Heated tobacco products (left and middle) are electronic devices that heat tobacco inserts. (The device on the right is an e-cigarette.)

Big tobacco companies are marketing heated tobacco products (HTP) as a less harmful alternative to cigarettes, but researchers warned this week that there is no evidence to support this or the industry claim that they can help smokers to quit.

HTPs are electronic devices that heat an insert of processed tobacco, often in a stick or pod, to produce an aerosol containing nicotine and other chemicals. The tobacco insert is often flavoured, including with flavours such as bubble gum and lime that appeal to young people.

“There are three key things policymakers and consumers need to know,” said Dr Sophie Braznell, a researcher from the University of Bath who co-authored a brief on HTPs released on Wednesday by STOP, a tobacco industry watchdog.

“First, heated tobacco products cause harmful effects. Second, there is no clear evidence that they are safer or less safe than other tobacco and nicotine products, even cigarettes. Third, available research lacks the independence and quality that might help us draw any conclusions about the impacts of real-world use,” Braznell told a media briefing on Wednesday.

Billion-dollar market

The main players in the HTP market.

The HTP market is estimated to be worth $36.7 billion and is projected to grow by over 52% between now and 2032, according to market research company Stellar.

“HTPs are available in at least 57 countries across Europe, North and South America, Eurasia, and East Asia. The market for HTPs in Africa and the Middle East is small but growing,” according to Stellar, with Asia Pacific being the fastest-growing region in the market.

HTPs have become more popular than cigarettes in Japan, while sales are surging internationally with promotions at events aimed at youth.

The HTP market leader is Philip Morris International’s (PMI) IQOS, an abbreviation of “I Quit Ordinary Smoking”, while British American Tobacco (which makes Glo) and Japan Tobacco International (Ploom) are the other key players.

HTPs are available in a limited number of African countries, including South Africa, Kenya, Nigeria, Botswana, Zambia, Zimbabwe and Ghana. 

However, the cost of the device is a barrier, acknowledged Frederic de Wilde, PMI’s president for South and Southeast Asia, the Commonwealth of Independent States, the Middle East, and Africa region.

“Africa definitely has a role to play and we are committed to coming up with smoke-free products to offer alternatives to African smokers,” de Wilde told African Business in an interview in late December 2024.

But he said that the current HTPs were “premium devices”, and PMI is “piloting a new simple device that is less expensive and targeted for medium and low price segments”.

How PMI’s Heated Tobacco Products are being consumed across the world.

Biased clinical trials

Braznell has spent the past five years reviewing clinical trials involving HTPs. She and colleagues found 49 clinical trials on humans, but 34 were linked to the tobacco industry, with one-third linked to Philip Morris International. 

In addition, they were usually run over a very short time – five days or less – and in controlled settings like laboratories, rather than real-world settings.

“Overall, 39 of the trials were judged to have a high risk of bias,” said Braznell, including selective reporting of results. She and colleagues also published their findings on the trials in the BMJ this week.

Aggressive marketing

Sophia San Luis, executive director of Imagine Law, a Philippines-based public interest law group

Sophia San Luis, executive director of Imagine Law, a Philippines-based public interest law group, told the media briefing that big tobacco companies were aggressively marketing their HTPs to young people.

President Ferdinand Marcos has hosted PMI since he assumed office in 2022, and the company has promoted its smoke-free products at events organised by First Lady Liza Araneta Marcos.

Renowned DJ Steve Aoki promotes IQOS products, and there is a ‘limited edition” HTP bearing his name. However, a range of NGOs and community organisations stopped an IQOS-sponsored concert featuring Aoki on the grounds that it violated advertising bans on tobacco products.

Marketing of PMI’s IQOS in Philippines was boosted by support from DJ Steve Aoki, with limite edition devices branded in his name.

Dmytro Kupyra, executive director of “Life,” a Ukrainian NGO working to reduce mortality and morbidity from non-communicable diseases, said his country had increased taxes on HTP six-fold in 2021, which had contained sales. 

However, in 2024, the Ministry of Finance reduced HTP taxes by 25%, after the tobacco companies conducted an intense campaign for taxes to be reduced. This means that Ukraine is no longer aligned with the European Union on taxation.

“For next four year, between 2025 to 2028, Ukraine will lose around $500 million in tobacco excise taxes, and Ukraine will have around 24,000 additional deaths from hamful tobacco use,” said Kupyra, who said that about 15% of young Ukrainians aged 18 to 28 use HTPs thanks to aggressive marketing.

Ukraine backtracked on HTP taxation in 2024.

Hazel Cheeseman, CEO of the UK’s Action on Smoking and Health (ASH), said that PMI had a three-pronged strategy to promote HTPs.

“First of all, they want to aggressively secure a share of the nicotine market for their heated tobacco product, and are aggressively marketing them in ways that the UK Government does not believe is in line with the law,” said Cheeseman, whose public health charity set up by the Royal College of Physicians to end the harm caused by tobacco in the UK.

Hazel Cheeseman, CEO of the UK’s Action on Smoking and Health (ASH)

“They’re also seeking to secure a beneficial regulatory environment for their products through their lobbying efforts. But also, they want to be seen as a credible partner by the UK government on the basis that they have this apparently less harmful product,” said Cheeseman.

The UK’s comprehensive advertising restrictions on tobacco products were passed before HTPs existed, so PMI had marketed HTPs more aggressively and openly than they could for cigarettes, said Cheeseman.

When the UK government challenged PMI, they undertook to suspend marketing – but there are  numerous pop-up promotions of IQOS.

Questionable industry claims

“We are often told by the industry that heated tobacco products are a scientifically backed better alternative for adult smokers. But our own research shows us that we should be questioning whether, in fact, they are better for health,” said Braznell.

We’ve brought up questions and concerns about the quality of the available evidence, as well as other research that we’ve done over the last few years, which has shown that the tobacco industry continues to manipulate and misuse science for profit. 

“Work of our colleagues around the world has shown that many heated tobacco product users are not successfully quitting smoking using these products, and in fact, are perpetually continuing to use both heated tobacco products and cigarettes. 

“And lastly, we know that again and again, the tobacco industry is not just marketing heated tobacco products at smokers, but also to non-smokers and children.”

Image Credits: Filter, PMI.

A support group for HIV positive mothers in Zimbabwe. With massive aid cuts, medicines and support for people with HIV are under threat.

As Donald Trump’s US presidency reaches its 100th day, Zimbabweans living with HIV are fearful about their futures as they struggle to get antiretroviral medication.

MWENEZI, Zimbabwe – Memory Sibanda tried three times to get antiretroviral medication from her usual clinic in February but was turned away.

The 67-year-old has lived with HIV for the past 28 years. Jobless and widowed since 2003 when her husband succumbed to AIDS, Sibanda is unable to afford to buy the medication should the government fail to supply it.

She finally received a three-month supply in late February – half the usual allocation – and is anxious about what will happen when this runs out.

“I don’t know if this reduction of our treatment pills is happening only here in our village. Nurses don’t say anything to us about what is happening with the pills. I fear we might eventually end up not receiving the drugs at all, meaning many of us might die,” Sibanda, who lives in Chomutsvairo village in the southern province of Masvingo, told Health Policy Watch.

In the capital, Harare, a similar crisis faces HIV/AIDS patients. Mavis Makumbe, 65, has depended on free ARV treatment from the government for decades. But in late February, her whole life changed when she visited the New Start Centre in the city to fetch her medication.

“I found a notice on the door saying it was closed and no longer in operation. From there, I went back home and started taking the remaining tablets, but those again were not enough,” said Makumbe, a widow who has lived with HIV for 24 years.

Fortunately, her daughter’s friends rescued her by buying six months’ allocation of ARVs. The current going rate is $20 for a month’s supply – a fortune for the average Zimbabwean, with 80% of people working in the low-income informal sector and battling huge inflationary costs each month.

This is unsustainable for Makumbe, who is also battling cancer on one of her legs.

HIV positive prisoners also told Health Policy Watch that medicines are scarce.

“Not so long ago, we were being given rations of limited ARVs. Things are now worse after America has stopped giving us aid. Even painkiller pills are now hard to find in jail,” said an HIV positive prison inmate at Chikurubi Maximum Prison in Harare.

Trump aid cuts

The ARV shortage was caused when US President Donald Trump suspended all foreign aid for 90 days with immediate effect on 20 January. The Trump administration has since disbanded the US Agency for International Development (USAID), and extended the aid cut for a further 30 days until 20 May.

“We were put in a very tough situation by the aid cut by President Trump’s government,” said Stanley Takaona, president of the Zimbabwe HIV/AIDS Activist Union Community Trust.

“The aid cut-off was a bit harsh. We are praying that both our government and the US government will put on a humanitarian face and save our lives, as people living with HIV,” added Takaona, 62, who tested HIV positive at the age of 34 and started taking ARV treatment in 2001.

The government’s pre-exposure prophylaxis (PrEP) initiative targeted at people with high exposure to HIV like sex workers has also been suspended amid the Trump administration’s global aid cuts.

In 2022, an estimated 1.3 million Zimbabweans were living with HIV, and 1.2 million were on ARVs – yet their medicine supply is now in jeopardy.

Progress under threat

Zimbabwe has made significant progress against HIV, and in 2023 it became one of only five African countries that achieved the 95-95-95 targets set by UNAIDS, with an estimated 95% of people with HIV aware of their status, 98% on treatment, and 95% of those on treatment having suppressed viral loads.

This is according to the United Nations Development Programme (UNDP), which has been the main recipient of the country’s Global Fund grant since 2009.

But with the US abandoning its commitments to combat the deadly virus abroad, activists like Sphiwe Chabikwa sees the gains made in fending off the disease being reversed.

“We are at risk. People may start dying again like what happened around 2000 and 2002 before ARVs were made available to everyone with HIV. I’m afraid,” said Chabikwa, who lives in Harare.

Chabikwa is a member of the Zimbabwe National Network of People Living with HIV (ZNNP+), the country’s network of people living with HIV.

For the past 25 years, Chabikwa has lived with HIV, and her steady access to ARVs has enabled her to manage the virus as a chronic disease.

“I get the second-line of antiretroviral treatment, but that again has had its supplies affected by the recent US aid cut. Instead of people living with HIV like me getting six months’ supplies of ARVs, this has now been reduced to three months’ supplies. That means the treatment drugs are in short supply and the authorities are trying to manage a crisis.”

Health experts predict that all the gains Zimbabwe made in defeating HIV might go to waste following the abrupt withdrawal of US aid.

Long queues now characterise the collection of HIV treatment, and patients are fearful about what the future holds for them.

Wilkins Hospital in Harare has stopped offering HIV tests and antiretroviral drugs since the US cut its aid to Zimbabwe.

Bribes for medicine

Fearing a future without ARVs, some other HIV patients admit to bribing nurses in order to get six months’ allocation of ARVs.

“Many HIV positive people in my area, including myself are now bribing nurses at local clinics in order to get the usual six months allocation of treatment drugs,” said a resident from Harare who asked to remain anonymous.

Zimbabwean nurses stationed at clinics distributing ARVs have capitalized on the patients’ fears.

“It’s our time to make money from the desperate HIV patients because our salaries alone can’t sustain us and so, with the now scarce ARVs, we just put a small fee on them for our own benefit in our backdoor deals with patients,” said a nurse at one of the clinics in Harare who spoke to Health Policy Watch on condition of remaining anonymous.

Authorities deny crisis

Yet the Zimbabwean authorities have denied that ARVs have run out. During a parliamentary question-and-answer session in February, Health Minister Douglas Mombeshora assured the nation that access to HIV treatment will continue despite global aid uncertainty.

Mombeshora claimed that Zimbabwe has secured enough stock of antiretroviral (ARV) drugs to last for the next six months. 

Despite the Minister’s assurance, HIV patients have seen their treatment allocations reduced and those living with HIV fear the worst.

However, the Zimbabwean government is developing an HIV sustainability plan to address long-term funding issues and mobilising domestic resources to maintain priority HIV programmes, according to a UNAIDS report released on 31 March.

Over the past five years, the US provided over $1 billion Zimbabwe to combat HIV.

Before widespread access to ARV therapy in Zimbabwe, AIDS was a leading cause of death and estimated 130,000 people dying from HIV-related complications in 2002 alone, according to UNAIDS.

The availability of ARVs significantly reduced AIDS deaths, with the death toll dropping to around 20,200 by 2021, according to UNAIDS. Adult HIV prevalence has fallen from its peak of 26.5% in 1997 to 11.9% in 2021.

Call on government to step up

Olive Mutabeni, executive director for Life Empowerment Support Organization (LESO), a community-based HIV/AIDS organization in Zimbabwe, has challenged authorities to step up and purchase ARVs.

“There is a need for the Ministry of Health and the National AIDS Council to address this issue of ARVs supplies urgently before we lose people,” said Mutabeni.

Mutabeni, aged 64, started taking ARVs in 2009 yet 16 years later, she is unsure of her access to treatment: “I am worried that many HIV patients like me might soon perish like flies.”

The permanent discontinuation of HIV programmes currently supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR) would lead to an additional 6.6 million new HIV Infections and additional 4.2 million AIDS-related deaths between 2025 and 2029, according to UNAIDS modelling.

 

Image Credits: DFID, Jeff Moyo.

Save Hands for Girls campaigns against female genital mutilation in The Gambia.

Urgent measures are needed to curtail the rising “medicalization” of female genital mutilation (FGM) and to engage health workers to prevent the practice, according to a new guideline published by the World Health Organization (WHO).

The guideline recommends professional codes of conduct that expressly prohibit health workers from performing FGM and stresses the need to train health workers to prevent the harmful practice. 

In several parts of the world, the practice is now increasingly performed by health workers. An estimated 52 million girls and women alive today were subjected to FGM by health workers –  around a quarter of all cases, according to the WHO.

The guideline offers sensitive communication approaches that can help health workers effectively decline requests to perform FGM, while informing people about its serious immediate and long-term risks, according to the WHO.

“Female genital mutilation is a severe violation of girls’ rights and critically endangers their health,” said Dr Pascale Allotey, WHO’s Director for Sexual and Reproductive Health and Research, and the United Nations’ Special Programme for Human Reproduction (HRP). 

“The health sector has an essential role in preventing FGM – health workers must be agents for change rather than perpetrators of this harmful practice, and must also provide high-quality medical care for those suffering its effects.”

Typically carried out on young girls before they reach puberty, FGM includes all procedures that remove or injure parts of the female genitalia for non-medical reasons.

Care for survivors

Over 230 million women and girls are estimated to be living with the effects of FGM. These include genital tissue damage, genitourinary tract infections, menstrual difficulties, urological complications (urinary tract infections and difficulty urinating), and sexual complications (dyspareunia and sexual dysfunction).

FGM/C is concentrated in a swath of countries from the Atlantic Coast to the Horn of Africa (2020 figures).

There is also an increased risk of obstetric complications including prolonged or obstructed labour, obstetric tears, caesarean birth, postpartum haemorrhage, episiotomy, fetal distress,, neonatal asphyxia and stillbirths. 

FGM also causes mental health disorders such as anxiety, depression, post-traumatic stress disorder [PTSD] and somatoform disorders.

Evidence shows that no matter who performs FGM, it causes harm. Some studies suggest it can even be more dangerous when performed by health workers, since it can result in deeper, more severe cuts. 

Its “medicalization” also risks unintentionally legitimizing the practice and may thereby jeopardize broader efforts to abandon the practice.

“Research shows that health workers can be influential opinion leaders in changing attitudes on FGM, and play a crucial role in its prevention,” said Christina Pallitto, Scientist at WHO and HRP, who led the development of the new guideline. 

“Engaging doctors, nurses and midwives should be a key element in FGM prevention and response, as countries seek to end the practice and protect the health of women and girls.”

Alongside effective laws and policies, the guideline highlights the need for community education and information, including community awareness-raising activities that involve men and boys. 

The guideline also includes several clinical recommendations to help ensure access to empathetic, high-quality medical care for FGM survivors. Given the extent of both short and long-term health issues that result from the practice, survivors may need a range of health services at different life stages, from mental health care to management of obstetric risks and, where appropriate, surgical repairs.

Burkina Faso has halved FGM prevalence among 15  to 19-year-olds over the past 30 years, while Sierra Leone and Ethiopia have reduced the incidence by 35% and 30% respectively, through collective action and political commitment to enforce bans and accelerate prevention.

Since 1990, the likelihood of a girl undergoing genital mutilation has decreased threefold but it remains common in 30 countries, and an estimated four million girls each year are still at risk.

 

Image Credits: Safe Hands for Girls, UNICEF.

Solar power at primary health centres in Karnataka state in India is improving healthcare delivery.

There’s an urgency to scale climate change solutions quickly, was the unofficial mantra at the World Health Summit, as delegates called for faster change and more funds.

NEW DELHI – It doesn’t cost much to ensure that a mother does not deliver her baby by candlelight, increasing the chances of the newborn’s and mother’s survival. 

Thousands of primary health centres (PHC) in India are benefiting from a solar project rollout that provides clean and sustainable power for around $4,000 to $5,000 per centre. This checks several sustainable development goal (SDG) boxes – for the planet, affordable and clean energy, good health and well-being and climate action. 

Installing solar at 25,000 primary and other health centres is scheduled to be completed next year, up from 15 centres ten years ago.

This was one of the few celebrated examples of climate action at scale at the World Health Summit (WHS) in New Delhi, a twice-a-year, influential gathering of health stakeholders, which ended on Sunday. 

Leading experts flagged hurdles that are slowing down such sustainable projects and programmes, ironically just as these should be accelerated, given the rapidly warming climate.

From scaling up affordable cooling, to faster funding mechanisms, to better data, experts from multilateral bodies such as the World Bank and Asian Development Bank (ADB), funders, NGOs and CSOs listed their priorities. 

Economic growth now vs net zero later

As if on cue, the WHS coincided with northern India experiencing extreme heat, southern India’s heat index topping 50°C, and Europe posting its hottest March on record.

Decarbonisation is the usual response to rising heat, but this needs to be looked at from another lens, Marion Jane Cros, the World Bank’s  (WB) Senior Economist for Health, pointed out. Decreasing the carbon footprint is important, but it’s more urgent in the short term to tackle heat and protect economic growth. 

The WB estimates that heat stress could result in 34 million job losses in India by 2030 and reduce GDP by up to 4.5%,, amounting to $150-250 billion.

It makes a case, in its AHEAD programme with the government, for action to reduce heat stress through affordable, energy-efficient cooling systems. With heat waves expected to intensify in the coming years, Cros made an argument to protect human capital.

“If you are affected by climate health-sensitive disease, by heat stroke, or different heat-related diseases, you might not be able to go to work,” said Cros.

“Then if you have to go to the health facility, you might not have health insurance. You have to pay some money. Then you might encounter a catastrophic health expenditure. So again, if you are protected against (this), it makes you more resilient, in particular for the vulnerable population.”

Nearly half of the Indian population lives below $3.65 per day, Cros says, and can’t afford many of the cooling systems currently available. 

Keeping cool on a tight budget

One of the groups rolling out affordable cooling solutions is the Mahila (women) Housing Trust (MHT).  They work with women in communities who can’t afford air coolers, let alone air conditioners, and support them to paint their roofs in white reflective paint, which has been estimated to reduce the temperature by 2°C to 6°C.

The cool-roofs project involves painting roofs white, which can reduce indoor temperatures by 2-6° according to the Mahila Housing Trust.

For a deeper engagement, MHT’s executive director Bijal Brahmbhat says, they explain the science to the women, install thermometers to log the temperature and ask the women to compare it with a non-cooled house or the Met department’s temperature for that day.

“They understand, and slowly they started taking it up at a settlement level and also talking to the government,” she says.

MHT’s other initiative is to cool bus stops, and it launched the first site in Ahmedabad along with the local administration in mid-March amid a heat wave warning. The low-cost tech uses a combination of curtains made of grass to block the sun and mist fans to absorb the heat. It reduces the heat by a significant 6-7°C; the city’s highest temperature has been 48°C.

India’s “first cool bus stop” launched in Ahmedabad.

The low-cost cooling solution has led to inquiries from other cities, including Delhi, Brahmbhat says. The first one was expensive at a little over $4,000. 

“The first cooling station we did was net zero, but the solar cost was around 350,000 rupees. At places where we didn’t have the funds and we couldn’t go for solar, we used energy-efficient systems which would go on for a certain time and then stop for a certain time.”

Climate vs health to climate and health

As local administrations scale up responses to climate change, an Asian Development Bank (ADB) official told the WHS how governments in the region have changed their approach to climate and health in the last few years. 

Dinesh Arora, ABD’s principal health specialist, recalls that countries used to tell the bank to go and talk to the Ministry of Environment when it wanted to discuss climate change and health.

“I’m seeing a sea-change. Indonesia is talking about a full climate and health directorate within the health systems,” said Arora.

The ADB is working to see how the infrastructure of public health hospitals can be more resilient and withstand, say, a flood or an earthquake or how quickly it can resume functions.

Funding challenges

The WHS brought health and climate together in a way that the UN’s Conference of the Parties (COP) gathering has rarely done. But funding is a challenge for health projects. 

“There’s an urgency here. We need to scale solutions quickly,” says Neeraj Jain, of the global health non-profit, PATH. The challenge described by several speakers was a chicken-and-egg situation: funders need data on the possible impact, but collecting the data needs funds. This creates delays in launching new solutions for climate change adaptation and mitigation.

A popular proposal for a way forward is for funders to start a climate action project, monitor its operational impact and course correct as needed. But this approach makes it easier for adaptation funding over mitigation, where the impact can be seen relatively quickly, for instance, greening of urban spaces to reduce the urban heat island effect, compared to setting up a wind power project.

The focus of funders is on real impact, not policy and narrative, says Jain, who is PATH’s Director of Growth Operations, Asia, Middle East and Europe at PATH. This is particularly the case in low and middle-income (LMICs) countries where the effects of climate change on health are most visible. 

“We as practitioners need to move into action mode and roll out solutions that have real, measurable impact. The impact has to be at scale and sustainable for the support from government, private, as well as philanthropic financing to flow in.”

Governments chase win-win climate solutions.

One of the largest examples of a decentralised decarbonisation and, so far, successful projects is the one by SELCO Foundation to solarise primary health centres (PHCS) in India. 

It began with 15 PHCs in 2016, and aims to cover 25,000 by 2026 at a cost of about $117 million (₹1,000 crores). So far, it has installed solar power in 10,000 PHCs for lights, fans, baby warming equipment, foetal monitoring systems, oxygen concentrators, vaccine and medicine storage refrigerators, diagnostics and so on. 

Twelve state governments have signed up for this, and SELCO’s director, Huda Jaffer explains that there are benefits in savings and health outcomes, including no deliveries by candlelight. 

“The way the program is packaged, they’re able to see a very tangible saturation based on a scale program for the state itself. Helping the fact is some catalytic capital, and systems in place for them to show that it has been rolled out, implemented and owned within a certain time frame at a certain saturation scale.”

Installing solar power in primary health centres in Karnataka state in India is making healthcare safer, including ensuring births don’t happen by candlelight, and addressing a warming planet.

But this demonstrable success comes with underlying constraints. India has well over 200,000 PHCs and sub-centres, many of which do not have reliable power from the grid or need diesel generators. 

The SELCO project only covers 12.5% of PHCs, costing about $4,000 to provide solar power per PHCs. It’s a model that could be scaled to Africa, where the electrification of health centres is low. 

Another issue is that several funders for such projects support the initial setting up of the systems (capex) but leave the running and maintenance (opex) to local communities and administrations that are usually understaffed, untrained, and have tight budgets. 

In India, there needs to be a dedicated government team to scale this from 25,000 PHCs to 200,000 plus, and ensure the solar set-up is maintained, Jaffer said, adding that SELCO is playing the role of a dedicated secretariat.

“But in Africa it has to be donor monies, and donor design is always capex-based systems, which typically leads to opex issues as there is no long-term ownership that is built in from the program design team.”

Equity: The same victims again and again

In the end, strip away the layers, and climate action is ultimately about equity.  Speaking at WHS, Dr Soumya Swaminathan, the former WHO Chief Scientist, said that every time we plan something, we must address where there are equity issues that we are forgetting about. 

Sustained heat exposure poses health risks like dehydration and cardiovascular diseases, especially for India’s informal workforce (85% of workers) and women engaged in household chores in poorly ventilated spaces, for example.

“Ultimately, those same people get left out of all programs, whether they are the elderly, the disabled or the very poor or women who have multiple of these risk factors,” said Swaminathan.

Image Credits: Selco Foundation, Mahila Housing Trust.

World Health Summit regional meeting, first-ever in South Asia, at Delhi’s Bharat Mandapam conference centre, originally built to host meetings of the G20.

NEW DELHI – The theme was “Scaling Access to Ensure Health Equity”, but that hardly reflected the intense concerns raised at the first World Health Summit regional meeting with the storm of Trump administration’s cutbacks and closures of global health programmes since January.  

Traditional medicine, climate and health, data transparency, and the role of artificial intelligence (AI) were among the key issues discussed and debated at the regional meeting, the first ever to be held in South Asia in the elegant Bharat Mandapam conference centre, a Modi pet project built for the G20.

The WHS global meeting is an influential gathering of global and national health officials, practitioners, the private sector and civil society held in Berlin supported by the German government and a range of influential partners including the World Health Organization.The regional summit in Delhi, seemed to copy that successful patent with over 4,500 participants from 54 countries in attendance at the three-day event, which ended on Sunday. 

For the Indian hosts of the WHS, the meeting was, however, part of a push for recognizing traditional medicine, a longstanding government priority, as an key player in global health.

The traditional medicine sessions at the summit “promises to serve as a major milestone for the global traditional medicine sector,” according to a statement by the Indian Press Information Bureau (PIB), and offer “opportunities to advance universal access to safe and effective traditional medicine practices.” 

In early December, New Delhi will host the second World Health Organization (WHO) Traditional Medicine Global Summit, which the government has framed as “sustainable health solutions rooted in cultural heritage.”

In its own statement, WHO noted the increasing demand for traditional herbal products, and rapid projected growth of over 8% annually, in coming years, almost doubling the industry value to $437 billion from $233 billion last year. 

“Significant new opportunities are driven by research findings, such as dehydrated greens for treating anemia, and the integration of Ayurvedic practices and yoga with biomedicine for successful management of filarial lymphedema,” said the WHO statement.

“Yet challenges persist, including the need for greater scientific validation, regulatory oversight, and sustainability. Increasing consumer and commercial demands, alongside inconsistent quality control, safety monitoring gaps, and environmental concerns, require more scientific innovation, regulatory reform, consumer engagement, and sustainable resource management.”

Trump’s attacks are ‘a wake-up call’ 

World Health Summit President: Prof. Dr. Axel R. Pries

Meanwhile, Trump’s decisions to withdraw from WHO and to dismantle USAID and its many health-focus aid programmes are a “wake-up call”, declared WHS president, Axel R. Pries in his remarks on the Summit’s opening day – adding that he hoped global health leaders could see this “as a challenge that they can operate effectively without the US.” 

At a packed session on ‘The changing face of global health – what does the US withdrawal mean for pandemic preparedness and response?’  and elsewhere, experts voiced similar concerns. 

“We’re in the perfect storm in global health,” said Helen Clark, the former Prime Minister of New Zealand and a leading campaigner for climate and health causes.

“We, of course, are very focused on the Trump factor and populism and what this is doing and this comes against a background of a financial crisis that countries are struggling with after the COVID-19 pandemic, a surge of violent conflict and the climate crisis which is causing more adverse events,” she added.

“The reality is if another pandemic threat is announced tomorrow we’re not going to see an operation warp speed out of the United States on the accelerated development of of vaccines and and treatments in fact at this point we can’t really count on the US endorsing vaccines at all given the views of the Secretary for health in the US,” Clark says.

Speaking to Health Policy Watch, Pries said, “If you say the US is pulling out and that’s creating a big change in the system, that tells you the system was wrong before, because we are many nations on the world. India is a big nation with three or four times the population of the US. So why should a single country make such a difference?”

Pries warned that if other nations follow in America’s footsteps and reduce health funding especially for global programmes, that would be “the wrong direction.” 

World Health Assembly likely to adopt traditional medicine strategy in May

Dr Tedros Adhanom Ghebreyesus in a video message to Summit: hopes that the new WHO strategy on traditional medicines will be approved by the WHA in May.

The Indian government, meanwhile, used the summit largely as a platform to promote major upcoming moves on traditional medicine remedies and strategies – including the Second WHO Global Summit on Traditional Medicine, scheduled for December and a pending new WHO global strategy on TM, which is due to come before the World Health Assembly in May for approval. 

Shri Prataprao Jadhav, Minister of Ayush, India’s traditional medicine ministry, described the event as an important leadup to the December summit, which will also be hosted in New Delhi. He called the regional meeting, “a timely opportunity to advance global dialogue on traditional medicine… in light of the “growing interest in holistic health.”

The focus on TM at the regional summit also reflects “India’s leadership in advancing traditional medicine globally,” Jadhav said.

The government is “supporting research to harness the power of these ancient practices. Using innovation, data and partnerships, we can increase safety and protect biodiversity,” said Ayush Ministry Secretary, Vaidya Rajesh Kotecha, at the Summit keynote session: ‘Restoring balance: Scaling up access to evidence-based traditional medicine for health and well-being.’  

The momentum by the Indian government and the WHO has been building up for some time now. The Indian government provided foundational support for the WHO to establish its headquarters for the Global Traditional Medicine Centre at Jamnagar, in Gujarat, India; incidentally, the city is famous for the world’s largest oil refinery, which is run by Mukesh Ambani, Asia’s richest man.

Last February, the WHO included a new module in  the International Classification of Diseases, covering TM treatments for certain conditions, which the Indian government had long sought. This aims to allow for the more systematic tracking of traditional medicine services, research, and reporting. India’s government later announced it will prepare a public health strategy based on the WHO’s new ICD listing. 

Hurdles to traditional medicine 

WHO South East Asia Regional Director Saima Wazed with India’s Secretary Vaidya Rajesh Kotecha.

While the WHA will “hopefully” approve the new global TM strategy, WHO Director General Dr Tedros Adhanom Ghebreyesus said in a recorded message, the WHO statement also stressed the need to ensure more rigorous scientific study and regulatory oversight of TM.  

Increasing consumer and commercial demands have come against a landscape of inconsistent quality control, safety monitoring gaps, and environmental concerns, said the WHO statement. Other challenges persist, include the need for more scientific innovation, informed consumer engagement, and sustainable resource management. 

Speaking at the keynote, the WHO’s Regional Director, Saima Wazed, said that without robust regulatory systems, “a lot of harmful toxins” can be incorporated into TM remedies, without consumers being aware.

“Traditional medicine has always been part of our culture, particularly in Southeast Asia, and all 11 countries have very robust practices. But the scientific evidence has not evolved in the similar strain as modern-day medicine. And so WHO’s role is to ensure that we have the right evidence,” she says.

Dr Soumya Swaminathan, the WHO’s former Chief Scientist, highlighted another challenge. Bridging the traditional and modern requires a common language and vocabulary. Acknowledging that this takes time and effort, she called on the WHO and national bodies to take the lead. 

And despite recent, rapid moves for wider discussions and research, traditional medicine remains controversial and contentious.  “You need an open mind on both sides to be able to develop this framework of how do you design and implement a clinical trial,” Swaminathan said. 

It’s not science versus TM – it’s science for TM

There’s a reason why allopathic (conventional) medicine took off and did so well, said the Indian entrpreneur Aditya Burman Dabur, whose family business, Dabur, has manufactured traditional medications for local and international markets for decades. That’s because of the practices that it followed of getting evidence, writing it down, and making it publicly available in a manner that can be replicated, he pointed out.

In contrast, traditional medicine’s reliance on anecdotal evidence is not enough, Burman explained: “That’s not going to carry it across the oceans.”

Rather  by making use of peer-reviewed journal publications and doing things the way “that people expect us to do it; not trying to get them to see our point of view, (but) showing it to them through their own lens”, TM can come into its own, he asserted.  

Pries, meanwhile, struck a conciliatory note.  While underscoring the need for science-based evidence, conferences such as the World Health Summit can offer a “platform where the stakeholders talk to each other,” he said, adding: 

“It’s not science versus traditional medicine, it’s science for traditional medicine.”  

Image Credits: Chetan Bhattacharji /HPW.

Self-care (illustrative)

Self-care can be a key strategy in tackling the global crisis of non-communicable diseases that are responsible for three-quarters of premature deaths globally and 86 percent of early deaths (before age 70) in low- and middle-income countries (LMICs). Moreover, dentists, pharmacists and community health workers are trained professionals who can provide innovative forms of self-care advice and guidance – reaching communities and individuals that are often beyond the reach of mainstream medicine, noted experts at a recent Global Self-Care Federation (GSCF) webinar held in the leadup to September’s High-Level meeting on NCDs.

Through these groups, countries are finding innovative ways to deliver informed self-care knowledge and tools to individuals and commnunities, which could help prevent many NCDs related to unhealthy diets and lifestyles – as well as making other disease conditions easier to diagnose and treat.

“I think it is important that society understands that the healthcare profession consists of physicians, pharmacists, dentists, and the nursing sector. It’s not just a focus on one of those four groups,” explained Greg Perry, GSCF director general. He added that it is important to look at how community health workers and other skilled health professionals can work together with individuals to expand access to self-care tools and encourage their use.

Stimulating such innovation around self-care is critical as the global health community prepares for the 2025 Fourth High-level Meeting on NCDs in New York this September, said experts from Africa CDC, patients organisations and the private sector at the recent GSCF webinar.

Inconsistent progress on self-care issues

Progress on integrating self-care into broader global strategies on NCDs has so far been inconsistent. The World Health Organization (WHO) has published a series of guidance on self-care strategies in various domains.  But so far, neither the WHO Global NCD Action Plan (2013–2030), nor the NCD and Universal Health Coverage aims of the UN Sustainable Development Goals, have sufficient emphasis on self-care strategies, critics say. At the same time, the world remains far from reaching the goals for reducing NCDs set forth in the UN SDGs or WHO action plans, and health systems, particularly in LMICs, are struggling to meet the growing demand for NCD care. GSCF has highlighted that a siloed approach to healthcare has failed in many regions.

In a new policy paper, GSCF makes the case for prioritizing self-care as a central pillar of the global NCD response. In that context, it calls for three key actions: Member states need to recognise self-care as a vital tool for easing the global burden of NCDs and reduce pressure on healthcare systems, including formally integrating certain self-care tools and tactics into national health coverage plans. Secondly, the 2025 High Level Political Declaration on NCDs should explicitly highlight the role of self-care in reducing NCD risks and improving prevention and management. And thirdly, self-care should be acknowledged as essential to empowering individuals and improving health outcomes.

According to Orajitt Bumrungskulswat, a board member of the International Alliance of Patients’ Organisations, several barriers hinder the greater integration of self-care into NCDs management. These include a lack of knowledge and skills about NCDs and self-care practices. Financial constraints also play a role, limiting access to affordable, high-quality self-care products and services. In addition, many communities face insufficient health education and a lack of supportive environments, networks, and peer groups.

Thailand’s campaign for healthier habits

In Thailand, there are 6.5 million people living with diabetes, 40 million with high blood pressure, approximately 1 million with kidney disease at various stages, 140,000 cancer cases per year, and up to 10 million people dealing with mental health issues, Bumrungskulswat said, citing Ministry of Health estimates.

“This is mainly because of individual behaviours and because people are not really aware of how to practice self-care,” Bumrungskulswat said.

To change this trajectory, the ministry launched a campaign aimed at encouraging healthier habits—such as reducing salty, oily, and sugary foods and increasing physical activity – particularly in southern Thailand’s more urbanised regions, where unhealthy diets and sedentary lifestyles are more prevalent. The campaign includes distributing prevention guidelines on social media and in communities and strengthening support networks and patient groups. These groups now collaborate closely with professionals and local healthcare centres to promote prevention and self-care education. Thailand is already beginning to see the impact of these efforts, Bumrungskulswat said.

Ireland’s dentists take the lead

In Ireland, dentists have been empowered to innovative forms of self-care guidance on topics like vaccination as well as smoking cessation.

Expanding the network of care providers is also proving to be a key strategy in the fight against non-communicable diseases. Dr Dympna Kavanagh, chair of the Platform for Better Oral Health, shared how Ireland has leveraged its dental professionals to support this goal.

“Embedding oral health into wider self-care and prevention frameworks, we can achieve better outcomes, not just for individuals, but for healthcare systems, populations and societies as a whole,” Kavanagh said.

In Ireland, Kavanagh’s program has redefined the free dental examination for lower-income patients to include oral check-ups, risk assessments, and lifestyle advice. Payments for delivering these services were increased by more than 25% to reflect dentists’ expanded role.

“We do see that there has been an increase of over 8,000 patients attending per month seeking treatment since introducing this change,” Kavanagh said.

Advice on smoking cessation and vaccination in oral health exams

And the same oral health checkups also support other preventative health measures, he noted, pointing out that:  “Dentists remain amongst the top three healthcare professionals providing tobacco cessation advice in Ireland.”

According to Ireland’s “Healthy Ireland” surveys, smoking rates have plateaued at 17%.

In recent years, oral health professionals have also been empowered to take on a role in advocacy around vaccinations.

Vaccination, a critical component of self-care, became a focal point during the COVID-19 pandemic. Ireland achieved high vaccine uptake in part by passing emergency legislation that authorised dentists and hygienists to administer vaccines. This policy has since been made permanent.

Today, Irish dentists are also supporting HPV vaccination efforts, which play a crucial role in preventing oral – as well as cervical – cancers.

“In our population campaigns, we are fortunate to see an uptake of 80% in girls and 76% in boys,” Kavanagh said.

She emphasised the need to keep oral health front and center in discussions about NCDs: “We must continue to amplify oral health as part of the global NCD agenda. We must remind policymakers and governments that prevention doesn’t begin with policy alone and doesn’t end with policy alone. It begins with empowered individuals who are supported to care for their own health by reducing tobacco and alcohol use, improving their diets, accessing vaccination and maintaining consistent oral hygiene.”

Expanding access through pharmacies

Purchasing drugs at a pharmacy in Johannesburg, South Africa.

Pharmacists are another group of caregivers who can play a vital role in guiding self-care strategies and choices, according to Mfonobong Timothy, Disease Prevention and Self-Care program coordinator for the International Pharmaceutical Federation (FIP). She explained that pharmacies are widely recognised as first-line healthcare providers—personal healthcare professionals who are knowledgeable and highly accessible.

“Pharmacists are also playing a crucial role in promoting the role of vaccination in good health and wellbeing,” Timothy said. “In 56 countries and territories, we now have pharmacy-based vaccination, and we continue to advocate for this to ensure policymakers know that this is a form of self-care that we can provide to individuals towards having good health and wellbeing.”

In addition to their role in vaccination, Timothy emphasised that pharmacists provide essential hands-on guidance for using medical devices—a key part of supporting patients in their daily self-care routines.

“Without the strong support system, individuals may not feel motivated,” Timothy noted.

Community Health Workers can support shift from treatment to prevention of NCDs

Community Health Workers attend a training session on HIV prevention in Kirehe, Rwanda.

In some low and middle-income countries, there has been a shift away from the traditional medical model toward a community- or society-based model of care, often led by Community Health Workers. This shift is helping societies move from treatment toward prevention – and along with that, more informed self-care practices, explained GSCF’s Perry.

“In high-income countries, we have the drugs, we have the guidelines, we have the digital tools, yet we still see that healthcare-associated costs are increasing along with life expectancy,” said Dr Adelard Kakunze, lead for the NCDs, Injuries and Mental Health Program at the Africa CDC. “The question is why? Why, if we have all the knowledge and tools, are we not able to really control these conditions?”

Kakunze believes the answer lies in the lack of personal engagement with self-care. In most countries, he said, health systems have failed to encourage citizens to practice the daily discipline required for self-care—what he describes as the “invisible work” that begins after the clinic door closes. This can include checking one’s blood pressure, adjusting one’s diet, or going for a walk – before resorting to drug-based treatments.

In Africa, however, this approach is gaining traction, he maintains. With limited access to specialists and resources, countries on the continent have been forced to innovate. At the core of this innovation is community. Kakunze noting that many African countries have strong networks of community health workers (CHWs), embedded in nearly every neighbourhood.

“We have learned that those specialized services are too expensive, so we need to rely on communities,” he said.

“We also now have a political commitment to deploy and equip 2 million community health workers on the continent, and what we’ve been seeing in many countries [is] that they have really embraced this with a contextualized, adapted training curriculum now that integrates NCDs,” he said. “Now, those community health workers can screen, counsel, and follow thousands of patients at home.”

Examples in mental health

A lay counsellor sits with a community member on the Friendship Bench in Zimbabwe.

In the mental health arena, one example is the Friendship Bench project, developed in Zimbabwe and cited by recent WHO guidance as a global model of community-based mental health support.

Using a cognitive behavioural therapy-based approach, trained community volunteers—affectionately called “grandmothers”—deliver structured problem-solving therapy to people suffering from common mental health conditions like anxiety and depression. Patients meet with the grandmothers for six 45-minute sessions on discreet wooden benches at local clinics, creating a safe and welcoming space for healing.

Since its launch, the Friendship Bench has shown impressive results. A 2016 study published in JAMA found a significant reduction in depressive symptoms amongst participants. The model’s success has inspired adaptations beyond Zimbabwe, including in Malawi, Zanzibar, and even New York City—showing how solutions developed in low-income countries can transform mental health care around the world.

More recently, community health workers have been paired with primary healthcare centres or general practitioners who can provide supervision and standardised health checklists.

“We have seen the impact of those community health workers when they are supervised; the impact is really increasing a lot,” Kakunze said.

Looking ahead, the Africa CDC is now exploring the use of advanced technologies and tools to support community health workers and enhance their effectiveness.

Kavanagh echoed similar sentiments. She noted that Europe has taken a “very siloed, very narrow” approach to the healthcare workforce, defining it strictly as doctors, dentists, pharmacists, and nurses. She suggested countries should also consider tapping into their ageing populations to broaden that workforce.

“Talented people retire, and then the country loses their wealth of knowledge,” she said.

Kavanagh also proposed that older medical professionals could be engaged to play a meaningful role in community healthcare, helping fill workforce gaps while contributing valuable experience.

Private-sector partnerships

Six out of ten smokers, or 750 million people globally want to quit tobacco use.

Finally, experts say the private sector also has a vital role to play in advancing self-care.

Dr Vinayak Mohan Prasad, head of the No Tobacco Unit at WHO, noted that there are 1.25 billion tobacco users worldwide—and more than 60% of them want to quit. To address this, WHO established a consortium that brings together private companies, non-state actors, and state actors to collaborate on tobacco cessation.

“We have a pharma pillar, so all the pharma companies can come in. We have a digital tech pillar, and we have a couple of very powerful tech companies already in the consortium,” he said. “We also have a health system group. We have the research group because there are a lot of research gaps still existing.”

This collaborative model is being applied beyond tobacco control. Tamara Rogers, chief marketing officer for Haleon, highlighted how private and public actors can also partner to improve access to healthcare.

She explained that while private industry can drive innovation and develop affordable health products and solutions, non-governmental organisations can play a key role in ensuring these tools reach the people who need them most.

“I think building trustful, stable, multi-year partnerships is really pivotal in making sure that we can best maximize all of the collective resources, expertise and innovation,” Rogers said.

–Part of a supported series in collaboration with the Global Self-Care Federation

Image Credits: Caroline LM/ Unsplash, Wikimedia Commons, Cecille Joan Avila / Partners In Health, Sarah Johnson.

MSF Nurse Gatwech Tuoch immunizes a child against measles at the MSF Mobile Clinic in Bulukat, Upper Nile State South Sudan.

During this World Immunization Week (24-30 April), Médecins Sans Frontières (MSF), shares recommendations for how Gavi – which is developing its new five-year strategy amidst looming funding cuts – can strengthen collaboration between governments and humanitarian organisations to ensure that more children up until the age of at least five, especially those living in fragile and humanitarian settings, get their routine vaccinations.

On 10 January 2024, South Sudan declared a measles outbreak in its Western Equatoria state. With an alarming number of people in Western Equatoria never having been vaccinated against measles, there was an urgent need to start a large-scale measles vaccination to curb the spread of the disease in the area and its surroundings, protect people from contracting measles and, ultimately, save as many lives as possible.

However, obstacles around getting and using the measles vaccine in-country meant that it took almost four months for any measles vaccinations to begin in Western Equatoria. In the interim, thousands of people fell ill and at least thirteen people died, seven of whom were children under five years old.

For over five decades, MSF (Doctors without Borders), a medical humanitarian organization working in over 70 countries has been vaccinating people through routine vaccination, preventive vaccination campaigns, and in response to disease outbreaks in some of the world’s most challenging settings. Sometimes, we – and other humanitarian, non-governmental organisations – are the only providers of vaccination for people who are not reached by government-led vaccination activities. This can happen for various reasons, including security constraints, geographic and infrastructural challenges, and sometimes, deliberate exclusion.

Our years of experience have taught us invaluable lessons about vaccinating in humanitarian settings, and it’s because of this that we know the delay in South Sudan was not exceptional. Often, getting access to vaccine supplies requires months of negotiations around how and when they can be accessed – negotiations which often start anew each time there is a need. Such slow-moving coordination wastes valuable time and risks lives.

Delays don’t have to be the norm

But we don’t think it has to be this way.

Right now, Gavi, The Vaccine Alliance – an organisation which supports governments of the world’s poorest countries vaccinate children against some of the world’s deadliest diseases – is preparing its strategy for the next five years. As part of this, Gavi is designing a “Fragility and Humanitarian Approach” to reach communities that consistently miss out on immunization.

In fragile and humanitarian settings, such as war zones, refugee camps, and hard-to-reach areas cut off from health care, it is often more difficult for people to access routine vaccination services, and ‘zero-dose’* children are disproportionately found in these environments. For example, as of July 2024, 31 World Health Organization member countries with fragile, conflict-affected settings accounted for 55% of unvaccinated children.

Gavi’s effort to address this is therefore much welcomed. However, it must include the recommendations of non-governmental, humanitarian organisations – like us – that have spent years working in and understand these settings.

Returning to South Sudan’s Western Equatoria, a flexible system allowing for rapid access to vaccines could enable faster and smoother emergency vaccination responses. One way to make this happen, would be for Gavi to work with governments and humanitarian organisations together, to ensure a closer collaboration: we don’t operate in a void, and effective cooperation with country governments allows us to better support them and work where they are not.

Developing standing agreements

The MSF Mobile Clinic in Bulukat Transit Centre, Upper Nile State in South Sudan. Bulukat hosts over 5,000 people who fled the conflict in Sudan.

Specifically, instead of having to negotiate with governments on a case-by-case basis, Gavi should help develop standing agreements to allow humanitarian organisations rapid access to existing in-country vaccine stockpiles in order to complement national immunisation efforts by vaccinating the children that fall outside of national immunisation programmes.

We’ve seen how this can work. In South Sudan’s Upper Nile State, MSF set up mobile clinics to screen and vaccinate displaced people, preventing outbreaks. This relatively simple intervention allowed people outside of national immunisation programmes to receive healthcare, and was successful because of sufficient vaccine supplies and space to work.

There is another critical part to getting vaccines to as many children as possible in hard-to-reach places, which is making sure that when we do vaccinate, including in targeted campaigns, we reach all children who previously missed out on their basic childhood vaccines, regardless of their age. Unfortunately, due to national policies, age-limited Gavi support and – therefore – limited vaccine supplies, children over the age of two often are left out of  vaccination drives. This leaves older children who are still at an increased risk of falling ill from vaccine preventable diseases unprotected and makes any future response to an outbreak even tougher.

In our experience, missing out on vaccinations can have devastating impacts. In last year’s response to the measles outbreak in Western Equatoria, 20 per cent of children treated for measles at MSF-supported facilities were over five. While the Big Catch Up – an initiative by Gavi, UNICEF and WHO – aims to reach zero-dose children up to the age of five with vaccination, this effort will come to a close at the end of this year. Going forward, we urgently need country policies that allow for vaccination until at least the age of five matched with dedicated financial support from an ambitiously funded Gavi.

Of course, sustainable funding for immunisation is essential. And due to logistical and geographic challenges that often exist in fragile and humanitarian settings, the delivery of vaccines can be more expensive than in “stable” settings. That’s why it’s especially critical for all institutional and government donors to ensure the effort to reach children in humanitarian settings with immunisation is ambitiously supported, both financially and politically.

It’s abundantly clear that we in global health must work better together to reach every child in a fragile or humanitarian setting with lifesaving childhood, routine, or emergency vaccination. Health systems need to be strengthened so that country-led responses remain at the core of immunisation efforts, with humanitarian partners able to support where children are not reached.

This means the learnings and recommendations of humanitarian organisations must be reflected in the policies and practices that aim to reach children in humanitarian settings with vaccination. Actively dismantling the barriers in getting timely access to and using vaccine supplies is a particularly key part of ensuring that children up until at least age five will have a better chance of being protected from vaccine preventable diseases, and getting a real shot at life.

Victorine de Milliano is a vaccine policy and advocacy advisor for Médecins Sans Frontières/Doctors Without Borders (MSF).

 

 Pamela Onango is medical coordinator in South Sudan for Médecins Sans Frontières/Doctors Without Borders (MSF).

—

*’Zero-dose’ children are defined as children who haven’t received a single dose of diphtheria, tetanus and pertussis-containing vaccine (DTP3).

Read MSF’s full recommendations on how Gavi can do more to reach people outside of government vaccination activities here, and for more information on Vaccination Barriers in complex settings, see here.

Image Credits: Gale Julius Dada/MSF, Gale Julius Dada/MSF.

Africa CDC headquarters, Addis Ababa, Ethiopia.

Uganda is set to declare an end to its Ebola outbreak on April 26 if no new cases emerge, Africa’s top public health agency announced Thursday. The country’s 83% recovery rate among confirmed cases significantly exceeds the typical 30-40% survival rate for Ebola outbreaks, with Uganda managing to contain the disease while simultaneously responding to mpox cases.

“We really keep our fingers crossed,” said Professor Yap Boum, Executive Director of the Institut Pasteur of Bangui, during the weekly Africa Centers for Disease Control and Prevention briefing. “The country will declare the end of Ebola.”

Boum, who delivered the briefing on behalf of Africa CDC Director John Kaseya, who was attending IMF-World Bank Spring meetings in Washington, also reported “promising news” on mpox, citing declining cases in several countries despite the disease’s continued spread.

“We can see a decrease in the decline in number of suspected cases, but also the confirmed cases,” Boum said. “This is due partly to Burundi, but also to some other countries.”

However, Malawi reported its first four cases of mpox on April 16, including a 2-year-old child. None of the patients had a recent travel history, indicating local transmission. The child’s case highlights what Boum called an “important opportunity” for countries to approve mpox vaccination for children between the ages of one and 12.

The Democratic Republic of Congo remains “the epicenter” of the continent’s mpox outbreak, though intensified community surveillance shows some positive trends, Boum said. Contact tracing has increased from an average of 1.7 to 7 contacts per case in recent weeks, indicating authorities’ surveillance of the outbreak is improving. 

“The Kivus are the place that carries the highest burden in internal number of cases,” Boum noted, adding that implementation of vaccination and other measures in this conflict-affected region of the Democratic Republic of Congo – where mpox has been endemic since at least the 1970s – would be “the turning point to the response in DRC and therefore in the continent.”

Boum also highlighted progress on a rapid diagnostic test for mpox that could deliver results in 15 minutes without requiring electricity, potentially replacing the current system that can take up to 30 days for results to reach patients, nullifying their efficacy to contain outbreaks. Africa CDC expects to receive updates on the performance of the rapid diagnostic tests in the second week of May, and anticipates improvement from the previous 23% sensitivity rate for accurate diagnosis, Boum said. 

As the continent slowly gets mpox under control, Africa CDC’s Emergency Committee will meet on May 17 to evaluate whether to maintain the Public Health Emergency of Continental Security declaration for mpox that was issued in August 2024.

The updates came as Africa CDC leadership attended IMF-World Bank Spring Meetings in Washington to discuss health financing amid funding cuts. Boum emphasized the need to increase domestic health financing, noting that only three of 44 African member states currently meet the Abuja Declaration target of allocating 15% of GDP to health.

Angola’s recent $5 million pledge to Africa CDC was cited as an example of “championing the Africa-led financing strategy,” particularly amid what Boum described as “an era where we need to do more with less” amid vast funding cuts from the largest supporter of the continent’s health systems – the United States – during Donald Trump’s first 100 days in office.

“This is an opportunity for our countries to follow the example of Angola, to increase the expenditure on health, especially considering the new era that we are in,” Boum said, adding Africa CDC leadership’s conversation in Washington will center on “how we should navigate considering the cuts that are happening.”

“Next week, when the Director-General will be back, we’ll have more outcomes on how Africa CDC, and the continent will benefit from this challenging environment,” Boum said.

Image Credits: Africa CDC.

A teacher at a school in Mozambique teaches local students about the health benefits of contraception.

The World Health Organization (WHO) has issued its first update in 13 years to guidelines aimed at preventing adolescent pregnancies, identifying child marriage as a primary driver behind millions of early pregnancies that endanger girls’ lives and futures.

The document published Thursday by the UN health agency pinpoints uptake and access to safe contraception, barriers to girls’ right to education, child marriage laws and access to sexual and reproductive health services broadly as fundamental to reducing early pregnancies, which endanger adolescents around the world.

“Early pregnancies can have serious physical and psychological consequences for girls and young women, and often reflect fundamental inequalities that affect their ability to shape their relationships and their lives,” said Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO.

The global crisis affects millions of girls, with devastating health consequences rippling across generations, particularly in regions torn by conflict and instability. Pregnancy and childbirth complications rank among the leading killers of girls aged 15-19 worldwide.

Over 21 million girls between 15 and 19 become pregnant annually in low and middle-income countries, the WHO review found. Half of those pregnancies are unintended, while 55% lead to abortions—often performed in unsafe conditions, carrying life-threatening risks.

Maternal conditions are among the top causes of disability-affected life years and mortality globally, according to UNICEF.

Health dangers from pregnancy are intensified for mothers aged 10-19, who face significantly higher risks than women in their twenties, including dangerous high blood pressure conditions like eclampsia, post-childbirth uterine infections and systemic infections.

The health consequences extend to their infants as well. Babies born to adolescent mothers have higher rates of low birth weight, premature birth and serious neonatal conditions compared to those born to older mothers. 

“Adolescents who give birth face higher risks of maternal and infant mortality compared with older women, while early pregnancies can restrict adolescents’ choices, limiting their educational and economic prospects,” Allotey said. “These limitations often perpetuate cycles of poverty and inequality.”

“Tackling this issue means creating conditions where girls and young women can thrive—by ensuring they can stay in school, be protected from violence and coercion, access sexual and reproductive health services that uphold their rights, and have real choices about their futures,” Allotey added. 

Child brides: one every three seconds

One in five young women worldwide were married before their 18th birthday. Levels are highest in sub-Saharan Africa.

An estimated 12 million girls marry before age 18 annually — approximately one every three seconds — according to Girls Not Brides, a coalition of over 14,000 international and human rights organizations. In low- and middle-income countries, nine out of ten adolescent births occur among girls married before turning 18.

“Early marriage denies girls their childhood and has severe consequences for their health,” said Dr Sheri Bastien, Scientist for Adolescent Sexual and Reproductive Health at WHO.

Though child marriage rates declined from 25% in 2010 to 19% in 2020, progress remains slow and is reversing in conflict zones. The prevalence has increased by 20% in Yemen and South Sudan amid ongoing conflicts.

About 650 million women alive today were married as children, with one in 20 girls worldwide wed before age 15.

The situation is most dire in fragile states, where Save the Children reported last year that a girl is married every 30 seconds. Global humanitarian crises from Sudan to Yemen, Gaza and Myanmar have only accelerated since that report, leaving millions of girls at heightened risk of dangerous pregnancies.

Child marriage not only leads to early pregnancies before girls’ bodies are fully developed, but also often restricts their access to adequate healthcare. Girls who marry before 15 are 50% more likely to experience intimate partner violence than those who marry later, creating additional health complications.

The issue forms part of a broader pattern of gender inequality. In regions where both female genital mutilation and child marriage are common practices, girls face compounded health risks. Countries including Sudan, Somaliland, Sierra Leone, Burkina Faso and Ethiopia report the highest rates of girls subjected to both practices.

Stark global divide in adolescent pregnancy crisis 

Girls living in rural areas are more likely to marry in childhood than girls in urban areas.

Progress region to region remains starkly uneven. Sub-Saharan Africa has far and away the highest prevalence of births to girls aged 15-19, with over six million occurring in 2021 alone, in addition to 332,000 births for girls between 10 and 14 years old. The best-performing region, Central Asia, saw just 68,000 adolescent births that same year.

This divide is also reflected in maternal death rates. Seventy percent of global maternal deaths in 2020 — over 200,000 — occurred in sub-Saharan Africa, where girls who reach age 15 face a one in 40 chance of dying from pregnancy-related complications in their lifetimes. In Chad, the country with the highest rate of maternal mortality, a 15-year-old girl has a one in 15 chance of dying of maternal causes.

Divides by income, culture and class can also occur within countries, undermining the representativeness of national-level statistics. The WHO cites examples of Zambia, where adolescent pregnancy rates vary from 14.9% in the capital region of Lusaka, to 42.5% in its Southern Province.

According to Save the Children’s 2024 Global Girlhood Report, the ten countries with the highest child marriage rates are either fragile or extremely fragile states. Eight of the top ten “fragility-child marriage hotspots” are in Africa, with Central African Republic, Chad, and South Sudan facing the most severe crises. In extremely fragile countries, almost 558,000 girls give birth before their 18th birthday, often without access to skilled birth attendants who could save their lives if complications arose. 

While worldwide adolescent birth rates have declined, the overall birth rate remains high. In 2021, an estimated 12.1 million girls aged 15–19 years and 499,000 girls aged 10–14 years gave birth globally, according to WHO.

“Ensuring that adolescents have the information, resources and support to exercise their sexual and reproductive health rights is not only a matter of health – it is a matter of justice,” concluded Allotey. “All adolescents need to be empowered to make choices that lead to healthier, more fulfilling lives.” 

Despite the heightened risks for girls worldwide, only 0.12% of all humanitarian funding between 2016 and 2018 was directed toward addressing gender-based violence, according to Save the Children.

Education as a shield

The WHO identifies education as a crucial human right and shield against adolescent pregnancies.

Among the WHO’s strongest recommendations is removing gender barriers to education, with evidence showing each additional year of secondary education reduces a girl’s likelihood of marrying as a child by six percentage points. 

Multiple randomized controlled trials from Kenya, India and Zimbabwe reviewed by WHO present strong evidence that that life skills curricula and support to remain in school effectively reduce child marriage rates.

“Quality education represents our strongest defense against early marriage and pregnancy,” WHO researchers noted in the guidelines. 

“These limitations often perpetuate cycles of poverty and inequality,” said Allotey. “In many parts of the world, adolescents – whether married or unmarried – lack access to the information and resources necessary to make informed decisions about their sexual and reproductive health. This leaves them vulnerable to early pregnancies and unprepared to navigate the physical, emotional and social changes that follow.”

While 50 million more girls enrolled in school between 2015 and 2023, completion rates for secondary education lag significantly behind primary education, with only 61% of girls finishing upper secondary school worldwide compared to 89% completing primary education.

Economic interventions also show promise according to the WHO guidelines. Programs focused on improving livelihood skills, financial literacy and economic autonomy demonstrated significant impact on reducing child marriage while increasing girls’ employment and control over resources.

“Education is critical to change the future for young girls, while empowering adolescents – both boys and girls – to understand consent, take charge of their health, and challenge the major gender inequalities that continue to drive high rates of child marriage and early pregnancy in many parts of the world,” Bastien said.

Beyond Legal Solutions

Child marriage–fragility hotspots where girls face high rates of child marriage and the challenges associated with fragility. / Save the Children 2024

The WHO also conditionally recommends implementing laws restricting marriage before age 18, though with important caveats. Criminalizing child marriage can produce unintended consequences, potentially driving the practice underground, which can make reporting more difficult for the child brides who are victims of sexual assaults, the guidance suggests. 

The evidence reviewed by WHO on worldwide child marriage laws suggests that legal restrictions show inconsistent results in reducing marriage rates without addressing underlying social factors.

“Laws alone are insufficient without addressing root causes,” concludes the report, citing the need for comprehensive frameworks tackling gender inequality.

Both the UN Convention on the Elimination of All Forms of Discrimination Against Women and the Convention on the Rights of the Child call for eliminating harmful practices affecting children’s health, but organizations like Girls Not Brides warn that punitive approaches without corresponding social support can harm the very girls they aim to protect.

“Progress is uneven,” Allotay said. “We must sustain efforts to ensure that the most vulnerable groups of adolescent girls are not left behind.” 

Image Credits: The Hepatitis Fund.

A rollout of the malaria vaccine in Western African countries with a special focus on immunising children is an important step towards eliminating the disease.

After the World Malaria Report 2024 was published, the global community confronted an undeniable and uncomfortable truth: while malaria affects entire communities, its burden is not equally distributed.

Women, particularly in malaria-endemic regions, are disproportionately impacted. Their physical, social and economic health suffers more than others’ as they bear the brunt of caregiving responsibilities, suffer barriers to accessing healthcare, and face the compounding effects of climate change on disease transmission.

Malaria is a preventable and treatable disease, yet the global tally of malaria deaths has risen in recent years. In 2023, the death count reached 597,000, up from 574,000 in 2018, in part due to antimalarial drug resistance, health systems weakening during COVID-19, and funding shortfalls.

But the hardship that malaria causes goes beyond countries grappling with staggering death counts. The disease leaves profound and lasting indirect impacts on communities –  falling disproportionately on women and girls.

The hidden costs of malaria on women and girls

Pregnancy weakens malaria immunity, increasing infection risk. For expectant mothers, malaria can cause severe anemia, pregnancy loss, premature birth, underweight newborns, or maternal death. / World Malaria Report 2024.

The fight against malaria is hindered by deeply rooted gender inequalities.

Women spend four times as many days on caregiving compared to men – a stark reality exacerbated by recurring malaria infections within families as poverty traps women in cycles of economic dependency and limits opportunities for education and employment.

Women’s contributions to the global health system are estimated to be around 5% of global GDP. But around 50% of this work is unrecognised and unpaid. In malaria-endemic regions, this labour often takes the form of informal caregiving, as women provide care in up to 83% of malaria cases.

For community health workers, 70% of whom are women, the imbalance is even larger. Female health workers spend significantly more unpaid hours than their male counterparts, despite forming the backbone of malaria detection, treatment, and prevention efforts in rural areas.

Women and girls often lack decision-making power in their households, preventing them from accessing life-saving interventions like insecticide-treated nets or seeking timely healthcare. Cultural norms can dictate who uses a bed net or who receives care first, often leaving women and girls at greater risk.

Malaria is a leading cause of death amongst adolescent girls in malaria-endemic countries. Many are forced to leave school to care for sick family members or themselves, disrupting their education and increasing their vulnerability to early marriage or exploitation. Without targeted interventions, these gendered gaps will continue to undermine global malaria eradication efforts.

Climate change is catalysing inequality and disease

Number of internally displaced people by endemic malaria region. Women and children face higher vulnerability during conflicts, natural disasters, and humanitarian crises. / World Malaria Report 2024

The accelerating effects of climate change are making the fight against malaria even harder.

Rising temperatures and shifting rainfall patterns are expanding the habitats of malaria-transmitting mosquitoes, bringing the disease to new regions and intensifying its prevalence in existing hotspots. These environmental changes disproportionately harm women, who already face barriers to health information and services.

Pregnant women are particularly vulnerable. In 2023, in 33 moderate-to-high transmission countries in the WHO African Region, there were an estimated 36 million pregnancies, of which 12.4 million (34%) were infected with malaria.

Malaria during pregnancy exponentially increases risks to both mother and child, including anaemia, stunted growth, and severe illness. The consequences ripple across generations, perpetuating cycles of poor health and poverty.

A gendered approach to malaria elimination

Four-year-old Aitano Valentina of Guatemala City proudly holds her health booklet after receiving DPT and Polio vaccination. For the first time in history, the number of under-five deaths has fallen below 5 million.

To accelerate progress against malaria and address these inequities, we must adopt a gender-responsive strategy that empowers women and girls as agents of change. Investing in women has far-reaching benefits – not just for malaria elimination but for broader health, economic, and societal outcomes.

When women are empowered with resources, time and decision-making agency, malaria outcomes improve. Research shows that households where women have greater bargaining power are 16 times more likely to use mosquito nets effectively, reducing malaria transmission.

It is equally important to address the structural barriers limiting women’s participation in the health workforce. Only 25% of women in the global health sector hold senior roles, despite making up 70% of the workforce. Providing pathways for professional advancement and fair compensation is essential to sustaining their contributions and ensuring a resilient healthcare system.

Change won’t happen by itself

WHO-recommended malaria vaccines are in the process of being rolled out across Africa, with over 10 million doses delivered in the first year of routine immunisation programmes in 2024.

Addressing the impact of malaria on women and girls can contribute to both malaria eradication efforts and gender equality progress. Action is overdue.

But if we commit now to putting economic resources in the hands of women, challenging gender norms, power imbalances and discriminatory laws, we can achieve a double dividend.

This should see us increase women’s economic ability to take charge of their health, the representation of women in leadership roles within malaria programs, research, and policymaking, ensuring interventions reflect the realities faced by women and girls.

Fair wages, adequate training, and professional development opportunities for female health workers are equally critical to building a robust and sustainable health workforce.

Malaria interventions must also account for gender dynamics, ensuring equitable access to tools such as insecticide-treated nets and addressing the unique barriers faced by pregnant women and adolescent girls. Closing the gender data gaps is another essential step to enable a deeper understanding of malaria’s full impact on women and girls, and to facilitate more effective and targeted solutions.

The fight against malaria is at a crossroads. With intentional investment in gender-focused strategies, we can eliminate this disease within a generation while empowering women and girls to lead healthier, more prosperous lives.

The World Malaria Report 2024 leaves no room for doubt; achieving this vision will require bold leadership, innovative solutions, and an unwavering commitment to leaving no one behind.

By placing women and girls at the centre of the malaria response, we can create a ripple effect of positive change that extends far beyond health, building stronger, more equitable communities worldwide.

About the authors

Dr. Jemimah Njuki is the Chief of Economic Empowerment at UN Women.

Lizz Ntonjira is the co-chair of the Zero Malaria Campaign Coalition & Author, #YouthCan. 

Image Credits: WHO, UNICEF 2024 , WHO.