A plastic bag floats underwater near the surface in Bali, Indonesia. At current rates, plastic waste is expected to outweigh all fish in the sea by 2050.

Thirty-five million tons of plastic waste have been dumped into the world’s oceans since negotiations on the United Nations plastics treaty began in Uruguay two years ago.

When delegates gather for the final session of UN Environment Programme (UNEP) led talks in Geneva in August, known as INC-5.2, around 1.2 billion tons of unrecycled plastic waste will have been produced since negotiators from 175 nations first put pen to paper.

With plastic production set to rise 40% in the next decade, tens of billions of tonnes of large, small and microscopic chemical particles will scatter throughout rivers, landfills, streams and coastlines, be burned into the air, or discarded in oceans around the world. 

All of them pose a direct threat to human health and the environment.

Ana Paula Souza discovered this firsthand when she participated in a scientific study last year. Despite living what she calls “a very ordinary life” in Geneva far from recycling plants or petrochemical facilities, tests revealed she had been exposed to more than 30 toxic chemicals that leach from plastics—compounds that can disrupt hormones, damage the nervous system, and weaken immunity.

“We live in a world where, just by walking on the street, you’re already being exposed to plastics,” Souza, who works on environment and climate change issues for the UN’s human rights office, told a gathering at the Geneva Graduate Institute on Wednesday, ahead of the upcoming treaty talks. “I’ve been exposed, and you too, without our consent.”

The upcoming Geneva talks may be negotiators’ final chance to achieve what UNEP and environmental groups call “the most important multilateral treaty” since the 2015 Paris climate agreement.

The negotiations pit over 100 nations advocating for caps on plastic production and chemical regulation against petrochemical giants including Saudi Arabia, the United States, Russia, and China—countries that view plastics as a crucial revenue stream as renewable energy threatens fossil fuel demand.

With all 175 countries required to agree by consensus, and talks having already failed in Busan, South Korea, in November, the path forward remains uncertain.

“There is little assurance that the next INC will succeed where INC-5 did not,” the Global Alliance for Incinerator Alternatives said after the Busan talks collapsed. “There is a strong probability that the same petro-state minority will continue their obstructionist tactics and further imperil the plastics treaty process.”

For health researchers, mounting evidence of the plastic threat is becoming impossible to ignore.

Planetary experiment with unknown consequences

The convenience, cost, durability and usefulness of plastics in industries from fashion to food, medicine, construction and healthcare has led to a societal addiction that has become a planetary-scale human health experiment. Despite their lightweight design, humanity has produced 8.3 billion metric tons of plastic—with 6.3 billion metric tons discarded as waste.

Plastics have grown immensely in chemical complexity since their invention, evolving from simple fossil fuel derivatives into materials containing thousands of synthetic compounds. They now surround us—in our food, air, water, and rain. Yet we remain largely unaware of the potentially toxic effects of thousands of these chemicals now ubiquitous in modern everyday life.

Researchers have identified over 16,000 chemicals used in plastic production, with at least 4,200 considered “highly hazardous” to human health and the environment, according to a landmark report published last year by scientists at the Norwegian University of Science and Technology (NUST).

Around 5,000 of the compounds in plastic are total unknowns—scientists have not sufficiently studied them to understand their toxicity, leaving potential health effects up in the air.

The 16,000 are also just those scientists have been able to identify—the report’s authors admit there are likely many more compounds out there they haven’t caught yet. Only 980 hazardous chemicals— 6% —are currently regulated by international treaties.

“Chemicals present in plastic products cause hazards such as cancers, genetic mutations, and harm to the reproductive system,” said Albert Magalang, a Philippine environment and climate change specialist who is a member of his country’s national delegation to the treaty talks. “I know for a fact that the health sector is aware that about 10,000 chemicals are used in plastics [for which] they don’t have any hazard data.”

Science and regulation can’t keep pace

Just 6% of all plastic chemicals are regulated under multilateral environmental agreements. Around 1000 additional compounds are regulated at the national level by a small number of states.

The regulatory challenge is compounded by industry practices. When authorities restrict or ban chemicals, manufacturers often replace them with structurally similar substitutes that carry the “same or other unknown hazards,” according to the Plastics Health Map, an open-source database mapping research on plastic chemical exposures.

The pace of scientific evaluation adds another layer of delay. Studies on the health impacts of substitute chemicals typically commence years after their introduction to the market, creating a perpetual knowledge gap. As plastic chemicals proliferate faster than research can evaluate them, both regulatory systems and scientific understanding struggle to keep pace with determining their health effects.

This regulatory gap reflects a deeper problem: the vast majority of plastic chemicals lack basic safety information. Researchers don’t know their identities and structure 25% of the time, their functions 50% of the time, whether they’re present in plastic 56% of the time, and their hazards 66% of the time, the NUST report found.

“We face a major challenge in the lack of transparency across the plastics value chain,” said Andrea Zbinden, senior policy advisor for the Swiss Plastics Treaty delegation, which will host the talks in August. “I want to know, actually, what is in the plastic product that I’m using every day.”

Despite this knowledge gap—likely to persist for decades as new chemical compounds continue to multiply—leading health experts believe human health must be central to negotiations on the plastics treaty, which will be legally binding but requires consensus to pass.

“Human health must be central to the plastic treaty,” said Dr Maria Neira, WHO’s environment lead. “Plastics pose risks to human health, and the risks are happening across the entire life cycle, from production to destruction and then use and disposal.”

The push for binding global action

Picking through waste in Banjar City, Jawa Barat, Indonesia

The demand for transparency is driving Zbinden and a group of 94 countries to push for a global list of banned chemicals and plastic products—something that has proved contentious in negotiations. Given how quickly manufacturers replace regulated chemicals with similar compounds, Zbinden insists the list must be regularly updated to reflect the latest science.

“The treaty must also include a mechanism to regularly update the list based on the latest science and development,” Zbinden said. “While every effort should be made to reach consensus, it is important to establish a clear procedure for decision making to ensure the list can be updated effectively.”

Major plastic producers have strongly opposed including such measures. During negotiations in Busan, references to “chemicals of concern included in plastic products” were dropped from the Chair’s Text, raising concerns that obstruction from industry may force countries supporting the strongest health measures to pursue separate commitments outside the treaty framework if consensus fails again.

Support for strengthening the plastic treaty has grown steadily. Char shows the number of nations backing WWF’s “must-haves”: global chemical bans, circular economy design requirements, financing, and guarantees to strengthen the treaty over time.

The most ambitious coalition of nations is pushing for sweeping changes that extend far beyond chemical bans. In a position paper released after the failed Busan negotiations, the 70 countries comprising the High Ambition Coalition reaffirmed their “common ambition of ending plastic pollution by 2040” and emphasized that “effective and common legally-binding global rules are essential.”

They want binding transparency and reporting requirements on plastic polymer production and chemical composition, time-bound targets to reduce production and consumption of primary plastic polymers to sustainable levels, as well as enforcement of the principle that “polluters should be held responsible for their activities and products.”

The coalition’s concerns extend to another health threat: microplastics—particles so small they can cross into organs and the bloodstream.

Research in this emerging field has revealed that microplastics can alter cellular behaviour in internal organs, with scientists identifying a new condition called “plasticosis” in studies of birds. Humans now consume approximately five grams of these particles weekly through normal eating, drinking and breathing, yet their long-term health impacts remain largely unknown.

“We call on all INC members to seize this historic opportunity to conclude an ambitious and effective treaty that demonstrates our collective resolve to end plastic pollution for the benefit of current and future generations,” the coalition stated. “We encourage everyone to continue their efforts, hold governments to account.”

Economic case for action

The coalition’s sweeping demands are backed by mounting evidence that inaction carries enormous economic costs in health damages.

Plastic pollution isn’t cheap, especially for health systems. A study published last year by the Endocrine Society found that chemicals used in plastics generate over $250 billion in annual health costs in the United States alone.

In the European Union, researchers estimate exposure to hormone-disrupting chemicals costs over €150 billion annually in health care expenses and lost earning potential. These endocrine-disrupting chemicals are present in everyday products and pesticides, but industry lobbying has delayed EU action to identify and restrict their use.

With microplastics now found in human blood and plastic production showing no signs of slowing down, UNEP has warned that the economic costs of inaction on the chemical and plastic pollution crisis could reach 10% of global GDP.

These costs are not borne by plastic producers—they’re shouldered by public health systems and taxpayers. As governments spend billions treating the toxic effects of plastic derivatives, the petrochemical industry continues its lucrative expansion, with market value projected to grow from $584.5 billion to $1 trillion by 2030.

“Where is the implementation of the polluter pays principle? A lot of resources are spent from public taxpayer money to deal with the pollution and the negative externalities,” said Julia Carlini, an observer to the treaty negotiations from the Centre for International Environmental Law. “They are profiting from the extraction of fossil fuels and selling plastic products without paying their fair share.”

Despite the scale of estimated damages, economic arguments haven’t guaranteed action in other environmental crises. The World Bank estimated that air pollution causes $8.1 trillion in annual health damage, but that figure hasn’t moved the needle in UN climate talks. The challenge now is whether financial pressure will prove more persuasive than health concerns in pushing through a strong plastics treaty.

Political battle ahead at INC-5.2

With the final leg of negotiations just months away, it remains unclear how health will be integrated into the final treaty, if at all. The latest negotiating document includes a dedicated health clause, though nations have not agreed on this provision and it’s unclear how many support the approach.

During previous talks, countries argued over whether health should be addressed in a standalone provision, woven throughout the treaty, included in overarching provisions, or excluded entirely. Some delegations questioned whether health falls within the treaty’s scope at all.

The World Health Organization has stated it is “open to including a standalone article on ‘Health’ provided that health considerations and protections are included as a cross-cutting issue throughout the text.”

Many of the treaty’s core flashpoints have direct health implications. Articles Three and Six—which address regulating toxic chemicals in plastic production and capping new virgin plastic production—would deliver significant downstream health benefits.

Virgin plastic production depends 98% on fossil fuels, driving air pollution and environmental contamination. Toxic chemicals in plastics can enter the human bloodstream and cause severe health effects, particularly in vulnerable communities living near production or disposal sites.

“If we are going to [target] upstream interventions, it means reducing the unnecessary plastic production, especially in those single-use plastics,” Neira said.

Massive expansion of petrochemical production in the US, China, Saudi Arabia and Russia makes them unlikely to agree to the most ambitious demands from health and environmental advocates. Over 220 fossil fuel industry lobbyists attended the latest talks in South Korea, many embedded within national delegations, according to the Center for International Environmental Law.

The US made a stunning reversal under Joe Biden ahead of the last negotiating round, surprising observers by backing production reductions and aligning with the European Union, Canada and the High Ambition Coalition. But with Donald Trump in office, that support has evaporated.

“The treaty, and especially the notion that the best way to reduce plastic pollution is to scale back plastic production, will go nowhere in the United States,” PlasticsToday, an industry outlet, wrote following Trump’s victory. “And for the vast majority of the plastics industry, that is, indeed, an answered prayer.”

Image Credits: Naja Bertolt Jensen, Muhammad Numan, Fiqri Aziz Octavian, Antoine Giret.

Addressing today’s global health challenges requires more than funding and innovation—it demands humility, open communication, and a shared commitment to collective action, according to IFPMA Director-General David Reddy.

Reddy, speaking at an IFPMA side event during the 78th World Health Assembly, acknowledged the socio-political and financial barriers facing global health systems. However, he urged the audience not to lose sight of the hard-earned lessons from the COVID-19 pandemic.

“Some of the lessons during the pandemic were hard, and they cost this global community a lot,” Reddy said. “We shouldn’t let what they have taught us about the importance of health care slip out of mind so easily.”

The evening’s event explored how health can serve as the foundation for driving economic growth and national security, through partnership and political leadership.

The panel discussion featured three speakers, each offering a unique perspective: Dr Ricardo Baptista Leite, president of the UNITE Parliamentarian Network for Global Health, Dr Kerri Elgar, senior policy analyst at the Organization for Economic Cooperation and Development (OECD) and Dr Jenelle Krishnamoorthy, MSD’s head of global public policy.

From left: Dr. Jenelle Krishnamoorthy, Vice President and Head of Global Public Policy for MSD; Dr. Kerri Elgar, Senior Policy Analyst at the OECD; and Dr. Ricardo Baptista Leite, Founder & President of the UNITE Parliamentarian Network for Global Health
From left: Dr. Jenelle Krishnamoorthy, Vice President and Head of Global Public Policy for MSD; Dr. Kerri Elgar, Senior Policy Analyst at the OECD; and Dr. Ricardo Baptista Leite, Founder & President of the UNITE Parliamentarian Network for Global Health and the evening’s moderator.

Leite painted a complex picture of the current global health landscape. On one hand, he noted, public trust in institutions is eroding. On the other, “too many political actors… are proactively contributing to misinformation and are provoking what I would call intentional disruption.”

He went on to explain that defense spending now dominates the priorities of many governments—diverting critical resources away from health. This shift, he warned, puts low- and middle-income countries at heightened risk, as their health systems often depend not just on funding but on infrastructure and support from international partners—many of whom are now pulling out.

“The United States is the main actor cutting off without giving an opportunity for transition. And this has devastating effects,” Leite said. “When we look at that, the ripple effects will mean millions of lives will be disrupted, lives will be lost in this process.”

Leite called for an immediate rethinking of global health funding models, urging innovative and inclusive approaches.

“We have to have all hands on deck and find how we do that,” he said. “Unusual actors that haven’t been stepping up, now we have to find them and bring them on board, and we have to have more of a collaborative effort to redesign the way we deliver health and care altogether.”

He also criticized the “broken disease model” of today, warning that it is not fit for the future. Without sustainable investment in health systems, he said, the world is headed toward a two-tiered reality where the wealthy receive care, and the rest are left behind.

“That’s not the world any of us wants,” Leite said.

Alternative health financing channels

This conversation is not new, but the urgency around health funding has escalated due to the budget cuts implemented this year. Elgar noted that many global actors have been calling for alternative channels for external health financing for some time.

In addition, the healthcare funding dialogue needs to be reframed to focus on prevention and view healthcare as a sound investment rather than a liability or budgetary burden, said Krishnamoorthy.

“We have to take a step back and think: We are on the verge with research and development to find some of the most amazing cures and ways that we can live longer, fuller, healthier lives,” Krishnamoorthy said.

“That is so exciting, but I think we understand in the private sector that that’s only the first step. It’s a tough first step, but you have to make sure individuals have access to these medicines and vaccines.”

Krishnamoorthy highlighted that if, in 2025, the world adequately funded the top five non-communicable diseases (NCDs), by 2030 the global economy could save $47 trillion—roughly 20 times the current global health budget.

“We don’t usually think of it like that,” she said, offering a relatable comparison to car maintenance.

“Would you ever take a car out of a lot? Drive it but not get the oil changed, never get your tires turned, never change the filters until the engine just freezes up and you throw it out?” Krishnamoorthy asked.

She argued that too many national healthcare payment systems are structured in exactly that way.

“IFPMA commissioned an analysis that showed that adult immunization programs yield up to a 19 to one return on investment. So you know, these are some basic things,” she said.

Spending to save

To encourage governments to invest more in healthcare, the economic case must be made demonstrating the potential returns on investment that can be achieved through better policies, smarter spending, and prioritizing value for money, explained Elgar.

“It’s not just what you might spend in general, it’s what you might spend to save,” she said. “Increased investment in patient safety, for example, can reduce diagnostic error by around half and represent a direct cost saving of almost 8% in health budgets, which is huge.

“Efficient use of digital tools, including AI, are expected to improve productivity by five percent to 10% and then for every dollar invested in AMR [antimicrobial resistance] for example, and the intervention packages for AMR, the rate of return is $10.

“These are the sorts of arguments that appeal to finance ministers,” Elgar continued.

However, Leite acknowledged that some responsibility lies with policymakers themselves.

He said many parliaments have “gone too lazy” and stopped exploring innovative models of healthcare financing—particularly those that incentivize long-term health and well-being rather than short-term fixes.

IFPMA Director-General David Reddy
IFPMA Director-General David Reddy

To move forward, Reddy stressed the importance of maintaining open dialogue and collaboration.

“Effectively, we’re a family… But in times of crisis, families pull together—and that’s what we need to do at this time,” he said.

Image Credits: Maayan Hoffman, Joy Corthesy, IFPMA.

WHO Director General Dr Tedros Adhanom Ghebreyesus at the 78th session of the World Health Assembly.

African countries at the World Health Assembly called for increased support to health systems across the continent following major cuts to all World Health Organization (WHO) regional office budgets amid a financial crisis triggered by the US withdrawal from the agency and falling global health spending.

The African region suffered the largest total cut, losing over $150 million in funds for WHO operations across the continent.

“It is imperative that the WHO provides focused support to strengthen the capacities and the capabilities in countries, including through enhanced local production technology transfer and equitable distribution mechanisms,” the Ethiopian delegation said on Wednesday in a joint statement on behalf of the 47 countries in the WHO Africa region.

The statement added that African nations need support in “strengthening integrated clinical services and everyday systems to handle emergencies, and the readiness in countries to deliver a timely and effective response.”

Middle-income countries also made cases to be prioritised alongside low-income ones. “Health resilience can only be achieved with long-term, predictable and equitable financing. We are calling for the pandemic fund to be bolstered with increased accessibility for middle-income countries,” a delegate from Morocco said.

Evolution of country-level programme budgets, by region. All six WHO regions face a steep decline in annual funding when the next budget takes effect in 2026. 

The plea from low- and middle-income nations follows member states’ approval on Tuesday of a new WHO budget for the 2026-27 period that slashed $1.1 billion from its previous target while raising membership fees by 20%. All WHO regions suffered the same flat 14% cut amid the financial squeeze, except Geneva headquarters, which faces a drop of nearly a quarter year-on-year.

Even with an extra $170 million raised from member states on Tuesday, the agency faces a $1.5 billion funding gap on top of the $1.1 billion already slashed from projections for the biennial budget prior to the US exit from the body, highlighting the impossible choices facing WHO as it confronts the largest financial crisis in its 76-year history.

Countries said the funding cuts leave them increasingly vulnerable as new health threats emerge.

“Geopolitical instability, climate change and emerging diseases reinforce the need for international cooperation and predictable financing to overcome challenges in global health system,” the delegate from Bangladesh said. “We need empathy, solidarity and unity.”

Crisis deepens funding gap

Despite repeatedly slashing its target for the next two-year budget, WHO still faces a $1.5 billion shortfall to cover its core work. 

Before the US exit, WHO’s 2026-27 budget targeted $5.3 billion over two years to cover its core operations. After Tuesday’s vote, that target dropped to $4.2 billion, a 22% reduction affecting the UN health agency’s work worldwide.

During Tuesday’s budget debates, WHO officials countered criticism of cuts to cash-strapped regions with a harsh truth: every regional office outside Europe and Geneva still has more allocated funding than the agency can actually spend.

“We can only implement the budget if we have the financing,” Imre Hollo, director of strategic planning and budget at WHO, told member states.

The exit of US funds has affected 23.8 million people worldwide, causing closure or reduction in services at over 2,600 health facilities, WHO’s Independent Oversight and Advisory Committee said Wednesday.

The US had committed $154 million in voluntary contributions to WHO’s base budget (29% of total voluntary contributions) for 2024-25, plus another $235 million to emergency operations (15% of total voluntary contributions).

But not all of this funding came through.

“Along with the reduction in voluntary contributions from other donors, the freeze and withholding of voluntary contributions from the United States resulted in an 18% decrease in overall financing available,” the IOAC analysis found.

Global aid for health at decade low

When excluding COVID-19-related aid, health development spending is declining across many major donors.

The US government under the Trump administration has slashed $60 billion in total aid, with severe implications for global health programs covering malnutrition, maternal mortality, and prevention and immunization programs for HIV, malaria, tuberculosis and other infectious diseases.

The US cuts represent the extreme edge of a global trend in reducing aid, especially for healthcare.

Setting aside COVID-19 spending, health-focused overseas aid in 2023 stayed beneath 2019 figures across the United States, Britain, Germany, Canada, European Union bodies, France, Italy and the Netherlands. Healthcare development funding also dropped year-over-year from 2022 to 2023 in Germany, Italy and Canada.

“The share of official development assistance going to health has dropped to its lowest point in 10 years,” an analysis by ONE found in January. “All indicators suggest this will fall even lower in years to come at a time when progress against preventable deaths is at risk of backsliding.”

Analysis by the Centre for Global Development classified 37 nations as “highly exposed” to US aid cuts, facing losses equivalent to 10% or more of their government’s national health expenditures. Twenty-five countries face losses of 20% or more, while 10 face losses of at least 50%.

Extreme scenarios include Afghanistan, Somalia, South Sudan and Malawi, where US health aid equals 341%, 237%, 235%, and 207% of national health spending respectively.

“This will also have knock-on impacts on disease detection, access to medical countermeasures, R&D, and social determinants of health from nutrition to clean water in some of the world’s most vulnerable settings,” the UK delegation said.

Calls for efficiency amid crisis

WHO is urging countries to look at domestic options wherever possible, using the funding crisis as a chance to reduce reliance on external health financing and build domestic infrastructure.

“From expanding domestic financing to pioneering real-time data systems, many of you are advancing solutions that are scalable, sustainable and rooted in equity,” WHO Director-General Tedros Adhanom Ghebreyesus told ministers gathered in Geneva on Thursday.

“Data and sustainable financing are not just technical matters,” Tedros added. “They are political choices. They shape who is reached, how quickly, and with what quality of care. And they determine whether we progress or fall behind.”

Professor Senait Fisseha, Vice President of Global Programs at the Susan Thompson Buffett Foundation, urged countries to “use this moment to rethink data and financing in a way that best meets your needs and the needs of your people.”

“For countries to truly lead and for funders and development partners to start to learn how to follow, data and financing are a natural place to start,” Fisseha added. “That is where ministers are telling us to start.”

Development spending on health hit its lowest level in a decade in 2025.

As WHO asks member states to fight the crisis with efficiency gains and data-driven approaches, members are demanding the same from the agency. Financial constraints are forcing WHO to reduce its workforce alongside other cuts.

The agency’s emergency program exemplifies the squeeze, cutting its budget from $1.2 billion to $812 million while facing mounting crises.

“We’ve adjusted our workforce. We’ve strategically controlled our expenses. We’ve put in place more efficient processes,” said Dr Mick Ryan, outgoing director of emergencies at WHO. “But there are headwinds… increasing frequency and intensity of conflict, increasing frequency and intensity of natural disasters and epidemics.”

Discussions ahead of Tuesday’s budget vote made clear approval of the financial lifeline for the UN health agency – which included member states agreeing to the 20% membership fee increase – came with expectations that WHO would continue reform efforts to be more “efficient,” “transparent”, and “cost-effective.”

“We have already taken serious measures, and we will continue to take serious measures to reform the organisation for the better,” Tedros said following the vote to approve the new budget.

“There is a crisis,” he added. “But we will use this crisis as an opportunity and make sure our organization emerges sharper and more empowered.”

Push for flexible funding

WHO Director-General Dr Tedros Adhanom Ghebreyesus and Raul Thomas, the Assistant Director-General for Business Operations at WHO address the committee following the successful vote on the agency’s new budget.

A demand that emerged from states at the World Health Assembly was the need for WHO funding to be flexible. Agency funding frequently comes with restrictions and is earmarked only for certain regions or projects, leaving limited resources to respond to critical issues like climate change and women’s health.

“We urge flexible and non-earmarked voluntary contributions for WHO to overcome current financing constraints,” the Bangladesh delegate said.

A major step in this direction came this week as member states agreed to the membership fee increase, which brings the total for the base budget funded by flexible dues up to 40%, rising from just 16% in 2020.

However, the agency remains critically reliant on voluntary funds. WHO’s emergency and polio budgets rely entirely on voluntary funding and bring the total target budget for operations from 2026-27 to $6.2 billion – meaning WHO is still around 75% reliant on voluntary funds across all operations.

Sri Lanka recommended WHO engage in high-level negotiations toward resource mobilisation to secure sustainable funding.

“We support the call for diversified financing from global health donors, development banks and private sector partners,” the country’s delegate said.

Image Credits: WHO/X, ONE, ONE.

African health ministers pose with the signed agreement of intent to eliminate visceral leishmaniasis.

In a region where war, displacement, and weak health systems fuel a deadly disease, nine African governments are trying a new approach: eliminate visceral leishmaniasis by working together.

As neglected tropical diseases (NTDs) continue to strain underfunded health systems across Africa, a regional political coalition has formalised its intent to eliminate visceral leishmaniasis (VL) through cross-border collaboration.

Six countries – Chad, Djibouti, Ethiopia, Somalia, South Sudan, and Sudan – signed a Memorandum of Understanding (MoU) during a World Health Assembly side event, outlining a joint strategy for surveillance, treatment, and disease control across borders.

The initiative aligns with WHO’s 2021–2030 NTD roadmap and the regional visceral leishmaniasis elimination framework launched in June 2024.

“This is more than a health initiative. It is a movement for social justice, equity and development,” said Dr Ibrahima Socé Fall, Director of the Global NTD Programme at the World Health Organization, who delivered remarks on behalf of WHO Director-General Dr Tedros Adhanom Ghebreyesus.

But while ministerial signatures and declarations signal a shift in political will, national officials said frameworks alone will not fill treatment gaps, rebuild surveillance in conflict-affected regions, or overcome decades of structural neglect.

Visceral leishmaniasis is endemic to much of Eastern Africa, where outbreaks have historically defied borders, and weak infrastructure has complicated responses. The disease has killed over 200,000 people in the region in the past 40 years, and about 74 million remain at risk, according to Ethiopia’s health ministry.

Dr Ibrahima Socé Fall, Director of the Global Neglected Tropical Disease Programme at the World Health Organization.

Sudan, currently affected by one of the world’s most severe humanitarian crises, illustrates the fragility of progress. Displacement, vector breeding in camps, and disrupted supply chains are driving a surge in untreated cases amid the raging civil war.

“Today, only 21 of 44 diagnostic and treatment centres are functioning across seven states,” said a Sudanese representative.

The country’s health officials are now prioritising adaptive, conflict-aware strategies, including mobile teams and decentralised logistics, but warned that regional gains could unravel without sustained support.

Nigeria, while not among the signatories, voiced its intent to establish a similar MoU with neighbours. With 67 border-region local government areas, officials described cross-border VL transmission as a pressing risk.

“The cost of care is steep, and we bear 25% of the global NTD burden,” said a representative on behalf of Nigeria’s Coordinating Minister of Health. “We cannot address this in isolation.”

Tanzania echoed the call for accountability. “We must hold each other accountable, track progress, and adapt strategies,” said its health minister. “There is no more time for words, but we still have time for action.”

Beyond coordination, speakers drew attention to persistent barriers: limited domestic financing, weak integration into primary care, and outdated tools.

DNDi’s CEO, Dr Luis Pizarro, described current VL treatments as “toxic, painful, and costly,” particularly for rural populations, emphasising that research and development must no longer be viewed as a luxury.

“It is not acceptable in 2025 to rely on outdated treatments,” Pizarro said.

The Africa CDC urged states to rethink the framing of NTDs. “These are not neglected diseases—they are priority diseases,” said the representative of Dr. Jean Kaseya, Director General, Africa CDC, citing the need to embed NTD strategies in health security planning and push for domestic investment despite fiscal constraints.

The meeting closed with ministers endorsing a call to action that commits signatory countries to concrete steps in eliminating VL, including shared data systems, joint planning, and community-based delivery.

From left: Nancy Aburto, Azucena Milana-Dayanghirang, Moumouni Kinda, Claudia Hudspet, and Lina Mahy
From left: Nancy Aburto, Azucena Milana-Dayanghirang, Moumouni Kinda, Claudia Hudspet, and Lina Mahy at the Geneva Health Forum panel discussion in May 2025.

GENEVA – Although the past decade has seen progress in the fight against malnutrition, 148 million children remain stunted, 45 million suffer from wasting, and anaemia affects nearly one in three women globally, according to experts at the Geneva Health Forum (GHF).

In 2023 alone, 733 million people experienced hunger—152 million more than in 2019—and over 2.8 billion people were unable to afford a healthy diet. The GHF noted that malnutrition also remains a contributing factor in 45% of deaths among children under five.

Looking ahead, the global nutrition crisis could worsen.

Francesco Branca of the Institute of Global Health at the University of Geneva warned that the number of obese people worldwide is expected to rise from a billion today to 2.3 billion by 2050.

“Nutrition has to be where we take action,” he told a room on Tuesday at Campus Biotech, where this year’s GHF side sessions of the 78th World Health Assembly are being held.

“Where do we take action?” Branca asked. “It has to be people-centered. So the action has to be where the problem is. The action has to be in the centres where children are presented with malnutrition. The action has to be taken in primary health care offices where doctors find people with obesity. The action has to be where people are suffering from a lack of food, indeed, and that’s, of course, the responsibility of people providing services and people who are making decisions about those services.”

The three-hour session brought together global experts from diverse sectors. It was held against the backdrop of a recent decision by WHO member states to extend the Decade of Action on Nutrition (2016-2025) to 2030, aligning it with the 2030 Agenda for Sustainable Development. It also took place following the 2025 Nutrition for Growth (N4G) Summit in March, where 47 participating states made more than 400 commitments.

Speakers highlighted the need for stronger governance and integrated, multisectoral approaches to combat malnutrition. They emphasised bundling services to improve efficiency, implementing regulatory measures such as taxation and food labelling, and exploring innovative financing mechanisms.

According to Valerie Bellino, president of the Geneva Global Health Cooperative, the session’s aim was also to position Geneva as a driving force in promoting global nutrition solutions and to help build the long-term momentum needed to meet the 2030 targets.

A ‘village’ of solutions

Afshan Khan (right), Assistant Secretary-General of the United Nations and Coordinator of the Scaling Up Nutrition (SUN) Movement
Afshan Khan (right), Assistant Secretary-General of the United Nations and Coordinator of the Scaling Up Nutrition (SUN) Movement

Afshan Khan, Assistant Secretary-General of the United Nations and Coordinator of the Scaling Up Nutrition (SUN) Movement, spoke passionately about the importance of the N4G Summit. She highlighted the strong participation of civil society in the summit, describing it as “a whole village of solutions.”

Khan emphasised that the event featured a whole day dedicated to showcasing best practices from civil society partners and youth-led discussions about how the intersection of nutrition, health, climate change, and conflict is shaping their lives, now and in the future.

She added that there was also a dedicated day of engagement with the private sector.

“We have to be able to address all forms of malnutrition and undernutrition with the right kinds of quality nutritious foods available at an affordable price, as well as having foods that are low in trans fat or sugars,” Khan explained. “A really important component is how we influence what people eat, which is influenced by what companies are putting out there on the market.”

She reiterated that nutrition is not just a health concern, but a key pillar of economic development.

“The Nutrition for Growth Summit helped connect the golden thread of the importance of nutrition for long-term growth and development of children, for the health of women… and also the economic imperative nutrition brings to building human capital,” she said.

“There is a real opportunity to emphasise and stress more that an investment in nutrition has a $23 rate of return for each dollar,” Khan added, citing World Bank estimates. “Here we see an opportunity to show the power of nutrition and its ability to transform societies.”

Still, while some countries have stepped up, others are pulling back—and the consequences are already unfolding.

Khan also warned that ongoing conflicts, climate stress, and budget cuts are combining to put millions of lives at risk.

“The situation in Gaza is perhaps one of the most visible and stark, because it’s clearly a man-made crisis—as is Sudan, as is Yemen,” she said.

She explained that nutrition programs are often amongst the first to be cut when aid is reduced. For example, more than 600,000 people in Kenya living in drought-stricken areas are expected to lose access to lifesaving food and nutrition services. Similar cuts are taking place in Sudan.

According to the Standing Together for Nutrition consortium, a 44% reduction in aid could erase decades of hard-won progress, leaving 2.3 million children without access to essential treatment.

Khan warned that as many as 60% of these children may not survive without intervention: “The long-term projections on death due to some of these cuts are stark.”

Learning from success

A panel discussion during the session highlighted where nutrition efforts yield results, offering practical takeaways that others in the field could adapt to their national contexts.

Azucena Milana-Dayanghirang, Assistant Secretary and executive director of the National Nutrition Council in the Philippines, shared that her country faces a triple burden of malnutrition: undernutrition, overnutrition, and micronutrient deficiencies. To address this, the government launched a multisectoral platform centred on what she called “ABCDY,” where A stands for academia, B for businesses, C for civil society, D for donors, and Y for youth.

She explained that these nutrition-focused collaborations are being implemented at all levels, from the federal government to local government units.

“What is unique about the Philippines is that we have 7,000 islands—geographically isolated areas where malnutrition is highest,” Milana-Dayanghirang explained.

To tackle these challenges, the government rolled out the Philippine Plan of Action for Nutrition (PPAN), a six-year strategy from 2023 to 2028. The plan focusses on three core pillars: promoting healthier diets, fostering improved social behaviours, and strengthening governance.

“We develop policies,” Milana-Dayanghirang said. She pointed to one example: the Philippines instituted a sugar-sweetened beverage tax that has effectively reduced consumption, especially amongst teenagers and children.

She added that the country is now in the final stages of approving a national nutrient profiling model and food labelling program—tools she hopes will further strengthen the country’s nutrition agenda.

From left: Nancy Aburto, Azucena Milana-Dayanghirang, Moumouni Kinda, Claudia Hudspet, and Lina Mahy
From left: Nancy Aburto, Azucena Milana-Dayanghirang, Moumouni Kinda, Claudia Hudspet, and Lina Mahy

In an Africa case study, Moumouni Kinda, director of the Alliance for International Medical Action (ALIMA), shared that globally the treatment of children for malnutrition has expanded significantly, from treating no children for malnutrition 55 years ago to nearly nine million in 2023. Last year, Alima teams treated 350,000 malnourished children in 13 countries.

However, despite this progress, Kinda said his teams receive weekly reports from more than a dozen countries warning of imminent food shortages. Amongst the hardest-hit nations are Niger, Chad, host to many Sudanese refugees, and Nigeria.

“The violent shutdown of USAID and funding cuts in the United Kingdom and Europe are worsening an already critical situation,” Kinda warned. “But we have hope.”

He explained that that hope lies in the potential to secure more sustainable, local sources of funding. Like the Philippines, Kinda suggested that more African countries could implement a sugar-sweetened beverage tax to help finance nutrition programs.

He emphasised that the tax could be modest—”only one cent”—but if adopted by several countries, it could have a significant impact.

“If we approach 10 countries, this could be about $1.4 billion annually,” Kinda said, noting that such a sum could help treat millions of children across the continent.

The WHO’s Lina Mahy highlighted significant funding imbalances in the global food system. She pointed out that during the COVID-19 pandemic, from 2020 to 2022, the food industry made approximately $1 billion in profit every two days. In that same period, 62 new food billionaires emerged.

“We have to put that into perspective,” Mahy said. “We need to talk about – these power imbalances and inequalities and how to address them. WHO is ready to talk about these elephants in the room.”

Investing in food systems

Bundabo Hassan Abdi at an Internally Displaced Persons camp in Baidoa, Somalia, where 33% of the children below 5 years of age were suffering from severe acute malnutrition with medical complications in 2024, a compounded effect of conflict and drought.

The Aga Khan Foundation is working to help fill funding and service gaps in the global nutrition space. Claudia Hudspet, the organisation’s global health lead, said the foundation has committed more than $45 million over the next five years to better integrate nutrition into healthcare systems and improve access to affordable, healthy food.

One of the foundation’s key programs is the Central Asia Stunting Initiative (CASI), which targets high stunting rates in remote parts of Afghanistan, Pakistan, and Tajikistan. The program is designed to improve maternal and child health outcomes by supporting frontline health workers in assessing and addressing nutritional needs.

In partnership with the Aga Khan Health Service and local partners in Pakistan, the foundation helped develop a mobile application for Lady Health Visitors (LHVs) in the Gilgit-Baltistan and Chitral regions. The app enables LHVs (health workers that specialise in maternal and child health) to assess the nutritional status of pregnant women, mothers, and children during household visits and provide targeted nutrition supplements when needed.

“The Central Asia Stunting Initiative really looks at integration into health systems,” Hudspet explained. She said a major focus is increasing the number of women giving birth in health facilities and ensuring that newborns are weighed at delivery. “It’s a very simple intervention, but many babies aren’t weighed at birth, and we miss a lot of those low birth weight and small for gestational age babies, and we’re not able to give them the best start in life,” she said. “Identifying growth faltering and catching children before they lose weight or stature… improves our chances of success.”

In Tajikistan, sweet potato is added to children’s diets with support of the Agha Khan Foundation’s Central Asia Stunting Initiative to curb malnutrition rates.

In addition to stunting prevention, the foundation is working to integrate nutrition into early childhood development efforts through the Nurturing Care Framework.

Hudspet also emphasised the foundation’s growing interest in food systems, particularly the links between agriculture, climate resilience, and nutrition.

One of its flagship programs in this area is the Indian Ocean Coastal Regeneration Initiative (IOCRI), which Hudspet described as supporting sustainable livelihoods in coastal communities while restoring degraded ecosystems. The program aims to rehabilitate 100,000 hectares of coastal lands and strengthen local economies through renewable energy and nature-based solutions.

“While this is a climate initiative, initially, we also are integrating nutrition through things like blue foods; aquaculture nutrition champions looking at food supply and social behaviour,” Hudspet said.

Because the foundation and Aga Khan University are part of the same network, the foundation can also leverage data to monitor program impact and adapt as needed.

“We monitor these programs very intensively, and tweak and learn from them,” she said.

Nutrition as a climate health strategy

Climate change added 41 days of dangerous heat in 2024, exacerbating drought in vulnerable parts of the world, according to World Weather Attribution (WWA) and Climate Central.

Nancy Aburto, Deputy Director of the Food and Nutrition Division at the Food and Agriculture Organization (FAO), said the growing body of data around food insecurity and its consequences offers new opportunities to move from talk to action.

“I’m going to start with a statistic that’s not very pretty,” she told the room. “It’s 2.8 billion people worldwide [who] cannot afford a healthy diet.”

But Aburto said that knowing this figure—and having tracked it for several years—has pushed researchers and policymakers to seek tangible solutions. One of the clearest, she said, lies in how we spend existing agricultural support.

“In 2022, the State of Food Security and Nutrition in the World report documented that worldwide support for food and agriculture was almost $630 billion a year,” she said.

When combined with recent true cost accounting from FAO that shows unhealthy diets account for about 70% of the $10 trillion in hidden costs to health systems, the case for repurposing that investment becomes even stronger.

“It tells us that we can repurpose that $630 billion a year to something that can help us reduce that $10 trillion cost burden on our health systems,” Aburto explained. “And that is moving us towards solutions for repurposing agricultural investments to diverse, nutritious foods, which can absolutely be monumental.”

She added that food systems reform has benefits beyond nutrition.

According to Aburto, shifting diets could reduce greenhouse gas emissions from the food and agriculture sector by up to 13%. The environmental benefit doesn’t stop there—healthier diets can also help protect forests, water systems, and biodiversity.

“This means enabling healthy diets is not just a solution for the nutrition community,” she said. “It’s a solution for the environmental community as well.”

Image Credits: Agha Khan Foundation/University of Central Asia / Azamat Azarov, Maayan Hoffman, Ismail Taxta/ WHO, WMO.

Lancet editor Richard Horton (left) moderates a panel with Helen Clark, Precious Matsoso and Raj Panjabi at the Geneva Graduate Institute.

There are tensions between World Health Organization (WHO) member states about how to approach the final negotiations on the pandemic agreement – an annex on Pathogen Access and Benefit Sharing system (PABS), according to Precious Matsoso, who co-chaired the negotiations.

“There’s an argument about whether you invite experts to start working on a technical document and then invite member states to discuss the details and negotiate amongst themselves, or get member states to submit their inputs and discuss and only then would you invite experts,” Matsoso told on event at the Global Health Centre at the Geneva Graduate Institute on Tuesday.

The Intergovernmental Negotiating Body (INB), co-chaired by Matsoso of South Africa and French Global Health Ambassador Anne-Claire Amprou, hands the PABS talks to an  Intergovernmental Working Group (IGWG). 

The working group is supposed to conclude talks on annex by next year’s WHA and, once adopted, the pandemic agreement will then be open for signature and ratification. Once 60 countries have ratified it, the agreement will enter into force.

The IGWG will also begin to set up a Coordinating Financial Mechanism for pandemic prevention, preparedness and response, and the Global Supply Chain and Logistics Network (GSCL).

Helen Clark, co-chair of The Independent Panel for Pandemic Preparedness and Response, said the IGWG was expected to start work in September.

She flagged the 2026 United Nations High-Level Meeting on pandemic prevention, preparedness and response as an opportunity to “push for rapid ratification” – or agreement on the annex if it has not yet been passed.

“The message we could send out to countries is: start looking at your national procedures and doing your national tests, and be ready to run on ratification when the annex is actually agreed,” Clark told the Graduate School audience.

Clark added that while South Africa, as chair of the G20, was supportive of pandemic prevention, preparedness and response, the US was due to assume the chair in 2026.

“Will they take the chair next year, or will it pass to someone else? If they take the chair, what hope is there for any of this? That’s an open question. I’m not a diplomat, so I can put this question on the on the table. If they take the chair, it could be treading water for a year, for with G20,” said Clark, who is a former Prime Minister of New Zealand.

Role of EU in talks

Speaking shortly after the World Health Assembly (WHA) plenary adopted the pandemic agreement, Matsoso said that the “Slovakia drama” raised questions about how regional blocs operated during negotiations.

Slovakia, whose Prime Minister Robert Fico is opposed to mRNA vaccines, demanded a vote on the pandemic agreement resolution during a committee discussion on Monday night. The resolution was passed by 124 votes in favour, zero objections, and 11 abstentions.

But Matsoso said Slovakia was part of the European Union (EU), which had negotiated as a bloc, so it should have been party to the regional position.

Matsoso added that some of the countries that had abstained had explained they “were still going through their own internal processes, and had not been given a mandate to vote” as they had expected the agreement would be adopted by consensus.

Dr Raj Panjabi, former White House official under Joe Biden, said there were three things to watch to ensure the pandemic agreement was implemented: independent monitoring and clear accountability; adequate financing, and “increasing regional self reliance”.

“Ensuring that financing is stepped up [is] very hard in this moment when overseas development assistance is being pulled back, not just by my country, the United States, but by several others,” said Panjabi.

“The WHO is more strained than ever, and that’s why ensuring that assessed contributions are increased is going to be critical, as is harmonising and leveraging other funds in the system,” said Panjabi.

Regional self-reliance

Panjabi defined regional self reliance as “an entire end-to-end focus, from research and development, investment and innovation to enhancing manufacturing and ensuring that the delivery of counter-measures in the next pandemic occurs,” said Panjabi.

Swedish global health expert Anders Nordström (left) moderates a panel with Diah Saminarsih, Eloise Todd, Michel Kazatchkine and Mariangelo Simao.
Swedish global health expert Anders Nordström (left) moderates a panel with Diah Saminarsih, Eloise Todd, Michel Kazatchkine and Mariangelo Simao.

However, Brazil’s deputy minister of health, Mariângela Simão, warned that, while there is a G20 coalition on local and regional production, “there’s so much that you can do at country level”. 

“Research and Development is one of the things that I’m more worried about – the capacity to copy what’s already developed and make safe and quality-assured products. We don’t need reinventing the wheel everywhere. We need to recognise what are global public goods and then make sure they are available at country level… you can’t have everyone producing everything.”

UNAIDS special adviser Michel Kazatchkine said that he could not see a world “that is just a juxtaposition of regions without any glue, without any coordination, without any compass”. This,  he added, is the role of the WHO, providing “vaccine blueprints, pre-qualification, its normative role”. 

In the future, global health “will not look like a top-down construction that it has been with money flowing from Geneva to various places”, Kazatchkine stressed. “The international money will be there to complement the national and the regional efforts, because global health is also about global solidarity.”

But Eloise Todd, who leads the Pandemic Action Network (PAN), noted that one of the biggest learnings from the COVID pandemic is “definitely no country, and certainly no region that can do it all themselves”. 

“We’re in a very uncomfortable place in which we know that there are modernisations and ways in which we need to reform to support the regionalisation agenda and the country agenda, but we certainly shouldn’t be doing it at the pace and with the disregard being done at present.

“We’re in this tension between the excellent work that some global entities do to fill a gap. And so what do you do about that? You can’t cut it away and risk lives, but we have to have, like, a 10 ,15, 20-year conversation about powering that down and getting towards proper national and regional level intersectionality.”

WHA member states meet on reform process Tuesday – in half empty room.

A formal procedure for investigating allegations of misconduct against WHO’s Director General got the greenlight from the World Health Assembly on Tuesday – after six years of mostly closed door debate and deliberations.  

The procedure is the first ever to be approved by the global health body for investigating any current or future head of organization – in line with United Nations recommendations to all UN family agencies, first issued in 2019. 

But the process developed for WHO also contains a few key loopholes.  The responsibility for recommending that an investigation begin rests with  WHO’s Office of Internal Oversight Services – which operates under the wings of the WHO Director General – although IOS also files an annual report to the WHO Executive Board.

According to the text of Tuesday’s WHA decision, “Following a prima facie determination from the Office of Internal Oversight Services that indicates further analysis of the allegation is warranted, the Office of Internal Oversight Services will (1) notify the Officers of the Board (Chair, Vice-Chairs and Rapporteur); (2) notify the IEOAC Chair [WHO’s Independent Expert Oversight Advisory Committee]; and (3) transmit the allegation along with any supporting documentation and the Office of Internal Oversight Services’ prima facie determination rationale, to an EIE [an external investigative entity] drawn from a pool of EIEs as provided for in chapter C below, for further analysis.”

WHO’s Secretariat and the EB are gatekeepers of the process.

Effectively, this means that any current or future investigation of allegations against WHO’s top official could not even begin unless WHO’s own in-house investigators first recommend such a step – with all of the inherent conflict of interests involved. 

Moreover, even if such a case went forward, it would be overseen by WHO’s Independent Expert Oversight Advisory Committee (IEOAC). The three-member IEOAC Secretariat includes WHO’s Chef de Cabinet and the ADG for Business Operations – both political appointees and members of the Director General’s leadership team.  

IEOAC, in turn, would be responsible for choosing which “external investigative entity” should pursue any case – should a case be pursued.  And there, too, WHO’s top leadership also appears to have a final say, as per section 3.2 (c): 

“If prioritization… results in two or more equally suitable [investigative] candidates, the WHO Secretariat will further narrow that short list to identify the best candidate on the basis of availability, efficiency, quality and value for money.”

Process contrasts with the UN investigation of WHO sex abuse allegations in DR Congo

The process contrasts sharply with WHO’s management of investigations into sexual harrassment and abuse allegations against agency staff and contractors in DR Congo during the 2018-2020 Ebola outbreak. Following a public outcry over the initial media reports of abuse, those cases were turned directly over to the UN Office of Internal Oversight Services (OIOS) – so as to ensure a more impartial outcome. See related story here:

In WHO’s Internal Justice System, All Roads Lead to Director General

Executive Board can halt an investigation at preliminary stage

Finally, once an preliminary investigation of any alledged misdeed involving the Director General is completed, the Executive Board, a member state body with vested political interests, could choose to halt further action altogether, according to Section B3.12 of the decision agreed to by WHA: 

“In a case where (a) the EIE determines a full investigation is warranted, (b) the IEOAC’s assessment confirms that due investigative procedure has been followed and recommends proceeding to a full investigation, (c) and the Officers of the Board have grave concerns about the EIE preliminary review and the IEOAC’s assessment and recommendation, the Officers of the Board may recommend to the Executive Board not to proceed to a full investigation.”

Demands by some member states to insure a role for the EB in such sensitive investigations, was a major stumbling block issue in the years’ long debate and delays over the final drafting of a investigation procedure – which led to the compromise reached Tuesday. 

 Once a full investigation is completed, the EB would review the results and decide what final actions to take as per Section B.6.1 of the procedure, which states: 

“Upon receipt of the investigation report, the Officers of the Board will review all of these materials and decide whether to close the case or to initiate disciplinary proceedings. The Officers of the Board may request advice from the IEOAC regarding the findings.”  

US objected but is outside of the room

In discussions last year over the process, the United States delegation raised strenuous objections over some of the circularity of some of the proposed procedures – but they were outside the room this WHA, in light of the US decision to withdraw from the global health agency – at least for now. (see related story). 

BREAKING – US Health Secretary Robert F Kennedy Jr Extends Olive Branch to WHO – With Strings Attached 

And at the Executive Board meeting in January 2025, the Representative of the WHO Staff Association raised concerns about the lengthy time required for WHO IOS investigations generally, noting that for rank and file staff, “It can take up to two years for internal justice cases to be resolved.”

Member states were adamant about their role   

Botswana delegate to WHA speaks about importance of member state control over investigative process.

But in the final analysis, member states were adamant about preserving their own right of review and decision at different stages of the process, through the Executive Board gate.

“We believe that the Executive Board and the World Health Assembly remain the appropriate bodies to oversee and manage these matters in accordance with their mandate,” said the WHA delegate from Iraq, speaking on behalf of the Eastern Mediterranean Regions. Members of the Africa group, echoed similar sentiments. 

“We welcome the decision to say that the governing bodies over five while maintaining the independence, integrity and confidentiality of the investigative process,” said Botswana.  

Need for independent oversight   

Poland’s WHA delegate speaking on behalf of the European Union.
Norway’s delegate calls the decision a milestone moment.

Other member states appeared relieved to have settled on a formal procedure that included any role at all for external investigators – should the need arise. 

“We emphasize the importance of accountability and independent oversight, and strongly believe that an independent body selected and appointed by the EB should investigate allegations against the Director General,” said Poland, speaking on behalf of the European Union member states, nine other European nations and Brazil. 

“We are in the 11th Hour, and we count on member states collective support in finalizing this key aspect of governance reform at the WHA.  We also emphasize the need for specific mechanisms which provide detailed, ongoing oversight over the WHO restructuring and its focus and core priorities, enhancing the organization’s accountability and in the new landscape.”

Meanwhile, Norway, speaking on behalf of a group of seven, primarily Nordic nations, sounded a more positive note. “The proposed procedures… have achieved the necessary balance between independent investigation and Member States visibility, while seeking to avoid politicization of the process. This is a defining moment for WHO and its member states.”

Only Japan seemed to insert a real note of reservation about the new process, saying, 

“We generally support this. However, Japan has three points for further thoughts of implementation. First, the importance of neutrality. Second, the avoidance of politicization. Thirdly, independence of the [WHO] Secretariat, particularly the Internal Oversight Services. 

“We expect this process will be properly implemented based on key principles, and we underscore the need to constantly review and improve the process, taking into account the consistency among the process of the other UN organs.”

Image Credits: Mudassar Iqbal /Pixabay.

Delegates gathered on Tuesday at the World Health Assembly agreed a new WHO budget for the 2026–2027 period which included a rise in membership fees. Photo WHO/Pierre Albouy.

Nations at the 78th World Health Assembly approved a new budget and a 20% increase in annual membership fees for the World Health Organisation (WHO), handing the embattled UN health agency a crucial lifeline as it grapples with the financial bomb dropped on Geneva by the United States’ withdrawal from international institutions.

The vote marks the second consecutive 20% hike in membership dues in as many budgets, which the agency’s member states approve on a biennial basis, the last coming in 2024.

The move is part of a long-term plan to boost mandatory contributions from 16% of WHO’s core budget at the start of the decade to 50% by 2030 to reduce its dependence on the whims of major donors like the now-departed US.

These membership fees provide the organization with flexible funding it can allocate according to its own priorities, unlike the voluntary contributions that typically come strictly earmarked by donors for specific programmes that have historically made up the vast majority of the WHO’s budget.

Under the new budget, assessed contributions will make up 40% of the WHO’s base program budget of $4.2 billion for the 2026-27 period. The core budget does not include emergency humanitarian appeals or polio programmes, which bring the total budget target up to $6.2 billion.

The fee increase, initially mandated in a 2022 resolution at the WHO’s executive assembly, faced an uncertain path to approval on Tuesday, with member nations engaging in tense pre-vote debates over the fairness of regional funding cuts in the new budget – which will run for two years starting in 2026 – and demands for greater transparency in expenditure tracking.

Projected financing for the base programmes segment of the budget for 2026–2027, compared to previous bienniums, in US$ million.

A battle of buzzwords played out during the proceedings: supporters of the fee increase championed “flexible, predictable, sustainable and agile” funding, while skeptics countered with demands for “efficiency,” “transparency,” elimination of “redundancy” and “cost-effectiveness” – signaling clearly that the WHO’s financial reprieve comes with strings and expectations attached.

WHO officials had acknowledged in the budget document they were “cognizant that such an increase will not be automatically granted” amid overlapping global crises straining national budgets worldwide.

In the end, a collective recognition of the existential financial threat facing the agency carried the budget over the line. The chamber fell silent during the vote, with no objections raised. 

“There is a crisis,” WHO Director-General Dr Tedros Adhanom Ghebreyesus declared following the vote. “But we will use this crisis as an opportunity and make sure our organisation emerges sharper and more empowered.”

Germany’s delegation, the WHO’s most important financial backer since the American departure, hailed the decision as “historic” — but not before voicing their support in song.

“I tell you what I want, what I really, really want,” the German representative sang in an awkward rendition of the Spice Girls hit befitting the oft-lively proceedings of Committee A, “and that is that we all indeed are serious about functioning and effective multilateralism.”

“The increase is the best vaccination against the highest financial risk that WHO faces,” he added, “its dependency on a very few donors, and the discrepancy between the expectations we all put on the organisation and its ability to fulfil them.”

Financial triage

Imre Hollo, director of strategic planning and budget at WHO.

The agency has been in financial triage mode since the US exit announcement in November, implementing drastic budget reductions to secure votes that earned praise from member states for its “budgetary realism.” 

Before the US departure, the 2026-27 budget required to fulfill WHO’s core mission was projected at $5.3 billion over the two year period. Following Tuesday’s vote, the target plummeted to $4.2 billion, a 22% cut that will impact the agency’s operations worldwide. 

The revised budget represents a $700 million decrease from projections presented at WHO’s January executive board meeting, but even this diminished figure approved in Geneva remains aspirational. 

Level of projected financing for the base programmes segment of the Proposed programme budget 2026–2027, US$ million.

While WHO secured an additional $170 million toward its 2026-27 budget Tuesday evening following major commitments of $50 million a year from China and first-time donors Mongolia and Cambodia, among others, the agency still faces a $1.5 billion funding shortfall on top of the $1.1 billion decrease from previous budget projections.

The two new donor nations join 42 additional first-time voluntary contributors to WHO, including seven low-income and 28 lower-middle and upper-middle income countries. 

“With the exception of the headquarters and the European region, the allocated or proposed budget for every regional office is currently higher, even after the reduction, than the projected implementation,” explained Imre Hollo, director of strategic planning and budget at WHO.

Without additional contributions, further life-threatening program cuts loom. All of the WHO’s six regions face significant cuts heading into the 2026-27 period covered by the budget. Regional office budgets are set to fall by 14%, with the African region facing the largest total cut of $153 million year-on-year. The agency’s Geneva headquarters will lose nearly a quarter of its annual funding.

China announced it will contribute $500 million to the WHO over the next five-year period, though it was unclear whether this includes the 20% increase in its fee contributions. This will make China, for the first time, the largest fee payer in the WHO, supplanting the US as it exits.

“We can only implement the budget if we have the financing,” Hollo said, noting the “personal sacrifice” that member states will need to make should the funding target remain unmet.

More freedom, less money

WHO Director-General Dr Tedros Adhanom Ghebreyesus and Raul Thomas, the Assistant Director-General for Business Operations at WHO address the committee following the successful vote.

The WHO’s budget victory comes amid a zero-sum competition for international aid dollars, with UN agencies and humanitarian organisations worldwide scrambling to fill gaps left by America’s retreat from global commitments.

Since January, the White House has systematically dismantled the US Agency for International Development (USAID) – historically the world’s largest humanitarian donor – while slashing support for the United Nations and WHO’s sister agencies. By March, over 80% of USAID programs had been shuttered, punching a $60 billion hole in global aid budgets.

This broader retreat from international commitments has left organisations like the UN Refugee Agency and Office for Humanitarian Affairs and non-governental humanitarian organisations scrambling for resources just as the WHO does the same, creating unprecedented competition for a dwindling pool of donor funds that no single government appears willing or able to replenish.

In the latest sign of distress, top UN officials told staff at a town hall in New York City Tuesday that the organization is considering a 20% reduction across every secretariat under the UN umbrella for 2026 — from humanitarian affairs, to human rights, peacekeeping operations, and development programs — heightening the financial crisis in the world of international institutions and those who depend on them.

Several major financial contributors to WHO, including Germany, France, and the EU delegation, pressed the agency to develop contingency plans for potential fundraising shortfalls as the UN system creaks under the weight of the US withdrawal. 

“Should the resources, the $1.65 billion, not materialise, the idea is that we will be in a position to actually scale back or ramp up,” said Raul Thomas, WHO’s Assistant Director-General for business operations who led the budget consultations with member states. “We never know – I’m the eternal optimist. Maybe we’ll get much more money than the 1.65 million. That’s the gap right now.”

Image Credits: WHO/Pierre Albouy.

Saima Wazed, daughter of deposed Bangladesh leader Sheikh Hasina, sworn in as Director of WHO’s South East Asia Region in February 2024.

Saima Wazed, WHO’s South East Asia Regional is attending the World Health Assembly in Geneva, and presiding over official events, even while her home country, Bangladesh, has a warrant outstanding for her arrest. 

The warrant follows the filing of charges in March against Wazed in March by Bangladesh’s Anti-Corruption Commission (ACC) alleging fraud, forgery and misuse of power, including in connection with her controversial 2023 campaign for election as WHO South East Asia Regional Director.

After being elected in October 2023, Wazed commenced her five-year term in February 2024.  

Following the flight of her mother, Prime Minister Sheikh Hasina, from Bangladesh last August, Saima Wazed remained in India on a diplomatic passport. In January, Bangladeshi authorities have called for her extradition, but that went unheeded in light of her diplomatic immunity.

In the latest developments, Bangladesh police were due to report on 25 May on their progress in executing an arrest order against Sheikh Hasina and her daughter Wazed, on one of the pending charges, related to allegations of land fraud, a national media outlet reported on Sunday.  

Country won’t acknowledge RD 

WHO Regional Director for South East Asia leading a regional member state briefing last weekend, on the eve of the World Health Assembly.

Bangladesh’s Ministry of Health has reportedly refused to work with Wazed since October 2024, bypassing her office and communicating directly with WHO Headquarters.  For instance, in a 19 March letter, obtained by Health Policy Watch, a Ministry of Health advisor asked WHO Director General Dr Tedros Adhanom Ghebreyesus to directly appoint a new Representative  to the country’s WHO office – a task that normally would be filled by the RD. 

“Her appointment has been the subject of widespread public scrutiny, due to allegations of nepotism and potential irregularities.  Right now, she is facing investigations by the Anti-Corruption Commission of Bangladesh,” stated the 19 March letter to the Director General from Nurjahan Begum, a Ministry of Health advisor, sent just before the formal charges against Wazed were filed.

March 19, 2025 letter to WHO’s Director General

“Consequently, we find ourselves in an embarrassing position working with her,” the letter further stated.  “A direct nomination from WHO Headquarters of Dr Jamsheed for the position of WHO Representative to Bangladesh would help us to get rid of the embarrassment linked to the incumbent RD. We would greatly appreciate if you allow us to communicate directly to HQ on issues of concern in the future.”

Last week in Geneva, Wazed attended a closed door member state Planning, Budget and Administration meeting (PBAC), and then led a weekend briefing for SEARO member states in Geneva on the WHA agenda – posted on the WHO SEARO LinkedIn page.  

WHO: no comment on investigations while in process

Asked why Wazed was continuing to act in her role even after the police investigation had been concluded and formal charges had been filed against her in Bangladesh, a WHO spokesperson said: 

“We are aware of allegations relating to the period before Ms Wazed took up her position as Regional Director for South East Asia, including in respect of activities during the election campaign for that position. 

“We understand that these allegations are the subject of investigation by the relevant authorities in Bangladesh.  We do not comment on such investigations or any consequential legal processes while they are ongoing.”

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

Already in 2023, Wazed’s election campaign was shadowed by charges that her influential mother, former Bangladesh Prime Minister Sheikh Hasina, had used her influence to gain her daughter’s election to the post. Then, only a few months later after Wazed took office, widespread protests prompted Hasina’s abrupt resignation and flight from the country in August 2024.

Second case recently involving a WHO Regional Director  

The charges against Wazed follow on a crisis involving former Western Pacific Regional Director Takeshi Kasai, who was put on administrative leave by the Director General Dr Tedros Adhanom Ghebreyesus in August 2022 after initial allegations of misconduct against the RD surfaced, and following preliminary investigations by WHO’s Office of Internal Oversight Services (IOS).

The IOS investigation culminated in a recommendation that he be dismissed. WPRO member states then voted to recommend his contract be terminated, culminating in his dismissal by the WHO Executive Board. 

In the case of Wazed, however, the charges against her have emanated from her home country – as compared to internal WHO staff complaints against Kasai. 

And high-level WHO officials typically enjoy diplomatic immunity from prosecution, unless those privileges are waived or revoked by the Director General. 

Waivers of immunity are not uncommon, in fact, for small violations by diplomats, like traffic accidents. Waiver of immunity for more serious offenses is a much bigger, and largely unprecedented occurrence – at least for WHO, expert sources told Health Policy Watch. 

“If Bangladesh requests a waiver of the RD’s immunities to have her prosecuted in her country and the DG accepts, he can waive her immunities and probably place her on administrative leave without firing her,” one expert said.  

“Immunities are not an intrinsic component of the position, they are again a protection of an international function against interference by states, but they can and should be waived to facilitate the course of justice if it doesn’t compromise WHO’s interests.  

At the same time, the political context of the accusations against Wazed, whose mother is a deposed former head of state, add layers of complexity to any DG decision – along with the basic legal principle of “presumption of innocence until there is a final conviction.”.  

While the new, interim Bangladesh government has reportedly asked the DG privately  to take action on various occasions – it has so far hesitated from making the affair public. 

And no other SEARO member states have addressed the issue publicly either – and it’s not. clear that they will. Notably, Wazed’s mother, Sheikh Hasina, historically maintained close political ties with the Indian government, which is a powerful member of the 11-nation SEARO region, as well as hosting the WHO Regional Office in Delhi.  

Regional impacts?

Even so, there are signs that the issue is making waves in SEARO. In an unprecedented move, Indonesia, Southeast Asia’s largest country, recently decided to transfer its regional affiliation from SEARO  to the Western Pacific Region (WPRO), a move due to be confirmed at the current World Health Assembly session. Reportedly, Timor-Leste may be considering a similar move.

A WHO spokesperson denied that Indonesia’s request, initiated in June 2024, had anything to do with Wazed, citing “the epidemiological situation in the country (which is similar to others in the WHO Western Pacific Region) and the geographical location of Indonesia (proximity to others in the WHO Western Pacific Region)”. 

But the extract of the SEARO Regional Committee meeting of October 2024 highlights the strenuous appeals by SEARO’s other 10 member states to Indonesia to reconsider or delay its decision, including Bangladesh, which asked it to delay a final decision “ keeping in view the bilateral and regional interests.”  

There are meanwhile reports that Bangladesh could seek to leave SEARO to join the Eastern Mediterranean Region (EMRO) – another heavy blow for the SEARO region that has the fewer number of member states in the entire WHO regional constellation. 

Uncharted territory 

Overall, independent legal experts call the Wazed case “uncharted” territory, and different from the case brought against WPRO’s Kasai, which emanated from internal allegations brought against him by other WHO staff, during his tenure as RD. 

“In this case, we have a difficult interface between actions at the national level against her as a Bangladeshi national (and daughter of the former PM), and her status as an elected RD within WHO, in particular taking into account the rather collusive culture within SEARO with a lot of mutual deference among states and a strong power imbalance between the few big powers like India (and in a lesser way Bangladesh) and the many small and more vulnerable countries like Bhutan, Timor Leste or the Maldives.” said one experienced analyst who requested anonymity.  

“As a WHO staff member, the RD is protected by diplomatic immunities precisely to shield her from political interference from her country or any other countries. The fact that her election campaign may have been influenced by her mother doesn’t mean that she is breaching WHO’s rules and regulations once she has been regularly nominated by the whole Regional Committee. And frankly political maneuvering is the order of the day in RD nomination campaigns.  WPRO offers even worse examples and that is one of the original sins of the WHO constitution and maybe of some reluctance to really address this case.” 

A credibility crisis for WHO

At the same time, critics inside the Organization and out, have also said that the optics of Wazed’s case bode ill for the organization, at a time when it is already navigating stormy waters: a $2.3 billion 2026-27 funding shortfall, increasing geopolitical tensions, and growing skepticism among Member States about institutional impartiality. 

In a period of reform, the case of the SEARO RD, following on from that of WPRO’s crisis, raises long-standing questions about the transparency and efficacy of the current process for electing WHO Regional Directors – who may be chosen on the basis of their national affiliation and political connections, as compared to administrative competencies. 

And in the case of acute crises, such as the one seen now, the questions raised are even more serious.  

“The presence of a Regional Director under criminal investigation—disavowed by her own country, rejected by others, and linked to serious human rights concerns—undermines WHO’s very foundations: neutrality, legitimacy, and trust,” said one critic, who asked to remain anonymous for fear of retaliation. 

“To preserve institutional integrity and regional stability, WHO should immediately place Saima Wazed on administrative leave pending the outcome of judicial processes. This is not about guilt or innocence—it is about governance, ethics, and safeguarding WHO’s future. If WHO fails to act decisively now, it risks complicity in a case that blends authoritarian impunity with multilateral decay.”

Image Credits: WHO, WHO SEARO/LinkedIn.

WHO officials including the co-chairs of the Intergovernmental Negotiating Body (INB) Ambassador Anne-Claire Amprou and Precious Matsoso (right) celebrate the World Health Assembly’s adoption of the pandemic agreement.

Presidents, prime ministers and even opera singers, celebrated the unanimous adoption of the world’s first Pandemic Agreement by consensus at the World Health Assembly (WHA) plenary on Tuesday morning.

Despite the 11th-hour insistence of Slovakia on a vote on the agreement in Committee A on Monday night, none of the World Health Organization (WHO) member states obstructed the agreement’s adoption at the plenary.

Instead, it was presented as a rare example of successful multilateral engagement in a world of heightened conflict.

Head of the African Union and Angolan President João Lourenço commended the WHO’s resilience in the face of “unfair and unjust criticism”, and pledged an additional $8 million from his country to the WHO.

Head of the African Union and Angolan President João Lourenço

Speaking on behalf of the 55 AU member states, Lourenço said the continent is “united in supporting the proposal to increase assessed contributions” [membership fees] as “the WHO is the only institution with a universal mandate to protect global health and promote equity”.

China’s Vice-Premier Liu Guozhong pledged an “additional quota of $500 million over five years” to the WHO, at the plenary, and urged all countries to “support the WHO to play a central coordinating role in global health governance” and enable it “to perform its duty in an independent, professional and science-based manner”.

Croatian Prime Minister Andrej Plenković, also in the room, described the WHO as “a beacon of hope and a guardian of humanity’s right to health”. 

Plenković described sustainable financing of the WHO as “a strategic imperative” to enable “timely responses to emergencies and meaningful support where it is needed most”. 

Egyptian opera singer Farrah El-Dibany and soprano singers Elaine Vidal and Eunice Miller of the Philippines also performed for the assembly.

Macron appeals to US scientists

Emmanuel Macron addresses the WHA plenary in a recorded message.

“Our first line of defence is the WHO,” said French President Emmanuel Macron in a recorded message. He then appealed to “all those researchers who want to freely continue to do their work” – a veiled reference to US scientists dismissed during US President Donald Trump’s massive budget cuts – to move to Europe.

“We will be happy to welcome you in Europe, because that will be good for Europe, for medical research, for you and for everyone. It’s not a question of ‘if’ we will have a new pandemic. It’s a question of ‘when’ we’ll have it,” said Macron.

South African and G20 President Cyril Ramaphosa, and the leaders of the Philippines, Peru, Mongolia and Senegal also sent recorded messages of support.

The UN Secretary-General Antonio Guterres called for a coherent global health architecture and described the pandemic agreement as “historic”.

As one leader after another defended the WHO and multilateralism, Trump’s withdrawal from the WHO loomed as the elephant in the room – and the target of unspoken rebuke. So it was timely – but also surprising – that US Health and Human Services Secretary Robert F Kennedy Jr also sent a recorded message to the plenary.

Unlike the other messages, however, Kennedy claimed that the WHO “has become mired in bureaucratic bloat, entrenched paradigms, conflicts of interest and international power politics”.

“The WHO has not even come to terms with its failures during COVID, let alone made significant reforms. Instead, it has doubled down with the pandemic agreement, which will lock in all of the dysfunctions of the WHO pandemic response,” he added, without articulating any specific US objections to the agreement.  

‘Eyes on the prize’

Namibian Health Minister and chair of Committee A, Dr Esperance Luvindao, Dr Tedros and Dr Mike Ryan applauding the vote on the pandemic agreement in Committee A on Monday night.

Addressing the plenary after the leaders’ messages, WHO Director General Dr Tedros Adhanom Ghebreysus paid tribute to those who negotiated the pandemic agreement.

“You have engaged in very tough negotiations. Sometimes the disagreements were sharp, the discussions heated and the frustration evident. Sometimes it seemed the distance between you might be too great to overcome. But you kept your eyes on the prize, and did not stop until you had achieved it,” said Tedros, adding that sometimes delegates had talked all night in the windowless basement room of the WHO headquarters where the Intergovernmental Negotiating Body (INB) met.

“The pandemic agreement has been negotiated by countries for countries, and will be implemented in countries in accordance with their own national laws,” stressed Tedros, referring to the “torrent of mis- and disinformation” that claimed the agreement will “infringe on national sovereignty” and  give the WHO Secretariat “power to impose mask or vaccine mandates or lockdowns.

“Today, you have sent a loud message that multilateralism not only works, but is the only way to find shared solutions to shared threats. Let’s not understate what you have achieved. You have made the world a safer place,” stressed Tedros.

Pathogens ‘won’t wait’

The agreement was welcomed by the co-chairs of The Independent Panel for Pandemic Preparedness and Response, Ellen Johnson Sirleaf, former President of Liberia, and Helen Clark, former Prime Minister of New Zealand.

“Consider this agreement a foundation from which to build, starting today,” said Clark. “Many gaps remain in finance, equitable access to medical countermeasures and in understanding evolving risks. Don’t wait to get started. Dangerous pathogens are looming, and they certainly will not wait.

The Third World Network said that the “next phases of negotiations, beginning with the Pathogen Access and Benefit-Sharing System (PABS), will determine whether this agreement becomes a meaningful tool for equity or if it remains merely symbolic”.
“At stake is the ability of developing countries to access affordable vaccines, treatments, and diagnostics swiftly and fairly during health emergencies and to realize the ambition of a fairer and more effective global health architecture that can equitably prevent, prepare for and respond to pandemics,” said TWN.

Dr David Reddy, director-general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), said that, as the next level of detail of the agreement is worked through, it is essential that the experience of  pharmaceutical companies is drawn upon “so that their expertise can be mobilized when needed”.

This includes how the PABS will work “where we must make sure that companies are able to access the pathogens and sequence information as quickly as possible to undertake scientific research and avoid unnecessary conditions that make it harder for companies to do so”, Reddy stressed.

He added that “intellectual property protections that are essential for pharmaceutical companies to invest in high-risk R&D, must not be eroded and instead should enable partnerships on voluntary and mutually agreed terms, in a way that draws on the expertise and networks of each company.”

‘US is not indispensible’

Public Citizen Access to Medicines Director Peter Maybarduk said that “WHO member states chose health and justice today, despite RFK’s cheap insult, the reckless US withdrawal and Trump’s deadly neglect of infectious disease threats.

“The world moved forward without the US today. Trump’s devastating cuts cast a shadow on the talks, and are on course to cost millions of lives, including the lives of Americans made more vulnerable to infectious disease,” said Maybarduk. “Still, countries came together amidst scarcity to commit themselves to a more just and healthy world, and that is worth celebrating.”

Matthew Kavanagh, director of Georgetown University’s Center for Global Health Policy and Politics, said that the US “did not show up for the final negotiations but it turns out the US is not indispensable and, in fact, perhaps not having the US engaged is what enabled more cooperation.”
“With the current administration seemingly intent on dismantling global public health efforts, it may be the best case scenario if the rest of the world can come together. In that way, this new agreement is a spot of light in and otherwise dark geopolitical environment for fighting pandemics,” Kavanagh told Health Policy Watch.

Image Credits: WHO.