NIH research building
The NIH is the world’s leading public funder of biomedical research, spending some $48 billion annually on universities, hospitals, labs, and other institutions.

WASHINGTON, DC – The abrupt decision by the United States National Institutes of Health to slash funding for overheads to the nation’s research centers and universities has provoked a fresh outcry among leading US researchers, global health experts and even some Republican politicians  – with leading one expert saying this latest move could “seriously jeopardize” the US’s global dominance in biomedical research and innovation.

“If the Trump administration goes ahead with its plan to slash NIH research funding, it would seriously jeopardize the standing of the US worldwide,” said Lawrence Gostin, Distinguished University Professor in Global Health Law at Georgetown University, in a statement to Health Policy Watch. 

Similar reactions echoed across the research world after NIH’s Friday announcement cutting grants to research institutions for their “indirect costs” – which include expensive laboratory equipment and technologies vital to cutting edge research.  The cuts to biomedical research investments followed a shock list of recent Trump measures to drastically curtail the public health watchdog activities of the US Centers for Disease Control, as well as dismantle USAID and related global health programs. 

Susan Collins, a Republican  from Maine, who chairs the powerful Senate Appropriatiations commitee, also expressed opposition to what she called “the poorly conceived directive imposing an arbitrary cap on the indirect costs,” adding that the Congressional act under which the NIH allocations are made, also forbids arbitrary alterations. But even so, she posted a statement saying that she would vote to approve PresidentDonald Trump’s nominee Robert F Kennedy Jr, a vaccine skeptic who has also questioned the solidity of research underpinning recent vaccines, as Secretary of Health and Human Services, when the issue comes before the Senate, presumably later this week. 

Judge temporarily freezes NIH funding cuts 

Researcher
A researcher tests the efficacy of a generic drug. 80% of the NIH’s budget goes to universities, hospitals, or other research institutions.

On Monday, a Massachusetts judge  issued a nationwide order, temporarily halted the directive to slash the NIH grants from the Office of the Director, just before it was due to take effect. The suspension came as 22 state attorney generals sued the federal government for violating the 2018 Congressional appropriations law, which prohibits the NIH from altering its indirect cost rates “without proper authorization,” according to the filing. US District Judge Angel Kelley scheduled a hearing for 21 February for further arguments. 

Another lawsuit was filed on Monday on behalf of private and public universities and hospital systems, which stand to lose millions in federal dollars. The American Association of Universties, American Council on Education, Brandeis, Brown, George Washington, Cornell, Johns Hopkins, University of Rochester, Massachusetts Institute of Technology, and the University of California, among others, joined in filing suit against HHS, NIH, and the acting heads of these two agenices. These also argue that the funding cuts violate the Congressional appropriations law, and breaks prior negotiated indirect costs rates.

Across the country, from Birmingham to Buffalo, NIH research dollars fuels economic growth, medical innovation, and offers jobs to millions of Americans. In 24 states, hospital or university systems are the single largest employers, and leading the US’s global dominance in cancer, cardiovascular, and public health research. 

The storm unfurled Friday, after the Office of the Director of the National Institutes of Health, under an order by the Trump administration, issued a notice limiting the indirect costs biomedical research relies on to fund laboratories, equipment, facilities, new faculty, and software, to a standard 15% across all grants and institutions receiving them. 

The move was widely condemned by universities, research institutions, and medical centers who said that the one-size-fits all payment fails to reflect the real costs of research, in terms of investments in laboratories, technology and other hardware. 

Chipping away at the NIH’s status as the ‘envy of the world’

NIH funding impacts graphic
24 US states have hospital or university systems as their largest single employer.

At stake, critics say, is the National Institutes of Health (NIH) and the US biomedical research operation’s preeminence as the leading research innovator in the world, at the forefront of cancer therapies, personalized medicine, and brain health, to name a few domains. The administration’s moves have deeply rattled the NIH, with  the number two official, Dr. Lawrence Tabak to resigning 12 February. 

“The NIH is the envy of the world and sets the gold standard for scientific research and innovation. NIH funding has led to breakthroughs, ranging from treatments for cancer and cardiovascular diseases to vaccines for infectious diseases, and so much more,” said Gostin. 

The economic and scientific impacts could reverberate across the country – and in cancer clinical trials and drug-development labs. 

“NIH does incredible work, and this seems like it’s an obscure overhead issue. It is not,” said Senator Mark Warner (D-Virginia) in a town hall for residents.

“If these cuts, without any congressional review go through, we will have less research, less cures.” The senator pointed out that institutions have already negotiated and signed contracts at existing indirect cost rates. “You cannot arbitrarily change the reimbursement level for existing contracts by executive order.” Warner alluded to the multitude of Trump-issued executive orders that violate the law.

Ttop universities and medical centers stand to lose “$100 million a year or more” if the sweeping changes to how the National Institutes of Health reimburses research costs takes effect, according to an analysis from STAT news. 

White House claims moves allows ‘more money and resources available for legitimate scientific research’

In a post on X, the NIH framed its decision as a cost-cutting move, given that elite universities have tens of billions of dollars in endowment funds. Even so, research institutions at Harvard University, Yale University, and Johns Hopkins University all receive indirect rates over 60%, the NIH said. The post highlights that the 15% cap would save $4 billion per year. About $9 billion of the $35 billion awarded to researchers through grants in 2023 was in the form of indirect costs.

“Contrary to the hysteria, redirecting billions of allocated NIH spending away from administrative bloat means there will be more money and resources available for legitimate scientific research, not less,” said White House spokesperson Kush Desai in a statement to Fox News Digital. The comment implies that the administration does not believe that current scientific research is not “legitimate.”

And on X, Elon Musk, the un-elected billionaire who leads Donald Trump’s Department of Government Efficiency (DOGE), echoed this sentiment, saying over the weekend “Can you believe that universities with tens of billions in endowments were siphoning off 60% of research award money for ‘overhead’? What a ripoff!”

But most universities are not Harvard, Gostin countered, saying, “Most small to medium sized universities actually take a loss in taking NIH dollars even with indirect payments,” he said in a statement to Health Policy Watch. 

“Research costs an enormous amount, including paying researchers, running laboratories, and conducting large clinical trials. Many universities could not afford to take NIH research grants with such low indirect costs. That means the pipeline of research innovation could dry up.”

“What administrative bloat?” he asked. 

Collins, Britt, say cuts could harm Republican states 

 

The NIH distributes about 80% of its $48 billion budget to research institutions in the US – in Republican as well as Democratic-majority states. As a result, lawmakers from both parties have scrambled to the defense of universities, hospitals, and institutions that rely on NIH funding.

“I oppose the poorly conceived directive imposing an arbitrary cap on the indirect costs that are part of NIH grants and negotiated between the grant recipient and NIH,” said Senator Susan Collins (R-Maine) in her statement, saying she’s heard from laboratories and research institutions and other schools in Maine about the cuts, which “would be devastating, stopping vital biomedical research and leading to the loss of jobs.”

Collins, who chairs the Senate Appropriations Committee, and noted that the fiscal 2024 appropriations law, which funds the federal government, “includes language that prohibits the use of funds to modify NIH indirect costs,” indicating that the NIH is not allowed to arbitrarily change its funding policies.

Still supporting Kennedy for Secretary of HHS

Despite her opposition to the NIH’s cap, Collins said she would support Robert F Kennedy Jr, Trump’s nominee for Secretary of Health and Human Services. Kennedy’s record of support for biomedical research has been uneven, at best, expressing skepticism over vaccine studies, in particular. Even so, Collins said she had contacted Kennedy about the cuts, and said he pledged to “reexamine” the issue.

During his Senate confirmation hearings, Kennedy repeatedly dodged questions as to whether he would continue NIH’s funding for vaccines, including the cutting-edge mRNA technology developed for the COVID-19 vaccines. And in the months following his nomination, Kennedy said he would cut 600 NIH jobs. 

Kennedy could afford three “no” votes from Republicans and still be confirmed. 

Alabama Senator also expresses misgivings over NIH cuts

Another Republican senator and Trump ally, Katie Britt of Alabama, also expressed misgivings over the funding cuts.

“While the administration works to achieve this goal at NIH, a smart, targeted approach is needed in order to not hinder life-saving, groundbreaking research at high-achieving institutions like those in Alabama,” Britt told AL.com, an Alabama-based news agency. Alabama is home to several research universities who receive billions in NIH funding.

The University of Alabama is the single largest employer in the state. 

The University is an example of how universities and hospitals often support entire towns, cities, or even states. 

In Western New York, the University of Rochester is the largest private employer in the region, generating approximately 56,000 jobs across Upstate New York. And in Pennsylvania, the University of Pittsburgh Medical Center system creates nearly a million jobs, and is the largest employer in the state.

In their filings against the NIH, leading US universities disclosed they received up to $1 billion dollars in NIH funding, in the case of Johns Hopkins. The University of Rochester disclosed receiving $188 million in fiscal year 2024, and with the current indirect cost rate at 15%, it stands to lose $40 million. The filing also revealed that universities in conservative states would lose tens of millions – the University of Florida would lose $70 million in funding.   

Department of Defense, philanthropies, and private companies unable to fill funding void

NIH Research
Scientist conducting coronavirus vaccine research at NIAID’s Vaccine Research Center, Moderna’s original collaborator on the SARS-CoV-2 vaccine.

With the rationale of government efficiency, DOGE has singled out the NIH’s funding structure as the leading public funder of biomedical research. Some observers hope that the Department of Defense (DOD), a frequent partner, could pick up some of the slack with its $800 billion budget. The DOD spent $1.5 billion on such biomedical research in fiscal year 2021.

But Trump has instructed DOGE to turn its attention to Defense spending next, saying in an interview on Friday “And I’ve instructed him [Musk] to go check out Education, to check out the Pentagon, which is the military. And you know, sadly, you’ll find some things that are pretty bad.”  Others have suggested that the private sector might step into NIH’s shoes. But historically,  private sector investors have not been eager to fund the kind of basic research that NIH supports – which often then lead to the breakthroughs, such as mRNA vaccine technology, that the private sector later develops.  

As for the DOD, Gostin notes that “it is possible that the DOD would expand its research portfolio but Musk will probably also cut Defense spending. But the main point is there is no substitute for the NIH. Many scientists want peer-to-peer relationships with NIH scientists and may be leary in getting too close to military applications of their research.”

The US has been the world’s leader in research and biomedical innovation for over 80 years. 

In a letter to the university community, Harvard president Alan M. Garber expressed the widespread sentiment: “At a time of rapid strides in quantum computing, artificial intelligence, brain science, biological imaging, and regenerative biology, and when other nations are expanding their investment in science, America should not drop knowingly and willingly from her lead position on the endless frontier.” 

Last updated 12 February.

Image Credits: NIH, FDA/Michael Ermarth, Kristy Ainslie, NIAID.

WHO Director General Dr Tedros Adhanom Ghebreyesus at the Executive Board meeting this week in Geneva.

WHO’s Director General Dr Tedros Adhanom Ghebreyesus appealed for a second time to the United States to “reconsider” it’s decision to withdraw from the UN global health agency.

Speaking Tuesday at the close of a fractious meeting of WHO’s 34-member Executive Board, the WHO DG said, “we regret the announcement by the United States, of its intention to withdraw, and it was also sad to see them participating less this week. I think we all felt their absence.

“We very much hope they would reconsider, and we would welcome the opportunity to engage in constructive dialogue,”  Tedros said.  While the US delegation attended the proceedings they remained silent throughout almost all of the proceedings – with the rare exception being a statement in support of Taiwan’s re-admission as a WHO observer.

The final hours of the eight-day long session  were wracked by some of the same geopolitical and culture wars that have shadowed recent WHO proceedings.

African and Middle Eastern member states, backed by Russia, protested WHO’s recognition last year of the US-based reproductive health rights group, the Center for Reproductive Rights, as a group in “Official Relations” with WHO as well as the renewal of ties with a second NGO “Women Deliver”  – saying that the groups contradict their values.

“We have some reservations of few names on the list, one of them is, Woman Deliver,” said Somalia. “Unfortunately, after revising the engagement report, 2022, 2024 and reviewing these organizations, interpretation to some terminologies and ideologies, it has came clear to us that we cannot accept this organization’s advocacy and promotion, fields of work. And hence we came to conclusion that such engagements with this organization would contradict gravely with our region’s values, culture and principles.”

‘Protecting sexual rights is a very contentious issue’

Egypt – will raise the WHO’s recognition of two reproductive health rights NGOs again at the WHA.

Added Russia: “The issue of protecting sexual rights is a very contentious issue within the WHO, and this concept is not acceptable for the majority of countries and this affects a whole host of spheres of activity. We would draw attention to the fact that one area of work, the association Women Deliver, talks about is gender diversity, which contradicts with the priorities that have been agreed on by all member states for this organization. So in this regard, we would ask for solidarity. We would express a solidarity with the position as expressed by Somalia” said the Russian Federation.

Egypt’s delegate said that it would raise the issue again before the World Health Assembly, the full member state body, at the annual meeting in May.

Meanwhile, Israel also protested the continuation of WHO relations with the International Federation of Medical Students Associations (IFMSA), in light of the global group’s decision in August 2024 to suspend relations with its Israel-affiliate body, The Israel Medical Students Association, in protest over the Gaza war.  However, the matter was set aside after WHO’s administration said that the IFSMA had recently written to the WHO, saying that it will table a motion to lift the suspension of the Israeli affiliate at the upcoming IFMSA General Assembly, scheduled for March.

The eight-day long meeting saw frequent geopolitical sparring over the Israel-Hamas war in Gaza as well as over remarks by some member states supporting Taiwan’s re-admission to the WHA as an observer.  The initiative, hotly opposed by China, was the sole issue that drew a United States statement during the entire EB session.

Budget crisis overshadows proceedings

But beyond the geopolitical and cultural rifts, the 8-day meeting was haunted, even more profoundly, by the budget crisis facing WHO, due to the imminent loss of US financial support – which in 2024-25 amounted to nearly $1 billion, including voluntary and assessed contributions. Although legally, the withdrawal only takes effect in January 2026, some of the assessed 2025 US contribution, however, also remains unpaid – raising questions over if and how WHO will be able to collect the fees.

With the exception of a resolution on Gaza emergency aid, EB approval of about three dozen other WHO initiatives on issues ranging from rare diseases to air pollution was made conditional on a “prioritization” of the most important and affordable activities, due to take place before the full WHA meets in May.

Along with the financial pain of the US withdrawal, China continued to oppose a planned 20% increase in assessed contributions by all WHO member states  – casting an even bigger pallor over the agency’s financial future.

Against this background, the EB approval of a 9.5% pay raise for WHO’s senior leadership team raised eyebrows and private concerns among some member states. But it was ultimately approved after WHO’s Tedros said it was a “no-gain, no loss” alignment of WHO with UN salaries – and came with a simultaneous reduction in a cost-of living allowance that Geneva-based officials receive.  And at the same time, member states said the specialized UN agency still needs to do more to in terms of financial transparency – with inadequate data provided to them on staff costs and their evolution. See related story:

China’s 2026 WHO Fee Could Match US Levels Today – But Beijing Resists Planned Increase

“We’ve had to face new realities with the announcement of the withdrawal of the US from the WHO,” the EB Chair, Jerome Walcott Minister of Health of Barbados, told the 34-member board, “Amidst all of this, you continue to demonstrate the true meaning of multilateralism, moving away from entrenched positions towards compromise for the greater good, or collective well being.” Looking forward to the May WHA, he said, “Our work over the next few months will not be easy, but we have learned that anything that is worthwhile comes with some sacrifice. “

Citing a “sluggish” global economy, China argued against raising WHO fee assessments to member states – but most don’t buy the argument.

China’s assessed contribution to the World Health Organization (WHO) would increase by more than $50 million – from $87.586 million in 2025 to $137.828 million in 2026 if WHO member states approve another 20% step-wise contribution from all countries at the May World Health Assembly (WHA). 

That would be even larger than the US contribution of $130 million for 2025. For 2026, the US assessment would increase at a much smaller rate than China’s, amounting to 155.572 million, were it to remain in the organization.  

The hike in China’s fees stems from an updated scale of assessment that distributes budget cost more fairly and proportionately amongst all 194 member states, in line with their GDP. 

The data was disclosed in documents published Monday morning ahead of the seventh day of WHO Executive Board discussions. 

Along with the proposed step-wise increase in all member state fees, China’s dues are being recalculated at a higher rate, in line with a new UN global assessment scale. The scale is largely based on GDP, while adjusting for debt burden, per capita income, and development status. The new UN formula translates into a proportionately larger share for Beijing of the WHO assessment.   

“China moves up as the scale of assessment is based on GDP,” one member state delegate told Health Policy Watch.

Effectively, the new scale would charge China for 20% of the entire amount to be paid by all 194 member states to WHO, as compared to 15% in 2025.  Meanwhile, the US share would remain steady at 22%. While there are minor adjustments up or down in assessment rates for some other member states none are as large China’s.  Some countries, like Brazil, would see a big decline. 

China’s asssessment to WHO in the old and new UN scale.

US President Donald Trump has long complained that China’s payments to WHO were out of sync with its economic prowess and population, citing that as one reason from withdrawing from the organisation just after his inauguration in January 2020.  Along with its assessed contributions to WHO, the US has traditionally paid hundreds of millions in donations. 

China still baulking at member state increase 

Ethiopia and other members of the 47-country African bloc expressed support for the assessed fee increase.

Altogether, WHO would receive some $537.4 million in 2026 from the planned 20% increase in assessed contributions by countries  – even without the United States participation. If the US were ever to remain in the organisation, WHO’s total budget from assessed contributions to be about  $692.9 million, according to the data published Monday. 

Proposed member state fee increase timeline published by WHO on Monday.

That is still only 22% – 28% of the $2.45 billion budget for 2026 that has been tabled this month’s EB meeting.  But increasing those assessments is regarded as an increasingly vital move to stave off a bigger WHO financial crisis.  And the total 2026-27 biennium budget of $2.9 billion has already been slashed by $400 million in anticipation of the US withdrawal. 

Speaking at Monday’s board meeting, China was one of only two states that once again expressed opposition to the 20% increase in assessed contributions for 2026, which had been agreed to in principle in 2022 as part of a step-wise plan to increased member state contributions to WHO to 50% of its budget by the end of the decade. 

“At present, the global economic recovery remains sluggish, and both Member States and international organisations are excessing caution in increasing their budgets. Against this backdrop, various parties, including China, agreed to a 20% increase in AC for 2024 to 2025 demonstrating great support for the organisation. Regarding the secretary’s proposal for further 20% increase in the EAC for 2026 and 2027 China has previously stated its position,” stated the delegate from Beijing.

China’s assessment in 2026 would almost as high as that of the US – if the latter  did not withdraw from the WHO.

However, in the day’s debate, Beijing was largely alone. 

A long list of African, as well as European, member states expressed support for the next of stepwise increase in assessed contributions in 2026. 

“We … wish to join others in supporting the 20% increase in the assessed contributions, which we think is even more important now that it drives our intention in our work towards sustainably financed who providing more support and better support for countries,” said Ethiopia, echoing a statement made by Senegal on behalf of the 47 member states of WHO’s African region.

Member states question pay raise for senior management 

Tedros says the pay raise for senior staff is on a no-gain, no loss basis.

Member states also questioned a proposal by the WHO administration to raise the pay rates of professional and senior staff by 9.5%, particularly in a period of austerity.

That means that the gross salary of the organisation’s 10 assistant director generals as well as directors in five WHO regions would be $216,655 per year in 2025, according to the new scale, as compared to about $198,000 previously.  

WHO’s Deputy Director-General, Mike Ryan, who also heads WHO’s emergency operations,  would receive a gross salary of US$ 235,064 per annum in 2025. And the gross salary of the director-general, Dr Tedros Adhanom Ghebreyesus, would be US$ 293,003 a year. 

Responding to EB member concerns, Tedros told the board that the increase had been proposed by the International Civil Service Commission of the United Nations to bring Geneva salaries in line with those of other UN agencies.  

However, the increase in base pay would be offset by a reduction in the “post adjustment” rate that WHO staff receive, leading to a net “no -gain, no loss” outcome in terms of their net pay, he stressed.  

Right now, post adjustment rates for Geneva’s professional staff, for instance, amount to a whopping 80% over WHO’s basic pay rate – due to the high cost of living in Switzerland.  Even so, it remained unclear if the “no-gain no/loss principle” would really apply to senior staff in WHO regions, where the cost of living, and thus post adjustment rates are much lower to begin with. 

WHO did not respond to enquiries from Health Policy Watch regarding the issue. 

Member states call for more transparency by WHO administration

Member states at the WHO Executive Board on Monday.

In Monday’s debate, however, several member states stressed that the WHO administration still needs to be more transparent regarding disclosures regarding staff costs, in terms of the organisational budget overall.  

Notably, in the hundreds of pages of WHO  documents before the Executive Board, there is no breakdown of average and aggregate costs to the organisation of staff, with respect to professional and administrative staff at different salary grades. 

And in the proposal to raise the pay of the DG and ADGs, it was unclear if the “net pay rates” cited, which were about 26% lower than the gross pay scales, really reflect all of the perks that senior staff enjoy.

Those would include post adjustments, [even at a reduced rate], as well as educational grants, dependency allowances, and other housing benefits. WHO professional staff also enjoy tax free status in Geneva and their home countries – with the exception of the United States where the organisation pays taxes on behalf of WHO professional staff. 

WHO did not reply to repeated Health Policy Watch requests for further budget details.    

Most WHA decisions and resolutions approved conditionally  

In other business, the executive board conditionally approved over a dozen new or expanded WHO initiatives on universal health coverage, environmental health, communicable and non-communicable diseases, for consideration at the May World Health Assembly. The green-lighted initiatives also included a new global strategy on women, children’s and adolescent health, as well as a strategy on the health care workforce.

But they added stipulation that resolutions requiring WHO to undertake new or expanded programme of activities at significant cost would be reviewed and prioritised prior to the WHA to see which should indeed be approved in May, or alternatively, amended or delayed.    

The conditions, initially proposed by Norway, would have implementation “subject to the operationalisation of the Programme budget 2026–2027 once approved””- with a consultation process leading up to the WHA to prioritise the most important activities. 

Amongst the measures considered, however, several were also delayed. The Board deferred to the full Assembly any decision on an initiative by Pacific Island states to update WHO’s guidance on nuclear weapons – due to Russian opposition. (See related story).

The Board also agreed to continue negotiations between now and the WHA over a draft strategy on Traditional Medicine as well as a new global strategy for climate change and health – which was presented to member states at the EB as an “initial draft” for feedback and negotiation over the course of the coming three months. 

Russia Opposes Updated WHO Assessment of Health Effects of Nuclear Weapons

 

South African programmes like this one, to encourage people living with HIV to adhere to treatment, face an uncertain future following US President Donald Trump’s latest Executive order cutting off aid to the country.

CAPE TOWN – A coalition of South African civil society groups have urged South Africa’s President Cyril Ramaphosa to “step up” and lead a coordinated national and regional response to prevent “mass healthcare disruptions, preventable deaths, and surges in new HIV infections and drug resistance,” in the wake of the US President Donald Trump’s cut off of aid to the country. 

Trump last week issued an Executive Order halting all aid to South Africa, citing “unjust racial discrimination” against the country’s Afrikaner farmers as well as the country’s case against Israel at the International Criminal Court, alleging genocide in Gaza. The Trump order was referring to a new South African government law that makes it easier to expropriate unused land from white landowners without compensation – when it’s deemed to be in the “public interest“. The new law is being challenged in court.

“Action is critical, particularly in his role as the African Union (AU) Champion on Pandemic Prevention, Preparedness and Response (PPPR) and as South Africa takes on the G20 Presidency,” said the coalition, Community Health and HIV Advocate Navigating Global Emergencies (CHANGE), in a statement on Saturday.

A few organisations have received waivers, but many haven’t

South African schoolgirls campaign on World AIDS Day.

While a few South African organisations delivering HIV and tuberculosis services through the US President’s Emergency Plan for AIDS Relief (PEPFAR) confirmed to Health Policy Watch that they had received PEPFAR waiver letters on Saturday exempting them from the 90-day freeze on PEPFAR activities, originally announced in late January, many others have seen activities cut or curtailed.

However, in light of the most recent Trump order, there is uncertainty about the fate of all PEPFAR-supported South African programmes beyond the 90 days exemption period. Meanwhile, the US Agency for International Development (USAID), which disburses a significant portion of the PEPFAR funding, is being dismantled and PEPFAR’s long-term future is in doubt as its budget comes up for consideration before the US Congress in late March.

Adding to the confusion, several other organisations have not received waivers, while forcing them to cut certain activities. 

For example, at least 9,000 people have lost access to needle exchange and opioid substitution therapy (OST), according to the South African National AIDS Council’s (SANAC) civil society forum.

Funding for HIV clinics catering for those most vulnerable to HIV – “key populations” including sex workers, men who have sex with men and trans people – is likely to be cut permanently.

Funding for a game-changing intervention for groups vulnerable to HIV – twice-yearly injections of lenacapivir that are 100% effective in preventing HIV infection or pre-exposure prophylaxis (PREP) has also been cancelled, according to various reports.

Witkoppen Clinic’s HIV services in Gauteng are among many South African clinics receiving PEPFAR funds via USAID.

Calling on Ramaphosa to “personally intervene” 

CHANGE has urged President Ramaphosa to “personally intervene before the situation worsens and to ensure a whole-of-government and civil society response.”

Sibongile Tshabalala, TAC chairperson.

“The reckless freezing of US foreign aid is nothing short of a death sentence for thousands of people in South Africa,” warned Sibongile Tshabalala, chairperson of the Treatment Action Campaign (TAC) which advocates for people living with HIV.

“Critical healthcare infrastructure is being dismantled, clinics forced to close, frontline workers without support, all while lives hang in the balance. We are watching decades of progress on HIV being decimated.” 

Historically, South Africa has had one of the highest rates of HIV infection in Africa and in the World.  However, rates of new infections have declined sharply thanks to aggressive campaigns to get those infected on anti-retroviral drugs.  Overall HIV prevalence is about 14% in South Africa, and nearly 20% amongst people aged 15-49 years.

No idea what is happening – people are going to start dying soon

“Health workers and people have no idea what is happening across the region. People are going to start dying soon. Can you imagine being dependent on treatment to save your life, and having it snatched away from you like this, with no alternative?” warned HIV clinician Dr Francois Venter, who directs the Ezintsha research centre in Johannesburg.

New HIV infections have declined sharply as ARV uptake increased.

Fatima Hassan, head of Health Justice Initiative (HJI), confirmed that while some projects had been given waivers “the issue is still the concern about key populations and what the waiver seeks to cruelly limit”.

“The loss of US government funding has left sex workers without life-saving healthcare, HIV prevention, and critical support. Without these services, they face higher risks of violence, stigma, and disease—pushing them further into isolation and vulnerability,” said Kholi Buthelezi of Sisonke, the National Sex Worker Movement of South Africa.

Grassroots organisations that fund outreach workers, peer educators, and service providers have been “left destitute”. “While the communities they serve face even greater barriers to safety and healthcare. Without urgent funding, these lifelines will disappear, leaving sex workers more isolated and at risk than ever,” said Buthelezi.

In light of the additional orders directed at South Africa, communities are also calling on Ramaphosa to use “all available domestic, as well as compulsory measures,” to ensure that life-saving tools and medicines reach all who need them.

Image Credits: UNAIDS, AIDS Healthcare Foundation, Witkoppen Clinic, TAC, UNAIDS.

Smoking chimneys air pollution
Smoking chimneys at a thermal power station powered by fossil fuels illustrates the nexus of air pollution, climate and health impacts.

WHO Member States appeared to give strong backing to a proposed new WHO roadmap to reduce air pollution’s health impacts – with the ambitious global goal of cutting mortality attributable to human-produced sources by 50% by 2040. 

At the same time, a draft Climate Change and Health Action Plan, also aired at Saturday’s WHO Executive Board meeting, received a slightly more conditional approval – with further negotiations on the final draft set to take place ahead of the World Health Assembly in May. 

Notably, the African group, China and other developing countries asked for a bigger emphasis on “common but differentiated responsibilities (CBDR)” – a longstanding equity principle in climate negotiations that holds historical emitters to a higher bar of responsibility for climate action. 

Some developing countries also asked WHO to emphasize climate “resilience” more – as compared to climate mitigation measures like clean energy that have powerful, long-lasting health benefits. The draft text, however, makes no mention at all, however, of phasing out fossil fuels – a political compromise that only one lone NGO, Health Action International, protested during the debate.  

In line with the process established at this EB session, the board postponed a decision on approving the air pollution road map, as well as a decision to move ahead with a third initiative measure on a “Lead-free future, accelerating lead phaseout in paints, building materials and other products. 

With the sole exception of emergency aid to Gaza, a decision on how to advance all of the three dozen other decisions and resolutions before this month’s EB has been postponed until the final days of the EB session next week. That is due to the burgeoning financial crisis provoked by the United States announced withdrawal from the WHO  – and the resulting uncertainty about how to maintain funding for existing programmes, let alone launching new initiatives.    

Air pollution roadmap – big leap forward 

Aerial view of Accra, Ghana. Traffic, waste burning and desert dust all combine to make pollution a problem in this fast-growing African city.

The WHO air pollution roadmap represents a big leap forward in ambition in comparison to its predecessor, which included no such global goal, or concrete targets at all.

As such, it exemplifies, perhaps, growing awareness in member states about the broad range of health impacts of air pollution  – estimated to cause some 6.8 million deaths annually. 

The proposed new global goal, which would have to be adopted by the May World Health Assembly, comes in the leadup to a major WHO conference on Air Pollution and Health, being convened in Cartagena, Colombia, in March 2025. 

There, member states are also being asked to raise their ambition on air pollution action with national commitments to mitigate sources and reduce peoples’ exposures. This includes improving systems for air quality monitoring and warning, as well as equipping health sector actors to assess and advocate for clean air measures such as: shifting to low-emissions transport modes; cleaner energy production; better waste management; and healthier household energy use as well as urban planning.  

In Saturday’s EB discussion most member states described air pollution as a critical health issue – requiring aggressive action along the lines suggested in the road map. China, however, said that WHO should more fully “consider the differences of levels in socio economic development, air pollution, pollution control, capacity and health impact of air pollution among countries, clarify the fixed targets, … and  assess the feasibility off achieving a 50% reduction in the population attributable fraction of mortality from anthropogenic source of air pollution by 2040.”

In fact, the road map states that countries with very high pollution levels should aspire to reduce their concentrations to one of the “interim targets” set out by WHO for better air quality.

WHO Interim Air Quality targets take a step-wise approach to reducing air pollution.

The cost of implementing the air pollution road map  – through an accelerated programme of WHO work with countries on monitoring and acting for better air quality and health – is estimated at about $39 million over the coming six years and beyond. However, the most immediate costs of some $4 million are already funded in the 2024-25 budget. 

At $5.6 million, the costs of a campaign to advance a “lead free future” are even more modest, according to the financial assessments that have accompanied every new initiative tabled at this year’s EB session. 

However, sources told Health Policy Watch that member states are at odds over whether they should approve most of the resolutions before this year’s EB, as is the tradition, but conditional on funds being found somehow – or alternatively triage the most important priorities and affordable measures for advancement – while leaving others in abeyance at this year’s WHA. 

Climate change  – a bold new approach    

In 2024, climate change added 41 days of dangerous heat exposure to people worldwide, on average – just one example of the interface between climate and health.

Like its air pollution counterpart, the WHO climate and health initiative also takes a much bolder and more holistic approach to the issue, as compared to previous action plans.  

It asks asking member states’ health sectors to take a stronger lead in climate mitigation efforts that also benefit health: 

 “Through stronger engagement in the circular economy and through the reduction of greenhouse gas emissions and other climate-changing pollutants, such as black carbon, through more sustainable energy-use choices, agricultural practices, transport options, reduced food loss and waste, city densification and use of industrial technology and practices, 

“As well as through support for healthier diets in low-income populations, with special attention to women of reproductive age, while promoting a shift to healthier and more environmentally sustainable diets among higher-income groups.”

The draft also encourages member states to “limit or reduce actions that cause emissions in other countries through manufacturing, shipping or energy production,” as well as to “promote demand-side mitigation that encompasses changes in infrastructure use, end-use technology adoption, and sociocultural and behavioural changes.”

In the past WHO’s climate and health initiatives focused more on “adaptive” actions such as promoting health sector resilience to climate change through measures such as improved early warning systems for climate sensitive disease outbreaks. 

Ultimately the aim is to see health-beneficial measures and outcomes as stronger elements in countries’  nationally determined climate contributions under the Paris Agreement.” 

Increasing health sector access to climate funding 

Climate-resilient health facilities aren’t just about rooftop solar panels – but involve a whole systems approach to greening buildings and operations.

Another key aim of the WHO strategy is to work with countries to increase health sector access to climate-related funding.  Until now, the health co-benefits of climate mitigation or adaptation are not consistently quantified or considered in countries’ climate pledges – or in the consequent climate finance that may flow from national determined commitments (NDCs). Nor are the health co-benefits of actions systematically tracked as part of climate mitigation and adaptation assessment.  

The plan also would work to ensure that health facilities are more climate resilient and environmentally sustainable. 

According to a recent WHO assessment, some 12-15% of the health facilities in Sub Saharan Africa and South Asia lack access to any electricity, and some 50% of health facilities in Sub Saharan Africa lack a reliable electricity supply.  Overall, one billion people worldwide are served by health clinics and hospitals without reliable electricity. Moreover, much of the electricity provision in low- and middle income countries is via expensive and unreliable diesel backup generators – that could be replaced with low-carbon wind or solar options, if adequate climate finance was made available. 

However, the Green Climate Fund, the world’s largest provider of climate finance, has so far  failed to include significant funding to Africa in its renewable energy funding portfolio.    And in the single GCF project approved last year for the health sector, in Malawi, energy infrastructure was ignored. See related story.

Against Rising Fossil Fuel Emissions, WHO and COP29 Hosts Call For More ‘Healthy’ Climate Commitments by Countries

While some low-income countries balked at the emphasis on mitigation given their negligible historic contribution to climate emissions  – others stressed that what they need mostly is finance to pave the way towards a healthier, low-carbon future.

Ethiopia, speaking on behalf of the African bloc called for:  “holistic solutions to the climate and  health nexus: more substantial and accessible funding mechanisms to support climate and health

Ethiopia – calls for more climate and health finance.

integration, especially in Africa and other developing countries, specific attention to address vulnerable populations who are disproportionately affected by the impacts of climate change, stronger focus on building climate resilient health systems, including strengthening healthcare infrastructure to withstand extreme weather events, capacity building to healthcare workers and implementing adaptation strategies for greater resilience in health systems.”

Added Senegal, “We want to make our health system more resilient, and we are looking at submitting a request to the Green Fund for financing. We are also doing our best to bring down greenhouse gas emissions and take other mitigation measures. We’re trying to develop a plan for investing in renewable  clean energy too.” 

‘Major Opportunity for WHO to lead’

Italy’s delegate welcomed the emphasis on healthy cities, including active transport.

Developed countries such as Belgium, Italy and the United Kingdom, meanwhile, welcomed the more holistic emphasis on healthier and more low-carbon cities, foods and manufacturing methods – as integral to the emerging approach to climate and health. 

“This is a major opportunity for WHO to lead Member States toward bolder commitments and more tangible actions with clear mandates for all stakeholders,” Belgium stated. 

“In addition a health and climate in all policies approach is fundamental to address the health impact of the triple environmental crisis in a comprehensive and coherent, coherent manner.

“We must adopt public policies with climate and health co-benefits, such as shaping sustainable and healthy diets, encouraging active mobility and supporting an economy that values health and well being, rather than investing in activities that harm people and the planet.” 

Only Russia, a major oil-producing nation, spoke out explicitly against the plan, saying, “we would want to, again, express our concern about the gradual extension and the activity of WHO on climate related issues. This risks diluting the mandate of the organization interfering with the activities of other competent international forum, and there’s an inefficient use of the WHO resources, which are already very limited.”

Climate action budget is ambitious – but first part is funded

One billion people worldwide lack access to health facilities with reliable electricity, resulting in treatment gaps that put their lives in danger.

In fact, the $161.5 million price tag makes the proposed climate and health action plan one of the most costly to be considered at this EB – second only perhaps to aid for Gaza ($648 million – which WHO says it intends to raise through emergency appeals. 

As for climate and health, the $38 million required for the current 2024-25 budget period is already funded in WHO’s existing budget plans  – including through a major donation announced by the Wellcome Trust to WHO at the October World Health Summit in Berlin. 

The Wellcome donation was made in the context of WHO’s new “Investment Round” initiative – which has sought to accelerate the pace of voluntary budget contributions from member states and philanthropies. 

Also, WHO’s past climate and health work has yielded new revenues for the countries themselves to act, pointed out WHO’s Assistant Director Ailan Li.

“WHO has mobilized over 150 million US dollars for low and middle income countries to address the health impact of climate change over the past years. 

“Through these resources, WHO has supported countries to develop national assessments and national health adaptation plans, which are now in place in about 50 member states,” she said, citing Uganda and Brazil as the most recent examples. 

“I think this is a good progress.”  

Image Credits: Chris LeBoutillier, INGImage, WHO/Blink Media, Nana Kofi Acquah, WHO, WMO, WHO/Bill & Melinda Gates Foundation.

The United States conducts a nuclear test, code-named Seminole, at Enewetak Atoll in the Marshall Islands in 1956.

Russia has rejected a World Health Organization initiative to update its assessment of the health effects of nuclear weapons use, breaking with nations still grappling with the devastating legacy of Cold War-era explosions. The opposition comes as Russia has threatened to resume nuclear testing amid its war in Ukraine.

In regions known as “sacrifice zones,” where thousands of nuclear tests have left the soil poisoned and communities ravaged, residents continue to face elevated rates of cancer and birth defects decades after the last Soviet-era detonations.

“The Russian delegation is not in favour of discussing this topic,” Russia’s representative told the WHO Executive Board on Saturday, arguing that “the negative impact of the destructive factors of nuclear explosions on humans and the environment, on which we have sufficient scientific data, is already obvious.”

The proposed initiative, which needs to be approved by the EB in order to go before the entire World Health Assembly in May, would update WHO’s guidance on the “Health effects of nuclear weapons and nuclear war on health and health services”, last revised in 1993. It is co-sponsored by the Marshall Islands, Micronesia and three other Pacific island states, as well as Iraq and Kazakhstan – regions where fall out from nuclear testing continues to have devastating health consequences generations after test explosions by either Russia or the United States.

“Nuclear weapons do not discriminate and have catastrophic consequences on health and the environment,” Samoa’s delegate said. “In the interest of health and in the interest of humanity, we need to ensure that nuclear weapons and nuclear war are fully understood.”

The expert study would cost $540,000, according to a cost assessment submitted to the EB. Kazakhstan called the cost a “modest but necessary investment in global health security.”

“The Pacific region has a painful nuclear legacy,” the Marshall Islands’ representative said. After taking control from Japan in 1944, the United States conducted 67 nuclear tests there. The delegate noted that “many other countries with similar nuclear legacies” would benefit from the resolution.

The initiative was dismissed by North Korea, which joined Russia in opposition. North Korea’s foreign policy relies heavily on its nuclear threat, and it has threatened nuclear strikes against targets like Guam. “Sufficient research and analysis in this regard has already been conducted,” its delegate said.

The last nuclear test was conducted in 2017 by North Korea. The U.N. Treaty on the Prohibition of Nuclear Weapons bans all forms of nuclear testing.

Nuclear threats 

Vladimir Putin has threatened to restart nuclear testing throughout his invasion of Ukraine.

The two nations opposing the WHO health study — Russia and North Korea — come as both face international scrutiny over their nuclear threats.

Russian President Vladimir Putin has repeatedly threatened nuclear weapon use during his invasion of Ukraine. Russia has lowered its threshold for nuclear weapon use, placed its arsenal on heightened alert, and deployed tactical nuclear weapons to Belarus – the first time since the Soviet Union’s collapse in 1991.

Putin’s threats to resume nuclear testing carry particular weight for nations like Kazakhstan that still bear the scars of Soviet-era explosions. These threats followed Russia’s withdrawal from the New START treaty — the last remaining agreement limiting nuclear weapons between the United States and Russia.

North Korea, meanwhile, has deepened ties with Russia throughout the Ukraine war, providing millions of artillery shells and ballistic missiles in exchange for economic support and military technology that experts warn could enhance its nuclear capabilities.

“The additional research proposed by a number of countries as regards the consequences of using nuclear weapons, are not capable of introducing radically new elements to international discourse on nuclear weapons,” Russia’s delegate said. Russia will “once again raise the issue of counterproductiveness of adopting this draft resolution” at the World Health Assembly in May, he said. 

The WHO’s EB moved to suspend debate on the initiative until the end of the session next week.  The Board has taken the same move on every draft decision and resolution to come before it so far  – with the exception of aid to Gaza – due to the WHO budget crisis triggered by the US announcement last month that it is withdrawing from the global health agency, to which it is the largest single contributor.

Haunting health legacy of nuclear testing

Craters dot the former Soviet Union nuclear test site Semipalatinsk, Kazakhstan.

Since the invention of the atomic bomb, Russia has conducted hundreds of nuclear weapons tests among more than 2,000 detonations worldwide. The United States is responsible for the largest share – nearly half – followed by France, the United Kingdom and China.

Five hundred of these tests were conducted in the atmosphere rather than underground, releasing radiation equivalent to 29,000 Hiroshima bombs. The radioactive particles dispersed remain in the soil, air and water around test sites decades later. “The legacy of nuclear testing is nothing but destruction,” U.N. Secretary-General António Guterres said in 2019.

Health impacts persist across generations

The health impacts persist across generations. Hereditary cancers, chronic health conditions and birth defects — from missing limbs to infants born with cancer — continue to afflict indigenous populations living near the more than 60 sites where nuclear explosions were conducted since 1945.

In the Kazakh steppes, where Russia detonated hundreds of nuclear bombs throughout the Cold War, populations in nearby cities like Semipalatinsk, home to 120,000 people just 75 miles from the testing site, were blanketed in radioactive ash. Doctors were forbidden by the government from diagnosing cancers, while authorities maintained the tests had no adverse health effects.

“Local people began to get sick and die young. Women suffered through miscarriages, complicated pregnancies, and stillbirths. Babies were born with missing limbs, Down syndrome, and other disabilities linked to radiation exposure,” according to the Carnegie Endowment for Peace.

Kurchatov city, East Kazakhstan Province, Kazakhstan – the center of the Semipalatinsk nuclear test site.

A series of studies by Kazakhstan’s Institute of Radiation Medicine and Ecology found significantly higher mortality rates amongst those exposed to radiation, with elevated risks of serious illness continuing through their children and grandchildren. The data on the fourth generation remains under study, but ongoing birth defects and elevated cancer rates in the region suggest the fallout will affect their health too.

“If you travel to the villages near the former testing site, you’ll meet small children born without limbs or sick with cancer, suggesting that the damage from the site continues to this day,” the Carnegie Endowment reported.

While Russia’s nuclear legacy haunts Kazakhstan, the United States left its own trail of devastation. Hundreds of nuclear tests were conducted on Native American land in Arizona, Nevada and Utah, yet the U.S. government has never studied or investigated the health effects on these communities. More than 900 tests were conducted on the land of the Shoshone nation, earning them the moniker of “the most bombed people on earth.” 

Similar patterns of official neglect persist in Pacific island nations, where the United States has refused to fully compensate populations for widespread damage to their health and ecosystems from nuclear testing.

“WHO must speak with the authority bestowed to it by its constitution to provide the most recent science and research to support the call for peace,” Samoa’s delegate said. “We need to ensure the negative consequences of nuclear weapons and nuclear war are fully understood for all people and the world.”

Image Credits: Comprehensive Nuclear-Test-Ban Treaty Organization, RIA Novosti archive.

A Pakistani health worker administers a polio vaccine at a girl’s home. Door-to-door campaigns are critical to eradicating poliovirus in under-vaccinated regions.

The disengagement of both USAID and the US Centers for Disease Control (CDC) from the WHO-led global polio eradication initiative, threatens efforts in the world’s poorest countries with about  $233 million more in a year in budget shortfalls, WHO’s Regional Director for the Eastern Mediterranean Region, Hanan Balkhy, said on Friday. 

This, in a year when polio cases increased by 283% in Afghanistan and by 550% in Pakistan in 2024, as compared to 2023. Vaccine-derived polio cases also were reported in 35 other African, Asian and Middle Eastern countries, as well as in Spain in 2024. The US also reported 31 cases in 2022.

Distribution of polio cases around the world as of July 2024.

“The disengagement of CDC and USAID is costing us already with the loss of their technical, strategic and functional support,” Balkhy told the WHO Executive Board in a session on Friday, devoted to progress on polio eradication, led by WHO jointly with the Global Polio Eradication Initiative (GPEI).

“In financial terms, this [the US suspension of support] means a loss of $133 million to the GPEI, and a loss of $100 million for the WHO each year,” said Balkhy.  She noted that the GPEI already faces a funding shortfall of $2.4 billion for its current five-year strategic plan that has been extended to 2029 – the new target date for wild poliovirus eradication. 

While it remains unclear if the US pause in funding for GPEI, a public-private partnership with heavy US involvement, will become permanent, prospects are not bright, in light of the oft-expressed vaccine skepticism of Robert F Kennedy Jr, the nominee for US Secretary of Health and Human Services. Although Kennedy declared in December he is “all for the polio vaccine”, he has a long history of expressing unsubstantiated doubts about the vaccine – and vaccines more generally.   

And as secretary of HHS, Kennedy would also oversee the US CDC’s engagements in global health. Kennedy’s nomination by US President Donald Trump is likely to come before the full Senate next week for approval, after he cleared the Senate Finance committee on Tuesday.   

GPEI, which was launched in 1988 as a semi autonomous programme, is co-led by WHO with Rotary International and the US CDC, along with UNICEF, the Gates Foundation, and Gavi, The Vaccine Alliance.  

Conflict and political instability – other factors 

Hanan Balkhy, WHO Director of the Eastern Mediterranean region, describes polio eradication challenges at the WHO EB on Friday.

WHO’s Eastern Mediterranean Region, which extends from North Africa to Pakistan,  is the only remaining region with endemic wild poliovirus still being transmitted amongst young children who have not been reached by vaccines. 

“As 2024 began, we were on the verge of eradicating wild poliovirus in Afghanistan and Pakistan, the last two polio endemic countries,” said Balkhy. 

“But then came a resurgence, alongside outbreaks of variant poliovirus in Somalia, Sudan, Yemen and the Gaza strip,” she observed, referring to vaccine-derived poliovirus strains that may be accumulate and mutate in untreated waste, and then be transmitted to children in populations with low-levels of background vaccine immunity.  

As of September 2024, a total of 40 wild poliovirus cases had been reported (21 cases from Pakistan and 19 from Afghanistan) as compared with only 12 cases in 2023, according to the WHO report before the EB.  By the end of the year, a total of 64 cases had been reported in the two nations.     

“This represents a 283% increase in paralytic cases in Afghanistan and a 550% increase in Pakistan compared to all of 2023,” stated WHO in December, 2024.

Endemic transmission is concentrated in high-risk districts of the southern area of Khyber Pakhtunkhwa province in Pakistan, and bordering areas of Afghanistan’s eastern region. 

While the “genetic diversity of wild poliovirus type 1” remains at a historic low, the increased detection of the virus outside the endemic districts points to a “heightened risk of re-establishment of poliovirus transmission in historic reservoirs, notably the southern region of Afghanistan, and the Karachi, Peshawar-Khyber and Quetta blocks in Pakistan,” the WHO reported added, noting that virus spread is exacerbated by population movements in border areas.

USAID cutbacks hit at female health workers in Afghanistan

Snapshot of USAID fact sheet on its work in Afghanistan before it was removed last week.

“I was privileged to visit Afghanistan and Pakistan twice last year, and Gaza as well,” Balkhy said. “I saw amazing work by the front line health workers in Afghanistan and Pakistan. We need to strengthen their capacity so they can do even more.”

In both countries, one of the most effective tactics in polio eradication in that region is house-to-house vaccination campaigns, the WHO report also notes. 

But the same USAID program cuts have also hit hard at US initiatives training female health workers in countries such as Afghanistan. Women are particularly critical to polio outreach in cultures where mothers of young children cannot receive male health workers in their homes. 

According to one USAID factsheet, published in January 2025, the agency had supported some 2,396 health facilities, employing over 10,000 female health workers over the past year.  

But the publication has now been removed from the agency’s website in the mass shutdown of USAID data by the new Trump administration, and replaced with the USAID  notice placing 95% of its employees worldwide on leave.

Blackout notice that has replaced thousands of USAID webpages and documents on its global health activities, including to combat poliovirus in Afghanistan

Gaza shows it can be done

Polio campaign gets unmderway in northern Gaza on 10 September, the third phase of the staged outreach.

The successful poliovirus vaccine campaign that took place last year in Gaza, during an active conflict, is evidence that ‘zero-dose’ children can be reached through poliovirus outreach can succeed when funding and political support exist, Balkhy added. Both Hamas and Israeli authorities cooperated in the campaign with humanitarian pauses to ensure healthworkers could reach children under the age of 10, who were targeted in the campaign. 

“Our strategy remains straightforward, vaccinate every child and keep up a robust search of poliovirus to stop further spread. Achieving this is far from simple. Afghanistan and Pakistan face immense geopolitical infrastructure, environmental and security challenges, but none of these challenges are insurmountable,” Balkhy said. 

“In Gaza, during a humanitarian pause, last year, over 560,000 children were vaccinated against polio thanks to who led multi actor, multi level coordination and the courage of communities and health workers. If we did it in Gaza, we can do it anywhere.

“At this crucial stage for the eradication efforts with diminishing resources, we are doing our part….We need the international community’s steadfast support to help us across the finish line. Let us make sure that every last child is vaccinated, only then will polio be eradicated.” 

Image Credits: Pakistan Polio Eradication Program , GPEI, USAID , WHO.

Bird flu in USA. Outbreaks in Ohio and NY
Bird flu is circulating across the US, affecting over 25 million poultry. Complicating outbreak efforts is the hampered health communication from the federal government, and the efforts to reduce the federal workforce by 10%.

The US Centers for Disease Control has not updated its bi-weekly bird flu (H5N1) situation summary since 17 January – even if it finally published a limited edition of its Mortality and Morbidity Weekly Report (MMWR) on Thursday, 6 February. In the wake of the CDC information flow shutdown and the US withdrawal from WHO, Dr Lynn Goldman, Dean of the Milken Institute School of Public Health, spoke with Health Policy Watch about how public health communications and global health collaboration remains all the more critical.

The highly pathogenic avian influenza has affected millions of US poultry birds since December 2024, with Ohio accounting for 10 million of these birds where infections were detected, according to the US Department of Agriculture (USDA). The pathogen, which has sickened 68 people and caused one death, led global experts to criticize the US response as inadequate and “inept” – long before the Trump administration began to curtail reporting operations of the US Centers for Disease Control.  

Politicizing the federal workforce

Now, educating the public and the agricultural workforce about the risks of bird flu, and how to combat them, has only become more complicated by the ongoing communications pause imposed by the Department of Health and Human Services, says Goldman, who also served in the US Environmental Protection Agency (EPA) during the administration of former US President Bill Clinton (1993-2001).

But Goldman expressed hopes that specialised US government agencies will remain anchored by civil service professionals, where “people are really just serving the public…They’re not serving a politician. They’re serving the public. They are experts, and we’re proud that they’re there for merit, not loyalty.”

However, that civil service workforce is shrinking rapidly. 

About 65,000 of 2.3 million federal employees – including those who work at key public health agencies such as US CDC, the US Department of Health and Human Services – have taken up the Trump administration’s offer to resign now, with pay until September. And on Friday, the new US administration was poised to lay off nearly 95% of the US Aid and International Development agency’s (USAID) workforce, following a freeze on operations announced earlier this week. Only 294 of the more than 10,000 employees worldwide appear set to remain. 

The implications for public health range from impeded infectious disease communication, slowed research, and hampered global collaboration, according to Goldman. 

Bird flu response jeopardized

CDC bird flu website Feb 2025
The CDC’s bird flu website displays a message saying the page is “being modified to comply with President Trump’s Executive Orders.”

Since last year’s ongoing avian flu outbreak, the US has seen 67 human cases and one death – and countless poultry, dairy cows, and wildlife sickened. Most of these cases originated in dairy herds or poultry farms. And on 31 January, a new variant of H1N5 was reported in a dairy herd in Nevada, according to the US Department of Agriculture (USDA). Egg farmers must cull or depopulate their flocks if the virus is detected. New York state shut down live poultry markets 7 February after bird flu was detected.

“As this flu spreads around, it is affecting the price of eggs and eventually will increase the price of milk as well,” said Goldman.

In fact, over the past month, eggs prices in the US soared to an average of $5.30 per dozen, up from $3.50 the same time last year. The situation is complex, and the communications “need to be very finely tuned,” argued Goldman.

“It’s very complicated to communicate to the public the risks around food products,” Goldman added, referring to issues such as risks of virus transmission through raw milk consumption. “It’s very complicated because you don’t want to create untoward concern because of the way you communicate it. 

“Stopping the communications means you’re not controlling the public health threat, because a good part of doing your job in public health, especially with regard to infectious diseases, like bird flu, is that you communicate.”

Communicating with the public is not the only aspect that worries Goldman. For physicians, the recent tumult in the transition has meant the relative lack of messaging from the federal government on bird flu can impact medical practice.

“As a pediatrician, I want to always have up to date information about what’s going on with bird flu. I need to know what’s going on if I’m in the clinic seeing people. Is this something I should be looking for? Has it been identified in my part of the country? That’s important for doctors to know.”

Halting NIH grant reviews – ‘highly unusual’ with a severe ‘financial downside’

The NIH is the world’s leading public funder of biomedical research, spending some $48 billion on universities, hospitals, labs, and other institutions.

While the Trump administration’s decision to freeze health communications and grants processes for a short transition period might be “fairly normal,” the halt to routine NIH grant review meetings is “highly unusual,” Goldman observed.

“I don’t know why you want to throw a wrench into that work,” said Goldman, adding, that new staff may simply be uninformed about research – although that is worrisome as well. “Maybe they’re just coming from a very negative point of view about the government and don’t understand those things.” 

The grant review meetings, also known as study sections, are often scheduled far in advance and they focus on the peer review of new scientific proposals on biomedical topics, such as cancer therapeutics. Although some reviews were reportedly resumed this week, NIH advisory panels across several research areas remained in hiatus. The National Science Foundation (NSF) pause of grant review panels also was ongoing as of this publication. 

“We are so dependent on the NIH to develop the science that we need for protecting the health of the public. No corporation does what they do. No one else will do it, including philanthropy.” The NIH is the largest single public funder of biomedical research in the US, with a $48 billion budget. Everything from the discovery of hundreds of new drugs, gene therapy and vaccines can trace its funding back to the NIH. Every $1 investment in this biomedical research yields a $2.46 return, according to the Office of Budget. 

With almost an entire month’s pause on the grant process, there could be a serious “financial downside,” noted Goldman. “This one month halt on meetings could result in a reduction in NIH expenditures for the year, unless they can play catch up. 

“And it’s important, as expenditures are what support scientists to do the research we need.”

Censoring diversity criteria in clinical trial research – a particularly acute impact

In addition to the CDC pages on urgent outbreaks like bird flu, the main page of the Food and Drug Administration’s “Diversity Action Plan” guidelines to pharmaceutical companies for including diverse populations in clinical trials of new new medicines and vaccines also has been taken down. That’s despite the fact that decades of research shows that considering ethnicity, gender, age and other similar factors is essential for assessing a vaccine or medicine’s overal efficacy.  

Helping to oversee the entire Department of Health and Human Services’ management is the HHS Office of the Inspector General (OIG), an independent watchdog responsible for fighting waste, fraud, and abuse in the department. On 31 January, the Trump administration fired 17 Inspector Generals, including the HHS IG. The two-sentence termination emails took the IG community by surprise, as the role is intended to be independent and non-partisan. 

“It’s not just the NIH, but it’s an effort across the federal government to politicize all the personnel in the government,” said Goldman. She noted that “it is part of our process” for certain but not largescale to occur during administration transitions. 

Goldman hopes the nominee to head the NIH, Dr Jay Battacharya, will outline his vision for the agency during his hearing process, which is not yet scheduled. “That is something all of us – the American public, the scientific community, and the public health community – need to hear from him.”

WHO withdrawal, USAID shutdown means US is ‘lagging behind’

The Trump administration’s decision to begin pulling the US out of the World Health Organization, the specialized United Agency which enjoys support from 194 member states since its founding in 1948, sent reverberations through the global health community. The administration also ordered CDC to cease communicating with the WHO. Similarly, the recent moves to dismantle the US foreign aid agency, USAID, which has saved tens of  millions of lives through work targeting maternal and newborn health, malnutrition, malaria, tuberculosis and HIV, threatens to leave a “vacuum” for geopolitical adversaries.

“Russia and China are cheering the work of DOGE [Department of Government Efficiency]. It’s not efficient to destroy capacity. We’re talking about world class expertise. It’s not an overhaul, it’s a destruction,” said Dr Atul Gawande, former global health head at USAID, in a CBS interview about the agency. He also noted that the fallout means monitoring for bird flu has been cut off in 49 countries, and that the malaria program has been shut down. 

“Health provides an entryway for us to engage with countries, many of whom we may not agree with, and to have diplomatic conversations and other conversations. If that is lost, it will have tremendous consequences for the U.S.’s security and long-term economic and political outlook,” Dr Judd Walson, chair of International Health at Johns Hopkins, said in an interview 28 January. 

“If we actually have an approaching bird flu pandemic, [withdrawing from WHO] would make that doubly worse, because we need global collaboration when epidemics are erupting globally,” said Goldman.

When it’s not just a local problem, we need to be able to share the data from across the world.”

 

Image Credits: Julio Reynaldo, CDC, NIH.

Displaced Gazans living amongst garbage and ruins in January as the Israeli-Hamas ceasefire went into effect.

The WHO Executive Board voted to advance a resolution on aid to war-torn Gaza to May’s World Health Assembly, the first to be greenlighted while several dozen other initiatives remain on hold due to budget constraints. Meanwhile, WHO Director General Dr Tedros Adhanom Ghebreyesus appealed to Israel to allow thousands of desperately sick and injured Palestinians to evacuate via its borders, and to reconsider the shuttering of UNRWA, the massive UN relief agency for Palestinians.

The Gaza aid resolution likely holds the steepest price tag of any new measure being considered by the Executive Board (EB) this week – some $648 million for the delivery of emergency aid and the initial rehabilitation of Gaza’s shattered hospitals and health clinics.

Those costs would be covered by the department’s “emergency appeals budget segment” according to a financial analysis accompanying the report. Even so, it was unclear how the huge price tag could be squared with a projected 25% cut in WHO’s budget for its emergency operations, under new austerity measures being imposed at the global health agency as a result of the United States withdrawal from the organisation.

See related story:

Crucial WHO Health Emergency Response Faces Budget Cut of 25%

The Wednesday evening vote on the Gaza measure came after an emotional five-hour debate and a prolonged back and forth on the technicalities of voting procedures. That came after Israel, which currently holds a seat on the EB, proposed that the resolution be “noted” by the EB without an explicit endorsement due to it’s failure to call out Hamas role in the conflict and ensuing humanitarian crisis.  

Brazil and others objected. And several hours later, the new EB resolution, identical to a Gaza measure approved at the May 2024 World Health Assembly, was approved by a vote of 26 to two. Amongst the 34-member EB, five member states also abstained and one country was absent. 

At the time of the vote, WHO swivelled its live video stream away from the EB assembly, so that no one outside of the EB room could witness the vote by show of hands in one of this session’s most charged moments of decision-making.  

While the United States, Israel’s staunchest ally, was at the table for the vote, it did not speak on behalf of Israel’s claims that both the resolution, as well as a WHO report accompanying it, were  “biased” because they targeted only one party to the conflict, Israel, and not Hamas.

Hamas is the “foremost” cause of civilian suffering: Israel’s Waleed Gadban, at the EB Thursday.

“Hamas is and remains the first and foremost cause of civilian sufferings in Gaza,” contended Waleed Gadban, Israeli delegate to the EB. 

“Yet the report in front of us keeps referring to effects in healthcare without acknowledging that hospitals in Gaza are used outside of their humanitarian function to store arms and ammunition, hide innocent [Israeli] hostages and commit acts on Israel and its citizens. Israel does not launch attacks in those facilities, but on Hamas personnel and on targets hiding in healthcare facilities.

“Even when, immediately after the announcement of the cease-fire, Hamas emerged from the Al Nassar Hospital complex, carrying their arms and weapons stored there, UN agencies still failed to condemn the blatant abuse,” Gadban said.     

Palestine and Arab states fiercely dispute contentions 

Ryad Awaja, counselor in Palestine’s Mission to the UN: “A shame we need to vote to say that killing health workers is wrong.”

The EB’s delegate from Palestine fiercely disputed Israel’s contentions regarding Hamas’ role in the conflict or its militarisation of health facilities, laying the blame for the 15 month-long destruction of the enclave solely on Israel.  

“Let Palestine remind you that the Gaza Strip’s 364 square kilometres has turned from an open air prison to an open air prison to an open air graveyard for Palestinians, stripped of basic rights and hope,” said Ryad Awaja, a counsellor in Palestine’s UN Mission to Geneva, referring to Israel’s decades-long blockade of Gaza, imposed when Hamas first took control in 2007. 

“The people in the Gaza Strip enclave were stripped of their basic human rights and access to health and most importantly, and were stripped of hope of a better life and future,” he said.

 “It’s a shame that we need a UN vote to say killing civilians is wrong.  

“It’s a shame that we need to vote to say that killing health workers is wrong. It is a shame that we need a vote to say bombing hospitals and health facilities are wrong. It’s a shame that we need a vote to say starving the whole population is wrong.”

Added Egypt: “We plead for the EB not to be compromised or intimidated by some member states and their groundless and twisted allegations against health workers. Those WHO staff, who have lost their lives while fulfilling their responsibilities didn’t belong to any factions. They didn’t carry weapons, and they’re certainly not terrorists.”

Concerns about Trump’s recent statements and UNRWA’s fate

Egypt protests recent US proposals to relocate Gaza Palestinians to neighboring states.

A long list of European, African and Asian states meanwhile expressed hopes that the current Hamas-Israel cease-fire would hold despite its fragility, leaving space for the daunting task of rebuilding the 365-km2 enclave, and a more lasting peace arrangement. 

Many delegates also denounced recent statements by US President Donald Trump describing how he wants to relocate Palestinians away from Gaza in order to expedite the rebuilding process and even take control of Gaza himself, something that has been staunchly opposed by countries across the region and beyond.    

“All attempts to displace the Gaza population outside is against international law,” said Spain. 

“Malaysia strongly opposes any proposal that could lead to the false displacements or movement of Palestinians that will constitute ethnic cleansing and a violation of international law,” said the country’s delegate. “Any attempt, whether direct or indirect, to unilaterally and forcefully impose solutions that disregard the Palestinians people’s right to self determination and infringe on their freedom is unacceptable, undesired, unjustifiable, and will only further deepen one of the longest conflicts in the region.” 

Norway, meanwhile, said it was “deeply concerned about the consequences of the Israeli laws seeking to prevent UNRWA from delivering services in Palestine, the implementation could have catastrophic consequences on the lives of Palestinians, including on their access to health services.” 

Will Hamas remain in control in Gaza?

Hamas forces have been visibly in control again in Gaza, since the ceasefire begin. Portrayed here, the moment on 17 January when the first three Israeli hostages, of 33 included in the ceasefire deal, are turned over to the Red Cross in Gaza City.

On the other side of the fence, several member states, including Australia, emphasised that Hamas, which has become much more visible in Gaza again since the cease-fire came into effect on 17 January, should not be allowed to retain control of the enclave in a final settlement. 

Two conservative member states, Argentina and Hungary, echoed Israel’s concerns regarding WHO bias in its reporting on the conflict, saying that the WHO report on Gaza’s humanitarian crisis, which accompanied the resolution, ignores evidence that Hamas frequently used health facilities to hide fighters, munitions as well as Israeli captives. 

Said Hungary: “We must make sure that Hamas and other terrorist organisations are no longer in position to gain power and military Gaza through coordinated attacks and misuse of civilian infrastructure, including hospitals and other medical facilities.”

And Argentina also complained about bias in the WHO reporting on Gaza saying “It does not mention in any way the use of hospitals by armed groups as cover.. It’s a completely biased report, with a warped view of reality.” On Wednesday, the country’s president Javier Milai announced that he intends to withdraw from WHO, following in the footsteps of the United States. 

Suffering in Gaza is beyond comprehension

Hanan Al-Balkhy, Eastern Mediterranean Regional Director at the EB meeting.

While the price tag of the aid to Gaza that would be delivered as part of the resolution approved Thursday is steep, it’s only the beginning. WHO has estimated that it will cost some $3 billion over the next 18 months to begin rebuilding Gaza’s shattered health system. Costs could be as high as $1o billion over several years.

To date, only 18 out of 35 hospitals are functioning, only partially, along with about one-third of primary health care centres and 11 field hospitals, Altaf Musani, WHO’s director of Health Emergencies interventions, told the EB assembly. 

“Some 12,000 to 14,000 critically ill patients, including 2500 children, require immediate medical evacuation”, he added, noting that WHO continued to encounter “significant access challenges” to medical evacuations – even after the opening of Gaza’s Rafah crossing into Egypt. 

“Some 12,000 to 14,000 critically ill patients, including 2500 children require immediate medical evacuation despite significant access challenges since the opening of Rafah.

“The suffering in the strip is beyond comprehension,” Hanan Al-Balkhy, director of the Eastern Mediterranean Regional office, told the EB. “Tens of thousands of people have died, and around 30,000 have life changing injuries. The health system is in ruins. Malnutrition is rising, the risk of famine persists. Families are returning to devastated neighborhoods, although no health facilities remain intact despite unimaginable challenges,” she added.  An estimated 85% of Gaza’s two million people have been displaced by the conflict.

“We urgently need systematic and sustained access to the population across Gaza, and we need an end to restrictions on the entry of essential supplies,” Balkhy said. “Equally critical is protecting civilians and healthcare workers, expediting the evacuation of patients in urgent need of specialised care and strengthening the referral system to [hospitals in] East Jerusalem and the West Bank.”

Tedros appeals for faster pace of medical evacuations

Sick and injured Palestinians leave Gaza for an airlift to the United Arab Emirates via Israel’s Ramon airfield in July 2024 – but Israel has allowed only a few hundred people to evacuate the enclave via it’s land borders or airports.

Meanwhile, the WHO DG appealed to Israel to enable a faster pace of medical evacuations to third countries through Israeli, as well as Egypt’s crossing points.

Between 1 and 3 February, only 105 sick and injured patients were evacuated via Egypt, a drop in the bucket of the need.  Israeli approval of transfers over its land borders have meanwhile moved at snails’ pace, even for infants with deadly genetic conditions.

In his remarks, Tedros also urged a reconsideration of Israel’s decision to shutter the Jerusalem operations of the UN Relief Works Agency (UNRWA), which has provided specialised health and education services to Palestinians since 1948. 

Israel took the move following reports that UNRWA employees had been involved in the bloody Hamas attacks on Israeli communities on 7 October. An UNRWA investigation subsequently determined that nine UNRWA workers, out of the thousands employed by the organisation, may have been involved in the attacks.   

“All of the UN agencies combined cannot replace UNRWA,” Tedros declares, and anyone who says so, it’s not true.   

Tedros also rebutted some of the member state comments about bias in the WHO report on the situation in Gaza – although he did not refer to the allegations about Hamas militarisation of health facilities. 

But Tedros noted that the number of Israeli deaths during the war, (about 1,539) had been cited alongside the death toll for Gaza Palestinians, reported at more than 45,000 casualties. 

And the report makes reference to the 251 hostages originally taken by Hamas, of which there were still 107 in Hamas captivity as of 31 August when the report was drafted, he said.  Following the hostage releases seen during the cease-fire, some 76 Israelis and foreigners remain in Hamas captivity, although only about 42 are still believed to be alive. 

“So I just wanted to remind the representatives that this is a balanced report,” he said.

Image Credits: @nabilajamal, WHO.

Dr Yap Boum, Africa CDC’s deputy incident manager.

Parties embroiled in the conflict around Goma in the eastern Democratic Republic of the Congo (DRC) are discussing a humanitarian corridor to enable supplies and staff to address the mpox outbreak, according to Dr Yap Boum, Africa CDC’s deputy incident manager for Africa.  Last week, the M-23 militia, reportedly supported by Rwanda, took over the strategically positioned city on the shores of Lake Kivu from DRC government forces, overwhelming hospitals with injuries, and sending hundreds of thousands of displaced people living in the vicinity into flight once again.  

Boum told the Africa CDC’s weekly briefing that 128 mpox patients had fled from health facilities in Goma during fighting and could be spreading the infectious disease in the community. Africa CDC is also concerned that incorrect handing of dead bodies may also result in disease.

Discussion is ongoing with the government and partners, on how to implement a humanitarian corridor so that the medical countermeasures can be sent to North Kivu, as well as the human resources to ensure doctors, infection control specialists and laboratory technicians are on site.

The DRC this week reported a decrease in the number of cases, but this may “because we no longer have data and testing being done in North Kivu”, said Boum. The National Institute for Biomedical Research (INRB) laboratory in Goma has stopped processing tests since the conflict began.

In the past week, there were 2,635 new cases (878 confirmed), and mpox 28 deaths. 

“The DRC, Uganda and Zambia are the countries where we still see an increased number of cases, and they currently represent 97.5% of all cases. “

In Burundi, we are now seeing a decrease in the number of suspected case, but also in the number of confirmed cases, which is a good news, knowing that the testing coverage is quite high.

Tanzania continues to battle with a Marburg outbreak, with one more person confirmed with the disease.

Meanwhile, Uganda continues to battle an Ebola outbreak with 10 suspected cases (only two confirmed).