WHO Director General Dr Tedros Adhanom Ghebreyesus with UN Under Secretary General Amina Mohammed at Thursday’s  opening of the UN High Level Meeting on Noncommunicable Diseases.

NEW YORK CITY – A painstakingly negotiated Political Declaration on Noncommunicable Diseases with overwhelming support from UN member states failed to win formal endorsement at a special High Level Session of the General Assembly (GA) Thursday – after the United States torpedoed its adoption by consensus.

The last minute moves means that the draft declaration will have to face a vote in the GA – most likely next month, observers said. 

Dozens of presidents, prime ministers and health ministers, speaking on behalf of the world’s largest blocs of both developed and developing countries, hailed the draft, saying it should be approved immediately, at the Fourth UN High Level Meeting on NCDs and Mental Health.  

But in a blustery statement, US Health and Human Services Secretary Robert F Kennedy Jr charged that the UN draft went too far in recommending measures like taxes on unhealthy products – while not going far enough on other chronic disease related issues. The US veto means the draft must be submitted to a formal member state vote to be endorsed as the declaration was supposed to be by consensus. 

Annalena Baerbock, UN General Assembly president, declares that the draft declaration will go before the UN General Assembly.

“Throughout the course of the plenary segment today, we have listened intensively to the position of member states regarding the draft political declaration,” said the current UN GA president, Annalena Baerbock, a German diplomat.

“While I understand that there remain objections by some member states, there is also broad support for the text. The document will be considered by member states in the General Assembly,” Baerbock concluded.

RFK Jr: Declaration ‘exceeds the UN’s proper role’

Robert F Kennedy Jr says the United States would ‘walk away’ from the political declaration.

Addressing the High Level Meeting,  Kennedy charged that the final draft text “exceeds the UN’s proper role while ignoring the most pressing health issues, and that’s why the United States will reject it. 

“More specifically, we cannot accept language that pushes destructive gender ideology,” Kennedy said. “Neither can we accept claims of a constitutional or international right to abortion. The WHO cannot claim credibility or leadership until it undergoes radical reform. The United States objects to the political declaration of non communicable diseases. 

“The draft declaration should not have been included in today’s agenda,” Kennedy insisted, adding it was “filled with controversy with provisions about everything from taxes to … management by international bodies of communicable diseases”.

However, the final draft text makes no reference to abortion, stating only that NCDs need to be mainstreamed into “sexual and reproductive health programmes” – a move to ensure the integration of health services. Cervical cancer is a substantial risk factors for women and can be picked up by simple screening.

The declaration’s single reference to gender calls for mainstreaming “a gender perspective” into NCD prevention and control as a critical lens for understanding and addressing the health risks of women and men “of all ages”.  Women are far more likely than men to be obese, while men are more prone to NCDs such as liver cancer.

Kennedy’s statement was also paradoxical as he has ostensibly made fighting chronic diseases, including risks like obesity an unhealthy foods, a cornerstone of his Make America Healthy Again (MAHA) agenda. 

“The United States will walk away from the declaration,” Kennedy concluded. “But we will never walk away from the world or our commitment to end chronic disease. We stand ready to lead to partner to innovate with every nation committed to a healthier future.”

Overwhelming support by other member states

Suriname’s President, Dr Jennifer Simons, a physician, stresses importance of mental health.

At the HLM meeting, the US role seemed to model anything but leadership.  The solid wall of statements by countries expressed support for the draft resolution as it was agreed to in early September.

Those included endorsements by:  the Group of 77 including China, the UN’s largest bloc representing 130 emerging economies; the Gulf Cooperation Council, representing a powerful group of Middle East oil-producing states; the Caricom alliance of Caribbean nations; the European Union; Pacific Island nations; and the Philippines, speaking on behalf of the Association of Southeast Asian Nations (ASEAN).  

The Philippines noted that it had deployed over 20,000 primary care providers to address NCDs and mental health at primary care level at a cost of about $518 million.

“The investment case is clear. NCDs cost the Philippines $13.5 billion annually through the health care cost and productivity losses,” said Secretary of Health Teodoro Herbosa. 

Suriname’s new President, Jennifer Simons, herself a physician, stressed the importance of addressing mental health, a theme echoed by many ministers as well as other heads of state and government.

“Our people are more and more confronted with the impact of mental health challenges. They feel lonely, depressed and often isolated. We will have to pay attention to the risk of social media and screen time in general, on the mental health of our children,” Simons said, adding that countries like hers also face “an escalating race of unhealthy lifestyles, which causes, of course, obesity among children, and adults.”

“The US seems to be trying to sabotage the process, but we don’t see how they can succeed at this point,” said Alison Cox of the NCD Alliance. “It is really short-sighted and reckless in the face of an urgent global crisis.”

In a subsequent statement the Alliance sounded an optimistic note: “while it is disappointing that a tiny minority of governments voiced their objection to the declaration, they stand isolated. The momentum for accelerated action is growing… The Declaration has been referred to the UN General Assembly. This means that it will now move forward through the formal UNGA process for adoption as a resolution in the coming weeks.” 

First political declaration to set clear NCD targets

The draft sets, for the first time ever, some defined, if modest, targets for combatting NCDs, stating that by 2030, there should be 150 million fewer people using tobacco; 150 million more people with hypertension under control and 150 million more people with access to mental health care. 

Testing a patient for hypertension. Two-thirds of Africans with high blood pressure are unaware of their condition.

Those targets are still far removed from aspirations of UN Sustainable Development Goal 3.4, established a decade ago, which calls for a reduction of premature NCD deaths by one-third by 2030. Since then, the NCD burden has only grown larger and chronic diseases now represent 74% of premature deaths worldwide. 

The final draft also saw language supporting national taxes on unhealthy products, one of the most potent tools for prevention, watered down under industry pressures. That text now recommends that member states: “consider introducing or increasing taxes on tobacco and alcohol to support health objectives, in line with national circumstances.”

WHO’s role in combating NCDs affirmed

The draft political declaration is the strongest appeal, to date, for access to mental health services.

Over earlier US objections, the draft declaration refers to WHO in half a dozen sections, recognising “the key role of the World Health Organization as the directing and coordinating authority on international health in accordance with its Constitution to continue to support Member States through its normative and standard-setting work, provision of technical cooperation, assistance and policy advice, and the promotion of multisectoral and multistakeholder partnerships and dialogues.” 

WHO “Best Buys” for prevention and control of NCDs are also cited. The Best Buys are a package of 16 key interventions to prevent and address smoking, excessive alcohol use, physical inactivity and obesity, as well as cancer risks.

“The political declaration before you is the strongest yet with ambitious, measurable and achievable targets,” said WHO Director General Dr Tedros Adhanom Ghebreyesus, speaking at the opening of the meeting. 

The political declaration, the fourth since 2011, also marks the first time that mental health risks are extensively addressed as part of the NCD paradigm, Tedros pointed out.

Examples of the 16 WHO Best Buys to prevent and control NCDs.

“For the first time, mental health is fully integrated into a political declaration. “It’s about time, in this declaration, you’re committing to expanding access to services for mental health care, but brick by brick, we must also tear down the walls of stigma that keeps so many people trapped.”

Indeed, the text not only makes reference to mental health conditions, including “anxiety, depression, and psychosis affect close to 1 billion people worldwide” but also to other neurological conditions, including “Alzheimer’s disease and other forms of dementia,” as well as substance abuse.

“It felt surreal that it was not expressely included before, when it is forecasted to be the 3rd leading cause of death overall, globally, by 2040,” remarked Paolo Barbarino, CEO of Alzheimer’s Disease International, one of many civil society groups celebrating this year’s breakthrough.

Tedros called on countries to implement three measures in connection with combatting NCDs; more preventive measures; full integration of NCD diagnosis and care into primary healthcare systems; and more equitable access to medicines and treatments. 

“Health does not start in clinics and hospitals. It starts in homes, schools, streets and workplaces, in the food people eat, the products they consume, the water they drink, the air they breathe, and the conditions in which they live and work,” Tedros declared.  “So the number 1 [ask] should be addressing the root causes and helping people to lead a healthy life.

“Second, I ask all countries to integrate services for NCDs and mental health into primary health care at the foundation of universal health coverage.  

“Third, I ask all countries to deliver equity through access and accountability.  That means making essential medicines and technologies available and affordable to all with financing that reduces out of pocket payments or costs. 

Air pollution mentioned – but not its fossil fuel sources

Smoke billows from power plant in Poland – generating both air pollution and CO2 emissions.

The new declaration also mentions air pollution as a ‘fifth’ risk factor for NCDs, a position for which environmental health advocates have long argued. 

The text states that member states  “recognize also that the main modifiable risk factors of noncommunicable diseases are tobacco use, harmful use of alcohol, unhealthy diets, physical inactivity and air pollution and are largely preventable and require cross-sectoral actions;”

It also notes that an estimated 7 million people die prematurely every year from air pollution-related diseases – most of them NCDs. These include air pollution-related hypertension, heart and lung diseases, and cancers that develop as tiny air pollution particles travel through the bloodstream and into key organs of the body, including the brain. 

And the draft text recommends measures that can reduce air pollution and its related disease burden, including:  “clean, efficient, safe, accessible and expanded urban public transport options, and active mobility, such as walking and cycling;” as well as reduced open waste burning; more affordable clean cooking, heating and electricity generation; vehicle and industrial controls on pollutants, as well as reduced exposures, particularly for children, to lead and other hazardous chemicals. 

(Center) Jane Burston, CEO Clean Air Fund: omitting fossil fuels is ‘like pledging to tackle smoking without mentioning tobacco.’

However, the declaration doesn’t go far enough on the sidesteps any reference to fossil fuels as a major source of health-harmful air pollutants, noted Jane Burston, CEO of the Clean Air Fund, and it makes no mention of the co-benefits that can be gained from reducing air pollutants – particularly for climate. 

“It’s like pledging to tackle smoking without mentioning tobacco,” Burston said of the omission, in an appearance at a side event Wednesday evening, organized by the civil society group, the NCD Alliance. “We need to acknowledge where it’s coming from.”

Norway’s Minister of International Development, Åsmund Grøver Aukrust, said that “the declaration reflects also a challenging geopolitical climates. This has clearly influenced the outcome of these documents… We regret the removal of targets for taxes on tobacco, alcohol and sugar sweetened beverages. We must work harder to prevent the devastating consequences of climate change, air pollution and their impact on health. We must be clear on our commitment on air pollution. Let’s remind ourselves that 95 percentage of all premature death due to air pollution occur in low- and middle-income countries.”

US objections – not entirely a surprise

Ralph Gonsalves, Prime Minister of St Vincent and the Grenadines, tells the Assembly that the draft was the result of a painstaking negotiation.

The US objections were not a complete surprise.  A 3 September memo to the president of the UN GA by the political declaration’s co-facilitators, Luxembourg and St. Vincent and the Grenadines, declared that the draft represents “the broadest possible consensus” – but not full agreement amongst all member states: 

“On 2 September, we were informed by one delegation that it is not able to join consensus despite all our collective efforts,” stated the letter, obtained by Health Policy Watch. “While there is no unanimity of views, it is our firm belief that the finalized version of the political declaration we are submitting to you adheres to the principle of consensus because it reflects a general agreement among the membership and garners the broadest possible political acceptance by Member States. It represents the broadest possible consensus.” 

Then, in a 18 September memo, the US Mission to the United Nations raised the issue again, saying: “The most recent draft of the political declaration has not been agreed by consensus in advance, and thus the conditions stipulated by the modalities resolution have not been met. Therefore, the draft political declaration should not be brought before the high-level meeting for approval.”

Ralph Gonsalves, Prime Minister of St. Vincent and Grenadines, which co-facilitated the negotiations, told the HLM: “We recognize that it is not perfect, but perfection is not the standard in multilateralism, nor is it the measure of progress. What we have is a declaration that is robust, comprehensive enough to provide the necessary catalyst for action, and reflects the broadest possible consensus.”

‘Birthday checkups’ and other country commitments

Indonesia’s Deputy Director General on NCDs, Bonanza Perwira Taihitu.

In public and informal fora around the HLM, member states talked about what they are already doing to combat the global NCD epidemic – from higher taxes on items like sugary drinks and tobacco, to training health care workers to screen ‘at risk’ populations.

“We didn’t want to call them mandatory checks, so we are calling them ‘birthday checks’,” quipped Bonanza Perwira Taihitu, Indonesia’s Deputy Director General for NCDs,  at an event sponsored by the NCD Alliance before the HLM. The country’s drive to conduct health screenings for hypertension, high blood pressure and other NCDs, which began in February, has already reached 32 million people out of Indonesia’s population of some 280 million people, he said.

Indonesia is also investing heavily in new digital health systems, Taihitu added, echoing calls by industry forces to national health systems to expand their reach  “via health innovation systems” along with expanding Universal Health Coverage to combat the high cost of NCD diagnosis and treatment.

Jeremy Farrar, WHO Assistant Director-General of Health Promotion, Disease Prevention and Control (right) at a NCD Alliance panel event Wednesday evening.

Meanwhile, Jeremy Farrar, WHO Assistant Director General said that while the politics around the declaration is regrettable, what really matters is the momentum being seen at the national level.

“Although we need to say nobody’s happy with it, everybody is moving forward,” Farrar said, looking at the glass half-full.  “And ultimately, does anybody in Ho Chi Minh City or Jakarta or London really care what’s in that declaration? What matters is what the governments now go back to do in their own jurisdiction, and that’s what really matters.”

Image Credits: Hush Naidoo Jade Photography/ Unsplash, WHO, PAHO, Janusz Walczak/ Unsplash, E. Fletcher/Health Policy Watch.

WHO Director General Dr Tedros Adhanom Ghebreyesus at the launch of the hypertension report.

World leaders are expected to commit to 150 million fewer tobacco users, 150 million more people under hypertension management, and 150 million more people with access to mental care by 2030 at the United Nations on Thursday.

These targets are in the final draft of the political declaration set for adoption at the UN High-Level Meeting on Non-communicable Diseases (NCDs) and Mental Health in New York.

Earlier in the week, the World Health Organization (WHO) released its global hypertension report, which showed that 1.4 billion people lived with hypertension in 2024 – yet only around 20% (320 million) had their high blood pressure under control.

“Hypertension is a leading cause of heart attack, stroke, chronic kidney disease, and dementia. It is both preventable and treatable – but without urgent action, millions of people will continue to die prematurely, and countries will face mounting economic losses,” according to the report, released on the sidelines of the UN General Assembly.

WHO Director General Dr Tedros Adhanom Ghebreyesus told the launch that he lived with hypertension, which is controlled by medication: “And that is the great paradox of hypertension. It can be controlled by relatively inexpensive medication.”

However, access to affordable medicine and blood pressure devices were the biggest barrier to controlling high blood pressure, added Tedros.

The report, which draws on data from 194 countries, also shows that only 28% of low-income countries had all five WHO-recommended hypertension medicines readily available in their clinics.

“Barriers span the pharmaceutical value chain, from regulatory systems and medicine selection, to pricing, procurement, prescribing, and dispensing,” according to the report.

Major gaps

Other major gaps in addressing hypertension include weak communication about risks – such as the consumption of alcohol, tobacco, salt and transfat, and physical inactivity.

Some countries had limited access to blood pressure devices, a lack of trained primary care teams, unreliable supply chains and costly medicines.

“Every hour, over 1,000 lives are lost to strokes and heart attacks from high blood pressure, and most of these deaths are preventable,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“Countries have the tools to change this narrative. With political will, ongoing investment, and reforms to embed hypertension control in health services, we can save millions and ensure universal health coverage for all.”

Dr Kelly Henning, head of Bloomberg Philanthropies Public Health Program.

Dr Kelly Henning, who leads the Bloomberg Philanthropies Public Health Program, told the report’s launch that countries that “integrate hypertension care into universal health coverage (UHC) and primary care are making real progress, but too many low- and middle-income countries are still left behind.” 

Dr Tom Frieden, CEO of Resolve to Save Lives, said that the lives of 50 million people can be saved if the global control of high blood pressure was increased from the current 20% to 50%. He also highlighted that uncontrolled high blood pressure is the cause of one-in-six patients’ dementia.

“It only costs $5 a year to treat a patient with the best medications in the world,” said Frieden. “Twenty-five years ago, South Korea’s hypertension control was 15%. They have increased this to 62% this year … and seen a decline of over 80% in cardiovascular deaths.”

Resolve to Save Lives CEO Dr Tom Frieden.

The report also gives credit to Bangladesh and the Philippines for making significant progress – largely by “integrating hypertension care into UHC, investing in primary care, and engaging communities”.

Low-cost anti-hypertensive medication and limited patient fees in South Korea have enabled the country to improve blood pressure control nationally.

Between 2019 and 2025, Bangladesh increased hypertension control from 15% to 56% in some regions by embedding hypertension treatment services in its essential health service package and strengthening screening and follow-up care.

The Philippines has effectively incorporated the WHO’s HEARTS technical package into community-level services nationwide.

The draft declaration commits countries to scaling up “early screening, monitoring and diagnosis, affordable and effective treatment, and regular follow-up for people at risk of cardiovascular disease or living with high blood pressure”.

Impact of mental health

Social isolation is a risk factor for mental illness and Alzheimer’s.

Meanwhile, over one billion people across the world are living with mental health disorders, according to two WHO reports, ‘World Mental Health Today’ and ‘Mental Health Atlas 2024’, released earlier this month.

In low-income countries, fewer than 10% of affected individuals receive care, compared to over 50% in higher-income nations.

“Transforming mental health services is one of the most pressing public health challenges,” said Dr Tedros. “Investing in mental health means investing in people, communities, and economies — an investment no country can afford to neglect. Every government and every leader has a responsibility to act with urgency and to ensure that mental health care is treated not as a privilege, but as a basic right for all.”

The draft declaration commits to several measures to address mental health, including scaling up “psychosocial and psychological support, and pharmacological treatment for depression, anxiety and psychosis”, particularly at the primary health care level and within general health care services.

It also commits to addressing the stigma associated with mental illness, and the “health risks related to digital technology, including social media, such as excessive screen time, exposure to harmful content, social disconnection, social isolation, and loneliness.”

Weakened declaration

While NCD advocates have welcomed the three “150 million” targets, they have lamented the weakening of language on taxing unhealthy products since the zero draft in May.

As previously reported by Health Policy Watch, the text no longer refers to taxing sugar-sweetened beverages, and describes higher taxes on tobacco and alcohol as “considerations… in line with national circumstances” rather than concrete proposals.

The zero draft target of “at least 80% of countries” implementing excise taxes on tobacco, alcohol, and sugar-sweetened beverages to levels recommended by the WHO by 2030 is completely absent from the final draft.

The declaration has also removed virtually all references to WHO recommendations. This is apparently at the insistence of the United States, which withdrew from the WHO when Donald Trump became president in January, sources close to the talks told Health Policy Watch.

Image Credits: Bruno Martins/ Unsplash.

Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections.

Two Indian manufacturers will be able to mass-produce cheap generic versions of the HIV ‘miracle’ drug, lenacapavir, which almost eliminates HIV transmission via an injection given twice a year – thanks to support from donors.

The Gates Foundation will support Hetero Labs, while Unitaid, the Clinton Health Access Initiative (CHAI), and Wits RHI will support Dr Reddy’s Laboratories. This will reduce the annual price per patient for the two injections to $40, according to simultaneous announcements in New York on Wednesday.

Gates is offering Hetero “upfront funding and volume guarantees”, and Unitaid-CHAI-Wits RHI will provide Dr Reddy’s with “financial, technical, and regulatory support to deliver affordable, quality-assured generic versions of lenacapavir to low- and middle-income countries (LMICs) by 2027, following regulatory approval.”

In clinical trials, lenacapvir eliminated 99% of HIV transmission, making it the closest product to an HIV vaccine.

One study shows that scaling up access to lenacapavir to just 4% of the population in high-burden countries could prevent up to 20% of new infections, according to the Gates Foundation.

It has made more than $80 million available in “catalytic investments” to accelerate market readiness, scale delivery, and shorten the timeline for generic entry of lenacapavir.

End HIV

“Scientific advances like lenacapavir can help us end the HIV epidemic—if they are made accessible to people who can benefit from them the most,” said Trevor Mundel, president of global health at the Gates Foundation. “We are committed to ensuring that those at highest risk, who can least afford it, aren’t left behind.”

“Securing a US$40 price for the twice-yearly lenacapavir injection for PrEP is a historic breakthrough that proves the most advanced tools can be made affordable from the very start,” said Unitaid’s executive director, Dr Philippe Duneton.

In 2024, Gilead Sciences granted royalty-free licenses for lenacapavir production to six generic manufacturers for 120 low- and middle-income countries. Following regulatory approvals, generic lenacapavir will flow through national HIV programs and public procurement channels such as the Global Fund.

On 4 September, the US government announced that lenacapavir’s US manufacturer, Gilead, had made the drug available to the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund at cost.

PEPFAR plans a “market-shaping initiative” to get the drug to some two million people in countries with high burdens of HIV, according to the US announcement.

PEPFAR will focus on using lenacapavir to prevent mother-to-child HIV transmission.

Still ‘far away’

“The deals announced today on generics are a major step forward in ending the HIV epidemic,” said Kate Hampton, CEO of the Children’s Investment Fund Foundation (CIFF), which is also supporting the rollout of lenacapavir via the Global Fund. 

“They build on full value-chain investments by CIFF and others to foster a competitive market so that access to lenacapavir is affordable and reliable for all those who need it.”

“This is a watershed moment. A price of $40 per person per year is a leap forward that will help to unlock the revolutionary potential of long-acting HIV medicines,” said Winnie Byanyima, executive director of UNAIDS.

Describing lenacapavir as “revolutionary”, UNAIDS pointed out that its current annual price in the US is $28,000 per person.

UNAIDS estimates that 1.3 million people were infected with HIV in last year.

Beatriz Grinsztejn, president of the International AIDS Society, welcomed lenacapavir generics being made affordable, but said “availability in 2027 still feels far away.”

“With the HIV response in a funding crisis, countries are already making difficult trade-offs. To realize the full potential of this innovation, [pre-exposure prophylaxis] options like lenacapavir must reach the most vulnerable people, which requires urgent, additional investment to avoid delays or denied access.”

Meanwhile, a global HIV activist coalition noted that the $40 price will be “restricted to the 115 LMICs and five territories covered by Gilead’s voluntary license” announced  earlier this year.

They called for global access tongenerics, particularly as “over a quarter of new HIV acquisitions occur in the 26 countries and territories that are excluded by Gilead from its license, including Argentina, Brazil, Mexico”.

Image Credits: Gilead, Gilead.

The Elders panel: Pandemic Action Network head Eloise Todd (moderator),  Juan Manuel Santos, former President of Colombia; Mary Robinson, ex-President of Ireland; Zeid Ra’ad Al Hussein, former UN High Commissioner for Human Rights; Helen Clark, former Prime Minister of New Zeland, and Dr Gro Harlem Brundtland, former Prime Minister of Norway and former WHO Director-General.

Despite the massive challenges of climate change, disease outbreaks and conflict, there is a glaring lack of leadership committed to long-term, science-based solutions, former world leaders told a meeting on the sidelines of the UN General Assembly (UNGA) in New York.

“We need leaders who have a long-term view and take decisions that, many times, are unpopular or difficult,” said Juan Manuel Santos, former President of Colombia and chair of The Elders.

“The UN has never met in more difficult times since its creation after the Second World War,” added Santos, calling for reform of the UN to “recover the world order from this present world disorder”.

Mary Robinson, Ireland’s former President, said that leaders need to be in “crisis mode” to tackle climate change and health.

“Some [leaders] are saying extraordinary things, but the science is clear, and it’s vital on climate and health. Somehow leaders are not actually grounding their way forward on science,” said Robinson.

Ireland’s former President, Mary Robinson

Her sentiment was echoed by Helen Clark, the former Prime Minister of New Zealand, who reminded the audience that the world had faced darker times – but conceded that at present “leadership is a missing component”.

Clark stressed that the UN High-Level Meeting on Pandemic Preparedness in a year’s time needs to be a rallying point for countries, who need to address the crises of health and climate together.

“It’s amazing how bereft we are of profound ideas,” said Zeid Ra’ad Al Hussein, former UN High Commissioner for Human Rights.

“Just look at Gaza. It’s emblematic of where the world is today: the enforced starvation of children, and we just sit there and sit there and we denounce and we condemn. Something has to snap, and we have to regain a sense of responsibility.”

Dr Gro Harlem Brundtland, former Prime Minister of Norway and former Director-General of the World Health Organization (WHO) added that world leaders cannot only think about their countries but about the world.

Shortly after The Elders spoke, US President Donald Trump told the UNGA that climate change is the ”greatest con job ever perpetrated in the world”, and that UN climate change predictions ”were wrong” and made by ”stupid people”.

Wellcome CEO John-Arne Røttingen

In a panel after the Elders, Wellcome CEO John-Arne Røttingen said that countries formerly dependent on aid, particularly in Africa, were determined to assume more responsibility for their own systems and capabilities, and this was a positive move.

However, he warned that a focus on national sovereignty ran the risk of undermining the collective action and mechanisms needed to tackle common problems of climate, outbreaks and pandemics.

“Without the mechanisms to look at the leadership, the evidence and the financing we need for the collective problems, we will have big problems coming,” warned Røttingen.

The Gates Foundation’s Dr Chris Elias warned that the current era of “crisis and scarcity” is “incredibly dangerous” as people tend to “focus on what’s in front of you” rather than take a long-term view.

Since the massive withdrawal of donor aid by the US earlier this year, the Gates Foundation has assisted several governments, and most want data and analytics to empower them to determine what they should priotitise.

“The role of philanthropy in a time of both crisis and scarcity is to work closely with countries as they weather this storm and, at the other side, to invest in some of those global public goods that are unlikely to get prioritised by individual countries or even regional bodies at a time of crisis,” said Elias, highlighting the Gates Foundation’s announcement on Monday to invest $912 million in the Global Fund over three years.

US ‘science denial’ is an ‘attack on global health’

Brazil’s Health and Environmental Surveillance Secretary Dr Mariângela Simão.

While several speakers avoided naming the US when lamenting how global priorities have been abandoned and undermined, Brazil’s Health and Environmental Surveillance Secretary, Dr Mariângela Simão, did not mince her words.

“We have attacks on multilateralism. We have attacks on specific countries. And my country is being attacked,” she said.

‘The US government is saying to Brazil that you shouldn’t put in jail in the ex-president [Jair Bolsanero] who tried to do a coup d’etat,” said Simão. 

The US “denial of science” is also an attack on global health, she added. “When denial is becomes a public policy, it affects the world. [There is] an attack on vaccines, and what we see in the Americas is a surge of measles.

“Brazil and our neighbours are all trying to stave off [outbreaks] by boosting up our vaccine coverage. But it doesn’t help when the US says you don’t need to vaccinate newborns against Hepatitis B unless the mother is positive.”

However, Simão said that Brazil, which hosts the next climate COP in Belém later this year, is working on a health action plan that will address how climate impacts on health.

Simão is leading Brazil’s health delegation to the UN after the US restricted Health Minister Alexandre Padilha’s visa to within “five blocks of the UN”. The US has also refused to give visas to the leaders of the Palestinian Authority to attend UNGA.

Preparing for pandemics

Priya Basu, who heads the Pandemic Fund, said there is “huge demand” from countries for support – with demand exceeding available funds five-to seven-fold every time the fund called for proposals.

“We have distributed $7 billion of pandemic prevention, preparedness and response investments across 75 countries in six regions,” said Basu.

These focus on surveillance, laboratory, strengthening workforce, and surge capacity that can be ramped up in crises.

Meanwhile, Felicitas Riedl, director of Innovation and Competitiveness at the European Investment Bank (EIB), said her bank invested in projects that had a “systemic approach” to addressing “health, climate and biosecurity”.

Intergovernmental Working Group (IGWG) vice-chair Madeleine Heywood of Australia and WHO Director General Dr Tedros Adhanom Ghebreyesus at the close of IGWG’s second meeting.

Text-based negotiations on the final piece missing from the World Health Organization’s (WHO) Pandemic Agreement will begin in November – and “relevant stakeholders’ will be allowed to observe them for the first time as a “pilot”.

This was resolved at the second meeting of the WHO Intergovernmental Working Group (IGWG), which concluded last Friday evening.

The Group of Equity proposed to the IGWG that the negotiations be opened up to “relevant stakeholders’, groups that have been formally recognised by the WHO. Several stakeholders have also made this call throughout the Pandemic Agreement negotiations.

Countering misinformation

In its submission to IGWG last week, Knowledge Ecology International (KEI) said: “The secrecy that surrounds negotiations on the WHO pandemic treaty undermines trust in the WHO, and enables misinformation to have more impact.”

It called on the WHO to follow the lead of the World Intellectual Property Organization (WIPO) and webcast all plenary sessions.

“The WHO could do better and allow the sharing of information from informals under the Chatham House rule, so that the public has information about what issues divide negotiators, and why,” KEI added.

There are over 200 stakeholders, according to a WHO list. These include intergovernmental agencies, such as the United Nations, African Union, Pan-American Health Organization and the South Centre. 

Groups with observer status, including the vaccine alliance, Gavi, and the Global Fund, non-state actors in official relations with the WHO and other stakeholders recognised by the WHO can also attend. This opens the door to groups such as the Coalition for Epidemic Preparedness Innovations (CEPI), Drugs for Neglected Diseases initiative (DNDi), KEI, Medicines Patent Pool, Médecins Sans Frontières (MSF) and the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).

Many of these groups have followed the pandemic agreement negotiations since the start and have frequently asked to observe the actual negotiations, rather than simply being allowed to attend and address plenaries.

WHO Director General Dr Tedros Adhanom Ghebreyesus welcomed the decision, saying that this would “give ownership to all stakeholders” when he addressed the end of the meeting.

Describing last week’s discussions as “substantive and positive”, Tedros said this gave him hope that the talks will be concluded by the deadline of next May.

The meeting discussed the draft outline of elements that need to be addressed by the outstanding annex on a Pathogen Access and Benefit-Sharing (PABS) System, including operation, access, benefit-sharing and governance, scope and use of terms, according to its report.

After a series of informal meetings in the week of 6 October, the IGWG Bureau will prepare a draft of the annex, “taking into account all elements, building on the draft outline of elements and taking into consideration written submissions by IGWG Members, inputs received during the second meeting of the IGWG, and informal discussions”, according to the report.

The actual negotiations will begin later at the third IGWG meeting from 3-7 November and continue at the final meeting of the year from 1-5 December.

Young people in Bengaluru, India, march on World No Tobacco Day. Through its work with the Partnership for Healthy Cities, Bengaluru has reduced smoking in public spaces by 25%.

On 25 September, world leaders will gather at the United Nations for the Fourth High-Level Meeting on Noncommunicable Diseases (NCDs).

It comes at a pivotal moment: funding for global health has plummeted, while NCDs like heart disease, cancer and diabetes continue to claim 75% of all lives lost worldwide. This amid recent efforts to water down the list of commitments to be made at the UN meeting, under pressure from industry groups.

Against this backdrop, one of the most powerful allies in the fight against NCDs is at risk of being overlooked: cities.

For centuries, cities have driven public health progress, from sanitation systems to outbreak response. Home now to almost 60% of the world’s population, they are especially well positioned to tackle modern health threats such as NCDs. 

Urban residents are often more exposed to risk factors such as polluted air, unhealthy food environments and unsafe streets than their rural counterparts – and cities have the local knowledge to spearhead targeted solutions.

A seat at the table

Active mobility in the El Zalate school district of Guadalajara, Mexico got a boost when the city worked with the Partnership for Healthy Cities to enhance safe pedestrian spaces.

This is why it’s imperative that all levels of government have a seat at the table, and that cities can secure support based on their well-established leadership on public health.  The Partnership for Healthy Cities, a network of 74 cities worldwide committed to reducing NCDs and injuries, is driving just towards those aims. The partnership is supported by Bloomberg Philanthropies together with the World Health Organization (WHO) and the global health non-profit, Vital Strategies.

In London, for instance, where rising NCD rates amongst children were disproportionately impacting lower-income areas, the city’s 2019 junk food advertising restrictions in public transportation are estimated to have prevented nearly 100,000 cases of obesity and are projected to save over £200 million in healthcare costs. The policy had the biggest health impacts on people from low-income areas, showing how population-based strategies to address NCDs reduce long-standing health inequalities.

Urban leadership also plays a critical role in implementing national health policies, bridging the gap between country-level policymaking and the realities of community-level enforcement. 

Take Bengaluru in India, home to around 14 million residents. Here, the city has helped bring India’s national tobacco control laws to life through a dedicated network of experts, successfully reducing smoking rates in public places and earning global recognition for their efforts.

Pilot sites for innovation

Quito in Ecuador launched a healthy foods in schools project as part of a Partnership for Healthy Cities initiative.

Finally, cities can accelerate progress by going beyond national legislation, introducing their own policies and even acting as pilot sites for new and innovative ideas. 

Córdoba, Argentina, the Latin American nation’s second largest city, last year removed junk food and sugary drinks from schools, directly benefiting 15,000 children.

The changes gained local support in part because policymakers could cite evidence that such early interventions positively shape children’s health by influencing consumption patterns and decision-making throughout life. The Córdoba model is currently being considered for adoption by other Argentinian cities and at the provincial level as well. 

Córdoba , Argentina, replaced sugary drinks with healthier alternatives.

Now is the time for national governments to empower municipalities to advance this kind of urban NCD prevention – at the September meeting and beyond – by increasing funding and giving local leaders greater authority to spearhead solutions that are working in cities around the world. 

Similarly, international bodies should support cities’ work with financing and technical tools that are tailored to their needs. 

Ahead of the High Level Meeting, the Partnership for Healthy Cities released a statement championing the role of cities in saving lives through NCD prevention. The World Health Organization has developed resources for cities including an Urban health capacities assessment and response resource kit that supports policymakers and practitioners to strengthen cross-sectoral action for healthier, more equitable cities.

This groundswell of support for urban authority and innovation must not be ignored, especially as the NCD crisis is getting worse. If we are to meaningfully address it and achieve the UN’s ambitious global targets to slash these preventable deaths by a third in the next five years, what’s required is unity and action.

NCDs are a global problem, but by bringing in allies such as cities, it is one we can tackle together. As the saying goes, a problem shared is a problem halved.

Ariella Rojhani is Director of the Partnership for Healthy Cities at Vital Strategies

Dr Etienne Krug is Director of the Department of Health Determinants, Promotion and Prevention at the World Health Organization

Image Credits: City of Bengaluru, City of Guadalajara, City of Quito/Juan Carlos Bayas, City of Córdoba , Argentina.

WHO Headquarters in Geneva where planned staff cuts are the focus of significant unrest.

In a 4 September message,  the WHO/HQ Staff Association called for an Extraordinary General Assembly (EGA), now due to take place on Monday, 22 September.

The message acknowledged what many staff were feeling: profound change, deep uncertainty, and a heavy personal and professional toll.

Their statement flagged key concerns raised by many WHO staff about the process that WHO’s top leadership has followed to make steep cuts in positions, worldwide and particularly at its Geneva Headquarters. The cuts were mandated by the budget crisis that hit the organization in early 2025 in the wake of the withdrawal of funding by new United States President Donald Trump, leading to a gaping $1.7 billion budget hole in WHO’s upcoming 2026-2027 two-year budget.

WHO staff working at the 78th World Health Assembly in Geneva, where a proposed $1.7 billion cut in the budget was a key topic of member state discussion

Transparency, fairness and sustainability cited as key concerns in process

Key concerns cited in the Staff Association message included failings of:

Transparency: organigrams revised without clear criteria or rationale, feedback disregarded;

Fairness: The “mapping and matching” of posts to be retained yielded a disproportionate impact on more junior grades, while senior posts were accommodated. That, as well as other process flaws created perceptions of bias;

Sustainability: a top-heavy structure of permanent posts, coupled with over-reliance on temporary contracts and revolving-door consultancy arrangements for core, operational tasks.

The letter called upon the WHO senior leadership for more data transparency, rebalancing of senior posts, fair recruitments, and accountability in termination meetings.

Staff Association demands to management in organization-wide letter on 4 September. A staff vote on Monday will consider several related resolutions.

Resolutions up for consideration on Monday

An Open House was convened on 9 September to hear staff points of vie. That is to be followed by the EGA on Monday, where staff members will vote on three resolutions contained in a “Call to Action” that has been circulating in parallel. Those resolutions demand:

  1. Full disclosure of Advisory Review Committee (ARC) discussions and results of all department-level reorganization plans, an “impact table of cuts”, post-by-post, with rationale and cost-savings; along with disclosures around named directors with open internal justice cases against them.
  2. A freeze on post abolitions, new assignments and external hires until the disclosures are completed and independently verified; all new/converted posts open to the staff reassignment pool applications, based on merit
  3. Mass relocations of jobs to regional and country hubs with a maximum of 10% of staff at Geneva’s headquarters; cancellation of all non-essential travel; and other ‘solidarity measures’, such as proportional trims by grade starting at the top, before reducing front-line technical posts.

And then came silence

Catherine Corsini, WHO Staff Association President reads a statement to the World Health Assembly in May 2025.

The Staff Association recent moves, while welcome, unfortunately come after a long period of silence when critical decisions were actually being made by WHO’s new senior leadership and departmental heads.

In the weeks of June, July and August, as draft organigrams were developed, post retention and abolition decisions were finalized and colleagues’ separations formalized, the Association was utterly silent.

So the question is how much impact can the petition that is to be debated and voted on at Monday’s EGA really have?

For some, it feels like a classic soap opera storyline:

🚨 the siren sounds only after the incident,

⚖ the damage is already done,

📺 and the drama shifts to hearings once the culprits are gone.

Judicial guardrails are still missing

A milestone process for investigating WHO’s Director General was approved at the May 2025 World Health Assembly – but WHO still lacks an independent internal justice system that puts all staff on an even playing field.

A deeper problem faced is the lack of accountability by WHO’s top-most echelons, and most of all, the director-general himself.

In February, a Staff Association statement before the WHO Executive Board’s 156th meeting stressed that:

“Reporting to the WHO governing bodies is not enough… A game-changing approach would be to establish an independent internal justice system reporting directly to the Board or an organ of the Health Assembly, similar to the current system for external audits.”

That call is even more urgent today. Petitions cannot replace a safe, trusted, and independent justice system where staff can raise concerns without fear of retaliation.

The restructuring is officially framed as down sizing due to funding cuts following the US pull-out. But in practice, it has also become an opportunity to forcefully and dishonourably remove longer-term staff with significant financial liabilities—sometimes worth years of payout packages (nearly around two and a half years of advance salaries, including indemnity and severances)—while retaining those on shorter contracts without financial liabilities but with closer reach to the DG’s office.

The World Health Assembly has already approved a milestone procedure to investigate the Director-General for misconduct at the Seventy-eight World Health Assembly in May 2025.

As reported in Health Policy Watch in May 2025, that new mechanism, however, also contains significant shortcomings, and is, at this stage is more symbolic and toothless than transformative. In addition, it is still not yet fully in place, and most unlikely during the period of this Director-General. See related story:

WHA Approves First-Ever Procedure for Investigating a WHO Director General  

Staff at all levels deserve the same protections

If oversight is necessary at the very top, surely staff at all levels deserve the same protections.

So the question remains: what purpose does a petition serve if there is no really independent mechanism to review the decisions being taken?

👉 The Staff Association was silent when that mechanism “to investigate the Director-General for misconduct”  was being drafted, negotiated, and adopted.

Without that, petitions such as the one being considered at Monday’s EGA risk becoming symbolic noise.  Staff may make their voices heard collectively for a moment in time. But they will still be forced to enter a lengthy, never-ending internal justice process as individuals – with no recourse to recouping their jobs – even if their cases are vindicated years later by the WHO’s supreme judiciary body, the International Labour Organizations, Tribunal of Appeals.

👉 For this petition to be truly extraordinary, staff, represented by the Staff Association, should also push for a genuinely independent mechanism where they can hold the Director-General himself accountable for all his decisions and actions—including the dishonourable removal of those who served with integrity. While the damage has already been done to those who lost their jobs due to so called restructuring, such an independent mechanism could protect others in the future.

Health Policy Watch disclaimer – The op-ed was submitted by a group of WHO staff representing diverse levels and functions in the organization, who requested anonymity, due to fear of reprisals.

Image Credits: Guilhem Vellut, WHO , WHO.

A woman prepares to get an HIV test in Uganda. The US will resume financing HIV tests, medicine and healthworkers delivering services.

The United States will resume funding HIV, tuberculosis, malaria and polio medicine and the salaries of health workers directly delivering most of these services to patients through bilateral deals with governments and faith-based organizations– at least for the 2026 financial year, according to the America First Global Health Strategy unveiled by the US State Department on Thursday.

The long-awaited strategy clarifies how the Trump administration aims to restructure the US President’s Emergency Plan for AIDS Relief (PEPFAR) and replace functions of the now defunct US Agency for International Development (USAID).

The three pillars underpinning the new strategy are to keep America safe, strong and prosperous, with aid for disease surveillance and containing outbreaks to feature in the new strategy as well.

US Secretary of State Marco Rubio described the strategy as “a positive vision for a future where we stop outbreaks before they reach our shores, enter strong bilateral agreements that promote our national interests while saving millions of lives, and help promote and export American health innovation around the world”.

Frontline investment to resume

Countries severely affected by the suspension of crucial US health aid when Donald Trump assumed office in January will welcome the news that around $1.3 billion in aid for HIV, TB and malaria diagnostics, drugs, and insecticide-treated bed nets will resume.

In addition, around $827 million for the salaries and benefits of healthcare workers directly serving affected patients will also resume in the 2026 financial year. 

Post 2026, the US “will cover a proportion of these costs, as countries will have required co-investment levels based on each country’s income level”.

It will “rapidly decrease”  funding that “does not go to frontline investments in commodities or healthcare workers”. The strategy flags international NGOs and social impact organisations, such as Abt, RTI International and Chemonics, which had traditionally played a major role as subcontractors implementing US aid programmes, as an approach the US will not support in future – citing outsize salaries for top executives as an example of waste. 

However, it aims to “leverage” faith-based hospitals and clinics to deliver health services, noting that these account for over 50% of the delivery capacity in countries such as Eswatini and Uganda.

Bilateral deals in a time-limited framework

The strategy thus favours bilateral deals over multilateralism, acknowledging that this is how China does business.

From next month, the US plans “intensive engagement with recipient country governments, other donors, and other in-country partners to shape a set of mutually agreeable priorities for future US health assistance”.

It aims to reach bilateral agreements with recipient countries by the end of 2025 and start implementing these agreements by April 2026. 

“These bilateral agreements will ensure funding for 100% of all frontline commodity purchases and 100% of all frontline healthcare workers who directly deliver services to patients,” according to the strategy.

However, the majority of 71 US-supported countries will “transition to full self-reliance during the term of the agreement,” the strategy also states – imposing a sharp time-limitation on most forms of aid. 

The new US global health strategy is aimed at making the US safe, strong and prosperous.

Integration of diseases

All US government health foreign assistance programs will be administered by the State Department, which “offers a tremendous opportunity to integrate across disease-specific programs including HIV/AIDS, TB, malaria, and polio”, according to the strategy.

Opportunities include the integration of supply chains, health workers, laboratories and data systems.

In the past, “separate disease-specific planning processes and implementing partners within an individual country that had little connection or collaboration with one another”, the strategy notes. 

This resulted in “duplication and missed opportunities to maximise and leverage investments across multiple diseases” and made it harder to integrate programs into countries’ existing health infrastructure, as these usually offer integrated care.

Aid as leverage

The strategy openly acknowledges aid as political leverage, saying that US health foreign assistance “has the potential to be an important counterweight to China, especially in Africa, a continent of strategic importance to US national interests”. 

“Africa also contains several of the largest deposits of key minerals and rare earth elements needed as inputs into advanced technologies that fuel critical military and commercial applications,” the strategy acknowledges.

“Rather than following the China model of loan-based agreements, which is aimed at extracting painful concessions from the country, the requirements that the United States will build into its agreements will be directed squarely at the achievement of public health goals and better facilitating transition towards country self-reliance,” the strategy notes.

Promoting US products as ‘commercial diplomacy’

The US will support the rollout of Gilead’s lenacapavir (branded as Sunlenca in the US) to prevent HIV infection.

It also wants US-supported global health programmes to use US-manufactured diagnostic tests and medicines.

In 2024, half the malaria rapid tests and 70% of the HIV rapid tests were purchased from American manufacturers, representing over $350 million of procurements. 

On 4 September, the US announced that it would support the US-based Gilead Sciences to roll out lenacapavir, a six-month injectable that has almost 100% efficacy in preventing HIV. 

It also acknowledges that US support for the Global Fund has created new markets for US products, with around $3.5 billion in US goods and services procured since 2010.

The US government will continue to make buying American products “a key component of future health foreign assistance programs, including ensuring that pooled procurement mechanisms are designed in a manner that facilitates access to the most critical medical innovations developed by US companies”.

It notes that the healthcare market in Asia alone is expected to reach $5 trillion by 2030, while Africa’s healthcare market is “projected to grow rapidly to more than $250 billion by 2030”, providing “several concrete opportunities where the US government can play a role in advancing commercial diplomacy”. 

A US official who spoke anonymously to Semafor shortly before the strategy was released said that, while Africa would continue to be a focus, the US is “going to invest more in the Western Hemisphere. We’re going to invest more in Asia-Pacific. We’re investing a quarter of a billion dollars in the Philippines, which is something we’re really, really excited about.”

‘Radical reset’

Dr Jirair Ratevosian, Hock Fellow at Duke University’s Global Health Institute

Dr Jirair Ratevosian, Duke University global health expert and former PEPFAR chief-of-staff, told Health Policy Watch that the strategy is “pragmatic, performance-oriented – and a bit ruthless”, marking “a radical reset” of how the US approaches global health.

Ratevosian welcomed the protection of life-saving medicine and the jobs of frontline health workers, and the integration of services.

“The next 18 months, as these bilateral agreements are signed, are going to be crucial. Civil society, the private sector, and global health advocates need to stay at the table to make sure this transition strengthens, rather than weakens, the fight against HIV, TB, malaria, and the next pandemic.”

He also noted that the strategy fails to mention South Africa, “the epicentre of the global HIV epidemic and a critical US partner”.

“The risk here is clear: the US may end up favouring countries that are geopolitically convenient rather than those where partnership is most needed to end AIDS,” he warned.

A nurse conducts an HIV test at a PEPFAR supported clinic in South Africa. It is unclear how much US support South Africa will get as the Trump administration has taken issue with various policy decisions.

The US has taken exception to various policy decisions taken by South Africa.

Ratevosian said that bilateral compacts with clear performance targets could make US aid more accountable and cut unnecessary overheads, “but only if countries actually can mobilise the money and systems to deliver”, he added.

“Many countries are nowhere near ready to pay 30–50% of program costs. If domestic budgets don’t materialise, we could see stock-outs, staff layoffs, and service collapse that could erase years of progress almost overnight.”

He also warned that bilateral deals could sideline the Global Fund and the global vaccine platform, Gavi, and their ability to pool resources to “create a united front against epidemics”. 

Meanwhile, AVAC warned that moving toward bilateral agreements “risks fragmenting coordination, intensifying the politicalisation of assistance, slowing disbursements, and creating uncertainty for countries already grappling with budget shortfalls”.

What about national sovereignty and generics?

The US wants aid recipients to buy US drugs and diagnostics.

Ratevosian noted that the strategy “doubles down on using foreign assistance to promote US health innovations” like lenacapavir, and this might not align with countries’ push for greater national sovereignty over their health programs.”

This was also flagged by pharmacist Andy Gray, who co-directs the World Health Organization (WHO) Collaborating Centre on Pharmaceutical Policy and Evidence-Based Practice in South Africa.

“There is an internal inconsistency in the plan, in that the US government wishes to promote countries taking responsibility for their own programme delivery, but at the same time, encourage dependence on US goods and services,” said Gray. 

“For many of the most important products, generic versions do not yet exist in the US,” noted Gray, adding that PEPFAR had been able to procure lower-priced, quality-assured generics from other countries. 

“Expecting African countries to continue to procure innovator lenacapivir from Gilead is unreasonable when lower-priced generic versions are expected within the next two years.”

UNAIDS ‘encouraged’ by HIV commitment

In its reaction, UNAIDS said it is “encouraged” by the strategy and its “strong commitment to continue to support people living with and affected by HIV”.

“The new strategy highlights several of UNAIDS’ global HIV targets as key benchmarks for US foreign health assistance, including ensuring that 95% of people living with HIV are aware of their HIV status, 95% of those who know their status are receiving lifesaving HIV treatment, and 95% of those on treatment achieve viral suppression,” UNAIDS noted.

The strategy is also committed to achieving a 90% reduction in new HIV infections and AIDS-related deaths by 2030 and eliminating mother-to-child transmission of HIV in high-burden countries.

UNAIDS added that it remains firmly committed to advancing and strengthening its “long-standing, strategic partnership with the US government and will continue to work hand-in-hand with PEPFAR to support countries to sustain durable, country-led HIV response”.

Image Credits: 2011, Sokomoto Photography for International AIDS Vaccine Initiative (IAVI), Gilead, Witkoppen Clinic, Wikimedia Commons.

Dr Tedros Adhanom Ghebreyesus addressing the media briefing.

For every $1 invested in cost-effective “best buys” to prevent non-communicable diseases (NCDs) over the next five years, there would be a four-fold return in social and economic benefits, according to the World Health Organization (WHO).

The WHO’s 29 “best buys” focus on reducing tobacco and alcohol consumption, addressing unhealthy diets and lack of exercise, and strategies to reduce cancer, cardiovascular and chronic respiratory diseases.

Ahead of the United Nations High-Level Meeting (HLM) on NCDs and mental health in New York on 25 September, the WHO released a report on Thursday showing the rewards from implementing these strategies.

If all countries fully embrace the “best buys”, this would save 12 million lives, prevent 28 million cases of heart attacks and strokes and generate economic gains exceeding $1 trillion by 2030.

If investment is sustained for a decade – until 2035 – there could be a seven-fold return on investment.

“We have the tools to save lives and reduce suffering,” WHO Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday. 

“This is not theoretical. Countries are doing it. Brazil has cut smoking rates in half by steadily increasing tobacco taxes. Mexico’s tax on sugary drinks reduced consumption while raising significant government revenue. Thailand channels tobacco and alcohol taxes into its National Health Promotion Foundation.”

The impact of implementing WHO ‘Best Buys”

Slowing progress

NCDs are the biggest global killer, while more than one billion people live with mental health conditions. Almost three-quarters of deaths related to NCDs and mental health – 32 million – take place in low- and middle-income countries. 

Only 19 of the 193 UN member states are on track to achieve the Sustainable Development Goal (3.4) of reducing NCD mortality by one-third by 2030.

Spending just 0.6% of the gross national income of LMICs could enable 90% of these countries to reach the SDG 3.4 target, according to the WHO.

While over 80% of countries have made progress in reducing NCD deaths since 2010, this has slowed down in 60% of countries from 2019 (in part because of COVID-19) in comparison to the previous decade.

Denmark has recorded the largest improvements, while China, Egypt, Nigeria, Russia, and Brazil have also reduced NCD deaths in both men and women.

“The biggest gains were driven by declines in cardiovascular disease and certain cancers—such as stomach and colorectal cancers for both sexes, cervical and breast cancers for women, and lung and prostate cancers for men,” according to the WHO.

“But pancreatic, liver cancers and neurological conditions contributed to rising mortality in many countries.”

HLM Political Declaration is ‘strongest’ yet

Dr Guy Fones, the WHO lead on NCDs

The final UN HLM political declaration is weaker than the zero draft, making higher taxes on tobacco and alcohol “considerations” not recommendations, and dropping any reference to taxing sugary drinks.

However, the targets of 150 million fewer tobacco users, 150 million more people under hypertension management, and 150 million more people with access to mental care by 2030 have survived the negotiations.

Dr Werner Obermeyer, director of the WHO office at the UN in New York, described the declaration as “a very strong outcome document” when considered holistically.

“There is very strong language in the text on taxation or alcohol and tobacco marketing restrictions, and also in terms of the regulation of food products,” said Obermeyer.

Dr Guy Fones, the WHO lead on NCDs, said the declaration is “the strongest we’ve had… because it has delivered on its call for equity and integration”, crediting the co-facilitators, president of the UN General Assembly and member states for traversing “a very complex path to arrive at the final draft”.

Next week’s HLM is the fourth on NCDs since 2011, but previous declarations have avoided concrete targets.

Last week, Alison Cox, the NCD Alliance’s policy and advocacy director,  “warmly welcomed” the declaration’s “time-bound and tangible targets”, particularly three “150 million” targets.

“The fact these targets have survived a tough negotiation process is evidence that this declaration represents political commitment to faster action,” said Cox.

Meanwhile, Vital Strategies said in a media release on Thursday that the declaration “marks significant multilateral commitments to address the world’s leading causes of death, such as cancer, hypertension and lung disease”.

It urged governments to “pivot to urgent action”, describing taxes on tobacco, alcohol and sugary drinks as “among the most effective steps governments can take to prevent disease, save lives and generate sustainable financing”.

“The era of governments subsidizing the profits of private industries by footing the long-term health care costs of cheap tobacco, alcohol and sugary drinks must end. Recent bold tax initiatives from countries as diverse as Brazil, Mexico, Montenegro, Cabo Verde and Ethiopia show that rapid progress is possible and should inspire delegations at the meeting,” it added.

Commercial interests

Dr Etienne Krug, WHO head of health determinants, promotion and prevention.

While the “best buys” do not include a tax on sugary drinks, “taxing sugary drinks has full support from WHO, and we believe strongly in this as a very cost-effective intervention”, said Dr Etienne Krug, WHO’s head of health determinants, promotion and prevention. 

“There is a whole series of unhealthy products on the market right now, ranging from tobacco, unhealthy foods, alcohol, etc. Acting against the interests of some of these very powerful companies is not always easy and not always done with the same energy by different governments,” Krug noted.

“But unless we take action to promote healthy products and limit the sale of unhealthy products, we will not make enough progress on tackling NCDs and not fast enough.”

Image Credits: WHO .

Dr Susan Monarez, former CDC director

US Health Secretary Robert F Kennedy Jr is driving an agenda based on ideology not science, and tried to reduce the Centers for Disease Control and Prevention (CDC) to a rubber stamp, according to the two former top officials.

Former CDC director Dr Susan Monarez and Dr Debra Houry, former Chief Medical Officer and deputy director for Program and Science, provided damning testimony of Kennedy’s interference at a Senate health committee hearing on Wednesday, called after the mass resignation of the CDC’s top leaders late last month.

Senator Bill Cassidy, instrumental in confirming Kennedy’s appointment after being assured that he would not change the country’s vaccine schedule, called the hearing. 

Earlier, Kennedy told the Senate finance committee that he had removed Monarez – who was the Republican Party’s representative and appointed by the Senate health committee – after she admitted to being “untrustworthy”.

But Monarez told the Senate health committee that Kennedy informed her on 19 August that she “required prior approval from [her] political staff for CDC policy and personnel decisions”.

Six days later, Kennedy “demanded two things of me that were inconsistent with my oath of office and the ethics required of a public official”, she added. “He directed me to commit in advance to approving every Advisory Committee on Immunization Practices (ACIP) recommendation regardless of the scientific evidence. He also directed me to dismiss career officials responsible for vaccine policy, without cause.

“He said if I was unwilling to do both, I should resign. I responded that I could not preapprove recommendations without reviewing the evidence, and I had no basis to fire scientific experts.”

Earlier, Kennedy sacked all 17 ACIP members and replaced them with eight people – including at least half of whom are vaccine sceptics. This week, Kennedy appointed a further five ACIP members, four of whom have expressed doubts about vaccines’ efficacy, according to The Guardian.

Kennedy was one of the foremost proponents of anti-vaccine misinformation during the COVID-19 pandemic, and the organisation he founded, Children’s Health Defense, has received hundreds of thousands in donations to litigate against vaccines.

Interference in vaccine decisions

Dr Debra Houry, former CDC Chief Medical Officer

Houry’s testimony detailed several examples of Kennedy’s interference in scientific decisions that threaten the health of Americans. 

These include replacing the ACIP with “known critics of vaccines” who operate with “decreased transparency” and “a willful refusal to follow established scientific and decision-making procedures”, said Houry, a career bureaucrat who has served at the CDC under six different administrations, including the first Trump administration.

CDC staff were asked at the “last minute” to summarise evidence about the risk of thimerosal, an additive in approximately 4% of flu vaccines, for the June ACIP meeting. 

“This thimerosal evidence review included a summary of rigorous studies and was pulled from existing information on CDC and FDA websites about its safety and lack of an association with autism,” said Houry.

But Kennedy rejected the document “while allowing an unvetted presentation on thimerosal, containing scientific assertions that were not assessed for data quality and bias”. 

“Science must be allowed to stand or fall on its merits, not on whether a scientific conclusion fits one individual’s ideological narrative,” declared Houry, who earlier stressed that US life expectancy had almost doubled in the past 150 years due to vaccines.

No flu vaccine campaign, measles vaccine undermined

The CDC has not been permitted to restart flu vaccine campaigns for the upcoming season, despite 270 influenza-associated paediatric deaths during the 2024-2025 season – the highest number of paediatric deaths ever recorded in a non-pandemic year since reporting started in 2004, Houry reported. 

Around 90% of the children who died were not fully vaccinated.

Despite the highest measles cases in the US in 30 years, Kennedy has “sowed doubt” about the measles vaccine by claiming that it “contained foetal parts”, while questioning its effectiveness and length of protection, while “promoting vitamins and unproven treatments such as inhaled steroids”, said Houry. 

“These dangerous statements can lead to adverse events like the one during an outbreak in Texas, where a hospital reported cases of Vitamin A toxicity in children,” she added.

Interference ‘beyond vaccines’

Houry detailed interference “beyond vaccines”, cutting staff “who work to decrease use of tobacco, prevent the transmission of HIV, improve oral health, and screen newborns for early detection of treatable health conditions, and many more.

Houry said the CDC’s reduced capacity put the US “at risk for threats like Ebola, Marburg, and other viral haemorrhagic fevers”, and “we won’t know which flu or COVID strain is emerging globally and when it’s coming or how bad it will be”. 

This was the result of a 60% decrease in flu submission samples and a 70% decrease in COVID submission samples, meaning “we do not have good visibility into these threats any more”, she said.

Kennedy’s plan to move the CDC’s non-communicable programs to the Administration for a Healthy America “will result in siloed, fragmented approaches to outbreaks and health threats”, said Houry, adding that non-infectious and infectious diseases are connected.

Two more paediatric vaccines may be removed

Health Secretary Robert F Kennedy Jr has campaigned against several vaccines over decades.

She also described a situation of “science censored, processes politicized, and transparency curtailed”, while Kennedy conveyed major decisions unilaterally via social media.

“One example: the Secretary altered CDC’s COVID vaccine guidance through a social media post without consultation, data, or process. I first learned of this vaccine policy change, not from dialogue with the Secretary’s office, but rather from an X social media post,” said Houry.

“Due to the secretary’s actions, our nation is on track to see drastic increases in preventable diseases and declines in health,” said Houry.

The ACIP meets on Thursday and Friday to review and vote on two paediatric vaccines for the hepatitis B vaccine and the measles, mumps, rubella, and varicella (MMRV). 

Monarez told the Senate that, based on her observations of ACIP, “there is real risk that recommendations could be made restricting access to vaccines for children and others in need without rigorous scientific review”.

“The stakes are not theoretical. We have already seen the largest measles outbreak in more than 30 years, which claimed the lives of two children. If vaccine protections are weakened, preventable diseases will return,” she asserted.

“I was fired for holding the line on scientific integrity. But that line does not disappear with me. It now runs through every parent deciding whether to vaccinate a child, every physician counselling a patient, and every American who demands accountability.”

Image Credits: HHS.