US Health Secretary Robert F Kennedy Jr.

The decision by United States Health Secretary Robert F Kennedy Jr to fire all members of the Centers for Disease Control and Prevention’s (CDC) vaccine advisory group is “a dangerous and unprecedented action that makes our families less safe”, according to Dr Tom Frieden, CEO of Resolve to Save Lives.  

The Advisory Committee on Immunization Practices (ACIP) develops recommendations on how to use vaccines to control disease in the US, according to the CDC.

“Seventeen dedicated doctors, paediatricians, scientists, and parents who served on the ACIP  were just fired by Secretary Kennedy based on false claims of conflicts of interest,” said Frieden, a former head of the CDC, late Monday.

Kennedy announced the move a few hours earlier in an op-ed published in the Wall Street Journal, claiming that “a clean sweep is needed to re-establish public confidence in vaccine science”.

He added that “vaccines have become a divisive issue in American politics”, and that the “committee has been plagued with persistent conflicts of interest and has become little more than a rubber stamp for any vaccine.”

But Dr Tina Tan, president of the Infectious Diseases Society of America President, said that “unilaterally removing an entire panel of experts is reckless, short-sighted and severely harmful”.

“This is one of the darkest days in modern public health history,” said Dr Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP). “Science does not matter to Mr Kennedy.” 

Frieden warned that “if this leads to vaccines not being recommended, millions of people could lose access, pay more for vaccines and for preventable illnesses, and children will be at greater risk of diseases we haven’t faced in decades.”

There have been 17 measles outbreaks in the US this year so far, and by 5 June, a total of 1,168 confirmed measles cases had been reported by 34 jurisdictions, according to the CDC. Some 95% of cases were either unvaccinated or their vaccination status was unknown.

The measles caseload is four times higher than in 2024 and is nearing a 30-year high, according to ABC news. The rise in measles cases stems from waning vaccination levels, with a vaccination rate of over 95% required to keep the highly infectious disease in check.

Anti-vax ‘empire’

Measles vaccination. Despite the growing US outbreak, routine vaccination against this and other highly infectious childhood diseases is under attack.

Biomedical scientist and science communicator Dr Andrea Love said that Kennedy, not ACIP, “is the one who has created distrust around vaccines and legitimate scientific experts”,  adding that he has spent “over 20 years systematically attacking vaccines for profit”.

“RFK Jr has built a multi-million dollar empire manufacturing vaccine distrust. His organisation, Children’s Health Defense (CHD), raked in over $16 million in 2021 alone – money made by terrifying parents, undermining public health, and selling false solutions,” Love wrote in her Immunologic newsletter.

During the COVID-19 pandemic, the Centre for Countering Digital Hate identified Kennedy as the second biggest purveyor of anti-vaccine disinformation, based on its analysis of  Facebook and Twitter during March 2021.

Eleven of the 12 “disinformation dozen” were selling alternative remedies for COVID-19, while the non-profit CHD, which Kennedy founded and ran until his presidential bid, receives donations to question vaccines.

“Every vaccine controversy he fabricates, every conspiracy theory he spreads, every scientific institution he attacks leads to donations, book sales, legal fees, speaking fees, and supplement partnerships,” said Love.

New members are ‘under consideration’

Replacement committee members are “currently under consideration” by Kennedy, and ACIP is still scheduled to meet on 25 June, according to an announcement by the US Department of Health and Human Services (HHS).

“ACIP’s new members will prioritize public health and evidence-based medicine. The Committee will no longer function as a rubber stamp for industry profit-taking agendas,” according to HHS.

Until Monday, ACIP was chaired by Dr Helen Talbot, professor of Medicine and Health Policy at Vanderbilt University in Tennessee, who also co-leads the university’s Emerging Infections Program that is working on understanding viral respiratory disease epidemiology. Other members were also primarily medical experts based at universities and research institutions.

ACIP members are “required to declare any potential or perceived conflicts of interest” during their tenure, and recuse themselves from deliberations and voting should they have such conflicts, according to the CDC, which publishes members’ disclosures.

Kennedy and Trump’s recent high-level health appointees give an indication of the likely direction of the new appointees.

Casey (left) and Calley Means after being interviewed about their book by conservative talk show host Tucker Carlson (centre)

Last month, President Donald Trump nominated Casey Means, who has linked vaccines to autism, as Surgeon General on the advice of Kennedy.

Her brother, Calley Means, co-founder of an online wellness sales platform, is Kennedy’s special advisor. 

The Means siblings co-authored Good Energy, in which they argue that all chronic conditions are caused by metabolic dysfunction linked to lifestyle.

The Means, like new National Institutes of Health (NIH) Director Dr Jay Bhattacharya; Food and Drug Authority (FDA) head Dr Marty Makary; and Dr Mehmet Oz, head of the Center for Medicare and Medicaid Services, are critical of mainstream medicine and how the COVID-19 pandemic was handled.

Image Credits: WHO, Facebook.

NIH staff are protesting against the politicisation of the body.

Over 300 employees of the US National Institutes of Health (NIH) have urged NIH director Dr Jay Bhattacharya to “restore grants delayed or terminated for political reasons so that life-saving science can continue”.

They have also appealed to him to reinstate staff, enable global collaboration, and research to be published in peer-reviewed journals.

“We dissent to [Trump] Administration policies that undermine the NIH mission, waste public resources, and harm the health of Americans and people across the globe,” the staff declared in a letter sent to Bhattacharya and Health Secretary Robert F Kennedy Jr on Monday morning.

In the letter, which they name the “Bethesda Declaration” after the location of the NIH headquarters, the staff say they are “compelled to speak up when our leadership prioritizes political momentum over human safety and faithful stewardship of public resources.”

They describe themselves as “workers from every Institute and Center at NIH”, including some who have signed anonymously “due to a culture of fear and suppression”.

“Standing up in this way is a risk, but I am much more worried about the risks of not speaking up,” said Dr Jenna Norton, one of the declaration organisers, in a media release circulated by a group called Stand Up for Science.

“If we don’t speak up, we allow continued harm to research participants and public health in America and across the globe,” added Norton, who is a programme director at the National Institute of Diabetes and Digestive and Kidney Diseases.

The letter is timed to coincide with Bhattacharya’s appearance at the Senate’s Appropriations Committee for the NIH’s budget request on Tuesday.

‘Multiple universities’ targeted for ‘political aims’

The staff decry the Trump administration’s “politicisation of research by halting high-quality, peer-reviewed grants and contracts” based on “political ideology”. 

Since Trump took office on 20 January, NIH has terminated 2,100 research grants totaling around $9.5 billion and $2.6 billion in contracts. 

Targets include “multiple universities” who have been hit “with indiscriminate grant terminations, payment freezes for ongoing research, and blanket holds on awards regardless of the quality, progress, or impact of the science’ for political aims, according to the letter.

“Many [research] terminations contradict federal regulations that mandate protections for research participants and require grant awards to specify potential termination reasons.”

Some terminations eliminate years of hard work and millions of dollars. 

“Ending a $5 million research study when it is 80% complete does not save $1 million, it wastes $4 million,” the letter notes.

In addition, “NIH trials are being halted without regard to participant safety, abruptly stopping medications or leaving participants with unmonitored device implants.”

“The partnership between NIH and the academic community has made huge contributions to almost every aspect of the health of people across the US,” said Jeremy Berg, former director of the National Institute of General Medical Sciences.

Reinstate staff, restore global partnerships

The NIH Clinical Center, formed in 1953, is a hospital devoted entirely to finding cures for a range of diseases.

They urge Bhattacharya to “reinstate the people who make NHI work”, noting that firing “talented, hard-working professionals and critical departments without thought to their purpose or need has slowed the pace of science, held up extramural grant and contract funding, made NIH less transparent and efficient, and put Clinical Center patients at risk.”

The NIH Clinical Center is the largest US hospital devoted entirely to clinical research, including of cancer, dementia and rare diseases.

They also urge him to “allow rigorously peer-reviewed research with vetted foreign collaborators to continue without disruption”, as American scientists are being “cut off from the global scientific community”.

South Africa may lose 70% of its medical research capacity following the cancellation of NIH funds, crippling 16 universities and setting back two decades of HIV and tuberculosis research.

This follows the NIH decision to prohibit US scientists from working with foreign researchers via “sub-awards”, leading to the immediate and mass cancellation of such grants with South African institutions.

At least 39 TB and HIV clinical research sites in South Africa are under threat due to NIH funding cuts, jeopardising at least 27 HIV trials and 20 TB trials, according to an analysis by the Treatment Action Group (TAG) and Médecins Sans Frontières (MSF) mostly of grants from the NIH’s Division of AIDS (DAIDS).The “unprecedented reduction in NIH spending does not reflect efficiency but rather a dramatic reduction in life-saving research,” they conclude.

Stand up for Science, a Washington-based non-profit formed to defend science and democracy, has also mobilised high-profile scientists, including 19 Nobel laureates, to support the NIH staff.

Echoing Great Barrington Declaration 

The Bethesda Declaration is deliberately styled after the Great Barrington Declaration, published by Bhattacharya and others during COVID-19, which argues against any measures to prevent COVID-19 other than “focused protection” for those most vulnerable, while allowing widespread SARS-CoV-2 infection to enable “herd immunity”.

The Great Barrington Declaration, sponsored by the American Institute for Economic Research (AIER), a libertarian free-market think tank associated with climate change denial, was widely condemned as being unscientific.

Last month, NIH staff staged a walkout during a Town Hall addressed by Bhattacharya in which he said he supported the idea that the COVID-19 pandemic was “caused by research conducted by human beings,” possibly partly sponsored by the NIH.

“If it’s true that we sponsored research that caused a pandemic – and if you look at polls of the American people, that’s what most people believe, and I looked at the scientific evidence; I believe it – what we have to do is make sure that we do not engage in research that’s any risk of posing any risk to human populations,” Bhattacharya said in a recording obtained by CNN.

Image Credits: Stand up for Science, NIH.

African health workers are immigrating because the health systems in many countries are broken.

When Dr Biira* qualified as doctor in Uganda, she was hopeful about her future. Instead, she faced a common barrier: no job. Despite a huge shortage of doctors, no posts were available. Like many others, she left to work overseas.

Across Africa, talented health workers overcome significant obstacles to train, only to be driven away by unbearable working conditions, low pay, and limited career prospects. Meanwhile, high-income countries aggressively recruit with promises of better pay and career progression.

Health workers have the right to migrate – but the system is broken. Africa must re-negotiate this arrangement and build a fit-for-purpose workforce for the continent on its own terms. 

There is no doubt about the critical role health workers play. As the backbone of strong, resilient health systems, they are the first line of defence against emerging outbreaks, key to achieving universal health coverage, and one of our best bets against the impacts of climate change. Without them, there is no healthcare.

Six million shortfall

Yet Africa, which is home to 18,8% of the global population but 24% of the world’s burden of disease, is critically underserved with just 3% of the world’s health workers. The continent is projected to face a staggering shortfall of 6.1 million health workers by 2030.

Why? As African countries struggle to train and retain health workers, high-income countries underinvest in their pipeline of health workers – relying on imports from overseas. A new World Health Organization (WHO) report underscores this issue – high income countries have 10 times the number of nurses compared to low-income countries – while 23% of nurses in high income countries are foreign-born.

Yet the WHO Global Code of Practice for ethical recruitment of health workers is voluntary and often ignored. Countries on the ‘red list’ from which countries should not recruit, such as Zimbabwe and Nigeria, continue to see active recruitment through private agencies – with the US, UK and Saudi Arabia routinely recruiting, despite claiming not to.

The current system is exploitative and unsustainable and it’s costing lives. Training a doctor in Africa costs between $21,000 and $59,000. Between 2010-18, nine African countries lost $2 billion in investment as trained doctors migrated.

Africa is not the medical school for the world, and it will never be able to build resilient health systems if its health workers continue to be recruited in droves. 

The WHO Code up for review, and long overdue overhaul, and we must see:

Stronger enforcement: The rules should be binding, and the WHO must monitor and penalise unfair practices, including naming and shaming of countries which flout the rules.

Structured and more ethical programs for temporary migration: Exchange of skills and experience for a limited period by design, not by chance. 

Compensation: If high-income countries benefit from workers trained overseas, they must reinvest through training partnerships, training facilities or direct contributions per worker to the affected country.

Yet, a stronger code alone will not fix this problem. The underlying cause is years of underinvestment, now compounded by the freeze on US aid. Africa deserves better.

 Expanded career paths

Nurses| Cameroon
Student nurses prepare for the morning rounds at Ndop District Hospital in Bamenda, Cameroon

To this end, people, not diseases, must be at the centre of health funding. A nurse plays multiple roles, treating HIV, vaccinating children, managing chronic illness, and curing TB. Investing in people is a more efficient pathway to better health outcomes. 

Financing is key. We need to create the fiscal space for countries to train and retain health workers. Countries must mobilise more domestic financing and prioritise the health workforce, addressing issues of low pay and poor working conditions to make sure those trained are absorbed and retained in the system.

 A key reason health workers migrate is a lack of training opportunities or because they can’t specialise, so this must be addressed through an expansion of career paths at home. 

In Malawi, where just 43 paediatricians serve a population of more than 20 million, Seed Global Health’s model of partnering with universities and hospitals to train more doctors, nurses and midwives helps – but we need support to not only scale training but to retain skilled providers in the country.

Further, donors and implementers must back African leadership and champion country-led initiatives, which offer more sustainable and long-term solutions to best meet the complex needs of countries in a context specific way. 

Amref Health Africa continues to enhance meaningful engagement and collaboration across sectors to initiate better incentives to motivate, retain staff and also re-attract migrant health workers from the diaspora. This is in recognition of the fact that the continent’s accessible health workforce is the driver of its success.

The Africa CDC has prioritised health workforce development as part of its ‘New Public Health Order’. Now, countries and donors must provide the necessary funding and political support to turn this vision into reality. 

The bottom line is that investing in health workers improves care for populations, but also creates jobs, drives gender equity – 70% of health workers are women – and builds resilience against increasing disease burdens and health emergencies.

The future of global health hangs in the balance. Can we afford to keep haemorrhaging health workers from the countries that need them most? Or will we seize this moment to forge a new path – one that values equity, fairness, and shared responsibility?

The choice we make today will shape the health and well-being of generations to come.

* not her real name.

Martin Msukwa is Chief Program and Innovation Officer for Seed Global Health

Isaac Ntwiga is Director of Health Workforce Ecosystem, Amref Health Africa

 

Image Credits: © Dominic Chavez/The Global Financing Facility, International Federation of Nurse Anesthetists.

People collect water from a pump in Kinshasa in the Democratic Republic of Congo. Cholera is an acute enteric infection, primarily linked to insufficient access to safe water and proper sanitation.

Cholera in Africa is being driven by years of under-investment in water and sanitation, according to the Africa Centres of Disease Control and Prevention (Africa CDC).

Four countries – Angola, Democratic Republic of Congo (DRC), Sudan and South Sudan  – account for over 85% of the continent’s cholera cases and all have above-average death rates, according to Dr Ngashi Ngongo, Africa CDC incident lead on mpox.

Access to clean water, sanitation and hygiene (WASH) is poor in all four countries. Only 35% of Sudanese have access to safe water, and although the DRC leads the group, only around two-thirds of its citizens have clean water, according to the Africa CDC.

Only 16% of those living in South Sudan have access to basic sanitation and almost three-quarters of the rural population practises open defecation.Only 10% of schools in South Sudan have handwashing facilities for children.

Half the Angolan population has basic sanitation, the best of the group.

South Sudan has the biggest cholera outbreak with 48,828 cases and 908 deaths. It is followed by DRC with 25,520 cases and 557 deaths, then Angola with 21,000 cases and 630 deaths and Sudan with 13,743 cases and 296 deaths, Ngongo told the Africa CDC media briefing on Thursday.

Ngongo said that the expected case fatality rate should be around 1% but this was far higher in all four countries. South Sudan’s rate is 1.9%, DRC is 2.1%, Sudan is 2.5%, and Angola is 3%.

Multi-sectoral, continental commitment

Earlier in the week, African Heads of State from the 20 countries worst affected by cholera convened and resolved to create a continental Incident Management Support Team (IMST) similar to that coordinating the mpox response, to reinforce cross-border surveillance. 

The countries also pledged to establish national presidential task torces on cholera to “strengthen multisectoral coordination, mobilise domestic resources, and enforce accountability frameworks”, according a media release from Africa CDC. 

Angolan President and African Union chairperson João Manuel Gonçalves Lourenço urged countries to “invest robustly in water, sanitation, and health systems”. 

Meanwhile, Africa CDC Director General Dr Jean Kaseya told the leaders that the systemic drivers of the crisis were “limited WASH infrastructure, insecurity, weak coordination, and vaccine shortages”.

“Africa needs 54 million doses of oral cholera vaccine annually but receives barely half. This gap is unacceptable. Urgent action is needed to scale up local production and secure supply,” said Kaseya.

Only one manufacturer is currently making the vaccine globally, producing around half the vaccines that are needed. 

“Africa needed 80 million doses but only received 26 million doses [in 2024] because doses had to be distributed also to other regions,” said Ngongo.

“This is the reason why there’s a greater push from Africa CDC, and now also from the Head of State for local manufacturing,” he said, adding that $150 million was needed to finance this.

In closing, Zambian President and meeting host Hakainde Hichilema said: “We have issued a clear Call to Action. Now we must deliver—through scaled-up domestic investments, strengthened cross-border coordination, and community-driven responses. Africa needs one continental IMST, one community-centred plan, and one accountability framework.”

Mpox ‘most concerning’ in Sierra Leone

The mpox outbreak in Sierra Leone, which accounts for over half of the new mpox cases in the past week, is the “most concerning”, said Ngongo.

The country has 4,032 suspected cases reported so far (3140 confirmed) and 15 deaths. Cases seem to be falling, with 531 cases in the past week in comparison to 684 the previous week, but the country’s surveillance is inadequate, he noted.

“What is of really great concern is the test positivity rate, which is at 93% overall for the entire country, with seven districts reporting 100% positivity rate,” said Ngingo.

“This means that people come themselves to health facilities, and those that come are already at advanced stage. It’s a reflection that the surveillance is primarily passive.” 

However, Ngongo acknowledged that Sierra Leone’s surveillance programme involving community health workers “has stopped because of difficulties in funding”.

While mpox appears to be stabilising in the DRC, which is where the majority of cases are, the country’s low testing rate “makes it very difficult to interpret the stabilisation that we are seeing”, said Ngongo.

However, he confirmed that conflict in North and South Kivu provinces was settling, enabling vaccination.

The DRC is the only country that is now vaccinating children below 18 years using the Japanese vaccine LC16. Japan has donated 4.5 million LC16 doses to the DRC, while France has donated 100,000 Bavarian Nordic doses and the United Arab Emirates has donated 20,000 doses.

Image Credits: Eduardo Soteras Jalil/ WHO.

Protestors gathered outside USAID headquarters in Washington DC.

Governments have been advised to impose ‘sin taxes’ on tobacco, alcohol and other unhealthy products to offset the severity of cuts to official development assistance (ODA), World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus told a tuberculosis meeting on Thursday.

His statements came two days after the administration of US President Donald Trump formally requested his country’s Congress to cancel previously approved budget allocations for global health programmes and projects amounting to $9.4 billion. Tuesday’s request was made by Russ Vought, head of the Office of Management and Budget in Trump’s office, and co-author of Project 2025, the conservative blueprint for the Trump presidency based on expanded presidential power and an ultra-conservative social vision.

Should Congress agree, this would officially endorse the cuts already made in grants to the US Agency for International Development (USAID) and US President’s Emergency Plan for AIDS Relief (PEPFAR) by the Department of Government Efficiency (DOGE) under the leadership of Elon Musk, who resigned from his DOGE role this week as well. Congressional action would also cement cuts to UN agencies including the WHO, UN Children’s Fund (UNICEF), UN Development Program (UNDP), and the UN Population Fund (UNFPA).

“In the past few months, I have spoken to many ministers, and the impact on their  programmes of the sudden cuts in official development assistance is severe,” Tedros told a WHO Town Hall meeting on tuberculosis.

“We are seeing treatment interruptions, clinics closed, health workers losing their jobs, disruptions and more – not just for TB, but for malaria, HIV, neglected tropical diseases, vaccinations, maternal and child health, sexually transmitted infections, family planning and so on.”

The WHO’s advice to countries trying to raise domestic resources to offset the cuts is to start immediately with the “sin taxes” while, in the longer-term, implementing social health insurance and community-based health insurance, Tedros added.

‘Reject rescission package’

Meanwhile, the Global Health Council urged US Congress to reject the rescission package, describing it as “a systematic effort to diminish the longstanding role of the United States as a global health leader” that puts lives at risk.

The One Campaign also called on Congress “to reject rushed attempts to override their previous decisions and to continue supporting smart, effective international assistance programs.”

One Campaign added that the rescissions package “gives scant detail about the nature and impact of the proposed cuts. When lifesaving assistance is at stake, Congress needs real details. For example, the package cuts nearly a billion dollars from health and infectious disease funding which deserves more explanation than 11 vague sentences.”

Trump claims the cuts are aimed at “wasteful foreign assistance spending” to “eliminate programs that are antithetical to American interests”.

Speaking in the US Senate on Thursday, Democratic Senator Dick Durbin asked “why in the world would we cut such low cost but impactful programmes?”

“If there were international programmes that were ineffective, and I admit such work can be difficult and with mistakes, the place to fix them is through the regular appropriations process, not the wholesale gutting of a complete programme like USAID.”

The US Congress has 45 days to consider the proposal.

Gutting of USAID

USAID staff offload emergency supplies.

The Trump administration wants to rescind $500 million of the USAID’s global health programs for “activities related to child and maternal health, HIV/AIDS, and infectious diseases”, claiming that this would not reduce treatment but “eliminate programs that are antithetical to American interests and worsen the lives of women and children, like ‘family planning’ and ‘reproductive health,’ LGBTQI+ activities, and ‘equity’ programs.”

Projections from March indicated that up to 29,000 health workers had lost or were at risk of losing their jobs in Uganda alone due to cuts in foreign assistance. Other African countries severely affected by the US cuts include Ethiopia, Nigeria, and the Democratic Republic of Congo.

“As Uganda’s health workers and Ministry of Health were mounting an effective, coordinated response to contain the Ebola outbreak, the sudden freeze of US foreign assistance created serious challenges,” said Irene Atuhairwe, Seed Global Health’s Country Director in Uganda.

“Health workers lost their jobs, and contact tracing and surveillance efforts had to be scaled back. With limited resources and reduced staffing, health officials were forced to narrow their efforts, potentially increasing the risk of further spread,” added Atuhairwe.

“Diseases like Ebola don’t stay within borders. It takes just one infected traveller boarding a plane or crossing borders for a local outbreak to go global. The very abrupt cuts to foreign assistance have made all of us less safe.”

There were more than 50 USAID-funded staff dedicated to outbreak response in Uganda, but that number has been reduced to just six, who are now responsible for preparedness and response efforts for Ebola, Marburg virus, mpox, and bird flu.

The Trump administration also wants to rescind $400 million of the $6 billion appropriated for HIV programmes, namely the PEPFAR grants administered via USAID.

Numerous African HIV treatment programmes receiving PEPFAR grants through USAID have had to scale down or close because their grants have been terminated, potentially affecting 20 million people.

Also on the rescinding chopping block is $2.5 billion in USAID development assistance to “end extreme poverty and promote resilient, democratic societies”, and $496 million for international disaster assistance in response to natural disasters, conflicts, and other emergencies.

Trump wants to rescind  $1.7 billion from the Economic Support Fund for “countries of strategic importance to the US”, claiming this has been used “to fund radical gender and climate projects.” However, it has largely assisted countries transitioning to democracy and for Middle East peace talks.

Trump also wants to jettison the entire $125 million allocated to the Clean Technology Fund, as it invests in “climate-friendly projects in developing countries that do not reflect America’s values or put the American people first”. 

The fund provides low-cost finance for “promising low-carbon technologies in developing countries”, including “renewable energy, energy efficiency, sustainable transport, and green industry projects.”

International organisations and programmes

The entire $437 million allocated to international organisations and programmes is up for rescission, which would eliminate funding for the UNICEF, UNDP, UNFPA and the Montreal Protocol, which regulates ozone-depleting substances. 

“Eliminating these programs will do real harm,” said Global Health Council President and CEO, Elisha Dunn-Georgiou. 

“These are not fringe initiatives. They make the world safer, healthier, and more just. When the US invests in equitable, inclusive, and evidence-based global health programs, we don’t just improve lives abroad – we strengthen public health security, global cooperation, and America’s reputation as a principled and effective leader.”

The council urged people to “push back against efforts to politicise public health”, noting that “these proposed cuts are about ideology, not money. And they put lives at risk.”

Image Credits: Reuters Youtube, USAID Press Office.

Ambassador Amma Twum-Amoah (left) and Dr Delese Mimi Darko.

CEO of Ghana’s Food and Drugs Authority (FDA) Dr Delese Mimi Darko has been appointed the inaugural Director-General of the African Medicines Agency (AMA) by the agency’s Conference of State Parties (CoSP) at a meeting in Rwanda this week.

Darko has a “wealth of experience and a distinguished track record in regulatory excellence”, according to a media release from the African Union.

Darko has been CEO of Ghana’s FDA since 2017, currently chairs the WHO African Vaccines Regulatory Forum and serves on several international and local committees related to medicines and regulation.

“The appointment of the Director General is an important step toward the operationalisation of AMA,” said Ambassador Amma Twum-Amoah, the AU’s Commissioner for Health, Humanitarian Affairs and Social Development. 

“The AMA has been established to harmonise and strengthen regulatory systems for medical products across Africa. We are confident that under Dr Darko’s leadership, the agency is poised to accelerate its efforts in coordinating and standardising regulatory practices, facilitating joint assessments and inspections, and fostering a harmonised approach to medicines regulation that will ultimately benefit all African citizens,” added Twum-Amoah.

Dr Francine Dekandji, Chad’s Minister of State of Health and chairperson of the CoSP, said that AMA “is crucial for ensuring that medical products on our continent meet international standards of quality, safety, and efficacy”. 

The CoSP also elected a new Bureau to guide its future work and endorsed an additional member to the AMA Governing Board. 

Establishing the agency has been a slow process in the evolution of the harmonisation of the regulation of medicines on the continent.

“The appointment of Dr Darko as the Director General of the AMA represents an important milestone for the organization. The depth of her scientific and regulatory experience will be invaluable in shaping the future of medicine regulation in Africa,” said David Reddy, Director General of the International Federation of Pharmaceutical Producers and Manufacturers Associations (IFPMA).

“By supporting national regulatory authorities across the continent, the AMA has real potential to help facilitate faster access to quality medicines, contribute to tackling substandard and falsified medicines, and support medical innovation.”

Bunmi Femi-Oyekan and Zainab Aziz, co-chairs of the Africa Regulatory Network at IFPMA, both offered their congratulations.

“Under her leadership, the AMA can make important progress in its mission to strengthen initiatives to harmonise medicines regulation and promote cooperation and reliance of regulatory decisions,” said Femi-Oyekan.

Aziz described her appointment as “a crucial step toward a fully functional agency that has the potential to transform access to quality-assured medicines across Africa and foster a more predictable, efficient regulatory environment for innovation”. 

Image Credits: African Union.

Few countries have submitted new climate commitments – fewer yet track health benefits of action, including reduced urban air pollution. Portrayed here, a street view in Beijing.

Most countries’ climate action plans refer to the health benefits of adaptation and mitigation strategies, such as reduced air pollution, but few actually track them. And as World Environment Day is observed Thursday, global climate commitments remain extraordinarily weak. 

Only 21 countries out of the 195 parties to the UN Paris Agreement have submitted updated national climate action plans (Nationally Determined Commitments) through the year 2035 – nearly four months after the plans were due. 

This is according to the latest report by Climate Action Tracker, which monitors submission of the reports to UN Climate Change.

Only 21 countries have so far submitted new national climate commitments due in February, according to Climate Tracker data. The United States has since renounced its targets.

Of those few countries that have submitted, most refer to the health benefits of mitigation strategies, such as reduced air pollution in general terms, while others make reference to health adaptation strategies. 

But there continues to be a lack of clear tracking systems to monitor progress in achieving the desired health outcomes, according to a recent analysis by the Global Climate and Health Alliance (GCHA), a global network that mobilises the health community towards climate action.

The GCHA looked in depth at 11 countries’ national climate plans in different regions of the world and at diverse economic development levels – from Botswana to Panama, Japan and the United Kingdom.

The assessment looked at a set of eight criteria, including references to health benefits from mitigation efforts, related financial commitments, and health sector adaptation initiatives.

Eight criteria used for evaluating health-related NDC commitments and targets.

Under the Paris Agreement, all countries are required to develop NDCs, which outline steps to reduce emissions and adapt to climate impacts. These plans are updated every five years.

This year, governments are submitting their third round, which details emission reduction targets for 2035.

As of the February 10 deadline, only 13 of the 195 parties to the agreement had submitted their 2035 NDC targets.

Since then, there have been just eight additional submissions, bringing the total to 21.

Ambitious NDC commitments would help health 

Countries analysed in the GCHA report included Botswana, Brazil, Canada, New Zealand, Japan, Panama, Switzerland, United Arab Emirates, United States, United Kingdom and Uruguay.

Notably, most national pledges acknowledge the health benefits of mitigation strategies aimed at improving air quality. However, only the United Kingdom’s NDC includes specific monitoring efforts for air quality. 

Some recent submissions are noteworthy for the health benefits that they may reap – even if they are not explicitly measured at all. For instance, Kenya’s NDC, submnitted in May, includes an ambitious pathway to 100% renewable energy and a 35% reduction in greenhouse gas emissions by 2035, even though the country contributes less than 0.1% to global GHGs.  

Those commitments would reduce the health impacts from outdoor air pollution, related to vehicle emissions as well as unsustainable waste burning, including of plastics.  Improved access to electricity at household level would similarly reduce air pollution from biomass burning very significantly. But air pollution is not mentioned as a benefit of the NDC actions. 

Summary of Kenya’s NDC commitments: They would yield far-reaching benefits to health, even if these are not explicitly measured.

Weak commitments contrast with temperature rises 

The NDCs are all the more critical this year, insofar as in 2024, global surface temperatures surpassed 1.5°C above pre-industrial levels for the first time, making it the warmest year on record. Several multilateral studies have warned that surpassing this mark would have catastrophic effects on both human health and the environment. However, by scaling up interventions, up to 1.9 million premature deaths could be prevented annually.

Although CO2 has been the primary focus of climate mitigation efforts, experts at the Second WHO Global Air Pollution and Health Conference in Cartagena, Colombia, urged the adoption of integrated strategies to also target super pollutants, which significantly contribute to global warming, but also disappear from the atmosphere within weeks or a few years, as compared to the centuries for CO2. Reducing emissions of super pollutant gases and particles, including methane, black carbon and ozone, can thus yield quick gains for slowing temperature rise. 

“These actions involve setting targets to reduce climate impacts on health and highlighting the co-benefits of climate action, such as in the forestry, water, and energy sectors. These would help facilitate inter-ministerial coordination, which remains a challenge in many countries’ climate plans,” Fabio Aleina, a senior consultant on climate adaptation and co-author of the GCHA report, told Health Policy Watch in an interview.

In 2024, global average surface temperatures rose 1.5C above the 1850-1900 pre-industrial mark for the first time in history.

Action to mitigate air pollution

Last year, the first-ever UN Climate Change global stocktake, a process to evaluate parties’ collective progress towards the goals of the Paris Climate Agreement, called for more ambitious emission reduction targets  spread out across the economy.

Recent NDC submissions such as Kenya’s show that countries are indeed diversifying strategies to curb emissions, including commitments to more sustainable management of waste, waters, forest and ecosystems, which can yield multiple cascading health benefits over time. 

The plan aims to increase tree cover through afforestation while reducing deforestation to curb emissions from the dominant AFOLU (combined agriculture, land use change and forestry) sector, as well as integrating other nature-based solutions for better ecosystem management.

The UK government has also placed significant focus on decarbonising the transport sector, a step expected to result in significant reductions in air pollution. For its industries, the UK will continue using the Best Available Techniques (BAT) framework to ensure the adoption of sustainable methods that reduce pollution to air, water and soil.

Brazil, the host of COP30 in November, places a strong focus on combating deforestation as a central strategy in its NDC. This has direct implications for reducing wildfires linked to widespread destruction of natural ecosystems, indigenous communities, and related livelihoods, as well as big surges in hospital admissions for respiratory and cardiovascular illness. 

Brazil’s climate plan also mentions transitioning away from fossil fuels. But it remains silent about new oil extraction plans, muddying its climate pledges with recent approvals for new offshore oil drilling near the sensitive Amazon River mouth, despite warnings from expert advisors.  The Senate recently passed legislation, dubbed the “devastation bill”, that severely curtails the Environment Ministry’s regulatory powers by allowing companies to self-license projects, or avoid environmental reviews altogether, including for road and dam construction.

The Brazilian NDC also lacks explicit reaffirmation of a zero deforestation by 2030 pledge, that was a hallmark of the 2021 UN Climate Conference (COP26).

Other nations take varied approaches 

Brazil’s NDC has targeted deforesation, while other countries take varied approaches.

New Zealand’s climate plan addresses several super pollutants, but its emission reduction target of 51–55% below gross 2005 levels by 2035 has been described as “shockingly unambitious,” as it only represents a 1% increase from its 2030 goal.

Japan remains heavily dependent on fossil fuels for electricity, which increases air pollution risks. In 2021, 80,000 deaths were attributed to air pollution (PM2.5) in Japan, with fossil fuels contributing to 31% of these deaths.

The United Arab Emirates NDC enhances transparency, through the development of a national monitoring system for greenhouse gases and air pollutants. Panama’s NDC emphasises renewable energy and active transportation, while Uruguay’s climate plan highlights fiscal incentives to promote electric mobility and sustainable transport.

In North America, Canada, an early mover towards the phase out of coal-fired electricity by 2030, is implementing regulatory measures to make its fuel less polluting and ensure a growing supply of zero-emission vehicles. 

The United States’ climate plans also showed a commitment to significantly cut emissions, including methane reductions and other super pollutants.

However, the US commitment to international climate agreements has seen a 180 degree about-face under new President Donald Trump, whose “drill baby drill” slogan has become a rallying cry for the fossil fuel industry.  On his first day in office, Trump issued an executive order to initiate the process of withdrawing the US from the 2015 Paris Agreement, that sent the 1.5C° benchmark for limiting global warming.

The outlook for climate action is notably more positive for its northern neighbor under Canada’s newly-elected Prime Minister Mark Carney.

Fabio Aleina, Co-author of the GCHA Report

Even so, the broader emission reduction targets of the NDCs submitted so far fall short of the goal to limit global warming, with the UK as the exception, as its target is deemed compatible with the 1.5°C limit.

“What makes the UK’s approach worth emulating by other high-emitting countries is its top-down approach. This collaboration is essential, as health outcomes and indicators can vary from one part of the country to another, making it important to involve local governments in aligning strategies with these indicators,” says Aleina. For instance, local authorities in the UK work with the government to ensure that legal limits for pollutants like nitrogen dioxide are met.

Growing climate finance gap

The US directly funded 8% of global climate finance in 2024.

The World Bank estimates that halving the global population exposed to average annual PM2.5 levels above 25 micrograms/cubic meter of air (25µg/m3) by 2040 would require increased annual investments in clean air from $8.5 billion in 2020 to $13.9 billion in 2040. That would save some two million lives annually from outdoor air pollution in the worst polluted cities and locations on earth. The WHO guideline limit is 5 µg/m3.

However, financial commitments to climate action have been disappointing over the years, with the US – one of the major contributors to climate finance – exiting key climate agreements, further straining resources.This reduction in funding particularly affects countries’ conditional climate targets, which are emission reduction efforts dependent on external financial support.

“The US exit could have a significant impact,” says Aleina. Notably, in 2018, following US President Donald Trump’s first attempt to withdraw from the Paris Agreement, the International Energy Agency reported a 1.7% increase in global CO2 emissions from energy-related sources, reversing three years of consistent declines.

“Without the corresponding financial commitment, countries might continue to struggle to improve their climate ambition,” says Aleina.

With nearly 90% of the parties to the Paris Agreement yet to submit their national climate plans, United Nations (UN) climate chief Simon Stiell has extended the deadline to September, just ahead of the NDC Synthesis Report, which will be released before COP30 in Belem, Brazil. 

“From the conversations I’ve been having, countries are taking this extremely seriously,” said Stiell  in February. “So, taking a bit more time to ensure these plans are first-rate makes sense.”

Image Credits: Markus Winkler/Unsplash, Climate Tracker , Global Climate and Health Alliance , Kenya NDC – 2031-2035, EC/Copernicus , Dirk Erasmus/Unsplash , Carbon Brief .

A health facility in Sopore in Kashmir’s Baramulla district. Mental health facilities are scarce in Kashmir.

SRINAGAR, India – Areeba* tucks a strip of tiny blue pills into the back of her mathematics textbook before heading to class. It’s become second nature.

“Half when I can’t sleep. One if I can’t walk,” says the 22-year-old university student, her voice calm, as if describing a cold remedy. “I don’t really want to take them, but it’s the only way to get through the day.”

Across Kashmir, India’s northernmost and politically volatile region, young people are self-medicating to cope with anxiety, sleeplessness and depression. The strains of decades-long conflict, repeated lockdowns, and recent flare-ups–including a drone strike and extended power blackouts during cross-border tensions in May–have left many struggling to find mental health care.

While India’s National Mental Health Mission has expanded services across several states, Kashmir remains critically underserved. With limited access to therapists, trained counsellors or psychiatrists, antidepressants, sedatives and illicit narcotics have become people’s primary coping mechanisms and are often obtained without prescription or follow-up.

Panic attack in the dark

Zubair Iqbal, a 20-year-old undergraduate in Sopore, recalls the night of 9 May vividly: “It was around 9pm. I had packed my bag for a flight to Delhi the next morning. “But because of the tension with Pakistan, it got cancelled. My mother came and said, ‘Zubair, come downstairs – we’ll eat in the blackout’.”

Iqbal was puzzled when the power went out, then heard what felt like “a thousand thunderstrikes.”

“My brother said it was just thunder, but I knew it wasn’t. It was a drone attack.”

He collapsed inside the house. “My legs were shaking. I couldn’t see properly. My heart was racing. I thought I was dying.”

The next day, he asked his father if he could see a doctor.

“My father said, ‘We won’t travel 40 kilometres to Srinagar for this. It’s nothing–you were just scared. Let’s go to the peer sahib (faith healer).’ I wanted to cry.”

Instead, Iqbal looked online for the name of an antidepressant, then went to a local pharmacy and bought it over the counter.

Hidden in plain sight

A clinical psychologist in downtown Srinagar, who requested anonymity because of workplace restrictions, says Zubair’s experience is typical.

“Because of the conflict and some of the highest unemployment rates in India – female unemployment here is 53.6% – symptoms of trauma are normalized,” she says.

She sees over 100 patients a day, many adolescents.

“Every other teenager between 15 and 18 reports some mental health concern. Many fear the schools will close again if the war escalates. Others worry their parents will lose their jobs. But very few actually seek therapy.”

Her observations reflect existing data. A 2015 survey by humanitarian group Médecins Sans Frontières (MSF) found that 1.8 million adults in Kashmir’s valley – about 45% of the population – experienced significant mental distress. Almost one in five people showed symptoms of post-traumatic stress disorder. Meanwhile, 41% of women and 26% of men showed symptoms consistent with depression, according to the study.

According to government Census figures from 2011, there were just 41 psychiatrists for the entire Jammu and Kashmir region, home to 12.5 million people. 

Mental health experts believe that the number has barely doubled in the past 14 years, leaving much of the population without access to specialized care.

Médecins Sans Frontières teams raise awareness about mental health in Kashmir.

‘We were just trying to survive’

Kubra Aziz, 24, lives in Uri, a village just 3km from the Line of Control, the heavily militarized border with Pakistan. She fled with her family to Baramulla during recent shelling in May.

“We left at night,” she recalls. “My cousin, who has a history of mental illness, began hyperventilating.”

They took shelter in a local college, where Kubra says her cousin screamed all night.

“The next morning, I took her to the district hospital, but the psychiatrist was on leave.”

That, she says, is routine: “Even when there’s a doctor, they may have 1000 patients. They’re overwhelmed. Misdiagnoses are common.”

In the absence of therapy, many Kashmiris turn to pills and substances – prescribed or not.

“Most people either buy psychiatric medication from pharmacies or turn to charas, tobacco, or anything that numbs the brain,” Kubra says.

One young man, Nadeem*, left Kashmir for Saudi Arabia three years ago.

“I was unemployed and addicted to hash. My family thought leaving Kashmir would help,” he says.

He quit drugs after moving abroad, but returned home recently amid renewed violence.

“The stress is back. I’m trying to hold on. But I don’t know how long I’ll last.”

A 2022 report from Kashmir’s only government-run drug de-addiction centre showed a 2,660% increase in patients since 2016. Doctors say most patients are not recreational drug users, but they are self-medicating trauma.

“I plan to leave again,” Nadeem says. “People from age 10 to 40 are trapped in addiction. Just look at the schoolkids.”

No therapists in schools

Residents of Kashmir seek health at one of the health facilities in the region during recent conflict between India and Pakistan.

Aman Bhat, a 17-year-old high school junior in Budgam district, says his missionary-run school has no mental health services.

“We don’t have a counsellor,” Bhat says. “If someone is anxious or depressed, there’s no one to talk to. Mental health is something we don’t even have words for here. We say, ‘My heart feels heavy.’ That’s it.”

Many of his classmates chew tobacco to manage stress. “What else can they do?”

In villages, Bhat notes, “We don’t have real hospitals like other parts of India. What do we have?”

Learning from Gujarat

Despite the scale of Kashmir’s mental health crisis, the region lacks community-based support models proven successful elsewhere in India, such as the Atmiyata program, which means “shared compassion” in Marathi.

Atmiyata was launched in Mehsana district of Gujarat in 2017 which comprises of 645 villages. Atmiyata Mitras – trained community volunteers – identify people in distress and provide up to six sessions of basic, evidence-based counselling in homes or local temples.

Volunteers use smartphones to screen culturally relevant films about unemployment, alcoholism, domestic violence, and other root causes of mental distress – issues that are difficult to talk about.

When symptoms exceed what a volunteer can handle, Mitras guide patients through India’s District Mental Health Programme, even accompanying them to clinics.

Because mental health and poverty are often intertwined, Mitras also help families apply for disability pensions, job schemes and social benefits.

What Kashmir needs now

“If the recent trauma in Kashmir has taught us anything, it’s that medication alone is not the answer,” says Dr Sameena Qadri, a South Asia-based public health psychiatrist. 

“Antidepressants and sedatives offer short-term relief. But without therapy, follow-up care and social support, the root causes remain untouched.”

This conversation is urgent as global leaders prepare for the UN High-Level Meeting (HLM) on Non-Communicable Diseases (NCDs) and Mental Health on 25 September. The meeting aims to ensure that 150 million more people worldwide gain access to affordable mental health care by 2030.

The HLM zero draft includes the target of 80% of public primary health care (PHC) facilities having essential mental health medicines and technologies available by 2030.

“These targets sound ambitious,” Qadri says. “But they must be grounded in places like Kashmir, where the mental health crisis is visible in pharmacies, schools and homes.”

She advocates for a multi-tiered, district-wide care system, with trained community volunteers delivering support and referring severe cases. She also calls for mobile mental health clinics and tele-psychiatry.

“School-based counselling is essential, especially in conflict zones. Children grow up with trauma and no outlet. Without care, we risk losing a generation.

“These aren’t luxuries,” she says. “They’re urgent needs.”

Call for global partnerships

“We need partnerships between governments, civil society and global health organizations to scale community care. The most vulnerable can’t wait for a perfect system. They need access now,” Qadri urges.

“Mental health is not a luxury. It’s dignity. You can’t talk about peace or sustainable development while millions suffer in silence.”

Kubra agrees: “We always talk about peace. But how can there be peace when people are breaking inside, and no one hears them?”

Until models like Atmiyata are adapted to Kashmir and scaled, young Kashmiris will continue to medicate their distress in silence – behind schoolbooks, in back-alley pharmacies and bedrooms darkened by blackout curtains, both literal and emotional.

*Not their real names.

 

Image Credits: MSF, Arshdeep Singh.

Dr Louisa Dunn, an investigator on the TB PRACTECAL clinical trial, consults with a patient.

In Nukus, Uzbekistan, 34-year-old surgical nurse Dilaram was devastated when she was diagnosed with drug-resistant tuberculosis (DR-TB). 

But instead of facing the standard treatment, including nearly 15,000 pills to be taken over two years and painful injections causing severe side effects, she could enrol in TB-PRACTECAL, the MSF-led clinical trial testing an all-oral, six-month regimen for DR-TB. 

After completing treatment with virtually no side effects, she returned to work and to caring for her two young daughters. This trial transformed her TB treatment journey and recovery. 

This profound revolution in her treatment journey is not a coincidence.  It is a result of years of dedicated clinical research, shaped by experiences of people like her and driven by significant contributions and efforts from public and non-profit organisations working closely with people affected by TB in low-resource settings.

TB-PRACTECAL, a landmark clinical trial led by Médecins Sans Frontières (MSF), not only identified an all-oral, six-month regimen for DR-TB,  but it is also the first clinical trial for which the detailed costs, €33.9 million, were published in the journal PLOS Global Public Health. 

This stands in stark contrast to the opaque norms of pharmaceutical research and development (R&D), where there is no transparency about what it costs to develop new medicines although high drug prices are often justified based on high R&D costs.

This moment is more than a medical milestone. It marks a critical step toward accountability in medical innovation and demonstrates  to all stakeholders that transparency in R&D is both possible and essential. 

When costs are hidden, governments—and organisations like MSF that purchase medical products—lose the leverage to negotiate affordable prices. We therefore ask: what does the pharmaceutical industry have to hide? If their costs are truly high, why not publish them? They refuse because transparency would undermine their ability to charge whatever prices they like, even for lifesaving TB medicines.

Costs of TB-PRACTECAL clinical trial

TB-PRACTECAL was a phase 2b-3 adaptive trial, which means it was designed to test how well different treatments work and confirm those results in a larger group of people, while also adapting the study design over time based on early results. 

The trial tested three new regimens for DR-TB against the standard of care. The total cost of €33.9 million was further broken down into 27 cost categories, enabling a detailed analysis of the key cost drivers of the trial.

Current estimates for the full R&D costs of developing a new drug range from €40 million to €3.9 billion, depending on the methodology used. Estimates for phase 2 and phase 3 pharmaceutical clinical trials alone range between €4.7 and €133 million. 

While the overall cost of TB-PRACTECAL fits within this range, several factors pushed its cost higher. These include the fact that it was both a phase 2b and phase 3 trial combined, it included multiple sub-studies, ran for a long duration of five years, and required significant investment in health facilities and infrastructure to carry out the trial. Medicine costs were also high. The cost of Bedaquiline alone made up 46% of all medicine expenses.

Breakdown of the cost of the TB-PRACTECAL trial.

Why transparency matters

The TB-PRACTECAL trial was conducted in resource-limited settings in South Africa, Uzbekistan, and Belarus – countries with a high prevalence of DR-TB. In 2022, the trial confirmed that a shorter, all-oral regimen using bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) could treat patients in six months or less, with significantly higher cure rates and fewer side effects compared to the previous 18–24 month regimens that relied on painful injections and caused severe side effects. 

After publication of the trial results, the World Health Organization (WHO) recommended the regimen as the preferred treatment for rifampicin-resistant TB. It has since been adopted for use in 40 countries. Sustained advocacy by TB activists and MSF played a crucial role in pushing for price reductions of key newer drugs, including bedaquiline and pretomanid, making broader rollout of this regimen possible.

Historically, pharmaceutical companies have justified sky-high drug prices under the pretext of recouping R&D expenses without ever disclosing the actual costs. For life-threatening diseases like TB, this secrecy costs lives.

MSF and TB activists witnessed this with bedaquiline, a core drug that is now an essential part of all DR-TB regimens. Although it was developed with substantial public funding, the pharmaceutical company Johnson & Johnson charged an exorbitant price, citing the need to recoup high R&D costs and sustain future innovation. 

Academic research showed that public investment in bedaquiline was up to five times greater than private investment. Civil society and health advocates used this information to successfully push for a price reduction. 

This transparency marked a turning point in the fight for access to this medicine and demonstrated the critical role of R&D cost transparency in enabling affordable access. The justification of high prices due to high R&D costs is a recurring argument from the pharmaceutical industry that MSF has encountered repeatedly when addressing the high cost of lifesaving medicines. 

This can no longer remain an evidence-free zone, which is why MSF chose to play its part by publishing the detailed cost breakdown of the TB-PRACTECAL trial.

We are calling on all funders and implementers of clinical trials – governments, product-development partnerships (PDPs), philanthropic organisations, academics, institutions, and pharmaceutical companies – to publicly disclose their R&D costs. MSF has developed a Clinical Trial Cost Reporting Toolkit to support publishing clinical trial costs, building on our own experiences.

Medicines shouldn’t be a luxury

Every year, 1.3 million people die of tuberculosis, making it the world’s deadliest infectious disease, disproportionately affecting people in low- and middle-income countries. Countries like India, which bear the world’s largest burden of TB and DR-TB, need timely access to the latest WHO-recommended treatments at affordable prices. However, exorbitant pricing has long stood in the way of widespread implementation of these regimens.

Without generic competition, national TB programmes struggle to widely implement updated WHO guidance on treatments that rely on newer, and often more expensive drugs.

The global community cannot afford another delay like the one we saw with bedaquiline, where people with DR-TB in low- and middle-income countries were left behind for over a decade. To truly end TB, we need to dismantle the barriers of cost, control, and corporate secrecy that continue to undermine access.

What needs to change

At MSF, we do not accept funding from pharmaceutical companies. From the front lines of conflict to work done with communities battling epidemics, our work is rooted in compassion, equity, and medical ethics. 

We took a big step to openly share our trial costs because we believe that when public resources are used, the public deserves accountability.

We urge the global health community to support transparency in medical R&D. We ask all stakeholders to recognize that transparency is not a threat but a lifeline. Without it, access to care remains a privilege for the few; with it, it becomes a shared responsibility to protect the many.

Six years ago, the World Health Assembly adopted the transparency resolution that urges all member states to “take appropriate measures to publicly share information on the net prices of health products”.  

All governments must take urgent steps to enact legislation mandating the disclosure of disaggregated R&D costs, including clinical trial costs, especially where the R&D has received public funding.

We will keep speaking out against systems that put profits ahead of people—because no one should be left to suffer, or die, from a disease that could be treated, simply due to hidden costs. Secrets cost lives.

Farhat Mantoo is the Executive Director of Médecins Sans Frontières (MSF) South Asia, with over two decades of leadership experience in humanitarian operations across Asia, Europe, and East Africa.

Bern-Thomas Nyang’wa is the Medical Director of Médecins Sans Frontières (MSF) Netherlands. He was the Chief Investigator of TB-PRACTECAL and has extensive TB clinical, programmatic and research experience.

 

Image Credits: Oliver Petrie/ MSF.

An oil rig operates off the coast of Denmark.

Over 30 health organizations representing 12 million doctors, nurses, and public health professionals globally have pledged to no longer work with advertising agencies that partner with the fossil fuel industry, citing conflicts of interest and the resulting health effects from industry disinformation campaigns.

The organizations span five continents and include prominent groups such as Médecins Sans Frontières, The Lancet, the World Organisation of Family Doctors, and the Yale Centre on Climate Change and Health.

For decades, oil and gas companies have employed PR and lobbying tactics strikingly similar to those of the tobacco industry: seeding doubt about established science, creating front groups, and pushing misleading narratives to stall regulation despite overwhelming evidence that fossil fuel pollution harms human and planetary health.

Yet many of the same PR and advertising agencies employed by health groups to promote healthy habits, vaccinations, and cancer prevention have continued partnering with fossil fuel companies, spreading misleading messages that downplay or deny these health harms and delay action needed to curb emissions.

“The same PR firms spreading fossil fuel disinformation are also working with health organizations—a clear conflict of interest for health,” said Shweta Narayan, Campaign Lead at the Global Climate and Health Alliance (GCHA). “Fossil fuels are making us sick, and the companies behind them are spending millions on advertising and PR to cover it up.”

Air pollution from fossil fuel combustion causes more than five million premature deaths annually. Burning oil and gas has been linked to increases in respiratory illnesses, cardiovascular diseases, cancers, and adverse pregnancy outcomes.

“As health professionals guided by humanitarian values, we have a responsibility to speak out when public health is under threat,” said Dr Maria Guevara, international medical secretary for Médecins Sans Frontières. “Fossil fuels are at the heart of a growing global health crisis, and the PR and advertising firms that help obscure this reality undermine efforts to protect lives.”

Cutting ties 

Royal Dutch Shell headquarters in The Hague, Netherlands.

The health sector often relies on professional advertising and PR services for public health messaging, including cancer awareness, infectious disease prevention, and vaccine uptake.

In 2020, the World Health Organization hired Hill+Knowlton to fight COVID-19-related disinformation. Scientists and environmental groups have widely criticised the company for its oil and gas portfolio, including clients ExxonMobil, Shell, Chevron and Saudi Aramco.

Edelman, the world’s largest PR company with over $1 billion in revenue, exemplifies this contradiction and the scale of the challenge.

The company assembled a task force of global health and pharmaceutical companies, including Novo Nordisk, GSK, and Roche to “accelerate the transition to net zero health systems” in India and China—a campaign hailed as groundbreaking public-private collaboration.

Yet Edelman won the bidding war for Shell’s worldwide public relations account in 2024, extending their decades-long relationship in a deal worth tens of millions—one of the agency’s most lucrative contracts. In March, Shell abandoned a key climate target for 2035 and weakened another goal for 2030.

While Edelman publicly states it “believes climate change is the biggest crisis we face as a society,” the firm creates “innovative promotional campaigns” for Shell, including a video game where users imagine themselves as engineers “keeping the lights on.”

The Climate Investigations Center describes Edelman as “the dominant PR firm for trade associations that promote an anti-environmental agenda.”

“Just like health leaders once stood up to Big Tobacco and its advertising, it’s time to stand up to Big Oil,” said Jeni Miller, GCHA executive director. “Organisations are demonstrating that they won’t help spread fossil fuel disinformation, and will use every tool they have, including their ad and PR dollars, to protect people’s health and the planet.”

Building on healthcare’s trusted voice

Ipsos Global Trustworthiness Index 2024.

With doctors and nurses consistently ranked among the world’s most trusted professions, advocacy groups believe their voices are essential to reframing fossil fuels as a health crisis rather than just a climate issue.

“We are trusted voices in the community,” said Dr Viviana Martinez Bianchi, president-elect of the World Organization of Family Doctors. “We are uniquely positioned to inform, explain, and speak about the equity implications. We can counteract this disinformation and mobilize public understanding and action.”

The decision to cut ties with these PR firms aligns with a broader movement to place health at the heart of climate policy and counteract the “commercial determinants of health,” where corporate practices from sectors like tobacco, ultra-processed food, and fossil fuels shape conditions for disease.

“We see the effects first-hand in vulnerable populations,” Bianchy explained, citing patients with asthma exacerbations, cardiovascular conditions, and poor respiratory health, all linked to pollution exposure.

Decades of scientific studies have linked fossil fuel activities to rising rates of asthma, heart disease, heat-related illness, infectious disease spread, and mental health stress during climate-related disasters—evidence that health professionals say has forced them to act.

“We, the health community, have a duty to warn humanity about the profound health harms from burning fossil fuels and to act on that knowledge,” said Edward Maibach, Director of the George Mason University Center for Climate Change Communication. “We must refuse to work with any marketing agency that works with fossil fuel companies.”

Industry disinformation campaigns

Plastic waste sorting
Over 30 metric tonnes of plastic are burned each year, mostly in lower and middle income countries, leaving millions exposed to toxic air pollutants.

For over fifty years, fossil fuel companies have run multi-billion-dollar campaigns to misinform, lobby, and confuse the public about the climate crisis, varying their messaging strategy by region and audience.

In the global North, these tactics focus on “greening” the gas industry by positioning fossil fuels as climate solutions.

The playbook includes shifting blame to individuals through concepts like the personal carbon footprint, which British Petroleum popularised in 2004 with a calculator that encouraged people to tally up how their morning commute, grocery runs, and vacation flights were heating the planet.

The industry also championed plastic recycling, rolling out blue bins across American driveways while chemical giants like Chevron, DuPont, and Exxon knew the technology to recycle at scale did not exist.

Plastics are now a key justification used by nations and companies to pursue higher fossil fuel production, even though only 9% of plastic ever produced has been recycled. The technology to recycle complex polymer plastics at scale still does not exist decades later.

In the global South, fossil fuel-producing nations and companies promote oil as essential for economic and sustainable development, according to Vivek Parekh, an analyst with London-based climate risk think tank Influence Map.

Saudi Arabia made this argument while trying to block the climate resolution at last week’s World Health Assembly, saying: “As an oil producing sector, we are aware of our role in [energy] transformation, but can’t ask developing countries to pay the price for transformation when they are not responsible for the problems.”

Saudi delegate explains their take on the WHO Climate Change and Health action plan in WHA debate.

“The fossil fuel industry dominates the lobbying landscape,” Parekh said. “What we see is the industry’s attempt to weaken and obstruct climate policy, despite clear economic, health and climate benefits.”

At major UN climate conferences, fossil fuel lobbying groups have dramatically outnumbered health organizations. Nearly 2,500 fossil fuel lobbyists attended COP28 in Dubai—more than delegates from the ten most climate-vulnerable nations combined.

At November’s plastic treaty negotiations, 220 fossil fuel and chemical industry lobbyists descended on Busan, forming the largest single delegation and outnumbering host South Korea’s 140 representatives as well as the European Union and its 27 member states.

The oil giants got what they came for, successfully derailing what was meant to be the final treaty adoption session by opposing any caps on plastic production.

This strategy has led UN Secretary-General António Guterres to call fossil fuel companies the “godfathers of climate chaos.”

“It’s an almost comical conflict of interest that Big Oil’s spin doctors are also in charge of communications for the UN climate talks,” Dr. Geoffrey Supran, a Harvard researcher who studies fossil fuel disinformation tactics, told environmental news website DeSmog.

Despite some victories, including a Dutch court upholding The Hague’s ban on fossil fuel advertising and Energy Australia apologizing for greenwashing, greater transparency is needed as the industry’s activities continue undermining climate action.

“We can’t be neutral,” added Dr. Jemilah Mahmood, executive director of Malaysia-based Sunway Centre for Planetary Health. “Our Hippocratic Oath goes beyond just treating disease to preventing it.” Like the tobacco industry, she argued, fossil fuel companies “manipulate the truth,” leaving marginalized communities polluted and vulnerable to health risks.

Image Credits: CC, IPSOS, SweepSmart.