People flee Goma during the latest clashes

 The eastern part of the Democratic Republic of Congo (DRC) particularly around Goma and Bukavu, may become a hotspot for disease transmission following renewed conflict and the freeze in aid from the United States, warned Dr Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC).

Amid fighting when M23 rebels recently seized the two towns from DRC forces, over 400 mpox patients fled from health facilities, while outbreaks of cholera and measles are also affecting the region.

Over a million displaced people living in Goma and over 150,000 in Bukavu are particularly vulnerable to disease.

“This can be the entry point for a new pandemic,” warned Kaseya, adding that none of the regions affected by insecurity are reporting on diseases and laboratory testing has been disrupted by the United States freeze on foreign funds.

“In regions like South Kivu and North Kivu, we don’t have information, either because of insecurity or the pause in the US government funding, because the mechanism that we had in place in terms of sample referral was based on US funding provided to DRC,” Kaseya told a media briefing on Thursday. 

The DRC’s mpox response is affected by conflict and lack of funds.

“The combination of insecurity, lack of funding and lack of medical countermeasures, [means] we are playing with fire.”

Earlier in the week, Grégoire Mateso Mbuta, president of the DRC Red Cross said that “the humanitarian situation is dire in Bukavu and Goma.

“In Goma, the morgues and hospitals are overwhelmed. Around 190 DRC Red Cross volunteers and a team of coordinators are working tirelessly to recover the bodies left in the streets, take measures to prevent epidemics and give the victims a dignified burial. In the face of so much need, more help must be provided urgently, ” he added in a joint statement released by the International Committee of the Red Cross, the International Federation of the Red Cross and the Red Cross Society in the DRC.

New fund for epidemics

Dr Jean Kaseya

The African Union finally gave the go-ahead for an African Epidemic Fund to raise money to address continental disease outbreaks at its meeting last week, which is crucial in the wake of the US  withdrawal of foreign funding.

The fund will be administered by Africa CDC and facilitate a flexible and speedy response to outbreaks, according to Kaseya.

“We can receive funding without any limitation, without any bureaucracy, to use that to support African countries to prepare and to respond to outbreaks,” said Kaseya.

Africa CDC will provide the secretariat for the fund, which will be guided by a board.

Aside from the DRC’s mpox outbreak, continental malaria, tuberculosis and HIV efforts, have been affected by the US aid freeze. 

The US under President Joe Biden pledged $500 million to assist the continent with mpox and other outbreaks with $385 million committed. 

Kaseya said that Africa CDC was negotiating to “see this commitment become real money”, but that talks were ongoing. 

Since the funds freeze announced on 20 January when Donald Trump assumed office, China and South Korea have pledged $4 million and Morocco has also pledged $2 million –  but this makes up a teeny percentage of US aid to the continent. 

Kaseya said that Africa CDC had engaged with US officials immediately after Trump announced the freeze a month ago, and claimed some credit securing the US waiver on life-saving humanitarian expenditure.

However, despite the waiver, numerous health projects are still in limbo as they wait for official waiver letters.

In addition, “all HIV prevention activities were excluded from the waiver, except for those aimed at preventing mother-to-child transmission”, according to amFar this week. 

“To date, few implementers have been approved to restart services under the waiver, leaving all activities, including treatment, still paused.” 

Mpox tech transfer deal with African company

While there are no accurate mpox figures from the DRC, the epidemic is growing in Uganda, Congo Brazzaville and Zambia, which has shown a huge jump in figures from 16 to 700 cases.

However, in a glimmer of good news mpox vaccine manufacturer Bavaria Nordic has “95%” concluded a technology transfer deal with an African company to enable the vaccine to be produced on the continent.

This transfer will be a “fill and finish” deal rather than the more comprehensive drug substance transfer.

Dr Ngashi Ngongo, head of Africa CDC’s Incident Management Support Team, said he was working on creating demand for the mpox vaccine including the creation of a continental stockpile to ensure that countries would buy the locally manufactured vaccine.

Image Credits: Ley Uwera/ International Committe of the Red Cross.

Miner Jean de Deau Ngirinshuti outside Tunnel 12, the site of the Marburg outbreak

As African countries baulk at One Health requirements in the draft Pandemic Agreement being negotiated in Geneva, Rwanda’s success in containing its Marburg outbreak underscores the essential role of international partnerships and a strong health system in containing human-animal outbreaks

KIGALI, Rwanda – The Egyptian fruit bats look like innocuous little furry grey umbrellas hanging upside down in Tunnel 12 of the Gamico Mine – yet one of them transmitted deadly Marburg Virus Disease to a miner not long ago, causing an outbreak that effectively shut down the country’s economy for weeks.

“There are about 10,000 bats roosting in the tunnel,” says Dr Edson Rwagasore, head of public health surveillance and emergency preparedness and response at the Rwanda Biomedical Centre (RBC), the implementation arm of the country’s health ministry.

Dr Edson Rwagasore, head of public health surveillance and emergency preparedness and response at the Rwanda Biomedical Centre (RBC), outside one of Gamico Mine’s tunnels.

Gamico Mining Company has dug a series of tunnels into the hillside to enable miners to extract tin ore, and the 27-year-old index case was infected in Tunnel 12 after coming into contact with the virus – likely shed in the faeces of a bat.

Although the index patient was initially misdiagnosed with malaria which has very similar initial symptoms, once Marburg was diagnosed, the Rwandan Health Ministry and the RBC swung into action.

“We worked to ensure no future bat-to-human spillovers,” said Rwagasore. “Our key interventions were to create a buffer between the bats and humans, conduct regular testing of bats and work on understanding transmission better.”

The buffer inside Tunnel 12 is a locked door separating bats from humans. The bats can exit the tunnel through a hole in the roof that has been fenced off to ensure no humans can get close. 

When Rwagasore unlocks the door, the bats squeak – and so do a few journalists – but luckily they fly away from us. 

This door stands between people and bats in Tunnel 12

GPS trackers have been attached to some bats to map their movements and weekly tests of bats’ blood, saliva and faeces check for Marburg. Bats are a reservoir for the virus, shedding it at certain times of the year: January to March and August and September, explained Rwagasore.

“We have mapped six other high-risk mining sites and established similar interventions. We have either established buffers or closed the sites,” said Rwagasore, adding that the health ministry encourages people to avoid bats not attack them.

Dominic Kayrgre, Gamico Mine’s safety officer, said that their 1,600 miners were issued with basic PPE and educated to avoid bats but allowed to keep working once the buffers were in place.

The Gamico Clinic, the on-site health facility that caters for miners and their families, has also been upgraded and can identify everyone with a fever and potential Marburg symptoms as soon as possible and link them to care.

Remarkably, the index patient survived, although his wife, newborn baby, healthcare workers who treated them and other contacts did not. In all, 66 people were infected during the outbreak and 15 died, a case fatality rate of 22.7% – the lowest ever recorded.

Gamico Mine’s safety officer Dominic Kayrgre and the Rwanda Biomedical Centre’s Dr Edson Rwagasore, outside the revamped Gamico Clinic.

International partnerships

Rwagasore, the Rwandan Health Ministry and international experts concur that partnerships across the country, region and globe and the country’s strong primary healthcare system were essential in containing the outbreak.

Health Minister Dr Sabin Nsanzimana stressed the importance of a One Health approach involving experts on human and animal health and the environment. 

Assistance from the World Health Organization (WHO) and other international experts experienced in zoonotic spillover of diseases from animals to humans was invaluable in helping to identify and contain the outbreak, Rwagasore said.

The US-based Sabine Vaccine Institute sent its investigational vaccines to Rwanda for an open-label study, which was also key in ensuring a low fatality rate. Rwanda also used the antiviral drug, remdesivir, to treat those infected.

Strong healthcare system

Nsanzimana also described his country’s efforts as  “an opportunity for us to expand our preparedness capabilities.”

A week after the first case had been confirmed, community health workers fanned out in at-risk communities, going door-to-door to “check anyone who had symptoms of fever and diarrhoea,” said Rwagasore.

Contacts of those infected were found, tested and isolated if infected.

WHO Director-General Dr Tedros Adhanom Ghebreyesus, who visited the country at the end of the outbreak, praised the level of Rwanda’s critical care for patients as well as how the country deployed high-level leadership to address the viral haemorrhagic fever, which often kills over 80% of those infected.

Two of the Marburg patients “experienced all of the symptoms of Marburg, including multiple organ failure, but they were put on life support, they were successfully intubated and extubated, and are now recovering,” Tedros told a media briefing in Rwanda on Sunday.

“We believe this is the first time patients with Marburg virus have been extubated in Africa. These patients would have died in previous outbreaks.”

Intubation involves inserting a tube through a patient’s nose or mouth into their windpipe (trachea) to help them breathe and extubation is when the tube is removed.

Around 1,600 people work at Gamico Mine, which is approximately 30 minutes from Kigali’s city centre.

Essential ‘One Health’ approach

Despite Rwanda presenting a first-class case study of the importance of the One Health approach to contain outbreaks, several African countries are reportedly against measures in the pandemic agreement that stipulate how such an approach should be implemented.

A dead bat in Tunnel 12. Rwanda was assisted by international One Health experts to address its Marburg outbreak.

According to Article 5 of the draft agreement, currently being negotiated by WHO member states in Geneva, member states “shall promote a One Health approach for pandemic prevention, preparedness and response” that is “coherent, integrated, coordinated and collaborative among all relevant organizations, sectors and actors”.

While stressing that whatever is undertaken is appropriate to countries’ national laws and circumstances, the draft “encourages” member states “to identify and address the drivers of pandemics and the emergence and re-emergence of infectious disease at the human-animal-environment interface”.

This involves  implementing and reviewing national policies and strategies to reflect a One Health approach, including community engagement and training for workers who are “at the human, animal and environmental interface”.

African countries in particular are reportedly reluctant to sign on for anything that might cost them extra money or result in sanctions should they fail to employ these to contain outbreaks.

In the past, the WHO and other international partners could be counted on to assist in outbreaks. However, the US contributes 25% of the WHO’s emergency budget which will be lost when the US exits the global body next January.

In addition, valuable support to contain pandemics supported by the US Agency for International Development (USAID) has also been lost since the Trump Administration closed the agency.

Over the past weekend, the African Union agev the go-ahead for an African Epidemics Fund to be administered by the Africa CDC to fundraise to address outbreaks on the continent. The previous US administration had pledged $500 million to Africa CDC but this is in jeopardy under the Trump Administration.

Image Credits: Kerry Cullinan.

In October 2024, the final phase of the polio vaccine campaign in Gaza’s northernmost neighborhoods was never fully completed due to intense fighting. Now, after discovering more poliovirus in Gaza wasteater, WHO and UNICEF are launching a third vaccination round.

A third mass polio vaccination campaign will be carried out next week in the embattled Gaza Strip, following the further detection of poliovirus in wastewater samples, WHO and UNICEF said in a surprise, joint announcement on Wednesday.

“This campaign follows the recent detection of poliovirus in wastewater samples in Gaza, signaling ongoing circulation in the environment, putting children at risk,” the agencies declared.

The new round follows two successful vaccine rounds last autumn, including one carried out during a brief pause from the height of bitter fighting in northern Gaza.  But while those succeeded in reaching over 95% of children 10 and under who were targeted, it apparently was not enough to wipe out the virus entirely. During the second round, in October, WHO also warned that the inability of vaccine teams to reach children in the northernmost neighborhoods of Gaza such as Jabalia, to which Israel had blocked healthworker access while heavy fighting raged, could create future pockets of vulnerability.

“Pockets of individuals with low or no immunity provide the virus an opportunity to continue spreading and potentially cause disease,” WHO and UNICEF said in the statement. ” The current environment in Gaza, including overcrowding in shelters and severely damaged water, sanitation, and hygiene infrastructure, which facilitates fecal-oral transmission, create ideal conditions for further spread of poliovirus. Extensive population movement consequent to the current ceasefire is likely to exacerbate the spread of poliovirus infection.”

Most of Gaza’s sewage infrastructure – along with homes, schools and other infrastructure, have been destroyed during Israel’s invasion of Gaza and 16 months of fighting with Hamas that followed the bloody Hamas raids 7 October into Israeli communities near the Gaza enclave, that led to 1200 deaths and the capture of some 250 hostages. Over 46,000 Gaza Palestinians have been killed by Israel in the ensuing war.

“No additional polio cases have been reported since a ten-month-old child was paralyzed in August 2024,” the agencies said.  “But the new environmental samples from Deir al Balah and Khan Younis, collected in December 2024 and January 2025, confirm poliovirus transmission. The strain detected is genetically linked to the poliovirus detected in the Gaza Strip in July 2024.”

Cease fire creates better access to areas missed

Health workers leaving Kamal Adwan Hospital in December after months of fierce fighting in Gaza’s northern communities – which also impeded polio vaccination.

The six week Israel-Hamas ceasefire, that began on 19 January, has also created a much better opportunity for vaccination teams to reach areas that were missed during the October round.

“In 2024, health workers faced significant challenges accessing certain areas of central, north and south Gaza, which required special coordination to enter during the conflict,” the WHO/UNICEF statement noted. “In inaccessible areas such as Jabalia, Beit Lahiya, and Beit Hanoun where humanitarian pauses for the vaccination campaign were not assured, approximately 7,000 children missed vaccination during the second round. The recent ceasefire means health workers have considerably better access now. ”

It’s also clear that the UN health agencies are moving quickly in order to seize the moment of relative calm. The first six-week ceasefire period ends next weekend.

And it almost fell apart last week when Hamas momentarily said it was pausing release of the next three Israeli hostages – before finally going ahead with their release on Saturday, 15 February, as planned.  This Saturday, Hamas has even speeded up the pace, saying it will release the last of the six living Israeli hostages set to be released in this phase of the deal – instead of the three to which it was committed by the agreement.  The bodies of eight deceased Israeli hostages are also to be released before the initial six-week period of calm ends on March 1 next weekend.  Although the two parties have pledged to preserve the peace as long as negotiations for a second phase are continuing, those talks are expected to be even more complex than the first stage agreement, which took months to reach.

All in all, some 33 Israeli hostages are due to be released in the six-week cease-fire. In exchange for each Israeli released, Israel has been releasing some 30–50 Palestinians held in Israeli jails. Israel has also pulled its forces back from the Netzarim corridor that blocked Palestinian movement from southern to northern Gaza, last autumn, as well as from Gaza’s Rafah cross with Egypt, and allowed a surge of humanitarian aid into Gaza.

Doron Steinbrecher, among the first three, of 33 Israeli hostages to be released during the current cease-fire deal, was turned over to the Red Cross on Sunday, January 19.

However, big question marks remain over the future of the present truce.  After the the next pending hostage releases are completed, Hamas will continue to hold over 58 Israelis, young civilian men and soldiers, less than half of whom may really be alive.  Those remaining hostages will only be released as part of a permanent ceasefire deal. At the same time, Israel’s government has said that it won’t agree to a permanent arrangement that leaves Hamas in power in Gaza – although neither Israel nor Arab mediators have so far come up with an alternative governance plan.

And while there is wide support among the Israeli public for the continuation of the ceasefire so that all hostages are released, government hardliners are pressing for a return to war. To complicate negotiations on a second phase even more, United States President Donald Trump has shocked and alienated both Palestinians and the Arab world with his recent declarations that Gazans should be evacuated so that the area can be turned into a “Riviera” under US control – something that would be illegal under international law.

Against this very uncertain future, next week’s polio campaign will unroll. WHO said all Gaza children under 10 years of age will be targeted with a second, or even a third, polio vaccine:  “The upcoming vaccination campaign aims to reach all children under 10 years of age, including those previously missed, to close immunity gaps and end the outbreak. The use of the oral polio vaccine will help end this outbreak by preventing the spread of the virus. An additional polio vaccination round is planned to be implemented in April.”

It added that “there is no maximum number of times a child should be vaccinated. Each dose gives additional protection which is needed during an active polio outbreak.”

Image Credits: WHO, Middle East Eye , @nabilajamal.

An International Rescue Committee team distributes drinking water to Sudanese displaced by the civil war.

(The New Humanitarian) The International Rescue Committee, one of the oldest humanitarian aid organizations in the United States, is cutting thousands of staff, in another sign of the turmoil rippling across the humanitarian sector as the US aid funding freeze continues.

“We have had to take immediate and significant cost-cutting measures, including laying off and furloughing thousands of IRC personnel around the world,” the IRC said in a statement to The New Humanitarian.

The organization cites “the dual impact” of the freeze on “the majority of foreign assistance programmes”, and “the difficulty accessing funds disbursed through the US government’s payment system”.

“Like many peer humanitarian agencies, IRC is responding to the impacts on our clients of disruptions to US foreign assistance funding for critical programmes,” the IRC statement read.

In a separate letter to staff last week, CEO David Miliband announced a first round of several hundred furloughs (unpaid leave) and imminent layoffs.

“As much as we would like to believe there will be some relief of the financial pressure on our organisation and that our programmes will be able to resume, the reality is that there will assuredly be a significant reduction of [US government] support for our programmes this fiscal year, impacting services and staffing,” Miliband wrote.

The IRC’s leadership board cancelled staff pay raises and will take a 20% pay cut, Miliband’s letter said. Miliband’s own salary – about $1.2 million including benefits, according to tax filings for 2022 – is one of the highest in the humanitarian sector.

The IRC has previously said it has more than 17,000 global staff.

Layoffs, furloughs, and frozen aid

The IRC moves mirror cuts, suspensions, and sudden aid stoppages happening throughout the humanitarian sector as decision-makers grapple with the fallout from US President Donald Trump’s freeze and the attempted dismantling of the government’s aid agency, USAID.

Layoffs and furloughs have hit many international NGOs and aid organisations, including the Danish Refugee Council, Mercy Corps, the Norwegian Refugee Council, Catholic Relief Services (CRS), and FHI 360.

Local aid organisations, from community groups to national NGOs, have been particularly hard hit – most have minimal reserves and fewer donors. NEAR, a network of Global South civil society organisations, says 83% of its members have had programmes paused, affecting millions, while staff lay-offs are widespread.

The vast majority of the humanitarian sector’s workforce are local staff, who are often a part of the communities they help.

The aid freeze pushed organisations to suddenly suspend programmes, leaving millions of people who use US-funded aid with little warning or time to find alternatives.

HIV-positive children dropping out of programmes

Some examples of the impacts, according to the NGO network ICVA: HIV-positive children are dropping out of anti-retroviral (ARV) treatment programmes, feeding centres for malnourished people have closed, and water and sanitation programmes have shut.

The funding crisis highlights the sector’s deep dependence on a small group of mainly Western donors, including the United States. About 42%, or $650 million, of the IRC’s original 2025 budget comes from the US government, Miliband’s letter said.

Save the Children’s US entity received 54% of its operating revenue from US government grants and contracts in 2023, according to financial statements. Staff there have told The New Humanitarian that internal announcements on cuts are imminent.

Similarly, US funding made up 37% of support for CARE, 35% for CRS, and at least 41% for Mercy Corps. Their dependence gets passed along to subcontracted frontline local organisations.

A turning point?

After a decade of growth, the IRC now faces severe cutbacks due to the freeze on most US government development assistance.

The upheaval at IRC and elsewhere may be a pivot point for the sector, which has grown rapidly over the last decade to match rising needs and donor funding – but mostly hasn’t planned for the day the taps might be turned off.

The  New York City-based IRC, first founded in 1933 to help people fleeing Nazi Germany, saw its operating revenue jump from about $560 million in 2014 to $1.36 billion in 2023, largely mirroring donor funding increases through the COVID-19 pandemic.

The organization, which in the 1950s and 1960s expanded operations to include the relief and resettlement of refugees from Eastern Europe, the Soviet Union, Viet Nam, and Cuba, today works in 40 crisis-affected countries around the world – from Gaza to Sudan and Afghanistan and the Democratic Republic of Congo. It was already weathering a fiscal crisis and previous staff cuts driven by poor budgeting and forecasting practices, rising costs, and lower-than-expected revenue.

Critics say NGOs like the IRC in particular have prioritised unchecked growth, buoyed by significant but unsustainable pandemic income.

Even at the start of its current fiscal year, and with other organizations cutting costs and undergoing painful restructures months earlier, the IRC was forecasting “sustained annual income” of $1.5 billion a year.

Now, like the rest of the humanitarian world and the wider aid sector, the IRC appears to be reining in its expectations.

“There is a clear path through this period,” Miliband told staff in his email. “The IRC will remain a vital resource for tens of millions of clients, smaller than five years ago but double the size of 10 years ago. I am just so sorry at the price to be paid to get there.”

This story was originally published by The New Humanitarian, an independent, Geneva-based media service covering humanitarian crises, and the people affected by those crises, around the world. 

Image Credits: Mustafa Saeed/IRC, The New Humanitarian/IRC.

Callie Weber, Dr Jackson Otieno, Amref’s Dr Mercy Mwangangi and Reach52’s Ben Kamarck

KIGALI, Rwanda – Confronted by a huge and growing burden of non-communicable diseases (NCDs), governments worldwide are under pressure to devote more of their domestic budgets to these illnesses.

Patients carry the burden of both the diseases and an estimated 60% of the cost of treating these, which include cardiovascular disease, cancer and diabetes.

Yet the sheer range of diseases, the high cost of NCD medicines and treatment and an apparent lack of donor interest in NCDs are daunting obstacles. (Only around 3% of official development assistance goes to NCDs.)

Ahead of the United Nations High-Level Meeting (HLM) on NCDs in September, NCD advocates want governments to commit to concrete implementation targets in whatever declaration is adopted.

Civil society organisations meeting at the NCD Alliance Forum in Kigali last week discussed various options for governments to increase domestic resources for NCDs, which are responsible for almost three-quarters deaths each year. 

Despite Africa’s youthful population, 37% of deaths on the continent are due to NCDs – and this is growing annually. Cardiovascular diseases such as strokes and heart attacks have overtaken tuberculosis and respiratory infections as the biggest killer on the continent.

Various possibilities exist for bolstering countries’ domestic resources for NCDs, including excise taxes, pooled procurement with other countries to bring down medicine prices and incentives to encourage the private sector to invest in NCDs.

Excise taxes are a win-win

If the excise taxes currently imposed on tobacco, alcohol and sugary drinks are increased by 50%, this would save 50 million lives over the next 50 years, said Vital Strategies CEO Mary-Ann Etiebet, quoting research from the Task Force on Fiscal Policy for Health.

Aside from deterring people from consuming these unhealthy products, these taxes could raise over $3.5 trillion in five years which could be ploughed back into NCD prevention, treatment and care.

Many governments have not embraced these taxes thanks to intense lobbying by the tobacco, alcohol and junk food companies.

Removing government subsidies for harmful products such as oil or sugar can also improve the overall pool of financing available for health, said Kimberly Green, PATH’s global director of primary health care and part of the Coalition for NCDs Access to Medicinces and Products (Coalition4NCDs).

But this too faces huge industry pushback.

Forecasting demand

For Green, “one of the fundamental challenges is demand forecasting”. Governments need to identify their priority NCDs and project how many people will be affected over the next five to 10 years.

“Without this, it is impossible to know how much medicine they will need. This is a fundamental gap yet demand forecasting has been very well done in HIV, TB and malaria,” said Green.

The Coalition4NCDs has developed a forecasting tool that it has shared with some parliamentarians to enable them to increase the budget for NCDs

But Rwanda’s Dr Evode Nyibizi warned that accurate data alone is not enough.

His country’s health system is fully digitised, so financial decisions are based on data fed from all tiers of the health system.

“In 2023, we were only utilising around 10% of the data that we collected on daily basis. So we established the National Health Intelligence Centre, which is helping us to draw insights from the data that we collect,” said Nyibizi, who heads the centre.

“The centre tells you what the problems are and where you need to invest your money,” Nyibizi explained.

Particularly in light of the global health financing crisis experienced by the withdrawal of United States aid, many countries need to reprioritizing where “the small amount of money left goes”, he added.

PATH’s Kimberly Green and MedAccess’s Mayank Anand

Creating demand

But even before demand forecasting, Ben Kamark’s organisation, Reach52, works to generate demand for essential health products to reach the 52% of the world who don’t have access to these.

“Out-of-pocket markets have peculiar market dynamics. They get stuck in a vicious cycle. Every distributor, every seller of pharmaceutical products, is incentivized to sell less products at a higher price,” explained Kamarck. 

“So they come into the market with a higher price, expecting a lower demand. But a higher price leads to lower demand, which also importantly, leads to lack of investment.”

Insulin is an example of a product for which the price is higher than it should be because demand is lower than it should be, he explained.

“Then the market doesn’t move. We believe that the only way to actually intervene in an out-of-pocket market is to be a market participant.”

And it takes a lot of risks. Reach52 launch medicines at prices that “would make sense in high volumes, even when there aren’t high volumes”, said Kamarck. 

They register products “that no one’s asking for and no one’s wanted, because we know there’s a need for them”.

Then Reach52 runs “hyper-targeted public health interventions and healthcare provider engagement” to create demand and drive sales of essential medicines.

“That’s a hard choice to make for a lot of private sector companies,” admitted Kamarck.

Reach52 runs “hyper-targeted public health interventions and healthcare provider engagement” to create demand and drive sales of essential medicines.

Reducing risks

Mayank Anand works for MedAccess, a social finance company established in 2017 with the support of donors, health advocacy organisations and pharmaceutical companies. 

Its aim is to reduce the risks in the NCD treatment supply chain for suppliers and procurers through volume guarantees, procurement guarantees, and concessionary loans.

“We’ve has done 11 guarantees so far across areas such as TB, HIV, malaria, syphilis, and COVID-19 with range of partners such as the Clinton Health Access Initiative (CHAI),” he explained.

“A volume guarantee is a backstop agreement between ourselves and supplier where we assure sales volumes over a period of two to six years in return for the supplier bringing the price down to an affordable price, but also making commitments to accelerate registration in markets,” said Anand.

The 11 deals done so far has enabled half a billion people to get access to medicines.

Another public-private partnership is the Financing Accelerator Network for NCDs (FAN), a new initiative started by Access Accelerated, the World Bank, and Results for Development (R4D), aimed at building sustainable health financing systems for NCDs.

Leadership is at the centre

Amref Health Africa’s Dr Mercy Mwangangi injected come realism into discussions by pointing out that almost 80% of the $9.8 trillion spent annually on health is spent in the global North.

In Kenya, where she is based, the per capita expenditure is $90 whereas in the US, it is $14,000.

“How do we ensure that drugs are available to the American who is spending $14,000 are also available to the Kenyan, where there’s a $90 spent every year?” she asks.

Aside from lack of finances, health systems also have to be ready to roll out medicines should innovative finances make them available, she adds.

Can a country screen for cancer? Does it have a national registry of the burden of disease?  Do supply chains work so that citizens can access care? Are the legal and regulatory frameworks amendable to access to medicines? 

To spell out the challenges, Mwangangi gave a rundown of Amref’s engagements with pharmaceutical company Roche to enable Kenyans to get access to the breast cancer drug, Herceptin.

“From the initiation of those conversations to having patients access these commodities took about two years of back-to-back conversations with government players, procuring agencies and with repayment systems,” she said.

Despite this energy investment, the programme has stalled because facilities are not able to pay the procuring agency for the medicine that they have been issued with.

“Leadership and governance is at the centre of innovative financing,” stressed Mwangangi.

Image Credits: Reach52.

Dr Tedros Adhanom Ghebreyesus (right) opens the 13th round of the pandemic talks, flanked by co-chair Anne-Claire Amaprou

“It’s now or never,” World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyussus told the start of the 13th round of talks on a pandemic agreement on Monday morning.

Five days of talks are scheduled this week with another five days scheduled in April. Thereafter, the plan is for an agreement to be presented at the World Health Assembly in May.

Those close to the process said that the “stock take” this Friday will be an important gauge of whether the talks will succeed.

Negotiators’ failure to reach agreement may mean the end of the road for the global endeavour to pandemic-proof the world. Energy and interest in the talks have waned considerably over the four-plus years of talks.

“I’m confident that you will choose ‘now’, because you know what is at stake. You remember the hard-won lessons of COVID-19, which left an estimated 20 million of our brothers and sisters dead,” said Tedros.

“We know that the next pandemic is a matter of when, not if. There are reminders all around us – Ebola, Marburg, measles, mpox, influenza and the threat of the next Disease X,” he added.

“No country can protect itself by itself. Bilateral agreements will only get you so far. Prevention is the responsibility of all countries. Preparedness is the responsibility of all countries, and response is the responsibility of all countries.” 

The US, although still technically part of the WHO until next January, informed the WHO last Friday (14th) that it would not take part in the Intergovernmental Negotiating Body (INB) overseeing the talks.

Trump’s executive order withdrawing the US from WHO explicitly states that “while the withdrawal is in process, the US will cease negotiations on the WHO Pandemic Agreement and the amendments to the International Health Regulations [IHR], and actions taken to effectuate such agreement and amendments will have no binding force on the United States.” 

“Like the [US] decision to withdraw from WHO, we regret this decision and we hope the US will reconsider,” Tedros told the INB.

Moving away from grandstanding?

INB co-chairs Precious Matsoso (left) and Anne-Claire Amprou.

INB co-chair Precious Matsoso told the meeting that the Bureau, which co-ordinates the talks, had taken heed of countries’ request to “propose text for all the outstanding work”.

“We did just that, and we’re hoping that, with what we’ve presented before you, to be able to move as fast as possible because we’ve got only 10 [negotiating] days left before we present the pandemic agreement to the World Health Assembly,” said Matsoso.

The latest draft of the pandemic agreement reflects that pathogen access and benefits sharing (PABS) and One Health remain sticking points. 

Matsoso also urged member states at the opening to confine their comments to the text at hand rather than making general comments – and for the first time, the open session was not dominated by repetitive grandstanding. 

With only Iran using the opening to make a general point, member states’ restraint is a positive indication that countries may finally be moving away from rigidly held positions.

Equity and solidarity

Stakeholders, who are not allowed into the negotiations, used their time slots during the open session to appeal for the deal to be struck, for equity to remain a cornerstone and to advocate for technology transfer to prepare for pandemics.

“Do not walk away from this vital mission,” urged the Pandemic Action Network’s Rafael Garcia Aceves.

“Bank and build on the promising consensus agreed thus far. Continue to advance a pandemic agreement that can lay the essential groundwork for equitable collective preparedness and response in 2025, which can be made stronger and more detail added in future through protocols.”

Ellen ‘t Hoen of Medicines Law and Policy.

Ellen ‘t Hoen of Medicines Law and Policy said that “more than ever, the world needs a signal that multilateralism works, that solidarity is at the core of the pandemic agreement and that no country will be left alone to deal with pandemics, either current or future ones”.

“That is not the predominant spirit in Geneva – or the world for that matter – at the moment, but you can bring it back.”

Spark Street senior researcher Elliot Hannon warned that “the world has changed immeasurably” since the last negotiating session in December before US President Donald Trump took over.

“The global multilateral system is under siege, threatening the very institutions developed to promote and protect health around the world,” said Hannon.

“The pandemic agreement is a concrete action against this great dismantling. Its completion would not only make the world safer but affirm the commitment to equity, integrity and solidarity,” said Hannon, adding that trying to perfect every aspect of the agreement was an unaffordable luxury.

The South Centre stated that, “without legal commitments to enhance sharing of technology and know how, and surge financing, it will not be possible to ensure timely global production of and equitable access to effective vaccines during pandemics, as during COVID-19.

The South Centre said that a “democratic vote” was the way forward to settle “divergencies” rather than “continuously” watering down the text down “to find consensus”, deferring  decisions “to uncertain future negotiations or decisions by the Conference of the Parties”.

Jamie Love

Knowledge Ecology International’s Jamie Love pointed out that the agreement’s definition of “technology transfer” was weaker than that permitted by US and European law, while, Oxfam’s Mogha Kamal-Yanni called for the agreement to contain “legal obligations” to share technology and remove intellectual property barriers.

This round of talks ends on Friday evening.

Dr. Sania Nishtar, Chief Executive Officer, Gavi, in Cairo.

In a breakthrough moment for Africa’s vaccine independence, two landmark deals could help put the continent on a path to becoming a producer, not just a buyer, of life-saving vaccines.

For the first time, an end-to-end mRNA vaccine production platform will be built in Africa, with plans to manufacture 100 million doses annually. A separate cross-continental partnership is advancing homegrown mRNA technology. These landmark agreements, signed in Cairo, are backed by a $1.2 billion investment from Gavi, The Vaccine Alliance. They aim to ensure vaccines are made by Africa, for Africa, and set the stage for expanded local vaccine production and cross-continental collaboration.

The first deal, signed in Cairo on the sidelines of the 2nd Vaccine & Other Health Products Manufacturing Forum, brings together EVA Pharma (Egypt) and European biotech firms DNA Script (France), Quantoom Biosciences (Belgium), and Unizima (Belgium) to establish Africa’s first “digital-to-biologics” end-to-end mRNA vaccine production platform. The facility is expected to produce up to 100 million vaccine doses annually, a significant boost for Africa’s ability to respond rapidly to infectious disease outbreaks and strengthen routine immunization programs.

2nd Vaccine Manufacturing Forum

In a second agreement, Biogeneric Pharma (Egypt) and Afrigen (South Africa) will expand their collaboration on mRNA vaccine technology development, reinforcing cross-continental expertise in cutting-edge mRNA vaccine applications to new diseases that have a high burden in Africa. 

“These agreements are proof that Africa is no longer just a buyer of vaccines—we are becoming producers,” said Dr. Jean Kaseya, Director-General of Africa CDC, at the conference’s closing ceremony. “This is the future of health security on the continent.”

Gavi’s $1.2 Billion Investment to Drive Manufacturing Growth

Afrigen’s mRNA hub in Cape Town, launched in February 2022, and now set to expand.

The two deals were announced alongside a broader effort to accelerate vaccine manufacturing in Africa, backed by a $1.2 billion investment from Gavi, the Vaccine Alliance.

The catalytic investments, recruited for Gavi’s newly formed African Vaccine Manufacturing Accelerator (AVMA), launched in June 2024, will be deployed over the next ten years to incentivize African manufacturers to produce priority vaccines, such as cholera and mRNA-based immunizations. AVMA leverages Gavi’s role as one of the world’s largest purchaser of vaccines to promote local manufacturing in Africa. Crucially, Gavi’s financial model ensures that licenses are held by African manufacturers, keeping intellectual property and production capacity on the continent.

“This is about building a sustainable vaccine ecosystem in Africa,” said David Kinder, Director of Development Finance at Gavi. “We are using our market power to drive investment where it’s most needed—ensuring Africa can produce its own vaccines, for its own people.”

Securing Demand and Regulatory Readiness

BioNTech’s modular mRNA vaccine manufacturing opened in Rwanda in 2023.

At present, while demand for vaccines in Africa is valued at over US$ 1 billion annually – Africa’s vaccine industry provides only around 0.1% of global supply. The African Union has set a target for the continent to produce 60% of the vaccines it needs by 2040.

While some new investments in vaccine production were made on the wave of interest created by the COVID pandemic, such as the Afrigen mRNA research hub, launched with WHO support in 2022, and BioNTech’s modular mRNA vaccine facility, in Rwanda, African manufacturers still face a major challenge: securing stable demand. Historically, global health agencies and African governments have sourced vaccines from long-established manufacturers in the Global North, leaving local producers struggling to compete.

To address this, officials at the Cairo summit called for a continent-wide pooled procurement mechanism, modeled after Egypt’s Unified Procurement Authority (UPA). Egypt’s system has successfully lowered costs and stabilized supply chains, and experts believe a similar approach at the African Union level could ensure consistent demand for vaccines produced within Africa.

“We must ensure that African-made vaccines have a guaranteed market,” said Dr. Khaled Abdel Ghaffar, Egypt’s Minister of Health and Population. “A pooled procurement system could be a game-changer, ensuring fair pricing and sustainability.”

Another critical issue discussed at the forum was Africa’s regulatory capacity. While manufacturing is expanding, vaccines must meet strict international quality standards to be used across the continent and beyond.

In December 2024, Egypt achieved WHO’s Maturity Level 3 in terms of the quality of its national regulation of vaccines and medicines – following South Africa, which reached that milestone in 2022.  The African Medicines Agency (AMA) , still in the process of establishment, is supposed to lead effort to harmonize regulatory approvals across Africa, making it easier for locally made vaccines to reach wider markets. See related stories here:

African Medicines Agency Countdown

Gavi’s Replenishment and Africa’s Push for Funding

The investments in African manufacturing come at a pivotal moment for Gavi, which is seeking $9 billion in new funding for 2026-2030 to sustain its work in Africa and beyond.

At the Cairo forum, African leaders threw their support behind Gavi’s replenishment effort, pushing for global donors to meet the funding target.

“We need a well-funded Gavi,” said Dr. Kaseya, who pledged to push for African leaders to back Gavi’s funding request at the upcoming African Union Assembly.

Momentum for local vaccine production will continue in June 2025, when Africa’s first annual vaccine and biopharmaceutical manufacturing exhibition, Africa Excon, will be held in Egypt. The event will showcase progress in local production and attract investment, ensuring Africa’s vaccine ambitions continue to gain traction.

Despite the challenges, leaders at the Cairo summit were optimistic about the future. “We are no longer just talking about vaccine sovereignty,” Dr. Kaseya said in his closing remarks. “We are making it happen.”

Image Credits: Rodger Bosch for MPP/WHO, BioNTech.

A tuberculosis patient in Mozambique who completed treatment thanks to a USAID-supported health worker. USAID administers all US bilateral aid for fighting TB.

A coalition of American non-profit, legal and small business groups welcomed a federal judge’s temporary restraining order (TRO) halting the Trump Administration’s executive order freezing virtually all USAID activities – followed by a “stop work” order on the agency by new US Secretary of State Marco Rubio. 

The ruling Thursday evening in a Washington DC District Court came in response to a lawsuit filed by the Global Health Council, the Small Business Association for International Companies, HIAS, the Jewish-American refugee aid agency; and the American Bar Association.

“This ruling is a vital first step toward restoring U.S. foreign assistance programs,” said Elisha Dunn-Georgiou, President of the Global Health Council, a member based body. “It clears the path for organizations to resume their life saving work, showcasing the best of American values: compassion, leadership, and a commitment to global health, stability, and shared prosperity.”

In their suit, the groups contended that by attempting to dismantle an independent agency established by Congress, the Trump Administration was “unlawfully withholding billions” in foreign aid. 

“The Administration has forced businesses large and small to shutter programs and lay off employees. These actions have caused widespread harm, weakening the infrastructure needed to combat mounting global health crises including bird flu, measles, and drug-resistant tuberculosis—diseases that have surfaced in the U.S.—and leaving hungry children without food, vulnerable populations without critical medical aid, and communities without life-saving support,” the charged the plaintiffs in the suit, which included Management Sciences for Health, Chemonics International, DAI Global, and Democracy International – non-profit and for-profit groups that are major USAID subcontractors.

Impacts and ongoing uncertainties 

MANA Nutrition Factory in Fitzgerald, Georgia, which produces specialized nutritious foods to treat acute malnutrition. Among the thousands of US businesses affected by the USAID freeze.

On paper, the TRO blocks the government from taking actions that would disrupt U.S. foreign assistance programs including:

  • Suspending, pausing, or otherwise preventing the obligation or disbursement of appropriated foreign-assistance funds in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025; or
  • Issuing, implementing, enforcing, or otherwise giving effect to terminations, suspensions, or stop-work orders in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025.

However, with USAID personnel around the world on forced furloughs, budget systems frozen, and grain donations rotting in US ports, it remained unclear if a temporary order, on its own, could rapidly reboot the massive $40 billion-a year apparatus  – including $8.5 billion in global health assistance. 

“Despite the restraining order, much of the damage to US foreign assistance and to our agencies and humanitarian workers is already done. Within a matter of weeks, the President has succeeded in all but decimating USAID and has perhaps irreparably damaged the goodwill and reputation of the United States,” said Lawrence Gostin of Georgetown University.

“It is hard to describe the chaos at USAID, with funds frozen, staff let go, and partners all over the world feeling shattered. Even foreign aid programs that have received a waiver from the freeze cannot carry out their functions. This has caused enormous human suffering and hardship, with children starving and at risk of stunting, persons living with HIV unable to access their medications, and humanitarian assistance at a grinding halt,” he added, citing a recent article in the peer-reviewed journal Health Affairs.

Gostin, who heads a WHO Collaborating Center on law and global health policy, was pessimistic about the possibility of legal action changing policies in the long-term, saying, “no matter what the courts ultimately do, the harms will be real and palpable. And in the end, the President will probably prevail in the courts. He may be forced to actually follow a logical process and not be arbitrary and capricious. He may have to unfreeze funds until he can get Congress to join him in decimating USAID. But the president has a highly compliant Supreme Court that seems to back him on almost anything consequential.”

Pressure growing on  Trump administration 

At the same time, the pushback, coming from multiple corners could help swing the pendulum back over time.  “Some push back is good and in the end things will not be as bad as first thought,” one USAID insider, speaking confidentially, told Health Policy Watch. 

Pressures are building, for instance, from farmers in so-called “Red” or Republican states, who sell hundreds of millions of dollars in grain to USAID and, via USAID, to the World Food Programme (WFP) every year, to feed hungry people around the world. Ambassadors, who see USAID as a vital form of “soft power” for the US in the geopolitical competition with China, Russia and Islamic extremists, are also likely to protest quietly.

“I have been waiting for the agriculture sector to weigh in. They will take a big hit from the President’s actions,” Gostin said. While WFP said on Tuesday that its deliveries of food aid stuck in US ports were allowed to resume on 11 February, the Trump-ordered pause in new food aid purchases and stop work orders on new WFP purchases has remained in effect.

Biggest provider of global health foreign aid

“By attempting to dismantle an independent agency established by Congress and unlawfully withholding billions in foreign-assistance funding, the Administration has forced businesses large and small to shutter programs and lay off employees,” said the Global Health Council in its statement on the temporary restraining order.

“These actions have caused widespread harm, weakening the infrastructure needed to combat mounting global health crises including bird flu, measles, and drug-resistant tuberculosis—diseases that have surfaced in the U.S.—and leaving hungry children without food, vulnerable populations without critical medical aid, and communities without life-saving support.”  

USAID implements most US global health funding.

With a global health budget of $8.5 billion annually, USAID is the largest US provider of global health assistance, far outpacing the Department of Health and Human Services, and PEPFAR, the President’s Emergency Plan for AIDS Relief.  In fact, USAID implements most US bilateral global health funding, including 60% of  PEPFAR’s $4.2 billion budget for HIV/AIDS in 2023. 

Along with the already well-reported impacts of USAID’s collapse in battles against infectious diseases like polio, HIV/AIDS, influenza, malaria, marburg and Ebola, there has been a ripple effect to an even broader range of activities related to global health security,  health services, and nutrition, the GHC noted in a briefing note issued last week. Some of those include: 

  • A halt to the flow in over $1 billion in pharmaceutical donations, including HIV drug supplies; as well as USAID facilitated global biotech and research partnerships with US companies; 
  • Interruption in the services of thosuands of maternal and child nutrition centers; care for pregnant women and orphans; in conflict zones and the world’s poorest countries.
  • A halt to USAID support for thousands of frontline health clinics in vulnerable countries and conflict zones, including: Afghanistan, Ethiopia, Myanmar, the Democratic Republic of Congo; Guatemala and Honduras.

For maternal and child health and TB, USAID was the implementer of all US bilateral support in 2023. It also managed 99% of family planning and reproductive health funds and 96% of funds for malaria control efforts.

CDC finally reports on avian flu spread   

CDC finds vets working with dairy cattle unknowingly exposed to H5N1 avian flu.

In other developments, the US Centers for Disease Control, finally issued an update on Avian flu to its Morbidity and Mortality Weekly Report (MMWR), which showed that some veterinarians working with cattle were unknowingly infected with the H5N1 (avian flu) virus last year.

The report is the latest to indicate that the outbreak in dairy cattle is spreading further under the wire. The CDC report was one of several MMWR reports on avian flu that were to have been released three weeks ago. 

Inother report published this week, the CDC cited new USDA data on the rapid spread of H5N1 bird flu in poultry, showing some 157 million birds have so far been affected, since the first detections in 2022. The outbreak has caught the attention of the US public as the price of eggs soars to a 50-year high. 

Avian flu continues to spread amongst US poultry flocks.

States can opt out of testing dairy cattle for avian flu 

As for the dairy herds, USDA tables and maps showing trends in the spread of the highly pathogenic virus in dairy herds, across different states, which typically linked to the MMWR reports were no longer visible on the web page.  The USDA pages have not been updated since 17 January.  

But even that data, when available, was incomplete since federal law allows states to opt out of testing dairy cattle, noted Kay Russo, a dairy and poultry veterinarian.  He said the new CDC report on the silent spread of the virus among veterinarians underscores an urgent need for more routine monitoring of animals in agriculture.

“The frequency may be insufficient to proactively warn and safeguard workers,” Russo told the Washington Post. 

“This is a critical worker safety issue for farm and processing plant workers,” said Russo, who has worked on the outbreak since last March. “I can’t help but feel we’re missing huge pieces of the puzzle at this time.”

–Updated 16 February, 2024

Image Credits: Arnaldo Salomão Banze, ADPP Mozambique, USAID, KFF , US CDC , US CDC .

INB negotiations underway in Geneva for a pandemic agreement

Civil society groups have urged World Health Organization (WHO) member states to “continue to advance a pandemic agreement that can lay the essential groundwork for equitable, collective preparedness and response” ahead of the 13th meeting of the negotiating forum on Monday  (17 February). 

Only 10 negotiating days are left until the World Health Assembly in May, which is due to adopt the pandemic agreement. 

“Despite geopolitical and policy challenges, do not walk away from this vital mission. We urge Member States to stay focused on the end goal. Bank and build on the promising consensus agreed thus far,” urged the Pandemic Action Network, Panel for a Global Public Health Convention, Spark Street Advisors and The Independent Panel for Pandemic Preparedness and Response in a statement.

The latest draft of the pandemic agreement (from INB12, 6 December) reflects that pathogen access and benefits sharing (PABS) and One Health remain sticking points as countries struggle to devise a global plan to advance pandemic prevention, preparedness, and response. 

However, the new draft also contains more detail about what is expected from each member state to prevent outbreaks from becoming pandemics – which is an anxiety for poorer nations who fear this might mean more onerous financial commitments.

Since the last meeting of the Independent Negotiating Body (INB) in December, “we have witnessed deepening outbreaks of mpox and H5N1 and new outbreaks of Sudan Ebola and Marburg viruses. Any one of these threats risks spreading further without strong and decisive leadership and action,” the groups note.

“The finish line is in sight. Pandemic threats remain. The world needs member states to agree to a historic pandemic agreement and demonstrate the solidarity essential to keep us all safer. We are counting on you to pull together and get the agreement done.”

While the US and Argentina have given notice that they intend to withdraw from the WHO,  the US has to give a year’s notice so it technically remains part of all WHO member state bodies. At the recent WHO Executive Board meeting, the US was represented by technical officers at the US Geneva Mission. But US delegates to the EB made just one statement, on Taiwan, along with voting on geopolitically charged issues, such as an Israeli motion to combine the annual debates on two resolutions related to the health situation in the Occupied Palestinian Territories, into the agenda of WHO’s broader emergency work – a motion which lost.

However, sources told Health Policy Watch that US diplomats would not attend the INB negotiations at all. In fact, the Trump executive order withdrawing from WHO explicitly states that the “while the withdrawal is in process, the US will cease negotiations on the WHO Pandemic Agreement and the amendments to the International Health Regulations [IHR], and actions taken to effectuate such agreement and amendments will have no binding force on the United States.”  Amendments to the IHR, intended to provide for faster notice by countries to WHO and more efficient global response on epidemic threats, were approved in fact at the 2024 World Health Assembly, so it’s unclear if the US can retroactively declare that those have no binding force.  See related story.

‘The World Has Won’: New International Regulations to Protect Against Pandemics Finally Approved

As for Argentina, there is in fact no process for members states besides the US to withdraw without first obtaining agreement of the World Health Assembly – remaining in WHO as an “inactive” member is an option a few member states have used in the past, said Chief Legal Counsel Steve Solomon in a WHO press briefing Wednesday.

Solomon explained that when the United States first joined the WHO in 1948, it did so with a condition that it was entitled to withdraw if it chose to do so, but no other member state made that a provision of their original membership.

Chinese assistance is recognised at the entrance to Masaka Hospital in Kigali

KIGALI, Rwanda – Behind blue scaffolding walls marked “China Aid for shared future”, a massive expansion of Masaka District Hospital is underway.

The hospital will expand from 330 to at least 830 beds, and it is destined to become the country’s top teaching hospital, with completion set for July.

China has provided a $42 million grant to the Rwandan government to expand the hospital, but it has a long association with Masaka, assisting to build it in 2011 and providing medical specialists for it since 2018.

The Chinese government is financing a $42 million expansion of Masaka District Hospital in Kigali

“The construction of the Masaka District Hospital is one of the largest China-aided projects in Rwanda, and it marks a milestone in health infrastructure cooperation between the two countries,” Chinese Ambassador to Rwanda Wang Xuekun said at the start of construction in 2023.

Chinese support is evident throughout Masaka. A billboard at the entrance features nine Chinese specialists currently based at the hospital.  A room offers Chinese medicine. (“Acupuncture,” explains a nurse.) 

China sends new medical staff to the hospital every year, says Dr Jean Damascene Hanyurwimfura, Director-General of the hospital.

A billboard at Masaka Hospital displays the Chinese doctors currently stationed at the hospital

China is Rwanda’s biggest trading partner. By 2022, the Rwanda Development Board had registered investments worth $182.4 million from China, an increase of 30% over the previous year.

Huge PEPFAR investment

There is a small US Agency for International Development (USAID) sign at the hospital’s entrance.

“The US has helped us in training and mentoring doctors and nurses in maternal and child health,” said Hanyurwimfura. “But since this month, that has stopped. It is not having such an impact yet because the people have been trained, but in future, there will be a gap.”

This follows the decision by incoming US president Donald Trump to suspend all foreign aid for 90 days from 20 January, followed by the dismembering of USAID by Trump appointee Elon Musk.

However, Rwanda has received significant funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR) since 2004. By 2020, it had received $1.45 billion from the plan. In 2022/ 23, it received over $67 million.

PEPFAR’s investment in Rwanda up to 2020 totalled $1.45 billion.

Unlike many other PEPFAR recipients, Rwanda delivers integrated health care, not a vertical programme focussed on HIV so PEPFAR funds have helped to build the country’s healthcare system and employ health workers.

After the initial shock following the US funds freeze, US Secretary of State Marco Rubio clarified that life-saving humanitarian programmes could continue.

On 1 February, a waiver notice was sent to PEPFAR implementing agencies and country coordinators clarifying that “life-saving HIV care and treatment services” covered HIV testing and counselling; prevention and treatment of opportunistic infections including tuberculosis, laboratory services; procurement and supply of medicines, and prevention of mother-to-child transmission services.

Despite walking back its freeze, the Trump administration’s dismantling of USAID means that the US staff ensuring payments and delivery of antiretroviral medicines is no longer there, so PEPFAR projects worldwide are experiencing disruptions.

In addition, support for certain key activities, such as services for sex workers and men who have sex with men, has been axed.

The US withdrawal from the World Health Organization (WHO) may also impact on Rwanda’s health sector. The WHO has supported Rwanda in various initiatives, most recently providing financial and technical support to address its outbreak of Marburg virus. The US funds a quarter of WHO’s emergency response so activities these will need to be cut back.

China’s ‘Health Silk Road’

China appears reluctant to step up at a multilateral level to fill the gap left by the US, baulking at the 20% increase in WHO membership fees at the recent executive board meeting – even though that had been agreed to by members in 2022.

But it is likely to assist countries left in the lurch by the US on a bilateral level, particularly those like Rwanda where it has invested substantially over a long period.

Between 2003 and 2018, China’s outbound foreign development investment in Africa has surged from $75 million to $5.4 billion, up 7100%, according to researchers Nader Habibi and Hans Yue Zhu.

While China named its multilateral cooperation programme the Belt and Road Initiative (BRI), which indicated its focus on helping poorer countries with infrastructure development, over the past few years it has referred to the “Health Silk Road (HSR), which is regarded as a key element of China’s new BRI agenda”, according to Habibi and Zhu.

Elements of the HSR include “high-tech telecommunication infrastructure, medical equipment and healthcare services”, they note.

“Amid increasing geopolitical competition, and facing escalating US efforts to contain China’s global role, the Chinese government is using the HSR initiative in Africa and elsewhere to expand its global influence,” they argue.

China’s President Xi Jinping addresses the Forum on China-Africa Co-operation

At the opening of the Forum on China-Africa Co-operation in Beijing last September, China’s President Xi Jinping pledged to support the continent in 10 different ways, one being health.

“China is willing to establish a China-Africa Hospital Alliance with Africa and build a joint medical centre.,” said Xi. 

“China will send 2,000 medical teams to Africa, implement 20 medical and anti-malarial projects, promote Chinese companies to invest in drug production, and continue to provide assistance to the epidemic in Africa to the best of its ability,” said Xi.

“China will support the construction of the Africa Centers for Disease Control and Prevention and enhance the public health capabilities of African countries,” he added.

To implement its “Ten Partners Initiative” China will provide $50 billion in investment over the next three years.

US loses ‘soft power’

The dismantling of USAID has opened doors all over the world for China – not just in Africa.

China moved fast to assist a Cambodian project that is clearing land mines and unexploded bombs a few days after the USAID freeze, according to Newsweek.

Huge gaps in funding for Latin America following the aid withdrawal also offers opportunities for China to assist in a range of countries including Brazil, Colombia and Perua.

This week, Central Asia’s poorest country, Tajikistan, reported that its HIV, TB, malaria and maternal and child programmes had been disrupted.

“Until a mechanism for USAID’s further activities is determined, we will look for other ways to continue our work.” Minister of Health and Social Protection of the Population Jamoliddin Abdullozoda told a media briefing this week.

“Through its Health Silk Road initiative, strategic personnel placement, and growing influence among developing nations, Beijing is carving a path to global health leadership that doesn’t require writing big cheques to Geneva [for WHO membership],” argues Professor Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations, and a professor at Seton Hall University.

Image Credits: Kerry Cullinan, US Embassy in Rwanda.