This has been a brutal year for global health, with shock cuts in development aid to countries most in need; a knock-on budget crisis for United Nations (UN) agencies; widespread humanitarian crises, extensive disease outbreaks, and mounting climate-related health challenges.

Health Policy Watch (HPW) has provided daily coverage of developments, and our reporters were often the first to break news on a range of issues despite our small and under-resourced newsroom.

Development aid plunge

Chaos followed the immediate “pause” of all development aid from the United States as soon as Donald Trump became president in January.

The “pause” included the US President’s Emergency Plan for AIDS Relief (PEPFAR), which funded three-quarters of HIV and tuberculosis programmes worldwide, including lifesaving antiretroviral medicine to 20.6 million people in 2024.

Within weeks, clinics across Africa closed, and patients were turned away as there was no money for staff or medicine. 

Although US Secretary of State Marco Rubio later issued a limited waiver for “lifesaving” programmes, this was narrowly focused and ideological. Influenced by the Heritage Foundation’s view that HIV is a “lifestyle disease”, the Trump administration stopped funding HIV measures aimed at “key populations” most vulnerable to infection – including sex workers and men who have sex with men.

Within two weeks of Trump assuming the presidency, his appointee, Elon Musk and a new Department of Government Efficiency (DOGE)  had also dismantled the US Agency for International Development (USAID). Musk declared that “USAID is a criminal organisation. It’s time for it to die.”

USAID was hugely influential, and its closure affected almost every country in the world – from Albania to Zambia.

As USAID had administered 60% of PEPFAR funds, in many instances, there was no one left to provide goods and services for those projects covered by Rubio’s waiver.

Reporting on this issue was led by HPW Deputy Editor Kerry Cullinan.

WHO slashes staff

The US withdrawal from the World Health Organization (WHO) on Trump’s first day in office, and its reduced support for other UN agencies. unleashed mass layoffs and restructuring.

The WHO is slashing its staff by around a quarter – aiming to shed about 2,371 staff by mid-2026 – many at the end of this year – with ripples across Geneva.

This has affected WHO’s ability to respond to health emergencies across the world.

HPW Editor-in-Chief Elaine Fletcher was often the first to report on the various developments, with an inside track to staff reactions, including the WHO Staff Association decision to challenge the fairness and legitimacy of the restructuring process and the mounting rage of lower-level staff as HPW highlighted data suggesting that low- and mid-level personnel will bear the brunt of cuts, while high-ranking executives, whose real costs far exceed their published salaries, remain largely protected. 

UNAIDS has also been forced to retrench 55% of its head office staff and cut its country offices by almost half after the US ceased to fund it, a move that affected 40% of its budget. The agency warned that the brupt funding cuts have resulted in “perilous risks” for the global HIV response that threaten the health and well-being of millions of people throughout the world.

“It feels like the ground has been ripped out from under our feet,” a Mozambican woman with HIV told UNAIDS, which reported at the year’s end that over two million women and girls have been “deprived of essential health services”, and millions of people at high risk of acquiring HIV have lost access to “the most effective prevention tools available” – pre-exposure prophylaxis (PrEP).

Gavi, the vaccine alliance,  has pared down its staff by a third, which will also affect global vaccination efforts.

Disease outbreaks surge – so does anti-vax activities

Amid the chaos in global health funding, diseases have surged. Africa has experienced large outbreaks of cholera, measles, Lassa fever and mpox, while deadly Ebola and Marburg have also affected several countries.

By 10 December, Africa CDC had recorded over 300,000 cholera cases, over 140,00 measles cases and almost 134,000 mpox cases this year.

Over the past year, both Latin America and the Caribbean saw record-breaking cases of the mosquito-borne dengue fever, with almost one-fifth of cases (about 45 million infections a year) attributable to climate change, Sophia Samantaroy covered issues from the Americas.

Measles has also surged in the US and Canada amid the rise of anti-vaccine misinformation. This has been fueled by the appointment of vaccine sceptic Robert F. Kennedy Jr. as US Health and Human Services Secretary.

So far, Kennedy and his appointees have cancelled mRNA research, restricted access to COVID-19 vaccines and made Hepatitis B vaccines non-mandatory for infants.

In an exclusive article for HPW, Dr Demetre Daskalakis, former Director of the US CDC’s National Center for Immunizations and Respiratory Diseases, describes how the “wall protecting science from political interference in the US has fallen”.

Humanitarian crises multiply

Conflict and humanitarian crises – particularly in Gaza, Sudan and Ukraine – inflicted heavy casualties on citizens and health workers, with ongoing and unprecedented attacks on health facilities.

HPW coverage of the conflict in Gaza included Israel’s blockade of Gaza, the resulting famine, Israeli attacks on WHO’s warehouse and efforts by Israel to secure the release of hostages being held by Hamas.

This coverage was also led by Editor-in-Chief Elaine Fletcher.

HPW has also consistently reported on the humanitarian crisis in Sudan, including the attack on a maternity hospital in El Fasher in which more than 460 people died.

Climate change is ‘needlessly killing millions’

Climate change is claiming millions of lives annually through extreme heat, air pollution, wildfires and the spread of deadly infectious diseases, according to the ninth annual Lancet Countdown report, the most comprehensive assessment to date of the links between climate change and health, published in October.

“We’re seeing millions of deaths that are occurring needlessly every year because of our persistent fossil fuel dependence, because of our delay in mitigating climate change, and our delays in adaptation to the climate change that cannot be avoided,” said Marina Romanello, executive director of the Lancet Countdown at University College London, describing this year’s report as “a bleak and undeniable picture of the devastating health harms reaching all corners of the world.”

Breaching the 2015 Paris Agreement, a legally binding global treaty adopted in 2015 to combat climate change by limiting global warming to well below 2°C (ideally 1.5°C) above pre-industrial levels, is now unavoidable, according to scientists. The world is heading for 2.8°C of warming by century’s end under current policies, according to a UN assessment.

Global greenhouse gas emissions rose 2.3% to a record 57.7 gigatons of CO2 equivalent in 2024, the largest annual increase since the 2000s. 

Land use change and deforestation account for 53% of the overall increase, while fossil fuel production continues to expand in direct contradiction of climate pledges.

The US is the worst emitter, yet Trump withdrew the US from the Paris Agreement on Day One of his presidency.

Domestically, the US Environmental Protection Agency (EPA) has committed to rolling back 31 climate, air and water pollution, and emissions regulations that will negatively affected citizens’ health.

The EPA has also announced that it will no longer require most polluters to report their emissions of carbon dioxide, methane and other greenhouse gases that cause climate change.

Stefan Anderson led HPW reporting on climate change.

The impact of air pollution

Meanwhile, 90% of people on the planet breathe dangerously unhealthy levels of air pollution every day, and millions fall ill every year with a range of respiratory and cardiovascular diseases as well as cancers, leading to at least seven million deaths each year. 

Air pollution is the number one killer across South Asia, accounting for 2.7 million deaths, of which 2.1 million are in India alone. There is growing evidence of the impact of air pollution on a range of medical conditions including strokes, diabetes, heart disease and lung cancer.

Significant sources of the deadly fine particulate matter (PM 2.5) come from fossil fuels in vehicles, power plants and other industrial facilities, and burning coal, wood, dung and agricultural residues for cooking.

India-based Chetan Bhattacharji, led reporting on air pollution.

Women’s rights

HPW has covered the backlash against sexual and reproductive rights, and women’s rights through stories on US anti-rights groups mobilising in Africa, the rollback of abortion rights in Argentina, the impact of intimate partner violence on children, efforts to enable access to menstrual products for girls and women, female genital mutilation, and several articles on women under Taliban rule in Afghanistan.

Disha Shetty and Munija Mirzaie contributed several articles on this topic.

New world order?

In the final few months of the year, the Trump administration sought to turn the chaos its funding cuts caused into opportunities for the US by signing bilateral health agreements with several African countries that promote American business opportunities – and also enable US access to African minerals.

This approach is detailed in the America First Global Health Strategy published in September, that “uses global health diplomacy and foreign assistance to make America safer, stronger, and more prosperous”. 

Driven by former DOGE official Brad Smith, these bilateral Memorandums of Understanding (MOUs) compel countries that receive US aid to fight HIV, tuberculosis and malaria to immediately share all information about “pathogens with epidemic potential” and give the US the right to share this information with other entities, including  US pharmaceutical companies. 

The MOUs directly undermine the WHO negotiations on a pathogen access and benefit-sharing (PABS) system underway in Geneva, placing African countries in a particularly difficult position. 

Unlike past PEPFAR agreements, the MOUs cut out the involvement of community groups, except faith-based service providers, some of which are known to be against contraception and any recognition of LGBTQ people. 

Civil society groups have described the MOUs as “extractive” and over 50 organisations issued a letter calling on African heads of state and government to demand “equity and sovereignty” in the new bilateral agreements.

However, in a positive reaction to plummeting aid, several African countries have allocated more money to health while several continental efforts are building Africa’s independence. 

At the Africa Health Sovereignty Summit,  Ghana’s President John Mahama announced the formation of the Presidential High-Level Task Force on Global Health Governance in response to the 40% reduction in development aid in the past two years.

“The world has changed, but global health governance has not kept pace with the changing world. At this moment, we’re called to redesign the architecture that has, for far too long, excluded Africa’s voices, excluded Africa’s needs and innovations,” said Mahama.

Writing for HPW, Nigerian Health Minister Muhammad Ali Pate Africa argues that Africa “can redefine its role in global health – emerging as a producer, innovator, and equal partner in shaping both the health of its people and the well-being of the world”.

Pate argues that this can be achieved by countries investing in health “with the same urgency it devotes to infrastructure, defence, or governance”; enhancing South–South cooperation and collaboration; and forging a continental alliance that harnesses shared expertise, resources, and innovation for collective health security. 

HPW was proud to be a media partner at the Conference of Public Health in Africa 2025, where African researchers discussed how best to build solidarity between countries on the continent.

Other Health Policy Watch team members and contributors include Maayan Hoffman (who also coordinates our social media), Arsalan Bukhari, Felix Sassmannshausen, Rahul Basharat Rajput, Kate Okorie, Abdullahi Jimoh, Edith Magak and Roisa Kerry.

We are deeply grateful to our donors and media collaborations that have supported HPW to remain afloat during this difficult year and provide an important platform of engagement for the Global South and North that is free of charge.

But most of all, we are grateful to all our readers for your engagement and interest. Please consider donating to HPW to ensure our ongoing survival. May 2026 be a more positive one for global health!

Image Credits: Guilhem Vellut, WHO/EMRO , Markus Spiske/ Unsplash, Health Ministry of Nigeria.