Military barriers like these have become an omnipresent site around the Israeli-occupied West Bank impeding Palestinian travel, including for health services.

ISRAELI-OCCUPIED WEST BANK – The oxygen mask slipped from three-month-old Ahmad Zaid’s face. He was in his father’s arms, in front of a closed Israeli military gate  blocking the road between  Deir Ammar refugee camp, northwest of Ramallah, where the family lives, and the city of Ramallah, with a hospital the family was desperate to reach.

His father, Maarouf, told Health Policy Watch that he begged the Israeli soldiers at the gate: “My son is dying. Let him through,” he said. They did not open it. Instead, they fired tear gas and stun grenades.

Hours earlier, the baby had simply drunk more milk than usual. It was 5 July, a hot day in summer,  and his father had gone to Ramallah to collect his birth certificate, to get ready for the baby’s first trip to Jericho the next day. Even a trip inside the West Bank requires the name of a newborn to be registered on their parents’ ID documents while crossing numerous Israeli military checkpoints. 

By the afternoon, his mother Yasmine found him unconscious. She rushed him to a local health clinic, where staff tried to revive him, and called an ambulance to take him to hospital in Ramallah. But the road was closed.

“They screamed at us to turn back. They were furious and threatened to shoot,” Zaid’s mother told Health Policy Watch. “When they saw the boy, they paused for a moment, then became even more violent.”

The family had to turn back and take a long dirt track to reach the ambulance. The baby got to the Arab Consultative Hospital just north of Ramallah at 3:20pm. It was too late. He died on the way to hospital.

Military gates block mobility across the West Bank 

West Bank Ambulance Palestine
Paramedics are searched by Israeli soldiers before being allowed to reach the wounded during an Israeli military raid on Jenin, West Bank, September 11, 2026.

The gate closure was not random.  It was part of heightened Israeli security measures. Paradoxically, Palestinians have increasingly been locked into their communities or even their homes in response to a wave of settler violence that has rocked the West Bank in recent weeks, with attacks on Palestinian homes, vehicles, and agricultural lands – while the perpetrators  have gone largely unpunished by Israeli authorities. 

According to an August report from OCHA, the UN’s humanitarian affairs office, there are now more than 900 physical obstacles blocking aid across the West Bank. 

Amid the violence and restrictions on movement, communities  have also been cut off from vital healthcare services, turning treatable health issues into fatal incidents.

Across the West Bank’s 5660 square kilometers, some 82% has remained under direct Israeli security control since the Oslo Accords divided up the occupied territory into Areas A, B, and C in a 1995 agreement – the last ever to be signed between the Palestinian Authority and Israel. 

And movement across the entire territory has now been paralyzed since late July, when Israeli Prime Minister Benjamin Netanyahu ordered a “wide-scale military operation”. 

This was after armed settlers from a new Israeli hilltop outpost attacked the Palestinian village of Tal, in the northern West Bank near Nablus, killing four Palestinians. Two Israelis died in the clashes that followed, one of them a soldier. In a series of reprisals, the army sealed off Nablus and threw a cordon around a broad swathe of towns in the Nablus district- from Deir Ammar to Aqraba, about 60 kilometers to the northeast.

Health fallout of the Qusra siege 

Access to essential medicines and supplies for childbirth remain critically low. WHO and Emirites-donated supplies for childbirth shown here being distributed across the Occupied Palestinian Territory.

Homes in the Ras al-Ain area, about 16 km south of Nablus, have meanwhile been under siege since August 9, this after a  mosque in the village was burned down on 26 July. The Israeli army has turned some of the besieged homes into military positions, Palestinian officials say. 

Then in late August, Israeli settlers stormed the home of a Palestinian American  in the nearby village of Qusra, while its owners were inside – generating headlines that went around the world. 

Qusra, which has fewer than 6,000 residents, also saw its water and power supplies damaged. The diplomatic fall out of the siege has gained wide media attention – less so the health consequences. 

Ruqaya Hassan, 28, lives in Qusra with her husband and two daughters. On 21 August, her younger daughter Hour, not yet two and a half, came down with a cold, a high fever and vomiting. “The family’s medicine was running low. The nearest doctor was not far, but the roads were sealed,” she told Health Policy Watch.

An ambulance’s first attempt to reach the house failed. It got through the next day, and Ruqaya left with her sick daughter:  “I thought I would be back soon. I was not,” she said. Two days later, she tried to return home and found she could not: “The Israeli army had entered the area and turned my house into a military position.”

She now stays temporarily with her two daughters at her brother-in-law’s house nearby, unable to close the few dozen metres that separate her from the relatives still trapped inside the besieged area. Her husband, Yousef, remained inside.

As the recent OCHA report notes,  three families have remained been trapped in Qusra since 9 August, after a new settler outpost was built next to their homes. It was only after repeated attempts that aid workers managed to bring the families some food, water, baby formula and medicine – but supplies of all items remain precarious and subject to military approval. On 4 September, about 100 activists who arrived with supplies were first blocked by the army, which declared Qusra a closed military zone, then let through, only to be detained on their way out for violating it.

Too late at health clinic for newborn  

On 27 July, the same day Nablus was sealed off, 34-year-old Rana Rasheed, six months pregnant, suddenly went into premature labor. An ambulance was called to take her to Rafidia Surgical Hospital in the city nearby.

“I was in severe pain, like labour pains, and felt extremely exhausted,” Rasheed told Health Policy Watch. 

What should have been a short trip of nearly 25 minutes became 90 minutes of driving between checkpoints and dirt tracks, as the driver found gate after gate closed before reaching the Awarta checkpoint.

By then, Rana’s condition had turned critical. She began to lose the baby, and bled heavily. “She was in a very critical condition,” Sabreen Attallah, the nurse and midwife travelling with her, told Health Policy Watch. “I’ve worked since 2014, and I had never seen bleeding like that before.”

At the checkpoint, soldiers ordered the driver to turn off the siren and open the ambulance doors, then raised their rifles at Attallah as she tried to explain in English that the patient could die. 

“They screamed at me: ‘shut up!’” she said. She had no choice but to deliver the baby moments before reaching the checkpoint. 

The baby did not survive. 

“I felt profound grief when they told me I had lost my baby,” Rasheed said. “I had been choosing names, getting ready to buy his clothes.”

Stillborn baby in Aqraba 

A similar horror story played out on 27 July in Aqraba, a town south of Nablus.

When Ibtisam Bani Jame, 28, went into labor, the road closures meant no ambulance could reach her either. 

“I felt like I had lost hope. I kept thinking I might lose my baby because of a closed road, not my medical condition,” she told Health Policy Watch.

After more than four hours in labour, the family went to the only place they could reach: a small clinic called Dar al-Hikma, never built for deliveries. It had no medicine to stop bleeding, no fetal heart monitor, no incubator, no spare blood.

The baby was stillborn. 

Who decides who gets treated? 

Map of West Bank
Occupied Palestinian Territory: West Bank including East Jerusalem & Gaza.  [Map Sources: ESRI, OCHA, UNGIS & for Areas A, B, C, OCHA: “The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area or of its authorities or concerning the delimitation of its frontiers or boundaries.”]
Qaryut, Deir Ammar, Aqraba and Qusra look like separate dots on a map, but their fate is  linked. 

A soldier’s split-second decision to open a gate or leave it shut to families seeking emergency treatment in a nearby hospital in one of the larger West Bank cities in “Area A” under Palestinian Authority control, like Nablus, Bethlehem, Ramallah, Hebron, or Jenin, can be random, arbitrary and lead to life-and-death consequences. 

Meanwhile, patients seeking more specialized treatment in the most sophisticated Palestinian hospitals of East Jerusalem, as well as in Israel, face a range of bureaucratic hurdles.  

They must obtain an official permit from Israel’s Civil Administration – something that cannot usually be had quickly. .

Amos Zwarts is the Israeli official in charge of health coordination for the West Bank.  His  office handles requests to move Palestinian patients into Palestinian East Jerusalem and Israeli hospitals for treatment, working with the Palestinian Health Ministry and its hospitals and health clinics. 

Approval of a patient’s passage is, “the result of coordination among several bodies,” Zwarts told Health Policy Watch.

“The decision is not subject to a unilateral decision by our office alone,” Zwarts added.  “Requests can come through an app, the Palestinian civil affairs ministry, or liaison officers, before being processed by a system that weighs both civilian and security concerns.”

Approval rates for entry into East Jerusalem or Israeli hospitals fell sharply right after the  war in Gaza began in October 2023, from 82% in 2022 to 56% in 2024, and while they have since recovered somewhat, they have yet to reach their pre-war rates.

According to WHO data, while about 51,444 permit requests were made in the first half of 2026,  more than 22% were not approved in time for appropriate treatment. 

No single body takes responsibility for the thousands of rejected or delayed requests -or their human health impacts. 

Empty medicine shelves, doctors on strike 

Violence, economic distress and funding cuts leave nearly a million people in the West Bank facing severe food insecurity, according to the WFP.
Violence, economic distress and funding cuts leave nearly a million people in the West Bank facing severe food insecurity and without access to essential medicines, according to the World Food Programme.

Behind the siege tactics and the surge in settler lies a deeper, structural crisis in West Bank healthcare, one that predates this summer and will outlast it – a health budget starved since May 2025 by the loss of Palestinian tax revenues.

The revenues have been withheld by Israel’s far-right Finance Minister Bezalel Smotrich  as part of what the liberal Israeli daily Ha’aretz described in one recent editorial as a “Slow Motion Execution of the West Bank Health System,”

To date, the unpaid bill amounts to some $5.7 billion and counting, according to the PA’s own finance ministry.

The budget crisis means that even patients who are lucky enough to reach a hospital in one of the West Bank’s major cities may find there are no medicines to treat them.

In June 2026, the Palestinian Authority Health Ministry said 180 of 520 essential medicines were out of stock on the West Bank. So were 50 of 97 cancer drugs along with medical supplies and laboratory materials.

West Bank medicine shortages threaten thousands of cancer and dialysis patients 

Palestinian healthcare workers have little supplies to work with as they also go without pay – and are often threatened with imprisonment. Continuation of care for chronic diseases is threatened by attacks and budget crises.

The ministry said the shortage threatened more than 4,000 cancer patients and thousands more on dialysis, and had delayed more than 11,000 operations since the start of the year.

The same budget crisis has emptied West Bank hospitals of staff, as well. 

Physicians hadn’t been paid in full since October 2023, when Hamas launched its surprise incursion into Israeli communities on its periphery, killing about 1200 people and taking 251 hostages -triggering a massive Israeli military onslaught that killed over 70,000 Gazans. 

The ensuing two years of war displaced most of Gaza’s population, damaged or destroyed most of the enclave’s hospitals and health clinics and  left tens of thousands of people with permanent injuries and amputations.  

The simultaneous halt to funds flowing to the West Bank’s Palestinian Authority’s health system has been far less visible on the television screens of the world or in the reports of humanitarian organizations  – but almost as insidious. 

In May, the Palestinian Doctors Association launched a partial strike across all PA-run hospitals and clinics over unpaid salaries. By early May, hundreds of clinics had shuttered, and nurses’ unions cut service hours over the same crisis.

Palestinian Health Minister Dr Majed Abu Ramadan told Health Policy Watch the financial crisis is hurting the ministry’s ability to do its job, at a time when demand for care keeps rising, both inside government hospitals and through referrals to private and foreign hospitals.

“Patients rely on referrals when treatment isn’t available in government hospitals. That makes steady funding key to getting them care on time,” he said.

Unpaid bills can make hospitals and clinics reluctant to accept referred patients, or slow down approvals, Abu Ramadan said.

“A delay in a referral isn’t just paperwork. For some patients, it means treatment they can’t get anywhere else arrives too late,” he said.

Health workers detained 

Access to healthcare is routinely impeded by barriers such as these lining East Jerusalem.

Arrests of medical staff have also depleted the ranks of some of the most public-minded professionals.

At dawn on 22 June, Israeli forces, backed by border police, arrested Dr Mazen al-Rantisi, 71, from his home in Ramallah. His family was not told why. Known for decades as the “doctor of the poor,” al-Rantisi chairs a committee overseeing clinics in remote villages. In August, his lawyer later told the Israeli newspaper Haaretz that he had been denied his medication in Ofer prison, and that staff refused to let him see a doctor. The Israel Prison Service said the claims were untrue.

Dr Khaled Ayyash, 63, was detained on 24 June and later released. Jamila Yacoub Abu Dahou, a Palestinian-Australian public health expert, 66, was arrested in July, accused of funnelling money to the Union of Health Work Committees, a health workers’ group that Israel banned in 2020. She was released after 23 days.

The most recent case is Dr Dima Mohammad Amin Barakat, 54, an obstetrician-gynaecologist arrested on 18 August. No reason was given. She later suffered a medical emergency in detention including a heart procedure, but a military court still  extended her detention. 

Medical Aid for Palestinians said her detention came amid “a wider and growing pattern of attacks, detention and intimidation targeting Palestinian healthcare workers.”

A Palestinian rights network said the arrests fit a pattern of targeting doctors and health institutions, though it stopped short of saying every case shares the same motive. 

WHO has so far recorded 25 arrests or detentions of health workers or patients in the West Bank so far this year, through the end of July. That figure is part of a broader tally of 98 attacks on health care documented across the West Bank over the first seven months of this year, which left 3 people dead and 87 injured. Some 83 health transport vehicles and 11 health facilities were also damaged in the process – with attacks alone nearly quintupling in July, from 8 in June to 37.  

Aseel Mafarjeh is a West Bank-based journalist covering the politics of the Israeli-Palestinian conflict, including settler violence, Israeli military operations and raids on refugee camps, Palestinian Authority governance and financial crises, and the impact of movement restrictions on daily life. Her work has appeared in Al Jazeera English, TRT World, +972 Magazine, The New Arab, and Mondoweiss.  This article is published in collaboration with Egab.

Image Credits: Aseel Mafarjeh/HPW, Health Policy Watch , WHO oPT, ESRI, OCHA, UNGIS & for Areas A, B, C, OCHA and Wikipedia Commons, WFP/Claire Nevill, BTSelem.

The five ED shortlist finalists (left to right): Mark Dybul, Richard Hatchett, Janti Soeripto, Lutz Hegemann, and Joyce Msuya.
The five ED shortlist finalists (left to right): Mark Dybul, Richard Hatchett, Janti Soeripto, Lutz Hegemann, and Joyce Msuya.

The shortlist of five finalists to serve as the next Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria was published on Wednesday (30 September), launching the final phase of its leadership search. 

By narrowing the global applicant field to five candidates, the Global Fund’s Executive Director Nomination Committee (EDNC) has taken a major step towards appointing the organization’s next chief. The new leader will assume office in early 2027, facing a massive funding shortfall and mounting geopolitical pressure to overhaul the global health architecture.

Two high-level United States global health leaders are shortlisted. As reported earlier by Health Policy Watch, Mark Dybul is on the shortlist. He has previously served as executive director of the Global Fund (2013 to 2017), as well as US Global AIDS Coordinator, leading the implementation of PEPFAR.  He is current a senior advisor to the Accra Reset initiative.

Joining him is Richard Hatchett, the outgoing chief executive of the Coalition for Epidemic Preparedness Innovations (CEPI) and a former US biodefense official.

Observers describe Janti Soeripto, president and CEO of Save the Children US, as a surprising candidate. Representing civil society, the Dutch-Indonesian brings experience in international humanitarian operations and private-sector management.

The high-level private sector candidate, Lutz Hegemann, is Novartis president of global health. The Swiss national currently leads company programs targeting malaria and neglected tropical diseases.

Rounding out the slate is Tanzanian diplomat Joyce Msuya, former UN Assistant Secretary-General and Deputy Emergency Relief Coordinator, who brings extensive experience across multilateral development and humanitarian agencies.

Shortlist prompts concerns over geopolitical interests

A child sits beneath an antimalarial net. As major donors reduce funding, global health initiatives navigate ongoing financial uncertainty.
A child sits beneath an antimalarial net. As major donors reduce funding, global health initiatives navigate ongoing financial uncertainty.

With two high-profile US candidates on the shortlist – and several senior global health leaders describing Mark Dybul to Health Policy Watch as the most likely candidate – observers emphasize the delicate balance between maintaining US financial support and preserving the agency’s multilateral mission.

A successful US candidate would maintain Washington’s global health influence, even as it has withdrawn from multilateral involvement in agencies like the World Health Organization (WHO).

Under an “America First” policy framework, Washington is increasingly pursuing direct bilateral agreements with recipient nations, bypassing multilateral approaches to secure domestic interests.

Speaking on the condition of anonymity, an African global health leader warned that the US approach risks politically driven US procurement, commercializing pharmaceutical innovations and treatment access at the peril of recipient states, particularly in Africa.

Health Policy Watch reached out to the United States Department of Health and Human Services and the US candidates but did not receive a response before publication.

Senior European global health experts interviewed by Health Policy Watch warn that European states risk being reduced to “passive watchers” if Washington exerts growing influence over the agency’s strategic direction and leadership selection.

Earlier, German policymakers had voiced frustration after the nomination committee did not shortlist the sole German-backed applicant during the initial round.

Governance divides and voting thresholds

Critics demand more transparency and equity in the Global Fund recruitment process.
Global Health Campus Geneva: Critics demand more transparency and equity in the Global Fund recruitment process.

The Global Fund Board will formally vote to appoint the next Executive Director at its 56th meeting in Geneva, held from 28 to 30 October.

To secure the post, the winning nominee must initially obtain a two-thirds majority in both donor and implementer Board blocs. Should a deadlock occur, the voting threshold is incrementally lowered – first requiring a two-thirds overall majority with a simple majority in each bloc, then a two-thirds overall majority regardless of groups, and finally a simple majority of at least 11 of the 20 total board votes.

Pointing to structural inequalities, sources note that around 40 African nations share just two voting seats. Meanwhile, major nations hold individual donor seats, including the US, the United Kingdom, France, Germany, and Japan, alongside private foundations.

Critics emphasize that this setup preserves legacy power dynamics that contrast sharply with the one-country, one-vote model of the WHO.

Health Policy Watch reached out to the Global Fund but did not receive a response ahead of publication.

Closed deliberations versus public debate

Former Global Fund Board Member Jirair Ratevosian calls for transparency.
Former Global Fund Board Member Jirair Ratevosian calls for transparency.

Despite calls from civil society for public candidate forums similar to the WHO election, the Global Fund is conducting the final evaluation process behind closed doors.

Former Global Fund Board member Jirair Ratevosian argued that the institution is “too important to treat this as just another executive search,” noting that the selection will shape health programs worldwide.

“The Executive Director will be responsible for leading the institution through a period of major political and financial change,” said Ratevosian, calling for public forums to test how contenders plan to address artificial intelligence, new financing models, and country ownership under the Accra Reset.

However, the Global Fund Board defended its restrictive protocols, asserting that strict confidentiality is vital to safeguard candidate privacy and recruitment integrity. Board leadership reaffirmed that candidate engagement will occur through structured constituency meetings rather than public debates.

“They have led a merit-based, transparent and well-governed process, carefully balancing the confidentiality of candidates with the Board’s responsibility to identify the strongest possible leader for the Global Fund,” said board chair Roslyn Morauta in a press statement disclosing the five finalists.

High stakes for global architecture

The election comes after major donor nations – including the United States, Germany, France, and the United Kingdom – cut official development assistance and have signalled further budget trims into 2027.

Reeling from an eighth replenishment that secured $12.64 billion against an $18 billion target, the multilateral fund faces unprecedented fiscal headwinds.

Amidst these cuts, recipient nations are demanding a fundamental shift toward health sovereignty under the Accra Reset framework, seeking to build local production capacities and expand country leadership.

Urging global health initiatives to “commit, collaborate, consolidate and close,” the framework warns that duplicative agencies must prepare for time-bound wind-downs and potential shuttering over the next decade.

Whoever takes the helm will inherit an institution at a historic crossroads, charged with bridging a $5.36 billion shortfall while proving the Global Fund can evolve rather than erode in a reordered global health landscape.

Who Should Lead the Global Fund? Let the Candidates Make Their Case

Image Credits: HPW, UNDP, Global Fund/Vincent Becker, Milken Institue.

Dr Wessam Mankoula, Africa CDC head of emergencies.

The security situation in the Democratic Republic of Congo (DRC) could be behind the significant decline in Ebola cases over the past week, the Africa Centre for Disease Control and Prevention warned on Thursday.

Africa CDC emergencies head Dr Wessam Mankoula cautioned against reading too much into the plunge in cases over the past week, saying that renewed conflict had made it hard for surveillance teams to do their work.

The Ebola Bundibugyo outbreak has claimed almost 4,000 deaths and infected 8,224 so far, Mankoula added.

James Swan, the United Nations special representative for the Stabilisation Mission in the DRC, told the UN Security Council this week that fighting between DRC forces and the rebel coalition of the AFC/M23 was ongoing in North Kivu, with both sides using heavy weapons and drones.

The DRC’s Ambassador Zenon Mukongo Ngay told the Security Council that the Rwanda Defence Force had been responsible for a drone attack on DRC troops in Nord-Kivu on Monday.

Africa CDC warned that “community resistance” in Ebola hotspots Katwa, Beni, Butembo, Nizi and Nia-Nia in Nord-Kivu was also hampering surveillance efforts.

A senior politician from the ruling party was beaten to death in Butembo on Sunday after promoting Ebola prevention during a radio interview, Reuters reported.

Marie-Celestin Karondwa, acting ​president of the Union for Democracy and Social Progress (UDPS) federal executive committee in ​Butembo, was attacked at his home and his house was set alight.

The day before, armed men ​had attacked a ⁠health checkpoint in Beni, killing at least one person and wounding several others.

A gold and rare earth minerals mine in South Kivu.

Meanwhile, Amnesty International has accused M23 of abusing artisanal miners at a coltan mine near the town of Rubaya in North Kivu province, and Lomera, a gold mine in South Kivu. 

The Amnesty International report, documented reports of M23 rebel “killings, torture and ill-treatment; arbitrary detention; forced labour; forced recruitment; and pillage”.

“Rwanda-backed M23 is committing horrific human rights abuses, which may amount to war crimes, against artisanal miners in eastern DRC,”  said Agnes Callamard, Amnesty International’s Secretary General at the launch of the report.

“These [abuses] are meant to punish and instil fear among miners and others living and working near the mines, as minerals are trafficked across the border into Rwanda, which has continued to profit from the exploitation of DRC’s mineral wealth,” added Callamard.

She called on the  African Union and its member states to take “far bolder steps” to end the pillage “driven by an endless international appetite for African critical minerals”.

Image Credits: IPIS/ USAID.

A vegetable seller at Gosa Market in Abuja, Nigeria. Traditional markets provide access to healthy, fresh foods that play critical roles in feeding individuals and households globally.

Progress towards global nutrition targets is too slow, and rising food prices threaten to put healthy diets even further out of reach for many, according to the 2026 State of Food Security and Nutrition in the World  published recently by the Food and Agriculture Organization (FAO).

Even before delivery systems began to strain under the combined pressure of climate change, conflict, disease outbreaks, economic shocks, and steep reductions in aid,2.6 billion people could not afford a healthy diet, according to the 2025 edition of the FAO report, which is published annually.

Climate shocks, conflict, and funding cuts are all hitting our food and health systems at the same time, and often in the same places. These converging pressures make it hard for countries to address all forms of malnutrition, with consequences reaching far beyond health. 

Nutrition is foundational to economic development, with an estimated return of $23 for every $1 invested. Despite decades of evidence, proven interventions, and global commitments, malnutrition persists at scale.

The problem is not a lack of evidence, but that nutrition continues to be treated as a sectoral issue instead of a shared outcome across food, health, and social protection systems, according to the report. 

If we are serious about achieving Sustainable Development Goal (SDG) 2 (zero hunger) and SDG 3 (health) by 2030, and building resilience in an era of overlapping crises, integration and accountability must become the norm rather than the exception.

The launch of the Global Nutrition Report: Integrating Food and Health Systems to Deliver Nutrition Amidst Climate Change – during Rome Nutrition Week.

Fragmented systems won’t deliver

For too long, nutrition has been viewed as an outcome that would naturally emerge from improvements in agriculture, health, or social protection. But nutrition depends on how these systems work together.

Food systems determine whether healthy diets are available, affordable, and sustainable. Health systems prevent and treat malnutrition across the life course. Social protection systems help households maintain access to nutritious foods when shocks occur. If these systems operate in isolation, they miss opportunities to maximise impact.

Climate change, conflict, and disease outbreaks do not respect institutional boundaries. The ongoing Ebola outbreak in central Africa is a reminder that health emergencies can simultaneously strain health systems, disrupt livelihoods and food access, and threaten nutrition outcomes. Yet policy responses stay siloed, governed by separate strategies, budgets, and delivery mechanisms.

Food policies that focus primarily on production may increase food availability without improving diet quality. Health interventions can address malnutrition and diet-related disease, but without supportive food environments, they largely remain therapeutic. Likewise, social protection programmes can reduce vulnerability, but if nutrition objectives are not embedded in their design, they may miss opportunities to improve long-term nutrition outcomes.

International integration

The UN report argues that improving nutrition requires intentional integration across systems.

This means using primary healthcare as a platform not only for treatment but also for prevention and behaviour change. It means designing food system reforms to improve nutritional outcomes, not simply agricultural productivity or emissions targets. And it means ensuring social protection programmes explicitly safeguard access to healthy diets.

“The lesson that we have learned is that integration cannot be improvised at the moment of shock. It’s built in advance, or it’s missed,” emphasizes Dr Giacomo Zanello, report co-author and co-chair of the Global Nutrition Report’s Independent Expert Group (IEG).

Countries that have begun integrating nutrition into universal health coverage and broader social policy reforms offer early lessons. Embedding nutrition services within existing systems can help strengthen continuity and resilience of delivery.

The challenge facing policymakers today is less whether these systems are connected and more how to operationalize that connection through deliberate policy choices, coordinated institutions, and shared objectives.

An agricultural worker in Jalisco, Mexico. Heat stress impacts agricultural workers.

Governance and financing 

If integration is the goal, governance is what makes it possible. There is a disconnect between promises on paper and the systems needed to deliver them. 

Despite a proliferation of commitments, including through the Nutrition for Growth summits, weaknesses remain in financing, coordination, and accountability mechanisms.

This helps explain why progress continues to lag despite widespread agreement on what works.

The challenge is not simply whether ambitious commitments are made. It is whether governments, donors, and institutions are held accountable for achieving outcomes. Too often, success is assessed through strategies published, meetings convened, or budgets allocated. 

The report argues for a stronger focus on substantive accountability: whether policies are improving diets, nutrition, and health outcomes.

Achieving this requires stronger governance arrangements. Policy coherence and cross-sector integration must move beyond aspiration and become embedded in coordination platforms with clear authority, mandates, and accountability mechanisms that encourage health, food, agriculture, and climate actors to work toward common outcomes.

Financing must become more strategic as well. The fiscal space is shrinking in many countries due to debt pressures, competing national priorities and declining external assistance. In this context, governments cannot simply spend their way out of malnutrition. They must prioritize investments that generate the greatest nutrition, health and resilience benefits.

“Successful implementation requires sharper prioritization, strong domestic policies, and sequencing that is firmly grounded in political feasibility,” stresses Dr Shibani Ghosh, also co-chair of the IEG and report co-author.

The report points to the importance of linking financing to substantive performance and outcomes, rather than focusing solely on inputs. Investments should support interventions that improve nutrition while also strengthening resilience, sustainability, and equity.

The result is a compelling case for viewing nutrition investments not as costs to be managed, but as catalysts for broader development gains.

A young girl helping her mother at her vegetable stall in Côte d’Ivoire.

Data, gender, and implementation capacity

Even the best policies will fail if countries lack the tools to implement them effectively.

One clear lesson is that stronger data systems are fundamental to better nutrition outcomes. Many countries lack timely information on diet quality, service coverage, and vulnerability to shocks, and data is becoming scarcer. This limits governments’ ability to target interventions, allocate efficiently, and monitor progress.

Strengthening nutrition surveillance and information systems should be treated as a core policy priority. Government decision-making and accountability can be improved by integrating nutrition indicators into health information systems, drawing on food price and climate data to anticipate risks, and investing in digital tools that support frontline workers.

Human capacity is critical. Delivering integrated nutrition services requires trained health workers, agricultural extension officers, social protection administrators, and local leaders capable of working across sectors. Without investment in this workforce, even well-designed policies fail to reach communities effectively.

Gender equity represents another critical implementation challenge. Women often bear primary responsibility for food preparation, caregiving, and household nutrition decisions, yet they frequently face barriers to resources, services, and decision-making power. These inequities have direct implications for nutrition outcomes.

Roughly seven in 10 “Nutrition for Growth” commitments show no meaningful connection to gender. This is a striking gap given the evidence linking women’s empowerment to improved health and nutrition outcomes. Policies that fail to address these realities risk reinforcing inequities rather than reducing them.

Integrating gender considerations into food and health systems is not an optional add-on. It is essential to achieving sustainable nutrition gains.

Civil society support

While governments remain responsible for delivering results, civil society has a critical role to play in ensuring commitments translate into action.

Civil society organizations ensure nutrition remains a political priority between global summits, international declarations, and funding announcements. They help monitor commitments, amplify the lived experiences of affected communities, and demand transparency when progress falls short.

This role becomes especially important when nutrition programmes struggle to compete for attention and resources.

The distinction between procedural and substantive accountability matters. Publishing a commitment or progress report is not the same as delivering results. Genuine accountability requires independent scrutiny extending well beyond new commitments.

Groups like the Scaling Up Nutrition Civil Society Network have already demonstrated how this can work by following commitments, documenting implementation gaps, and maintaining public attention on nutrition priorities. Their continued engagement is essential for governments and donors to move beyond promises and deliver real change.

The persistence of malnutrition is not a mystery. It reflects policy choices that continue to treat nutrition as peripheral rather than foundational, even as climate shocks, conflict, and economic pressures expose the costs of that approach.

The 2026 Global Nutrition Report arrives at a pivotal moment. As governments prepare for COP31, its message is simple: nutrition is not only a health issue. It is also a climate, food systems, and development issue.

The tools exist. The framework exists. The evidence exists.

What remains is the political will to act and the accountability to ensure promises translate into results. In today’s constrained fiscal environment, nutrition remains one of the smartest investments available because it improves health, strengthens resilience, and supports long-term economic development.

As underscored by Dr Lawrence Haddad: “We are not going to be the burst pipe under pressure. We are going to become the diamonds under pressure.”

Irshad Danish is a policy advocacy and governance specialist and co-chair of the Global Nutrition Report Stakeholder Group, working on nutrition, social protection, accountability, and food systems policy.

Dr Supreet Kaur is head of Programs, Policy and External Relations at the Global Alliance for Improved Nutrition (GAIN). She is also co-chair of the Global Nutrition Report Stakeholder Group and has extensive experience across food systems transformation, micronutrient deficiencies, nutrition policy, and social protection.

 

Image Credits: SUN Movement, Michael Casmir, Pierce Mill Media, Pier Paolo Cito/ FAO, Rafael Duarte/ ILO.

US State Department’s senior advisor for global health security and diplomacy, Brad Smith (centre right), at a meeting to discuss a bilateral agreement with Kenya.

Although the United States’ bilateral health memorandums of understanding (MOUs) with 35 countries are due to come into effect on Thursday (1 October), the start of the US fiscal year, the money will not flow yet – as countries have until Friday to submit their final 2027 budgets.

And while US officials have hailed the agreements as promoting countries’ self-reliance, Ghana’s President said his country refused to sign an MOU as the terms were “humiliating” and would compromise his country’s sovereignty.

The US has committed around $14 billion for the MOUs, in terms of its America First Global Health Strategy, which replaces grants from the now-defunct US Agency for International Development (USAID) and the US President’s Emergency Plan for AIDS Relief (PEPFAR).

However, country teams have until Friday (2 October) – the day after the start of the US government fiscal year –  to submit new documentation of “budget allocations, organisational charts and commodity procurement plans” for the 2027 fiscal year, according to author Emily Bass, who has been tracking the MOUs closely.

Clearly, the MOUs are not on track for implementation, and countries will have to wait – again – for their funds.

Initially, the MOUs were due to kick in on 1 April, but that would have given most countries mere weeks to develop complex budgets. So the US State Department made bridging finance available until 30 September – and it is likely to make yet another arrangement for bridging finance.

Meanwhile, US State Department’s senior advisor for global health security and diplomacy, Brad Smith, said the 35  countries “have committed in aggregate to increase their domestic health spending by more than $10 billion”.

Speaking at an event on the sidelines of the UN General Assembly (UNGA) last week, Smith said that the America First Global Health Strategy had been launched “with a clear premise: American leadership, paired with the ingenuity of the private sector and true partnership with recipient nations, could usher in a new era of global health assistance focused on improving health outcomes while simultaneously increasing country ownership and self-reliance.” 

The MOUs signed in terms of the America First Global Health Strategy were supposed to come into effect on 1 October, but implementation plans are not ready.

‘Humiliating’ terms

However, Ghanaian President John Mahama told another UNGA side event a few days’ later that his Cabinet had rejected an MOU with the US, describing its terms as “humiliating”.

“We flagged several things in the compact. One, it says that we shall give the United States our pathogen profile…And then it also says we should give our medical records. I mean, who takes another country’s medical records?” Mahama told an event hosted by the Council on Foreign Relations in New York last Friday.

“And then it says we would have to put up a certain amount of money as part of the programme into healthcare. And then it also says that any medication or medical products that shall be brought into our country, our Food and Drugs Administration has absolutely no right to inspect. I mean, it was humiliating,” he added.

Zimbabwe and Namibia have also refused the terms offered by the US, the main sticking point being US demands for sensitive health data.

Intermingled minerals and health deals

Guinea and the US sign a minerals MOU around the time that they signed a health MOU.

The US is particularly intent on getting access to critical and rare earth minerals, which China has a monopoly over, and some of the health MOUs have been intermingled with negotiations over access to such minerals.

Shortly before the International AIDS Conference in July, acting US global AIDS co-ordinator Jeff Graham told a briefing on the America First Global Health Strategy that “there are no critical minerals mentioned in any MOU”.  

But several of the MOUs – notably with Cameroon, the Democratic Republic of Congo (DRC), Guinea, Madagascar, Malawi and Rwanda – were signed along with deals that offer the US favourable terms to access their minerals.

Kenyan President William Ruto met Rubio last week to discuss “how critical minerals opportunities in Kenya can position the country as a key player in the sector while presenting opportunities for US firms to provide value addition”, according to the US Bureau of African Affairs.

Nigeria and the US also signed a minerals deal alongside UNGA last week.

Zambia is struggling to find a way to secure US aid without agreeing to punishing terms. Dr Lloyd Mulenga, Zambia’s National HIV programme coordinator, told Health Policy Watch in July that he was unable to divulge why his country had been able to proceed with an MOU.

However, earlier in the year, The New York Times reported on a leaked memo from the US State Department’s Africa Bureau to Secretary of State Marco Rubio, which posited: “We will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale.”

Dr Mike Reid, PEPFAR’s former chief science officer, resigned as a result of the extractive terms being imposed on Zambia, explaining in a Substack post: “When life-saving health assistance, often beyond the immediate capacity of partner countries, is conditioned on unrelated commercial or strategic objectives, something essential is lost.” 

Sovereignty – for who?

Ghanaian President John Mahama launching the Accra Reset report at an UNGA event in New York last Monday.

Earlier in the week, Mahama co-hosted an UNGA side event to report on progress on the Accra Reset, an initiative he launched to help African leaders to respond to the massive and immediate cuts to health aid implemented by the Trump administration. 

The Accra Reset has since evolved into a global platform pushing for the reform of global health and aid institutions, based on empowering countries and regions.

Given the Trump administration’s stated support for national sovereignty, a key reason for its withdrawal from UN forums including the World Health Organization (WHO), the Accra Reset should have been a natural ally.

However, the US has not engaged with the initiative. Rather, it has alienated Mahama – who is culturally aligned with US conservatives.

Furthermore, the US pathogen asks in the MOUs directly undermine African countries’ sovereign rights – something that the WHO talks on a pathogen access and benefit sharing (PABS) system are currently stuck on.

Meanwhile, the Trump administration has refused any further aid to South Africa, the country with the largest HIV population in the world, primarily over its measures to address apartheid-era racial injustice and its case against Israel at the International Court of Justice.

South Africa’s Minister of Science, Technology & Innovation, Blade Nzimande, told a media briefing this week that said the country had lost $152 million [R2.5bn] when Trump withdrew funding.

“Collaborative biomedical, health, and clinical trial programmes, particularly those focused on HIV/Aids and tuberculosis”, had suffered most, said Nzimande.

 However, he added: “Our co-operation with China is increasing in leaps and bounds in terms of science, technology and innovation”.

Meanwhile, as Bass notes: “Continued foreign aid from the US government for health has to reach countries. This to work. Everyone needs this to work.

“[The] State Department can rally this support by sharing the real calendar, reflecting on lessons learned from the past year and moving on from tallying signed MoUs to transparent updates on the number and contents of approved implementation plans, and public health outcomes in the countries where [America First Global Health Strategy Fiscal Year 2027] money finally starts flowing.”

US Health and Human Services Director of Global Affairs Bethany Kozma and PAHO regional director Dr Jarbas Barbosa. Kozma warned PAHO against ‘overhyping the impact of the climate crisis on health’.

At the opening of the Pan American Health Organization’s (PAHO)’s annual meeting on Monday, officials celebrated progress made in tackling regional health challenges – despite political and economic challenges.

However, the US warned PAHO’s 63rd Directing Council not to stray into “ideological” issues, as it continues to withhold millions in unpaid members’ dues.

The opening highlighted the regional achievements, including the elimination of mother-to-child transmission of HIV in Brazil and the Bahamas, Chile’s elimination of leprosy, and immunization recovery following the COVID-19 pandemic. 

“For more than 120 years, the Pan American Health Organization has worked with countries across the Americas to make yesterday’s impossible the reality of today,” said PAHO Regional Director Dr Jarbas Barbosa.

Barbosa argued that PAHO was born from the “powerful idea” of pan-Americanism: “The conviction that we are stronger when we work together and more effective when we move forward with a common purpose.”

Yet, despite Barbosa’s call for cooperation, the underlying political tensions currently afflicting the region, particularly the polarizing effect of the Trump administration’s anti-globalism stance, were evident. 

Geopolitical tensions surface

Tensions escalated as country delegates made their interventions after presentations by PAHO’s director and the General Committee’s annual report.  

The General Committee reported that its sub-committee on Program, Budget, and Administration had recommended the continuation of official relations with several non-state actors, including the Clean Air Institute, but had been unable to reach consensus on the renewal of relations with the World Association for Sexual Health, which was referred back to the Executive Committee.

However, the US contested the admission of the Clean Air Institute and the World Association for Sexual Health. 

US Health and Human Services Director of Global Affairs Bethany Kozma also warned PAHO not to stray into “a divisive political and social agenda, including expanding resources to overhype the impact of the climate crisis on health, promoting a gender ideology approach on health issues and impeding freedom of expression with so-called anti-misinformation campaigns.”

While most countries highlighted national advances achieved with PAHO’s support, the US  and Cuba had an altercation after the Caribbean delegate reported how US embargoes are negatively affecting its population. 

The oil blockade enforced by the US in 2026 has disrupted the Cuban health care system and sanitation services, exacerbating what PAHO described as an “unparalleled crisis” for Cuba. 

However, the US stated that the embargoes were legal and wouldn’t end without a change in government on the island. 

“The US message to Cuban regime leaders is simple: they must make immediate and irreversible political and economic reforms,” said one of the US delegates. 

In response, the Cuban representative reasserted his country’s sovereignty, saying that the US couldn’t interfere in their government, that such a demand had no place at the council, and that it was hypocritical for the US to push for a change of government. 

Innovation and resilience drive health gains 

Presenting the highlights of the organization’s annual report, Barbosa noted that the year marked a “critical transition” for the region as it met financial constraints and health challenges with resilience and innovative approaches. 

He stressed achievements across key pillars, including strengthening primary healthcare, improving vaccination, expanding digital health, preventing and controlling outbreaks, reducing deaths from chronic diseases, and advancing disease elimination.

PAHO’s annual report also pointed to milestones in disease elimination across several nations, including Chile’s elimination of leprosy, and Brazil and the Bahamas’s elimination of mother-to-child transmission of HIV. 

Advances in digital health were especially emphasised as a response to the region’s unequal access to care. PAHO’s surveillance systems analyzed more than 2.2 million signals related to potential public health events and more than 780 telehealth kits were distributed to 20 countries.

Ilan Goldfajn, president of the Inter-American Development Bank, told the meeting that over the past three years, nearly one in four dollars in the bank’s health portfolio supported digital health initiatives. He added that the current goal is to increase that investment by 50% by 2030.

The ‘fragility of hard-won progress’  

Measles cases in the Americas have tripled in the past year.

However, the challenges are evident. Last year, the Americas lost its measles-free status after several countries faced sustained outbreaks. This year, cases have tripled with dozens of deaths reported and in the US, the number of babies infected at birth, once a rarity, is increasing. 

With seven of the 42 member countries reporting less than 80% coverage for the first dose of the measles, PAHO urged countries to strengthen immunization activities. 

“The resurgence of measles reminds us that our work is far from finished,” said Barbosa.

“Viruses don’t recognize borders,” said Chile’s Minister of Health, Dr May Chomalí Garib, who was elected as the council’s president on Monday. “An emergency in one country can quickly become a regional emergency.”

“When we speak about anticipating disease, we can’t only look at what takes place in health systems,” said Garib. “We also need to take a look at the conditions in which people live: the environment, the changes that are occurring in the ecosystem, and our relationship to those changes.” 

Climate challenges

PAHO assisted Venezuela to respond to a series of earthquakes earlier this year.

Over the past year, PAHO also monitored more than 24 health emergencies and mobilized 174 tons of essential supplies to help countries prepare for and respond to disasters like Hurricane Melissa, which affected Cuba, Haiti, and Jamaica, and the earthquakes that hit Venezuela. 

This year’s Super El Niño is an additional concern for the region, as rising temperatures, changing rainfall patterns, and extreme weather events can expand the areas where mosquitoes and other disease vectors circulate.

The Americas face a wide variety of health emergencies and disasters that are increasing in scale and frequency. According to the United Nations Population Fund (UNFPA), 41% of the population and 37.5% of emergency hospitals in the region are located in medium to high hazard zones. 

This year marks the 50th anniversary of PAHO’s Health Emergencies Program, initiated in 1976. 

Lisa Cummins, Minister of Health and Wellness of Barbados and outgoing president of the Directing Council, warned that emergency preparedness “cannot be a promise made in crisis and forgotten when the fear passes.

“The measure of regional solidarity and hemispheric capacity is when we build it together and keep it ready for the people who will need it,” she said. 

Financial threats to PAHO

Barbosa also drew member states’ attention to the financial sustainability of the organization. The US, PAHO’s largest donor, hasn’t paid its membership fees since 2024, and owes the body over $134 million. In addition, the Trump administration has signalled its intention to cut all funds to PAHO by 2027.

Last year, member states approved a 19% budget reduction, which Barbosa said had affected the organization’s ability to sustain operations across the region. 

At the same time, PAHO’s director said that, despite growing financial constraints, the body has demonstrated resilience, adaptability and leadership. 

The meeting approved a change that unified technical cooperation mechanisms into one single Regional Revolving Fund, which should be stronger and more efficient. 

“Being efficient doesn’t just mean spending less. It also means better use of public resources,” said Garib. “Every resource that is better used becomes surgery on time, timely detection, medication, care that doesn’t impose great economic burden on families.”

Image Credits: Toposdigitales .

A young girl eating therapeutic food at a health centre in Yemen. The WHO warned on Tuesday that it has run out of lifesaving supplies at its warehouse in Aden.

Thousands of people displaced by conflict in Yemen are at risk of cholera, measles, malaria and dengue as the El Niño season approaches, the World Health Organization’s (WHO) Eastern Mediterranean region warned this week.

A four-year ceasefire between Iran-backed Houthi forces and the Saudi-based Yemeni government collapsed in August after Houthi forces attacked Saudi Arabian territory and tankers in the Red Sea.

In the past month, the Houthi forces have captured virtually all of Yemen’s Red Sea coast and effectively control the Bab el-Mandeb Strait, an important route for trade between Europe and Asia.

Nine health facilities have been damaged or directly attacked in the recent conflict, and obstetric and newborn care has been suspended in two hospitals in Marib and Ras Al-Arah to care for those injured in the conflict.

Even before the latest conflict, 60% of health facilities in Marib, Taiz, Ad Dali’ and Aden were functioning.

Meanwhile, 7,784 suspected cholera cases have been reported, including in two camps for internally displaced people (IDP) in Aden.

More than 22,000 suspected measles cases and 128 deaths have been reported this year, and 9,604 dengue cases.

Years of conflict have pushed around 80% of the population into poverty.

WHO reports that it has only secured $2 million of the $9 million it needs to support health in Yemen, and stocks of some lifesaving supplies, including trauma kits and essential medicines, have already run out at its Aden warehouse.

Image Credits: Gabreez/ UNICEF.

French Ambassador for Global Health Dr Anne-Claire Amprou (centre) and speakers at the UNGA side event, hosted by the Medicines Patent Pool with support from Roche.

The Medicines Patent Pool (MPP) has signed sublicense agreements with 11 manufacturers across multiple regions to expand access to generic baloxavir marboxil, a single-dose antiviral treatment for influenza that was originally developed by Swiss pharmaceutical company Roche. 

The announcement, made the night before last Friday’s UN High-Level Meeting on Pandemic Prevention, Preparedness and Response, reignited calls for partnership to strengthen geographically diverse manufacturing capacity during what has been referred to as an era of ‘peacetime’ for flu before the next pandemic. 

“Rather than waiting for that crisis to come again, and we’ve seen it with COVID, let’s prepare in what we call peacetime, and this is peacetime for flu, and that is really critical because when the pandemic hits, we need to collectively respond with steam and scale,” said Tamara Schudel, Roche’s vice president and head of global policy.

Schudel and other global health leaders, civil society representatives, and pharmaceutical manufacturers welcomed news of the agreement at an event on the sidelines of the 81st session of the UN General Assembly hosted by MPP with support from Roche. 

The event, “Advancing pandemic preparedness through voluntary licensing, technology transfer, and local production,” was moderated by Health Policy Watch editor-in-chief Elaine Ruth Fletcher. It focused on how practical access arrangements, technology transfer and regional manufacturing can help strengthen pandemic preparedness before the next crisis.

Enabling proactive preparedness 

The agreements follow an initial voluntary licensing agreement made in May 2026 between MPP and Roche to expand access to baloxavir by allowing generic manufacturers to develop, manufacture and supply affordable generic versions of the treatment in 129 countries, subject to local regulatory authorization. 

The 11 manufacturers include four manufacturers with a global presence – Laurus Labs and MSN in India, and Desano and Guilin Pharma (Fosun) in China – alongside seven regional manufacturers with Biolab in Brazil, Kimia Farma in Indonesia, Hovid in Malaysia, Fidson in Nigeria, QCIL in Uganda, Lekhim in Ukraine and Stellapharm in Vietnam. 

The manufacturers celebrated the agreements and their significance as an important next step in expanding access to baloxavir and pandemic preparedness.

“We know pandemics won’t and can’t wait, and we should be ready at any time,” Biolab CEO Fabio Amorosino said. 

“[The sublicense agreements] enable proactive preparedness versus a reactive response. When licensing, manufacturing pathways, and supply arrangements are established in advance, we can respond much faster when demand arises,” said Kundal Reddy Bairy of MSN Pharmaceuticals. 

Innovative treatment benefits patients and public health 

The agreements are timely as influenza has been identified as the pathogen with the most pandemic potential.  Baloxavir has also proven to be effective against strains that are resistant to other classes of antiviral medicines, thus creating a more resilient defense against the evolving threat of influenza. 

“This is a single dose, which means it is going to be much easier on the healthcare workforce,” said Schudel. “It will also help ensure patient adherence. You don’t have to worry about a full package or a week. You take one pill, you’re done. 

“It also rapidly lowers the viral shedding, and that’s very critical from a public health perspective because it curbs the transmission. If you need to manage a local outbreak, that is absolutely critical.” 

MPP executive director Charles Gore said baloxavir can be used seasonally, giving manufacturers incentives to develop the antiviral: “With a lot of the other pathogens, there may not be a market. There may not be an incentive to develop fully. Nonetheless, that should not stop them licensing now, so that’s in place for the next pandemic.”

Ensuring access 

Erika Placella (Swiss Development Corporation); Tenu Avafia (Unitaid deputy executive director); Tamara Schudel (Roche vice president); Charles Gore (MPP executive director) and moderator Elaine Ruth Fletcher (editor-in-chief, Health Policy Watch).

Expanding access to treatments such as baloxavir shouldn’t be thought of only when there is an outbreak or pandemic, but instead be incorporated into a government’s health system and preparedness agenda well before the next pandemic strikes.

“Access shouldn’t be an afterthought,” said Unitaid deputy executive director Tenu Avafia. “When there is an outbreak or an epidemic or pandemic, that’s not the optimal time to start discussions and to negotiate voluntary licenses. That’s not the best time to start looking at regulatory pathways to shape the market, to address procurement and supply chain challenges. The best time to do it is before the pandemic breaks.”

“The whole issue of access has to be built in, baked right into the preparedness agenda,” said Bruce Aylward, Assistant Director General for Promotion, Disease Prevention, and Care at the World Health Organization.

James Anderson, chair of the INTREPID Alliance, a consortium of pharmaceutical companies dedicated to accelerating the pipeline of antiviral treatments, used the ongoing Bundibugyo Ebola outbreak in DRC as an example of how the typical supply-demand market approach does not apply to pandemics or outbreaks. 

“The standard economics market-driven approach doesn’t work in pandemics, when you have an unpredictable, periodic outbreak. We only have to look at Bundibugyo. How can you be investing for something that the last time it could have been used was 12 years ago? The standard economics do not work [in this case], so we do need to fix that.” 

Currently, Anderson noted, of the 14 priority viruses with pandemic potential that INTREPID evaluated in their latest landscape analysis, three of viral families have nothing in the pipeline, in either the preclinical stage or in the clinical stage. Another six viral families have nothing in the development stage, meaning there will be no products available in the next three to five years. 

He called for sustained R&D investment and funding to move these viruses through the research pipeline. 

African investment

Speakers also called for more investment in African manufacturing to expand access, building on the momentum and regional transformation on the continent with the establishment of institutions such as the African Medicines Agency and the Africa CDC. 

“We will have to move forward by investing in African institutions,” said the Swiss Development Corporation’s Erika Placella. “We have to support governance, and we have to support capacity building and technology transfer, but all this will happen in Africa for Africa.” 

This aligns with high-level discussions made during the UN General Assembly pushing towards ‘practical sovereignty’ and a move away from foreign aid dependence. 

Kenya is one country in Africa that is moving from policy to action and is investing in local manufacturing opportunities for vaccines and other therapeutics by strengthening its healthcare system. 

A Kenyan Ministry of Health official, representing Dr Consolata Oggot, said his country is close to achieving WHO Maturity Level 3 status, which demonstrates a country’s ability to effectively regulate medical products and ensure their safety, quality, and efficacy.

This is important for Kenya to be “able to manufacture not only vaccines, but other pills as well”, he said. “All this licensing requires resources to build capacity through the healthcare system. Therefore, political goodwill is very important. We are happy to build on partnerships that exist, and partners that can provide financing are key to supporting our initiatives.” 

Moving with accountability 

While part of the problem of access to treatments is technical, there are also social and political challenges that need to be addressed, noted Resilience Action Network Africa (RANA) Executive Director Aggrey Aluso. 

Aluso referred to the ongoing Ebola outbreak in DRC as an example, pointing to how misinformation had undermined the public health measures needed to combat the spread of disease. 

He also notes that the word ‘generics’ is stigmatised when associated with medicine in Africa. 

To overcome these challenges, Aluso called for the “deliberate” involvement of communities to incentivize both manufacturers and the community, with manufacturers using innovative ways to engage the community and build awareness of therapeutics and vaccines.  

“We need to move with speed, but that speed needs to be accompanied by an enforceable and accountable mechanism that also incorporates the interest of the public, accountability, and equity,” said Aluso.

Diene Keita, executive director of UNFPA, addressing UNGA last week.

Several significant pledges for global health – covering reproductive health, ‘transition’ and Ebola – were made on the fringes of last week’s United Nations General Assembly amid massive donor withdrawal from the sector.

Reproductive health, which has suffered massive funding losses, got a $337.8 million boost from the United Kingdom, which announced its pledge at an event co-hosted by the United Nations Population Fund (UNFPA).

Most of the money will go to the UNFPA’s Supplies Partnership, which ensures reliable access to contraceptives and maternal health medicines in 54 low- and middle-income countries.

Globally, UNFPA estimates that 259 million women who want to avoid or delay pregnancy are still not using safe, modern methods of contraception, and UNFPA executive director Diene Keita told UNGA that there was a $185 million deficit in contraception funding this year alone.

Announcing the pledge, UK Minister for Development Kirsty McNeill, said: “It is a scandal that women and girls are denied the fundamental right to make informed choices about their own bodies, free from coercion, discrimination and violence. 

“Every woman and girl should be able to make decisions about her own future. That choice can mean staying in school, finding work or surviving childbirth.”

UNFPA described the UK pledge as “the largest single government investment in reproductive health supplies worldwide this year”, making “voluntary family planning a possibility for more than 15 million women per year and [it] could prevent 14 million unintended pregnancies and over 35,000 maternal deaths by 2028”.

Four of the world’s poorest countries – Burundi, Madagascar, Mozambique and Zimbabwe – announced increased domestic investment in reproductive health services. 

Zimbabwe has committed $250 million to improving its hospitals, 30% of which will boost maternal and child services, and $2.25 million for reproductive health supplies. Madagascar will spend $20 million on reproductive health products, Mozambique $17.6 million and Burundi, $4.5 million on products and improving obstetric services.

“Record-high domestic commitments show that national governments are investing more of their own resources to help prevent unintended pregnancies and reduce maternal and newborn health complications and deaths,” added UNFPA.

Longstanding donor governments, including Denmark and Norway, also announced new and multi-year support for UNFPA, while private philanthropic organisation GiveWell announced its first investment in UNFPA with a $10 million grant.

In 2024, 43% of global family planning aid – around $500 million – was funded by the US, according to US health organisation, KFF. 

Despite a US Congressional allocation of over $600 million to support global family planning programmes this financial year, the Trump administration has indicated that it does not wish to fund any family planning, and its bilateral ‘America First Global Health Strategy’ grant agreements do not include reproductive health.

Aid for Africa’s transition

Meanwhile, Coefficient Giving announced the launch of the Health Aid Transition Fund (HATF) to assist low- and middle-income countries to adapt their health systems amid rapidly declining aid. 

The Fund will recommend at least $165 million in grants over the next three years, with support from Good Ventures, the Livelihood Impact Fund, and a private donor. 

By 2030, health aid is projected to be more than 25% lower than 2024 levels, and LMICs will need to rapidly scale up the financing of key public health systems themselves.

“These changes are a real shock to health budgets, but they’re also a chance to fix systems that were built around donor requirements rather than people,” said Amanda Glassman, Coefficient Giving’s managing director for global health and development policy. “Whether those systems come out of this weaker or stronger depends on decisions over the next few years.”

The HATF will focus on four main issues: keeping key services running during the transition; helping governments set priorities with smaller budgets; increasing the share of money that reaches health facilities and people living in poverty by addressing blocks, including misaligned budgets; and mobilising domestic financing for health, including exploring revenue sources such as debt-for-health swaps. 

Glassman told Health Policy Watch that the fund will “primarily pay for technical teams to advise governments in managing the transition from the historic drop in aid”. 

“It will also directly fund services where there are broader benefits. For example, when philanthropic support can unlock bilateral aid that would otherwise go unspent or where there is opportunity to give governments space to pursue more ambitious reforms,” said Glassman.

“This is a multi-donor fund and our aim is for more philanthropic partners to join, increasing the overall pot of funding to support work that builds stronger health systems, even as global aid levels fall.”

Welcoming the fund, Sierra Leone’s Health Minister, Dr Austin Demby, said that his country has spent years building a health system alongside partners.

“That is rapidly changing now, and we intend to come out of it owning our systems outright. What we need from partners now is financing and expertise that strengthens what we are building,” said Demby.

Boost for Ebola response

An additional $700 million was also pledged by the G20+ foreign ministers – with $267 million from the United States – to contain the Ebola outbreak in the Democratic Republic of the Congo, as previously reported by Health Policy Watch.

Dr Jean Kaseya, head of Africa Centre for Disease Control and Prevention, described the additional money as “huge”.

“But pledges alone will not stop Ebola,” Kaseya added. “We must be able to trace every single dollar—from commitment to disbursement, from implementing partner to expenditure, and ultimately to the services delivered to affected communities. Transparency builds trust, accelerates delivery and saves lives.”

People living in places with poor air quality have heightened risk of asthma, and often depend on inhalers to clear their lungs.

Lisa Sama is a 19-year-old medical student in Cameroon. As far back as she can remember, she has lived with asthma, and in recent years, she has turned her attention to the role that air pollution plays in her health. 

“From the very beginning, my life involved inhalers, medication, hospital visits, and many sleepless nights. One of my earliest memories [is of] having my first serious asthma attack at just five years old… it felt like someone was pressing on my chest…That moment was terrifying, and little did I know, it was only the beginning. In my community, air pollution is part of our daily life,” she said, speaking at a webinar ahead of the Africa Clean Air Forum in Pretoria in July 2026.  

Lisa is not alone, and on a continent where the average age is 19 years, air pollution requires urgent attention and intervention to halt the impacts on developing bodies and minds. 

Significant health impacts across the continent 

In 2023, there were an estimated 1.2 million deaths in  Africa and of these, 371,584 deaths were in children under five years of age, mostly from exposure to smoke from cooking with charcoal or firewood. Nearly 970 million Africans still depend on wood and biomass used for household cooking; in some countries, nine out of 10 people use polluting fuels for cooking. 

In southern Africa, energy generation is a major source of air pollution. Research in South Africa, which is still heavily dependent on coal power, found that people living in municipalities with coal-fired power stations face a 6%  higher risk of air-pollution-related health impacts than those who don’t.

This means an increased risk for heart disease,  an increase in hospital visits due to lung diseases, including tuberculosis and chronic obstructive pulmonary disease, and ultimately, a lower quality of life for residents and higher healthcare system costs for the government.

The continent also receives polluting second-hand diesel vehicles from Europe and Asia. Diesel generators provide backup power in many homes, businesses and hospitals to make up for unreliable grids. This adds to poor air quality, especially in cities.   

Vehicle emissions also affect air quality in African cities.

Double burden of disease 

Breathing polluted air early in life can have immediate and long-term impacts. In some African countries, nearly one third of lower respiratory infection deaths in children under five years of age are linked to air pollution. 

Where people live, what they do, what fuels they use to cook food, and how they travel are all factors that determine the levels of air pollution an individual is exposed to. 

Air pollution exposure from household use of solid fuels and fossil fuel sources combines with demographic and other shifts affecting the underlying health of the population. This causes uneven impacts across countries in Africa where rates of chronic noncommunicable conditions (such as heart disease and diabetes) are rapidly rising while the relative burdens imposed by communicable diseases such as lower respiratory tract infections, tuberculosis, and malaria remain high. 

Africa has the youngest population of all continents. Millions of babies, children and young people breathing polluted air risk their lives and the continent’s future. 

Millions of people rely on dirty cooking methods using fossil fuel, charcoal and wood, which impacts on air pollution. 

The cost of inaction

Behind each of these statistics is a lived experience – loss of school days, missing work to take care of a family member, frequent hospital visits, the cost of medication, not being able to play a game of football. These impose substantial social and economic burdens on children, their families, and health systems. 

Across the continent, air pollution causes the loss of billions of dollars lost due to medical expenditures, productivity losses and missed workdays, and premature deaths. 

An estimated 5-10% GDP equivalent is lost due to ambient and household air pollution across African countries – 9.1% in Burkina Faso, 7.8% in Sierra Leone and 5% in South Africa and the Democratic Republic of the Congo. High pollution may also deter businesses, and skilled workers, as has been seen in some South Asian cities.   

Growing awareness 

Air pollution in Ghana

Encouragingly, awareness is growing along with political willingness to act on air pollution, and governments are taking steps to expand air quality monitoring, set up air quality standards, and raise awareness about the health harms of air pollution. 

This was evident at the Africa Clean Air Forum in July, as well as in political expressions around the recent International Clean Air for Blue Skies days, and in the increased focus on air quality at the continental scale through the African Union (AU) Africa Clean Air Programme. 

During its 2024 AU Presidency, South Africa led the adoption of the first-ever G20 ministerial declaration on air quality, and is now actively working to engage members of the Southern African Development Community (SADC) region to identify opportunities for clean air action. 

Health worker involvement

Doctors, nurses, and community health volunteers see the lived reality of air pollution every day – a child admitted for an asthma attack, an older patient whose Chronic obstructive pulmonary disease (COPD) keeps worsening despite treatment, or a baby born early due to complications. 

Dr Maria Neira, former director of climate and health at the World Health Organization (WHO), has called for health professionals to support calls for investment in clean air for Africa. 

“We have more than enough [evidence] to promote very, very strong interventions, particularly on access to clean fuels at the household level and interventions to reduce air pollution at the outdoor level,” said Neira.

In South Africa, health professionals and civil society worked together in the Highveld Priority Area (HPA), an area with extremely poor air quality due to coal-fired power plants, to secure a landmark court ruling affirming clean air as a constitutional right.

Investing in Africa’s future 

African cities and countries are already offering locally relevant solutions, and the time for bold investments is now. The continent needs investment, not only financial, but also in human capital, infrastructure, and community. 

In the last few years, the infrastructure to measure and monitor air quality has rapidly expanded, but there is a need to also strengthen and enhance health data collection and link up air quality, health, and other sectors, including finance.  

Reducing the health burden of air pollution will mean fewer hospital beds, medications, and staff time- resources that can be invested in expanding care elsewhere. 

A new global analysis has identified Africa as one of the regions with the highest returns on investment in clean air and climate action: every dollar spent on clean air and climate action in Sub-Saharan Africa results in $11 in benefits, while in southern Africa, every dollar invested results in $26 in return. 

We have the data, and the evidence is clear: this is the moment to invest boldly in clean air action and improve the health and well-being of people across Africa. 

Dr Pallavi Pant is Director of Global Initiatives at the Health Effects Institute. 

Xoli Fuyani is the Director of Black Girls Rising. 

Dr Obianuju Ozoh is the current President of the Pan-African Thoracic Society and a Professor at the University of Lagos, Nigeria.

This article reflects discussions at a webinar organized by the Health Effects Institute, in partnership with the Pan-African Thoracic Society, Makerere Lung Institute, Africa Clean Air Network, and the South African Medical Research Council and deliberations at the Africa Clean Air Forum 2026.  

Image Credits: Gulshan Khan / Climate Visuals , Loise Akello, Gulshan Khan / Climate Visuals , Prince Junior Asilevi.