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, 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.

WHO’s Maria Neira (center) with air pollution activists from around the world at the opening plenary of the WHO Air Pollution and Health Conference.

CARTAGENA, Colombia – From toxic methane flares in the Amazon rainforest to the death of a nine-year-old girl from London smog, the second WHO Conference on Air Pollution and Health opened Tuesday  with a series of emotional testimonials on the deadly effects of smog. 

Behind the human stories, however, stands  a mounting array of evidence about the adverse effects of air pollution on everything from newborn health to brain health and ageing that the three-day conference will explore.  

The conference is the first on the topic to be convened by WHO since 2018. It takes place at a time when the evidence about the adverse effects of air pollution on everything from newborn health to brain health and ageing continues to snowball. 

The conference sessions and side events, ranging from the emotional and artistic to the drily scientific, are covering a widening range of air pollution topics that has grown even broader since the last conference was convened. 

Some sessions cover relatively new topics for the health sector such as the  impacts of air pollution on agriculture, new knowledge on wildfires and dust storms, and opportunities for the health sector to reduce its own emissions through shifting to renewable energy and climate resilient health facility design.

Goal to halve deaths attainable with right investments

Meanwhile, a new World Bank report estimates that some two million deaths annually from outdoor air pollution can be avoided if the number of people exposed to deadly PM2.5 pollution particles above 25 micrograms per cubic meter was halved by 2040.

But investments in clean air strategies would need to increase from $8.5 billion to nearly $14 billion annually to meet that 2040 goal, said World Bank analyst Sandeep Kohli. 

$8.1 trillion is the current cost of air pollution to global GDP: WHO’s Maria Neira.

At the same time, with the costs of air pollution amounting to over $8 trillion annually, or some 10% of global GDP today, the economic gains would be immediate and significant. 

In the most optimized strategy of integrated action in the energy, transport, waste and industry, reducing air pollution emissions would yield between $1.9 and $2.4 trillion over the coming 15 years  (in 2021 dollar terms) and reduce deaths from outdoor air pollution alone by about two million annually – from about 6.2 million to 4.2 million deaths annually, according to the new World Bank Report, Accelerating Access to Clean Air for a Livable Planet.

Integrated strategies will slow warming trends

Helena Naber, Senior World Bank Environmental Economist

 Well-planned, integrated strategies would also reduce emissions of major climate “super pollutants” that have an outsized impact on global warming but also much shorter lifespans than CO2, putting the brakes on climate change if they are reduced.   

“Reducing the number of people exposed to PM 2.5 concentrations above 25 micrograms ..globally, by 2040 by half, is both feasible and can be affordable,” said Helena Naber, Senior World Bank Environmental Economist. 

 “An integrated approach, combining conventional air quality management measures, clean energy and climate policies that are designed to achieve other goals, such as energy independence reducing greenhouse gas emissions, could achieve substantial progress ….by 2040 reducing mortality that is associated with air pollution compared to current policies.”

The benefits are not only theoretical, stated Hongbing Shen, vice-minister of China’s National Health Commission, who made the long journey to the Cartagena conference site to relate the story of China’s “Asian miracle” in battling extreme levels of air pollution. 

WHO Director-General sitting out the event 

WHO Director-General Dr Tedros Adhanom Ghebreyesus at a WHO global press conference, 17 March, in Geneva. He cancelled his travel to Cartagena at the last minute.

In contrast with the high-level Chinese presence here, not a single United States government delegate was in attendance.  And against the new narrative of climate denial being advanced by the new administration of President Donald Trump, even the most compelling environmental health and economic arguments still risk being pushed aside.

Inside WHO, which is battling for survival in the wake of the US withdrawal and a deepening budget crisis, climate and environment risk being marginalized even more as there are soaring demands for the body to respond to health emergencies from a growing array of disease outbreak threats and regional conflicts. 

A telling sign is that WHO Director General Dr Tedros Adhanom Ghebreyesus will not be visiting for the high-level portion of the meeting Thursday where countries will make national commitments to reduce air pollution in line with the stated conference goal of reducing deaths from air pollution by one-half by 2040. 

Latin America venue has plusses and minuses

Vision of a greener and cleaner world by Brazilian street artist, Eduardo Kobra on the Esplanade of the Cartagena Conference Center where the WHO conference is taking place.

Another challenge is travel difficulties for African and Asian officials to the event – people from the very regions that are the world’s biggest pollution hotspots today. Due to the limited travel routes, some Asian and African participants spent 30 to 48 hours in transit.  

But the conference comes at an opportune moment for Latin America, which has relatively better developed air pollution monitoring systems, and where cities like Bogota and Barranquilla in Colombia, as well as Curitiba in Brazil, have been long-time pioneers in Bus Rapid Transit and bicycle lanes. 

About a dozen ministers of health, mostly from the continent, are expected to participate in the day of high-level commitments Thursday, where countries will outline their national objectives for reaching the 50% air pollution mortality reduction goal.  

Amazon region is becoming a risk for health  

Brazilian activist Fany Kuiru describes toxic impacts of methane gas flaring in Amazonia.

Against the political inertia, speakers in the keynote sessions – including bereaved mothers, lung specialists, youth leaders and activists – pleaded for politicians to wake up to the reality of what air pollution is doing to health, environment and communities. 

Brazilian activist Fany Kuiru described how dozens of methane gas flaring sites in areas of oil and gas extraction are killing indigenous community members in Amazonia region.  

A lawsuit against the Government of Ecuador in 2021 failed to lead to real change, as  there has been a 23% increase in emissions in 2023 in comparison to 2021, said the Kuirut, coordinator of the Organization of Indigenous Communities in Amazonia. . 

“Each gas flaring system is a death system for the Amazon and its inhabitants,” she declared. 

Throughout Amazonia the rain forest is taking a big hit from air pollution of multiple forms. 

“Forest fires, contaminants released from illegal mining… All of this evaporates into air, so that the Amazon region, which is supposed to save life, is becoming a risk for health,” said Kuiru.  

‘Every asthma attack was associated with a pollution peak’

Rosamund Kissi-Debrah describes the death of her daughter, Roberta Ella, from air pollution at age 9.

“My daughter Ella would be 21 today had she survived, and yet her legal case has only just ended,” said Rosamund Kissi-Debrah, founder of the Ella Roberta Foundation.  She has waged more than a decade long legal battle in the UK to have air pollution recorded as the cause of her daughter’s death in February 2013 at the age of nine. 

Ella was diagnosed with severe asthma at seven after being seen by a doctor for a “persistent cough that just wouldn’t disappear,” Kissi-Debrah told a plenary audience of hundreds on the conference’s opening day. 

“Over the next thirty months, she was hospitalized over a dozen times.  Her siblings had to know what to do in times of emergency,” said Kissi-Debrah.

“She survived five comas and managed to fight back from them… until the final, severe asthma attack on 15 February, at age nine.  The horror of those years is not something I would wish upon any family.”  

While the cause of death was initially recorded as “respiratory failure” an autopsy revealed that her lungs “resembled those of a smoker.”

“It wasn’t until she died and they opened her up did we really see the horrors of what was going on,” he mother said. Belatedly, the family realized that the triggers for Ella’s acute episodes and hospitalizations all were linked to spikes in air pollution along the heavily trafficked London freeway where they lived.  

‘Air pollution is killing us’

Mother and child walk through a polluted cityscape – visualization on walls of the Cartagena conference center.

“This meeting is about one thing. Air pollution is killing, killing, killing us,” declared Maria Neira, director of WHO’s Department of Climate, Environment and Health and the ‘doyenne’ of the global air pollution and health movement. 

“Have we advanced, yes,” she said. “Have we advanced to the level of commitment required, no.” 

Looking around the huge conference auditorium that looks out onto the Pacific Ocean one the one side  and onto streets choked with diesel traffic on the other, she recalled that Cartagena is the setting for Gabriel Garcia Marquez classic novel, “One Hundred Years of Solitude” that established a new style of “magical reality” in storytelling. 

“This place is a magical one and reality is here as well…We are hoping that in a few years from now, the reality will be changed,” said Neira, adding, “We need to make our lungs healthy again.”

The aspiration for a pollution-free city – transforming imagination into reality.

Image Credits: Sophia Samantaroy.

A baby gets a BCG vaccination in a Gavi-supported programme.

The United States plans to stop funding the global vaccine alliance, Gavi, which assists developing countries to buy vaccines to protect their children, according to a spreadsheet obtained by the New York Times.

Gavi is one of the 5,341 US Agency for International Development (USAID) grantees that the US intends to cut, according to the 281-page spreadsheet sent to Congress this week.

The US covers 13% of Gavi’s budget, and its vaccine programmes are estimated to have saved almost 19 million lives over its 25-year existence.

“We have not received a termination notice from the US government and are engaging with the White House and Congress with a view to securing $300m approved by Congress for our 2025 activities and longer term funding for Gavi,”  Dr Sania Nishtar, CEO of Gavi, told Health Policy Watch.

“A cut in Gavi’s funding from the US would have a disastrous impact on global health security, potentially resulting in over a million deaths from preventable diseases and endangering lives everywhere from dangerous disease outbreaks.”

Responding to the news on X, Gavi said that it could save “over eight million lives over the next 5 years and give millions of children a better chance at a healthy, prosperous future”. 

An investment in Gavi will also keep the US safe, it added: “By maintaining global stockpiles of vaccines against deadly diseases like Ebola, mpox and yellow fever we help keep America safe. These diseases do not respect borders, they can cross continents in hours and cost billions of dollars.”

“Every dollar we invest in lower income countries generates a return of $54. This helps countries develop and communities thrive, taking away pressure to migrate in search of a better life elsewhere.”

‘Political decision to ignore science’

Public Citizen’s Liza Barrie said that the Trump administration’s decision “abandons 25 years of bipartisan commitment to global immunisation and undermines the very systems that help prevent deadly outbreaks from reaching our own doorsteps”.

“The administration is walking away from a $2.6 billion pledge — jeopardizing routine vaccinations for 75 million children over the next five years,” said Barrie, who heads the organisation’s global vaccine access programme.

“This isn’t fiscal responsibility. It’s a political decision to let preventable diseases spread— to ignore science, lend legitimacy to anti-vaccine extremism, and dismantle the infrastructure that protects us all,” she stressed, adding that Congress has authority over foreign assistance funding.

“The administration’s attempt to unilaterally walk away from its Gavi commitment raises serious legal questions and should be challenged. Lawmakers must stand up for the rule of law, and for the belief that the value of a child’s life is not determined by geography.”

Schoolgirls line up to receive the HPV vaccine in Central Primary School in Kitui, Eastern Kenya

The US also plans to ditch the United Nations Food and Agriculture Organization, which tracks zoonotic diseases despite the US being in the midst of a months’ long H5N1 outbreak in cattle that has also infected farm workers.

Only 898 grantees will be retained, including scaled back support for HIV and tuberculosis and food aid during humanitarian crises.

Around 60% of grants for the US President’s Emergency Plan for AIDS Relief (PEPFAR) were administered by USAID and at least eight countries are on the brink of running out of HIV medicine.

Only 869 USAID staff are still in office out of over 6,000 and the US State Department has taken control of the agency.

Earlier, Health Policy Watch reported on a leaked plan for US foreign aid which would see a new body, the Agency for International Humanitarian Assistance (IHA), take over the remnants of USAID.

The plan envisages three “pillars” for future aid thematically organised as “safer”, “stronger”, and “more prosperous”.

The “safer” pillar will cover “humanitarian assistance, disaster response, global health and food security” under a new body, which will fall under the State Department.

US Vice President JD Vance is in charge of deciding on the future of USAID.

Updated on 27 March to include comment from Gavi CEO Sania Nishtar,

Image Credits: Gavi, the Vaccine Alliance, Keystone / EPA / Karel Prinsloo / GAVI.

Panelists Rachel Huxley, Claire Henly, and Pierpaolo Mudu discussed the threat of super pollutants ahead of the WHO Air Pollution and Health Conference.

CARTAGENA, Colombia – A small group of climate pollutants– including the air pollutants black carbon, methane, and ozone – are responsible for nearly half of global temperature increases to date. 

Reducing these emissions, which only remain in the atmosphere for a few weeks to decades, could serve as the “emergency brake” critical to halting runaway climate change, said experts Monday on the eve of the second WHO Air Pollution and Health Conference.

Although these pollutants exert enormous 20-year climate-warming potential that is 80 to 2,000 times greater than carbon dioxide (CO2) per ton of emissions, their lifespan is far shorter than CO2, which remains in the atmosphere for a century or more.

These pollutants are also projected to continue warming the climate with greater potency than CO2 over the next century.

“If you reduce them today, we’ll see impacts in our lifetimes,” said Claire Henly, executive director of the Super Pollutant Field Catalyst, a US start-up NGO, at a media briefing ahead of the conference. 

While CO2 has received the overwhelming amount of climate mitigation attention, Henly and others argued that addressing a class of “super pollutant” greenhouse gases and particles, also known as “short-lived climate pollutants,” offers the greatest opportunity to have a rapid, and meaningful impact on both health and climate.

Henly and others identified ozone, black carbon, and methane as super pollutants because of their wide-ranging impacts on food security, health, and climate change. Slowing the rate of climate change would make it easier for the “world to adapt to climate change,” said Henly. 

Nexus of climate change, air pollution and health

It is also the nexus where health, climate, and food security concerns directly converge – leading scientists to dub them “super pollutants” precisely due to those wide-ranging impacts. 

Black carbon is a sub-component of dangerous particulate matter, associated with some 7 million deaths annually from air pollution. 

Ground-level ozone, formed as pollutants emitted by vehicles, industry and waste, is a leading factor in respiratory illness, particularly asthma, as well as damaging some 90% of global crop production every year. Methane, emitted by waste dumps, agriculture, and oil and gas flaring, is a leading precursor to ozone formation.  

Slowing emissions would also slow the rate of climate change, buying time for the world to transition to cleaner energy sources and other longer-range climate solutions, said Henly. 

Two leading super pollutant gases, methane and nitrous oxides (N2Ox), are formally recognized in the Paris climate agreement as powerful greenhouse drivers with a climate forcing potential that is 80, and 270, times more than CO2 respectively in the next 20 years. But black carbon is ignored, leading to a fragmented approach.  

Super pollutants sources chart
Compared to carbon dioxide, super pollutants exert stronger climate warming in both the short and longterm, but drop out of the atmosphere faster.

Similarly, the shared concerns of climate and health sectors around super pollutant emissions are often siloed, said Sergio Sanchez, senior policy director at the Environmental Defense Fund. Greater recognition of super pollutants as detrimental to both health and climate could help break through the barriers to more climate action, he said.

Reducing these pollutants could avoid four times more warming by 2050, as opposed to decarbonization policies alone – and also prevent some 2.4 million deaths a year from air pollution. 

Yet emissions of super pollutants, including methane, are currently on the rise.

Agricultural sector is getting more attention

Punjab environmental officers put out fires set by Pakistani farmers in Province, an annual ritual on both sides of the border that leaves the entire Indo-Gangetic Plain shrouded in smoke.

Most attention on super pollutants has focused on methane leaks from the fossil fuel industry. These occur at nearly every stage of the extraction and production cycle, with natural gas flaring the most glaring example of methane emissions. 

However, another key source of potent methane emissions is the agricultural sector, which accounts for  40% of global human-made methane emissions, with livestock, rice cultivation and crop debris being key sources. 

People often forget the fact that in some regions, such as the European Union, the agricultural sector accounts for 54% of methane emissions, noted Pierpaulo Mudu, WHO scientist.

Another 34% of global methane emissions comes from fossil fuels and 19% from rotting urban and household solid waste. Some methane is also emitted by natural sources, such as peat bogs and wetlands. Overall, two-thirds of global methane emissions come from human activities, according to the Global Carbon Project. 

Methane emissions from agriculture harder to track

Methane emissions from agriculture, however, are much harder to track and monitor than emissions from the oil and gas sector.

“In agriculture, these pollutants are not emitted in high concentrations,” said Henly. 

“The emissions are distributed, and the kind of detection, whether it’s through on the ground sensors or remote detection, is just a bit more challenging than in the oil and gas coal sectors.

Whereas previously, only big methane spikes or leaks from oil and gas installations could be detected, that is changing now, Henly said. 

Recently, new technology, in the form of higher resolution satellite imaging, has opened the way for more granular estimates from sources like agriculture.

This week’s WHO conference will therefore feature the first session ever about the links between methane emissions in agriculture, climate, and health.  Solutions that can be promoted,, experts say, include biogas capture from anaerobic digestion of crop waste and manure as well as improved compost management – so that methane gas is not produced at all.

Ozone chokes crops

But agriculture is also impacted by super pollutants, particularly ozone. It’s now estimated that ozone leads to a loss of 12% of wheat, 16% of soybean, 4% of rice, and 5% of corn production every year.  

“So we can see that the super pollutants are a real growing threat to food security,” said Rachel Huxley, Head of Climate Mitigation and Health at Wellcome Trust.

Ground level ozone (O3) is a product of the vicious cycle of super pollutant formation. Gases produced by cars and industry, crop and waste incineration, interact in sunlight, leading to ozone’s creation. 

Unlike the “good” layers of stratospheric ozone that protect the planet and people from harmful ultraviolet radiation levels, ground level ozone is harmful to crop production as well as human health. 

Inhaling ozone leads to respiratory and a host of other health issues. And when over farmland, the pollutant can dramatically disrupt staple crop growth, according to a 2025 report by the Clean Air Fund.

This week, for the first time ever, WHO is convening a meeting on agriculture, air pollution, climate and health, with the hopes of drawing more attention to these linkages within health and environment circles. 

“Everyone is obsessed with transport,” said Mudu, the WHO scientist leading the session. “Because of the visibility of the black smoke, but there are many different sources of air pollution with many sorts of invisible gases.”

Black carbon and snowmelt 

A traditional brick factory in southern Tunisia. In Africa and South Asia brick making and waste burning are major sources of black carbon emissions.

On the other side of the coin, when urban and household waste or crop debris is burned, rather than left to rot, it produces smoke – a mixture of gases and particles, including black carbon. 

The burning of rice crop debris regularly envelopes large parts of the Indian subcontinent in billowy smoke every autumn. Burning of household and urban solid waste is also a common practice in many developing regions. 

Waste burning, together with the use of wood and charcoal for household cooking and heating, as well as in traditional brick kilns, cast a chronic pallor of smoke or smog over cities and farmland in many other low- and even middle-income regions of the world – also contributing to the formation of ozone.   

super pollutants
Super pollutants exist at the nexus of climate and air quality, making them cost effective pollutants to target.

But the tiny specks of black contained in the smoke do even more harm than other types of fine particles. They accelerate climate change in mountain regions, where they settle on snow and ice, absorbing additional sunlight and thus increasing snow and ice melt. 

Scientists estimate that  black carbon is responsible for 39% of glacier melt in certain Himalayan glaciers, and there are similar impacts being observed in the Himalayas, Alps, Andes and the Rockies, according to a 2025  Clean Air Fund report. 

Locally, glacier melt reduces the reliability of water sources that rural regions of Nepal and northern India rely on for crop irrigation as well as domestic use. 

But there are global implications as well. It is a major reason that the Arctic is warming four times faster than other parts of the world, increasing the chances of “dangerous climate tipping points being breached,” the report stated.

Regulation and action

super pollutants
Often “forgotten” as potent drivers of climate change and poor health, super pollutants contribute to nearly half of warming.

Regulation of super pollutants is challenging – because so many pollutants, and sectors, are involved. In the case of ground level ozone, as well, the pollution is not emitted directly, but rather is a product of reactions between methane, nitrogen oxides, and volatile organic compounds. So the precursors need to be regulated. 

Despite such complexities, the fact that black carbon as well as methane, ozone and other powerful short-lived gases – only reside in the atmosphere for weeks to decades, makes Huxley hopeful that policymakers can see the “economic sense” in cutting back on such emissions. 

“This is one of the most effective ways to keep 1.5ºC alive,” she said, referring to the Paris climate agreement goal. “This is our emergency brake on climate change.” 

The Global Methane Pledge aimed at reducing the gas, was launched at COP26 by the United States and the European Union and has so far been supported  by over 150 countries, including over two dozen African nations. 

“Methane has been globally recognized as a super pollutant since COP26, thanks to the launch of the Methane Global Pledge and the commitments made by countries since then,” said Elisa Puzzolo, Super Pollutants policy manager at the Clean Air Fund.

“Now, is the time to raise our ambition and address all super pollutants, including black carbon and troposheric ozone, to protect the climate, safeguard public health, and support most-affected regions and communities.”

Super-pollutants ‘movement’

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

What Wellcome and the Clean Air Fund want to foster is a more coordinated super-pollutants “movement” that cuts across sectors – together with the UN Enviroment Programme-hosted Climate and Clean Air Coalition.

“Solutions are proven,” Puzzolo said. For super-pollutants though, the regulatory landscape is a bit more complicated. Black carbon, though harmful to health and the climate, is not included in the Paris Climate agreement because it is a particle.

“Reducing black carbon, alongside other super pollutants, is the fastest, most effective way to slow climate change, while also mitigating the enormous health impacts of air pollution,” said Jane Burston, CEO of the Clean Air Fund. “Yet to date not enough has been done.”

“Action on short-lived climate pollutants is a matter of time and temperature,” said Martina Otto, head of the secretariat at the Climate and Clean Air Coalition, which was founded over a decade ago specifically to spearhead awareness and action on superpollutants. 

“They have a higher warming potential than CO2 and don’t accumulate in the atmosphere. Cutting them turns down the heat within decades and reduces air pollution now. A double dividend that we cannot afford to miss.”

Image Credits: WHO/Diego Rodriguez, E. Fletcher/HPW, Climate and Clean Air Coalition, Punjab Enviornment Department, Climate and Clean Air Coalition, A. Bose/ HPW.

The USAID office in Washington

Civil society organisations (CSOs) globally face investigation, restrictions and harassment in dozens of countries after US President Donald Trump claimed that the US Agency for International Development (USAID) was run by “radical left lunatics” and Elon Musk claimed that several grantees supported terror organisations.

This is according to a recent survey carried out by the EU System for an Enabling Environment (EU SEE), which documents the experiences of 54 organisations, and draws on information from two global surveys involving almost 1000 CSO respondents.

There have been calls for investigations of CSOs that receive US funding in nine countries including Brazil and Hungary, and increased harassment of CSOs in 13 including Peru, Paraguay and Russia. Six countries are considering restrictions on foreign funding, including Guatemala and India.

The Nigerian National Assembly has launched investigations into the activities of USAID and nonprofits in the country “following the recent statement by a US Senator that USAID funds [terrorist group] Boko-Haram in Nigeria”, according to a Nigerian CSO.

“An investigative committee set up on 20 February 2025, by the House of Representatives will focus on the activities of CSOs in the Northwestern part of the country,” the respondent said. “If not objectively carried out, the investigation may become part of an ongoing process of attack on civil society and push for stiffer regulations, a common trend which started in 2015 and continues until today.” 

The President of El Salvador, Nayib Bukele, alleged publicly that “USAID funds had been misused by journalists, independent media, and other civil society actors as part of a global money laundering operation”, according to a CSO from that country, which said his statements  “are part of a broader pattern of stigmatisation and discrediting of civil society”.

“The most reported impact by far is increased criticism and stigmatisation of international funding,” according to EU SEE. 

Disrupting critical programmes

The abrupt halting of US foreign aid is disrupting “critical human rights, democracy, gender equality and health programmes, leaving vulnerable communities without essential support”, the survey found.

Over two-thirds (67%) of surveyed organizations have been directly impacted by the termination of USAID, with 40% of them losing 25-50% of their budgets, 

“Without swift action, many organizations that hold governments accountable, defend human rights, and support vulnerable communities may disappear altogether,” according to EU SEE.

A USAID grantee from Myanmar reported that the cuts have “severely impacted” work such as programmes on “conflict-related sexual violence, transnational repression, and Association of Southeast Asian Nations (ASEAN) advocacy”. 

“The funding cuts are causing huge shortages and closure of projects providing medical and subsistence support to the most vulnerable communities inside the country and along the border,” it added.

“The suspension of USAID funding has affected more than 60 civil society actors in Peru, putting at risk projects related to democracy, human rights, governance, the environment, and the fight against drugs,” according to a Peruvian organisation.

“The loss of international funding compromises the sustainability of many NGOs, limiting their ability to offer training, empowerment and support to vulnerable communities.” 

Indonesia received $153.5 million from USAID in 2024 and the funding freeze has left CSOs “in a precarious position”, according to an Indonesian CSO. 

“Some CSOs have had to implement unpaid leave for their staff, while others are managing to pay only half of their employees’ salaries until the review process concludes,” it added. “The ramifications of this aid freeze threaten the livelihoods of those working within these organisations and jeopardize critical programmes in health, education, and environmental conservation.” 

Sectors most affected by USAID grant terminations, according to the Global Aid Freeze Tracker.

The Global Aid Freeze Tracker, reports that the health and protection sectors have been worst hit, with particularly significant disruptions in HIV, malaria, and protection services. The second most affected category is governance, particularly anti-corruption activities, followed by projects offering economic and livelihood support for vulnerable populations, especially women and children.

Image Credits: Global Aid Freeze Tracker.