Manufacturers of Coldrif cough syrup used an industrial solvent as a base for their product, killing 22 children.

At least 22 children have died in India this month after consuming a contaminated cough syrup found to contain nearly 45% diethylene glycol (DEG), a toxic industrial solvent used in brake fluid and antifreeze. The concentration is hundreds of times above the permissible limit of 0.1% set by pharmacopeial safety standards.

The syrup, branded Coldrif, was manufactured by Sresan Pharmaceuticals in Tamil Nadu and distributed across several districts of Madhya Pradesh. Laboratory tests confirmed the dangerously high DEG levels. 

Following the deaths, authorities arrested the company’s owner, sealed the factory, and ordered an immediate recall of all implicated batches.

While these steps suggest swift action, the tragedy is far from an isolated event. It fits a recurring pattern of deadly contamination in India’s pharmaceutical industry, one that has repeatedly exposed significant regulatory gaps and a culture of neglect that allows such disasters to keep unfolding.

The cough syrup market was worth $262.5m in 2024, and has been predicted to grow to $743m by 2035, growing at by 9.9% each year, according to Market Research Future.

Driving this consumption is both the lack of doctors, particularly in rural areas, which sees people resorting to over-the-counter remedies. In addition, high levels of air pollution in many areas cause children to cough – something that cannot be solved by cough syrup, yet many parents buy it in the hope that it will help.

Pattern of deaths

The deaths in Madhya Pradesh echo earlier incidents that have shaken global confidence in Indian drug exports. In 2022, nearly 70 children in The Gambia and 18 in Uzbekistan died after consuming contaminated syrups manufactured by Indian firms.

In Uzbekistan, the victims had taken Dok-1 Max, produced by Marion Biotech, a Noida-based manufacturer. Tests revealed that the syrup contained ethylene glycol (EG), a poisonous chemical used in industrial antifreeze. 

A few months earlier, a similar tragedy unfolded in The Gambia. The World Health Organization (WHO) linked dozens of Gambian children’s deaths to four syrups made by another Indian company, Maiden Pharmaceuticals Ltd. 

“Laboratory analysis of samples of each of the four products confirm that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants,” according to the WHO.

“Toxic effects can include abdominal pain, vomiting, diarrhoea, inability to pass urine, headache, altered mental state and acute kidney injury, which may lead to death.”

A health expert based in Delhi told Health Policy Watch, on condition of anonymity, that such incidents are not surprising: “To understand why this keeps happening, you have to look at where and how these medicines are actually made – and what rules are being ignored.” 

WHO warned of four contaminated cough syrups causing deaths in Gambia.

Factory of filth and neglect

That warning proved eerily accurate in the case of Sresan Pharmaceuticals, the company behind Coldrif. 

A recent Indian Express investigation described a scene of chaotic abandonment inside the factory: “Stacked plastic jars, stained concrete floors, hoses still snaking across the ground. Windows closed tight, some blocked with makeshift barriers.” 

Through a narrow opening, reporters saw “piles of white and blue containers leaning against the walls, black buckets on the floor, and discarded labels charred in the backyard.”

In the ashes outside, investigators found half-burnt labels of Pronic Iron Syrup and Cyproheptadine Hydrochloride Syrup IP — products also manufactured by Sresan. The site, the report said, reeked of hurried abandonment, as if workers had fled in panic.

An India Today report from Kanchipuram, where the factory operated, revealed over 350 violations, including rusted machinery, unhygienic conditions, and the absence of mandatory quality testing. 

These findings paint a grim picture of how, without proper regulation, some life-saving drugs are brewed in conditions closer to workshops than laboratories.

India’s weak oversight

India’s Central Drugs Standard Control Organisation (CDSCO) is responsible for the oversight of new drugs, imports, clinical trials, and setting national standards. 

It falls under the Union Health Ministry, and licenses large manufacturers and handles export approvals.

Under CDSCO’s oversight, there are six zonal offices, four sub-zonal offices, and a network of central drug testing laboratories.

However, according to the Indian Drugs & Cosmetics Act, 1940, the regulation of the manufacture, sale and distribution of most drugs is a mandate of state drug controllers. The states are also responsible for licensing, market sampling, and post-market surveillance. 

State drug controllers oversee thousands of small and medium-scale manufacturers,  including firms like Sresan Pharmaceuticals that produce drugs for local markets.

But this dual regulatory model has serious cracks, and two authorities that rarely work in sync.

The CDSCO has acknowledged that state labs and regulatory bodies frequently lack capacity, both in terms of trained personnel and infrastructure to carry out rigorous testing for impurities or enforce license compliance. 

As the state authorities hold many of the licensing powers, these gaps in state enforcement often turn into systemic fatal oversights.

A 2024  inspection drive led by CDSCO and state drug controllers checked over 400 premises, including many medicine manufacturers. 

The drive found widespread non-compliance: a large fraction of units were issued show-cause notices, suspended, or shut down for failing to meet GMP and other safety standards. 

“There must be coordination between the Centre and the state agency. We can’t play the blame game,” said Ishtiyaq Wani, editor of a local health news outlet, speaking to Health Policy Watch. “India is one of the largest drug exporters to low-income countries, but unless both regulators act jointly, such tragedies will keep repeating.

India’s Central Drug Testing Laboratory in Hyderabud does not test locally distributed medicines.

Cheap illegal substitutes 

Most cough syrup contamination originates from substandard or illegal raw materials. Pharmaceutical-grade solvents such as glycerin and propylene glycol, the standard base in syrup medicines, must meet strict purity standards. 

Cheaper industrial-grade substitutes, including diethylene glycol or ethylene glycol, are sometimes used illegally as substitutes because they cost less than half the price. Such shortcuts have repeatedly led to child deaths in both domestic and international markets.

Each time a crisis erupts, officials promise reform. But even after global embarrassment over the Gambia and Uzbekistan tragedies, India’s domestic safeguards remain barely changed.

State regulators, meant to be the first line of defense, often lack accredited testing labs, qualified inspectors, and digital systems to track batches. The result is predictable: contaminated drugs slip through until lives are lost.

“The system responds only after people die,” said a retired scientist  who spoke on condition of anonymity. “Once the media leaves, the checks fade again.”

Without a coordinated surveillance network between the central and state authorities, accountability simply dissolves. Factories are shuttered for a few months, then quietly reopen under new names or owners.

A crisis of confidence

India’s drug industry built its global reputation by supplying affordable medicines to the developing world. But repeated incidents of fatal contamination are eroding that trust. In countries from Gambia to Indonesia, authorities demand independent testing of Indian exports before distribution. 

At home, families of victims are left with little recourse. Few cases ever result in a conviction. Compensation is rare, and company directors often vanish into bureaucratic loopholes.

The problem, health economists warn, is not a lack of rules but their uneven enforcement. “The law is strong on paper,” said one public health lawyer in Bengaluru. “But when state regulators are underfunded and overburdened, even the best laws mean little.”

In the aftermath of the Coldriff tragedy, experts have again called for tighter oversight — a unified drug safety authority, routine supplier audits, and real-time data sharing between states and the CDSCO. But unless these proposals move beyond press conferences, little will change.

For now, the pattern remains painfully familiar: a deadly batch, public outrage, temporary bans – then silence and inaction until the next tragedy.

India’s pharmaceutical industry is still the “pharmacy of the Global South,” but each new contamination weakens that claim. Behind every bottle of syrup, there’s a fragile chain of trust. And each time that chain breaks, it costs more than reputation — it costs children’s lives.

Image Credits: WHO, CDSCO.

Global CO2 levels continued to rise in 2024, along with other greenhouse gases like nitrous oxide, according to the latest WMO report.

Global carbon dioxide (CO2) concentration in the atmosphere reached record levels in 2024 due to a combination of wildfires and weakening carbon sinks, according to the latest report by the World Meteorological Organization (WMO) released on Wednesday.

The rise in CO2 will intensify the impact of temperature increases, including by worsening extreme weather events.

“The heat trapped by CO2 and other greenhouse gases is turbo-charging our climate and leading to more extreme weather. Reducing emissions is therefore essential not just for our climate but also for our economic security and community well-being,” said WMO Deputy Secretary-General Ko Barrett.

CO2  levels have tripled since the 1960s, accelerating from an annual average increase of 0.8 ppm per year to 2.4 ppm per year in the decade from 2011 to 2020, according to the report in WMO’s Greenhouse Gas Bulletin.

From 2023 to 2024, the global average concentration of CO2 surged by 3.5 ppm, the largest increase since modern measurements started in 1957.

When the bulletin was first published in 2004,  the annual average level of CO2 measured by WMO’s network of monitoring stations was 377.1 ppm. In 2024, it was 423.9 ppm.

The report also revealed that the concentrations of methane and nitrous oxide – the second and third most significant long-lived greenhouse gases related to human activities – have also risen to record levels.

“Sustaining and expanding greenhouse gas monitoring are critical to support such efforts,” said Oksana Tarasova, coordinator of the Greenhouse Gas Bulletin, which is one of WMO’s flagship scientific reports and is now in its 21st issue.

The annual report provides an update ahead of this year’s UN Climate Change conference COP30 scheduled for November in Belém, Brazil. Global stakeholders will once again convene to try to ramp up support for climate action.

The WMO data comes a few days after a report found that the Earth is crossing the planetary boundaries that keep life stable and healthy.

Warm-water coral reefs are under unprecedented attack due to warming oceans, the Amazon rainforest is very close to its tipping point as well. Once these points are crossed, the damage will be hard to contain and possibly irreversible, according to researchers from the University of Exeter and the PIK – Potsdam Institute for Climate Impact Research.

CO2 emissions rise, but carbon sinks weaken

Globally averaged CO2 concentration (a) and its growth rate (b) from 1984 to 2024. Increases in successive annual means are shown as the shaded columns in (b). The red line in (a) is the monthly mean with the seasonal variation removed; the blue dots and blue line in (a) depict the monthly averages. Observations from 179 stations were used for this analysis.

The likely reasons for the record growth between 2023 and 2024 are wildfire emissions and a reduced uptake of CO2  by land and the ocean in 2024, the warmest year on record, with a strong El Niño.

Carbon sinks such as land ecosystems and the ocean usually absorb about half of the CO2 released. As the temperature rises, the oceans absorb less CO2  because of decreased solubility at higher temperatures. The land sinks are also impacted in a number of ways, including the potential for more persistent drought.

During El Niño years, CO2  levels tend to rise because the efficiency of land carbon sinks is reduced by drier vegetation and forest fires – as was the case with exceptional drought and fires in the Amazon and southern Africa in 2024.

“There is concern that terrestrial and ocean CO2  sinks are becoming less effective, which will increase the amount of CO2  that stays in the atmosphere, thereby accelerating global warming. Sustained and strengthened greenhouse gas monitoring is critical to understanding these loops,” said Oksana Tarasova, a WMO senior scientific officer.

A portion of the CO2 released today is likely to remain in the atmosphere for hundreds of years, and will continue to impact the global climate for a long time.

Concentration of other gases is rising as well

Contribution of the most important long-lived greenhouse gases to the increase in global radiative forcing from the pre-industrial era to 2024.

Methane accounts for about 16% of the warming effect on our climate and stays in the atmosphere for about nine years. This also makes it a low-hanging fruit when it comes to climate action.

The globally averaged methane concentration in 2024 was 1,942 parts per billion (ppb),  an increase of 166% above pre-industrial (pre-1750) levels.

Around 40% of methane is emitted into the atmosphere by natural sources, such as wetlands, which are sensitive to climate as well. The other 60% comes from anthropogenic sources such as cattle, rice farming, fossil fuel, landfills and biomass burning.

The third most important long-lived greenhouse gas, nitrous oxide, that stays in the atmosphere for around a century, reached 338.0 ppb in 2024, an increase of 25% over the pre-industrial level. This gas comes from both natural sources and human activities such as biomass burning, fertilizer use and various industrial processes.

WMO said that countries need to continue to strengthen the monitoring of CO2 levels to inform policy action. In addition, it emphasized the need to preserve existing carbon sinks.

Image Credits: WMO.

UNICEF’s Benjamin Schreiber

Where is the accountability for those who produce health misinformation that harms the health of children, asked Benjamin Schreiber, a senior adviser to the United Nations Children’s Fund (UNICEF), at the World Health Summit in Berlin on Tuesday.

“We are now living in a situation where the information environment in which we live has become a determinant of health,” said Schreiber, adding that misinformation is a “key risk to achieving global vaccination goals”.

The United States has become a global focal point for vaccine scepticism since Robert F Kennedy Jr was appointed Health Secretary. He has defunded mRNA vaccine research, dismissed members of the national vaccine advisory body and appointed several vaccine sceptics in their place, and revived the discredited notion that high autism rates are linked to vaccines.

The US state of Florida is also removing vaccine mandates for children.

Social listening

Through digital community engagement in 40 countries, using AI-enabled social listening that identifies high-risk messages, UNICEF has identified 229 such messages that have reached 111 million people this year alone.

These messages usually resonate with underserved and excluded communities who have low trust in government, “and this is where the zero-dose children are sitting”, Schreiber added, referring to children who have not had any vaccinations.

Prof Heidi Larsen

Professor Heidi Larsen founded the Vaccine Confidence Project 15 years ago, and said that the biggest thing the project has learnt is that “60 to 70% of the time, the issue was not about the vaccine. It was about distrust of the government, distrust of the producers of vaccines, a bad experience in the clinic… It was a whole mix of things that we needed to understand.”

During COVID-19, the project conducted a study on people’s attitudes to vaccines in 70 countries, and the biggest thing we came away with was that actually there is trust in science… but people trust other sources more.”

Larsen, who is based at the London School of Hygiene and Tropical Medicine, said that it emerged from their study that people in African countries trusted their family doctor, family members and religious and community leaders more than science.

Religious leaders more trusted than scientists

“Religious leaders, aside from in one country, far outweighed the influence of scientists. In other places, it was family members. We need to look at the ecosystem of influences.”

Larsen’s project launched a global vaccine confidence index in 2015, which “identified Europe as being the most sceptical region about vaccines, with France being the single most sceptical country in the world, as 42% of the population said they did not believe the statement that vaccines are safe”, she said. 

At that stage, most African countries believed that vaccines were safe, but three years later, in 2018 when the same survey was conducted, vaccine scepticism had grown in Francophone Africa – influenced by “the sceptical French media”.

During COVID-19, viral social media posts – many originating from the US – promoted conspiracy theories that eroded trust and reduced demand for COVID-19 and childhood vaccines.

“Misinformation and conspiracy theories have become a growing challenge to public perceptions of vaccines,” according to UNICEF’s 2023 report, State of the World’s Children.

‘Falsehoods travel fast’

WHO Africa regional director Dr Mohamed Janabi

Dr Mohamed Janabi, the World Health Organization Africa regional director, warned that “falsehoods travel very, very fast through social media, radio shows, talks, community gossip and even pulpits”.

“Spiritual cures have led families to hesitate or refuse completely vaccines that protect the children from polio, measles and other preventable diseases. And the unfortunate thing about the misinformation don’t need visas. They just travel,” said Janabi.

“A recent survey found fewer than four in every 10 Africans trust governments. Where mistrust is high, children are 10% more likely to miss vaccines,” he added, quoting a 2021 study.

“When people feel respected and heard, they begin to trust the nurse, the clinic, the local authorities and the institution that saved them. So, combating misinformation, to me, is not only about saving lives today. It’s about rebuilding the social contract that sustains public health.”

Karla Soares-Weiser, the newly appointed CEO of Cochrane, a global independent network of researchers and health professionals.

“For more than 30 years, Cochrane has been dedicated to a single purpose: producing and sharing trusted evidence to inform health decisions,” Soares-Weiser explained.

“Founded in 1993, our movement began with a very simple but radical idea that health decisions should be guided by the best available evidence, not by opinion, ideology or commercial interests.”

Karla Soares-Weiser, CEO of Cochrane.

Pre-bunking vaccine myths

She said that three steps are necessary to rebuild people’s trust in science: “First, we must invest in trusted evidence as a global public good. Second, we need to strengthen intermediaries and local voices, because trust is built locally. And third, we must embed equity, transparency and inclusion, ensuring that leadership from the Global South is not the exception, but the norm.”

Schreiber said that UNICEF, which runs the biggest vaccination programme in the world, is building the capacity of health workers from Ministries of Health to proactively address misinformation.

“Of the lessons learned, number one is that speed matters. It’s really important, once you see these high-risk messages coming out, that you react quickly.

“We can ‘pre-bunk’ certain myths. We know already the myths are coming. So when we introduce a new vaccine, we can already spread messages that are pre-bunking these myths upfront and like vaccination causes sterilisation.”

The Vaccine Confidence Project has also founded Iris, a consortium of universities, working on “ways that we can pre-bunk with positive information and different strategies to encourage and basically nudge people towards the more credible information,” added Larsen.

Helen Clark, former New Zealand prime minister, calls for stronger links between animal and human health at a World Health Summit session on pandemics.

There is an urgent need for a more comprehensive pandemic risk monitoring system that tracks threats and preparedness in real time, according to the WHO-hosted Global Preparedness Monitoring Board, in a report launched at the World Health Summit. This followed the release of a new World Health Organization data documenting the sharp global rise in drug-resistant bacterial infections. 

BERLIN – One in six laboratory-confirmed, common bacterial infections were resistant to antibiotic treatments in 2023, rising to one in three reported infections in WHO’s South-East Asia and Eastern Mediterranean Regions, according to a new report published  Monday. 

Between 2018 and 2023, antibiotic resistance rose in over 40% of pathogen-antibiotic combinations monitored, with an average annual increase of 5–15%, according to the Global antibiotic resistance surveillance report 2025. 

Trends in drug resistance for common bacterial infections.

The report, which highlights the growing threat of antibiotic resistance (AMR) to public health, also underlines the heightened pandemic risks from AMR.

Those risks are tackled in a report released Monday by the WHO-hosted Global Pandemic Monitoring Board, a group of political leaders, agency heads and experts, co-sponsored with the World Bank.

The GPMB report recommends the establishment of a “comprehensive pandemic risk monitoring system that tracks threats, vulnerabilities and preparedness in real time, integrating health, social, economic and environmental data into clear signals for leaders.” 

At present, while WHO monitors and reports publicly on antibiotic resistance trends in human health, its animal health counterpart, the World Organization for Animal Health (WOAH) has only just launched an observatory to track drug resistance in livestock. Historically, however, the data collected by this non-UN, member-based organization has made use of different, and far less transparent reporting methods, leading to a major disconnect in terms of signals and risks. 

The report also recommends a global pandemic spending tracker for every country, with recommended benchmarks of $15 billion annually or 0.1-0.2% of GDP. And 0.5-1% of security and defense budgets.

AMR surveillance now includes data from 104 countries

The number of countries reporting data on antibiotic-resistant infections has increased from just 25 to 104 countries and territories.

The WHO report synthesizes data from the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS), to which 104 countries are now reporting. That represents a four-fold increase in country participation in GLASS since 2016, when only 25 countries were reporting data through the system.

However nearly half WHO’s member and observer states are not yet reporting data. And about half of the reporting countries still lack the systems to generate reliable data, WHO said, in a press release. 

Countries facing the largest challenges lacked the surveillance capacity to assess their antimicrobial resistance (AMR) situation, and many have been affected by cuts in global funding, including the closure earlier this year of the Fleming Fund  after the withdrawal of UK government funds. The Fleming Fund had been supporting 25 low-income and middle-income countries (LMICs) in Africa and Asia to monitor AMR.

Countries reporting antimicrobial use (AMU), antimicrobial resistance (AMR), or both, in human health settings.

The new report presents, for the first time, resistance prevalence estimates across 22 antibiotics used to treat infections of the urinary and gastrointestinal tracts, the bloodstream and those used to treat gonorrhoea.

It also looks at regional differences in resistance trends. Along with the soaring resistance in EMRO and SEARO regions, one in five laboratory confirmed infections in WHO’s Africa region are also antibiotic resistant.  

South-East Asia and Eastern Mediterranean regions have the highest overall levels of reported antibiotic-resistant infections, followed by the African region.

Globally, more than 40% of E. coli and over 55% of K. pneumoniae globally are now resistant to third-generation cephalosporins, the first-choice treatment for these infections. Altogether, the report covers eight common bacterial pathogens: Acinetobacter spp., Escherichia coli, Klebsiella pneumoniae, Neisseria gonorrhoeae, non-typhoidal Salmonella spp., Shigella spp., Staphylococcus aureus and Streptococcus pneumoniae.

In the African region, resistance to gram-negative bacteria exceeds 70%. Among these, E. coli and K. pneumoniae are the leading drug-resistant gram-negative bacteria found in bloodstream infections. These are also among the most severe bacterial infections that often result in sepsis, organ failure, and death, WHO said.

Greater emphasis on One Health 

Protestors outside of the World Health Summit call for a halt to the global wildlife trade and the factory farming of livestock, so as to ‘prevent the next pandemic.’

The political declaration on AMR adopted at the United Nations General Assembly in 2024 committed countries to strengthening surveillance systems and addressing AMR through a ‘One Health’ approach coordinating across human health, animal health, and environmental sectors. However, massive animal industry resistance exists and there is a lack of transparent, and systematic reporting on AMR trends in livestock populations. Combined with that are financial incentives to veterinarians in LMICs who earn much of their revenue from selling drugs to farmers.

Speaking at a WHS session Tuesday launching the GPMB report, former New Zealand Prime Minister Helen Clark ,who in 2021 co-chaired the “Independent Panel” that investigated the COVID-19 pandemic, lauded the “strong push for a prevention focus and a One Health approach” in the WHO pandemic agreement, approved in May. 

“But that actually calls for a lot more, a broader spectrum of collaboration than was business as usual before, at the multilateral level and within countries. And we really do have to get the agriculture and health ministry much closer together,” Clark said.

Creating new institutions while sunlighting others ? 

Paul Zubeil, deputy director of international health in the German Federal Ministry of Health. 

The new needs highlighted by the COVID pandemic contrast sharply with the budget pressures being faced by countries and agencies to retrench their budget and their spending. 

These and other challenges to global health governance and agency alignment were the focus of another WHS session Monday, on the shifting powers of global health governance. The discussion focused on the need for strategic reforms in global health governance, that could allow for the sunsetting of institutions that have filled their role – but even allow for their creation of new ones, should needs arise. 

The discussion follows on recent recommendations by the UN80 in September to sunset UNAIDS by 2026 – a plan opposed by the UNAIDS board and dozens of NGO affiliates. The UNAIDS board had earlier endorsed a more gradual five-year transition of the agency’s remaining functions and workforce to other entities to other entities, after slashing the UNAIDS workforce by more than half, and country offices from 85 to 54.

The UN80 plan, put forward by UN Secretary General Antonio Guterres at the UN General Assembly, also proposes merging the UN Population Fund (UNFPA) and UN Women (UNFPA) “to create a unified voice and platform on gender equality and women’s rights.”  The merger of the world’s two largest non-UN health agencies, Gavi, the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria has also been discussed more informally – although the agencies themselves have preferred to talk about closer collaboration, or “radical reform”. And that’s not to mention several dozen other smaller global partnerships in the global health galaxy – all funded one way or another by increasingly budget conscious donor states advocating openly for reforms. 

“What we really do need is that we need clarity of mandate and that will not only save money, that will also eliminate the inefficiencies currently face,” said Paul Zubeil, deputy director of international health in the German Federal Ministry of Health. 

“We actually need to have someone taking the lead and looking at that system and how we can make it lean. And of course, we need to talk also about sunsetting, and that’s very painful, because it involves people. It involves things that people have watched close to their hearts,” Zubeil added.

Joy Phumaphi, (left) African Leaders Malaria Alliance: UN and Bretton Woods institutions need to be remodelled for a post-colonial world.

GPMB co-chair Joy Phumaphi, executive secretary of the African Leaders Malaria Alliance (ALMA) said that “Both the UN and the Bretton Woods institutions were crafted at a certain time and were designed for a certain global ecosystem… when most African countries were not even independent. And they need to be remodelled in order to suit the current global environment.

“They are really not helping us, the developing countries,” she said, referring to the vicious cycle of high interest rates, large debts and tough austerity measures that have trapped many low-income countries as a result of World Bank and International Monetary Fund policies. 

“I think that the starting point is: what does the country need?” said Wellcome Trust CEO John Arne Røttingen. “It’s not a one size fits all.”

He said that development assistance had too often been managed similarly to humanitarian aid fostering excessive dependency on international institutions – inevitably followed by the shocks seen in recent months when that aid was abruptly withdrawn. 

“Of course, we know that there are fragile states, conflicts, states, countries with large populations due to migration that need extra support. And there, the international system probably needs just partly be involved in operations and humanitarian context and operational support. 

“[But] I think actually we have delivered some of global health almost as a humanitarian system… not in the most fragile countries only, but maybe up to 100 countries where we have delivered services from afar.

“it means that when these politicians in high income countries make decisions to stop a program, the program is actually stopped a couple of days later on the ground. And that just indicates that level of verticalization and dependence that is not sustainable.” 

John-Arne Røttingen, CEO Wellcome (right).

 ‘Neurotic and fearful’ about change

Engineering change, however, is extremely difficult because the multiple new global health institutions that were created are now “neurotic and fearful and frightened about their futures, and thus not good bedfellows,” observed Jeremy Farrar, WHO Assistant Director General and a former Wellcome CEO.  

“No institution should think it’s there forever because, because that just brings complacency and arrogance and all of the things that go with it,” Farrar declared.

“But [that] is not a criticism of why those agencies were established,” he stressed. “They were established for a good reason. The question is not …why on earth did we set up the Global Fund or Gavi…in 2000.  The question is, what do we need for 2025 or 2050?  And it may or may not be, those organizations. 

“It’s not that we’re not saying they were rubbish and they should never have been established. They drove the world forward, and there are millions of people around the world now being vaccinated as a result of having Gavi. And we would not be where we are now with TB, HIV, and malaria, without the Global Fund. So let’s celebrate that success,” said Farrar.

“But in this more horizontal than vertical world…. when you have malaria and TB vaccines, is that Global Fund or is that Gavi? And how do you integrate those interventions into complex systems? 

“So it’s not that we should never have done them. We should. The question is: what do we need next?” 

Image Credits: E. Fletcher/Health Policy Watch, E Fletcher, https://www.who.int/publications/i/item/B09585O, 2025, WHO, 2025, WHO/GLASS , WHO , E. Fletcher/Health Policy Watch .

Chris Murray, Director of Institute for Health Metrics and Evaluation, describes key findings of the 2023 Global Burden of Disease study at the World Health Summit launch.

BERLIN – Global life expectancy rose again in 2023 after a decline during the COVID pandemic with overall life expectancy 20 years higher as compared to 1950. 

But North America and Latin America are seeing higher death rates among adolescents and young adults due to a crisis in mental health – reflected in higher rates of suicide, drug abuse and excessive alcohol consumption. In sub-Saharan Africa, infectious diseases and unintentional injuries also struck young people disproportionately. 

These were among the key findings of the 2023 Global Burden of Disease Study, by the Institute for Health Metrics and Evaluation, published Sunday in the Lancet. 

The report was launched on the opening day of the annual World Health Summit. Some 14,000 people are attending the three-day science and policy event, including 4,000 on site. 

Germany donates $1 billion to Global Fund 

The Global Fund’s Peter Sands (on left) thanks Germany for the $1 billion commitment announced at the World Health Summit.

At the WHS opening, the German government announced it would be making a mammoth €1 billion donation to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria for the 2027-2029 period. The Global Fund is in the midst of its triennial replenishment campaign, with the aim of raising $18 billion for the upcoming three-year period. It’s replenishment ‘summit’ is scheduled for 21 November in Johannesburg, on the margins of the G-20. 

“It’s not often that you stand on stage and you get a pledge for a billion euros,” quipped Global Fund head Peter Sands. “But this announcement is a really important milestone, setting the tone and a benchmark for other donors.

Strinkingly, Sands was also the only head of a global health agency to be on the main stage on Sunday night, in what the organisers described as a pared-down event in comparison with the past, elaborate, openings. WHO Director Director General Dr Tedros Adhanom, who in past years had been dubbed a WHS “patron” was appearing only remotely as a speaker at a few events Monday and Tuesday.  WHO is in the throes of massive budget cuts and staff layoffs as a result of the United States withdrawal from the global health agency in Geneva.

In response to a query from Health Policy Watch, a WHS spokesperson said: “due to other commitments, all three of our patrons were unable to join us in person this year. We hope to welcome them at #WHS2026.”  Along with Tedros, German Chancellor Frederich Merz and French President Emmannuel Macron, both facing major government crises, were named as ‘patrons’ of the 2025 WHS session in August.

WHO Director General Dr Tedros Adhanom Ghebreyesus speaks remotely at a WHS session on NCDs on Monday, with German Minister of Health Nina Warken attending in person.

“We all know that 2025 has been a very tough year,” Sands added. “We’ve had a lot of complicated geopolitics. We’ve had disruption of funding, a whole range of issues confronting us, and those issues aren’t going to be solved quickly, right? 

“The politics is complicated, the funding is difficult. But we should also look at this as a moment of opportunity in terms of making changes we should have been making anyway,” he said, remarking on how a “fragmented” global health sector could seize the moment to create “efficiencies and greater synergies.”

It’s also a moment of opportunity for harnessing medical innovation, he added, citing the Global Fund rollout of twice yearly injections of lenacapavir (LEN), which WHO recommended in July as a pre-exposure prophylaxis (PrEP) option for HIV prevention. 

“With the emergence of lenacapavir  and the fact that we can roll it out at scale this year, we really have the prospect of bringing AIDS to an end as a public health threat. That is an extraordinarily exciting thing.”

Worrying trends among youths and young adults 

Mental disorders are increasing – and their impacts are particularly evident in trends among youths.

The new GBD report shows that Global life expectancy returned to pre-pandemic levels with 76.3 years of life expectancy for females and 71.5 years for males. That is also  more than 20 years higher compared to 1950. 

Despite this progress, stark geographic differences remain, with life expectancy ranging from as high as 83 years in high-income regions to as low as 62 years in sub-Saharan Africa.

Among adolescents and young adults, the largest increase in deaths was registered among those aged 20 to 39 years-old in high-income North America from 2011 to 2023, mainly due to suicide, drug overdose, and excessive alcohol consumption. During the same period, deaths in the 5–19-year age group also increased in high-income North America, the Caribbean, and Eastern Europe, the report found, with trends in the latter region linked to the ongoing conflict in Ukraine.

Across all ages, mental health disorders are rising steeply, with anxiety disorders increasing by 63% and depressive disorders by 26% between 2010 and 2023. In addition, sexual abuse and intimate partner violence were identified as preventable contributors to depression and anxiety.

The GBD 2023 study highlights the need for policymakers to extend their thinking about health priorities beyond reducing child mortality to adolescents and young adults, IHME experts stressed. 

“The share of burden that is from mental disorders, is going up in all of the World Bank income groups, with the most marked increases actually in low and lower middle income countries, but certainly rises everywhere,” said Chris Murray, IHME director, speaking at a launch panel on the GBD study. 

NCDs now account for nearly two-thirds of mortality and morbidity

Premature deaths in Africa and parts of South East Asia from cardiovascular disease are much higher than in most developed countries.

The report also underlines how non-communicable diseases (NCDs) now account for nearly two-thirds of the world’s total mortality and morbidity, with ischemic heart disease, stroke, and diabetes leading the way.  Some 75% of all deaths are due to NCDs. Researchers estimate that nearly half of all death and disability could be prevented by modifying leading risk factors, such as reducing high levels of blood sugar and obesity, which is increasing almost everywhere in the world. 

In Germany, some 90% of the burden of disease is due to NCDs, said German’s Health Minsiter, Nina Warken, at an NCD session on Monday, adding that if NCDs were a pandemic of infectious disease “Germany would be in a lockdown.”

Comparatively, however, premature deaths from NCDs are much higher in low-and middle-income countries than in developed ones, due to the lack of access to diagnosis and treatment. And in some of the poorest countries, premature deaths from NCDs are rising as unhealthy processed foods and more sugary drinks make inroads into dietes, while physical activity levels also decline .  

In parts of Africa, for instance, deaths from cardiovascular disease may range from 57 to around 70 years of age, while in developed countries, as well as in Latin America and China, the average age is in the range of 70-85.  

Air pollution, lead contamination and heat risks 

Deaths from high temperatures have increased sharply since 1990, with most of the burden falling on the lowest income countries.

Climate-sensitive risks, such as air pollution and heat, are also having an ever-more significant impact on NCDs.  Levels of particulate matter, a major risk for cardiovascular diseases, lung disease and cancer, and the world’s second leading health risk factor overall, were highest in South Asia, sub- Saharan Africa, and North Africa and the Middle East, the GBD study found. 

High temperatures are also exacerbating health vulnerabilities in that same regions that air pollution is a major issue. Particularly in the Sahel, extreme heat is compounding the effects of drought, food insecurity, and displacement.

“If you want the sort of high level view, the number of heat related deaths in 1990 were about 250,000 and there are about 550,000 in 2023,” said Murray. 

New evidence about the burden of lead also shows that heavy metal is playing a much larger role in NCD health risks, than previously understood, Murray added.  And even after unleaded gasoline has become the norm, environmental lead exposures through other pathways, like paints and solvents, continue to make a health impact throughout the life cycle.

“With new evidence from published studies, we realized that the burden from lead [exposure] is now much larger than previously assessed. So lead is now the tenth leading risk factor, and you can see the causes are mostly ischemic heart disease,” Murray said.  

‘Take charge of your own health services’ 

Zulfiqar Bhutta, Pakistan urges countries to regain charge of their health systems from donors.

IHME experts also warned about the impacts of the recent sharp cuts in international aid for global health initiatives on decades of disease control efforts. 

“Decades of work to close the gap in low-income regions with persistent health inequities are in danger of unraveling due to the recent cuts to international aid,” said Emmanuela Gakidou, senior author and professor at IHME. “These countries rely on global health funding for life-saving primary care, medicine, and vaccines. Without it, the gap is sure to widen.”

At the GBD launch, meanwhile, Zulfiqar Bhutta, founding director of Pakistan’s Agha Khan University, urged countries and health leaders to “take charge of your own health services”.

“Every country in the world, barring a few, which are heavily indebted countries, has capacity, has the capacity to do more,” he asserted. 

“I think for women and children’s health, the first and foremost thing that would make a difference is domestic financing. I come from a region where we spend far, far more on defense and other expenditures that we do on social systems, on education, on empowering women and girls, improving primary care and universal health.”

-Updated 13.10.2025

Image Credits: E. Fletcher/Health Policy Watch, Patricia Ferrini, IHME, IHME , E. Fletcher/HP Watch.

Experts from across the globe discussed advances and challenges in single-dose antimalarial therapy at the MMV Science of Malaria Symposium.

Malaria affects millions worldwide, and progress against the disease is stalling. Emerging drug resistance threatens to reverse hard-won gains, putting many more lives at risk. Public–private partnerships are racing to close the treatment gap before the current drugs begin to fail.

“We believe that the eradication of malaria is in sight, but it’s an ongoing challenge,” said Martin Fitchet, chief executive officer of Medicines for Malaria Venture (MMV), at a one-day scientific event on 7 October. MMV, a Geneva-based not-for-profit public-private partnership, focuses on developing and delivering affordable antimalarial drugs.

MMV’s first-ever “Science of Malaria Medicine” symposium brought together experts and practitioners from around the world to discuss the challenges and advancements in preventing and curing malaria.

According to Cristina Donini, Executive Vice President, Head of Research, Early Development and Modelling at MMV, the progress seen towards  achieving the goals set out in the World Health Organization’s (WHO) Global Technical Strategy for malaria elimination is stalling.

Trends in malaria case incidence versus targets shows stalled progress.

To stay on the path of reducing malaria cases by at least 90% by 2030, this year’s number of infections would have needed to decrease to 14.5 per 1,000 people at risk. However, current projections estimate the actual figure at more than four times higher, standing at 60.4/1000.

The African region continues to suffer the highest burden, accounting for 94% of reported cases and 95% of the 597,000 malaria-related deaths worldwide in 2023. Among the most affected are pregnant women, for whom new treatments have just entered Phase 3 trials.

Increased signs of drug resistance

A major challenge is the parasite’s ability to develop antimalarial drug resistance. With partial drug resistance to artemisinin, the backbone of standard of care, now present and expanding across multiple countries  in the African region, experts are alarmed.

Dorothy Achu, of WHO’s Regional Office for Africa, warned of increased signs of antimalarial drug resistance, to artemisinin in particular.

 

This development poses an existential threat to populations at risk, warned Dorothy Achu, team leader for tropical and vectorborne diseases at the WHO Regional Office for Africa. 

The WHO forecasts an additional 78 million cases of malaria over five years in the absence of pre-emptive action. ‘This could result in over 80,000 excess deaths per year,’ she said.

Extreme weather events caused by climate change, as well as crises or conflicts that displace populations or damage public health infrastructure, exacerbate the risks.

The increased transmissibility of drug-resistant parasites, particularly in non-immune populations, as well as so-far limited deployment of new malaria vaccines, which have only recently been rolled out in Africa, also help drive resistance, she said. Companies like GSK are currently developing second-generation vaccines.

Mapping of confirmed and suspected anti-malaria drug resistance in African countries.

 

Urgency for single dose cure

Dyann Wirth, Harvard School of Public Health at podium, talks about new anti-malaria molecules and drug combinations.

Another main driver of drug resistance is patients failing to comply with the doses of multiple medications, which are  common Artemisinin Combination Therapy (ACT) treatments. The resulting subtherapeutic dosage is unable to fully eliminate the parasites from the body. In some regions, the adherence rate to a full course of treatment is as low as 40%.

To counter this, and to make treatment easier to administer for health workers and patients, efforts are underway to combine up to three different antimalarial drugs into a single dose. ‘Single-dose combinations are the way forward,’ said Joseph Okebe from the pharmaceutical giant Merck. Phase 1 trials on single-dose treatment by the pharmaceutical company Novartis in partnership with MMV are ongoing.

Additionally, researchers have yet to solve other crucial problems. Vomiting after oral administration and drug-drug interactions are common issues in antimalarial treatment, and that also may result in subtherapeutic dosage. With the single-dose approach, only one treatment is foreseen. Still, patients must be monitored for adverse effects, and countermeasures taken, if necessary. This is particularly difficult in low-resource areas.

‘A single-dose cure is a good approach, but we have to weigh the risks carefully,’ warned Omary Hassan from the Ifakara Health Institute, a leading biomedical and public health research centre in Tanzania.

Funding cuts also jeopardize malaria goals

A health worker dispenses a child-friendly formulation of Coartem®. This month, the first malaria treatment for newborns <5 kg , Coartem® Baby, co-developed with MMV, began its rollout in Ghana.

The impact of recent, massive cuts in global health funding by major donor countries, including the United States, was another recurring thread of discussion throughout the day at the event, which drew some 100 researchers and experts from more than 16 countries.

Can the necessary funds be mobilised to finance more progress?  For instance, the new Novartis anti-malarial drug specifically designed for newborns and infants under 5 kg, which was co-developed with MMV, was launched this month in Ghana. But support will be required to ensure this live-saving formulation, and other new innovations, reach the patients that need them. See related story here:

Ghanaian Newborns First to Get New Malaria Medication

In 2023, the WHO projected that an estimated $8.3 billion would be required for that year alone, to maintain progress in the WHO’s global technical strategy for malaria (GTS) goals as the world emerged from the COVID-19 pandemic. 

However, actual funding amounted to just $4 billion in 2023. And this year, the drastic cuts to global health funding triggered by new United States President Donald Trump, are further exacerbating the shortfalls. If the current trajectory continues, analysts expect that only 60% of the necessary funding will be achieved by 2030.

Huge gains were made in the past year, with 173 million cases of malaria treated in 2024 and medical advances picking up momentum. Said Fitchet, while “‘institutions are under strain and public health sectors are struggling, scientific momentum is unfolding against a backdrop of global challenges.” See related story: 

https://healthpolicy-watch.news/global-fund-declines-in-malaria-hiv-and-tb-deaths-threatened-by-donor-aid-cutbacks-climate-and-conflict/

Image Credits: Novartis, Violaine Martin/MMV, MMV, Violaine Martin/MMV , WHO .

Prof Hassan Shehata, president of the Royal College of Obstetricians and Gynaecologists, Dr Hannah Nazri, Asia Network to end FGM/C and Anna af Ugglas, chief executive of the International Confederation of Midwives.

CAPE TOWN – More and more health workers are performing female genital mutilation (FGM) in South and South East Asia – although the process is internationally recognised as a serious human rights violation with no medical justification. 

Health professional associations mulled over how to ensure that health workers stop performing this harmful practice at the World Congress of Gynaecology and Obstetrics (FIGO) in Cape Town on Wednesday.

Growing “medicalisation” has been observed in Brunei, India, Indonesia, Malaysia, Pakistan, Singapore, Sri Lanka, and Thailand, according to a new report released at the FIGO congress.

Around 80 million women and girls have experienced FGM or cutting (FGM/C) in the region, which entails procedures that involve partial or total removal of external female genitalia, or other injury to the female genital organs for non-medical reasons. 

Of the eight countries, only Indonesia explicitly bans the performance of FGM, including by healthcare professionals, according to the report, which was compiled by Equality Now, the Asian-Pacific Resource and Research Centre for Women (ARROW), Orchid Project, and the Asia Network to End FGM/C.

Despite this ban, implemented in 2024, almost half of all procedures in Indonesia are now done by trained midwives, often as part of maternity packages.

In Malaysia, doctors are the primary providers, and 85.4% of the doctors interviewed in a 2020 study said that female genital cutting should continue. 

In Singapore, almost half the women interviewed in a 2020 study had been cut by doctors. In Sri Lanka, FGM is increasingly being performed by physicians in private clinics, with services being advertised on social media, according to a 2025 report.

“FGM is being offered in government hospitals in Brunei, which indicates government support,” according to Equality Now’s Julie Thekkudan.

In Thailand, there is a rise in girls undergoing FGM/C in health facilities, with doctors disclosing that they perform 10 to 20 procedures monthly. 

‘Regulation of sexual desires’

The motivation for cutting women’s and girls’ genitalia is rooted in cultural and religious beliefs – primarily that it will prevent promiscuity. 

It is also often performed on babies and young girls before they reach puberty, subjecting them to intense pain as the area is dense with nerve fibres and blood vessels, added Nazri.

In the Gambia, 70% of girls have undergone FGM by the age of nine, while in Malaysia, it is most commonly performed on infants and pre-school girls. 

“If you have to perform a harmful procedure to regulate a person’s sexual desires, there is something very wrong,” said Dr Hannah Nazri from the Asia Network to End FGM/C.

“If people want to prevent their daughters from being promiscuous, then they should educate them,” she said, adding that parents should not be able to give consent on behalf of their daughters for a procedure that would cause permanent harm.

Nazri, who also represents Malaysian Doctors for Women and Children, added that human sexuality is a complex process that is rooted in reactions in the brain as well as the body, so damaging a woman’s genitals will not remove her sexual desire.

Dr Hannah Nazri

Medicalising does not reduce harm

There is no evidence that the use of health workers reduced the harm. Instead, some studies found that healthcare professionals were more likely to conduct more severe forms of the procedure than traditional practitioners, using their anatomical knowledge and anaesthesia, which often resulted in deeper, more extensive cuts.

“Medicalisation of FGM/C does not make the practice safe. On the contrary, it risks embedding it within health systems, undermining medical ethics, and exposing women and girls to long-term physical and psychological harm,” said ARROW’s Safiya Riyaz.

“Medicalising FGM/C may be intended to reduce harm, but it does not make the practice safe,” she added. “With medicalisation rising across Asia, healthcare professionals are in a unique position to protect women and girls. They must be supported by clear laws, accountability, and cultural change to end this harmful practice.”

Role of professional bodies

The World Health Organization (WHO) strongly urges health workers not to perform FGM and has developed a global strategy to support the health sector and health workers to end FGM medicalisation, which is practised in 94 countries.

Dr Christina Pallito, WHO lead on harmful practices, said that the global body’s guidances on the issue are aimed at “shifting values, shifting beliefs and to change the behaviours, to bring more health workers to be against medical FGM and understand why they should not do it”.

Anna af Ugglas, chief executive of the International Confederation of Midwives (ICM) which has over one million members, said that her organisation believes FGM is a “harmful cultural practice that should never be performed”.

She called for closer alignment between health professionals to stop FGM/C.

While she advocated for a “stick and carrot” approach to stop health workers from performing the procedures, “there must be consequences for harm”, she added.

Professor Hassan Shehata, president of the Royal College of Obstetrians and Gynaecologists (RCOG), said that 44,000 women and girls died each year from FGM: “That’s one every 12 minutes.”

The RCOG, which has members across the world, makes it clear that FGM/C is a human rights abuse and has clear guidelines for its members, said Shehata.

“We have embarked on a lot of work about FGM in Africa, and [run] a training course where we address three main issues: One, advocacy; Two, training that FGM has no place, whether it’s medically, religiously or socially. Three for members to understand the complexities and implications of FGM – mental health, sexual health, physiology, obstetrics, and gynaecology.”

Nazri believes educating health workers is more effective than banning FGM: “A lot of health workers are not aware that FGM is a human rights violation. The law is silent about it in Malaysia and often junior doctors don’t want to go against their seniors, so a legal framework would help and also allow doctors to educate their patients.”

Equality Now’s Thekkudan said there was low awareness of the harms of FGM/C and there need to be “national awareness campaigns” that include the medical fraternity.

The procedure is not taught in medical schools, and health workers learnt how to perform it from older health workers and traditional birth attendants, she added.

International development aid is still prioritising fossil fuel-based energy projects while funding for clean air initiatives fell sharply in 2023, according to a new Clean Air Fund Report.

Development funding for fossil fuel-based energy projects jumped 80 per cent in 2023 to $9.5bn, up from $5.3bn in 2022, even as toxic air causes more than 8m premature deaths annually, according to a new report.

Governments continue to channel billions more in international aid into projects that prolong fossil fuel use than into tackling air pollution, the Clean Air Fund found. Direct support for outdoor air quality initiatives fell 20 per cent to $3.7bn, representing just 1 per cent of all international development financing, according to the organisation’s annual State of Global Air Quality Funding report released Wednesday.

However, total international development aid for clean energy projects with air quality co-benefits reached $32.6 billion in 2023, nearly 3.5 times fossil fuel investments — a marginal increase from $31.8 billion in 2022.

“Air pollution is a public health emergency hiding in plain sight,” said Jane Burston, chief executive of Clean Air Fund. “Every year, toxic air kills more people than tobacco — contributing to 8.1 million deaths — yet governments are still funnelling billions into the fuels that cause it.”

Beyond international aid budgets, national fossil fuel subsidies from governments totalled $7 trillion globally in 2022, equivalent to 7.1% of global GDP, according to International Monetary Fund data. That represents 1,400 times more than what flows to clean air projects, even as roughly 85% of global air pollution stems from burning fossil fuels and biomass.

“You can’t build healthy societies on dirty air,” Burston added. “When aid money props up fossil fuels instead of cleaning our air, it’s not just bad for the planet — it’s deadly for people.”

Total air quality funding, including clean energy projects, as a proportion of international development aid, 2019-2023.

The scale of the mismatch has prompted calls for a fundamental reorientation of development finance. World Bank research shows that integrated air quality and climate policies could save more than 2 million lives annually by 2040 while boosting global GDP by up to $2.4 trillion each year.

As funding continues flowing towards fossil fuels, the report calls for development institutions to go in the opposite direction: embed clean air objectives at the core of climate and development finance, redirect fossil fuel funding toward cleaner transitions and target resources toward currently underfunded regions, particularly Africa.

The findings come as governments face pressure to deliver on a pledge made earlier this year at the World Health Organization’s World Health Assembly to halve the health impacts of anthropogenic air pollution by 2040.

Air pollution ranks as the world’s second-largest health risk factor after high blood pressure, claiming over 8 million lives annually. Fine particulate matter known as PM2.5 — particles smaller than 2.5 micrometres — penetrates deep into the lungs and bloodstream, damaging the cardiovascular system, triggering strokes and heart attacks, and contributing to dementia, cancer and respiratory disease.

Total air quality funding compared to fossil fuel funding as a share of international development finance, 2019-2023.

The WHA resolution marks the first time air quality has been included in a WHO roadmap with a clear global health target tied to pollution reduction. Under South Africa’s G20 presidency, air quality was also elevated as a standalone priority for the first time in the G20’s environment and climate workstream.

But with the Trump administration having axed the vast majority of USAID, which contributed 29 per cent of official development assistance in 2023 – by far the largest single provider of aid in the world, supporting everything from infectious disease prevention to food security programmes – development budgets are under strain globally.

Wider cuts by OECD donors could see development aid fall by 9 to 17%, with least developed countries facing declines of 13 to 25%, respectively. Air pollution, already a relatively minor component of global aid budgets, representing just 1 per cent of international development funding, risks falling by the wayside. Experts warn that momentum risks stalling before meaningful progress can be made.

“Governments pledged to halve air pollution harm by 2040, but the money is still flowing the wrong way, Burston said. “With budgets already under pressure and the world’s largest development donor shutting down, we cannot afford to keep bankrolling fossil fuels. Unless we change course, millions more people will die from toxic air. Every dollar spent on fossil fuels pushes that goal further out of reach.” 

Most polluted regions are left behind

The ten most polluted countries for air quality, according to the Air Quality Life Index.

The limited funding available for air quality is highly geographically concentrated. Three countries — the Philippines, Bangladesh and China — received 65 per cent of all outdoor air quality finance between 2019 and 2023, while regions bearing the heaviest pollution burdens received almost nothing.

Nine in ten air pollution deaths occur in low and middle-income countries, where resources to respond are most limited. The World Bank projects deaths from outdoor air pollution will rise from 5.7 million in 2020 to 6.2 million by 2040 without stronger action. 

Sub-Saharan Africa experienced a 91% collapse in outdoor air quality funding in 2023, dropping to just $11.8m — less than 1 per cent of global clean air support and roughly equivalent to the cost of a single superyacht. The staggering drop occurred as the region faces the world’s fastest urbanisation rate, leaving communities increasingly vulnerable to worsening air pollution.

Seven of the ten countries with the highest air pollution levels received less than $1 per person in total air quality financing in 2023. Countries including Cameroon, the Democratic Republic of Congo and Burundi received as little as $0.02 per person.

“Air pollution is the world’s largest environmental health crisis, yet it receives neither the attention nor the resources it demands. Each year, eight million people die prematurely from a crisis that is largely preventable. Today, nine in ten of these deaths occur in lowand middle-income countries,” Dr Dion George, South Africa’s minister of forestry, fisheries and the environment, wrote in the report’s foreword. “Without urgent action, this tragic toll will continue to rise.”

Air quality funding by type and sector, 2019-2023.

Children face particularly severe impacts. Air pollution causes over 700,000 deaths annually in children under five, making it the second leading risk factor for child mortality worldwide after malnutrition. Air pollution is also linked to 34 per cent of preterm births globally, with 570,000 neonatal deaths attributed to pollution exposure in 2021. 

“What we see currently is not so good – the availability of data from public actors is poor, and when available, the level of finance directed to improve air quality is far too low,” said Barbara Buchner, global managing director of Climate Policy Initiative, which co-authored the report. “But our work confirms that the opportunities are tremendous. With public budgets constrained, increasing air quality finance is one the most impactful investments that can achieve multiple goals: to address climate change, strengthen economies, and significantly improve daily life for millions globally.”

The economic burden is also crushing. World Bank analyses place global health damage costs at $8.1tn annually, equivalent to 6.1 per cent of global GDP. Lower-middle-income countries bear losses equivalent to 9 per cent of GDP compared to 2.8 per cent in high-income nations. India alone loses $95bn annually from reduced productivity, work absences and premature deaths, while China spends $44bn annually on healthcare for PM2.5-related illness.

In 2023, development funders committed 2.5 times more to fossil fuel-prolonging activities than to outdoor air quality improvements. The tension between energy access and air quality poses particular challenges for developing countries. While fossil fuel projects may offer faster paths to expanding electricity access, they lock in polluting infrastructure that carries severe long-term health costs.

Outdoor air quality funding as a share of total international development commitments, 2019-2023.

“Financing remains a major barrier to progress,” George wrote. “The evidence in this report is stark. In 2023, outdoor air quality funding fell by a fifth, even as the health burden grew.”

Funding for projects with air quality co-benefits — initiatives that improve air quality without explicit objectives to do so — rose 7% from $27.1 billion in 2022 to $28.8 billion in 2023. Examples include electric vehicle incentive programmes and projects that promote alternatives to crop residue burning.

Between 2019 and 2023, 86% of total air quality funding was directed towards projects that also addressed climate change, the report found. Transport sector investments attracted 61% of outdoor air quality funding during this period.

In the Greater Beijing-Tianjin-Hebei Region, coordinated action supported by the World Bank, Asian Development Bank and KfW reduced annual average PM2.5 concentrations by 44.2% from 2015 baseline levels by 2030, showing policy action is possible and effective.

“We know how to fix this,” Burston said. “Clean air policies deliver results within months — healthier lungs and fewer deaths. The science is clear, the technology exists, and the health benefits are immediate.”

Image Credits: Pete Markham.

Newborns are susceptible to malaria but there has been no treatment specially for them until recently.

Ghana is the first country in the world to roll out a malaria treatment specially formulated for newborn babies.

The new treatment, known as Coartem <5 kg Baby, uses a new ratio and dose of artemether-lumefantrine to account for metabolic differences in babies under 5kg. Small babies handle drugs differently due to the immaturity of their metabolising organs

The treatment received regulatory approval in Ghana in February and was also approved by the Swiss agency for therapeutic products, Swissmedic, in July.

Three-quarters of those who die from malaria are children under the age of five. Until now, babies under 4.5 kg with malaria were given formulations designed for older children, which increased either the risk of overdose and toxicity or underdose and treatment failure.

Coartem Baby was developed by Novartis, with support from the Medicines for Malaria Venture (MMV). It was tested in a trial known as CALINA, which was conducted in eight African countries with support from the PAMAfrica consortium, which is funded by the European and Developing Countries Clinical Trials Partnership (EDCTP2).

“These tiny patients handle drugs differently due to the immaturity of their metabolising organs, which can lead to overdose and toxicity. Coartem <5 kg Baby provides optimised dosing specifically tailored to the needs of these vulnerable patients,” according to Novartis in a media release, following the successful conclusion of the CALINA trial.

“Infants under 5 kg can be affected by placental malaria, leading to poor birth outcomes, or contract malaria from the bite of an infected mosquito. The prevalence of the disease in this age and weight group is poorly understood, and it is therefore often misdiagnosed.

“Infants below 5 kg make up a critical neglected group, and developing antimalarials specifically suited to their needs is essential to malaria control efforts,” added Novartis.

Protecting the most vulnerable

“Malaria remains one of the deadliest diseases for children under five years old, and Ghana’s leadership in approving Coartem Baby is a powerful step toward protecting the most vulnerable,” said MMV CEO Dr Martin Fitchet

“This optimised formulation offers a well-tolerated and effective solution to a long-standing unmet medical need.”

Ghana is one of 11 African countries designated by WHO as High Burden to High Impact for malaria. 

About 30 million babies are born in malaria-risk areas in Africa every year, and a large survey across three West African countries reported infections in babies under six months old ranging from 3.4% to as high as 18.4%.

Novartis has committed to introducing Coartem Baby on a largely not-for-profit basis.

This week, Mali recruited the first pregnant woman infected with malaria into a Phase 3 trial that is evaluating the efficacy and safety of antimalarial drugs during the first trimester of pregnancy.

MMV is also supporting this trial, known as SAFIRE,which will compare the safety and efficacy of pyronaridine-artesunate (PA) and dihydroartemisinin-piperaquine (DP), both approved for the general population but not yet in early pregnancy, to artemether-lumefantrine (AL), which is approved by the WHO for use in the first trimester.

Pregnant women are more susceptible to malaria as they have reduced immunity, and malaria poses serious risks to both mothers and babies.

Malaria in pregnancy is responsible for 20% of all stillbirths and 11% of all newborn deaths in sub‑Saharan Africa, as well as 10,000 maternal deaths globally each year. It can also cause severe maternal anaemia, miscarriage, stillbirth, preterm delivery and low birthweight. 

Image Credits: UNICEF/Zahara Abdul 2019.

Tobacco use is waning worldwide.

There has been a significant global reduction in smoking, but use remains stubbornly high in some countries and groups – while the tobacco industry is aggressively marketing new nicotine products to young people.

This is according to the World Health Organization (WHO) tobacco trends report, which was released on Monday.

“In 2000, one in three adults in the world used tobacco. By 2010, it was one in four. Today, in 2025, it’s fewer than one in five,” Jeremy Farrar, WHO’s Assistant Director General, told a media briefing.

“That means millions of premature deaths have been, and will be, averted,” he added, crediting “stronger policies, better awareness and the extraordinary efforts of individuals, governments, civil society and communities” for the progress.

South East Asia has achieved the most progress, with tobacco use in men almost halving from 70% in 2000 to 37% in 2024. In this region, India and Nepal have made good progress.

Tobacco use trends (2000-2030)

However, despite progress, the world is 3% short of achieving a 30% reduction in tobacco use between 2010 and 2025 (Sustainable Development Goal 3).

Slightly less than a third of the world – 61 countries, including 24 in Africa – are likely to achieve this target.

Three regions – Eastern Mediterranean (19% reduction), Europe (19%) and the Western Pacific (12%) – are also going to miss the target.

However, women already met the 30% target five years early in 2020.

“Most countries that are on track have something in common,” Farrar noted. “They all implement the WHO Framework Convention on Tobacco Control, and they put MPower measures in place, raising taxes, banning advertising, protecting people from smoke and warning of the harms and providing help for those to quit.”

MPower refers to the measures the WHO recommends to countries to reduce tobacco use.

“Nearly 20% of adults still use tobacco and nicotine products. We cannot let up now,” said Farrar. “The world has made gains, but stronger, faster action is the only way to beat the tobacco epidemic.”

Jeremy Farrar, WHO Assistant Director-General.

Progress lagging in Europe and men 

Europe has the highest prevalence in the world, with 24.1% of its adults using tobacco in 2024. Countries in the Balkans and former Soviet republics have the highest rates.

In Bulgaria, almost 36% of people smoke, the highest in Europe.

Some 17.4% of European women smoke, which is more than double the current global average of 6.6% (down from 11% in 2010).

Alison Commar, WHO technical officer and lead author of the report, said that only one Western European country, the Netherlands, has implementing MPower, the full WHO anti-tobacco suite of policies.

“They are really having success bringing down prevalence,” Commar added. In 2010, almost 28% of Dutch people smoked, whereas 20% currently smoke.

“Many of the European countries rely on the EU [Tobacco Products] Directive, which we call the minimal floor,” Commar added.

Alison Commar, WHO technical officer and lead author of the report

“Women in Europe have been using tobacco products a lot longer than women in other areas,” she added, explaining that the industry had “heavily advertised” cigarettes in the women’s movement in the early 1900s.

“So the use has really begun from then, and the normalisation as well. People have grown up with their mothers and their grandmothers smoking.” 

In the Western Pacific Region, some 43.3% of men smoke – the highest prevalence in the world. Indonesia has the highest rate in the region (30.2%), followed by China (22.7%), while a mere 8% of Australians smoke.

Globally, smoking is highest in men aged 45 to 54 and women aged 55 to 64. Men in upper-middle countries smoke the most – some 39%.

Over 40 million adolescents are reported to smoke cigarettes (26 million boys), with the Western Pacific Region having the highest prevalence of teen smokers.

“The tobacco and nicotine industries are deliberately targeting the next generation with new and many times under-regulated products. We cannot allow this to continue and to succeed,” said Farrar.

New nicotine products

Smokeless tobacco use

For the first time, WHO report estimated global e-cigarette use, finding that more than 100 million people worldwide are now vaping – some 7% of the world’s population.

Around 86 million adults, mostly in high-income countries, and 15 million children aged 13–15, already use e-cigarettes. 

Use is by far the highest in the Southeast Asia region, averaging 21.1%. The second-highest region is the  Eastern Mediterranean (4.9%).

Among the 85 countries with data on e-cigarettes, the highest use was reported in Serbia (18.4%), Luxembourg (17%), New Zealand (14%), Croatia (12%), Ireland (11.2%), Czechia (11.1%) and Brunei (11%).

In all but six countries, more teens vaped than adults.

More teens are likely to vape than adults, fuelling nicotine addiction, according to the WHO.

“In countries with data, children are on average nine times more likely than adults to vape,” according to the WHO, which accused the tobacco industry of “introducing an incessant chain of new products and technologies” to market tobacco addiction, including “e-cigarettes, nicotine pouches, and heated tobacco products”.

“E-cigarettes are fuelling a new wave of nicotine addiction,” said Etienne Krug, WHO Director of Health Determinants, Promotion and Prevention. 

“They are marketed as harm reduction but, in reality, are hooking kids on nicotine earlier and risk undermining decades of progress.” 

Comma said that the science is “now showing that [e-cigarettes] are very much a gateway for the young people to move later into tobacco or to maintain a nicotine addiction as they grow older”.

“WHO recommends that all countries regulate e-cigarettes immediately,” she added.

The report, which is produced every two years, derives most of its data from national surveys.

Image Credits: PAHO, WHO, WHO.