Albania to Zambia. As USAID had administered 60% of PEPFAR funds, in many instances, there was no one left to provide goods and services for those projects covered by Rubio’s waiver. Reporting on this issue was led by HPW Deputy Editor Kerry Cullinan. WHO slashes staff The WHO headquarters in Geneva has been in upheaval all year over how to rearrange the organisation’s budget to make up the 25% cut. The US withdrawal from the World Health Organization (WHO) on Trump’s first day in office, and its reduced support for other UN agencies. unleashed mass layoffs and restructuring. The WHO is slashing its staff by around a quarter – aiming to shed about 2,371 staff by mid-2026 – many at the end of this year – with ripples across Geneva. This has affected WHO’s ability to respond to health emergencies across the world. HPW Editor-in-Chief Elaine Fletcher was often the first to report on the various developments, with an inside track to staff reactions, including the WHO Staff Association decision to challenge the fairness and legitimacy of the restructuring process and the mounting rage of lower-level staff as HPW highlighted data suggesting that low- and mid-level personnel will bear the brunt of cuts, while high-ranking executives, whose real costs far exceed their published salaries, remain largely protected. UNAIDS has also been forced to retrench 55% of its head office staff and cut its country offices by almost half after the US ceased to fund it, a move that affected 40% of its budget. The agency warned that the brupt funding cuts have resulted in “perilous risks” for the global HIV response that threaten the health and well-being of millions of people throughout the world. “It feels like the ground has been ripped out from under our feet,” a Mozambican woman with HIV told UNAIDS, which reported at the year’s end that over two million women and girls have been “deprived of essential health services”, and millions of people at high risk of acquiring HIV have lost access to “the most effective prevention tools available” – pre-exposure prophylaxis (PrEP). Gavi, the vaccine alliance, has pared down its staff by a third, which will also affect global vaccination efforts. Disease outbreaks surge – so does anti-vax activities Mosquitoes, which can carry dengue virus, thrive at warmer temperatures. Climate change is fueling dengue cases globally. Amid the chaos in global health funding, diseases have surged. Africa has experienced large outbreaks of cholera, measles, Lassa fever and mpox, while deadly Ebola and Marburg have also affected several countries. By 10 December, Africa CDC had recorded over 300,000 cholera cases, over 140,00 measles cases and almost 134,000 mpox cases this year. Over the past year, both Latin America and the Caribbean saw record-breaking cases of the mosquito-borne dengue fever, with almost one-fifth of cases (about 45 million infections a year) attributable to climate change, Sophia Samantaroy covered issues from the Americas. Measles has also surged in the US and Canada amid the rise of anti-vaccine misinformation. This has been fueled by the appointment of vaccine sceptic Robert F. Kennedy Jr. as US Health and Human Services Secretary. So far, Kennedy and his appointees have cancelled mRNA research, restricted access to COVID-19 vaccines and made Hepatitis B vaccines non-mandatory for infants. In an exclusive article for HPW, Dr Demetre Daskalakis, former Director of the US CDC’s National Center for Immunizations and Respiratory Diseases, describes how the “wall protecting science from political interference in the US has fallen”. Humanitarian crises multiply Some 42,000 Gazans will need prolonged rehabilitation care and support due to war-related trauma injuries and amputations. Conflict and humanitarian crises – particularly in Gaza, Sudan and Ukraine – inflicted heavy casualties on citizens and health workers, with ongoing and unprecedented attacks on health facilities. HPW coverage of the conflict in Gaza included Israel’s blockade of Gaza, the resulting famine, Israeli attacks on WHO’s warehouse and efforts by Israel to secure the release of hostages being held by Hamas. This coverage was also led by Editor-in-Chief Elaine Fletcher. HPW has also consistently reported on the humanitarian crisis in Sudan, including the attack on a maternity hospital in El Fasher in which more than 460 people died. Climate change is ‘needlessly killing millions’ Climate change is claiming millions of lives annually through extreme heat, air pollution, wildfires and the spread of deadly infectious diseases, according to the ninth annual Lancet Countdown report, the most comprehensive assessment to date of the links between climate change and health, published in October. “We’re seeing millions of deaths that are occurring needlessly every year because of our persistent fossil fuel dependence, because of our delay in mitigating climate change, and our delays in adaptation to the climate change that cannot be avoided,” said Marina Romanello, executive director of the Lancet Countdown at University College London, describing this year’s report as “a bleak and undeniable picture of the devastating health harms reaching all corners of the world.” Breaching the 2015 Paris Agreement, a legally binding global treaty adopted in 2015 to combat climate change by limiting global warming to well below 2°C (ideally 1.5°C) above pre-industrial levels, is now unavoidable, according to scientists. The world is heading for 2.8°C of warming by century’s end under current policies, according to a UN assessment. Climate change protest Global greenhouse gas emissions rose 2.3% to a record 57.7 gigatons of CO2 equivalent in 2024, the largest annual increase since the 2000s. Land use change and deforestation account for 53% of the overall increase, while fossil fuel production continues to expand in direct contradiction of climate pledges. The US is the worst emitter, yet Trump withdrew the US from the Paris Agreement on Day One of his presidency. Domestically, the US Environmental Protection Agency (EPA) has committed to rolling back 31 climate, air and water pollution, and emissions regulations that will negatively affected citizens’ health. The EPA has also announced that it will no longer require most polluters to report their emissions of carbon dioxide, methane and other greenhouse gases that cause climate change. Stefan Anderson led HPW reporting on climate change. The impact of air pollution Disease burden from air pollution. Meanwhile, 90% of people on the planet breathe dangerously unhealthy levels of air pollution every day, and millions fall ill every year with a range of respiratory and cardiovascular diseases as well as cancers, leading to at least seven million deaths each year. Air pollution is the number one killer across South Asia, accounting for 2.7 million deaths, of which 2.1 million are in India alone. There is growing evidence of the impact of air pollution on a range of medical conditions including strokes, diabetes, heart disease and lung cancer. Significant sources of the deadly fine particulate matter (PM 2.5) come from fossil fuels in vehicles, power plants and other industrial facilities, and burning coal, wood, dung and agricultural residues for cooking. India-based Chetan Bhattacharji, led reporting on air pollution. Women’s rights The ‘Green Tide’: Argentinians demanding the legalisation of abortion. HPW has covered the backlash against sexual and reproductive rights, and women’s rights through stories on US anti-rights groups mobilising in Africa, the rollback of abortion rights in Argentina, the impact of intimate partner violence on children, efforts to enable access to menstrual products for girls and women, female genital mutilation, and several articles on women under Taliban rule in Afghanistan. Disha Shetty and Munija Mirzaie contributed several articles on this topic. New world order? In the final few months of the year, the Trump administration sought to turn the chaos its funding cuts caused into opportunities for the US by signing bilateral health agreements with several African countries that promote American business opportunities – and also enable US access to African minerals. This approach is detailed in the America First Global Health Strategy published in September, that “uses global health diplomacy and foreign assistance to make America safer, stronger, and more prosperous”. Driven by former DOGE official Brad Smith, these bilateral Memorandums of Understanding (MOUs) compel countries that receive US aid to fight HIV, tuberculosis and malaria to immediately share all information about “pathogens with epidemic potential” and give the US the right to share this information with other entities, including US pharmaceutical companies. The MOUs directly undermine the WHO negotiations on a pathogen access and benefit-sharing (PABS) system underway in Geneva, placing African countries in a particularly difficult position. Unlike past PEPFAR agreements, the MOUs cut out the involvement of community groups, except faith-based service providers, some of which are known to be against contraception and any recognition of LGBTQ people. Civil society groups have described the MOUs as “extractive” and over 50 organisations issued a letter calling on African heads of state and government to demand “equity and sovereignty” in the new bilateral agreements. However, in a positive reaction to plummeting aid, several African countries have allocated more money to health while several continental efforts are building Africa’s independence. At the Africa Health Sovereignty Summit, Ghana’s President John Mahama announced the formation of the Presidential High-Level Task Force on Global Health Governance in response to the 40% reduction in development aid in the past two years. “The world has changed, but global health governance has not kept pace with the changing world. At this moment, we’re called to redesign the architecture that has, for far too long, excluded Africa’s voices, excluded Africa’s needs and innovations,” said Mahama. Dr Muhammad Ali Pate, Nigeria’s Coordinating Minister of Health and Social Welfare. Writing for HPW, Nigerian Health Minister Muhammad Ali Pate Africa argues that Africa “can redefine its role in global health – emerging as a producer, innovator, and equal partner in shaping both the health of its people and the well-being of the world”. Pate argues that this can be achieved by countries investing in health “with the same urgency it devotes to infrastructure, defence, or governance”; enhancing South–South cooperation and collaboration; and forging a continental alliance that harnesses shared expertise, resources, and innovation for collective health security. HPW was proud to be a media partner at the Conference of Public Health in Africa 2025, where African researchers discussed how best to build solidarity between countries on the continent. Other Health Policy Watch team members and contributors include Maayan Hoffman (who also coordinates our social media), Arsalan Bukhari, Felix Sassmannshausen, Rahul Basharat Rajput, Kate Okorie, Abdullahi Jimoh, Edith Magak and Roisa Kerry. We are deeply grateful to our donors and media collaborations that have supported HPW to remain afloat during this difficult year and provide an important platform of engagement for the Global South and North that is free of charge. But most of all, we are grateful to all our readers for your engagement and interest. Please consider donating to HPW to ensure our ongoing survival. May 2026 be a more positive one for global health! Image Credits: Guilhem Vellut, WHO/EMRO , Markus Spiske/ Unsplash, Health Ministry of Nigeria. Escalating DR Congo Conflict Exacerbates Refugee Flight; Gaza Famine Threat Eases 22/12/2025 Editorial team Thousands of Congolese families are fleeing intense fighting in eastern DRC and crossing into Burundi in search of safety. UNHCR, the UN Refugee Agency, has said it is “deeply alarmed” by the worsening humanitarian situation in Burundi, which has reached a crisis point following a rapid influx of refugees and asylum-seekers fleeing a new wave of violence in the eastern part of the Democratic Republic of the Congo (DRC). Since early December, over 84,000 Congolese have crossed into neighbouring Burundi, fleeing escalating clashes in DRC’s South Kivu region where M-23 militias continue to make major inroads against government forces. Congolese refugees and asylum-seekers in Burundi now number more than 200,000m, said UNHCR’s Representative in Burundi, Brigitte Mukanga-Eno. Thousands of people crossing the border on foot and by boats each day have overwhelmed local resources, creating a major humanitarian emergency that requires immediate global support, Mukanga-Eno told reporters in Geneva on Friday. Women and children are particularly affected, arriving exhausted and severely traumatized, bearing the physical and psychological marks of terrifying violence. “In Burundi, transit centres and informal sites where new arrivals are hosted have far surpassed capacity, in some cases by nearly 200 per cent,” while “acute water and sanitation shortages are increasing the risk of outbreaks of life-threatening diseases, including cholera and Mpox,” Mukanga-Eno said. Across the border in the DRC’s South Kivu, violence, drone attacks and bombardments have forced more than 500,000 Congolese from their homes, many “displaced several times this year alone.” Speaking at an end year press briefing in Geneva, UNHCR, WHO and other UN agencies also warned that as 2025 draws to a close, humanitarian needs in Africa, the Middle East, and worldwide “remain staggering” and recent gains against famine in Gaza since a US-brokered cease-fire between Hamas and Israel last October are “extremely fragile.” In a separate press release, WHO meanwhile declared that “attacks on health care in Sudan are becoming deadlier and more widespread.” Gaza – famine threat rolled back, but hunger remains Famine averted by hunger crisis remains critical according to December IPC report and early 2026 projections.. On a more positive note, the threat of famine in Gaza has eased somewhat since the October cease-fire opened the gates to more aid – but hunger remains a constant threat for most Gazans. The latest Integrated Food Security Phase Classification (IPC) analysis for Gaza confirms that no areas of the Strip are currently classified in famine, but UN officials described this welcome progress as “extremely fragile.” “At least 1.6 million people – or 77 per cent of the population – are still facing high levels of acute food insecurity in the Gaza Strip,” including “over 100,000 children and 37,000 pregnant and breastfeeding women projected to suffer acute malnutrition,” said four UN agencies, including WHO and UNICEF, in a press release Friday, which coincided with release of the latest IPC report, containing a snapshot of the situation today as well as projections for 2026. All four Gaza governorates are still described as facing Phase 3 or 4 hunger conditions marked by “large food consumption gaps, high levels of acute malnutrition, and an elevated risk of mortality.” While “the ceasefire has improved some deliveries of food,” UN agencies said “most families are still grappling with severe shortages,” with “more than 730,000 people” displaced and “heavily reliant on humanitarian assistance,” the UN agencies said. “Gaza’s children are no longer facing deadly famine, but they remain in grave danger,” UNICEF’s Lucia Elmi warned at the Geneva press briefing. She added: “Food is now in markets, but many families simply cannot afford to buy it. Health facilities are barely functioning, clean water and sanitation services are scarce, and winter is bringing increasing suffering to displaced people huddling in makeshift shelters. These fragile gains could vanish overnight if fighting resumes. We need sustained humanitarian access, restored basic services, and above all, lasting peace.” Only 50% of Gaza health facilities functioning even partially Palestinian’s in Gaza’s Deir al Balah receive winterization assistance – an estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Only fifty per cent of Gaza’s health facilities are partially functional, and that “much more is needed to address the vast health needs,” warned WHO’s Tarik Jašarević, also speaking at the Geneva press event. Access constraints facing Gazan Emergency Medical Teams have, however, eased, with denial rates decreasing to about 20 per cent, compared with 30 – 35 per cent before the ceasefire, according to the Health Cluster. There are 343 EMT staff in Gaza, including 73 international staff and 270 national staff, OCHA stated, in a related press release on Friday. Since the cease-fire there has also been an increase in the number of medical evacuations. But more than 18,500 patients, including 4100 children, still are awaiting evacuation, Jašarević added. According to the Palestinian Ministry of Health, more than 1000 patients had died while awaiting medical evacuation between July 2024 and November 2025. Last week, at least ten Gazans reportedly died due to heavy rains, underscoring the life-threatening conditions that families were facing in Gaza, Jašarević said. That included three children who died of hypothermia in a context of cold temperatures and lack of medical infrastructure and medicine, said Ricardo Pires, for United Nations Children’s Fund (UNICEF), citing other reports. The severe storm conditions affected nearly 55,000 households, and forced the evacuation of 370 families from shoreline sites, said OCHA, the UN Office for Coordination of Humanitarian Affairs, in a separate press statement. An estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Sudan North Darfur’s strategic capital of El Fasher (Al Fashir), has been beseiged by the RSF for over a year while 650,000 people fleeing the war have clustered in Tawila (red dotted line) and other areas of the region, like Nyala, which also come under periodic attack. Meanwhile, WHO issued a stark warning over the increase of attacks on health care in Sudan, saying they are “becoming deadlier and more widespread, cutting off access to lifesaving services and placing health workers and humanitarian operations at serious risk.” The latest incident occurred on 14 December when nine health workers were killed and 17 injured in an attack on a hospital in Dalanj, a town in South Kordofan state, WHO said. Dalanj is a key administrative and health hub for surrounding communities, where health workers provide critical referral care. Earlier this month, on 4 December, a kindergarten and the Kalogi Rural Hospital in South Kordofan were also hit, with 114 people killed – including at least 60 children – and 35 injured. Health staff were treating casualties when the attack occurred at the hospital, which serves as a key referral health facility for surrounding rural communities. Evacuations of injured patients to Abu Jebaiha Hospital took place amid ongoing fire. In Nyala, South Darfur, at least 70 health workers were detained, alongside around 5000 civilians, over the past few months according to reports in early December. This incident followed multiple attacks on health facilities in El Fasher in October 2025, including targeted attacks on a maternity hospital that killed more than 460 patients, their families and other civilians, and the abduction of six health workers from El Fasher and surrounding localities in November 2025. Since the conflict began in April 2023, WHO has verified 201 attacks on health care in Sudan, resulting in 1858 deaths and 490 injuries,” with 2025 accounting for “more than 80% of all deaths from attacks on health care verified by WHO in complex humanitarian emergencies globally.” “Health workers have been providing health services with exceptional courage and dedication under extremely challenging conditions,” said WHO in a press release. WHO called “for an immediate halt to attacks on civilians, health workers, health facilities and humanitarian operations in Sudan,” and urged “safe, rapid and unimpeded humanitarian access in line with international humanitarian law.” See related story here: ‘Beyond Horrific’ Conditions in Sudan’s El Fasher; Gaza Swamped by Flooding Image Credits: © UNHCR/Bernard Ntwari, IPC , OCHA , Google Maps . New Flu Strain Sweeping Europe Says WHO; but Vaccines Remain Effective, ECDC Finds 19/12/2025 Felix Sassmannshausen Hans Henri Kluge, the WHO/Europe Regional Director, emphasised that vaccines save lives in the midst of a new flu strain surging early. Sudden fever, a severe cough and acute respiratory distress are the familiar onset symptoms of seasonal flu, which has affected WHO’s European Region with unusual intensity and speed this year. As the Northern Hemisphere enters winter, health systems are struggling to manage an epidemic driven by an aggressive, genetically mutated influenza strain A(H3N2) subclade K. But a new report by the European Centre for Disease Prevention and Control (ECDC), published on Friday, concluded that current seasonal influenza vaccines remain effective against this new strain of the virus. Health experts urge vulnerable groups to get vaccinated. The current influenza outbreak is dominated almost entirely by the A(H3N2) subclade K, which now accounts for up to 90 per cent of all confirmed cases in the region, according to data from WHO’s European Regional Office (EURO). Subclade K marks a “notable evolution in influenza A(H3N2) viruses,” having undergone genetic drift and displaying several amino acid changes in the hemagglutinin protein (the “key” the virus uses to unlock and enter human cells). Due to these slight changes, antibodies acquired from previous infections or older vaccines may not recognise the virus as effectively. “Flu comes around every winter, but this year is a little different,” stated Hans Kluge, WHO Regional Director for Europe, in a press release on Wednesday. Although there is no evidence that it causes more severe disease, Kluge explained that the small genetic variation in the virus places “enormous pressure on our health systems because people don’t have built-up immunity against it.” Flu season gains early momentum A(H3N2) subclade K is fuelling a flu surge across the WHO/Europe region, with protection stalling as most countries fail to meet critical vaccination targets. With the new strain spreading quickly, the current influenza season began approximately four weeks earlier than in previous years. High or very high activity is now being reported in at least 27 of the 38 countries being monitored by the WHO European Region. These countries range from EU Member States such as Ireland and Slovenia to Kyrgyzstan and Montenegro. “This is expected to cause a significant burden in terms of morbidity and mortality, as observed in past years, and target groups should be vaccinated rapidly,” said Bruno Ciancio, an ECDC senior expert, in response to a query from Health Policy Watch. WHO data shows that the strain has been detected in more than 34 countries globally over the last six months. While it is most prevalent in the European and Western Pacific regions, its expansion has also been confirmed in the WHO South-East Asia region. Since October, A(H3N2) subclade K sequences have been reported in Nepal, India and Thailand, as well as in the WHO African and Eastern Mediterranean Regions. Vaccines remain primary shield against severe illness Vaccinations remain effective and a key protection against the new strain, experts emphasize, based on preliminary findings. With cases expected to continue rising, likely peaking in late December or early January, protecting the most vulnerable is paramount. Public health authorities are emphasising urgently that vaccination is the most important protective measure for vulnerable groups, including adults aged 65 and over, pregnant women, people with chronic conditions and healthcare workers. Although recent reports suggest that subclade K shows “reduced reactivity” to current vaccines, it remains effective in preventing severe health outcomes, the ECDC concluded. “The current influenza vaccine is not perfectly matched to circulating strains, including H3N2. However, the primary aim of vaccination is to prevent severe disease, and effectiveness against severe outcomes is expected to be preserved,” explained ECDC expert Ciancio. According to the preliminary data published by the ECDC for this flu season, vaccine effectiveness in preventing influenza cases that require medical attention at the primary care level ranges from 52% in children (ages 0–17) and 57% in adults (ages 18–64). For the critical group of individuals aged 65 and older, it was not possible to estimate vaccine effectiveness separately, due to the low number of influenza cases so far considered in the study. ECDC experts emphasized, moreover, that the findings rely on small sample sizes from nine participating countries and have low statistical precision (e.g. wide confidence intervals). Efficacy could fluctuate as the season progresses. According to a ECDC analysis released only this week, vaccines significantly cut hospital admission rates in the last 2024-25 flu season. The modeling study found that seasonal vaccines were 70-75% effective at preventing hospital admissions among children aged 2-17 years and 30-40% effective in adults. Using computer simulations, the analysis estimated that vaccination programmes prevented 26-41% of flu-related hospitalisations among adults aged 65 and over across European Union (EU) countries between August 2024 and June 2025. Low vaccination rates remain public health concern To protect the vulnerable and to reduce transmission, a multilayered approach following the WHO playbook is essential. Within the EU, only Denmark, Portugal, and Ireland met the 75 percent target for older adults during the reporting period. The ECDC projects that a 75% vaccination rate can prevent up to three-quarters of flu-related hospitalisations, significantly reducing the strain on public health systems. Influenza vaccination rates for high-risk groups in other EU countries remained below WHO targets in the past seasons, as ECDC data from the most recent available season (2021-2022) shows. The overall median influenza vaccine coverage for adults aged 65 years and older was only 43 percent. The scale of the challenge is huge. Recent interim data from Germany’s Robert Koch Institute (RKI) for the 2024-25 season found that flu vaccination coverage among German adults aged 60+ declined from 39.7-34.5% since 2020-21, the first year of the COVID pandemic, reaching its lowest level in over 17 years. And at the same time, a severe flu season can strain hospital staff and capacity in already overburdened health systems. Combating the flu requires a multi-layered approach, experts underline. Slowing transmission requires proactive public health and social measures alongside vaccination, says WHO. These steps, proven effective during the COVID-19 pandemic, include staying home if unwell, wearing a mask in public if symptomatic, maintaining regular hand hygiene, and improving indoor ventilation. European health systems have “decades of experience managing influenza,” said Kluge, striking a note of optimism alongside the WHO warning. “We have safe vaccines that are updated annually, and we have a clear playbook of protective measures that work.” Image Credits: European Union, WHO/Europe , World Health Organization, European Union. Cervical Cancer in India: Early Marriage, Poor Screening and Gender Inequality Fuel a Preventable Killer 19/12/2025 Arsalan Bukhari Though largely preventable, cervical cancer continues to kill thousands of Indian women each year. MUMBAI, India – Cervical cancer kills more than 75,000 women in India each year, according to figures recently disclosed in Parliament – yet it is one of the most preventable cancers. In India, low human papillomavirus (HPV) vaccination coverage, limited access to routine screening and deep-rooted social behaviours – such as early marriage and low condom use – drive late diagnosis and high mortality. Globally, cervical cancer is the fourth most common cancer among women, with an estimated 660,000 new cases and 350,000 reported deaths in 2022, accoridng to WHO. Public health experts say these factors increase exposure to HPV, the underlying cause of nearly all cervical cancer cases, while allowing the disease to progress silently for years before detection. For Neha, a 29-year-old hotel worker in the city of 12.5 million, India’s largest, the statistics reflect a deeply personal loss. My two cousins died from cervical cancer,” she told Health Policy Watch. “What frightens me most is how silent it is. People seem completely normal for years, and then you discover they have had cancer for a long time only when they are close to dying. Early marriage and rising HPV exposure A wedding procession in India, where early marriage remains common. Doctors say nearly all cervical cancer cases are caused by persistent infection with high-risk types of HPV, one of the most common sexually transmitted infections worldwide. Mumbai physician, Dr Sonali Roy told Health Policy Watch that HPV exposure in India is closely tied to early marriage, low awareness and limited access to vaccination and screening, particularly in rural areas. “In some villages, girls are married as young as 14 or 15,” Roy said. These marriages often do not last, and women may remarry multiple times. Each marriage increases exposure to HPV, especially when condoms are rarely used and sexual health awareness is very low. Early marriage often leads to early sexual debut, repeated pregnancies and limited agency over reproductive health decisions, experts say all of which raise the risk of persistent HPV infection. The biological vulnerability of the cervix during adolescence further increases susceptibility to the virus. Unlike many high-income countries, India has yet to roll out a nationwide HPV vaccination programme, despite repeated recommendations from public health experts and the World Health Organization (WHO). While some states have launched pilot projects, coverage remains patchy and largely urban, leaving millions of girls unprotected before sexual debut. Routine cervical cancer screening also remains uneven across Indian states, with weak outreach in rural areas and among informal urban settlements, where health services are often overstretched. Evidence from research HPW vaccine introduction; India and South-East Asia lag behind most other regions of the world in routine HPV vaccination. Research supports the link between early sexual debut, multiple partners and higher HPV infection risk. A 2019 study reviewing medical records of 349 women who tested positive for high-risk HPV found that women who began sexual activity at a younger age or had multiple sexual partners faced a significantly higher risk of infection with HPV types 16 and 18, the two strains responsible for the majority of cervical cancer cases globally. The study found that about one in five women was infected with HPV 16, while nearly 9% were infected with HPV 18 – the types of HPV most likely to cause cervical cancer. Women who reported their first sexual intercourse at age 19 or younger were significantly more likely to be infected with HPV 16 than those who became sexually active later. The risk rose sharply with multiple partners. Women who reported more than three lifetime sexual partners were four times more likely to be infected with HPV 18 than women who had fewer partners. Public health researchers caution that these findings reflect structural conditions rather than individual behaviour. “In many cases, women do not have the power to negotiate when to marry, when to have sex or whether protection is used, ” said a health researcher. Men refuse to use protection With fewer than one in 10 Indian men using condoms, women bear the health consequences of preventable HPV infections. Even when women understand the risks, many say they have little control over prevention. A 27-year-old woman from the East Mumbai suburb of Kurla, who spoke on condition of anonymity, told Health Policy Watch that her partner refuses to use condoms.“He says it affects his pride,” said Priya (not her real name). This is common, even in cities like Mumbai, India’s modern financial center. She said stigma is far stronger in rural areas, where access to contraception is limited and social scrutiny is intense. Many women end up with these infections simply because men refuse to use protection. Her account echoes broader national trends. A 2021 report found that fewer than one in 10 men in India use condoms, making male sterilisation and barrier contraception among the least-used family planning methods in the country. Female sterilisation remains the dominant form of contraception, often placing the burden of reproductive health entirely on women. By comparison, a 2025 Zipdo educational report estimated that around 45% of sexually active people worldwide used a condom during their last sexual encounter. Priya recalled a close friend who had part of her cervix surgically removed after an early cancer diagnosis. Doctors later told her that consistent condom use would likely have prevented the HPV infection that led to the disease. Screening gaps Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. In India, the absence of a structured nationwide screening system has meant that many women are diagnosed only at advanced stages of the disease when treatment is more expensive and survival rates drop sharply. Under India’s National Programme for Prevention and Control of Non-Communicable Diseases and Ayushman Bharat, its health insurance for vulnerable families, women aged 30 to 65 are supposed to be screened for cervical cancer at primary health centres using visual inspection with acetic acid, a low-cost test known as VIA. Coverage, however, remains extremely low. Only about 2% of eligible women are currently being screened, with wide variations across states based on education levels and rural–urban divides. Health workers cite multiple barriers, including staff shortages, limited training, lack of privacy at health centres and social stigma around gynaecological examinations. For many women, domestic responsibilities and daily wage work also make preventive care a low priority. Cancer means financial ruin Doctors perform a surgical procedure on a woman patient. For some women, barriers go beyond awareness and access. A woman living on the rural outskirts of Mumbai, nearly 87 kilometres from the city centre, told Health Policy Watch that fear of financial ruin often outweighs concern about infection itself. “May God save us from expensive diseases. Unfortunately, cancer is one,” said Afshana, not her real name. “Even though we have a five lakh cover [around $5,500 annually] under Ayushman Bharat [insurance plan], we often end up going to private hospitals because services are lacking.” Her experience reflects broader systemic gaps. A 2024 NITI Aayog review of Health and Wellness Centres linked to Ayushman Bharat, India’s flagship government insurance scheme, found significant shortfalls in cancer screening delivery. While most centres had initiated screening for noncommunicable diseases, fewer than 10% had completed a full annual round. Cervical cancer screening was “yet to be operationalised,” according to the report, while oral cancer screening was carried out only selectively. The review also found that many auxiliary nurse-midwives, staff nurses and medical officers had not received adequate training to conduct screenings or manage referrals. Although most centres met basic infrastructure standards and provided essential medicines free of charge, service delivery continued to lag behind national goals for early detection and prevention. A preventable tragedy Cervical cancer is widely regarded as one of the most preventable forms of cancer. HPV vaccination, regular screening and timely treatment of precancerous lesions have dramatically reduced incidence and mortality in countries that have invested in these measures. Public health experts warn that without urgent action, India risks continuing to lose tens of thousands of women each year to a disease that can largely be stopped. “Cervical cancer is not just a medical issue,” Roy said. “It is a reflection of gender inequality, weak health systems and the failure to prioritise women’s health.”For women like Neha, the cost of that failure is already painfully clear. “If they had found it earlier, my cousins might still be alive,” she said. “No one should die from something that can be prevented.” Image Credits: Saiyan Mondal/Pexels, Gurpreet Singh/ Unsplash, Han J et al, eClinicalMedicine, Vol. 84June 2025, Deon Black/ Unsplash, Bermix Studio/Unsplash, Richard Catabay/Unsplash. Malawi’s New Government Faces National Hunger, Dwindling Aid and Soaring Debt 18/12/2025 Dingaan Mithi Almost a quarter of Malawians face malnutrition until the next harvest in March. This story was originally published by The New Humanitarian. Just a few months into his new term, President Peter Mutharika is grappling with a triple crisis: a deep-seated food emergency, diminishing aid, and soaring debt. With over four million Malawians – 22% of the population – facing the threat of acute malnutrition until the next harvest in March, Mutharika last month declared a nationwide state of disaster. But the $119 million humanitarian response is underfunded. Although crucial to staving off the risk of hunger-related deaths, it has so far raised only $26 million from Malawi’s aid partners – roughly 21% of the amount required. The trigger for Malawi’s food emergency has been a 20% drop in maize yields last year as a result of drought and localised flooding. The harvest failure hit small-scale farmers especially hard – the backbone of food production. The problem is not just food availability, but also its affordability. Reduced farm output, a severe foreign exchange shortage, plus perennial fuel scarcities, have pushed Malawi’s inflation rate to around 28% – the highest in Africa. Even though Monica Jasteni runs a small fish business in her home area of Salima, in central Malawi, the 34-year-old mother of four is struggling. “The money I make is not enough [to buy the food we need],” she told The New Humanitarian. “I try to persuade my children to go to school without eating, telling them that they’ll have food after school, because things are difficult.” She supplements what she makes from selling fish by also farming. But as she can’t afford irrigation, her small plot is susceptible to dry spells. An unsustainable debt burden The experience of Jasteni – trying to make ends meet, yet failing – is why a coalition of 50 civil society organisations is demanding urgent action by the government. “The hunger crisis is a huge national emergency,” said Amon Lukhele, national coordinator of the Civil Society Social Protection Network (CSSPN). “We are calling upon the government to act now to protect the poorest households before the hunger situation worsens.” CSSPN wants the government to accelerate implementation of its National Social Protection Policy, a safety net programme that aims to provide relief to the most vulnerable. But Mutharika, elected in September, has inherited public finances in a critical state. That has put pressure on what spending the government can afford, and the speed with which remedial programmes can be rolled out. Malawi is heavily debt-distressed. Its total debt burden is around $9.25 billion – an unsustainable 86% of GDP. It also faces a looming debt service obligation of $1.8 billion. That affects not only economic growth, but also the provision of essential social services. As a result, Malawi spends more on debt servicing than it does on health. The closure of the US Agency for International Development – a key health donor – has only made the government’s budget calculations even harder. Yet opportunities have been squandered. In 2006, Malawi had its debt cancelled under the Highly Indebted Poor Country Initiative (HIPC). But 19 years down the line, after years of heavy borrowing, it is back in arrears – and has been forced to swallow two painful currency devaluations, in 2022 and again in 2023. “Too much debt erodes Malawi’s capacity to strengthen food security,” said Mavuto Bamusi, a prominent political analyst and anti-corruption campaigner. “Debt repayments to lenders, especially the IMF [International Monetary Fund], are taking out a lot of money that could have been used for agricultural commercialisation.” Malawi needs to urgently restructure its debt, and find domestic and international support for reforms to revive its economy after years of mismanagement, analysts suggest. Joseph Mwanamvekha, the new finance minister, has announced new reform measures to stabilise the economy, and combat the food crisis. They include a commitment to improve public debt management and fiscal discipline, strict expenditure controls, and management of the wage bill. Getting food security right This is the fifth time in a decade Malawi has declared a food-related state of disaster. It not only signifies a deepening cycle of climate volatility, but also reflects the deep structural issues around food security. The agricultural sector is central to Malawi’s economy, accounting for almost a quarter of GDP and employing three quarters of the population – mostly through subsistence farming. But productivity gains have stagnated over the past decade, with an over-reliance on maize leading to soil degradation and micro-nutrient deficiencies in people’s diets. Successive governments have implemented input subsidy programmes, providing cut-price fertiliser and seeds. But historically they have suffered from logistical bottlenecks leading to late input deliveries, as well as targeting problems, fraud, and political interference. Mutharika’s government is trying again. He has launched the 2025/2026 Farm Input Subsidy Programme (FISP) aimed at 1.1 million farming households. Each will receive two 50kg bags of subsidised fertiliser plus a 5kg pack of seed of their choice. Political commentators suggest this will be a defining test for his administration. The goal for Mutharika is to deliver on his election campaign promises to provide farm inputs on time – and nationwide – avoiding favouring political constituencies. The rollout of digital registries and e-vouchers, backed by the World Bank, may help fix some of those problems. Yet the FISP will reach only a fraction of Malawi’s farming households. It also doesn’t fully address the problem of farmers’ preference for drought-vulnerable maize at a time of worsening climate volatility. Dominic Nyasulu, the national coordinator at the National Youth Network on Climate Change, argues that the new government needs to reframe food security policies to promote drought tolerant crops such as millet and sorghum – crops that were traditionally grown before the commercialisation of maize. “This country has potential to defeat hunger, but our policies need to be reformed in view of extreme weather events and other climate impacts,” said Nyasulu. Tamani Nkhono-Mvula, a Malawian agriculture and food security expert, said a more far-reaching change will come with irrigation. Only 4% of farming land is currently irrigated. The drawbacks are that it is expensive, there is a lack of rural financing, water management has historically been a problem, and women farmers are particularly disadvantaged. The lack of government capacity is also a significant drawback, as is access to commercial markets, according to 2021 evaluation of a World Bank irrigation and rural development project. However, Nkhono-Mvula argues that the potential “for Malawi to feed itself is there – the leadership just needs to be transformative”. The New Humanitarian puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world. Image Credits: Fatsani Gunya/ The New Humanitarian. Two More WHO Officials Cut from Senior Leadership Team Move into Other Roles 16/12/2025 Elaine Ruth Fletcher WHO Director General’s former Senior Leadership Team – which he slashed from 11 to six positions as part of a major reshuffle in May 2025. Two more senior WHO officials, Bruce Aylward and Ailan Li, who were among those dropped from WHO’s Senior Leadership Team during the first phase of an Agency shake-up, have now been appointed to leading roles elsewhere in the organisation, according to a memo from Director General Tedros Adhanom Ghebreyesus. Li, a Chinese national and former assistant director-general for UHC/Healthier Populations at WHO Headquarters in Geneva, has been appointed as WHO Representative to the Kingdom of Thailand, Tedros announced, in a message seen by Health Policy Watch. Aylward, formerly assistant director-general for the Division of Universal Health Coverage/Life Course, was appointed director of the WHO-World Bank Global Preparedness Monitoring Board in August, and will now also be coordinating the work on the UN80 Initiative, Tedros confirmed in the message, emailed to all staff on Friday. The new appointments complete the sweep of WHO’s 17 former senior management officials, now reduced to 12 as part of major cost-cutting moves triggered by the withdrawal of the United States from the organisation in January. The US retreat left a gaping $1.7 billion budget gap for the upcoming 2026-27 budget period. That has now been reduced to $1.05 billion due to a projected 25% reduction in WHO’s workforce next year. Three of six ADGs cut from senior leadership ranks actually left WHO Dr Mike Ryan addresses a meeting of WHO pandemic negotiators in one of his last public appearances before retiring. The new senior leadership team includes four assistant director generals at headquarters, a Chef de Cabinet and Chief Scientist, as well as Tedros himself. The directors of five WHO Regional Offices (not including the head of the Pan American Health Organisation, counted separately) also hold an equivalent ranking, for total of 12 such posts. Of the six ADGs who were cut from team in May, three have actually left the organisation, including Samira Asma, formerly ADG for Data, Analytics and Delivery, now with the Susan Thompson Buffett Foundation; Jérome Salomon, ADG for Universal Health Coverage who left WHO in September; and Health Emergencies Executive Director Mike Ryan, who retired in September. The recent appointments mean that three others, including Li, Aylward and former ADG for External Relations Catherine Boehme have now moved into other roles, with Boehme serving as “Officer in Charge” of WHO’s South-East Asia Regional Office (SEARO). Tedros placed SEARO’s Regional Director, Saima Wazed on leave on 11 July, after the Bangladeshi government filed two cases against her for alleged fraud, forgery and misuse of power, also issuing a warrant for her arrest. No return date has so far been announced. See related story: Controversial WHO Regional Director Placed on Leave Former HQ Directors also named to lead WHO country offices In his message Friday, Tedros also named a number of other former department directors and team heads at headquarters to head country offices in the global organisation, including: Indrajit Hazarika, formerly Senior Public Health Officer, of Country Strategy and Support at HQ, as WHO Representative to the Republic of Angola. Ann Maria Lindstrand, formerly Unit Head, Essential Programme on Immunisation in the Health Emergencies Division, as WHO Representative to the Republic of Cabo Verde. Dr Pavel Ursu, formerly Director of the Department of Delivery for Impact at headquarters in Geneva, as WHO Representative to the Federal Republic of Nigeria. Dr Michel Yao, formerly the Director of the Department of Strategic Health Operations, will become the WHO Representative to the Republic of Senegal. In 2021, Yao as well as another senior WHO official, were named in an alleged cover-up of allegations of sexual abuse brought against WHO field staff and consultants responding to an Ebola outbreak in the Democratic Republic of Congo. They were later cleared by an UN investigations panel. Nedret Emiroglu, a former Director for Country Readiness Strengthening in the Health Emergencies Division, was meanwhile named to head the WHO Secretariat for the Intergovernmental Working Group (IGWG), which is negotiating further provisions of the WHO Pandemic Agreement approved in May – most notably a proposed system for Pathogen Access and Benefit Sharing (PABS). Staff Reductions to date WHO workforce, headquarters, country offices and regions, in 3rd Quarter 2025, a reduction of over 500 staff in comparison with December 2024. In a press briefing last week, Tedros publicly acknowledged that the organisation plans to reduce WHO staff worldwide by an estimated 2371 positions by mid-2026, shedding about 25% of the workforce, which numbered 9,466 at the end of December 2024, and just under that as of 1 January. Around 1,089 staff are being shed through what WHO described as “natural attrition.” This includes retirements, early retirement, and the non-renewal of short-term staff contracts that expire. In addition, another 1,282 long and short-term posts have been abolished outright, according to statements at the presser and the earlier briefing to WHO member states. That should bring WHO’s global staff headcount down to about 7,360 professional and administrative positions by mid-2026. In terms of sheer numbers, professional staff at low and mid-level are among those hit hardest by the staff cuts.. Of those cuts, some 505 staff had left WHO by end September, WHO human resource records show; that count was confirmed by a WHO spokesperson. “A large number of staff are exiting at the end of December, three-months notice while notified in September,” the spokesperson told Health Policy Watch. “And another large number will leave in June 2026, i.e. the ones with reassignment rights.” In terms of D1 and D2 directors, whose numbers nearly doubled in the first six years of Tedros’ administration, costing the organisation nearly $100 million annually, some 21 Directors’ positions had been eliminated as of 30 September. That brings the number of directors worldwide down from a peak of 188 at end 2024 to 167 in Q3 2025. WHO Directors – 3rd Quarter 2025 – versus December 2024. That still leaves another 30 D1 and D2 posts to be eliminated by June 2026, mostly at headquarters. The massive reorganisation announced in April and May, slashed the number of departments and directors at headquarters by more than half – from 76 to 34 positions). The reason those reductions haven’t yet been reflected in the HR records is simple, WHO says. “Some directors who are sitting on positions that have been abolished have up to 6 months reassignment [rights] plus a 3-month notice period,” a WHO spokesperson said, “hence they still appear in the Q3 report. The target remains for June 30, 2026.” How will cuts translate into budget savings? Despite the painful plans to cut more 2,371 staff worldwide by June 2026, a projected funding gap remains of $1.05 billion, according to the director general’s last report to member states in November. The $1.7 billion funding gap for 2026-27 has been reduced to $1.05 billion, according to current projections. And the degree to which cuts in rank-and-file, as well as high level positions, will lead to actual savings remains to be seen. WHO’s November reports to member state did not offer any detailed analysis of projected savings that would be gained through the reductions by staff grade or office location. Even less detail provided on the status, conditions and costs of non-staff contract holders – about which there is no reporting even of pay grades or geographic base, let alone gender and age. That’s despite the fact that WHO’s non-staff’s headcount of 7582 (full-time equivalents) in 2024 was approaching that of actual staff numbers (9466) for that year. WHO officials say that the lack of more detailed reporting on non-staff contracts, is linked to legal and ethical issues. “WHO does not systematically capture, aggregate or publish individual-level information (such as grade equivalence, age, gender or demographic background) for non-staff contractual arrangements,” a WHO spokesperson told Health Policy Watch. “Doing so would raise legal, ethical and data-protection concerns, as WHO is not the employer of these individuals and does not have a mandate to collect or process such personal data beyond what is strictly required for contractual and financial compliance.” This table in WHO’s bi-annual HR report is the sole data available on non-staff contracts. It notes full-time equivalents for part-time engagements (consultants and APWs). Presuming that most Special Service Agreements (SSAs) are full-time, total estimated full time equivalent contracts numbered nearly 7600 in 2024. At the highest levels of WHO staff, meanwhile, some directors whose departments at headquarters were abolished remained in the organisation as a heads of unit, which typically carries a top-level professional grade of P6. In the UN grading system, the salaries of D1 directors and P6 professionals are virtually identical. And some former department heads now running units have even clung to their old titles, regardless of the formalities. Signature of a former director – (phone number and email have been erased to protect privacy). In an email invitation to colleagues for a late November reception at the WHO canteen, the former Director of the Department of Public Health and Migration (PHM), who is now technically a unit head, couldn’t resist signing the invite with his old title as well: “Head of Special Initiative on Health and Migration (Director). Division of Universal Health Coverage and Healthier Populations.” Observed one WHO staff member: “This kind of thing is all over the place. As for cost reduction, NADA!” Image Credits: WHO HR database , WHO , WHO Workforce Data, December 13 2024, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
2025: A Brutal Year for Global Health 28/12/2025 Editorial team This has been a brutal year for global health, with shock cuts in development aid to countries most in need; a knock-on budget crisis for United Nations (UN) agencies; widespread humanitarian crises, extensive disease outbreaks, and mounting climate-related health challenges. Health Policy Watch (HPW) has provided daily coverage of developments, and our reporters were often the first to break news on a range of issues despite our small and under-resourced newsroom. Development aid plunge Chaos followed the immediate “pause” of all development aid from the United States as soon as Donald Trump became president in January. The “pause” included the US President’s Emergency Plan for AIDS Relief (PEPFAR), which funded three-quarters of HIV and tuberculosis programmes worldwide, including lifesaving antiretroviral medicine to 20.6 million people in 2024. Within weeks, clinics across Africa closed, and patients were turned away as there was no money for staff or medicine. Although US Secretary of State Marco Rubio later issued a limited waiver for “lifesaving” programmes, this was narrowly focused and ideological. Influenced by the Heritage Foundation’s view that HIV is a “lifestyle disease”, the Trump administration stopped funding HIV measures aimed at “key populations” most vulnerable to infection – including sex workers and men who have sex with men. DOGE’s Elon Musk brandishing a chainsaw given to him by Argentinian President Javier Milei (right) after cutting US government programmes and global development aid, resulting in deaths and chaos. Within two weeks of Trump assuming the presidency, his appointee, Elon Musk and a new Department of Government Efficiency (DOGE) had also dismantled the US Agency for International Development (USAID). Musk declared that “USAID is a criminal organisation. It’s time for it to die.” USAID was hugely influential, and its closure affected almost every country in the world – from Albania to Zambia. As USAID had administered 60% of PEPFAR funds, in many instances, there was no one left to provide goods and services for those projects covered by Rubio’s waiver. Reporting on this issue was led by HPW Deputy Editor Kerry Cullinan. WHO slashes staff The WHO headquarters in Geneva has been in upheaval all year over how to rearrange the organisation’s budget to make up the 25% cut. The US withdrawal from the World Health Organization (WHO) on Trump’s first day in office, and its reduced support for other UN agencies. unleashed mass layoffs and restructuring. The WHO is slashing its staff by around a quarter – aiming to shed about 2,371 staff by mid-2026 – many at the end of this year – with ripples across Geneva. This has affected WHO’s ability to respond to health emergencies across the world. HPW Editor-in-Chief Elaine Fletcher was often the first to report on the various developments, with an inside track to staff reactions, including the WHO Staff Association decision to challenge the fairness and legitimacy of the restructuring process and the mounting rage of lower-level staff as HPW highlighted data suggesting that low- and mid-level personnel will bear the brunt of cuts, while high-ranking executives, whose real costs far exceed their published salaries, remain largely protected. UNAIDS has also been forced to retrench 55% of its head office staff and cut its country offices by almost half after the US ceased to fund it, a move that affected 40% of its budget. The agency warned that the brupt funding cuts have resulted in “perilous risks” for the global HIV response that threaten the health and well-being of millions of people throughout the world. “It feels like the ground has been ripped out from under our feet,” a Mozambican woman with HIV told UNAIDS, which reported at the year’s end that over two million women and girls have been “deprived of essential health services”, and millions of people at high risk of acquiring HIV have lost access to “the most effective prevention tools available” – pre-exposure prophylaxis (PrEP). Gavi, the vaccine alliance, has pared down its staff by a third, which will also affect global vaccination efforts. Disease outbreaks surge – so does anti-vax activities Mosquitoes, which can carry dengue virus, thrive at warmer temperatures. Climate change is fueling dengue cases globally. Amid the chaos in global health funding, diseases have surged. Africa has experienced large outbreaks of cholera, measles, Lassa fever and mpox, while deadly Ebola and Marburg have also affected several countries. By 10 December, Africa CDC had recorded over 300,000 cholera cases, over 140,00 measles cases and almost 134,000 mpox cases this year. Over the past year, both Latin America and the Caribbean saw record-breaking cases of the mosquito-borne dengue fever, with almost one-fifth of cases (about 45 million infections a year) attributable to climate change, Sophia Samantaroy covered issues from the Americas. Measles has also surged in the US and Canada amid the rise of anti-vaccine misinformation. This has been fueled by the appointment of vaccine sceptic Robert F. Kennedy Jr. as US Health and Human Services Secretary. So far, Kennedy and his appointees have cancelled mRNA research, restricted access to COVID-19 vaccines and made Hepatitis B vaccines non-mandatory for infants. In an exclusive article for HPW, Dr Demetre Daskalakis, former Director of the US CDC’s National Center for Immunizations and Respiratory Diseases, describes how the “wall protecting science from political interference in the US has fallen”. Humanitarian crises multiply Some 42,000 Gazans will need prolonged rehabilitation care and support due to war-related trauma injuries and amputations. Conflict and humanitarian crises – particularly in Gaza, Sudan and Ukraine – inflicted heavy casualties on citizens and health workers, with ongoing and unprecedented attacks on health facilities. HPW coverage of the conflict in Gaza included Israel’s blockade of Gaza, the resulting famine, Israeli attacks on WHO’s warehouse and efforts by Israel to secure the release of hostages being held by Hamas. This coverage was also led by Editor-in-Chief Elaine Fletcher. HPW has also consistently reported on the humanitarian crisis in Sudan, including the attack on a maternity hospital in El Fasher in which more than 460 people died. Climate change is ‘needlessly killing millions’ Climate change is claiming millions of lives annually through extreme heat, air pollution, wildfires and the spread of deadly infectious diseases, according to the ninth annual Lancet Countdown report, the most comprehensive assessment to date of the links between climate change and health, published in October. “We’re seeing millions of deaths that are occurring needlessly every year because of our persistent fossil fuel dependence, because of our delay in mitigating climate change, and our delays in adaptation to the climate change that cannot be avoided,” said Marina Romanello, executive director of the Lancet Countdown at University College London, describing this year’s report as “a bleak and undeniable picture of the devastating health harms reaching all corners of the world.” Breaching the 2015 Paris Agreement, a legally binding global treaty adopted in 2015 to combat climate change by limiting global warming to well below 2°C (ideally 1.5°C) above pre-industrial levels, is now unavoidable, according to scientists. The world is heading for 2.8°C of warming by century’s end under current policies, according to a UN assessment. Climate change protest Global greenhouse gas emissions rose 2.3% to a record 57.7 gigatons of CO2 equivalent in 2024, the largest annual increase since the 2000s. Land use change and deforestation account for 53% of the overall increase, while fossil fuel production continues to expand in direct contradiction of climate pledges. The US is the worst emitter, yet Trump withdrew the US from the Paris Agreement on Day One of his presidency. Domestically, the US Environmental Protection Agency (EPA) has committed to rolling back 31 climate, air and water pollution, and emissions regulations that will negatively affected citizens’ health. The EPA has also announced that it will no longer require most polluters to report their emissions of carbon dioxide, methane and other greenhouse gases that cause climate change. Stefan Anderson led HPW reporting on climate change. The impact of air pollution Disease burden from air pollution. Meanwhile, 90% of people on the planet breathe dangerously unhealthy levels of air pollution every day, and millions fall ill every year with a range of respiratory and cardiovascular diseases as well as cancers, leading to at least seven million deaths each year. Air pollution is the number one killer across South Asia, accounting for 2.7 million deaths, of which 2.1 million are in India alone. There is growing evidence of the impact of air pollution on a range of medical conditions including strokes, diabetes, heart disease and lung cancer. Significant sources of the deadly fine particulate matter (PM 2.5) come from fossil fuels in vehicles, power plants and other industrial facilities, and burning coal, wood, dung and agricultural residues for cooking. India-based Chetan Bhattacharji, led reporting on air pollution. Women’s rights The ‘Green Tide’: Argentinians demanding the legalisation of abortion. HPW has covered the backlash against sexual and reproductive rights, and women’s rights through stories on US anti-rights groups mobilising in Africa, the rollback of abortion rights in Argentina, the impact of intimate partner violence on children, efforts to enable access to menstrual products for girls and women, female genital mutilation, and several articles on women under Taliban rule in Afghanistan. Disha Shetty and Munija Mirzaie contributed several articles on this topic. New world order? In the final few months of the year, the Trump administration sought to turn the chaos its funding cuts caused into opportunities for the US by signing bilateral health agreements with several African countries that promote American business opportunities – and also enable US access to African minerals. This approach is detailed in the America First Global Health Strategy published in September, that “uses global health diplomacy and foreign assistance to make America safer, stronger, and more prosperous”. Driven by former DOGE official Brad Smith, these bilateral Memorandums of Understanding (MOUs) compel countries that receive US aid to fight HIV, tuberculosis and malaria to immediately share all information about “pathogens with epidemic potential” and give the US the right to share this information with other entities, including US pharmaceutical companies. The MOUs directly undermine the WHO negotiations on a pathogen access and benefit-sharing (PABS) system underway in Geneva, placing African countries in a particularly difficult position. Unlike past PEPFAR agreements, the MOUs cut out the involvement of community groups, except faith-based service providers, some of which are known to be against contraception and any recognition of LGBTQ people. Civil society groups have described the MOUs as “extractive” and over 50 organisations issued a letter calling on African heads of state and government to demand “equity and sovereignty” in the new bilateral agreements. However, in a positive reaction to plummeting aid, several African countries have allocated more money to health while several continental efforts are building Africa’s independence. At the Africa Health Sovereignty Summit, Ghana’s President John Mahama announced the formation of the Presidential High-Level Task Force on Global Health Governance in response to the 40% reduction in development aid in the past two years. “The world has changed, but global health governance has not kept pace with the changing world. At this moment, we’re called to redesign the architecture that has, for far too long, excluded Africa’s voices, excluded Africa’s needs and innovations,” said Mahama. Dr Muhammad Ali Pate, Nigeria’s Coordinating Minister of Health and Social Welfare. Writing for HPW, Nigerian Health Minister Muhammad Ali Pate Africa argues that Africa “can redefine its role in global health – emerging as a producer, innovator, and equal partner in shaping both the health of its people and the well-being of the world”. Pate argues that this can be achieved by countries investing in health “with the same urgency it devotes to infrastructure, defence, or governance”; enhancing South–South cooperation and collaboration; and forging a continental alliance that harnesses shared expertise, resources, and innovation for collective health security. HPW was proud to be a media partner at the Conference of Public Health in Africa 2025, where African researchers discussed how best to build solidarity between countries on the continent. Other Health Policy Watch team members and contributors include Maayan Hoffman (who also coordinates our social media), Arsalan Bukhari, Felix Sassmannshausen, Rahul Basharat Rajput, Kate Okorie, Abdullahi Jimoh, Edith Magak and Roisa Kerry. We are deeply grateful to our donors and media collaborations that have supported HPW to remain afloat during this difficult year and provide an important platform of engagement for the Global South and North that is free of charge. But most of all, we are grateful to all our readers for your engagement and interest. Please consider donating to HPW to ensure our ongoing survival. May 2026 be a more positive one for global health! Image Credits: Guilhem Vellut, WHO/EMRO , Markus Spiske/ Unsplash, Health Ministry of Nigeria. Escalating DR Congo Conflict Exacerbates Refugee Flight; Gaza Famine Threat Eases 22/12/2025 Editorial team Thousands of Congolese families are fleeing intense fighting in eastern DRC and crossing into Burundi in search of safety. UNHCR, the UN Refugee Agency, has said it is “deeply alarmed” by the worsening humanitarian situation in Burundi, which has reached a crisis point following a rapid influx of refugees and asylum-seekers fleeing a new wave of violence in the eastern part of the Democratic Republic of the Congo (DRC). Since early December, over 84,000 Congolese have crossed into neighbouring Burundi, fleeing escalating clashes in DRC’s South Kivu region where M-23 militias continue to make major inroads against government forces. Congolese refugees and asylum-seekers in Burundi now number more than 200,000m, said UNHCR’s Representative in Burundi, Brigitte Mukanga-Eno. Thousands of people crossing the border on foot and by boats each day have overwhelmed local resources, creating a major humanitarian emergency that requires immediate global support, Mukanga-Eno told reporters in Geneva on Friday. Women and children are particularly affected, arriving exhausted and severely traumatized, bearing the physical and psychological marks of terrifying violence. “In Burundi, transit centres and informal sites where new arrivals are hosted have far surpassed capacity, in some cases by nearly 200 per cent,” while “acute water and sanitation shortages are increasing the risk of outbreaks of life-threatening diseases, including cholera and Mpox,” Mukanga-Eno said. Across the border in the DRC’s South Kivu, violence, drone attacks and bombardments have forced more than 500,000 Congolese from their homes, many “displaced several times this year alone.” Speaking at an end year press briefing in Geneva, UNHCR, WHO and other UN agencies also warned that as 2025 draws to a close, humanitarian needs in Africa, the Middle East, and worldwide “remain staggering” and recent gains against famine in Gaza since a US-brokered cease-fire between Hamas and Israel last October are “extremely fragile.” In a separate press release, WHO meanwhile declared that “attacks on health care in Sudan are becoming deadlier and more widespread.” Gaza – famine threat rolled back, but hunger remains Famine averted by hunger crisis remains critical according to December IPC report and early 2026 projections.. On a more positive note, the threat of famine in Gaza has eased somewhat since the October cease-fire opened the gates to more aid – but hunger remains a constant threat for most Gazans. The latest Integrated Food Security Phase Classification (IPC) analysis for Gaza confirms that no areas of the Strip are currently classified in famine, but UN officials described this welcome progress as “extremely fragile.” “At least 1.6 million people – or 77 per cent of the population – are still facing high levels of acute food insecurity in the Gaza Strip,” including “over 100,000 children and 37,000 pregnant and breastfeeding women projected to suffer acute malnutrition,” said four UN agencies, including WHO and UNICEF, in a press release Friday, which coincided with release of the latest IPC report, containing a snapshot of the situation today as well as projections for 2026. All four Gaza governorates are still described as facing Phase 3 or 4 hunger conditions marked by “large food consumption gaps, high levels of acute malnutrition, and an elevated risk of mortality.” While “the ceasefire has improved some deliveries of food,” UN agencies said “most families are still grappling with severe shortages,” with “more than 730,000 people” displaced and “heavily reliant on humanitarian assistance,” the UN agencies said. “Gaza’s children are no longer facing deadly famine, but they remain in grave danger,” UNICEF’s Lucia Elmi warned at the Geneva press briefing. She added: “Food is now in markets, but many families simply cannot afford to buy it. Health facilities are barely functioning, clean water and sanitation services are scarce, and winter is bringing increasing suffering to displaced people huddling in makeshift shelters. These fragile gains could vanish overnight if fighting resumes. We need sustained humanitarian access, restored basic services, and above all, lasting peace.” Only 50% of Gaza health facilities functioning even partially Palestinian’s in Gaza’s Deir al Balah receive winterization assistance – an estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Only fifty per cent of Gaza’s health facilities are partially functional, and that “much more is needed to address the vast health needs,” warned WHO’s Tarik Jašarević, also speaking at the Geneva press event. Access constraints facing Gazan Emergency Medical Teams have, however, eased, with denial rates decreasing to about 20 per cent, compared with 30 – 35 per cent before the ceasefire, according to the Health Cluster. There are 343 EMT staff in Gaza, including 73 international staff and 270 national staff, OCHA stated, in a related press release on Friday. Since the cease-fire there has also been an increase in the number of medical evacuations. But more than 18,500 patients, including 4100 children, still are awaiting evacuation, Jašarević added. According to the Palestinian Ministry of Health, more than 1000 patients had died while awaiting medical evacuation between July 2024 and November 2025. Last week, at least ten Gazans reportedly died due to heavy rains, underscoring the life-threatening conditions that families were facing in Gaza, Jašarević said. That included three children who died of hypothermia in a context of cold temperatures and lack of medical infrastructure and medicine, said Ricardo Pires, for United Nations Children’s Fund (UNICEF), citing other reports. The severe storm conditions affected nearly 55,000 households, and forced the evacuation of 370 families from shoreline sites, said OCHA, the UN Office for Coordination of Humanitarian Affairs, in a separate press statement. An estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Sudan North Darfur’s strategic capital of El Fasher (Al Fashir), has been beseiged by the RSF for over a year while 650,000 people fleeing the war have clustered in Tawila (red dotted line) and other areas of the region, like Nyala, which also come under periodic attack. Meanwhile, WHO issued a stark warning over the increase of attacks on health care in Sudan, saying they are “becoming deadlier and more widespread, cutting off access to lifesaving services and placing health workers and humanitarian operations at serious risk.” The latest incident occurred on 14 December when nine health workers were killed and 17 injured in an attack on a hospital in Dalanj, a town in South Kordofan state, WHO said. Dalanj is a key administrative and health hub for surrounding communities, where health workers provide critical referral care. Earlier this month, on 4 December, a kindergarten and the Kalogi Rural Hospital in South Kordofan were also hit, with 114 people killed – including at least 60 children – and 35 injured. Health staff were treating casualties when the attack occurred at the hospital, which serves as a key referral health facility for surrounding rural communities. Evacuations of injured patients to Abu Jebaiha Hospital took place amid ongoing fire. In Nyala, South Darfur, at least 70 health workers were detained, alongside around 5000 civilians, over the past few months according to reports in early December. This incident followed multiple attacks on health facilities in El Fasher in October 2025, including targeted attacks on a maternity hospital that killed more than 460 patients, their families and other civilians, and the abduction of six health workers from El Fasher and surrounding localities in November 2025. Since the conflict began in April 2023, WHO has verified 201 attacks on health care in Sudan, resulting in 1858 deaths and 490 injuries,” with 2025 accounting for “more than 80% of all deaths from attacks on health care verified by WHO in complex humanitarian emergencies globally.” “Health workers have been providing health services with exceptional courage and dedication under extremely challenging conditions,” said WHO in a press release. WHO called “for an immediate halt to attacks on civilians, health workers, health facilities and humanitarian operations in Sudan,” and urged “safe, rapid and unimpeded humanitarian access in line with international humanitarian law.” See related story here: ‘Beyond Horrific’ Conditions in Sudan’s El Fasher; Gaza Swamped by Flooding Image Credits: © UNHCR/Bernard Ntwari, IPC , OCHA , Google Maps . New Flu Strain Sweeping Europe Says WHO; but Vaccines Remain Effective, ECDC Finds 19/12/2025 Felix Sassmannshausen Hans Henri Kluge, the WHO/Europe Regional Director, emphasised that vaccines save lives in the midst of a new flu strain surging early. Sudden fever, a severe cough and acute respiratory distress are the familiar onset symptoms of seasonal flu, which has affected WHO’s European Region with unusual intensity and speed this year. As the Northern Hemisphere enters winter, health systems are struggling to manage an epidemic driven by an aggressive, genetically mutated influenza strain A(H3N2) subclade K. But a new report by the European Centre for Disease Prevention and Control (ECDC), published on Friday, concluded that current seasonal influenza vaccines remain effective against this new strain of the virus. Health experts urge vulnerable groups to get vaccinated. The current influenza outbreak is dominated almost entirely by the A(H3N2) subclade K, which now accounts for up to 90 per cent of all confirmed cases in the region, according to data from WHO’s European Regional Office (EURO). Subclade K marks a “notable evolution in influenza A(H3N2) viruses,” having undergone genetic drift and displaying several amino acid changes in the hemagglutinin protein (the “key” the virus uses to unlock and enter human cells). Due to these slight changes, antibodies acquired from previous infections or older vaccines may not recognise the virus as effectively. “Flu comes around every winter, but this year is a little different,” stated Hans Kluge, WHO Regional Director for Europe, in a press release on Wednesday. Although there is no evidence that it causes more severe disease, Kluge explained that the small genetic variation in the virus places “enormous pressure on our health systems because people don’t have built-up immunity against it.” Flu season gains early momentum A(H3N2) subclade K is fuelling a flu surge across the WHO/Europe region, with protection stalling as most countries fail to meet critical vaccination targets. With the new strain spreading quickly, the current influenza season began approximately four weeks earlier than in previous years. High or very high activity is now being reported in at least 27 of the 38 countries being monitored by the WHO European Region. These countries range from EU Member States such as Ireland and Slovenia to Kyrgyzstan and Montenegro. “This is expected to cause a significant burden in terms of morbidity and mortality, as observed in past years, and target groups should be vaccinated rapidly,” said Bruno Ciancio, an ECDC senior expert, in response to a query from Health Policy Watch. WHO data shows that the strain has been detected in more than 34 countries globally over the last six months. While it is most prevalent in the European and Western Pacific regions, its expansion has also been confirmed in the WHO South-East Asia region. Since October, A(H3N2) subclade K sequences have been reported in Nepal, India and Thailand, as well as in the WHO African and Eastern Mediterranean Regions. Vaccines remain primary shield against severe illness Vaccinations remain effective and a key protection against the new strain, experts emphasize, based on preliminary findings. With cases expected to continue rising, likely peaking in late December or early January, protecting the most vulnerable is paramount. Public health authorities are emphasising urgently that vaccination is the most important protective measure for vulnerable groups, including adults aged 65 and over, pregnant women, people with chronic conditions and healthcare workers. Although recent reports suggest that subclade K shows “reduced reactivity” to current vaccines, it remains effective in preventing severe health outcomes, the ECDC concluded. “The current influenza vaccine is not perfectly matched to circulating strains, including H3N2. However, the primary aim of vaccination is to prevent severe disease, and effectiveness against severe outcomes is expected to be preserved,” explained ECDC expert Ciancio. According to the preliminary data published by the ECDC for this flu season, vaccine effectiveness in preventing influenza cases that require medical attention at the primary care level ranges from 52% in children (ages 0–17) and 57% in adults (ages 18–64). For the critical group of individuals aged 65 and older, it was not possible to estimate vaccine effectiveness separately, due to the low number of influenza cases so far considered in the study. ECDC experts emphasized, moreover, that the findings rely on small sample sizes from nine participating countries and have low statistical precision (e.g. wide confidence intervals). Efficacy could fluctuate as the season progresses. According to a ECDC analysis released only this week, vaccines significantly cut hospital admission rates in the last 2024-25 flu season. The modeling study found that seasonal vaccines were 70-75% effective at preventing hospital admissions among children aged 2-17 years and 30-40% effective in adults. Using computer simulations, the analysis estimated that vaccination programmes prevented 26-41% of flu-related hospitalisations among adults aged 65 and over across European Union (EU) countries between August 2024 and June 2025. Low vaccination rates remain public health concern To protect the vulnerable and to reduce transmission, a multilayered approach following the WHO playbook is essential. Within the EU, only Denmark, Portugal, and Ireland met the 75 percent target for older adults during the reporting period. The ECDC projects that a 75% vaccination rate can prevent up to three-quarters of flu-related hospitalisations, significantly reducing the strain on public health systems. Influenza vaccination rates for high-risk groups in other EU countries remained below WHO targets in the past seasons, as ECDC data from the most recent available season (2021-2022) shows. The overall median influenza vaccine coverage for adults aged 65 years and older was only 43 percent. The scale of the challenge is huge. Recent interim data from Germany’s Robert Koch Institute (RKI) for the 2024-25 season found that flu vaccination coverage among German adults aged 60+ declined from 39.7-34.5% since 2020-21, the first year of the COVID pandemic, reaching its lowest level in over 17 years. And at the same time, a severe flu season can strain hospital staff and capacity in already overburdened health systems. Combating the flu requires a multi-layered approach, experts underline. Slowing transmission requires proactive public health and social measures alongside vaccination, says WHO. These steps, proven effective during the COVID-19 pandemic, include staying home if unwell, wearing a mask in public if symptomatic, maintaining regular hand hygiene, and improving indoor ventilation. European health systems have “decades of experience managing influenza,” said Kluge, striking a note of optimism alongside the WHO warning. “We have safe vaccines that are updated annually, and we have a clear playbook of protective measures that work.” Image Credits: European Union, WHO/Europe , World Health Organization, European Union. Cervical Cancer in India: Early Marriage, Poor Screening and Gender Inequality Fuel a Preventable Killer 19/12/2025 Arsalan Bukhari Though largely preventable, cervical cancer continues to kill thousands of Indian women each year. MUMBAI, India – Cervical cancer kills more than 75,000 women in India each year, according to figures recently disclosed in Parliament – yet it is one of the most preventable cancers. In India, low human papillomavirus (HPV) vaccination coverage, limited access to routine screening and deep-rooted social behaviours – such as early marriage and low condom use – drive late diagnosis and high mortality. Globally, cervical cancer is the fourth most common cancer among women, with an estimated 660,000 new cases and 350,000 reported deaths in 2022, accoridng to WHO. Public health experts say these factors increase exposure to HPV, the underlying cause of nearly all cervical cancer cases, while allowing the disease to progress silently for years before detection. For Neha, a 29-year-old hotel worker in the city of 12.5 million, India’s largest, the statistics reflect a deeply personal loss. My two cousins died from cervical cancer,” she told Health Policy Watch. “What frightens me most is how silent it is. People seem completely normal for years, and then you discover they have had cancer for a long time only when they are close to dying. Early marriage and rising HPV exposure A wedding procession in India, where early marriage remains common. Doctors say nearly all cervical cancer cases are caused by persistent infection with high-risk types of HPV, one of the most common sexually transmitted infections worldwide. Mumbai physician, Dr Sonali Roy told Health Policy Watch that HPV exposure in India is closely tied to early marriage, low awareness and limited access to vaccination and screening, particularly in rural areas. “In some villages, girls are married as young as 14 or 15,” Roy said. These marriages often do not last, and women may remarry multiple times. Each marriage increases exposure to HPV, especially when condoms are rarely used and sexual health awareness is very low. Early marriage often leads to early sexual debut, repeated pregnancies and limited agency over reproductive health decisions, experts say all of which raise the risk of persistent HPV infection. The biological vulnerability of the cervix during adolescence further increases susceptibility to the virus. Unlike many high-income countries, India has yet to roll out a nationwide HPV vaccination programme, despite repeated recommendations from public health experts and the World Health Organization (WHO). While some states have launched pilot projects, coverage remains patchy and largely urban, leaving millions of girls unprotected before sexual debut. Routine cervical cancer screening also remains uneven across Indian states, with weak outreach in rural areas and among informal urban settlements, where health services are often overstretched. Evidence from research HPW vaccine introduction; India and South-East Asia lag behind most other regions of the world in routine HPV vaccination. Research supports the link between early sexual debut, multiple partners and higher HPV infection risk. A 2019 study reviewing medical records of 349 women who tested positive for high-risk HPV found that women who began sexual activity at a younger age or had multiple sexual partners faced a significantly higher risk of infection with HPV types 16 and 18, the two strains responsible for the majority of cervical cancer cases globally. The study found that about one in five women was infected with HPV 16, while nearly 9% were infected with HPV 18 – the types of HPV most likely to cause cervical cancer. Women who reported their first sexual intercourse at age 19 or younger were significantly more likely to be infected with HPV 16 than those who became sexually active later. The risk rose sharply with multiple partners. Women who reported more than three lifetime sexual partners were four times more likely to be infected with HPV 18 than women who had fewer partners. Public health researchers caution that these findings reflect structural conditions rather than individual behaviour. “In many cases, women do not have the power to negotiate when to marry, when to have sex or whether protection is used, ” said a health researcher. Men refuse to use protection With fewer than one in 10 Indian men using condoms, women bear the health consequences of preventable HPV infections. Even when women understand the risks, many say they have little control over prevention. A 27-year-old woman from the East Mumbai suburb of Kurla, who spoke on condition of anonymity, told Health Policy Watch that her partner refuses to use condoms.“He says it affects his pride,” said Priya (not her real name). This is common, even in cities like Mumbai, India’s modern financial center. She said stigma is far stronger in rural areas, where access to contraception is limited and social scrutiny is intense. Many women end up with these infections simply because men refuse to use protection. Her account echoes broader national trends. A 2021 report found that fewer than one in 10 men in India use condoms, making male sterilisation and barrier contraception among the least-used family planning methods in the country. Female sterilisation remains the dominant form of contraception, often placing the burden of reproductive health entirely on women. By comparison, a 2025 Zipdo educational report estimated that around 45% of sexually active people worldwide used a condom during their last sexual encounter. Priya recalled a close friend who had part of her cervix surgically removed after an early cancer diagnosis. Doctors later told her that consistent condom use would likely have prevented the HPV infection that led to the disease. Screening gaps Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. In India, the absence of a structured nationwide screening system has meant that many women are diagnosed only at advanced stages of the disease when treatment is more expensive and survival rates drop sharply. Under India’s National Programme for Prevention and Control of Non-Communicable Diseases and Ayushman Bharat, its health insurance for vulnerable families, women aged 30 to 65 are supposed to be screened for cervical cancer at primary health centres using visual inspection with acetic acid, a low-cost test known as VIA. Coverage, however, remains extremely low. Only about 2% of eligible women are currently being screened, with wide variations across states based on education levels and rural–urban divides. Health workers cite multiple barriers, including staff shortages, limited training, lack of privacy at health centres and social stigma around gynaecological examinations. For many women, domestic responsibilities and daily wage work also make preventive care a low priority. Cancer means financial ruin Doctors perform a surgical procedure on a woman patient. For some women, barriers go beyond awareness and access. A woman living on the rural outskirts of Mumbai, nearly 87 kilometres from the city centre, told Health Policy Watch that fear of financial ruin often outweighs concern about infection itself. “May God save us from expensive diseases. Unfortunately, cancer is one,” said Afshana, not her real name. “Even though we have a five lakh cover [around $5,500 annually] under Ayushman Bharat [insurance plan], we often end up going to private hospitals because services are lacking.” Her experience reflects broader systemic gaps. A 2024 NITI Aayog review of Health and Wellness Centres linked to Ayushman Bharat, India’s flagship government insurance scheme, found significant shortfalls in cancer screening delivery. While most centres had initiated screening for noncommunicable diseases, fewer than 10% had completed a full annual round. Cervical cancer screening was “yet to be operationalised,” according to the report, while oral cancer screening was carried out only selectively. The review also found that many auxiliary nurse-midwives, staff nurses and medical officers had not received adequate training to conduct screenings or manage referrals. Although most centres met basic infrastructure standards and provided essential medicines free of charge, service delivery continued to lag behind national goals for early detection and prevention. A preventable tragedy Cervical cancer is widely regarded as one of the most preventable forms of cancer. HPV vaccination, regular screening and timely treatment of precancerous lesions have dramatically reduced incidence and mortality in countries that have invested in these measures. Public health experts warn that without urgent action, India risks continuing to lose tens of thousands of women each year to a disease that can largely be stopped. “Cervical cancer is not just a medical issue,” Roy said. “It is a reflection of gender inequality, weak health systems and the failure to prioritise women’s health.”For women like Neha, the cost of that failure is already painfully clear. “If they had found it earlier, my cousins might still be alive,” she said. “No one should die from something that can be prevented.” Image Credits: Saiyan Mondal/Pexels, Gurpreet Singh/ Unsplash, Han J et al, eClinicalMedicine, Vol. 84June 2025, Deon Black/ Unsplash, Bermix Studio/Unsplash, Richard Catabay/Unsplash. Malawi’s New Government Faces National Hunger, Dwindling Aid and Soaring Debt 18/12/2025 Dingaan Mithi Almost a quarter of Malawians face malnutrition until the next harvest in March. This story was originally published by The New Humanitarian. Just a few months into his new term, President Peter Mutharika is grappling with a triple crisis: a deep-seated food emergency, diminishing aid, and soaring debt. With over four million Malawians – 22% of the population – facing the threat of acute malnutrition until the next harvest in March, Mutharika last month declared a nationwide state of disaster. But the $119 million humanitarian response is underfunded. Although crucial to staving off the risk of hunger-related deaths, it has so far raised only $26 million from Malawi’s aid partners – roughly 21% of the amount required. The trigger for Malawi’s food emergency has been a 20% drop in maize yields last year as a result of drought and localised flooding. The harvest failure hit small-scale farmers especially hard – the backbone of food production. The problem is not just food availability, but also its affordability. Reduced farm output, a severe foreign exchange shortage, plus perennial fuel scarcities, have pushed Malawi’s inflation rate to around 28% – the highest in Africa. Even though Monica Jasteni runs a small fish business in her home area of Salima, in central Malawi, the 34-year-old mother of four is struggling. “The money I make is not enough [to buy the food we need],” she told The New Humanitarian. “I try to persuade my children to go to school without eating, telling them that they’ll have food after school, because things are difficult.” She supplements what she makes from selling fish by also farming. But as she can’t afford irrigation, her small plot is susceptible to dry spells. An unsustainable debt burden The experience of Jasteni – trying to make ends meet, yet failing – is why a coalition of 50 civil society organisations is demanding urgent action by the government. “The hunger crisis is a huge national emergency,” said Amon Lukhele, national coordinator of the Civil Society Social Protection Network (CSSPN). “We are calling upon the government to act now to protect the poorest households before the hunger situation worsens.” CSSPN wants the government to accelerate implementation of its National Social Protection Policy, a safety net programme that aims to provide relief to the most vulnerable. But Mutharika, elected in September, has inherited public finances in a critical state. That has put pressure on what spending the government can afford, and the speed with which remedial programmes can be rolled out. Malawi is heavily debt-distressed. Its total debt burden is around $9.25 billion – an unsustainable 86% of GDP. It also faces a looming debt service obligation of $1.8 billion. That affects not only economic growth, but also the provision of essential social services. As a result, Malawi spends more on debt servicing than it does on health. The closure of the US Agency for International Development – a key health donor – has only made the government’s budget calculations even harder. Yet opportunities have been squandered. In 2006, Malawi had its debt cancelled under the Highly Indebted Poor Country Initiative (HIPC). But 19 years down the line, after years of heavy borrowing, it is back in arrears – and has been forced to swallow two painful currency devaluations, in 2022 and again in 2023. “Too much debt erodes Malawi’s capacity to strengthen food security,” said Mavuto Bamusi, a prominent political analyst and anti-corruption campaigner. “Debt repayments to lenders, especially the IMF [International Monetary Fund], are taking out a lot of money that could have been used for agricultural commercialisation.” Malawi needs to urgently restructure its debt, and find domestic and international support for reforms to revive its economy after years of mismanagement, analysts suggest. Joseph Mwanamvekha, the new finance minister, has announced new reform measures to stabilise the economy, and combat the food crisis. They include a commitment to improve public debt management and fiscal discipline, strict expenditure controls, and management of the wage bill. Getting food security right This is the fifth time in a decade Malawi has declared a food-related state of disaster. It not only signifies a deepening cycle of climate volatility, but also reflects the deep structural issues around food security. The agricultural sector is central to Malawi’s economy, accounting for almost a quarter of GDP and employing three quarters of the population – mostly through subsistence farming. But productivity gains have stagnated over the past decade, with an over-reliance on maize leading to soil degradation and micro-nutrient deficiencies in people’s diets. Successive governments have implemented input subsidy programmes, providing cut-price fertiliser and seeds. But historically they have suffered from logistical bottlenecks leading to late input deliveries, as well as targeting problems, fraud, and political interference. Mutharika’s government is trying again. He has launched the 2025/2026 Farm Input Subsidy Programme (FISP) aimed at 1.1 million farming households. Each will receive two 50kg bags of subsidised fertiliser plus a 5kg pack of seed of their choice. Political commentators suggest this will be a defining test for his administration. The goal for Mutharika is to deliver on his election campaign promises to provide farm inputs on time – and nationwide – avoiding favouring political constituencies. The rollout of digital registries and e-vouchers, backed by the World Bank, may help fix some of those problems. Yet the FISP will reach only a fraction of Malawi’s farming households. It also doesn’t fully address the problem of farmers’ preference for drought-vulnerable maize at a time of worsening climate volatility. Dominic Nyasulu, the national coordinator at the National Youth Network on Climate Change, argues that the new government needs to reframe food security policies to promote drought tolerant crops such as millet and sorghum – crops that were traditionally grown before the commercialisation of maize. “This country has potential to defeat hunger, but our policies need to be reformed in view of extreme weather events and other climate impacts,” said Nyasulu. Tamani Nkhono-Mvula, a Malawian agriculture and food security expert, said a more far-reaching change will come with irrigation. Only 4% of farming land is currently irrigated. The drawbacks are that it is expensive, there is a lack of rural financing, water management has historically been a problem, and women farmers are particularly disadvantaged. The lack of government capacity is also a significant drawback, as is access to commercial markets, according to 2021 evaluation of a World Bank irrigation and rural development project. However, Nkhono-Mvula argues that the potential “for Malawi to feed itself is there – the leadership just needs to be transformative”. The New Humanitarian puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world. Image Credits: Fatsani Gunya/ The New Humanitarian. Two More WHO Officials Cut from Senior Leadership Team Move into Other Roles 16/12/2025 Elaine Ruth Fletcher WHO Director General’s former Senior Leadership Team – which he slashed from 11 to six positions as part of a major reshuffle in May 2025. Two more senior WHO officials, Bruce Aylward and Ailan Li, who were among those dropped from WHO’s Senior Leadership Team during the first phase of an Agency shake-up, have now been appointed to leading roles elsewhere in the organisation, according to a memo from Director General Tedros Adhanom Ghebreyesus. Li, a Chinese national and former assistant director-general for UHC/Healthier Populations at WHO Headquarters in Geneva, has been appointed as WHO Representative to the Kingdom of Thailand, Tedros announced, in a message seen by Health Policy Watch. Aylward, formerly assistant director-general for the Division of Universal Health Coverage/Life Course, was appointed director of the WHO-World Bank Global Preparedness Monitoring Board in August, and will now also be coordinating the work on the UN80 Initiative, Tedros confirmed in the message, emailed to all staff on Friday. The new appointments complete the sweep of WHO’s 17 former senior management officials, now reduced to 12 as part of major cost-cutting moves triggered by the withdrawal of the United States from the organisation in January. The US retreat left a gaping $1.7 billion budget gap for the upcoming 2026-27 budget period. That has now been reduced to $1.05 billion due to a projected 25% reduction in WHO’s workforce next year. Three of six ADGs cut from senior leadership ranks actually left WHO Dr Mike Ryan addresses a meeting of WHO pandemic negotiators in one of his last public appearances before retiring. The new senior leadership team includes four assistant director generals at headquarters, a Chef de Cabinet and Chief Scientist, as well as Tedros himself. The directors of five WHO Regional Offices (not including the head of the Pan American Health Organisation, counted separately) also hold an equivalent ranking, for total of 12 such posts. Of the six ADGs who were cut from team in May, three have actually left the organisation, including Samira Asma, formerly ADG for Data, Analytics and Delivery, now with the Susan Thompson Buffett Foundation; Jérome Salomon, ADG for Universal Health Coverage who left WHO in September; and Health Emergencies Executive Director Mike Ryan, who retired in September. The recent appointments mean that three others, including Li, Aylward and former ADG for External Relations Catherine Boehme have now moved into other roles, with Boehme serving as “Officer in Charge” of WHO’s South-East Asia Regional Office (SEARO). Tedros placed SEARO’s Regional Director, Saima Wazed on leave on 11 July, after the Bangladeshi government filed two cases against her for alleged fraud, forgery and misuse of power, also issuing a warrant for her arrest. No return date has so far been announced. See related story: Controversial WHO Regional Director Placed on Leave Former HQ Directors also named to lead WHO country offices In his message Friday, Tedros also named a number of other former department directors and team heads at headquarters to head country offices in the global organisation, including: Indrajit Hazarika, formerly Senior Public Health Officer, of Country Strategy and Support at HQ, as WHO Representative to the Republic of Angola. Ann Maria Lindstrand, formerly Unit Head, Essential Programme on Immunisation in the Health Emergencies Division, as WHO Representative to the Republic of Cabo Verde. Dr Pavel Ursu, formerly Director of the Department of Delivery for Impact at headquarters in Geneva, as WHO Representative to the Federal Republic of Nigeria. Dr Michel Yao, formerly the Director of the Department of Strategic Health Operations, will become the WHO Representative to the Republic of Senegal. In 2021, Yao as well as another senior WHO official, were named in an alleged cover-up of allegations of sexual abuse brought against WHO field staff and consultants responding to an Ebola outbreak in the Democratic Republic of Congo. They were later cleared by an UN investigations panel. Nedret Emiroglu, a former Director for Country Readiness Strengthening in the Health Emergencies Division, was meanwhile named to head the WHO Secretariat for the Intergovernmental Working Group (IGWG), which is negotiating further provisions of the WHO Pandemic Agreement approved in May – most notably a proposed system for Pathogen Access and Benefit Sharing (PABS). Staff Reductions to date WHO workforce, headquarters, country offices and regions, in 3rd Quarter 2025, a reduction of over 500 staff in comparison with December 2024. In a press briefing last week, Tedros publicly acknowledged that the organisation plans to reduce WHO staff worldwide by an estimated 2371 positions by mid-2026, shedding about 25% of the workforce, which numbered 9,466 at the end of December 2024, and just under that as of 1 January. Around 1,089 staff are being shed through what WHO described as “natural attrition.” This includes retirements, early retirement, and the non-renewal of short-term staff contracts that expire. In addition, another 1,282 long and short-term posts have been abolished outright, according to statements at the presser and the earlier briefing to WHO member states. That should bring WHO’s global staff headcount down to about 7,360 professional and administrative positions by mid-2026. In terms of sheer numbers, professional staff at low and mid-level are among those hit hardest by the staff cuts.. Of those cuts, some 505 staff had left WHO by end September, WHO human resource records show; that count was confirmed by a WHO spokesperson. “A large number of staff are exiting at the end of December, three-months notice while notified in September,” the spokesperson told Health Policy Watch. “And another large number will leave in June 2026, i.e. the ones with reassignment rights.” In terms of D1 and D2 directors, whose numbers nearly doubled in the first six years of Tedros’ administration, costing the organisation nearly $100 million annually, some 21 Directors’ positions had been eliminated as of 30 September. That brings the number of directors worldwide down from a peak of 188 at end 2024 to 167 in Q3 2025. WHO Directors – 3rd Quarter 2025 – versus December 2024. That still leaves another 30 D1 and D2 posts to be eliminated by June 2026, mostly at headquarters. The massive reorganisation announced in April and May, slashed the number of departments and directors at headquarters by more than half – from 76 to 34 positions). The reason those reductions haven’t yet been reflected in the HR records is simple, WHO says. “Some directors who are sitting on positions that have been abolished have up to 6 months reassignment [rights] plus a 3-month notice period,” a WHO spokesperson said, “hence they still appear in the Q3 report. The target remains for June 30, 2026.” How will cuts translate into budget savings? Despite the painful plans to cut more 2,371 staff worldwide by June 2026, a projected funding gap remains of $1.05 billion, according to the director general’s last report to member states in November. The $1.7 billion funding gap for 2026-27 has been reduced to $1.05 billion, according to current projections. And the degree to which cuts in rank-and-file, as well as high level positions, will lead to actual savings remains to be seen. WHO’s November reports to member state did not offer any detailed analysis of projected savings that would be gained through the reductions by staff grade or office location. Even less detail provided on the status, conditions and costs of non-staff contract holders – about which there is no reporting even of pay grades or geographic base, let alone gender and age. That’s despite the fact that WHO’s non-staff’s headcount of 7582 (full-time equivalents) in 2024 was approaching that of actual staff numbers (9466) for that year. WHO officials say that the lack of more detailed reporting on non-staff contracts, is linked to legal and ethical issues. “WHO does not systematically capture, aggregate or publish individual-level information (such as grade equivalence, age, gender or demographic background) for non-staff contractual arrangements,” a WHO spokesperson told Health Policy Watch. “Doing so would raise legal, ethical and data-protection concerns, as WHO is not the employer of these individuals and does not have a mandate to collect or process such personal data beyond what is strictly required for contractual and financial compliance.” This table in WHO’s bi-annual HR report is the sole data available on non-staff contracts. It notes full-time equivalents for part-time engagements (consultants and APWs). Presuming that most Special Service Agreements (SSAs) are full-time, total estimated full time equivalent contracts numbered nearly 7600 in 2024. At the highest levels of WHO staff, meanwhile, some directors whose departments at headquarters were abolished remained in the organisation as a heads of unit, which typically carries a top-level professional grade of P6. In the UN grading system, the salaries of D1 directors and P6 professionals are virtually identical. And some former department heads now running units have even clung to their old titles, regardless of the formalities. Signature of a former director – (phone number and email have been erased to protect privacy). In an email invitation to colleagues for a late November reception at the WHO canteen, the former Director of the Department of Public Health and Migration (PHM), who is now technically a unit head, couldn’t resist signing the invite with his old title as well: “Head of Special Initiative on Health and Migration (Director). Division of Universal Health Coverage and Healthier Populations.” Observed one WHO staff member: “This kind of thing is all over the place. As for cost reduction, NADA!” Image Credits: WHO HR database , WHO , WHO Workforce Data, December 13 2024, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Escalating DR Congo Conflict Exacerbates Refugee Flight; Gaza Famine Threat Eases 22/12/2025 Editorial team Thousands of Congolese families are fleeing intense fighting in eastern DRC and crossing into Burundi in search of safety. UNHCR, the UN Refugee Agency, has said it is “deeply alarmed” by the worsening humanitarian situation in Burundi, which has reached a crisis point following a rapid influx of refugees and asylum-seekers fleeing a new wave of violence in the eastern part of the Democratic Republic of the Congo (DRC). Since early December, over 84,000 Congolese have crossed into neighbouring Burundi, fleeing escalating clashes in DRC’s South Kivu region where M-23 militias continue to make major inroads against government forces. Congolese refugees and asylum-seekers in Burundi now number more than 200,000m, said UNHCR’s Representative in Burundi, Brigitte Mukanga-Eno. Thousands of people crossing the border on foot and by boats each day have overwhelmed local resources, creating a major humanitarian emergency that requires immediate global support, Mukanga-Eno told reporters in Geneva on Friday. Women and children are particularly affected, arriving exhausted and severely traumatized, bearing the physical and psychological marks of terrifying violence. “In Burundi, transit centres and informal sites where new arrivals are hosted have far surpassed capacity, in some cases by nearly 200 per cent,” while “acute water and sanitation shortages are increasing the risk of outbreaks of life-threatening diseases, including cholera and Mpox,” Mukanga-Eno said. Across the border in the DRC’s South Kivu, violence, drone attacks and bombardments have forced more than 500,000 Congolese from their homes, many “displaced several times this year alone.” Speaking at an end year press briefing in Geneva, UNHCR, WHO and other UN agencies also warned that as 2025 draws to a close, humanitarian needs in Africa, the Middle East, and worldwide “remain staggering” and recent gains against famine in Gaza since a US-brokered cease-fire between Hamas and Israel last October are “extremely fragile.” In a separate press release, WHO meanwhile declared that “attacks on health care in Sudan are becoming deadlier and more widespread.” Gaza – famine threat rolled back, but hunger remains Famine averted by hunger crisis remains critical according to December IPC report and early 2026 projections.. On a more positive note, the threat of famine in Gaza has eased somewhat since the October cease-fire opened the gates to more aid – but hunger remains a constant threat for most Gazans. The latest Integrated Food Security Phase Classification (IPC) analysis for Gaza confirms that no areas of the Strip are currently classified in famine, but UN officials described this welcome progress as “extremely fragile.” “At least 1.6 million people – or 77 per cent of the population – are still facing high levels of acute food insecurity in the Gaza Strip,” including “over 100,000 children and 37,000 pregnant and breastfeeding women projected to suffer acute malnutrition,” said four UN agencies, including WHO and UNICEF, in a press release Friday, which coincided with release of the latest IPC report, containing a snapshot of the situation today as well as projections for 2026. All four Gaza governorates are still described as facing Phase 3 or 4 hunger conditions marked by “large food consumption gaps, high levels of acute malnutrition, and an elevated risk of mortality.” While “the ceasefire has improved some deliveries of food,” UN agencies said “most families are still grappling with severe shortages,” with “more than 730,000 people” displaced and “heavily reliant on humanitarian assistance,” the UN agencies said. “Gaza’s children are no longer facing deadly famine, but they remain in grave danger,” UNICEF’s Lucia Elmi warned at the Geneva press briefing. She added: “Food is now in markets, but many families simply cannot afford to buy it. Health facilities are barely functioning, clean water and sanitation services are scarce, and winter is bringing increasing suffering to displaced people huddling in makeshift shelters. These fragile gains could vanish overnight if fighting resumes. We need sustained humanitarian access, restored basic services, and above all, lasting peace.” Only 50% of Gaza health facilities functioning even partially Palestinian’s in Gaza’s Deir al Balah receive winterization assistance – an estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Only fifty per cent of Gaza’s health facilities are partially functional, and that “much more is needed to address the vast health needs,” warned WHO’s Tarik Jašarević, also speaking at the Geneva press event. Access constraints facing Gazan Emergency Medical Teams have, however, eased, with denial rates decreasing to about 20 per cent, compared with 30 – 35 per cent before the ceasefire, according to the Health Cluster. There are 343 EMT staff in Gaza, including 73 international staff and 270 national staff, OCHA stated, in a related press release on Friday. Since the cease-fire there has also been an increase in the number of medical evacuations. But more than 18,500 patients, including 4100 children, still are awaiting evacuation, Jašarević added. According to the Palestinian Ministry of Health, more than 1000 patients had died while awaiting medical evacuation between July 2024 and November 2025. Last week, at least ten Gazans reportedly died due to heavy rains, underscoring the life-threatening conditions that families were facing in Gaza, Jašarević said. That included three children who died of hypothermia in a context of cold temperatures and lack of medical infrastructure and medicine, said Ricardo Pires, for United Nations Children’s Fund (UNICEF), citing other reports. The severe storm conditions affected nearly 55,000 households, and forced the evacuation of 370 families from shoreline sites, said OCHA, the UN Office for Coordination of Humanitarian Affairs, in a separate press statement. An estimated 70% of Gazans are living in tents following the massive wartime destruction of housing, half a million in flood-prone areas. Sudan North Darfur’s strategic capital of El Fasher (Al Fashir), has been beseiged by the RSF for over a year while 650,000 people fleeing the war have clustered in Tawila (red dotted line) and other areas of the region, like Nyala, which also come under periodic attack. Meanwhile, WHO issued a stark warning over the increase of attacks on health care in Sudan, saying they are “becoming deadlier and more widespread, cutting off access to lifesaving services and placing health workers and humanitarian operations at serious risk.” The latest incident occurred on 14 December when nine health workers were killed and 17 injured in an attack on a hospital in Dalanj, a town in South Kordofan state, WHO said. Dalanj is a key administrative and health hub for surrounding communities, where health workers provide critical referral care. Earlier this month, on 4 December, a kindergarten and the Kalogi Rural Hospital in South Kordofan were also hit, with 114 people killed – including at least 60 children – and 35 injured. Health staff were treating casualties when the attack occurred at the hospital, which serves as a key referral health facility for surrounding rural communities. Evacuations of injured patients to Abu Jebaiha Hospital took place amid ongoing fire. In Nyala, South Darfur, at least 70 health workers were detained, alongside around 5000 civilians, over the past few months according to reports in early December. This incident followed multiple attacks on health facilities in El Fasher in October 2025, including targeted attacks on a maternity hospital that killed more than 460 patients, their families and other civilians, and the abduction of six health workers from El Fasher and surrounding localities in November 2025. Since the conflict began in April 2023, WHO has verified 201 attacks on health care in Sudan, resulting in 1858 deaths and 490 injuries,” with 2025 accounting for “more than 80% of all deaths from attacks on health care verified by WHO in complex humanitarian emergencies globally.” “Health workers have been providing health services with exceptional courage and dedication under extremely challenging conditions,” said WHO in a press release. WHO called “for an immediate halt to attacks on civilians, health workers, health facilities and humanitarian operations in Sudan,” and urged “safe, rapid and unimpeded humanitarian access in line with international humanitarian law.” See related story here: ‘Beyond Horrific’ Conditions in Sudan’s El Fasher; Gaza Swamped by Flooding Image Credits: © UNHCR/Bernard Ntwari, IPC , OCHA , Google Maps . New Flu Strain Sweeping Europe Says WHO; but Vaccines Remain Effective, ECDC Finds 19/12/2025 Felix Sassmannshausen Hans Henri Kluge, the WHO/Europe Regional Director, emphasised that vaccines save lives in the midst of a new flu strain surging early. Sudden fever, a severe cough and acute respiratory distress are the familiar onset symptoms of seasonal flu, which has affected WHO’s European Region with unusual intensity and speed this year. As the Northern Hemisphere enters winter, health systems are struggling to manage an epidemic driven by an aggressive, genetically mutated influenza strain A(H3N2) subclade K. But a new report by the European Centre for Disease Prevention and Control (ECDC), published on Friday, concluded that current seasonal influenza vaccines remain effective against this new strain of the virus. Health experts urge vulnerable groups to get vaccinated. The current influenza outbreak is dominated almost entirely by the A(H3N2) subclade K, which now accounts for up to 90 per cent of all confirmed cases in the region, according to data from WHO’s European Regional Office (EURO). Subclade K marks a “notable evolution in influenza A(H3N2) viruses,” having undergone genetic drift and displaying several amino acid changes in the hemagglutinin protein (the “key” the virus uses to unlock and enter human cells). Due to these slight changes, antibodies acquired from previous infections or older vaccines may not recognise the virus as effectively. “Flu comes around every winter, but this year is a little different,” stated Hans Kluge, WHO Regional Director for Europe, in a press release on Wednesday. Although there is no evidence that it causes more severe disease, Kluge explained that the small genetic variation in the virus places “enormous pressure on our health systems because people don’t have built-up immunity against it.” Flu season gains early momentum A(H3N2) subclade K is fuelling a flu surge across the WHO/Europe region, with protection stalling as most countries fail to meet critical vaccination targets. With the new strain spreading quickly, the current influenza season began approximately four weeks earlier than in previous years. High or very high activity is now being reported in at least 27 of the 38 countries being monitored by the WHO European Region. These countries range from EU Member States such as Ireland and Slovenia to Kyrgyzstan and Montenegro. “This is expected to cause a significant burden in terms of morbidity and mortality, as observed in past years, and target groups should be vaccinated rapidly,” said Bruno Ciancio, an ECDC senior expert, in response to a query from Health Policy Watch. WHO data shows that the strain has been detected in more than 34 countries globally over the last six months. While it is most prevalent in the European and Western Pacific regions, its expansion has also been confirmed in the WHO South-East Asia region. Since October, A(H3N2) subclade K sequences have been reported in Nepal, India and Thailand, as well as in the WHO African and Eastern Mediterranean Regions. Vaccines remain primary shield against severe illness Vaccinations remain effective and a key protection against the new strain, experts emphasize, based on preliminary findings. With cases expected to continue rising, likely peaking in late December or early January, protecting the most vulnerable is paramount. Public health authorities are emphasising urgently that vaccination is the most important protective measure for vulnerable groups, including adults aged 65 and over, pregnant women, people with chronic conditions and healthcare workers. Although recent reports suggest that subclade K shows “reduced reactivity” to current vaccines, it remains effective in preventing severe health outcomes, the ECDC concluded. “The current influenza vaccine is not perfectly matched to circulating strains, including H3N2. However, the primary aim of vaccination is to prevent severe disease, and effectiveness against severe outcomes is expected to be preserved,” explained ECDC expert Ciancio. According to the preliminary data published by the ECDC for this flu season, vaccine effectiveness in preventing influenza cases that require medical attention at the primary care level ranges from 52% in children (ages 0–17) and 57% in adults (ages 18–64). For the critical group of individuals aged 65 and older, it was not possible to estimate vaccine effectiveness separately, due to the low number of influenza cases so far considered in the study. ECDC experts emphasized, moreover, that the findings rely on small sample sizes from nine participating countries and have low statistical precision (e.g. wide confidence intervals). Efficacy could fluctuate as the season progresses. According to a ECDC analysis released only this week, vaccines significantly cut hospital admission rates in the last 2024-25 flu season. The modeling study found that seasonal vaccines were 70-75% effective at preventing hospital admissions among children aged 2-17 years and 30-40% effective in adults. Using computer simulations, the analysis estimated that vaccination programmes prevented 26-41% of flu-related hospitalisations among adults aged 65 and over across European Union (EU) countries between August 2024 and June 2025. Low vaccination rates remain public health concern To protect the vulnerable and to reduce transmission, a multilayered approach following the WHO playbook is essential. Within the EU, only Denmark, Portugal, and Ireland met the 75 percent target for older adults during the reporting period. The ECDC projects that a 75% vaccination rate can prevent up to three-quarters of flu-related hospitalisations, significantly reducing the strain on public health systems. Influenza vaccination rates for high-risk groups in other EU countries remained below WHO targets in the past seasons, as ECDC data from the most recent available season (2021-2022) shows. The overall median influenza vaccine coverage for adults aged 65 years and older was only 43 percent. The scale of the challenge is huge. Recent interim data from Germany’s Robert Koch Institute (RKI) for the 2024-25 season found that flu vaccination coverage among German adults aged 60+ declined from 39.7-34.5% since 2020-21, the first year of the COVID pandemic, reaching its lowest level in over 17 years. And at the same time, a severe flu season can strain hospital staff and capacity in already overburdened health systems. Combating the flu requires a multi-layered approach, experts underline. Slowing transmission requires proactive public health and social measures alongside vaccination, says WHO. These steps, proven effective during the COVID-19 pandemic, include staying home if unwell, wearing a mask in public if symptomatic, maintaining regular hand hygiene, and improving indoor ventilation. European health systems have “decades of experience managing influenza,” said Kluge, striking a note of optimism alongside the WHO warning. “We have safe vaccines that are updated annually, and we have a clear playbook of protective measures that work.” Image Credits: European Union, WHO/Europe , World Health Organization, European Union. Cervical Cancer in India: Early Marriage, Poor Screening and Gender Inequality Fuel a Preventable Killer 19/12/2025 Arsalan Bukhari Though largely preventable, cervical cancer continues to kill thousands of Indian women each year. MUMBAI, India – Cervical cancer kills more than 75,000 women in India each year, according to figures recently disclosed in Parliament – yet it is one of the most preventable cancers. In India, low human papillomavirus (HPV) vaccination coverage, limited access to routine screening and deep-rooted social behaviours – such as early marriage and low condom use – drive late diagnosis and high mortality. Globally, cervical cancer is the fourth most common cancer among women, with an estimated 660,000 new cases and 350,000 reported deaths in 2022, accoridng to WHO. Public health experts say these factors increase exposure to HPV, the underlying cause of nearly all cervical cancer cases, while allowing the disease to progress silently for years before detection. For Neha, a 29-year-old hotel worker in the city of 12.5 million, India’s largest, the statistics reflect a deeply personal loss. My two cousins died from cervical cancer,” she told Health Policy Watch. “What frightens me most is how silent it is. People seem completely normal for years, and then you discover they have had cancer for a long time only when they are close to dying. Early marriage and rising HPV exposure A wedding procession in India, where early marriage remains common. Doctors say nearly all cervical cancer cases are caused by persistent infection with high-risk types of HPV, one of the most common sexually transmitted infections worldwide. Mumbai physician, Dr Sonali Roy told Health Policy Watch that HPV exposure in India is closely tied to early marriage, low awareness and limited access to vaccination and screening, particularly in rural areas. “In some villages, girls are married as young as 14 or 15,” Roy said. These marriages often do not last, and women may remarry multiple times. Each marriage increases exposure to HPV, especially when condoms are rarely used and sexual health awareness is very low. Early marriage often leads to early sexual debut, repeated pregnancies and limited agency over reproductive health decisions, experts say all of which raise the risk of persistent HPV infection. The biological vulnerability of the cervix during adolescence further increases susceptibility to the virus. Unlike many high-income countries, India has yet to roll out a nationwide HPV vaccination programme, despite repeated recommendations from public health experts and the World Health Organization (WHO). While some states have launched pilot projects, coverage remains patchy and largely urban, leaving millions of girls unprotected before sexual debut. Routine cervical cancer screening also remains uneven across Indian states, with weak outreach in rural areas and among informal urban settlements, where health services are often overstretched. Evidence from research HPW vaccine introduction; India and South-East Asia lag behind most other regions of the world in routine HPV vaccination. Research supports the link between early sexual debut, multiple partners and higher HPV infection risk. A 2019 study reviewing medical records of 349 women who tested positive for high-risk HPV found that women who began sexual activity at a younger age or had multiple sexual partners faced a significantly higher risk of infection with HPV types 16 and 18, the two strains responsible for the majority of cervical cancer cases globally. The study found that about one in five women was infected with HPV 16, while nearly 9% were infected with HPV 18 – the types of HPV most likely to cause cervical cancer. Women who reported their first sexual intercourse at age 19 or younger were significantly more likely to be infected with HPV 16 than those who became sexually active later. The risk rose sharply with multiple partners. Women who reported more than three lifetime sexual partners were four times more likely to be infected with HPV 18 than women who had fewer partners. Public health researchers caution that these findings reflect structural conditions rather than individual behaviour. “In many cases, women do not have the power to negotiate when to marry, when to have sex or whether protection is used, ” said a health researcher. Men refuse to use protection With fewer than one in 10 Indian men using condoms, women bear the health consequences of preventable HPV infections. Even when women understand the risks, many say they have little control over prevention. A 27-year-old woman from the East Mumbai suburb of Kurla, who spoke on condition of anonymity, told Health Policy Watch that her partner refuses to use condoms.“He says it affects his pride,” said Priya (not her real name). This is common, even in cities like Mumbai, India’s modern financial center. She said stigma is far stronger in rural areas, where access to contraception is limited and social scrutiny is intense. Many women end up with these infections simply because men refuse to use protection. Her account echoes broader national trends. A 2021 report found that fewer than one in 10 men in India use condoms, making male sterilisation and barrier contraception among the least-used family planning methods in the country. Female sterilisation remains the dominant form of contraception, often placing the burden of reproductive health entirely on women. By comparison, a 2025 Zipdo educational report estimated that around 45% of sexually active people worldwide used a condom during their last sexual encounter. Priya recalled a close friend who had part of her cervix surgically removed after an early cancer diagnosis. Doctors later told her that consistent condom use would likely have prevented the HPV infection that led to the disease. Screening gaps Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. In India, the absence of a structured nationwide screening system has meant that many women are diagnosed only at advanced stages of the disease when treatment is more expensive and survival rates drop sharply. Under India’s National Programme for Prevention and Control of Non-Communicable Diseases and Ayushman Bharat, its health insurance for vulnerable families, women aged 30 to 65 are supposed to be screened for cervical cancer at primary health centres using visual inspection with acetic acid, a low-cost test known as VIA. Coverage, however, remains extremely low. Only about 2% of eligible women are currently being screened, with wide variations across states based on education levels and rural–urban divides. Health workers cite multiple barriers, including staff shortages, limited training, lack of privacy at health centres and social stigma around gynaecological examinations. For many women, domestic responsibilities and daily wage work also make preventive care a low priority. Cancer means financial ruin Doctors perform a surgical procedure on a woman patient. For some women, barriers go beyond awareness and access. A woman living on the rural outskirts of Mumbai, nearly 87 kilometres from the city centre, told Health Policy Watch that fear of financial ruin often outweighs concern about infection itself. “May God save us from expensive diseases. Unfortunately, cancer is one,” said Afshana, not her real name. “Even though we have a five lakh cover [around $5,500 annually] under Ayushman Bharat [insurance plan], we often end up going to private hospitals because services are lacking.” Her experience reflects broader systemic gaps. A 2024 NITI Aayog review of Health and Wellness Centres linked to Ayushman Bharat, India’s flagship government insurance scheme, found significant shortfalls in cancer screening delivery. While most centres had initiated screening for noncommunicable diseases, fewer than 10% had completed a full annual round. Cervical cancer screening was “yet to be operationalised,” according to the report, while oral cancer screening was carried out only selectively. The review also found that many auxiliary nurse-midwives, staff nurses and medical officers had not received adequate training to conduct screenings or manage referrals. Although most centres met basic infrastructure standards and provided essential medicines free of charge, service delivery continued to lag behind national goals for early detection and prevention. A preventable tragedy Cervical cancer is widely regarded as one of the most preventable forms of cancer. HPV vaccination, regular screening and timely treatment of precancerous lesions have dramatically reduced incidence and mortality in countries that have invested in these measures. Public health experts warn that without urgent action, India risks continuing to lose tens of thousands of women each year to a disease that can largely be stopped. “Cervical cancer is not just a medical issue,” Roy said. “It is a reflection of gender inequality, weak health systems and the failure to prioritise women’s health.”For women like Neha, the cost of that failure is already painfully clear. “If they had found it earlier, my cousins might still be alive,” she said. “No one should die from something that can be prevented.” Image Credits: Saiyan Mondal/Pexels, Gurpreet Singh/ Unsplash, Han J et al, eClinicalMedicine, Vol. 84June 2025, Deon Black/ Unsplash, Bermix Studio/Unsplash, Richard Catabay/Unsplash. Malawi’s New Government Faces National Hunger, Dwindling Aid and Soaring Debt 18/12/2025 Dingaan Mithi Almost a quarter of Malawians face malnutrition until the next harvest in March. This story was originally published by The New Humanitarian. Just a few months into his new term, President Peter Mutharika is grappling with a triple crisis: a deep-seated food emergency, diminishing aid, and soaring debt. With over four million Malawians – 22% of the population – facing the threat of acute malnutrition until the next harvest in March, Mutharika last month declared a nationwide state of disaster. But the $119 million humanitarian response is underfunded. Although crucial to staving off the risk of hunger-related deaths, it has so far raised only $26 million from Malawi’s aid partners – roughly 21% of the amount required. The trigger for Malawi’s food emergency has been a 20% drop in maize yields last year as a result of drought and localised flooding. The harvest failure hit small-scale farmers especially hard – the backbone of food production. The problem is not just food availability, but also its affordability. Reduced farm output, a severe foreign exchange shortage, plus perennial fuel scarcities, have pushed Malawi’s inflation rate to around 28% – the highest in Africa. Even though Monica Jasteni runs a small fish business in her home area of Salima, in central Malawi, the 34-year-old mother of four is struggling. “The money I make is not enough [to buy the food we need],” she told The New Humanitarian. “I try to persuade my children to go to school without eating, telling them that they’ll have food after school, because things are difficult.” She supplements what she makes from selling fish by also farming. But as she can’t afford irrigation, her small plot is susceptible to dry spells. An unsustainable debt burden The experience of Jasteni – trying to make ends meet, yet failing – is why a coalition of 50 civil society organisations is demanding urgent action by the government. “The hunger crisis is a huge national emergency,” said Amon Lukhele, national coordinator of the Civil Society Social Protection Network (CSSPN). “We are calling upon the government to act now to protect the poorest households before the hunger situation worsens.” CSSPN wants the government to accelerate implementation of its National Social Protection Policy, a safety net programme that aims to provide relief to the most vulnerable. But Mutharika, elected in September, has inherited public finances in a critical state. That has put pressure on what spending the government can afford, and the speed with which remedial programmes can be rolled out. Malawi is heavily debt-distressed. Its total debt burden is around $9.25 billion – an unsustainable 86% of GDP. It also faces a looming debt service obligation of $1.8 billion. That affects not only economic growth, but also the provision of essential social services. As a result, Malawi spends more on debt servicing than it does on health. The closure of the US Agency for International Development – a key health donor – has only made the government’s budget calculations even harder. Yet opportunities have been squandered. In 2006, Malawi had its debt cancelled under the Highly Indebted Poor Country Initiative (HIPC). But 19 years down the line, after years of heavy borrowing, it is back in arrears – and has been forced to swallow two painful currency devaluations, in 2022 and again in 2023. “Too much debt erodes Malawi’s capacity to strengthen food security,” said Mavuto Bamusi, a prominent political analyst and anti-corruption campaigner. “Debt repayments to lenders, especially the IMF [International Monetary Fund], are taking out a lot of money that could have been used for agricultural commercialisation.” Malawi needs to urgently restructure its debt, and find domestic and international support for reforms to revive its economy after years of mismanagement, analysts suggest. Joseph Mwanamvekha, the new finance minister, has announced new reform measures to stabilise the economy, and combat the food crisis. They include a commitment to improve public debt management and fiscal discipline, strict expenditure controls, and management of the wage bill. Getting food security right This is the fifth time in a decade Malawi has declared a food-related state of disaster. It not only signifies a deepening cycle of climate volatility, but also reflects the deep structural issues around food security. The agricultural sector is central to Malawi’s economy, accounting for almost a quarter of GDP and employing three quarters of the population – mostly through subsistence farming. But productivity gains have stagnated over the past decade, with an over-reliance on maize leading to soil degradation and micro-nutrient deficiencies in people’s diets. Successive governments have implemented input subsidy programmes, providing cut-price fertiliser and seeds. But historically they have suffered from logistical bottlenecks leading to late input deliveries, as well as targeting problems, fraud, and political interference. Mutharika’s government is trying again. He has launched the 2025/2026 Farm Input Subsidy Programme (FISP) aimed at 1.1 million farming households. Each will receive two 50kg bags of subsidised fertiliser plus a 5kg pack of seed of their choice. Political commentators suggest this will be a defining test for his administration. The goal for Mutharika is to deliver on his election campaign promises to provide farm inputs on time – and nationwide – avoiding favouring political constituencies. The rollout of digital registries and e-vouchers, backed by the World Bank, may help fix some of those problems. Yet the FISP will reach only a fraction of Malawi’s farming households. It also doesn’t fully address the problem of farmers’ preference for drought-vulnerable maize at a time of worsening climate volatility. Dominic Nyasulu, the national coordinator at the National Youth Network on Climate Change, argues that the new government needs to reframe food security policies to promote drought tolerant crops such as millet and sorghum – crops that were traditionally grown before the commercialisation of maize. “This country has potential to defeat hunger, but our policies need to be reformed in view of extreme weather events and other climate impacts,” said Nyasulu. Tamani Nkhono-Mvula, a Malawian agriculture and food security expert, said a more far-reaching change will come with irrigation. Only 4% of farming land is currently irrigated. The drawbacks are that it is expensive, there is a lack of rural financing, water management has historically been a problem, and women farmers are particularly disadvantaged. The lack of government capacity is also a significant drawback, as is access to commercial markets, according to 2021 evaluation of a World Bank irrigation and rural development project. However, Nkhono-Mvula argues that the potential “for Malawi to feed itself is there – the leadership just needs to be transformative”. The New Humanitarian puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world. Image Credits: Fatsani Gunya/ The New Humanitarian. Two More WHO Officials Cut from Senior Leadership Team Move into Other Roles 16/12/2025 Elaine Ruth Fletcher WHO Director General’s former Senior Leadership Team – which he slashed from 11 to six positions as part of a major reshuffle in May 2025. Two more senior WHO officials, Bruce Aylward and Ailan Li, who were among those dropped from WHO’s Senior Leadership Team during the first phase of an Agency shake-up, have now been appointed to leading roles elsewhere in the organisation, according to a memo from Director General Tedros Adhanom Ghebreyesus. Li, a Chinese national and former assistant director-general for UHC/Healthier Populations at WHO Headquarters in Geneva, has been appointed as WHO Representative to the Kingdom of Thailand, Tedros announced, in a message seen by Health Policy Watch. Aylward, formerly assistant director-general for the Division of Universal Health Coverage/Life Course, was appointed director of the WHO-World Bank Global Preparedness Monitoring Board in August, and will now also be coordinating the work on the UN80 Initiative, Tedros confirmed in the message, emailed to all staff on Friday. The new appointments complete the sweep of WHO’s 17 former senior management officials, now reduced to 12 as part of major cost-cutting moves triggered by the withdrawal of the United States from the organisation in January. The US retreat left a gaping $1.7 billion budget gap for the upcoming 2026-27 budget period. That has now been reduced to $1.05 billion due to a projected 25% reduction in WHO’s workforce next year. Three of six ADGs cut from senior leadership ranks actually left WHO Dr Mike Ryan addresses a meeting of WHO pandemic negotiators in one of his last public appearances before retiring. The new senior leadership team includes four assistant director generals at headquarters, a Chef de Cabinet and Chief Scientist, as well as Tedros himself. The directors of five WHO Regional Offices (not including the head of the Pan American Health Organisation, counted separately) also hold an equivalent ranking, for total of 12 such posts. Of the six ADGs who were cut from team in May, three have actually left the organisation, including Samira Asma, formerly ADG for Data, Analytics and Delivery, now with the Susan Thompson Buffett Foundation; Jérome Salomon, ADG for Universal Health Coverage who left WHO in September; and Health Emergencies Executive Director Mike Ryan, who retired in September. The recent appointments mean that three others, including Li, Aylward and former ADG for External Relations Catherine Boehme have now moved into other roles, with Boehme serving as “Officer in Charge” of WHO’s South-East Asia Regional Office (SEARO). Tedros placed SEARO’s Regional Director, Saima Wazed on leave on 11 July, after the Bangladeshi government filed two cases against her for alleged fraud, forgery and misuse of power, also issuing a warrant for her arrest. No return date has so far been announced. See related story: Controversial WHO Regional Director Placed on Leave Former HQ Directors also named to lead WHO country offices In his message Friday, Tedros also named a number of other former department directors and team heads at headquarters to head country offices in the global organisation, including: Indrajit Hazarika, formerly Senior Public Health Officer, of Country Strategy and Support at HQ, as WHO Representative to the Republic of Angola. Ann Maria Lindstrand, formerly Unit Head, Essential Programme on Immunisation in the Health Emergencies Division, as WHO Representative to the Republic of Cabo Verde. Dr Pavel Ursu, formerly Director of the Department of Delivery for Impact at headquarters in Geneva, as WHO Representative to the Federal Republic of Nigeria. Dr Michel Yao, formerly the Director of the Department of Strategic Health Operations, will become the WHO Representative to the Republic of Senegal. In 2021, Yao as well as another senior WHO official, were named in an alleged cover-up of allegations of sexual abuse brought against WHO field staff and consultants responding to an Ebola outbreak in the Democratic Republic of Congo. They were later cleared by an UN investigations panel. Nedret Emiroglu, a former Director for Country Readiness Strengthening in the Health Emergencies Division, was meanwhile named to head the WHO Secretariat for the Intergovernmental Working Group (IGWG), which is negotiating further provisions of the WHO Pandemic Agreement approved in May – most notably a proposed system for Pathogen Access and Benefit Sharing (PABS). Staff Reductions to date WHO workforce, headquarters, country offices and regions, in 3rd Quarter 2025, a reduction of over 500 staff in comparison with December 2024. In a press briefing last week, Tedros publicly acknowledged that the organisation plans to reduce WHO staff worldwide by an estimated 2371 positions by mid-2026, shedding about 25% of the workforce, which numbered 9,466 at the end of December 2024, and just under that as of 1 January. Around 1,089 staff are being shed through what WHO described as “natural attrition.” This includes retirements, early retirement, and the non-renewal of short-term staff contracts that expire. In addition, another 1,282 long and short-term posts have been abolished outright, according to statements at the presser and the earlier briefing to WHO member states. That should bring WHO’s global staff headcount down to about 7,360 professional and administrative positions by mid-2026. In terms of sheer numbers, professional staff at low and mid-level are among those hit hardest by the staff cuts.. Of those cuts, some 505 staff had left WHO by end September, WHO human resource records show; that count was confirmed by a WHO spokesperson. “A large number of staff are exiting at the end of December, three-months notice while notified in September,” the spokesperson told Health Policy Watch. “And another large number will leave in June 2026, i.e. the ones with reassignment rights.” In terms of D1 and D2 directors, whose numbers nearly doubled in the first six years of Tedros’ administration, costing the organisation nearly $100 million annually, some 21 Directors’ positions had been eliminated as of 30 September. That brings the number of directors worldwide down from a peak of 188 at end 2024 to 167 in Q3 2025. WHO Directors – 3rd Quarter 2025 – versus December 2024. That still leaves another 30 D1 and D2 posts to be eliminated by June 2026, mostly at headquarters. The massive reorganisation announced in April and May, slashed the number of departments and directors at headquarters by more than half – from 76 to 34 positions). The reason those reductions haven’t yet been reflected in the HR records is simple, WHO says. “Some directors who are sitting on positions that have been abolished have up to 6 months reassignment [rights] plus a 3-month notice period,” a WHO spokesperson said, “hence they still appear in the Q3 report. The target remains for June 30, 2026.” How will cuts translate into budget savings? Despite the painful plans to cut more 2,371 staff worldwide by June 2026, a projected funding gap remains of $1.05 billion, according to the director general’s last report to member states in November. The $1.7 billion funding gap for 2026-27 has been reduced to $1.05 billion, according to current projections. And the degree to which cuts in rank-and-file, as well as high level positions, will lead to actual savings remains to be seen. WHO’s November reports to member state did not offer any detailed analysis of projected savings that would be gained through the reductions by staff grade or office location. Even less detail provided on the status, conditions and costs of non-staff contract holders – about which there is no reporting even of pay grades or geographic base, let alone gender and age. That’s despite the fact that WHO’s non-staff’s headcount of 7582 (full-time equivalents) in 2024 was approaching that of actual staff numbers (9466) for that year. WHO officials say that the lack of more detailed reporting on non-staff contracts, is linked to legal and ethical issues. “WHO does not systematically capture, aggregate or publish individual-level information (such as grade equivalence, age, gender or demographic background) for non-staff contractual arrangements,” a WHO spokesperson told Health Policy Watch. “Doing so would raise legal, ethical and data-protection concerns, as WHO is not the employer of these individuals and does not have a mandate to collect or process such personal data beyond what is strictly required for contractual and financial compliance.” This table in WHO’s bi-annual HR report is the sole data available on non-staff contracts. It notes full-time equivalents for part-time engagements (consultants and APWs). Presuming that most Special Service Agreements (SSAs) are full-time, total estimated full time equivalent contracts numbered nearly 7600 in 2024. At the highest levels of WHO staff, meanwhile, some directors whose departments at headquarters were abolished remained in the organisation as a heads of unit, which typically carries a top-level professional grade of P6. In the UN grading system, the salaries of D1 directors and P6 professionals are virtually identical. And some former department heads now running units have even clung to their old titles, regardless of the formalities. Signature of a former director – (phone number and email have been erased to protect privacy). In an email invitation to colleagues for a late November reception at the WHO canteen, the former Director of the Department of Public Health and Migration (PHM), who is now technically a unit head, couldn’t resist signing the invite with his old title as well: “Head of Special Initiative on Health and Migration (Director). Division of Universal Health Coverage and Healthier Populations.” Observed one WHO staff member: “This kind of thing is all over the place. As for cost reduction, NADA!” Image Credits: WHO HR database , WHO , WHO Workforce Data, December 13 2024, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
New Flu Strain Sweeping Europe Says WHO; but Vaccines Remain Effective, ECDC Finds 19/12/2025 Felix Sassmannshausen Hans Henri Kluge, the WHO/Europe Regional Director, emphasised that vaccines save lives in the midst of a new flu strain surging early. Sudden fever, a severe cough and acute respiratory distress are the familiar onset symptoms of seasonal flu, which has affected WHO’s European Region with unusual intensity and speed this year. As the Northern Hemisphere enters winter, health systems are struggling to manage an epidemic driven by an aggressive, genetically mutated influenza strain A(H3N2) subclade K. But a new report by the European Centre for Disease Prevention and Control (ECDC), published on Friday, concluded that current seasonal influenza vaccines remain effective against this new strain of the virus. Health experts urge vulnerable groups to get vaccinated. The current influenza outbreak is dominated almost entirely by the A(H3N2) subclade K, which now accounts for up to 90 per cent of all confirmed cases in the region, according to data from WHO’s European Regional Office (EURO). Subclade K marks a “notable evolution in influenza A(H3N2) viruses,” having undergone genetic drift and displaying several amino acid changes in the hemagglutinin protein (the “key” the virus uses to unlock and enter human cells). Due to these slight changes, antibodies acquired from previous infections or older vaccines may not recognise the virus as effectively. “Flu comes around every winter, but this year is a little different,” stated Hans Kluge, WHO Regional Director for Europe, in a press release on Wednesday. Although there is no evidence that it causes more severe disease, Kluge explained that the small genetic variation in the virus places “enormous pressure on our health systems because people don’t have built-up immunity against it.” Flu season gains early momentum A(H3N2) subclade K is fuelling a flu surge across the WHO/Europe region, with protection stalling as most countries fail to meet critical vaccination targets. With the new strain spreading quickly, the current influenza season began approximately four weeks earlier than in previous years. High or very high activity is now being reported in at least 27 of the 38 countries being monitored by the WHO European Region. These countries range from EU Member States such as Ireland and Slovenia to Kyrgyzstan and Montenegro. “This is expected to cause a significant burden in terms of morbidity and mortality, as observed in past years, and target groups should be vaccinated rapidly,” said Bruno Ciancio, an ECDC senior expert, in response to a query from Health Policy Watch. WHO data shows that the strain has been detected in more than 34 countries globally over the last six months. While it is most prevalent in the European and Western Pacific regions, its expansion has also been confirmed in the WHO South-East Asia region. Since October, A(H3N2) subclade K sequences have been reported in Nepal, India and Thailand, as well as in the WHO African and Eastern Mediterranean Regions. Vaccines remain primary shield against severe illness Vaccinations remain effective and a key protection against the new strain, experts emphasize, based on preliminary findings. With cases expected to continue rising, likely peaking in late December or early January, protecting the most vulnerable is paramount. Public health authorities are emphasising urgently that vaccination is the most important protective measure for vulnerable groups, including adults aged 65 and over, pregnant women, people with chronic conditions and healthcare workers. Although recent reports suggest that subclade K shows “reduced reactivity” to current vaccines, it remains effective in preventing severe health outcomes, the ECDC concluded. “The current influenza vaccine is not perfectly matched to circulating strains, including H3N2. However, the primary aim of vaccination is to prevent severe disease, and effectiveness against severe outcomes is expected to be preserved,” explained ECDC expert Ciancio. According to the preliminary data published by the ECDC for this flu season, vaccine effectiveness in preventing influenza cases that require medical attention at the primary care level ranges from 52% in children (ages 0–17) and 57% in adults (ages 18–64). For the critical group of individuals aged 65 and older, it was not possible to estimate vaccine effectiveness separately, due to the low number of influenza cases so far considered in the study. ECDC experts emphasized, moreover, that the findings rely on small sample sizes from nine participating countries and have low statistical precision (e.g. wide confidence intervals). Efficacy could fluctuate as the season progresses. According to a ECDC analysis released only this week, vaccines significantly cut hospital admission rates in the last 2024-25 flu season. The modeling study found that seasonal vaccines were 70-75% effective at preventing hospital admissions among children aged 2-17 years and 30-40% effective in adults. Using computer simulations, the analysis estimated that vaccination programmes prevented 26-41% of flu-related hospitalisations among adults aged 65 and over across European Union (EU) countries between August 2024 and June 2025. Low vaccination rates remain public health concern To protect the vulnerable and to reduce transmission, a multilayered approach following the WHO playbook is essential. Within the EU, only Denmark, Portugal, and Ireland met the 75 percent target for older adults during the reporting period. The ECDC projects that a 75% vaccination rate can prevent up to three-quarters of flu-related hospitalisations, significantly reducing the strain on public health systems. Influenza vaccination rates for high-risk groups in other EU countries remained below WHO targets in the past seasons, as ECDC data from the most recent available season (2021-2022) shows. The overall median influenza vaccine coverage for adults aged 65 years and older was only 43 percent. The scale of the challenge is huge. Recent interim data from Germany’s Robert Koch Institute (RKI) for the 2024-25 season found that flu vaccination coverage among German adults aged 60+ declined from 39.7-34.5% since 2020-21, the first year of the COVID pandemic, reaching its lowest level in over 17 years. And at the same time, a severe flu season can strain hospital staff and capacity in already overburdened health systems. Combating the flu requires a multi-layered approach, experts underline. Slowing transmission requires proactive public health and social measures alongside vaccination, says WHO. These steps, proven effective during the COVID-19 pandemic, include staying home if unwell, wearing a mask in public if symptomatic, maintaining regular hand hygiene, and improving indoor ventilation. European health systems have “decades of experience managing influenza,” said Kluge, striking a note of optimism alongside the WHO warning. “We have safe vaccines that are updated annually, and we have a clear playbook of protective measures that work.” Image Credits: European Union, WHO/Europe , World Health Organization, European Union. Cervical Cancer in India: Early Marriage, Poor Screening and Gender Inequality Fuel a Preventable Killer 19/12/2025 Arsalan Bukhari Though largely preventable, cervical cancer continues to kill thousands of Indian women each year. MUMBAI, India – Cervical cancer kills more than 75,000 women in India each year, according to figures recently disclosed in Parliament – yet it is one of the most preventable cancers. In India, low human papillomavirus (HPV) vaccination coverage, limited access to routine screening and deep-rooted social behaviours – such as early marriage and low condom use – drive late diagnosis and high mortality. Globally, cervical cancer is the fourth most common cancer among women, with an estimated 660,000 new cases and 350,000 reported deaths in 2022, accoridng to WHO. Public health experts say these factors increase exposure to HPV, the underlying cause of nearly all cervical cancer cases, while allowing the disease to progress silently for years before detection. For Neha, a 29-year-old hotel worker in the city of 12.5 million, India’s largest, the statistics reflect a deeply personal loss. My two cousins died from cervical cancer,” she told Health Policy Watch. “What frightens me most is how silent it is. People seem completely normal for years, and then you discover they have had cancer for a long time only when they are close to dying. Early marriage and rising HPV exposure A wedding procession in India, where early marriage remains common. Doctors say nearly all cervical cancer cases are caused by persistent infection with high-risk types of HPV, one of the most common sexually transmitted infections worldwide. Mumbai physician, Dr Sonali Roy told Health Policy Watch that HPV exposure in India is closely tied to early marriage, low awareness and limited access to vaccination and screening, particularly in rural areas. “In some villages, girls are married as young as 14 or 15,” Roy said. These marriages often do not last, and women may remarry multiple times. Each marriage increases exposure to HPV, especially when condoms are rarely used and sexual health awareness is very low. Early marriage often leads to early sexual debut, repeated pregnancies and limited agency over reproductive health decisions, experts say all of which raise the risk of persistent HPV infection. The biological vulnerability of the cervix during adolescence further increases susceptibility to the virus. Unlike many high-income countries, India has yet to roll out a nationwide HPV vaccination programme, despite repeated recommendations from public health experts and the World Health Organization (WHO). While some states have launched pilot projects, coverage remains patchy and largely urban, leaving millions of girls unprotected before sexual debut. Routine cervical cancer screening also remains uneven across Indian states, with weak outreach in rural areas and among informal urban settlements, where health services are often overstretched. Evidence from research HPW vaccine introduction; India and South-East Asia lag behind most other regions of the world in routine HPV vaccination. Research supports the link between early sexual debut, multiple partners and higher HPV infection risk. A 2019 study reviewing medical records of 349 women who tested positive for high-risk HPV found that women who began sexual activity at a younger age or had multiple sexual partners faced a significantly higher risk of infection with HPV types 16 and 18, the two strains responsible for the majority of cervical cancer cases globally. The study found that about one in five women was infected with HPV 16, while nearly 9% were infected with HPV 18 – the types of HPV most likely to cause cervical cancer. Women who reported their first sexual intercourse at age 19 or younger were significantly more likely to be infected with HPV 16 than those who became sexually active later. The risk rose sharply with multiple partners. Women who reported more than three lifetime sexual partners were four times more likely to be infected with HPV 18 than women who had fewer partners. Public health researchers caution that these findings reflect structural conditions rather than individual behaviour. “In many cases, women do not have the power to negotiate when to marry, when to have sex or whether protection is used, ” said a health researcher. Men refuse to use protection With fewer than one in 10 Indian men using condoms, women bear the health consequences of preventable HPV infections. Even when women understand the risks, many say they have little control over prevention. A 27-year-old woman from the East Mumbai suburb of Kurla, who spoke on condition of anonymity, told Health Policy Watch that her partner refuses to use condoms.“He says it affects his pride,” said Priya (not her real name). This is common, even in cities like Mumbai, India’s modern financial center. She said stigma is far stronger in rural areas, where access to contraception is limited and social scrutiny is intense. Many women end up with these infections simply because men refuse to use protection. Her account echoes broader national trends. A 2021 report found that fewer than one in 10 men in India use condoms, making male sterilisation and barrier contraception among the least-used family planning methods in the country. Female sterilisation remains the dominant form of contraception, often placing the burden of reproductive health entirely on women. By comparison, a 2025 Zipdo educational report estimated that around 45% of sexually active people worldwide used a condom during their last sexual encounter. Priya recalled a close friend who had part of her cervix surgically removed after an early cancer diagnosis. Doctors later told her that consistent condom use would likely have prevented the HPV infection that led to the disease. Screening gaps Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. In India, the absence of a structured nationwide screening system has meant that many women are diagnosed only at advanced stages of the disease when treatment is more expensive and survival rates drop sharply. Under India’s National Programme for Prevention and Control of Non-Communicable Diseases and Ayushman Bharat, its health insurance for vulnerable families, women aged 30 to 65 are supposed to be screened for cervical cancer at primary health centres using visual inspection with acetic acid, a low-cost test known as VIA. Coverage, however, remains extremely low. Only about 2% of eligible women are currently being screened, with wide variations across states based on education levels and rural–urban divides. Health workers cite multiple barriers, including staff shortages, limited training, lack of privacy at health centres and social stigma around gynaecological examinations. For many women, domestic responsibilities and daily wage work also make preventive care a low priority. Cancer means financial ruin Doctors perform a surgical procedure on a woman patient. For some women, barriers go beyond awareness and access. A woman living on the rural outskirts of Mumbai, nearly 87 kilometres from the city centre, told Health Policy Watch that fear of financial ruin often outweighs concern about infection itself. “May God save us from expensive diseases. Unfortunately, cancer is one,” said Afshana, not her real name. “Even though we have a five lakh cover [around $5,500 annually] under Ayushman Bharat [insurance plan], we often end up going to private hospitals because services are lacking.” Her experience reflects broader systemic gaps. A 2024 NITI Aayog review of Health and Wellness Centres linked to Ayushman Bharat, India’s flagship government insurance scheme, found significant shortfalls in cancer screening delivery. While most centres had initiated screening for noncommunicable diseases, fewer than 10% had completed a full annual round. Cervical cancer screening was “yet to be operationalised,” according to the report, while oral cancer screening was carried out only selectively. The review also found that many auxiliary nurse-midwives, staff nurses and medical officers had not received adequate training to conduct screenings or manage referrals. Although most centres met basic infrastructure standards and provided essential medicines free of charge, service delivery continued to lag behind national goals for early detection and prevention. A preventable tragedy Cervical cancer is widely regarded as one of the most preventable forms of cancer. HPV vaccination, regular screening and timely treatment of precancerous lesions have dramatically reduced incidence and mortality in countries that have invested in these measures. Public health experts warn that without urgent action, India risks continuing to lose tens of thousands of women each year to a disease that can largely be stopped. “Cervical cancer is not just a medical issue,” Roy said. “It is a reflection of gender inequality, weak health systems and the failure to prioritise women’s health.”For women like Neha, the cost of that failure is already painfully clear. “If they had found it earlier, my cousins might still be alive,” she said. “No one should die from something that can be prevented.” Image Credits: Saiyan Mondal/Pexels, Gurpreet Singh/ Unsplash, Han J et al, eClinicalMedicine, Vol. 84June 2025, Deon Black/ Unsplash, Bermix Studio/Unsplash, Richard Catabay/Unsplash. Malawi’s New Government Faces National Hunger, Dwindling Aid and Soaring Debt 18/12/2025 Dingaan Mithi Almost a quarter of Malawians face malnutrition until the next harvest in March. This story was originally published by The New Humanitarian. Just a few months into his new term, President Peter Mutharika is grappling with a triple crisis: a deep-seated food emergency, diminishing aid, and soaring debt. With over four million Malawians – 22% of the population – facing the threat of acute malnutrition until the next harvest in March, Mutharika last month declared a nationwide state of disaster. But the $119 million humanitarian response is underfunded. Although crucial to staving off the risk of hunger-related deaths, it has so far raised only $26 million from Malawi’s aid partners – roughly 21% of the amount required. The trigger for Malawi’s food emergency has been a 20% drop in maize yields last year as a result of drought and localised flooding. The harvest failure hit small-scale farmers especially hard – the backbone of food production. The problem is not just food availability, but also its affordability. Reduced farm output, a severe foreign exchange shortage, plus perennial fuel scarcities, have pushed Malawi’s inflation rate to around 28% – the highest in Africa. Even though Monica Jasteni runs a small fish business in her home area of Salima, in central Malawi, the 34-year-old mother of four is struggling. “The money I make is not enough [to buy the food we need],” she told The New Humanitarian. “I try to persuade my children to go to school without eating, telling them that they’ll have food after school, because things are difficult.” She supplements what she makes from selling fish by also farming. But as she can’t afford irrigation, her small plot is susceptible to dry spells. An unsustainable debt burden The experience of Jasteni – trying to make ends meet, yet failing – is why a coalition of 50 civil society organisations is demanding urgent action by the government. “The hunger crisis is a huge national emergency,” said Amon Lukhele, national coordinator of the Civil Society Social Protection Network (CSSPN). “We are calling upon the government to act now to protect the poorest households before the hunger situation worsens.” CSSPN wants the government to accelerate implementation of its National Social Protection Policy, a safety net programme that aims to provide relief to the most vulnerable. But Mutharika, elected in September, has inherited public finances in a critical state. That has put pressure on what spending the government can afford, and the speed with which remedial programmes can be rolled out. Malawi is heavily debt-distressed. Its total debt burden is around $9.25 billion – an unsustainable 86% of GDP. It also faces a looming debt service obligation of $1.8 billion. That affects not only economic growth, but also the provision of essential social services. As a result, Malawi spends more on debt servicing than it does on health. The closure of the US Agency for International Development – a key health donor – has only made the government’s budget calculations even harder. Yet opportunities have been squandered. In 2006, Malawi had its debt cancelled under the Highly Indebted Poor Country Initiative (HIPC). But 19 years down the line, after years of heavy borrowing, it is back in arrears – and has been forced to swallow two painful currency devaluations, in 2022 and again in 2023. “Too much debt erodes Malawi’s capacity to strengthen food security,” said Mavuto Bamusi, a prominent political analyst and anti-corruption campaigner. “Debt repayments to lenders, especially the IMF [International Monetary Fund], are taking out a lot of money that could have been used for agricultural commercialisation.” Malawi needs to urgently restructure its debt, and find domestic and international support for reforms to revive its economy after years of mismanagement, analysts suggest. Joseph Mwanamvekha, the new finance minister, has announced new reform measures to stabilise the economy, and combat the food crisis. They include a commitment to improve public debt management and fiscal discipline, strict expenditure controls, and management of the wage bill. Getting food security right This is the fifth time in a decade Malawi has declared a food-related state of disaster. It not only signifies a deepening cycle of climate volatility, but also reflects the deep structural issues around food security. The agricultural sector is central to Malawi’s economy, accounting for almost a quarter of GDP and employing three quarters of the population – mostly through subsistence farming. But productivity gains have stagnated over the past decade, with an over-reliance on maize leading to soil degradation and micro-nutrient deficiencies in people’s diets. Successive governments have implemented input subsidy programmes, providing cut-price fertiliser and seeds. But historically they have suffered from logistical bottlenecks leading to late input deliveries, as well as targeting problems, fraud, and political interference. Mutharika’s government is trying again. He has launched the 2025/2026 Farm Input Subsidy Programme (FISP) aimed at 1.1 million farming households. Each will receive two 50kg bags of subsidised fertiliser plus a 5kg pack of seed of their choice. Political commentators suggest this will be a defining test for his administration. The goal for Mutharika is to deliver on his election campaign promises to provide farm inputs on time – and nationwide – avoiding favouring political constituencies. The rollout of digital registries and e-vouchers, backed by the World Bank, may help fix some of those problems. Yet the FISP will reach only a fraction of Malawi’s farming households. It also doesn’t fully address the problem of farmers’ preference for drought-vulnerable maize at a time of worsening climate volatility. Dominic Nyasulu, the national coordinator at the National Youth Network on Climate Change, argues that the new government needs to reframe food security policies to promote drought tolerant crops such as millet and sorghum – crops that were traditionally grown before the commercialisation of maize. “This country has potential to defeat hunger, but our policies need to be reformed in view of extreme weather events and other climate impacts,” said Nyasulu. Tamani Nkhono-Mvula, a Malawian agriculture and food security expert, said a more far-reaching change will come with irrigation. Only 4% of farming land is currently irrigated. The drawbacks are that it is expensive, there is a lack of rural financing, water management has historically been a problem, and women farmers are particularly disadvantaged. The lack of government capacity is also a significant drawback, as is access to commercial markets, according to 2021 evaluation of a World Bank irrigation and rural development project. However, Nkhono-Mvula argues that the potential “for Malawi to feed itself is there – the leadership just needs to be transformative”. The New Humanitarian puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world. Image Credits: Fatsani Gunya/ The New Humanitarian. Two More WHO Officials Cut from Senior Leadership Team Move into Other Roles 16/12/2025 Elaine Ruth Fletcher WHO Director General’s former Senior Leadership Team – which he slashed from 11 to six positions as part of a major reshuffle in May 2025. Two more senior WHO officials, Bruce Aylward and Ailan Li, who were among those dropped from WHO’s Senior Leadership Team during the first phase of an Agency shake-up, have now been appointed to leading roles elsewhere in the organisation, according to a memo from Director General Tedros Adhanom Ghebreyesus. Li, a Chinese national and former assistant director-general for UHC/Healthier Populations at WHO Headquarters in Geneva, has been appointed as WHO Representative to the Kingdom of Thailand, Tedros announced, in a message seen by Health Policy Watch. Aylward, formerly assistant director-general for the Division of Universal Health Coverage/Life Course, was appointed director of the WHO-World Bank Global Preparedness Monitoring Board in August, and will now also be coordinating the work on the UN80 Initiative, Tedros confirmed in the message, emailed to all staff on Friday. The new appointments complete the sweep of WHO’s 17 former senior management officials, now reduced to 12 as part of major cost-cutting moves triggered by the withdrawal of the United States from the organisation in January. The US retreat left a gaping $1.7 billion budget gap for the upcoming 2026-27 budget period. That has now been reduced to $1.05 billion due to a projected 25% reduction in WHO’s workforce next year. Three of six ADGs cut from senior leadership ranks actually left WHO Dr Mike Ryan addresses a meeting of WHO pandemic negotiators in one of his last public appearances before retiring. The new senior leadership team includes four assistant director generals at headquarters, a Chef de Cabinet and Chief Scientist, as well as Tedros himself. The directors of five WHO Regional Offices (not including the head of the Pan American Health Organisation, counted separately) also hold an equivalent ranking, for total of 12 such posts. Of the six ADGs who were cut from team in May, three have actually left the organisation, including Samira Asma, formerly ADG for Data, Analytics and Delivery, now with the Susan Thompson Buffett Foundation; Jérome Salomon, ADG for Universal Health Coverage who left WHO in September; and Health Emergencies Executive Director Mike Ryan, who retired in September. The recent appointments mean that three others, including Li, Aylward and former ADG for External Relations Catherine Boehme have now moved into other roles, with Boehme serving as “Officer in Charge” of WHO’s South-East Asia Regional Office (SEARO). Tedros placed SEARO’s Regional Director, Saima Wazed on leave on 11 July, after the Bangladeshi government filed two cases against her for alleged fraud, forgery and misuse of power, also issuing a warrant for her arrest. No return date has so far been announced. See related story: Controversial WHO Regional Director Placed on Leave Former HQ Directors also named to lead WHO country offices In his message Friday, Tedros also named a number of other former department directors and team heads at headquarters to head country offices in the global organisation, including: Indrajit Hazarika, formerly Senior Public Health Officer, of Country Strategy and Support at HQ, as WHO Representative to the Republic of Angola. Ann Maria Lindstrand, formerly Unit Head, Essential Programme on Immunisation in the Health Emergencies Division, as WHO Representative to the Republic of Cabo Verde. Dr Pavel Ursu, formerly Director of the Department of Delivery for Impact at headquarters in Geneva, as WHO Representative to the Federal Republic of Nigeria. Dr Michel Yao, formerly the Director of the Department of Strategic Health Operations, will become the WHO Representative to the Republic of Senegal. In 2021, Yao as well as another senior WHO official, were named in an alleged cover-up of allegations of sexual abuse brought against WHO field staff and consultants responding to an Ebola outbreak in the Democratic Republic of Congo. They were later cleared by an UN investigations panel. Nedret Emiroglu, a former Director for Country Readiness Strengthening in the Health Emergencies Division, was meanwhile named to head the WHO Secretariat for the Intergovernmental Working Group (IGWG), which is negotiating further provisions of the WHO Pandemic Agreement approved in May – most notably a proposed system for Pathogen Access and Benefit Sharing (PABS). Staff Reductions to date WHO workforce, headquarters, country offices and regions, in 3rd Quarter 2025, a reduction of over 500 staff in comparison with December 2024. In a press briefing last week, Tedros publicly acknowledged that the organisation plans to reduce WHO staff worldwide by an estimated 2371 positions by mid-2026, shedding about 25% of the workforce, which numbered 9,466 at the end of December 2024, and just under that as of 1 January. Around 1,089 staff are being shed through what WHO described as “natural attrition.” This includes retirements, early retirement, and the non-renewal of short-term staff contracts that expire. In addition, another 1,282 long and short-term posts have been abolished outright, according to statements at the presser and the earlier briefing to WHO member states. That should bring WHO’s global staff headcount down to about 7,360 professional and administrative positions by mid-2026. In terms of sheer numbers, professional staff at low and mid-level are among those hit hardest by the staff cuts.. Of those cuts, some 505 staff had left WHO by end September, WHO human resource records show; that count was confirmed by a WHO spokesperson. “A large number of staff are exiting at the end of December, three-months notice while notified in September,” the spokesperson told Health Policy Watch. “And another large number will leave in June 2026, i.e. the ones with reassignment rights.” In terms of D1 and D2 directors, whose numbers nearly doubled in the first six years of Tedros’ administration, costing the organisation nearly $100 million annually, some 21 Directors’ positions had been eliminated as of 30 September. That brings the number of directors worldwide down from a peak of 188 at end 2024 to 167 in Q3 2025. WHO Directors – 3rd Quarter 2025 – versus December 2024. That still leaves another 30 D1 and D2 posts to be eliminated by June 2026, mostly at headquarters. The massive reorganisation announced in April and May, slashed the number of departments and directors at headquarters by more than half – from 76 to 34 positions). The reason those reductions haven’t yet been reflected in the HR records is simple, WHO says. “Some directors who are sitting on positions that have been abolished have up to 6 months reassignment [rights] plus a 3-month notice period,” a WHO spokesperson said, “hence they still appear in the Q3 report. The target remains for June 30, 2026.” How will cuts translate into budget savings? Despite the painful plans to cut more 2,371 staff worldwide by June 2026, a projected funding gap remains of $1.05 billion, according to the director general’s last report to member states in November. The $1.7 billion funding gap for 2026-27 has been reduced to $1.05 billion, according to current projections. And the degree to which cuts in rank-and-file, as well as high level positions, will lead to actual savings remains to be seen. WHO’s November reports to member state did not offer any detailed analysis of projected savings that would be gained through the reductions by staff grade or office location. Even less detail provided on the status, conditions and costs of non-staff contract holders – about which there is no reporting even of pay grades or geographic base, let alone gender and age. That’s despite the fact that WHO’s non-staff’s headcount of 7582 (full-time equivalents) in 2024 was approaching that of actual staff numbers (9466) for that year. WHO officials say that the lack of more detailed reporting on non-staff contracts, is linked to legal and ethical issues. “WHO does not systematically capture, aggregate or publish individual-level information (such as grade equivalence, age, gender or demographic background) for non-staff contractual arrangements,” a WHO spokesperson told Health Policy Watch. “Doing so would raise legal, ethical and data-protection concerns, as WHO is not the employer of these individuals and does not have a mandate to collect or process such personal data beyond what is strictly required for contractual and financial compliance.” This table in WHO’s bi-annual HR report is the sole data available on non-staff contracts. It notes full-time equivalents for part-time engagements (consultants and APWs). Presuming that most Special Service Agreements (SSAs) are full-time, total estimated full time equivalent contracts numbered nearly 7600 in 2024. At the highest levels of WHO staff, meanwhile, some directors whose departments at headquarters were abolished remained in the organisation as a heads of unit, which typically carries a top-level professional grade of P6. In the UN grading system, the salaries of D1 directors and P6 professionals are virtually identical. And some former department heads now running units have even clung to their old titles, regardless of the formalities. Signature of a former director – (phone number and email have been erased to protect privacy). In an email invitation to colleagues for a late November reception at the WHO canteen, the former Director of the Department of Public Health and Migration (PHM), who is now technically a unit head, couldn’t resist signing the invite with his old title as well: “Head of Special Initiative on Health and Migration (Director). Division of Universal Health Coverage and Healthier Populations.” Observed one WHO staff member: “This kind of thing is all over the place. As for cost reduction, NADA!” Image Credits: WHO HR database , WHO , WHO Workforce Data, December 13 2024, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Cervical Cancer in India: Early Marriage, Poor Screening and Gender Inequality Fuel a Preventable Killer 19/12/2025 Arsalan Bukhari Though largely preventable, cervical cancer continues to kill thousands of Indian women each year. MUMBAI, India – Cervical cancer kills more than 75,000 women in India each year, according to figures recently disclosed in Parliament – yet it is one of the most preventable cancers. In India, low human papillomavirus (HPV) vaccination coverage, limited access to routine screening and deep-rooted social behaviours – such as early marriage and low condom use – drive late diagnosis and high mortality. Globally, cervical cancer is the fourth most common cancer among women, with an estimated 660,000 new cases and 350,000 reported deaths in 2022, accoridng to WHO. Public health experts say these factors increase exposure to HPV, the underlying cause of nearly all cervical cancer cases, while allowing the disease to progress silently for years before detection. For Neha, a 29-year-old hotel worker in the city of 12.5 million, India’s largest, the statistics reflect a deeply personal loss. My two cousins died from cervical cancer,” she told Health Policy Watch. “What frightens me most is how silent it is. People seem completely normal for years, and then you discover they have had cancer for a long time only when they are close to dying. Early marriage and rising HPV exposure A wedding procession in India, where early marriage remains common. Doctors say nearly all cervical cancer cases are caused by persistent infection with high-risk types of HPV, one of the most common sexually transmitted infections worldwide. Mumbai physician, Dr Sonali Roy told Health Policy Watch that HPV exposure in India is closely tied to early marriage, low awareness and limited access to vaccination and screening, particularly in rural areas. “In some villages, girls are married as young as 14 or 15,” Roy said. These marriages often do not last, and women may remarry multiple times. Each marriage increases exposure to HPV, especially when condoms are rarely used and sexual health awareness is very low. Early marriage often leads to early sexual debut, repeated pregnancies and limited agency over reproductive health decisions, experts say all of which raise the risk of persistent HPV infection. The biological vulnerability of the cervix during adolescence further increases susceptibility to the virus. Unlike many high-income countries, India has yet to roll out a nationwide HPV vaccination programme, despite repeated recommendations from public health experts and the World Health Organization (WHO). While some states have launched pilot projects, coverage remains patchy and largely urban, leaving millions of girls unprotected before sexual debut. Routine cervical cancer screening also remains uneven across Indian states, with weak outreach in rural areas and among informal urban settlements, where health services are often overstretched. Evidence from research HPW vaccine introduction; India and South-East Asia lag behind most other regions of the world in routine HPV vaccination. Research supports the link between early sexual debut, multiple partners and higher HPV infection risk. A 2019 study reviewing medical records of 349 women who tested positive for high-risk HPV found that women who began sexual activity at a younger age or had multiple sexual partners faced a significantly higher risk of infection with HPV types 16 and 18, the two strains responsible for the majority of cervical cancer cases globally. The study found that about one in five women was infected with HPV 16, while nearly 9% were infected with HPV 18 – the types of HPV most likely to cause cervical cancer. Women who reported their first sexual intercourse at age 19 or younger were significantly more likely to be infected with HPV 16 than those who became sexually active later. The risk rose sharply with multiple partners. Women who reported more than three lifetime sexual partners were four times more likely to be infected with HPV 18 than women who had fewer partners. Public health researchers caution that these findings reflect structural conditions rather than individual behaviour. “In many cases, women do not have the power to negotiate when to marry, when to have sex or whether protection is used, ” said a health researcher. Men refuse to use protection With fewer than one in 10 Indian men using condoms, women bear the health consequences of preventable HPV infections. Even when women understand the risks, many say they have little control over prevention. A 27-year-old woman from the East Mumbai suburb of Kurla, who spoke on condition of anonymity, told Health Policy Watch that her partner refuses to use condoms.“He says it affects his pride,” said Priya (not her real name). This is common, even in cities like Mumbai, India’s modern financial center. She said stigma is far stronger in rural areas, where access to contraception is limited and social scrutiny is intense. Many women end up with these infections simply because men refuse to use protection. Her account echoes broader national trends. A 2021 report found that fewer than one in 10 men in India use condoms, making male sterilisation and barrier contraception among the least-used family planning methods in the country. Female sterilisation remains the dominant form of contraception, often placing the burden of reproductive health entirely on women. By comparison, a 2025 Zipdo educational report estimated that around 45% of sexually active people worldwide used a condom during their last sexual encounter. Priya recalled a close friend who had part of her cervix surgically removed after an early cancer diagnosis. Doctors later told her that consistent condom use would likely have prevented the HPV infection that led to the disease. Screening gaps Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. In India, the absence of a structured nationwide screening system has meant that many women are diagnosed only at advanced stages of the disease when treatment is more expensive and survival rates drop sharply. Under India’s National Programme for Prevention and Control of Non-Communicable Diseases and Ayushman Bharat, its health insurance for vulnerable families, women aged 30 to 65 are supposed to be screened for cervical cancer at primary health centres using visual inspection with acetic acid, a low-cost test known as VIA. Coverage, however, remains extremely low. Only about 2% of eligible women are currently being screened, with wide variations across states based on education levels and rural–urban divides. Health workers cite multiple barriers, including staff shortages, limited training, lack of privacy at health centres and social stigma around gynaecological examinations. For many women, domestic responsibilities and daily wage work also make preventive care a low priority. Cancer means financial ruin Doctors perform a surgical procedure on a woman patient. For some women, barriers go beyond awareness and access. A woman living on the rural outskirts of Mumbai, nearly 87 kilometres from the city centre, told Health Policy Watch that fear of financial ruin often outweighs concern about infection itself. “May God save us from expensive diseases. Unfortunately, cancer is one,” said Afshana, not her real name. “Even though we have a five lakh cover [around $5,500 annually] under Ayushman Bharat [insurance plan], we often end up going to private hospitals because services are lacking.” Her experience reflects broader systemic gaps. A 2024 NITI Aayog review of Health and Wellness Centres linked to Ayushman Bharat, India’s flagship government insurance scheme, found significant shortfalls in cancer screening delivery. While most centres had initiated screening for noncommunicable diseases, fewer than 10% had completed a full annual round. Cervical cancer screening was “yet to be operationalised,” according to the report, while oral cancer screening was carried out only selectively. The review also found that many auxiliary nurse-midwives, staff nurses and medical officers had not received adequate training to conduct screenings or manage referrals. Although most centres met basic infrastructure standards and provided essential medicines free of charge, service delivery continued to lag behind national goals for early detection and prevention. A preventable tragedy Cervical cancer is widely regarded as one of the most preventable forms of cancer. HPV vaccination, regular screening and timely treatment of precancerous lesions have dramatically reduced incidence and mortality in countries that have invested in these measures. Public health experts warn that without urgent action, India risks continuing to lose tens of thousands of women each year to a disease that can largely be stopped. “Cervical cancer is not just a medical issue,” Roy said. “It is a reflection of gender inequality, weak health systems and the failure to prioritise women’s health.”For women like Neha, the cost of that failure is already painfully clear. “If they had found it earlier, my cousins might still be alive,” she said. “No one should die from something that can be prevented.” Image Credits: Saiyan Mondal/Pexels, Gurpreet Singh/ Unsplash, Han J et al, eClinicalMedicine, Vol. 84June 2025, Deon Black/ Unsplash, Bermix Studio/Unsplash, Richard Catabay/Unsplash. Malawi’s New Government Faces National Hunger, Dwindling Aid and Soaring Debt 18/12/2025 Dingaan Mithi Almost a quarter of Malawians face malnutrition until the next harvest in March. This story was originally published by The New Humanitarian. Just a few months into his new term, President Peter Mutharika is grappling with a triple crisis: a deep-seated food emergency, diminishing aid, and soaring debt. With over four million Malawians – 22% of the population – facing the threat of acute malnutrition until the next harvest in March, Mutharika last month declared a nationwide state of disaster. But the $119 million humanitarian response is underfunded. Although crucial to staving off the risk of hunger-related deaths, it has so far raised only $26 million from Malawi’s aid partners – roughly 21% of the amount required. The trigger for Malawi’s food emergency has been a 20% drop in maize yields last year as a result of drought and localised flooding. The harvest failure hit small-scale farmers especially hard – the backbone of food production. The problem is not just food availability, but also its affordability. Reduced farm output, a severe foreign exchange shortage, plus perennial fuel scarcities, have pushed Malawi’s inflation rate to around 28% – the highest in Africa. Even though Monica Jasteni runs a small fish business in her home area of Salima, in central Malawi, the 34-year-old mother of four is struggling. “The money I make is not enough [to buy the food we need],” she told The New Humanitarian. “I try to persuade my children to go to school without eating, telling them that they’ll have food after school, because things are difficult.” She supplements what she makes from selling fish by also farming. But as she can’t afford irrigation, her small plot is susceptible to dry spells. An unsustainable debt burden The experience of Jasteni – trying to make ends meet, yet failing – is why a coalition of 50 civil society organisations is demanding urgent action by the government. “The hunger crisis is a huge national emergency,” said Amon Lukhele, national coordinator of the Civil Society Social Protection Network (CSSPN). “We are calling upon the government to act now to protect the poorest households before the hunger situation worsens.” CSSPN wants the government to accelerate implementation of its National Social Protection Policy, a safety net programme that aims to provide relief to the most vulnerable. But Mutharika, elected in September, has inherited public finances in a critical state. That has put pressure on what spending the government can afford, and the speed with which remedial programmes can be rolled out. Malawi is heavily debt-distressed. Its total debt burden is around $9.25 billion – an unsustainable 86% of GDP. It also faces a looming debt service obligation of $1.8 billion. That affects not only economic growth, but also the provision of essential social services. As a result, Malawi spends more on debt servicing than it does on health. The closure of the US Agency for International Development – a key health donor – has only made the government’s budget calculations even harder. Yet opportunities have been squandered. In 2006, Malawi had its debt cancelled under the Highly Indebted Poor Country Initiative (HIPC). But 19 years down the line, after years of heavy borrowing, it is back in arrears – and has been forced to swallow two painful currency devaluations, in 2022 and again in 2023. “Too much debt erodes Malawi’s capacity to strengthen food security,” said Mavuto Bamusi, a prominent political analyst and anti-corruption campaigner. “Debt repayments to lenders, especially the IMF [International Monetary Fund], are taking out a lot of money that could have been used for agricultural commercialisation.” Malawi needs to urgently restructure its debt, and find domestic and international support for reforms to revive its economy after years of mismanagement, analysts suggest. Joseph Mwanamvekha, the new finance minister, has announced new reform measures to stabilise the economy, and combat the food crisis. They include a commitment to improve public debt management and fiscal discipline, strict expenditure controls, and management of the wage bill. Getting food security right This is the fifth time in a decade Malawi has declared a food-related state of disaster. It not only signifies a deepening cycle of climate volatility, but also reflects the deep structural issues around food security. The agricultural sector is central to Malawi’s economy, accounting for almost a quarter of GDP and employing three quarters of the population – mostly through subsistence farming. But productivity gains have stagnated over the past decade, with an over-reliance on maize leading to soil degradation and micro-nutrient deficiencies in people’s diets. Successive governments have implemented input subsidy programmes, providing cut-price fertiliser and seeds. But historically they have suffered from logistical bottlenecks leading to late input deliveries, as well as targeting problems, fraud, and political interference. Mutharika’s government is trying again. He has launched the 2025/2026 Farm Input Subsidy Programme (FISP) aimed at 1.1 million farming households. Each will receive two 50kg bags of subsidised fertiliser plus a 5kg pack of seed of their choice. Political commentators suggest this will be a defining test for his administration. The goal for Mutharika is to deliver on his election campaign promises to provide farm inputs on time – and nationwide – avoiding favouring political constituencies. The rollout of digital registries and e-vouchers, backed by the World Bank, may help fix some of those problems. Yet the FISP will reach only a fraction of Malawi’s farming households. It also doesn’t fully address the problem of farmers’ preference for drought-vulnerable maize at a time of worsening climate volatility. Dominic Nyasulu, the national coordinator at the National Youth Network on Climate Change, argues that the new government needs to reframe food security policies to promote drought tolerant crops such as millet and sorghum – crops that were traditionally grown before the commercialisation of maize. “This country has potential to defeat hunger, but our policies need to be reformed in view of extreme weather events and other climate impacts,” said Nyasulu. Tamani Nkhono-Mvula, a Malawian agriculture and food security expert, said a more far-reaching change will come with irrigation. Only 4% of farming land is currently irrigated. The drawbacks are that it is expensive, there is a lack of rural financing, water management has historically been a problem, and women farmers are particularly disadvantaged. The lack of government capacity is also a significant drawback, as is access to commercial markets, according to 2021 evaluation of a World Bank irrigation and rural development project. However, Nkhono-Mvula argues that the potential “for Malawi to feed itself is there – the leadership just needs to be transformative”. The New Humanitarian puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world. Image Credits: Fatsani Gunya/ The New Humanitarian. Two More WHO Officials Cut from Senior Leadership Team Move into Other Roles 16/12/2025 Elaine Ruth Fletcher WHO Director General’s former Senior Leadership Team – which he slashed from 11 to six positions as part of a major reshuffle in May 2025. Two more senior WHO officials, Bruce Aylward and Ailan Li, who were among those dropped from WHO’s Senior Leadership Team during the first phase of an Agency shake-up, have now been appointed to leading roles elsewhere in the organisation, according to a memo from Director General Tedros Adhanom Ghebreyesus. Li, a Chinese national and former assistant director-general for UHC/Healthier Populations at WHO Headquarters in Geneva, has been appointed as WHO Representative to the Kingdom of Thailand, Tedros announced, in a message seen by Health Policy Watch. Aylward, formerly assistant director-general for the Division of Universal Health Coverage/Life Course, was appointed director of the WHO-World Bank Global Preparedness Monitoring Board in August, and will now also be coordinating the work on the UN80 Initiative, Tedros confirmed in the message, emailed to all staff on Friday. The new appointments complete the sweep of WHO’s 17 former senior management officials, now reduced to 12 as part of major cost-cutting moves triggered by the withdrawal of the United States from the organisation in January. The US retreat left a gaping $1.7 billion budget gap for the upcoming 2026-27 budget period. That has now been reduced to $1.05 billion due to a projected 25% reduction in WHO’s workforce next year. Three of six ADGs cut from senior leadership ranks actually left WHO Dr Mike Ryan addresses a meeting of WHO pandemic negotiators in one of his last public appearances before retiring. The new senior leadership team includes four assistant director generals at headquarters, a Chef de Cabinet and Chief Scientist, as well as Tedros himself. The directors of five WHO Regional Offices (not including the head of the Pan American Health Organisation, counted separately) also hold an equivalent ranking, for total of 12 such posts. Of the six ADGs who were cut from team in May, three have actually left the organisation, including Samira Asma, formerly ADG for Data, Analytics and Delivery, now with the Susan Thompson Buffett Foundation; Jérome Salomon, ADG for Universal Health Coverage who left WHO in September; and Health Emergencies Executive Director Mike Ryan, who retired in September. The recent appointments mean that three others, including Li, Aylward and former ADG for External Relations Catherine Boehme have now moved into other roles, with Boehme serving as “Officer in Charge” of WHO’s South-East Asia Regional Office (SEARO). Tedros placed SEARO’s Regional Director, Saima Wazed on leave on 11 July, after the Bangladeshi government filed two cases against her for alleged fraud, forgery and misuse of power, also issuing a warrant for her arrest. No return date has so far been announced. See related story: Controversial WHO Regional Director Placed on Leave Former HQ Directors also named to lead WHO country offices In his message Friday, Tedros also named a number of other former department directors and team heads at headquarters to head country offices in the global organisation, including: Indrajit Hazarika, formerly Senior Public Health Officer, of Country Strategy and Support at HQ, as WHO Representative to the Republic of Angola. Ann Maria Lindstrand, formerly Unit Head, Essential Programme on Immunisation in the Health Emergencies Division, as WHO Representative to the Republic of Cabo Verde. Dr Pavel Ursu, formerly Director of the Department of Delivery for Impact at headquarters in Geneva, as WHO Representative to the Federal Republic of Nigeria. Dr Michel Yao, formerly the Director of the Department of Strategic Health Operations, will become the WHO Representative to the Republic of Senegal. In 2021, Yao as well as another senior WHO official, were named in an alleged cover-up of allegations of sexual abuse brought against WHO field staff and consultants responding to an Ebola outbreak in the Democratic Republic of Congo. They were later cleared by an UN investigations panel. Nedret Emiroglu, a former Director for Country Readiness Strengthening in the Health Emergencies Division, was meanwhile named to head the WHO Secretariat for the Intergovernmental Working Group (IGWG), which is negotiating further provisions of the WHO Pandemic Agreement approved in May – most notably a proposed system for Pathogen Access and Benefit Sharing (PABS). Staff Reductions to date WHO workforce, headquarters, country offices and regions, in 3rd Quarter 2025, a reduction of over 500 staff in comparison with December 2024. In a press briefing last week, Tedros publicly acknowledged that the organisation plans to reduce WHO staff worldwide by an estimated 2371 positions by mid-2026, shedding about 25% of the workforce, which numbered 9,466 at the end of December 2024, and just under that as of 1 January. Around 1,089 staff are being shed through what WHO described as “natural attrition.” This includes retirements, early retirement, and the non-renewal of short-term staff contracts that expire. In addition, another 1,282 long and short-term posts have been abolished outright, according to statements at the presser and the earlier briefing to WHO member states. That should bring WHO’s global staff headcount down to about 7,360 professional and administrative positions by mid-2026. In terms of sheer numbers, professional staff at low and mid-level are among those hit hardest by the staff cuts.. Of those cuts, some 505 staff had left WHO by end September, WHO human resource records show; that count was confirmed by a WHO spokesperson. “A large number of staff are exiting at the end of December, three-months notice while notified in September,” the spokesperson told Health Policy Watch. “And another large number will leave in June 2026, i.e. the ones with reassignment rights.” In terms of D1 and D2 directors, whose numbers nearly doubled in the first six years of Tedros’ administration, costing the organisation nearly $100 million annually, some 21 Directors’ positions had been eliminated as of 30 September. That brings the number of directors worldwide down from a peak of 188 at end 2024 to 167 in Q3 2025. WHO Directors – 3rd Quarter 2025 – versus December 2024. That still leaves another 30 D1 and D2 posts to be eliminated by June 2026, mostly at headquarters. The massive reorganisation announced in April and May, slashed the number of departments and directors at headquarters by more than half – from 76 to 34 positions). The reason those reductions haven’t yet been reflected in the HR records is simple, WHO says. “Some directors who are sitting on positions that have been abolished have up to 6 months reassignment [rights] plus a 3-month notice period,” a WHO spokesperson said, “hence they still appear in the Q3 report. The target remains for June 30, 2026.” How will cuts translate into budget savings? Despite the painful plans to cut more 2,371 staff worldwide by June 2026, a projected funding gap remains of $1.05 billion, according to the director general’s last report to member states in November. The $1.7 billion funding gap for 2026-27 has been reduced to $1.05 billion, according to current projections. And the degree to which cuts in rank-and-file, as well as high level positions, will lead to actual savings remains to be seen. WHO’s November reports to member state did not offer any detailed analysis of projected savings that would be gained through the reductions by staff grade or office location. Even less detail provided on the status, conditions and costs of non-staff contract holders – about which there is no reporting even of pay grades or geographic base, let alone gender and age. That’s despite the fact that WHO’s non-staff’s headcount of 7582 (full-time equivalents) in 2024 was approaching that of actual staff numbers (9466) for that year. WHO officials say that the lack of more detailed reporting on non-staff contracts, is linked to legal and ethical issues. “WHO does not systematically capture, aggregate or publish individual-level information (such as grade equivalence, age, gender or demographic background) for non-staff contractual arrangements,” a WHO spokesperson told Health Policy Watch. “Doing so would raise legal, ethical and data-protection concerns, as WHO is not the employer of these individuals and does not have a mandate to collect or process such personal data beyond what is strictly required for contractual and financial compliance.” This table in WHO’s bi-annual HR report is the sole data available on non-staff contracts. It notes full-time equivalents for part-time engagements (consultants and APWs). Presuming that most Special Service Agreements (SSAs) are full-time, total estimated full time equivalent contracts numbered nearly 7600 in 2024. At the highest levels of WHO staff, meanwhile, some directors whose departments at headquarters were abolished remained in the organisation as a heads of unit, which typically carries a top-level professional grade of P6. In the UN grading system, the salaries of D1 directors and P6 professionals are virtually identical. And some former department heads now running units have even clung to their old titles, regardless of the formalities. Signature of a former director – (phone number and email have been erased to protect privacy). In an email invitation to colleagues for a late November reception at the WHO canteen, the former Director of the Department of Public Health and Migration (PHM), who is now technically a unit head, couldn’t resist signing the invite with his old title as well: “Head of Special Initiative on Health and Migration (Director). Division of Universal Health Coverage and Healthier Populations.” Observed one WHO staff member: “This kind of thing is all over the place. As for cost reduction, NADA!” Image Credits: WHO HR database , WHO , WHO Workforce Data, December 13 2024, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Malawi’s New Government Faces National Hunger, Dwindling Aid and Soaring Debt 18/12/2025 Dingaan Mithi Almost a quarter of Malawians face malnutrition until the next harvest in March. This story was originally published by The New Humanitarian. Just a few months into his new term, President Peter Mutharika is grappling with a triple crisis: a deep-seated food emergency, diminishing aid, and soaring debt. With over four million Malawians – 22% of the population – facing the threat of acute malnutrition until the next harvest in March, Mutharika last month declared a nationwide state of disaster. But the $119 million humanitarian response is underfunded. Although crucial to staving off the risk of hunger-related deaths, it has so far raised only $26 million from Malawi’s aid partners – roughly 21% of the amount required. The trigger for Malawi’s food emergency has been a 20% drop in maize yields last year as a result of drought and localised flooding. The harvest failure hit small-scale farmers especially hard – the backbone of food production. The problem is not just food availability, but also its affordability. Reduced farm output, a severe foreign exchange shortage, plus perennial fuel scarcities, have pushed Malawi’s inflation rate to around 28% – the highest in Africa. Even though Monica Jasteni runs a small fish business in her home area of Salima, in central Malawi, the 34-year-old mother of four is struggling. “The money I make is not enough [to buy the food we need],” she told The New Humanitarian. “I try to persuade my children to go to school without eating, telling them that they’ll have food after school, because things are difficult.” She supplements what she makes from selling fish by also farming. But as she can’t afford irrigation, her small plot is susceptible to dry spells. An unsustainable debt burden The experience of Jasteni – trying to make ends meet, yet failing – is why a coalition of 50 civil society organisations is demanding urgent action by the government. “The hunger crisis is a huge national emergency,” said Amon Lukhele, national coordinator of the Civil Society Social Protection Network (CSSPN). “We are calling upon the government to act now to protect the poorest households before the hunger situation worsens.” CSSPN wants the government to accelerate implementation of its National Social Protection Policy, a safety net programme that aims to provide relief to the most vulnerable. But Mutharika, elected in September, has inherited public finances in a critical state. That has put pressure on what spending the government can afford, and the speed with which remedial programmes can be rolled out. Malawi is heavily debt-distressed. Its total debt burden is around $9.25 billion – an unsustainable 86% of GDP. It also faces a looming debt service obligation of $1.8 billion. That affects not only economic growth, but also the provision of essential social services. As a result, Malawi spends more on debt servicing than it does on health. The closure of the US Agency for International Development – a key health donor – has only made the government’s budget calculations even harder. Yet opportunities have been squandered. In 2006, Malawi had its debt cancelled under the Highly Indebted Poor Country Initiative (HIPC). But 19 years down the line, after years of heavy borrowing, it is back in arrears – and has been forced to swallow two painful currency devaluations, in 2022 and again in 2023. “Too much debt erodes Malawi’s capacity to strengthen food security,” said Mavuto Bamusi, a prominent political analyst and anti-corruption campaigner. “Debt repayments to lenders, especially the IMF [International Monetary Fund], are taking out a lot of money that could have been used for agricultural commercialisation.” Malawi needs to urgently restructure its debt, and find domestic and international support for reforms to revive its economy after years of mismanagement, analysts suggest. Joseph Mwanamvekha, the new finance minister, has announced new reform measures to stabilise the economy, and combat the food crisis. They include a commitment to improve public debt management and fiscal discipline, strict expenditure controls, and management of the wage bill. Getting food security right This is the fifth time in a decade Malawi has declared a food-related state of disaster. It not only signifies a deepening cycle of climate volatility, but also reflects the deep structural issues around food security. The agricultural sector is central to Malawi’s economy, accounting for almost a quarter of GDP and employing three quarters of the population – mostly through subsistence farming. But productivity gains have stagnated over the past decade, with an over-reliance on maize leading to soil degradation and micro-nutrient deficiencies in people’s diets. Successive governments have implemented input subsidy programmes, providing cut-price fertiliser and seeds. But historically they have suffered from logistical bottlenecks leading to late input deliveries, as well as targeting problems, fraud, and political interference. Mutharika’s government is trying again. He has launched the 2025/2026 Farm Input Subsidy Programme (FISP) aimed at 1.1 million farming households. Each will receive two 50kg bags of subsidised fertiliser plus a 5kg pack of seed of their choice. Political commentators suggest this will be a defining test for his administration. The goal for Mutharika is to deliver on his election campaign promises to provide farm inputs on time – and nationwide – avoiding favouring political constituencies. The rollout of digital registries and e-vouchers, backed by the World Bank, may help fix some of those problems. Yet the FISP will reach only a fraction of Malawi’s farming households. It also doesn’t fully address the problem of farmers’ preference for drought-vulnerable maize at a time of worsening climate volatility. Dominic Nyasulu, the national coordinator at the National Youth Network on Climate Change, argues that the new government needs to reframe food security policies to promote drought tolerant crops such as millet and sorghum – crops that were traditionally grown before the commercialisation of maize. “This country has potential to defeat hunger, but our policies need to be reformed in view of extreme weather events and other climate impacts,” said Nyasulu. Tamani Nkhono-Mvula, a Malawian agriculture and food security expert, said a more far-reaching change will come with irrigation. Only 4% of farming land is currently irrigated. The drawbacks are that it is expensive, there is a lack of rural financing, water management has historically been a problem, and women farmers are particularly disadvantaged. The lack of government capacity is also a significant drawback, as is access to commercial markets, according to 2021 evaluation of a World Bank irrigation and rural development project. However, Nkhono-Mvula argues that the potential “for Malawi to feed itself is there – the leadership just needs to be transformative”. The New Humanitarian puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world. Image Credits: Fatsani Gunya/ The New Humanitarian. Two More WHO Officials Cut from Senior Leadership Team Move into Other Roles 16/12/2025 Elaine Ruth Fletcher WHO Director General’s former Senior Leadership Team – which he slashed from 11 to six positions as part of a major reshuffle in May 2025. Two more senior WHO officials, Bruce Aylward and Ailan Li, who were among those dropped from WHO’s Senior Leadership Team during the first phase of an Agency shake-up, have now been appointed to leading roles elsewhere in the organisation, according to a memo from Director General Tedros Adhanom Ghebreyesus. Li, a Chinese national and former assistant director-general for UHC/Healthier Populations at WHO Headquarters in Geneva, has been appointed as WHO Representative to the Kingdom of Thailand, Tedros announced, in a message seen by Health Policy Watch. Aylward, formerly assistant director-general for the Division of Universal Health Coverage/Life Course, was appointed director of the WHO-World Bank Global Preparedness Monitoring Board in August, and will now also be coordinating the work on the UN80 Initiative, Tedros confirmed in the message, emailed to all staff on Friday. The new appointments complete the sweep of WHO’s 17 former senior management officials, now reduced to 12 as part of major cost-cutting moves triggered by the withdrawal of the United States from the organisation in January. The US retreat left a gaping $1.7 billion budget gap for the upcoming 2026-27 budget period. That has now been reduced to $1.05 billion due to a projected 25% reduction in WHO’s workforce next year. Three of six ADGs cut from senior leadership ranks actually left WHO Dr Mike Ryan addresses a meeting of WHO pandemic negotiators in one of his last public appearances before retiring. The new senior leadership team includes four assistant director generals at headquarters, a Chef de Cabinet and Chief Scientist, as well as Tedros himself. The directors of five WHO Regional Offices (not including the head of the Pan American Health Organisation, counted separately) also hold an equivalent ranking, for total of 12 such posts. Of the six ADGs who were cut from team in May, three have actually left the organisation, including Samira Asma, formerly ADG for Data, Analytics and Delivery, now with the Susan Thompson Buffett Foundation; Jérome Salomon, ADG for Universal Health Coverage who left WHO in September; and Health Emergencies Executive Director Mike Ryan, who retired in September. The recent appointments mean that three others, including Li, Aylward and former ADG for External Relations Catherine Boehme have now moved into other roles, with Boehme serving as “Officer in Charge” of WHO’s South-East Asia Regional Office (SEARO). Tedros placed SEARO’s Regional Director, Saima Wazed on leave on 11 July, after the Bangladeshi government filed two cases against her for alleged fraud, forgery and misuse of power, also issuing a warrant for her arrest. No return date has so far been announced. See related story: Controversial WHO Regional Director Placed on Leave Former HQ Directors also named to lead WHO country offices In his message Friday, Tedros also named a number of other former department directors and team heads at headquarters to head country offices in the global organisation, including: Indrajit Hazarika, formerly Senior Public Health Officer, of Country Strategy and Support at HQ, as WHO Representative to the Republic of Angola. Ann Maria Lindstrand, formerly Unit Head, Essential Programme on Immunisation in the Health Emergencies Division, as WHO Representative to the Republic of Cabo Verde. Dr Pavel Ursu, formerly Director of the Department of Delivery for Impact at headquarters in Geneva, as WHO Representative to the Federal Republic of Nigeria. Dr Michel Yao, formerly the Director of the Department of Strategic Health Operations, will become the WHO Representative to the Republic of Senegal. In 2021, Yao as well as another senior WHO official, were named in an alleged cover-up of allegations of sexual abuse brought against WHO field staff and consultants responding to an Ebola outbreak in the Democratic Republic of Congo. They were later cleared by an UN investigations panel. Nedret Emiroglu, a former Director for Country Readiness Strengthening in the Health Emergencies Division, was meanwhile named to head the WHO Secretariat for the Intergovernmental Working Group (IGWG), which is negotiating further provisions of the WHO Pandemic Agreement approved in May – most notably a proposed system for Pathogen Access and Benefit Sharing (PABS). Staff Reductions to date WHO workforce, headquarters, country offices and regions, in 3rd Quarter 2025, a reduction of over 500 staff in comparison with December 2024. In a press briefing last week, Tedros publicly acknowledged that the organisation plans to reduce WHO staff worldwide by an estimated 2371 positions by mid-2026, shedding about 25% of the workforce, which numbered 9,466 at the end of December 2024, and just under that as of 1 January. Around 1,089 staff are being shed through what WHO described as “natural attrition.” This includes retirements, early retirement, and the non-renewal of short-term staff contracts that expire. In addition, another 1,282 long and short-term posts have been abolished outright, according to statements at the presser and the earlier briefing to WHO member states. That should bring WHO’s global staff headcount down to about 7,360 professional and administrative positions by mid-2026. In terms of sheer numbers, professional staff at low and mid-level are among those hit hardest by the staff cuts.. Of those cuts, some 505 staff had left WHO by end September, WHO human resource records show; that count was confirmed by a WHO spokesperson. “A large number of staff are exiting at the end of December, three-months notice while notified in September,” the spokesperson told Health Policy Watch. “And another large number will leave in June 2026, i.e. the ones with reassignment rights.” In terms of D1 and D2 directors, whose numbers nearly doubled in the first six years of Tedros’ administration, costing the organisation nearly $100 million annually, some 21 Directors’ positions had been eliminated as of 30 September. That brings the number of directors worldwide down from a peak of 188 at end 2024 to 167 in Q3 2025. WHO Directors – 3rd Quarter 2025 – versus December 2024. That still leaves another 30 D1 and D2 posts to be eliminated by June 2026, mostly at headquarters. The massive reorganisation announced in April and May, slashed the number of departments and directors at headquarters by more than half – from 76 to 34 positions). The reason those reductions haven’t yet been reflected in the HR records is simple, WHO says. “Some directors who are sitting on positions that have been abolished have up to 6 months reassignment [rights] plus a 3-month notice period,” a WHO spokesperson said, “hence they still appear in the Q3 report. The target remains for June 30, 2026.” How will cuts translate into budget savings? Despite the painful plans to cut more 2,371 staff worldwide by June 2026, a projected funding gap remains of $1.05 billion, according to the director general’s last report to member states in November. The $1.7 billion funding gap for 2026-27 has been reduced to $1.05 billion, according to current projections. And the degree to which cuts in rank-and-file, as well as high level positions, will lead to actual savings remains to be seen. WHO’s November reports to member state did not offer any detailed analysis of projected savings that would be gained through the reductions by staff grade or office location. Even less detail provided on the status, conditions and costs of non-staff contract holders – about which there is no reporting even of pay grades or geographic base, let alone gender and age. That’s despite the fact that WHO’s non-staff’s headcount of 7582 (full-time equivalents) in 2024 was approaching that of actual staff numbers (9466) for that year. WHO officials say that the lack of more detailed reporting on non-staff contracts, is linked to legal and ethical issues. “WHO does not systematically capture, aggregate or publish individual-level information (such as grade equivalence, age, gender or demographic background) for non-staff contractual arrangements,” a WHO spokesperson told Health Policy Watch. “Doing so would raise legal, ethical and data-protection concerns, as WHO is not the employer of these individuals and does not have a mandate to collect or process such personal data beyond what is strictly required for contractual and financial compliance.” This table in WHO’s bi-annual HR report is the sole data available on non-staff contracts. It notes full-time equivalents for part-time engagements (consultants and APWs). Presuming that most Special Service Agreements (SSAs) are full-time, total estimated full time equivalent contracts numbered nearly 7600 in 2024. At the highest levels of WHO staff, meanwhile, some directors whose departments at headquarters were abolished remained in the organisation as a heads of unit, which typically carries a top-level professional grade of P6. In the UN grading system, the salaries of D1 directors and P6 professionals are virtually identical. And some former department heads now running units have even clung to their old titles, regardless of the formalities. Signature of a former director – (phone number and email have been erased to protect privacy). In an email invitation to colleagues for a late November reception at the WHO canteen, the former Director of the Department of Public Health and Migration (PHM), who is now technically a unit head, couldn’t resist signing the invite with his old title as well: “Head of Special Initiative on Health and Migration (Director). Division of Universal Health Coverage and Healthier Populations.” Observed one WHO staff member: “This kind of thing is all over the place. As for cost reduction, NADA!” Image Credits: WHO HR database , WHO , WHO Workforce Data, December 13 2024, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
Almost a quarter of Malawians face malnutrition until the next harvest in March. This story was originally published by The New Humanitarian. Just a few months into his new term, President Peter Mutharika is grappling with a triple crisis: a deep-seated food emergency, diminishing aid, and soaring debt. With over four million Malawians – 22% of the population – facing the threat of acute malnutrition until the next harvest in March, Mutharika last month declared a nationwide state of disaster. But the $119 million humanitarian response is underfunded. Although crucial to staving off the risk of hunger-related deaths, it has so far raised only $26 million from Malawi’s aid partners – roughly 21% of the amount required. The trigger for Malawi’s food emergency has been a 20% drop in maize yields last year as a result of drought and localised flooding. The harvest failure hit small-scale farmers especially hard – the backbone of food production. The problem is not just food availability, but also its affordability. Reduced farm output, a severe foreign exchange shortage, plus perennial fuel scarcities, have pushed Malawi’s inflation rate to around 28% – the highest in Africa. Even though Monica Jasteni runs a small fish business in her home area of Salima, in central Malawi, the 34-year-old mother of four is struggling. “The money I make is not enough [to buy the food we need],” she told The New Humanitarian. “I try to persuade my children to go to school without eating, telling them that they’ll have food after school, because things are difficult.” She supplements what she makes from selling fish by also farming. But as she can’t afford irrigation, her small plot is susceptible to dry spells. An unsustainable debt burden The experience of Jasteni – trying to make ends meet, yet failing – is why a coalition of 50 civil society organisations is demanding urgent action by the government. “The hunger crisis is a huge national emergency,” said Amon Lukhele, national coordinator of the Civil Society Social Protection Network (CSSPN). “We are calling upon the government to act now to protect the poorest households before the hunger situation worsens.” CSSPN wants the government to accelerate implementation of its National Social Protection Policy, a safety net programme that aims to provide relief to the most vulnerable. But Mutharika, elected in September, has inherited public finances in a critical state. That has put pressure on what spending the government can afford, and the speed with which remedial programmes can be rolled out. Malawi is heavily debt-distressed. Its total debt burden is around $9.25 billion – an unsustainable 86% of GDP. It also faces a looming debt service obligation of $1.8 billion. That affects not only economic growth, but also the provision of essential social services. As a result, Malawi spends more on debt servicing than it does on health. The closure of the US Agency for International Development – a key health donor – has only made the government’s budget calculations even harder. Yet opportunities have been squandered. In 2006, Malawi had its debt cancelled under the Highly Indebted Poor Country Initiative (HIPC). But 19 years down the line, after years of heavy borrowing, it is back in arrears – and has been forced to swallow two painful currency devaluations, in 2022 and again in 2023. “Too much debt erodes Malawi’s capacity to strengthen food security,” said Mavuto Bamusi, a prominent political analyst and anti-corruption campaigner. “Debt repayments to lenders, especially the IMF [International Monetary Fund], are taking out a lot of money that could have been used for agricultural commercialisation.” Malawi needs to urgently restructure its debt, and find domestic and international support for reforms to revive its economy after years of mismanagement, analysts suggest. Joseph Mwanamvekha, the new finance minister, has announced new reform measures to stabilise the economy, and combat the food crisis. They include a commitment to improve public debt management and fiscal discipline, strict expenditure controls, and management of the wage bill. Getting food security right This is the fifth time in a decade Malawi has declared a food-related state of disaster. It not only signifies a deepening cycle of climate volatility, but also reflects the deep structural issues around food security. The agricultural sector is central to Malawi’s economy, accounting for almost a quarter of GDP and employing three quarters of the population – mostly through subsistence farming. But productivity gains have stagnated over the past decade, with an over-reliance on maize leading to soil degradation and micro-nutrient deficiencies in people’s diets. Successive governments have implemented input subsidy programmes, providing cut-price fertiliser and seeds. But historically they have suffered from logistical bottlenecks leading to late input deliveries, as well as targeting problems, fraud, and political interference. Mutharika’s government is trying again. He has launched the 2025/2026 Farm Input Subsidy Programme (FISP) aimed at 1.1 million farming households. Each will receive two 50kg bags of subsidised fertiliser plus a 5kg pack of seed of their choice. Political commentators suggest this will be a defining test for his administration. The goal for Mutharika is to deliver on his election campaign promises to provide farm inputs on time – and nationwide – avoiding favouring political constituencies. The rollout of digital registries and e-vouchers, backed by the World Bank, may help fix some of those problems. Yet the FISP will reach only a fraction of Malawi’s farming households. It also doesn’t fully address the problem of farmers’ preference for drought-vulnerable maize at a time of worsening climate volatility. Dominic Nyasulu, the national coordinator at the National Youth Network on Climate Change, argues that the new government needs to reframe food security policies to promote drought tolerant crops such as millet and sorghum – crops that were traditionally grown before the commercialisation of maize. “This country has potential to defeat hunger, but our policies need to be reformed in view of extreme weather events and other climate impacts,” said Nyasulu. Tamani Nkhono-Mvula, a Malawian agriculture and food security expert, said a more far-reaching change will come with irrigation. Only 4% of farming land is currently irrigated. The drawbacks are that it is expensive, there is a lack of rural financing, water management has historically been a problem, and women farmers are particularly disadvantaged. The lack of government capacity is also a significant drawback, as is access to commercial markets, according to 2021 evaluation of a World Bank irrigation and rural development project. However, Nkhono-Mvula argues that the potential “for Malawi to feed itself is there – the leadership just needs to be transformative”. The New Humanitarian puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world.
Two More WHO Officials Cut from Senior Leadership Team Move into Other Roles 16/12/2025 Elaine Ruth Fletcher WHO Director General’s former Senior Leadership Team – which he slashed from 11 to six positions as part of a major reshuffle in May 2025. Two more senior WHO officials, Bruce Aylward and Ailan Li, who were among those dropped from WHO’s Senior Leadership Team during the first phase of an Agency shake-up, have now been appointed to leading roles elsewhere in the organisation, according to a memo from Director General Tedros Adhanom Ghebreyesus. Li, a Chinese national and former assistant director-general for UHC/Healthier Populations at WHO Headquarters in Geneva, has been appointed as WHO Representative to the Kingdom of Thailand, Tedros announced, in a message seen by Health Policy Watch. Aylward, formerly assistant director-general for the Division of Universal Health Coverage/Life Course, was appointed director of the WHO-World Bank Global Preparedness Monitoring Board in August, and will now also be coordinating the work on the UN80 Initiative, Tedros confirmed in the message, emailed to all staff on Friday. The new appointments complete the sweep of WHO’s 17 former senior management officials, now reduced to 12 as part of major cost-cutting moves triggered by the withdrawal of the United States from the organisation in January. The US retreat left a gaping $1.7 billion budget gap for the upcoming 2026-27 budget period. That has now been reduced to $1.05 billion due to a projected 25% reduction in WHO’s workforce next year. Three of six ADGs cut from senior leadership ranks actually left WHO Dr Mike Ryan addresses a meeting of WHO pandemic negotiators in one of his last public appearances before retiring. The new senior leadership team includes four assistant director generals at headquarters, a Chef de Cabinet and Chief Scientist, as well as Tedros himself. The directors of five WHO Regional Offices (not including the head of the Pan American Health Organisation, counted separately) also hold an equivalent ranking, for total of 12 such posts. Of the six ADGs who were cut from team in May, three have actually left the organisation, including Samira Asma, formerly ADG for Data, Analytics and Delivery, now with the Susan Thompson Buffett Foundation; Jérome Salomon, ADG for Universal Health Coverage who left WHO in September; and Health Emergencies Executive Director Mike Ryan, who retired in September. The recent appointments mean that three others, including Li, Aylward and former ADG for External Relations Catherine Boehme have now moved into other roles, with Boehme serving as “Officer in Charge” of WHO’s South-East Asia Regional Office (SEARO). Tedros placed SEARO’s Regional Director, Saima Wazed on leave on 11 July, after the Bangladeshi government filed two cases against her for alleged fraud, forgery and misuse of power, also issuing a warrant for her arrest. No return date has so far been announced. See related story: Controversial WHO Regional Director Placed on Leave Former HQ Directors also named to lead WHO country offices In his message Friday, Tedros also named a number of other former department directors and team heads at headquarters to head country offices in the global organisation, including: Indrajit Hazarika, formerly Senior Public Health Officer, of Country Strategy and Support at HQ, as WHO Representative to the Republic of Angola. Ann Maria Lindstrand, formerly Unit Head, Essential Programme on Immunisation in the Health Emergencies Division, as WHO Representative to the Republic of Cabo Verde. Dr Pavel Ursu, formerly Director of the Department of Delivery for Impact at headquarters in Geneva, as WHO Representative to the Federal Republic of Nigeria. Dr Michel Yao, formerly the Director of the Department of Strategic Health Operations, will become the WHO Representative to the Republic of Senegal. In 2021, Yao as well as another senior WHO official, were named in an alleged cover-up of allegations of sexual abuse brought against WHO field staff and consultants responding to an Ebola outbreak in the Democratic Republic of Congo. They were later cleared by an UN investigations panel. Nedret Emiroglu, a former Director for Country Readiness Strengthening in the Health Emergencies Division, was meanwhile named to head the WHO Secretariat for the Intergovernmental Working Group (IGWG), which is negotiating further provisions of the WHO Pandemic Agreement approved in May – most notably a proposed system for Pathogen Access and Benefit Sharing (PABS). Staff Reductions to date WHO workforce, headquarters, country offices and regions, in 3rd Quarter 2025, a reduction of over 500 staff in comparison with December 2024. In a press briefing last week, Tedros publicly acknowledged that the organisation plans to reduce WHO staff worldwide by an estimated 2371 positions by mid-2026, shedding about 25% of the workforce, which numbered 9,466 at the end of December 2024, and just under that as of 1 January. Around 1,089 staff are being shed through what WHO described as “natural attrition.” This includes retirements, early retirement, and the non-renewal of short-term staff contracts that expire. In addition, another 1,282 long and short-term posts have been abolished outright, according to statements at the presser and the earlier briefing to WHO member states. That should bring WHO’s global staff headcount down to about 7,360 professional and administrative positions by mid-2026. In terms of sheer numbers, professional staff at low and mid-level are among those hit hardest by the staff cuts.. Of those cuts, some 505 staff had left WHO by end September, WHO human resource records show; that count was confirmed by a WHO spokesperson. “A large number of staff are exiting at the end of December, three-months notice while notified in September,” the spokesperson told Health Policy Watch. “And another large number will leave in June 2026, i.e. the ones with reassignment rights.” In terms of D1 and D2 directors, whose numbers nearly doubled in the first six years of Tedros’ administration, costing the organisation nearly $100 million annually, some 21 Directors’ positions had been eliminated as of 30 September. That brings the number of directors worldwide down from a peak of 188 at end 2024 to 167 in Q3 2025. WHO Directors – 3rd Quarter 2025 – versus December 2024. That still leaves another 30 D1 and D2 posts to be eliminated by June 2026, mostly at headquarters. The massive reorganisation announced in April and May, slashed the number of departments and directors at headquarters by more than half – from 76 to 34 positions). The reason those reductions haven’t yet been reflected in the HR records is simple, WHO says. “Some directors who are sitting on positions that have been abolished have up to 6 months reassignment [rights] plus a 3-month notice period,” a WHO spokesperson said, “hence they still appear in the Q3 report. The target remains for June 30, 2026.” How will cuts translate into budget savings? Despite the painful plans to cut more 2,371 staff worldwide by June 2026, a projected funding gap remains of $1.05 billion, according to the director general’s last report to member states in November. The $1.7 billion funding gap for 2026-27 has been reduced to $1.05 billion, according to current projections. And the degree to which cuts in rank-and-file, as well as high level positions, will lead to actual savings remains to be seen. WHO’s November reports to member state did not offer any detailed analysis of projected savings that would be gained through the reductions by staff grade or office location. Even less detail provided on the status, conditions and costs of non-staff contract holders – about which there is no reporting even of pay grades or geographic base, let alone gender and age. That’s despite the fact that WHO’s non-staff’s headcount of 7582 (full-time equivalents) in 2024 was approaching that of actual staff numbers (9466) for that year. WHO officials say that the lack of more detailed reporting on non-staff contracts, is linked to legal and ethical issues. “WHO does not systematically capture, aggregate or publish individual-level information (such as grade equivalence, age, gender or demographic background) for non-staff contractual arrangements,” a WHO spokesperson told Health Policy Watch. “Doing so would raise legal, ethical and data-protection concerns, as WHO is not the employer of these individuals and does not have a mandate to collect or process such personal data beyond what is strictly required for contractual and financial compliance.” This table in WHO’s bi-annual HR report is the sole data available on non-staff contracts. It notes full-time equivalents for part-time engagements (consultants and APWs). Presuming that most Special Service Agreements (SSAs) are full-time, total estimated full time equivalent contracts numbered nearly 7600 in 2024. At the highest levels of WHO staff, meanwhile, some directors whose departments at headquarters were abolished remained in the organisation as a heads of unit, which typically carries a top-level professional grade of P6. In the UN grading system, the salaries of D1 directors and P6 professionals are virtually identical. And some former department heads now running units have even clung to their old titles, regardless of the formalities. Signature of a former director – (phone number and email have been erased to protect privacy). In an email invitation to colleagues for a late November reception at the WHO canteen, the former Director of the Department of Public Health and Migration (PHM), who is now technically a unit head, couldn’t resist signing the invite with his old title as well: “Head of Special Initiative on Health and Migration (Director). Division of Universal Health Coverage and Healthier Populations.” Observed one WHO staff member: “This kind of thing is all over the place. As for cost reduction, NADA!” Image Credits: WHO HR database , WHO , WHO Workforce Data, December 13 2024, WHO . Posts navigation Older postsNewer posts