A nurse tests a woman for tuberculosis.

A Phase 3 trial for the tuberculosis vaccine known as M72/AS01E is running a year ahead of schedule and has already recruited 90% of the 20,000 people it needs, according to Dr Alemnew Dagnew, who leads its clinical development.

The vaccine aims to prevent adolescents and adults already infected with latent TB from developing pulmonary TB. In countries with high TB burden, vast numbers of people have latent TB, which means that they are infected with the TB bacteria but not symptomatic or infectious. People with latent TB do not generally develop TB disease unless their immune systems are compromised.

The trial scientists initially thought it would take two years to recruit all the study participants at the 54 trial sites spread across South Africa, Kenya, Zambia, Malawi and Indonesia.

“We started the trial last year in March, and we have already enrolled more than 90% of the participants, which is huge progress, and we are hoping to have full enrollment in the coming weeks,” Alemnew told Health Policy Watch this week. “It’s one year ahead of our projection.”

Alemnew works for the Gates Medical Research Institute (Gates MRI), which is sponsoring the trial, while funding comes from the Gates Foundation and Wellcome Trust.

The sites were chosen because they are in communities where there is a high TB incidence and because of the countries’ capability to conduct clinical research, said Alemnew.

Dr Alemnew Dagnew

Efficacy of 50% in Phase 2b trial

A Phase 2b trial of the vaccine found that it was 50% effective in blocking latent TB from becoming pulmonary TB. This would not have been efficacious enough to persist with a costly Phase 3 trial for many other diseases. But because of the enormous global burden of TB, 50% efficacy will save millions of lives.

“If we think about the population level, the impact is going to be huge,” said Alemnew.

“If I can throw in some numbers, the World Health Organisation (WHO) estimates that, over 25 years, a vaccine with 50% efficacy for protecting adolescents and adults could save 8.5 million lives, prevent 76 million new TB cases and save $41.5 billion for TB-affected households.”

Currently, the only available TB vaccine is BCG, which is given to newborn babies. It was first administered to humans in 1921 and no new vaccines have been developed despite TB being one of the world’s most deadly infectious diseases.

While the BCG vaccine “works well in preventing severe forms of childhood TB, its efficacy against prevention of preliminary TB in adolescents and adults is insignificant,” notes Alemnew.

Of the 20,000 participants – aged from 15 to 44 – 18,000 will be infected with TB, 1000 participants will be non-TB infected and 1000 will be people living with HIV.

The trial will stop once 110 people have developed pulmonary TB, he adds – by which time scientists enough data will have been generated to analyse the vaccine’s efficacy.

Tech transfer

First developed by GSK, the M72/AS01E vaccine is made up of a fusion of two TB antigens combined with an adjuvant (AS0) to boost the body’s immune response.

Trial participants will get two doses of the vaccine or a placebo 28 days’ apart, with telephonic follow-up every two months and a clinic visit every six months until the trial is over.

GSK developed the vaccine over many years, and published the results of its Phase 2b results in the New England Journal of Medicine (NEJM) in 2018 and 2019. Gates MRI then stepped in to license the vaccine candidate.

“GSK continues to provide the adjuvant component for clinical trials, and will also for the commercial product [if the Phase 3 trial is successful]. They have also been working with us to have technology transfer to manufacture the antigen component,” said Alemnew.

Personal mission

Alemnew was born and raised in Ethiopia, where he also trained as a physician and practised medicine.

“One of the most one of the common health conditions that I used to manage was TB, so have seen the devastating impact of TB on patients, their families and also the communities,” he said.

“TB affects people of poor socio-economic status. If a family member gets sick with TB, then they would have to stop working. If that family member is the only source of income, the whole family will be in a bad situation. 

“Developing a vaccine like the one which I’m currently working on, [if successful] is going to be like a gift to the community that I came from.

 “So for me, it’s a great honour and privilege to work on this important vaccine. It’s going to motivate not only those of us who are working on this vaccine, but the whole TB research community.”

Image Credits: Socios en Salud , Bryce Vickmark.

Without proper guidance, fasting can lead to dangerous fluctuations in blood sugar levels.

ALEXANDRIA, Egypt – As the sun sets over Alexandria, the scent of simmering Molokhia fills the air, mingling with the voices of street vendors calling out their final sales before Ramadan fasting ends for the day.

Long tables offer festive dishes of lamb with grilled meats, dates, lentil soup and rice, beloved traditions passed down through generations. Yet this plenty poses a chronic health risk – because many Egyptian adults live with diabetes.

In Irbid, Jordan, a similar scene unfolds. Families sit down to enjoy Mansaf, Jordan’s rich national dish of lamb, alongside plates of fresh vegetables, pickles, yoghurt, and warm Shrak bread.

Again, the celebrations pose dietary changes as well as possible medication issues, with many disadvantaged Muslims choosing holiday food purchases over insulin. In many other nations, providing insulin without holiday interruptions or unfair pricing is a challenge.

Ramadan is not just about fasting – it is about community, generosity, and celebration. But amid the joy and indulgence, people with diabetes face a difficult puzzle: how to balance their health with the deep-rooted traditions.

Fasting and blood sugar

Without proper guidance, fasting can lead to dangerous fluctuations in blood sugar levels, dehydration, and cardiovascular complications. These lead to serious illness and death, but also disability with job loss and further demands on health budgets.

Pre-Ramadan nutrition education is a public health necessity. Scaling up structured, culturally relevant diabetes education programs can empower Muslims worldwide to observe Ramadan safely while maintaining their health.

While the global rise in diabetes prevalence is well known, fasting during Ramadan presents unique challenges from Zamboanga to Tangier. Across diverse Muslim communities – whether in majority-Muslim nations or as minorities worldwide – growing diabetic populations need knowledge to fast safely.

In Egypt and Jordan, pre-Ramadan nutrition education has emerged as a policy-driven intervention that empowers individuals with diabetes to make informed dietary and lifestyle choices while fasting. By integrating structured education into national healthcare systems, policymakers can ensure that diabetes patients receive the guidance they need to observe Ramadan safely.

The new interface between social media and telehealth is showing promise in providing culturally sensitive education about diabetes. Starting before the holiday and continuing to measure results months later, researchers have found ways to help patients complete Ramadan with greater knowledge and more stable blood sugar levels.

Ramadan also poses challenges in terms of medication access and distribution, raising a major public health concern in a nation where nearly 15% of adults live with type 2 diabetes. Across all regions, individuals with diabetes face significant risks, including hypoglycemia, hyperglycemia, dehydration, and cardiovascular complications if not properly managed.

Bridging the gap between faith and health

Fasting from dawn to sunset disrupts the typical dietary and medication routines of individuals with diabetes. Without proper guidance, some consume high-sugar, high-fat meals at iftar, leading to post-fasting hyperglycemia, while others experience dangerously low blood sugar throughout the day. Irregular medication use further complicates diabetes management, making fasting particularly risky for those on insulin or glucose-lowering therapies.

Despite medical concerns, fasting is a strong religious and cultural obligation for Muslims – but most lack accessible fasting and dietary guidance, increasing their vulnerability to complications.

Equipping patients with practical and culturally relevant guidance can help with diabetes management during fasting periods.

The International Diabetes Federation (IDF) and the Diabetes and Ramadan (DAR) International Alliance have long recommended personalized strategies including meal planning, medication adjustments, and frequent glucose monitoring to mitigate risks. Yet these strategies remain rare, inconsistent and underdeveloped across healthcare systems.

Nutrition education in diabetes management

Nutrition is central to diabetes management, and education programs tailored to Ramadan fasting have shown significant benefits.

Patients who receive structured guidance before Ramadan learn how different foods affect blood sugar and adjust meal choices accordingly. This enables them to reduce their risk of complications such as hypoglycemia and cardiovascular issues.

Improved medication adherence and modified dosages can be undertaken safely under medical supervision.

These interventions enable people with diabetes to sustain healthier habits beyond Ramadan, promoting long-term diabetes control.

Studies from Egypt, Jordan, and Pakistan show that individuals who participate in pre-Ramadan nutrition education programs experience improved glycemic control and lower rates of diabetes-related complications.

By equipping patients with practical, culturally relevant guidance, these programs have the potential to transform diabetes management during fasting periods.

Scaling pre-Ramadan education through policy

Despite its benefits, pre-Ramadan diabetes education is not widely institutionalized. To bridge this gap, policymakers must integrate structured education programs into primary healthcare systems.

If pre-Ramadan education is mandated in healthcare settings, primary care providers could offer structured guidance for diabetes patients who intend to fast.

Public health campaigns need to provide accessible, culturally relevant materials that address common misconceptions and promote balanced eating. Mobile health (mHealth) applications and telemedicine services can extend the reach of diabetes education, providing real-time support to fasting individuals.

Physicians, dietitians, and community health workers should be equipped with specialized training on Ramadan-focused diabetes management.

National media campaigns should highlight the importance of pre-Ramadan preparation and safe fasting practices.

The UK and Canada have begun integrating Ramadan-focused diabetes education into their broader public health initiatives, providing models that can be adapted in other regions with large fasting populations.

Holiday Training Pays Health Dividends 

Pre-Ramadan nutrition education is more than a clinical intervention – it is a public health necessity. By embedding structured, culturally sensitive diabetes education into care systems, governments protect both fasting individuals and health budgets without undermining religious practices.

Tight health budgets and rising diabetes rates require policy-driven education strategies to reduce illness and deaths. These simple preventive programs can improve the quality of life worldwide for nearly two billion Muslims. The time to act is now—because no one should have to choose between their faith and their health.

Naqaa Alomari is a Jordanian health educator and nutritionist working in Egypt on diabetes. Work experience at the Diabetes and Diabetic Foot Center and as a Saudi government health specialist deepened her focus on health policy needs. Her research merging new media with Ramadan education is forthcoming. She compared US and Taiwan school lunch programs for a global health and development thesis at Taipei Medical University.

Image Credits: Unsplash, Unsplash.

Depletion of world’s glaciers that are also its water towers threatens water supply to hundreds of millions downstream.

Many glaciers in western Canada, the United States, Scandinavia, Central Europe, the Caucasus, New Zealand and the tropics will not survive the 21st century – and this will have a “dramatic impact” on mountain communities and hundreds of millions of people who depend on water that originates from these glaciers.

These are the key findings of the latest reports from the United Nations (UN) agency World Meteorological Organization (WMO), and the Zurich-based glacier monitoring agency World Glacier Monitoring Service (WGMS).

Glaciers are among the key indicators of the health of our planet, and some of the world’s largest rivers including the Ganga, Brahmaputra, Indus, and Yangtze, originate from the glaciers.

But those glaciers are now rapidly retreating.

“WMO’s State of the Global Climate 2024 report confirmed that from 2022-2024, we saw the largest three-year loss of glaciers on record. Seven of the ten most negative mass balance years have occurred since 2016,” said WMO Secretary-General Celeste Saulo.

“Preservation of glaciers is a not just an environmental, economic and societal necessity. It’s a matter of survival.”

Since 1975, the world’s glaciers have lost 9,000 billion tonnes of ice or an ice block the size of Germany, with a thickness of 25 meters. This has pushed the sea levels up by 25 mm.

See related story: The Year 2024 Was Warmest-Ever on Record – Temperature Rise Likely Exceeded 1.5°C

Melting glaciers are putting food security at risk

Distribution of glaciers around the world.

The 2024 data shows that, for the third consecutive year, all the glaciers around the world had lost mass.

The rate of melting of glaciers is directly linked to the rising global temperatures, Stefan Uhlenbrock, Director of Water and Cryosphere department at the WMO said.

As 2024 was the warmest year on record, temperatures are expected to continue to rise, and Uhlenbrock warned the changes this will cause will be dramatic.

“Globally, in the interconnected economy, it’s everyone around the world who’s indirectly impacted from these dramatic changes. It’s putting at risk the water supplies. It’s putting at risk food security, energy security, as well as the ecosystem services that water resources and other resources provide. But you shouldn’t also forget the social, the cultural as well as the spiritual values glaciers have,” he said during a press conference.

The reports were released to mark the first World Day for Glaciers on March 21 this year, and sound alarm that the accelerating glacier melt risks unleashing cascading impacts on economies, ecosystems and communities.

Source of 70% of world’s freshwater under threat

There are approximately 275,000 glaciers around the world that cover roughly 700,000 km² or the equivalent of twice the size of Germany. These exclude the continental-sized ice sheets of Greenland and Antarctica.

The glaciers are in high mountain regions often referred to as the world’s water towers as glaciers are the source of about 70% of the world’s freshwater reserves.

In the short-term, increased glacier melting increases the risk of natural hazards such as floods for those living downstream. But in the long-term, they threaten the water security of people as the rivers that the glaciers feed risk running dry. In dry and hot seasons in some areas, glacier runoff is often the only water available.

“Hotspots of water availability from glaciers are Central Asia and the central Andes, where glaciers in the hottest and driest months are often the only water resource,” Dr Michael Zemp, Director of the WGMS said during the press conference. WGMS has been coordinating glacier monitoring for over 130 years now.

Glacier melt contributes to sea-level rise

Annual global glacier mass changes from 1976 to 2024 in gigatons. The shades of blue refer to years the glaciers increased in mass while the shades of red refer to the years the glaciers lost mass.

The new findings complement a recent study published in the journal Nature in February, which found that between 2000 and 2023, glaciers lost 5% of their remaining ice.

From 2000 to 2023 alone, the global glacier mass loss totals 273 billion tonnes of ice every year, according to the reports. This amounts to 6,552 billion tonnes over 24 years or what the entire global population currently consumes in 30 years (assuming three litres per person per day).

Regionally, the loss of glacier ice ranges from 2% in the Antarctic and subantarctic islands to almost 40% in Central Europe.
This melting ice is currently the second-largest contributor to global sea-level rise, after the warming of the ocean.

During this period, glacier melt contributed 18 mm to global sea-level rise. “This might not sound much, but it has a big impact: every millimeter sea-level rise exposes an additional 200,000 to 300,000 people to annual flooding,” says Zemp.

Based on a compilation of worldwide observations, the WGMS estimates that glaciers (separate from the continental ice sheets in Greenland and Antarctica) have lost a total of more than 9,000 billion tonnes since records began in 1975.

The changes in global glaciers since 1975 in gigatons (Gt).

“If you take the example of Germany, it would be an ice block of the size of Germany, with a thickness of 25 meters. That is the ice that we lost since 1975 from glaciers,” Zemp said. “This is about 25 millimetres of sea level rise, or currently, a bit more than one millimetre each year,” he said.

The Greenland ice sheet is also melting while the Antarctic ice sheet is not contributing “so much” to the rising water levels at the moment. But as the temperatures continue to rise that will change.

“For the next decades, the glaciers are the drivers for the sea level rise. When we talk about the next centuries, it’s the ice sheets that we have to worry about,” Zemp said.

Preservation of glaciers is a necessity

The 2024 hydrological year, calculated from 1 October 2023 to 30 September 2024, saw the fourth-highest glacier mass loss on record. It was also the third year in a row during which all 19 glacier regions in the world experienced a net mass loss.

This loss was relatively moderate in regions like the Canadian Arctic and the Greenland periphery but glaciers in Scandinavia, Svalbard (Norwegian archipelago) and North Asia experienced their largest annual mass loss on record.

“I just want to want to stress that preserving glaciers is not only an environmental imperative, it’s really a survival strategy,” said WMO’s Uhlenbrock.

He pointed to the 2022 heatwave in Europe when the heat caused the Swiss Alps to lose 10% of its ice in two years.

“This was also the year when it was so hot that several nuclear power plants in France had to be shut down because of the lack of cooling water. It was such a dry and hot time that there were energy supply problems,” he said.

“We need to advance through better observation systems, through better forecasts and better early-warning systems for the planet and the people. Only then we can protect our water supplies, the livelihoods of people, as well as ecosystems for future generation,” he said.

The way forward is to limit the global emissions of greenhouse gases, experts said, adding that there are no other viable long-term measures.

This year is being marked as the International Year of Glaciers’ Preservation by the United Nations (UN). Global leaders, policymakers, scientists and civil society members will attend a UN high-level event in Paris and New York on March 20 and 21 to address the crucial role of glaciers in the climate system and water availability.

Image Credits: WMO, World Glacier Monitoring Service (WGMS), C3S/ECMWF/WGMS.

Witkoppen Clinic’s HIV services in Johannesburg was one of many African clinics receiving PEPFAR funds via USAID.

Two to four million additional Africans are likely to die annually as a result of the shock aid cuts by the United States and other key donors, according to Dr Jean Kaseya, who heads the Africa Centre for Disease Control and Prevention.

Kaseya heads to Washington next week to coincide with the end of US Congress’s reauthorisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) on 25 March.

Numerous PEPFAR projects have already been terminated in the past two months by Trump appointee Elon Musk’s Department of Government Efficiency (DOGE) and it is unclear what the Republican-dominated Congress envisages for the plan.

Kaseya said he planned to meet members of the Trump administration, PEPFAR officials and Members of Congress next week in a bid to restore US aid.

“It is a disaster,” Kaseya told a media briefing on Thursday, disclosing that some African countries relied on “external assistance” for 80% of their HIV and malaria responses.

‘Overnight, everything is gone’

“Overnight, everything is gone,” he said, noting that 30% of Africa’s health expenditure comes from official development assistance (ODA) – yet there had been a 70% cut in ODA this year from $81 billion to $25 billion.

Aside from the gutting of virtually all the US Agency for International Development (USAID) grants, major European donors have also cut ODA.

Earlier in the week, the World Health Organisation (WHO) reported that Kenya, Lesotho, South Sudan, Burkina Faso and Nigeria would run out of antiretroviral medicine for HIV within the next few months as a result of USAID cuts.

WHO Director-General Dr Tedros Adhanom Gebreyesus said that while the aid withdrawal was the right of the US administration it “has a responsibility to ensure that, if it withdraws direct funding for countries, it is done in an orderly and humane way to allow them to find alternative sources of funding.”

Kaseya reported that he has been travelling the breadth of the continent and internationally to secure three key pillars of support for health on the continent: increased domestic funding, “innovative financing” for outbreaks and “blended financing”.

Africa CDC is pursuing three sources of funds to address the enormous gap left by the US withdrawal of aid.

The aid cut will “reverse two decades of health achievements in maternal, child health and infectious diseases”, warned Kaseya, adding that entire health systems “could collapse”.

Alongside the cuts is a surge in disease outbreaks – up 41% in the past two years.

The African health response is also hampered by countries’ debt servicing burden and dependence on imported medical countermeasures, said Kaseya.

Africa CDC projects an additional 39 million people will be pushed into poverty as part of the ODA cuts. The calculations are based on CDC modelling.

Kaseya has held several briefings with health ministers and African Union leaders to address the crisis, particularly focusing on alternative sources of funding.

Only two of the 55 member states – Botswana and Rwanda – spend 15% of their GDP on health – something that African states pledged to do in the Abuja Declaration back in 2001.

Only 16 countries have national health financing plans.

Kaseya said the Africa CDC is also trying to ensure that the health sector access to some of the $95 billion contributions made by the diaspora, including possibility via taxes.

With blended finance, Kaseya said private sector investment is needed “mostly in local manufacturing, electrification of health centres, connectivity, digital health and supply chain infrastructure”.

Mpox plateaus – but fall in testing is to blame

While mpox cases appear to have plateaued, this is due to challenges related to testing – particularly in the Democratic Republic of Congo (DRC) – rather than the disease being controlled, said Kaseya.

Conflict in eastern DRC and the loss of USAID funding that was covering the transportation of mpox samples to laboratories have led to a 16% drop in testing in the DRC over the past week alone. Less than a quarter of suspected cases were tested. Meanwhile, the turnaround time for testing has increased in many regions due to transport problems.

Image Credits: International AIDS Society, Witkoppen Clinic.

The method used in carcass sampling utilizes the knowledge and experience gained during previous outbreaks and the samplers work in pairs and in wearing personal protective equipment

The proposed pandemic agreement being negotiated at the World Health Organization (WHO) represents a critical opportunity for the global community to prevent future pandemics – including through coordinated multi-sectoral surveillance across human, animal, and environmental health data. As WHO member states gather in closed meetings over the next few week, three experts in wildlife health policy and research present field-based evidence that such a surveillance approach is critical to prevent pandemics.

The next pandemic is not a matter of if, but when, unless strong action is taken. The world remains highly vulnerable to outbreaks of zoonotic diseases that jump from animals to humans due to increasing urbanization, deforestation, and globalized travel.

As the world scrambles to strengthen pandemic prevention, preparedness, and response, the proposed pandemic agreement being negotiated at the WHO represents a critical opportunity for the global community to prevent future pandemics. 

Central to this effort is Article 4 of the draft Pandemic Agreement , which calls for countries to develop plans for coordinated multi-sectoral surveillance across human, animal, and environmental health data. While some countries express concerns about feasibility, such surveillance is not only necessary but entirely achievable with the right global commitment.

Multi-sectoral surveillance takes a One Health approach that recognizes the interdependence of human, animal, and environmental health. Given that the majority of emerging infectious diseases originate in animals, particularly wildlife, this type of surveillance is essential to prevent future pandemics.

In practice, it involves human health workers, veterinarians, environmental scientists, empowered citizens, and others on the spillover frontlines working together to detect early warning signs of potential pathogen emergence and outbreaks.

Lessons from Republic of Congo 

Dr. Alain Ondzie leading educational outreach on Ebola at a village in northern Republic of Congo

The Republic of Congo (RoC) provides a compelling example of effective multisectoral surveillance. Following devastating Ebola virus outbreaks that took thousands of lives and threatened great ape populations, a collaborative effort between wildlife experts and the Congolese Ministry of Health established a low-cost wildlife mortality reporting network covering 50,000 km².

This system serves as an early warning mechanism for potential Ebola virus outbreaks, which have historically been linked to infected wildlife and consumption of animal carcasses, especially in the Congo Basin. 

The program demonstrates how resource-efficient surveillance can function in challenging settings. Local personnel were trained in safe specimen collection protocols, and geographically distributed bases were equipped with sampling kits.

Critically, the system established in-country diagnostic capabilities for Ebola virus testing, reducing turnaround time from months to hours. The program not only monitored wildlife mortality but also provided educational outreach to over 6,600 people in rural northern RoC. That outreach aimed to encourage behavioral changes to reduce human activities that lead to pathogen spillover.

 This initiative represents the essential elements of multi-sectoral surveillance: cross-sector collaboration, community engagement, strategic resource allocation, and rapid diagnostic capabilities.

While the RoC has not experienced an Ebola epidemic since 2005, this surveillance system has detected anthrax in carcasses and continues to function as an early warning mechanism in a high-risk region, protecting both human communities and the country’s globally significant great ape populations.

Carcass sampling a great ape in the Republic of Congo.

Southeast Asia’s wildlife surveillance

Similarly, the WCS initiative WildHealthNet in Southeast Asia has shown how national wildlife health surveillance programs can be built on partnerships with local governments, existing resources, and targeted technical support.

Such wildlife health surveillance programs were first to detect African Swine Fever, a devastating domestic pig disease, in free-ranging wildlife in Laos, Cambodia and Vietnam, and identified biosecurity breaches that contributed to its spread. 

The network also identified a significant transnational outbreak of Highly Pathogenic Avian Influenza (HPAI) in multi-use wetlands, rapidly informing public and livestock health partners to limit onward transmission to domestic animals and humans.

The governments of Lao PDR and Cambodia have now formally adopted legislation codifying the network’s reporting structures and standard operating protocols. Building on this regional progress, WCS has expanded WildHealthNet to additional regions and is helping lead a global community of practice (Wildlife Health Intelligence Network-WHIN).

Some countries with large animal populations are concerned that multi sectoral surveillance, particularly an obligation to identify settings and activities where humans and animals interact, would be onerous and not implementable due to resource limitations and coordination challenges.

Developing countries also worry that institutions, companies, and other countries could profit from the data they share. Meanwhile, developed countries are keen to include multisectoral surveillance so that outbreaks can be detected and mitigated as soon as possible.

Coordination, data-sharing and sovereignty

Coordination between health, animal, and environmental sectors presents challenges, but establishing clear communication protocols, creating joint task forces, and standardizing data-sharing procedures can streamline collaboration. Emerging One Health governance platforms help formalize these mechanisms, ensuring smoother cross-sectoral cooperation.

Regarding data-sharing concerns, the proposed WHO agreement can establish frameworks that protect data sovereignty while enabling critical information exchange. Tiered data sharing – where non-sensitive data is shared widely, while sensitive data remains under member State control – can balance sovereignty with global health security.

Technology significantly reduces the burden of cross-sectoral surveillance. Digital platforms, mobile data collection, and analytics facilitate real-time surveillance without excessive cost and present additional savings through adoption and scaling of common tools.

The RoC initiative demonstrates that even with limited resources, establishing strategic diagnostic capabilities can dramatically reduce response times. Low-cost technologies, like instant messaging groups, can ensure effective communication and surveillance even in low-resource settings.

Those sampling dead wild animals now wear full personal protective equipment.

The cost-benefit case 

The economic benefits of investing in multi-sectoral surveillance far outweigh the costs. The COVID-19 pandemic cost the global economy trillions of dollars (and millions of deaths), while preventative measures would have been exponentially cheaper.

Early detection and containment of future zoonotic threats could prevent not only countless lives lost but also devastating economic consequences. Ebola outbreaks can run from the millions to tens-of-billions for the 2014 West Africa outbreak. The RoC’s surveillance system represents a modest investment compared to the potential costs of another Ebola epidemic.

The draft pandemic agreement, through its Article 4, has the potential to make multi-sector surveillance both achievable and sustainable by facilitating international cooperation, channeling resources, fostering capacity-building, and ensuring standardized protocols. It can empower governance frameworks that formalize multi-sectoral surveillance while safeguarding national sovereignty. 

The stakes are simply too high to exclude coordinated multi sectoral surveillance from the agreement. The perceived challenges are not insurmountable; they are challenges the global community is well-equipped to solve. A world without catastrophic pandemics is within reach, but only if we dare to work together. The time for action is now.

 

Sarah Olson is director of health research for the health program at the Wildlife Conservation Society (WCS). She provides leadership and research support to field veterinarians and conservation staff around the world. Her research with WCS has focused on frontline wildlife conservation and One Health challenges, including the wildlife trade and emerging infectious diseases, Ebola virus in great apes and bats, avian influenza in wild birds, and white-nose syndrome in North American bats. She is currently focused on understanding and mitigating wildlife health and zoonotic disease threats  and helping grow sustainable and effective wildlife health surveillance systems.

Manoly Sisavanh is  the WCS Deputy Country Director for Laos Program. She leads the policy dialogue with government in the areas of environmental policy on protected areas, forest and wetland management, supervises counter-wildlife trafficking and One Health programs, and oversees office operations. 

Dr Michel Masozera is WCS director of policy and institutional partnerships for Africa. He is an experienced professional in the field of biodiversity conservation, protected areas management and sustainable development. He received the National Geographic/Buffet Award for Leadership in African Conservation in 2004 for his role in the creation of Nyungwe Forest National Park, one of the largest remaining mountain forests in Rwanda.  

 

Image Credits: Sebastien Assoignons/ Wildlife Conservation Society, Sarah Olson/ Wildlife Conservation Society, Wildlife Conservation Society Congo, Wildlife Conservation Society.

Record warming has led to cascading impacts, such as a higher rate of glacier melting and ocean warming, which threaten fisheries and freshwater supplies.

The past ten years (2015-2024) were the ten warmest years on record, individually and collectively, according to the State of the Global Climate 2024 report released on 19 March.

The year 2024 was also the warmest year in the 175-year observational record of temperature tracking, according to the United Nations’ agency World Meteorological Organization (WMO), in the annual report.

And it was the first calendar year during which average temperatures were “likely” more than 1.5°C above the pre-industrial era (1850-1900) baseline, WMO experts said at a press conference on the report’s findings on Tuesday.

They use the term “likely” due to a highly technical scientific debate over what exactly may be considered the pre-industrial temperature baseline.

2024 was likely the warmest year on record and an estimated 1.55°C above the pre-industrial average, with a margin of error of ±0.13 C.

Key climate indicators worsening

Key climate indicators have worsened and some of the consequences are irreversible over hundreds if not thousands of years, said, Chris Hewitt, WMO’s Director of Climate Services at Tuesday’s press briefing.

“The climate has always been changing, if we look back at the distant past, then these rates of change are pretty high and not very welcome,” he said.

Among those, atmospheric concentrations of the greenhouse gas (GHG), carbon dioxide (CO2), are now at the highest levels it has been in the last 800,000 years.

The largest three-year loss of glacier mass on record also occurred over the past three years. This has pushed up the rate of sea level rise which has doubled since satellite measurements began.

In 2024, extreme weather events like tropical cyclones, floods, droughts, and other hazards led to the highest-ever number of people displaced in the past 16 years. Those events also contributed to worsening food crises and caused massive economic losses.

“While a single year above 1.5°C of warming does not indicate that the long-term temperature goals of the Paris Agreement are out of reach, it is a wake-up call that we are increasing the risks to our lives, economies and to the planet,” said WMO Secretary-General Celeste Saulo in a press statement.

See related story: Many of the World’s Glaciers Will Not Survive This Century With Dire Consequences for Hundreds of Millions

Rising planetary distress

Record temperatures extended over a wide area.

Rising heat is also affecting the integrity of the world’s oceans, critical habitats for fish, upon which around 16% of the world’s population depends as a key source of protein, with each of the past eight years having set a new record for ocean heat content.

“Our planet is issuing more distress signals — but this report shows that limiting long-term global temperature rise to 1.5°C is still possible. Leaders must step up to make it happen — seizing the benefits of cheap, clean renewables for their people and economies  —  with new National climate plans due this year,” United Nations Secretary-General António Guterres said in a press statement.

Right now, the contrary is happening in the world’s largest economy and second-largest GHG emitter, the United States.  The US government has fired key scientists affiliated with the National Oceanic and Atmospheric Administration (NOAA), which monitors oceans and temperatures; removed key climate data and pollution references from websites; abolished climate-related Environmental Protection Agency pollution regulations, rescinded incentives for clean energy production.

See related story: US EPA Rollback of Dozens of Air, Water and Chemical Pollution Regulations Threatens America’s Health, Experts Warn

In the case of the 2024 report, data was not affected, WMO experts at the conference said. But they did not elaborate on the extent to which scientific collaborations with US government scientists were still continuing.

“So, in the world of meteorology, whether in climates and oceanography, we exchange and share data and science and knowledge. So that would apply to any country and the US is clearly one of the world leaders in the field of climate. So, we certainly value the engagement in collaboration with us scientists and US organizations,” Hewitt said.

Scientists also stressed that the WMO report relies on multiple datasets, including, but not limited to data provided by NOAA.

Long-term warming hasn’t yet exceeded 1.5°C

While the average temperature in 2024 may have been above 1.5°C, the average over the past several decades was estimated at 1.34-1.41°C above the 1850-1900 baseline, the scientists said. Effectively, this means that the 1.5°C limit set out in the 2015 UN Paris Agreement, hasn’t yet been formally breached.

The record global temperatures seen in 2023 and broken in 2024 were also due to the ongoing rise in GHG emissions, coupled with a shift from a cooling La Niña to warming El Niño event, the report said.

Several other factors may have contributed to the unexpectedly unusual temperature jumps, including changes in the solar cycle, a massive volcanic eruption and a decrease in cooling aerosols, according to the report.

A WMO team of international experts is working to ensure even more reliable tracking of long-term global temperature changes, in collaboration with the Intergovernmental Panel on Climate Change (IPCC) – the UN body set up to assess science related to climate change.

Why oceans are warming faster

Annual global ocean heat content down to 2000 m depth for the period 1960–2024.

Around 90% of the energy trapped by GHGs in the earth’s system is absorbed by the oceans. The rate of ocean warming over the past two decades, 2005-2024, is more than twice that in the period 1960-2005.

“The ocean is warming, and it’s a continued warming, and in 2024 we observed ocean heat content which reached the highest levels in a 65-year observational record,” Karina von Schuckmann, an oceanographer at Mercator Ocean in France said during the press conference.

“Data for 2024 show that oceans continued to warm, and sea levels continued to rise. The frozen parts of Earth’s surface, known as the cryosphere, are melting at an alarming rate: glaciers continue to retreat, and Antarctic sea ice reached its second-lowest extent ever recorded. Meanwhile, extreme weather continues to have devastating consequences around the world,” said Saulo of WMO.

The 18 lowest Arctic sea-ice extents on record were all in the past 18 years.

Cascading impacts of extreme weather events

In 2024 extreme weather events worsened around the world.

Meanwhile, extreme weather driven by rising temperatures, such as cyclones, forest fires and floods, displaced over 100,000 people, the highest number since 2008, and destroyed homes, critical infrastructure, forests, farmland and biodiversity.

The compounded effect of various shocks, such as intensifying conflict, drought and high domestic food prices drove worsening food crises in 18 countries globally by mid-2024, the WMO report said.

Tropical cyclones were responsible for many of the highest-impact events of 2024. Tropical cyclone Chido on 14 December 2024 caused casualties and economic losses in the French Indian Ocean island of Mayotte, Mozambique and Malawi.

But high displacement numbers are not all bad, experts stressed.

“Early warning systems, when they’re effective, say, for a tropical storm, can often mean that people have moved out of an area and may be counted amongst displaced people,” explained John Kennedy, co-chair of WMO’s expert team on Climate Monitoring and Assessment.

“So rather than seeing casualties, we see people being moved to safer areas.”

Ocean warming will continue until the end of the century, even in low-carbon scenarios

Real-time data from specific locations show that levels of the three main GHGs – carbon dioxide, as well as methane and nitrous oxide – already at the highest levels in the last 800,000 years – continued to increase in 2024.

Gases like carbon dioxide remain in the atmosphere for generations, trapping heat.

Ocean warming leads to the degradation of marine ecosystems, biodiversity loss, and reduction of the ocean’s ability to act as a carbon sink. It fuels tropical storms and contributes to sea-level rise. Ocean warming is even more irreversible – on centennial to millennial time scales.

Climate projections thus show that ocean warming will continue for at least the rest of the 21st century, even for low-carbon emission scenarios.

Along with the urgent need to reduce GHG emissions, experts stressed on the need to strengthen early warning systems for countries.

Investments in weather, water and climate services are more important than ever to meet the challenges and build safer, more resilient communities, Saulo stressed.

“Only half of all countries worldwide have adequate early warning systems. This must change,” said Saulo.

Image Credits: WMO, WMO , WMO.

WHO head of immunisation Dr Kate O’Brien and Dr Joachim Hombach, WHO senior health advisor and SAGE Executive Secretary

Cuts to global immunisation budgets are hitting measles vaccine coverage, disease surveillance, laboratory networks and outbreak response the hardest, according to the Strategic Advisory Group of Experts on Immunization (SAGE).

SAGE, which advises the World Health Organization (WHO) on immunisation, issued the warning at a media briefing on Tuesday after its four-day biannual meeting.

It warned that the recent cuts by the Trump administration in the United States create a risk of further backsliding in immunisations “just when countries are recovering from the impact of the COVID-19 pandemic”. 

“The number of zero dose children, meaning those children that have not received any vaccines, have increased, even though the big [post-COVID] catch-up has helped,” SAGE chair Dr Hanna Nohynek told the media briefing.

Dr Kate O’Brien, WHO’s head of immunisation, said that vaccines have saved at least 154 million lives over the past 50 years, “and 60% of those lives saved were attributable to the measles vaccine”. 

Measles labs shutdown

However, WHO’s global measles and rubella network of more than 700 laboratories, funded solely by the US, faces “imminent shutdown”, WHO Director-General Dr Tedros Ahhanom Ghebreyesus told a media briefing on Monday. 

The collapse of the network, called Gremlin, would mean that outbreaks would not be detected – either at all or not rapidly, said O’Brien.

“Measles is one of the most infectious viruses, and it can have serious consequences, including infections of the brain, of the lung, pneumonia and  encephalitis,” she noted.

“The purpose of detecting [measles outbreaks] rapidly is to stamp them out at source as quickly as possible and to respond,” said O’Brien. 

She warned that measles was already surging, with 57 countries having outbreaks last year, in comparison to 35 countries in the two prior years. 

“Without that lab network and the epidemiologists, scientists and public health workers that are part of that response, we will certainly see many, many more outbreaks, many, many more deaths and many, many more cases,” said O’Brien.

Gremlin costs $8million a year, which O’Brien described as a “best buy” investment to save lives. It had been funded by the US Centers for Disease Prevention (CDC) not the US Agency for International Development (USAID).

The major theme of the four-day meeting was the “very high concern” of SAGE members of the impact of the funds cut on the “eradication, elimination and control of diseases”, added O’Brien.

Polio transmission

SAGE is “highly concerned” about the continued transmission of wild poliovirus in Pakistan and Afghanistan and the circulation of vaccine-derived poliovirus type 2 and its expansion into new areas, including European countries.

SAGE also reviewed updated evidence and concluded that a polio vaccination schedule with a minimum of three vaccine doses of the inactivated poliovirus (IPV), starting at six weeks of age or later is adequate, without the need for a scheduled IPV booster dose (4th dose). 

SAGE reaffirmed that three doses of pneumococcal conjugate vaccines (PCVs) is the most effective way to prevent childhood pneumococcal disease. 

SAGE noted that PCV10 by the Serum Institute of India had recently received WHO-prequalified for the immunization of infants, joining PCV10 (GlaxoSmithKline) and PCV13 (Pfizer).

It also recommended varicella vaccines, using a two-dose schedule with a minimum four-week interval between doses, for children in populations where varicella is an important public health problem. 

Varicella vaccination could also be introduced for special populations, such as immunocompromised people, those living with well-controlled HIV infection and health workers in areas where they 

SAGE also received a report from the global vaccine platform, Gavi. Highlights include that Gavi’s HPV vaccine initiative is on track to immunise 86 million girls by the end of the year,  while significant progress has been made in rolling out malaria vaccines.

Gavi will invest $800 million in polio vaccines this year and $5.6 million to address mpox.

Gavi aims to launch a new strategy in 2026 that will focus on introducing new vaccines, strengthening country programmes, and reducing zero-dose children.

 

Cows grazing

Europe has successfully controlled many livestock diseases over the years, but the threat of animal diseases is never truly over – and climate change is increasing this threat.

In 2023, the continent saw an outbreak of bluetongue virus that cost the Netherlands alone an estimated €200 million.

Earlier this year, Germany experienced its first foot-and-mouth outbreak in more than three decades, resulting in bans on German meat and dairy exports.

These recent outbreaks have underscored  the perennial threat of animal disease to the security of food, health, and economic systems across the continent. They cause massive losses to livestock farmers, present risks to human health, and damage food availability.

Perhaps most importantly, the danger of these diseases is predicted to grow as global warming changes Europe’s climate.

Take bluetongue virus, for instance. The disease is endemic to the tropics but began to migrate to Europe in the 1990s and has moved further north in the last decade as a result of rising temperatures, allowing for a virus adapted to warmer climates to thrive across Europe.

The shorter, milder winters have allowed for a longer transmission period for the virus. These changes are likely to be seen in other livestock diseases as well.

Sustainable future

Given these conditions, improving animal health is integral to ensuring a healthy, sustainable future for the livestock sector and all Europeans. As consultations continue on the European Union (EU) Animal Health Law and work starts on a sustainable livestock strategy, concrete measures to improve animal health should be at the centre.

This first means bringing the animal health sector, which represents the manufacturers of animal medicines, vaccines and other animal health products, to the table by allowing a regular and constructive dialogue with veterinary authorities.

The animal health sector can assist in achieving greater sustainability of livestock. Current strategies largely consist of shared principles and approaches amongst member states, but they lack the solid measures needed to make real impacts.[1]  This marks a huge blind spot in the potential strategy.

Animal health experts can offer actionable measures to improve animal health that will ultimately benefit all of Europe.

For example, investing in preventative tools allows governments to curb risks before they become full crises. This includes improving vaccinations, advancing disease surveillance and early warning systems, and implementing biosecurity upgrades and farm-level prevention practices.

Disease prevention is also critical for reducing the livestock sector’s emissions. Fewer losses mean fewer wasted resources and less resources needed to make up the difference.

It also reduces the need to cull animals and spend public money to compensate farmers for these losses.

Reducing disease levels also helps address concerns around antimicrobial resistance (AMR), which threatens the health of people and animals across the continent. AMR occurs when microorganisms no longer respond to antimicrobial treatments. While this can happen naturally, it is accelerated by the improper use of antimicrobial medicines in human and veterinary medicine.

 Thankfully, antimicrobial use in animals has dropped 53% in the EU since 2011, largely due to the dramatic increase in prevention products such as vaccines that reduce the need for antibiotics in the first place.

Supporting improved breeding can also help reduce the sector’s climate impact. This includes genomic testing to support farmers to select breeds for traits such as disease resistance, reduced emissions, and climate adaptation.

In New Zealand, for example, the government has been working with researchers to breed high-productivity, low-methane ruminants like sheep, which have produced 12% lower methane emissions than traditional breeds.

With more than 220 million ruminants in Europe, including innovative breeding approaches such as those in the Sustainable Livestock Strategy can make a big impact on the continent’s emissions.

Disease prevention

Disease prevention and breeding strategies go a long way to improving the sustainability of livestock farming from an environmental perspective, but they are also central to improving animal welfare and farm economics.

For example, new technologies such as sensors used to detect cows’ rumination can detect disease up to five days before clinical signs of the disease.

Calving prediction technologies give alerts from six to 12 hours in advance of calving, reducing calf mortality, and automatic feeding machines can be used to detect bovine respiratory disease in calves with high accuracy at least one day before clinical diagnosis.

Integrating policies on preventative measures, new technology use, and improved breeding, can offer exponential benefits for people and animals.

The EU is one of the world’s largest trading blocs, with nearly 450 million people relying on policymakers to protect them from economic and health crises.

 The continent cannot afford a passive approach to animal health and disease prevention, especially as animal diseases persist despite the measures already in place.

 An EU-wide strategy needs more than just shared principles and approaches. It needs tangible policies and best practices to be effective, covering the full livestock supply chain. Without decisive and inclusive action, the next major outbreak is not a question of “if” but “when”—and Europe cannot afford to be unprepared for “Disease X”.

Pierre Sultana is the Public Affairs Director of AnimalhealthEurope, which represents the manufacturers of animal medicines, vaccines and other animal health products in Europe.

 

Image Credits: pxfuel, Charyse Reinfelder.

WHO Director-General Dr Tedros Adhanom Ghebreyesus

A grim picture is emerging of people running out of food, countries running out of medicine and hospitals closing as a result of the shock slashing of global health budgets by the United States, according to multiple World Health Organization (WHO) staff addressing a media briefing on Monday.

Meanwhile, the WHO is mulling “terrible choices” as it tries to trim 25% of its budget in the wake of the US withdrawal from the body.

Malaria: Additional 15 million cases this year?

“There are now severe disruptions to the supply of malaria diagnostics, medicines and insecticide-treated bed nets due to stockouts, delayed delivery or lack of funding,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus, reporting on the early impact of the US Agency for International Development (USAID) funding cuts.

Over the last 20 years, the US has been the largest bilateral malaria control donor, helping to prevent an estimated 2.2 billion cases and 12.7 million deaths.

“If disruptions continue, we could see an additional 15 million cases of malaria and 107,000 deaths this year alone, reversing 15 years of progress,” said Tedros.

HIV: Imminent disruption to ARV supplies

Dr Meg Doherty, WHO’s head of HIV, hepatitis and STIs

“It’s a similar story with HIV,” said Tedros. “The suspension of most funding to PEPFAR, the President’s Emergency Plan for AIDS Relief, caused an immediate stop to services for HIV treatment, testing and prevention in more than 50 countries. 

“Eight countries now have substantial disruptions to antiretroviral (ARV) therapy and will run out of medicines in the coming months. Disruptions to HIV programmes could undo 20 years of progress, leading to more than 10 million additional cases of HIV and three million HIV-related deaths, more than triple the number of deaths last year.”

The eight countries in the most immediate danger of running out of ARVs are Haiti, Kenya, Lesotho, South Sudan, Burkina Faso, Mali, Nigeria and Ukraine.

Dr Meg Doherty, WHO’s head of HIV, hepatitis and STIs, said there have already been reports of deaths of mothers and babies in settings such as South Sudan who were unable to get ARVs. In other settings, overdose deaths among injecting drug users soared within a week of opioid substitution therapy being stopped, a complementary therapy designed to reduce risks of acquring HIV infection from contaminated needles. 

“We are just going to need time to be able to get the data in, but we are seeing effects on the ground right now,” said Doherty.

‘Crippling breakdowns’ in TB response

WHO’s Director of TB, Dr Tereza Kasaeva

“On tuberculosis, 27 countries in Africa and Asia are facing crippling breakdowns in their response, with shortages of human resources, disruptions to diagnosis and treatment, data and surveillance systems collapsing and vital community engagement work deteriorating,” said Tedros.

“Nine countries have reported failing procurement and supply chains for TB drugs,  jeopardising the lives of people with TB.”

Over the past 20 years, US support for TB services has saved almost 80 million lives. 

WHO Director of TB Dr Tereza Kasaeva, said that during COVID-19, there were 700,000 additional TB deaths as a result of service disruptions, and this was a grim indication of what to expect.

“When [service] disruptions last more than three months, even a 20% drop in [diagnosis] will lead to a significant increase in TB deaths,” said Kasaeva.

Threat to immunisation

WHO head of immunisation Dr Kate O’Brien

WHO’s global measles and rubella network of more than 700 laboratories, funded solely by the US, faces “imminent shutdown”, said Tedros. 

“This comes at the worst possible time when measles is making a comeback. Last year, there were 57 live or disruptive measles outbreaks, and that number has been increasing for the past three years.”

WHO head of immunisation Dr Kate O’Brien described the cuts to immunisation programmes as “life-threatening”, although the results may only become clear in the years to come.

“We estimate that there will be hundreds of thousands of additional deaths as a result of the actions to compromise the vaccine programmes in place now, and many hundreds of thousands more as a result of the failure to deploy and introduce vaccines that are ready to go and to protect communities around the world, including the malaria vaccine,” said O’Brien.

Collapsed humanitarian response

Teresa Zakaria, WHO head of humanitarian relief.

“Almost 24 million people living inside crisis are at risk of not being able to access essential health services,” said Tedros.

“More than 2,600 health facilities in 12 humanitarian crises have already suspended services at least partially, or will do very soon.”

 In Afghanistan, funding shortages could force the closure of 80% of WHO-supported essential health care services. By the first week of March, 167 health facilities had already closed, denying lifesaving medical care to 1.6 million people across 25 provinces.

“Without urgent intervention, over 220 more facilities could close by June 2025, leaving an additional 1.8 million Afghans without access to primary health care,” said the WHO in a statement on Monday.

“In Cox Bazar in Bangladesh, the largest refugee camp in the world, diagnosis and treatment of hepatitis C has been disrupted, and disease surveillance, primary and secondary health care, laboratory services, procurement of supplies and salaries of health workers,” said Tedros.

Teresa Zakaria, WHO head of humanitarian relief, said that over 300 million people in 72 countries “require urgent humanitarian assistance to remain alive”. 

With data from only 12 countries, 23.8 million people are “directly affected by reduced health services” and “without urgent life saving health services, all of these individuals will be at risk of dying”. 

In these 12 countries, over 2,600 health facilities have been impacted and 900 hospitals in and over 1200 primary healthcare facilities are at risk of closing. 

It’s very early in our determination and quantification of the entire impact, but already we’re seeing how bad the situation is,” said Zakaria.

‘Terrible choices’ with WHO restructuring

WHO executive director of health emergencies, Dr Mike Ryan, is also chairing the WHO’s prioritisation committee

WHO executive director of health emergencies, Dr Mike Ryan, is also chairing the WHO’s prioritisation committee to determine how to reduce costs while maintaining essential programmes.  

“We’re severely containing our costs to $4.9 billion over the next two years,” said Ryan, adding that a re-prioritised budget will be presented to the World Health Assembly in May.

The health emergencies budget needs to be cut from $1.2 billion for two years to around $872 million.

“That will result in a 25% contraction of the emergencies programme,” said Ryan. “What do you want to stop doing? Do you want to stop doing Ebola? Do you want to stop doing emergency medical teams responding to major disasters in the world? Would you like to stop intelligence gathering so that we know what the next epidemic or pandemic will be? There are some terrible choices to be made.”

All departments are “making similar terrible choices we would never have wanted to make,” said Ryan. 

“But we will ensure that this organisation moves into the future. We will be smaller, but we will be efficient as ever, and we will be stronger, and we will be ready to to to grow again when the time is right.”

To meet the crisis, WHO has already frozen new staff hires, laid off temporary staff, and offered early retirement packages to employees over the age of 55. But it has not responded to the Health Policy Watch report on the dramatic rise in numbers of consultants and expansion of senior WHO Directors, and particularly those at the top  (D2) level, which occurred since Tedros took over as Director General in 2017 – with corresponding costs increases.

EXCLUSIVE: Number of WHO Senior Directors Nearly Doubled since 2017, Costs Approach $100 million

US responsible for ‘orderly and humane withdrawal’

“The US administration has been extremely generous over many years, and of course, it’s within its rights to decide what it supports and to what extent,” said Tedros.

“But the US also has a responsibility to ensure that, if it withdraws direct funding for countries, it is done in an orderly and humane way, to allow them to find alternative sources of funding. 

“We ask the US to reconsider its support and help, which not only saves lives around the world, it also makes the US safer by preventing outbreaks from spreading internationally,” he added.

Meanwhile, Ryan said that he mourns the loss of his US colleagues, “not for the dollars, but for the loss of contact”. 

“I’ve worked in this space for 30 years. We speak every day with colleagues in the United States, with institutions around the United States. They are the core of global public health. They are the heroes of disease control.”

How can health inequality be reduced?

This was the topic of the most recent episode of the Global Health Matters podcast with Dr. Garry Aslanyan.

Understanding Health Inequality

“Health inequity is produced by and within social relations that govern the production and exchange of concrete material things that we need to survive and flourish, to ensure well-being, like health,” explained guest Hani Kim, executive director of the Right Foundation in Seoul, Korea. “By material conditions, I mean how much we own and control various economic resources—resources that can produce things like money, land, credentials, and labour. What you own and how much of these resources you control critically determine what you have to do to get what you need to ensure your well-being.”

In other words, she explained, the relationships amongst different actors within global health—be it nations, non-governmental organisations, private philanthropies, or stakeholder groups within nations—are deeply embedded in a system that perpetuates inequalities of resources and power both amongst and within countries.

“These inequalities, along with material and power relations, have a profound impact on the strategies and directions that the field of global health employs to meet its goals,” Kim added.

The Role of Local Voices

Kim pointed out that global health efforts are often led by elites who impose solutions from above, assuming they have the best answers. This tendency normalises and universalises their perspectives at the cost of marginalising views that do not align with them.

She has made it a priority to invite and listen to partners from countries facing local health challenges. While she has seen some progress in this area, she emphasised that there is still a long way to go. Moreover, she cautioned that simply including local voices is not enough—it is essential to ensure they are truly representative, not just elites from their own communities.

“We live in a structure where inequalities of resources and power are so pervasive that even within these countries, the degree of inequality is immense. So, figuring out what the working classes and communities really want cannot be achieved simply by selecting a few so-called representatives,” Kim said. “The needs and wants of these communities are best expressed through movements and actions led by the members of those communities and working-class groups in their local context. This is inherently difficult to capture by simply selecting one or two representatives for forums, meetings, and conferences hosted by elites.”

Taking Action

Kim stressed that achieving change requires individuals to act within their own domains—whether as students, researchers, or professors—and to acknowledge their inherent limitations.

“Let us guard ourselves against the temptation to portray a world-view where what we can do, just because it is something we can do, is the most important or the best approach,” Kim added. “Solving health inequity is possible only when inequalities and material relations are addressed. And history teaches us that struggles for equality have been fought and won by the oppressed and exploited classes, not by elites.”

Building Sustainable Change

Another guest on the podcast, Seye Abimbola, an associate professor of health systems research at the University of Sydney’s School of Public Health, echoed much of what Kim said but added another critical perspective: many change efforts fail because people assume change will happen on its own.

“Change doesn’t just happen by accident or on autopilot,” Abimbola emphasised. “You have to build things, and be part of building structures that consistently do right by the people on whose behalf, with whom, and for whom we ought to be working.”

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

Image Credits: TDR Global Health Matters.