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

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

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

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

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

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

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

Air pollution roadmap – big leap forward 

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

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

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

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

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

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

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

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

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

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

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

Climate change  – a bold new approach    

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

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

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

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

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

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

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

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

Increasing health sector access to climate funding 

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

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

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

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

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

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

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

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

Ethiopia – calls for more climate and health finance.

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

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

‘Major Opportunity for WHO to lead’

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

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

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

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

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

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

Climate action budget is ambitious – but first part is funded

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

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

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

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

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

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

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

“I think this is a good progress.”  

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

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

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

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

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

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

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

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

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

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

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

Nuclear threats 

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

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

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

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

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

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

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

Haunting health legacy of nuclear testing

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

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

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

Health impacts persist across generations

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conflict and political instability – other factors 

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

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

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

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

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

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

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

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

USAID cutbacks hit at female health workers in Afghanistan

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

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

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

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

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

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

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

Gaza shows it can be done

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

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

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

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

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

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

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

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

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

Politicizing the federal workforce

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

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

However, that civil service workforce is shrinking rapidly. 

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

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

Bird flu response jeopardized

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Image Credits: Julio Reynaldo, CDC, NIH.

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

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

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

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

See related story:

Crucial WHO Health Emergency Response Faces Budget Cut of 25%

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

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

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

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

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

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

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

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

Palestine and Arab states fiercely dispute contentions 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Will Hamas remain in control in Gaza?

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

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

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

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

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

Suffering in Gaza is beyond comprehension

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

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

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

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

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

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

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

Tedros appeals for faster pace of medical evacuations

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

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

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

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

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

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

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

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

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

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

Image Credits: @nabilajamal, WHO.

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

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

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

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

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

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

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

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

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

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

Uganda's Ministry of Health, WHO and partners launch the first ever vaccine trial for Ebola from the Sudan species of the virus.
Uganda’s Ministry of Health, WHO and partners launched a first ever vaccine trial for Ebola from the Sudan species of the virus this week.

Responding to health emergencies is at the heart of the work of the World Health Organization (WHO), which assisted almost 90 million people with humanitarian health support in the first nine months of 2024.

But the loss of United States funding, which has included the immediate freezing of funds already committed, means that this essential work will need to be cut back by as much as 25%.

There were 45 graded emergencies affecting 87 countries, and 18 required major support, according to the WHO Director General’s report on health emergencies to the Executive Board.

Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme, joined the EB on Zoom from Uganda where he is assisting the country to respond to an outbreak of Ebola.

“The immediate response here in WHO was to use our Emergency Response Framework, to realign the functions at the country office to deploy an incident manager and core staff from the Afro rapid response mechanism, to send specialist expertise in from both the regional and from the HQ level,” explained Ryan.

“Dr Tedros immediately issued contingency funds of $1 million to support the response, and that allowed that response to start up very quickly,” added Ryan, who explained that the WHO has worked with the Ugandan government for the past year to prepare for such an emergency.

“It took less than one day to sequence the virus, and it was immediately published for the global community. An incredible achievement by public health laboratories here in Uganda,” added Ryan.

Uganda’s Ministry of Health, WHO and other partners also launched the first-ever clinical efficacy trial for a vaccine for Ebola Sudan virus in that country this week.

Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme, joined the EB on Zoom from Uganda

Immediate impact of US aid cut

But the US funds around 20% of the WHO’s emergency appeal and acute response side, and about 25% of its core programme, Scott Pendergast, Director for Strategy, Financing, and Partnerships for the WHO Health Emergencies Programme, told the EB.

“We’re also having to deal with the immediate withdrawal, the instruction of the US to stop any spending against the existing awards we have. This is putting a major challenge on our teams on the ground in terms of how to reduce operations or meet the obligations that we have now that we no longer have access to that financing,” Pendergast added.

The WHO’s health emergency appeal is only 65% funded for 2025, while there is only $22 million in the contingency fund for rapid action in health emergencies, he explained.

“More than 80% of the financing for the emergency programme is going to the country level,” said Pendergast. But the department was working with regions on the “new reality” of potentially having to cut a quarter of its budget and a report on how this will be done will be available next month.

Scott Pendergast (left), Director for Strategy, Financing, and Partnerships for the WHO Health Emergencies Programme

Switzerland noted that some emergency relief programmes “are currently under immediate operational risk”. 

“For example, numerous CDC deployments from the United States no longer appeared at work since last Monday. These are specialized experts who played key roles in functions such as immunization, surveillance and the preparation against the pandemics in many countries. Contracts for contractors and suppliers are frozen. Therefore expertise is already starting to leave the organization and offices are starting to cut back on staff.” 

Budget cut comes amid growing need

The loss of US funding comes at a time of increased health emergencies, fuelled by rising conflict and climate-related health emergencies. In the African Region alone, 56% of all public health emergencies between 2001 and 2021 were climate-related.

Over several hours on Wednesday, member states at the EB expressed gratitude to WHO teams for assistance in a wide variety of situations.

Lebanon, speaking for the Eastern Mediterranean region, described 2024 as being “marked by violence, death, disease, destruction and displacement”. 

“It is sobering to note that over one-third of all health emergencies responded to by WHO last year occurred in our region. Outbreaks of measles, cholera, dengue and other diseases escalated, fueled by conflict, fragility, disrupted surveillance and control systems and effects of climate change,” Lebanon noted.

“The most devastating humanitarian crisis unfolded in the occupied Palestinian territory,  Sudan and Lebanon.

“Wars and armed conflicts do not only shatter buildings and destroy lives. They can leave people mentally and emotionally scarred, sometimes for a lifetime.”

Togo, speaking for the Africa region, described how the WHO African region has “actively intervened in 17 emergencies, with 14 extreme emergencies, four of which were at level three, requiring the highest level of support, and three prolonged emergencies”.

WHO assistance included training health workers, establishing health emergency operations centres, and providing medicines, vaccines and diagnostics “in considerable quantities to help countries in crisis”.

Attacks on health workers

WHO officials survey the destruction around Northern Gaza hospitals in mission over weekend of 2-3 March 2024.

“By 30 September 2024, 1080 attacks on healthcare workers and facilities had been reported through the WHO surveillance system, in 13 countries/ territories – resulting in 554 deaths and 923 injuries among staff and patients,” according to the DG’s report.

The occupied Palestinian territory, including east Jerusalem, accounted for the highest number of incidents (505), followed by Ukraine (320).

 “Attacks on health care have become an unacceptable norm in these conflicts,” Lebanon noted.

“These assaults undermine the very essence of humanity. In Gaza, aid workers describe the war as the most brutal and severe crisis they have ever faced. In Sudan, violence has displaced more people than any recent emergency. Over half of the population now needs urgent humanitarian assistance.”

Questions for Secretariat

Switzerland asked how the WHO Secretariat can “protect the critical work in all these areas, as well as other essential work”, but pledged to support the WHO,

Meanwhile, Germany urged WHO and member states to “do whatever it takes to secure flexible and sustainable funding for these now severely underfunded functions”.

“We would also appreciate more information by the Secretariat on the immediate measures taken by who to address this gap,” said Germany.

“Let us not forget that it is in our collective and national interest to maintain and prioritize work and health emergencies. Filling funding gaps and funding the initial response is particularly crucial, and the contingency fund for emergencies has an important role to play,” added Germany, urging all countries to increase their commitments to the fund. 

While Brazil acknowledged the WHO’s efforts in strengthening surveillance preparedness and response, it urged the WHO to “fulfil the estimated $55.5 million needed to bolster global response capabilities”.

Meanwhile, Namibia urged the WHO Secretariat “to collaborate with relevant stakeholders, including the World Bank and IMF, to support developing countries in addressing their international debt burdens, which have colonial underpinnings.

“Facilitating debt restructuring reforms is crucial for improving the fiscal space of African nations, enabling them to allocate more resources toward domestic health investments. 

By doing so, we believe the Secretariat can help build a more robust financial foundation for member states, facilitating improved health outcomes and stronger resilience against future health emergencies.”

Dr Tedros addresses the EB

In response, Director General Dr Tedros Adhanom Ghebreyesus told member states that the WHO’s operational arm, “will stay and will be very important”.

“There is no way that we can leave the community behind and go, and in some places, our colleagues paid the ultimate sacrifice. So I hope you will understand that, when we talk about financing, prioritization and balancing, it’s not just norms and standards. We have the operational arm that we develop, and that cannot be starved because the people we serve need it.”

“We need to continue to mobilize resources, and we need to also be careful about expenditure, meaning we need to do efficiency gains, meaning, tighten our belts,” added Tedros.

He appealed to member states: “We have the assessed contribution. If you agree on that 20% that means a lot. We have the investment round. For countries who haven’t contributed to that, if you can contribute, that will help us in balancing.

“And we have the WHO Foundation. If your private sectors could be convinced, if you can convince them, and then we have some resources through that. I think that will really keep the balance.”

Image Credits: WHO, WHO .

Ailan Li, WHO’s Assistant Director-General for Universal Health Coverage and Healthier Populations
Ailan Li, WHO’s Assistant Director-General for Universal Health Coverage and Healthier Populations

Social isolation as a driver of poor mental health was discussed for the first time at the World Health Organization’s (WHO) executive board meeting (EB) on Wednesday.

Several member states called for WHO guidance on addressing loneliness and social isolation, and for measures to combat these to be included in the body’s Comprehensive Mental Health Action Plan.

“This is a historical discussion as a social connection is being addressed at this executive board for the first time,” said Ailan Li, WHO’s Assistant Director-General for Universal Health Coverage and Healthier Populations.

“We are working to strengthen data and metrics on social isolation. The available evidence already shows the impacts on health and also the economy,” said Li, adding that more evidence was still needed.

“We are continuing to work together to expand the evidence base. This will allow us to develop metrics to monitor our progress while exercising our financial wisdom and efficiency as required by the current difficult situation.”

The WHO Commission and technical advisory group on social connection will launch its report later in the year.

This “will provide more evidence and recommendations for action, including developing evidence-based policy, implementing tailored country support based on the culture and social context and promoting partnerships,” said Li.

The WHO Director-General’s report on mental health and social connection maps the extent of the problem, noting that a quarter of older people and at least one in six adolescents are socially isolated or lonely.

“Lack of social connection poses serious health risks, and is associated with a 14–32% higher risk of mortality, akin to other known risk factors such as smoking, excessive alcohol consumption, physical inactivity, obesity and air pollution,” notes the report.

“It has a serious impact on physical health, increasing the risk of stroke by 32% and cardiovascular disease by 29%… and is linked to higher rates of anxiety, depression and suicide. Moreover, 5% of global dementia risk is attributable to social isolation.”

NCD High-Level Meeting

Much of the discussion at the EB on Wednesday focused on non-communicable diseases (NCDs) in preparation for the United Nations High-Level Meeting (HLM) on NCDs in September.

This is the fourth HLM on the issue yet “underinvestment in health services has created a significant gap in care and support for people affected by NCDs and mental health conditions,” according to a report from the WHO Director-General to the EB.

“Targeted investments are needed to reorient health systems towards primary health care as the foundation for universal health coverage and health security, with a focus on NCDs and mental health,” it adds.

The WHO has “launched multistakeholder engagement activities, including global and regional consultations, briefings and other processes” to encourage input from stakeholders in preparation for the HLM.

“The fourth high-level meeting of the General Assembly on the prevention and control of NCDs provides an opportunity to adopt a new, ambitious and achievable political declaration on NCDs, based on evidence and grounded in human rights, to accelerate the global NCD response beyond 2025,” the report notes.

During the discussion, there was significant support for resolutions on a dedicated cervical cancer elimination day (proposed by South Africa) and kidney health (from Guatemala).

However, in view of the funding crunch caused by the withdrawal of the United States, the EB is considering pausing new resolutions pending their costing. A report from the WHO to the EB notes on Tuesday notes that the board is discussing 19 new resolutions that all have funding implications.

Germany has been particularly insistent the financial implications of every new action needs to be worked out but several member states have not let that dampen their enthusiasm for new activities.

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

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

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

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

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

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

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

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

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

Setbacks for African HIV services 

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

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

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

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

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

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

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

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


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

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

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

Journals ‘forbidden’ to ‘bow to political censorship

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

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

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

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

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

Doctors file lawsuit

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

The CDC website was still offline on Wednesday.

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

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

More lawsuits?

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

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

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

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

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

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

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

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

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

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

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

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

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

Cost impacts slow approval of new WHO initiatives

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

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

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

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

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

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

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

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

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

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

Germany urges caution

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

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

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

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

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

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

Rare diseases resolution gets widespread endorsement 

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

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

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

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

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

Resolution calls for WHO Global Action Plan

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

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

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

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

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

Taiwan also surfaces as issue

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

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

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

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

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

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