A Flag Recaptured: US Exit from WHO Highlights Anger Over COVID-19 Pandemic

27/01/2026 Sophia Samantaroy

The US accused the WHO of “holding hostage” the American flag that once flew outside the Organization’s Geneva headquarters (seen here in 2025).

A dispute over an American flag has become symbolic of the bitter public dispute between the US and the World Health Organization (WHO) after the US withdrew from the organization on 22 January.

In a joint statement by Secretary of State Marco Rubio and Secretary of Health and Human Services Robert F Kennedy Jr on the termination of US membership of the WHO, they accused the organization of keeping the American flag that hung outside its Geneva headquarters captive.

“Even on our way out of the organization, the WHO tarnished and trashed everything that America has done for it. The WHO refuses to hand over the American flag that hung in front of it, arguing it has not approved our withdrawal and, in fact, claims that we owe it compensation. From our days as its primary founder, primary financial backer, and primary champion until now, our final day, the insults to America continue.

“We will get our flag back for the Americans who died alone in nursing homes, the small businesses devastated by WHO-driven restrictions, and the American lives shattered by this organization’s inactivity,” the statement said.

A day after the official withdrawal, the State Department declared victory, posting: “Under @POTUS leadership, the @StateDept and @HHSGov have secured its return, now safely held by U.S. Marines @usmissiongeneva, and on its way back to USA.”

The dispute over the flag underscores broader and long-simmering tensions between the Trump administration and the WHO, particularly over the Organization’s handling of the COVID-19 pandemic.

US still owes WHO $260.6 million

The @WHO‘s refusal to hand over the American Flag was entirely unacceptable. It was the epitome of globalist disrespect for America—a globalist institution holding our flag captive. Under @POTUS leadership, the @StateDept and @HHSGov have secured its return, now safely held by…

— Bureau of International Organization Affairs (@State_IO) January 23, 2026

The US’s highest-ranking health officials, including National Institutes of Health director Dr Jay Bhattacharya, rose to prominence during the pandemic for their criticism of COVID-19 policies, tapping into widespread public anger over restrictions, school closures, and vaccine mandates.

In the view of current US leadership, the WHO is an organization “beyond repair.”

Instead, the Trump administration has begun pursuing a series of bilateral agreements with 14 sub-Saharan African countries, aiming to recreate aspects of the WHO’s multilateral system for pooling scientific and public health data.

But according to global health policy experts at Georgetown University, Sam Halabi and Lawrence O Gostin, this “transactional alternative” assumes that the US could strike comparable agreements with nearly every country in the world – “which of course it cannot,” they wrote in a commentary published in the Washington Post.

The WHO is expected to discuss how to address the US withdrawal at its upcoming Executive Board meetings on 2 February and again at the annual World Health Assembly in May. The organization also maintains that the US owes $260.6 million in unpaid membership dues.

WHO says withdrawal makes US and world ‘less safe’

WHO Director General Dr Tedros Adhanom Ghebreyesus at a press briefing in Geneva. Tedros defended the Organization’s COVID-19 response.

The WHO responded to the US’s accusations on Saturday, saying that “[w]hile no organization or government got everything right, WHO stands by its response to this unprecedented global health crisis. Throughout the pandemic, WHO acted quickly, shared all information it had rapidly and transparently with the world, and advised Member States on the basis of the best available evidence.”

WHO Director General Dr Tedros Adhanom Ghebreyesus echoed the sentiment, saying: “While WHO recommended the use of masks, physical distancing and vaccines, WHO did not recommend governments to mandate the use of masks or vaccines and never recommended lockdowns.

“WHO supported sovereign governments with technical advice and guidance that was developed on the basis of evolving evidence on COVID-19 for them to make policy decisions in the best interests of their citizens. Each government made their own decisions, based on their needs and circumstances.”

The WHO pointed to the US’s global participation in some of the world’s greatest public health achievements, despite the fact that the US promises to continue “leading the world in public health” without collaborating with the UN organization.

“As a founding member of the World Health Organization, the United States of America has contributed significantly to many of WHO’s greatest achievements, including the eradication of smallpox, and progress against many other public health threats including polio, HIV, Ebola, influenza, tuberculosis, malaria, neglected tropical diseases, antimicrobial resistance, food safety and more.

“WHO therefore regrets the United States’ notification of withdrawal from WHO – a decision that makes both the United States and the world less safe.”

This story is a continuation of Health Policy Watch’s coverage of the US-WHO withdrawal. See related stories here:

Stars and Stripes No Longer Flying at WHO – But US Can’t Really Leave Until Dues are Paid, Agency Says

America First is Not America Absent

Image Credits: Arkansas Advocate , E. Fletcher/Health Policy Watch.

Geopolitical Risk is Undermining Global Pandemic Preparedness

27/01/2026 Kerry Cullinan

The mission to ensure safe, effective and affordable diagnostics, therapeutics and vaccines (DTVs) within 100 days of a pandemic threat being identified is not possible in many regions, according to the International Pandemic Preparedness Secretariat.

Global pandemic preparedness is becoming “increasingly fragile at a time of growing biosecurity and geopolitical risk”, according to the International Pandemic Preparedness Secretariat (IPPS), which launched its Fifth Implementation Report of the 100 Days Mission on Tuesday.

IPPS is an independent entity that promotes the “100 Days Mission”, the global ambition to develop safe, effective and affordable diagnostics, therapeutics and vaccines (DTVs) within 100 days of a pandemic threat being identified.

But pressure on global R&D pipelines, declining investment in pandemic countermeasures, and heavy reliance on a small number of funders mean that the 100-day target is not possible in many areas, according to the report.

“Major reductions in global health and research budgets in 2025 have exposed structural vulnerabilities, disrupted development pipelines, and weakened preparedness,” the IPPS notes in a media release.

“Investment in pandemic countermeasure R&D continued to decline through 2024, with the steepest impacts seen in therapeutics. Pipelines across diagnostics, therapeutics and vaccines remain uneven and clustered in early stages, with limited progression into mid-stage and late-stage development.

“Progress on enabling systems, including regulatory preparedness, clinical trial readiness, data-sharing frameworks and manufacturing coordination, remains slow,” the media release notes.

Outbreaks of mpox, a continental health emergency in Africa until last week; the zoonotic spillover risk of H5N1; and outbreaks of Ebola, Marburg, Rift Valley Fever and Chikungunya “have highlighted persistent challenges in early detection, coordination and equitable access to countermeasures”, according to the IPPS, which is funded by the Wellcome Trust and Gates Foundation

“The science needed to respond faster to pandemics continues to advance, but this report makes clear that progress in applying these advances to delivering effective tools is insufficient,” said Dr Mona Nemer, chair of the IPPS Steering Group and Chief Science Adviser of Canada.

“Today, despite the landmark WHO Pandemic Agreement, the world remains vulnerable to funding shocks, uncoordinated R&D efforts and fragile development pipelines – particularly for therapeutics.”

Priorities for 2026

For the first time, the 100-day scorecard includes an assessment of pandemic preparedness and response (PPR) capacity in Africa.

This evaluates the continent’s capabilities in clinical trials, laboratory systems, regulatory frameworks and manufacturing.

“Advances in platform technologies, including mRNA, monoclonal antibodies and artificial intelligence, continue to offer opportunities to accelerate development,” according to the report, which also identifies “significant pressures”.

However, it notes that Africa shows “growing regulatory maturity and manufacturing capability”. It highlights Rwanda’s integration of the 100 Days Mission framework and scorecard into national preparedness planning as an example of how the mission can be operationalised at the country level.

The report, launched in Paris, identifies 2026 as a decisive year as France begins its G7 presidency.

It identifies four priority action areas for 2026:

Operationalising the Therapeutics Development Coalition to address persistent gaps in antiviral R&D.
Enhancing coordination across the diagnostics ecosystem and implementing recommendations from the Global Diagnostics Gap Assessment.
Sustaining vaccine investment and strengthening alignment across diagnostics, therapeutics and vaccines.
Agreeing on a sustainable mechanism for pandemic preparedness monitoring, including a long-term path for the 100 Days Mission Scorecard beyond the IPPS mandate(which ends in 2027).

Image Credits: PREZODE , Photo by Carlos Magno on Unsplash.

Pandemic Agreement on Hold: Can Countries Bridge the Divide on Pathogen Access and Benefit Sharing?

27/01/2026 Daniela Morich

WHO member states at an Intergovernmental Working Group meeting, negotiating a pathogen access and benefit-sharing (PABS) system.

Only 12 more negotiating days remain until WHO member states hit the May 2026 deadline for an agreement on a Pathogen Access and Benefit Sharing (PABS) system, as part of the new Pandemic Agreement adopted at last year’s World Health Assembly (WHA).

The gap between developed and developing blocs of countries remains large, and progress has been slow in bridging the divide. A bloc of approximately 100 low-and middle-income countries (LMICs) continues to call for mandatory benefit sharing, including guaranteed LMIC access to vaccines, therapeutics, and diagnostics (VTDs) as the price of their rapid sharing of information on novel pathogens that might pose a pandemic risk.

High-income countries, on the other hand, remain focused on protecting the pharma innovation ecosystem and ensuring open pharma access to pathogen sequence data. In terms of benefit-sharing, they tend to favor more flexible and voluntary commitments by manufacturers and research institutions to share products and manufacturing know-how with LMICs.

While some elements of the PABS might actually be settled in time for adoption at this year’s 79th WHA (18-23 May), other issues are likely to be kicked further down the road, potentially to a future Pandemic Agreement Conference of Parties (COP).

In the seventh issue of the Governing Pandemics Snapshot, Daniela Morich dissects the choices facing member states.

Longstanding tension between rapid pathogen sharing and access to benefits

Cheers among the lead negotiators as the World Health Assembly adopts the Pandemic Agreement, 20 May 2025

On 20 May 2025, the global health community welcomed the adoption of the Pandemic Agreement (PA) as a much-needed triumph of multilateralism in a year marked by significant challenges and strains on global cooperation.

Although adopted, the Agreement will not be opened for signature until a supplementary Annex on the Pathogen Access and Benefit Sharing (PABS) system is completed—an uncommon feature in international law that temporarily halts the Agreement’s progress toward entry into force until the details of the Annex are agreed.

At the core of the Annex lies a longstanding tension: how to ensure rapid and reliable sharing of pathogens and their genetic sequence data – crucial for managing health emergencies and for the development of health products – while also guaranteeing fair and meaningful access to the benefits derived from their use, such as vaccines and therapeutics.

Article 12 of the PA sets out the foundational principles of the PABS system. But the specifics – such as the recognition of obligations for countries and manufacturers, benefit-sharing arrangements, and implementation mechanisms – remain to be negotiated. An ad hoc Intergovernmental Working Group (IGWG), open to all WHO member states, has been tasked with translating these principles into operational rules.

Wide divide from the start

Ethiopia representing the position of the Africa group during pandemic agreement negotiations in March 2024.

The IGWG officially began its work in mid-2025. In August, WHO Member States submitted 17 textual proposals reflecting the views of approximately 100 countries. These proposals revealed, from the outset, deep divergences in how countries imagine the PABS System, and those differences have continued to shape the negotiations ever since.

Developing countries advocate for strong equity provisions, including mandatory benefit-sharing and guaranteed access to vaccines, therapeutics, and diagnostics (VTDs). Their approach relies on transparency and traceability, with a strong role for WHO in administering the system and oversight by a future Conference of the Parties (COP).

Developing country blocs also have placed a greater emphasis on technology transfer, and as part of that, licensing of medicines and vaccines as core benefits they should reap from the PABS agreement. As such, their proposals prioritize binding obligations operationalized through contractual mechanisms to ensure traceability and enforceability of commitments and to support the development of regional production capacity.

Consistent with this approach, the leading LMIC negotiating blocs, known as the Africa Group and the Group for Equity, as well as Egypt, Libya, Somalia and Sudan jointly submitted an ad hoc proposal for draft contractual agreements for negotiation (see Adam Strobeyko’s piece Avoiding Contract Fatalism.).

High-income countries, by contrast, focus on protecting the innovation ecosystem, maintaining open access to pathogen sequence data, and preserving incentives for private-sector research and development, which is still mainly happening in the Global North.

With regards to benefit-sharing obligations, they tend to favor voluntary and flexible commitments for manufacturers and research institutions. Their concern is that overly rigid obligations could undermine scientific collaboration or discourage investment in pandemic-related technologies.

First draft text does not bridge divides

IGWG3 gets underway on 4 November 2025.

In October 2025, the IGWG’s Bureau, a six-person panel steering the negotiations, released the first Draft Text of the Annex ahead of the Group’s third meeting. Although the text drew significant criticism from many delegations, it nonetheless became the basis for negotiations during the two subsequent meetings in November and December.

Progress was extraordinarily slow. Delegations used the sessions not to narrow differences but to reinsert the language they considered had been omitted from the Bureau’s proposal. As a result, the document expanded from seven pages to 37, producing a dense and unwieldy “rolling text” in which every proposal reappeared.

The only areas where common ground emerged were a few preliminary words on governance elements, notably that the COP would oversee the PABS System and that a PABS Advisory Group would be created.

Following calls for more transparency in the proceedings, the second IGWG meeting marked a surprising shift by deciding, on a pilot basis, to invite stakeholders to observe discussions starting at IGWG3 in November 2025.

However, this openness was quickly revoked at the beginning of IGWG3, with no access to the negotiating room granted to observers. Further constraints on meaningful participation were introduced in January 2026, when participation was limited to virtual attendance. It is hoped that greater transparency will be allowed as the process moves forward.

Revising the Draft: Gains Limited to Pathogen Definition

The fourth session of the IGWG made some progress in clarifying the definition of a pathogen with pandemic potential. Here, a microscopic view of SARS-COV-2.

In the fourth resumed session of the IGWG (20–22 January 2026), progress remained slow. The Bureau, following regular intersessional informal meetings, released a revised draft text.

Some advancement was seen in clarifying language on the definition of “pathogen with pandemic potential,” an important step in defining the system’s scope, but little progress was made elsewhere in the text. Despite a generally positive mood in the room, the ticking clock reinforced a sense of urgency. Progress in bridging the divides continues to be painfully slow.

A small but highly engaged group of relevant stakeholders continues to follow the process closely, although it remains state-led and conducted behind closed doors. Interaction with delegates is limited to short briefings led by the Bureau and is restricted to stakeholders duly accredited to the process.

Are we nearing the finish line?

With the May 2026 deadline approaching – and only 12 actual negotiation days remaining – clear divergences between blocs of countries remain a significant obstacle.

Additionally, while some issues—such as laboratory networks, databases, and traceability—have been discussed, other critical topics, including financing, have yet to be meaningfully addressed, as highlighted by Suerie Moon in her companion article “Could money grease the wheels of compromise on PABS?”

Against the ticking clock, an overarching question now looms: which elements of the PABS parties might be willing to settle now – and which they might further kick down the road to a future Pandemic Agreement’s COP.

Problematically, these negotiations also unfold against the backdrop of a spate of US bilateral agreements with developing countries – so far 15 in all. In these arrangements, seen as a cornerstone of the new US global health policy, aid and commercial deals are offered in exchange for access to pathogen samples and data about disease outbreaks.

Some experts worry that these deals will negatively affect the negotiations in Geneva, and the future PABS systems, as they could create structural dependency that constrains a country’s ability to share data independently with regional or WHO-coordinated networks.

With only a few months remaining, parties will need to be realistic about what can be achieved. Successfully concluding this work would consolidate years of effort and strengthen the foundations of a more equitable global pandemic preparedness and response system.

Daniela Morich is head of policy engagement and Global Health Platform at the Geneva Graduate Institute’s Global Health Centre.

Explore the three other articles available in the seventh issue of the Governing Pandemics Snapshot:

In “Avoiding Contractual Fatalism: Lessons from PIP Framework for Standardising PABS contracts” Adam Strobeyko looks at how the experience of the Pandemic Influence Preparedness (PIP) Framework could help inform the PABS process. He examines WHO contracts that enable pharma access to a global network of influenza samples in exchange for benefit-sharing commitments channelled through WHO.

In PABS laboratory networks: building a new system or using what we have? Gian Luca Burci examines whether existing WHO-managed networks, such as the Global Influenza Surveillance and Response System (GISRS), could take on the additional role of a PABS laboratory network, presuming an agreement is reached.

Finally, in her piece, Could money grease the wheels of compromise on PABS? Suerie Moon explores how finance for Access and Benefit Sharing (ABS) could be generated in “interpandemic” times when the absence of a clear pandemic threat provides limited incentive to pharma companies to invest in related products.

Image Credits: NIAID-RML .

Activists Organise Against Erosion of Sexual and Reproductive Health Rights

26/01/2026 Kerry Cullinan

Women are being taught how to access information about contraception on their smartphones in Indonesia. The UN’s Universal Periodic Review (UPR) provides an avenue for human rights activists to advocate for more rights for citizens.

Grassroots organising, using the United Nations’ Universal Periodic Review (UPR) and creating new multilateral coordination are some of the ways to counter the current attack on sexual and reproductive health (SRH), according to activists.

There is a “rise of unapologetic, unabashed, hegemonic masculinity and really harmful gender stereotypes,” Paola Salwan Daher, Women Deliver’s senior director for collective action, told a webinar on the anti-rights pushback.

Far-right governments “are bringing the message that women should not have the same rights as men,” and tech billionaires “have put their incommensurable wealth behind this”, she added.

“We are seeing deeply biased misinformation around women’s bodies, around women’s health, and the undermining of women and girls’ agency.”

To counter what she describes as “Conservative International”, Women Deliver is convening a global gender equality conference in April to enable like-minded organisations “to meet each other to strategise together”.

“We are organising to push forward a more progressive agenda that really centres the autonomy, the rights to dignity for women and girls,” she said.

Salwan Daher added that the current “crisis of multilateralism doesn’t come from nowhere”.

“It has been exacerbated by the postures of the Trump administration, but really, it was brewing before. It was brewing because of double standards in the application of international law. The genocide in Palestine has really exposed the fault lines,” said Salwan Daher.

“We do not want a world without multilateralism. So now is the time to reimagine collectively what multilateral can look like. How do we make it people-centred? How do we make accountability at the root of everything, every process and every global space? How do we ensure the legal obligations of states?”

Abortion taboo

Pauline Fernandez, coordinator of the Philippines Safe Abortion Advocacy Network (PINSAN), said that despite her country having one of the harshest laws against abortion, there was growing recognition of the need to decriminalise abortion.

“Despite it being criminalised, abortion remains a widespread and urgent reality in the Philippines,” said Frenandez.

“Data shows that upwards of a million women undergo abortions annually, and because of abortion-related complications, up to three women die every day in the Philippines.”

Sustained organising about the importance of decriminalisation had seen PINSAN to her grow from 10 to 130 organisations.

Over 30,000 people have signed PINSAN’s petitionin support of decriminalisation, helped by a recent Netflix documentary on the subject by a famous local filmmaker.

Regular reviews

Dr Virginia Kamowa, regional and country manager at the Global Center for Health Diplomacy and Inclusion (CeHDI), which co-hosted the event, said that the Universal Periodic Review UPR) provides a lever to ensure better SRH services.

“The UPR is the only mechanism of UN that reviews every country on a regular cycle against the human rights obligations of the governments, and produces a public on-the-record government commitment,” explained Kamowa.

“More and more recommendations have been on health,” she said, adding that aroung 82% of health recommendations were accepted by the country being reviewed.

Improving maternal health involved many aspects of SRH, she noted.

Rwanda was reviewed last week, while the reviews of St Lucia, Namibia, Mozambique, Somalia, Seychelles, Sierra Leone and Eswatini are imminent.

“All 193 UN member states undergo a UPR. There’s a national report that is written by the government within the country, but also the UN bodies within the country that also do their own population and stakeholder research, civil society, NGOs and human rights institutions also compile their summary reports.

“During the process, other states ask questions and make recommendations to the country that is being reviewed, and the reviewed country can accept or not those recommendations, and then there is follow up in the next cycle of the UPR review.”

Image Credits: ©Gates Foundation/ Prashant Panjiar.

America First is Not America Absent

23/01/2026 Christina Liu

Stars and stripes lowered at WHO headquarters.

One year after the United States announced its withdrawal from the World Health Organization, a former WHO Headquarters Staff Association President reflects on how presence, governance, and leadership shape influence in global health.

In January 2024, I stood before the WHO’s Executive Board, chaired by Qatar’s Minister of Health, Dr. Hanan Mohammed Al Kuwari. I was speaking as an elected staff member representing more than 10,000 staff across the WHO and its partner agencies. When I opened my remarks by honoring a colleague killed in Gaza, the room, filled with health delegates from 194 member states, fell silent. Across political lines, delegates expressed empathy.

That moment reminded me that global health cooperation does not run on treaties or budgets alone. It is held together by trust, the fragile belief that even adversaries can remain in the same room long enough to cooperate on what keeps people alive.

I did not set out to work in global health. I began my career at a New York investment bank. During the pandemic, I helped lead launch preparations for a COVID-19 therapeutic and saw American leadership at its best through Operation Warp Speed.

I joined the WHO to work on vaccine supply equity so that, in the next pandemic, access and supply chains don’t break along geopolitical lines. I eventually reported to a senior Chinese official who had risen through the ranks at headquarters. We were supposed to be adversaries. My Taiwanese heritage and American upbringing placed me in a rivalry I did not choose. Yet she treated me with professionalism and fairness. Over time, we built trust and found common ground on expanding access to essential medicines. But trust is only half the equation. The other half is presence.

America pays, others decide

WHO Director General Dr Tedros Adhanom Ghebreyesus and his senior leadership meet with the WHO Headquarters Staff Association in Geneva in March 2024.

The United States has historically been the WHO’s largest funder contributing roughly 18% to the annual budget through a combination of assessed fees and voluntary donations. Yet Americans are chronically underrepresented in the professional workforce.

According to the latest workforce data to be presented at the 158th session of the Executive Board in early February, U.S. citizens continue to hold roughly 7% of professional positions. The European region holds about one in three professional posts, more than four times America’s representation. This influence gap runs to the top. No American has ever served as Director-General. For years, Washington has tried to influence the organization from outside through press releases and funding threats. In these institutions, indignation is noise. Seats are power.

I learned this first hand when headquarters staff elected me President of the Staff Association of WHO’s headquarters, representing about 3000 staff in Geneva as well as HQ-managed offices in Japan, New York City, Budapest, Lyon, Berlin and Tunis. It was a role that put me regularly in the room with Director-General Tedros Adhanom Ghebreyesus and senior leadership. Institutions like the WHO rarely change because they are denounced from afar. They change because people stay in the process long enough to turn criticism into votes, rules and resolutions.

Downsizing Is Not Accountability

WHO Director General Dr Tedros Adhanom Ghebreyesus meets with staff association presidents for WHO’s African, European and South-East Asian regions and Headquarters (Liu), in Lyon in December 2024.

None of this requires romanticizing the WHO.

It is a glacial bureaucracy. Last year, leadership launched one of the largest downsizings in its history, announcing plans to cut roughly a quarter of the workforce by June 2026, in a massive restructuring exercise. But making an institution smaller is not the same as making it accountable. Thousands of front-line staff were terminated while a shadow workforce of consultants remained. This narrowed a roughly $1.7 billion funding gap without changing how power is exercised or decisions are made and enforced.

The finality of the US decision, and its inevitable budget impacts, began to permeate in December 2024, shortly after the US Presidential elections.

On 17 December WHO leadership gathered in Lyon, France, with President Emmanuel Macron for the opening of the new WHO Academy. The setting was elegant. It felt like a toast raised on the proverbial cruise ship deck while someone, somewhere, had already spotted the iceberg. Yet the music played on.

In the afternoon session, the mood shifted. Dr. Tedros paused and said quietly, “Let’s give them a peaceful holiday.” Shortly afterward, WHO staff were told they would receive two additional days of leave. It was a kind gesture, and also a telling one. The calm before the storm. By then, those of us who had been in Lyon knew the die was already cast – the US would withdraw on Day 1 or Day 2 of President-elect Donald Trump’s second term in the White House. On Inauguration day, 20 January 2025, the announcement was made.

Navigating the Rupture: Beijing’s Opportunity in America’s Absence

China speaks at the February 2025 WHO Executive Board meeting. The US largely abstained from participating following January’s announcement of its withdrawal.

The United States withdraws largely alone. Except for Argentina, every other WHO member state has chosen to remain. And in fact, for historical reasons there is no real legal provision allowing WHO member states to withdraw, with the exception of the United States.

With the next Director-General election approaching in 2027, leadership choices and reform priorities are being shaped by those still present. The question is whether American absence makes China’s influence easier, or harder, to counter.

We have seen this before. In 2019, China ran a disciplined campaign to win the top job at the United Nations Food and Agriculture Organization (FAO). U.S. officials were caught off guard. “It made us look like complete fools,” one State Department official was later quoted as saying. This is not about relitigating 2019. It is about not repeating the same mistake.

In May 2025, Beijing arrived at the World Health Assembly with about 180 officials, according to press and delegate accounts, and announced a $500 million pledge to the organization. Washington sent no delegation. Taiwan was again blocked by WHA member states from being granted observer status, this time without visible resistance.

Winning the 2027 Director-General election is an even bigger strategic prize. The organization that sets global health standards and coordinates pandemic response is an asset Beijing will pursue with patience. The groundwork is being laid now, while the United States steps away.

Reform Requires Presence

Countries indicating their wish to speak about the pandemic agreement in Committee A, just prior to a vote approving the agreeement.

So who wins when America leaves? It is a Catch-22.

US Secretary of State Marco Rubio and Secretary of Health and Human Services Robert F Kennedy Jr have been clear that the United States should no longer write blank checks to international bureaucracies that lack accountability.

As Rubio recently put it, “sometimes true leadership means knowing when to walk away.” Demanding results is not retreat. It is a leadership responsibility, some critics of continued engagement might say.

They raise a fair point. Staying only works if reform and cooperation are possible.

But in global health, they are – if and only if U.S. leadership is present. Allies do not follow a country that leaves the room. They follow one that shows up with a plan. The world is not waiting for us. It is waiting for someone to lead.

What Re-engagement Would Require

WHO’s 78th World Health Assembly meets at Geneva’s Palais des Nations 19-27 May, 2025.

If Washington really wants a more effective and accountable WHO, the pathway to getting that is clear and concrete.

Reengage with conditions tied to transparency and governance. Align representation with contribution by rebuilding the American professional pipeline. Place American experts where technical norms and standards are written.

Demand enforceable oversight, not cosmetic restructuring. Work with our allies on the Executive Board to advance a serious reform agenda. Reinvigorate WHO’s technical expertise as a truly merit-based organization that recruits and hires the most qualified staff at all levels transparently and internationally – and not through fixed appointments, political favoritism, or over-reliance on consultants who just happen to be living in relatively close proximity to Geneva. Deliver a genuine reset, not just headlines.

Make WHO great again.

The Way Forward: Leadership is a Choice

World Health Assembly member state delegates pose with WHO Director General Tedros after a critical HA Committee vote adopting the Pandemic Agreeemnt on 20 May 2025.

Today, the American flag no longer flies at WHO headquarters. That absence is visible to every delegation, every staff member, and every government navigating the institution that remains.

The Pandemic Agreement is moving forward, and the campaign to elect a new WHO Director-General in 2027, when Tedros’ second term ends, is already underway. WHO will evolve with or without the United States. Even Dr. Tedros has described U.S. withdrawal as a “lose-lose.” On that point, he is right.

America First cannot mean America absent. While our stars and stripes have come down, the threats to our health, security, and sovereignty have only gone up. I remain hopeful that one day our flag can fly again over an institution worthy of American taxpayers’ support and the American people’s trust. Leadership has always been a choice, and we the American people can make it again: to lead as one Nation, indivisible, with peace, strength, and the accountability our citizens deserve.

Christina Liu

Christina Liu served at WHO from 2022 to 2025 as a technical officer on vaccines and access to medicines. She was the President of WHO Headquarters Staff Association from 2024-2025.

A US citizen and native of California, she is currently a Board Advisor for Global Public Health at BioLiterate. She has over 18 years of experience spanning global health, international policy and in the pharmaceutical industry, including with Roche and Novartis. Liu holds a dual Masters in Biotechnology/MBA from The Wharton School and the University of Pennsylvania.

Image Credits: Anonymous/HPW, Christina Liu, WHO, WHO/Pierre Albo .

Stars and Stripes No Longer Flying at WHO – But US Can’t Really Leave Until Dues are Paid, Agency Says

23/01/2026 Elaine Ruth Fletcher

The Missing Star-Spangled Banner: A vacant flagpole stands between the flags of Uruguay and Uganda at the WHO headquarters in Geneva after the United States said it had completed its withdrawal from the World Health Organization.

The United States said Thursday that it had officially completed its withdrawal from the World Health Organization (WHO).

But WHO member states are not obliged to accept the US departure as legally binding until it pays up on some $260.6 million in dues owed for 2024- and 2025, WHO’s Director General contends in a report to WHO member states, published this week.

The report, to be discussed at an upcoming meeting of WHO’s Executive Board governing body 2-7 February, cites a little-known provision of the original Congressional Act ratifying US membership in WHO in 1948, which states:

“The United States reserves its right to withdraw from the organization on a one-year notice, provided, however, that the financial obligations of the United States to the organization shall be met in full for the organization’s current fiscal year.”

Meanwhile, an angry joint statement by US Health and Human Services Secretary Robert F. Kennedy Jr and US Secretary of State Marco Rubio accused WHO of holding hostage the US flag that has now been removed from its pole outside of WHO’s Geneva headquarters until the dues are delivered.

Thursday’s US announcement – and ensuing brouhaha over the legalities around withdrawal – comes exactly one year after President Donald Trump signed an executive order to leave the agency, within hours of being inaugurated as President in January 2020.

Blames WHO for delayed action on global emergency and transmission modes of virus

Too late? WHO Director General Dr Tedros Adhanom Gehebreyesus (left) and Didier Houssin, chair of the WHO Emergency Committee on 30 January 2020, when the COVID International Health Emergency was first declared.

A separate statement by the Department of Health and Human Services (HHS), announcing the completion of the year-long withdrawal period on Thursday, focused on WHO’s behaviour during the COVID pandemic, charging that late response to the fast-moving virus in the early days of the pandemic had exacerbated the damage done.

“The WHO delayed declaring a global public health emergency and a pandemic during the early stages of COVID-19, costing the world critical weeks as the virus spread,” charged HHS in its statement.

“During that period, WHO leadership echoed and praised China’s response despite evidence of early under-reporting, suppression of information and delays in confirming human-to-human transmission. The organization also downplayed asymptomatic transmission risks and failed to promptly acknowledge airborne spread,” said the HHS statement.

“After the pandemic, the WHO did not adopt meaningful reforms to address political influence, governance weaknesses or poor coordination, reinforcing concerns that politics took priority over rapid, independent public health action and eroding global trust.

“Its report evaluating the possible origins of COVID-19 rejected the possibility that scientists created the virus, even though China refused to provide genetic sequences from individuals infected early in the pandemic and information on the Wuhan laboratories’ activities and biosafety conditions.”

In a response issued Saturday, WHO said: “While no organization or government got everything right, WHO stands by its response to this unprecedented global health crisis. Throughout the pandemic, WHO acted quickly, shared all information it had rapidly and transparently with the world, and advised Member States on the basis of the best available evidence. WHO recommended the use of masks, vaccines and physical distancing, but at no stage recommended mask mandates, vaccine mandates or lockdowns. We supported sovereign governments to make decisions they believed were in the best interests of their people, but the decisions were theirs.”

Spat over US payment of back WHO dues and WHO’s return of US flag

Lowering the stars and stripes from WHO headquarters under a grey Geneva sky Thursday.

Along with the flag spat, the joint press release by Kennedy Jr and Rubio, took a deeply bitter tone saying:

“The WHO tarnished and trashed everything that America has done for it…..Although the United States was a founding member and the WHO’s largest financial contributor, the organization pursued a politicized, bureaucratic agenda driven by nations hostile to American interests.”

Their statement also stressed that “all U.S. funding for, and staffing of, WHO initiatives has ceased.” However, behind the scenes, some White House sources as well as global health experts questioned if this is entirely the case. For instance, US Centers for Disease Control scientists participated in last year’s WHO consultation to determine the composition of the seasonal flu vaccine; a senior HHS official told reporters in Washington that such limited engagement might still continue in this year’s session, planned for February.

In terms of funding, new US global health policy will focus on “direct, bilateral, and results-driven partnerships.” Since withdrawing from WHO and abruptly closing down USAID, Washington has signed some 15 such bilateral deals mostly with African countries, amounting to an estimated $16 billion. See related story.

One Year Later: The Effect of US ‘Chainsaw’ on Global Health

WHO – legally, US needs to pay dues to withdraw

The unpaid dues at the center of debate include assessed contributions of $130.3 million for 2024, which the previous US Administration of former President Joe Biden failed to pay before Trump took over the White House in January 2025. Added to that is another $130.3 million in unpaid dues for 2025, before withdrawal took effect this January.

In a report to the upcoming EB meeting, WHO Director General Dr Tedros Adhanom Ghebreysus, notes that in fact, there is no legal means for a country to withdraw from the Organization – short of a change in WHO’s 1948 Constitution that another member state might find “unacceptable”. Since WHO has never changed its Constitution that remains purely theoretical.

“[t]he draftsmen of the Constitution of WHO, by reason of the world-wide character of the struggles against disease, placed great emphasis on the need for the organization to be completely universal, and, as in the case of the Charter [of the United Nations], deliberately omitted any withdrawal clause,” states the WHO report.

Uniquely, however, among all 194 WHO member states, the US Congress retained the legal right to withdraw when it ratified the US decision to join WHO on 14 June 1948 – a condition accepted by WHO.

The Congressional act, however, also committed the US to pay up on outstanding dues before it leaves:

“In adopting this joint resolution the Congress does so with the understanding that, in the absence of any provision in the World Health Organization Constitution for withdrawal from the organization, the United States reserves its right to withdraw from the organization on a one-year notice, provided, however, that the financial obligations of the United States to the organization shall be met in full for the organization’s current fiscal year.” See related story:

Member States to Discuss US Withdrawal from WHO as Failure to Pay 2024-25 Fees Violates Legal Obligations

Argentina’s withdrawal not legally valid

WHO Executive Board in session on Wednesday 5 February 2025, just as Argentina’s decision to withdraw was announced.

The lack of any real legal offramp for other nations to leave WHO also means that Argentina’s February 2025 declaration that it was withdrawing is legally invalid, and need not be accepted by WHO member states, according to the Director General’s EB report:

“Unless the Health Assembly were to decide to adopt a different approach to this issue than it has taken on previous occasions, the conclusion may be drawn that the purported notification of withdrawal by Argentina should not be accepted as effective.”

The notices of withdrawal by Argentina and the United States are not the first by disgruntled member states.

In 1949-50, at the height of the cold war, the Soviet Union and six Soviet puppet governments in Ukraine, Belorussia, Bulgaria, Romania, Albania and Czechoslovakia – all notified WHO that they were withdrawing. By 1956, the member states had all rejoined, with WHO’s agreement to accept a symbolic fee for the time that their membership was suspended.

In response to a query by Health Policy Watch, a WHO spokesperson said that the legal issues around the US and Argentinian moves would be further discussed by WHO member states at the upcoming WHO Executive Board Meeting, February 2-7 – with the final decision of how to respond left up to them.

‘Lose-lose’ proposition

WHO Director General Dr Tedros Adhanom Ghebreyesus calls on the US to return to WHO in May 2025 – one of a series of appeals over the past year.

Over the course of the past year, Director General Tedros has launched various appeals both public and behind the scenes to the US to reconsider its action – saying that the withdrawal is a lose-lose proposition.

Loss of support from the US, historically WHO’s largest donor, has meanwhile triggered a budget crisis, leading to the planned reduction of about 25% of the regular workforce by June 2026 – and turmoil amongst staff.

Even with the drastic cutbacks, the agency still has to fill an outstanding $1 billion budget deficit for the current 2026-2027 biennium of planned spending. See related story here:

EXCLUSIVE: WHO Cutting Up to 25% of Staff by June 2026 – But ‘Shadow Workforce of Consultants’ Is Unreported

How to woo back the US?

HHS Secretary Robert F Kennedy Jr has fiercely criticized WHO and declared that the US would build an alternative global health infrastructure.

Critics of Washington’s moves both in the US and internationally have called upon the Trump administration to reconsider – saying that withdrawal will only exacerbate the very problems that it has claimed the Organization is fostering.

Former CDC director Tom Frieden, described the move as a “grave error”: “Walking away from WHO doesn’t create accountability or reform. It gives the U.S. less say and less warning. History shows what cooperation can achieve. Through WHO, the world eradicated smallpox and reduced millions of preventable deaths. Those successes protected Americans too,” Frieden said.

“Because these emergencies can start anywhere, a multilateral approach involving all countries is needed. Global health security is squarely in the U.S. national interest,” said the Canadian physician General Peter Singer, a former senior advisor to Tedros, in Think Global Health, published by the Council on Foreign Relations.

But Singer also called on WHO and its member states to advance a deeper reform agenda – shaped around the three pillars of “accountability”, “innovation” and “trust” – noting that the looming 2027 election of a new WHO Director General offers a pivotal opportunity for deeper institutional change.

“WHO’s decisions on the origins of the pandemic, mode of transmission, and its recommendations on public health measures and quarantine—even when defensible on scientific grounds—contributed to controversy and appear to have affected trust among governments and public alike,” argued Singer.

“In public health crises, institutions should actively seek to challenge their own internal decision-making,” he added, calling for more proactive debate considering adversarial points of view (red-teaming) during internal decision-making as well as better monitoring of public attitudes.

“The election of a new director general in May 2027 offers an opportunity to revisit these issues,” Singer added, saying, “The ideal candidate would be one who underscores country ownership, revitalizes the WHO’s results agenda, promotes the organization as the world’s leading scaler of health innovations, makes the WHO the most neutral organization in the UN system, and establishes mechanisms to protect trust in pandemics.”

See related story here:

America First is Not America Absent

–Updated 25.1.2025 with the WHO response to the US press statements.

Image Credits: Felix Sassmannshausen/HPW, Twitter: @WHO, Anonymous/HPW, Health Policy Watch , HHS.

‘Suspended or Cancelled’: Guinea-Bissau Health Minister Halts Controversial Hepatitis B Trial

22/01/2026 Kerry Cullinan

Guinea-Bissau Health Minister Quinhim Nanthote (right), with his director-general, Dr Armando Sifna.

A controversial trial to examine various impacts of the hepatitis B vaccine on newborn babies in Guinea-Bissau has been “suspended or cancelled”, the country’s Health Minister, Quinhim Nanthote, told a media briefing convened by the Africa Centres for Disease Control and Prevention (Africa CDC) on Thursday.

This is despite recent assertions by the US Health and Human Services (HHS) Department, which is funding the trial, that it was going ahead.

Nanthote initially told the briefing that his country’s ethics committee had not yet held a meeting about the trial, but later said that it “did not have the required technical resources” to approve the trial.

Nanthote, who addressed the briefing in military fatigues, was only appointed health minister on 29 November 2025, following a military coup three days earlier. He was not part of discussions about the trial, which has been proposed by the Danish research group, Bandim Health Project.

According to Bandim’s trial protocol, dated 14 January, “the Guinea-Bissau Committee of Ethics approved the trial on 5 November, 2025, with approval number 036-CNES-INASA-2025”. However, this was before the military coup.

Global outrage

There has been global outrage over the ethics of the trial, which would only give half the 14,000 babies it aims to enrol a hepatitis B vaccination shortly after birth – despite clinical evidence that early vaccination is highly effective at preventing mother-to-child transmission of the virus, which is the leading global cause of liver disease.

Although babies in the country only start to get vaccinated against hepatitis B at six weeks, around 11% of children in the country are already infected with hepatitis B by the age of 18 months,and the government has resolved to introduce vaccination at birth from 2027/8.

While Bandim says it will stop its trial before the national rollout, health experts assert that it is unethical to knowingly withhold a proven treatment from a baby born to a mother with hepatitis B (the trial is single-blinded, so researchers will know which babies get the vaccination and which get the placebo).

US involvement

The US Centers for Disease Control and Prevention (CDC) awarded Bandim a $1,6 million five-year grant to “assess the effects of neonatal Hepatitis B vaccination on early-life mortality, morbidity, and long-term developmental outcomes”, according to the US HHS federal register.

Dr Christine Stabell Benn, co-leader of Bandim, is an adviser to the US Advisory Committee on Immunization Practices (ACIP), which recently resolved to stop recommending hepatitis B vaccines to US newborns.

HHS Secretary Robert F Kennedy Jr fired most of the ACIP members last year, replacing them with a committee dominated by vaccine critics.

For years, Stabell Benn, co-principal investigator of the Guinea-Bissau trial, has researched the “non-specific effects” (NSE) of vaccines. She and colleagues have conducted trials involving thousands of children in Guinea-Bissau and Denmark, and assert that all vaccines should also be tested for NSEs.

One of the research aims of their Guinea-Bissau trial is to investigate the effect of the vaccination “on neurodevelopment by five years of age”. This dovetails with Kennedy’s belief that the rise of autism is linked to childhood vaccinations.

“RFK Jr. has manipulated the [Guinea-Bissau] study to support his unsupportable, science-resistant beliefs about harms caused by the hepatitis B vaccine,” observed US paediatrician Dr Paul Offit, co-inventor of a rotavirus vaccine, on his Substack platform.

Role of Africa CDC

Africa CDC Director-General Dr Jean Kaseya

Africa CDC Director-General Dr Jean Kaseya said that African countries were in “total control” of clinical trials conducted in their countries.

However, Africa CDC has developed a 13-step guide to assist countries.

“I was talking to the minister [of Guinea-Bissau] who called me three days ago and clearly said, told me: ‘DG, I’m a new Minister. I’m still waiting for the two steps, the National Medicine Regulatory Authority and the National Ethics Committee, to come to brief me and to give me the recommendations. I’m also asking if Africa CDC can come and support us to see this protocol and all other documents, then I can make a decision based on this recommendation’,” Kaseya told the media briefing.

He also dismissed a report that unnamed HHS officials had made disparaging remarks about Africa CDC over its contention at a media briefing last week that the trial had been cancelled.

“We have our diplomatic relationship with the US. Yesterday, senior people from HHS were talking to senior people from Africa CDC, and I was briefed that they don’t know anything about any statement against Africa CDC,” said Kaseya, who said that his organisation has an “excellent relationship” with the US government.

Kaseya added that Africa CDC had decided not to involve itself in the bilateral Memorandums of Understanding that the US was negotiating with African governments under its “America First Global Health Strategy”.

However, he said that the implementation of the MOUs would be discussed at a meeting of health and finance ministers that he is convening on 13 February.

Not All Diseases Are Equal: How a World Economic Forum Report quietly reshaped the NCD agenda

22/01/2026 Habib Benzian

As the World Economic Forum (WEF) met in Davos this week, a new WEF report on NCDs reflects the influences of powerful groups on disease priorities.

The World Economic Forum’s (WEF) latest report on acting early on noncommunicable diseases (NCDs) signals more than urgency. It signals a shift in what counts.

Beneath familiar calls for earlier action sits a quieter move: a re-ordering of NCD priorities themselves. Some diseases now sit firmly at the centre of the agenda. Others, no less prevalent or consequential, are absent or muted.

The clearest indicator is the report’s treatment of chronic kidney disease (CKD). CKD is presented, not as a downstream complication, but as a core NCD, positioned comfortably alongside cardiovascular disease, diabetes, cancer, and chronic respiratory disease. No extended justification is offered. Its inclusion is just assumed.

CKD’s elevation is overdue, but its inclusion in the WEF report also reveals how NCD categories solidify. Diseases move to the centre not only because of burden, but because they align with existing biomedical pathways, specialist care models, insurance logic, and pharmaceutical governance.

Seen this way, the report is not simply about acting earlier. It is about which disease problems global health institutions are structurally prepared to organise around.

The politics of NCDs

NCDs have never been a neutral list. They are the product of political and institutional settlement. Inclusion brings visibility, financing, and organisational ownership. Exclusion does not erase a condition, but it shapes how seriously it is taken in policy, planning, and budgets. What this report suggests is that the settlement is shifting again, quietly rather than through open debate.

The contrast between what fits and what does not is striking. Oral health is absent altogether, despite affecting more people globally than all other NCDs combined. Dementia barely registers, even as it reshapes ageing societies and long-term care systems.

Air pollution appears only as a generic risk factor, detached from its regulatory implications. Obesity and physical inactivity are acknowledged but they never organise the analysis. Mental health is present, but thinly so. Eye health and several other NCDs are missing entirely.

This is not ignorance. The WEF itself has published economic analyses making the case for investing in oral health. It is well aware of dementia, air pollution, and obesity as global challenges. The issue is not whether these conditions matter, it is whether they fit prevailing system architectures.

Institutional compromises

Debates around expanding the NCD frame, including the so-called 6×6 perspective, were never simply about adding conditions to a list. They exposed how the NCD framework hardened into an institutional compromise, privileging problems that are easier to govern, finance, and narrate.

Oral health and others were excluded not because the evidence was weak, but because their inclusion would have unsettled that compromise.

What the WEF report suggests is that the frame is being adjusted again, but cautiously. Rather than opening outward to accommodate conditions that strain existing arrangements, it tightens inward around those that reinforce them.

CKD aligns neatly with this logic. It can be framed as an extension of diabetes and hypertension. It lends itself to biomedical markers, specialist pathways, and pharmaceutical management. It fits insurance systems and performance frameworks.

Crucially, it does not force difficult conversations about food systems, sugar, taxation, or commercial power. It can be absorbed without rewriting the rules.

Other conditions are less accommodating. Oral diseases pull sugar into view as a specific commercial determinant, not a vague lifestyle choice. They expose the fragility of private financing and fee-based care, and make inequality impossible to ignore. Dementia collapses the boundary between health and social care.

Air pollution pushes responsibility far beyond the health sector. Climate-related exposures, including extreme heat, increasingly shape NCD risk and outcomes, yet remain difficult to absorb into disease-specific prevention frameworks, as they demand action across labour policy, urban design, housing, and climate governance. Obesity, if taken seriously, leads quickly to trade policy and regulation.

These are not marginal complications. They are precisely the kinds of questions that strain consensus and unsettle partnerships.

Inclusive understanding

This quiet consolidation sits alongside longer-standing efforts by groups such as the NCD Alliance to defend a broad and inclusive understanding of NCDs. That advocacy has helped keep multiple conditions visible in political commitments, even as institutional practice increasingly favours a narrower, more governable set of priorities.

The institutional setting matters. The WEF operates through public–private convening. Pharmaceutical companies, diagnostics firms, and health-technology actors are not peripheral to its health work; they are part of the room. This does not mean reports are written to serve corporate interests, but it does shape which narratives travel easily and which stall.

One contemporary signal reinforces this pattern. This week at the WEF in Davos, a global partnership was announced between Colgate-Palmolive (the leading global manufacturer of oral hygiene products) and the WHO Foundation.

At a moment of tightening budgets at WHO, including the loss of dedicated oral-health staff, such arrangements are widely hoped to help stabilise institutional capacity and preserve visibility for conditions otherwise at risk of further marginalisation.

Analytically, they reflect the same logic at work: when conditions fall outside the core NCD architecture, they advance through parallel channels rather than through the centre of system reform.

The risk is subtle but real. The NCD discourse begins to tilt away from the conditions that most shape lived experience towards those that best fit institutional comfort. Authority shifts not because of burden or equity, but because of governability.

CKD did not move to the centre by chance. It arrived because it belongs to the version of NCDs that the global health sector currently finds easiest to manage. Other conditions remain outside, not because they matter less, but because they ask harder questions about responsibility, power, and what health systems are ultimately for.

That is what this report reveals. It is not primarily a story about acting early. It is a story about how carefully and quietly the boundaries of action are being redrawn.

Habib Benzian is Professor at the University of the Western Cape (Cape Town, South Africa), Noel Martin Visiting Chair at the University of Sydney’s Dental School; and a member of the Lancet Commission on Oral Health. He advises governments and international organisations on health policy and equity.

Image Credits: WEF.

EU Parliament Backs Critical Medicines Act, Sparking Supply Concerns in Africa

21/01/2026 Felix Sassmannshausen

The EU Parliament endorsed the Critical Medicines Act on Tuesday, after Commission President Ursula von der Leyen presented the legislative proposal last year.

STRASBOURG – The European Parliament backed the EU’s Critical Medicines Act (CMA) on Tuesday in a decisive move to secure Europe’s pharmaceutical supply chains from geopolitical shocks.

With an overwhelming majority of 503 votes in favour, 57 against, and 108 abstentions, MEPs endorsed a sweeping industrial policy designed to re-shore the production of active ingredients (API’s), critical medicines and essential drugs like antibiotics and insulin.

While the vote marks a major step toward European “health sovereignty,” critics warn that the EU’s push for resilience could inadvertently drain global supply, drive up prices for essential drugs, and undercut Africa’s emerging pharma industry.

“The Critical Medicines Act is a bold step for Europe,” said Boniface Mbuthia, director of health financing at Amref Health Africa, in a statement to Health Policy Watch. “But its true success will be measured not only by securing EU resilience, but by its contribution to global health equity”. Amref Health Africa is the continent’s leading health NGO.

‘Buy European’ in response to US protectionism

The vast majority of APIs are imported from two countries: India and China. The EU wants to diversify its supply chains by re-shoring production capacities.

The Critical Medicines Act, first proposed by the Commission in March 2025, aims to address the structural vulnerabilities that leave European patients facing empty pharmacy shelves. It complements the EU’s pharma act that was endorsed by European legislators in December, and is designed to boost the industry’s competitiveness.

To counter supply chain vulnerabilities, the Parliament’s position centres on “Strategic Projects” – industrial initiatives to modernise or build manufacturing capacity within the Union, supported by fast-tracked permits and state aid.

An exploratory study issued by the EU Commission found that over 50% of recent critical medicine shortages in the EU were caused by manufacturing issues, exacerbated by a heavy reliance on active pharmaceutical ingredients (APIs) from India and China. A medicine is considered critical if an insufficient supply results in serious harm or a risk of serious harm to patients.

Tomislav Sokol, the Parliament’s lead lawmaker responsible for drafting the bill, framed the legislation as a necessary response to an increasingly aggressive global trade environment, specifically citing pressure from the United States.

“The pharma industry is the strongest European exporting industry,” the representative of the conservative European People’s Party (EPP, Croatia) told reporters at a press conference following the parliament vote. “Unfortunately, Europe so far has not recognised this fact to the most significant extent, but US President Trump has.”

He warned that if the EU doesn’t bring back generic drug and API production capabilities, Europe faces a dual dependency: “We are currently to a large extent dependent on importing APIs and generic medicines from China. If we don’t do anything about this, we will add a new dependency on imports of innovative medicines from the US.”

Incentives to re-shore production capacities

The responsible legislator, MEP Tomislav Sokol, presented the EU Parliament’s negotiating position in the ongoing legislative process at a press conference on Tuesday.

A cornerstone of the Parliament’s proposal for the Critical Medicines Act is a reform of public procurement. Currently, national health systems often award contracts based solely on the lowest price, driving production to cheaper Asian markets.

The Parliament instead wants to mandate “Most Economically Advantageous Tender” (MEAT) criteria, prioritising security of supply and environmental sustainability.

Crucially, the Members of the European Parliament (MEPs) are pushing for preferential treatment of companies in public tenders whose “significant proportion” of production is located in the EU. “We define this as having at least 50% of the production of active ingredients or final products in Europe,” Sokol explained.

These measures are expected to raise drug prices, which will lead to heavier burdens on patients or national health budgets. Experts estimate price increases of 20%-40% for some critical medicines.

In an interview with Health Policy Watch, Tiemo Wölken, MEP for the Socialists and Democrats (S&D) and co-legislator, acknowledged this trade-off but defended it as essential for security.

“National and EU funds must be spent in the European Union. This means production must also happen in the European Union,” Wölken said.

“It has a higher value regarding security of supply because we make our own rules here. It is a bargain: money for access and security of supply,” he emphasised.

Industry pushback against joint procurement

To secure the supply of critical medicines, the EU is negotiating the Critical Medicines Act.

While the pharmaceutical industry acknowledges the Critical Medicines Act as an opportunity to improve supply resilience, they insist that the final design must remain “proportionate, targeted and evidence-based”, the European Federation of Pharmaceutical Industries and Associations (EFPIA) explained in a statement.

“In order to successfully achieve its aim, the Critical Medicines Act needs to focus on real supply risks and practical solutions,” Nathalie Moll, Director General of EFPIA, summarised the association’s position.

A key concern addressed by EPFIA is the local-content consideration. The association argues that favouring procurement based on manufacturing location risks “weakening global supply diversification, reducing flexibility in supply chains and undermining Europe’s position as an export-oriented base for innovative medicines.”

While the Commission originally focused on industrial manufacturing capacity, the Parliament’s proposal to also include compounding activities within pharmacies or hospitals in the scope of manufacturing capacity measures has opened a new front of industry concern.

“This risks enabling stockpiling or broader use of unlicensed products, raising patient safety concerns and undermining public trust, as they are prepared on an ad-hoc basis,” EFPIA argues.

Notably, the industry continues to push back against the “scope and thresholds for joint and collaborative procurement,” warning that these elements risk diluting the Act’s original intent.

The Parliament voted on Tuesday to lower the threshold for activating joint procurement mechanisms from nine member states to five, making it easier for smaller countries to band together to negotiate prices.

Legislator Sokol was adamant: “I know for a fact that the industry is not really thrilled about the principle.” But he added that additional safeguards, such as binding quantities, will support the industry.

EU Parliament demands stockpiling

Re-shoring and mandatory stockpiling on EU-level are to help against supply shortages.

With the Parliament’s position adopted, the file now moves to trilogue negotiations with the Council and Commission before it can enter into force.

The pressure is on to finalise the regulation quickly, with Sokol hoping for a deal “within a couple of months,” citing the urgency of US protectionist trends.

A major point of contention in the upcoming negotiations will be the “Union coordination mechanism” for stockpiles. The Parliament wants to empower the Commission to order the redistribution of medicines from one Member State to another in cases of critical shortages.

“What we have now, unfortunately, is that national stockpiling in some Member States, especially the big ones, directly contributes to shortages in small Member States,” Sokol said.

He described the redistribution mechanism as a “last resort” to ensure European solidarity, acknowledging that it will likely face fierce opposition from national governments in the Council who view health as a sovereign competence.

The triple health threat to African countries

Boniface Mbuthia, Amref Health Africa’s director of health financing, warns of price and supply chain disruptions.

It is this very mechanism that is likely to cause issues on the global market, as Amref Health Africa points out.

The organisation has raised alarm bells regarding the Critical Medicines Act’s potential to disrupt the nascent pharmaceutical sovereignty of the African continent, pointing to three distinct risks:

EU mandates to fill stockpiles could drain global markets of limited supplies, leaving African nations with shortages
A massive spike in EU demand for APIs could drive up global commodity prices, making medicines unaffordable in the Global South
By incentivising “made in Europe,” the EU may inadvertently undercut efforts to build pharmaceutical manufacturing hubs in Africa, an initiative heavily promoted by the African Union.

Without coordination, EU stockpiling could lead to “supply diversion,” reducing availability of medicines in African markets, warned Mbuthia, Amref’s director of health financing.

EU fails to consider Global South perspectives

Social Democrat MEP Timo Wölken emphasises that European resilience should not be bought at the cost of security of supply in the Global South.

Asked about these risks, the Social Democratic MEP Wölken insisted that safeguards are necessary. “We must ensure that European resilience is not bought at the cost of security of supply in the Global South,” the Social Democrat said. He referenced the COVID-19 pandemic, where export bans left the Global South waiting for vaccines, as a scenario the EU must avoid repeating.

However, he admitted that the instruments designed in the Act look particularly at the internal EU rather than at external relations. Specific implications for third countries were not the central topic of discussion, he said.

While the EU Commission had proposed a mechanism for international cooperation with preliminary expert reports underscoring the need for cooperation with African countries to diversify supply, the actual mechanism remains vague.

During Tuesday’s press conference, responding to a query by Health Policy Watch, Sokol clarified that the Parliament’s political compromise focused on EU candidate countries – such as those in the Western Balkans and Ukraine – rather than partners in Africa.

While partnerships with other nations are theoretically possible, some political groups felt broader inclusion was “exaggerated”, Sokol disclosed.

Focus on immediate neighbourhood part of Europe’s geopolitics

Amref Health Germany’s Director Ralph Achenbach calls on EU policymakers for more international cooperation.

This focus on the “immediate neighbourhood” is part of Europe’s geopolitical ambitions and risks leaving African partners, identified by the Critical Medicines Alliance as key for diversification, out of the loop.

For stakeholders like Amref, the coming months will be critical to see if the final text includes explicit protections for global health equity, or if the EU’s drive for autonomy turns into a “Europe First” policy.

“We call on European policymakers to ensure that the Critical Medicines Act promotes cooperation, transparency, and shared resilience,” Ralph Achenbach, Executive Director at the German branch of Amref Health Africa emphasised.

It should be set up to be complementary to the African Union’s African Health Sovereignty initiative, Achenbach emphasised, supporting diversified manufacturing, investing in pharmaceutical production capacity on the continent, and strengthening equitable procurement mechanisms.

Image Credits: European Union/Emilie Gomez, European Union/Christophe Licoppe, European Commission, European Union/Alain Rolland, European Union/Christophe Licoppe, Amref Health Africa, Waldemar Salesski, Amref Health Africa Deutschland.

Gates and OpenAI Team Up to Pilot AI Solutions to African Healthcare Problems

21/01/2026 Kerry Cullinan

Community Health Workers attend a training session on HIV prevention in Kirehe, Rwanda.

The Gates Foundation and OpenAI announced a $50 million “pilot” on Wednesday to “advance AI capabilities for health” in Africa. Horizon 1000 promises “funding, technology, and technical support” to roll out AI solutions to 1,000 African primary healthcare clinics by 2028.

“AI is going to be a scientific marvel no matter what, but for it to be a societal marvel, we’ve got to figure out ways that we use this incredible technology to improve people’s lives,” said Sam Altman, CEO of OpenAI, in a media release.

“The goal is to make [health care] much higher quality, and if possible, twice as efficient as it is today – taking away the paperwork, organising resources so the patient knows what is available and when to come for their appointments,” Gates Foundation CEO Bill Gates told a session at the World Economic Forum (WEF) in Davos on Wednesday.

Starting with Rwanda

The pilot will start in Rwanda, and later branch out to Kenya, South Africa and Nigeria, Gates added.

Rwanda is already exploring the use of AI to help health workers with disease diagnosis, relieve them of onerous administrative tasks, and model the trajectory of diseases.

Paula Ingabire, Rwanda’s Minister of Information, Communication and Technology and Innovation, told the WEF that her country has been working on technological solutions for its “pain points” for over two decades.

As a start, the country has rolled out internet access to around 97% of its population – a significant achievement in a country where most people live in rural areas.

It is currently building “some of the foundational digital infrastructure that is enabling and powering [technological] advancements,” said Ingabire.

One of Rwanda’s aims is to use AI to create “decision-support tools” for its 60,000-plus community health workers (CHW) who provide primary healthcare to communities across the country.

As around 70% of the cases CHW deal with every year are malaria, the country wants an AI tool to help them to improve diagnosis and to better anticipate when and where to expect malaria cases, said Ingabire.

Paula Ingabire, Rwanda’s Minister of Information, Communication and Technology (ICT) and Innovation.

Rwanda has already used a combination of drones and AI to address malaria – with the drones pinpointing and spraying mosquito breeding sites and AI helping with the prediction and modelling of the disease.

Two years ago, Rwanda set itself the goal of quadrupling its health workforce in four years – something it has already almost achieved.

“But they’re going to need these tools to support better care delivery. Some of the administrative tasks that they’ve been working on, we can use AI to do that, so they’re more focused on delivering better and targeted care to our people,” Ingabire said.

The government also wants to use AI to improve its demand forecasting for health commodities to prevent medicine stockouts.

“We started this digital transformation journey more than 15 years ago. We have a lot of data that we’re not using. Building national data intelligence platforms that help us is critical. Once we build these models, they need to be trained on our own data, they need to be context specific, and they need to come in to address real problems.”

Ingabire added that her country is also in conversation with the AI company Anthropic, which developed the large language model Claude, “to see how we can have an instant health intelligence platform that then feeds into the entire national health planning systems and allows us to allocate better resources”.

AI-based TB screening

Global Fund CEO Peter Sands

Peter Sands, CEO of the Global Fund to Fight AIDS, Tuberculosis and Malaria, told the WEF that the fund has invested $170 million over the past four years in AI-based TB screening.

This is one of the largest single applications of AI and health, and it is delivering a “very significant impact”, he added.

One example of how the Fund has used AI-based TB screening is in refugee camps.

“There are well over a million Sudanese refugees in Chad, and we set up mobile clinics with the government of Chad to go into these refugee camps and do screening for TB,” said Sands.

As there were no radiologists, “if you want the screening to be interpreted, there is no alternative [but AI]”, he added.

However, Sands warned that some “very basic problems” still need to be fixed to enable the rollout of AI-driven solutions – primarily that many African primary health care facilities lack internet connectivity, and some even lack power.

He also urged the use of AI to be “framed around problems needing solutions, as opposed to a whole bunch of tools needing a problem to fix” – akin to people “running around with a whole lot of hammers looking for nails”.

He added that tools are easier to develop than finding people “who can actually use them and make things happen”.

Faster progress in LMICs than wealthy countries?

Gates Foundation CEO Bill Gates

Gates believes that there may be faster progress with the rollout of AI in healthcare in developing world health than the “rich world” because “the need is so great, and the governments are embracing this and making sure that it’s moving at full speed”.

“The $50 million commitment is just the beginning. I believe that people in Africa should have this ‘health advisor’ without having to pay anything for it. It should just be a basic capability available to them.

“As you go into the health system, instead of filling out paperwork and redescribing everything, the AI that you’ve been talking to is summarising that… getting rid of the paperwork together.”

Sands also believes that low- and middle-income countries could adopt AI tools faster than developed economies, which are more regulated and where AI is more likely to take away jobs.

“One of the reasons this may well take off faster in middle-income countries is because there won’t be the resistance from people who say: ‘This has taken my job’ and ‘I don’t want to change the way we do things’, because it’s compensating for the fact that those people don’t exist.”

Image Credits: Cecille Joan Avila / Partners In Health.