Chula Pop Bus’ is an electrically powered bus servicing students and staff of Chulalongkorn University in Bangkok.

The 12th Better Air Quality conference opened with a call to treat clean air as vital economic infrastructure, highlighting the large benefit-cost return – but financing clean-tech is a challenge in developing nations.

BANGKOK – Short-term impacts of bad air quality don’t just cause high economic costs but also lead to children scoring poorly in tests, warned a World Bank senior official at the opening of the Better Air Quality (BAQ) conference on Wednesday. 

The option to invest in cleaner air results in healthier people and stronger economies. Failure to do so means countries will continue to bear the costs of pollution –  in hospitals, in lost productivity, and in weakened economies, says Bindu Lohani, chair of Clean Air Asia, BAQ’s main organiser. 

A significant concern for the BAQ conference is how to increase financing for clean air action. It costs about 0.1% of regional GDP annually to roll out the most effective measures, a World Bank report estimates, while the benefit-cost ratio can be more than 9:1 for countries like Pakistan, India and Bangladesh.

Lohani called on governments to treat clean air as core economic infrastructure and set targets to achieve the net-zero climate target by 2050.

By 2030, governments should significantly reduce urban particulate pollution, electrify transport systems, expand monitoring, and eliminate the most polluting fuels and practices, such as agricultural and open burning, Lohani proposed. By 2040, air quality should be fully aligned with climate policy and on a path to achieve the 2050 target. 

The World Bank’s Ann Jeanette Glauber acknowledged that tools such as emissions inventories and enforcement capacity are “essential public goods, but they aren’t sexy”. 

“There’s no ribbon cutting. Often, they don’t make money, necessarily,” Glauber said, adding that the most financially viable solution is to focus on industry.

“For us in South and Southeast Asia, the main sources of emissions are industries.  And these need clean tech boilers, furnaces, kilns and pollution control devices,” she said, adding that there were limited resources to roll these out.

Tussle over clean-tech finance

Reena Gupta (centre, with microphone), chairperson of the Punjab Pollution Control Board

Reena Gupta, chairperson of the Punjab Pollution Control Board, said there is very little money flowing into developing countries to assist with air pollution.

Citing the clean tech projects presented at her panel discussion, Gupta said that while they are excellent, they are “only pilots”. 

In Punjab in north India, most furnaces in a town known for metal recycling are still being run on coal:  “We know the clean technology exists. But it is not viable for the recycling businesses,” she said.

Gupta proposed that the international finance agencies develop mechanisms to cover risk for businesses to change to cleaner technology for the first couple of years, after which costs can be borne by the business. 

In contrast, the World Bank’s Glauber suggested that affected countries should first leverage things like their finance policies, “then investment flows…  It’s really about helping commercial finance go into those actual technologies, and you’re basically pushing them over that cost barrier so that they become financially viable.”

Citing Nepal’s example, Glauber said that the government made it far cheaper to import electric than fossil fuel vehicles. It is now one of the fastest electric vehicle markets in the world, and has the second highest electric vehicle only to Norway, in terms of electric vehicle penetration.

“You play with those [policy] levers, and then investment flows. Obviously, lots to be done in risk-sharing mechanisms that crowd-in private finance for industrial pollution control technology. That’s where the magic needs to happen,” Glauber said.

Ann Jeannette Glauber, from the World Bank’s Environment Department (South Asia).

‘Exporting air pollution’

Wealthier nations are also offloading their obsolete and polluting products in the region.

“We have had to shut down a few tyre pyrolysis units (in Punjab) that were not deploying proper air pollution control devices. Latest reports have shown that waste tyres are being sent to India from the UK and the Middle East. This is becoming a big source of black carbon, a super pollutant,” she told Health Policy Watch.

A study by philanthropic organisation Clean Air Fund (CAF) shows that measures to prevent air pollution are massively underfunded and funding does not reach populations with the highest exposure. 

Despite the 9:1 benefit-cost advantage, and despite studies that put premature deaths because of air pollution at 8.1 million in 2021, air quality solutions receive 1% of international development funding, according to CAF. This too saw a 20% decrease between 2022 and 2023. 

Bangkok is turning the tide on air pollution

The BAQ was last held in Bangkok 18 years ago. City officials say much has changed since then. Along with the economy and skyline growing, air pollution is a “visible” problem. 

“On the worst days, parents keep their children indoors, hospitals fill with patients, and the residents lose their trust that the government is doing anything at all,” says PornphromVikitsreth Techapaiboon, chief sustainability officer of the Bangkok Metropolitan Administration, speaking at the opening session. 

But there have been measurable improvements in the last year in reducing PM2.5 pollution, he added. The number of “orange and red’ (poor air quality) days has almost halved since 2015 and the PM2.5 concentration fell from nearly 50 micrograms per cubic metre to 37.6, a 22% decrease. 

These, he says, are “genuine turning points” and that “PM2.5-related patients have decreased in January.”

The causes of air pollution are unfavourable geography (Bangkok is in a basin), vehicular, especially diesel pollution, and biomass burning, as shown by their “dust detective” teams with experts from academia and civil society organisations. 

This has led Bangkok to create an air quality strategy, declaring itself last year to be a pollution control zone. This includes working with upwind provinces where biomass is burnt, leading to more burn-free days. It introduced a ‘green list’ for heavy trucks that are banned from Bangkok unless they can show evidence of recent maintenance. Industrial monitoring is being ramped up.

A portable air quality monitor on display at BAQ 2026 in Bangkok

Pornphrom says they’re investing in green spaces, not just for aesthetics, but as a public health intervention. PM2.5 levels inside parks are 33-43% lower than in surrounding areas. They message seven-day PM2.5 forecasts and are installing ‘clean air rooms’ in schools. 

Thailand is emerging as a test case for integrated air quality and climate investment, the conference heard. The Asian Development Bank (ADB) presented a proposed Thailand Integrated Air Quality Investment Program. 

The proposal outlines a 10-year investment platform aligned with Thailand’s PM2.5 Action Plan and forthcoming Clean Air Act, designed to bring together multiple sectors under a single framework.Priority areas include transport electrification, crop residue management, renewable energy expansion and industrial emission standards.

The ADB referenced a programme in Beijing–Tianjin–Hebei in China, where coordinated action across sectors, including fuel switching, clean heating, and industrial upgrading, helped reduce PM2.5 levels by around 40% compared to 2015.

At the city level, Bangkok also highlighted the need for sustained partnerships.

“Air pollution is a complex challenge that no single city can solve alone. Sustainable air quality improvement requires long-term investment and strong international collaboration,” said Pornthep.

Image Credits: UN Thailand, Chetan Bhattacharji.

The Global Fund’s eighth replenishment faces a critical $5.36 billion shortfall, securing only $12.64 billion against its $18 billion target to fight AIDS, tuberculosis, and malaria.
The Global Fund’s eighth replenishment secured $12.64 billion against its $18 billion target to fight AIDS, tuberculosis, and malaria.

Battered by a 58% cut from France, a delayed European Union (EU) pledge, and a US pullback, the Global Fund faces a significant shortfall, securing $12.64 billion against its $18 billion target during the 8th replenishment.

According to the organization, reaching the full target would have prevented roughly 400 million new AIDS, tuberculosis, and malaria infections between 2027 and 2029.

Despite this compounding retreat, executive director Peter Sands praised the final tally as a “remarkable result, achieved in a challenging global context.”

Significant changes in global health financing have forced a strategic shift, introduced in late 2025, toward the poorest nations bearing the heaviest disease burdens, while placing middle-income countries on accelerated transition timelines toward national self-reliance.

“It’s our duty to steer the partnership through this period of uncertainty in a way that protects sustainability, preserves impact, and ensures that the Global Fund continues to deliver for the people and communities we serve,” said Roslyn Morauta, chair of the Global Fund Board, at the 54th Board meeting in February 2026.

To manage the Global Fund shortfall, the board approved $10.78 billion in core country allocations for the 2027-2029 implementation period. To maximize the impact of the remaining funds, the board also earmarked $260 million for “catalytic investments” designed to expand access to innovative health products.

Executive leadership stressed the urgent need to prioritize these game-changing biomedical innovations, specifically highlighting the continued scale-up of the HIV prevention tool Lenacapavir, alongside new molecular diagnostics for tuberculosis and advanced vector control tools for malaria.

French budgetary constraints compound shortfall

Driven by domestic fiscal pressure, France’s contribution to the Global Fund plummeted by 58%.
Driven by domestic fiscal pressure, France’s contribution to the Global Fund plummeted by 58%.

The Global Fund shortfall is compounded by a broader shift towards fiscal restraint and budgetary scrutiny across major Western nations. France has traditionally stood as the second-largest contributor to the institution, having regularly increased its support with successive 20% bumps during the previous two replenishment cycles.

But, as first reported by franceinfo, the state has now decided to severely slash its international health budget, reducing its financial contribution by 58% for the upcoming cycle, down from the €1.6 billion it previously provided.

In a response to a query by Health Policy Watch, the Ministry for Europe and Foreign Affairs framed the retreat as a fiscal necessity, citing a mandate to cap the public deficit at 5% of Gross Domestic Product (GDP) by 2026, demanding significant budgetary efforts across all government sectors.

Despite the cut signaling a shift in priorities, the ministry stressed that these temporary financial constraints should not be interpreted as a principled retreat from multilateralism.

“The reduction in French investments in global health must be understood in this context, which in no way calls into question our commitment in this area,” stated the Quai d’Orsay in its response.

As the pledge is yet to be finalised, the French government insists that global health remains a crucial concern, with the ministry noting that health was recently confirmed as one of France’s “10 priority political objectives” for solidarity investments, specifically aimed at strengthening pandemic resilience and primary health systems.

The current intense budgetary pressure stems from the legislative instability gripping President Emmanuel Macron’s administration. After losing its parliamentary majority, the fragmented centrist government only managed to pass the 2026 budget by utilizing a special constitutional tool to bypass a standard vote.

EU caught in a budget deadlock

The EU Commission remains in a budget deadlock, delaying a multi-year pledge.
The EU Commission remains in a budget deadlock, delaying a multi-year pledge to the Global Fund despite previous announcements.

The impact of the Global Fund shortfall is exacerbated by the European Commission’s continued inability to pledge any commitments, a deadlock extending through the February 2026 board meeting.

The European bloc missed the formal November 2025 pledging summit, claiming it could not legally secure a multi-year pledge because the replenishment cycle falls between two long-term EU budgets, the Multiannual Financial Framework (MFF). The current MFF ends 2027, the new framework from 2028-2034 is yet to be formally adopted.

According to recent budget hearings, the European Commission formulated a workaround and intended to officially pledge €700 million over a four-year span at the February board meeting. However, the Commission experienced an ongoing delay in formalizing this pledge by the time the board convened, research by Health Policy Watch confirms.

This delay comes as the European Parliament warns of severe constraints and a “very limited level of availabilities” as the bloc approaches the final year of its current 2021-2027 long-term budget.

EXCLUSIVE: EU to Pledge €700 Million to Global Fund, Less Than Previous Years

Even if this severely delayed pledge eventually materializes, stretching it over four years instead of three would represent a significant funding reduction of approximately 26.5% on an annualized basis. Furthermore, the European Commission has confirmed there will be no dedicated “health window” to ringfence budget appropriations in the upcoming long-term budget.

Other major donors had already drastically cut their contributions to the Global Fund, fundamentally altering the global health financing landscape. Driven primarily by an inward-looking “America First” political strategy, the US commitment fell from $6 billion in the seventh replenishment to just $4.6 billion in the eighth.

Private sector growth cannot counter cuts

A health worker in Gyabankrom, Ghana, prepares a malaria vaccine.
A health worker in Gyabankrom, Ghana, prepares a malaria vaccine.

Despite the shortfall from major donors, the latest replenishment cycle yielded encouraging progress from alternative sources. The global private sector and various philanthropic organizations stepped forward, successfully mobilizing $1.34 billion for the eighth replenishment.

The Bill & Melinda Gates Foundation maintained its role as the premier private global donor by pledging $912 million. Other corporate actors stepped up to fund vital localized health initiatives, including a £6 million joint financial pledge  from GSK and ViiV Healthcare.

The Children’s Investment Fund Foundation (CIFF) pledged $50 million to accelerate the rollout of innovative tuberculosis diagnostics across affected regions. Goodbye Malaria also reaffirmed its leadership with a $5.5 million contribution to sustain targeted malaria elimination efforts in Eswatini, Mozambique, and South Africa.

However, while private funding sits at a record high, it cannot structurally replace the loss of sovereign anchor donors. Even with the $1.34 billion private surge, the overall replenishment total remains more than $5 billion short of the necessary goal to defeat these diseases.

African states stepping up

Demonstrating a surge in sovereign agency, several African nations have increased or maintained their Global Fund commitments, including South Africa and Nigeria.
Demonstrating a surge in sovereign agency, several African nations have increased or maintained their Global Fund commitments, including South Africa and Nigeria.

African states are stepping up, taking a larger financial stake in their health systems. Uganda maintained its previous funding levels with a $3 million pledge, which African diplomats celebrated as a powerful demonstration of the continent’s shared responsibility.

This contribution from Uganda is part of a broader, encouraging trend of African implementer-donors actively increasing their domestic financing. South Africa more than doubled its previous commitment to pledge $26.6 million, while Nigeria increased its pledge from $13.2 million to $15 million.

African diplomats have continually emphasized the critical importance of increased sovereign investment to accelerate health gains across the continent.

As the global health architecture enters this new era of austerity, the structural reliance on domestic African financing will inevitably grow. Despite the current Global Fund shortfall from the West, this emerging sovereign agency offers a resilient pathway toward long-term sustainability and equitable health outcomes.

Image Credits: WHO/Fanjan Combrink , Felix Sassmannshausen/Health Policy Watch, European Union.

Thousands of people claim that exposure to Roundup has given them cancer.

US President Donald Trump’s recent executive order on “elemental phosphorus and glyphosate-based herbicide” is facing renewed scrutiny for potentially shielding a controversial weapon of war.

The order promotes the domestic production of elemental phosphorus and glyphosate. Elemental phosphorus is the raw material used in white phosphorus weapons, which cause severe burns and tissue damage, and their use is controlled under international humanitarian law.

Glyphosate is the key ingredient of Roundup, the most commonly used herbicide by US agriculture. Back in 2015, the World Health Organization’s (WHO) International Agency for Research on Cancer (IARC) classified glyphosate as “probably carcinogenic to humans”.

Under the order, the US Secretary of Agriculture is directed to ensure that no government “order, rule, or regulation” threatens the “financial viability of domestic producers of either substance”. Crucially, it also grants those producers immunity under the Defense Production Act — a provision critics say could insulate manufacturers from legal accountability.

Initial reaction to the order focused on Trump’s support for glyphosate, drawing condemnation from some of the leaders of Make America Healthy Again (MAHA), the lobby group that supports US Health Secretary Robert F Kennedy Jr.

Controversially, however, Kennedy backed Trump’s order, claiming that it safeguards America’s national security.

“Donald Trump’s Executive Order puts America first where it matters most — our defense readiness and our food supply. We must safeguard America’s national security first, because all of our priorities depend on it,” Kennedy said in a statement to CNBC.

The executive order also declares that “elemental phosphorus is a scarce material that is critical to national defense and security”, and the New York Times reports that Trump’s decision “was significantly influenced by “concerns about the availability of phosphorus for defense”.

Monsanto supplies US military

In response to the executive order, Roundup’s manufacturer, Monsanto, said that it “will comply with this order to produce glyphosate and elemental phosphorus.”

Monsanto is the only US company that produces white phosphorus. It supplies it to the ICL Group (formerly Israel Chemicals Ltd) which sells it to the US military, where it is processed into weapons, according to Corruption Tracker, a US group that tracks corruption in the arms industry.

Last month, Monsanto, which was bought by the German company Bayer in 2018, reached a provisional $7.25 billion settlement with US law firms representing clients who claim that exposure to Roundup caused them to develop non-Hodgkin lymphoma (NHL). 

The agreement covers plaintiffs exposed to Roundup before 17 February and currently have a medical diagnosis of NHL, or who receive a medical diagnosis within 16 years following the final approval of the agreement, according to an announcement from Bayer, which bought Monsanto in 2018.

The executive order may provide the company with protection against other legal challenges.

‘Deep, severe burns’

White phosphorus, which “ignites spontaneously in air at temperatures above 30 °C”, is extremely hard to extinguish and can cause “deep and severe burns”, according to the WHO. 

“White phosphorus is harmful to humans by all routes of exposure,” according to the WHO.

It can cause “severe deep burns” as it is “highly soluble in lipids” and can penetrate skin tissue. Its smoke harms people’s eyes and respiratory tract as phosphorus oxides dissolve in moisture to form phosphoric acids. 

Exposure can also cause “cardiovascular effects and collapse, as well as renal and hepatic damage and depressed consciousness and coma,” says the WHO. 

White phosphorus in Lebanon

White phosphorus being fired into Lebanon by Israel in 2024.

Human Rights Watch (HRW) reported last week that Israel had fired white phosphorus (a type of elemental phosphorus) bombs over a residential area of Yohmor, a town in southern Lebanon.

HRW has previously reported Israel’s use of white phosphorus in at least 17 municipalities in Lebanon between October 2023 and May 2024. HRW has previously documented Israel’s use of white phosphorus in Gaza in 2008-2009.

In October 2023, Amnesty International’s Crisis Evidence Lab verified that Israel’s attacks on Gaza used M825 and M825A1 projectiles labelled with the US Department of Defense (now Department of War) Identification Codes for white phosphorus-based rounds. 

White phosphorus is classified as an “incendiary weapon”, not a chemical weapon as military forces claim that they use it as a smokescreen. The use of white phosphorus is governed by Protocol III of the Convention on Conventional Weapons (CCW), which prohibits the use of airdropped incendiary weapons in “concentrations of civilians”. Israel is not a signatory to the convention.

Bayer’s influence in the Trump administration

A recent investigation by US Right to Know exposed extensive links between the Trump administration and Bayer, which owns Monsanto. 

It linked 22 key Trump administration staff members to Bayer’s lobbying or legal network. White House Chief of Staff Susie Wiles and US Attorney General Pam Bondi have both been partners in Ballard Partners, the lobbying firm that  represents Bayer.

Ballard Partners founder Brian Ballard “raised more than $50 million for Trump’s 2024 campaign, and served on the 2024 inaugural and transition finance committees.”

“More than 30 senior officials at lobby firms retained by Bayer have direct ties to Trump, having worked in one or both of his administrations or political campaigns,” according to Right to Know.

Image Credits: Aljazeera, Pesticide Action Network.

Staff from the now-defunct US Agency for International Development (USAID) offload emergency supplies.

Funding cuts over the past year have created a crisis for multilateral health institutions. Which institutions emerge from this crisis, and in what form, will have real consequences for the health of people in countries like South Africa.

In recent weeks, there has been a glut of articles from global health big-hitters, all concerned with how multilateral health institutions should, or should not be redesigned.

These include articles from Philippe Duneton, Executive Director of UNITAID, Sania Nishtar, CEO of GAVI, and one co-authored by, among others, Anders Nordström, a former acting Director-General of the WHO, Helen Clark, a former New Zealand Prime Minister, and Peter Piot, the driving force behind UNAIDS from the mid-90s to 2008.

The immediate cause of all this debate is the stark reality that funding for multilateral health institutions have been cut dramatically in the last year, mainly, but not exclusively, due to the United States’ retreat from such international forums in favour of bilateral agreements. Even before the funding cuts, the financial outlook at entities like the World Health Organization (WHO) and UNAIDS was bleak. Over the last year, it has tipped over into outright crisis.

The WHO has already undertaken drastic organisational restructuring. Last year, a UN document raised the possibility of “sunsetting” UNAIDS by the end of 2026. It is likely that we will see several more organisations shrinking or disappearing altogether in the coming years.

Why does this matter?

The multilateral health institutions we’ve had in recent decades have not been perfect. They were often overly politicised, fraught with power imbalances, and not always capable of responding quickly and effectively to health emergencies.

But even so, it is unequivocally true that when it comes to healthcare, multilateralism has yielded many tangible benefits that are helping keep people alive. In a world where every country stands alone, these benefits will simply fall away.

There are many examples of such benefits. The WHO’s treatment guidelines for diseases like HIV and TB are public goods that are invaluable in many countries. In South Africa, they were particularly important as an antidote to the crackpot science that flourished in the period of state-sponsored AIDS denialism. 

The sharing of genomics data between countries was critically important at the height of the COVID-19 pandemic. Over an even longer period, the sharing of data on influenza strains has enabled the rational selection of vaccine components for each hemisphere each year.

Medicine regulators in different countries increasingly share some of their work in order to speed up their processes and avoid duplication.

Lenacapavir, packaged as Sunlenca in the US, is being rolled out in South Africa and other countries with significant HIV burdens.

This year, a new HIV prevention injection containing the ARV lenacapavir is being rolled out in South Africa and several other countries, largely with the help of the Global Fund, another international entity. 

A stable supply of low-cost lenacapavir should be available in around a year or two from now, due to market-shaping work done by UNITAID, the Gates Foundation, the Clinton Health Access Initiative, and Wits RHI.

Such market-shaping often involves committing ahead of time to purchase certain volumes of a product to incentivise manufacturers to invest in production capacity, thus kick-starting the market for the product.

Then there is the recent history of how rapidly a new antiretroviral medicine called dolutegravir was rolled out in South Africa from 2019. Today over five million people here are taking it.

The Geneva-based Medicines Patent Pool (MPP) negotiated licenses that allowed generic competition to start years earlier than would otherwise have been the case. That enabled the low prices and supply security that has facilitated the massive uptake of dolutegravir here and in dozens of other countries.

It is clearly in the interest of countries like South Africa to help keep mechanisms like these going.

But to reduce the value of these institutions to purely the technical would miss the essence of what animates them in the first place.

The reality is that multilateral health institutions have often been at their most effective when people were driven by the need to address urgent health needs, as in the early days of UNAIDS, for example.

The belief that people’s health matters, no matter who they are, or where they live – essentially a belief in human rights – can make the difference between an ineffectual bureaucracy and a vital health movement.

Our current crisis is not only one of technical capacity, but also one where the animating power of human rights-based thinking is being challenged.

Charles Gore, executive director of Medicines Patent Pool, which has successfully negotiated licenses that allowed the production of several cheaper generic medicines.

How should we think about redesigning global health?

There are some tensions between fighting to keep what we currently have and embracing big reforms. For example, on the one hand, given the aid cuts of the last year, people have good reason to be concerned about the potential closure of UNAIDS being a precursor to the further unravelling of the global HIV response.

On the other hand, there are legitimate questions as to whether UNAIDS is still fit for purpose, given how the HIV epidemic has changed over the last three decades.

One of the most useful contributions on how to think about all this comes from Nordström and his co-authors. They outline four key paradigm shifts that help bring the current moment into focus. Their paper is worth reading in full for the nuances, but here is a brief paraphrasing of the four paradigm shifts:

  •   The first shift is about recognising the fundamental changes underway in the global burden of disease and in demography. In short, while the key threats in the last three decades were the infectious diseases malaria, tuberculosis, and HIV, they are increasingly being overtaken by non-communicable diseases (like diabetes and hypertension) and mental health disorders. This shift is not yet reflected in the architecture of multilateral health institutions.
  •   The second shift relates to the recentring of power from Geneva in Switzerland and New York and Washington in the USA to countries and regions, giving rise to an increasingly multipolar world. “This shift does not imply that multilateral cooperation is obsolete,” write the authors, “however, it requires a clarification of which future functions should be performed at the global level, and which should be performed by national and regional bodies.”
  •   The third shift refers to the growing push to modernise global health institutions. The authors write: “Leaders from low-income and middle-income countries have repeatedly critiqued the dearth of systemic support, the inefficiencies of vertical initiatives, and the resource-intensive bureaucratic processes that accompany them”. Considering these external and internal pressures, they argue that there is a need to move from a complex and competitive system to a simpler, needs-based, and agile system.
  •   The fourth shift is linked to the declining relative importance of development assistance, coupled with countries’ rising commitments to increase domestic financing for health. Although some international support will remain essential for low-income countries and humanitarian responses, the authors argue that domestic resources must be the engine of a new ecosystem and ways of working together.
Power in global health needs to be decentralised from the UN hubs in Geneva and New York and located in regions and countries, argue Anders Nordström and co-authors.

All of these shifts are now occurring within the broader geopolitical context of what Canadian Prime Minister Mark Carney recently described as a “rupture in the world order”.

He stressed that the great powers have turned their backs on the rules-based world order and have “begun using economic integration as weapons, tariffs as leverage, financial infrastructure as coercion, supply chains as vulnerabilities to be exploited”.

This shift can already be seen in the US’s pivot from multilateralism to bilateral health agreements. As Carney put it: “The multilateral institutions on which the middle powers have relied – the WTO, the UN, the COP – the very architecture of collective problem solving, are under threat.”

He argues that middle-powers like Canada, and I’d argue South Africa too, should aspire to be part of this group, and chart a way forward where they are not overly reliant on super-powers like the US and China. Avoiding such an over-reliance is of course also an obvious lesson to take from the US’s abrupt cuts to health aid last year.

Maybe a first harsh reality to come to terms with, then is that the rupture that is taking place in global geopolitics is also occurring in the world of global health.

To think that we can go back to the way the WHO or UNAIDS were 20 years ago is wishful thinking. The “rupture” might take time to propagate, but it will extend all the way.

What is to be done?

Carney also makes the point that the rules-based order wasn’t in fact working as well for everyone as we liked to pretend. To a lesser extent, something similar could be said for multilateralism in health.

Getting things done was often hard, the politics was often tricky, and when it came to the crunch, say on something like patents on medicines, the US and Europe almost always held sway.

As outlined above, countries like South Africa benefited in very concrete ways from multi-lateral forums, but somehow those benefits were never widely appreciated. Ultimately, it is telling that so many national governments have failed to put up the money the WHO requires to do its work – even before the current US withdrawal.

Maybe then, to make a reset of multilateral health institutions a success, will require that governments reassess and newly appreciate why it is that we need multilateral health institutions in the first place.

This will require a thorough and honest assessment of what we have gained from these institutions in recent decades. Things like market-shaping, patent pooling, pooled procurement, sharing of genomics and other data, regulatory harmonisation, guideline development, research cooperation, and multilateral fund-raising have all been important and will continue to be so.

We must make sure that, whatever emerges in the next few years, we have multilateral mechanisms that can deliver in all these areas.

But we will have to accept that those entities might look quite different from what we’ve come to know in recent decades. There will certainly be areas in which we still need global institutions like the WHO, but for some issues, we might get more done by working with coalitions of the willing, or collaborating at a regional level – as we’re already seeing with the African Medicines Agency (although South Africa rather inexplicably hasn’t yet ratified the related treaty).

The reality is that apart from governments not being willing to spend more on health at the moment, the enabling geopolitical substructure that we’ve been relying on for decades has given way.

In many respects, this has been a disaster for our common good, but it is also an opportunity to craft new and more fit-for-purpose multilateral health institutions that are animated by a shared commitment to human rights. This is an opportunity that countries like South Africa must grasp.

As Carney put it: “We know the old order is not coming back. We shouldn’t mourn it. Nostalgia is not a strategy, but we believe that from the fracture, we can build something bigger, better, stronger, more just. This is the task of the middle powers, the countries that have the most to lose from a world of fortresses and most to gain from genuine cooperation.”

*Low is editor of Spotlight. This article was co-published with Spotlight,  a South African public health magazine that aims to deepen public understanding of important health issues. The article mentions The Gates Foundation, which provides some funding to Spotlight, but is editorially independent.

Image Credits: US Mission in Geneva / Eric Bridiers via Flickr, USAID Press Office, Gilead, MPP.

UN Special Rapporteur Astrid Puentes Riaño (third from left) presents her report to the Human Rights Council in Geneva, demanding accountability from air polluters.
UN Special Rapporteur Astrid Puentes Riaño (second left at table) presents her report to the Human Rights Council in Geneva.

While air pollution claims more than eight million lives annually, the burden of proving exactly which air polluters or tailpipes caused a specific lung cancer or child’s asthma attack has rested firmly on the shoulders of the sick.

That is about to change, according to a landmark United Nations (UN) report by Astrid Puentes Riaño, Special Rapporteur on the right to a clean environment, presented to the Human Rights Council in Geneva.

She signals a seismic shift in international jurisprudence: moving the burden of proof away from the victims and onto the state, ultimately targeting the polluters.

This mechanism suggests that once dangerous pollution levels and health harms are established in an area, the onus shifts to holding governments accountable when they fail to prevent exposure to dangerous contamination.

UN Special Rapporteur Astrid Puentes Riaño spoke with Health Policy Watch in Geneva following her presentation to the Human Rights Council.
UN Special Rapporteur Astrid Puentes Riaño spoke with Health Policy Watch in Geneva.

“Legally speaking, there is a conclusion from the Inter-American system and also the European system that whenever there are victims of air pollution, and there is clarity of the high risks that air pollution has on their health and their life, then we have to change the burden of proof,” Puentes Riaño said in an interview with Health Policy Watch.

The report of the renowned environmental lawyer highlights that this legal precedent has already been set. Relying on recent landmark cases before the Inter-American Court of Human Rights – a case she litigated herself – and the European Court of Human Rights, the Special Rapporteur emphasized that state responsibility is established if exposure is demonstrated alongside a failure to prevent contamination by air polluters.

The mandate calls on all states to universally recognize this jurisprudence and implement domestic regulations that “place the burden of proof on the polluter by requiring injunctive relief in the form of payment of fees and penalties.” This will protect populations who suffer from respiratory and cardiovascular diseases.

“People should not be having to prove the link because that’s very difficult legally,” Puentes Riaño added. “That should be assumed, and then it’s for the state to actually change the burden of proof”.

Subsidies for air polluters exacerbate crisis

A stark funding disparity that leaves clean air initiatives with less than 1% of comparative funding.
A stark funding disparity that leaves clean air initiatives with less than 1% of comparative funding.

Implementing this legal shift and combatting the air pollution crisis requires overcoming financial roadblocks. The Special Rapporteur’s presentation to the council highlighted the major difference between government investments in public health versus heavily polluting industries.

Between 2018 and 2024, an average of $600 billion was spent globally per year subsidizing fossil fuels, while only $3.6 billion was invested annually in controlling outdoor air pollution – less than 1% of the spend on subsidies, Puentes Riaño noted during the Geneva discussions.

“There is money in the world, and we know that; unfortunately, there’s more money being used for fossil fuels and war,” she stated.

Consequently, 99% of the global population breathes toxic air, with the highest levels concentrated in low- and middle-income countries.

Pollution has also been exported from the Global North to the Global South, yet international accountability for air polluters remains limited, added Weenarin Lulitanonda, co-founder of the Thailand Clean Air Network.

In Southeast Asia, nearly 20% of Thailand’s 65 million people suffer from illnesses related to atmospheric toxicity. “If you live in Chiang Mai right now, about four to five months of the year you’re breathing in toxic air,” Lulitanonda said.

Battling the respiratory emergency on the ground

Panelists at the Geneva discussions shared perspectives on the health and developmental impacts of the global air pollution crisis.
Panelists at the Geneva discussions shared perspectives on the health and developmental impacts of the global air pollution crisis.

Polluted air frequently leads to worsening anxiety disorders, cognitive developmental delays, and respiratory distress in early childhood. At the panel discussion, civil society advocates detailed the lifelong harms inflicted on children in India.

“For a long time, air pollution was considered an environmental hazard … but the health connect came only when these stories were told,” Bhavreen Kandhari, co-founder of the Warrior Moms movement in India, explained. “When a mother speaks, then everyone states their own experiences, and that is how the impact started to show”.

Kandhari asked that clean air standards be legally enforced rather than treated as recommendations. Her testimony underscored the Special Rapporteur’s finding that structural inequalities create “sacrifice zones,” where marginalized communities face cumulative health harms from nearby air polluters.

Experts note that overcoming this environmental blight requires predictable public finance and international solidarity. Roqaya Dhaif, a human rights policy specialist at the UN Development Programme, stated during the debate that developing nations require reliable technology transfers and capacity building to transition towards clean energy.

“The root causes of pollution are in fact development challenges,” Dhaif said. “To truly tackle air pollution, we must address it through integrated, equitable development policies”.

WHO data highlights scale of atmospheric toxicity

Thick smog blankets the skyline of Bangkok, Thailand, in 2018.
Thick smog blankets the skyline of Bangkok, Thailand, in 2018.

Recent scientific data from the World Health Organization (WHO) demonstrates that this respiratory emergency is a leading global cause of death.

Rüdiger Krech, interim director of the WHO department of environment, climate change, and health, outlined the physiological impacts of toxic air to the delegates.

“Fine particulate matters penetrate deep into the lungs and bloodstream, triggering asthma attacks in children, heart attacks and strokes in adults,” Krech said. “These everyday preventable harms highlight why clean air is not only an environmental necessity but a fundamental health right”.

These everyday preventable harms highlight why clean air is not only an environmental necessity but also a fundamental health right. To assist member states in tracking national progress on these exposures and policies, the WHO recently updated its Health and Environment Scorecards, condensing 25 key indicators into a single summary score.

“Tackling environmental risks isn’t optional – it’s a prescription for better health, stronger economies, and a safer future,” Maria Neira, WHO director of Environment, Climate Change, and Health, stated regarding the updated scorecards. “You can’t have healthy people on a sick planet”.

To advance this, a new voluntary target calls on all countries to cut the health impacts of air pollution by 50% by 2040.

Fossil fuel producers hit brakes on action

A representative from the Kingdom of Bahrain emphasized the need to balance environmental protections with national economic development.
A representative from Bahrain emphasized the need to balance environmental protections with national economic development.

While most countries supported the report’s findings and the necessity of concrete measures, representatives from major fossil fuel-producing countries responded with caution to the call to drastically reduce emissions from air polluters.

Saudi Arabia, speaking on behalf of the Arab Group, argued that the right to a clean environment must be “progressively implemented”. The delegation stated that tackling the issue requires an approach that respects national circumstances and the specific features of each country, signaling a desire for more time to implement measures without disrupting their economies.

Other oil- and gas-producing nations echoed this sentiment, emphasizing the need to balance environmental protection with domestic economic development.

Oman advocated for a framework that “balances between economic growth and conservation of natural resources”. Similarly, Bahrain highlighted its 2060 net-zero targets but insisted that international efforts must be based on “common differentiated responsibilities”.

This approach contrasted sharply with the requests expressed by vulnerable nations facing the brunt of the environmental blight, with the Marshall Islands explicitly demanding concrete steps to “rapidly and equitably transition away from production and use of fossil fuel”.

Corporate complicity shields air polluters

Industrial chimneys release thick plumes of smoke into the atmosphere, illustrating the persistent challenge of regulating stationary emission sources to mitigate the global respiratory health crisis.
Industrial chimneys release thick plumes of smoke into the atmosphere.

This would also require confronting the corporate actors and business interests that delay health-based regulations. The report notes that influence from sectors linked to emission drivers continues to weaken environmental measures.

The pushback is a daily reality for policymakers attempting to strengthen air quality frameworks, Puentes Riaño confirmed. She noted that state authorities frequently encounter resistance from industries claiming that clean air measures are too costly or impossible to implement.

“When it comes to actually pushing for legislation behind the scenes, it is big corporations, the big polluters, that are pushing back on this,” Thailand Clean Air Network’s Lulitanonda added. ”

Corporations will only internalize the externalities if it’s mandated or required; there’s no other way,” explained the economist who specializes in the ‘hidden costs’ of environmental degradation.

To achieve this, businesses must conduct human rights due diligence and comply with environmental licensing conditions, Puentes Riaño states in her report. Shifting the burden of proof, alongside imposing injunctive fees, would force air polluters to prioritize public health over unregulated expansion.

Charting a path forward

Air Pollution and Heatwaves Take Centre Stage at Mumbai Climate Week

This claim was countered by Roberto Céspedes, Minister Counselor at the permanent mission of Costa Rica. “Taking care of the environment is good business,” he said. “It will, of course, cost money at the beginning, but it will save countless more in the future, and it makes economic sense to invest in this.”

Protecting public health from toxic emissions is increasingly recognized as a catalyst for sustainable development rather than a barrier to economic growth. A transition to renewable energy sources mitigates climate change and reduces the healthcare burdens associated with the respiratory emergency, the report states.

To prevent further harm, the report advises enacting a presumption against granting permits for new contaminating facilities in already overburdened communities, while requiring rigorous environmental, social, and human rights impact assessments—including specific health evaluations—for any major polluting activities

Puentes Riaño plans to take these findings to the upcoming World Health Assembly and international climate negotiations. By shifting the burden of proof and demanding strict corporate accountability, the international community has the tools necessary to regulate air polluters and protect future generations, she stated.

Image Credits: Felix Sassmannshausen, urf/Getty Images via Canva, Info Timisoara/Pixabay via Canva.

CSW chair Maritza Chan Valverde from Costa Rica, and UN Secretary General Antonio Guterrez at the 70th session of the commission.

The United States was isolated in its opposition to the adoption of “agreed conclusions” at the Commission on the Status of Women (CSW) on Tuesday, recording the only “no” vote at the United Nations headquarters in New York on Monday.

There were 37 votes in favour and six abstentions from Côte d’Ivoire, the Democratic Republic of Congo, Egypt, Mali, Mauritania, and Saudi Arabia. The CSW is made up of 45 elected members.

“Prior to the adoption, the representative of the United States [Dan Negrea] first proposed that its consideration be deferred, then that the text be withdrawn and then proposed eight amendments to the text,” according to a UN media release.

The US sought the removal of “controversial social issues” from the document, Devex reports. US objections included “ambiguous language promoting gender ideology”, “vague, unqualified commitments to sexual and reproductive health that can be interpreted as implying abortion rights”, and “censorship language on regulating artificial intelligence”, according to the UN media release.  

Earlier, Nigeria and Egypt called for more time to reach consensus – the usual route for UN decision-making and the only route the CSW has taken in 70 years. Pakistan later proposed voting separately on each of the US’s eight amendments.

However, CSW chair Maritza Chan Valverde from Costa Rica said that “every effort has been made to listen to delegations and to reflect the diversity of views expressed”.  

“We are convinced that the text represents the most balanced outcome achievable at this stage,” Valverde said, adding that her Bureau has decided to put the text to a vote.

Measures to address gender-based violence

UN Women director Sima Bahous and CSW chair Maritza Chan Valverde from Costa Rica

The CSW, which was established in 1946, is the main global intergovernmental body exclusively dedicated to the promotion of gender equality, and the rights and the empowerment of women. 

The theme of this year’s CSW is “ensuring and strengthening access to justice for all women and girls” by eliminating discriminatory laws, policies, and practices, as well as structural barriers to justice

The agreed conclusions “seek to create justice systems that work for everyone equally”, according to Valverde.

The proposals focus strongly on justice for survivors of gender-based violence, including integrating gender-responsive access to justice across sectors, formally recognising community justice actors, and introducing new language on digital justice and AI governance aimed at protecting women and girls.  

The text also strengthens standardised systems for gender-based violence data and promotes a whole-of-society approach that recognises civil society’s role.

Valverde stressed that hard-won progress on gender equality must not be reversed.  “We owe it to the trailblazers who charted the path for us, and to those who shall follow in our footsteps.  To our mothers, grandmothers, daughters, and sisters,” she said.

‘Epstein criminal enterprise’

President of the UN General Assembly Annalena Baerbock.

President of the UN General Assembly Annalena Baerbock told the opening of CSW that the backlash against women’s rights “feels as though we are forced to fight the same old battles again and again, battles from 80 years ago”.

Baerbock, a former German foreign minister, pointed out that she is only the fifth woman to be President of the General Assembly and that, in 80 years, a woman has never been Secretary-General. 

“If we do not address the fact that three-quarters of parliamentarians worldwide are men, and 103 countries have never had a female Head of State, then we will hardly deliver on justice.

“Women’s rights are nothing new,” she added. “They have been embedded in the DNA of this institution from the very beginning.”

“We will not stop fighting for equal representation and women’s rights… until the women of Afghanistan are free and girls worldwide are not being forced anymore to marry before they finish school; until we see justice for survivors of sexual abuse, whether it occurs at home or as part of an exploitive global sexual network as exposed in the Epstein files; where women are equally paid and represented, whether in newsrooms, in boardrooms, in governments and yes, at the helm of this institution, our United Nations,” said Baerbock.

UN Special Rapporteur on violence against women and girls, Reem Alsalem, also referred to Jeffrey Epstein, remarking that “the partial release of the information on the atrocities committed by the Epstein criminal enterprise… have been committed across the globe for decades, while flaunting nauseating levels of impunity.”

Deeply contested

Maitree Muzumdar, co-convenor of the Young Feminists’ Caucus,
Josefina Sabate, co-convenor of the Young Feminists’ Caucus,

“The decision to break consensus and proceed to a vote underscores how deeply contested commitments to gender equality, human rights and access to justice remain in this current geopolitical moment,” Maitree Muzumdar, co-convenor of the Young Feminists’ Caucus, told a media briefing on Tuesday.

“The negotiations revealed resistance by powerful states and mobilised anti-gender, anti-rights actors.”

Muzumdar, who is based in India. also criticised member states for approaching access to justice as a “technical issue rather than a political issue, focusing on procedural reforms without addressing the structural conditions that produce injustice.”

The negotiations revealed resistance by powerful states and mobilised anti-gender, anti-rights actors, 

Argentinian activist Josefina Sabate, also co-convenor of the Young Feminists’ Caucus, paid tribute to the CSW’s chair’s ability to ensure that a document was adopted.

Sabate said there has been a “real pushback in terms of gender equality policies” in Latin America following the election of conservatives in Argentina and now Chile.

Israel’s attack on Iran’s oil depot has caused massive fires, thick smoke and black acid rain.

The 12th Better Air Quality conference in Bangkok, which opens on Wednesday, is the first large climate and air quality gathering since the US and Israel attacked Iran, triggering an oil and gas-energy crisis. 

BANGKOK – The ‘Gulf War 3’ threatens to slow down climate action and the move to cleaner air. However, in the first major climate conference since the war began, experts are banking on progress thanks to market forces and the cost-benefit of countries not just sticking to the current climate and air quality ambitions but scaling these up. 

“There’s no doubt it [fighting in the Gulf] will slow progress. However, the fact is that the market forces are ultimately going to drive things. There’s only so much political will can do,” Nathan Borgford-Parnell, scientific affairs lead at the UN’s Climate and Clean Air Coalition (CCAC), told Health Policy Watch.

He was speaking on the eve of the Better Air Quality (BAQ) conference, which is being held in Bangkok from Wednesday until Friday (11-13 March), bringing together scientists, funders, think-tanks, and civil society.

“The United States is really boosting coal now. But coal energy is decreasing rapidly in the US, not because of some green policy, but because of the economics of it. Renewable energies are cheaper now. And those economics are not going to change,” Borgford-Parnell explained.

The conference is being organised by Clean Air Asia, with co-organisers CCAC, the Asian Development Bank (ADB), the United Nations Environmental Programme (UNEP) and the Economic and Social Commission for Asia and the Pacific (ESCAP). 

Cleaner solutions protect health

Bjarne Pedersen, executive director of Clean Air Asia, said that while there can be tension between environmental ambition and short-term economic pressures, this can be resolved by taking a longer-term outlook.

“Clean air solutions increasingly show that protecting health, improving productivity, and supporting economic growth can go hand in hand,” said Pedersen.

He sees the conference as an opportunity to “elevate air quality from a relatively niche environmental issue to a cross-cutting investment priority” that delivers benefits across sectors. 

Glynda Bathan-Baterina, deputy executive director of Clean Air Asia, concedes that air pollution control measures are “often seen as a cost rather than an investment”.

She lists the “positive returns on clean air investments” as “improved health, increased crop yields, more livelihoods from green industries, and greater competitiveness of cities.”

Later this year, the CCAC is expected to update its report of 25 science-based solutions, making a strong case for local and national economic benefits. However, ADB refused to comment on the issue on the grounds that it is “politically sensitive.” 

Nathan Borgford-Parnell (right), scientific affairs lead, at the UN Climate and Clean Air Coalition, and panellists at an event before the Better Air Quality meeting.

Health risks from air pollution

Over eight million deaths are attributed to air pollution annually. If there’s a silver lining, Borgford-Parnell assesses that this number could remain stable.

On the one hand, air pollution, in particular PM2.5 fine particulate matter pollution, has been decreasing because of economic forces, and countries like India and China are taking steps to reduce it, he says. 

On the other hand, the rapidly ageing global population, – particularly in the Asia-Pacific – is more susceptible to illness and premature death.

The WHO’s World Health Assembly and its Global Conference on Air Pollution and Health last year set a “voluntary target” to cut premature deaths caused by air pollution by 50% by 2040. Toxic air is linked to millions of cases of heart attacks, childhood asthma, COPD or chronic lung disease, diabetes, strokes, dementia and lung cancer. 

Air pollution’s link to diabetes and dementia is also a growing concern. It worsens the complications of diabetes, and increases the risk of people developing type 2 diabetes through mechanisms such as inflammation and oxidative stress, which can cause cell damage. 

With dementia, air pollution increases risk through similar inflammatory pathways and by damaging blood vessels. This can lead to vascular dementia and increase the likelihood of Alzheimer’s disease. The tiny particles from pollution can also directly enter the brain, potentially causing cellular damage. 

A Better Air Quality 2026 side-event.

‘Together for clear skies’

The theme for this 12th BAQ is Together for Clear Skies. But the ‘together’ part is hard to achieve. Air pollution is a transboundary issue, which means that one region or one country is often polluted by air from outside its jurisdiction. 

The World Bank points out that the governance systems across nations in the most polluted region of the world – Bangladesh, Bhutan, India, Nepal, and Pakistan – remain largely “siloed, reactive, and compliance-oriented rather than preventive”. 

Its report, A Breath of Change, documents the cross-border crisis in the northern belt of South Asia, across the plains and the Himalayan foothills, which is home to about one billion people.

Around 68% of the pollution in Nepal’s Terai region, for example, originates in other countries. Even in areas with the highest local contribution, such as Kathmandu Valley (Nepal), Uttar Pradesh (India), and Dhaka (Bangladesh), over a third of the pollution can be from other countries. 

The hosts have highlighted at least four regional agreements on air pollution control. Two for South Asia are the Malé Declaration (1998) and Thimpu Outcome (2024),  and two for South East Asia are the ASEAN Agreement and Asia-Pacific Regional Action Programme on Air Pollution (RAPAP), both adopted in 2022.

But progress, especially in South Asia, has been slow.

“Countries like the PRC (China) have shown that economic growth can be decoupled from its environmental impacts, including air pollution. In seven years, PRC was able to reduce PM2.5 pollution by more than 50%, while growing its economy,” says Bathan-Baterina. 

The hosts hope that financing discussions at the conference will demonstrate that clean air solutions can attract investment.

“Many governments already have air quality plans but face challenges in translating them into finance-able programs,” Pedersen says. 

By highlighting the economic returns and health savings associated with cleaner air, the conference aims to strengthen the case for sustained investment. Despite being closely linked, air quality and climate action are still treated by many as two separate buckets. But Pedersen points out that linking air quality initiatives to climate finance frameworks can help unlock new funding streams for cleaner air.

Image Credits: UN-CCAC., Chetan Bhattacharija .

Nobel laureate Malala Yousafzai addresses the CSW opening session.

The United Nations Commission on the Status of Women (CSW) began its 10-day session in New York on Monday, amid efforts by the United States to weaken women’s rights proposed in the draft outcome document.

The theme of the CSW, the world’s biggest global meeting on women’s rights, is “ensuring and strengthening access to justice for all women and girls.”

But the US, after initially abstaining from negotiations on the outcome document to be adopted by CSW, changed tack in the past few days and urged the removal of “controversial social issues” from the document, Devex reports.

The US wants references to climate change and a gender-responsive justice sector removed, and does not support the proposed reparations fund for survivors of violence, for example.

However, the entire purpose of the CSW’s 70th session is to chart a path to eliminating gender discriminatory laws, policies, and practices, as well as structural barriers to justice – and the outcome document due to be adopted by the end of Monday was supposed to guide this.

However, the US stance is similar to last year, when it refused to endorse the CSW’s final declaration last year, rejecting references to the UN’s Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and dismissing gender quotas, climate policies and even the Sustainable Development Goals as “globalist overreach”.

Fewer rights

Women only have 64% of the legal rights of men, according to a report issued last week by the UN Secretary-General.

“Globally, 54% of countries lack consent-based legal definitions of rape, while 72% allow child marriage in all or some circumstances,” according to the report.

“More than 45 countries retain at least one provision in their legislation regarding nationality that discriminates on the basis of gender, and 44% of countries do not have legislation that mandates equal remuneration for work of equal value.”

Extract from the UN Secretary General’s report on the status of women.

In many countries, women’s rights are weakening. The position of women and girls who live near conflicts – 676 million in 2024 – is particularly dangerous. 

“The number of conflict-related sexual violence violations documented by the United Nations has increased by 87% in just two years,” according to the report.

Iran, Gaza and Afghanistan

Raising the plight of women and children in Iran, Gaza and Afghanistan, Nobel laureate Malala Yousafzai told the CSW opening session: “Never have I seen so many children suffering from war and violence, injured and dying at the hands of unaccountable leaders.

“I am devastated for families in Iran whose daughters left for school and did not return home, for parents in Gaza who buried their children beneath the rubble of their classrooms, for Afghan girls living under the brutal Taliban regime for nearly five years,” said Yousafzai, the Pakistani activist shot in the head as a schoolgirl for advocating for the right of girls to education.

“You will be hearing a lot this week about access to justice, but true justice does not defend the humanity of children in one place and ignore it in another,” added Yousafzai, who lived in a territory of Pakistan under Taliban rule.

“It is not selectively applied. It does not claim that our rights are dependent on where we were born or what is politically safe for the people in this room. Under international law, killing children in their classrooms is a war crime.

Nobel laureate Malala Yousafzai addresses the CSW, appealing for justice for all women and girls.

“When civilians are deprived of food, water, medicine and shelter, the law obligates states to act. Looking around the world today, we must ask ourselves why justice is a privilege.”

Yousafzai said that nowhere is the backlash against women and girls more evident than in Afghanistan: “Since the Taliban took over the country in 2021, they have controlled courts, the police, and they have used their power to abuse women and girls, preventing them from going to school or university. Women cannot go to work, leave their homes without a male chaperone, or even speak in public.”

Afghan singer Sunbul Reha also addressed the CSW opening, appealing to the UN delegates to “protect a girl’s right to an education, defend a woman’s right to speak out safely and without retaliation [and] fight to block the erosion of our progress.”

Afghan singer and student Sunbul Reha with Sima Bahous, executive director of UN Women.

Merger plan?

Country delegates may also discuss the potential merger of UN Women and UNFPA, which deals with sexual and reproductive health, first mooted by the UN Secretary-General in his plan to reform the UN, UN80.

The US has withdrawn from both bodies and defunded them, sparking a serious resource crisis.

The global feminist organisation, Fos Feminista, and other groups have opposed the merger, stressing that the two have different functions with little overlap.

For Fos Feminista, UN Women was created to “hold the entire UN system accountable for gender equality” with a mandate to ensure “gender equality is not treated as an afterthought but as a binding obligation”.

“UNFPA, meanwhile, leads on sexual and reproductive health and rights (SRHR), population data and demographic analysis, humanitarian gender-based violence coordination and reproductive health supply chains that reach women in the most fragile settings. Its work is technical, operational and often lifesaving.”

European Commissioner for Equality Hadja Lahbib addresses the press following the Commission's landmark decision on opening funds for access to safe abortions.
European Commissioner for Equality Hadja Lahbib addresses the media following the commission’s landmark decision on opening funds for access to safe abortions.

In a landmark decision, the European Commission is allowing member states to utilize existing EU funds to finance access to safe abortions. This move represents a significant shift in European reproductive health, although it stops short of providing financial certainty for women seeking essential reproductive healthcare.

“Behind every unsafe abortion is a woman forced to risk her life because she has no safe alternative, no support, and no protection,” stated European Commissioner for Equality Hadja Lahbib following the decision last week.

After intense public pressure, the EU executive branch declared that governments can voluntarily mobilize their national European Social Fund Plus (ESF+) envelopes to support safe abortion access.

These existing funds can cover medical treatments, travel, and accommodation for women seeking this life-saving care, whether they are travelling to another member state or from a rural to an urban area within their own country.

With a massive budget of €142.7 billion for the 2021-2027 period, the ESF+ traditionally supports employment initiatives, education frameworks, and severe poverty reduction programs.

Member states willing to provide this vital support will simply need to officially amend their national or regional ESF+ programmes to include safe abortion care in their health priorities.

Citizens’ initiative for safe abortions claims victory

The WHO's framework for abortion care underscores that equitable financing and a rights-based policy environment is essential to eliminating the risk of unsafe abortions.
The WHO’s framework for abortion care underscores that equitable financing and a rights-based policy environment is essential to eliminating the risk of unsafe abortions.

The Commission’s landmark decision was directly triggered by the European Citizens’ Initiative (ECI) ‘My Voice, My Choice’. This grassroots campaign gathered more than 1.2 million signatures across Europe to demand an opt-in financial mechanism that universally guarantees safe abortion access.

The campaign hailed the Commission’s acknowledgement of its core objectives as a triumph. “This is not symbolic, it is a political commitment to women’s rights,” declared Nika Kovač, the primary coordinator of the initiative.

Activists leading the campaign highlighted the grim reality that more than 20 million women in the EU currently lack access to safe abortions. This healthcare shortfall is driven by restrictive national laws and entrenched financial, procedural, and personal barriers across the bloc.

The initiative specifically aims to support vulnerable women residing in countries like Poland and Malta, where almost complete bans on abortion remain in effect.

It also highlights the plight of women in states like Italy, where despite the procedure being legal, many doctors refuse to perform the procedure based on personal beliefs, often leaving entire regions without willing providers.

According to the World Health Organization (WHO), this lack of reliable access directly leads to approximately 483,000 unsafe and potentially lethal abortions occurring in Europe every year. The WHO recognizes and approaches sexual and reproductive health and rights as fundamental human rights.

The European Commission’s public health justification aligns closely with the WHO’s comprehensive abortion care guidelines, which classify the procedure as an essential health service and urge the removal of financial barriers.

Legal boundaries in public health policy

The European Commission decided on a voluntary budget mechanism that allows member states to opt-in to using existing funds.
The European Commission decided on a voluntary budget mechanism that allows member states to opt in to using existing funds.

By relying on the existing ESF+, the Commission successfully navigated the strict boundaries of EU treaties, which designate the organization of healthcare systems primarily as a national competence.

“Health policy is a national competence and the Commission has limited room to act,” acknowledged Lahbib when explaining the legal constraints of the decision.

To respect national sovereignty, the newly approved funding pathway operates on a voluntary basis. Leading legal experts had paved the way for this intervention, arguing in an open letter that providing cross-border funding successfully respects the EU’s limited supportive competence without forcing the harmonization of national abortion laws.

The Commission must now rapidly provide member states with clear, actionable instructions on properly utilizing the existing money, the ‘My Voice, My Choice’ initiative urged.

Future funding remains in peril

Nika Kovač (fourth from right), Primary coordinator of the 'My Voice, My Choice' initiative, at a visit to the EU Commission in October.
Nika Kovač (fourth from right), Primary coordinator of the ‘My Voice, My Choice’ initiative, at a visit to the EU Commission in October.

While the ESF+ pathway offers a theoretical legislative solution, it lacks long-term financial security for reproductive healthcare. The fund relies on voluntary budgetary reallocation by member states, leaving women depending on the fluctuating political goodwill of national governments.

Fierce financial competition within the already strained ESF+ budget poses another significant barrier. Because the €142.7 billion fund was originally designed to combat structural poverty and support employment, safe abortion access will now have to compete directly against other critical social welfare programmes.

The organizers of the ‘My Voice, My Choice’ campaign have voiced their disappointment over the lack of new, dedicated financial resources. They firmly urged the Commission to establish additional funding in the near future, rather than relying solely on existing budgets.

Progressive political factions are determined to make the current compromise work while pushing for more permanent solutions.

“We will continue working to ensure that this clarification translates into structural change by promoting the effective use of available funding,” stated the liberal Renew Europe group, a fierce parliamentary supporter of the initiative.

Right is divided on reproductive rights

Margarita de la Pisa Carrión of the Patriots for Europe criticized EU financial support for abortion access.
Margarita de la Pisa Carrión of the far-right Patriots for Europe criticized EU financial support for abortion access.

The Commission’s decision comes in the midst of a global pushback against reproductive rights and abortion access in countries like Argentina and the United States.

It follows a historic vote by European legislators late last year supporting the citizens’ initiative. The December 2025 resolution secured a broad majority, primarily driven by a united front of progressive and liberal blocs.

Rollback and Resistance: The Erosion of Abortion Access in Argentina

However, this decisive majority exposed a deep geographic and ideological fracture within the centre-right European People’s Party (EPP). Already heavily divided during the initial vote, the chamber’s largest political faction has yet to establish an official stance on the Commission’s compromise, a query by Health Policy Watch confirms.

However, the Catholic Church in the European Union (COMECE) condemned the decision in an official statement, claiming: “Redirecting this financial instrument towards the financing of abortions departs from its original purpose and risks creating political friction rather than strengthening cohesion.”

Far-right political factions have also condemned the funding initiative as a massive legislative overreach and an unacceptable intervention into sovereign national affairs.

“If the Commission financially supports circumventing member states’ abortion laws, it means a fight of Europe against Europe,” argued Margarita de la Pisa Carrión from the Patriots for Europe during the December parliamentary debate. Many member parties within the far-right group oppose defining access to safe abortion as a fundamental human right.

Looking ahead to the long-term budget

Committee Chair Lina Gálvez (left) and Commissioner Hadja Lahbib (center) participate in a December 2025 hearing of the Committee on Women’s Rights and Gender Equality.
Committee Chair Lina Gálvez (left) and Commissioner Hadja Lahbib (centre) participate in a December 2025 hearing of the Committee on Women’s Rights and Gender Equality.

Now that the Commission’s decision has been finalized, liberal and progressive lawmakers are setting their sights on securing long-term financial planning for reproductive rights across the bloc.

The European Parliament’s Committee on Women’s Rights and Gender Equality is officially demanding that the EU integrates permanent abortion funding mechanisms into its future budgetary frameworks. Integrating reproductive healthcare directly into the next long-term budget, spanning from 2028 to 2034 would create a dedicated budget line that avoids draining the already burdened ESF+.

“We called on the Commission to consider without delay the budgetary implications of meeting the demands of the European citizens’ initiative,” said Lina Gálvez, committee chair and member of the centre-left Socialists and Democrats (S&D).

With debates on the next long-term budget currently heating up, dedicated funding seems unlikely.

Nonetheless, the European Commission has publicly promised comprehensive action regarding women’s rights in the very near future to build upon this political momentum.

“We will strengthen women’s health and rights across Europe, including their sexual and reproductive health and rights because this is the Europe we believe in,” promised Lahbib regarding the upcoming gender equality strategy.

Image Credits: European Union, WHO, Felix Sassmannshausen, European Union, European Union/Laurie Dieffembacq, European Union/Alexis Haulot.

Sister Miriam Chibale Mushoda RN, at the ultrasound station in the new Nakachenje Mini Hospital, Zambia – one of 108 facilities built with GE Healthcare, the Zambian Ministry of Health and NMS Infrastructure, a private Zambian firm.

As USAID programmes funding vital treatments for HIV/AIDS, malaria, maternal and child health, and other critical needs were imploding across Africa last year, a for-profit social enterprise startup geared up for its first real test.

Using medicines procurement as its lever, the Swiss-based startup Axmed called for a radical reboot of national systems — to digitize and streamline purchases, scale up pooled procurement, and drive down medicine costs.

“Has the system crumbled enough to finally compel us to rethink medicine procurement entirely? Asked Sofia Radley-Searle, Axmed COO, in a March 2025 oped.

“While deep-rooted barriers such as market fragmentation, regulatory complexity, supply chain inefficiencies, weak infrastructure, and financial constraints persist, real targeted solutions already exist,” she argued.

“Technology- enabled platforms, digital pooled procurement, data-driven forecasting, and new financing mechanisms are no longer theoretical concepts; they are active interventions reshaping healthcare systems. It is time we dared to imagine, and build, a world where fragmented, inefficient procurement cycles are replaced by digital platforms that match demand and supply in real-time, eliminating costly delays and unnecessary complexities.”

Over the past year, Axmed — a spinoff of the Gates Foundation — did just that.

Medicines delivered through the Axmed online logistics platform.

It integrated more than 5,000 essential health products in 10 therapeutic areas into a cutting-edge business-to-business (B2B) marketplace connecting healthcare buyers in low- and middle-income countries (LMICs) directly with suppliers.

Working with more than 130 commercially active procurers and suppliers, some 4.2 million patients were reached with a 35% average savings on medicines and other health products, said Alejandro Bes, Axmed General Counsel.

He was speaking at a gathering of private and public sector leaders focused on “unlocking private sector engagement” to improve health systems at the Geneva AIDEX 2025 conference, an annual global conference on humanitarian aid and development. Bes and other experts are featured in a newly published report by the Geneva Health Forum on ‘Unlocking Private Sector Engagement for more Resilient Health Systems.’  

Public-private partnerships increasingly urgent 

‘Can we imagine new forms of collaboration that support vital action … while avoiding pitfalls of conflicts of interest?’ Benoît Miribel (far left) asks panelists.

The private sector has long been deployed across the entire healthcare value chain – from the R&D and manufacture of  medicines, vaccines and medical devices, to logistics and supply chains, digital and technological solutions, workforce training, and health system management.

But how can such engagement be used more optimally to advance more robust and sustainable health facilities in a world of mounting humanitarian crises and declining donor aid? 

“Can we imagine new forms of collaboration that support vital action where resources are scarce, while avoiding the pitfalls of conflicts of interest? “ asked Benoît Miribel,  Secretary General of the Sustainable Health for All Foundation, France,who moderated the GHF session.

“Beyond financial contributions, these alliances can take many forms: technical support, joint operational projects, research and development of crisis-adapted solutions, or even the deployment of new technologies to strengthen the humanitarian response.”

“This is a reflection on the future of solidarity, at a time when finding new paths has become an essential necessity.”

Procurement: a neglected lever of access

Alejandro Bes, Axmed

Axmed, founded in 2024, identified developing country medicine procurement systems as a niche opportunity for win-wins. 

While bulk procurement has long been a practice of multilateral groups like the Global Fund, little attention has been given to practices in national marketplaces. 

In LMICs, those are often characterized by outdated, manual purchasing systems, complex regulations, and fragmented patterns of demands, driving inefficiencies and markups of 250% or more.

Axmed’s Business to Business (B2B) technology platform aggregates medicine demand across countries and presents it to manufacturing suppliers.

“In doing so, we created a viable economic model where none previously existed, reducing dependence on aid and strengthening health systems,” Bes said.

“Automation is central to our approach,” he explained. “We replace fragmented, manual systems with integrated digital solutions. We also deploy predictive technologies that assess future medicine needs based on historical consumption patterns.”

Rather than maintaining stockpiles, medicines are sourced directly from manufacturers with careful supply chain management to ensure reliable flow to partners.

“This allows us to anticipate demand, identify when medicines will be needed, and respond quickly.”

As a for-profit social enterprise, AXMED caps its markup at 10% in a market where markups of 250% are common, and redeploys 30% of profits back into the health systems it serves.

“Our objective is to reduce dependency on humanitarian aid and direct donations, and to transform existing models into more resilient, long-term systems that can sustain themselves over time,” said Bes.

Win–wins in hospital strengthening

Nakachenje Mini Hospital, Zambia – one of 108 rural facilities built through a public-private collaboration with GE Healthcare.

Large private-sector firms are also reshaping partnerships in LMICs. GE Healthcare is a flagship example.

In the past 15 years, the medical technology company — which controls about 60% of the global medical device market — has developed partnerships in more than 160 countries, with a focus on low- and middle-income settings, said Chris Bonnett, who heads its strategic projects initiatives.

“Our approach goes well beyond the delivery of medical equipment: we co-develop projects from both clinical and architectural perspectives, support implementation on the ground, and accompany our partners throughout the entire project lifecycle,” Bonnet said.

“Our ambition is to act as a long-term partner in strengthening health systems and improving access to quality care worldwide.”

The approach is a win-win because the more developed a country’s infrastructure becomes, the better equipped it is to procure and use the newest and most life-saving medical products that GE Healthcare produces. 

In Zambia, for instance, GE Healthcare worked with the UK government and partners to design and deploy deploy 108 primary healthcare centers in rural areas since 2020. The centers function as “mini-hospitals,” enabling women in some regions to access prenatal care for the first time.

“This initiative had a direct and tangible impact on maternal and child health,” said Bonnet.

“Real impact requires partnerships, shared ownership, and accountability. One of our projects in Ethiopia is a strong example of this approach. It was designed, monitored, and evaluated solely based on outcome indicators. Through close collaboration with the government, local midwives, and other partners, we succeeded in reducing neonatal mortality by 24%,” he said, citing the results of a 2018 pilot study on outcomes. 

Strengths and pitfalls of private sector engagement

Ethiopia vaccines
First doses of the AstraZeneca COVID-19 vaccine arrive in Addis Ababa, Ethiopia in March 2021. Rapid COVID vaccine development was the fruit of private-public partnerships although inequalities in rollout highlighted the importance of finding better ways to collaborate.

In its engagements, the private sector can call upon inherent resources such as: strong innovation capacity, control over industrial and production processes, operational efficiency, experience in managing complex projects and the ability to scale solutions rapidly. 

The private sector’s capacity to move quickly from design to implementation is a critical asset in emergency contexts. At the same time, there are also limitations and risks. 

For companies, the risks include financial exposure, reputational risk and staff security. For health systems, poorly coordinated engagement may result in parallel systems, increased dependency or misalignment with national health strategies. 

Conflicts of interest cannot be ignored and must be proactively managed, participants at the AIDEX event underlined. 

Key safeguards include clear governance arrangements, transparency around funding and partnerships, separation between public decision-making and commercial objectives, and alignment with priorities set by national authorities and multilateral organizations. 

These can  mitigate risks and help ensure that private-sector engagement reinforces—rather than undermines— trust in health systems. 

Mobilizing private sector know-how for emergencies

Aurélien Hubert, Foundation S

“Mobilizing private-sector expertise, resources, and operational capacity is essential if we want to respond more effectively to emergencies and support health systems in an increasingly complex global context, observed Aurélien Hubert, head of Emergency Responses and Operations at Foundation S, the philanthropic arm of Sanofi.

“The idea is to use public money more imaginatively, to unleash the potential of the private sector to achieve impact.

He described the Foundation’s role in emergency situations, such as the 2023-2024 wartime crisis in Lebanon, when his role included securing needed medicines internally while negotiating with local NGOs on the ground to organize transport.

“Everything starts with manufacturing, but production alone is not enough. Medicines must be distributed, delivered safely, and administered properly, especially in crisis settings,” Hubert observed.

“However, this process does not always succeed.”

“Failures do happen, and they can occur for many reasons. One of the most challenging situations arises when we cannot guarantee the quality of a product once it reaches the field.

A key factor is often lack of appropriate infrastructure on the ground, he added, citing the absence of cold chain equipment critical for many vaccines as well as insulin.

“Without a reliable cold chain, it is impossible to ensure that insulin can be transported and administered safely. In such cases I sometimes have to make the difficult decision to stop [deliveries].

Reliance on local NGO capacity is critical

Dozens of white tents stand outside Türkiye’s Gaziantep train station housing Turks and Syrian refugees, shortly after the February 6 2023 earthquake.

At the same time, there are moments when everything comes together, Hubert added. 

He recalled the February 2023 earthquake in southern Turkey as one such moment – when the Foundation managed to deliver DT (diphtheria and tetanus)  vaccines to extremely hard-to-reach areas within just two days.

“Vaccines were shipped from the United States to Turkey in full compliance with regulatory requirements, enabling rapid support to affected populations. This response was made possible through close collaboration with partners such as the Red Crescent, he said adding:

“These experiences highlight a key lesson: as a private-sector actor, it is essential to rely on efficient local and international NGOs capable of operating in crisis situations. Public aid alone is no longer sufficient. Collaboration is not a slogan; it is a necessity. To improve effectiveness, control costs, and maximize efficiency, all actors must work together.

Cutting edge technology emerging out of crises 

Familiy member connects safely with an Ebola-infected patient in DR Congo in 2022, thanks to the innovative “cube” developed by ALIMA with private partners.

Crises can also accelerate private-public partnerships that yield important new  innovations. The 2014-2016 Ebola crisis in West Africa offers one such example.

Together with a private-sector partner, the international medical NGO, ALIMA co-developed a major innovation: the “Cube” to protect health workers from the highly infectious and deadly virus. 

The modular medical unit was installed directly within villages, allowing Ebola patients to be isolated, protecting healthcare workers through fully transparent plastic walls, and keeping patients close to their families. 

The innovation caught on across the region, winning prizes from the African Presidential Council as well as the 2019 Global Innovation Accelerator Prize by the Bill & Melinda Gates Foundation. 

“This example reflects our core belief: by combining medical expertise, innovation, strong partnerships, and deep local engagement, we can respond effectively to health crises and contribute to the long-term strengthening of health systems,” said Alexandra Seidel-Lauer, ALIMA’s  director of development. 

ALIMA’s Cube, developed with partners in the 2014-16 West African Ebola outbreak, was deployed again in DR Congo during the 2018-19 emergency.

How USAID’s collapse fast-tracked AXMED’s rollout

Similarly, the 2025 collapse of USAID proved to be a turning point for AXMED’s new procurement model – fast-tracking its uptake.

“When USAID abruptly suspended its operations, many of our clients—who rely heavily on its support— were deeply worried, and so were we,” recalls Bes. “The question was simple: what do we do now?

The company fast-tracked deployment of its B2B system. What began as a proof of concept became a scalable model.

This year, the system is now set to expand to more than 20 LMIC countries, primarily in Africa, supported by a second $5 million Gates Foundation grant and additional investor backing.

“Ultimately, this approach allows us to move away from constant emergency response and instead build sustainable, replicable procurement models that strengthen health systems over the long term,” Bes said.

“This success demonstrates that while traditional aid approaches remain important, building resilient health systems also requires thinking differently and developing innovative solutions to address chronic challenges such as weak infrastructure, limited funding, and unreliable supply networks. This is what we aim to do: make a modest but meaningful contribution to the steady and sustainable improvement of health systems in LMICs.”

Second in a series.  See also: Innovative Finance can Strengthen Fragile Health Systems 

Image Credits: GE Healthcare , Axmed, Geneva Health Forum , Gerneva Health Forum , GE Healthcare , WHO, Geneva Health Forum , Abdulsalam Jarroud/TNH, ALIMA , Caroline Thirion/ALIMA .