WHO Director General Dr Tedros Adhanom Ghebreyesus at the February Executive Board meeting, which cut the global healthy agency’s 2026-27 budget to $4.2 billion – but funds still fall dramatically short.

WHO’s budget crisis is even bigger than previously thought. The global health organization is short nearly $1.9 billion from a planned $4.2 billion budget for 2026-27, along with a $600 million deficit through end-2025, senior WHO officials revealed at a global ‘Town Hall’ meeting of WHO staff on Tuesday, heard by Health Policy Watch.

The $1.9 billion gap means that WHO is short nearly 45% of the funding it needs to run even on a the reduced budget of $4.2 billion that had been planned for the upcoming 2026-2027 budget period, Imre Hollo, WHO official in charge of Planning, Resource Coordination, and Performance Monitoring, told staff at the Town Hall meeting. 

The outgoing administration of United States President Joe Biden never paid the US 2024 dues of $130 million owed before leaving office, Raul Thomas, Assistant Director General of Business Operations, revealed at the meeting.  Withdrawal of the United States, WHO’s largest donor historically, has been the key factor in the crisis. The US gave WHO nearly $1 billion in fixed as well as voluntary contributions in 2022-23,

Altogether, the United States owes $260 million in dues for 2024-25 – funds that WHO is unlikely to ever receive from new US President Donald Trump despite a legal obligation to pay. Trump announced in January that he is pulling out of the global health agency, but the withdrawal will only be effective January 2026 as the US is obliged to give a year’s notice.  

Reductions ‘starting with senior leadership’ Tedros pledges

Budget projection and gap from a WHO briefing presented to member states last week. On Tuesday, WHO officials said the gap is even larger – totaling $1.9 billion.

Speaking to WHO staff worldwide via Zoom, Director General Dr Tedros Adhanom Ghebreyesus pledged that the reductions in staff will be made, “starting with senior leadership, but will reflect all levels and regions.

“The reduction will be done carefully and strategically based on a prioritization exercise that we are now conducting to ensure we focus on 0ur core functions, leveraging our comparative advantage and delivering the greatest possible impact with our reduced resources. 

“Everything is on the table, including merging divisions, departments and units, and relocating functions,” Tedros said. 

“We aim to complete the prioritization exercise in the second half of this month, At that point, we will be able to provide more clarity about the size of the reduction and how it will be done. 

“They [cuts] will be made according to the outcome of prioritization, and not according to contract type, grade or anything else,” he stressed. 

A “prioritization working group” is being led by Deputy Director General Dr Mike Ryan, together with the Regional Director for Europe, Hans Kluge, and the Regional Director for the Eastern Mediterranean Region, Hanan Balkhy, Tedros said. They are being supported by Thomas, of business operations, as well as Jeremy Farrar, currently WHO chief scientist and former head of the multi-billion philanthropy, Wellcome Trust.

Despite management transparency pledge, Staff Association hasn’t been included 

Some 9473 WHO staff are deployed at headquarters, regional offices and in some 120 countries. Here, a WHO field staff member speaks to a woman fetching water from a water catchment tank in Kiribati, a Pacific Island nation threatened by fresh water shortages due to climate change.

While Tedros has said that the WHO Staff Association would be engaged in the process, Staff Association President Catherine Kirorei Corsini told meeting participants that to date they have not been engaged, as reported in Health Policy Watch on Monday. 

“Just to make a disclaimer of the Staff Association, we appreciate feedback that we have received so far from management. But we want to inform you that up to this point, the Staff Association has not taken part of the decisions that have been made. That was done by the prioritization exercise working group,” Corsini said, while also posing questions about staff rights in the event of inevitable layoffs.

“Can management ensure a three months’ period for all staff, regardless of contract type? How will you prioritize existing staff for vacant positions that are currently in the house?” Corsini demanded.

“How do you ensure not pushing our younger people on more precarious contracts? What are the implications for staff on parental leave? Will staff be prioritized over contracts, over contractors?”

Corsini also asked why WHO did not even receive the 2024 assessed US contribution of $130 million. That could have been paid before the January 2025 departure of US President Joe Biden, who was highly supportive of WHO, from the White House. 

 “They traditionally always pay late,’’ replied Thomas.  “So we were under the impression, up until the end of this year, that we would have been paid. And even early this year, there were indications that they were going to pay. Then, in the exercise in Washington, nobody received any funding in terms of international organizations.”

Fact check: Tedros denies nearly $100 million spent on directors and senior leadership 

Sources: WHO bi-annual HR reports, and UN salary scales, in comparison to proportion of costs attributable to entitlements and benefits. Note: Costs of P6 positions, while comparable to D1, are included in the P- category, not D category.

In his comments at the Town Hall, Tedros also denied that WHO is spending nearly $100 million on the contracts of 215 directors at D1 and D2 grades along with the organization’s senior leadership; the latter includes the DG and his 11 member team at headquarters as well a five WHO regional directors.

Commenting directly on a Health Policy Watch assessment published 10 March, Tedros claimed the “nearly $100 million” cited in the report also included some 86 P6 staff members, who are on the same salary scale as the D1s but play a very direct role in managing many WHO teams and units. 

However, that is not a correct. In the Health Policy Watch analysis, published on 10 March, costs of directors and senior leadership were separately assessed  – with an estimate of $92 million attributed to the 215 officials holding D1 posts, on up to the level of the Director General himself.  

A separate assessment was made for some 86 P6 positions, amounting to costs estimated at $37.5 million, for a total of $127.6 million – as per the breakdown in the table below. 

Sources: Appendix 1 to WHO staff rules 2024, effective as of January 2023, EB 2023 Salaries of Ungraded Positions and 31 July 2024 HR update: Estimates are based on costs of a D2 at Step VI and a D1/P6 at Step X of the published salary scale.

Without an official, transparent disclosure by WHO of the average, per capita costs of all staff positions, at all grades and at all locations – it’s difficult to derive more refined estimates, a point noted in the original article. 

Notably as well, the Health Policy Watch estimates also did not include senior leadership, directors or staff at the Pan American Health Organization (PAHO).

The PAHO budget is managed separately by member states of the Americas region, and so data on PAHO staff and their costs are not typically included in the global WHO HR reports. 

Even so, PAHO, also known as the Region of the Americas (AMRO), receives some budget from WHO headquarters, and stands to be affected by the overall crisis. But the extent of those impacts could be more limited if the US remains a member of the storied organization, founded in 1902.

PAHO’s 123 year-history pre-dates WHO’s creation in 1948 after World War II. And the US, which played a pivotal role in PAHO’s creation, so far has not announced any move to pull out. 

Pledges new top-level organogram – but no details on existing structure  

WHO’ Director General Dr Tedros Adhanom Ghebreyesus’ Senior Leadership team at Headquarterrs.

At the Town Hall, Tedros also pledged to provide a new top-level organigram of WHO’s proposed new structure as soon as the prioritization process was completed. 

However, unless the current organigram of the entire organization is also disclosed – it’s impossible for staff or member states to assess the efficiencies proposed as a result of the current prioritization exercise against any baseline, WHO experts told Health Policy Watch. 

A complete mapping of WHO’s teams, departments and stafffing has not been published since 2019, when Tedros led the WHO “transformation” aimed at making the organization more responsive and fit for purpose.

In that exercise, existing and proposed mappings of all WHO teams, at least at headquarters, were made available to the Staff Association, as well as to individual department teams, for review and inputs. 

Retrospectively, it’s now apparent that the 2019 WHO transformation also led to an expansion in the number of WHO divisions, directors and senior leaders in  subsequent months and years. But  organizational mappings were never updated in line with the many ad hoc changes made.

During the COVID pandemic, when many donor countries expanded voluntary contributions to WHO, as well as in the post-pandemic period, there was also a doubling in the numbers of temporary contractors worldwide, to over 7,500 in July 2024.

South East Asia Regional Director absent from the meeting 

At the town hall, WHO’s South East Asia Regional Director Saima Wazed was noticeably absent from the meeting. Regional Directors from all other WHO regions – including Africa, the Americas, Eastern Mediterranean, Europe and the Western Pacific  –  were present and spoke. 

Wazed is the object of two criminal cases filed in late March, by Bangladesh’s Anti Corruption Comission (ACC) for fraud, forgery, and misuse of power in connection with her campaign to become the WHO’s top official in the South East Asia region, as reported by Health Policy Watch on 22 March. See related story:

WHO Regional Director Saima Wazed Accused of Fraud and Forgery by Bangladesh Authorities

The charges against Wazed, who took office as WHO Regional Director in January 2024 following her election by SEARO member states, are the culmination of an ACC investigation that began in January 2025.

Her  2023 WHO election campaign also was overshadowed by charges that her influential mother, former Bangladesh Prime Minister Sheikh Hasina, had used her influence to gain her daughter’s election to the post a few months before widespread protests prompted Hasina’s resignation and flight from the country in 2024.

The SEARO region, which Wazed heads, faces a salary shortfall alone of about $12 million in 2025, according to a breakdown presented to WHO directors this week. But the largest gap, by far, is in  headquarters, facing a whopping $173 million salary gap, followed by the African region, according to a presentation made to WHO directors this week, and seen by Health Policy Watch.

It was unclear if those figures include all salary costs. And while staff salaries comprise the largest component of the budget, costs for consultancies, operations and maintenance, travel and also medical supplies, in the case of emergency operations, are other significant components.

WHO staff salary gaps by region, as portrayed in slides circulated to WHO directors this week.

Image Credits: WHO / Yoshi Shimizu, WHO HR and EB records, 2023-2024, WHO .

Candida auris is a multi-drug-resistant fungus

There is a “critical lack” of medicines and diagnostic tools for invasive fungal diseases, according to the World Health Organization (WHO), which released its first analysis of antifungals on Tuesday.

Invasive fungal diseases are on the rise, particularly in immune-compromised people – yet they get little attention or resources, asserts the global body.

Common infections such as candida (which causes oral and vaginal thrush) are growing increasingly resistant to treatment, but there are not enough medicines in the pipeline to combat this.

Several current anti-fungal treatments cause serious side effects, frequent drug-drug interactions, and treatment requires prolonged hospital stays. 

“Invasive fungal infections threaten the lives of the most vulnerable but countries lack the treatments needed to save lives,” said Dr Yukiko Nakatani, WHO interim Assistant Director-General for Antimicrobial Resistance. 

“Not only is the pipeline of new antifungal drugs and diagnostics insufficient, but there is a void in fungal testing in low- and middle-income countries, even in district hospitals,” added Nakatani.

“This diagnostic gap means the cause of people’s suffering remains unknown, making it difficult to get them the right treatments.”

Only four new drugs in a decade

In the past decade, only four new antifungal drugs have been approved by regulatory authorities across the United States, the European Union and China. 

Nine antifungal medicines are in clinical development against the most health-threatening fungi identified in the WHO’s fungal priority pathogens list (FPPL), according to the WHO analysis, which conducted a rigorous evaluation of antifungal agents in clinical and preclinical development with the assistance of an expert advisory group on the R&D of novel antifungal treatments.

Only three of the nine are in phase 3 trials, which means “few approvals are expected within the next decade”, according to the WHO. 

“Children are particularly underserved with few clinical trials exploring paediatric dosing and age-appropriate formulations,” the global body notes.

Critical priority pathogens

Many of the fungi in the critical priority pathogen (CPP) category of the WHO’s FPPL are deadly, with mortality rates reaching as high as 88%.

This critical group includes Cryptococcus neoformans (which causes cryptococcal meningitis); Candida auris (causes infections, including in wounds and blood); Aspergillus fumigatus (causes aspergillosis, a lung infection) and Candida albicans (thrush). 

These infections disproportionately affect those with weakened immune systems, including people undergoing cancer chemotherapy, living with HIV, and who have had organ transplants.

Candida auris is particularly drug-resistant and often acquired by vulnerable people in hospitals.

The nine new antifungals all target the critical group – and most target more than one of these fungal infections. 

Aspergillus fumigatus is targeted by the highest number of antifungal candidates, followed by Candida albicans and Candida auris. Cryptococcus neoformans gets the least attention.

There are 22 drugs in pre-clinical development, but this is “insufficient” given the dropout rates, risks and challenges associated with earlier development stages, says the WHO.

Antifungal drugs preclinical pipeline

Diagnostic challenges

Current tests for fungal priority pathogens “rely on well-equipped laboratories and trained staff, which means that most people in low- and middle-income countries (LMICs) do not benefit from them”, according to the WHO’s diagnostics analysis. 

In addition, these tests “work only for a limited range of fungi, are insufficiently accurate and take a long time to obtain results”. Health workers often lack knowledge about fungal infections.

WHO recommends investing in global surveillance, expanding financial incentives for drug discovery and development, funding basic research to help identify new and unexploited targets on fungi for medicines, and investigating treatments that work by enhancing patients’ immune responses.

It also urges the development of “faster, more accurate, cheaper and easier” tests for a broad range of fungal priority pathogens.

Image Credits: Science Media Centre, WHO.

air pollution quilt
Air pollution impacts the most vulnerable, including children showcased in a quilt from the Indian advocacy group Warrior Moms.

From Warsaw to Mexicali, a group of mothers from six cities worldwide came together to create and present a quilt highlighting the threat of dirty air to their children at the World Health Organization (WHO) Conference on Air Pollution and Health held in Cartagena, Colombia last week.

Each block of the quilt tells the story of a child suffering from the harmful effects of poor air quality, highlighting the devastating impact of pollution on children’s health in Warsaw (Poland), Quito (Ecuador), Jharia (India), Akim Wenchi (Ghana), Mpumalanga (South Africa) and Mexicali (Mexico).

The idea of a quilt surfaced a couple of months before the 2021 climate change conference, COP26, within the Indian movement, Warrior Moms. They wanted it to carry the faces of children from across India and intertwine their stories of pollution, representing at least one city from each state. 

Logistical challenges prevented the project from taking off in time for COP26, but  a few months ago, as a new global delegation of mothers called ‘The Clean Circle’ was taking shape, the idea resurfaced.

Warrior Moms, founded by Bhavreen Kandhari, reignited the project weeks ahead of WHO’s Air Pollution and Health conference. 

After meetings that lasted until midnight meetings, a proposal was put to WHO, which enthusiastically embraced and encouraged the initiative.

Kandhari, the mother of twins, has been at the forefront of the fight for clean air to ensure a better life for future generations.

“Air pollution is a child killer, accounting for one in five deaths of children under five. The ‘Quilt of Hope’ is a living testimony to the urgency of the air pollution crisis, calling on political leaders to safeguard our children’s future,” Kandhari said.

Six regions, one health challenge

This time, the logistics were meticulously planned. Sustainability remained at the heart of the project, with upcycled fabrics forming the quilt’s foundation. 

Small fabric samples were exchanged, tested, and reworked. But beyond materials and design, the real challenge for these mothers was to find artisans who would stitch this powerful symbol with the care and reverence it deserved. 

That’s when the craftswomen ‘Shades of India’, stepped in and pieced together – not just fabric, but stories, hope and resilience with skills and unwavering dedication. 

The process of gathering these images faced numerous challenges. The resolution of photos varied, making it difficult to ensure uniformity in print. 

In Jharia, where pollution from coal fires darkens the skies, finding high-quality images was especially tough. But photographer Vishal Singh captured striking images of the children, ensuring that their stories were not just seen but felt by every individual.

While the quilt features stories from six different regions, the health consequences of air pollution remain tragically similar: bronchitis, asthma, and other respiratory illnesses.

Ana Badillo, the mother of a five-year-old child, said that she put her child’s image on the quilt to show that the air pollution crisis is real, personal, and urgent.

“As a mother, I watch my child breathing toxic air in a city that should be full of life, not smog. Quito’s air is stealing our children’s health and their futures. Clean air is not a privilege, it is their right. We want leaders to feel this concern of mothers across the globe,” Badillo said. 

Asthma and developmental delays

The top left section of the quilt depicts a mother with her two children, one of whom is wearing an oxygen mask in Mpumalanga in South Africa, a region where coal-fired power plants release some of the highest levels of sulphur dioxide in the world, contributing to rising cases of asthma and developmental delays in children.

The story of a 12-year-old boy, Suresh, from Jharia, India, is highlighted in the top left corner. Suffering from chronic bronchitis since childhood due to underground coal fires in his region, Suresh’s experience is a stark reminder of the long-term health effects of air pollution.

The centre of the quilt showcases narratives from Mexico and Ghana, representing worsening asthma attacks and limited access to healthcare.

In Warsaw, Poland, smog from vehicle emissions and coal heating during winter fills the air, forcing children like Maciek, whose image appears in the bottom right corner, to carry an inhaler just to get through the school day. The seven-year-old has been struggling with bronchial hyperreactivity for the past year.

The last image from Quito, Ecuador, shows a five-year-old child wearing a mask and holding a banner.

 A call to action

Each panel in the ‘Quilt of Hope’ is not just fabric, it holds the emotions, struggles, and resilience of mothers who, despite living continents apart, are united by the same fight for their children’s right to breathe clean air. It is a testament to sustainability, craftsmanship, and resilience.

According to the delegation of mothers, the Quilt for Hope was not just a display at the WHO Conference in Cartagena, it was a call to action.

“As policymakers, scientists, and health professionals gathered to discuss the urgent need for cleaner air, the quilt serves as a tangible reminder that, behind every statistic, there is a child struggling to breathe,” the mothers said.

 

Image Credits: A. Bose/ HPW.

Over 2,600 people are now reported to have died in the two powerful earthquakes that devastated central Myanmar last Friday, while thousands have been injured or are missing, trapped under the rubble.

The 7.7- and 6.4 strength quakes hit regions of Mandalay, Nay Pyi Taw, Sagaing, Bago, and Shan regions, which are also where most of the almost 20 million people displaced by conflict have been living.

Thailand’s capital, Bangkok, was also affected with 17 people reported dead, while in Ruili city, in China’s southeastern Yunnan province, 2,840 people have also been affected and 847 houses have been damaged.

The World Health Organization (WHO) is “responding at its highest level of emergency activation”, but the cash-strapped global body has appealed for donations, as it needs $8 million to “deliver life-saving trauma care, prevent disease outbreaks, and restore essential health services over the next 30 days”.

Three hospitals have been destroyed and 22 have been partially damaged in the country, according to the WHO.

“Hospitals are overwhelmed with thousands of injured in need of medical care. There is a huge need for trauma and surgical care, blood transfusion supplies, anaesthetics, essential medicines, management of mass causality, safe water and sanitation, mental health and psychosocial support among others,” reported WHO.

UNICEF has also called for “urgent funding to scale up the delivery of life-saving support to children and families affected by the earthquake, including clean water, medical care, protection, psychosocial support, and emergency education”.

Myanmar has been controlled by a military junta since 2021, and foreign media are not allowed into the country. 

Meanwhile, China, Russia, India, Thailand, Malaysia and Vietnam have sent aid to the country – but the United States, which has dismantled its Agency for International Development (USAID) has not yet responded, according to the New York Times.

Some staff were preparing a response on Friday rwhen the received layoff notices, the newspaper added.

Myanmar, which has been controlled by a military junta since 2021, has reportedly refused to allow foreign media into the country to cover the earthquake.

However, Myanmar miliary leader Min Aung Hlaing issued a rare “open invitation to any organizations and nations willing to come and help the people in need within our country,” after the quakes – an indication of the severity of the disaster.

Image Credits: UNICEF.

Scientists at the Flanders Institute for Biotechnology, which developed Nanobody® technology that is the basis for Caplacizumab.

The journey of the medicine, Caplacizumab – from a publicly funded scientific breakthrough to a high-cost pharmaceutical product controlled by a multinational corporation – illustrates the contradictions of the existing drug development system. 

It is a story of public investment, private capital, industrial consolidation, and the persistent question: Who ultimately benefits from medical innovation?

At the heart of this story lies a dilemma that defines the pharmaceutical landscape. On the one hand, venture capital, biotech start-ups, and pharmaceutical corporations are undeniably necessary under the current neoliberal system to bring new treatments to market. 

On the other, the logic of profit maximization, patents, and monopolistic pricing often ensures that life-saving medicines remain inaccessible to those who need them most.

Caplacizumab is a medicine developed to treat a rare and serious blood clotting disorder called acquired thrombotic thrombocytopenic purpura (aTTP), which can lead to blood clots in small blood vessels throughout the body.

Its development is a scientific success. But it is also a cautionary tale about the uneasy relationship between public good and private gain. 

What if there were an alternative that did not rely on the inevitable transition from public research to private ownership? The emerging vision of Public Pharma presents a radically different pathway, challenging the assumption that industrial monopolization is the only way forward.

Caplacizumab: A publicly funded breakthrough

The Flanders Institute for Biotechnology (VIB)

The development of Caplacizumab lies in the publicly funded research of the Flanders Institute for Biotechnology (VIB), where scientists explored the potential of Nanobody® technology – antibody fragments derived from camelids. 

These tiny, stable molecules were an academic curiosity before they became the backbone of life-saving drugs such as Caplacizumab (trade name Cablivi).

This discovery was a testament to the power of curiosity-driven research. Without the support of public grants, institutional funding, and the intellectual freedom afforded to researchers, Nanobody® technology might never have seen the light of day. 

However, scientific discovery, no matter how groundbreaking, is not enough. Translating molecules into medicines requires capital, infrastructure, and expertise in clinical development.

This is where the state played a second vital role, not just as a funder of early research but as a creator of an environment where biotechnology start-ups could thrive. 

Belgium, recognizing the economic and medical potential of biotech, provided tax incentives, payroll deductions for research staff, and R&D grants to support companies willing to take risks.

These policies laid the groundwork for the creation of Ablynx in 2001—a spin-off from VIB tasked with commercializing Nanobody-based therapies. The company embodied the promise of academia-industry partnerships under the current pharmaceutical eco-system: scientific excellence paired with private investment.

Private capital: Necessary compromise or structural failure?

Ablynx, despite its academic origins, was not a philanthropic endeavor. From the moment it was founded, it needed funding beyond what government grants could provide. Venture capitalists like Gimv and Sofinnova recognized its potential and were willing to take some financial risk of investing in early-stage biotech.

Their bet paid off. Caplacizumab, developed over nearly two decades, demonstrated remarkable efficacy in treating acquired thrombotic thrombocytopenic purpura (aTTP). Clinical trials confirmed a dramatic reduction in the time required for platelet recovery and a significant decrease in relapses.

These results were not inevitable. They required substantial financial investment, regulatory navigation, and strategic decision-making. But the presence of private capital also meant that the endgame was never purely about patient access; it was about return on investment.

This is precisely where the structural failure of the system becomes evident. The reliance on venture capital means that, no matter how much public funding supports early-stage research, the final product is destined to end up as a private asset. Public resources de-risk innovation for investors, but they do not retain any claim over the resulting medicines.

When innovation becomes an asset

By 2018, Caplacizumab was on the cusp of regulatory approval. For Ablynx’s investors, this meant one thing: it was time to sell. Sanofi, one of the world’s largest pharmaceutical corporations, acquired Ablynx for €3.9 billion, securing exclusive rights to the company’s entire Nanobody® platform.

From a business perspective, the acquisition was a success. From a scientific perspective, it was validation. But from a public health perspective, it raised concerns. Caplacizumab, once a product of public funding and venture-backed risk-taking, was now firmly in the hands of a multinational corporation with an obligation to maximize shareholder value.

Caplacizumab, marketed as Cablivi, costs €5,000/vial in Belgium although the government helped to fund its discovery.

What did this mean for patients? It meant that Caplacizumab, now marketed as Cablivi, would be priced at nearly $8,000 per vial in the US with a full treatment course costing around $270,000. 

Even in Belgium—the country that helped fund its discovery—government agencies had to negotiate reimbursement schemes to make it accessible to patients. This medicinal product costs still over €5,000 per vial. 

And so the cycle continued: public institutions fund research, venture capital funds development, pharmaceutical corporations acquire and monopolize, and governments end up paying exorbitant prices to access the very medicines they helped create.

‘Public Pharma’ as an alternative 

If the story of Caplacizumab is emblematic of a system where public investment leads to private gain, what would an alternative look like?

The Public Pharma for Europe (PPfE) Coalition offers a concrete vision for breaking this cycle. The coalition argues that the current profit-driven pharmaceutical model is inherently dysfunctional by prioritizing profit over health, restricting innovation, and keeping essential medicines out of reach. 

Instead of a system where the state merely de-risks investments for private enterprises, Public Pharma calls for full public leadership in the research, development, production, and distribution of medicines.

Under such a system, the development of Caplacizumab might have taken a different path. Instead of transitioning from a publicly funded lab to a venture capital-backed startup and ultimately into the hands of Sanofi, the entire process – from research to commercialization – could have remained in public hands. 

This would not mean a return to slow-moving bureaucracy but rather a new model of state-led pharmaceutical infrastructure, one that prioritizes affordability, access, and transparency.

A Public Pharma approach would have ensured:

  • Retention of public ownership: Instead of selling off promising biotech startups, public institutions could maintain ownership stakes, ensuring that profits are reinvested into further research rather than extracted by shareholders.
  • Affordable pricing: Without the need to maximize returns, drug prices could be set based on production costs and equitable access rather than speculative market value.
  • Health sovereignty: Countries and regions would not be at the mercy of multinational corporations for access to life-saving medicines.
  • Democratic oversight: Instead of decisions being made behind closed doors by corporate executives, governance structures could involve public participation and transparency.

The PPfE Coalition asserts that governments should no longer limit their role to mitigating risks for the private sector. Instead, they should take full responsibility for pharmaceutical development to ensure medicines are developed for people, not profits.

Flawed but inevitable?

Caplacizumab’s journey raises difficult questions. Should we reject private capital, knowing that under the current economic paradigm few governments can afford to fund clinical development at scale? Should we reject industry, knowing that corporations provide the infrastructure for global manufacturing and distribution?

The problem is not that industry or investment exist – it is that the terms of engagement overwhelmingly favor the few over the many. If governments and public institutions play a crucial role in early research, why do they relinquish all control at the moment of commercialization? If taxpayers fund innovation, why do they then pay again—often at exploitative prices—to access the resulting treatments?

Caplacizumab is a triumph of scientific ingenuity, but it is also a reminder that scientific breakthroughs alone are not enough. Without structural changes, they will continue to follow the same path: from the lab to the marketplace, from the public to the private, from a breakthrough for humanity to an asset for shareholders.

The PPfE Coalition offers a bold alternative that ensures that life-saving medicines remain what they were always meant to be: a public good, not a private asset.

David Franco is a scientist and public health activist based in Leuven, Belgium. As a member of the People’s Health Movement, he focuses on the Public Pharma for Europe (PPfE) initiative, where he supports grassroots struggles for health justice and equity. David holds a PhD in Pharmaceutical Sciences from the Free University of Brussels (VUB).

Image Credits: VIB.

As the World Health Organization (WHO) grapples with an estimated $600 million funding gap for 2025, it is planning to slash its biennial 2026-27 budget by 21% from $5.3 billion to $4.2 billion, according to an email Friday from Director General Dr Tedros Adhanom Ghebreyesus, obtained by Health Policy Watch.

But despite the DG’s promises that the WHO “Staff Association will play an active role”, critical decisions about workforce reductions, budget allocations, and organizational restructuring are being made behind closed doors so far.

The Staff Association, representing WHO’s 9,473 staff members worldwide including 2,666 in headquarters, has had no real access to the data underpinning critical choices that must be made over how and where to cut the budget. 

“This is not just about numbers – it’s about trust,” said one senior staff member. “We were promised transformation with people at the center. What we’re seeing now feels like a rollback of everything we fought for.”

In his recent message to staff, Tedros promised that the restructuring, however tough, will also be conducted “with fairness, transparency, and humanity.”

 “Despite our best efforts, we are now at the point where we have no choice but to reduce the scale of our work and workforce,” he said. “This reduction will begin at headquarters, starting with senior leadership, but will affect all levels and regions.”

Key information about costs, organigram remain unpublished  

According to an internal briefing presented to member states last week, and seen by Health Policy Watch, WHO is weighing a series of measures to cope with the financial shock that include:

  • A 20% average budget cut across all base programmes
  • The elimination of over 40% of current outputs – eg. products that are typically part of the World Health Assembly 
  • A 25% reduction in staff positions
  • The merging of entire divisions, departments, and units
  • Relocation of functions away from Geneva to regional and country offices.
Budget projection from the internal briefing presented to member states.

These are hard, necessary decisions. But without access to information about current costs and staff positions, it ia almost impossible for either member states or staff members to play an active role in reviewing priorities or plans. The most glaring omissions include items such as:  

  • A current organigram of staff and management distribution: the most recent one is from 2019 when WHO’s initial “transformation” process, intended to make the organization more efficient and fit-for-purpose, was launched by Tedros shortly after he first assumed office.  Despite multiple ad hoc changes since, the only organisational mapping current to 2025 is of divisions and their department heads at headquarters. 
  • Costs of staff positions by grade and region: real costs vary wildly from published salaries due to multiple layers of post adjustments, entitlements and agency contributions to pension and insurance funds.
  • Costs of consultancies along with more granular data about the number of full-time-equivalent consultants per region.

Also critical to consider are the savings that could be gained from other big-ticket items such as moving key tasks and staff to regional or country offices, 

But along with the resistance to “mobility plans” by staff at headquarters, there is also fierce debate within the organization about what tasks could be most effectively relocated, and what core functions (eg WHO standards and guidelines development) would best be retained at headquarters. Irrespective of which way the debate ends, keeping key HQ normative functions can still be retained if relevant staff are moved to less expensive duty stations, 

Certain technical support functions, such as IT support, could feasibly also be moved to much cheaper European locations, such as Lyon and Istanbul. More digitized administrative processes could also save administrative costs and staff. 

Directors without portfolios?

Sources: Appendix 1 to WHO staff rules 2024, effective as of January 2023, EB 2023 Salaries of Ungraded Positions and 31 July 2024 HR update: Estimates are based on costs of a D2 at Step VI and a D1/P6 at Step X of the published salary scale.

In an exclusive, Health Policy Watch documented the top-heavy structure of WHO’s senior leadership that has evolved, unbeknownst to most since 2017. Over the past eight years, the number of senior directors (D2) has nearly doubled, and the total cost of directors at both D1 and D2 grades, plus WHO’s senior leadership (ADGs and Regional Directors) are now costing the organization close to $100 million annually.

In terms of a top-heavy senior management, WHO insiders also point to the uneven distribution of tasks between different directors and the large teams associated with every Assistant Director General as potential areas for efficiencies.

While some directors manage large departments of dozens of people, others manage teams that include only a handful of staff or may not actively manage teams or departments at all, insiders report.  

“When we began looking at the directors in our region, we found that two D2s had been appointed for six-month contracts without any clarity about their roles,” said one senior scientist working in a regional office. 

Another issue emerging is the entourage of staff around each of the 10 Assistant Director Generals serving on Tedros’ leadership team in headquarters, not to mention the Deputy Director General and the office of the Director General. 

It is estimated that each ADG is managing a team of 6-7 people – which together with the ADG’s own post. But even an ADG plus a team of just 4-5 people, will  cost the organization an estimated $1.5 million, as a conservative figure, considering an average cost of $250,ooo per position for a team including senior advisors and professionals along with administrative staff.  Again, since no organigram or published costs of staff posts exists, only estimates can be made.   

The March Health Policy Watch investigation also revealed that consultants now make up over half of WHO’s workforce – 7,579 posts in comparison to the 9,473 staff. That is a precarious and costly staffing model in light of the administrative management requirements of consultancy contracts.  

Can’t continue to operate like a think tank

Sources: WHO bi-annual HR reports, and UN salary scales, in comparison to proportion of costs attributable to entitlements and benefits. Note: Costs of P6 positions, while comparable to D1, are included in the P- category, not D category.

“WHO cannot continue to operate as if it were a luxury think tank,” one anonymous official told Health Policy Watch. “We need boots on the ground not bloated bureaucracy in headquarters.”

The situation has led many to ask: If WHO is indeed undergoing a prioritization process, why are all divisions still fighting to preserve their full portfolios? Why have no clear de-prioritizations been communicated? 

In a climate where transparency is a necessity, the apparent sidelining of frontline voices adds to a growing anxiety about how this restructuring will unfold.

A WHO Global Town Hall is scheduled for Tuesday, April 1, where senior leadership is expected to provide further clarity to staff. But for now, trust is fraying and WHO stands at a crossroads: either double down on the values of its 2019 transformation—or risk losing the confidence of the very people it relies on to carry out its mission.

 

Image Credits: US Mission in Geneva / Eric Bridiers via Flickr, WHO HR and EB records, 2023-2024.

Second from right, Colombia President Gustavo Petro at Thursday’s close of the WHO Conference on Air Pollution and Health.

CARTAGENA – Colombia President Gustavo Petro launched into a blistering attack on the new administration of United States President Donald Trump on the closing day of a three-day WHO conference here on air pollution – warning that progress on critical environmental health and climate topics depends on the “common agenda” that has been fostered by the system of multilateral cooperation – “and if the multilateral system doesn’t exist all of this will be in vain.”

The Trump administration, with its ultranationalist agenda, is “repeating the mistakes of history,” that led to the rise of fascism and  World War 2” he warned, saying, “we need to act against a vision that aims to impose itself over all of humanity. 

He warned that in the new international order the US is trying to shape, ideology threatens to overcome scientific facts, adding: “As George Orwell said in 1984, when each individual will imagine their own reality – then one of the victims of that new reality is health.”

And the “greed” of unbridled markets dominated by fossil fuel interests, meanwhile, stands in the way of a clean energy transition that would clean up the air and stabilize the climate, he said.

Turning calls for change into action

The conference featured a call to action signed by organizations representing 47 million health care professionals and other members of civil society. Center, WHO’s Maria Neira.

The president spoke ahead of a closing day that saw 17 countries and about 40 cities, civil society organizations and philanthropies make commitments to reducing air pollution – along the lines of a WHO call for halving air pollution-related mortality by 2040. 

Some 47 million health care professionals also signed a call for urgent action to reduce air pollution, published at the conference opening.

“Now, our collective task is to turn this call into action. Last month, WHO’s Executive Board agreed to a new global target to reduce the health impacts of air pollution by 50%,” said WHO Director General Dr Tedros Adhanom Ghebreyesus in a video-taped statement to conference participants.  “We estimate that meeting this goal would save around 3 million lives every year.”

But with few high-level ministers in attendance at the Cartagena event, rallying more member states to the new WHO global target needs to be a long-term endeavor taken up at other climate and health fora, and with mechanisms and funding for tracking of progress over time – something lacking until now. 

The most immediate opportunity will be the upcoming May World Health Assembly – when member states are expected to review and adopt a new WHO Road Map for reducing air pollution’s health impacts, which includes the 50% target in the text. At February’s Executive Board meeting,  the 34 member governing body endorsed the Road Map. Final WHA approval in May would clear the way, at least politically, for a sustained effort amongst member states to meet the 50% target.   

Until now, there has never been a clear, quantifiable UN Sustainable Development Goal or WHO target for reducing air pollution, against which progress can be monitored and reported. SDG Target 3.9.1 , which calls for a “substantial” reduction in air pollution deaths and illnesses, is not really a target it all.

In addition, the health and economic benefits of air pollution mitigation, particularly the dual air and climate pollutant black carbon, need to be recognized more fully in climate treaties and finance mechanisms – and trillions in fossil fuel subsidies shifted to clean air incentives –  conference participants stressed over and over again.

Conference commitments are largely symbolic

China CDC representative commits to sharing its successful experiences in controlling air pollution with other developing nations.

In a difficult geopolitical climate, US government officials, who would have typically been a forceful presence at a WHO conference held in the Americas, were entirely absent.  And most European nations did not send ministerial-level delegates. Public commitments made at the conference were often more symbolic than tangible – representing only the start of a long, uphill battle for change. 

China and Brazil, as well as the United Kingdom, Mexico and Vietnam, for instance, committed to strengthening their air quality standards to align more closely with WHO air quality guidelines, although specific targets were not named.  China also said it would expand international collaborations on air pollution, based on its own national successes in driving down exceedingly high air pollution levels. 

Spain committed to a carbon-neutral health-care system by 2050, and Colombia committed to expand initiatives that improve air quality through a clean energy transition and advanced wildfire prevention and mitigation. 

Germany, Mongolia, Norway, Cuba, Mongolia and Mexico were among the countries commiting to reducing emissions in other key sectors, from agriculture to transport. Mexico said it would incorporate black carbon, a powerful climate as well as air pollutant, into national vehicle regulations to reduce particulate matter emissions. Mexicoi, together with Mongolia and Vietnam, also pledged to make air quality and health data publicly available.

Conflict-wracked Somalia committed to a 75% transition to clean cooking by 2040. The Philippines, Pakistan and Cuba also made various forms of commitments, as well as France.

India has already set a target of reducing particulate air pollution by 40% by 2026, over a 2017 baseline, said Dr Aakash Shrivastava, of the Ministry’s National Center for Disease Control, adding, “Even if this target is delayed it will likely progress towards 35% [reduction] by 2035,” in lines with the target outlined by WHO.  

On behalf of the powerful C40 cities network, representing almost 100 of the world’s biggest cities, the Deputy Mayor of London, Mete Coban, committed to advancing urban goals and strategies in line with WHO’s 2040 target and roadmap.

Meanwhile, the Clean Air Fund committed $90 million over the next two years to a series of ongoing air pollution and climate initiatives. Among those, it is collaborating with C-40 and Bloomberg in the new “Breathe Cities” network that is financing urban air pollution mitigation efforts – from afforestation to clean transit and waste management – in dozens of low- and middle income cities and towns across Africa, Asia and Latin America. It aims to expand the network to 100 cities by 2030. 

Action at urban level and repurposing fossil fuel subsidies 

Jane Burston, Clean Air Fund, describes how action at city level can benefit health, air quality and climate.

A Clean Air Fund report launched at the conference found that halving the health impacts of air pollution by 2040 in just 60 cities worldwide could avoid 650,000-1 million deaths a year and save up to $1 trillion annually. 

Large cities, in particular, often wield considerable budget, regulatory and planning clout that can empower them as early adopters of new approach. 

“To tackle toxic air pollution as an issue of social justice,” said London Deputy Mayor, Mete Coban, who described how he grew up thinking it was normal for a kid to carry around a nebulizer for asthma, and now is part of London’s city government team that has brought center city air pollution levels down to suburban levels in just a few short years, through strategies such as the creation of an ultra-low emissions traffic zone.

“It’s an issue of racial justice, but also it’s an issue of economic justice; Mayor of London, Sadiq Khan has put his own political career on the line because he doesn’t want to keep kicking the can down the road.”

Mete Coban, Deputy Mayor, City of London, describes the sharp decline in the cities’ air pollution emissions. seen since 2017.

Even so, national governments need to create a stable regulatory environment as well as consider the quantifiable air pollution and health benefits of clean energy and green sector investments, in government tax and finance policies, Jane Burston, head of the Clean Air Fund, told conference participants.  

“We found, for example, that climate investments only very barely consider the economics of the parallel reduced air pollution, and when that’s added in a third more climate investments become positive for ROI (return on investment),” Burston said. 

Governments also need to cut back on the trillions of dollars being spent on fossil fuel subsidies and redeploy those monies into clean energy and other healthy development strategies.

“Subsidies for fossil fuels for agriculture and fisheries exceed $7 trillion, that’s 8% of GDP, she said, citing the World Bank’s  2023 Detox Development report. 

“We know that there’s a shortage of development aid and at the same time, governments are spending trillions on ineffective subsidies that are worsening climate change,” Burston said.  “Money is tight. We know that. That’s why we need to invest in solutions that pay dividends in multiple ways… Clean Air is that solution, and investing in clean air isn’t only the right thing, it’s the smart thing.”

A 65% increase in annual investments could lead to transformative changes

Benoit Bosquet, the Bank’s Regional Director for Sustainable Development in Latin America and the Caribbean.

A World Bank report launched at the conference, meanwhile, projected that an integrated basket of about $14 billion annually of investments in energy, transport, waste and other pollution producing sectors could halve by 2040 the number of people exposed to average outdoor (ambient) air concentrations of the most health harmful pollutant, PM2.5 above 25 micrograms per cubic meter (25 µg/m3). 

The relatively modest investments, roughly a 65% increase over current spending levels of about $8.5 billion a year, would reduce related air pollution mortality by about 2 million annually. The measures would also reduce emissions of black carbon by as much as 75 percent and yield about $1.9-$2.1 trillion in economic returns annually, said Benoit Bosquet, the Bank’s Regional Director for Sustainable Development in Latin America and the Caribbean.. 

Conversely, in a business as usual scenario, exposure to levels of outdoor air pollution above (25 µg/m3), will affect nearly 6 billion people by 2040, as compared to about 3.3 billion today, he warned. 

Costs of air pollution today are estimated at about $8.1 trillion, or about 10% of global GDP. 

President: the Amazon to transport, need stronger preventive health systems and strategies

Busy tourist industry, luxury hotels and poverty all collide in the coastal city of Cartagena.

But while the financial case for change, on paper, may be crystal clear, in the reality of a developing country, the challenges are far greater, as the Colombian president vividly described. 

“You are here in one of the most unequal cities in the world,” he declared. “Outside of the walled city, a few steps from the millionaire dachaus, you’ll find the poor neighborhoods of Colombia’s former slaves.  Draw a map of the ATMs, and you’ll also find the private hospitals and clinics – beyond which a huge proportion of the population has been left behind.”

Against that landscape of stark contrasts between rich and poor, the challenges for Colombia to weaning itself away from the oil economy are all the more daunting, he said. Beyond the view of the luxury yaughts anchored in the city’s marinas, off shore oil rigs line the Pacific coast, providing the second largest source of income for the region after tourism. 

Dirty diesel remain the dominant energy source for transport, and the results are palpable in the smoke belching from tourist buses and trucks that clog Cartagena’s city center. Despite the acclaim that Bogota received several decades ago for its pioneering urban bus rapid transit system, initiatives to shift to cleaner fuels have so far stalled, thanks to oil industry pressures.

“There is no electric bus transport,” Petro declared, describing efforts underway now to change that.

Colombia President Gustavo Petro.

Criminal gangs continue to deforest parts of Colombia’s Amazon region, changing rainfall patterns and watersheds so dramatically that rivers around Bogota have dried up entirely and the capital city faces chronic water shortages. But the poverty driving such illegal land grabs is also a legacy of the colonial era, which robbed peasants of farmland and left them landless, the president pointed out. 

A transition to clean energy, and steps to restore deforested parts of Amazonia are critical “preventive” health policies that are critical to stabilizing planetary systems, and staving off the next “pandemic” leap of animal viruses to humans, Petro asserted. 

“Better nutrition, physical exercise and clean air are critical to prevention,” he said.  “And stronger preventive health systems are critical to combat new viruses coming due to climate change,” he said. “But in prevention there is no business incentive.  The market makes money on diseases, not preventing them.

“The planet is becoming warmer, but that’s not because of humanity, that is the poor people, it’s because of big capital imposing itself on the world, because of greed…. Decarbonization, to stop using coal, oil and gas, means a change in the powers of production; it won’t happen just because of politically correct declarations,” he added. 

“Some 34 deaths out of every 100,000 in Colombia are due to air pollution – more than by murder – and Colombia has one of the highest murder rates in the world. We are dying from our own air …because of greed.” 

Image Credits: HP Watch .

The Department of Health and Human Services oversees the US health system, including the FDA, CDC, NIH, and Medicare and Medicaid programs that serve millions of Americans.

The Department of Health and Human Services will cut an additional 10,000 full-time employees, bringing total reductions to nearly a quarter of the federal workforce responsible for Americans’ health.

HHS Secretary Robert Kennedy Jr., who rose to prominence as the leader of the world’s largest anti-vaccine activist group before taking control of the US health system, announced Thursday the cuts would save $1.8 billion annually from the agency’s $2 trillion budget – a cost reduction of 0.09% in exchange for a loss of 20,000 total employees.

“I think most Americans would agree with me that throwing more money at healthcare isn’t going to solve the problem, or it would have solved it already,” Kennedy said in an address posted to social media. “Obviously, what we’ve been doing hasn’t worked.”

The cuts are part of an all-out assault by the Trump administration on the federal workforce overseen by billionaire Elon Musk and his pseudo agency, the Department of Government Efficiency, or DOGE, HHS said in a media release. 

“The entire federal workforce is downsizing now, so this will be a painful period for HHS as we downsize from 82,000 full-time employees to around 62,000,” Kennedy said, describing the agencies he oversees as “pandemonium,” “fiefdoms,” and a “sprawling bureaucracy.”

Despite cutting thousands of government programs, billions in grants, and eliminating tens of thousands of federal jobs, the Trump administration has so far failed to slow spending, with the US government spending more during Trump’s first month than during the same period last year.

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy said. “This Department will do more – a lot more – at a lower cost to the taxpayer.”

‘All that money’

The cuts will be distributed across several key agencies, according to a fact sheet posted by HHS.

The Food and Drug Administration will lose approximately 3,500 employees, though officials insist drug reviewers and food inspectors won’t be affected. The CDC will shed about 2,400 staff members as it “returns to its core mission” of epidemic response. The National Institutes of Health will eliminate 1,200 positions by consolidating administrative functions. The Centers for Medicare and Medicaid Services will cut 300 employees, with officials claiming this won’t impact services to beneficiaries.

These identified cuts account for just 7,400 positions, leaving thousands more staff reductions still unspecified in the department’s announcements.

The fact sheet characterized the changes as a “dramatic restructuring” while noting that under the Biden administration, health spending increased by 38% and staffing grew by 17%. Kennedy sharply criticized those increases as ineffective and wasteful: “All that money has failed to improve the health of Americans. We are the sickest nation in the world and have the highest rate of chronic disease.”

The Biden-era budget expansions had targeted initiatives related to pandemic preparedness, mental health, and public health infrastructure.

Critics argue these workforce reductions will harm Americans’ access to healthcare while yielding minimal savings. Kennedy and HHS have already been under fire for mass firings, failure to respond to a measles outbreak that has killed the first two Americans in over a decade, and billions in medical research cuts.

Senator Ed Markey, Democrat of Massachusetts, blasted the decision on social media: “RFK Jr. wants to cut 10,000 more jobs at HHS. People are waiting too long and paying too much for care. Meanwhile, this Administration is cutting grants for lifesaving medical research and fighting to cut Medicaid—all to pay for billionaire tax breaks. It’s outrageous.”

The US spends up to four times as much as comparable nations on healthcare per capita, despite being the only developed country without universal health care, according to data from the Commonwealth Fund.

Americans already pay the highest amount per capita for healthcare globally, spending nearly double its OECD counterparts and up to four times more than health systems in South Korea, New Zealand and Japan. Despite these costs, the United States remains the only high-income nation without universal health coverage.

More significant than staffing numbers in America’s healthcare cost crisis is the inability of US taxpayers to negotiate fair prices with pharmaceutical companies that wield enormous influence in Washington. Prescription drugs frequently cost two to four times more in the US than in Canada, the European Union, or Mexico.

HHS oversees all major US health agencies, including the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration. The vast majority of HHS funding supports Medicare and Medicaid, which provide healthcare coverage for elderly, disabled, and low-income Americans.

“We are going to do more with less,” Kennedy added. “No American will be left behind.”

Health in Trump’s image

Robert Kennedy Jr.’s banner photo on X, formerly Twitter, where he boasts over 4.5 million followers.

Across federal agencies, the Department of Health and Human Services is undergoing perhaps the most profound ideological transformation, reflecting the priorities of both President Trump and Kennedy.

Internal memos obtained by news agencies reveal an expanding list of scientific topics the National Institutes of Health now “no longer supports” – including research on vaccine hesitancy, COVID-19, diversity initiatives, climate change health effects, and transgender healthcare.

Since Kennedy’s appointment, HHS agencies have terminated hundreds of previously approved scientific studies.

Among the hundreds of terminated studies are grants that reveal a clear ideological pattern in the administration’s scientific priorities: investigations into Alzheimer’s disease in sexual and gender minority older adults, mental health interventions for LGBTQ+ communities affected by COVID-19, strategies to improve vaccine acceptance among Alaska Native populations, and research examining how institutional trust influences vaccine decisions—representing just a fraction of studies canceled for addressing topics now disfavored by Kennedy’s HHS.

Sample of federal grants cut by HHS since Kennedy took over the department.
Studies show that air pollution is associated with worsening mental health outcomes.

Air pollution has been linked to poor brain development, as well as a higher risk of dementia and stroke. A link has also been established between exposure to air pollution and depression as well as higher suicide rates.

The subject received attention at the second WHO’s global conference on air pollution and health in Cartagena, Colombia this week.

“Air pollution is increasing the risk of new mental health problems and worsening mental health in people with pre-existing mental health problems,” Alessandro Massazza, policy and advocacy advisor at United for Global Mental Health, a global non-profit that focuses on mental health advocacy, told Health Policy Watch.

The societal costs of mental disorders due to air pollution, climate-related hazards, and inadequate access to green space are estimated to reach around $47 billion annually by 2030 — a significant portion of the massive $8.1 trillion annual price tag for the overall health impacts of air pollution.

Alessandro Massazza (right) speaking on the impact of air pollution on mental health during a session at WHO’s global conference on air pollution and health in Colombia’s Cartagena.

Around 99% of the world’s population breathes air that does not meet the air quality standard set by the World Health Organization (WHO). Exposure to high levels of air pollution claim over eight million lives worldwide every year.

“It’s not just that we’re all exposed to air pollution, not just that it affects everybody, but it affects non-communicable diseases (NCDs),” said Mark Miller of the World Heart Federation. He pointed out that NCDs are already the world’s biggest killer, responsible for 74% of all deaths annually.

“Tackling NCDs has to be one of the greater priorities for the world, no matter what sector of life that you’re in,” Miller said.

 How air pollutants reach the brain 

Burcin Ikiz, neuroscientist and director at EcoNeuro.

The exact pathway through which air pollutants reach the brain is now becoming clearer.

“The pollutants from the air enter our brains through two mechanisms. One is directly from our nasal cavities up to our olfactory bulb, but also from systemic inflammation,” Burcin Ikiz, neuroscientist and director at EcoNeuro, a research and consulting company working in global health, told Health Policy Watch.

“When the lungs get inflamed due to the pollutants in the air, those send inflammatory responses into the bloodstream, and through the bloodstream reaches the blood-brain barrier,” Ikiz explained. “Normally, our blood-brain barrier should be our protective layer that protects the brain from any outside pollutants or harmful substances. But it’s not perfect. It’s a leaky system.”

Children, the elderly population, and those living with other neurological conditions such as multiple sclerosis and Alzheimer’s are especially vulnerable, she added.

Potential pathways for air pollutants to reach the brain and create an impact

“We know less about what may be driving this association between air pollution but it’s likely to be the result of a mixture of biological (e.g., inflammation), social (e.g., not being able to go outside or socialize outdoors), and psychological (e.g., impact on mood, cognition, or sleep) mechanisms,” Massazza said.

Air pollution is also linked to poor brain development in children, starting in utero.

“Looking at pregnant women and their babies that are still in the womb being exposed to pollution, we see their brain structures changing,” Ikiz said. Post-birth, “we see them having…. developmental delays and lower IQs and so on.”

Adolescence has been identified as another crucial period during which many mental health disorders first develop.

The risk of strokes in which the blood flow to the brain is reduced, also increases due to air pollution, studies have found. Air pollution is also among the 14 modifiable risk factors for dementia.

Air pollution has also been found in several studies to be associated with depression on both short and long-term time scales, drawing attention to its impact on poor mental health outcomes.

Need for evidence-based interventions

The additional societal costs of these mental health disorders influenced by environmental factors are expected to rise further, according to an estimate that pegs it at US $537 billion by 2050, relative to the baseline scenario in which the environmental factors remain at 2020 levels.

“People with chronic and severe mental health problems often live with co-morbid non-communicable diseases such as respiratory or cardiovascular conditions, which can further increase their vulnerability to the physical health impacts of air pollution,” Massazza.

Limited research on interventions shows that significant mental health gains are seen when air pollution is reduced. One study from China demonstrates how the country’s clean air policies are not only contributing to large reductions in air pollution but have also been deemed responsible for preventing 46,000 suicides over just five years.

Significant data gaps remain, with only a handful of studies on air pollution’s impact on mental health coming from low- and middle-income countries. Experts say efforts are needed to improve research in understanding the pathways between environmental stressors and mental illness.

In September, the UN headquarters in New York will host a high-level meeting on NCDs and mental health, where the impact of climate change on NCDs and mental health is likely to be discussed.

“Clean air policies are mental health policies. From reduced energy poverty and more access to green spaces to increased physical activity resulting from active modes of transport, actions aimed at reducing air pollution have considerable potential co-benefits for mental health,” Massazza said.

Sophia Samantaroy contributed reporting. 

Image Credits: Unsplash, By arrangement, Elaine Fletcher, Air quality and mental health: evidence, challenges and future directions.

Dr Susan Monarez, newly appointed head of the US CDC (2nd left) and other US government officials meet Africa CDC Director General Dr Jean Kaseya and Dr Ngashi Ngongo in Washington.

Leaders of the Africa Centres for Disease Control and Prevention (Africa CDC) held a five-hour meeting with Dr Susan Monarez, newly appointed head of the US CDC, and other US officials on Wednesday – for the first time since the US slashed funding to Africa’s health sector.

Discussion centred on health security, funding for Africa CDC and options for health financing on the continent, Dr Ngashi Ngongo, Africa CDC’s incident management head, told a media briefing on Thursday.

“From the [US] administration’s perspective, they would like to see more of health as a business, rather than something that functions on grants,” added Ngongo. 

African programmes worst affected by the US’s abrupt termination of funding are those dealing with maternal and child health, HIV, malaria and emergency preparedness and response, said Ngongo, speaking from Washington DC, where he and Africa CDC Director General Dr Jean Kaseya are meeting a range of US leaders.

Aside from Monarez, the meeting was attended by high-level officials from the White House, the US State Department’s Bureau of Global Health Security and Diplomacy, Health and Human Services (HHS), and an assistant secretary from the President’s Emergency Plan for AIDS Relief (PEPFAR).

“We made the point, which was accepted by our American counterparts, that global health security starts with what happens outside the US,” said Ngongo, adding that the Trump administration “remains committed to addressing health security”. 

‘Health as a business’

Ngongo said that the Trump administration is interested in “exploring how can we go into a partnership that translates into health as a business”, adding that private sector opportunities exist in the local manufacturing of medicines, digitalisation of health records and the electrification of clinics.

“On programmes, we discussed malaria, HIV, and also support in the area of systems for emergency preparedness and response, in particular surveillance, laboratory capacity strengthening, and the health workforce,” said Ngongo.

The aim of the meeting, he added, was “to make sure that we understand them and they also understand the priorities for Africa CDC”. Discussions with US government officials will continue in April around the World Bank’s spring meeting in Washington, he added.

A report published in The Lancet this week predicted that, across all low and middle-income countries, an anticipated 24% weighted average of international aid reductions plus discontinued PEPFAR support “could cause an additional 4·43–10·75 million new HIV infections and 0·77–2·93 million HIV-related deaths between 2025 and 2030”.

If PEPFAR support is “reinstated or equivalently recovered, this reduced to 0·07–1·73 million additional new HIV infections and 0·005–0·061 million HIV-related deaths”, the modelling study adds

“Unmitigated funding reductions could significantly reverse progress in the HIV response by 2030, disproportionately affecting sub-Saharan African countries and key and vulnerable populations,” the authors note.

Funding gap

Meanwhile, Africa CDC has a funding gap of $224 million – in part due to the US walking away from a pledge made to the continent by the Biden administration.

Official development assistance (ODA) for Africa has dropped from $81 billion in 2021 and to $25 billion 2025, yet there has been a 41% increase in disease outbreaks on the continent between 2022 and 2024. 

Lack of funds, weak health systems and conflict “risk the reversal of two decades of health achievement on the continent”, said Ngongo

“We are also concerned about the risk of another African pandemic, which … would translate into more crisis, with the economic vulnerability that will push more Africans into poverty,” said Ngongo.

“But it really doesn’t help to complain. We have to be proactive in terms of thinking that, if that is the new normal, if that is the direction that the world is taking, how do we remain fit in that context?”

Options include increasing domestic financing, a “solidarity levy” on all airline tickets sold on the continent, higher “sin taxes” on alcohol and tobacco and partnerships with the private sector.

Three-pronged plan to raise funds for African health

“The European Union (EU) has already committed to imposing a minimal import levy on goods that are imported to Africa” to assist, he added.

“All that is on the backbone of the optimization of the use of resources to ensure that there is less corruption, there is less misuse and inefficiencies,” said Ngongo, adding “you cannot really leave your health in the hands of the partners”.

New mpox plan

An updated plan to address the ongoing mpox outbreak was recently completed by the Africa CDC’s Incident Management Support Team.

Its goals are to stop the human-to-human transmission, halve the burden of impact and strengthen the health system as part of countries’ epidemic preparedness and response.

“The response strategy is mainly community-centred under the leadership of community health workers,” said Ngongo.

It is a multi-sectoral approach that relies on strengthening co-ordination, digitalizing surveillance – which will assist with other diseases, and completing laboratory decentralisation.

“We need to vaccinate about 6.4 million people during the next six months on this second plan and on the case management, we target at least 80% of confirmed cases that need to be taken care of,” he added.

The total budget estimated is $429 million, of which a quarter will be for surveillance and a quarter for vaccination and logistics. 

Mpox cases rose by 22% increase over past week to 3,323 cases. Confirmed cases also rose from 381 to 925. The Democratic Republic of Congo (DRC), Burundi and Uganda account for 91% of all cases.

Surveillance was slightly improved in the DRC with 21 out of 26 provinces reporting (up from 19 the previous week) and testing up from 13% to 20% of suspected cases. There were 2,451 new cases in comparison to 2,183 the week before, with 312 confirmed cases in comparison to 150.

Sierra Leone, which has 114 confirmed cases, became the sixth country to start vaccinating people on Thursday.