At Davos Brain Health forum, from left: WHO’s Catharina Boehme, Patrick J. Kennedy, Shelley Lyford Sandy Torchia and  Jon Clifton.

DAVOS, Switzerland – While the United States decision to withdraw from the World Health Organization has thrown the world of global health into turmoil, former US Congressman Patrick J. Kennedy remains hopeful that a “more thoughtful” conversation can be held with the new US Administration of President Donald Trump once the political dust has settled. 

Kennedy, a cousin of Robert F. Kennedy Jr, Trump’s nominee for Secretary of Health and Human Services (HHS), also believes that common ground on new and emerging health issues, such as mental health and healthy ageing, can be found with the new administration in Washington DC – particularly if his cousin is confirmed for the position. 

“Decisions being made at the beginning of this administration are very reactive and political in  nature,” Kennedy told Health Policy Watch on the sidelines of an event on Brain Health hosted by the Davos Alzheimer’s Collaborative at the World Economic Forum (WEF).

“They don’t reflect the kind of thoughtful decision-making we’re going to need to move forward not only for the United States but also for the world,” he said.

“So I hope that in the future we’ll be able to revisit these questions and have a thoughtful conversation about the importance of multilateral organizations – including the WHO.”

Kennedy appeared at the DAC event just hours after the bombshell announcement of Trump’s decision on Monday, just after his inauguration. The US is currently WHO’s biggest contributor, providing roughly 20% of its  funding in the 2022-23 budget biennium. See related story:

Trump May Face Lawsuit Over US Withdrawal from WHO

But Kennedy said he still had “great hopes” for what his cousin, RFK Jr might be able to do as Secretary of HHS, should his appointment be confirmed by the US Congress – despite his deep disagreement with Trump’s decision to withdraw from WHO, as well as the controversies surrounding RFK Jr’s positions on vaccines. 

‘Not going to argue the vaccine issue, but.. ‘

“I’m not going to argue the vaccine issue,” said Kennedy, the youngest son of the late Edward Kennedy, brother of the late Senator Robert F Kennedy, RFK Jr’s father, who was  assassinated in 1968. 

“I would have preferred the other side win,” added Kennedy, a former US Congressman from Rhode Island who publicly endorsed Joe Biden for a second term as US President. 

“But we cannot retreat. We have to engage with the new administration and try to do positive things where they are willing to go in positive directions,” he said. 

Within that context, he believes his now famous cousin, “Bobby” could be part of the solution: “I believe he can go in positive directions on these big issues of mental illness, and addiction.” 

He noted that they had shared a similar journey from substance abuse and addiction to the pursuit of better mental health and a healthy lifestyle. 

‘Bobby and I are both in recovery together,” said Kennedy, co-founder of The Kennedy Forum, a non-profit organization advocating for policies on mental health, addiction and substance use disorders.

“He’s a big supporter of all the things that have worked for me, including in my case, medication assisted treatment…. One of his concepts is to build community.  So I appreciate his vision.”

Brain health, a lifecycle approach 

George Vrandenburg, founder of  the Davos Alzheimer’s Collaborative.

Kennedy was appearing at a DAC session on a “Lifespan Approach” to brain health on the sidelines of the 2025 WEF.

Increasingly, Alzheimer’s advocates are recognizing that much more attention needs to be focused on preventing the disease, which is the underlying factor in an estimated 60-80% of dementia, said DAC founder George Vrandenburg, in opening remarks that set the tone for a three-day series of events.  

That means taking a more holistic view of “brain health” which also involves considering social and environmental brain “risks” and benefits, from poverty alleviation to healthier lifestyles, diets and environment, added Vrandenburg.

An attorney based in DC, Vrandenburg was a senior executive at CBS, AOL, Time Warner and Fox, before becoming a “patient advocate” after seeing two generations of his own family succumb to the disease.

He launched DAC at the WEF meeting of 2021, virtually at the height of the COVID pandemic, as a multi-stakeholder partnership involving business, academic and civil society supporters from around the world.

Four years later, the organization is now pivoting to encourage more research on those multiple facets of risks. 

“In fact, Alzheimer’s is a product of brain problems that occurred during your entire life,” Vrandenburg noted. “So we have now expanded to brain health across the lifespan.”  

‘It’s the brain, stupid’ 

WHO Assistant Director-General of External Relations Catharina Boehme.

Paradoxically, while the brain is the most critical organ in the human body – it’s also the one that we know the least about in terms of tools for ensuring good health, as well as effectively diagnoses and diseases prevention strategies. 

And yet, unlike TB, malaria and other deadly diseases, or even chronic diseases, there is no global programme or strategy for brain health.  

“Why is brain health important?  Because it’s the brain, stupid,” said Kennedy, recalling the famous “It’s the economy, stupid” campaign slogan of Bill Clinton in his 1992  presidential campaign.

“Investing in our brain capital matters and addressing brain health determinants such as education, healthcare, climate and healthy environments will be fundamental for meeting modern societal challenges,” added WHO’s Catharina Boehme, Assistant Director-General of External Relations.

Boehme was standing in for WHO Director General, Dr Tedros, Adhanom Ghebreyesus, who flew to Tanzania earlier in the week to support the country’s response to a deadly Marburg outbreak.  

Costs of treatments soaring as world’s population ages

Colorized brain scan – there are few techniques available to probe the brain’s inner workings.

“It impacts us all. Every single person in this room has been impacted,” said  Shelley Lyford, CEO and chair of the West Health Institute, part of a group of US non-profit organizations that advocates for the health of older Americans.

By 2030, one in six people worldwide will be aged 60 or over, according to the latest WHO projections. By 2050, the world’s population of people aged 60 years and older will double from what it was in 2020 (1 billion), to 2.1 billion.

“Cost is something that we’re going to have to think very, very seriously about in 2050 it’s estimated that Alzheimer’s and dementia related diseases will cost the US healthcare system alone over $1 trillion,” Lyford added.

“We are already on an unsustainable trajectory with respect to healthcare costs, especially in America. But if we look at this as a worldwide issue, this it’s a tsunami that is facing us, and we need to get in front of it.”

In light of the growing numbers of older people, as well as the high costs of treating Alzheimer’s and other dementia related diseases, prevention is ever more key, stressed Vrandenburg – and that means prevention in all areas of life, from exposures to environmental pollution to diet and lifestyle choices.  

Delhi: Air pollution exposure, among other risks, can set the stage for dementia at later stages of life.

But it also means that the quest for new, and more affordable, diagnostics and drugs needs to span both the global south as well as the north.

While problems of ageing and dementia have so far received the most attention in the North, the proportion of older people in low- and middle-income countries is growing and they have little access to treatments available in higher income nations.   

“We’re looking at how we can bring innovations occurring in the global North to the south,” Vrandenburg said.

“But we’re also looking at the kinds of innovations that the Global South may ‘force’ on the north,” he said, referring to earlier R&D breakthroughs born out of resource scarcity.   

“This means lower cost diagnostics, lower cost interventions, lower cost treatments than what we could afford in the north,” Vrandenburg said.

And “quite frankly,” he added, “a lot of people in the North can’t afford” what’s available in health care systems today, in any case.”

‘We can’t do this on our own’

Fig. 1: Vulnerable ‘last in, first out’ (LIFO) network of higher-order brain regions that degenerate earlier and faster than the rest of the brain.
Network of higher-order brain regions that degenerate earlier and faster than the rest of the brain.

“One of the things we learned from the COVID pandemic is that we’re all interconnected… When we have an effort that is a joint effort amongst all the world’s countries, then we’re stronger,” Kennedy added.

“For the future, in terms of brain health, mental health, which I am concerned about, we need to be in this together, because every country in the world is facing the same challenges for both depression, anxiety and also Alzheimer’s and neurodegenerative disorders. 

“The only way to find those  [new] interventions is to have more people participate in the science and research…. in a valid, evidence based science.

“That’s going to require immense data sets, and the only way you’re going to get those data sets is If we’re getting China, Australia, Europe, US, Latin America, Africa, we don’t have that mindset now, and we need multilateral organizations like the WHO to help build the future of healthcare. We can’t do this all on our own.” 

Image Credits: DigitalRalph, Health Policy Watch , Health Policy Watch, Flickr: Florey Institute of Neuroscience & Mental Health, Chetan Bhattacharji, Nature Communications Screenshot.

President Donald Trump’s first day in office saw a barrage of executive orders aimed at dismantling US climate policy, boosting fossil fuel production and undercutting green energy technologies.

Hours after reclaiming the presidency, Donald Trump moved swiftly on Monday to withdraw the United States from the Paris climate agreement and unleash a barrage of executive orders aimed at dismantling US climate policy, boosting fossil fuel production, and undercutting green energy technologies.

The sweeping actions, which are expected to trigger months of legal challenges from states, cities, and environmental groups test the limits of executive authority to reshape national climate policy. They also mark a dramatic reversal of American climate action that threatens to undermine global efforts to combat warming.

The actions, including orders to clear the way for fossil fuel infrastructure expansion and eliminate government support for clean energy technologies from electric cars to wind power, will once again make the United States one of only four nations — alongside Iran, Libya and Yemen — to stand outside the landmark Paris climate accord signed by 196 countries.

“The United States has purported to join international agreements and initiatives that do not reflect our country’s values,” Trump said in one executive order, describing the Paris agreement as a “rip-off.”

Trump also terminated the US International Climate Finance Plan, ending American support for developing nations fighting climate change. The move cuts off $9.5 billion in annual climate funding — representing just 0.147% of the U.S. federal budget — that the Biden administration had scaled up from $1.5 billion to support frameworks like the Green Climate Fund and Global Environment Facility.

“These agreements steer American taxpayer dollars to countries that do not require, or merit, financial assistance in the interests of the American people,” Trump said.

CO2 emissions from Trump policies could ‘negate’ global clean energy gains

Solar panels being affixed to a hospital in Alberton, South Africa. New US emissions generated by Trump policies could negate gains of renewables deployed over past five years.

The withdrawal process will take a year to complete, but its effects could be far more immediate and lasting. An analysis by Carbon Brief projects that a second Trump term would generate an additional four billion tonnes of carbon dioxide emissions over four years — enough to negate “twice over” all the emissions reductions achieved through global clean energy deployment in the past five years.

And that comes against the specter of a rapidly warming climate.  Earlier this month, the EU Copernicus weather service declared 2024 the hottest year on record and the first to breach the 1.5-degree Celsius warming threshold that the Paris agreement aimed to prevent. Scientists warn the world is now tracking toward 3.1 degrees of heating by century’s end, risking catastrophic impacts for billions around the globe.

The orders represent a sharp departure from the Biden administration’s climate agenda. In December, President Biden unveiled plans to cut US greenhouse gas emissions by more than 60% by 2035 and had increased American international climate funding sixfold to $9.5 billion annually.

Trump’s directive also freezes all US foreign development aid for 90 days, citing a “foreign aid industry and bureaucracy” that he claims works against American interests. The freeze could affect critical programs like the World Food Programme, where the United States serves as the largest donor, at a time when climate-related drought and hunger is on the rise, along with conflicted-related hotspots such as Gaza and Sudan.

Swift international criticism

European Commission President Ursula von der Leyen pledges “Europe will stay the course” in the fight against climate change.

The Trump administration’s moves drew swift international criticism, particularly from developing nations that are most vulnerable to climate impacts while contributing least to global emissions.

“This threatens to reverse hard-won gains in reducing emissions and puts our vulnerable countries at greater risk,” said Evans Njewa, chair of the Least Developed Countries group, which represents 45 nations and 1.1 billion people. The bloc’s members account for less than 1% of global emissions despite comprising about 14% of the world’s population.

At the World Economic Forum in Davos, European leaders vowed to maintain their climate commitments even without American participation.

“All continents will have to deal with the growing burden of climate change. Its impact is impossible to ignore,” said Ursula von der Leyen, the European Commission president. “The Paris Agreement continues to be humanity’s best hope. Europe will stay the course.”

Human health toll of US withdrawal

Trucks and buses spew out soot, including climate-changing black carbon and health harmful PM2.5.

The human health cost of the US withdrawal could be severe. The World Health Organization estimates that urgent climate action could save two million lives annually, including over one million from reduced air pollution alone. And with every degree of temperature increase, approximately one billion people will be pushed outside the climate niche where humans have lived for millenia.

“The most tragic consequences will be felt in developing countries,” said Harjeet Singh, policy lead at the Fossil Fuels Non-Proliferation Treaty. “These vulnerable nations and communities, which have contributed the least to global emissions, will bear the brunt of intensifying floods, rising seas and crippling droughts.”

The World Economic Forum estimates the global cost of climate change damage will reach between $1.7 trillion and $3.1 trillion annually by 2050. But Simon Stiell, head of the United Nations climate body UNFCCC, warned at Davos that climate concerns are being overshadowed by other global crises.

“We only seem to have the attention span for one crisis at a time,” Stiell said. “The science behind climate hasn’t changed, the impacts actually have changed, in that they are getting worse and worse.”

No country followed the United States in abandoning the Paris Agreement during Trump’s first withdrawal in 2017, which took three years to complete and was immediately reversed when President Biden took office in 2021. But climate experts also worry that a second US exit could have broader ripple effects on global climate cooperation and financing at a crucial moment for planetary action.

G20 president Cyril Ramaphosa, also speaking from Davos, captured the mounting concern: “This is a time of rising geological geopolitical tensions, unilateralism, nationalism, protectionism and isolation… Yet this is a moment when we should be standing together as the global community. We are called upon by the exigency of the moments to act together with greater urgency to halt the destruction of our planet.”

Withdrawing from Paris Agreement was just the beginning

Even before Trump’s election, US oil and gas production had reached record highs, even as wind and solar outpaced coal power generation for the first time ever, as well.

The withdrawal from the Paris Agreement was just the tip of the melting iceberg of Trump’s energy and climate policy overhaul. In a series of executive orders, he declared a “national energy emergency” and vowed to “unleash American energy,” despite the fact that the United States isn’t facing energy shortages at all.

In fact, the Biden administration had already let both oil and natural gas production rise to historic highs. Throughout Biden’s term, the US, the world’s largest historical GHG emitter, remained second-largest emitter behind China. Trump, however, claimed that “climate extremism has exploded inflation and overburdened businesses with regulation.”

His orders included lifting moratoriums on natural gas export permits and approving oil and gas drilling in Alaska’s Arctic National Wildlife Refuge, one of America’s last pristine wilderness areas.

Trump also ordered a freeze on offshore wind development, stating “we’re not doing that wind thing,” while directing federal agencies to expedite fossil fuel infrastructure projects and freeze Biden-era funding for clean energy technologies.

“We have something that no other manufacturing nation will ever have, the largest amount of oil and gas of any country on Earth, and we are going to use it,” Trump declared in his inaugural address. “We will be a rich nation again, and it is that liquid gold under our feet that will help to do it.”

The push for increased production comes at an uncertain time for global energy markets. International oil demand has plateaued, and many American energy companies have expressed reluctance to significantly boost output, concerned that oversupply could drive down prices and squeeze profits. US oil prices fell around 1% on Monday as details about Trump’s energy plans emerged.

Fossil fuel industry celebrates

Oil refinery in Big Spring, Texas.

The fossil fuel industry, which donated $75 million to Trump’s campaign, celebrated the policy changes at a gathering in the Hay-Adams Hotel attended by leading oil and gas executives and hosted by Harold Hamm, the billionaire founder of Continental Resources, the New York Times reported.

American fossil fuel companies have known about climate change impacts for over five decades while publicly downplaying risks and advocating for continued production. Global fossil fuel companies have recorded a combined $3 billion in profits every day for the past 50 years.

“American success relies on American chemistry,” said Chris Jahn, President of the American Chemistry Council, a powerful lobby group representing fossil fuel and petrochemical manufacturers including ExxonMobil and Chevron. “Working with the Trump Administration and 119th Congress we can expand US chemical production and help keep America strong.”

Trump’s cabinet nominations further signal his fossil fuel agenda. His pick for Energy Secretary, Chris Wright, heads the world’s largest fracking company and has declared on LinkedIn that “there is no climate crisis, and we’re not in the midst of an energy transition, either.” The president himself has previously called climate change a “hoax” orchestrated by China.

For the Environmental Protection Agency, Trump has nominated Lee Zeldin, who during eight years in Congress consistently opposed environmental and climate policies. Zeldin has already outlined plans to reduce regulations, including air pollution standards.

In parallel, a rollback of energy efficiency regulations on everything from dishwashers to vehicle tailpipe emissions standards was also part of Monday’s executive orders – effectively allowing the production of more polluting vehicles. Monday’s executive orders also repealed Biden-era subsidies for electric vehicles — decisions that clean air advocates say could have serious public health implications.

AI and tech applications demand more power

Global data centre energy consumption is set to match India, the world’s most populous nation and third largest polluter, by 2035.

But even if the country appears to be awash in oil and gas, the declaration of a “national energy emergency”, however, was also being driven by another sector – the soaring power demands of technology, including artificial intelligence (AI).

After 15 years of relative stability, US energy demand is surging, driven largely by the proliferation of data centres as tech giants race to develop increasingly powerful AI systems. The US data centre boom has stretched the country’s dated power grids, delayed the retirement of coal plants and catalysed concerns that: America is running out of power.

Global projections suggest data centre energy consumption could reach 1,580 terawatt hours by 2034, roughly equivalent to the total electricity usage of India, the world’s most populous nation. This would make data centers collectively the world’s third-largest energy consumer, outpacing the 27-member European Union, if they were counted as a country.

Already today, data centres worldwide consume more electricity combined than all but 15 countries globally.  US data centres will comprise 8% of national electricity usage by 2035, according to an analysis by Goldman Sachs, which described the boom as “the kind of electricity growth that hasn’t been seen in a generation.”

A White House official speaking to reporters on Monday confirmed that the energy emergency declaration was partly motivated by viewing AI as a national security priority and the resulting need to expand the energy grid. The administration’s focus on AI was underscored by the announcement of $500 billion in new funding for artificial intelligence development — more than 55 times the amount cut from international climate finance.

Tech oligarchs stand to benefit

At the inauguration ceremony, a row of tech industry billionaires including Elon Musk, Sundar Pichai, Tim Cook, Mark Zuckerberg, and Sam Altman occupied prime seats in the Capital Rotunda, positioned more prominently than several incoming cabinet members.

The seven tech leaders present at the inauguration standing to benefit from the mass expansion of US power consumption command a combined personal fortune of $371.9 billion — enough to fund more than a year of global climate finance commitments. Their companies’ combined annual revenue of $1.39 trillion dwarfs the world’s promised climate funding target of $300 billion agreed in November at COP30 in Baku by nearly five times.

States and cities vow to fight back

“We’re building an implementation plan that meets our targets under the Paris Agreement and ensures that our cities remain resilient and prosperous for future generations,” Gina McCarthy, co-chair of America Is All In, said in a statement.

Even so, the sweeping executive orders issued in Mr. Trump’s first hours as president are already facing resistance, with questions emerging about both their legal standing and economic wisdom.

Legal experts suggest the “national energy emergency” declaration could face court challenges if the administration cannot demonstrate conditions that justify bypassing standard environmental review procedures. But the more immediate resistance will come from within the United States itself.

America Is All In, a climate coalition representing nearly two-thirds of the US population and three-quarters of US GDP, has pledged to maintain climate action despite the federal retreat. According to Public Citizen, state and local government initiatives alone could achieve nearly 75% of US climate goals under the Paris Agreement.

“By leaving the Paris Agreement, this Administration is abdicating its responsibility to protect the American people and our national security,” said Gina McCarthy, co-chair of the alliance and former national climate advisor to President Biden. “But rest assured, our states, cities, businesses, and local institutions stand ready to pick up the baton of US climate leadership.”

Abandoning climate leadership could be costly to the US in the long run

Critics also argue that abandoning climate leadership could prove costly to the US in the emerging global green economy. With sustainable production projected to triple to $2 trillion by 2035, according to the International Energy Agency, many analysts increasingly view the shift toward clean energy as irreversible, driven by falling costs and improving technology.

As the US reverses course, the European Union and China continue to accelerate their transition to cleaner and greener technologies. France recently achieved 95% renewable power on its grid in 2024 as nuclear and clean energy sources displaced fossil fuels. China has leveraged massive state investment to dominate the renewable energy supply chain, while the E.U. has implemented ambitious emissions reduction targets and green technology incentives.

China has already established dominance through state investment, controlling over 80% of solar panel production – including half of US domestic production – and 76% of electric vehicle manufacturing. The country has cornered the market on rare earth minerals crucial for green technology, managing 70% of extraction and 90% of processing, according to Oxford University research.

Walking away from the Paris Agreement will hand China and EU a competitive edge

“Walking away from the Paris Agreement won’t protect Americans from climate impacts, but it will hand China and the European Union a competitive edge in the booming clean energy economy,” said Ani Dasgupta, president of the World Resources Institute.

“If the Trump administration truly wants America to lead the global economy, become energy independent, and create good-paying American jobs,” Ms. McCarthy added, “then they must stay focused on growing our clean energy industry. And if they want to be tough on China, don’t punish US automakers and hard-working Americans by handing our clean car keys to the Chinese.”

 ‘Red’ states could oppose Trump’s plans to rollback IRA investments

Republican-controlled districts receive 85% of Inflation Reduction Act funding, presenting a potential roadblock for Trump’s efforts to cut funding, according to reporting by journalism consortium Investigate Midwest.

Trump’s ability to completely unwind America’s climate initiatives faces significant obstacles in another, unexpected quarter – and that is among US states that have benefited from federally-subsidized investments in electric car production and renewable energy grids, thanks to the Inflation Reduction Act.

The Biden administration has already finalized contracts for $96.7 billion — or 84% — of the law’s clean energy grants. These include $8.8 billion for state energy-efficiency programs, $3 billion for reducing port pollution, and $9 billion to help rural electric providers transition from fossil fuels to alternatives like wind, solar, and nuclear power.

While approximately $11 billion in grants remain unfinalized, including funds for agricultural conservation and pollution reduction in disadvantaged communities, the law’s implementation is well advanced.

So his executive order for federal agencies to pause and review grant spending under the Inflation Reduction Act may have come too late to have its intended effect.

Even more significantly, 85% of the IRA’s funding has been invested in majority-Republican districts, drawing new firms and jobs to economically underprivileged areas. That, observers say, creates a potential political firewall against attempts to undo the legislation.

The economic stakes are also considerable. Analysis by Johns Hopkins University suggests that unwinding US climate policies could result in $50 billion in lost revenue for US companies and up to $80 billion in lost investment opportunities that competing nations stand ready to capture. This economic reality, combined with the IRA’s bipartisan benefits, may make a full repeal politically unpalatable, even if the administration pushes for one.

 “The community that believes in, endorses, underpins that [climate] science is far, far more significant than those few voices that challenge,” Stiell, the UNFCCC chief, said. “The science has been weaponized, and that’s reflective of the politics.”

Image Credits: Flickr: Radek Kucharski, Netcare-Alberton Hospital, UNEP, Carbon Brief , James St. John, Investigate Midwest.

Sudan food insecurity
REACH gives a common antibiotic to vulnerable children under the age of five.

As leaders from across sectors gather this week at the World Economic Forum to tackle global challenges, all solutions and priorities should be assessed first with a view to dismantling entrenched inequities. 

One urgent disparity that demands attention is child survival in Africa. A child born in sub-Saharan Africa is 14 times more likely to die before their fifth birthday than a child born in Europe and North America, reflecting inequities in access to essential healthcare services.

Achieving health equity is not just a goal but a necessity for sustainable development. In 2025, efforts to ensure that all children have a fair chance at survival must be a priority for policymakers and practitioners alike.

Distribution of common antibiotic

Resiliency through Azithromycin for Children (REACH) is a regional and international network of researchers, policy makers and public health actors dedicated to reducing child mortality. 

The REACH network offers a practical, collaborative approach to reducing child mortality through biannual distribution of the common antibiotic, azithromycin, to children under five in high-mortality settings. 

The common antibiotic, azithromycin, helps to reduce deaths in children under five in high-mortality settings.

More than a health intervention, it emphasizes Africa’s collective commitment, as articulated in the recent Abuja Declaration, to achieving health equity, sustainable progress, and a future where no child is left behind.

For us, as co-chairs, this work is deeply personal. We grew up in communities much like those REACH now serves, where access to basic healthcare was limited, and preventable illness took countless young lives.

REACH is equity in action – here’s why:

The program is most impactful in places with the least access to health care and the highest rates of child mortality. A randomized control trial with 200,000 children in Niger, Tanzania, and Malawi found that the average mortality reduction was 13.5% and the impact was highest in areas with the most significant under-5 mortality at 18.1%. To date, over one million children across six countries have been treated for as little as $1–$3 per dose, proving that health equity is within reach.

 Health equity

REACH is owned and led by countries. We know firsthand that health equity can only be achieved when the countries themselves take ownership, driving solutions that address their people’s unique needs.

 This model of national leadership is vital, and through REACH, we are laying the groundwork for lasting change by empowering African nations to adapt, scale, and collaborate on solutions that transcend borders.

We must acknowledge the critical role played by governments and local communities across Burkina Faso, Côte d’Ivoire, Mali, Niger, Nigeria, and Sierra Leone, whose commitment and support make this progress possible.

The REACH Network is also strengthening primary healthcare systems and building capacity to tackle wide-ranging needs and challenges that often go unmet.

In addition to reducing preventable child deaths, REACH has the potential to support iron supplementation for pregnant women, nutritional aid for at-risk populations, ivermectin for parasitic infections, and increased vaccination efforts in zero-dose areas. 

Lifeline approach

This “lifeline approach” ensures that each intervention is strategically woven together, creating a safety net that addresses the complex health needs of our communities. Through targeted training and capacity-building, REACH also empowers local healthcare workers to deliver consistent, community-based care.

By prioritizing local capacity-building, we ensure that our progress is sustainable, building community trust and resilience within healthcare systems that are prepared to endure.

REACH supports families to drive economic growth. By focusing on the hardest-to-reach populations, REACH becomes a lifeline for mothers, children, and families in dire need of care.

This approach does not stop at health—it is also a foundation for economic empowerment. Healthier children lead to stronger communities and accelerate demographic transitions. By reducing child mortality, REACH strengthens Africa’s workforce of tomorrow, driving the continent closer to sustained economic growth and prosperity.

The program is implemented responsibly, to ensure its longevity and continued impact. Through robust frameworks, we continually assess our strategies to make certain they are scalable, adaptable, and responsive to the needs of those who need them most. 

AMR surveillance

Antimicrobial resistance (AMR) surveillance is a key pillar, ensuring that the immediate survival benefits of azithromycin do not compromise long-term sustainability. As health ministers from REACH countries come together to share challenges and successes, we are creating a unified roadmap for addressing shared priorities, and this network-wide collaboration strengthens our collective commitment to measurable, lasting change.

Imagine a future where no African child is left behind—a future where a child born in the remotest village has the same chance at survival as one born in the most advanced urban center. Where no child or mother is denied essential healthcare services. With REACH, this is not just a vision; it is a possibility within our grasp.

Sustaining the REACH Network requires broad support and new partnerships. With over one million children treated already, imagine the exponential impact if REACH could reach two million or more, supported by enhanced infrastructure, data collection systems, and local workforce capacity.

With continued collaboration and dedicated resources, this lifeline will reach every child in need, ensuring that each can thrive and contribute to the Africa of tomorrow.

We call on all who believe in a future where every African child has the chance to live a healthy, fulfilled life to join us on this journey and to embrace these principles of equity to transform lives across the continent.

Dr Muhammad Ali Pate is the Minister of Health in Nigeria and co-chair of the REACH Network

Professor Samba Sow is Director-General of the Center for Vaccine Development in Mali and co-chair of the REACH Network

Image Credits: The Global Alliance to end AIDS in children, WFP/Ala Kheir.

Donald Trump gives a speech in Arizona, the state with one of the fastest rising coronavirus caseloads in the US, on 23 June 2020.

United States President Donald Trump may face a lawsuit over his failure to get the approval of US Congress to withdraw from the World Health Organization (WHO).

“Trump made a unilateral decision to pull out of WHO. But we joined WHO in 1948 by an Act of Congress. Trump needs Congress’ approval to withdraw,” said Professor Lawrence Gostin, who directs the  O’Neill Institute and is the Chair of Global Health Law at Georgetown University in Washington DC.

“His decision is too catastrophic to be made without Congress and the courts. As director of a WHO Center, I am considering a lawsuit,” added Gostin, who also heads the WHO Center on Global Health Law.

Meanwhile, German Health Minister Karl Lautenbach wants to persuade Trump to change his mind, describing the decision as “a catastrophe for the poorest people on the planet” who need WHO support, such as those in Gaza.

The US is obliged to give a year’s notice of its intention to withdraw from the WHO, yet Trump’s Executive Order directs State officials to “take appropriate measures, with all practicable speed” to “pause the future transfer” of US of government “funds, support, or resources to the WHO”.

The order also recalls all US “personnel or contractors working in any capacity with the WHO”.

A senior WHO official told Health Policy Watch that “it has been a long night”, but that the UN health agency will survive if all its remaining 193 member states stick together in the coming days. The tiny European monarchy of Liechtenstein is the only other country that is not part of the WHO.

China ‘rationale’

Trump’s rationale for withdrawing from the WHO is the same as he advanced during his first presidency: WHO’s “mishandling” of the COVID-19 pandemic, its “failure to adopt urgently needed reforms”, and its “inability to demonstrate independence from the inappropriate political influence of WHO member states” – primarily China.  

Trump also noted that the WHO “continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments”, such as that of China.

Of the 196 WHO member states, the US is by far the largest funder. It is due to pay nearly $261 million in “assessed contributions” (membership fees) during 2024/5.  

US contribution to WHO in 2023

China, the second-largest contributor in terms of assessed contributions, is only due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates.

 

China’s contribution to WHO in 2023

While blaming the WHO for mishandling COVID-19, it is worth remembering that US Republicans died of COVID-19 at a significantly higher rate than Democrats, in all likelihood because of the anti-vaccine rhetoric and confusing treatments being suggested by Trump and his party.

After the introduction of COVID-19 vaccines, the excess death rate amongst Republicans was 10.4% higher than that of Democrats, according to a study published in the American Journal of Public Health.

Between January 2018 and December 2021, there were 15% more COVID-19 deaths amongst Republicans in Florida and Ohio than Democrats, ballooning to a 43% higher excess deaths amongst Republicans once vaccines were introduced, according to a 2023 study in JAMA Internal Medicine.

Excess Death Rates and Vaccination Rates in Florida and Ohio During the COVID-19 Pandemic

WHO asks Trump to ‘reconsider’

In a measured response, the WHO said that it “regrets” the decision and hopes the US will “reconsider”.

“We look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe,” the WHO stated.

“WHO plays a crucial role in protecting the health and security of the world’s people, including Americans, by addressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go.”

It also noted that the US was a founding member of WHO in 1948 and assisted in saving “countless lives”, ending smallpox and bringing polio to the “brink of eradication”. 

The WHO also noted that, in the past seven years, it has “implemented the largest set of reforms in its history, to transform our accountability, cost-effectiveness, and impact in countries”.

In 2022, the World Health Assembly adopted in full recommendations for financing reform made by the Sustainable Financing Working Group, which also include proposals to increase the body’s efficiency, as previously reported by Health Policy Watch.

US condemnation

Dr Tom Frieden, CEO of Resolve to Save Lives, said that Trump’s decision makes Americans and the world less safe and increases “the risk of a deadly pandemic”.

“The plain truth is that WHO is irreplaceable. WHO’s track record demonstrates its value to the world. The historic US-Soviet collaboration through WHO to eradicate smallpox – one of humanity’s greatest achievements – shows how cooperation on global health can transcend political differences to protect everyone,” said Frieden, a former head of the US Centers for Disease Control and Prevention.

“Withdrawing from WHO not only cuts crucial funding from the agency, but it also surrenders our role as a global health leader and silences America’s voice in critical decisions affecting global health security,” he added.

“Real reform requires engagement, not abandonment. We cannot make WHO more effective by walking away from it.”

Physicians for Human Rights executive director Sam Zarifi said that the withdrawal “needlessly, heedlessly, endangers the tremendous advances in global public health over the last century” as “diseases respect no borders and demand global collaboration”. 

US domestic health is also under fire

US domestic health measures were also the target of the swathe of executive orders signed by Trump on Monday, reports Stat.

Trump rescinded Biden-era orders aimed at lowering medicine costs for Medicare and Medicaid, expanding access to the Affordable Care Act, COVID-19 treatments and vaccines, as well as various protections for race, gender and sex discrimination.

Foreign aid is frozen

Trump has also frozen US foreign aid for 90 days in an executive order aimed at “re-evaluating and realigning” aid.

“All department and agency heads with responsibility for United States foreign development assistance programs shall immediately pause new obligations and disbursements of development assistance funds to foreign countries and implementing non-governmental organizations, international organizations, and contractors pending reviews of such programs for programmatic efficiency and consistency with United States foreign policy, to be conducted within 90 days of this order,” according to the order.

Excerpt from Trump’s executive order on foreign aid 2025

The rationale given is that the “foreign aid industry and bureaucracy are not aligned with American interests and in many cases antithetical to American values”.  

Furthermore, they “serve to destabilize world peace by promoting ideas in foreign countries that are directly inverse to harmonious and stable relations internal to and among countries”.

The controversial right-wing blueprint for Trump’s victory coordinated by the Heritage Foundation, Project 2025, proposes that all US aid including humanitarian assistance, is conditional on the rejection of abortion.

“Proposed measures for USAID [US Agency for International Development] include a significant restructuring, and reduction of budget, the removal of diversity, equity, and inclusion programs, and dismantling of the apparatus that supports gender equality and LGBTQ+ rights,” notes researcher Malayah Harper in an analysis of Project 2025.

So far, Trump is following the mandate of Project 2025 despite feigning ignorance about it during his election campaign.

Image Credits: Gage Skidmore, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2807617#google_vignette.

President Donald Trump has signed an executive order to withdraw the United States from the World Health Organization (WHO), citing its handling of the COVID-19 pandemic and other global health crises.

Trump criticised the WHO for failing to operate independently of what he called “inappropriate political influence” from its member states. He also took issue with the financial burden on the US, the organization’s largest contributor, providing about 18% of its total funding.

“The World Health Organization has taken advantage of us, just like everyone else,” Trump said during the signing. “That stops now.”

The WHO responded by expressing “regret” over Trump’s decision and reminding the administration that America was a founding member of the organisation in 1948 and has helped shaped WHO’s work ever since.

“For over seven decades, WHO and the USA have saved countless lives and protected Americans and all people from health threats,” the organisation said in a statement. “Together, we ended smallpox, and together we have brought polio to the brink of eradication. American institutions have contributed to and benefited from membership in WHO.”

The organisation stressed the role it plays in protecting health and security for everyone, including Americans, “by addressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go.”

The withdrawal will take effect in 12 months, with the US ceasing all financial contributions to the agency’s $6.8 billion 2024–2025 budget. Trump argued that the organisation demanded “unfairly excessive payments” from the U.S., especially compared to contributions from other major nations, such as China.

This is a developing story.

Act-up protest to end AIDS

The good news first: HIV science has made remarkable progress. While we still lack a vaccine or cure, a single dose of a new long-acting injectable drug can now offer protection against HIV for up to six months.

This breakthrough could revolutionize efforts to curb a pandemic that still claims a life every minute. However, the rise of populism and regressive governance threatens to unravel many hard-won gains in HIV and public health.

In the United States, the highly successful and bipartisan President’s Emergency Plan for AIDS Relief (PEPFAR) is under attack, and its potential undoing could cut millions off from access to life-saving medication. The program is estimated to have saved some 26 million lives over the past two decades. It was conceived out of concerns that the AIDS pandemic could devastate generations of people in lower- and middle-income countries and fuel political instability.

The National Institutes of Health (NIH) faces scrutiny over its funding of HIV research, with some policymakers questioning the validity of decades of peer-reviewed science.

Robert F Kennedy Jr., the Trump administration’s pick for the next US health secretary, is a vaccine sceptic who has for many years falsely linked vaccines to autism. Kennedy is also on record denying the causal relationship between HIV and AIDS. Treating evidence-based research as opinions that can be traded for other views without any scientific validity is a grave danger, especially if it takes hold at the highest levels of government.

Human rights restrictions continue to challenge the HIV response in regions most affected by the epidemic. In 2024, Uganda upheld one of the world’s harshest anti-gay laws. At least half of the 67 countries that still criminalize same-sex relationships are in sub-Saharan Africa, where HIV burdens are highest. Anti-gay laws correlate with higher HIV rates globally. In Russia, punitive drug laws and restrictive LGBTQ+ policies continue to drive the world’s fastest-growing HIV epidemic.

A protest against Uganda’s earlier attempts to pass a ‘kill the gays’ law in 2012

Undermining science and human rights risks reversing progress and invites the next pandemics. The re-emergence of Mpox and H5N1 bird flu are warning shots—HIV could be next. But there’s a blueprint that can do the opposite and end HIV for good:

Defend human rights

Protecting human rights is not merely an ideological stance; it’s a proven public health strategy. Punitive laws and discriminatory policies harm those most in need and undermine HIV prevention and care.

Urgent legal reforms are required to protect key populations and repeal laws that criminalize LGBTQ+ communities, migrant workers, sex workers, people who inject drugs, and incarcerated individuals. Empowering civil society organizations—including those of people living with HIV—has been and continues to be the bedrock of the HIV response.

Protect shrinking civil society spaces

One of the most powerful lessons from four decades of HIV response is that successful public health efforts require an engaged, empowered civil society. Activism by those most affected has shaped the HIV response, from trial design to health policy.

Civil society organizations provide vital services, especially for those whose access to public health systems is hindered by stigma and discrimination. Protecting these organizations—rather than defunding and persecuting them—saves lives. Yet, over 50 countries have laws restricting the foreign funding that many HIV initiatives depend on.

As conveners of the world’s largest HIV conferences, we at the International AIDS Society feel the impact of shrinking civil society spaces. The countries most affected by HIV are often off-limits for our conferences due to safety concerns for the most marginalized and persecuted.

In other instances, governments have threatened to interfere with the agendas and debates of our gatherings, compromising our movement’s independence. We demand the protection of civil society spaces so that people can organize and assemble freely—because a functioning public health response depends on it.

HIV activists Ganna Dorbach and Elena Rostokina from Eastern Europe, speaking at IAS 2024 in Munich, blamed stigma for the rapid spread of HIV in their region, particularly in Russia.

Depoliticize public health

Despite the lessons of the COVID-19 pandemic, efforts in 2024 by WHO member states to draft a new pandemic treaty were frustrated. The treaty was meant to address gaps exposed by COVID-19—such as inequitable vaccine distribution and lack of global coordination.

The failure to agree on a treaty text highlighted how geopolitical and economic power increasingly shapes international health policy to the detriment of global health equity. It’s vital that this is resisted in ongoing negotiations, and a strong treaty text premised on public health is adopted at the World Health Assembly this coming May.

The likely return of the Global Gag Rule is another example of how unrelated political agendas undermine the HIV response. First introduced under the Reagan administration and reinstated under the first Trump government, it bars international organizations from receiving US funding if they provide abortion services or related information.

Paradoxically, this policy increases reliance on abortion by limiting access to contraception. A study published in PNAS found it contributed to 360,000 new HIV acquisitions in just four years (2017-2021). With two-thirds of international HIV funding coming from the U.S., reintroducing the Gag Rule would be devastating.

Strengthen International Cooperation

Protestors call for greater investment in HIV at the IAS conference in 2022.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), its funding in 2024 has dipped to less than 50% of the resources available in 2015, and other essential multilateral health institutions such as the World Health Organization (WHO) are also struggling for funding.

Institutions such as PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria have between them saved some 90 million lives. They are worth defending, not defunding. Funding shortfalls and inequities undermine global health cooperation

Progress happens when science, policy, and civil society unite. The HIV movement is built on transformative social movements—women’s rights, LGBTQ+ rights, and civil rights—which have shown that inclusive, collaborative approaches drive sustainable change.

Today, we must build on this legacy, organize, push back against anti-human rights movements, and defend science as the foundation of our societies’ progress. The alternative is a place humanity has been many times before, offering little but regression and pain.

Beatriz Grinsztejn is President of the International AIDS Society.

Birgit Poniatowski is Executive Director of the International AIDS Society.

Image Credits: Kerry Cullinan, Peter Tatchwell Foundation.

Moment at which three Israeli hostages, Doron Steinbrecher, Romi Gonen and Emily Damari, are turned over by Hamas to the Red Cross in Gaza City on Sunday.

WHO welcomed Sunday’s Israel-Hamas ceasefire and hostage release deal as the first Israeli hostages – three young women – were released to the Red Cross amidst throngs of masked Hamas operatives, who brandished guns atop the Red Cross vehicles and fired shots at times into the air to ward off the crowds of people that gathered to watch the handoff in Gaza City. 

The Israeli hostage release, followed by Israel’s release of some 90 Palestinian prisoners, all women and minors, came as the shaky ceasefire deal took effect on Sunday. 

The deal ushered in a 42-day halt in the fighting and a partial Israeli military withdrawal away from Gaza’s dense population centers and parts of Gaza’s Rafah crossing to Egypt – which is supposed to be accompanied by a massive surge in humanitarian aid.  The six week-long period is supposed to see the release of some 33 Israeli hostages in all, including remaining women, children and elderly hostages, some already presumed dead, along with more than 1700 Palestinian prisoners from Israeli jails.  

Negotiations that will continue during the first phase are supposed to lead to a second stage, including what Qatari mediators have described as a complete Israeli military withdrawal from Gaza and the release of the remaining 65 Israeli and foreign hostages, all men, as well as several thousand more Palestinian prisoners in Israeli jails. 

“The ceasefire in #Gaza and the start of the hostage and prisoner release process bring great hope for millions of people whose lives have been ravaged by the conflict,” said WHO Director General Dr Tedros Adhanom Ghebreyesus in an X post. “It is a moment I have been calling and hoping for.”   

“However, addressing the massive health needs and restoring the health system in Gaza will be a complex and challenging task, given the scale of destruction, operational complexity and constraints involved,” said Tedros, citing a lengthy WHO statement focused on the challenges of Gaza reconstruction. 

garbage accumulates in gaza, raising risk of polio
Tent camps of displaced Gazans amidst piles of garbage, and contaminated water supplies, raises infectious disease risks.

WHO European Region release separate statement on Israeli hostages release

In a separate statement,  WHO’s European region welcomed the release of “WHO welcomes the release of traumatized hostages taken from Israel, after enduring 470 days of brutal captivity in Gaza.” 

It was a rare WHO statement on the hostage situation in a conflict where the deaths of over 46,000 Palestinians in Gaza, and it’s near physical destruction, has overshadowed the plight of Israeli hostages held by Hamas since their bloody 7 October, 2023 incursion into Israeli border communities that killed nealry 1200 people and took over 240 captive. 

“WHO is acutely aware that the hostages face complex mental and physical health needs and may take years to recover. The families of hostages also require sensitive mental health care,” said the WHO European Region statement.

“WHO is reassured that Israel – a WHO/Europe Member State – possesses the resources and relevant expertise to respond to the medical, mental, and nutritional challenges to restore the health of the hostages, and the well-being of their families.

“In Gaza, WHO and partners are scaling up operations to deliver critical medical supplies and resources, addressing urgent health needs and contributing to recovery efforts including the process of rebuilding the shattered health system,” the WHO European statement also said. 

“We reaffirm our readiness to support affected communities on all sides.”

Fears of potential breakdown in ceasefire running high

Fears about a potential breakdown in the ceasefire arrangements have been running high on all sides as armed Hamas fighters emerged from refugee encampments and hospital compounds in a visible display of force. Meanwhile, Israel’s hard-right politicians vowed that the country would return to fight Hamas in Gaza to its total destruction, following the initial six-week cease fire period. 

A third phase of the cease fire deal, if finalized,l is supposed to see a permanent cessation of the conflict, opening the way for the massive task of rebuilding Gaza’s shattered housing, education, water and sanitation infrastructure.

It’s estimated that more than 90% of the enclave’s two million Palestinians have been displaced from their homes – many of which no longer exist at all.  

And rebuilding the health infrastructure, alone, will cost an estimated $10 billion, according to initial estimates by WHO, with only about one-half of the enclaves hospital’s functioning, even partly, and most of the primary health care system destroyed.

“More than 46 600 people have been killed and over 110 000 have been injured. The real figures are likely much higher,” the WHO HQ  statement noted. “Only half of Gaza’s 36 hospitals remain partially operational, nearly all hospitals are damaged or partly destroyed, and just 38% of primary health care centres are functional.

“An estimated 25% of those injured – around 30 000 people – face life-changing injuries and will need ongoing rehabilitation. Specialized health care is largely unavailable, medical evacuations abroad are extremely slow. Transmission of infectious diseases has massively increased, malnutrition is rising, and the risk of famine persists. The breakdown of public order, exacerbated by armed gangs, raises further concerns.”

Indeed, the elephant in the room remains the governance of Gaza. In his final press conference last week, outgoing US Secretary of State Anthony Blinken, a key architect of the deal, said that Gaza should not be left in Hamas hands, leaving Israel open for future missile attacks and border threats such as the ones experienced on 7 October 2023 and since. 

That stance has been echoed by members of new US President Donald Trump’s incoming administration. But much-discussed proposals for turning Gaza’s governance over to a regional coalition or back to the internationally-recognized Palestinian Authority have failed to pick up steam – partly due to the PA’s own record of corruption and ineffectual government, as well as it’s lack of regional political support.

And so as the fragile cease-fire took hold, the Islamist group that has controlled the 365 square kilometer enclave for nearly 20 years, remains the only visible Palestinian force on the ground.

Image Credits: @nabilajamal, UNRWA .

Health workers during a Marburg outbreak

Tanzania has confirmed an outbreak of Marburg virus disease in the northwestern Kagera region after one case tested positive for the virus following investigations and laboratory analysis of suspected cases of the disease. 

Tanzanian President Samia Suluhu Hassan announced this during a press briefing on Monday with World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus. 

“Laboratory tests conducted at Kabaile Mobile Laboratory in Kagera and later confirmed in Dar es Salaam identified one patient as being infected with the Marburg virus. Fortunately, the remaining suspected patients tested negative,” the president said from the country’s capital, Dodoma. 

A total of 25 suspected cases have been reported, all of whom have tested negative and are currently under close follow-up, the president said. The cases were reported in Biharamulo district in Kagera. 

“We have demonstrated in the past our ability to contain a similar outbreak and are determined to do the same this time around,” added the president. “We have resolved to reassure the general public in Tanzania and the international community as a whole of our collective determination to address the global health challenges, including the Marburg virus disease.”

Last week, Tanzanian health authorities disputed a WHO report of a suspected outbreak, noting that five suspected cases had tested negative in its laboratories.

Emergency funds

Tedros announced that he has made $3 million available from the WHO Contingency Fund for Emergencies to assist Tanzania in addressing the outbrea, and pledged the WHO’s support for the country.

“Since the first suspected cases of Marburg were reported earlier, Tanzania has scaled up its response by enhancing case detection, setting up treatment centres and a mobile laboratory for testing samples, and deploying national response teams,” Tedros told the media briefing.

“Tanzania has gained strong experience in controlling Marburg as this is the second reported outbreak of the disease in Kagera. The first outbreak was almost two years ago, in March 2023, in which a total of nine cases and six deaths were reported,” he added.

The Africa Centres for Disease Control and Prevention (Africa CDC) also pledged support for the country.

“ A team of 12 public health experts will be deployed as part of an advance mission in the next 24 hours. The multidisciplinary team includes epidemiologists, risk communication, infection prevention and control (IPC), and laboratory experts to provide on-ground support for surveillance, IPC, diagnostics, and community engagement,” said Africa CDC.

“To support the government’s efforts, we are committing $2 million to bolster immediate response measures, including deploying public health experts, strengthening diagnostics, and enhancing case management,” said Africa CDC Director General Dr Jean Kaseya.

“Building on Tanzania’s commendable response during the 2023 outbreak, we are confident that swift and decisive action, combined with our support and those of other partners, will bring this outbreak under control.”.

Marburg virus, a highly infectious and often fatal disease, is similar to Ebola and is transmitted to humans from fruit bats. It spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials.

Although several promising candidate medical countermeasures are currently undergoing clinical trials, there currently is no licensed treatment or vaccine for Marburg. 

However, early access to treatment and supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improve survival. 

Previous outbreaks and cases have been reported in Angola, the Democratic Republic of the Congo, Ghana, Kenya, Equatorial Guinea, Rwanda, South Africa and Uganda.

Image Credits: WHO.

Dr Matshidiso Moeti, outgoing Africa regional director

The World Health Organization (WHO) Regional Committee for Africa resolved to reopen nominations for a regional director at a special session last week. 

This follows the unexpected passing of director-elect Dr Faustine Ndugulile in November 2024. He was due to assume the post in February once his election had been confirmed by the WHO Executive Board.

According to the resolution passed by the regional committee, member states will receive a letter from the WHO Director-General by tomorrow (21 January) inviting them to nominate candidates by 28 February.

A virtual live candidates’ forum is planned for 2 April. Thereafter, the region has requested the Director General to convene an in-person special session of the Regional Committee in Geneva on 18 May for member states to elect the next Regional Director who will then be nominated to the Executive Board.

Fast-tracked

The fast-tracked process requires the suspension of Rule 52 of the region’s election procedures, which mandates a process of no less than six months for nominations.

Derek Walton, WHO legal counsel in Geneva, confirmed that the regional committee had determined the next steps, with a final selection in May during another special session of the Regional Committee for Africa. 

“This session will be held just before the World Health Assembly, and at that point, the committee will make a fresh nomination for the position of Regional Director,” Walton told Health Policy Watch last week.

“If all goes to plan, we should have a new Regional Director for Africa in place by 1 June,” Walton confirmed.

However, the regional director-elect will still need to be formally appointed by the WHO Executive Board when it meets in February 2026, according to the region’s resolution.

The role of WHO Regional Director for Africa is crucial in guiding the organization’s public health efforts across the continent, including responses to disease outbreaks, strengthening health systems, and implementing WHO policies tailored to African health challenges.

Ndugulile secured 25 of the 46 votes at the WHO Africa regional conference in the Republic of Congo, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). 

A former deputy health minister and ICT minister in Tanzania, Ndugulile represented the Kigamboni constituency in Dar Es Salaam as a Member of Parliament since 2010 and chaired the country’s parliamentary health committee.

The three candidates could be renominated by their respective countries. Socé Fall is currently Director of the Department of Control of Neglected Tropical Diseases at WHO headquarters in Geneva.

Mihigo is the vaccine alliance, Gavi’s Senior Director of Programmatic and Strategic Engagement with the African Union and Africa CDC, but worked for WHO Africa until March 2022.

Sambo serves as the WHO’s Head of Mission and Representative to the Democratic Republic of the Congo (DRC).

Whoever is ultimately selected will have big shoes to fill, succeeding Matshidiso Moeti, who is retiring after making a name for herself during the COVID pandemic. She was also the first female Regional Director for WHO AFRO, leaving behind a legacy of resilience and leadership.

Africa faces numerous public health challenges, including infectious disease outbreaks, vaccine distribution disparities, and the worsening effects of climate change on health.

A child born with HIV takes a paediatric dose of antiretroviral medication.

Influential conservatives have long sought to curtail the United States President’s Emergency Plan for AIDS Relief (PEPFAR) – and the actions of four nurses in Mozambique may have inadvertently given them the ammunition to do just that.

Deeply uncomfortable with the sexual dimension of HIV transmission, the powerful Heritage Foundation, which authored the conservative Project 2025 blueprint for a Donald Trump takeover, argues that PEPFAR should be “restructured as a development rather than an emergency assistance program”. 

Right-wing organisations and politicians have also claimed the plan is being used to “promote abortion, LGBT ideology, and comprehensive sexuality education”, a school sex education programme.

But they had so far failed to demonstrate this until last week – when the US State Department Bureau of Global Health Security and Diplomacy (GHSD), which implements PEPFAR, provided documentation in a briefing to the Senate Foreign Relations Committee and House Foreign Affairs Committee that the Mozambique nurses, whose salaries are partly covered by PEPFAR, also provided abortions.

‘Unacceptable violation’

The US has not allowed its foreign aid to be used to fund abortions or lobby for abortions since it enacted the Helms Amendment in 1974.

However, the four nurses, whose salaries were partly covered by PEPFAR, did not know that they could not provide abortions (which are legal in Mozambique) if they received PEPFAR funding.

GHSD’s “compliance mechanisms identified this violation, and we took immediate corrective action with the partner”, the bureau said in a statement issued on Friday, the day after it had briefed politicians with oversight of PEPFAR about the issue.

“This violation is unacceptable, and the US government has made that clear at all levels of program implementation, as well as immediately suspended funding,” it added.

PEPFAR secured “reimbursement from the Government of Mozambique for the salaries of the four health workers involved in the violations of award terms and conditions” and in future will require “an annual signed attestation by PEPFAR-funded clinical service providers to ensure compliance with US funding restrictions”.  

Although the GHSD uncovered, rectified the transgression, and reported it to the politicians, Republicans have jumped on the report as an opportunity to reform PEPFAR.

‘Disgusting’

“It is disgusting that the Biden Administration has allowed US taxpayer dollars to be used to perform abortions overseas,” fumed Republican Senator Jim Risch, chair of the Senate Foreign Relations Committee. “This violation means that the future of the PEPFAR program is certainly in jeopardy.”

Republican Congressional representative Chris Smith, whose committee oversees PEPFAR, promised a “series of hearings to investigate the activities by PEPFAR-funded countries” and to hold the Centers for Disease Control and Prevention (CDC) and GHSD to account.

“This is just the tip of the iceberg,” said Smith, who chairs the House Foreign Affairs Subcommittee on Africa and Global Health Security and Diplomacy Bureau. 

“Frankly, it’s not a surprise to find that they are performing abortion with US taxpayer dollars. Their denials over the years have rung hollow in the face of their aggressive promotion of abortion and collaboration with some of the largest international abortion providers.”

With Trump assuming the White House on Monday (20 January), and his party controlling the US Senate and House, the Republican Party is in a strong position to shake up PEPFAR.

PEPFAR’s key achievements by 2024

Democratic Representative Gregory Meeks warned that “using this unfortunate error as a pretext to end funding for PEPFAR, which has saved millions of lives by combating HIV around the world, would be a grave mistake”.

Furthermore, said Meeks: “CDC’s response to this violation shows that when wrongdoing occurs, there are checks in place to address them and Mozambique reimbursed the US government for the $4,066, which accounts for less than 0.001% of one year of PEPFAR’s funding for Mozambique.”

HIV is a ‘lifestyle disease’

PEPFAR is the most successful US aid programmes ever, credited with saving over 26 million lives since its launch by Republican president George W Bush in 2003.

By last September, PEPFAR was funding antiretroviral medicine for 20.6 million people to suppress HIV in their bodies.

Yet far-right conservatives in the US and Africa are deeply ambivalent about PEPFAR, largely because they believe that HIV is a sexually transmitted “lifestyle disease” – the inference being that most of those with HIV have themselves to blame.

The Heritage Foundation spelt this out in a 2023 paper, arguing that, “except in cases of rape or maternal transmission, HIV/AIDS in the US and in developing countries is primarily a lifestyle disease (like those caused by tobacco) and as such should be suppressed through education, moral suasion, and legal sanctions”. 

The foundation added that “for conservatives committed to personal responsibility, [PEPFAR] also should not enjoy greater priority than deadlier and more unavoidable diseases receive in the allocation of public funds”. 

According to the Heritage Foundation, “as with any venereal disease, education and abstinence could end the AIDS epidemic” – although this approach has failed miserably in both the US and Africa.

Undetectable viral load = untransmittable HIV

South African activists launch a public information campaign to raise awareness of U = U (undetectable HIV = untransmittable) to encourage people living with HIV to take treatment and maintain an undetectable viral load.

Scientific evidence from multiple studies shows that one of the most powerful ways to end HIV transmission is to ensure that people living with HIV are on antiretroviral (ARV) medicine and have undetectable viral loads, because then they do not transmit the virus – even during unprotected sex. 

New HIV infections decreased by 39% world-wide between 2010 and 2023, largely thanks to the massive campaign against the disease focused on the rollout of ARVs, education about its transmission and condom distribution.

But there are enclaves where HIV still thrives, described by UNAIDS as “key populations” which include men who have sex with men, sex workers, people who inject drugs, transgender people and prisoners.

“In 2022, the relative risk of acquiring HIV was 14 times higher for people who inject drugs, 23 times higher for gay men and other men who have sex with men, nine times higher for sex workers and 20 times higher for transgender women than in the wider population globally,” according to UNAIDS. 

In 2022, 55% of all new HIV infections in 2022 occurred among people from key populations and their sexual partners.

But these groups are amongst those most denigrated by right-wing groups who ignore the scientific evidence of their vulnerability and instead claim that the Biden Administration, UNAIDS and anyone following this evidence are trying to impose a “woke agenda” on the world.

‘Radical sexual agenda’

Their crusade against the mainstream HIV sector’s approach to ending the disease gained momentum in 2023 as the US geared up to reauthorise PEPFAR for a further five years.

On 1 May 2023, US right-wing groups claimed in a letter sent to Senate and Congress leaders that PEPFAR grantees  “are using taxpayer funds to promote a radical sexual and reproductive health agenda”. 

The first signature on the letter is that of Heritage Foundation president Kevin Roberts. Other signatories include Austin Ruse of the radical Catholic group, the Center for Family and Human Rights (C-FAM) that opposes contraception, and Tony Perkins of the Family Research Council, a radical evangelical group that has supported African governments to pass anti-homosexuality laws and even lobbies against the HPV vaccine.

The letter cited examples of PEPFAR-supported organisations that are promoting abortion but their claims were not supported by evidence. 

A similar letter was sent on 6 June 2023 to the same US politicians by African politicians and religious leaders – primarily Catholic and evangelical bishops, and Ugandan MPs – claiming that PEPFAR “is supporting so-called family planning and reproductive health principles and practices, including abortion, that violate our core beliefs concerning life, family, and religion”.

Representative Smith, who co-sponsored PEPFAR’s refinancing in 2018, also claimed PEPFAR is being used to “promote abortion on demand” in a letter to his congressional colleagues in June of that year.

March deadline for PEPFAR reauthorisation

Some 20.6 million people are dependent on PEPFAR for their antiretroviral medicine.

After much wrangling, PEPFAR was eventually reauthorised in March 2024 – but only for one year instead of the customary five. This mandate expires in March.

With Trump’s “America First” approach and his mandate to Elon Musk and Vivek Ramaswamy to slash the federal budget, PEPFAR funds are almost certain to be cut.

However, big policy changes are also likely, particularly if Project 2025’s proposals are implemented. These include stopping all US aid to LGBTQ groups and even preventing support for contraception and comprehensive sexual education. 

Ultimately, if the Heritage Foundation and its allies get their way, PEPFAR will be transformed into “a development program focused on developing sustainable heath systems and the prevention and treatment of infectious diseases, including HIV/AIDS”.

To prepare for this and to encourage more domestic support for HIV, the foundation proposes that PEPFAR cuts its coverage of ARVs by 10% every year in the next five -year phase.

But finding the money to cover half the cost of ARVs within five years will be impossible for many of the countries that receive PEPFAR support. Some of Africa’s most vulnerable people are going to bear the brunt of this policy change, which may roll back decades of progress against HIV and AIDS. 

Image Credits: The Global Fund/John Rae, Paul Kamau/ DNDi, UNAIDS, Flickr.