Dr Adriana Blanco Marquizo, Head of the Secretariat of the WHO FCTC (center) at a 20th anniversary press briefing of the Convention’s entry into force.

Global tobacco use prevalence has dropped by one-third, and there are now an estimated 118 million fewer tobacco users in the world today, as compared with 2005, said Dr Adriana Blanco Marquizo, Head of the Secretariat, on Tuesday. 

She was speaking at a WHO press conference marking the 20th anniversary of the WHO Framework Convention on Tobacco Control (WHO FCTC), which entered into force on 27 February, 2005. 

In other successes, : She added that, “138 countries require pictorial health warnings on tobacco products, and dozens of countries require plain packaging measures, which require a standard shape and appearance without branding design or a logo on cigarette packages. 

Countries with best practices on restrictding tobacco advertising, 2020.

“Both measures reduce tobacco consumption and warn users about the dangers of tobacco. Up to 66 countries have implemented bans on tobacco advertising, promotion and sponsorship in response to a tobacco industry that spent tens of billions of dollars on promoting their products and hooking new generations.”

All in all, some 5.6 billion people are covered by at least one tobacco control measure – although a full suite of measures is critical to reduce tobacco use prevalence, she stressed. 

“But while there have been great gains in tobacco control over the last two decades, there is a long way to go. 1.3 billion people are estimated to still use tobacco products globally, and tobacco use is one of the leading factors for non communicable diseases, including heart disease, stroke, chronic respiratory diseases, diabetes and cancer,” she noted. 

Affecting climate, environment and sustainable development 

Preparing to plant tobacco in Malawi. Workers are exposed to toxins both from the fertiliser used and nicotine in seeds.

In addition, tobacco use affects climate, environment and sustainable development, she pointed out. 

“The economic cost of smoking, from health expenditure to productivity losses, is estimated at 1.8% of annual GDP, and most of this burden is felt in developing countries,” Marquiso said.

“The environmental burden of tobacco use must also be acknowledged. 

“Billions of cigarette butts are discarded every year into our environment, one of the largest  forms of plastic pollution in the world, and valuable resources such as agricultural land and water are wasted on growing tobacco instead of food. Production and consumption of tobacco also contributes to climate change, releasing 80 million tons of carbon dioxide in the air every year.”

Meeting new challenges in products, social media and illicit trade 

Ms Kate Lannan, Senior Legal Affairs Officer, WHO FCTC Secretariat.

In terms of implementing the FCTC, a range of new challenges have emerged from an industry that has creatively developed new ways to sidestep Convention measures, and get smokers hooked. 

Heated tobacco products and nicotine vaping have become widely popular – and while the smoking prevalence rates contain some data on heated tobacco products, “it’s not a complete picture” said Kate Lannan, Senior Legal Affairs Officer in the FCTC Secretariat.  That’s because countries are only just now updating national surveys to include these new modes of tobacco and nicotine delivery. “So it depends on what their latest survey includes.”

At the same time, while vaping nicotine in some kind of chemical formulation remains a grey area, heated tobacco products are fully covered by the Convention, Lannan said. 

“”They are tobacco products. The implementation of the Convention should also cover heated tobacco products to the same extent as all other tobacco products, which means surveillance, monitoring, etc.”

Another challenge is new media.  While facing strict curbs on traditional advertising modes, like TV, billboards, and packaging, it has developed a strong presence in social media forms – which has proven much harder to regulate. 

New guidelines on social media 

Heated tobacco products, social media and illicit trade pose new challenges for tobacco use control.

Just last year, the FCTC Conference of Parties (COP 10) adopted new “guidelines” on Article 13 of the Convention, which addressed tobacco advertising, to address social media, entertainment platforms, cross border streaming services, and media influencers “who are able to reach our young people in a way that simply wasn’t envisioned at the time of the entry into force of the Framework Convention,” Lannan said, adding, “These specific guidelines are sort of activating the convention in a new way to specifically address those issues.” 

Marquiso called on more FCTC member states to follow the guidelines for developing more comprehensive bans on tobacco advertising, including “social media advertising and sponsorship deals.”

Finally, while many countries have raised taxes on tobacco products sharply, cross-border trade in cheaper illicit products has flourished in many regions and countries of the world.  

In 2012 the Protocol to eliminate illicit trade in tobacco products, was adopted by member states, although work to advance enforcement is still ongoing today, Marquiso noted.  

“This work addresses the threat posed by the illicit trade of tobacco, which undermines control measures, diminishes tax revenues and fuels criminal activities.” 

Finishing outstanding business 

School-based arts and craft project In Krygyzstan promotes anti-tobacco education.

Marquiso also called upon WHO member states, who have not done so yet, to implement bans on smoking in indoor places. 

“Smoke-free laws have been enacted covering more than a quarter of the world population, protecting people from the dangers. “This has proven itself to be one of the most cost effective tools at reducing consumption, and we call on more countries to implement these measures,” she said. 

She described political will and interference from the tobacco industry as the biggest single barrier to better implementation and enforcement of the FCTC.

“We have a lot of requests from countries to help them technically in implementing measures. 

“But I think the most important thing that countries will need to do in order to be able to implement the treaty is to be aware of the interference of the tobacco industry. 

“We need more political will. And it’s not an easy moment, given the geopolitical situation in this moment in the world.  And we need more awareness of the interference of the industry and how to stop that interference.” 

Image Credits: WHO, WHO Report on the Global Tobacco Epidemic, bacco Report, 2021 , Josephine Chinele, pixabay.

Health workers at the National Health Command Center in Saudi Arabia’s Ministry of Health.

Make “Health in All Policies” a global and national priority to improve health and reduce healthcare spending long-term, says a senior Saudi health official, Dr Nouf Al Numair.

The health of a nation’s population is a critical determinant of its economic productivity, educational outcomes, and the sustainability of its healthcare systems. Yet health considerations are often overlooked in policymaking as many view them solely as the duty of the healthcare system, not recognizing that health is a shared responsibility shaped largely by policies beyond the healthcare sector.

 As a result, healthcare costs continue to rise, outpacing economic growth. A report from the World Health Organization (WHO) shows that global spending on health increased to $9.8 trillion (10.3% of global GDP) in 2021. Similarly, PwC’s Health Research Institute (HRI) projects an 8% year-on-year global increase in medical costs by 2025. This immense increase in expenditure is a result of global and national inaction.

Evidence suggests that integrating health considerations across all policy areas – commonly referred to as the Health in All Policies (HiAP) approach – yields significant benefits for population health, health equity and socioeconomic resilience. 

By addressing the root causes of poor population health and well-being, commonly known as risk factors and the underlying drivers behind the burden of disease, HiAP can reduce healthcare spending in the long run. Therefore, HiAP must become a global priority to reduce spending on treatment and shift the focus from treatment to prevention.

 HiAP is a framework that acknowledges the multidimensional influences on health, extending beyond the healthcare sector to areas such as education, employment, urban planning, and environmental policy. Health is a shared responsibility that requires collaboration across all sectors to address its social, economic, and environmental determinants.

Proactive primary prevention

Ensuring access to healthy, fresh foods is but one example of an HiAP approach that can generate a cascade of health and economic benefits.

Research shows that socioeconomic factors such as income, housing, and access to education play a substantial role in shaping health outcomes. For example, a 2021 study published in The Lancet demonstrates a clear correlation between cross-sector policy integration and improvements in population health indicators, particularly in non-communicable diseases and health equity.

Demographic projections and trends further emphasize the urgency of adopting the HiAP framework that promotes proactive primary prevention over reactive treatment. By 2030, an estimated 1.4 billion people–approximately one in six globally–will be aged 60 or older, with this figure expected to reach 2.1 billion by 2050.

As longevity increases, policymakers are shifting their focus from extending lifespan to enhancing health span– the number of years lived in good health while remaining economically and socially productive. 

Initiatives such as the UK’s National Health Service program, Adding Years to Life and Life to Years, and Finland’s National Health Promotion Policy underscore this transition, prioritizing primary prevention and quality-of-life improvements.

Finland’s North Karelia Project, launched in the 1970s, is a leading example of a prevention-first approach, helping reduce cardiovascular disease mortality by over 80% in four decades through dietary improvements, tobacco control, and physical activity promotion.

Multi-sectoral approach

Sprinkling salt on tomatoes
Saudi Arabia has launched an initiative to reduce salt consumption, a key risk factor for hypertension and cardiovascular disease.  

Saudi Arabia, through Vision 2030, has made significant progress in population health over recent decades. Life expectancy has increased from 46 years in the 1960s to 76 years in 2020. 

The Saudi Ministerial Committee for HiAP, established in 2018 under a Royal Decree and chaired by the Minister of Health, institutionalizes this approach. It brings together over 10 ministries, spanning Education, Labor, Environment, Economy, Sport, Housing, and Urban Development, to align policies that promote health and to ensure they do not harm population health and health equity across sectors.

This multi-sectoral approach has made progress across the Kingdom, delivering concrete results. One example is Saudi Arabia’s initiative to reduce salt consumption, a key risk factor for hypertension and cardiovascular disease. Recognized by the World Health Organization, this initiative–led by the Saudi Food and Drug Authority in collaboration with the Ministry of Health, manufacturers, and importers–demonstrates how policy interventions targeting both supply and dietary habits can contribute to improved cardiovascular health outcomes.

These measures align with WHO recommendations for reducing premature mortality from NCDs by one-third by 2030, a key Sustainable Development Goal (SDG 3.4) as well as Saudi Vision 2030’s goal of fostering a thriving society.

The economic benefits of health-conscious policymaking are well-documented. A healthier population contributes to increased labour productivity and reduced healthcare expenditures. A 2020 analysis by the Organization for Economic Cooperation and Development (OECD) found that investments in preventive health measures generate an average return of 4:1 in economic benefits by reducing healthcare costs and improving workforce efficiency.

Sustainable health improvements

Despite these advantages, challenges remain in fully integrating health into all sectors of policymaking. Effective implementation requires a whole-of-government approach, sustained inter-ministerial coordination, governance, robust data collection and analysis, capacity building, and long-term financial commitments, strong legislative and regulatory frameworks, and continuous advocacy efforts.

However, evidence from countries with established HiAP frameworks, such as Finland and South Australia, suggests that the systematic integration of health into public policy decisions can reduce health disparities and improve national resilience. Saudi Arabia’s HiAP model provides a valuable case study for other nations seeking to implement similar frameworks.

 As healthcare systems worldwide contend with rising demands, adopting a multi-sectoral, primary preventive approach is increasingly recognized as a viable strategy for sustainable health improvements.

 Ongoing monitoring and data-driven analysis will be essential for refining and scaling such frameworks to ensure that healthy public policymaking remains a central component of national development strategies at both regional and global levels.

Governments worldwide must prioritize HiAP to enhance population health, curb rising healthcare costs and build resilient societies. Policymakers must collaborate across sectors to create long-term policies that protect and promote health. HiAP practitioners should engage in global discourse, share best practices, and invest in evidence-based strategies that advance health equity and well-being.

The time to act is now – to secure a healthier, more prosperous future for generations to come.

Dr Nouf Al Numair is the Secretary General of Saudi Arabia’s Ministerial Committee for Health in All Policies

Image Credits: Department of Labor, Saudi Arabia, World Bank Tanzania/Twitter , WHO/S. Volkiv.

Encephalitis, the inflammation of the brain, can cause long-term damage. Its current global burden is unknown.

Encephalitis “remains under-recognized, under-diagnosed, and underfunded”,  according to a new policy report from the World Health Organization (WHO).

Climate change, vaccine hesitancy, and the rising burden of vector-borne diseases are also fuelling an increased number of encephalitis cases, a rare but serious inflammation of the brain. 

The technical document urges coordinated global action to “confront and tackle the growing public health threat from encephalitis,” and points to prevention strategies, as well as gaps in diagnosis, research, treatment, and care. 

“Unless prompt action is taken, encephalitis will continue to drive avoidable deaths and disability,” notes Encephalitis International, a global advocacy non-profit.

“Regrettably, the withdrawal of support for the WHO and potential dissolution of USAID by President Donald J Trump’s Administration, among other recent executive actions, threaten to worsen an already challenging situation,” said the non-profit in a statement.

The report comes as measles, which in some cases can cause encephalitis ,continues to plague higher-income countries, including a recent outbreak in West Texas, where a “close-knit, undervaccinated” Mennonite community is at the epicentre of a 58-person outbreak.

Vaccine skeptics received a strong boost in the confirmation of Robert F Kennedy Jr as Secretary of the Department of Health and Human Services. The Secretary spent more than 30 years sowing doubt as to the safety of vaccines. Measles, mumps, and rubella–diseases prevented by routine childhood vaccines–can also in some cases cause encephalitis. 

‘Life-threatening’ brain inflammation

Encephalitis, the swelling of the brain, affects people across all age groups, and has high mortality rates. 

“Unlike other organs or organ systems, the brain is very sensitive to swelling and inflammation…when the brain is injured, it can have permanent effects on the brain’s function – like walking, talking, even causing seizures,” said Dr Youssef Kousa, a neurologist and founder of the Zika Genetics Consortium at Children’s National Hospital, in an interview with Health Policy Watch.

“For a lot of encephalitdes, there are no treatments.”

The condition often leads to significant long-term complications including hearing loss, seizures, limb weakness, and difficulties with vision, speech, language, memory and communication, according to the WHO.

Globally in 2021, encephalitis was the fourth leading cause of neurological health loss in children under five years and the 13th across all age groups. The report notes that in the same year, over 80,000 people died from encephalitis and up to 50% of people with encephalitis suffered long-term after-effects of the condition, losing “independence, income and quality of life.”

Underdiagnosed and lacking political commitment

Encephalitis mortality map
Mortality from encephalitis is the highest in South and South-East Asia, where Japanese Encephalitis Virus is likely to continue spreading.

“Encephalitis is a growing public health challenge, and by prioritizing it within global and national health agendas and strengthening collaboration, we can reduce its impact and save lives,” said Dr Tarun Dua, head of the Brain Health Unit at the WHO, in a press release. 

“These efforts will not only improve health outcomes and quality of life for those affected and their families but also result in stronger, more resilient health systems.” The Brain Health Unit at WHO was only formed in 2020, as a growing number of brain-related conditions affect both lower and higher income countries, notably Alzheimer’s, Parkinson’s, epilepsy, and encephalitis. 

“I sit here just as Oropouche virus is increasing in cases in South America, right now and as yet, barely studied. Without surveillance, this virus will continue to spread almost unnoticed,” said Dr Aline MB Matos, a neurologist from São Paulo, Brazil, at the report’s launch on Wednesday.

“Encephalitis today is not a funding priority in many low and middle income countries, not because it is not important, but because these countries face multiple crises. Lack of clean water, limited access to education, an overburdened healthcare system, armed conflicts. And as a reality, it is difficult to choose what to prioritize.

“But encephalitis must be a priority.”

Diagnosis in lower-and-middle income countries is especially difficult, because the condition requires a confirmatory lumbar puncture, and sometimes highly specialized tests such as brain imaging and electroencephalography (EEG). However, as the report notes, and as Matos highlighted in her remarks, most of the world’s population lives in areas with no immediate access to comprehensive or rapid encephalitis diagnostics. 

“In many countries, lumbar punctures are performed on only some of the people with suspected brain infections. This may be due to a lack of trained workforce or procedural kits, and misconceptions about lumbar puncture indications and safety,” noted the report. 

But even in higher-income countries, there are only so many treatments for the viruses that cause encephalitis, said Kousa. Even if Zika or West Nile Virus can be diagnosed more readily in the US, providers have nearly the same limited treatment options as those in lower-income countries. 

Vector-borne diseases pose new threat 

Although JEV is rare, the mosquito-borne disease can have a case-fatality rate as high as 30%.

Several pathogens can cause encephalitis, with the herpes simplex virus being the most common cause of the condition, according to the WHO. But other viruses, notably vector-borne diseases, are a rising threat for encephalitis. 

Dengue, Zika virus, and oropouche virus are all increasing in incidence and prevalence in South America, the Caribbean, and South and South-East Asia, as warming climates, deforestation, and urbanization spur mosquitoes into closer proximity to humans. Almost half of the global population is now at risk for these diseases.

Recent dengue outbreaks have plagued the Indian subcontinent, and oropouche virus, a relatively rare vector-borne disease, is likely to see case levels similar to last year’s record-breaking season.

Also of concern is Japanese Encephalitis virus (JEV), which has now spread to 24 South-East Asia and Western Pacific countries, including Australia, and a novel tick-borne encephalitis. 

“We do not know the full number of encephalitis cases worldwide, but we do know that infectious causes play a major role, and in low and middle income countries, many of these pathogens are either emerging or being neglected,” said Matos. The problem is only exacerbated by climate change, as previously uninhabitable regions become mosquito breeding grounds. 

“This renders large populations at increasing risk of vector-borne diseases such as arboviruses,” noted the report.

While these diseases have few – or even no – vaccines, some more established, and vaccine-preventable diseases, are seeing a resurgence.

Encephalitis-inducing viruses can be prevented by vaccines, such as influenza, varicella-zoster virus (VZV), rabies, poliomyelitis, and measles, mumps and rubella (MMR). The COVID-19 pandemic-related disruptions in routine immunizations and vaccine hesitancy have left experts worried about encephalitis cases due to MMR. 

“Vaccine hesitancy is an issue for us, and it’s part of this bigger picture science skepticism and false information. So it’s up to us as a community to push out the right messages,” said Dr Tom Solomon CBE, a neurologist at Liverpool University Brain Infections Group, at the report launch. Solomon is also President of Encephalitis International and an advisor to the WHO

Hopes that WHO support will lend greater awareness

encephalitis international 2025 event
Experts convened in London to discuss the impact of the WHO’s new brief. From left: Dr Tom Solomon, Dr Benedict Michael, Dr Aline MB Matos, and Dr Nicoline Schiess.

For Professor Benedict Michael, a neurologist at the University of Liverpool, the new report “puts encephalitis on the map,” building on the advocacy successes in the past decade. While epilepsy and Parkinson’s have garnered more attention on the brain health front, the experts gathered at the Encephalitis International-WHO launch hope that the report will improve public health policies, including vaccine programs and vector control. 

“Encephalitis is just one example of why working together matters. From COVID-19 we learnt diseases do not respect borders, politics or ideologies. They affect us all,” said Dr Aline MB Matos.

Understanding the disease burden through improved surveillance, and improving patient care in rehabilitation and access to healthcare were also high on the priority list.

“Our recent research has shown that many of the interventions needed to improve diagnosis and treatment of encephalitis are not particularly expensive. A lot of it is about increasing surveillance and recognition of the condition, providing simple equipment for early diagnosis, and making sure the right treatments, many of which are very affordable, are available,” said Solomon.

The report points to several key factors that would reduce the burden of encephalitis, stating countries should prioritize relevant medicines for inclusion into national essential medications lists and standardized treatment protocols, include both autoimmune and infectious encephalitis and their treatments in publicly funded UHC packages, use and expand existing surveillance systems for forecasting demand and supply chains, and pair better availability and affordability of medicines with appropriate training and education of the health workforce to recognize and treat encephalitis in a timely manner. 

“There’s huge potential for this technical brief to have genuine global impact that’s transformative in the brain health agenda,” concluded Benedict.

Image Credits: Flickr: Florey Institute of Neuroscience & Mental Health, WHO, WHO, Encephalitis International.

Dr Tedros addresses the closing session.

Negotiators working to nail down the pandemic agreement have offered assurances that they can meet the May deadline – for the sake of global security and to restore faith in multilateralism.

Despite only five formal days of talks remaining in April, Pakistan’s Umair Khalid said his country believes there is enough time to clinch the agreement. 

“I don’t think any treaty is negotiated and agreed within a 9am-to-6pm, Monday to Friday setting. So you always have to put in some extra hours, and we have been doing that, and  we’ll continue to do that,” Khalid told a gathering of civil society groups meeting in Geneva during lunchtime on Friday.

“We will use March, we will use April, and we will use all the time that we have.”

India’s Dr Pradeep Khasnobis said that talks “are moving forward” and that “some of those very tough articles, at least have some kind of a landing zone”. 

Eswatini, speaking for the African region, Egypt and Sudan in the closing session, described the week’s talks as “constructive”.

“While we acknowledge concerns about the moderate pace, we are optimistic that the remaining issues, though critical, are manageable,” said Eswatini. 

“We must prepare to conclude our discussions in the five days allocated for the month of April, and we thank the Bureau for proposing additional discussions to address these gaps. We are ready to burn the midnight oils.”

The Philippines, speaking for a 11 diverse countries including Brazil, Canada and the UK, stressed the importance of reaching agreement to restore faith in multilateralism.

“Given the increased challenges facing this organisation, and multilateralism itself, there is a need to demonstrate that countries can indeed come together to solve common problems. We did this in May when we amended the International Health Regulations. This year, we need to adopt the WHO Pandemic Agreement,” said the Philippines, adding that member states managed to make “incremental improvements” to the text “by really listening to one another”.

“We have sat together in this room too many times over the last three years to not have a decent understanding of each other’s positions. We all have some sense of what the consensus text should look like,” id added.

“Let us finish what we have started. Adopting a meaningful Pandemic Agreement will be a win for all of us. The conclusion of the pandemic agereement in May will be a testimony to the world of our commitment to global health and of the continuing relevance of WHO in a time of major political challenges.”

Colombia’s Maria Tenorio Quintero told the civil society gathering that meeting the May deadline would take “extra effort”, and appealed to civil society to help raise public awareness about the positive impact that the agreement could have.

Norway’s Eirik Bakka stressed that the draft agreement “is not an empty shell, and there are important elements that are already agreed to bring it to the finishing line”.

‘Use every opportunity to find common ground’

Joining the closing session, Dr Tedros Adhanom Ghebreyessus, World Health Organization (WHO) Director-General, said that the 13th meeting of the Intergovernmental Negotiating Body (INB) had made progress – but “maybe not as much as you would have hoped”.

“As you move to finalize the pandemic agreement in time for the World Health Assembly, you have one week of formal negotiations left. 

“But you’re so close, closer than you think. You’re on the cusp of making history. This agreement should not fail on a word; it should not fail on a comma and it should not fail on a percentage.

 “History will not forgive us if we fail to deliver on the mandate the world needs, and a sign that multilateralism still works. Reaching a WHO pandemic agreement in the current geopolitical environment is a sign of hope.”

Tedros concluded with two messages: “We believe you can do it” and “Use every opportunity during the intercessional period to come closer together towards finding common ground.”

Civil society anxiety

Nina Jamal of Four Paws and KEI’s Jamie Love.

Civil society organisations following the pandemic agreement negotiations over the past three years are anxious that it won’t be completed by May – and that impetus for the initiative will fizzle and further undermine multilateralism.

A sombre group of over 75 people met in person and online in Geneva over lunch on Friday to express frustration at the slow pace of talks over the past five days. 

With only five official negotiating days remaining – 7-11 April – many complex parts of the agreement are not agreed. The group also raised concerns about provisions being watered down of provisions, particularly on technology transfer and intellectual property, and the absence of clauses on prevention.

Knowledge Ecology International’s Jamie Love expressed disappointment over “the lowering of the ambitions on the initial versions of the text and watering down of provisions”.

He also raised that it may suit some parties, particularly the European Union, not to have an  agreement in May given the “rise of the anti vaxxers and right-wing populism”.

Ellen ‘t Hoen of Medicines Law and Policy described reaching agreement as “crucial now in the current political context and the huge global health crisis caused by the United States withdrawal of aid and European countries slashing their aid budgets”.

“This makes the need for having a signal that multilateralism still works even more important than in the earlier days of the pandemic. This total lack of international solidarity is of huge concern.”

Meanwhile, Four Paws’ Nina Jamal said member states seemed to accept the importance of the agreement for multilateralism

However, Jamal added that pandemic prevention offers the best chance to protect people in countries with weak health systems.

“This is the deepest level of equity that we can achieve. And we are disappointed because a lot of countries who  support prevention and are taking action nationally on prevention with a One Health approach are not being vocal in the negotiations because they think if they talk about prevention, they’re disadvantaging their negotiating position for medical countermeasures, preparedness and response.”

Maria Neira, WHO’s Director of Climate, Environment and Health (center stage) talks about why health is the best argument for climate action.

Bolstered by strong support in Africa, Europe and Latin America, there are high hopes that an ambitious new Global Action Plan on Climate Change and Health will be approved in May by the World Health Assembly, said  Maria Neira, World Health Organization (WHO) Director of the Department of Climate, Environment and Health. 

The WHO move will also help set the stage for an initiative by Brazil on a “Bélem Action Plan” on climate change and health at COP30, in Bélem, Brazil, which aims to reinforce UN Member states’ commitments to include health goals in their climate strategies, said Gustavo dos Santos Souza, coordinator of Climate Change and Health Equity in Brazil’s Ministry of Health.

“We are advancing several COP-specific initiatives,” Souza said. “Our focus is to present an action plan on climate change and health, which we are considering naming the Bélem Action Plan.

“The goal of this plan is to support countries implementing equitable health adaptation strategies and policies in response to climate change. This plan will align its goals and objectives with the global goal on adaptation under the UNFCCC, reinforcing the need for a unified global approach with a minimal set of measurable outcomes, it will also apply specific adaptation strategies to strengthen health system resilience to climate-related impacts. And we hope countries will voluntarily endorse this plan in Brazil.”

Gustavo dos Santos Souza, Ministry of Health of Brazil.

Neira and Souza were speaking, along with representatives from The Netherlands and civil society, at a panel Thursday on Health at the Heart of Climate Action, hosted by the Global Health Centre of the Geneva Graduate Institute. 

Ambitious new Global Plan of Action 

The discussion also focused on the upcoming WHO Global Plan of Action, that is to go before member states at the May World Health Assembly, which was subject to an initial review at February’s meeting of the WHO Executive Board, the 34-member governing body. 

The new action plan, anchored in a WHA resolution on Climate and Health approved in 2024, takes a bolder and more holistic approach to the issue than previous WHO climate initiatives. Past initiatives, anchored in a 2008 WHA resolution,  had focused mainly on  “adaptive” actions such as promoting health sector resilience to climate change through measures such as improved early warning systems for climate sensitive disease outbreaks. 

In contrast, the new action plan asks member states to take a stronger lead in climate mitigation efforts that also generate significant health co-benefits.  

These include:  “stronger engagement in the circular economy and through the reduction of greenhouse gas emissions and other climate-changing pollutants, such as black carbon, through more sustainable energy-use choices, agricultural practices, transport options, reduced food loss and waste, city densification and use of industrial technology and practices, as well as through support for healthier diets in low-income populations, with special attention to women of reproductive age, while promoting a shift to healthier and more environmentally sustainable diets among higher-income groups.”

The draft also encourages member states to “limit or reduce actions that cause emissions in other countries through manufacturing, shipping or energy production,” as well as to “promote demand-side mitigation that encompasses changes in infrastructure use, end-use technology adoption, and sociocultural and behavioural changes.”

Developing countries seek more emphasis on adaptation, and climate equity

Ethiopia – calls for more climate and health finance.

During the EB debate, African countries asked for more WHO focus on climate finance to support adaptation and resilience strategies critical to the continent.

China, backed by other developing country partners, asked for more emphasis on “common but differentiated responsibilities” a reference to the historical role of industrialized economies in creating most of the climate problem. 

At the same time, Neira expressed confidence that the plan of action would be approved by the WHA in May – even at a time when the United States and other conservative member states are rolling back commitments on climate action.

At the EB debate, Russia, a major oil and gas producer, was the only country to vocally oppose the initiative, while the US, which has announced it is withdrawing from the WHO, was silent.

Said Neira, “This is about health, and therefore is our business as the health community, and it’s the business of the member states in the World Health Assembly.”  

“The little issues we have, honestly, I don’t think there are real challenges. Some countries will see more balance on adaptation versus mitigation. Other countries will like [more] reference to common but differentiated responsibility.  Other countries,  maybe due to a conflict of interest, are not very keen on us talking too much about fossil fuels.  So let’s talk about renewable energy, this will benefit our health. Is that okay?”

Convergence on climate resilience for health sector  

Solar panels power Mulalika health clinic in Zambia ensuring a more reliable power supply than diesel generators for health services.

One place that has seen a strong convergence of diverse points of view is around bolstering the climate resilience of the health sector – a major element in the WHO global plan of action, as well as of Brazil’s thrust in the lead-up for COP.   

That agenda also has a great deal of elasticity, Neira pointed out – motivating developed countries to devise strategies to “decarbonize” health facilities with energy efficiency solutions.

And at the same time, for low- and middle-income countries, the agenda can address basic shortages in clean water and sanitation, as well as better electricity access – through renewable energy solutions, she pointed out.  

“It’s about how the health system can contribute, but by decarbonizing and reducing our own carbon footprint,” Neira said. It is a footprint that can exceed 5% of a country’s GHG emissions in affluent economies – and as much as 7% in The Netherlands, rivalling that of the aviation industry. 

In contrast, an estimated 12-15% of the health facilities in South Asia and Sub Saharan Africa respectively lack access to any electricity, and some 50% of health facilities in Sub Saharan Africa lack a reliable electricity supply, according to a recent WHO assessment. 

“And a little detail: if you want to do telemedicine, you need to have electricity, and that’s why we want to solarize the healthcare facilities, because otherwise they don’t have access to electricity,” she added. 

Win-wins reducing toxic air pollutants

Across developed and developing country settings, there are common win-wins to be had, not only from clean energy but from other climate-friendly solutions, Neira pointed out. 

Shifting over to biodegradable plastics, for instance, is a potential solution that is good for well-funded and poorly funded clinics alike. The health sector is a huge consumer of single use plastics, which produce toxic particles of PM2.5, containing persistent organic pollutants (POPs) such as dioxins and furans, when burned. In developing countries, open pit incineration of medical waste is common practice for most health clinics and hospitals. In contrast, plastic waste made from biodegradable materials could also be used as an input to biogas, a clean source of energy. 

“So you have the director of a hospital in a very rural area”and the director of a big hospital in Milan, and somebody working in the private sector, all saying, ‘okay, we can reduce plastic, we can innovate on new materials that will replace plastic.” 

A new WHO-managed initiative, ATACH, (the Alliance for Transformative Action on Climate and Health), is already busy promoting such solutions  – with 90 member states active on the platform – exchanging knowledge about climate resilient, low carbon health facility strategies and technologies, Neira noted.  

 “You can’t imagine the motivation that this is generating” Neira said, noting that the measures are also highly cost-efficient, as well as being “about how the health system can contribute, but by decarbonizing and reducing our own carbon footprint.” 

Grappling with the global wave of populism and climate skepticism 

Astrid Dunselman, Ministry of Health, Welfare and Sport, The Netherlands.

One future challenge facing WHO and member states is the new, populistic wave of  political conservatism sweeping the world, with the victory of Donald Trump in recent United States elections as a watershed moment, globally. 

At the same time, most governments, even more conservative ones, continue to acknowledge that climate change is an important challenge, said Astrid Dunselman, of the Ministry of Health, Welfare and Sport in the Netherlands, which co-led negotiations on the 2024 WHA resolution on Climate and Health.  

“We also have a more conservative or right wing government after our elections compared to the one that started off the work on the WHA resolution [negotiations] that we co chaired,” said Dunselman.  “And yet still, also for our current government, climate change and health is still a priority,” she said. 

“The reason is health is where climate change gets personal. So we all will experience the effects of climate change on our well being and on that of our families, and I think that it is politically, speaking, still an issue.” 

‘Primary prevention’ is climate change mitigation 

Smoke billows from chimneys in Poland – generating both air pollution and climate emissions of CO2.

In The Netherlands, climate is also a topic formally included in the portfolio of the State Secretary for Health, Welfare and Sport, Dunselman added, noting that this signals a recognition “of the importance of taking measures to truly prevent health issues before they even arise.” 

Some examples, added Neira, include the seven million deaths annually from air-pollution-related diseases.  A  significant proportion of this pollution is created by fossil fuel emissions from electricity production, transport, building heating and cooling systems, and industry, and the unsustainable use of wood and charcoal as fuels in poor homes. 

Other, more indirect examples, include the estimated five million deaths from diseases related to unhealthy diets produced by carbon-intensive farm systems, and physical inactivity in cities overwhelmed by traffic and smog. 

“Mitigating climate change means nothing else done to do pure public health interventions,” she asserted.  

“When we talk about mitigation of climate change, we are talking about transition to clean sources of energy. This is a huge public health agenda. What a coincidence that air pollution causes and climate change causes overlap at 75%, including fossil fuels. So an energy transition means that we can have less exposure to pollution, and more efficient energy in our buildings and cities.” 

Addressing climate skeptics

Protest by Delhi ‘Warrior Moms’ outside India’s Health Ministry in November 2024, as air pollution reaches ‘severe’ levels.

And the link between protecting the climate and protecting health, Neira added, should also be foremost in discussions with climate skeptics – including the new United States administration. 

In January, new US President Donald Trump declared that he was leading the country out of the WHO over its handling of the COVID pandemic. 

Since then, Washington has launched a major effort to stamp out climate-related language and initiatives from the US Forest Service, Department of Agriculture, Environmental Protection Agency, and more. And there are strong signals that it will pursue the same agenda in its foreign policy agenda. 

In a statement to the World Food Programe’s annual meeting in Rome this week, the US Mission told WFP to immediately halt work on “gender ideology and wasteful diversity, equity, and inclusion (DEI) programmes,” but added that climate was also on its radar. 

“It is right and proper for WFP to assist people who have been hard hit by weather events. The United States may advance other needed areas of correction or recalibration – such as regarding climate change initiatives – in the UN system’s work.”

‘Big catalogue of arguments to dialogue around’ 

Drought in Burkina Faso, yet another sign of climate change impacting health in Africa.

As for WHO, “definitely we want the US back in WHO.  We don’t want them to go. It’s an extremely important member state among the 194 that we have,” Neira told the GHC fora. 

“But at the Executive Board meeting discussions around climate change, we had many countries in Africa saying ‘you don’t need to explain to me what climate change is and how it’s affecting health. I see it every day.’ The same in Asia. 

“And when you look at the WHO Global Health Observatory [database], you will see that the number one risk factor for health, competing very heavily with tobacco, is exposure to air pollution,” she added. 

“From the need to improve the quality of the air we breathe to the rise in dengue cases in South East Asia, this is all about public health interventions. 

“And when you look at issues related to vulnerability and displacement, I think we have a big catalogue of arguments to dialogue around – why we identify climate change as one of the biggest health risks that we face. And this would be my response….We will be very happy to discuss.”

Image Credits: Yoda Adaman/ Unsplash, UNDP/Karin Schermbrucker for Slingshot , Janusz Walczak/ Unsplash.

Health professionals – icluding those working on outbreak investigation, maternal mortality, and vector-borne disease – across HHS’s 13 divisions saw mass layoffs as the Trump administration attempts to reduce the size of the federal workforce.

The large-scale government firings have now targeted thousands of probationary employees at the Department of Health and Human Services (HHS), wiping out the ranks of young and up-and-coming scientists from the nation’s leading health and research agencies as well as the more senior staff who had advanced to new positions. 

Although it is unclear how many workers the Trump administration plans to cut, dismissing scientists on probation who do not yet enjoy the same job protections in the civil service system, offer an easy target for termination. 

“It’s using a machete instead of a surgical knife,” Dr Michael Osterholm, an epidemiologist and director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP), told Health Policy Watch in an interview. 

Contrary to popular perceptions about government bloat, he noted that the federal government workforce is slightly smaller today than 50 years ago in the 1970s despite a 68% growth in the US population. The number of government contractors, however, has doubled. 

Dismissal emails continue to be sent out to the 13 operating divisions under HHS citing “poor performance,” even though many had just received “outstanding” job reviews. 

Last Thursday, the Office of Personnel Management (OPM) directed all federal agencies to terminate those in their probationary period.

Federal employees remain on probation for one to two years after hiring, depending on the position and agency, many of which are highly competitive. Probationary status lacks the benefits of permanent employment, making them easier to remove. Those in probation include recent hires and career staffers who began new positions or were promoted.

Public health experts targeted

“The probationary period is a continuation of the job application process, not an entitlement for permanent employment. Agencies are taking independent action in light of the recent hiring freeze and in support of the President’s broader efforts to restructure and streamline the federal government to better serve the American people at the highest possible standard,” an OPM spokesperson said in a statement, and as reported by The Hill.

The move is a reversal from an OPM directive just days earlier, when agencies were told to remove probationary employees only if they were poor performers.

The exact number of health professionals has not been released, but the New York Times reports that 1,200 NIH employees were dismissed, and National Public Radio reports that 750 Centers for Disease Control and Prevention (CDC) experts received notice of their removal. 

FDA, CMS, CDC see lay-offs, other divisions spared

Indian health service flags
The Indian Health Service (IHS) serves 2.8 million American Indians and Alaskan Natives. The order to fire over 1,000 IHS employees was rescinded.

Emails firing probationary employees were sent to the Food and Drug Administration (FDA), Centers for Medicare and Medicaid Services (CMS), and the Administration for Strategic Preparedness and Response (ASPR). Staff affected include researchers investigating emerging diseases, such as rabies, dengue, oropouche, and others, reports the Washington Post, in what it called the “Valentine’s Day massacre” of federal layoffs.

Also nixed is the CDC’s Public Health Associate’s Program, which places trainees into local, state, and tribal public health agencies in an effort to alleviate workforce shortages.

Initially, over 1,000 Indian Health Service (IHS) employees received notice of their removal last Friday, reported Native News Online. The IHS provides care to 2.8 million indigenous Americans and Alaska Natives, who suffer disproportionately high rates of diabetes, cancer, COVID-19, and other illnesses.

But later in the evening, the firings were rescinded. The newly confirmed HHS Secretary, Robert F Kennedy Jr, told Native News that he acknowledged that IHS “was chronically understaffed and underfunded.” 

At the CDC, similar turmoil and mixed messaging meant that the Epidemic Intelligence Service (EIS) was potentially facing disbanding last Friday. But the quick public outcry meant that the nation’s deployable “disease detectives” were spared. 

“Efficiency is more than cutting dollars— it’s about improving processes, strengthening infrastructure, and ensuring sustainability – making every dollar work to its fullest potential for Americans,” said Dr Katelyn Jetelina, an epidemiologist and founder of Your Local Epidemiologist. “Prevention and early intervention are an investment – often paying 2-60x in return by reducing healthcare costs, improving workforce productivity, and making communities safer.

“There’s room for improvement, but if we want to lose weight, let’s not cut off our legs.”

Even so, this is less than the 10% cuts promised by the administration.

The firings were not unique to public health operations – air traffic controllers at the FAA, TSA agents, and the National Science Foundation were also affected. Some experts have been asked to come back – notably nuclear safety officers – after the new administration realized their work is vital to government operations. The Trump administration is reportedly having trouble reaching these experts.

On Thursday, a federal judge denied a lawsuit filed by unions representing federal workers that OPM is overstepping its authority. The judge said he did not have jurisdiction over the matter as it should be decided by the Federal Labor Relations Authority.

For public health experts, the indiscriminate firings are a matter of American public health security. 

“Whether it be at FDA, CDC, NIH, I think those three agencies in particular are going to be severely challenged over the weeks and months ahead,” said Osterholm, in an interview with Health Policy Watch. 

“I don’t think we have any idea yet of just what the breadth of those cuts are going to be or how it happens.”

Dr Georges Benjamin, executive director of the American Public Health Association, echoed this sentiment in a statement to NPR, calling the cuts at the CDC “indiscriminate, poorly-thought-out layoffs” that would be “very destructive to the core infrastructure of public health.”

Bird flu response in flux

Officials trying to contain bird flu were among those fired over the weekend. USDA says it is “working swiftly to rectify the situation.”

The US Department of Agriculture (USDA), which trying to contain the ongoing avian influenza epidemic, has been trying to reach the experts it “accidentally” fired over the weekend.

“Although several positions supporting [bird flu efforts] were notified of their terminations over the weekend, we are working to swiftly rectify the situation and rescind those letters,” a USDA spokesperson said in a statement. 

“USDA’s Food Safety and Inspection Service frontline positions are considered public safety positions, and we are continuing to hire the workforce necessary to ensure the safety and adequate supply of food to fulfill our statutory mission.”

Lawmakers on both sides of the aisle have expressed concerns over the firings, which are part of the Department of Government Efficiency (DOGE)’s attempts to cut back on government spending.

“They need to be more cautious,” Rep. Don Bacon (R-NE), a member of the Agriculture Committee, told NBC News in a statement about the DOGE team. 

“There’s an old saying, ‘Measure twice, cut once.’ Well, they are measuring once and having to cut twice. Some of this stuff they’re going to have to return back. I just wish they’d make a better decision up front.”

Cuts are ‘arbitrary’ 

The public health activities of HHS span overseeing food and drug safety, responding to and containing disease outbreaks, and providing direct healthcare to hundreds of thousands of Americans. 

But critics point to the growing US deficit, which has grown to $1.3 trillion since 2001, as a compelling reason for DOGE to continue cutting the federal workforce. 

DOGE “senior advisor,” billionaire Elon Musk, has said that his goal is to cut federal spending by $2 trillion, out of a $6.75 trillion annual budget in the latest fiscal year. The entrepreneur has made unsubstantiated claims that he has already saved $8 billion.

In reality, the federal workforce has not grown in proportion to the US population. “I understand the need to address the growing deficit problem,” said Osterholm. “But…we should be looking to find ways to strategically and tactically [reduce the deficit], and not just arbitrarily. 

“There’s no real rhyme or reason as to who you’re cutting or why.”

RFK commission to ‘scrutinize childhood vaccine schedules’

Robert F Kennedy Jr (RFK Jr) day 2 confirmation hearing
Amid mass lay-offs of federal health workers, HHS Secretary Robert F Kennedy Jr has set up a commission to look at childhood vaccines.

Efforts to downsize the nation’s public health workforce come just as new HHS Secretary Robert F  Kennedy Jr, said he was moving forward with plans to create a presidential commission to scrutinize childhood vaccine schedules. 

That commission, part of the overall effort to “Make America Healthy Again” will likely target CDC’s Advisory Committee on Immunization Practices, which sets influential vaccine recommendations. 

“Nothing is going to be off limits,” Kennedy said in an HHS meeting that was reported by several news outlets. 

“Some of the possible factors we will investigate were formally taboo or insufficiently scrutinized. Childhood vaccine schedule, electromagnetic radiation, glyphosate, other pesticides, ultra-processed foods, artificial food allergies, SSRI [antidepressants] and other psychiatric drugs, PFAS, PFOA, microplastics — nothing is going to be off limits,” Kennedy said on Tuesday. And late Thursday, HHS ordered CDC to halt some vaccine advertisements to emphasize “informed consent.”

His moves come despite promises by the HHS secretary after his confirmation that employees who are “involved in good science” or who “care about public health” have “nothing to worry about.”

 

Image Credits: CDC, IHS, Charlotte Kesl/ World Bank.

People flee Goma during the latest clashes

 The eastern part of the Democratic Republic of Congo (DRC) particularly around Goma and Bukavu, may become a hotspot for disease transmission following renewed conflict and the freeze in aid from the United States, warned Dr Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC).

Amid fighting when M23 rebels recently seized the two towns from DRC forces, over 400 mpox patients fled from health facilities, while outbreaks of cholera and measles are also affecting the region.

Over a million displaced people living in Goma and over 150,000 in Bukavu are particularly vulnerable to disease.

“This can be the entry point for a new pandemic,” warned Kaseya, adding that none of the regions affected by insecurity are reporting on diseases and laboratory testing has been disrupted by the United States freeze on foreign funds.

“In regions like South Kivu and North Kivu, we don’t have information, either because of insecurity or the pause in the US government funding, because the mechanism that we had in place in terms of sample referral was based on US funding provided to DRC,” Kaseya told a media briefing on Thursday. 

The DRC’s mpox response is affected by conflict and lack of funds.

“The combination of insecurity, lack of funding and lack of medical countermeasures, [means] we are playing with fire.”

Earlier in the week, Grégoire Mateso Mbuta, president of the DRC Red Cross said that “the humanitarian situation is dire in Bukavu and Goma.

“In Goma, the morgues and hospitals are overwhelmed. Around 190 DRC Red Cross volunteers and a team of coordinators are working tirelessly to recover the bodies left in the streets, take measures to prevent epidemics and give the victims a dignified burial. In the face of so much need, more help must be provided urgently, ” he added in a joint statement released by the International Committee of the Red Cross, the International Federation of the Red Cross and the Red Cross Society in the DRC.

New fund for epidemics

Dr Jean Kaseya

The African Union finally gave the go-ahead for an African Epidemic Fund to raise money to address continental disease outbreaks at its meeting last week, which is crucial in the wake of the US  withdrawal of foreign funding.

The fund will be administered by Africa CDC and facilitate a flexible and speedy response to outbreaks, according to Kaseya.

“We can receive funding without any limitation, without any bureaucracy, to use that to support African countries to prepare and to respond to outbreaks,” said Kaseya.

Africa CDC will provide the secretariat for the fund, which will be guided by a board.

Aside from the DRC’s mpox outbreak, continental malaria, tuberculosis and HIV efforts, have been affected by the US aid freeze. 

The US under President Joe Biden pledged $500 million to assist the continent with mpox and other outbreaks with $385 million committed. 

Kaseya said that Africa CDC was negotiating to “see this commitment become real money”, but that talks were ongoing. 

Since the funds freeze announced on 20 January when Donald Trump assumed office, China and South Korea have pledged $4 million and Morocco has also pledged $2 million –  but this makes up a teeny percentage of US aid to the continent. 

Kaseya said that Africa CDC had engaged with US officials immediately after Trump announced the freeze a month ago, and claimed some credit securing the US waiver on life-saving humanitarian expenditure.

However, despite the waiver, numerous health projects are still in limbo as they wait for official waiver letters.

In addition, “all HIV prevention activities were excluded from the waiver, except for those aimed at preventing mother-to-child transmission”, according to amFar this week. 

“To date, few implementers have been approved to restart services under the waiver, leaving all activities, including treatment, still paused.” 

Mpox tech transfer deal with African company

While there are no accurate mpox figures from the DRC, the epidemic is growing in Uganda, Congo Brazzaville and Zambia, which has shown a huge jump in figures from 16 to 700 cases.

However, in a glimmer of good news mpox vaccine manufacturer Bavaria Nordic has “95%” concluded a technology transfer deal with an African company to enable the vaccine to be produced on the continent.

This transfer will be a “fill and finish” deal rather than the more comprehensive drug substance transfer.

Dr Ngashi Ngongo, head of Africa CDC’s Incident Management Support Team, said he was working on creating demand for the mpox vaccine including the creation of a continental stockpile to ensure that countries would buy the locally manufactured vaccine.

Image Credits: Ley Uwera/ International Committe of the Red Cross.

Miner Jean de Deau Ngirinshuti outside Tunnel 12, the site of the Marburg outbreak

As African countries baulk at One Health requirements in the draft Pandemic Agreement being negotiated in Geneva, Rwanda’s success in containing its Marburg outbreak underscores the essential role of international partnerships and a strong health system in containing human-animal outbreaks

KIGALI, Rwanda – The Egyptian fruit bats look like innocuous little furry grey umbrellas hanging upside down in Tunnel 12 of the Gamico Mine – yet one of them transmitted deadly Marburg Virus Disease to a miner not long ago, causing an outbreak that effectively shut down the country’s economy for weeks.

“There are about 10,000 bats roosting in the tunnel,” says Dr Edson Rwagasore, head of public health surveillance and emergency preparedness and response at the Rwanda Biomedical Centre (RBC), the implementation arm of the country’s health ministry.

Dr Edson Rwagasore, head of public health surveillance and emergency preparedness and response at the Rwanda Biomedical Centre (RBC), outside one of Gamico Mine’s tunnels.

Gamico Mining Company has dug a series of tunnels into the hillside to enable miners to extract tin ore, and the 27-year-old index case was infected in Tunnel 12 after coming into contact with the virus – likely shed in the faeces of a bat.

Although the index patient was initially misdiagnosed with malaria which has very similar initial symptoms, once Marburg was diagnosed, the Rwandan Health Ministry and the RBC swung into action.

“We worked to ensure no future bat-to-human spillovers,” said Rwagasore. “Our key interventions were to create a buffer between the bats and humans, conduct regular testing of bats and work on understanding transmission better.”

The buffer inside Tunnel 12 is a locked door separating bats from humans. The bats can exit the tunnel through a hole in the roof that has been fenced off to ensure no humans can get close. 

When Rwagasore unlocks the door, the bats squeak – and so do a few journalists – but luckily they fly away from us. 

This door stands between people and bats in Tunnel 12

GPS trackers have been attached to some bats to map their movements and weekly tests of bats’ blood, saliva and faeces check for Marburg. Bats are a reservoir for the virus, shedding it at certain times of the year: January to March and August and September, explained Rwagasore.

“We have mapped six other high-risk mining sites and established similar interventions. We have either established buffers or closed the sites,” said Rwagasore, adding that the health ministry encourages people to avoid bats not attack them.

Dominic Kayrgre, Gamico Mine’s safety officer, said that their 1,600 miners were issued with basic PPE and educated to avoid bats but allowed to keep working once the buffers were in place.

The Gamico Clinic, the on-site health facility that caters for miners and their families, has also been upgraded and can identify everyone with a fever and potential Marburg symptoms as soon as possible and link them to care.

Remarkably, the index patient survived, although his wife, newborn baby, healthcare workers who treated them and other contacts did not. In all, 66 people were infected during the outbreak and 15 died, a case fatality rate of 22.7% – the lowest ever recorded.

Gamico Mine’s safety officer Dominic Kayrgre and the Rwanda Biomedical Centre’s Dr Edson Rwagasore, outside the revamped Gamico Clinic.

International partnerships

Rwagasore, the Rwandan Health Ministry and international experts concur that partnerships across the country, region and globe and the country’s strong primary healthcare system were essential in containing the outbreak.

Health Minister Dr Sabin Nsanzimana stressed the importance of a One Health approach involving experts on human and animal health and the environment. 

Assistance from the World Health Organization (WHO) and other international experts experienced in zoonotic spillover of diseases from animals to humans was invaluable in helping to identify and contain the outbreak, Rwagasore said.

The US-based Sabine Vaccine Institute sent its investigational vaccines to Rwanda for an open-label study, which was also key in ensuring a low fatality rate. Rwanda also used the antiviral drug, remdesivir, to treat those infected.

Strong healthcare system

Nsanzimana also described his country’s efforts as  “an opportunity for us to expand our preparedness capabilities.”

A week after the first case had been confirmed, community health workers fanned out in at-risk communities, going door-to-door to “check anyone who had symptoms of fever and diarrhoea,” said Rwagasore.

Contacts of those infected were found, tested and isolated if infected.

WHO Director-General Dr Tedros Adhanom Ghebreyesus, who visited the country at the end of the outbreak, praised the level of Rwanda’s critical care for patients as well as how the country deployed high-level leadership to address the viral haemorrhagic fever, which often kills over 80% of those infected.

Two of the Marburg patients “experienced all of the symptoms of Marburg, including multiple organ failure, but they were put on life support, they were successfully intubated and extubated, and are now recovering,” Tedros told a media briefing in Rwanda on Sunday.

“We believe this is the first time patients with Marburg virus have been extubated in Africa. These patients would have died in previous outbreaks.”

Intubation involves inserting a tube through a patient’s nose or mouth into their windpipe (trachea) to help them breathe and extubation is when the tube is removed.

Around 1,600 people work at Gamico Mine, which is approximately 30 minutes from Kigali’s city centre.

Essential ‘One Health’ approach

Despite Rwanda presenting a first-class case study of the importance of the One Health approach to contain outbreaks, several African countries are reportedly against measures in the pandemic agreement that stipulate how such an approach should be implemented.

A dead bat in Tunnel 12. Rwanda was assisted by international One Health experts to address its Marburg outbreak.

According to Article 5 of the draft agreement, currently being negotiated by WHO member states in Geneva, member states “shall promote a One Health approach for pandemic prevention, preparedness and response” that is “coherent, integrated, coordinated and collaborative among all relevant organizations, sectors and actors”.

While stressing that whatever is undertaken is appropriate to countries’ national laws and circumstances, the draft “encourages” member states “to identify and address the drivers of pandemics and the emergence and re-emergence of infectious disease at the human-animal-environment interface”.

This involves  implementing and reviewing national policies and strategies to reflect a One Health approach, including community engagement and training for workers who are “at the human, animal and environmental interface”.

African countries in particular are reportedly reluctant to sign on for anything that might cost them extra money or result in sanctions should they fail to employ these to contain outbreaks.

In the past, the WHO and other international partners could be counted on to assist in outbreaks. However, the US contributes 25% of the WHO’s emergency budget which will be lost when the US exits the global body next January.

In addition, valuable support to contain pandemics supported by the US Agency for International Development (USAID) has also been lost since the Trump Administration closed the agency.

Over the past weekend, the African Union agev the go-ahead for an African Epidemics Fund to be administered by the Africa CDC to fundraise to address outbreaks on the continent. The previous US administration had pledged $500 million to Africa CDC but this is in jeopardy under the Trump Administration.

Image Credits: Kerry Cullinan.

In October 2024, the final phase of the polio vaccine campaign in Gaza’s northernmost neighborhoods was never fully completed due to intense fighting. Now, after discovering more poliovirus in Gaza wasteater, WHO and UNICEF are launching a third vaccination round.

A third mass polio vaccination campaign will be carried out next week in the embattled Gaza Strip, following the further detection of poliovirus in wastewater samples, WHO and UNICEF said in a surprise, joint announcement on Wednesday.

“This campaign follows the recent detection of poliovirus in wastewater samples in Gaza, signaling ongoing circulation in the environment, putting children at risk,” the agencies declared.

The new round follows two successful vaccine rounds last autumn, including one carried out during a brief pause from the height of bitter fighting in northern Gaza.  But while those succeeded in reaching over 95% of children 10 and under who were targeted, it apparently was not enough to wipe out the virus entirely. During the second round, in October, WHO also warned that the inability of vaccine teams to reach children in the northernmost neighborhoods of Gaza such as Jabalia, to which Israel had blocked healthworker access while heavy fighting raged, could create future pockets of vulnerability.

“Pockets of individuals with low or no immunity provide the virus an opportunity to continue spreading and potentially cause disease,” WHO and UNICEF said in the statement. ” The current environment in Gaza, including overcrowding in shelters and severely damaged water, sanitation, and hygiene infrastructure, which facilitates fecal-oral transmission, create ideal conditions for further spread of poliovirus. Extensive population movement consequent to the current ceasefire is likely to exacerbate the spread of poliovirus infection.”

Most of Gaza’s sewage infrastructure – along with homes, schools and other infrastructure, have been destroyed during Israel’s invasion of Gaza and 16 months of fighting with Hamas that followed the bloody Hamas raids 7 October into Israeli communities near the Gaza enclave, that led to 1200 deaths and the capture of some 250 hostages. Over 46,000 Gaza Palestinians have been killed by Israel in the ensuing war.

“No additional polio cases have been reported since a ten-month-old child was paralyzed in August 2024,” the agencies said.  “But the new environmental samples from Deir al Balah and Khan Younis, collected in December 2024 and January 2025, confirm poliovirus transmission. The strain detected is genetically linked to the poliovirus detected in the Gaza Strip in July 2024.”

Cease fire creates better access to areas missed

Health workers leaving Kamal Adwan Hospital in December after months of fierce fighting in Gaza’s northern communities – which also impeded polio vaccination.

The six week Israel-Hamas ceasefire, that began on 19 January, has also created a much better opportunity for vaccination teams to reach areas that were missed during the October round.

“In 2024, health workers faced significant challenges accessing certain areas of central, north and south Gaza, which required special coordination to enter during the conflict,” the WHO/UNICEF statement noted. “In inaccessible areas such as Jabalia, Beit Lahiya, and Beit Hanoun where humanitarian pauses for the vaccination campaign were not assured, approximately 7,000 children missed vaccination during the second round. The recent ceasefire means health workers have considerably better access now. ”

It’s also clear that the UN health agencies are moving quickly in order to seize the moment of relative calm. The first six-week ceasefire period ends next weekend.

And it almost fell apart last week when Hamas momentarily said it was pausing release of the next three Israeli hostages – before finally going ahead with their release on Saturday, 15 February, as planned.  This Saturday, Hamas has even speeded up the pace, saying it will release the last of the six living Israeli hostages set to be released in this phase of the deal – instead of the three to which it was committed by the agreement.  The bodies of eight deceased Israeli hostages are also to be released before the initial six-week period of calm ends on March 1 next weekend.  Although the two parties have pledged to preserve the peace as long as negotiations for a second phase are continuing, those talks are expected to be even more complex than the first stage agreement, which took months to reach.

All in all, some 33 Israeli hostages are due to be released in the six-week cease-fire. In exchange for each Israeli released, Israel has been releasing some 30–50 Palestinians held in Israeli jails. Israel has also pulled its forces back from the Netzarim corridor that blocked Palestinian movement from southern to northern Gaza, last autumn, as well as from Gaza’s Rafah cross with Egypt, and allowed a surge of humanitarian aid into Gaza.

Doron Steinbrecher, among the first three, of 33 Israeli hostages to be released during the current cease-fire deal, was turned over to the Red Cross on Sunday, January 19.

However, big question marks remain over the future of the present truce.  After the the next pending hostage releases are completed, Hamas will continue to hold over 58 Israelis, young civilian men and soldiers, less than half of whom may really be alive.  Those remaining hostages will only be released as part of a permanent ceasefire deal. At the same time, Israel’s government has said that it won’t agree to a permanent arrangement that leaves Hamas in power in Gaza – although neither Israel nor Arab mediators have so far come up with an alternative governance plan.

And while there is wide support among the Israeli public for the continuation of the ceasefire so that all hostages are released, government hardliners are pressing for a return to war. To complicate negotiations on a second phase even more, United States President Donald Trump has shocked and alienated both Palestinians and the Arab world with his recent declarations that Gazans should be evacuated so that the area can be turned into a “Riviera” under US control – something that would be illegal under international law.

Against this very uncertain future, next week’s polio campaign will unroll. WHO said all Gaza children under 10 years of age will be targeted with a second, or even a third, polio vaccine:  “The upcoming vaccination campaign aims to reach all children under 10 years of age, including those previously missed, to close immunity gaps and end the outbreak. The use of the oral polio vaccine will help end this outbreak by preventing the spread of the virus. An additional polio vaccination round is planned to be implemented in April.”

It added that “there is no maximum number of times a child should be vaccinated. Each dose gives additional protection which is needed during an active polio outbreak.”

Image Credits: WHO, Middle East Eye , @nabilajamal.

An International Rescue Committee team distributes drinking water to Sudanese displaced by the civil war.

(The New Humanitarian) The International Rescue Committee, one of the oldest humanitarian aid organizations in the United States, is cutting thousands of staff, in another sign of the turmoil rippling across the humanitarian sector as the US aid funding freeze continues.

“We have had to take immediate and significant cost-cutting measures, including laying off and furloughing thousands of IRC personnel around the world,” the IRC said in a statement to The New Humanitarian.

The organization cites “the dual impact” of the freeze on “the majority of foreign assistance programmes”, and “the difficulty accessing funds disbursed through the US government’s payment system”.

“Like many peer humanitarian agencies, IRC is responding to the impacts on our clients of disruptions to US foreign assistance funding for critical programmes,” the IRC statement read.

In a separate letter to staff last week, CEO David Miliband announced a first round of several hundred furloughs (unpaid leave) and imminent layoffs.

“As much as we would like to believe there will be some relief of the financial pressure on our organisation and that our programmes will be able to resume, the reality is that there will assuredly be a significant reduction of [US government] support for our programmes this fiscal year, impacting services and staffing,” Miliband wrote.

The IRC’s leadership board cancelled staff pay raises and will take a 20% pay cut, Miliband’s letter said. Miliband’s own salary – about $1.2 million including benefits, according to tax filings for 2022 – is one of the highest in the humanitarian sector.

The IRC has previously said it has more than 17,000 global staff.

Layoffs, furloughs, and frozen aid

The IRC moves mirror cuts, suspensions, and sudden aid stoppages happening throughout the humanitarian sector as decision-makers grapple with the fallout from US President Donald Trump’s freeze and the attempted dismantling of the government’s aid agency, USAID.

Layoffs and furloughs have hit many international NGOs and aid organisations, including the Danish Refugee Council, Mercy Corps, the Norwegian Refugee Council, Catholic Relief Services (CRS), and FHI 360.

Local aid organisations, from community groups to national NGOs, have been particularly hard hit – most have minimal reserves and fewer donors. NEAR, a network of Global South civil society organisations, says 83% of its members have had programmes paused, affecting millions, while staff lay-offs are widespread.

The vast majority of the humanitarian sector’s workforce are local staff, who are often a part of the communities they help.

The aid freeze pushed organisations to suddenly suspend programmes, leaving millions of people who use US-funded aid with little warning or time to find alternatives.

HIV-positive children dropping out of programmes

Some examples of the impacts, according to the NGO network ICVA: HIV-positive children are dropping out of anti-retroviral (ARV) treatment programmes, feeding centres for malnourished people have closed, and water and sanitation programmes have shut.

The funding crisis highlights the sector’s deep dependence on a small group of mainly Western donors, including the United States. About 42%, or $650 million, of the IRC’s original 2025 budget comes from the US government, Miliband’s letter said.

Save the Children’s US entity received 54% of its operating revenue from US government grants and contracts in 2023, according to financial statements. Staff there have told The New Humanitarian that internal announcements on cuts are imminent.

Similarly, US funding made up 37% of support for CARE, 35% for CRS, and at least 41% for Mercy Corps. Their dependence gets passed along to subcontracted frontline local organisations.

A turning point?

After a decade of growth, the IRC now faces severe cutbacks due to the freeze on most US government development assistance.

The upheaval at IRC and elsewhere may be a pivot point for the sector, which has grown rapidly over the last decade to match rising needs and donor funding – but mostly hasn’t planned for the day the taps might be turned off.

The  New York City-based IRC, first founded in 1933 to help people fleeing Nazi Germany, saw its operating revenue jump from about $560 million in 2014 to $1.36 billion in 2023, largely mirroring donor funding increases through the COVID-19 pandemic.

The organization, which in the 1950s and 1960s expanded operations to include the relief and resettlement of refugees from Eastern Europe, the Soviet Union, Viet Nam, and Cuba, today works in 40 crisis-affected countries around the world – from Gaza to Sudan and Afghanistan and the Democratic Republic of Congo. It was already weathering a fiscal crisis and previous staff cuts driven by poor budgeting and forecasting practices, rising costs, and lower-than-expected revenue.

Critics say NGOs like the IRC in particular have prioritised unchecked growth, buoyed by significant but unsustainable pandemic income.

Even at the start of its current fiscal year, and with other organizations cutting costs and undergoing painful restructures months earlier, the IRC was forecasting “sustained annual income” of $1.5 billion a year.

Now, like the rest of the humanitarian world and the wider aid sector, the IRC appears to be reining in its expectations.

“There is a clear path through this period,” Miliband told staff in his email. “The IRC will remain a vital resource for tens of millions of clients, smaller than five years ago but double the size of 10 years ago. I am just so sorry at the price to be paid to get there.”

This story was originally published by The New Humanitarian, an independent, Geneva-based media service covering humanitarian crises, and the people affected by those crises, around the world. 

Image Credits: Mustafa Saeed/IRC, The New Humanitarian/IRC.