Bill Gates observes a device used for analyzing the nutrient qualities of rice during the Innovation Tech & Science Fair in Abuja, Nigeria, on September 4, 2024. ©Gates Archive/Andrew Esiebo

On its 25th anniversary, the Gates Foundation has announced that it is winding down – but in 20 years’ time, during which it expects to spend $200 billion.

“During the first 25 years of the Gates Foundation – powered in part by the generosity of Warren Buffett – we gave away more than $100 billion. Over the next two decades, we will double our giving,” said Bill Gates,  foundation chair in post on Thursday.

“The exact amount will depend on the markets and inflation, but I expect the foundation will spend more than $200 billion between now and 2045.”

The funding pledged exceeds the foundation’s current endowment, with the balance coming over time from Gates’ personal fortune.

‘The man who dies rich dies disgraced’

Gates said he did not want to “die rich”, but that he had initially planned for the foundation to wind down decades after his death.

However, he was influenced by an 1889 essay by Andrew Carnegie called The Gospel of Wealth which “makes the case that the wealthy have a responsibility to return their resources to society” and argues that “the man who dies thus rich dies disgraced.”

This notion is as radical today as Carnegie’s article was then, given the era of widening wealth inequality and the concentration of wealth in fewer and fewer hands.

The foundation’s charter initially stated that the organisation would sunset 20 years after Gates’ death.

“There are too many urgent problems to solve for me to hold onto resources that could be used to help people. That is why I have decided to give my money back to society much faster than I had originally planned,” writes Gates.

“I will give away virtually all my wealth through the Gates Foundation over the next 20 years to the cause of saving and improving lives around the world.”

The foundation intends to “much progress as possible towards three primary goals”:

  • ending preventable deaths of mothers and babies;
  • ensuring the next generation grows up without having to suffer from deadly infectious diseases;
  • and lifting millions of people out of poverty, putting them on a path to prosperity.

Additional areas of focus will continue to be:

  • helping US students to prosperity; 
  • strengthening digital public infrastructure so more people have access to the financial and social services that foster inclusive economies and open, competitive markets
  • applying new uses of artificial intelligence, which can accelerate the quality and reach of services, from health to education to agriculture
  • Lifting up women, their families, and their communities by advancing gender equality to help women access education, health care, and financial services.

“Underpinning all our work—on health, agriculture, education, and beyond—is a focus on gender equality. Half the world’s smallholder farmers are women, and women stand to gain the most when they have access to education, health care, and financial services,” Gates notes.

Parents learn how to access information about contraception on their smartphones during a session on family planning in Makassar, Indonesia.

Urgency and opportunity

This announcement comes in the midst of tens of billions of dollars in cuts to aid funding “that stand to have devastating consequences for the world’s poorest people”, according to the foundation

“The shift in the sunset date is driven by urgency and opportunity. The foundation hopes to capitalise on the extraordinary global progress in health and development between 2000 and 2025—a period when child deaths were halved, deaths from deadly infectious diseases were significantly reduced,” according to a media release from the foundation.

“The needs at this time are greater than any we’ve seen in the lifetime of the foundation, but the achievements of the past 25 years have shown the tremendous progress that is still possible,” said Mark Suzman, CEO and board member of the Gates Foundation. 

Since 2000, the Gates Foundation has contributed to saving 82 million lives through its support for the vaccine alliance, Gavi, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

“Along with Rotary International, we have been a key partner in reviving the effort to eradicate polio. We supported the creation of a new vaccine for rotavirus that has helped reduce the number of children who die from diarrhoea each year by 75%,” wrote Gates.

The foundation has also helped develop more than 100 innovations, including vaccines, diagnostic tools, and treatments to address pressing global health problems.  

“The truth is, there have never been more opportunities to help people live healthier, more prosperous lives. Advances in technology are happening faster than ever, especially with artificial intelligence on the rise,” writes Gates. 

“Even with all the challenges that the world faces, I’m optimistic about our ability to make progress—because each breakthrough is yet another chance to make someone’s life better.

 “The work of making the world better is and always has been a group effort. I am proud of everything the foundation accomplished during its first 25 years, but I also know that none of it would have been possible without fantastic partners,” says Gates. “I believe we can leave the next generation better off and better prepared to fight the next set of challenges.”

Image Credits: ©Gates Foundation/ Prashant Panjiar, Andrew Esiebo/ Gates Archive, Gates Foundation.

WHO Director General Dr Tedros Adhanom Ghebreyesus’ Senior Leadership Team in January 2025.

Samira Asma, assistant director of Data, Analytics and Delivery since 2020, is reportedly leaving WHO in the first of an expected departure of five senior leadership team members as the Organisation sets out to dramatically shrinks its Geneva footprint and staffing. 

Of the existing 11-member team, only six would remain, if a plan shared by Director General Dr Tedros Adhanom Ghebreyesus with WHO Staff and Member States in late April is implemented in full.

The re-organization would shrink WHO’s 10 operations and programme divisions to just four. The office”s of “Chef de Cabinet” (External Relations) and “Chief Scientist” would round out a total of six senior leadership positions, as well as the director general. 

WHO ADG Samira Asma, a US national, has been at WHO since 2018. She previously led NCD and tobacco control work at the US Centers for Disease Control (CDC).

In terms of DDI, not only would the division be eliminated, but its activities would be subsumed into a single department that also includes: “Digital Health, AI, AI and ICD” (International Classification of Diseases) alongside “health metrics.” That carries a mandate so broad as to be difficult to unravel.

It’s also unclear what would happen to WHO’s new World Health Data Hub and Geospatial Centre, featured on the WHO website as a “world class interactive data platform” and a flagship DDI initiative. Despite the time and resources spent, their promised objectives have not, so far, been met, critics say.

But the recent collapse of USAID and probable dissolution of the USAID supported Demographic and Health Surveys series, which financed bread and butter data collection in low- and middle-income countries for decades, may force WHO to go refocus on a much more fundamental task that involves helping the world’s poorest nations report accurate baseline data on key health indicators – also critical to WHO’s mandate tracking the health-related Sustainable Development Goals.  

Question-marks?  

Yukiko Nakatani, ADG of Access to Medicines, is a former director of the Cancer Division in Japan’s Ministry of Health.

According to other still-unconfirmed reports, the pending leadership reshuffle is also likely to see the departure of Yukiko Nakatani, ADG of WHO’s Division of Access to Medicines and Acting ADG for the Division of Antimicrobial Resistance (AMR). Both divisions are to be folded into a consolidated “Health Systems” Division, which will also address a wide range of functions with respect to WHO product standards, health workforce, primary health care, finance and governance; as well as digital health.  

New WHO Organizational plan reduces 10 divisions at headquarters to just four.

Finally, there are question marks over the continued tenure of the ADG for Universal Health Coverage and Life Course, Dr Bruce Aylward, a Canadian physician who played a major role in the early days of WHO’s COVID response, as Tedros’ special advisor at the time. 

Bruce Aylward in February 2020 shows reporters China’s COVID infection curve in relation to lockdown measures – after leading the first WHO delegation to Wuhan.

Aylward has also served in a wide range of WHO roles since first joining in 1992, including as a past leader of polio eradication, Ebola response, WHO Health Emergencies, WHO’s Transformation Initiative, as well as key aspects of the Organisation’s COVID-19 response. Now, the 10 departments of the UHC and Life Course division that he now heads are set to be parcelled out to two other WHO divisions, as well as being merged with other departments. But Aylward is reportedly pushing back against leaving – and no formal announcements have been made yet, even internally.

“To my knowledge there’s been no final decision on the final leadership team,” one WHO insider told Health Policy Watch. “And when you take these political level/appointment roles, you are serving at the DG’s discretion – that is part of the deal.  He’s got to balance a heap of considerations in putting together his team.”

The new WHO austerity plan would also eliminate the role of WHO Deputy Director, now held by Mike Ryan in tandem with his role as Executive Director of WHO’s Health Emergencies Division.

Ryan, however, is likely to continue on in his old role as Health Emergencies Executive Director during this tumultuous phase in WHO’s history, other WHO observers  predicted. This, despite reports a year ago that Ryan, age 60, was considering early retirement. 

Asked by Health Policy Watch for a response to the early reports of the leadership reshuffle, WHO did not comment. As for an official announcement by the Director General of his new team, a WHO spokesperson said:  

“We don’t know ourselves, but we expect it before the WHA”  – referring to the 78th World Health Assembly meeting of WHO member states, which begins on Monday, 19 May. 

EU member states ask if even a $4.2 billion budget is feasible? 

Budget projection and gap from an internal briefing presented to member states in late April 2025.

Along with shrinking the number of divisions in WHO’s Geneva headquarters from 10 to four, the new WHO reorganisation would cut the number of departments at headquarters by roughly half – from 57 full-fledged departments as of January 2025 to around 33, according to the new organigram. The number of directors at headquarters would be slashed by more than half, from 76  to 34, according to Tedros, speaking at a WHO Town Hall on 22 April.

The announcement in January by US President Donald Trump that he was withdrawing support from WHO thrust the global health agency into a deep budget crisis, with roughly 15-20% of the agency’s annual budget dependent on US voluntary and assessed contributions.  

In April, WHO’s leadership revealed that the organisation was facing a $600 million budget deficit for 2025, including a salary gap of about $333 million, one half of that at headquarters. 

For the upcoming 2026-2027 biennium, the problems are even more severe, with an estimated  $1.8-1.9 billion deficit projected over the two-year budget period.  Since the crisis began, WHO officials have reduced their 2026-27 projected budget from $5.3 billion to $4.9 and then $4.2 billion as of May 2025.  

But in a WHO member state briefing on 22 April, European Union member states questioned if even the $4.2 billion budget target is feasible, in light of the current circumstances.   

“Is this a realistic budget scenario? Can WHO advise on progress towards the $1.8 billion target [of additional fund-raising], and provide details on the actions to achieve this?” the 27 EU members asked in a joint statement. 

“The information provided suggests cost savings from reorganisation and administrative cost containment could generate significant additional savings to reduce the financial gap. What are the realistic forecasts for such savings? Can the Secretariat provide details on the amounts expected?” the EU member states asked. 

UNAIDS says no merger with WHO in cards

The EU delegation also called on WHO to “lead” inter-agency reform of the UN’s multiple, and often overlapping, health institutions, in cooperation with the UN Secretary General’s UN80 initiative. Amongst its initiatives, UN80 recently proposed consideration of a merger of the financially troubled UNAIDS with WHO as well as a merger of humanitarian aid operations on the ground.  

“We reiterate our call on WHO to lead the reform of the global health ecosystem with other UN bodies as part of the UN80 initiative and global health actors,” said the EU statement from late April. “We would welcome an update from WHO on the actions undertaken and plans with regard to the coordination of mandates and operations of key actors.”

UNAIDS, however, is pushing back hard against any proposal to fold back into WHO – despite the big financial crisis both agencies face and potential economies of scale.

“No merger is in the cards right now,” UNAIDS spokesperson Charlotte Sector, told Health Policy Watch in an email Wednesday evening, while also confirming the reports Tuesday that UNAIDS would slash its staff in headquarters along with its country presence by half or more:

“UNAIDS will cut its staff from 600 to 280-300. Instead of having a country presence in more than 80 countries, we will now have a presence in half that (35-40),” she said.

But “its mandate remains relevant as long as the epidemic continues,” Sector added, saying:

“In 1996 when AIDS deaths were at their peak, UNAIDS was founded to fill policy gaps and pick up where WHO could not. WHO and the Global Fund and PEPFAR as well as governments use UNAIDS data. UNAIDS also trains community members and others to collect and monitor local, national data.

“We will continue to be the link between communities, governments, donors and the UN as well as the Global Fund. Our data and analysis is key to saving lives because our data steers programmatic work with impact.”

See related story here:

UNAIDS and HIV Sector Struggle Amid Funding Cuts

8.5.2025 -Updated with 7 May link to 2026-2027 programme budget and number of directors WHO’s Director General pledged to reduce.

 

Image Credits: WHO , LinkedIn, LinkedIn, WHO.

Vadym, a Ukranian living with HIV, with a box of ARV medication. Ukraine’s HIV response has been severely affected by the US government’s withdrawal of funds.

As countries dependent on United States aid for their HIV response report looming shortages of antiretroviral medicine, the Joint UN Programme on HIV/AIDS (UNAIDS) is also fighting for survival.

Meanwhile, more shocks may be ahead for the HIV sector as the US Health and Human Services plans to curtail research collaboration between US scientists and foreign researchers, a common occurrence in the HIV sector.

UNAIDS is cutting full-time staff by more than half – from 608 to 280 – and almost halving country offices, from 75 to 36, according to a communique sent to staff, as reported by Devex.

This follows the Trump administration’s decision to end US Agency for International Development (USAID) funds to UNAIDS, which affects around 40% of its budget.

Further cuts may be necessary if a proposal from an internal UN task force is heeded, which would see UNAIDS merging with the World Health Organization, as previously reported by Health Policy Watch.

But Farhan Aziz Haq, deputy spokesperson for the UN Secretary General’s Office, said that the UN restructuring proposals are “the preliminary result of an exercise to generate ideas and thoughts from senior officials”. The UN80 task force will report its final recommendations to the UN General Assembly in 2026.

UNAIDS executive director Winnie Byanyima and International AIDS Society chair Sharon Lewin at the launch of the UNAIDS report in Munich

Medicines, supply chains disrupted

While UNAIDS faces an internal crisis, so too do the countries and communities worst affected by HIV that it serves.

By the end of 2023, 30.7 million people were accessing antiretroviral (ARV) treatment and 61% lived in just 10 countries – South Africa, Mozambique, India, Nigeria, Tanzania, Kenya, Zambia, Uganda, Zimbabwe and Malawi.

The US President’s Emergency Plan for AIDS Relief (PEPFAR) was one of the biggest purchasers of ARVs and the breakthrough injectable ARV, cabotegravir, that prevents HIV infection that was being rolled out as pre-exposure prophylaxis (PrEP).

PEPFAR spent almost $500 million a year on ARVs and PrEP, and any reduction in its orders is likely to push global prices up, yet another obstacle in the fight against HIV.

“Sustained predictability in HIV commodity demand forecasts is essential to guarantee a stable supply, maintain prices, and ensure the availability of affordable generic medicines for national HIV responses,” according to a UNAIDS report issued on 30 April.

PEPFAR also funded ARV supply chains and logistics in many countries, and almost half (46%) of the 56 countries most affected by HIV have reported supply chain disruptions in the past month or so, according to UNAIDS.

By the end of April, seven countries out of the 56 most HIV-affected reported that they had six or less months of stock in at least one antiretroviral line. These are Burundi, Côte d’Ivoire, Ghana, Haiti, Uganda, Ukraine and Zimbabwe.

The Democratic Republic of Congo (DRC), one of the biggest PEPFAR beneficiaries, expects both ARV and condom stockouts in the next three to six months.

It’s antenatal testing of pregnant women, delivery care for women living with HIV, early infant diagnosis and paediatric treatment services are all affected, UNAIDS reported last week.

However, 22 countries said that they were not reliant on PEPFAR funding for ARV procurements but that the loss of funds had disrupted their medicine supply chains.

Focus on ‘key populations’ is lost

The HIV sector’s focus on the “key populations” most vulnerable to HIV is likely to be lost – possibly forever – due to a lack of funds. 

Key populations comprise groups that face heavy stigma – sex workers, gay men and other men who have sex with men, transgender people, people who inject drugs and prisoners. 

HIV is stubbornly high in these groups, who are generally difficult to reach and often face legal barriers to access treatment. 

However, the scientific consensus in the sector is that HIV can only be stopped if it is addressed in these groups – and until Donald Trump became US president, PEPFAR was prepared to fund this approach.

In South Africa, for example, only 17% of the country’s HIV response was covered by PEPFAR, but the vast majority of those funds went to providing services for key populations.

But all PEPFAR-supported services for key populations have been stopped, as these groups are pariahs for Trump Republicans.

So too has a plan to integrate mental health and HIV services, according to Dr Gloria Maimela from the Foundation for Professional Research.

However, South Africa also prioritises young women who are amongst the most vulnerable to HIV, and outreach to them has also been curtailed.

The HIV treatment centre in Bahir Dar in Ethiopia geared to helping young people and key populations has closed.

The situation is similar in Ethiopia, where centres for key populations and young people have closed as staff have not been paid.

Centres offering services to key populations and young people in Bahir Dar to Mikadra, Humera, and Dansha have stopped.

“For two months, no new clients have been enrolled in PrEP, the prevention prophylaxis taken orally that protects from HIV infection. HIV testing has dropped by 43%. More than 800 people have faced treatment interruption. And 215 survivors of gender-based violence have lost access to the support services they once relied on,” according to a UNAIDS report issued last week.

Numerous countries report longer-term closures of certain ARV dispensing points, particularly at community level and those serving key populations, according to UNAIDS

Global PrEP rollout affected

PEPFAR funding covered more than 90% of PrEP initiations globally in 2024, and numerous countries report that they have been unable to sustain high-risk patients on PrEP, including in Guatemala, El Salvador, Haiti, Ukraine, Viet Nam and Zambia.

Last year, PEPFAR purchased 95% of ViiV’s cabotegravir stock for PrEP, but it has not delivered much of this to low and middle-income countries as promised, including to South Africa which was promised 230,000 doses.

“Restrictions in eligibility to access US government-funded HIV prevention commodities effectively leaves out numerous populations at high risk of acquisition,” UNAIDS notes.

HIV-linked commodities such as condoms and opiod replacement medication have also been disrupted thanks to the dominant role of PEPFAR in their  procurement, distribution and delivery.

Close to a quarter (23%) of countries reported six or less months of condom or PrEP stocks.

A recent survey by International Network of People who Use Drugs (INPUD) reports a large-scale suspension of outreach and harm reduction programmes, including needle and syringe distribution, HIV and hepatitis C testing, overdose prevention and legal support services.

Centres distributing opioid agonist maintenance therapy (OAMT) closed for a month in Uganda and Tanzania, for example.

OAMT is often prescribed as oral medication to alleviate the symptoms of withdrawal and reduce injecting drug use. In 2022, the risk of acquiring HIV was 14 times higher for people who inject drugs than the overall adult population.

“Fearing a stock out of methadone–the OAMT medicine–we have witnessed people returning to heroin use and hitting the black market,” Banza Omary Banza, director of Community Peers for Health and Environment Organisation in Tanzania, told UNAIDS.

Millions of lives at risk

While the Global Fund is helping to address some gaps, it is unable to fill the gap left by PEPFAR. 

UNAIDS modelling predicts that the permanent discontinuation of PEPFAR-supported HIV programmes would lead to an additional 6.6 million new HIV Infections (about 2300 per day) and an additional 4.2 million AIDS-related deaths (over 600 per day) by 2029.

Image Credits: The Global Fund/ Saiba Sehmi, Global Fund, UNAIDS.

Afghan families navigate daily life under challenging conditions, with the WHO warning that 80% of the health facilities it supports may close by June due to aid cuts.

Bibi Sharifa’s grandmother died of tuberculosis when there was no medicine available in her village in central Afghanistan and visiting shrines of the dead holy men was the only healing they could get.

That was two decades ago when the country’s entire healthcare system was in shambles under the first term of a brutal Taliban regime in the late 1990s. Then, when the west-backed democracy was set up following the US invasion in 2001, Afghanistan saw the establishment of clinics and community healthcare centers in villages and towns that revived the miserable population’s hopes and trust in modern medicine to some extent.

Now, Sharifa herself is infected by that consuming disease which killed her grandmother. With the drastic cuts by the Trump administration to the healthcare system worldwide, she told Health Policy Watch she has no hope of healing except by visiting the dead holy men’s graves.

“I cough all night and head to the Mazar (shrine) of Hakeem Senai in Ghazni in the day. Whenever I visit and ask for help, the preachers there advise me to either just touch and kiss the shrine, or they give me a paper with something written on it to put in a leather cover and wear it. I don’t even know what is written on it and it hasn’t helped me stop coughing,” Sharifa explained.

She was referring to a ‘taweez’, or amulet worn on the body in some beliefs to give the wearer protection. 

Dr Siraj Uddin, a physician in Ghazni province, Bibi’s home town, told the Health Policy Watch that many deadly diseases, such as TB  are prevalent. Until the latest aid cut, medicines and treatments were available to keep them under control.

“These days, all the government hospitals and the few charity-run clinics throughout Afghanistan are running out of medicine and other resources and with the cut in aid announced by (President Donald) Trump, it is going to get worse”, he said.   

Patients like Sharifa are facing the effects of this aid cut already. 

“There is no healthcare or medicine available even when we go to the hospitals,” she lamented, her voice heavy with despair. “And if it is in the private pharmacies, it’s too expensive. We pay for both healthcare and visiting the Mazar. If I could, I would rather pay the money for medicine to get some relief because the Mazar could not heal my grandmother,” she said.

The situation is similarly bleak in the capital, Kabul.

“First, we lost access to female doctors due to the Taliban’s policies, and now the lack of access to medicines via aid agencies is only making our difficulties worse,” said Sumaya Ahmadi, speaking on the telephone from  western Kabul while visiting a shrine in Karte Sakhi to seek help for her daughter’s chronic kidney condition.

“My husband and I brought our daughter to Mazar. We also visited a holy man in our area who wrote something on a piece of paper and performed a blessing over our daughter. If she drinks the water with that paper in it, hoping it will help. We try to manage, but it’s never enough.”

Vicious cycle of poverty and suffering

Afghan children are particularly vulnerable as immunization rates are critically low and food insecurity is widespread.

The United Nations (UN) has urged the global donor community to continue critical support to Afghanistan, where almost 23 million people will need humanitarian assistance this year.

“If we want to help the Afghan people escape the vicious cycle of poverty and suffering, we must maintain support to meet urgent needs while laying the foundation for long-term stability,” said Indrika Ratwatte, UN Resident and Humanitarian Coordinator in Afghanistan.

The UN has warned that the global funding crisis “could jeopardize the fragile improvements achieved in stabilizing Afghanistan over the last four years, such as improved food security levels and moderate economic growth”.

The World Health Organization (WHO) has also sounded the alarm, warning that 80% of the health services it supports could cease by June due to funding shortages.

By early March, 167 healthcare facilities had closed, depriving 1.6 million Afghans of access to healthcare. Another 220 are at risk of closing, affecting 1.8 million people.

“Afghanistan is already battling multiple health emergencies, including outbreaks of measles, malaria, dengue, polio and Crimean-Congo haemorrhagic fever,” according to the WHO.

“Without functioning health facilities, efforts to control these diseases are severely hindered. Over 16 000 suspected measles cases, including 111 deaths, were reported in the first 2 months of 2025. With immunization rates at critically low levels (only 51% for the first dose of the measles vaccine and 37% for the second), children are at heightened risk of preventable illness and death.”

The Trump administration’s decision to slash United States aid to Afghanistan is particularly devastating given that the US is the country’s largest donor, contributing over 43% of the $1.72 billion in aid raised last year. While the US has pledged waivers for life-saving aid, the scope and reliability of these waivers remain unclear.

The UN-coordinated $2.4 billion Afghanistan Humanitarian Needs and Response Plan for 2025 is only about 13% funded.

Meanwhile, a woman dies every two hours from preventable complications in Afghanistan and 3.5 million children and 1.2 million pregnant or breastfeeding women are acutely malnourished or at risk of becoming so.

Women like Sharifa and Ahmadi know little about the geopolitical decisions that are stripping away their access to healthcare. 

In desperation, they turn to shrines and holy men, seeking the only kind of healing still available to them. But their stories raise a critical question for the international community: where does the moral responsibility of the global healthcare system begin – and end?

Image Credits: WHO EMRO.

Dr Sudhvir Singh, unit head for equity and health in WHO’s Department of Social Determinants of Health

There is a 33-year gap in life expectancy between people born in the country with the highest life expectancy and those born in the country with the lowest life expectancy, while 94% of maternal deaths happen in low- and middle-income countries (LMICs), according to a World Health Organization global report on the social determinants of health released on Tuesday.

“Where we are born, grow, live, work and age significantly influences our health and well-being,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the release of the report, the first on the issue since 2008.

While some progress has been made in addressing inequity –  there was a 40% decrease in maternal morality between 2000 and 2023, for example – income inequality is increasing within countries, and this is impacting on health outcomes. The COVID-19 pandemic also reversed some of these gains, as have worsening economic conditions in the aftermath of the pandemic.

Dr Etienne Krug, director of the WHO’s Social Determinants of Health department, said that “broad societal factors” are more important than our genes for health – including people’s  level of education and employment, structural discrimination like racism and gender inequality, weak public services, social isolation and loneliness, climate change, access to digital systems and conflicts and displacement.

Dr Etienne Krug, director of the WHO’s Social Determinants of Health department,

Race and education

“The gap in life expectancy between the Indigenous and non-Indigenous population is 12.5 years for the Inuit in Canada, 10 years for Indigenous Australians, 21.5 years for the Baka in Cameroon and 13 years for the Maasai in Kenya,” according to the report.

Meanwhile, in Hungary, Poland, Latvia and Slovakia, “there are gaps in life expectancy of 10 years and more between men with high and low education levels”.

“In the United States in 2020, the maternal mortality rate for non-Hispanic Black women was nearly three times higher than that of non-Hispanic White women (55.3 vs. 19.1 deaths per 100 000 live births),” according to the report.

During the COVID-19 pandemic, death rates were higher across the globe in poorer communities.

Where a person lives in a country also affects their health. Over half the world’s population currently resides in cities, and approximately a quarter of the global urban population lives in slums where they are more susceptible to disease.

Air quality is also an important determinant of health, with the combined effects of ambient air pollution and household air pollution associated with almost seven million premature 

Commercial interests

The report also points to four health-harming commercial actors – junk food and drinks, fossil fuels, alcohol and tobacco – pointing out that these account for at least a third of global preventable deaths, collectively in 2021 causing 19 million deaths annually.

“Experience has shown that these industries can and will prevent and undermine public-sector action to limit health-harming products, services and practices, including by seeking to shape public discourse, and to bias or undermine research,” the report notes.

It singles out the unhealthy food industry as being “particularly effective in influencing national governments to reduce or not implement regulations, and in marketing products which misinform about their effects on health, the environment and other social determinants”. 

Debt distress

“Countries are facing serious challenges when it comes to fiscal space, meaning there’s inadequate resources for universal public services such as social protection, housing, education and health,” said Dr Sudhvir Singh, unit head for equity and health in WHO’s Department of Social Determinants of Health.

“We have a current spike of inflation and reduced development assistance for health and development, but we also have an incredible challenge with debt distress. Over the last decade, the total value of debt interest payments in the world’s 75 poorest countries has quadrupled,” said Singh.

Many countries are caught in a vicious economic cycle that is fuelling poor health.

Over 3.8 billion people have no social protection coverage, while 2024 was not only the hottest year on record, but the year with the highest number of conflicts since the Second World War, he added.

This has resulted in a tripling of the number of people facing forced displacement in the last 15 years.

WHO calls for collective action from national and local governments and leaders within health, academia, research, civil society, alongside the private sector to address economic inequality and invest in social infrastructure and universal public services.

Midwife Kanata Akter is checking Ninni’s one-day-old daughter. She gave birth to the child with the assistance of midwives in Hope Hospital. Cox’s Bazar in Bangladesh

On International Midwives’ Day (5 May), the crucial role of midwives – particularly in humanitarian crises – needs recognition, and their voices need to be included in planning and policies.

Being pregnant, giving birth or having a newborn are times of change and challenge – but when a woman is also facing a humanitarian crisis, they can quickly become deadly. 

Sexual and reproductive health needs don’t stop in a crisis; despite this they are too often ignored in crisis preparedness planning and response. According to the latest United Nations estimates, countries affected by conflict or considered “fragile” account for 61% of maternal deaths globally, despite representing only 25% of global live births.

In many crisis-affected settings, midwives are among the first responders. Based in the communities they serve, they are able to provide essential care with limited resources, often before comprehensive response efforts can be mobilised.

“Some women gave birth in the water,” said Neha Mankani, a midwife from Pakistan, reflecting on her experience during the 2022 floods. “We saw fungal infections. We saw maternal deaths. The sheer amount of tragedy is something you couldn’t understand until you were there, on the ground.”

Neha’s story is one of four short documentaries shared during a global event for the International Day of the Midwife, highlighting the work of midwives in humanitarian settings — from Morocco’s earthquake response and Pakistan’s floods, to the refugee camps of Bangladesh and the overwhelmed maternity wards of the West Bank conflict zones.

Undervalued and overwhelmed

In the West Bank, two midwives often care for up to 20 labouring women at a time, a burden made worse by the stress of waiting for hours at checkpoints to get to work, or to get to a hospital in labour. This is made worse by the constant threat of violence.

In Pakistan, makeshift clinics meant for a few hundred people saw over 1,000 show up in a single day, overwhelming staff and resources. In Morocco, midwives were among the first to respond after the earthquake, in an area that was impossible to reach from the outside for days. Midwives had to deliver everything from antenatal care to psychological support for survivors of gender-based violence that is more common during crises.

Even though they are among the first to respond in a crisis, midwives are rarely included in official crisis response planning. As one advocate in Pakistan put it, “Strategies are being made. Frameworks are being made. But midwives are absent from all of it.”

“Sometimes your mental health suffers because you have no more energy and you just can’t,” shared a midwife from the West Bank, describing the emotional toll of working in understaffed facilities during periods of intense demand.

In Bangladesh, a midwife explained how food and basic supplies that were once distributed regularly in the Rohingya camps have now stopped arriving. Community trust is harder to maintain when essential needs go unmet. And for the midwives themselves, already working in extreme conditions, the lack of resources means doing more with less — or watching people go without the care they need.

Recent global aid cuts will only make these situations worse, further reducing the availability of essential goods and services in humanitarian settings. “We encouraged women to trust us and we earned their confidence in our work. In the beginning, we had only three or four deliveries each month. Now, we’re handling over 100,” said a midwife from Bangladesh. This trust can easily be broken if midwives are unable to provide the care that women need because of a lack of funding, supplies, or equipment, and women may give birth alone.

Midwives are not a luxury

A midwife assists a patient in Pakistan during floods.

In fragile and crisis-affected settings, midwives are not an optional add-on to the health system — they are the only health providers solely dedicated to sexual and reproductive health, often stepping in when other services are unavailable or disrupted. According to the International Confederation of Midwives, trained midwives can provide up to 90% of essential sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) services. They offer antenatal and postnatal care, help women birth babies safely, manage pregnancy loss and comprehensive abortion care, support breastfeeding, respond to gender-based violence, and offer contraception.

The documentaries show that midwives are often based in the communities they serve, speak the local languages, know where to obtain supplies and medicines, and are trusted by those most affected. They provide culturally competent care, rooted in local knowledge and community trust.

In crisis settings, where time and access mean the difference between life and death, midwives are an efficient, cost-effective solution. They deliver care even when infrastructure is damaged or missing. They educate communities, distribute clean birth kits, set up referral systems, and provide support through grief and loss. And as seen in Morocco, they also play a vital role in post-disaster recovery, helping women and children heal from trauma.

Include midwives in planning

Despite the evidence and best practice, midwives are too often excluded from national and international crisis planning efforts. Their voices are missing from policy and funding decisions. Their expertise is overlooked in disaster preparedness. And their personal safety and rights are not prioritised in crisis response.

They are expected to show up, and make do, with little or no support. The same is expected of the women who need their care. This gap has consequences.

“At full capacity, our antenatal clinic could see 300 people a day. But more than 1,000 showed up. There was a stampede. Many went back without getting anything,” said a midwife from Pakistan.

Better planning could have helped. So could recognising midwives as essential partners in preparedness and response.

This year’s theme for the International Day of the Midwife — Midwives: Critical in Every Crisis — is a call to action. If we are serious about reducing maternal deaths and building health systems that can respond to conflict, disaster, and displacement, we must invest in midwives. That means educating them, protecting them, and including them at every level of decision-making, everywhere. Creating an enabling environment for midwives to work to their full scope of practice, even during crises.

The next crisis is not a matter of ‘if’, but ‘when’. Midwives are ready. It’s time the world is ready, too.

Daniela Drandić is Head of Advocacy and Communications at the International Confederation of Midwives

 Ana Gutierrez is Communications Lead at the International Confederation of Midwives

 

 

 

 

 

 

Image Credits: International Confederation of Midwives.

The UN multi-stakeholder hearing on NCDs

Calls for more resources to address non-communicable diseases (NCDs), higher taxes on unhealthy products and the decriminalisation of suicide were made at a multi-stakeholder hearing at the United Nations (UN) on Friday.

The hearing was convened by UN General Assembly President Philemon Yang to enable stakeholders to identify priorities to address NCDs ahead of the UN High-Level Meeting (HLM) on these diseases set for 25 September.

Seventy percent of deaths are caused by NCDs, as unhealthy diets, lack of exercise, smoking, air pollution, and poor mental health take their toll globally.

Yet only 19 countries are on track to achieve the UN’s Sustainable Development Goal 3.4 to reduce premature mortality from NCDs by one-third by 2030.

NCD Alliance CEO Kaie Dain

“The last decade has been coined as a policy success, but an implementation failure. This HLM has to change this, renewing commitments to cost-effective policies that we know work to reduce the risk factors and improve access to care,” Katie Dain, CEO of the NCD Alliance, told the hearing.

After months of intense civil society mobilisation, the NCD Alliance issued a Call to Lead on NCDs this week, signed by over 500 civil society organisations and backed by 2.5 million people.

“This High-Level Meeting must address the glaring mismatch between the scale of the burden of NCDs and the level of funding,” said Dain. “We urge governments to increase sustainable financing for NCDs by adopting specific and measurable financing targets for NCDs and improving financing data and tracking, as well as committing to health taxes that have a triple win of raising revenue, improving health outcomes and reducing long-term healthcare costs.”

Dain also called on governments to protect health policy from “undue influence and health of health-harming industries: big tobacco, alcohol, ultra-processed foods and fossil fuels”.

‘Elephant in the room’: Harmful industries

Youth speaker Stephanie Whiteman

Youth speaker Stephanie Whiteman described the impact of harmful industries as the “elephant in the room” during the hearing’s opening.

“The unhealthy food environments, aggressive marketing of ultra-processed products, tobacco use, alcohol use, and digital platforms that amplify harmful messages all shape our health outcomes, including mental health,” said Whiteman, who is part of the Global Mental Health Action Network and a Vital Strategies fellow.

“To tackle these determinants, we must enact and enforce policies that tax and restrict unhealthy products, require clear front-of-package warning labels, restrict marketing to children and regulate industries through conflict of interest safeguards,” urged Whiteman, who is from the West Indies.

“A young person today is more likely to die by suicide than at the previous High Level Meeting,” Whiteman noted, urging the 25 countries that still criminalise suicide and suicide attempts to change this “immediately”. 

“We should be helping persons at their lowest, not punishing them. Every country should have a suicide prevention plan based on WHO’s Live Life approach.”

Several other speakers called for the decriminalisation of suicide, including in India, which has one of the highest suicide rates in the world, accounting for  40% of global suicides among women and 25% among men.

Address gender gap and taxes

Magda Robalo, executive director of Women in Global Health

Magda Robalo, executive director of Women in Global Health, reminded the hearing that women and girls “face the steepest barriers to NCD prevention, diagnosis and care, and the heaviest pressures leading to mental stress”, particularly in low and middle-income countries.

“In Africa, only one in five women diagnosed with breast cancer survives beyond five years, a stark contrast to high-income settings,” said Robalo, who warned against “a dangerous rollback on health rights, amplified by misinformation, shrinking civic space and weakened accountability”. 

Robalo called on governments to “embed gender equity and financial protection in universal health coverage design”.

Vital Strategies CEO Dr Mary-Ann Etiebet urged countries to impose taxes on harmful products: “The Task Force on Fiscal Policy for Health has shown that increasing the price of tobacco, alcohol and sugary beverages by just 50% could save 50 million lives over 50 years. 

“Such taxes could generate $3.7 trillion globally in just five years, and if these revenues were directed towards health, we could boost healthcare budgets 40% in low and middle-income countries,” said Etiebet.

Undue influence on political declaration?

A “zero-draft” of the political declaration to be adopted by the HLM is expected to be released this month, with member state negotiations due to end in July.

However, NCD advocates have told Health Policy Watch that they are concerned about how harmful industries – including the big food, alcohol and fossil fuel industries – are attempting to influence content of the declaration.

The NCD Alliance is advocating for “a concise, high-level, and political outcome document that galvanises heads of government and state to action, leadership, and ownership of the NCD response through time-bound commitments and tangible targets free from industry interference from health-harming sectors”.

‘Nothing about us without us’

Lucía Feito Alonca of International Diabetes Federation

Meanwhile, Lucía Feito Alonca of International Diabetes Federation challenged member states to include communities and people living with NCDs in their decision-making 

“If we truly want to build stronger health systems and achieve universal self coverage, we must listen to those who live with these conditions every single day. That means putting people at the centre of care, ” said Alonca, who lives with diabetes.

“We don’t want to be included at the last minute or just as a formality. We want to be part of the process from the beginning, helping shape policies, signing services and evaluating results, because we are the experts in living with these conditions.

“My question to all of you is: Are you ready to share power, or just space? Because nothing about us should ever be decided without us.”

Less than 15 years ago, UNAIDS opened its shining new Geneva headquarters opposite WHO’s. Now, a UN Task Force has suggested the two might merge.

Merging WHO and UNAIDs, and combining the “operational” component of WHO’s Emergencies response with that of other agencies are just two among the several dozen ideas pitched by the UN80 Initiative Task Force – in the full text of options for interagency budget cuts and efficiencies, obtained by Health Policy Watch. 

The list of over 50 bullet points, dubbed a “compilation of non-attributable suggestions by the Task Force,” that was commissioned by UN Secretary António Guterres in March, cites options for wide-ranging operational reforms and mergers amongst the patchwork of UN agencies active in four key areas: peace and security; humanitarian affairs; sustainable development; and human rights.  

The listing, marked “strictly confidential” also proposes to “reduce number of high-level posts (D1 and above),” systems wide – echoing plans for cutbacks in senior staff, now reportedly planned by the World Health Organization, the Geneva-based specialized UN agency, as it faces a $2.5 billion budget deficit from mid-2025 to end 2027.   

A companion memo, issued by UN Deputy Secretary General Guy Bernard Ryder on 25 April, also obtained by Health Policy Watch, requests all UN Secretariat operations in New York City and Geneva – the highest-cost UN duty stations – to undertake internal reviews “to identify as many functions as possible that could be relocated to existing lower-cost locations, brought closer to mandate implementation or clients/stakeholders in the field, or otherwise reduced or abolished if they are duplicative or no longer viable.”

UN SG Memo to Heads of Secretariat Entities in New York and Geneva – 25 April 2025.

The initiative to review UN-wide relocation options was initially reported Wednesday by Devex while excerpts from the UN Task Force 80 memo were reported on Thursday by Reuters.  

Asked to comment on the feasibility of a UNAID/WHO merger and other Task Force 80 ideas, a WHO spokesperson deferred, saying it was a UN initiative, and referred Health Policy Watch to the UN Secretary General’s Office.

Farhan Aziz Haq, Deputy Spokesperson for the UN Secretary General’s Office, said in an emailed response: “These documents are part of an internal process which represents the operationalization of the UN80 initiative that the Secretary-General launched on 12 March. [It] is the preliminary result of an exercise to generate ideas and thoughts from senior officials on how to achieve the Secretary-General’s vision.”

The UN80 Task force is due to report its final recommendations to the 2026 UN General Assembly. 

UNAIDS-WHO merger and other global health moves? 

Task Force 80 suggests “strategic” merger of UNAIDS into WHO and UN Women Merger with the UN Population Fund (UNFPA).

With regards to the UN’s activities on health, emergencies and related humanitarian and sustainable development initiatives, the task force’s list of consolidated ideas includes the following: 

Under Sustainable Development:  

  • “Strategic integration of UNAIDS into WHO, creating a more unified and efficient global health authority.” Alternatively, the Task Force also notes that “UNAIDS, under severe financial pressure and with a sunset clause of 2030, could transition into another, larger entity such as WHO or UNDP.”

Under Humanitarian Response:  

  • “Merge operational responsibilities and capabilities of major operational agencies (WFP, UNHCR, UNICEF, WHO) in humanitarian and conflict affected contexts.”

Although WHO made no comment, the agency’s Emergencies Department is one of the Organization’s largest, and some outside observers have long advocated for consolidating its on-the-ground operations with those of other humanitarian relief agencies.  The WHO Emergency response to the COVID pandemic, followed by mpox and a series of humanitarian crises was also the main reason for WHO’s massive surge in consultants – whose ranks doubled between 2017 and 2024, WHO’s Director General Tedros Adhanom Ghebreyesus told media on Thursday.  See related story.

UNAIDS also did not respond to Health Policy Watch requests for comment, as of publication.  However, the organization has been in deep trouble ever since the US government terminated its support earlier this year, with rumors of a possible closure or merger. The $93 million US contribution to the agency comprised some 41% of UNAIDS $222 million budget in 2023. Switzerland, the agency’s fourth largest donor also has announced it will end its support.

Merging UN institutions on climate and environment; women and sexual/reproductive health   

COP28, the 28th Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC), November 2023 in Dubai.

Other major innovations proposed by the UN 80 Task Force in the sustainable development arena include  the formal integration of the UN Environment Programme (UNEP) with the UN Framework Convention on Climate Change (UNFCCC), which manages the annual rounds of climate negotiations and tracks countries’ climate commitments. 

The task force also pitches a merger of UN WOMEN and the UN Nations Population Fund  (UNFPA) “to create a powerful new entity focused on advancing gender equality and reproductive health and rights.” 

As part of that latter move, the Task Force also calls for better alignment of “select UNICEF programmes with this new entity, especially those focused on adolescent girls’ well-being and gender-based violence prevention and response.”

The UN80 Task Force also proposes that the UN Secretariat establish a UN Sustainable Development Department “that consolidates relevant entities to ensure cohesive and integrated support for the 2030 Agenda and the SDGs, including: (Secretariat entities) DCO, DESA, UNDRR, UN-OHRLLS and (other entities) UNDP, UNCDF, UNV, UNRISD, FAO, IFAD, UN-Habitat, WHO, UN-Women, UNESCO, UNICEF, UNEP, WB, IMF, WTO, UNOPS, UNICEF, UNIDO, UNESCO.”

And the Task Force says that UNEP and UN Habitat should enhance their coordination to promote “sustainable urban development” – in a world seeing runaway, unplanned urban expansion – although it stops short of calling for a merger of the two agencies.   

Refugees and Human Rights 

UNRWA shelters in Khan Yunis in November 2023, at the start of the Israel-Hamas war. Most of Gaza’s population has been displaced by the war, multiple times.

The Task Force also suggests establishing a “UN Human Rights Department led by a High Commissioner for Human Rights, coordinating human rights promotion and protection across the UN system, including servicing the UN human rights mechanisms and integrating human rights into sustainable development, peace & security and humanitarian engagement.”

Currently, human rights work is centralized in a separate Geneva-based entity, the Office for the High Commissioner of Human Rights OHCHR, which also oversees the UN Human Rights Council, whose members have often been criticized for selectively focusing on human rights violations in the Israel-Palestine dispute, while while ignoring violations in China, Iran and elsewhere with regards to the systematic repression of minorities and dissident voices.   

With regards to humanitarian affairs, the Task Force suggested creating a “streamlined “UN Humanitarian Response and Protection Organization”, by integrating the OCHA (the UNOffice for Coordinating Humanitarian Affairs (OCHA), the UNHCR (the UN Refugee Agency) and the IOM (International Organization of Migration), leveraging WFP’s expertise for material assistance procurement, distribution and logistics.”

Alternatively, it proposes creating “a new UN Refugee and Migration Agency (merging UNHCR and IOM).”

Strikingly, the Task Force does not suggest merging UNRWA, the UN Relief Agency for Palestinian Refugees – with the UN’s other main refugee entity UNHCR. It does, however, suggest creating a “UN Humanitarian Operations Department – including OCHA, WFP, UNRWA and a UN Refugee & Migration Agency (merging UNHCR and IOM)” to manage UN-wide humanitarian preparedness and response.  

UNRWA’s $1.16 billion budget to a major blow when the United States halted its support while some European nations paused contributions in the wake of the bloody 7 October 2023 Hamas attacks on Israeli communities, in which Israel alleged some UNRWA employees participated. UNRWA has also been complicit in Hamas’ use of schools and clinics for military purposes, as well as filching humanitarian aid, Israel says. In the face of UNRWA’s rebuttals as well as Gaza’s dire humanitarian crisis, some donors resumed funding, while others, like Sweden, made the stoppage permanent.  Even so, UNRWA continues to enjoy strong financial and political support from key European nations, like Ireland and Norway, as well as many other G70 nations. 

Structural reorganization and response 

UN Secretary-General António Guterres launched the UN 80 initiative in March.

The Task Force 80 document also proposes a wide range of cross-cutting UN reforms, including:  “structural reform proposals around our four basic pillars, each with a geographic focus (Nairobi/ Africa should be the center of development agencies, including UNDP/ UNICEF/ UNFPA).”

It says that a patchwork of UN agencies working on “peace and security” should also be merged and consolidated, with resources and personnel “moved closer to the field.” 

Along with addressing fragmentation and duplication, it states that “outdated working methods are leading to inefficiencies,” citing intergovernmental meetings as one example of fora that “are not making use of modern tools and technologies.”

“The progressive proliferation of agencies, funds, and programmes has led to a fragmented development system, with overlapping mandates, inefficient use of resources, and inconsistent delivery of services,” the Task Force states.

Along with the consolidation of overlapping agencies and functions, it calls for “a strategic reduction of the UN’s presence in high-cost locations to ensure long-term financial sustainability” positioning forms as “proactive measures to enhance UN agility and responsiveness that extends beyond measures for cost-cutting or austerity.”

Image Credits: Wikimedia Foundation, United Nations , UN SG/Task Force 80, Dennis Sylvester Hurd, WHO/EMRO, UN.

In the first episode of “Trailblazers with Gary,” Global Health Matters podcast host Dr Garry Aslanyan sat down in South Africa with Professor Tulio de Oliveira — one of TIME Magazine’s 100 most influential people in global health.

Oliveira leads the Centre for Epidemic Response and Innovation at Stellenbosch University and was part of the team that first identified the Beta and Omicron variants of COVID-19.

Aslanyan and Oliveira met in Oliveira’s lab to talk about the real story behind the Omicron discovery, how Africa came together to fight the pandemic, and why pandemic preparedness must remain a top priority, even as the world moves on.

Oliveira opened up about his roots in Brazil, his family’s move to Africa during the post-apartheid years, and how those early experiences shaped his life’s mission. Oliveira said he sees global health not as a job, but as a moral responsibility — one that requires constant vigilance, collaboration, and investment.

Aslanyan and Oliveira also discussed how climate change is already fueling new health crises across the globe. From dengue outbreaks in Ethiopia to cholera in Malawi, Oliveira explained how extreme weather, flooding, and increased mobility are making epidemics more likely — and more dangerous.

His message was clear: global health funding cuts are not just short-sighted — they’re dangerous. Pathogens don’t respect borders. Without strong, coordinated systems in place, we’re setting ourselves up for the next pandemic to hit even harder.

His advice to the global health community? Stay focused. Deliver results. And never underestimate the power of preparation.

Watch the full episode:

 

Image Credits: TDR – Global Health Matters.

(on right) WHO Director General Dr Tedros Adhanom Ghebreyesus – ‘no regrets’ but
appeals to US to return to WHO

The United States’ dismantling of its vast network of global health aid and assistance programmes constitutes “greatest disruption to global health finance in memory” and it is “sowing chaos in public health”, that threatens to roll back decades of progress on infectious and neglected diseases of poverty that affect billions of people, said WHO’s Director General Dr Tedros Adhanom Ghebreyesus on Thursday. 

But Tedros still expressed hopes that the WHO’s biggest donor might eventually rejoin – asserting boldly that the global health agency had already fulfilled key demands made by US President Donald Trump when he withdrew from the organization in January.  

“We still believe the US will reconsider and join. Because for me, the US withdrawal is not about losing money. … More important for me is its impact on the partnership. US leadership is important. US partnership is important. No country should be out of WHO because it [countries] benefit.…. The decision is lose, lose. The US loses, and the rest of the world, we know for sure, loses.”

The WHO Director General’s comments at a two hour-long briefing with Geneva’s UN press constituted his most significant statement on WHO’s budget crisis, restructuring, and the troubled US relationship since Trump’s inauguration. 

In a related development, an internal UN task force memo has suggested merging another financially troubled Geneva agency, UNAIDS, into the WHO, as well as merging WHO’s emergency operations with those of other agencies delivering emergency relief, including the World Food Programme, UNICEF and the UN Refugee Agency (UNHCR) into a single humanitarian entity, Reuters reported. Asked for comment by Health Policy Watch, a WHO spokesperson declined, saying it was was a UN document.

Pushes back against Trump – saying reforms are happening

On the campaign trail, prior to being elected, Trump repeatedly blasted the organization as a “corrupt globalist scam, paid for by the United States but owned and controlled by China.” 

At the Geneva briefing, Tedros pushed back saying that most of the reforms that the Trump had cited in his Executive order issued shortly after his inauguration were already being made by the agency.  

At the same time, Tedros referred to the “catastrophic” health and hunger crisis in war-torn Gaza; a major cholera outbreak in Angola; and gang violence in Haiti as examples of public health threats faced by WHO – and the world. On a brighter note, he expressed optimism that WHO member states would finally approve a pandemic treaty in the upcoming World Health Assembly, 19-27 May, after negotiators, working around the clock, finally reached an accord last month.      

Countries Say YES to Pandemic Agreement

Trump’s reasons for leaving WHO are now ‘good reasons to stay’

Budget projection and gap from an internal briefing presented to member states in April.

Legally, the US withdrawal would take effect in January 2026, but WHO officials admit that along with the lost of voluntary funds, they also haven’t any of the $260 million in US assessed contribution for 2024-2025. Those losses, along with other laggard member state payments, has contributed to a $600 million budget shortfall for 2025. The agency faces a whopping $1.9 billion deficit for 2026-2027. 

“As far as we know, there were four issues mentioned in the Executive order” issued by Donald Trump to withdraw from the Organization,” Tedros said.  

“One is [organizational] reform, second is [US] payments, third is COVID management and fourth is independence. 

“And all four are good reasons for the US to stay,” he added, saying that the agency had undertaken more than 94 reform initiatives; WHO  is gradually  increasing all member states’ required contributions so that ultimately the United States would be able to “pay less” overall. 

In terms of COVID management, Tedros argued that the pandemic agreement would improve the world’s and WHO’s response to a future crisis without sacrificing national sovereignty- although the US has said that they will not participate in the accord. 

“And there are even many Americans in Congress who say that the accountability and transparency of the organization has improved,” Tedros maintained.  But the problem, he added, is “wrong information, and other people running around and blaming the organization.”

Praises past collaborations

Preventative treatment for NTDS, schistosomiasis and soil-transmitted helminths, for school children in Tanzania – just one example of initiatives now facing cuts.

The Director General also praised WHO’s longstanding partnership with the United States – saying: “Of course, donor countries can spend money where they want – and we are grateful to those that have for decades funded health systems globally – but instead of an orderly decline, the abrupt cuts to overseas development aid and a challenging economic and trade environment are sewing chaos in public health.

“For example, advances in tackling Neglected Tropical Diseases, which affect over one billion people and disproportionately impact the poorest and most marginalized communities, are at real risk of backsliding,” Tedros said.

“Thanks to the huge efforts of the US government, more than three billion treatments have been delivered to 1.7 billion people in 26 countries over the past two decades.

“The combination of $1.4 billion from the United States, generous pharmaceutical donations, private sector innovation and (largely public sector) health workers, has helped stop transmission of lymphatic filariasis, river blindness, schistosomiasis, intestinal worms and trachoma in 14 countries.

“However, the abrupt cuts and withdrawal of US funding, on top of other donor countries cutting investments to NTDs, have led to treatment campaigns for more than 140 million people being paused, and research on new medical tools being cut.

“But it doesn’t have to be this way, and we urge governments to not turn their backs on the poorest and most marginalized and undermine decades of progress,” he said, pointing out that, “diseases continue to be born, with a heating world, protracted conflict and continuing outbreaks.”

25% of 2026-27 salary costs are unmet

New WHO Organizational plan reduces 10 divisions at headquarters to just four.

Just last week, WHO unveiled a new plan to staff and member states that would dramatically reduce the number of departments at headquarters from around 60 to around 33, while programme divisions at headquarters would shrink from 10 to just four. 

As for rank and file staff, some projections have held that cuts at headquarters, which faces the biggest deficit, could ultimately be in the range of 40%.

WHO staff salary gaps by region, as portrayed in slides circulated to WHO directors.

Tedros confirmed that the cutbacks would affect the Geneva headquarters’ operations most deeply, followed by rollbacks in WHO’s six regional and 152 country offices. 

While country offices should be the least affected, WHO is also planning to close country offices operating in high and upper middle income countries – which depend far less on the global health agency’s technical support, Tedros added.

But WHO’s head of Business Operations, Raul Thomas, said that officials are so far unable to make projections – until WHO management completes a “prioritization” exercise to determine more precisely what projects and programmes should be cancelled, which should remain – as well as what teams or initiatives might actually relocate outside of Geneva to less expensive locations.   

“The outcome of the shape of the organization will be heavily dependent on the prioritization exercise,” Thomas told journalists. “And out of that, we will then be able to determine the location of those positions that we’re going to reduce, the grades of those positions – which will heavily impact the number of positions [to be cut]. 

“What we do know is that, based on our projections, our financial projections, 25% of our salary costs for the next biennium are not met. So what that translates into in terms of number of positions and unknown at this point in time.”

At the same time, Tedros sought to put a positive light on the cutbacks, saying that in the end, it would make WHO more efficient and responsive to country needs. 

“We will make sure that this prioritization will help us to …focus the organization … to sharpen the organization and make it more focused and even more impactful.”

He made no reference at the briefing to the UN task force memo circulating, an initiative of  UN Secretary General António Guterres, which raises the possibility of even more dramatic changes – particularly regarding a possible UNAIDS merger with WHO and the merger of operational aspects of WHO’s Emergencies Department with those of other agencies.  The memo, prepared by a task force appointed in March by Guterres, was described by his Spokesperson Stéphane Dujarric as an exercise to “generate ideas and thoughts from senior officials on how to achieve the Secretary General’s vision.” 

No regrets about past years of expansion 

Tedros, meanwhile, said that he had no regrets about the expansion of staff, consultants and senior directors positions that he has overseen since taking office in July 2017. 

An earlier report by Health Policy Watch found that globally, the number of the most senior, D2, directors had nearly doubled, increasing from 39 to 75 worldwide as of July 2024. The number of non-staff affiliates also soared from roughly 3800 in 2017 to around 7600 as of July 2024, while rank and file staff increased by 17%. See related story: 

EXCLUSIVE: Number of WHO Senior Directors Nearly Doubled since 2017, Costs Approach $100 million

On the large increase in D2 directors, Tedros said that the creation of new initiatives, such as the Chief Scientists’ Office, the WHO Academy; a new Berlin-based office of Pandemic Surveillance; and a Department of Digital Technology, had warranted the creation of new high-level positions – as part of initiatives to make WHO more fit for the future. 

“These were intentional and conscious …  things that can help the organization or prepare the organization for the future. It’s on science. It’s on evidence, on data, on digital technology.”

Beyond the creation of new positions, however, Tedros acknowledged that the near doubling of D2 directors, from 39 to 75 as of July 2024, as noted in the 10 March Health Policy Watch report, was largely a function of promotions. 

“Of course, if you count them as doubling, there were directors to be promoted from D1 to D2, and the reason for that is we need to be competitive, to attract talent. … And in terms of money, by the way, it’s a very small amount,” he said.

Sources: Appendix 1 to WHO staff rules 2024, effective as of January 2023, EB 2023 Salaries of Ungraded Positions and 31 July 2024 HR update: Estimates are based on costs of a D2 at Step VI and a D1/P6 at Step X of the published salary scale.

Swollen consultants’ ranks

As for the increase in consultants as well as staff, Tedros said that the COVID pandemic, followed by two mpox public health emergencies, not to mention other outbreaks and humanitarian crises, had led to the increase in WHO’s non-staff hires.  

“It had to be done. There was no other way. And I would do it again if there was an emergency,” he said, “We went from one thing to another, we don’t regret. There was a need.””

But he contended that the agency had been “over the last two years, trying to decrease” its consultants corps. In fact, 2023 was a peak year for WHO hires of both “consultants” as well as of personnel on non-staff Special Service Agreements, according to Health Policy Watch’s analysis of the HR data from 2017-2024.

New data published just ahead of WHA shows that consultancy contracts of all kinds did finally decline in end 2024 – from approximately 6311 contracts in 2023 to 5317 as of end 2024. And the number of full time equivalents (FTE) those contracts represent shrunk from 2398 to 1717 as of end year. For Special Services Agreements, the other major type of long-term, non-staff agreement, there was a very slight decline from 5606 to 5494 contract holders. 

WHO non-staff ‘affiliates’ in 2024: slight decline from 2023, which represented a six year peak.

In either case, Tedros said that he aims to use the present crisis to put WHO on a stronger footing. 

“That’s why I say it’s an opportunity, because we wanted to make the organization especially want a better footing addressing the systemic problems related to financing, and make sure that the organization is involved.”

As for the pending appointments of just four new Assistant Director General’s out of a team of 11 senior leadership members today, Tedros said that “It will be very difficult to satisfy the various expectations.  But I’m having a session with every senior manager, we are discussing openly, and I hope the outcome of the appointments will be for the best of the organization – make the organization even better.” 

Updated 2.5.2025

Image Credits: Health Policy Watch , WHO, RTI Fights NTDs, WHO , WHO HR and EB records, 2023-2024, WHO HR Update Tables as of 31.12.2024.