At the ‘Build the resistance” protest in Washington DC, people protest against the disbanding of USAID.

Many HIV programmes worldwide remain paralysed despite being exempted from the United States’ 90-day freeze on foreign aid and “stop work order”.

This is largely because the axe Elon Musk has taken to US agencies has resulted in there being too few staff members left to support their work, including processing payments and ensuring that supplies reach projects.

On 1 February, a waiver notice was sent to implementing agencies and country coordinators of the President’s Emergency Plan for AIDS Relief (PEPFAR) clarifying which “life-saving” HIV activities could be resumed.

These include “life-saving HIV care and treatment services” including HIV testing and counselling; prevention and treatment of opportunistic infections including TB, laboratory services; procurement and supply of medicines, and prevention of mother-to-child transmission services.

But the US Agency for International Development (USAID) is being dismantled with all staff except those with essential functions being placed on leave from this Friday.

US President Donald Trump’s administration has also taken PEPFAR databases offline, raising suspicions that it plans to close the programme credited with saving 26 million lives and supporting over 20 million people on antiretroviral treatment.

However, US Secretary of State Marco Rubio blamed organisations for being “too incompetent” or deliberately sabotaging their work to make a “political point”, when asked by The Washington Post why many lifesaving projects were not functioning.

Meanwhile, thousands of people took part in protests against Trump’s actions across the US on Wednesday under the banner, “Build the resistance“. The decentralised movement organised 50 marches in 50 cities with Washington DC march reported to have attracted  thousands of people.

Setbacks for African HIV services 

The Joint UN Agency on HIV/AIDS (UNAIDS) said in a statement on Wednesday that the permanent dismantling of PEPFAR would lead to “an estimated additional 6.3 million AIDS-related deaths, 3.4 million AIDS orphans, 350,000 new HIV infections among children and an additional 8.7 million adult new infections by 2029”.

In Ethiopia, the US funding freeze “has caused critical delays in the supply of essential HIV services, including testing kits and other resources”, according to UNAIDS.

The country is running short of reagents for viral load tests and babies’ HIV tests, that are procured by PEPFAR.

In addition, Ethiopia’s Ministry of Health has terminated the contracts of around 5,000 public health workers and 10,000 data clerks working in the HIV program who were funded by the US. 

A meeting of civil society organisations providing HIV services in Uganda this week noted that crucial work is under threat, including mother-to-child HIV transmission.

“We were on the verge of eliminating mother-to-child transmission,” said Mwehonge, Executive Director of the Coalition for Health Promotion and Social Development. “Without urgent intervention, at least 41 children will face new HIV infections daily.”

The Centre for Human Rights and Development (CEHURD) in Uganda reported on a meeting of Ugandans living with HIV this week:

“For the past 22 years, the US government has been a major supporter of HIV funding, contributing about 80% of the total [Ugandan HIV] budget. Cutting off this support is essentially a death sentence for the 1.3 million people currently on antiretroviral treatment,” CEHURD notes. 


Meanwhile, South African civil society organisations wrote to their government on Wednesday, urging it to develop an emergency plan and increased budget to address the PEPFAR freeze. PEPFAR funds cover around 17% of South Africa’s HIV budget. 

HIV activist organisations that have been at the forefront of fighting the virus for decades – ActUp, HealthGap and Treatment Action Group – have organised a protest outside the US State Department in Washington DC on Thursday morning.

“Trump’s global freeze on foreign aid is an attack on millions of people around the world with HIV and people at greatest risk of acquiring HIV,” according to the groups, which described the waiver announced by US Secretary of State Marco Rubio as “too little, too late”.  

Journals ‘forbidden’ to ‘bow to political censorship

BMJ’s editor-in-chief Kamran Abbasi and international editor Jocalyn Clark have appealed to medical journal editors to “resist CDC order and anti-gender ideology” after the Trump administration instructed CDC scientists to withdraw or retract articles from medical and science journals that include terms such as “gender, transgender, LGBT, or transsexual”.

Describing the instruction as “sinister and ludicrous”, the editors stressed “this is not how it works”.

Medically relevant terminology follows “evidence-based reporting standards” not “political orders”.

In addition, co-authors “cannot simply scrub themselves from articles,” they note. “If authors wish to withdraw submissions under review at a journal, this process is feasible should all of their co-authors agree. However, if somebody who merits inclusion in the authorship group of an article requests to be removed, even with the approval of the co-authors, this is a breach of publication ethics.”

“The US was considered a world leader in public health and research. With one repressive stroke that reputation risks being shattered and broken. If anything is forbidden now, it is that medical and science journals, whose duty is to stand for integrity and equity, should bow to political or ideological censorship,” they conclude.

Doctors file lawsuit

On Tuesday, Doctors for America filed a lawsuit against the Office of Personnel Management (OPM), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Department of Health & Human Services (HHS) challenging the removal of health-related data and other information used by health professionals and researchers from publicly accessible government websites.

The CDC website was still offline on Wednesday.

“The removal of the webpages and datasets creates a dangerous gap in the scientific data available to monitor and respond to disease outbreaks, deprives physicians of resources that guide clinical practice, and takes away key resources for communicating and engaging with patients,” according to court papers. 

“Like many of my colleagues, I am both a doctor who takes care of patients and a researcher. Removing critical clinical information and datasets from the websites of CDC, FDA, and HHS not only puts the health of our patients at risk, but also endangers research that improves the health and health care of the American public,” said Dr Reshma Ramachandran, a Doctors for America board member, physician and Yale professor “Federal public health agencies must reinstate these resources in full to protect our patients.”

More lawsuits?

So far, the Trump administration is facing 33 lawsuits and many more are likely in the coming days, particularly as many legal experts assert that the abolition of USAID is illegal.

The Foreign Affairs Reform and Restructuring Act of 1998 restricts the president’s ability to abolish the agency unilaterally. 

“USAID is an independent agency with authorities legislated by Congress. Its history is complex but its status is clear: Congress intended for US foreign aid functions to operate with independence. The President does not have the legal authority to abolish it or move it under the State Department unilaterally,” writes Dr Matthew Kavanagh, Director of Georgetown University’s Center for Global Health Policy and Politics.

“There is a new, dangerous outbreak of Ebola Virus in the Democratic Republic of Congo and Uganda, Marburg virus in Tanzania, and the extremely rare Chapare Hemorrhagic Fever in Bolivia,” added Kavanagh.

“For each of these, USAID is a key responder – moving money and commodities from its congressionally authorized emergency response fund to stop these viruses before they move. Suggesting the State Department, which deals in policy, can morph into an effective operational humanitarian and aid agency is absurd.  

“Imagining it can do so overnight via executive order is reckless. Believing that other governments will cooperate the same way with the department responsible for US political manoeuvring and diplomacy as they do to a humanitarian aid agency is nonsensical.”

 Dr Nina Schwalbe, Senior Scholar at Georgetown Center, described the closure as “an act of violence and targeted creation of chaos”, warning that it would take decades to rebuild the trust this has broken. 

“Destroying USAID through a rash and rushed order, firing most of the staff, and putting an immediate freeze on resources coupled with a stop work order to partners around the globe providing life-saving treatments and programs, will cause countless avoidable deaths,” said Schwalbe.

WHO Executive Board in session on Wednesday just as Argentina’s decision to withdraw was announced.

Argentina’s maverick President, Javier Milei, declared Wednesday that he would follow the United States in withdrawing from the World Health Organization,citing “profound differences in health management, especially due to the pandemic, which led us to the longest confinement in the history of humanity.”

The announcement came as another blow to the morale of the Geneva-based specialised UN agency, which has enjoyed broad support from member states of all political shades since its founding in 1948. It has, however, less financial consequences insofar as Argentina’s assessed contribution to WHO is comparatively small, amounting to only $8 million as for the 2024-25 biennium, as compared to some nearly $1 billion paid by the US, including over $260 million in assessed contributions.

The announcement came as WHO’s Executive Board was meeting in Geneva to debate the agenda for the May World Health Assembly. 

Total USA contributions to WHO for the 2024-25 two year period.
Argentina’s total contribution to WHO for the two-year 2024-25 budget period.

Cost impacts slow approval of new WHO initiatives

The financial fallout of the US withdrawal was evident in the proceedings where decisions to move forward with several new member state initiatives – addressing issues ranging from rare diseases to strengthening health finance – were paused until their costs could be more fully assessed. 

WHO’s leadership, meanwhile, laid out three options that it said the EB could consider in advancing new member state resolutions and decisions to the WHA: 

“According to the option chosen,” stated an administration memo, “the Board could mandate the Programme, Budget and Administration Committee to recommend that Health Assembly:

(1) adopt the resolutions as proposed and ask the Secretariat to de-prioritize other

activities to allow for implementation of resolutions within the defined budget envelope;

(2) postpone adoption of all resolutions by one year to 2026; or (3) approve the resolutions but with a provision that their implementation, other than

advocacy for the topic at minimal costs, should be postponed until the review of the programme budget proposed for 2026”.

The memo included a massive table of cost implications for every new decision being considered by the EB – more than two dozen in all. 

That includes projected costs as low as $9 million for stepped up advocacy and action on rare diseases to costs of $79.6 million for implementing a draft decision on strengthening global health financing by working with countries to help them devise better public health financial and insurance schemes.  

Other big ticket items, not yet debated, include a new draft global strategy on climate change and health ($161 million); an action plan for the global health care workforce ($125 million); and traditional medicines strategy ($119 million). More modest investments would be required for items like new WHO guidelines to governments on combating loneliness in mental health care ($38.77);  accelerating guinea worm eradication ($35 million); and a road map for air pollution response ($34 million); as well as much more modest initiatives on prevention and care of sensory impairments ($18 million); and child nutrition planning ($3.38 million). 

Germany urges caution

German delegate urges caution in green-lighting any new resolutions until priorities can be aligned with a shrinking budget.

Against the gloomy financial outlook, member states such as Germany urged “caution” in the EB’s decisions to advance new WHA resolutions for which the budget might not exist to cover the promised work. 

“We would caution against deciding on resolutions before the budgetary implications and the process of prioritisation has been clarified and decided,” said Germany, during a discussion on Universal Health Coverage (UHC) that dominated the morning EB session.

She added that Germany regards four priorities as central to achieving UHC.

“First, essential health services must be accessible to all, especially the most vulnerable; a well- functioning primary health care system is the foundation of UHC. Second, we must make universal access to sexual and reproductive health and rights a reality,” she said.

“We must expand health financing and social protection systems based on solidarity and equity. This is key to reducing out of pocket payments and ensuring access to health services. Fourth, we must establish efficient and sustainable financing mechanisms for UHC and social protection, primarily through domestic resources.”

Rare diseases resolution gets widespread endorsement 

Luxembourg, one of the co-sponsors of the rare diseases resolution considered at Wednesdays Executive Board meeting

Despite the cost concerns, a new resolution aimed at promoting greater inclusion of rare diseases in health care services received widespread endorsement, with some 21 countries co-sponsoring the initiative, ranging from France, Spain and Luxembourg to China, Brazil, Somalia and island states like Vanuatu.  

“Somalia faces challenges in addressing rare diseases, which includes limited awareness and diagnostic capacity with no specialised centres for rare diseases,” said the nation’s EB delegate “Out of pocket expenditures place a disproportionate burden on affected families. Workforce shortages hinder the integration of her disease services into primary health care.

“But there is opportunity to overcome these challenges, notably the growing political commitment to universal health coverage and health system strengthening and the potential for partnering with international organisations and research institutions to get the capacity and share knowledge. 

“Somalia is committed to integrate rare disease screening and management into essential package of health services, leveraging existing maternal and child health programs, training health workers to recognise rare diseases and refer cases to higher level facilities.”

Resolution calls for WHO Global Action Plan

Along with urging efforts by countries, the draft resolution would commit WHO to map existing policies and develop a draft plan of action on diseases that range from rare forms of cancer to genetic disabilities, and affect millions of people collectively – but too few individually to receive the kind of private sector investments and public sector attention that other leading infectious diseases and NCDs receive. 

In fact, some 300 million people worldwide are living with a rare disease, noted Rare Diseases International, the leading civil society advocacy group, along with the International Alliance of Patients Organizations and other NGOs.

“Yet despite the growing recognition of their importance, millions of families continue to face barriers to timely diagnosis, treatment and care, hindering their ability to lead dignified and fulfilling lives. The WHO estimates that there are more than 7000 rare diseases defined and this number is steadily increasing. More than 80% of rare diseases are of genetic origin. 70% start in childhood, and about 95% lack treatments.  The average time for an accurate diagnosis is four to eight years,” she added, “and about 30% of the affected children died before five years of age.” 

A WHO global action plan would provide member states with a strategic framework to integrate rare diseases into their national health priorities, she added, as well as fostering collaborations; supporting more innovation in diagnostics and therapies; and strengthening data collection.

While the associated costs are only about $9 million, one civil society group, Knowledge Ecology International, said that one affordable solution “in a time of severe fiscal challenges” could include low-cost surveys of member states, regarding the publication of “prices, sales revenue, costs of trials and subsidies related to R&D” for medical products related to rare diseases. 

Taiwan also surfaces as issue

US delegate makes a rare statement on Taiwan at the WHO Executive, on Wednesday.

Throughout the day, the issue of Taiwan’s exclusion from the WHA and EB debates surfaced intermittently with China, Pakistan and Belarus, amongst others, punctuating their comments on universal health coverage with political references to the “One China” policy that should, they argued, exclude Taiwan.

“With reference to the participation of Taiwan, that is to say, the Republic of China, in WHO and its bodies as an observer, we strongly abide by the one China principle. This issue is one that we think should guide all that we do. We should act in accordance with relevant WHO and resolutions that make it clear that the People’s Republic of China has the right to determine the membership.”  

Meanwhile, in a rare statement Wednesday afternoon, a member of the US delegation, which had been silently observing proceedings until then, spoke on behalf of re-admitting Taiwan to the assembly as an observer, the status it held until 2016.  

“We need the engagement of all members of the global community to help reach this shared aim,” said the US delegate to the EB, during a discussion of mental health strategies.  “To that end, we urge WHO member states to support Taiwan’s meaningful participation in WHO and its work, and to call for the resumption of Taiwan’s participation as an observer to the WHO.”

Image Credits: WHO Budget portal, WHO Budget Portal , Thiru Balasubramaniam .

Women and children are worst affected by pollution caused by cooking on open fires

DAR ES SALAAM, Tanzania – African leaders and global financial institutions have launched a landmark $40 billion Africa Energy Fund to fast-track investments in renewable energy and bridge the continent’s persistent financing gap. 

Reliance on dirty cooking fuels such as firewood and charcoal causes an estimated 600,000 premature deaths annually across Africa.

The World Bank has pledged $22 billion to support the fund, while the African Development Bank (AfDB) has committed $18.2 billion. Other contributions included $2.65 billion from the Islamic Development Bank and $1 billion from the OPEC Fund.

The initiative, announced at the Mission 300 Africa Energy Summit in Dar es Salaam last week, is expected to expand sustainable electricity access and stimulate economic growth, particularly in underserved regions. 

The summit, attended by 30 African Heads of State, also adopted the Dar es Salaam Energy Declaration which commits the continent to achieving universal energy access by 2030, prioritizing renewable energy projects, energy efficiency, and rural electrification.

“This declaration represents a turning point for Africa’s energy future,” said Tanzania’s President Samia Suluhu Hassan. “We are committed to delivering affordable, reliable electricity to transform lives and economies across the continent.”

The Dar es Salaam Declaration also lays out strategies to lower electricity costs, reduce dependence on firewood, and boost clean energy production—offering hope for a brighter and healthier future for millions across Africa.

Tanzania’s President Samia Suluhu Hassan hosted the energy summit.

Deadly toll of indoor air pollution

Some 83% of the world’s energy-deprived population live in sub-Saharan Africa. Rashid Abdallah, Executive Director of the African Energy Commission (AFREC), told the summit that 600 million Africans live without access to electricity, but one billion were without access to clean cooking, relying on biomass fuels such as wood and charcoal, with severe economic, social and environmental impact.

In rural and low-income urban households, inefficient wood-burning stoves and open fires release toxic pollutants, including fine particulate matter, carbon monoxide, and benzene. These pollutants have been linked to respiratory infections, chronic lung diseases, and cardiovascular conditions, particularly affecting women and children who spend extended hours near cooking areas. 

Reliance on wood and charcoal also contributes to deforestation.

AfDB President Akinwunmi Adesina has said that approximately 600,000 women and children die annually in Africa due to lack of access to clean cooking.

Speaking at the summit alongside representatives of the Rockefeller Foundation and the World Bank, Adesina explained that lack of access to clean cooking sources claims the lives of 300,000 children and 300,000 women annually.

He explained that the deaths are caused by the effect of smoke from the use of firewood or charcoal for cooking rather than clean cooking sources.

“Today we have 1.2 billion women in Africa without access to clean cooking and we lose 300,000 kids every single year that their mothers carry on their backs because of lack of access to clean food because of the secondary effect of smoke. We lose 300,000 women also every year,” he said.

“Why should anybody have to die just for trying to cook a decent meal that is taken for granted in other parts of the world? That is not acceptable! In good conscience, we just can’t do that. And that’s why a big part of what we’re trying to do is to make sure that women in Africa can cook decently without having to have smoke; without their kids having to die because of that.” 

Invisible killer

“Indoor air pollution is an invisible killer in many African homes,” said Wale Shonibare, AfDB Director of Energy Financial Solutions. “Addressing energy poverty is crucial not just for development but also for public health.”

Studies show that household air pollution levels in biomass-dependent homes often exceed World Health Organization (WHO) safety guidelines by up to 100 times. 

Women who cook over unvented wood stoves face an increased risk of chronic obstructive pulmonary disease, while children are more susceptible to pneumonia—a leading cause of child mortality.

Despite the dangers, the transition to cleaner cooking fuels remains slow due to economic constraints and limited infrastructure.

“We know that liquefied petroleum gas (LPG) and biogas offer cleaner alternatives, but for many families, these fuels are either unavailable or too expensive,” said Jenister Mhagama, Tanzania’s Health Minister.

Health facilities lack reliable energy

About half of the health centres in sub-Saharan Africa also lack reliable electricity, according to WHO data. This shortage disrupts essential services such as emergency care, maternal health services, and vaccine refrigeration.

“In many rural clinics, we rely on solar lanterns during surgeries. This is very inconvenient and extremely dangerous,” said Patrick Bulikunda, Acting Chief Medical Officer at Kitete Regional Referral Hospital in western Tanzania. 

“Without consistent power, our clinics cannot function optimally. Energy is as vital to healthcare as any medicine.”

A WHO database on the electrification of healthcare facilities highlights stark disparities in energy access. Rural health centres suffer the most, with frequent outages compromising critical medical services. Even facilities that have electricity often face unreliable power supplies, forcing staff to ration essential medical procedures.

Accelerating investment

The Fund will promote investment in renewable energy including solar (above) and wind power

The Africa Energy Fund is set to accelerate investments in renewable energy, including solar, wind, hydropower, and off-grid solutions.

“Access to energy is a cornerstone of economic development and human dignity,” said Tanzania’s President Hassan in her keynote address. “Africa cannot afford to leave its people in the dark any longer.”

The financing will help countries scale up affordable, clean energy while reducing reliance on fossil fuels. Countries that want to access the fund are expected to take steps to attract private investment and commit to using the lowest-cost electricity, mostly renewables. 

 “We cannot depend on outdated solutions for modern challenges. Africa must innovate to lead the energy revolution,” said Kenya’s Energy Minister Apiyo Wandayi.

However, Adesina said that funding of about $4 billion is required yearly to ensure that every African has access to clean cooking. The AfDB has committed $2 billion to this course.

Adesina also noted that several countries including Tanzania, Nigeria and Ghana have pledged to “100% access to clean cooking solutions by 2030.”

“It is about lives. A lot of time we talk about energy transition, but it is not just about energy transition. Already for women in Africa, they are transitioning life just to be able to cook. It is more about dignity as far as I am concerned. Africa must develop with dignity, with pride. Its women must have access to clean cooking solutions.”

Addressing climate challenges and energy inequality

The Africa Energy Fund will also tackle climate change, reducing Africa’s dependence on polluting energy sources. Coal, oil and traditional biomass account for over 70% of Africa’s total energy mix, according to AfDB data.

Twelve countries – including Tanzania, Nigeria, Senegal, Zambia, and Malawi – presented National Energy Compacts at the summit, outlining their strategies to scale up clean energy. These plans focus on grid expansion, mini-grids, and innovative financing mechanisms to ensure affordability for consumers.

Tanzania leads regional clean cooking efforts with its National Clean Cooking Strategy. It aims to transition 80% of its population to clean cooking technologies by 2034. The country currently loses 400,000 hectares of forest annually to charcoal and firewood use.

The country is also committed to increasing electricity access from 35% to 75% by 2030, with a strong emphasis on rural electrification and investments in solar and wind power.

Private sector innovations include M-Gas’s pay-as-you-cook LPG model, which has reached 500,000 households in Kenya and Tanzania. “With 35 cents they can cook three meals in a day,” said M-Gas CEO, Martin Kimani.

However, affordability remains a major hurdle. 

“Many rural households simply cannot afford to switch to cleaner energy sources without financial support,” said Professor Kwame Mensah from Accra University in Ghana. “Governments must step in with subsidies, while private investors should help scale up production to lower costs.”

Dotto Biteko, Tanzania’s Deputy Prime Minister and Energy Minister, stressed the importance of private sector engagement in expanding mini-grids and off-grid solutions for rural areas. “The private sector must play a pivotal role in this transformation,” he said.

“This is Africa’s moment to shine—literally and figuratively. We must rise to the occasion,” said Biteko.

Image Credits: Mission 300 Summit, Mission 300, Mission 300 summit.

WHO's New Leadership Team

China has signalled it could oppose a planned increase in national membership fees to the World Health Organization (WHO) aimed at increasing the reliability of its funding, threatening to deepen the financial crisis at the UN health agency as it faces the loss of its largest donor, the United States.

The proposed 20% increase in assessed fees for the budget year 2026-27 was debated at WHO’s Executive Board meeting on Tuesday – despite being agreed too, in principle, by member states in 2022 when the World Health Assembly (WHA) passed a resolution to increase the agency’s funding that comes from member states to half by 2030. 

The proposed  increase in member states’ national contributions is not an increase to WHO’s budget as an agency. But the shift would give WHO greater predicability in budget planning and control over its priorities. Right now, only about 22% of WHO’s budget is financed by fixed, member state fees, while the rest is reliant upon voluntary donations from member states and large charities.  

“China does not have clear information on the specific amount of assessed contribution increase or how it will be calculated for the coming year,” China’s representative told the EB, expressing the country’s unease with the plan, which was the focus of extensive debate in 2022 and 2023 before being passed by the WHA.

“It is difficult for any country to agree to such a plan under such opacity.”

The WHO aims to gradually ramp up fixed state contributions as a proportion of its overall budget, to reach the 50% mark for 2030-2031. While states in 2023 approved the first 20% increase for 2024-2025, the next stepwise hike, of another 20%, would require WHA approval this May to kick in for the next 2026-27  budget biennium.

The Chinese delegation also questioned whether the proposed 20% increase in national contributions was necessary, pressing for additional options as low as 5%.

“China believes that the secretariat, as of now, should further study the feasibility of the 20% increase in assessed contributions and avoid rushing into any decisions,” China said. “Member states need more time to discuss and China hopes the secretariat will present multiple scenarios with varying levels of increase, allowing member states to discuss and make a decision.”

The calculations underlying the step-wise increase still include the US share, as Washington remains a legal WHO member until its withdrawal takes effect in early 2026. This means that the true impact of the US exit has yet to be factored in, and without the US, an even higher step wise increase would likely be required to reach the 50% mark by 2030.

Proposal to slash next biennial budget

WHO on Monday revised down its upcoming biennial budget by $400 million in the wake of the US exit.

Chinese opposition to the plan comes at a time of unprecedented budget crunch at WHO.

In line with the current budget uncertainty, WHO’s administration also has proposed to cut its 2026-2028 budget to $4.9 billion, slashing $400 million from its planned spending and acknowledging it could not be “business as usual” following the US exit.  That proposal is contained in the budget documents before the EB, and will presumably be approved by the board later this week. 

The agency has also imposed an immediate hiring freeze and shifted to virtual meetings while limiting technical support to only the most critical missions. Behind closed doors, WHO finance director George Kyriacou warned the organization would face “a hand-to-mouth type situation” in early 2026 at current spending rates, according to recordings obtained by The Associated Press.

The US, WHO’s largest donor, has yet to pay its full fees for 2024-2025, WHO has also said. WHO’s attempts to reclaim these dues have been largely rejected, pushing the agency into deficit even before the formal withdrawal takes effect. The US was set to provide $900 million in total funding for 2024-2025, including both assessed fees and voluntary funding.

Under budget, behind schedule

WHO Director General Dr Tedros Adhanom Ghebreyesus addresses the opening day of the WHO Executive Board’s 156th session.

The drive to boost assessed member state contributions aims to free WHO from its current constraints, where over 80% of its funding is earmarked for specific programs dictated by donor countries and organizations.

“When it is within the purview of the Secretariat, we do the right thing to make sure that funding is equitably allocated across the organization. However, when it is highly earmarked, we are actually handcuffed,” Raul Thomas, WHO Assistant Director General of Business, told the board.

But WHO Director-General Dr Tedros Adhanom Ghebreyesus warned the board that the plan to ensure that the agency can meet 50% of its budget goals by 2030-31 with assessed member state contributions is already faltering. At the current pace – assuming that the contested 20% 2026-27 increase is finally approved – the target won’t be met until 2032-33, he said.

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

“That [timeline] was what was agreed by our member states, by you,” Tedros told the board. “If the 2026-2027 20% is not agreed, that will push further the target to be reached by 2034-2035, almost 12 years after the agreement. Compared to the earliest target you set, it will be delayed by six years.”

The flexibility crisis is acute – just 4.1% of voluntary donations in 2022-2023, worth $320 million, came without strings attached. Tedros suggested the organization might need to seek short-term solutions, including renegotiating with existing donors to loosen restrictions on their funding.

His warnings came as several middle-income nations joined China in expressing reservations about the planned increases, despite supporting the principle of sustainable financing for WHO.

“We do need to express our concern about the burden of time in which this contribution increases going ahead that countries are facing economic difficulties, inflationary pressures and the domestic context mean that we need to take into we will struggle to deal with this increase,” Chile’s representative said.

Peru, while backing the broader goal of increasing membership fees to 50% of WHO’s budget, emphasized that the plan must “take into account the economic reality and the fiscal reality in our countries.”

China will not fill US vacuum

China donated 239 million vaccines during the COVID-19 pandemic. Just seven million went through the WHO-led COVAX financing facility.

China’s resistance to increased WHO funding indicates it won’t fill the financial vacuum left by the U.S. withdrawal, countering, at least initially, some of the speculation that the US departure would boost Chinese influence over the global health body.

Instead, China’s approach reflects its preferred model of health diplomacy: direct bilateral engagement rather than working through multilateral institutions. This pattern became evident during the COVID-19 pandemic when China largely bypassed COVAX, the global vaccine-sharing initiative designed to ensure equitable distribution of COVID-19 vaccines, especially to lower-income countries.

Of the 239 million vaccine doses China provided globally, only about seven million – roughly 3% – went through COVAX. China instead favoured country-to-country arrangements, a stark contrast to the US and European Union, which donated 682 million and 265 million doses respectively through the COVAX mechanism.

EU stands alone 

Top donors during the WHO’s recent investment round.

As the world’s two largest economies step back from WHO, the financial burden is shifting to European states – and philanthropies.

WHO’s recent investment rounds have so far secured $1.7 billion in new commitments toward its $11.15 billion budget for 2025-2028 – less than half its target. European nations provided the overwhelming majority of new funding, accounting for 77.3% ($1.27 billion) raised in the blitz. 

Brazil and Saudi Arabia, despite co-hosting two different fundraising efforts, made no pledges themselves, while China contributed just $20 million. The US, constrained by Trump’s executive order, made no new commitments. Qatar made the only contribution from the Middle East region, providing $4 million – 0.2% of the total.

“We remain strongly concerned about structural funding challenges, in particular the unhealthy dependency on a very few donors,” Germany’s representative said at the board meeting. “The announced withdrawal of the United States raises serious financial concerns and will affect core and emergency response funding.”

“We wonder why one region did not contribute financially,” he added, in an apparent reference to the complete absence of wealthy Gulf states from the funding commitments. 

WHO’s revised budget of $2.45 billion a year, or $4.9 billion for the entire 2026-2028 ‘biennium’, divided among its 194 member states, would amount to approximately $12.6 million per country – a fraction of what major economies spend on healthcare.

“The EU wants to stress the relevance of continuing efforts to broaden the funding base of WHO now more than ever,” the EU representative told the board – a diplomatic call for greater contributions from China, Middle Eastern oil-producing states, emerging economies like Brazil, India and other wealthy nations.

“Now more than ever, we should be aware of the vulnerability for the work of who to be dependent on the small number of donors.”

Image Credits: Guilhem Vellut, AidData.

Senate finance committee RFK Jr
The Senate Finance Committee voted to advance RFK Jr’s HHS nomination to the full Senate.

WASHINGTON – The 27-member Senate Finance Committee voted to send Robert F Kennedy Jr’s Health and Human Services (HHS) nomination to the full Senate floor. 

The 14-13 approval came along party lines, despite RFK Jr’s often heated exchanges with Republican and Democratic Senators during two confirmation hearings last week. Kennedy weathered accusations of profiting from lawsuits against vaccine manufacturers, refusing  to deny that vaccines cause autism, and recanting his pro-abortion stance. 

Senator Bill Cassidy (R-Louisiana) voted to advance the nominee, even though the Health, Education, Labor, and Pensions (HELP) chairman expressed grave concerns over Kennedy’s anti-vaccine statements. 

Kennedy could not afford to lose Cassidy’s vote, and the two met over the weekend for “intense conversations,” Cassidy said in a statement after the vote. Cassidy, a medical doctor, appeared conflicted in last week’s hearing after he asked Kennedy to “convince” him that “you will become the public health advocate, but not just churn old information so that there’s never a conclusion” – a question Kennedy sidestepped. 

“With the serious commitments I’ve received from the administration and the opportunity to make progress on the issues we agree on like healthy foods and a pro-American agenda, I will vote yes,” Cassidy said.

The Senator, who is from a state where President Trump won by 22 points, could lose his party’s nomination in the next election if he continues to have a “strained relationship” with the President’s backers, reports Politico. 

Finance chair Mike Crapo (R-Idaho) urged his committee members to vote in favor of the nomination, saying Kennedy “has spent his career fighting to end America’s chronic illness epidemic and has been a leading advocate for health care transparency, both for patients and for taxpayers.” Indeed, Kennedy, a former environmental lawyer, gained a large national following for his campaign to “Make America Healthy Again.”

Kennedy committee vote
Senator Mike Crapo (R-Idaho), chairman of the Senate Finance Committee, urged his colleagues to confirm Kennedy, speaking highly of his career to “end the chronic disease epidemic.”

However, the Committee’s Democratic members remained unconvinced. Ranking member Ron Wyden (D-Oregon) stated “last week, Mr Kennedy was given ample opportunity on a bipartisan basis to recant his decades-long career peddling anti-vaccine conspiracies.

“Instead, he dodged and weaved, and gave no indication that if confirmed as HHS Secretary, he would stand by the long-settled science surrounding routine vaccinations…Peddling these conspiracy theories as the nation’s chief healthcare officer will be deadly for kids across the country.”

“He’s not qualified, and I daresay everyone here knows it,” said Senator Ralph Warnock (D-Georgia) in a short statement before the vote. “Mr Kennedy appears more obsessed in chasing conspiracy theories than in chasing solutions to lower healthcare costs for working families in Georgia.”

Senate committee vote for RFK Jr (Kennedy) Ralph Warnock
Senator Ralph Warnock (D-Georgia), represents a state with nearly 15,000 CDC employees. Robert F Kennedy Jr would oversee the CDC, along with 12 other HHS agencies or divisions.

Now that RFK Jr has cleared the Finance Committee with a “favorable” recommendation, the entire Senate will vote whether to confirm him. His nomination is one of several of President Trump’s high-profile picks, and Kennedy could only afford to lose three Republican votes if Democrats unite against the nominee. 

The three Republican senators who voted against Pete Hegseth, the Secretary of Defense, could potentially vote against Kennedy as well, according to the Hill. But Kennedy appears to have cleared the major hurdle in convincing the Finance Committee members that he is “pro-safety” and pro-life. No date has been set yet for the vote.

Hans Kluge re-elected as Regional Director of the WHO European Region.

WHO’s Dr Chikwe Ihekweazu has been appointed as Acting Regional Director of the African Regional Office, until a new regional director is nominated and confirmed by the Executive Board – moves all due to happen in May and early June. 

Meanwhile, the EB also confirmed the appointment of Hans Henri Kluge to a second five-year term as the Regional Director of the European Region. 

WHO Director General Dr Tedros Adhanom Ghebreyesus announced Ihekweazu’s appointment Tuesday at the WHO Executive Board meeting going on this week in Geneva.  

The African Regional Committee of WHO African region member states is set to meet in Geneva on 18 May, just ahead of the World Health Assembly to nominate a new candidate, following the sudden death of the RD-elect. 

The appointment will then be approved, exceptionally, at the WHO EB 157 session, to be held just after the conclusoin of the May WHA, in what WHO’s legal counsel Derek Walton, described as an ‘expedited process’  – which was confirmed by  the EB on Tuesday. 

The moves follow the sudden death of RD-elect Dr Faustine Ndugulile in November 2024. He was due to assume the RD post this month once his election had been confirmed by the WHO Executive Board.

An expedited election process is currently underway to allow candidates for the African RD to campaign for the position, according to a resolution passed by the African Regional Committee in late January.

Candidates are supposed to be nominated by member states by 28 February.  An online candidates forum is then planned for 2 April.   

Chikwe, who joined WHO in 2021, is currently the Assistant Director General and Deputy Executive Director of the WHO Health Emergency Preparedness and Response Program in Geneva.

Kluge entered his first term as European Regional Director just ahead of the COVID pandemic, and then had to grapple with the fallout of Russia’s invasion of Ukraine, as well as the mpox health emergency.  At the EB meeting, member states gave Kluge highly positive reviews or steering the diverse 53 member European region with a strong hand amidst geopolitical crises, as well as deep social rifts that also defy public health aims – such as  the marginalization of LGBTQI groups in terms of access to HIV/AIDS and other treatments. 

Elon Musk, named a “special government employee” by the Trump administration, secured the president’s backing to eliminate USAID, the country’s foreign aid agency, sending shockwaves throughout the global humanitarian world.

The richest man in the world and the President of the United States sent a message over the weekend to USAID, the world’s largest provider of humanitarian assistance depended on for survival by millions of the world’s poorest people: “Time to die.”

Two weeks into Donald Trump’s return to the Oval Office, the Washington headquarters of the US Agency for International Development (USAID) shuttered its doors on Monday, making it the latest, most visible casualty in the new administration’s sweeping dismantling of America’s foreign aid apparatus. 

Hours later, USAID employees couldn’t tell if their agency still existed. Its website went dark, social media accounts vanished, and staff found themselves locked out of email servers. Overnight, photos documenting decades of aid work and agency logos vanished from the Washington office’s walls.

Protesters gathered outside USAID headquarters in Washington after employees were told by email to stay home Monday.

The unravelling of the agency, which employs over 10,000 people who assist tens of millions worldwide every year, began last week with sweeping personnel cuts: half its global health staff dismissed, 60% of its humanitarian assistance bureau eliminated, and 500 employees terminated, including at least 56 senior officials. 

By Saturday night, two top security officials were placed on administrative leave for refusing to grant billionaire Elon Musk’s personnel access to classified agency systems.

The assault further escalated as Musk announced he had secured the president’s support to abolish USAID entirely after over six decades of operation.

“I went over it with him in detail, and he agreed that we should shut it down,” Musk said. “USAID is a criminal organization. It’s time for it to die.”

Speaking to reporters in front of Air Force One on Sunday night, Trump tore into the agency and confirmed Musk had his support.

“It’s been run by a bunch of radical lunatics,” Trump said. “And we’re going to get them out.”

USAID’s $42.8 billion budget represents just 2.14% of America’s annual domestic healthcare spending of $2 trillion.

Agency under attack 

Musk’s Department of Government Efficiency (DOGE) leading the attack on USAID has no official status, as Congress would need to approve establishing such an agency. Musk is neither a federal employee nor a government official. The question of who, if anyone, DOGE is accountable to, remains unresolved.

“We spent the weekend feeding USAID into the wood chipper,” Musk said, noting he had foregone “some great parties” to focus on dismantling the aid agency that tens of millions in over 150 countries rely upon for health care, education, emergency assistance and economic development. 

Amid a barrage of over 200 tweets in 24 hours, the DOGE chief described the agency as “a viper’s nest full of radical left Marxists who hate America,” “evil,” and “beyond repair.” The volume aligns with Musk’s typical social media presence – a Financial Times analysis found he averaged 168 tweets daily over a recent week, totalling more than 1,180 posts.

In one exchange, Musk responded with a bullseye icon to far-right commentator Milo Yiannopoulos’s statement: “By closing USAID, Trump and Musk have toppled the most gigantic global terror organization in history.”

Veterans of the agency quickly fired back at the accusations. 

“I oversaw global health programs at USAID. They reached hundreds of millions of people, added six extra years to the lifespan of children in partner countries, and were eradicating health threats worldwide,” said Atul Gawande, former global health lead at USAID. “What insanity and cruelty to break that.”

‘Another assault on the constitution’

A letter from ranking Senate Democrats on the Foreign Relations Committee noted they “had not been notified of any such visit by DOGE or other agency officials.”

Democrats defending the agency argue Trump has no authority to unilaterally dismantle USAID, which Congress created under John F. Kennedy in 1961.

“Trump isn’t satisfied just to close programs and fire staff. He is now planning to ELIMINATE THE ENTIRE AGENCY,” said Connecticut Senator Chris Murphy. “That would be illegal. He cannot unilaterally close a federal agency. Another assault on the Constitution.”

Yet since retaking office, Trump’s administration has repeatedly exceeded executive authority with little resistance from the Republican-controlled House and Senate, including overturning a congressional ban on TikTok. His iron grip on the party has so far prevented any meaningful pushback.

The involvement of Musk’s unofficial Department of Government Efficiency in the weekend raid on USAID headquarters triggered additional alarms. Senate Democrats sent an urgent letter to Secretary of State Marco Rubio demanding explanations for the agency headquarters’ closure and potential unauthorized access to classified information by DOGE appointees. 

“It is unclear whether those who accessed secure classified facilities had proper clearance or what they were seeking to access,” the ranking members of the Senate Foreign Relations Committee wrote. “We understand that security guards present at the facility were threatened when they raised questions.”

The letter expressed “deep concern” that officials from DOGE may have compromised national security in their rush to dismantle the agency.

“Staff tell me, “It is frightening being inside USAID right now,”” Gawande said. “Our checks and balances failed,” current staffers told him. “Congress has abdicated its responsibilities.” 

USAID goes dark 

USAID’s website was taken offline without warning over the weekend. The Internet Archive retains backups of the majority of pages deleted from the official site.

The shredding of USAID led by Musk halted long-running programs protecting millions from AIDS, infectious diseases, tuberculosis, malaria, pregnancy and childbirth complications. Aid providing electricity to Ukrainian refugees, medical care for displaced Palestinians and Yemenis, mpox surveillance, and HIV medications are also among the long list of casualties. 

Thousands enrolled in clinical trials backed by USAID now find themselves stranded, the New York Times reported, unable to continue experimental treatments as researchers and medicines are withdrawn. The world’s largest anti-malaria donor, the President’s Malaria Initiative established under former President George W. Bush funded by USAID, has terminated two-thirds of its workforce.

Though Secretary of State Marco Rubio moved to exempt “lifesaving humanitarian assistance” from the funding freeze at USAID last week, aid workers remain paralyzed by confusion. 

Staff on the ground cannot resume work without explicit USAID approval. But with mass layoffs at the agency, including hundreds of staff who handle communications with aid recipients, there is no one left to process these lifesaving waiver requests that would allow partners to resume operations. 

Speaking from El Salvador, Rubio defended the organizational changes at USAID, accusing its officials of acting like “a global charity separate from the national interest” and failing to cooperate with Trump administration inquiries. He insisted the agency’s core programs would continue under State Department oversight, though he did not name who would lead them.

“The sudden freeze on US-funded aid programs will put millions of lives at risk, including some of the most vulnerable people on the planet,” Suerie Moon, a global health expert at the Geneva Graduate Institute told Health Policy Watch. “It is sickening to watch the world’s richest man toying so carelessly with the lives of infants, children, the sick, victims of natural disasters and war.” 

“Aid programs are not rockets to be tinkered with,” Moon added. “There are millions of lives and livelihoods at stake.” 

Third of global health aid at risk of vanishing 

USAID financial flows by sector, country and region for 2022.

USAID is the backbone of global health assistance. For two decades, the US has been the largest contributor to global health programs, providing $11.4 billion in health aid in 2022 — nearly a third of the $33.9 billion spent globally. The agency’s programs have saved tens of millions of lives through work targeting maternal and newborn health, malnutrition, malaria, tuberculosis and HIV.

Thousands of aid organizations now face an impossible choice: defy the order and continue working, or halt care and watch patients die. In famine-stricken Sudan, staff at US-funded medical facilities told ProPublica that complying with Trump’s order would mean the death of 100 babies and toddlers in their care overnight. They chose to continue working, knowing their supplies would last only days.

Their dilemma is replicated across the globe. Medical facilities, nutrition programs, and disease prevention initiatives must each decide whether to risk operating without guaranteed funding or shut down immediately. Health workers and organizations staying open to help patients have only one question left: not if, but when their last medical supplies will run out.

“Cutting that support overnight is sowing chaos in dozens of countries,” Moon said.

Low-income countries on average depend on foreign aid for one-third of their national health spending. Facing their highest debt burdens in decades, many of the world’s poorest nations are unlikely to be able to compensate for the budget hole blown open by USAID’s withdrawal.

During his first term, Trump’s “America First” budget proposed a 28% reduction to State Department and USAID funding. An impact assessment by PATH at the time estimated that just a 33% cut to maternal health services would result in 20.5 million women and children losing access to essential care, leading to approximately 2 million deaths over two years.

The total closure of USAID would prove deadlier than the projections issued by PATH in 2019. 

“The immediate consequences of this are cataclysmic. Malnourished babies who depend on US aid will die,” Murphy said. “Diseases that threaten the US will go unabated and reach our shores faster.”

How much does America pay? 

The US ranks 25th in aid delivery by percentage of national GDP.

The US leads global aid spending, providing  42% of worldwide humanitarian assistance tracked by the United Nations in 2024. But these figures reflect its economic dominance more than exceptional generosity.

Measured against economic capacity data, US aid flows tell a different story. The US economy exceeds China’s, its nearest rival, by over $10 trillion – two-thirds of China’s economy – and is five times larger than third-ranked Japan’s. Yet America ranks 25th in development assistance as a percentage of gross national income, contributing 0.24% in 2023. 

This falls well short of the 0.7% target United Nations member states agreed to in 1970. Only five European countries meet this benchmark, while OECD countries countries average 0.37% – triple the US contribution.

“Of all the targets of the administration’s ire, why USAID?” Professor Lawrence Gostin, a public health expert at Georgetown University, asked on social media. “It gives vital assistance to people in poverty, suffering in a disaster, or in dire health conditions. All for under 1% of the federal budget.”

A legacy of lives saved, a gift to America’s rivals  

President John F. Kennedy speaks to USAID officials a year after the agency’s launch, Washington D.C., 1962.

In 2023 alone, USAID provided essential healthcare to 92 million women and children. Over the past decade, its programs saved more than 7.4 million lives, helping slash global child mortality by more than half and reducing maternal deaths by a third.

The agency’s flagship program PEPFAR has saved an estimated 26 million lives through HIV treatment and prevention. Its collapse would have immediate, devastating consequences: in just three months, nearly 136,000 babies – about 1,500 each day – would be born with HIV as pregnant women lose access to transmission-prevention medication.

As USAID’s operations grind to a halt, America’s geopolitical rivals are celebrating. Russian state media quickly declared “USAID is dead,” while former Russian President Dmitry Medvedev publicly endorsed Musk’s dismantling of the agency. 

“Smart move by Elon Musk,” Medvedev said. “Let’s hope the notorious deep state doesn’t swallow him whole.” 

The vacuum created by USAID’s collapse threatens to reshape global influence. Policymakers across party lines warn that USAID’s dissolution could create a vacuum for geopolitical adversaries, particularly in Africa. 

“China – where Musk makes his money – wants USAID destroyed. So does Russia,” said Murphy. “As developing countries will now only be able to rely on China for help, they will cut more deals with Beijing to give them control of ports, critical mineral deposits. US power will shrink.”

USAID’s work extends far beyond humanitarian aid, including supporting allies against Chinese economic coercion in Asia, combating fentanyl trafficking, and providing military assistance to key allies like Taiwan, South Korea, and Ukraine. All this was achieved for just one cent of every American tax dollar.

“Having an unelected billionaire, with his own foreign debts and motives, raiding US classified information is a grave threat to national security,” warned Congresswoman Alexandria Ocasio-Cortez. “The people elected Donald Trump to be President – not Elon Musk.” 

Image Credits: White House , Reuters Youtube, ONE Data , USAID Archive.

   

WHO Director General Dr Tedros Adhanom Ghebreyesus addresses the opening of the WHO Executive Board’s 156 session, on Monday.

World Health Organization (WHO) member states expressed unanimous public support for the body at its executive board (EB) meeting on Monday (3 February) following the United States’ decision to quit. But several countries also urged diplomatic efforts to woo the US back.

US ally Israel noted that while the loss of US membership fees is a “huge problem”, the bigger problem is that “international bodies, companies, industry and academia” may “lose interest in this organisation”.

“We must find the route to have a productive discussion with our American colleagues and see if there is a path to revise their decision and how to go and take the next steps,” said Israel’s Dr Asher Salmon.

Senegal’s Health Minister, Dr. Ibrahima Sy, proposed “mobilising health diplomacy around the world to urge the US to change its decision”, urging the executive board to engage the US government, Congress and Senate to encourage that country to remain within the WHO.

The US, which remains a WHO member for the next year as it serves out its notice, was represented at the EB by officials Michael Lim and Steve Smith, who did not speak.

There was no sign of Tressa Rae Finerty, the new Chargé d’Affaires for the US mission in Geneva although her name was on a published WHO roster of EB participants.

Biggest donors pledge support

Aside from the US, the WHO’s biggest donors are (in order): The European Commission, Germany, the United Kingdom, China, Japan, Canada then France, when both assessed and voluntary contributions are added up.  All reiterated their support for WHO.

WHO’s top 25 donors for 2024/25

Poland, speaking for the European Union (EU), reaffirmed its “strong commitment to WHO in these challenging times”, noting that “a common agenda is increasingly important in the face of growing health challenges and constrained financing”. 

However, it warned that the US withdrawal could impact on the organisation’s “predictable financing”, and called for “the cost implications of new actions must be assessed to ensure continuity of essential programmes”. 

Germany “emphasised our unwavering commitment to WHO as the cornerstone of global health governance and an indispensable pillar of multilateralism”. 

“As an advocate of multilateralism, we will continue to support the WHO financially, politically and technically. We call on all member states to join us in providing robust and sustainable financial support so that WHO is able to truly fulfil its mandate.” said Alicia Longthorne, a senior policy officer in Germany’s Ministry of Health. She urged the WHO to “prioritise the continuity of essential programmes”.

Germany’s Alicia Longthorne addresses the EB

The UK is “committed to supporting the organisation to deliver for today’s health challenges, and that is why we pledged £310 million in fully flexible funds at the WHO’s investment round in November …to support the delivery of WHO’s transformation efforts”.

China, which could massively increase its paltry voluntary contributions to the WHO, confirmed its support for the WHO and multilateralism – but warned of the growing health access gap between developed and developing countries and called on WHO to improve its efficiency.

China’s Mingzhu Li confirms his country’s support for multilateralism at the EB

“Japan remains safe, steadfast in dedication to working closely with the WHO and member states,” it stated.

“The world needs an effective, accountable, inclusive and well governed WHO and we are here with you to support these efforts,” said Canada’s Christine Harmston. “Indeed, the hard work over recent years to strengthen organisational integrity, transparency and accountability is recognised, and this must be maintained.”

And “France will do its utmost to support the organisation, its teams and its Director-General”, stating: “WHO remains a normative benchmark for public health. That is a key role that it plays, and it’s something we must continue to defend  We continue to support ambitious reform of funding for WHO which, as an organization must not be weakened, because if it was weakened, then the health of all is endangered.” 

Africa will be ‘most seriously affected’

Senegal’s Sy, on behalf of the Africa region’s 47 member states, expressed full solidarity with WHO on this current criris although “it is clear the African region is going to be most seriously affected” by the US withdrawal.

“We urge that people show solidarity so that what will be an immense gap for the African region, can be plugged,” said Sy.

Even Ethiopia, which opposed the re-election of Director-General Dr Tedros Adhanom Ghebreyesus, thanked him for his report. Ethiopian Health Minister Dr Mekdes Daba also called on “all member states to support the WHO investment round and honour a collective commitment of increasing accessed contributions”. 

Ethiopian Health Minister Dr Mekdes Daba, seated alongside US representative Dr Steve Smith

Tedros highlights challenges and achievements

The member states spoke after a detailed report from Tedros about the challenges and progress made by the WHO over the past year, beginning with his life being in danger during an attack on Yemen’s airport in late 2024.

He outlined the significant health challenges and an impressive list of achievements of the global body – from eliminating tropical diseases to a new guideline on midwifery.

Tedros was in Tanzania supporting the country in responding to a Marburg virus outbreak when US President Donald Trump announced his country’s withdrawal from WHO.

“We regret the decision, and we hope the US will reconsider. We would welcome constructive dialogue to preserve and strengthen the historic relationship between WHO and the USA that helped bring significant impacts like the eradication of smallpox,” said Tedros, who also rebuffed Trump’s reasons for withdrawing.

Responding to Trump’s Executive Orders

Trump’s Executive Order gives four reasons for the US leaving the WHO. First, WHO’s “failure to adopt urgently needed reforms” – yet over the past seven years, WHO has implemented “the deepest and most wide-ranging reforms in the organization’s history”, said Tedros.

Its transformation process “has touched every part of our work: our strategy, operating model, processes, partnerships, financing, workforce and culture”, and implemented 85 of the 97 reforms proposed in the Secretariat Implementation Plan on reform.

Second, Trump said WHO “demands unfairly onerous payments from the US, out of proportion with what other countries contribute”.

But member states “understand how assessed contributions are calculated” and “some countries choose to make higher voluntary contributions than others”, said Tedros. In the past budgetary period, the US voluntary contributions were higher than its assessed contributions.

The US contribution to WHO in 2023

“Addressing the imbalance between assessed and voluntary contributions, and reducing WHO’s over-reliance on a handful of traditional donors, has been one of the major areas of our transformation,” Tedros noted.

Third, the order refers to WHO’s alleged “mishandling of the COVID-19 pandemic and other global health crises”.

“From the moment we picked up the first signals of ‘viral pneumonia’ in Wuhan, we asked for more information, activated our emergency incident management system, alerted the world, convened global experts, and published comprehensive guidance for countries on how to protect their populations and health systems – all before the first death from this new disease was reported in China on the 11th of January 2020,” said Tedros.

Multiple independent reviews of the global response to COVID-19 made more than 300 recommendations to address the challenges and weaknesses.

“In response to those recommendations, WHO and our member states have taken many steps to strengthen global health security: the Pandemic Fund; the WHO Hub for Pandemic and Epidemic Intelligence; the mRNA Technology Transfer Hub; the Global Training Hub for Biomanufacturing; the Global Health Emergency Corps; the interim Medical Countermeasures Network, and more,” said Tedros.

Trump’s final reason is WHO’s “inability to demonstrate independence from the inappropriate political influence” from member states.

“As a UN agency, WHO is impartial and exists to serve all countries and all people. Our member states ask us for many things, and we always try to help as much as we can. But when what they ask is not supported by scientific evidence, or is contrary to our mission to support global health, we say no, politely,” Tedros noted.

Higher members’ fees, lower base budget

Dr Jerome Walcott (right), health minister of Barbados, chairs the EB.

The WHO’s Programme, Budget and Administrative Committee (PBAC) committee, which met before the EB, proposed that members’ assessed contributions be increased by 20%. This is in line with a 2023 World Health Assembly resolution that maps out that members’ fees should cover 50% of the WHO’s funding by 2030.

Tedros described the increase as “a critical element of our long-term plan to broaden our donor base, and will over the long term reduce the burden of financing for traditional donors, including the US.

“We therefore continue to seek the support and engagement of all member states, including the US, for our shared vision to put WHO on a more sustainable financial footing,” he told the EB.

The Africa region, via Senegal, committed to the increased fees despite economic challenges.

PBAC also proposed to decrease the base segment of the 2026–2027 budget to $4.9 billion rather than the $5,324 billion proposed before the US announcement – slightly less than the current budget for 2024/25 ($4.968 billion).

In light of the funding crunch, the 34-member of the EB met informally on Sunday to discuss PBAC’s proposals.

“There was a common understanding that WHO is in a difficult situation and that our consideration of the budget and on WHO reform, could not be business as usual. In response, WHO would pursue the twin goals of resource mobilisation and efficiency gains,” EB chair Dr Jerome Walcott, health minister of Barbados, told the start of the EB.

As part of discussions on improved efficiency, delegates noted that having too many resolutions – 23 are being prepared for the World Health Assembly in May – dissipated the focus of the WHA.

The EB also discussed the process to be followed if member states had complaints about the Director-General.

Image Credits: https://open.who.int/2024-25/contributors/top25.

The world remains unprepared for another pandemic, according to the  International Pandemic Preparedness Secretariat (IPPS) which published its Fourth Implementation Report of the 100 Days Mission (100DM) last Friday.

The IPPS is an initiative aimed at ensuring global access to diagnostics, therapeutics, and vaccines (DTVs) within 100 days of a public health emergency of international concern (PHEIC)

Critical gaps remain, particularly in developing and distributing diagnostics and therapeutics for diseases with pandemic potential. 

Only six new diagnostic tests (for Chikungunya and Ebola) and one therapeutic (Ebola monoclonal antibody treatment) were approved, with no new vaccines for priority pathogens from Scorecard 1.0.

Seven vaccines entered Phase 1 trials, but only one advanced to Phase 3. The therapeutics pipeline saw just two candidates progress to phase 1 and 2 trials, highlighting limited development for non-COVID pathogens.

Non-COVID funding for diagnostics, therapeutics, and vaccines fell by 31% from 2022 to 2023, with sharp decreases for Rift Valley Fever (92%), MERS (84%), and SARS (77%), while overall R&D funding for priority pathogens remains reactive.

The US government accounted for 60% of global R&D funding (68% excluding COVID-19), highlighting the need for other funders to step in and share both investments and benefits.

“With the world still grappling with the impacts of COVID-19 and the emergence of new threats like H5N1 and mpox, the need for the 100 Days Mission has never been more urgent,” said IPPS chair Dr Mona Nemer in a IPPS media release.

“Despite progress, significant gaps remain in diagnostics, therapeutics, and vaccines that must be addressed through sustained investment, harmonised regulatory frameworks, and global collaboration. The clock is ticking—now is the time to act decisively to strengthen our collective health security and ensure no country is left behind,” added Nemer, who is Chief Science Adviser of Canada.

Three action areas

The 100 Days Mission Implementation report highlights three key areas for action in 2025 that would ensure the world is better prepared for future outbreaks. The report calls on all stakeholders to work together to:

  • Reinvigorate the therapeutics pipeline with a focus on early-stage R&D: Prioritise early-stage research and development to advance therapeutics for priority viral families, ensuring robust pipelines are prepared to address emerging threats.
  • Enhance coordination to implement the Diagnostics 100DM roadmap: Collaborate with global partners to implement the 100 Days Mission diagnostics roadmap, improving alignment and advancing innovation across the diagnostics sector.
  • Sustain clinical trial infrastructure and strengthen preparatory regulatory approaches: Ensure clinical trial networks remain functional between pandemics and adopt harmonised regulatory approaches to accelerate approvals during emergencies.

Case studies

The report also includes a case study on lessons from the mpox response, which highlights the competing health priorities, evidence gaps and institutional dynamics that affected the speed of the response.

The report also highlights Rwanda’s response to the 2024 Marburg outbreak as a model of 100DM principles in action at a country level. By leveraging pre-established partnerships and rapidly deploying vaccines and therapeutics, Rwanda reduced the outbreak’s fatality rate from 88% to 22.7%. It also enabled trials of vaccines and therapeutics within nine days of the outbreak being declared.

Looking ahead, the IPPS calls on G7 and G20 leaders, with Canada and South Africa respectively assuming their presidencies for 2025, to catalyse global action by:

  • Accelerating diagnostic, therapeutic and vaccine R&D for priority pathogens with equity embedded by design
  • Agreeing a shared framework for regulatory preparedness in order to increase harmonisation and safely accelerate emergency authorisations.
  • Enhancing collective health security by expanding biosafety, biosecurity and pre- clinical capabilities

With just two years left in its mandate, the IPPS remains committed to working with all partners to drive systemic change and ensure that the lessons of COVID-19 and subsequent outbreaks result in a safer, more prepared world.

From left: George Vradenburg; Lucy Pérez, McKinsey Health Institute; Cara Altimus, Milken Institute; Christa Studzinski, Ontario Brain Institute; Claudio Lino Bassetti, European Brain Council, at the ‘Brain House’ last week in Davos.

DAVOS – With populations ageing and mental health disorders at a record high, halting the global “pandemic” of brain disorders needs to be a paramount concern of industry – as well as the global health community.

What is needed is a global effort spawning a “healthy brain economy” for the future, reflecting the same sense of commitment and investments as those displayed in preventing childhood diseases.

That was a key message of George Vrandenburg, founder of the Davos Alzheimer’s Collaborative, on the closing day of a three-day ‘’Brain House’’ series of panels and seminars at the World Economic Forum, the first such event ever to be mounted during the WEF. 

“We live in a mega trend of aging demographics, which means that the chronic diseases of aging, in terms of numbers, in terms of DALYs by brain disorders are growing rapidly, and the cost to governments, the cost to families and the cost each of us is rising rapidly,” Vradenburg said, after bringing brain health to the main Davos stage for the first time ever.

In classic Davos style, the three day dialogue series that took place in a custom-built “Brain House” pod near the WEF mainstage venues, not only made the health case – it highlighted the business case for tackling brain health, as an economic and workforce imperative – as well as a global health goal. 

Brain economy – negative or positive

Given demographic trends, there will be far fewer working people to support growing populations of older people, and ensure the level of affluence that industrialized economies, in particular, have seen to date, Vradenburg pointed out.

The ‘Brain House’ – built just for the DAVOS WEF series

“If we have fewer workers for larger populations, without increasing worker productivity and participation in the economy, we’re not going to be in the same place at the end of the century, as we were at the beginning.

“So moving from a ‘brain negative’ world we have fewer brains working, more brain’s sick, to a ‘brain positive’ world in which the brain is contributing to economic growth, to capital, as well as to our own health, is a transformation of comparable scope and scale to climate change toward what we’re seeing with AI. 

“The big number is $26 trillion of economic opportunity from addressing brain health, including in the workplace, where proactively investing in holistic employee health could create close to $12 trillion of global economic value,” said Lucy Pérez, who co-leads McKinsey Health Institute (MHI), a non-profit branch of the global consultancy. She cited recent research by MHI in collaboration with DAC and the US-NGO Us Against Alzheimer’s on how investments in brain health would enhance workforce performance, ignite innovation and “reclaim” millions of years of quality life years – now lost to disability.  

Against the opportunities are also the costs. Brain disorders currently cost the global economy some $5 trillion annually — a figure projected to soar to $16 trillion by 2030, MHI projects. 

“But let’s admit it, this can be quite challenging for employers, because we’ve been looking at brain health in very siloed ways,”  Pérez said, referring to the fact that employers face a crowded marketplace of solutions addressing entry points like mental health or workforce performance, which can be difficult to navigate.

‘Disruptive’ agenda ? 

Lucy Pérez, McKinsey Health Institute, makes the business case for investments in brain health.

Indeed, while Vradenburg’s own journey into the issue began after watching three generations of family members succumb to Alzheimer’s – he soon realized that focusing only on Alzheimer’s disease and dementia, as such, was not enough. 

As a movement, DAC, as well, has gradually moved to embrace a more holistic ‘life course’ approach – which sees brain health embracing a wide range of issues – from the ways in which prenatal nutrition, environmental health and climate change, and a host of lifestyle factors increase – or reduce – one’s risks.  

“What we have learned is that Alzheimer’s disease can only be prevented and addressed by a holistic life-course approach to brain health – from maternal health to mental health, from workforce stress to cardiometabolic treatments, from autism to Alzheimer’s.   

 “We’ve got to change our nutrition, we’ve got to change our educational system. We’ve got to do a better job of maternal health – so that in the early childhood years, when the brain is developing, those kids are positioned to realize their dreams in life,” said Vradenburg.

“So how do we bring about change? How do you basically stop the pandemic of brain disorders with the same energy and commitment that we applied to preventing childhood diseases?

“This is an epidemic caused by demography. It’s not an epidemic caused by infection, but the consequences in terms of the globe are comparable. 

“How is it that we develop the brains of our young people – and increase health and productivity, for the next few years as well for the next 20-30 years?

Uniquely positioned – for all sides of the political spectrum 

Texas Medical Center Houston -World’s largest medical complex

As the Trump administration introduces sharp disruptions to the global health agenda – including withdrawing from the World Health Organization and a freeze on some, but not all, of its global health funding and support to the developing world, DAC’s agenda and its evolution also seems oddly timely.  

Brain health is a theme that people on diverse sides of the political spectrum seem to want to embrace even in today’s polarized world – and that’s something rare these days.

For traditional liberals, the holistic appeal of looking at maternal health and environment and healthier lifestyles as contributors to dementia and Alzheimer’s is both scientifically sound as well as welcome – against the usual siloed disease categories. 

But the initiative also holds great appeal to conservatives  – who like the linkages being made to addiction and mental health – particularly big worries in the United States – as well the focus on  cutting edge scientific discovery. 

One of the biggest new backers of a new brain health initiative, in fact, is the Lieutenant  Governor of Texas, Dan Patrick, a close Trump ally. In November 2024, he announced a proposal for a new “moonshot” initiative investing  some $3 billion of the state’s revenue surplus into a new “Brain Research Institute of Texas” modeled on the state’s world famous Cancer Prevention and Research Institute (CPRIT).

Texas conservatives and brain health research

Jochen Reiser, president of the University of Texas Medical Branch in Galveston, describes the big investments the state is making in brain health.

The interest of Texas conservatives in funding research on brain health is more obvious than many realize, observers point out. Few people realize that Texas has one of the highest proportions of philanthropists of anywhere in the world. The Texas Medical Center (TMC), a sprawling agglomeration of some 60 research and health care institutions linked together in a non-profit corporation, is the largest in the world, with a GDP of $25 billion. And that’s not to mention the potential for exploring new brain health solutions driven by AI, in a state that is home Space X and Elon Musk.  

Speaking at the DAC forum last week, Jochen Reiser, president of the University of Texas Medical Branch in Galveston, echoed the governor’s plan and how it dovetailed with the DAC agenda. 

“The lieutenant governor has made a commitment – obviously this has to go to [state] Congress – but the commitment is there to put $3 billion for brain health and dementia research forward,” he said. 

“And we will only be able to do this together with you, because when we do this alone, we might actually get some of it, but we won’t be successful. So this is, for me, a call to collaboration… And if we invest together in a movement, it can’t be stopped. 

“We are thinking of more engagement here with DAC. And I really want to see Texas lead.  I think this is ideal for Texas. We do have a lot of mental health issues in the state, and we have the leadership position, we have the political climate right now, and we have the funds, quite frankly, to be a dominant force, not just for Texas, really for everybody.”

Taking the ‘Brain House’ on the Road

The interface of brain health solutions and AI. The Brain House series is set to go on the road nextd.

With this convergence of forces in play, DAC and McKinsey will be holding a further series of “Brain House” consultations in venues around the world, asking stakeholders in the private and public sector, as well as philanthropy, about how to take the initiative forward. 

The Brain House “Roadshow” is planning stops at the G20 and G7 venues as well as the May World Health Assembly (WHA), and September’s United Nations General Assembly (UNGA) in New York City.

One initial aim is to simply get brain health on the map, as such. Strikingly, it’s a term that, to date, has no major stake in the global health architecture.

“The Brain House will serve as a hub for dialogue and action at the intersection of brain health and pressing global issues such as brain disorders, mental health, climate change, aging populations, and artificial intelligence,” says Vradenburg.

“By spotlighting the economic and societal imperatives of brain health, DAC aims to position brain health as a cornerstone of global health agendas in 2025 and beyond.” 

Indeed, there are as yet no WHO “brain health” resolutions on record. Nor are there global action plans or reports mapping the extent of the problem and tracking progress on solutions. 

While there are dozens of multilateral organizations dealing with AIDS, TB and Malaria, lesser-known neglected diseases, tropical diseases, NCDs, disabilities, – and just about every other global health permutation that you can think of, nothing comparable exists for the brain.  

A new global Brain Health organization ?

So, we asked Vradenburg, is a WHO ‘Department of Brain Health’ a DAC aspiration?  

Vradenburg doesn’t answer ‘yes or no’,  right now.  He said he sees the WHO as a partner in the dialogue – but in line with the evolving dynamics of health diplomacy today, his outlook is more polycentric. 

“WHO is particularly a trendsetter in the global south,” he said. “But developed countries will anyway go their own way first in setting national priorities and agendas. 

“We’re a big tent,” he says, of the Swiss and US-registered public-private partnership. In fact its 30-odd “strategic partners” include some of the biggest names in pharma, like Roche, Johnson &Johnson and Abbvie, alongside philanthropies, universities and research entities. But there are several hundred more informal collaborators from research, philanthropy and the private sector.

And what about five years down the road?  His vision is big. He sees DAC spawning the creation of a new global organization “with the scope, scale and impact of GAVI, the Vaccine Alliance and CEPI [Coalition for Epidemic Preparedness Innovations] to address the epidemic of brain disorders across the lifespan, from the first 1000 days of life, to the last.”

Image Credits: Health Policy Watch, Daniel Kraft/DAC, TMC, HP Watch.