UN peacekeeping vehicle MONUSCO, patrols streets of Goma, DRC as the rebel takeover of the city sends hundreds of thousands of people fleeing.

Hospitals in Goma, the city at the epicentre of the M23 rebel advance in the eastern Democratic Republic of Congo are being flooded with casualties. Health facilities and workers have been targeted in attacks. Humanitarian food stores are being looted. Women are at increased risk of rape, and the safe evacuation of wounded has been impeded by the closure of Goma airport, said the World Health Organization and other UN bodies at a joint press briefing Friday in Geneva on the worsening crisis in the DRC.

There are currently hundreds of people in Goma’s overloaded hospitals, mostly with gunshot and shrapnel wounds, said Adelheid Marschang, DRC Emergency Response Coordinator for WHO.

Some 700 people are believed to have been killed and 2800 injured, said Stephane Dujarric, spokesman for UN Secretary-General Antonio Guterres, speaking from UN Headquarters in New York City later on Friday.

Marschang stressed that WHO was especially worried for the health and safety of women and girls who are at a higher risk of violence, including rape.

With people  water stations and electricity grids damaged, and bodies of victims visible on Goma’s main streets, the conditions were rife for the spread of infectious diseases like cholera and measles, Marschang added. The fighting has led to a halt to immunizations against mpox – in the eastern DRC region which is the epicenter of the current epidemic, in which more than 20,000 cases were reported in North and South Kivu in 2024, and 6,000 in the past six weeks.  See related story here:

US Aid Pause Hampers Response to Multiple African Disease Outbreaks and Escalating DRC Conflict

The eastern DRC region also reported 21 672 cholera cases, including 59 deaths, and 11 710 measles cases, including 115 deaths last year. Before  Goma airport closed on Saturday, WHO was able to send critical medical supplies for trauma and emergency care, infection prevention, and cholera, among others. WHO was providing tents for hospitals to expand their treatment capacities, she also said. But with air and road passages out of the conflict zone blocked, evacuation of hundreds of wounded people remained in limbo, the WHO coordinator noted.

Food insecurity another worry

Jens Laerke, of the UN Office for the Coordination of Humanitarian Affairs (OCHA) said colleagues remaining in Goma had reported heavy small arms fire, mortar fire and the presence of dead bodies in the street. There were reports of gender-based violence and rape, committed by M-23 fighters, and the looting of a humanitarian warehouse and other facilities.

He reiterated recent calls for humanitarian pauses to facilitate the safe evacuation of wounded people and civilians trapped in combat zones, as well as the safe reopening of Goma airport and land crossings between DRC and Rwanda so as to enable people to flee the violence.

Speaking from the DRC capital of Kinshasa, Shelley Thakral, of the World Food Programme, said that WFP had been obligated to halt its activities. She also expressed concern about rising food insecurity in Goma as well as rising food prices as airports and major access roads remain blocked. The next 24 hours would be critical, she said, as people started to run low on supplies.

OCHA has allocated $17 million from the UN’s Central Emergency Relief Fund (CERF) to support lifesaving assistance – yet it remains unclear how relief agencies can even mobilize the aid to people in need, given the ongoing hostilities, officials also said.

Internally displaced fleeing Goma, where they once sought refuge

Displaced persons near Goma – most camps have now been emptied due to the M-23 rebel’s advances.

Goma, which sits along Lake Kivu adjacent to the Rwandan border, was once a place of refuge for some 700,000 displaced people fleeing rebel violence elsewhere in eastern Congo. But since the flare-up of hostilities near the city at the beginning of January, the area has now seen an emptying out of the massive camps that had developed on the outskirts of the city.

On Friday, sites hosting at least 300,000 internally displaced people were completely emptied due to the rapid advancements of the frontlines. Non-essential humanitarian staff had been relocated, but critical personnel remained in Goma. The UN’s emergency fund CERF had immediately allocated US$17 million to support the humanitarian response.

Sudan and DRC – civilians caught in crossfire

On Friday, horrific images also emerged in Sudan from Al Saudi Teaching Hospital in Sudan’s city of Al Fasher, reported Patrick Youssef, Regional Director, Africa, for the International Committee of the Red Cross (ICRC). He described how dozens of people had reportedly been killed in an attack that damaged the hospital building, which the ICRC supports.

At the same time, in Goma, heavy shelling and shooting send more than 100 people within 24 hours to the city’s N’dosho Hospital, where an ICRC surgical team is based, he observed, noting that “they would normally receive this number of patients in a month.”

These were two different conflicts in different countries, but there is a common thread that is alarming, he noted: civilians were paying an increasingly heavy price for brutal armed conflicts.

–Updated 2.2.2024 with estimates of casualties from Goma fighting.

Image Credits: MONUSCO/Aubin Mukoni, © UNHCR/Blaise Sanyila.

Robert F Kennedy Jr (RFK Jr) day 2 confirmation hearing
Robert F Kennedy Jr Day 2 of his Senate Confirmation hearings for the nomination of Secretary of Health and Human Services.

WASHINGTON, DC – Robert F Kennedy (RFK) Jr’s Senate confirmation as Health and Human Services (HHS) Secretary faced fresh obstacles on Thursday after Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Bill Cassidy (R-Louisiana) said he “wasn’t sure “ he could vote for someone “who spent decades criticizing vaccines, and who’s financially vested in finding fault with vaccines — can he change his attitudes and approach now ?” 

“I’ve got to figure that out for my vote,” he said, referencing his position on the Senate Finance Committee, which must vote to advance his nomination to the full floor. 

His comments came during a second day of grueling Senate confirmation hearings, which drilled down further on Kennedy’s beliefs on vaccine safety, funding, and his past statements claiming vaccines cause autism.  During the hearings, he walked back many of his past statements opposing vaccines and, conversely, supporting a woman’s right to abortion. In his second hearing, on Thursday, Kennedy also refused to comment on if vaccines cause autism, also in response to questions from Senator Cassidy. 

Kennedy, who would oversee a $1.7 trillion agency that includes the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and Centers for Medicare and Medicaid (CMS), has vowed to “put the health of Americans back on track” by addressing the nations growing mental health and chronic health crises – the latter by addressing unhealthy foods and environmental exposures, as well as high drug costs.

All eyes on medical doctor from Louisiana

Senator Bill Cassidy (R-Louisiana)
Senator Bill Cassidy (R-Louisiana) asked Kennedy to “convince him” that he believes that the measles vaccine does not cause autism.

All eyes are now on Cassidy, the medical doctor from Louisiana who also sits on the Senate Finance Committee, the body that will vote on whether to advance Kennedy’s confirmation to a vote before the full Senate. Kennedy would need the support of nearly all Republican senators for a positive recommendation.  

In a series of questions built around his own experiences as a medical doctor, Cassidy zeroed in on Kennedy’s  stance regarding vaccines such as Hepatitis B – whose benefits he said he’d witnessed firsthand – reducing  serious liver disease by 95% since its introduction.

“Will you reassure mothers unequivocally and without qualification, that the measles and hepatitis B vaccines do not cause autism?” He asked the HHS nominee.

Kennedy answered he would, “if the data is there.”

Cassidy retorted “And I don’t mean to cut you off, but that really is a ‘yes’ or ‘no’. There is the data, because I used to treat Hepatitis B as I said, I know the data is there,” replied Cassidy. Kennedy then pledged that he would publicly apologize for past statements if he’s proven wrong on the vaccine’s benefits versus its risks.

Later citing research papers disproving vaccines’ links to autism, Cassidy asked RFK Jr to “convince him” that “that you will become the public health advocate, but not just churn old information so that there’s never a conclusion” – a question Kennedy also sidestepped. 

Taking aim at the sentiments of his fellow Republicans, Cassidy also raised concerns over whether Kennedy could taint Trump’s legacy by advocating vaccine hesitant policies that lead to a loss of life. “You will have the responsibility to restore trust in our public health institutions…” he told Kennedy. “ I want President Trump to be successful. It’s important for our country. Any action you take as HHS Secretary will shape his legacy. And we both want that legacy to be positive.”

Although Thursday’s hearing took place in the Senate HELP committee, Cassidy is an important swing vote for RFK Jr.’s confirmation on the Finance Committee, which  is expected to vote next week on whether to advance his confirmation to the full Senate. 

The committee can make a recommendation that is “favorable,” “unfavorable”, or make none at all.  

RFK Jr refutes data that COVID-19 vaccine saved millions of lives

Bernie Sanders RFK jr hearing HHS jan 2025
Senator Bernie Sanders (I-Vermont) questions RFK Jr on whether he believes the COVID-19 vaccines, developed under President Trump’s Project Warpspeed, saved lives.

In a heated exchange with Senator Bernie Sanders (I-Vermont), Kennedy also asserted that “we don’t have a good surveillance system” to say whether the COVID-19 vaccine was successful in saving lives. “I don’t know,” he said.

 In fact, the vaccines, which were developed under the Trump administration, saved over three million lives during the pandemic period, according to US research. Kennedy continued to cast doubt on the COVID-19 vaccines, defending his efforts to sue the CDC over its ongoing recommendations that most Americans, six months and older, get the vacccine.

Sanders called Kennedy’s statements “really problematic”  – casting doubt on conclusions “established” by the scientific community.

Kennedy also said he stood by previous statements that “we should not be giving Black people the same vaccine schedule that’s given to whites, because their immune system is better than ours,” under questioning from Sen. Angela Alsobrooks (D-Maryland).

His assertions that African Americans have a “better” immune system prompted sharp criticism from Alsobrooks saying “what vaccination schedule should I have received?” 

“Mr. Kennedy, with all due respect, that is so dangerous,” said the senator, who is African American. “Your voice would be a voice that parents would listen to, that is so dangerous.”

In other remarks, Kennedy also said:

  • The country’s vaccine safety data systems are ‘broken’ and that the Centers for Disease Control and Prevention keeps the data “under locks” and will not let independent scientists review raw data.
  • Praised the popular GLP-1 weight loss drugs but said they should not be the first-line treatment for obesity.
  • Promised to relinquish rights to legal fees that he might otherwise receive from anti-HPV vaccine lawsuits in which he has continued to be involved as part of his legal practice.
  • Denied ever calling Lyme’s disease a “biological weapon,” contradicting statements made on Wednesday.

Pledge to address environmental contamination and “broken” health system

Kennedy also described how his experience as an environmental lawyer working with hunter’s fisherman and farmers along the Hudson River had sensitized him to the health impacts of pesticides and environmental pollutants early in his career. 

He has pledged  to tackle the obesity crisis, unhealthy processed foods, and environmental pollution to “make America healthy again” – as well as confronting big Pharma and high drug prices – messages that clearly resonated with many senators.

“Something is poisoning the American people and we know that the primary culprits are our changing food supply, highly processed foods,” he said, citing the unusually high proportion of obese people in the US in comparison to other developed nations, something that he called an “existential threat”.

But it’s unclear how much leeway he’d really have to move such a massive agenda in the new Trump administration – which is deeply indebted to big food and the pharma industry for supporting Trump’s election campaign. 

See the first day of coverage of the RFK Jr hearings here: 

RFK Jr Backtracks Anti-Vax Statements at Start of Contentious Confirmation Hearing

Watch the full confirmation hearing:

 

A 2022 meeting of the WHO Working Group on Sustainable Finance hammer out the final agreement on increasing member state contributions in 2022.

Finances will dominate the World Health Organization’s (WHO) 156th executive board meeting, which begins on Monday (3 February) under the shadow of the withdrawal of the United States, the body’s biggest member state.

As the US has to give a year’s notice of its withdrawal from WHO, it is still technically a member until January 2026 and has a seat on the 34-person board.

Tressa Rae Finerty has been appointed the new Chargé d’Affaires for the US mission in Geneva. And on the eve of the EB session, it appeared she would be leading a 10-member US delegation to the eight-day WHO Executive Board session that begins Monday – despite the US announcement that it is leaving the organization. Finerty’s name, as well as that of the State Department’s new “Team Lead” for Global Health Security and Diplomacy,  appeared on a published WHO roster of EB participants, Sunday evening, ending speculation that the USA might not show up at all. 

List of USA participants in the WHO EB156 session.

The opening day of the EB focuses on finances and efficiency, kicking off with the Director General’s report, which as of Friday evening remained unpublished in the EB’s otherwise detailed agenda.

The report of the Programme, Budget and Administration Committee (PBAC), which has been meeting this week, will also take centre stage as the committee will have had to grapple with the imminent loss of some 18% of the WHO’s budget. Although, legally, the US exit is only supposed to take effect in a year’s time, Washington has meanwhile frozen its contributions. 

Also on the agenda is the presentation of the first draft of the proposed budget for 2026/ 27. The total proposed budget for 2026-2027 is $7,473.2 million, a 9% increase from the previous biennium, divided into four segments: base programmes mostly aimed at strengthening member states’ technical capacities;  emergency operations and appeals, polio eradication and special programmes.

However, without the US contribution, it is unclear how this budget will be raised. Ostensibly, the US must pay its remaining assessed dues before finalizing its withdrawal, but not voluntary funds, which form the bulk of its annual contribution.

Universal health coverage

There will be a focus on member states’ progress in extending access to universal health coverage (UHC), including primary healthcare and “integrated people-centred health services”. Particular areas of focus include noncommunicable diseases, looking forward to the September UN High Level Meeting on NCDs and reviewing strategies for mental health and social connection, cervical cancer elimination, and oral health.  A new draft resolution on rare diseases, obtained by Health Policy Watch, commits WHO and member states to redouble efforts to find treatments and cures for conditions that often fall below the radar of R&D initiatives because of the comparatively few numbers of people affected.  The resolution, co-sponsored by Brazil and 11 other nations, calls for countries to create national task forces and registries of rare diseases, improve access to rare diseases diagnosis and treatment, as well as R&D.  It has received strong support from a wide variety of patient and medicines access groups.

Health Emergencies raging from Ukraine to Gaza, DRC and Sudan, are also expected to get significant attention at the meeting.

The Director-General will also submit a report on the third review of WHO’s Global Code of Practice on the International Recruitment of Health Personnel , which facilitates the ethical migration of health workers.

Ambitious new climate and air pollution action 

Air pollution darkens skis in Delhi during the November 2024 seasonal emergency.

The board will also need to take positions on three major new documents on environmental health – including a new draft Global Action Plan on Climate Change and Health; an updated ‘Road Map’ for addressing the health impacts of air pollution; and a controversial proposal for WHO to play a leading role in a new intergovernmental science-policy panel on pollution and health, which is part of the UNEP-led International Framework on Chemicals and Waste management.  

The Air Pollution road map includes an ambitious new voluntary target, which would aspire to see countries achieve a 50% reduction in deaths related to human-made air pollution sources by 2040, relative to 2015 baseline values. 

The previous WHA air pollution roadmap, approved in 2016, only a year after the very first WHA resolution calling for action on air pollution and health was approved, contained no such ambition. 

However nearly a decade later, little progress has yet been made in pollution hotspots like South Asia – with air pollution as the number 1 risk factor, accounting for some 2.7 million deaths annually, 2 million of which are in India.  

The EB’s consideration of the new Air Pollution road map comes in the lead up to the Second WHO Global Conference Air Pollution and Health, 24-28 March in Cartagena. At the conference, the first since 2018, countries are expected to make fresh commitments to tackling air pollution and health – in domains ranging from more stringent air quality standards – to better monitoring, enforcement and reporting.  

At a preparatory meeting this week in Cartagena, WHO launched a “call to action” to the broader health community – for which it is hoping to gain tens of millions of signatures. 

It remains to be seen if the administration of new US President Donald Trump will oppose the new WHO targets for reducing air pollution levels globally in the same way that it can be expected to oppose WHO initiatives on climate and health – (which it denies is an issue at all).  

In the past, Trump has said he wants “really clean air and water”. But his recent executive orders included numerous measures to loosen restrictions on vehicle efficiency and tailpipe pollution emissions, lower standards for energy efficient appliances, and promote fossil fuels exploration– all of which contribute to more health-harmful air pollution as well as to climate change. 

-Updated Sunday 2.2.2024, with list of US EB participants.

Image Credits: Germany's UN Mission in Geneva , Chetan Bhattacharji.

Dr Jean Kaseya

Ebola in Uganda. Marburg in Tanzania. Cholera in Angola. War in Goma in the Democratic Republic of Congo (DRC) that escalated the risk of multiple disease outbreaks – and then the United States decision to halt foreign aid for 90 days and order grantees to stop all work.

“This is not the kind of week we like,” Dr Jean Kaseya, Director General of Africa Centres for Disease Control and Prevention (Africa CDC) told a media briefing on Thursday.

“I was shaking, to be honest with you, when there was this US pause regarding the [Marburg] response in Tanzania,” Kaseya admitted. “And if we talk about mpox, we have a pledge of $500 million from the US. We got around 60% from what the US committed, and we are waiting for this 40%.”

However, Kaseya expressed gratitude that the US had exempted “life-saving humanitarian assistance” from the 90-day pause. The US State Department has defined humanitarian assistance as “core to life-saving medicine, medical services, food, shelter, and subsistence assistance, as well as supplies and reasonable administrative costs as necessary to deliver such assistance”. 

Africa CDC is waiting to engage with the US about its financial assistance once the appointment of the US Secretary for Health and Human Services (HHS) is finalised and the head of the US CDC is appointed. Trump’s HHS pick, Robert F Kennedy Jr is currently in Senate confirmation hearings.

Uganda reports Ebola – and maybe DRC too

Uganda announced an Ebola outbreak on Thursday, following the death on Wednesday of a 32-year-old male nurse in Kampala after five days of illness.

Uganda has set up an incident management team and is tracing 45 contacts, mostly people working in Mbale Hospital in eastern Uganda and Abubakar Islamic Hospital in Kampala.

Kaseya said that there was also a possible Ebola outbreak in DRC where seven out of 12 suspected cases had died. Samples from five of the cases have been sent to a laboratory in Kinshasa for diagnosis.

Ebola in Uganda 30 January 2025

Conditions in war-torn Goma ripe for epidemic

Kaseya expressed deep concern about people in Goma, the capital of DRC’s North Kivu province, which was taken over by Rwandan-backed M23 rebels this week.

Hundreds of people have reportedly died and the city is without water, electricity and the internet. 

However, Kaseya said there was a high risk of multiple health outbreaks in the heavily congested city, home to up to three million people including almost one million who have fled fighting elsewhere.

“We are talking about an area where so many people are together. Health infrastructure is broken. Access to basic services, even water and sanitation, doesn’t really exist. In addition to mpox, we have cholera outbreaks, measles and other diseases. I’m calling on our leaders to stop this unnecessary war that already killed 300 people. The guns cannot kill all of us, but outbreaks can.”

Kaseya said he did not know whether Goma’s health laboratory had been affected, and if it had been destroyed in fighting this would affect the country’s disease surveillance.

The rebels control the airport, so the L16 mpox vaccines donated by Japan that recently arrived in the DRC’s capital, Kinshasa, can’t reach Goma at present.

Meanwhile, mpox continues to dominate the outbreak statistics on the continent with almost 10,000 suspected cases reported in the past week along with 85 deaths. The one bright spark, however, is that Burundi has finally agreed to start vaccinating its citizens after months of scepticism.

Africa CDC is also supporting Angola to address a cholera outbreak that had already killed 51 people and infected around 1200 people. Some 2000 cholera vaccines will reach  Angola on 7 February. 

‘Difficult times’

“We are facing a very difficult moment. Western countries are decreasing their aid budgets,” said Kaseya, noting that in 2023, the US gave Africa in $8 billion in assistance, mostly for health and humanitarian assistance. 

“African countries are facing a tough economic situation. Projection from Africa CDC shows that we can expect two to four million additional deaths per year by 2025, which will push 39 million people into poverty, and reverse even the gain in mortality almost comparable to what we had 25 years ago,” said Kaseya.

“All of these conditions can lead one day to a pandemic from Africa. And if there is a pandemic from Africa, all of us in the world will be affected.”

African leaders are meeting on 14 February at the invitation of Rwandan President Paul Kagame to discuss more sustainable financing for health.

 

 

Robert F Kennedy (RFK) Jr, President Donald Trump’s nominee for the United States Department of Health and Human Services (HHS), faced two days of tense questioning from senators on the finance and health committees. He walked back many of his past statements on vaccines and abortion, and emphasized his commitment to address America’s chronic illness, mental health, and environmental exposure crises. 

WASHINGTON –  Robert F Kennedy Jr appeared at the first of two Senate confirmation hearings on Wednesday, facing sometimes tense standoffs between the HHS nominee and Senate Democrats, as well a few Republicans, critical of his record of vaccine hesitancy, skepticism of research, and pro-choice stance. 

Kennedy, who would oversee a $1.7 trillion agency that includes the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and Centers for Medicare and Medicaid (CMS), is a vocal anti-vaxxer who has vowed to “put the health of Americans back on track.” 

The hearing comes as the Trump administration paused health communications, and ceased global health funding and programs, including HIV-medication services. 

His hearing in front of the Senate Finance Committee was interrupted by protesters, some of whom wore “Make Polio Great Again” shirts, and also applause from the crowd when he promised to “make America healthy again.” There were also protests outside the hearing.

A medical doctor protests RFK’s nomination outside the Senate hearing.

Senate Republicans praised his emphasis on addressing the chronic disease burden in the US, and expanding rural health care access. “Mr Kennedy, you represent a voice for an inspiring coalition of Americans who are deeply committed to improving the health and well-being of our nation,” said committee chair Senator Mike Crapo (R-Idaho). 

But others questioned his shifting stance on abortion, vaccines, and food policy, accusing Kennedy of switching his views for political and monetary gain.

Kennedy made $2.5 million in lawsuit referrals against vaccine companies, and refused to commit to withdraw his own personal support of anti-vax groups that he has founded and sponsored. In response to a query by Senator Elizabeth Warren (D-Massachusetts), he also refused to commit to withdraw from his involvement in anti-vax lawsuits that have yielded him millions of dollars in income annually prior to his HHS nomination.

New statements contradict long anti-vax record 

“News reports have claimed that I am anti-vaccine or anti-industry. Well, I am neither; I am pro-safety … All of my kids are vaccinated, and I believe vaccines have a critical role in healthcare,” said Kennedy in his opening statement. 

Kennedy insisted that he was not “anti-vaccine”, and that he merely supports more testing and safety studies. As founder of the non-profit Children’s Health Defense, he has repeatedly cast doubt on the safety and efficacy of childhood vaccinations, and his organization continues to push the debunked claim that vaccines cause autism.

But in a contentious exchange with Senator Bernie Sanders (I-Vermont), RFK Jr dismissed the senator’s questions about his past as head of Children’s Health Defense. 

He also refused to say that healthcare is a human right, saying that the chronically ill and those who make poor health choices should not have the same access to healthcare. A smoker, he said, would be “taking from the pool [healthcare costs]”.

Promises to revolutionize approach to chronic illness

At the same time, he said he’d find new ways to tackle high drug prices, and address the root causes of America’s obesity and addiction epidemics with healthier foods and more mental health services – messages that clearly resonated with many senators.

“Something is poisoning the American people and we know that the primary culprits are our changing food supply, highly processed foods,” he said, citing the unusually high proportion of obese people in the US in comparison to other developed nations, something that he called an “existential threat”.

He added that the government needed to support a transition away from chemical dependence to “regenerative” agriculture to support healthier food production.

Sidestepping abortion questions

RFK Jr testimony day 1 Jan 2025
RFK Jr testified before the US Senate Finance Committee in his first of a two-day confirmation hearing schedule.

Several Democratic senators questioned Kennedy on his open pro-choice stance, quoting back to him his past statements. “In 2023, you came to New Hampshire and said, ‘I’m pro choice. I don’t think the government should tell people what they cannot do with their body.’ But you also said, ‘we need to trust the women to make that choice, because I don’t trust the government to make any choices,’” said Senator Maggie Hassan (D-New Hampshire).

“It is remarkable that you have such a long record of fighting for women’s reproductive freedom, and really great that my Republican colleagues are so open to voting for a pro-choice HHS Secretary.

“When was it that you decided to sell out the values you’ve had your whole life in order to be given power by President Trump?” Hassan asked.

Senator Michael Bennet (D-Colorado) brought up more of Kennedy’s statements, asking “did you say on a podcast ‘I wouldn’t leave it [abortion] to the states, my belief is we should leave it to the woman. We shouldn’t have the government involved, even if it’s full term’?” 

Kennedy did not refute his past remarks, but said “every abortion is a tragedy” and that he serves at the discretion of the president’s policies. 

He was also questioned on his stance on the abortion drug mifepristone, saying he promised to look into the safety of the drug. 

Kennedy “agreed to disagree” with Trump about climate change

He said that he’d “agreed to disagree” with Trump on the impacts of climate change. Trump recently withdrew the US from the Paris Climate Agreement. But he said he’d uphold the new US Administration’s positions on restricting abortion rights – “I serve at the pleasure of the president. I’m going to implement his policies.” 

Queried about whether Medicaid, the US health insurance program for America’s poorest, “was a critical program,” he said “I believe it’s a critical program but it’s not working as well as it should be. I support making it better. ”

Family speaks out against RFK Jr

The hearing followed the publication of two new appeals by prominent Kennedy relatives to reject his appointment.

“Bobby preys on the desperation of parents of sick children, vaccinating his own kids while building a following, hypocritically discouraging other parents from vaccinating theirs,” said his first cousin, Caroline Kennedy, daughter of assassinated US President John F Kennedy.

In a letter to Senators that was also released on social media, Caroline Kennedy said that he “encouraged” siblings and cousins “down the path of substance abuse”. RFK’s brother died of a drug overdose.

RFK’s niece, medical doctor Kerry Kennedy Meltzer, released emails from her uncle in which he falsely links childhood vaccinations to autism, questions the safety of flu vaccines and shares articles by COVID-19 anti-vaxers.

However, in his opening statement to the Senate Finance Committee on Wednesday, Kennedy said that he supported the measles and polio vaccines.

“In my advocacy I have often disturbed the status quo by asking uncomfortable questions. Well, I won’t apologize for that. We have massive health problems in this country that we must face honestly.”

 

Image Credits: CSPAN.

Many PEPFAR-funded projects are confused about whether they can continue to offer all HIV services to clients.

The Trump Administration exempted “life-saving humanitarian assistance” from the “stop-work order” issued to all foreign aid recipients late Tuesday – but widespread confusion remained about which programmes could continue to operate unimpeded. Meanwhile, US Senate confirmation hearings for Robert F Kennedy Jr, Trump’s pick for Secretary of Health and Human Services (HHS), began Wednesday with a tense stand-off between the HHS nominee and Senate Democrats. 

US Secretary of State Marcus Rubio issued the memo announcing the foreign aid waiver, defining humanitarian assistance as “core to life-saving medicine, medical services, food, shelter, and subsistence assistance, as well as supplies and reasonable administrative costs as necessary to deliver such assistance”. 

However, he warned that the “resumption is temporary in nature”.

It does not apply to programmes that involve “abortions, family planning conferences, gender or DEl [diversity, equity and inclusion] ideology programs, transgender surgeries, or other non-life-saving assistance”, he added – many of which have never been covered by US foreign aid.

The waiver follows a global outcry over HIV clinics providing antiretroviral (ARV) medicine and other services being told to immediately cease operations over the past few weeks. Any interruption of ARVs threatens the wellbeing of people with HIV, weakening their immune systems and possibly leading to drug-resistant HIV.

UNAIDS Executive Director Winnie Byanyima welcomed the waiver, saying that it “ensures that millions of people living with HIV can continue to receive life-saving HIV medication during the assessment of US foreign development assistance.”

“This urgent decision recognises PEPFAR’s critical role in the AIDS response and restores hope to people living with HIV,” she added.

Despite the partial reversal, many projects funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) said they remained unclear about whether they could resume providing ARV medicine and other services to people with HIV.

Health Minister is ‘baffled’

South African Health Minister Aaron Motsoaledi

South African Health Minister Aaron Motsoaledi told a media briefing that he had not received any official notice of the stop work order from the US government, adding that “the world is baffled by the decisions”.

“We have been fighting the scourge of HIV, TB and malaria together for more than 20 years as a global community, depending very much also on global funding,” Motsoaledi told the  briefing on Tuesday evening.

South Africa has the world’s biggest HIV programme, with 5.5 million people on ARVs, he added. PEPFAR funds have covered around 17% the country’s HIV work, assisting the government in the 27 most affected districts (out of 52), he added. South Africa’s Cabinet will discuss the issue this week, according to the health ministry.

However, most other African countries are heavily dependent on PEPFAR to fund their ARV programmes. PEPFAR funding covers the ARV medication of around two-thirds of those on treatment, according to Byanyima.

HIV testing essential to save babies

However, it is not just HIV treatment that is urgent, according to amFAR, the Foundation for AIDS Research.

HIV testing is also urgency, particularly of pregnant women to ensure that, if they’re HIV positive, they can be given treatment to prevent them from transmitting the virus to their babies.

PEPFAR also cover the salaries of over 270,000 health care workers who deliver health services, including over 12,500 doctors or clinical officers, and these may be the only health workers in their category at a health facility.

In Mozambique, for example, an impoverished country in south-western Africa, PEPFAR funds over 1,000 doctors and over 800 nurses and midwives, according to amFAR.

Commenting on Tuesday, the World Health Organization (WHO) called on the US government “to enable additional exemptions to ensure the delivery of lifesaving HIV treatment and care”.

 “A funding halt for HIV programmes can put people living with HIV at immediate increased risk of illness and death and undermine efforts to prevent transmission in communities and countries.

“Such measures, if prolonged, could lead to rises in new infections and deaths, reversing decades of progress and potentially taking the world back to the 1980s and 1990s when millions died of HIV every year globally, including many in the US,” the WHO added..

‘Does it make America safer?’

Commenting on the Trump Administration’s new approach to foreign aid, State Department spokesperson Tammy Bruce stated: “American taxpayer dollars spent overseas should be spent wisely, and for the benefit of Americans.The pause in foreign assistance has allowed the State Department to prevent unjustified and non-emergency spending.

“Our test is simple: Does it make America safer, stronger, and more prosperous? Some aid programs fail this test. Others may have merit, but are not emergency spending and can be reviewed during the 90-day pause.”

 

Image Credits: International AIDS Society.

Over 20 million people with HIV get ARVs funded by PEPFAR

Non-governmental organisations that receive US government funds across a range of sectors – including HIV, LGBTQ support and climate change – have been told to cease operations immediately.

Over the past two days, letters have been sent to US grant recipients following a “stop-work order” issued late Friday by the US State Department’s Office of Foreign Assistance.

While US President Donald Trump’s executive order on 20 January ushered in a 90-day pause on disbursements of foreign aid, the “stop-work order” approved by US Secretary of State Marco Rubio four days later has unexpectedly ordered all current work to stop immediately. 

Detail of US State Department stop-work order, January 2025

Chilling effect on HIV clinics

Among the worst affected will be people living with HIV, over 20 million of whom depend on the US President’s Emergency Plan for AIDS Relief (PEPFAR) for antiretroviral medicine (ARVs) to keep their HIV in check.

“Any interruption in antiretrovirals is harmful to people with HIV. The degree of harm depends on how sick they are, how long they have been on treatment, how long the interruption is – but there is definite harm, with risk of illness, death and transmission,” South African HIV Clinician Dr Francois Venter told Health Policy Watch.

South Africa is one of the biggest recipients of PEPFAR aid, receiving $332.6 million in 2024.

HIV clinics across South Africa notified their shocked clients this week that they have been forced to close immediately.

Many people depend on these clinics for life-saving ARVs that they need to take every day for life to keep their immune systems healthy, prevent drug-resistant HIV – and stop them from transmitting HIV to others once their viral load is undetectable.

Some clinics gave clients until the end of Tuesday to fetch ARVs while others directed them to government clinics.

Many South African recipients of PEPFAR funds provide HIV services to “key populations” –  people most vulnerable to infection including men who have sex with men (MSM), sex workers and trans people. Others focus on young women, who bear the brunt of new infections, and men in rural areas, who are unlikely to seek healthcare.

Fear and confusion

On Monday, OUT and Engage Men’s Health, which provides HIV services to MSM, notified clients that, “due to an immediate ‘stop-work order’ issued by our funder, we cannot provide any services until further notice.

“We understand the urgency of your health needs and urge clients to seek care and access ARVs or PrEP [pre-exposure HIV prophylaxis] at their nearest public health facility or healthcare provider,” the NGO urged, providing contact details for mental health services including a suicide crisis hotline.

OUT and Engage Men’s health announcement on Instagram

The University of the Witwatersrand confirmed that USAID had issued it with a stop-work order for some of its HIV programmes.

However, several large organisations with significant PEPFAR funding declined to comment, afraid to jeopardise the review of their grants by the US State Department.

The reviews, to be completed within 90 days, will decide whether to “continue, modify, or cease each foreign assistance program”. 

Aside from being told to stop work, grantees have also been told to cease any “radical and wasteful” “diversity, equity, inclusive, accessibility” programmes.

Extract from letter to US aid grantees

Global ‘havoc’

“The stop-work orders, which apply broadly to all grantees and sub-awardees, are wreaking havoc across the globe,” Dr Jirair Ratevosian, a former PEPFAR chief of staff, told Health Policy Watch.

“From Tanzania to Ukraine, I’ve heard from colleagues forced to comply with directives that carry deadly consequences. According to an analysis by amfAR, some 220,000 people – including women and children – present daily to PEPFAR programs to receive HIV medications, which are lifesaving and must be taken consistently to ensure viral suppression. Now, many are being turned away,” added Ratevosian, who is currently the Hock Infectious Disease Fellow at Duke Global Health Institute.

“In the early days of this crisis, we worried about empty shelves in pharmacies. Today, we face the opposite problem: the shelves are full, but our hands are tied. I urge the administration to find a way to reverse the pause while simultaneously reviewing funding—because we can and must do both.”

Using PEPFAR’s 2024 dispensing data, the Foundation for AIDS Research (amFAR) said that “222,333 people pick up new supplies of ARVs every single day, 365 days per year. This is the number of people who will lose access to treatment for every day that the stop work order is in effect.”

Half of these (101,368) are South Africans, while 7,445 are children under the age of 15. “Critically, getting people back onto treatment after the stop work order is lifted will take enormous effort,” noted amFAR.

PEPFAR to close?

PEPFAR is the most successful US aid programme ever, credited with saving over 26 million lives since its launch by Republican president George W Bush in 2003. By last September, PEPFAR was funding ARVs for 20.6 million people.

However, PEPFAR’s data systems were closed down late Monday, according to the New York Times. Officials worldwide were given around three hours’ notice of this, heightening speculation that the plan might be heading for permanent closure. 

Over the past two years, PEPFAR has been under huge pressure from conservatives, which reduced its five-year reauthorisation mandate to a single year in 2024. 

PEPFAR is due for renewal in March, which falls within the 90-day review period.

The influential conservative think-tank, the Heritage Foundation, which authored the Trump takeover plan, Project 2025, spelt out in a 2023 paper its view that HIV is “primarily a lifestyle disease” that “such should be suppressed through education, moral suasion, and legal sanctions”. 

According to the foundation, “as with any venereal disease, education and abstinence could end the AIDS epidemic” – although this approach has failed miserably in both the US and Africa.

Beatriz Grinsztejn, president of the International AIDS Society (IAS), said that stopping PEPFAR funding essentially stops HIV treatment for over 20 million people: “If that happens, people are going to die and HIV will resurge. It makes no sense to suddenly stop this incredible catalyst of our global progress towards ending HIV as a threat to public health and individual well-being.”

Not just HIV

However, the stop-work order extends far beyond PEPFAR recipients. People working for a range of PEPFAR-funded projects in southern and East Africa told Health Policy Watch that there was chaos at their workplaces. 

Some staff have been told to stay at home as there is no work. In some cases, soon there will be no money to pay them. One organisation was told it would need to repay money spent on air tickets to attend a forthcoming conference.

Extract from the US government’s “stop-work order”.

Dr Atul Gawande, who ran USAID’s health programmes under the Biden Administration, noted a range of other activities that would be affected including monitoring bird flu in 49 countries, assisting Tanzania in addressing its Marburg outbreak, and assisting over 90 million women and children to get “low cost vaccinations, prenatal care, safe childbirth, contraception, and other basic lifesaving health needs”.

Gawande added that the order would also “furlough all USAID contract staff — which includes half of its global health bureau”.

“This Administration is trashing US standing, alliances with scores of countries built over half a century, world-leading capacity and expertise, and American security,” said Gawande.

Meanwhile, the Trump Administration also announced a freeze on all federal grants and loans on Tuesday pending reviews, according to the Washington Post.

Image Credits: The Global Fund/ Saiba Sehmi.

The Wuhan Institute of Virology, guarded by police officers during the visit of the WHO team in January 2021.

The weekend release of the US Central Intelligence Agency (CIA) report favouring a laboratory leak as the likely origin of COVID-19 – albeit with “low confidence” – has reignited a vitriolic debate.

On the one side of the divide are those who argue that SARS-CoV2, the virus causing COVID-19, originated from a lab leak from the Wuhan Institute of Virology (WIV) that was studying coronaviruses in bats.

Some researchers who favour the lab-leak thesis argue that the virus contains unusual features that indicate it may have been genetically modified by humans. These focus on the virus’s furin cleavage site, a strange feature on the spike protein of the virus that is not present in other coronaviruses, that cast doubt on whether the virus had evolved naturally.

The other camp (the zoonosis thesis) believes the virus was transmitted from bats to humans via an animal source – Animal X – that has never been conclusively identified but is believed to have been in the Huanan wet market in Wuhan.

They argue that early COVID-19 cases centred around the market and environmental swabs that tested positive for SARS-CoV-2 clustered in the corner of the market where animals were sold.  SARS-CoV2 is not the same as the coronavirus in bats, although there is one that is 96% similar. It would have needed to have mutated in “Animal X” in order to infect humans.

Virus origins team

The World Health Organization (WHO) assembled a team of independent scientists to examine the origin of the pandemic in 2020, but the Chinese government denied it access to the data it requested on a visit to Wuhan in January 2021.

The WHO team investigating the origins of the COVID-19 pandemic arriving at the Wuhan Tianhe International Airport in January 2021.

The origins team report in March 2021 posed four possible hypotheses about the virus’ origin, but concluded that zoonotic transmission was the most plausible, describing a lab leak as “extremely unlikely”.

But the failure of the WHO-convened team to carefully consider the possibility that a biosafety accident caused the pandemic was heavily criticised by a group of international experts, in a series of open letters to WHO. 

WHO Director-General Dr Tedros Adhanom Ghebreyesus said candidly in July 2021 that China’s failure to share data meant that a lab accident could not be ruled out.

“There was a premature push to refute one of the [origins] options, the laboratory theory. I was a lab technician myself, an immunologist, and have worked in the lab and lab accidents happen,” said Tedros during a WHO media briefing in July 2021.

China rebuffs scientific advisory group 

The WHO then established an international Scientific Advisory Group on Origins of Novel Pathogens (SAGO) to replace the group that led the first mission to Wuhan. 

However, China refused SAGO’s request in July 2021 to review more data on Wuhan’s sensitive coronavirus research laboratories, and the wild animal species on sale in 2019 at the city’s live animal markets. (China favoured the thesis that the virus came from imported frozen goods).

“We will not accept such an origin-tracing plan as it, in some aspects, disregards common sense and defies science,” said Zeng Yixin, Vice Minister of the National Health Commission.

“We hope the WHO would seriously review the considerations and suggestions made by Chinese experts and truly treat the origin tracing of the COVID-19 virus as a scientific matter, and get rid of political interference,” Zeng said.  

The joint WHO-Chinese experts investigating the emergence of SARS-CoV2 in Wuhan at a media briefing on 9 February 2021.

The CIA’s report, initiated during the Biden Administration but released by Donald Trump’s pick for CIA head, John Ratcliffe, was not the result of any new evidence but rather a re-examination of available evidence, according to reports.

However, the CIA added that it  “continues to assess that both research-related and natural origin scenarios of the Covid-19 pandemic remain plausible”.

In 2023, the US Federal Bureau of Investigation (FBI) said it favoured the lab leak theory as did a US Congress sub-committee in December 2024. 

‘Gain of function’ research?

Some of those who favour the lab leak thesis have claimed that there was a cover-up of the lab leak theory because a US research group, EcoHealth Alliance, had been involved with the WIV and received government research funds.

They allege that the WIV, assisted by EcoHealth, engaged in “gain of function” research that involved manipulating coronaviruses to see how they responded to environmental pressures.

A 2018 grant application submitted by EcoHealth to the US Defense Advanced Research Projects Agency (DARPA) shows the group wanted to conduct gain-of-function research that included inserting novel cleavage sites into coronaviruses in their lab. This was denied as it was deemed it too risky.

China rejects CIA report

Over the weekend, Chinese authorities dismissed the CIA report as being unhelpful and motivated by politics. On Saturday, a spokesperson for China’s US embassy said the CIA report has no credibility.

“We firmly oppose the politicisation and stigmatisation of the source of the virus, and once again call on everyone to respect science and stay away from conspiracy theories,” a spokesperson from China’s US embassy, Liu Pengyu, told Associated Press.

The failure of the Chinese government to allow independent scientists access to Wuhan, COVID-19’s “ground zero”, and various data sets, means that conclusive evidence to support one or other thesis is unlikely.

However, the politicisation of the quest to find the origins of SARS CoV2 has also polarised research and contaminated research.

Image Credits: CNN, CGTN, WHO.

The Indian city of Gurgaon is engulfed in smog due to the high levels of air pollution.

The health risks posed by air pollution in the 23 Asian countries sandwiched between Russia and Australia have been analysed together for the first time – and over 3.4 million deaths occurred in this area in 2021, representing 40% of global air pollution deaths. 

These countries include India, Pakistan, Kazakhstan, Thailand, Singapore and Indonesia, excluding East and West Asia, most of which are middle- and high-income countries. 

Air pollution is hitting their economies hard. They lost 4 to 11% of gross domestic product (GDP) in 2019 due to citizens’ exposure to fine particulate matter pollution, PM 2.5.

Regions of Asia included in the State of Global Air Asia report

The report, produced by the Health Effects Institute (HEI) in Boston and the Institute for Health Metrics and Evaluation, presents the latest comprehensive estimates of exposures to the three major air pollutants: PM2.5, nitrogen dioxide (NO2) and ozone.

Number One killer in South Asia

South Asia is the worst off by far. Air pollution is the number one risk factor for death across the region, accounting for 2.7 million deaths, of which 2.1 million are in India alone. 

Ranking of risk factors by total number of deaths in 2021 in South Asia. Source: State of Global Air

Forty-one per cent of all non-communicable disease deaths in South Asia have been linked to exposure to air pollution, which increases the risk of heart disease, strokes, lung cancer, chronic lung disease and type 2 diabetes. 

Exposure to ambient PM 2.5 has also been associated with cardiovascular health including increased blood pressure and risk of cardiac arrest in India, Singapore, and Vietnam.

The effect of air pollution on children is particularly concerning. The report reveals several details. For instance, in Central Asia one in four deaths in children under five years of age in 2021 was attributable to air pollution. 

Comparison of annual average PM2.5 concentrations in 2019 with WHO Air Quality Guidelines.

Old technologies, rapid urbanisation

The degrees of pollution and health effects vary between the three regions. But there’s a common theme in the sources of pollution: old technologies and practices, urbanisation particularly a rapid rise in motor vehicles. 

Significant sources of PM 2.5 come from burning fossil fuels in vehicles, power plants and other industrial facilities; burning coal in homes for heating and kitchens burning solid fuels, like wood, coal, dung and agricultural residues, for cooking.

Household air pollution (HAP) in homes with little or no access to clean cooking solutions, resulted in almost 1.8 million deaths in the three regions in 2021, which is more than half the number of deaths. 

In Nepal, exposure to HAP was associated with reductions in child height-for-age and weight-for-age, as well as increased rates of stunted and underweight children. Similarly, in India, exposure to PM 2.5 has been associated with a higher risk of underweight and stunting in children. 

In both South Asia and South East Asia, burning vegetation or agricultural waste has severe health effects. In SE Asia, the slash-and-burn practice leads to increased deaths and illness, especially in the lower-income countries like Myanmar. 

In South Asia, extensive burning of crop stubble severely affects the communities living near the agricultural fields. A study in northern India found that living in a district in the top quintile of fires per day was associated with a threefold higher risk of acute respiratory infections

In Tajikistan and Kazakhstan, coal and other biomass are widely used to heat homes – something that polluted Beijing many years ago until the China government government cracked down. 

NO2 harms children, especially in cities

Nitrogen dioxide is mainly generated through fuel burning in vehicles, power plants, and industrial facilities causing asthma and other respiratory diseases. It is the pollutant that, if you’re in heavy traffic, can irritate the eyes, nose, and throat, potentially causing coughing and shortness of breath. 

In cities across the three regions, burning of fossil fuels, especially in vehicles, is a health risk to children. In Bengaluru, India, average temperature and NO2 levels significantly influenced the number of childhood asthma hospital admissions. 

In Hanoi, Vietnam, an increase in short-term exposure to NO2 increased the number of lower respiratory infections (LRI) hospitalisations among children aged 0–7 years.

However, the highest average levels of NO2 worldwide in 2019 were in Central Asia where the average NO2 exposure is 13.3 μg/m³ (micrograms per cubic metre), significantly higher than the World Health Organization (WHO) guideline of 10. 

NO2 levels rose in all five countries analysed in sharp contrast to the global trend. The blame falls on old vehicles and coal-fired power plants. Across most countries, the average vehicle age is well over 10 years, with some vehicles as old as 20 years. 

Cities including Bishkek (Kyrgyzstan), Ashgabat (Turkmenistan) and Tashkent (Uzbekistan) rank among the cities with the highest annual average NO2 exposures. 

A large review of studies conducted in South East Asia found that the relative risk of childhood asthma increases for every 10 μg/m³ rise in NO2, indicating a higher likelihood of childhood asthma due to NO2.

Gridded population-weighted annual average NO2 concentrations in 2019 in Central, Southeast and South Asia.

Vehicles emit super-pollutant

Ground-level (tropospheric) ozone is a super pollutant with a more powerful warming impact than a ton of carbon dioxide (CO2), the biggest cause of global warming. But it is very shortlived with a life span of a few days or weeks. Death rates attributed to ozone are 3-5 times higher in South Asia than the global average. 

Notably, India carries around 50% of the global disease burden from exposure to ozone. In a business-as-usual scenario, this is likely to increase by 2050 to such a level that its health impacts are comparable to PM 2.5. 

Ozone is rising in most countries in line with the global trend, with increasing temperatures caused by global warming a major contributor. 

Ozone is a product of hydrocarbons reacting with nitrogen oxides in the presence of sunlight in higher temperatures. It is a major component of smog and can worsen bronchitis, cause emphysema, a chronic lung disease that damages, triggers asthma and permanently damages lung tissue. 

It can also damage plants by entering the pores in their leaves and burning plant tissue during respiration so rising ozone poses a growing threat to food security. 

Air pollution deaths are higher than COVID

“Bold investment is needed to strengthen technical capabilities and the to bolster the data and technology infrastructure at local and regional scales,” Pallavi Pant, a contributor and HEI’s Head of Global Initiatives, told Health Policy Watch.

Pant points out that interventions to reduce household solid fuel use or transportation emissions have shown promising results in several countries, like India’s Ujjwala scheme to provide free or subsidised cooking gas to poor households. Sustained action on these and other locally important sources including waste burning are needed.

In some countries the death rates from air pollution are worse than during the COVID-19  pandemic. 

The global average of age-standardised death rates attributed to air pollution was 100 deaths per 100,000 people. But in Nepal, it was 242 deaths/100,000. 

In India, it was 201 deaths/100,000. The COVID-19 death rate in 2021, as estimated by the Global Burden of Disease, was 157 deaths/100,000 for India, and the global average was 94/100,000.

Several of the 23 countries have taken some steps to reduce air pollution.  Many have implemented tighter emission controls for vehicles, and others – especially in South East Asia and Central Asia – are cooperating to tackle trans-boundary pollution. This is yet to pick up in South Asia, although the Thimpu initiative, aims for cooperation between India, Pakistan, Bangladesh, Nepal and Bhutan. 

Image Credits: Chetan Bhattacharji.

The World Health Organization flag above its headquarters in Geneva.

The World Health Organization (WHO) is introducing immediate cost-cutting measures including a freeze on all but critical staff recruitment, according to an email from the Director-General to staff sent late Thursday.

The body is also prioritising activities related to health priorities, “significantly reducing” travel, limiting procurement and suspending office upgrades.

All meetings will be virtual except in “exceptional cases” and only essential missions to provide technical support to countries will go ahead, according to the email.

This comes in response to Monday’s announcement by President Donald Trump that he is pulling the United States out of the global body.

“This announcement has made our financial situation more acute” and “created uncertainty for the WHO workforce,” said Tedros.

The US is the WHO’s biggest donor, both in “assessed contributions” (membership fees) and “voluntary contributions” (donations, usually earmarked for specific health programmes). The combined US contribution amounts to around 18% of the WHO budget.

The WHO’s budget for the two-year period 2024-2025 is $6.83 billion. The US is due to pay over $261 million in “assessed contributions” during 2024/5 and has often given over double that in voluntary contributions. In 2023, it contributed over $367 million. 

The US is obliged to give a year’s notice of its withdrawal to the United Nations, which confirmed that it had received this and the withdrawal will officially come into effect next January. The effect will be massive.

More cuts lie ahead

Tedros’s email warns that the immediate cost-cutting measures are “not comprehensive” and more cuts lie ahead.

“Change is a constant, and we are committed to continuous improvement. Navigating the challenges we face will require solidarity across who shared responsibility for good stewardship of our financial resources, flexibility to adjust to the needs of our member states, and creativity in finding solutions at every level,” said Tedros.

“I thank those staff who have already sent suggestions for mobilizing resources and further improving our efficiency and cost effectiveness, and I invite all staff to do the same,” he added.

“WHO’’s people have always been and remain our greatest asset, and we will do everything possible to support and protect you.”

Financial reform process

The WHO been engaged in a process of reforming its finances and performance for over five years in response to pressure from powerful member states for improved efficiency and less donor reliance.

After lengthy deliberations led by Germany’s Björn Kümmel, the 2022 World Health Assembly adopted a raft of financial reforms, including that there should be a substantial increase in member states’ “assessed contributions”, from covering merely 16% of the budget at that time to 50% of the budget by 2030.

Björn Kümmel (left) of the German Ministry of Health, makes the case for a new approach to WHO funding.

With over 80% of the WHO budget covered by grants and voluntary contributions – usually earmarked for specific activities – the body’s activities were skewed towards donor priorities rather than member states’ needs.

Aside from increased members’ fees, the WHO also launched its first Investment Round late last year to fundraise for flexible funds for its day-to-day operations.

Kümmel told the EB that the WHO was managing 3,300 grants “with individual reporting requirements”. 

“The average length of a grant in WHO is 13 months. This is everything else but predictable,” Kümmel added.

Last year, Tedros told the WHO’s executive board (EB) that he was embarrassed by the fact that the many WHO staff members were on 60-day rolling contracts due to financial restraints, which made them vulnerable and undermined stability.

“If you talk about motivated and fit-for-purpose workforce, retaining and attracting talent without sustainable financing is impossible,” said Tedros.

Meanwhile, WHO Africa director Dr Matshidiso Moeti told a 2022 WHA roundtable that “many of our staff members are spending a disproportionate amount of their time processing these grants”.

In addition, the earmarked funds for Africa were mainly for communicable diseases, so there was a lack of funds for non-communicable diseases, Moeti added.

The shock decision by the US will undermine the reform process of the past five years. This will introduce even more precarity for staff at the global body as they battles to respond to a growing tide of health challenges, that are worsening with climate change.

Image Credits: US Mission in Geneva / Eric Bridiers via Flickr.