Health workers during a Marburg outbreak

Tanzania has confirmed an outbreak of Marburg virus disease in the northwestern Kagera region after one case tested positive for the virus following investigations and laboratory analysis of suspected cases of the disease. 

Tanzanian President Samia Suluhu Hassan announced this during a press briefing on Monday with World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus. 

“Laboratory tests conducted at Kabaile Mobile Laboratory in Kagera and later confirmed in Dar es Salaam identified one patient as being infected with the Marburg virus. Fortunately, the remaining suspected patients tested negative,” the president said from the country’s capital, Dodoma. 

A total of 25 suspected cases have been reported, all of whom have tested negative and are currently under close follow-up, the president said. The cases were reported in Biharamulo district in Kagera. 

“We have demonstrated in the past our ability to contain a similar outbreak and are determined to do the same this time around,” added the president. “We have resolved to reassure the general public in Tanzania and the international community as a whole of our collective determination to address the global health challenges, including the Marburg virus disease.”

Last week, Tanzanian health authorities disputed a WHO report of a suspected outbreak, noting that five suspected cases had tested negative in its laboratories.

Emergency funds

Tedros announced that he has made $3 million available from the WHO Contingency Fund for Emergencies to assist Tanzania in addressing the outbrea, and pledged the WHO’s support for the country.

“Since the first suspected cases of Marburg were reported earlier, Tanzania has scaled up its response by enhancing case detection, setting up treatment centres and a mobile laboratory for testing samples, and deploying national response teams,” Tedros told the media briefing.

“Tanzania has gained strong experience in controlling Marburg as this is the second reported outbreak of the disease in Kagera. The first outbreak was almost two years ago, in March 2023, in which a total of nine cases and six deaths were reported,” he added.

The Africa Centres for Disease Control and Prevention (Africa CDC) also pledged support for the country.

“ A team of 12 public health experts will be deployed as part of an advance mission in the next 24 hours. The multidisciplinary team includes epidemiologists, risk communication, infection prevention and control (IPC), and laboratory experts to provide on-ground support for surveillance, IPC, diagnostics, and community engagement,” said Africa CDC.

“To support the government’s efforts, we are committing $2 million to bolster immediate response measures, including deploying public health experts, strengthening diagnostics, and enhancing case management,” said Africa CDC Director General Dr Jean Kaseya.

“Building on Tanzania’s commendable response during the 2023 outbreak, we are confident that swift and decisive action, combined with our support and those of other partners, will bring this outbreak under control.”.

Marburg virus, a highly infectious and often fatal disease, is similar to Ebola and is transmitted to humans from fruit bats. It spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials.

Although several promising candidate medical countermeasures are currently undergoing clinical trials, there currently is no licensed treatment or vaccine for Marburg. 

However, early access to treatment and supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improve survival. 

Previous outbreaks and cases have been reported in Angola, the Democratic Republic of the Congo, Ghana, Kenya, Equatorial Guinea, Rwanda, South Africa and Uganda.

Image Credits: WHO.

Dr Matshidiso Moeti, outgoing Africa regional director

The World Health Organization (WHO) Regional Committee for Africa resolved to reopen nominations for a regional director at a special session last week. 

This follows the unexpected passing of director-elect Dr Faustine Ndugulile in November 2024. He was due to assume the post in February once his election had been confirmed by the WHO Executive Board.

According to the resolution passed by the regional committee, member states will receive a letter from the WHO Director-General by tomorrow (21 January) inviting them to nominate candidates by 28 February.

A virtual live candidates’ forum is planned for 2 April. Thereafter, the region has requested the Director General to convene an in-person special session of the Regional Committee in Geneva on 18 May for member states to elect the next Regional Director who will then be nominated to the Executive Board.

Fast-tracked

The fast-tracked process requires the suspension of Rule 52 of the region’s election procedures, which mandates a process of no less than six months for nominations.

Derek Walton, WHO legal counsel in Geneva, confirmed that the regional committee had determined the next steps, with a final selection in May during another special session of the Regional Committee for Africa. 

“This session will be held just before the World Health Assembly, and at that point, the committee will make a fresh nomination for the position of Regional Director,” Walton told Health Policy Watch last week.

“If all goes to plan, we should have a new Regional Director for Africa in place by 1 June,” Walton confirmed.

However, the regional director-elect will still need to be formally appointed by the WHO Executive Board when it meets in February 2026, according to the region’s resolution.

The role of WHO Regional Director for Africa is crucial in guiding the organization’s public health efforts across the continent, including responses to disease outbreaks, strengthening health systems, and implementing WHO policies tailored to African health challenges.

Ndugulile secured 25 of the 46 votes at the WHO Africa regional conference in the Republic of Congo, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). 

A former deputy health minister and ICT minister in Tanzania, Ndugulile represented the Kigamboni constituency in Dar Es Salaam as a Member of Parliament since 2010 and chaired the country’s parliamentary health committee.

The three candidates could be renominated by their respective countries. Socé Fall is currently Director of the Department of Control of Neglected Tropical Diseases at WHO headquarters in Geneva.

Mihigo is the vaccine alliance, Gavi’s Senior Director of Programmatic and Strategic Engagement with the African Union and Africa CDC, but worked for WHO Africa until March 2022.

Sambo serves as the WHO’s Head of Mission and Representative to the Democratic Republic of the Congo (DRC).

Whoever is ultimately selected will have big shoes to fill, succeeding Matshidiso Moeti, who is retiring after making a name for herself during the COVID pandemic. She was also the first female Regional Director for WHO AFRO, leaving behind a legacy of resilience and leadership.

Africa faces numerous public health challenges, including infectious disease outbreaks, vaccine distribution disparities, and the worsening effects of climate change on health.

A child born with HIV takes a paediatric dose of antiretroviral medication.

Influential conservatives have long sought to curtail the United States President’s Emergency Plan for AIDS Relief (PEPFAR) – and the actions of four nurses in Mozambique may have inadvertently given them the ammunition to do just that.

Deeply uncomfortable with the sexual dimension of HIV transmission, the powerful Heritage Foundation, which authored the conservative Project 2025 blueprint for a Donald Trump takeover, argues that PEPFAR should be “restructured as a development rather than an emergency assistance program”. 

Right-wing organisations and politicians have also claimed the plan is being used to “promote abortion, LGBT ideology, and comprehensive sexuality education”, a school sex education programme.

But they had so far failed to demonstrate this until last week – when the US State Department Bureau of Global Health Security and Diplomacy (GHSD), which implements PEPFAR, provided documentation in a briefing to the Senate Foreign Relations Committee and House Foreign Affairs Committee that the Mozambique nurses, whose salaries are partly covered by PEPFAR, also provided abortions.

‘Unacceptable violation’

The US has not allowed its foreign aid to be used to fund abortions or lobby for abortions since it enacted the Helms Amendment in 1974.

However, the four nurses, whose salaries were partly covered by PEPFAR, did not know that they could not provide abortions (which are legal in Mozambique) if they received PEPFAR funding.

GHSD’s “compliance mechanisms identified this violation, and we took immediate corrective action with the partner”, the bureau said in a statement issued on Friday, the day after it had briefed politicians with oversight of PEPFAR about the issue.

“This violation is unacceptable, and the US government has made that clear at all levels of program implementation, as well as immediately suspended funding,” it added.

PEPFAR secured “reimbursement from the Government of Mozambique for the salaries of the four health workers involved in the violations of award terms and conditions” and in future will require “an annual signed attestation by PEPFAR-funded clinical service providers to ensure compliance with US funding restrictions”.  

Although the GHSD uncovered, rectified the transgression, and reported it to the politicians, Republicans have jumped on the report as an opportunity to reform PEPFAR.

‘Disgusting’

“It is disgusting that the Biden Administration has allowed US taxpayer dollars to be used to perform abortions overseas,” fumed Republican Senator Jim Risch, chair of the Senate Foreign Relations Committee. “This violation means that the future of the PEPFAR program is certainly in jeopardy.”

Republican Congressional representative Chris Smith, whose committee oversees PEPFAR, promised a “series of hearings to investigate the activities by PEPFAR-funded countries” and to hold the Centers for Disease Control and Prevention (CDC) and GHSD to account.

“This is just the tip of the iceberg,” said Smith, who chairs the House Foreign Affairs Subcommittee on Africa and Global Health Security and Diplomacy Bureau. 

“Frankly, it’s not a surprise to find that they are performing abortion with US taxpayer dollars. Their denials over the years have rung hollow in the face of their aggressive promotion of abortion and collaboration with some of the largest international abortion providers.”

With Trump assuming the White House on Monday (20 January), and his party controlling the US Senate and House, the Republican Party is in a strong position to shake up PEPFAR.

PEPFAR’s key achievements by 2024

Democratic Representative Gregory Meeks warned that “using this unfortunate error as a pretext to end funding for PEPFAR, which has saved millions of lives by combating HIV around the world, would be a grave mistake”.

Furthermore, said Meeks: “CDC’s response to this violation shows that when wrongdoing occurs, there are checks in place to address them and Mozambique reimbursed the US government for the $4,066, which accounts for less than 0.001% of one year of PEPFAR’s funding for Mozambique.”

HIV is a ‘lifestyle disease’

PEPFAR is the most successful US aid programmes 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 antiretroviral medicine for 20.6 million people to suppress HIV in their bodies.

Yet far-right conservatives in the US and Africa are deeply ambivalent about PEPFAR, largely because they believe that HIV is a sexually transmitted “lifestyle disease” – the inference being that most of those with HIV have themselves to blame.

The Heritage Foundation spelt this out in a 2023 paper, arguing that, “except in cases of rape or maternal transmission, HIV/AIDS in the US and in developing countries is primarily a lifestyle disease (like those caused by tobacco) and as such should be suppressed through education, moral suasion, and legal sanctions”. 

The foundation added that “for conservatives committed to personal responsibility, [PEPFAR] also should not enjoy greater priority than deadlier and more unavoidable diseases receive in the allocation of public funds”. 

According to the Heritage 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.

Undetectable viral load = untransmittable HIV

South African activists launch a public information campaign to raise awareness of U = U (undetectable HIV = untransmittable) to encourage people living with HIV to take treatment and maintain an undetectable viral load.

Scientific evidence from multiple studies shows that one of the most powerful ways to end HIV transmission is to ensure that people living with HIV are on antiretroviral (ARV) medicine and have undetectable viral loads, because then they do not transmit the virus – even during unprotected sex. 

New HIV infections decreased by 39% world-wide between 2010 and 2023, largely thanks to the massive campaign against the disease focused on the rollout of ARVs, education about its transmission and condom distribution.

But there are enclaves where HIV still thrives, described by UNAIDS as “key populations” which include men who have sex with men, sex workers, people who inject drugs, transgender people and prisoners.

“In 2022, the relative risk of acquiring HIV was 14 times higher for people who inject drugs, 23 times higher for gay men and other men who have sex with men, nine times higher for sex workers and 20 times higher for transgender women than in the wider population globally,” according to UNAIDS. 

In 2022, 55% of all new HIV infections in 2022 occurred among people from key populations and their sexual partners.

But these groups are amongst those most denigrated by right-wing groups who ignore the scientific evidence of their vulnerability and instead claim that the Biden Administration, UNAIDS and anyone following this evidence are trying to impose a “woke agenda” on the world.

‘Radical sexual agenda’

Their crusade against the mainstream HIV sector’s approach to ending the disease gained momentum in 2023 as the US geared up to reauthorise PEPFAR for a further five years.

On 1 May 2023, US right-wing groups claimed in a letter sent to Senate and Congress leaders that PEPFAR grantees  “are using taxpayer funds to promote a radical sexual and reproductive health agenda”. 

The first signature on the letter is that of Heritage Foundation president Kevin Roberts. Other signatories include Austin Ruse of the radical Catholic group, the Center for Family and Human Rights (C-FAM) that opposes contraception, and Tony Perkins of the Family Research Council, a radical evangelical group that has supported African governments to pass anti-homosexuality laws and even lobbies against the HPV vaccine.

The letter cited examples of PEPFAR-supported organisations that are promoting abortion but their claims were not supported by evidence. 

A similar letter was sent on 6 June 2023 to the same US politicians by African politicians and religious leaders – primarily Catholic and evangelical bishops, and Ugandan MPs – claiming that PEPFAR “is supporting so-called family planning and reproductive health principles and practices, including abortion, that violate our core beliefs concerning life, family, and religion”.

Representative Smith, who co-sponsored PEPFAR’s refinancing in 2018, also claimed PEPFAR is being used to “promote abortion on demand” in a letter to his congressional colleagues in June of that year.

March deadline for PEPFAR reauthorisation

Some 20.6 million people are dependent on PEPFAR for their antiretroviral medicine.

After much wrangling, PEPFAR was eventually reauthorised in March 2024 – but only for one year instead of the customary five. This mandate expires in March.

With Trump’s “America First” approach and his mandate to Elon Musk and Vivek Ramaswamy to slash the federal budget, PEPFAR funds are almost certain to be cut.

However, big policy changes are also likely, particularly if Project 2025’s proposals are implemented. These include stopping all US aid to LGBTQ groups and even preventing support for contraception and comprehensive sexual education. 

Ultimately, if the Heritage Foundation and its allies get their way, PEPFAR will be transformed into “a development program focused on developing sustainable heath systems and the prevention and treatment of infectious diseases, including HIV/AIDS”.

To prepare for this and to encourage more domestic support for HIV, the foundation proposes that PEPFAR cuts its coverage of ARVs by 10% every year in the next five -year phase.

But finding the money to cover half the cost of ARVs within five years will be impossible for many of the countries that receive PEPFAR support. Some of Africa’s most vulnerable people are going to bear the brunt of this policy change, which may roll back decades of progress against HIV and AIDS. 

Image Credits: The Global Fund/John Rae, Paul Kamau/ DNDi, UNAIDS, Flickr.

How do you define “white saviorism?”

According to Themrise Khan, white saviorism is “imprinted psychologically in the minds of anyone who wants to be a saviour, anyone who thinks that they are superior to others and thinks that it is only them who can bring betterment into the lives of others.”

This phenomenon often manifests in the global health system when researchers, scientists, and even NGO staff and volunteers from the Global North parachute into the Global South, attempting to “save” people without genuinely collaborating with them.

In simpler terms, white saviorism is “the idea of how the white industrialised Western world wants to save the non-Western marginalised world,” Khan said.

Quote by Themrise Khan on the Global Health Matters podcast
Quote by Themrise Khan on the Global Health Matters podcast

Khan, a Pakistani independent development professional and researcher with nearly 30 years of experience in international development, aid effectiveness, gender, and global migration, recently discussed this topic on the Dialogues segment of the Global Health Matters podcast with Dr. Garry Aslanyan.

Khan said that little to no progress has been made in the decolonization of healthcare, largely due to the pervasive influence of white saviorism. She believes the only way forward is to “burn it all down” and start afresh, emphasizing the need for a complete overhaul of the system.

Khan is also the co-editor of the book Preventing the next pandemic, White Saviorism in International Development: Theories, Practices and Lived Experiences. In both the book and the podcast, she provides specific examples of how white saviorism impacts autonomy, perpetuates global power imbalances, and shapes race relations.

One striking example she shared involved visits from white Westerners to her community to oversee projects they had funded.

“The white foreigner who had all the money, who was coming in with the money to make sure that everything was going well so they could continue getting the money, was the one who was feted like royalty. That really stuck out for me in terms of how international development as a profession has created this dynamic of royalty versus the people,” Khan said.

So, is there hope for change?

While Khan describes herself as inherently pessimistic, she explained that her call to “burn it all down” is not entirely negative. On the contrary, she believes that embracing this concept allows us to “rebuild properly again, so there is hope in that.”

Listen to more Global Health Matters podcasts on Health Policy Watch >>

Image Credits: TDR | Global Health Matters Podcast.

Saima Wazed, Regional Director for WHO SEARO with Dr Tedros Adhanom Ghebreyesus, WHO-Director General, during her swearing in ceremony in January 2024.

As Bangladesh presses for its former prime minister, Sheikh Hasina, to be extradited to face charges of human rights abuses, her daughter, the World Health Organization (WHO) regional director for South East Asia (SEARO), is also under scrutiny.

Saima Wazed was elected to the WHO position by regional leaders in November 2023 amid allegations that her mother had improperly influenced the election process. 

Last August, Hasina fled the country after a revolt against her government following its harsh crackdown on student protests. She is currently in India as is her daughter, who is based at the WHO SEARO office in New Delhi.

This week the director of Bangladesh’s Anti-Corruption Commission (ACC), General Akhtar Hossain, confirmed to The Business Standard that his commission’s probe into Hasina would include Wazed’s election. 

Hossain told the newspaper that corruption was suspected to be involved in Wazard’s appointment.

SEARO has 11 member countries including India and Pakistan, yet only tiny Nepal put up a candidate to contest for the regional director position.

In an article published by Health Policy Watch before Wazed’s election by member states, public health specialist Mukesh Kapila noted that her own capability statement “does not reveal the ‘strong technical and public health background and extensive experience in global health’, required by the official criteria for the role”.

Neither did she have “the mandatory substantive track record in public health leadership and significant competencies in organisational management”, required by WHO.

“But being introduced by her mother at recent high-level summits such as BRICS, ASEAN, G20 and the UN General Assembly to craft deals in exchange for votes may be seen as crossing the fine line between a government’s legitimate lobbying for its candidate and craven nepotism,” Kapila wrote.

Wazed is a psychologist with a special interest in autism.

Code of conduct

The 2024 Executive Board recommended that the code of conduct of all regional directors should be expanded to include provisions on “sexual misconduct and other abusive conduct and a disclosure of interests by candidates”, more stringent reference checks and due diligence review of qualifications and employment history. 

It also recommended that nominating member states should “disclose grants or aid funding for candidates” in the two years before their appointment.

In response to the news reports that Wazed’s appointment was being investigated, the WHO said: “If there are allegations of wrongdoing by or within a member state in connection with a WHO election campaign, it is appropriate for these to be investigated by the competent national authorities.  We would not comment on such investigations or any consequential legal processes while they are ongoing.”

According to Article 52 of the WHO Constitution, regional directors are appointed by the WHO’s Executive Board, “in agreement with the regional committee”.

A note from the WHO’s legal counsel flags that, despite a decision by the 2012 World Health Assembly, to implement “a process for the assessment of all candidates’ qualifications”, only the European Region has done so.

Image Credits: X, X/Saima Wazed.

Dr Jean Kaseya, director Africa CDC, at press briefing Thursday.

A new mpox outbreak in Sierra Leone and a rising case toll across Africa are fueling urgent calls for stronger containment efforts, even as the Democratic Republic of Congo (DRC) finally speeds up its mpox vaccine drive and Rwanda’s swift response to Marburg suggests a model for epidemic control.

Health authorities in Sierra Leone have reported the country’s first cases of mpox, with two confirmed infections in the country’s Western Area Urban and Western Area Rural districts. The cases, announced on 10 January, have no known travel history, and 25 contacts are being monitored, according to the Africa Centres for Disease Control and Prevention (Africa CDC).

The outbreak in Sierra Leone adds to the growing burden of mpox across the continent. Dr Jean Kaseya, Director-General of Africa CDC, described the situation as a major public health emergency and urged governments to intensify containment efforts. “We are seeing a sharp increase in cases compared to 2023, and this remains a significant threat to public health in Africa,” Kaseya said in a press briefing on Thursday.

Progression of mpox across Africa.

Africa has recorded 77,888 mpox cases over the past year, with 16,767 confirmed infections across 21 countries, according to Africa CDC data. The Central African region continues to bear the brunt of the outbreak, accounting for 85% of all confirmed cases and 99% of deaths, with the DRC serving as the epicenter.

The death toll in 2024 reached 1,321, with a case fatality rate of 1.8%, highlighting the severe impact of the new clades of the virus that have emerged, particularly Clade 1b. “This outbreak is driven by the lack of adequate testing, slow vaccination rollout, and gaps in community-level health interventions,” Kaseya said.

DRC has improved vaccine deployment and is shifting to community-based vaccine strategy – Kaseya  

Mpox vaccines in deep freeze storage in Kinshasa, DRC, in September – awaiting distribution in remote regions.

Kaseya also acknowledged concerns over the sluggish vaccine rollout, confirming that the DRC had received 365,000 doses of the MVA vaccine, but had only administered 55,000 doses, as of early December.  

But he contended that there had been improvements since. “In the past month alone, we have administered over 120,000 additional doses, and we are now moving to a targeted vaccination of entire high-risk areas instead of just contacts,” Kaseya said.

The shift from a contact-based approach to a wider community-based immunization effort makes it much easier to deploy vaccinations more rapidly. 

Additionally, Africa CDC has deployed 80 epidemiologists and 2,400 community health workers to hotspot regions, including DRC, Uganda, and Burundi, in an effort to strengthen surveillance and case management, the Africa CDC director said. 

Africa CDC  has also secured Japan’s LC16 vaccine to be deployed in February and March, primarily for children in DRC, he added. Whereas the milder Clade 2 mpoxvirus, that triggered a WHO global health emergency in 2022-23 was transmitted largely between men having sex with men, children have been amongst the hardest hit  in the outbreak of the Clade 1B virus.

Unlike the Bavarian Nordic MVA-BN vaccine, the LC16 has been approved for administration to children. However, the vaccine requires an ‘intradermal’ (ID) jab, [between the upper and lower skin layers]. The vaccine was commonly used in the early and mid-2oth century to administer the first vaccines against smallpox, typhoid and other diseases, and is still used for the Bacille Calmette-Guérin (BCG) vaccine against tuberculosis. It also offers certain advantages due to smaller dose requirements. However, ID jabs fell out of fashion in recent decades and younger health workers will require training to administer them properly.  

China becomes ninth country outside Africa to report an mpox Clade 1b case

China is the latest country outside of the continent to report a Clade 1b mpox case. Thirteen African nations have active mpox cases with a mix of Clades 1 and 2.

Meanwhile, the outbreak of Mpox Clade 1b has continued to spread abroad. On Jan. 9, Chinese health authorities confirmed a case, linked to a traveler returning from Africa, Kaseya said. That made China the ninth country outside of the continent to report a case of the more deadly mpoxvirus clade, after a case reported by Belgium in December. 

“This is an opportunity for global collaboration,” Kaseya said. “We need solidarity in responding to emerging health threats.”

The deadly Clade 1b triggered a second WHO health mpox emergency declaration in August 2024 – due to the infection’s spread across the continent and its even more deadly potential – even if it had not yet been reported as widely in other regions of the world.    

WHO showcases Rwanda’s successful Marburg response

Prof. Claude Muvunyi, Director-General of the Rwanda Biomedical Centre.

While the continent continues to grapple with mpox, Rwanda was being commended for its response to the Marburg virus outbreak last year.

Speaking at the launch of WHO’s  2025 Health Emergency Appeal for $1.5 billion, Prof. Claude Muvunyi, Director-General of the Rwanda Biomedical Centre, outlined how the defeated its first Marburg virus disease (MVD) outbreak in September 2024 with a coordinated response. 

“From the very start of this outbreak, the government of Rwanda activated its emergency response mechanism, prioritizing the health and safety of our people,” Muvunyi said. “We rapidly deployed specialized teams for case detection, contact tracing, and patient isolation.”

He noted that one of the significant achievements was the establishment of a specialized Marburg treatment center, which helped reduce the case fatality rate (CFR) to 23%—notably lower than the typical 24-88% CFR seen in previous Marburg outbreaks.

He acknowledged the World Health Organization’s key role in providing technical expertise, laboratory test kits, and personal protective equipment. He added that WHO also facilitated the deployment of 39 health professionals from Uganda, Liberia, and Sierra Leone to strengthen Rwanda’s capacity.

“WHO’s support gave our clinicians confidence in managing the disease, contributing to one of the lowest recorded fatality rates for a Marburg outbreak,” Muvunyi said.

Rwanda’s experience, he added, underscores the importance of early detection, regional collaboration, and sustained global health investments. “We must continue investing in global health security. Outbreaks do not happen in isolation, and without timely interventions and predictable funding, the next emergency could be just around the corner,” he said.

Concerns Over Marburg Virus in Tanzania

Marburg – Tanzania reports a suspected case after Rwanda squashed it’s oubreak.

But while lauding Rwanda’s success, Africa CDC said it was now closely monitoring a suspected Marburg virus outbreak in Tanzania. The first suspected case, a 27-year-old pregnant woman, died on 16 December, followed by a health worker on 27 December. Thus far, nine suspected cases and eight deaths have been reported, though five samples tested negative for Marburg. The Africa CDC said it is maintaining surveillance in the region.

In a statement issued on Thursday, WHO AFRO said authorities have deployed a team of experts to Kagera region, in Tanzania’s north-west where the suspected cases have been reported. It highlighted the need for early notification of the outcome of the investigation, describing it as crucial in facilitating swift response.

“We stand ready to support the government in its efforts to investigate and ensure that measures are in place for an effective and rapid response,” said Matshidiso Moeti, WHO Regional Director for Africa, who is due to retire soon. “With the existing national capacities built from response to previous health emergencies, we are able to swiftly scale up efforts to protect communities as well as play our advocacy role for international support and solidarity.”

In the new year, As Africa CDC said it is intensifying its response, focusing on expanding laboratory capacity, strengthening testing, and deploying rapid-response teams to contain the spread of mpox.

“From now until March, we are intensifying efforts in hotspots, expanding vaccination, and ensuring that public health systems are resilient enough to manage this outbreak,” Kaseya said.

Image Credits: Africa CDC , BBC/YouTube.

Displaced Gazans live amongst garbage and ruins.

WHO and other UN and international relief agencies heartily welcomed Wednesday’s announcement of a long-awaited  Israeli-Hamas ceasefire. Israelis and Palestinians, meanwhile, began an anxious countdown, hoping that the agreement would indeed take effect as planned Sunday – even as Israel and Hamas traded accusations Thursday that the other was trying to torpedo the accord.

“Wednesday’s announcement of a ceasefire and hostage release deal between Israel and Hamas is, of course, wonderful and long overdue news,” said Tedros on Thursday, at the launch of  WHO’s 2025 Health Emergency Appeal, for $1.5 billion dollars.

“It is just about the best news we could have hoped for to start the new year,” Tedros added at the first WHO global press conference of 2025.  “We welcome this news with great relief, but also with sorrow that it has come too late for those who have died in the conflict, and with caution, given that …the deal has not yet been confirmed.  Although the agreement would only come into effect on Sunday if both sides are committed to a ceasefire, it should start immediately. We urge Israel’s cabinet to approve the deal and all sides to honour and implement it.

WHO Director General Dr Tedros Adhanom Ghebreyesus at WHO briefing Thursday.

Noting the ongoing conflict-related health crises raging in dozens of countries around the world, as well as disease outbreaks and natural disasters around the world, he added:  

“We can only hope that this agreement [between Israel and Gaza] will not be the only one this year, and that we will also see an end to wars and insecurity in Ukraine, Sudan, Haiti, DRC, Myanmar and elsewhere,” he observed, noting that WHO responded to 51 emergencies in 89 countries last year, and estimates that some 300 million will need emergency health assistance this year.  “In Sudan, almost two years of civil war and catastrophic displacement have left 70% of those facilities non functional, and in Ukraine, more than 2000 attacks on health care over almost three years of war have caused significant damage and eroded hope.”

Meanwhile, UN Secretary General António Guterres called on both Israel and Hamas to facilitate the rapid, unhindered, and safe humanitarian relief for all civilians in need, saying, “It is imperative that this ceasefire removes the significant security and political obstacles to delivering aid across Gaza so that we can support a major increase in urgent lifesaving humanitarian support,” he told reporters at UN Headquarters, warning that “the humanitarian situation is at catastrophic levels.”

Agreement in three phases 

Hostage families gather in Tel Aviv to express hope – but also fears that pending hostage deal will leave many captives behind for an unforeseen period.

The agreement calls only for the release of some 33 of the estimated 98 Israeli hostages still being held captive in Gaza in the first phase during an initial 6 week (42 day) ceasefire – some of whom may have already perished but have not been confirmed dead, according to the Qatar and US brokers of the deal in statements Wednesday night. 

Those hostages set to be release right away include the ill, people over age 50, women still in captivity, and two infants/toddlers, of the Bibas family, who also are still being held by Hamas – although the group has said that they died some  months ago in an Israeli attack. 

Israel would, in turn,  release more than 1700 Palestinians now in Israeli jails, and withdraw away from the Gaza enclave’s most heavily populated areas, and closer to Israel’s border. A surge in humanitarian aid would also follow, including the Israeli evacuation of some, but not all, posts around Gaza’s southernmost Rafah border crossing with Egypt. Reopening of that crossing, closed since Israel’s occupation of the border area last year,  would help expedite a aid deliveries from Egypt and medical evacuations from Gaza.

While displaced Gaza Palestinians are also supposed to be allowed to return to their homes, it appeared likely that Israel would retain control of a central Gaza Netzarim corridor that could curb the flow of Palestinians now in the south back to homes in Gaza City and its environs. Most of the enclave’s two million people have been displaced at one time or another during the war.

It also appeared likely Israel would remain in control of the northernmost band of the Gaza strip, closest to many of Israel’s communities that were attacked by Hamas on 7 October, which killed some 1200 Israelis, mostly civilians, and took 240 hostage. That is likely to include the central “Netzarim corridor” dividing Gaza from north to south, as well as border areas north of Jabalya refugee camp and Beit Hanoun, which also saw some of the heaviest fighting in late 2024, including the Israeli occupation of Kamal Adwan hospital and it’s closure in the last week of December.  

Healthworkers leaving northern Gaza’s Kamal Adwan Hospital in December after Israel’s occupation of the facility, which it claimed was shielding Hamas fighters.

Conclusion of second phase, remains unclear

During the initial 42 day ceasefire period, negotiations would continue over details of a second phase, which would presumably involve the release of the remaining Israeli and foreign hostages – all men under the age of 50 – as well as a more complete withdrawal of Israeli troops from the 360 square kilometre enclave. Significantly, however, the details of Phase 2 have not yet been fully agreed to by the warring parties. 

A final Phase 3 of the deal, if achieved, would see the definitive end to the war, and the launch of a multi-billion Gaza reconstruction plan, according to the US Secretary of State Anthony Blinken,  who unveiled the key elements of the plan Wednesday evening.

“As for the details of the second and third phase, they will be agreed upon during the implementation of  the first phase, said Qatar’s prime minister Mohammed Al-Thani in a separate press briefing Wednesday evening. “We have faith.. We are committed, we will do everything possible to ensure that this deal is implemented as agreed and will bring us peace; it depends on the parties, acting in good faith.”

Celebrations and last minute crisis and jitters 

Celebrations in Gaza Wednesday evening after news of a ceasefire deal.

News of the agreement led to massive street celebrations in Gaza, where Palestinians have endured 467 days of war, and over 46,000 casualties, with slightly more than half being women, children or older people according to Gaza’s Palestinian authorities, where Hamas continues to retain control – despite the devastating Israeli invasion and months of occupation. 

 

In Israel, hostage families gathered with supporters in a major Tel Aviv square with hopes that their ordeal, too, may soon be over.  But many families and friends of the hostages also expressed anger over the facts that two-phased deal, leaves most of the remaining male hostages in Hamas captivity for the time being. And if negotiations over the second stage break down, that would and effectively constitute a “death sentence” for them – in view of the long months of confinement in tunnels with no access to clean air, water, adequate food or medical care.

Those fears were exacerbated on Thursday as Prime Minister Benjamin Netanyahu declared that Hamas was trying to make last minute changes to the agreement – and said he would postpone the Israeli cabinet meeting to approve the deal until Hamas clarifications were received. Meanwhile hard-right Israeli cabinet members threatened to resign in protest over the ceasefire plan – although Netanyahu still appeared to have sufficient votes for its approval.

Both Israeli and Palestinian critics also pointed out that the deal agreed to by Israel’s government now, was effectively the same one that had been on the table since May or June of 2024. The only reason that Netanyahu had agreed now was because his fears of angering incoming US President Donald Trump had now become a bigger concern than the Israeli prime minister’s fears that the hard right wing of his government might trigger its collapse.   

$10 billion needed just to rebuild Gaza health system  

Al Shifa, Gaza’s largest hospital, on 23 November 2024: After being severely damaged earlier in the war, it’s back in service at least partially, but most Gaza hospitals have been damaged somehow, and only about half are functioning at all, according to WHO.

Looking forward, WHO’s new emergency appeal aims to muster initial humanitarian support to Gaza’s shattered health system in the first phases of the ceasefire, said WHO Representative to the Occupied Palestinian Territories, Dr Rick Peeperkorn at Thursday’s press briefing.  But Gaza will need some $3 billion over the next 1.5 years and $10 billion over the next 6-7 years to rebuild its health system.  

“The destruction is so massive,” Peeperkorn said. “All hospitals are either damaged or partly destroyed, and the same applies for the primary health care clinics. When my team came back with these  initial assessments, it was even more than $3 billion for the first one and a half year, and then actually $10 million for the five to seven years, I was a little surprised that we’re just talking about health.”

He said that the focus of the coming weeks, where the full implementation of all three phases of the deal remains uncertain, should be “pragmatic humanitarian support.”

“But assuming that the ceasefire processes, which is three phases, that it progresses to a lasting peace, that we rapidly expand this early work of rehabilitation and reconstruction.”

Urging Palestinian authorities to plan a more comprehensive health care package

WHO is also initiating discussions with the West Bank-based Palestinian Authority’s on the provision of a more comprehensive primary healthcare package for Palestinians as part of post-conflict recovery, Peeperkorn noted. Due to the spotty coverage of public health services and insurance coverage, West Bank Palestinians pay a huge amount of their health costs out of pocket for private health services – and are frequently forced to turn to expensive, hospital-based care for many more basic procedures. This in a time when they, have also been hard hit economically by the Israeli closures imposed by the war.

“It’s also, of course, an opportunity to relook as sectors, including the health sector,” said Peeperkorn.  “How can we now really base it [Palestinian health services] properly on Comprehensive Primary Healthcare, which was not always the case; it was more in hospital-centered system. How can we work with an updated Essential Health package for Palestine, an updated Essential Health package, which should be the basis of our investments. A lot of work was done already before the crisis on this, and we’re working with government partners to further update that. And those processes should guide any any investments.”

Both Peeperkorn and Tedros also repeated earlier  appeals for a dramatic increase in the pace of medical evacuations of sick and wounded Gazans abroad, following the cease-fire agreement. 

“The ceasefire deal offers an opportunity for expedited medical evacuations for over 12,000 people, including many children, who urgently need lifesaving care outside Gaza. We hope the deal will be sustained, because lives depend on it. Peace is the best medicine!” said Tedros, in an X post.

Image Credits: X/Good Morning America, Middle East Eye , X/GMA , @WHO.

A Palestinian child in the rubble of a bombed building in Gaza. State-based armed conflict is the Number 1 current concern of respondents.

Armed conflict, mis- and disinformation and environmental risk dominate the World Economic Forum’s (WEF) Global Risks Report, released on Wednesday.

The report, released on the eve of WEF’s annual meeting in Davos next week, is based on a Global Risks Perception Survey (GRPS) of over 900 global leaders in academia, business, government and civil society polled in September and October 2024.

“We seem to be living in one of the most divided times since the Cold War,” the report notes.

“Over the last year, we have witnessed the expansion and escalation of conflicts, a multitude of extreme weather events amplified by climate change, widespread societal and political polarisation, and continued technological advancements accelerating the spread of false or misleading information.”.

The survey results reveal a bleak outlook across all periods respondents were questioned about – current, short-term and long-term. 

Current risks

State-based armed conflict is the most pressing immediate global risk for 2025, according to the respondents. 

“The current geopolitical climate, following Russia’s invasion of Ukraine and with wars raging in the Middle East and in Sudan, makes it nearly impossible not to think about such events when assessing the one global risk expected to present a material crisis in 2025,” the report notes.

The “escalation pathways” for conflict in Ukraine and the Middle East depend on how the new Trump administration in the United States (US) responds, the report notes.

“Will the US take a firmer stance towards Russia, counting on such a move acting as a deterrent to further Russian escalation, and/or will it increase pressure on Ukraine, including reducing financial support?” it asks.

“The spectrum of possible outcomes over the next two years is wide, ranging from further escalation, perhaps also involving neighbouring countries, to uneasy agreement to freeze the conflict.”

In the Middle East, an escalation of Iran-Israel conflict will draw the US in more and “generate more long-term instability in the entire region, including the Gulf economies, where US military bases could become targets”.

Conflict over Taiwan also cannot be ruled out, it notes.

“The growing vacuum in ensuring global stability at a multilateral level will lead governments around the world increasingly to take national security matters into their own hands,” it warns.

Extreme weather events and “geo-economic confrontation” are the next biggest current concerns.

Short-term risks

Misinformation and disinformation remain the top short-term risks for the second consecutive year, posing risks to “societal cohesion and governance by eroding trust and exacerbating divisions within and between nations”.

The report also notes that it is “becoming more difficult to differentiate between AI- and human-generated misinformation and disinformation”, and that AI tools are enabling “a proliferation in such information”.

Extreme weather events, state-based armed conflict, societal polarisation, cyber-espionage and warfare are other key risks over the next two years. Pollution is ranked the sixth biggest risk.

To complement the GRPS short-term (two-year) data, the report also draws on the WEF’s Executive Opinion Survey (EOS) to identify risks to specific countries over the next two years, as identified by over 11,000 business leaders in 121 economies.

Longer-term risks

Environmental risks dominate the longer-term, 10-year outlook, with extreme weather events, biodiversity loss and ecosystem collapse, critical change to Earth systems and natural resources shortages leading the 10-year risk rankings.

There was near-unanimous identification of “extreme weather events” as the biggest threat in the coming decade across the different stakeholder groups and regions surveyed.

The third highest risk, critical changes to the Earth systems, covers issues such as sea level rise from collapsing ice sheets, carbon release from thawing permafrost, and disruption of oceanic or atmospheric currents.

While pollution ranked 10th, younger people were much more concerned with this and those under the age of 30 listed it as their third biggest threat.

Extreme weather events are becoming more common and expensive, with the cost per event having increased nearly 77% (inflation-adjusted) over the last 50 years, the report notes.

Biodiversity loss and ecosystem collapse has “experienced one of the largest increases in ranking among all risks, moving from number 37 in 2009 to number 2 in 2025”, the report notes.

“Respondents are far less optimistic about the outlook for the world over the longer term than the short term,” according to a media release from WEF.

“Nearly two-thirds of respondents anticipate a turbulent or stormy global landscape by 2035, driven in particular by intensifying environmental, technological and societal challenges.”

Global fragmentation

However, the WEF warns that, as experts anticipate “a fragmented global order marked by competition among middle and great powers”, multilateralism will face ‘significant strain”.

But in response, the WEF urges leaders to “rebuild trust, enhance resilience, and secure a sustainable and inclusive future for all” by prioritising dialogue, strengthening international ties and fostering conditions for renewed collaboration.

“Rising geopolitical tensions and a fracturing of trust are driving the global risk landscape” notes WEF’s managing director, Mirek Dušek. “In this complex and dynamic context, leaders have a choice: to find ways to foster collaboration and resilience, or face compounding vulnerabilities.”

Ironically, WEF’s Davos meeting, themed “Collaboration for the Intelligent Age”, opens on the same day as the inauguration of US President-Elect Donald Trump, who is widely predicted to disrupt multilateral organisations and deepen global divisions.

Image Credits: UNICEF/UNI501989/Al-Qattaa.

Obesity is growing fastest among children and adolescents

Diagnosing obesity should extend beyond body mass index (BMI) to include measures such as waist circumference and individual physical symptoms.

So says the Commission on Clinical Obesity, comprising 58 experts from a range of medical institutions and countries in an article published in Tuesday’s The Lancet Diabetes & Endocrinology.

There has long been a debate in the medical fraternity about whether obesity is a disease itself, or a cause of disease.

The commission introduces a definition for “clinical obesity” which it classifies as a disease, but argues that its diagnosis should be far more nuanced than BMI. BMI should rather be used to screen for obesity.

It also introduces “pre-clinical obesity”, which is associated with a variable level of health risk, but no ongoing illness.

All-or-nothing

“The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,” says  commission chair Professor Francesco Rubino.

“Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” adds Rubino, from the School of Cardiovascular and Metabolic Medicine and Sciences a King’s College in London.

“Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone,” he adds. 

“On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.”

Nuanced approach

The commission defines “clinical obesity” as being associated with “symptoms of reduced organ function, or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating and continence, directly due to excess body fat”. 

The Commission sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and  adolescents. 

These include breathlessness, obesity-induced heart failure, knee or hip pain, with joint stiffness and reduced range of motion as a direct effect of excess body fat on the joints.

Pre-clinical obesity is defined as “obesity with normal organ function”. 

“People living with pre-clinical obesity do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases (NCDs) in the future,” according to the commission

BMI limitations

Although BMI is useful for identifying individuals at increased risk of health issues, the commission stresses that BMI is “not a direct measure of fat, does not reflect its distribution around the body and does not provide information about health and illness at the individual level”.

“Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says commissioner Professor Robert Eckel.

“But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” adds Eckel, who is from the University of Colorado Anschutz Medical Campus in the US.

“Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness,” 

Appropriate care

“This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur from the University of Sydney, Australia.

Image Credits: Commons .

A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that.

If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health?

“The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University.

According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General.

“But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch.

However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. 

“The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.”

US is by far largest donor 

The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). 

Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5.  

US contribution to WHO in the 2024-25 biennium

China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As  China is still classified as a “developing country”, it benefits from lower rates.

But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China.

In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. 

China’s contribution to WHO in the 2024-2025 biennium

Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. 

When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China.

Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body.

WHO’s top 25 donors for 2024/25

China favours bilateralism

Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave.

But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. 

Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists,

“[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article.

“Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.”

While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN.

Europe is preoccupied by Ukraine; turns to the right

Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. 

“Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU.

With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine.

In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries.

In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal.

The EU has thus neither the means nor the will to cough up more for global health.

Russia
ICRC members unload supplies in Ukraine.

‘Anti-globalist’ Trump to chop UN fees

Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”.

An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. 

Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights.

During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion.

During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”.

During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. 

Leadership vacuum

But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. 

The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence.

Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population.

The US may also weaken its own health if its steps outside the WHO.  It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold.

However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”.

Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition.

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