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

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

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

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

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

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

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

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

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

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

The situation is similarly bleak in the capital, Kabul.

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

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

Vicious cycle of poverty and suffering

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

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

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

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

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

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

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

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

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

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

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

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

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

Image Credits: WHO EMRO.

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

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

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

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

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

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

Race and education

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

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

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

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

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

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

Commercial interests

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

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

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

Debt distress

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

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

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

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

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

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

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

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

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

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

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

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

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

Undervalued and overwhelmed

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

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

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

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

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

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

Midwives are not a luxury

A midwife assists a patient in Pakistan during floods.

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

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

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

Include midwives in planning

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

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

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

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

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

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

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

 Ana Gutierrez is Communications Lead at the International Confederation of Midwives

 

 

 

 

 

 

Image Credits: International Confederation of Midwives.

The UN multi-stakeholder hearing on NCDs

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

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

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

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

NCD Alliance CEO Kaie Dain

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

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

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

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

‘Elephant in the room’: Harmful industries

Youth speaker Stephanie Whiteman

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

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

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

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

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

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

Address gender gap and taxes

Magda Robalo, executive director of Women in Global Health

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

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

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

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

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

Undue influence on political declaration?

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

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

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

‘Nothing about us without us’

Lucía Feito Alonca of International Diabetes Federation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

UNAIDS-WHO merger and other global health moves? 

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

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

Under Sustainable Development:  

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

Under Humanitarian Response:  

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

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

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

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

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

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

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

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

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

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

Refugees and Human Rights 

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

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

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

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

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

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

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

Structural reorganization and response 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Watch the full episode:

 

Image Credits: TDR – Global Health Matters.

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

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

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

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

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

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

Pushes back against Trump – saying reforms are happening

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

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

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

Countries Say YES to Pandemic Agreement

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

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

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

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

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

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

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

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

Praises past collaborations

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

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

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

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

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

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

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

25% of 2026-27 salary costs are unmet

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

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

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

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

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

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

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

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

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

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

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

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

No regrets about past years of expansion 

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

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

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

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

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

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

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

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

Swollen consultants’ ranks

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

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

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

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

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

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

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

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

Updated 2.5.2025

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

A baby being vaccinated in Abidjan in Côte d’Ivoire.

African countries like Uganda and South Africa are rewriting the rules of emergency response. The rest of the world must follow – or fall behind.

Every April, World Immunisation Week is observed with predictable rhetoric: health leaders celebrate progress, governments make declarations, and global agencies issue reports highlighting gains and gaps in vaccination.

But as we enter a new phase of global health uncertainty with mounting climate shocks, geopolitical upheavals, and pandemic threats. We must go beyond ritual. It’s time to fundamentally reframe how we see vaccines: not just as tools to end disease, but as core infrastructure in the architecture of pandemic preparedness and response (PPR).

To do this, we must first understand how we got here.

From smallpox to COVID-19

Vaccines have always been about more than biology, they are about equity, power, and politics. The roots of modern immunisation trace back to the 18th century, when Edward Jenner introduced the smallpox vaccine in 1796.

But in truth, the practice of inoculation dates far earlier, with African, Asian, and Indigenous communities using forms of variolation centuries before Jenner’s discovery.

In the 20th century, vaccination scaled into a global public good. The World Health Organisation (WHO) launched the Expanded Programme on Immunisation (EPI) in 1974, with a mission to provide universal access to life-saving vaccines such as those for measles, polio, diphtheria, and tuberculosis.

This catalysed one of the greatest public health successes of all time: a 99% reduction in polio cases, millions of measles deaths averted, and a world finally free of smallpox by 1980.

Yet, in this century, immunisation programmes have struggled to maintain momentum. The COVID-19 pandemic disrupted routine services worldwide, and in many African countries, immunisation coverage dropped sharply due to supply chain failures, misinformation, and funding gaps. In 2021 alone, nearly 25 million children missed routine vaccinations — 6 million more than in 2019.

But the pandemic also proved something profound: that immunisation systems, if properly funded and embedded into broader health systems, can serve as vital early warning and rapid response mechanisms.

Mainstreaming immunisation in pandemic preparedness

Immunisation programmes are often treated as siloed verticals, disconnected from national health security strategies. This is a mistake. In reality, robust immunisation systems are the frontline infrastructure for epidemic intelligence, surveillance, risk communication, and rapid response.

They have three critical advantages that pandemic preparedness cannot afford to overlook:

First up: Trusted Community Networks. Immunisation programmes have built decades of trust with communities. These networks—often led by nurses, midwives, community health workers, and civil society—are essential for communicating risk and reaching marginalised populations quickly during outbreaks.

Cold chain infrastructure is a second bonus.  No other area of the health system has the logistical muscle that immunisation programmes do. From solar fridges in rural Mali to drone deliveries in Rwanda, the cold chain is a backbone for health commodities distribution.

Lastly, immunisation drives are data-driven systems.  Immunisation tracking systems such as DHIS2 and electronic immunisation registries are already collecting real-time, geo-tagged health data. These can be integrated into early warning systems for new outbreaks.

Mainstreaming immunisation into PPR is not just smart, it is urgently necessary. The WHO’s Immunisation Agenda 2030 (IA2030) is clear: immunisation must be part of a life-course approach to health, linked to emergency response and resilient systems.

Africa is already showing us the way.

Uganda: Integrating immunisation and emergency preparedness

In 2018, Uganda launched a National Action Plan for Health Security (NAPHS), aligning its immunisation efforts with the International Health Regulations (IHR) framework. When COVID-19 hit, the country was able to leverage its longstanding immunisation network, especially in rural districts like Lira and Gulu, to support pandemic response.

Immunisation personnel were re-trained to support contact tracing, community awareness campaigns, and vaccine rollout. Cold chain equipment originally purchased for EPI was used to store COVID-19 vaccines. And thanks to the country’s Electronic Immunisation Register, Uganda was able to rapidly track coverage rates and identify gaps.

The result? Despite global inequities in vaccine supply, routine immunisation coverage bounced back faster than expected, aided by strengthened surveillance and data systems.

Uganda’s model demonstrates what is possible when immunisation and preparedness are not in competition, but in collaboration.

South Africa’s ‘whole-of-government’ vaccine response

South Africa’s response to COVID-19 was complex, but one standout success was integrating its immunisation programme with broader disaster management systems. From the outset, the National Institute for Communicable Diseases (NICD) worked closely with the Expanded Programme on Immunisation to align data streams, forecasting, and workforce planning.

The government built an innovative digital platform—EVDS (Electronic Vaccine Data System)—that merged COVID-19 vaccination records with existing health databases, enabling real-time tracking and equitable rollout strategies [1]. Community-based organisations, many of which had deep roots in HIV vaccine research and advocacy, were mobilised to counter disinformation and support outreach.

Importantly, lessons from COVID-19 were fed back into South Africa’s revised National Pandemic Preparedness Plan, which now explicitly positions routine immunisation as a frontline defence and key surveillance tool.

This whole-of-government approach shows that mainstreaming immunisation isn’t about reinventing the wheel, it’s about unlocking the full potential of existing systems.

Risk of missing the moment

Despite these examples, many global frameworks still fail to treat immunisation as a core element of pandemic prevention. After three years of negotiations, the Pandemic Accord that will be presented at the World Health Assembly on 27 May makes only superficial mention of routine vaccination.

The text mentions strong primary health care and immunisation as important prevention, but for all intents and purposes these strategies are presented in siloes. Ideally, member states should have been mandated to integrate routine immunisation into primary health services, an approach which has “some of the greatest reach and demonstrable health outcomes,” according to Gavi, The Vaccine Alliance.  

Funding from initiatives such as the Pandemic Fund risks bypassing immunisation programmes altogether unless civil society and national governments push for integration.

This gap is not just technical—it’s political. Immunisation, especially in African contexts, has too often been treated as donor-driven charity rather than essential sovereignty. Reclaiming vaccines as part of national security and public infrastructure is part of a larger decolonial project: one that sees African states not as passive recipients of aid, but as active shapers of their own health futures.

Delivering on immunisation agenda 2030

As we mark Immunisation Week in 2025, we must move from commemoration to transformation. This means taking concrete steps to mainstream immunisation into national and global pandemic preparedness strategies:

Governments must include immunisation in national PPR Plans. Every country must revise its pandemic preparedness frameworks to explicitly include immunisation networks, data systems, and cold chain assets.

We must push for immunisation to be funded as core infrastructure. Donors and financing bodies, including the Pandemic Fund, must stop treating immunisation as a “vertical” programme and start investing in it as cross-cutting, systems-strengthening infrastructure.

Community leadership must be supported. Civil society, especially women-led and Indigenous organisations, must be funded and integrated into immunisation and emergency response planning.

Finally, the WHO’s Immunisation Agenda 2030 lays out a bold vision, but it will remain paper unless national governments are held accountable for delivering on its goals, including equity, coverage, and resilience.

This is not just about vaccines. It’s about dignity, sovereignty, and building systems that protect everyone, especially the most vulnerable, not just in times of crisis but every day.

Ultimately, the future of pandemic preparedness in Africa may lie not in high-tech labs or global summits, but in the quiet strength of a nurse with a cooler on her back, walking dusty roads to reach the last mile. That is where the next pandemic will be won—or lost.

Let us act before we forget.

Tian Johnson is the founder of the African Alliance and served on the South African Ministerial Advisory Council for COVID-19 at the height of the pandemic.

 

Image Credits: UNICEF.

Heated tobacco products (left and middle) are electronic devices that heat tobacco inserts. (The device on the right is an e-cigarette.)

Big tobacco companies are marketing heated tobacco products (HTP) as a less harmful alternative to cigarettes, but researchers warned this week that there is no evidence to support this or the industry claim that they can help smokers to quit.

HTPs are electronic devices that heat an insert of processed tobacco, often in a stick or pod, to produce an aerosol containing nicotine and other chemicals. The tobacco insert is often flavoured, including with flavours such as bubble gum and lime that appeal to young people.

“There are three key things policymakers and consumers need to know,” said Dr Sophie Braznell, a researcher from the University of Bath who co-authored a brief on HTPs released on Wednesday by STOP, a tobacco industry watchdog.

“First, heated tobacco products cause harmful effects. Second, there is no clear evidence that they are safer or less safe than other tobacco and nicotine products, even cigarettes. Third, available research lacks the independence and quality that might help us draw any conclusions about the impacts of real-world use,” Braznell told a media briefing on Wednesday.

Billion-dollar market

The main players in the HTP market.

The HTP market is estimated to be worth $36.7 billion and is projected to grow by over 52% between now and 2032, according to market research company Stellar.

“HTPs are available in at least 57 countries across Europe, North and South America, Eurasia, and East Asia. The market for HTPs in Africa and the Middle East is small but growing,” according to Stellar, with Asia Pacific being the fastest-growing region in the market.

HTPs have become more popular than cigarettes in Japan, while sales are surging internationally with promotions at events aimed at youth.

The HTP market leader is Philip Morris International’s (PMI) IQOS, an abbreviation of “I Quit Ordinary Smoking”, while British American Tobacco (which makes Glo) and Japan Tobacco International (Ploom) are the other key players.

HTPs are available in a limited number of African countries, including South Africa, Kenya, Nigeria, Botswana, Zambia, Zimbabwe and Ghana. 

However, the cost of the device is a barrier, acknowledged Frederic de Wilde, PMI’s president for South and Southeast Asia, the Commonwealth of Independent States, the Middle East, and Africa region.

“Africa definitely has a role to play and we are committed to coming up with smoke-free products to offer alternatives to African smokers,” de Wilde told African Business in an interview in late December 2024.

But he said that the current HTPs were “premium devices”, and PMI is “piloting a new simple device that is less expensive and targeted for medium and low price segments”.

How PMI’s Heated Tobacco Products are being consumed across the world.

Biased clinical trials

Braznell has spent the past five years reviewing clinical trials involving HTPs. She and colleagues found 49 clinical trials on humans, but 34 were linked to the tobacco industry, with one-third linked to Philip Morris International. 

In addition, they were usually run over a very short time – five days or less – and in controlled settings like laboratories, rather than real-world settings.

“Overall, 39 of the trials were judged to have a high risk of bias,” said Braznell, including selective reporting of results. She and colleagues also published their findings on the trials in the BMJ this week.

Aggressive marketing

Sophia San Luis, executive director of Imagine Law, a Philippines-based public interest law group

Sophia San Luis, executive director of Imagine Law, a Philippines-based public interest law group, told the media briefing that big tobacco companies were aggressively marketing their HTPs to young people.

President Ferdinand Marcos has hosted PMI since he assumed office in 2022, and the company has promoted its smoke-free products at events organised by First Lady Liza Araneta Marcos.

Renowned DJ Steve Aoki promotes IQOS products, and there is a ‘limited edition” HTP bearing his name. However, a range of NGOs and community organisations stopped an IQOS-sponsored concert featuring Aoki on the grounds that it violated advertising bans on tobacco products.

Marketing of PMI’s IQOS in Philippines was boosted by support from DJ Steve Aoki, with limite edition devices branded in his name.

Dmytro Kupyra, executive director of “Life,” a Ukrainian NGO working to reduce mortality and morbidity from non-communicable diseases, said his country had increased taxes on HTP six-fold in 2021, which had contained sales. 

However, in 2024, the Ministry of Finance reduced HTP taxes by 25%, after the tobacco companies conducted an intense campaign for taxes to be reduced. This means that Ukraine is no longer aligned with the European Union on taxation.

“For next four year, between 2025 to 2028, Ukraine will lose around $500 million in tobacco excise taxes, and Ukraine will have around 24,000 additional deaths from hamful tobacco use,” said Kupyra, who said that about 15% of young Ukrainians aged 18 to 28 use HTPs thanks to aggressive marketing.

Ukraine backtracked on HTP taxation in 2024.

Hazel Cheeseman, CEO of the UK’s Action on Smoking and Health (ASH), said that PMI had a three-pronged strategy to promote HTPs.

“First of all, they want to aggressively secure a share of the nicotine market for their heated tobacco product, and are aggressively marketing them in ways that the UK Government does not believe is in line with the law,” said Cheeseman, whose public health charity set up by the Royal College of Physicians to end the harm caused by tobacco in the UK.

Hazel Cheeseman, CEO of the UK’s Action on Smoking and Health (ASH)

“They’re also seeking to secure a beneficial regulatory environment for their products through their lobbying efforts. But also, they want to be seen as a credible partner by the UK government on the basis that they have this apparently less harmful product,” said Cheeseman.

The UK’s comprehensive advertising restrictions on tobacco products were passed before HTPs existed, so PMI had marketed HTPs more aggressively and openly than they could for cigarettes, said Cheeseman.

When the UK government challenged PMI, they undertook to suspend marketing – but there are  numerous pop-up promotions of IQOS.

Questionable industry claims

“We are often told by the industry that heated tobacco products are a scientifically backed better alternative for adult smokers. But our own research shows us that we should be questioning whether, in fact, they are better for health,” said Braznell.

We’ve brought up questions and concerns about the quality of the available evidence, as well as other research that we’ve done over the last few years, which has shown that the tobacco industry continues to manipulate and misuse science for profit. 

“Work of our colleagues around the world has shown that many heated tobacco product users are not successfully quitting smoking using these products, and in fact, are perpetually continuing to use both heated tobacco products and cigarettes. 

“And lastly, we know that again and again, the tobacco industry is not just marketing heated tobacco products at smokers, but also to non-smokers and children.”

Image Credits: Filter, PMI.

A support group for HIV positive mothers in Zimbabwe. With massive aid cuts, medicines and support for people with HIV are under threat.

As Donald Trump’s US presidency reaches its 100th day, Zimbabweans living with HIV are fearful about their futures as they struggle to get antiretroviral medication.

MWENEZI, Zimbabwe – Memory Sibanda tried three times to get antiretroviral medication from her usual clinic in February but was turned away.

The 67-year-old has lived with HIV for the past 28 years. Jobless and widowed since 2003 when her husband succumbed to AIDS, Sibanda is unable to afford to buy the medication should the government fail to supply it.

She finally received a three-month supply in late February – half the usual allocation – and is anxious about what will happen when this runs out.

“I don’t know if this reduction of our treatment pills is happening only here in our village. Nurses don’t say anything to us about what is happening with the pills. I fear we might eventually end up not receiving the drugs at all, meaning many of us might die,” Sibanda, who lives in Chomutsvairo village in the southern province of Masvingo, told Health Policy Watch.

In the capital, Harare, a similar crisis faces HIV/AIDS patients. Mavis Makumbe, 65, has depended on free ARV treatment from the government for decades. But in late February, her whole life changed when she visited the New Start Centre in the city to fetch her medication.

“I found a notice on the door saying it was closed and no longer in operation. From there, I went back home and started taking the remaining tablets, but those again were not enough,” said Makumbe, a widow who has lived with HIV for 24 years.

Fortunately, her daughter’s friends rescued her by buying six months’ allocation of ARVs. The current going rate is $20 for a month’s supply – a fortune for the average Zimbabwean, with 80% of people working in the low-income informal sector and battling huge inflationary costs each month.

This is unsustainable for Makumbe, who is also battling cancer on one of her legs.

HIV positive prisoners also told Health Policy Watch that medicines are scarce.

“Not so long ago, we were being given rations of limited ARVs. Things are now worse after America has stopped giving us aid. Even painkiller pills are now hard to find in jail,” said an HIV positive prison inmate at Chikurubi Maximum Prison in Harare.

Trump aid cuts

The ARV shortage was caused when US President Donald Trump suspended all foreign aid for 90 days with immediate effect on 20 January. The Trump administration has since disbanded the US Agency for International Development (USAID), and extended the aid cut for a further 30 days until 20 May.

“We were put in a very tough situation by the aid cut by President Trump’s government,” said Stanley Takaona, president of the Zimbabwe HIV/AIDS Activist Union Community Trust.

“The aid cut-off was a bit harsh. We are praying that both our government and the US government will put on a humanitarian face and save our lives, as people living with HIV,” added Takaona, 62, who tested HIV positive at the age of 34 and started taking ARV treatment in 2001.

The government’s pre-exposure prophylaxis (PrEP) initiative targeted at people with high exposure to HIV like sex workers has also been suspended amid the Trump administration’s global aid cuts.

In 2022, an estimated 1.3 million Zimbabweans were living with HIV, and 1.2 million were on ARVs – yet their medicine supply is now in jeopardy.

Progress under threat

Zimbabwe has made significant progress against HIV, and in 2023 it became one of only five African countries that achieved the 95-95-95 targets set by UNAIDS, with an estimated 95% of people with HIV aware of their status, 98% on treatment, and 95% of those on treatment having suppressed viral loads.

This is according to the United Nations Development Programme (UNDP), which has been the main recipient of the country’s Global Fund grant since 2009.

But with the US abandoning its commitments to combat the deadly virus abroad, activists like Sphiwe Chabikwa sees the gains made in fending off the disease being reversed.

“We are at risk. People may start dying again like what happened around 2000 and 2002 before ARVs were made available to everyone with HIV. I’m afraid,” said Chabikwa, who lives in Harare.

Chabikwa is a member of the Zimbabwe National Network of People Living with HIV (ZNNP+), the country’s network of people living with HIV.

For the past 25 years, Chabikwa has lived with HIV, and her steady access to ARVs has enabled her to manage the virus as a chronic disease.

“I get the second-line of antiretroviral treatment, but that again has had its supplies affected by the recent US aid cut. Instead of people living with HIV like me getting six months’ supplies of ARVs, this has now been reduced to three months’ supplies. That means the treatment drugs are in short supply and the authorities are trying to manage a crisis.”

Health experts predict that all the gains Zimbabwe made in defeating HIV might go to waste following the abrupt withdrawal of US aid.

Long queues now characterise the collection of HIV treatment, and patients are fearful about what the future holds for them.

Wilkins Hospital in Harare has stopped offering HIV tests and antiretroviral drugs since the US cut its aid to Zimbabwe.

Bribes for medicine

Fearing a future without ARVs, some other HIV patients admit to bribing nurses in order to get six months’ allocation of ARVs.

“Many HIV positive people in my area, including myself are now bribing nurses at local clinics in order to get the usual six months allocation of treatment drugs,” said a resident from Harare who asked to remain anonymous.

Zimbabwean nurses stationed at clinics distributing ARVs have capitalized on the patients’ fears.

“It’s our time to make money from the desperate HIV patients because our salaries alone can’t sustain us and so, with the now scarce ARVs, we just put a small fee on them for our own benefit in our backdoor deals with patients,” said a nurse at one of the clinics in Harare who spoke to Health Policy Watch on condition of remaining anonymous.

Authorities deny crisis

Yet the Zimbabwean authorities have denied that ARVs have run out. During a parliamentary question-and-answer session in February, Health Minister Douglas Mombeshora assured the nation that access to HIV treatment will continue despite global aid uncertainty.

Mombeshora claimed that Zimbabwe has secured enough stock of antiretroviral (ARV) drugs to last for the next six months. 

Despite the Minister’s assurance, HIV patients have seen their treatment allocations reduced and those living with HIV fear the worst.

However, the Zimbabwean government is developing an HIV sustainability plan to address long-term funding issues and mobilising domestic resources to maintain priority HIV programmes, according to a UNAIDS report released on 31 March.

Over the past five years, the US provided over $1 billion Zimbabwe to combat HIV.

Before widespread access to ARV therapy in Zimbabwe, AIDS was a leading cause of death and estimated 130,000 people dying from HIV-related complications in 2002 alone, according to UNAIDS.

The availability of ARVs significantly reduced AIDS deaths, with the death toll dropping to around 20,200 by 2021, according to UNAIDS. Adult HIV prevalence has fallen from its peak of 26.5% in 1997 to 11.9% in 2021.

Call on government to step up

Olive Mutabeni, executive director for Life Empowerment Support Organization (LESO), a community-based HIV/AIDS organization in Zimbabwe, has challenged authorities to step up and purchase ARVs.

“There is a need for the Ministry of Health and the National AIDS Council to address this issue of ARVs supplies urgently before we lose people,” said Mutabeni.

Mutabeni, aged 64, started taking ARVs in 2009 yet 16 years later, she is unsure of her access to treatment: “I am worried that many HIV patients like me might soon perish like flies.”

The permanent discontinuation of HIV programmes currently supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR) would lead to an additional 6.6 million new HIV Infections and additional 4.2 million AIDS-related deaths between 2025 and 2029, according to UNAIDS modelling.

 

Image Credits: DFID, Jeff Moyo.