A technician works on production of medicines.

Patients will face costlier medicine and European and Indian drug companies face billion-dollar losses if US President Donald Trump’s threat issued late Tuesday of “a major tariff on pharmaceuticals” produced outside his country is realised.

However, amid chaos on the financial markets, Trump back-pedalled on Wednesday and announced a 90-day pause on all tariffs except for China – where he announced a 125% tariff on Chinese goods.

Trump’s threat was made a few hours after major European pharmaceutical companies met with European Commission (EC) President Ursula von den Leyen, urging her to negotiate with the US or they would face supply chain issues, according to Euro News.

The European Federation of Pharmaceutical Industries and Associations (EFPIA) issued a “stark warning to President von der Leyen that unless Europe delivers rapid, radical policy change then pharmaceutical research, development and manufacturing is increasingly likely to be directed towards the US,” in a statement on Tuesday.

Eighteen EFPIA member companies identified “as much as 85% of capital expenditure investments (approximately €50.6 billion) and as much as 50% of R&D expenditure (approximately €52.6 billion) potentially at risk” in an industry survey. 

“This is out of a current combined total of €164.8 billion in investments planned for the period 2025-2029 in the EU-27 territory. Over the next three months, companies that responded estimate that a total of €16.5 billion ie. 10% of the total investment plans is at risk,” the federation noted.

‘Little incentive to invest in Europe’

“In addition to the uncertainty created by the threat of tariffs, there is little incentive to invest in the EU and significant drivers to relocate to the US,” the federation warned, noting that the US “now leads Europe on every investor metric from availability of capital, intellectual property, speed of approval to rewards for innovation.

They called on von der Leyen to develop a competitive EU market that “rewards innovation”, stronger intellectual property provisions, and “policy coherence across environmental and chemical legislation to secure a resilient manufacturing and supply chain of medicines in Europe”.

“Europe needs to make a serious commitment to invest in a world-class pharmaceutical ecosystem, or at best, risk being reduced to a consumer of other region’s innovation.”

Pharma giants Bayer, Novartis, Novo Nordisk, Roche and Sanofi are based in Europe. Their shares all tumbled by around 5%, while US pharma companies’ shares fell by 3-6 %, according to Reuters. Shares in the UK-based AstraZeneca and GSK also lost value.

Costly to relocate

The share price of US pharmaceutical giants including Pfizer, Johnson & Johnson, Eli Lilly, Bristol-Myers Squibb, Gilead and AbbVie also lost value. These have significant European manufacturing capacity, based primarily in Ireland and it would be costly to relocate.

Han Steutel, head of the German Association of Research-Based Pharmaceutical Companies (VFA), said that moving production to the US could cost billions of dollars and take five to 10 years to set up.

“It will be devastating for patients if medication is no longer available as they cannot easily switch from one drug to another, like with other commodities,” Steutel told CNBC.

‘We are a global industry in terms of research and development and production,” said Steutel. “Unlike with generic companies, the active [pharmaceutical] ingredients for patented drugs are solely produced in Europe or the US,” he said.

“If a company has a plant producing this in Europe it’s not going to set up another plant in the US or vice versa because it would just make the production process inefficient,” he noted.

Huge losses for Indian companies

​​However, 90% of API for US medicines are manufactured outside that country – by 2021, mostly in India (48%), followed by Europe (22%) and China (13%). 

Indian companies face potentially huge cost increases from tariffs on pharmaceutical products as the US is their biggest market – worth $8.7 billion in 2024, according to the Pharmaceuticals Export Promotion Council of India.

Some 45% of US generics are made in India and tariffs would cause price hikes that would affect both patients and companies outside the US.

However, given Trump’s last-minute flip-flop on tariffs, uncertainty is only certain element of the US’s global trade war.

Image Credits: AMR Industry Alliance.

Rain falls on a camp in Khan Younis where some of the 1.9 million Palestinians displaced by the violence shelter.

Heads of six UN agencies including the World Health Organization, UNICEF, and the World Food Programme issued a desperate warning that blockades of aid, food, medicine and life-saving supplies to Gaza since Israel resumed its attack on the enclave show “utter disregard for human life.”

“For over a month, no commercial or humanitarian supplies have entered Gaza,” the agency chiefs wrote in a joint statement with the Office for the Coordination of Humanitarian Affairs (OCHA), UN Relief and Works Agency (UNRWA), and UN Office for Project Services (UNOPS) on Monday.

“More than 2.1 million people are trapped, bombed and starved again, while, at crossing points, food, medicine, fuel and shelter supplies are piling up, and vital equipment is stuck,” the letter continues, calling on world leaders to “act – firmly, urgently and decisively – to ensure the basic principles of international humanitarian law are upheld.”

Since Israel broke the ceasefire in March, the humanitarian situation has dramatically deteriorated. The letter authored by UN leaders is the latest alarm sounded by humanitarians as Israel’s military enforces a blockade on essential food and medicine while its troops press deeper into Gaza. 

The Ministry of Health in Gaza reports that at least 50,523 Palestinians have been killed and 114,776 injured since the war began, including 1,163 deaths and 2,735 injuries since the escalation of hostilities three weeks ago. A study published in The Lancet in January found the statistics published by Gaza’s Health Ministry likely underestimate the true death toll by as much as 40%, placing the total deaths at 61,000 four months ago. 

Approximately 1.9 million Palestinians—nearly everyone in the territory—have been displaced by the fighting, most several times. Much of the territory has been leveled into uninhabitable rubble, with entire cities like Rafah, once home to hundreds of thousands of people, effectively deleted from the map.

“We are witnessing acts of war in Gaza that show an utter disregard for human life,” the UN leaders wrote. “Protect civilians. Facilitate aid. Release hostages. Renew a ceasefire.”

Israel launched the offensive in response to Hamas’s October 7, 2023 surprise attack on over a dozen Israeli communities on the periphery of the Gaza enclave, during which militants killed 1,200 people, mostly civilians. 

Another 251 Israelis and foreign nationals were taken hostage.  Over 100 hostages, mostly women and children, were released in an initial week-long truce in November, while several more were rescued alive and the bodies of others found in Gaza by the Israeli military. 

Israel’s UN mission in Geneva, responding to the UN agencies’ letter, did not refer directly to the humanitarian crisis or its blockade, blaming “the terrorist organization Hamas” as the “first and foremost cause of suffering in the Gaza Strip… cynically seeking to maximize civilian harm as a matter of strategy.”

“All international organizations” should “uniformly call for the immediate and unconditional release of the 59 hostages” still held by Hamas, the mission said.  Among the 59 hostages still held captive in Gaza, only 24 are believed by Israel to be alive.

Humanitarian progress reversed

As food stocks in #Gaza run out, WFP's various assistance programmes are gradually shutting down.◼️All WFP-supported bakeries are closed◼️Last food parcels were distributed this week◼️Hot meals continue, but supplies are running lowWe urgently need aid to enter Gaza.

— World Food Programme (@wfp.org) 2025-04-04T11:40:34.396Z

During the ceasefire, UN and humanitarian agencies made vital progress in Gaza after Israel temporarily ended its blockade – a practice that violates international humanitarian law’s prohibition on collective punishment of civilian populations. Aid workers rushed to alleviate the most urgent crises, treating malnourished children, rehabilitating hospitals, and replenishing critical food and medicine stocks.

“The latest ceasefire allowed us to achieve in 60 days what bombs, obstruction and lootings prevented us from doing in 470 days of war: life-saving supplies reaching nearly every part of Gaza,” the joint UN agency letter stated.

UNICEF began repairing critical wells and water points to increase safe drinking water access. Now that progress has been wiped away by renewed fighting and blockades.

“While this ceasefire offered a short respite, assertions that there is now enough food to feed all Palestinians in Gaza are far from the reality on the ground, and commodities are running extremely low,” the agency chiefs warned.

All 25 UN subsidized bakeries that were opened during the last reprieve have now closed due to a lack of cooking gas and flour. WFP reports approximately 5,700 tons of food stocks remain in Gaza—enough to support its operations for a maximum of two weeks.

With 91 percent of Gaza’s population facing crisis-level food insecurity, families are struggling amid unprecedented destruction and constant displacement, WFP said on Monday.

Health system on the brink

Latest data on Gaza’s health system according to the World Health Organization.

Gaza’s health infrastructure, already in ruins, now faces total collapse. The fragile system is overwhelmed by casualties, particularly among children, while essential medicines and supplies rapidly dwindle.

“The partially functional health system is overwhelmed. Essential medical and trauma supplies are rapidly running out, threatening to reverse hard-won progress in keeping the health system operational,” the joint letter states.

The situation is particularly dire for pregnant women and children. An estimated 55,000 women are pregnant in Gaza, with one-third facing high-risk pregnancies. Around 20% of the 130 babies born each day are pre-term, underweight, or born with complications, needing advanced care that is rapidly diminishing.

“Gaza continues to be one of the most dangerous places to be a child and where pregnancy is clouded by fear due to ongoing violence, displacement and lack of medical access,” WHO reported over the weekend.

Médecins Sans Frontières warns that the month-long siege has forced their teams to ration medications and turn patients away. Critical medications including pain killers, anesthetics, pediatric antibiotics, and medicines for chronic conditions are running out.

“The Israeli authorities have condemned the people of Gaza to unbearable suffering with their deadly siege,” says Myriam Laaroussi, MSF emergency coordinator in Gaza. “This deliberate infliction of harm on people is like a slow death; it must end immediately.”

“UNICEF has thousands of pallets of aid waiting to enter the Gaza Strip,” said UNICEF Regional Director for the Middle East and North Africa Edouard Beigbeder. “Most of this aid is lifesaving – yet instead of saving lives, it is sitting in storage. It must be allowed in immediately. This is not a choice or charity; it is an obligation under international law.”

As the blockade continues and bombs fall, UNRWA chief Philippe Lazzarini echoed UNICEF’s concerns for Gaza’s youth, who represent nearly half of the territory’s population.

“The ceasefire at the beginning of the year gave Gaza’s children a chance to survive and be children,” said Lazzarini, citing a new UNICEF report which found an average of 100 children have been killed or injured in Gaza every day since the war began.

“The resumption of the war is again robbing them of their childhood,” Lazzarini added. “The war has turned Gaza into a ‘no land’ for children.”

Humanitarian workers in the crosshairs

More aid workers have died in Gaza than any conflict since data recording began.

The joint UN statement comes on the heels of a bloody incident near Gaza’s southern border in Rafah on 23 March, when Israeli forces shot dead 15 Palestinian emergency workers, before burying their bodies in a shallow grave along with the crushed remains of their vehicles.

A video released by the Palestine Red Crescent Society, obtained from the cell phone of one of the victims of the attack, contradicted initial Israeli military claims that the emergency vehicles were not properly marked. The footage, published by the New York Times, clearly showed ambulances with lights and emergency signals on when they came under fire.

“During [the] day and at night, it’s the same: external and internal lights are on. Everything tells you it’s an ambulance that belongs to the Palestinian Red Crescent,” the sole survivor of the incident, Munther Abed, told the BBC. “All the lights were on until we came under direct fire.”

The Palestine Red Crescent released a video made by a paramedic before he was killed by Israelis in Gaza, and called the deaths of 15 rescue workers “a full-fledged war crime.” Israel has said it is investigating, but Red Crescent officials called on the UN for an independent investigation.

— The New York Times (@nytimes.com) 2025-04-07T18:23:22.084Z

The world looked on as aid workers in Gaza have been killed at a rate unprecedented in modern humanitarian operations, making this the deadliest conflict for UN workers in the history of the organization founded after World War II.

Since 2023, 411 aid workers have been killed in the Occupied Palestinian Territories—more than eight times the total killed in the previous two decades combined. The recent period represents approximately 89% of all recorded aid worker deaths in the region’s history, including all previous conflicts with Israel, according to an International Aid Worker Security Database.

WHO has recorded 670 attacks on healthcare workers or facilities in Gaza and another 754 in the West Bank since the war began. Israel accuses Hamas of militarizing Gazan schools, healthcare facilities and hospitals, including the holding of numerous hostages in at least one hospital in the first stages of the war.

The toll on journalists is equally unprecedented in modern warfare. Between 147 and 232 journalists have been killed in Gaza since October 7, 2023—more than in the U.S. Civil War, World Wars I and II, the Korean War, the Vietnam War, the wars in Yugoslavia, and the post-9/11 war in Afghanistan combined—according to the Brown Institute for the Costs of War.

“What is happening here, it defies decency, it defies humanity, it defies the law,” said Jonathan Whittall, head of OCHA’s office for the Occupied Palestinian Territory. “It really is a war without limits.”

A mother and newborn at a health center in the Patna district of Bihar, India. International aid cuts threaten progress on maternal health.

Maternal mortality rates have dropped by 40% since 2000, largely due to improved access to essential health services. But WHO officials warn that the recent, deep cuts to international aid could be as disruptive as the COVID-19 pandemic, if not more so, to a woman’s chances of surviving pregnancy and childbirth.

And in 2023, more than a quarter million women still died from pregnancy and childbirth complications, according to a report on global maternal mortality released on Monday, World Health Day, which focused on maternal and newborn health.

That’s a death every two minutes. 

“This is not just a medical failure,” said Dr Pascale Allotey, director of the WHO Department of Sexual and Reproductive Health and Research, at the report’s launch. “It’s a failure of society.”

The report by UNICEF, WHO and the UN Population Fund (UNFPA) comes as the dismantling of most of USAID’s international health programmes, and other cuts to health and humanitarian aid send shockwaves through global health, forcing countries to roll back vital services for maternal, newborn and child health, the WHO said. 

Without urgent action, fading attention, funding cuts, and humanitarian crises will jeopardize pregnant women in conflict settings – and make the persistent tragedy of maternal mortality “alarmingly high,” warned WHO officials convened at a press conference last week. 

International aid cuts could mirror COVID-19 chaos

Maternal mortality ratios 2000-2023 by SDG region.
Maternal mortality ratios by region. The COVID-19 pandemic caused an upsurge in deaths, particularly in 2021.

This year’s report is also the first to delve into how the pandemic affected deaths from pregnancy-related conditions.

“I hate to use the term ‘surviving’ pregnancy,” said Dr Bruce Aylward, WHO assistant director general for Universal Health Coverage and life course at a press conference. “But that’s what our reality is.”

The pandemic “shocked” health systems, said Aylward, meaning that many women could not access needed care for their pregnancies and deliveries.

As a result, more than 40,000 more women died in pregnancy and childbirth in 2021 (322,000) as compared to 2020 (282,000), the report concludes, as the pandemic was gathering steam in low-income regions such as Africa and South Asia.  

The upsurge in deaths was partly linked to direct complications caused by COVID-19 during pregnancy, but not only that. There were also widespread interruptions to maternity services – due to the competing demands of the pandemic on hospital beds and healthcare workers, limitations on travel, and other factors limiting access to hospitals and primary healthcare services. 

Severe bleeding, infections, preeclampsia and eclampsia, delivery complications, and unsafe abortions are the largest drivers of maternal mortality. 

Yet the spike in deaths during the pandemic was temporary. In 2022, the global MMR and number of maternal deaths were lower than they had been in the three years immediately prior to the COVID-19 pandemic, the report notes. 

Whether the disruptions now being experienced as a result of the broad funding cutbacks in international health assistance led by the United Strates, but also including the United Kingdom, will be as short-lived, remains to be seen.  

Aid crisis threatens to reverse decades of progress

To date, aid cuts have already led to facility closures and loss of health workers, while also disrupting supply chains for supplies and medicines for the pregnancy complications, WHO said in a joint statement with UNICEF. 

“Global funding cuts to health services are putting more pregnant women at risk, especially in the most fragile settings, by limiting their access to essential care during pregnancy and the support they need when giving birth. The world must urgently invest in midwives, nurses, and community health workers to ensure every mother and baby has a chance to survive and thrive,” UNICEF Executive Director Catherine Russell, said in the press statement. 

She added, “When a mother dies in pregnancy or childbirth, her baby’s life is also at risk. Too often, both are lost to causes we know how to prevent.”

Lead author Dr Jenny Cresswell also predicted a rise in unsafe abortions as one consequence of the recent funding cuts – which target reproductive health services, in particular.

“Any sudden disruptions will eventually lead to adverse outcomes,” she said.

US international assistance also “underpins” WHO’s ability to collect and analyse country data, and more importantly, support the “basic ability of a woman to survive during pregnancy,” Aylward noted at last week’s briefing. 

“The American people have been incredibly generous in the past 25 years – and share in the credit for progress so far. It makes a real difference” Aylward. This progress is now “at risk of disappearing.” 

And the most economically fragile countries are also the ones with the least ability to rapidly adjust to the abrupt funding halt, and are consequently at highest risk, he concluded.

Huge global disparities – particularly in conflict zones

The report gathers data from 195 countries and territories, with a third of all countries having “very low” maternal mortality ratios (MMR). No country was rated as having an “extremely high” ratio for the first time, defined as the number of deaths per 100,000 live births. 

In 2000, nearly a million women died from pregnancy-related conditions. In 2023, maternal morality had declined to 260,000.  That represents a 40% decline in the rate of maternal deaths, as compared to live births per 100,000 population. 

And while the WHO pointed to these significant improvements since 2000,  “there is a huge unfinished agenda in which a quarter million women die trying to give life,” said Aylward. 

The burden is not equal. Lower and middle income countries and countries caught in conflict are the places where the vast majority of maternal deaths occur – nine in ten in fact.  

Sub Saharan Africa did see the largest improvements over the past two decades. Even so, some 70% of maternal deaths still occur in that region, noted Cresswell. Globally, Chad, the Central African Republic (CAR), Nigeria, and Somalia face the highest burden of maternal mortality – along with Afghanistan. 

Conflict zones are especially vulnerable to high rates of maternal mortality. Countries in conflict – such as Afghanistan, Somalia, and CAR – accounted for three in ten deaths. 

The maternal mortality ratio is “significantly higher” in conflict-affected areas (504 deaths per 100,000 live births) compared to non-conflict of non fragile settings (99 per 100,000 live births), the report notes. 

Persistent social and economic inequalities underline uneven progress between regions. Post-2015, progress stalled in five regions: North Africa and Western Asia, Eastern and South-Eastern Asia, Oceania (excluding Australia and New Zealand), Europe and North America, and Latin America and the Caribbean.

“We cannot be complacent,” said Cresswell. 

Skilled health workers at the center of solutions

“This is not just a medical failure – it is a failure of society,” said Dr Pascale Allotey of the WHO, referring to maternal mortality. A child is tested for malnutrition by a WHO healthcare provider.

The most important factor in healthy pregnancy outcomes is having a skilled attendant at the time of childbirth – most deaths occur around the time of delivery. 

Part of the remarkable progress seen in the past two decades is attributable to the upsurge in midwifery programs, as well as in programmes targeted at reducing unsafe abortions, a major cause of complications. 

“Having a skilled health worker in place is key, and we have seen positive progress, particularly in Sub Saharan Africa,” said Cresswell. “There is still work to be done. There are still too many women who are delivering without a skilled health provider.”

Also imperative is improved access to family planning services, and preventing underlying health conditions like anaemias, malaria and noncommunicable diseases that increase pregnancy risks, the report notes. 

Allotey, from the department of sexual and reproductive health, also emphasized the role of access to comprehensive information throughout pregnancy. This means generally making sure girls stay in school and receive the knowledge and resources to protect their health.

“There are a whole range of preventive measures to make sure that women are safe,” she said. These include making sure the pregnancies are wanted, and therefore mothers are able to access better care, as well as political commitments.

In recent years, increased political support from African nations has begun to “move the needle” on maternal and child health. 

This year’s World Health Day theme “Healthy beginnings, hopeful futures,” aims to raise awareness on maternal and child health because “it is not okay for a woman to die trying to give birth,” said Aylward. 

“While this report shows glimmers of hope, the data also highlights how dangerous pregnancy still is in much of the world today – despite the fact that solutions exist to prevent and treat the complications that cause the vast majority of maternal deaths,” said Dr Tedros Adhanom Ghebreyesus, Director General of WHO. 

Image Credits: BMGF, WHO, Twitter.

Wearing green for go: INB co-chair Precious Matsoso, WHO’s Dr Tedros Adhanom Ghebreyessus and Mike Ryan at the INB opening.

Countries keep increasing their military budgets yet seem unwilling to prepare for an “invisible enemy” – a pandemic-causing pathogen that can be more damaging than a war, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyessus warned at the start of the final negotiations for a pandemic agreement on Monday.

The COVID-19 pandemic killed up to 20 million people and wiped $10 trillion from the global economy, while the 1918 influenza epidemic killed up to 50 million people – and First World War killed 15-22 million people, Tedros pointed out. 

WHO member states have a mere five days to reach consensus on the pandemic agreement if they are to present it to the World Health Assembly (WHA) next month – yet three ‘big ticket’ items and a myriad of process questions are still on the table.

Articles on how to share information about dangerous pathogens – the Pathogen Access and Benefit-Sharing (PABS) system; technology transfer (purely voluntary or not) and the pandemic preparedness responsibilities of member states (including ‘One Health’ measures) are still lacking agreement.

READ: What’s New in the Pandemic Agreement

Waning political will

The opening day coincided with International Health Day and the WHO’s 77th anniversary, and WHO and INB staff wore green to signify all systems go for the talks.

Tedros, hastily tying his green tie, urged all countries to “find a balance in protecting their people from both bombs and bugs” as the next pandemic is an “epidemiological certainty”.

While the talks at the Intergovernmental Negotiating Body (INB) could continue beyond this week and after the WHA, there is widespread consensus that member states’ already-waning political will to nail down a treaty will simply fizzle out.

The pandemic agreement has also been the target of a systematic misinformation campaign based on the incorrect claim that it will enable the WHO to undermine countries’ sovereignty. 

Right-wing parties and organisations, including a significant portion of US President Donald Trump’s Republican Party, have bought into various anti-WHO conspiracies as they have sought to blame the WHO for everything that went wrong during the COVID-19 pandemic.

Several influential countries have swung to the right, including Germany, the Netherlands and France, and this has also undermined support for the agreement as these right-wing parties typically opposed COVID-19 lockdowns and vaccine mandates, and have seen the pandemic agreement as an attempt to enforce these.

Growing health threats

The talks come amid serious and growing health threats. Disease outbreaks in Africa have increased by 41% between 2022 and 2024. Yet the continent has experienced a 70% loss in official development assistance (ODA), from $81 billion in 2021 plummeting to $25 billion in 2025 – largely as a result of US funding cuts – and ODA covers 30% of the continent’s health spending.

Dr Jean Kaseya, head of the Africa Centres for Disease Control and Prevention (Africa CDC), warned last week that the continent no longer has the means to adequately monitor outbreaks – including the mpox outbreak in central Africa.

The reduction in aid means fewer trained health workers, less equipment and medical countermeasures – vaccine, medicines and diagnostics, said Kaseya.

“It means we are, all of us, at risk. Our message to our colleagues from Western countries is:  ‘You are not protected, because if there is a pandemic coming from Africa, you will be affected’,” he added.

Ironically, however, the US also poses a risk to the rest of the world as it has dismantled vast areas of its health system, including cutting 2,400 posts at the Centers for Disease Control and Prevention (CDC), which monitors disease outbreaks – amid a serious and ongoing outbreak of H5N1 in cattle and a measles outbreak. In addition, the US’s radical aid cuts have also weakened global disease surveillance and response – including or mpox and Ebola.

Stakeholders’ pleas

IFPMA’s Grega Kumer.

Various stakeholders spoke in support of the pandemic agreement – with some caveats – on Monday, with several underlining that enough progress has been made to close the deal.

Grega Kumer, representing the International Federation of Pharmaceutucal Manufacturers and Associations (IFPMA), stressed the need for entrenched intellectual property rights and the voluntary transfer of technology and know-how during a pandemic (Article 11). 

“The significance of including both ‘voluntary’ and ‘on mutually agreed terms’ for tech transfer is paramount as it facilitates the sharing of technologies and expertise in a manner that respects the interests and agreements of all parties involved,” said Kumer.

Various other parties have pointed out that even the US and Germany have laws that allow their governments to enforce compulsory tech transfer during crises such as wars and pandemics.

Oxfam’s Mogha Kamal-Yanni told the INB that “technology transfer cannot be left to the whim of pharmaceutical companies”. 

“We see the clear evidence of the failure of voluntary action in the fact that, four years since the establishment of the mRNA hub in South Africa and despite several attempts to get companies to share the mRNA technology, not a single one agreed,” she said.

“Let’s hope that on Friday, we celebrate your hard work resulting in an agreement that is fair and that protects all people everywhere, and proves that the multilateral system works,” said Kamal-Yanni.

Spark Street Advisors CEO Nina Scwalbe

Spark Street Advisors CEO Nina Schwalbe said: “As currently drafted, the pandemic agreement secures important gains, including on research and development, equitable access to pandemic countermeasures and a One Health approach to pandemic threats. 

“While not all policy goals have been achieved, this potentially historic agreement lays essential groundwork for equitable, collective preparedness and response now and can be strengthened through additional protocols in the future,” said Schwalbe, also speaking for the Pandemic Action Network, the Panel for a Global Public Health Convention, Helen Clark, the co chair of the Independent Panel for Pandemic Preparedness and Response, and various members of the Global Preparedness Monitoring Board.

“We urge you, member states, to stay laser focused on the end goal and find room to give and take to reach agreement… We are counting on you to pull together and get this agreement.”

WHO member states convened in Geneva on Monday (7 April) for the final pandemic agreement negotiations before the May World Health Assemby.

World Health Organization (WHO) member states have entered their final week of scheduled negotiations on the pandemic agreement (PA), amid renewed urgency following the United States withdrawal from the organization and widespread aid cuts that carry serious implications for global health. With limited time before the May World Health Assembly, when a final version of the accord is supposed to be ready, the Governing Pandemics Initiative Team at the Global Health Centre of the Geneva Graduate Institute offers a preliminary analysis of the 21 February draft.

The newly released policy brief “What’s new in the draft Pandemic Agreement?” shows how the draft agreement builds on lessons from COVID-19 by proposing a systemic approach to pandemic prevention, preparedness, and response (PPPR).

The analysis is structured in three parts: (1) a comparison with the amended International Health Regulations (IHR) to understand why a new instrument was deemed necessary and how the two frameworks could work together; (2) a thematic grouping of related articles, illustrating the integrated logic of the draft text; and (3) a focus on the ‘green’ provisions—articles already broadly agreed—which introduce meaningful innovations and mark progress beyond existing international health law.

A summary of Part 2 is included below. The full paper is available on the Governing Pandemics Initiative’s website.

Main content and interlinkages

Treaty negotiations must often focus on specifics – an article, a sentence, a single word. After over three years of intense negotiations, as the finish line approaches, it is not always easy to consider the totality of what has been negotiated and achieved, especially for those who have been closest to the process.

Here we offer a high-level summary of the main substantive topics addressed by the draft PA, as reflected in the draft of 21 February 2025. We also highlight linkages between articles, since the provisions of a treaty cannot be read in isolation but have to be interpreted in light of the overall text, including the preamble and any annexes.

While it is understandable that attention focuses on the issues where consensus has not yet been forged, it is also important to recognize the breadth, depth and novelty of what has been agreed. 

After laying out the context, definitions, objectives, overarching principles and approaches (Preamble and Chapter I), the draft PA addresses five main thematic areas (Chapters II and III):

Preventing pandemics (Articles 4 and 5) 

These articles are still largely under negotiation. The current text lays out obligations on parties to reduce the likelihood of pandemics by mitigating the risks that outbreaks emerge in the first place – whether in humans, animals, the environment, or the intersection among them – and that once they do, they are detected quickly through surveillance.

The obligations go further upstream than the International Health Regulations (IHR) in seeking to reduce the risk of outbreaks occurring in humans in the first place. It is recognized that obligations on a Party to implement such preventive measures will be “in accordance with its national and/or domestic laws and subject to the availability of resources,” reflecting flexibility, and underscoring the importance of effective governance arrangements to enable the Conference of the Parties (COP) to discuss whether an appropriate balance is being struck between national sovereignty and effective implementation (Chapter III).

In addition, international cooperation in the form of “technical assistance, capacity building, technology transfer and financing” may be needed to implement these articles fully, highlighting the connection to international support (Articles 19 and 20). 

Societal and health system capacities (Articles 6, 7, 17, 18) 

These articles are nearly uniformly green, and lay out obligations on parties to “develop, strengthen and maintain a resilient health system” capable of providing healthcare services and public health functions during and between pandemics, and ensuring the appropriate healthcare workers (HCW) to do so (see further discussion of Articles 6, 7 and 17 below).

Some of the key provisions in Article 4 on prevention (i.e. on routine immunization, infection prevention and control, and lab safety) rely on day-to-day functioning health systems. Parties also commit to strengthen their societal capacities to address pandemics by adopting inclusively-developed whole-of-government, whole-of-society plans, and increasing population literacy and trust through community-engagement and risk communication.

No other treaty binds countries to such specific or deep obligations on societal or health system capacities to address pandemics. Repeated throughout is language that gives Parties flexibility, such as “taking into account its national circumstances” and “as appropriate,” underscoring the importance of effective governance arrangements (Chapter III). Implementing these obligations will also require domestic and in some cases international financing, and hence should be read alongside Articles 19 and 20 on international support.

Pandemic-related health products (Articles 9-14)

Convergence has largely been achieved on most of these articles, with the exception of Articles 11 on technology transfer and 12 on a Pathogen Access and Benefit-Sharing (PABS) system. They establish an interconnected set of obligations on Parties with the aim to improve equity in access to pandemic-related health products.

Obligations span from R&D to manufacturing of products, from regulatory review to stockpiling. The provisions are both nationally-oriented (i.e. commitments to invest in R&D domestically or develop regulatory capacities), and internationally-oriented (i.e. licensing publicly-owned technologies and refraining from stockpiling more than a country needs).

A connecting thread throughout is transparency, including parties’ commitments to transparency of R&D priorities, clinical trial protocols, research results, licensing agreements, supply chains, and relevant terms of procurement contracts. Another area of emphasis is consideration for access to health products in fragile or humanitarian settings. 

The specificity of norms on what countries commit to do and/or should do with respect to pandemic-related products, and the depth of international cooperation they establish, are unprecedented in international treaty law (see, for example, further discussion of Articles 9 and 13 below).

That said, throughout these articles, there is frequent appearance of language such as “promote”, “encourage”, “within means and resources at their disposal”, and “in accordance with national and/or domestic law and policy,” underscoring (as elsewhere) a fair amount of flexibility for implementation and the importance of effective governance arrangements for follow-up and accountability.

Article 12 is still under negotiation, but if agreed close to its current form, it would eventually establish a PABS system with additional details to be negotiated subsequently in an annex.

This Article connects and mutually reinforces two major parts of the draft PA: a functioning PABS system could enhance international surveillance (Articles 4 and 5 on prevention and surveillance) while facilitating product development and access (Articles 9-14 on products).

Under such a system, parties would commit to provide access to “PABS Materials and Sequence Information” in accordance with data safety, biosafety and biosecurity standards, in a manner that would provide legal certainty to participating actors, and facilitate research and innovation.

On an equal footing, parties would commit to benefit-sharing during pandemic emergencies, with different benefits potentially during public health emergencies of international concern (PHEICs) and to prevent outbreaks from progressing into emergencies. Such benefits are envisioned to include monetary and non-monetary benefits, including a percentage of real-time manufacturing of products to be supplied to WHO for allocation to countries in need.

Implementing these obligations will require domestic and international resources, both financial and technological, such that Articles 19 and 20 on international support and financing are highly relevant here, as is Article 11 on technology transfer. The PABS system may generate its own financing through sources such as annual fees or royalties, but this issue remains to be agreed in future negotiations of the Annex.

International support (Articles 19 and 20)

These articles are almost entirely green, and obligate Parties to cooperate to strengthen capacities for implementation, especially in developing countries. Domains of cooperation may include technology transfer, sharing of legal and scientific expertise, capacity-strengthening and financing.

Parties commit to “maintain or increase domestic funding” for PPPR, “work to mobilize” additional international financing and establish a Coordinating Financial Mechanism that is to provide strategic information, analysis and support to parties in securing financing.

A core purpose of the mechanism is coherence and increased transparency in a fragmented and opaque financing landscape; it is envisioned that a single mechanism would address financing issues related to both IHR and PA obligations. As flagged above, financing and other forms of international support are critical to all three substantive thematic areas – prevention, societal and health systems capacities and pandemic-related health products.

Governance, including the role of WHO (chapter III, Articles 21-37)

These articles are largely green, with the exception of Articles 30 and 31 on Annexes and Protocols. They establish the governance arrangements for the PA, including a COP, voting rights, reporting obligations, settlement of disputes, reservations and amendments, annexes and protocols, and arrangements for entry into force and withdrawal.

As flagged above, effective governance is critical for meaningful implementation in all three substantive thematic areas, since many commitments are subject to caveats (i.e. “within means and resources at their disposal,” “taking into account its national circumstances,” “in accordance with national and/or domestic law and policy,” “as appropriate”) or exhortatory rather than obligatory (i.e. “encourage,” “promote,” “work to”).

Establishing what is “appropriate,” for example, will certainly be discussed by the COP and other governance arrangements. How monitoring and accountability will function has been left to a “mechanism” that the COP is to establish at its second meeting; the draft PA specifies that the mechanism is to “facilitate and strengthen effective implementation” and is to be “transparent, cooperative, non-adversarial, non-punitive and cognizant of respective national circumstances.”

Article 24 establishes the WHO Secretariat as the Secretariat of the PA. The role of WHO is also specified in various articles throughout the draft PA, for example, as a provider of support to Parties including reviewing national policies; offering training programs; developing norms, frameworks and recommendations; coordinating technology transfer; operating the PABS system; convening the Global Supply Chain and Logistics (GSCL) Network; and coordinating with other international relevant organizations and bodies. While the envisioned role of WHO is varied and extensive, a key distinction between the PA and IHR is that the PA entails far more extensive obligations on states (Parties) as also discussed above in Part 1. 

Read the full policy brief here: “What’s new in the draft Pandemic Agreement?”

To read the Governing Pandemics Snapshot—a series of periodic briefings on the state of global reforms for pandemic preparedness and response—please visit  the Governing Pandemics Initiative’s website.

Gian Luca Burci is Senior Visiting Professor of International Law at the Geneva Graduate Institute and Academic Adviser at the Global Health Centre.

Ava Greenup is Project Associate with the Governing Pandemics Team at the Global Health Centre, Geneva Graduate Institute.

Ricardo Matute is Policy Engagement Advisor with the Governing Pandemics Team at the Global Health Centre, Geneva Graduate Institute.

Suerie Moon is Co-Director of the Global Health Centre and Professor of Practice at the Geneva Graduate Institute.

Daniela Morich is Senior Manager and Adviser at the Global Health Centre, Geneva Graduate Institute.

Adam Strobeyko is an affiliated international law researcher at the Global Health Centre, Geneva Graduate Institute.

On 1 April 2025, locals pass by a collapsed building in the aftermath of the 7.7-magnitude earthquake that struck central Myanmar last week, killing and injuring thousands.

Myanmar’s health system was collapsing. Then the earthquake hit.

“The houses, which were all built on the water, were gone — all flattened,” 15-year-old Myat Nyein from Inle Lake in Shan State, recalled in testimony to Save the Children. His mother died in the disaster, her body found covered in bruises with stitches on her head. He survived by jumping into the lake with his brother.

“I will never forget the moment I pulled my younger brother into the water, the sight of our fallen village, or my mother’s broken body,” Nyein said. “These memories will stay with me forever.”

Myat Nyein’s story is just one of thousands that have unfolded across Myanmar since the 7.7-magnitude earthquake struck a week ago. The earthquake shook six regions across the country, home to approximately 28 million people, including 6.7 million children.

The disaster has killed at least 3,838 people and injured over 4,000, with another 500 still missing, according to the latest UN estimates. The United States Geological Survey warns the death toll could potentially exceed 10,000 as search and rescue operations continue in remote regions.

Aid officials describe the situation as a humanitarian catastrophe of historic proportions.

“The needs are beyond words,” said Nadia Khoury, head of the International Federation of Red Cross and Red Crescent Societies (IFRC) in Myanmar. “Our response must match the sheer scale of the disaster – now and for the longer term.”

The disaster has devastated a health system already crippled by years of civil war. The earthquake destroyed three hospitals and partially damaged 22 others, according to the World Health Organization, severely limiting healthcare capacity when it is most needed. Around 40% of hospitals in Myanmar are located in territories contested in the civil war, making them inaccessible to many seeking urgent medical care.

“The earthquake has taken a heavy toll. Thousands of lives are lost. Families displaced. Health facilities have been damaged or overwhelmed in the hardest hit areas,” said Hyon Chol Pak, administrative officer at WHO’s Myanmar office.

Even before the earthquake – the largest to hit Myanmar in over a century – the country faced a dire humanitarian crisis. In its December 2024 assessment, the UN had already declared that “the health system is in collapse,” with 12.9 million people requiring humanitarian health interventions. Due to severe underfunding, only 2.4 million were targeted for assistance, UN figures show. 

This deterioration follows years of political and economic instability after the February 2021 military coup in the country, which had already shuttered hospitals, disrupted medical supply chains, and internally displaced millions of people. 

“Myanmar is shattered,” the UN Refugee Agency said Thursday. “Millions urgently need shelter, safety, and aid.”

Disease threats mount amid a health system in ruins

Poe Kyal Sin Lin, 6, stands in front of a collapsed wall of the Aye Thukha Community Hall in the Mahar Aung Myay Ward of Mandalay, several days after the devastating earthquake.

Health officials warn that disease outbreaks now pose an imminent threat to earthquake survivors, many of whom are sleeping outdoors in temperatures exceeding 40 degrees Celsius. An estimated 100 people, mostly children and the elderly, died in a similar heatwave last year as power outages left civilians with no recourse to escape the scorching heat. 

Medical staff, many themselves affected by the earthquake, are struggling to provide care in impossible conditions. In many areas, patients are being treated outdoors in unseasonal heat as buildings remain unsafe, with healthcare workers attempting to manage thousands of traumatic injuries without adequate supplies or facilities. 

Water and sanitation infrastructure has been destroyed in numerous communities, leaving many without safe access to drinking water. The contaminated water is causing rising illness rates among populations in Myanmar’s regions impacted by the earthquake, according to Malteser International. The WHO has already detected cases of acute watery diarrhea in displacement sites, with 47 cases reported across Mandalay and Sagaing regions.

“Especially for young children and older people, watery diarrhea combined with dehydration can quickly lead to death,” said Arno Coerver, Malteser International’s Global WASH advisor. “Additionally, contaminated water used to clean wounds significantly increases the risk of infections for injured individuals.”

Myanmar was battling multiple disease outbreaks before the historic seismic shocks hit the nation this week. Elena Vuolo, the deputy head of WHO’s Myanmar office, told Reuters that “cholera remains a particular concern for all of us,” pointing to an outbreak last year in Mandalay, one of the regions hardest hit by the earthquake.

Malaria and tuberculosis cases spiked sevenfold since the coup in 2021, while HIV infections have grown by 10%, according to WHO data.

“Due to the ongoing shortage of malaria supplies, malaria cases are resurging in several regions and states of Myanmar,” the WHO reported. “Dengue remains a major public health concern, affecting an increasing number of people, mostly children under 15 years of age.”

Vaccination coverage for childhood illnesses was already “persistently low” before the disaster. “An estimated 1.5 million children under-five have missed basic vaccinations since 2018, posing a serious threat to the risk of measles and diphtheria outbreaks and possible re-emergence of polio,” according to WHO assessments.

Now the earthquake has created conditions that could accelerate disease spread. 

“Earthquake-related displacement, limited access to safe water and food, overcrowded displaced populations, poor sanitation, inadequate disease prevention measures and potential movement of rodents into urban areas increase the likelihood of water-borne, vector-borne, and airborne disease transmission and risk of plague re-emergence,” WHO warned.

“Widespread displacement caused by armed conflict, climatic disasters, and ethnic tensions has put IDPs and migrant populations at increased risk of public health threats due to overcrowding, poor overall living standards, and limited health care infrastructure,” the UN health agency added. 

Aid organizations identify clean drinking water, sanitation, medical care, shelter, and access to basic necessities as the most critical immediate needs.

The Red Cross reports operating mobile health clinics, water purification units, and ambulances in Mandalay and Sagaing. WHO has transported essential medical supplies, including trauma kits and essential medicines, to hospitals and first responders in affected regions.

Beyond physical injuries and infectious diseases, the earthquake has inflicted severe psychological trauma on survivors.

“The scars of the earthquake are not all physical,” the Red Cross reported, noting the critical need for mental health and trauma support following the disaster. “The coming days, weeks and months will be critical for the people of Myanmar.”

“Mental health challenges are also a major concern,” WHO confirmed, explaining that the earthquake “exacerbates the mental health challenges because of its sudden and traumatic nature, leading to widespread disruption and amplifying feelings of fragility in an already vulnerable setting.”

Cascading crises

The earthquake struck a country already grappling with multiple humanitarian challenges. Before the disaster, approximately 19.9 million people—over a third of Myanmar’s population—required humanitarian assistance.

“In the INFORM Risk for 2025, Myanmar ranks 11th out of 191 countries, with a ‘very high’ risk classification driven by extremely high scores for hazards and conflict intensity,” the UN assessed months before the earthquake struck. “If the current trajectory is not reversed, the humanitarian situation in Myanmar is expected to remain extremely dire and further deteriorate in 2025.”

The epicenter was near Sagaing Township, a region that was already hosting one-third of the country’s internally displaced persons due to the ongoing civil war. Nationwide, an estimated 3.5 million people had been displaced since the military overthrew the democratically elected government of Aung San Suu Kyi in 2021, all before the earthquake struck.

Myanmar’s civil war, now in its fourth year, has become the world’s most violent conflict, killing at least 50,000 people, including at least 8,000 civilians, according to the Armed Conflict Location and Event Data Project.

The 7.7 magnitude quake reverberated as far as Thailand from its epicenter in Mandalay, Myanmar.

The situation is set to worsen in the coming days, with weather forecasts predicting heavy rains from Sunday through April 11 in the earthquake-affected regions. 

“The monsoon season is right around the corner, it’s arriving in a couple weeks,” said Tommaso Della Longa, spokesperson at IFRC. “Of course, we cannot say the severity of the monsoon season, the severity of the rains, but by experience, we know that this kind of makeshift tent and temporary shelter are not enough to keep people safe. 

“There is a kind of domino effect where there is no proper shelter, where there is no proper water sanitation, where there is no proper health support, then you can have health issues,” Della Longa said. 

Regions hit by the earthquake were still recovering from the devastating floods caused by Typhoon Yagi, which swept across Myanmar and Thailand last year, raising concerns that another severe weather season could be even more catastrophic given the compounded crises of war and seismic damage.

“Imagine a disaster is a hammer,” said Unni Krishnan, global humanitarian director at Plan International. “One disaster has already struck which is the earthquake, then you bring another one called rains, then you bring the cyclone, and the floods and the storm surge. So, you’re talking about a bunch of hammers hitting the same spot again and again.”

Military operations hampering aid

The catastrophic health situation has been compounded by ongoing military operations and restricted humanitarian access. UN High Commissioner for Human Rights Volker Türk reported that the Myanmar military has continued operations and attacks in the aftermath of the earthquake, including airstrikes – some launched shortly after tremors subsided.

“The Office has received reports that the military has carried out at least 53 attacks, including strikes by aircraft and drones, artillery and paramotors in areas affected by the earthquake. At least 14 attacks by the military have been reported since they announced a temporary ceasefire taking effect on 2 April,” Türk stated.

While both the military junta and the opposition National Unity Government have announced ceasefires to facilitate aid operations, the continuing violence has severely restricted humanitarian access.

The humanitarian response faces additional challenges from an information blackout imposed by the military, making it extremely difficult to contact affected communities and assess the situation. Internet and telecommunication shutdowns have severely hampered coordination efforts.

“Sources from the ground describe a catastrophic humanitarian situation in earthquake-hit areas, especially those outside the military’s control, an absence of relief efforts, and a lack of clean water, food, and medicines,” Türk reported. “Fear and shock have augmented the suffering of a civilian population already subjected to four years of military violence since the coup.”

“I urge a halt to all military operations, and for the focus to be on assisting those impacted by the quake, as well as ensuring unhindered access to humanitarian organizations that are ready to support,” Türk said.

For Myanmar’s population, already suffering through years of conflict and inadequate healthcare, the earthquake has turned an ongoing crisis into a catastrophe of historic proportions—one that could have health implications extending far beyond the country’s borders.

“The people of Myanmar have suffered enough,” Türk concluded. “The response to this horrendous disaster must open pathways towards a comprehensive solution that upholds democracy and human rights.”

Image Credits: UNICEF.

A Gobi desert dust storm hits a village in the Qinghai province in China.

CARTAGENA, Colombia — “When I met with taxi drivers in Abu Dhabi about the pollution from their cars, they told me to talk to the desert,” recalled Dr George Thurston, director of New York University’s research program on the health impacts of ambient and occupational air pollution.

The taxi drivers’ retort points to a global challenge in the fight for clean air: while human-caused pollution can be regulated, natural sources — like sand storms, wildfires and dust — cannot be legislated away.

In cities across the Middle East, North Africa and Central Asia, sand and desert dust storms regularly buffet buildings, cars and neighbourhoods. These natural phenomena generate millions of tons of particulate matter annually that can travel thousands of miles, with well-documented health consequences for millions.

Yet dust from desert sandstorms is only part of the picture, according to experts convened at the second World Health Organization Air Pollution and Health conference in Cartagena, Colombia, last week. 

Rapid urbanisation in regions like the Middle East is adding new pollutants to the mix — sulfur dioxide, black carbon and nitrogen dioxide from factories, vehicles and shipping — all with well-established links to health conditions. This toxic blend makes the region an emerging pollution hotspot, affecting millions in Cairo, Tripoli, and Abu Dhabi daily.

But how to protect human health, and where more research is needed on long-term exposure impacts in arid countries, remains up for debate. Progress has been complicated by the misconception — shared by Abu Dhabi’s taxi drivers — that poor air quality in desert regions is an unavoidable “natural” fact of desert life.

Protecting health from ‘natural’ emissions

Sand and dust storms force road and airport closures, dramatically reduce visibility, deteriorate buildings and halt solar energy production, leading concerns to typically center around visibility, said Dr Kenza Khomsi, Morocco’s coordinator at the UN Industrial Development Organization.

Yet sand and dust storms hurl tonnes of loose sediment into the air, creating a whirlwind of health effects for livestock, agriculture and people alike. These microscopic particles pick up toxic, man-made chemicals and allergens, worsen coughs, trigger wheezing, exacerbate respiratory infections, and contribute to serious lung and cardiovascular diseases.

“We know particulate matter is harmful,” Khomsi said. “Dust is never just dust.” 

Morocco sits at the nexus of atmospheric currents — the Sahara, Atlantic Ocean and Mediterranean Sea all converge around the country, making it especially vulnerable to sandstorms. Khomsi, who previously served as head of the climate and climate change department for Morocco’s meteorological administration, said the country has increased its number of air monitoring stations, but “the health part is not aligned.”

Though severe sandstorms occur only about 10% of the year in the Middle East, dust is continuously re-suspended and natural desert particles mix with human-made pollutants year-round, creating air quality challenges that persist even when sandstorms aren’t occurring.

Region-specific research

Satellite image shows a Saharan dust plume crossing the Atlantic from Africa’s coast towards Europe, reaching capitals from Berlin to London.

Dust from sandstorms can travel thousands of miles. In 2020, an abnormally strong Saharan dust storm crossed the Atlantic Ocean to deposit 182 million tons of dust across the US and the Caribbean. The resulting air quality was hazardous in Puerto Rico and other Caribbean islands.

Just last year, plumes of Saharan dust sailed over the Atlantic from Africa’s coast over Europe, turning the skies of cities like London orange in a weather phenomenon observed by millions.

Though experts convened in Colombia emphasized that air pollution from sand and dust storms, especially fine particulate matter, has been extensively researched, the Middle East and North Africa lacked region-specific studies.

Most of the research on sand and dust health impacts comes from “receptor” regions in Southern Europe, North America, and other places where Sahara and desert sand settles. Sand traveling thousands of miles is diluted, and the chemical composition can change as well, said Rami Alfarra, principal scientist at the Qatar Environment and Energy Research Institute.

But in “source” regions — where the sand and dust originate — “we’re just starting this research,” said Alfarra, whose home country of Qatar, alongside the rest of the Middle East and North Africa, has emerged as an air pollution “hotspot,” according to University of Chicago research.

No representatives from the Middle East or North Africa were present at the WHO conference. 

University of Chicago research estimates reducing fine particulate matter pollution in Qatar would increase life expectancy by over three years.

“Particulate matter in the Middle East is different from the Amazon which is different from Europe.” This distinction means that for regions with huge exceedances from dust storms, perhaps the WHO guidelines are not specific enough, according to Alfarra. “Those [guidelines] are based on particulate mass, instead of region, decomposition, and source. There’s no definitive answer yet if [particle] toxicity is from the mass or chemical composition.”

Alfarra proposed region-specific air quality guidelines “where we have weighted factors for source-specific emissions”- differentiating between dust and combustion, for example – to account for natural sources.

But the composition of the particles shouldn’t matter, argued Dr Jonathan Samet, an American pulmonary physician and epidemiologist who served as dean of the Colorado School of Public Health. For Samet, whose career has spanned decades of air pollution research, the threat of air pollution requires action.

“In this case, the precautionary principle can be applied,” Samet said, noting the scientific literature is robust enough on the harms of particles that can travel deep into the lungs, implicated in cardiovascular and respiratory diseases, along with lung cancer, asthma, and allergies. He argues that the lack of full scientific certainty about the specifics of air pollutants should not be used as a justification to postpone action. 

“There’s been discussion for decades about what aspects of particles make them toxic,” Samet said. “There are many things that make particles toxic – the size, shape, charge, nature of their surface – but in the end they’re all going to go down the airway.”

“To try to pin down exactly what makes it toxic is a spurious question now.” 

Sufficient evidence to decarbonize 

Sandstorm arrives in Nyala, Sudan.

Air quality in arid regions like the Middle East has continued to deteriorate in the past two decades, fueled by population growth and energy usage. Particulate matter pollution jumped 13% from 2021 to 2022, making the region’s air nearly four times more polluted than WHO guidelines recommend. 

Much of this increase comes from fossil fuel burning, not sand and dust storms. Nitrogen dioxide emissions – from transportation and industry in Egypt, Lebanon, Iraq, and Qatar have all increased since 2005, according to NASA satellite analysis.

If pollution levels were reduced to meet the WHO guideline, the 466.5 million residents of this region stand to gain 1.3 years in life expectancy, according to a report from the Air Quality Life Index from the University of Chicago.

And for a region producing 31% of global oil production, there is a clear leadership opportunity for energy-rich countries to drive decarbonization, asserts the Clean Air Task Force, a climate technology organization.

In Qatar, whose air ranks as one of the worst polluted in the world, “we don’t need any more research to regulate anthropogenic sources,” said Alfarra.

When nature fights back

Pollution from wildfire smoke has been linked to a significant increase in dementia risk.

Like desert regions contending with sandstorms, forest ecosystems face their own form of uncontrollable natural air pollution — wildfires.

Canada exemplifies this struggle against nature’s fury as the escalating impacts of the climate crisis raze forests around the world. While wildfires are a natural part of forest regeneration, their frequency and intensity have increased due to climate change.

Globally, wildfires have progressively burned larger portions of the world’s forests. These fires account for 33% of tree loss cover, compared to 20% in 2001, according to a World Resources Institute analysis.

Canada now battles approximately 8,000 wildfires annually, which consume more than 2.5 million hectares of forest. In 2023 alone, fires scorched an area equivalent to the size of England — representing 65% of global tree loss due to fires and releasing carbon dioxide equivalent to India’s annual fossil fuel emissions. The resulting smoke plumes, like desert dust, can travel thousands of miles to contaminate air in distant population centers.

“Seventeen percent of fine particulate matter in Canada — which can penetrate deep into the lungs and cause a host of health issues — is from wildfires,” said Dr Kathleen Buset, director of water and air quality at Health Canada. “That’s on par with emissions from cars, buses and trucks [combined].”

Unlike urban pollution sources that can be regulated, these forest fires often rage beyond human control. With finite sources to fight fires, many are left to burn in remote areas, she said. Canada cannot feasibly mobilize resources to extinguish all fires in its forests 15 times the size of the Great Lakes. Instead, the country has resorted to initiatives like satellite systems to monitor burns. 

“It’s an adaptation issue,” Buset added, highlighting a parallel to desert regions’ approach. When nature itself is the polluter, traditional regulatory tools become ineffective — cars, buses and factories can all be regulated, but the desert or a remote wildfire cannot.

For communities in both fire-prone and arid regions, adaptation takes similar forms: implementing better early warning systems to alert residents of poor air quality, mitigating re-suspension of dust after storms, and most critically, protecting indoor air quality.

“Eighty to 90 percent of our time is spent indoors,” noted Alfarra, adding that in the Middle East, that percentage can be even higher during the brutally hot summers.

This reality makes improved filtration systems, indoor air quality monitoring and public awareness campaigns essential components of any realistic solution. Buset emphasized the importance of “layered communication” — ensuring people check outdoor air quality conditions, limit time outdoors during hazardous periods and actively protect their indoor air environments.

Regulators can differentiate between car emissions and wildfire smoke, but really, “we breathe in everything,” said Alfarra.

Image Credits: WMO, Marc Szeglat/ Unsplash.

Africa CDC Director General Dr Jean Kaseya

The tariffs imposed by the United States on goods from several African countries on Wednesday will make it even more difficult for African countries to increase their health spending, said Dr Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC).

These tariffs – ranging from 10% for Kenyan goods to 50% for impoverished Lesotho – come on top of the loss of billions of dollars of US aid for health programmes including vaccinations, maternal and child health, HIV, tuberculosis and malaria.

The cuts to aid for healthcare is likely to result in two to four million additional Africans dying annually according to Africa CDC modelling, Kaseya said recently.

“[These tariffs] will not make African products competitive. Africa will sell less products and get less money. And when there is not enough funds, you have competition because you have so many priorities,” Kaseya told a media briefing on Thursday.

Dr Susan Monarez, newly appointed head of the US CDC (2nd left) and other US government officials meet Africa CDC Director General Dr Jean Kaseya and Dr Ngashi Ngongo in Washington.

The Africa CDC reported that White House officials they met with in Washington DC last week want the continent to provide opportunities for US companies – a “health as business” approach rather than support via grants.

Since last week’s meeting, there has been “almost daily contact” between Africa CDC and US officials to explore financing options, said Kaseya.

A joint Africa-US team was working on “all ideas and concepts that we developed” and how to translate these into a concrete action plan, he added.

“They told us life-saving humanitarian interventions will continue, and they shared with us some places where it has restarted,” said Kaseya who claimed a “strong relationship” with the Trump administration. “We are following everything that is done. We are also providing our feedback to them.”

The challenge of domestic financing

The Africa CDC launched a concept paper on health financing on Thursday outlining how countries could mobilise more resources for health in the face of a 70% decline in official development assistance (ODA) between 2021 and 2025, from $81 billion to $25 billion.

“This collapse is placing immense pressure on Africa’s already fragile health systems as ODA is seen as the backbone of critical health programs: pandemic preparedness, maternal and child health services and disease control programs are all at risk,” the Africa CDC notes.

“Compounding this is Africa’s spiralling debt, with countries expected to service $81 billion by 2025—surpassing anticipated external financing inflows—further eroding fiscal space for health investments,” the paper notes.

It proposes a three-pillar approach involving increased domestic funding, “innovative financing” including targeted ‘sin taxes’ and airline ticket levies; and “blended financing” involving public-private partnerships, the World Bank and donors.

Kaseya castigated African countries for under-investing in health despite a 2001 undertaking to spend 15% of the budgets on the sector – something only Rwanda, Botswana, and Cabo Verde have done. Over 30 African countries spend well below 10% of their national budgets on health.

“Countries were expecting that US will be there forever. EU will be there forever. Gavi will be there forever. Global Fund will be there forever. World Bank will be there forever. We need to stop that,” said Kaseya.

“If today we start to provide more resources, others will match what they are doing and they will respect us.”

While acknowledging that domestic financing was tight – most African economies have not recovered from the COVID-19 pandemic – he hailed the “innovative financing mechanisms” as a means to bolstering national budgets.

“We are talking about a tax on airline tickets, a tax on tobacco, sugar. That there will be a solidarity fund that can help to resolve a number of issues while we are supporting countries for pandemic preparedness and response,” said Kaseya.

“The solution for the future is not to see what Western countries can do. The solution for the future is to see what Africans can do for themselves, by themselves, complementing what is coming from external partners.”

However, Kaseya acknowledged that the slashing of ODA means that fewer health workers will be trained, countries will be less equipped, with fewer vaccines, medicines and diagnostics to respond to outbreaks.

“Our message to our colleagues from Western countries is: you are not protected, because if there is a pandemic coming from Africa, you will be affected,” said Kaseya.

The Africa CDC also launched its annual report for 2024 which notes a 41% increase in disease outbreaks between 2022 and 2024.

Mpox continues to spread

Meanwhile, mpox continues to spread with a 17,7% increase over the past week – although the conflict in the eastern Democratic Republic of Congo (DRC), the epicentre of the outbreak, makes it hard to establish a full picture of the extent of new cases. Ghana reported a new mpox case after 11 weeks without any new cases in a man with no history of travel – proving that there is “community transmission”, said Kaseya.

“We are doing our best to support countries, providing test kits, providing PCR machines, providing training, but we are not donors. We don’t have funding to support sample collection and sample transportation,” Kaseya added.

 

NIH research building
The NIH is the world’s leading public funder of biomedical research, spending some $48 billion on universities, hospitals, labs, and other institutions.

Public health experts and labour unions are seeking to overturn the mass cancellation of research grants by appointees of United States President Donald Trump at the US National Institutes of Health (NIH).

In legal papers filed on Wednesday, the complainants describe an “ ideological purge of hundreds of critical research projects” – supposedly because they have “some connection to ‘gender identity’ or ‘Diversity, Equity, and Inclusion’ (“DEI”) or other vague, now-forbidden language.”

But, they add, the action of the defendants – NIH Director Jay Bhattacharya and Health and Human Services Secretary Robert F Kennedy – against “peer-reviewed science has not stopped at topics deemed to be related to gender or DEI.” 

“The defendants’ ideological purity directives also seek to cancel research deemed related to ‘vaccine hesitancy,’ ‘COVID,’ and studies involving entities located in South Africa and China, among other things,” they note.

They also object to the NIH’s cancellation of initiatives “designed to diversify the backgrounds of those in tenure-track positions at research universities.”

Impact on complainants

The court action has been brought by the American Public Health Association, Ibis Reproductive Health, United Automobile, Aerospace and Agricultural Implement Workers (UAW), which all represent members who have lost grants and jobs.

 Researchers Brittany Charlton, Katie Edwards, Dr Peter Lurie and Nicole Maphis are also complainants.

Charlton, a professor at Harvard Medical School, is the founding Director of the university’s LGBTQ Health Center of Excellence. She has lost five NIH grants worth over $9 million, had to lay off 18 staff and lost most of her salary.

Edwards, a professor at the University of Michigan School of Social Work, has lost $11.9 million of grant money for research on preventing sexual and related forms of violence amongst minority communities. She has to retrench 50 staff.

Lurie, executive director of the Center for Science in the Public Interest, has lost funding for research on HIV prevention.

Maphis, a postdoctoral fellow at the University of New Mexico’s School of Medicine, had her research grant on the link between alcohol and Alzheimer’s disease cancelled solely because it was aimed at diversifying the science profession. She is the first person in her family to attend college.

The NIH is the largest funder of biomedical research in the world, with an operating budget of $48 billion as allocated by the US Congress. It provides almost 50,000 competitive grants to more than 300,000 researchers at more than 2,500 universities, medical schools, and other research institutions in every state.

‘Unlawful and unconstitutional’

The complainants argue that the NIH’s action violates the Administrative Procedure Act in five different ways, including that it is arbitrary and capricious and exceeds its statutory authority as well as violating the separation of powers.

It wants the court to declare the NIH’s directives on grant terminations from 28 February to be “unlawful and unconstitutional”, and for the grants to be restored.


Aside from the grant cancellations, the directors of four of the NIH’s 27 institutes have been removed, including the country’s top infectious diseases official, reports Nature.

Jeanne Marrazzo of the National Institute of Allergy and Infectious Diseases (NIAID), Diana Bianchi of the National Institute of Child Health and Human Development (NICHD), Eliseo Pérez-Stable of the National Institute on Minority Health and Health Disparities (NIMHD) and Shannon Zenk of the National Institute of Nursing Research (NINR) were placed on administrative leave on 31 March. 

Only the NIH head is usually removed by an incoming president. Pérez-Stable, for example, has served three different presidents over his tenure.

“This will go down as one of the darkest days in modern scientific history in my 50 years in the business,” says Dr Michael Osterholm, an infectious-diseases epidemiologist at the University of Minnesota. “These are going to be huge losses to the research community.”

The gutting of the NIH follows mass firings of HHS staff last month, with around 10,000 people losing their jobs.

Image Credits: NIH.

INB co-chairs Anne-Claire Amprou and Precious Matsoso

On the eve of the final round of pandemic agreement negotiations ahead of the World Health Assembly (WHA), 30 legal experts have cautioned against using “voluntary” to describe technology transfer.

The latest draft of the pandemic agreement (text agreed by end of 21 February) states that technology transfer for the production of pandemic-related health products shall be on “mutually agreed terms” in a yet-to-be-agreed  footnote in Article 11. 

This inherently implies that it is voluntary, the experts state in a letter sent to the co-chairs of the World Health Organization (WHO) Intergovernmental Negotiating Body (INB) on Wednesday.

But if the agreement also describes tech transfer as “voluntary”, this will undermine member states’ “sovereign right … to implement legislation within their jurisdiction, and equity in pandemic preparedness and response”, according to the experts, who hail mostly from law departments of global universities.

“By insisting on manufacturers only coming to the negotiating table voluntarily, States Parties are limiting their options for facilitating or otherwise incentivising technology transfer, and for taking non-voluntary measures even where their domestic laws do or would provide for them,” they note.

Domestic non-voluntary measures

Several countries have laws allowing non-voluntary measures under exceptional circumstances, including the United States Defense Production Act, and Germany’s 2020 Act on the Protection of the Population in Case of an Epidemic Situation of National Significance, passed during COVID-19.

Insisting solely on voluntary measures will “defeat two principles that guide the Pandemic Agreement’s core objective: respect for the sovereign right of States to implement legislation within their jurisdiction, and equity in pandemic preparedness and response”, they note.

“The challenge during the COVID-19 pandemic was that manufacturers had little incentive to do transfer technology. By enshrining technology transfer as ‘voluntary,’ the pandemic agreement would codify an approach that has failed,” they note.

Article 11 is one of the few clauses where substantial disagreement exists, with Germany in particularly digging its heels in about the use of “voluntary tech transfer”.

“Among the European Union countries, it seems that Germany is taking a hard line and continues to insist on adding the term ‘voluntary’ in addition to ‘mutually agreed terms and conditions’,” according to Ellen ‘t Hoen, one of the signatories. 

“This raises eyebrows because Germany recognised, early in the Covid-19 pandemic, that it needed to amend its legislation to enable effective use of compulsory measures,” added ‘t Hoen, who heads Medicines Law & Policy based in Europe.

Another signatory, Nina Schwalbe from the O’Neill Institute for National & Global Health Law at Georgetown University in the US, notes that United Nations agreements on global health challenges “define tech transfer as occurring on mutually agreed terms—without specifying that it must be voluntary”.

‘The bottom line is that adding ‘voluntary’ is unnecessary and could weaken governments’ ability to act in future pandemics. Keeping the language as is ensures flexibility while upholding sovereign rights and equity in pandemic response,” says Schwalbe.

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has stated several times to the INB that “respect of intellectual property in pandemic times, support for tech transfer on voluntary and mutually agreed terms, the strengthening of regulatory agility and harmonization, and the removal of trade restrictions” are key to “to harness and leverage industry’s expertise”.

Article 12 on Pathogen Access and Benefit-Sharing System (PABS) is the other key area lacking in agreement. This article covers one of the most substantial parts of the agreement: that each manufacturer that is part of the PABS system will make 20% of their pandemic-related vaccines, therapeutics and diagnostics available to the WHO, with at least 10% as a donation.

‘Get it done’

The INB convenes from 7-11 April – next Monday to Friday – for the last time before the May WHA.  There is widespread acknowledgement that momentum and political will is likely to trickle rapidly away should negotiators fail to conclude an agreement to present to the Assembly.

The Pandemic Action Network and allies urged negotiators to “get it done” in a statement on Tuesday.

“New and resurging infectious diseases with pandemic potential threaten our collective health as our world becomes more fractured,” they note

“As currently drafted, the pandemic agreement secures important gains, including on research and development, equitable access to pandemic countermeasures, and a One Health approach to pandemic threats.

“While not all policy goals have been achieved, this potentially historic agreement lays essential groundwork for equitable, collective preparedness and response now and can be strengthened through additional protocols in the future. We urge Member States to stay laser focused on the end-goal, and find room to give-and-take to reach agreement.”