“Health is not charity. It is sovereignty,” Dr Olive Shisana at CPHIA closing day.

DURBAN, South Africa — The “Durban Promise”, the ambitious outcome document of the Conference of Public Health In Africa 2025 (CPHIA) will be on the menu when global leaders meet at various Group of 20 (G20)  meetings, starting with the health working group meeting on 6 November.

That was the message from the conference, which closed on 25 October, with a pledge from its convenors to keep pressing for universal health coverage (UHC) at the next G20 meeting, capitalising on South Africa’s presidency. 

Along with UHC, the CPHIA outcome document cites five key priorities as “pillars of Africa’s Health Sovereignty”. Those include: African manufacturing; innovative health financing; pandemic preparedness and response; and data ownership and governance.

“The Durban Promise and continental commitments is what we are taking out of this conference. From Durban, a unified message resounded across Africa: Health is not charity. It is sovereignty. It is our political choice, and our economic future,” declared Olive Shisana at Saturday’s conference closing ceremony. Shisana, the first director-general of South Africa’s Department of Health under Nelson Mandela, is now president and CEO of the private health research firm, Evidence-Based Solutions.

Shisana said the Durban Promise priorities aim to transform Africa from a “passive recipient” to a “strategic contributor” in the health arena. 

“This marks the birth of Africa’s health sovereignty movement, turning crisis into opportunity and aspiration into action,” said Shisana, who co-chaired the conference’s scientific programme committee and received at the weekend its Distinguished Scientist Award for her work helping to host the annual event since its 2021 inception.   

“It will manufacture vaccines, finance systems, strengthen its primary health care, prepare for pandemics, empower its people and own its data,” she told participants at Saturday’s closing session.  Co-sponsored by Africa Centres for Disease Control, the Government of South Africa, Gavi the Vaccine Alliance, and others, the conference attracted more than 1400 in-person and 16530 livestream participants, with more than 70 countries represented. 

Important financial juncture 

Official Development Assistance (ODA) for health is projected to fall back to mid-2000 levels by 2027.

The conference comes at an important financial juncture as Shisana and others reminded participants.

Global health funding to Africa has nosedived, part of a 70% decline in international development assistance between 2021-2025, according to an Africa CDC brief released in April. 

The US shuttered USAID and with it, most of its global health aid programmes, earlier this year.  Major European donors such as Germany and the United Kingdom have also reduced contributions, shifting resources towards the Russia-Ukraine war. Meanwhile, African countries struggled to plug the funding gap, crippled by obligations to pay interest on mounting debt burdens. Official Development Assistance for health (ODA) is projected to continue to decline and could even fall to mid-2000s levels, said the OECD in June. 

What should be done about this precipitous funding drop was a recurring theme at plenaries, special sessions and panel discussions over the course of the five-day conference. 

Shisana, echoing many others, said “Africa must pack away its begging bowl” and find other means to foot its healthcare bills. 

A constant refrain was that when donors do contribute, they must work through the health ministries and treasuries of national governments; they must respect African sovereignty.

“Africa is no longer content to be just being on the side of the global response; we should now shape global health priorities. [The conference] should indeed affirm that our destiny must be African-led, African-financed and African owned,” asserted Joe Phaahla, South Africa’s deputy minister of health.

The hard part — where is the money to come from?

“Sin taxes” on tobacco, alcohol and sugar-sweetened beverages and fewer subsidies for fossil fuels could help narrow the UHC funding gap.

There was no let-up in that message throughout the event – “nothing about us without us”. 

But the hard part — where the money is to come from — and how to get more of it, did not yield easy formulas. 

Various strategies for tapping into the African diaspora were proposed. Collectively,  African nations can boast the third most populous diaspora after India and China. 

Other ideas revolved around the levying of new or better taxes on emerging or overlooked revenue sources. These include the growing informal economies in urban Africa and digital economies. 

‘Sin taxes’ got a look-in too, with some speakers advocating the ring-fencing of revenue from new levies on alcohol, tobacco and sugar so that these can fund health.

There also were discussions on how to grow African economies to expand the fiscal pie, so more funds would be available for competing domestic needs. 

While some speakers deferred to economists to spell out how this might best be achieved, it was agreed that Africa remained heavily dependent on extractive activities, notably mining, with too-little capacity to create value-added from its rich natural resources, robbing the continent of vast export revenue that ought to be funding health.

Shisana mentioned inter-Africa free trade, especially in health products and medicines, as an under-realized opportunity to spur growth and improve public health supply chains.

“If all of us in Africa were to trade across our borders,” economies across the board would be in much better shape, she declared. “We’ve got a big market of 1.4-billion people. There is no reason that Africa should be poor.” 

Less waste and corruption  

Placide Mbala, scientific programme co-chair, shares his priorities for African health on closing day.

Along with the talk about eking out new income sources and tax revenues to underwrite health spending, there was perhaps even more talk on how money being spent could be used more efficiently or redirected. In other words, less waste and corruption.

At the closing,  Placide Mbala, CPHIA’s scientific programme co-chair, summarized takeaways from the event’s eight tracks — broadly themed areas of discussion.  His comments echoed the priorities cited by The Durban Promise, with some special twists.  

For one, he stressed the importance of putting the roles of Community Health Workers on a more formal footing, and involving them in planning, with dedicated budgets and frameworks that recognised them — as part of PHC reform.

Mbala said that the primary health discussions at the conference had also identified the importance of grounding “all interventions in local ownership”.

Ibanga (MAB114), a monoclonal antibody, is one new African-born treatment. Discovered by Congolese scientist Prof Jean-Jacques Muyembe, Africa CDC is supporting its deployment against Ebola.

Solutions must be found that “require domestic investment, data-driven decision-making, and partnerships that position communities as co-designers and sustainers of their own healthcare systems, not passive recipients”, said Mbala.

“When communities lead, services become more equitable and scarce resources are used when they matter most, again reducing costs,” he concluded, quoting Paul Ngwakum, regional health adviser at UNICEF’s Eastern and Southern Africa regional office: 

Zambia’s Christine Kaseba also stressed that primary health care contained the key to unlocking many of the difficulties facing the public health sector in Africa, including its funding crisis.

“We are stuck because we are yet to understand that primary is fundamental to achieving universal healthcare,” said Kaseba, a specialist in gynecology and obstetrics as well as a prominent Zambian politician and the widow of the country’s late president Michael Sata.

Digital innovation and AI 

Satellilte technology in rural Guyana enables high-quality telehealth consultations. Africa aims to develop similar systems.

In terms of digital innovation and artificial intelligence – another Durban Promise priority,  the opportunities technologies may create to provide better services at less cost  loomed large. 

Everyone agreed that digital technology can  provide the solution to many logistical difficulties faced in hard-to-access rural areas, opening up  better, faster, and cheaper patient monitoring and disease surveillance.. 

But there was also a call for focus on health worker digital and AI literacy, with delegates cautioning that new tools need to be well embedded  into existing workflows, rather than assuming that technology alone would drive success.

In the same track, Caroline Mbindyo, chief executive of Amref Health Africa echoed another recurring conference theme:  healthcare as an investment rather than a cost.

“In Africa, we rarely view the health sector as a place for investment or innovation. We need to think differently about how we design digital tools, creating systems that not only improve health outcomes but also provide commercial value,”  Mbindyo said.

African manufacturing and youth engagement 

Youth Programme booth at CPHIA 2025
Jean Kaseya, director Africa CDC.

As for African manufacturing, panelists summing up the discussions on that topic on  closing day all agreed that more political will is needed to foster manufacturing capacity and to provide the necessary investments in skills, infrastructure and technology. 

And while calls for strengthening regulatory measures to safeguard patients and ensure confidence in African health products resonated, manufacturers also stressed that  regulatory bottlenecks were preventing drug makers from realising their potential.

“We can’t wait six years to bring a product to market. We need WHO and national regulators to align and fast-track African innovation,” said Stavros Nicolau, a senior executive at South Africa’s Aspen Pharma Group. 

And Serge Emaleu, a Gabon-based epidemiologist, reminded the audience that without local production Africa will continue to react to crises. 

“The boldest choice Africa can make is to exercise political courage, the political courage for taxing fairly, spending wisely and pooling regionally and collectively for the collective good,” said Emaleu, who is with the Economic Community of Central African States (ECCAS) .

Dr Jean Kaseya, director-general of Africa Centres for Disease Control and Prevention (Africa CDC), the conference’s principal host, highlighted the importance of youth engagement and mentioned the launch at the conference of the YES! Health Youth initiative, in collaboration with conference co-hosts, AfricaBio, a non-profit biotechnology stakeholders association.

The next Conference of Public Health In Africa conference is to be held in Addis Ababa, Ethiopia in November 2026, Kaseya said.

Image Credits: CPHIA 2025 , OECD, 2025 , World Bank, 2019, CPHIA, 2025, Africa CDC , @TuwilikaNafuka.

WMO marked 75th year of operations with a push for countries to ramp up early warning systems as climate impacts intensify.

Of the 62 countries who were assessed globally, only half have the basic capacity to monitor extreme weather events, and 16% of the countries have less-than-basic capacity, according to a new report by the World Meteorological Organization (WMO).

The report, ‘Early Warnings for All in Focus: Hazard Monitoring and Forecasting’ was released during last week’s Extraordinary Session of the WMO Congress (October 20-23), found the situation is worst in fragile, conflict and violence-affected contexts.

But there is also some progress. The land-based stations that record weather data have increased the observations and daily reports that they share with WMO by 60% since 2019, the report documented. More data helps with faster and more accurate weather forecasting.

WMO is focusing on early warning systems for all countries around the world by 2027 as a part of its ‘Early Warnings for All’ initiative. “Without your rigorous modelling and forecasting, we would not know what lies ahead — or how to prepare for it,” the UN Secretary-General António Guterres Secretary-General said at a dialogue during the Congress.

“Without your long-term monitoring, we wouldn’t benefit from the warnings and guidance that protect communities and save millions of lives and billions of dollars each year,” he added.

This year marks the 75th year of the UN weather agency. Apart from the discussions on early warning system, a special session of the WMO governing body, the Executive Council,  on Friday saw deliberations on finance and future investment strategies at a challenging time for the global development sector, which is plagued by a decline in donor contributions.

Countries struggling to keep up with weather data

Of the 62 countries assessed by the WMO for their capacity to collect weather data for forecasting of extreme weather events, 16% had less-than-basic capacity.

Climate change is increasing the frequency of extreme weather events. But better forecasting makes it more possible to predict many of these, including heat waves, cold waves, heavy rainfall, droughts and cyclones.

Even so, the capacity to do this remains low, particularly in Least Developed Countries (LDCs) and Small Island Developing States (SIDS), according to the report.

For countries with low capacity and gaps in their own system, WMO provides support. Currently 85 countries are receiving forecasting for severe weather conditions from the WMO of the 193 member countries.

Related to that, access to satellite data and other technologies also remains limited in many parts of the developing world.

Globally 56% of members now use satellite data for at least one hazard, but only 20% do so for all their priority hazards. Regional partnerships are helping plug some of the gaps by combining hardware, training and institutional capacity-building that is tailored to regional needs.

“The success of ‘Early Warnings for All’ is not measured in reports or resolutions, but in lives saved and livelihoods protected. This report is both a record of progress and a call to action,” WMO Secretary-General Celeste Saulo wrote in the report’s Foreword.

“It shows that global solidarity, guided by science and driven by partnership, can deliver transformative change. As we look toward 2027, let us redouble our efforts to ensure that no one — no matter where they live — is left unprotected.”

Staff changes at WMO amidst funding challenges

Top funders of the WMO ‘Early Warnings for All’ initiative in 2025.

While the US is one of the top funders of the WMO report ‘Early Warnings for All’, the new Trump administration has meanwhile slashed funding to its own weather agency National Oceanic and Atmospheric Administration (NOAA).  The dismantling of United States government’s aid agency, USAID, also has affected the collection of weather and climate data globally.

The US is yet to pay WMO the amount it had committed for the years 2024 and 2025. The WMO Secretariat did not name US explicitly during the finance discussions on the final day of the Congress but acknowledged it was a “challenging time for funding.”

To the relief of some observers, the United States has so far not withdrawn support from the meteorological agency.  In last week’s sessions, the US representative played a “very constructive” and “positive” role, according to Clare Nullis, WMO’s media officer.

“The US is… still very active member of WMO. We need their support. We count on their support. And the US also needs WMO in terms of observations, data sets. Obviously, it’s an area that we are watching very, very closely,” Nullis said in response to a question from Health Policy Watch at a Geneva press conference during the Congress.

The US did make a push for striking a reference to the Paris agreement in a key document on global greenhouse gas emissions, but it did not go through, given the pushback from other countries.

So far, Washington has also not sought to openly challenge WMO’s growing role in monitoring climate – which effectively is long-term weather patterns. This despite the cutbacks at NOAA as well as recent moves to defund and dismantling some of the most powerful US climate monitoring tools.

Those slated to be decommissioned before their time include  NASA’s Orbiting Carbon Observatory-2 (OCO-2), which measures atmospheric carbon dioxide, and can identify sources and sinks from space. Another is OCO-3—not technically a satellite, but an instrument that has been affixed to the International Space Station—which also measures atmospheric carbon dioxide.

SAGE 3, short for Stratospheric Aerosol and Gas Experiment, which measures stratospheric ozone, aerosols, and water  vapour, is also in the administration’s crosshairs, as is Deep Space Climate Observatory, or DSCOVR, a joint project of NOAA and NASA. The budget proposal also recommends shutting down the development of the next generation of satellites and space instruments for Earth science, measuring storms, clouds and aerosols, among other phenomenon, according to the prestigious US-based journal, Bulletin of the Atomic Scientists.

2026-27 Budget allocating more money to activities and trimming staff

WHO revised its budget for 2026-27, cutting staff budget to give it more flexibility to invest in research and other costs.

In contrast to the World Health Organization, WMO’s neighbour at the UN campus in Geneva, the WMO said it did not plan to drastically cut its 2026-27 budget, which is planned for $138.7 million.  However, the organization is realigning its spending, Nullis said, with funding allocated to staff being cut by 7.2% and allocated to “other costs” to increase the agency’s “flexibility.”

Several senior (D2) roles have been eliminated and new roles created that will focus on regional coordination and digital transformation to help improve the efficiency of WMO’s operations while using lesser resources.

WMO has also set up a task force that will identify areas of priority for the organization going further.

While voluntary contributions from other donor countries and foundations have helped close the 2026 budget gap, 2027 looks more uncertain, Saulo admitted.

“I would also like to appreciate those countries that have been supporting us with voluntary contributions and also have been advancing their payments to facilitate navigating these difficult times,” Saulo said at the Congress, adding. “In a world where we are facing challenges, …. the idea is that we will try to look for extraordinary or extra budgetary funds to allocate to the regions.”

Image Credits: WMO, Early Warnings for All in Focus: Hazard Monitoring and Forecasting report.

A young patient with diabetes attends a check-up in Kigali, Rwanda. Rwanda is trying to improve chronic disease treatment in primary health care as part of its 4×4 initiative to quadruple its health care workforce between 2023-2027.

Africa is continuing to make progress in meeting its Universal Health Coverage (UHC) targets (part of the United Nations’ Sustainable Development Goals). Countries like Rwanda and Ethiopia are two examples of African countries making exemplary progress. Kenya, Ghana and South Africa are also among those making significant progress towards realising this dream. However, there is still a long way to go if the continent is to achieve its target on the Service Coverage Index by 2030. The continent’s average on the scale of UHC rose from 23 in 2000 to 44 in 2021, still only halfway to its projected goal.

Accelerated progress toward UHC is possible, however, it requires an initial step; resilient primary health care (PHCs) systems.

Why primary health care systems matter

Mother and young child in clinic in Sudan. Primary health care is the anchor to Universal Health Care (UHC).

Those who are most vulnerable across our continent – women, children, and under-resourced communities – continue to be at risk. Each year, approximately  70% of global maternal deaths occur in sub-Saharan Africa, with an estimated 178,000 mothers and 1 million newborns dying each year, many from preventable illness.

For too long Africa has focused on addressing individual diseases, largely a result of international donors and their priorities. The result is a fragmented system that misses the opportunity to provide more streamlined, holistic care through robust primary care systems.

Primary health care (PHC) systems provide essential services ranging from prenatal care and child vaccines to other life-saving treatments. They are frequently the only times many people and communities receive health care. Over 60% of the continent’s population lives in rural areas, where primary healthcare facilities are often the only available health service. Put simply, without strong PHC systems, universal health coverage will not be achievable.

This week, Africa’s leading health experts have convened at the 4th International Conference on Public Health (CPHIA) in Durban, South Africa to explore the theme: “Moving towards self-reliance to achieve universal health coverage and health security in Africa”. In those discussions, health leaders are sharing ideas to support and shape more innovative, dynamic, and visionary PHC systems in Africa.  See related story.

Africa Seeks More Self-Reliance Amid Disease Outbreaks and Decline in Donor Funds

Supporting PHC infrastructure through innovation

The 2020 pandemic exposed a critical gap in the public health sector: the infrastructure needed to support resilient primary health systems. Countries buckled under the clinical demands of COVID-19, which were exacerbated by the lack of basic commodities in many healthcare facilities.

Electricity
Nearly one-eighth of the global population does not have access to health facilities with reliable electricity, with the highest rates of energy poverty in Africa.

A 5-year study conducted in Sub-Saharan Africa from 2013 – 2018 found that over 40% of PHC facilities lack clean water. Some 15% of Sub-Saharan health facilities have no electricity at all while an estimated 50% lack reliable electricity services. Another study of health facilities across 18 sub-Saharan African countries also found that only 74% of health facilities had basics like soap, running water, or alcohol-based hand rub. The result is that only 17% of facilities could ensure infection prevention protocols. These are the same facilities that were on the frontlines of the deadly pandemic two years later. And beyond these infrastructure issues is a human resources crisis: Africa has only 1.3 health workers per 1,000 people, which sits well below the WHO minimum threshold of 4.5.

To ensure everything from surgeries to childbirth can occur safely, investing in robust PHC system infrastructure is a must. We are starting to see the deployment of African-made technology, from solar-powered clinics to smart water systems. Our technology can power the pathway forward.

The private sector can step up as a partner

Nurse calls an expert on videoconference in a patient consultation. Telehealth and AI can improve access to services and their quality.

This is where the business community has a critical role to play. Across the continent, the private sector is increasingly stepping up as a partner in delivering stronger and more resilient primary health care systems. Businesses are investing in digital tools, data systems, and supply chain innovations that help extend quality services to communities that public facilities alone cannot always reach. In Kenya, for instance, the rapid growth of homegrown telehealth platforms and mobile-based health insurance models has expanded access to consultations and coverage, particularly for peri-urban and rural areas. Similar collaborations are emerging in Nigeria, where private logistics companies are supporting vaccine delivery to last-mile clinics. These examples show how Africa’s business community can be an active force for progress – bridging gaps, driving innovation, and strengthening partnerships that make universal health coverage and health security truly attainable.

Primary health clinics with digital health record systems have been shown to deliver higher quality care. For example, a study at Festac Primary Health Centre in Lagos, Nigeria, found that introducing electronic health records significantly reduced paperwork and improved service delivery, freeing health workers to spend more time on patient care.

African innovation can further power PHC infrastructure by supporting the training demands of the health workforce today and in the future. The WHO estimates a shortfall of 6.1 million healthcare workers in Africa by 2030. This gap poses a major barrier to achieving universal health coverage. Remote medical training distributed through mobile devices can help make opportunities for frontline health more accessible and affordable. These tools can help incentivise young professionals to pursue health careers and close this critical workforce gap in PHC systems. Another example is Kenya’s M-JALI platform, which has trained thousands of community health workers via mobile devices, improving service delivery and making health careers more attainable.

CPHIA 2025 and beyond

We stand at a time where innovation and necessity are converging, giving Africa the chance to rewrite its health story and build a future where all Africans have access to quality healthcare. Achieving this demands bold, cross-sector partnerships that strengthen primary health systems to meet Africa’s evolving health challenges. Universal health coverage isn’t some far-off goal. It’s something we must start working toward today.

Dr. Amit N. Thakker, is executive chairman, Africa Health Business, which facilitates collaborations acros sAfrica between governent, businesses and communiites on the development of better tools for community health care.

 

Image Credits: G Lontro/ NCD Alliance, WHO/Lindsay Mackenzie, DC Studio on Freepik.

A doctor checks the amputated limb of a young man in Gaza. Some 5,000 Palestinians have lost limbs as a result of the war.

At least $7 billion is needed to rebuild Gaza’s health system, which has no fully functioning hospitals, and critical shortages of essential medicines, equipment and health workers, World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday.

While Tedros welcomed the ceasefire negotiated by US President Donald Trump on 10 October as “the best medicine”, he portrayed a grim picture of the impact of Israel’s attack on the territory in retaliation for Hamas’s attacks on 7 October 2023.

“More than 170,000 people have injuries in Gaza, including more than 5,000 amputees and 3,600 people with major burns,” said Tedros.

“At least 42,000 people have injuries that require long-term rehabilitation, and every month, 4,000 women give birth in unsafe conditions. Hunger and disease have not stopped, and children’s lives are still at risk.”

Dr Tedros Adhanom Ghebreyesus.

The WHO’s immediate focus since the ceasefire took effect has been on sending medical supplies to hospitals, deploying additional emergency medical teams and scaling up medical evacuations. 

Around 15,000 patients need specialist treatment outside Gaza, including 4,000 children, and Tedros appealed for more countries to assist in their treatment and for referrals to the West Bank, including East Jerusalem, to resume.

In the coming days, the WHO will focus on four areas: maintaining life-saving and life-sustaining essential health services; strengthening public health intelligence, early warning and prevention and control of communicable diseases; coordinating health partners; and supporting the recovery, rehabilitation and reconstruction of the health system. 

“Our 60-day ceasefire plan calls for $4.5 billion, but the total cost for rebuilding Gaza’s health system will be at least $7 billion,” said Tedros.

Israel obliged to ensure Gaza’s ‘basic needs’

Dr Theresa Zakaria, WHO unit head for humanitarian and disaster action.

On Wednesday, the International Court of Justice issued an advisory opinion that Israel, as Gaza’s occupying power, is obliged to “ensure the basic needs of the local population, including the supplies essential for their survival” and “not to impede the provision of these supplies”.

However, the Rafah Crossing between Israel and Egypt remains closed, although Israel had agreed to open it last week.

Dr Rik Peeperkorn, WHO’s Representative in Occupied Palestinian territory (oPT), said that while the Kerem Shalom and Kissufim crossings between Israel and Gaza were open, the flow of aid was too slow and opening the Rafah passage between Egypt’s Sinai and Gaza is “urgent”.

Since the ceasefire, the WHO has been able to bring in one of 39 pallets of vital supplies, but it still has 2,100 pallets of medical supplies ready to move, said Peeperkorn.

Less than half the 600 agreed-on daily number of trucks have been able to enter Gaza since the ceasefire, which meant that people were not getting the food they needed, said Tedros.

“Over 600,000 people in Gaza are facing a catastrophic level of food insecurity. It is our collective duty to also make sure they do not lose their lives because we have not been able to scale up the aid at the level that we require,” stressed Dr Theresa Zakaria, WHO unit head for humanitarian and disaster action.

30% polio budget cut threatens progress seen to date

A Pakistani health worker administers a polio vaccine in a door-to-door campaign in a sensitive region of the country. Such outreach is critical to eradicating wild poliovirus in the regions where it remains endemic.

Tedros also took up the new challenges faced in polio eradication, noting that Friday, October 24, is World Polio Day. Polio incidence has dropped by 99% since 1988, when the Global Polio Eradication Initiative was launched by WHO, with the United States, Rotary International and UNICEF as founding partners.

“When we launched the Global Polio Eradication Initiative (GPEI),  more than 350,000 children were paralysed by polio every year,” Tedros noted. “Today, that number has dropped by more than 99%.” Just 39 cases of wild poliovirus have been reported so far this year, 9 in Afghanistan and 30 in Pakistan, according to the latest WHO and GPEI data.   

However, that progress is also threatened today by the 30% budget cut that GPEI will see next year.  The 2026 budget of $786.456 million was  released on 13 October,  following a New York City meeting of GPEI partner agencies. That’s as compared to $1.1 billion in 2025. There is also a $1.7 billion funding gap for the GPEI 2022-2029 strategy,  revised last year.

The budget cuts include a 26% reduction for outbreak response, and a 34% reduction in surveillance activities in WHO’s African Region and the Eastern Mediterranean regions outside of Pakistan and Afghanistan – the two countries where wild poliovirus continues to be transmitted. These two countries remain, according to WHO, the highest priority “as they are key to a polio-free world.”

Cases down this year in Afghanistan and Pakistan

Polio worldwide

Both Afghanistan and Pakistan have so far seen a decline in cases this year, with 30 cases of wild poliovirus recorded in Pakistan – as compared to 74 in 2024. Afghanistan’s Taliban regime conducted their first polio vaccination campaign in April  2025, and as of 22 October,  just nine cases had been confirmed in the country as compared to 25 in 2024, according to GPEI.

However, along with budget cuts, devastating floods and the recent earthquakes in Afghanistan have hampered continuing surveillance, as well as the Taliban’s continued suspension of door-to-door campaigns as well as the ban on female health workers delivering vaccines.

In other lower risk areas, “more extensive active surveillance, supervision and training, will need to be reduced,” the plan states, warning that these countries, particularly in low-income countries in Africa,  “face the greatest risk for surveillance gaps that may lead to missed transmission and delayed outbreak response.”

Those cuts could affect detection and response to outbreaks like the wild poliovirus outbreak detected in Malawi and Mozambique in 2022 – beginning with a case that had reportedly been imported from Pakistan several years earlier, and leading to a mass vaccination campaign. Currently, there are ongoing outbreaks of circulating vaccine-derived poliovirus (cVDPV) in the Lake Chad Basin and the Horn of Africa. Madagascar officially ended its cVDPV1 outbreak in May 2025. Circulating virus type 3 (cVDPV3) has also been detected in the last 12 months in Algeria, Cameroon, Nigeria, and Chad.

Vaccine-derived cases are the main concern in the world today, occuring when unvaccinated or undervaccinated groups are exposed to live virus shedded by other, vaccinated people through contact with feces or sewage.  Poliovirus is still found in the sewage of WHO’s European and American regions – with vaccine-derived cases periodically surfacing in those regions too. While new, more genetically stable oral vaccine formulations are gradually being introduced to limit vaccine-derived cases, they are not a magic bullet. 

Dr Ahmed Jamal

US Congress pledging continued support but….

Leading Republican members of the US Congress  have pledged to continue supporting polio elimination efforts in 2026, at the same level as this year’s $265 million. However, it’s unclear how the money will be distributed insofar as USAID, one major channel, has been dismantled while the United States withdrew in January from the World Health Organization, which typically implemented 40% of the polio elimination programme, while UNICEF handled the other 40%.  The US is today GPEI’s second leading donor after the Gates Foundation, while Rotary International is third.

Tedros and other WHO officials did not discuss the details of how GPEI monies would now be distributed in light of the US freezeout – but stressed that political and geopolitical tensions shouldn’t be allowed to set back progress.

After all smallpox was eradicated in the midst of the Cold War, WHO’s Director of Polio Eradication, Dr Ahmed Jamal, noted: “It wasn’t an easy time. There were so many other conflicts that were going on. So the mission is possible. We all committed to ending polio.”

Added Tedros, “Decades ago, the world overcame geopolitical and geographic barriers to end smallpox. Let’s do the same for polio. Let’s finish the job.”

-Elaine Ruth Fletcher contributed to reporting on GPEI. 

Image Credits: WHO, Pakistan Polio Eradication Program , WHO/GISC.

Aspen Pharmacare’s Dr Stavros Nicolaou

DURBAN, South Africa — A top executive at Africa’s biggest drug company shared a few home truths with the continent’s health policymakers about the obstacles to local manufacturing at the Conference on Public Health in Africa (CPHIA) 2025.

Aspen Pharmacare’s Dr Stavros Nicolaou blamed regulatory bottlenecks and procurement policies for the failure of drug manufacturers on the continent to realise their potential.

“It is unacceptable for African manufacturers to undergo a six-year [qualification] process before you get to market. We can do this in half the time,” he told a conference plenary session on local manufacturing on Thursday.

He is both Aspen’s group senior executive for strategic trade and chair of the industry body, the Pharmaceutical Manufacturers in South Africa.

It is a myth that African manufacturers are uncompetitive, added Nicolaou. For example, Aspen is active in 55 markets, reaches patients in over 150 countries, and is the global leading supplier of generic anaesthetics outside of the US.

Shift procurement

Nicolaou called for a shift in multilateral procurement, including by Gavi, UNICEF and the Global Fund to Fight Aids, Tuberculosis and Malaria.

He told delegates that the establishment last year of the African Vaccine Manufacturing Accelerator (AVMA) was “a start”, but that the accelerator is “not fit for purpose” in its present form.

AVMA is a financing mechanism set up to raise $1.2 billion for manufacturers over 10 years. Nicolaou told Health Policy Watch that this amount  – earmarked for “fill-and-finish” drug manufacturers – was rather modest. 

He feels that there is insufficient incentive to spur the growth of the sector, upon which the future expansion of the medical products value chain depends.

“We can’t have African solutions compiled elsewhere and imposed on Africa. It won’t work.”

Pooled procurement of vaccines, therapeutics and diagnostics must be established “with speed”, he said.

‘Nothing has happened’

Nicolaou noted that more than four years had passed and “nothing” had happened since the African Union and the Africa Centres for Disease Control and Prevention (Africa CDC) announced their ambition to ensure the continent manufactures 60% of its vaccine needs by 2040. 

The AVMA launch came in the wake of the COVID-19 pandemic, which exposed the continent’s 99% reliance on foreign vaccine manufacturers and how its urgent needs were relegated to the back of the world procurement queue.

Nicolaou also responded to comments by South Africa’s Minister of Science, Technology and Innovation, Dr Blade Nzimande, who gave the session’s keynote address.

South Africa’s Minister of Science, Technology and Innovation, Dr Blade Nzimande

Nzimande called for efforts to “build sovereign capacity” in R&D, science and technology, including across the “whole health manufacturing value chain…  be it therapeutic, diagnostic or vaccines we need for our continent”.

He described as “historic” the 60% by 2040 plan to develop tools to secure the continent’s health. He sketched how the initiative sought to expand capacity, implement health standards, and harmonise regulations — all themes elaborated on by other speakers and panellists at the session.

Nzimande toasted the initiative with a glass of water while at the lectern, encouraging his audience to join with applause.

“Government has an important role to play by acquiring locally produced therapeutics, diagnostics and vaccines,” he said.

Serial importer

Nicolaou said he was disappointed that Africa had the highest disease burden yet remained a serial importer and “every year the trade deficit in pharmaceuticals grows”.

South Africa and Egypt have the continent’s largest pharmaceutical markets.

“If you’re talking about security of supply for the continent, South Africa is immensely important. Charity starts at home in that we need to fix our own [national] procurement legislation first,” he said.

“Most of the volumes are procured via the state, and yet we continue to be a serial importer of pharmaceutical products in South Africa. The market is valued at R70-billion (manufacturers’ exit price)… and our trade deficit is more than 50% or around R39-billion.”

There was big potential for local production, yet South Africa continued to import high-volume products like antiretrovirals and vaccines, putting the brakes on local manufacturing development.

“There’s a heavy weighting towards importers, and we now have the data,” he said, citing customs figures, including information on imports from India.

Delegates at CPHIA 2025

Import reliance

“It demonstrates the extent of the problem. So we import significant and vast sums of our antiretrovirals. We have the largest HIV population of any country in the world; 17% of the world’s HIV population; there are about eight million infected people; about 6.6 million on treatment; and yet we continue to import most of our antiretrovirals.”

These imports were growing every year and, apart from antiretrovirals, included other high-volume products such as vaccines, TB medicines, and insulins.

He said this was despite local companies often being price competitive or representing “best value”: an opportunity to grow the local economy through the multiplier effect.

He proposed a three-point plan to remedy matters. First, the introduction of a priority review and parallel submission to expedite the licensing of medicines. The review of drugs by the national regulator should happen at the same time as the World Health Organisation’s review, instead of sequentially, which can add two to three years of costly delays.

Second, increase Gavi subsidies for the local production of vaccines to stimulate the market.

Third, establish a pool for procurement for the entire continent — as was successfully done during COVID-19 — to unlock economies of scale.

African Union leaders signed an agreement with Rwanda’s Ministry of Health to establish the African Medicines Agency’s (AMA) headquarters in the capital, Kigali, in June 2023. Once operational, AMA will harmonise drug regulation across the continent.

Also addressing the plenary, Nhlanhla Msomi, president of AfricaBio, called for a compact with the manufacturing industry to localise innovation.

However, Nicolaou said that it was premature to expect expansion of the value chain.

It was first necessary to support African manufacturers with fill-and-finish products to allow them to develop capacity and grow volume.  In time, they could then invest in extending the value chain.

“Unless you start getting orders and you start succeeding in fill-and-finish first, companies are not going to backwardly integrate into drug [active] substance development,” he said.

Nicolaou said progress was not happening fast enough, and this was sapping momentum to achieve the “60% by 2040” aim.

“There’s a domestic issue to sort out, and then a continent,” he said.

Also at the plenary session, Dr Serge Blaise Emaleu, a global and public health and infectious diseases expert, said sustainable development could shift Africa from being an epicentre of disease to the centre of innovation.

Local manufacture was the “backbone of a sovereign health ecosystem”, but he cautioned that the commitment by African leaders to promote manufacture and invest in research “must be backed by financing” and that governance and leadership were required, and these things must be “moving in lockstep”.

Emaleu identified five interconnected pillars upon which Africa’s R&D self-reliance must be built: linking science to production; funding for research and development; investing in human resources; *building infrastructure and technology, and finally a regulatory framework to safeguard and sustain momentum.

Image Credits: Africa CDC, Rwanda Ministry of Health.

Dancers at the opening ceremony of the Conference on Public Health in Africa (CPHIA) 2025.

DURBAN, South Africa – Is Africa ready for another big pandemic? The answer is a resounding “No”, said Dr Jean Kaseya, Director-General of the Africa Centres for Disease Control and Prevention (Africa CDC).

Kaseya blames this worrying state of affairs on the absence of national public health institutes in some countries, data management difficulties, a lack of laboratories, shortcomings in surveillance and coordination, and the recent sharp decline in donor funding.

Briefing media at the start of the Conference on Public Health in Africa (CPHIA) 2025, which Africa CDC is co-hosting, Kaseya said there had been more outbreaks of disease in Africa in the first semester of this year than in the whole of last year.  

“We are still fragile,” he warned, but added that there were reasons to be upbeat.

The response to outbreaks, while not up to scratch in Africa, has improved since the COVID-19 pandemic.

In Kaseya’s home country, the Democratic Republic of Congo (DRC) “that gets outbreaks every week”, ad hoc committees established to deal with individual outbreaks have been replaced with institutes. This has meant better, quicker responses, benefiting from “institutional memory”, he said.

Further improvements in public health in Africa must be supported by efforts to increase domestic financing, drawing on properly costed, multi-year plans; innovative taxes and the rollout of universal health insurance; local drug manufacture and better connectivity, Kaseya added.

African sovereignty

Africa CDC Director-General Dr Jean Kaseya, at the opening of CPHIA 2025.

In his opening address to the conference on Wednesday evening, Kaseya said African countries need to assume greater sovereignty over their healthcare to secure the well-being of their people. 

The theme of the conference is “Moving Towards Self-Reliance to Achieve Universal Health Coverage and Health Security in Africa”, and sustainable financing and local manufacturing were recurring subjects on the opening day.

Kaseya quoted Rwandan President Paul Kagame as saying that the work to build the continent, including health, cannot be outsourced. 

Africa CDC will deploy 10 public finance experts to 10 countries in November to bridge the gap between the ministries of health and finance.

This initiative must be allied to efforts to strengthen governance, to see that money goes where it is intended, while donors and other partners must align their visions of the countries they support, said Kaseya.

Aligning with national visions

Dr Sania Nishtar, the chief executive of Gavi, the vaccine alliance, spoke to the conference  via video link about her organisation’s determination to redirect more of its funding to Africa and of its desire to ensure it aligns its programmes with the national visions of the individual African countries it is assisting

Kaseya welcomed this, praising Gavi for listening to African voices, and said pressurise other global health initiatives to follow this model.

“We don’t want to hear of a partner coming to a country and implementing a programme without the knowledge of the ministry,” he said, calling for respect.
Kaseya said driving the “manufacturing agenda” to develop and make vaccines and other drugs in Africa was vital to sovereignty.

He pointed out that, in India, there were about 10,000 manufacturing companies making health products, in China, about 5,000, but in Africa, with its growing population, there were only around 570 manufacturers.

Africa CDC is involved in a mapping exercise to better coordinate manufacturing on the continent, supported by efforts to harmonise regulations to make local manufacture more viable, driving down prices and allowing countries to redirect money to primary health.

Kaseya told guests there would be a strong emphasis on science at the conference, which included 113 speakers and 94 abstract presenters, representing 35 countries.

 “We want to see how science can lead the decision-making process,” he said, adding that the aim would be to take conference recommendations to the G20 Health Ministers’ meeting in early November under South Africa’s G20 Presidency. 

The South African government and AfricaBio are co-organisers of the conference, which closes on Saturday.

Global Fund replenishment

Dr Joe Phaahla, South Africa’s Deputy Minister of Health, tackled the thorny question of declining funding from donor agencies and countries.

These were threatening multilateral organisations, including the WHO, UNAIDS, and the Global Fund to fight AIDS, Tuberculosis and Malaria, he said.

On 21 November, the Global Fund will host its final replenishment summit in Johannesburg and seeks “a very ambitious” $18 billion for 2027-2029.

The United States was the Global Fund’s largest contributor, but with US priorities having shifted elsewhere, Phaahla called on African governments and the continent’s private sector to step up and contribute to the fund.

Geopolitical developments were very concerning, said Phaahla, noting that several other countries that had been contributing to the African health initiatives were now focusing on climate change and national security, and this was affecting Africa’s ability to fight epidemics.

Phaahla called on the continent to look for innovative, sustainable funding solutions.

“If we fail to make sure our people can access good quality health services without catastrophic expenditure, we will not have made good progress,” said Phaahla.

Some of the delegates at the opening of CPHIA 2025, which has attracted scientific papers from 35 countries.

Drug discovery

Dr Nhlanhla Msomi, president of AfricaBio, told Health Policy Watch that biotechnology offered an opportunity for African countries to leapfrog other technology-driven industries.

The conference is part of efforts to “decouple sexy science” in “favour of innovations with impact” and that “we as scientists should not be playing with our toys”, said Msomi.

Unless the continent moved away from “borrowed” technology and science, it was not likely to win the public health battle, he said.

Msomi said that his non-profit hoped to work with Africa CDC to roll out a drug discovery platform geared towards developing drugs and products on a priority list.

He said that by working together and sharing infrastructure, the healthcare industry could be transformed to better address African challenges while spurring economic development and entrepreneurship.

Image Credits: Africa CDC.

Alzheimer's Disease and dementia can lead to loneliness in old age.
New research finds that 28% of deaths from Alzheimer’s and other forms of dementia can be attributed to air pollution, which harms brain health across the life cycle.

From killing over 600,000 elderly from dementia to an almost equal number of infants under the age of one-year, air pollution’s impact on young and old is explained simply through hard-hitting numbers in the latest State of Global Air  (SOGA) report, by the Boston-based Health Effects Institute. The report identifies plenty of scope for immediate policy action with multiple benefits for reducing an estimated 7.9 million deaths annually from air pollution. 

Dementia attributable to air pollution resulted in 626,000 deaths in 2023, a new report finds. That is more than one death every minute. 

This is the first time that the State of Global Air, an annual assessment of air quality worldwide, includes information about the burden of dementia attributable to air pollution – including some 28% of total dementia deaths every year.  

The new data is based on the 2023 Global Burden of Disease study by the Institute for Health Metrics and Evaluation (IHME), reflecting the growing epidemiological evidence about the higher levels of dementia disease and deaths in cities and regions that are more polluted.  

Deaths from Alzheimer’s and other forms of dementia attributable to air pollution, per 100,000 people, age standardised, 2023.

“The scientific evidence linking air pollution to increased dementia risk is now strong enough to justify policy action, even as research continues to refine causal mechanisms,” Dr Burcin Ikiz, a neuroscientist at Stanford University, told Health Policy Watch, adding that now, “multiple (studies) have shown consistent associations between long-term exposure to fine particulate matter (PM₂․₅), nitrogen oxides, and other traffic-related pollutants and higher rates of cognitive decline, Alzheimer’s disease, and all-cause dementia.”

Effects on brain health at all stages of life 

Air pollution needs recognition as a ‘brain health’ issue, researchers say.

On both sides of the lifecycle, however, the toll is high. Air pollution contributed to 7.9 million deaths in 2023, including more than five million deaths from a range of non-communicable diseases in older adults. 

But it also kills approximately 610,000 babies under the age of one year old, who are more susceptible to pneumonia and other serious infections as a result of exposures to both fine particulates (PM 2.5), as well as ozone, and other noxious pollutants, mostly as a result of dirty household air as well as pollution outdoors.

“Babies born prematurely or with low birth weight are more susceptible to lower respiratory infections and other serious infections, diarrheal diseases, inflammation, blood disorders, jaundice, and impacts on brain development. If affected babies survive infancy, they remain at a higher risk for lower respiratory tract infections, other infectious diseases, and major chronic diseases throughout life,” the report underlines.

“We can’t say we didn’t know,” said George Vradenburg, founding chairman of the Davos Alzheimer’s Collaborative. “The evidence linking air pollution and dementia is now undeniable – and the story starts long before old age. Brain health begins before birth, shaped by the air a mother breathes and the environment a child grows up in. Policymakers have a chance to act on that science – to protect brain health across the lifespan and improve lives from the very start.”

Most air pollution deaths in lower-income countries

Age-standardized rates of death attributable to ambient PM2.5 in 2023 shows hotspots are in low-income regions.

Most of the 7.9 million deaths continue to occur in lower-income countries, and more men than women died due to air pollution, the latest data also shows.

World Bank Income Group  Number of Deaths Attributable to Air Pollution in 2023 
High income   657,000 
Upper middle income  2.9 million 
Lower middle income  3.7 million  
Low income   642,000 

Source: State of Global Air, 2025.

Exposure to PM 2.5 has actually increased in seven of the world’s most populous countries between 2013 and 2023, the highest being in Nigeria, followed by Indonesia, Pakistan, Bangladesh, India, Brazil and Iran. 

Conversely, the biggest decreases in PM 2.5 exposure were seen in France, China and Germany. 

Nigeria and other countries in dark blue saw the biggest increases in air pollution exposures over a decade, while China and France saw the biggest declines.

Despite massive reductions in ambient air pollution levels over the past decade,  China continues to be the world’s leading air pollution epicentre in terms of overall mortality – due to its sheer size. Other mortality hotspots include India and neighboring countries in South-East Asia along with Egypt and Nigeria.

Due to its sheer size, China continues to have the world’s highest levels of air pollution-related mortality.

There is some good news. Thanks to household air pollution (HAP) declining with the shift to cleaner cooking fuels, related deaths among women and young children who spend the most time around cookstoves, have been reduced. 

The trend has been most marked in India, Ecuador and China, although in parts of Africa household air pollution levels are also going down. In some countries, however, those gains have been offset by rising deaths due to ambient PM 2.5 and ozone pollution. 

Noncommunicable diseases are the cause of most air pollution-related deaths

Air pollution links with leading chronic diseases.

About 95% of air pollution-related deaths in adults over the age of 60 are due to noncommunicable diseases – accounting for 5.8 million deaths in all.

Air pollution, especially small particulate (PM 2.5) exposure, is a leading risk factor for NCDs including: ischaemic heart disease, hypertension, chronic lung disease (COPD) and other lung diseases, as well as lung cancer and Type 2 diabetes. NCDs are now responsible for 65% of healthy life years lost, and 75% of deaths every year, according to the Seattle-based IHME. 

Even short-term exposures when PM 2.5 and other pollutant levels spike over a couple of days can result in health complications, increasing heart attacks, strokes and related hospitalization, as well as reducing the effectiveness of some chronic disease treatments, such as for cancer. 

Impacting on all forms of dementia

Woman with dementia (illustrative)
An estimated 10 million people develop dementia each year.

Exposure to PM 2.5 is associated with Alzheimer’s disease as well as other forms of dementia (e.g., vascular dementia), and mild cognitive impairment in older adults. These disorders can cause problems with thinking, memory, and decision-making, and typically worsen over time.

About 10 million people develop dementia each year, with incidence rising as the global population ages. The economic impact of this disease is estimated at over a trillion dollars a year, since people with dementia are dependent on daily care. A high prevalence of this disease has rippling effects on economic productivity for families and caregivers. Women bear the largest burden, being both more likely to provide care for people with dementia and are more likely to develop dementia themselves.

Asia and the United States are among the countries with the highest levels of air pollution related dementia.

The report explains how air pollution, in particular PM 2.5, causes brain damage. The fine pollutants penetrate the lungs, circulating through the blood stream, and thus flowing to the brain, causing inflammation and brain tissue damage. 

While dementia largely affects the elderly population, air pollution exposure may also impact brain development and functioning in younger people, including an increased risk for neurodevelopmental disorders such as autism and psychological disorders such as anxiety and depression.

Scientists contributing to the report have called for more research on questions such as pollutant-specific effects, critical exposure windows across the lifespan, and risks in under-studied populations, particularly in low- and middle-income countries, where multiple environmental and socioeconomic factors may be harming the brain simultaneously.

Because air pollution affects such a broad swathe of the population in heavily polluted areas, even a small increase in neurodegeneration can have major effects at the societal scale.

Ozone pollution rising

Ozone pollution has risen sharply South Asia and Sub-Saharan Africa, and more gradually in Latin America, North Africa and the MIddle East.

The global average exposure to ambient ozone pollution has steadily increased since 1990, with the average exposure in 2020 reaching 49.8 parts per billion (ppb). At the country level, Qatar (67.6 ppb) had the highest exposure to ozone pollution, with Nepal (67.5 ppb), India (67.2 ppb), Bangladesh (65.4 ppb), and Bahrain (64.3 ppb) making up the remaining top five countries with the highest exposure. 

In the last two decades, the disease burden of ozone has increased by more than 50%, from 261,000 deaths in 2000 to 470,000 deaths in 2023.

Ground-level, or tropospheric, ozone is a pollutant that harms human health, damages plants, and contributes to climate change. It’s seen as a super pollutant, warming agents that are far more potent than carbon dioxide per ton; they have significant, harmful effects on both human health and the environment.

Ozone is formed through chemical reactions between nitrogen oxides, produced by burning fossil fuels, so places with heavy traffic are vulnerable, and volatile organic compounds (VOCs), in the presence of sunlight. 

Multiple benefits from pollution reductions

Green, sustainable urban design can reduce air pollution generating a range of knock-on health benefits.

The report advocates for the multiple benefits of reducing air pollution exposure, including slowing climate change, reducing pollution-related illnesses, improving economic productivity, and healthcare savings. 

This poses an existential question to decision-makers and leaders in their fifties today, but who may also be more personally vulnerable to air pollution tomorrow. How should they factor in SoGA’s findings in their areas of work, many of which no doubt will have a bearing on air pollution emissions?

For example, every dollar spent on reducing air pollution in the United States, which passed its landmark Clean Air Act in 1970, has resulted in approximately $30 in benefits. In Delhi, with a much shorter historical record, the economic value of air pollution abatement still exceeds costs by 2 to 3.6 times, the report stated, citing World Bank data. 

Indeed, the latest SoGA report should further bolster demand for and action towards better air quality, its authors say. 

“Many people in decision-making roles are often at ages where the impacts can be more pronounced. Clean air action is an important way of helping ensure good health and better quality of life for all,” Pallavi Pant, head of Global Initiatives at Health Effects Institute, Boston, told Health Policy Watch. 

“The data presented in the State of Global Air report highlight the significant impacts of poor air quality on the health and well-being of billions of people around the world, especially those living in Asia and Africa,” said Pant, who oversaw the report’s preparation. “We hope this report can further bolster the demand for, and action towards, better air quality where it’s needed most.”

Image Credits: Photo by Steven HWG on Unsplash, IHME/State of Global Air , HEI/State of Global Air , HEI/State of Global Air, HEI/State pf Global Air , Pixabay, WHO.

Keynote speakers at the ‘Make Europe Health Again’ (MEHA) launch: András László,  president of Patriots for Europe Foundation (PfEF) and Hungarian Member of the European Parliament (MEP) ; MAHA leader Dr Robert Malone; PfEF’s Gerald Hauser, an Austrian MEP from the far-right Freedom Party of Austria; Dr Aseem Malhotra and MEHA’s founder and president, Dr Maria Hubmer-Mogg.

The Make Europe Healthy Again (MEHA) launch at the European Parliament in Brussels last week brought together what is now a familiar alliance of far-right politicians, anti-vaxxers and alternative health practitioners. 

Leaders of Make America Health Again (MAHA), the movement behind US Health Secretary Robert F Kennedy Jr, were prominent at the launch, and several are members of MEHA’s steering committee and international advisory board.

The Patriots for Europe Foundation, a right-wing alliance led by the Hungarian government, hosted the launch.

MEHA’s mission is to “nurture a Europe where people reclaim their power, their voice, their health, and their traditions”. 

MEHA’s mission statement adds: “By protecting the essentials of life – clean food, water, air, earth, space, and safe communities – we help to empower nations to build supportive systems that break cycles of chronic disease, promote vitality, and honour culture, sovereignty, peace, and human dignity.”

MEHA’s founder and president, Dr Maria Hubmer-Mogg.

MEHA’s founder and president, Dr Maria Hubmer-Mogg, is an anti-vaccine campaigner and far-right Austrian politician who has opposed European Union (EU) sanctions on Russia and wants tougher immigration policies.

She claims that a large number of people are suffering from “post-vaccine syndrome” since COVID-19, and is opposed to the World Health Organization (WHO).

MEHA’s vice-president is Dutch politician Rob Roos, vice-chair of the European Conservatives and Reformists Group until mid-2024, when his term as a Member of the European Parliament (MEP) ended. 

MEHA lists the Global Wellness Forum (GWF) as its “partner”, and GWF co-founder Sayer Ji is on MEHA’s steering committee.

Ji campaigned against vaccine mandates during the pandemic alongside other GWF leaders, including osteopath Sherri Tenpenny, identified as one of the most prolific sources of anti-vax information on social media during COVID-19. Tenpenny had her medical license suspended after claiming that the COVID-19 vaccine “magnetised” people.

The MEHA 17-person steering committee is dominated by European anti-vaxxers, including Dr Aseem Malhotra.

MAHA leader Dr Robert Malone addressing the MEHA launch.

Seven of the steering committee are Americans, including MAHA leader Dr Robert Malone, who Kennedy controversially appointed to the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) after he fired all 17  existing members.

Malone has promoted several false and alarmist claims about COVID-19 vaccines, and promoted the use of hydroxychloroquine and Ivermectin as SARS-CO-V2 treatments despite numerous studies showing they did not work.

Recently, Malone controversially claimed that an eight-year-old child, Daisy Hildebrand, who died of measles in Texas had died of sepsis and blamed a medical institution for mismanaging her illness. 

Others Americans on the steering committee include Mary Holland, CEO of Children’s Health Defense, the anti-vaccine organisation started by Kennedy; Tony Lyons, MAHA political action committee (PAC) co-chair; Reggie Littlejohn, an anti-abortion and “anti-globalist” campaigner, and Tom Harrington from the right-wing think-tank Brownstone Institute, which became an important bridge between conservative supporters of Donald Trump and anti-vax libertarians during the COVID-19 pandemic.

Australian local councillor Adrian McRae, who campaigned against the COVID-19 vaccine and is known for his pro-Russian views, is also on the advisory committee.

Australian MEHA advisory board member Adrian McRae

‘Totalitarianism’

Speakers at the launch stressed the need to break the influence of the pharmaceutical industry over health, and railed against the “totalitarianism” of “unelected globalist” institutions, including the WHO and the European Commission.

Hubmer-Mogg called for the European Medicines Agency (EMA) to be funded by the EU not pharmaceutical companies. Over 90% of the EMA’s operating costs are covered by fees charged to companies for the evaluation of their applications for marketing authorisation and monitoring the safety of medicines, and for scientific advisory services.

However, MEHA does not want pharmaceutical companies to conduct clinical trials on medicines, although it is these companies that develop and will ultimately profit from new medicines.

“No more conflict of interest, no more concealment of side effects, no more pharma-financed studies,” Hubmer-Mogg concluded.

Malhotra built on this theme, claiming in an hour-long keynote address that “evidence-based medicine… has become an illusion. It has become hijacked by powerful commercial vested interests, and the degree of influence of these commercial interests also means that we have created a pandemic of misinformed doctors and, unwittingly, misinformed and harmed patients”.

Steering committee member Mattias Desmet told the launch that the WHO’s One Health policy was “evidence” of a “globalist institution” trying to impose its one-size-fits-all approach to health. However, One Health simply refers to the recognition that the health of people, animals and ecosystems are closely linked and often need to be addressed together – particularly to prevent zoonotic spillover and growing antibiotic resistance.

During the pandemic, Desmet, a Belgian psychologist, claimed that official government policies on the COVID-19 pandemic were “collective insanity” that he called “mass formation”.

Global Fund chief warns disease now his greatest concern among major killers as new analysis shows 750,000 children at risk. 

BERLIN – The head of the world’s largest malaria funder has issued a stark warning that the disease now poses a greater threat than HIV or tuberculosis, as a new analysis released Tuesday reveals funding cuts could trigger 990,000 additional deaths by 2030, including 750,000 children under five.

“If I think about the situation we face right now on HIV, TB and Malaria, the one that keeps me awake at night is malaria,” Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, told scientists and advocates at the World Health Summit in Berlin last week.

“It’s pretty clear to me that this year more people will die of malaria than last year,” Sands said. “The disruptions in funding have had that impact, and malaria is such an unforgiving disease that it reacts incredibly quickly.”

The report by the African Leaders Malaria Alliance (ALMA) and the NGO Malaria No More UK warns that a malaria resurgence could result in 525 million additional cases and wipe $83 billion from sub-Saharan Africa’s GDP by the end of the decade, killing an additional 165,000 people, most of them children, every year.

“The choice is clear: invest now to end malaria or pay far more when it returns,” said Gareth Jenkins of Malaria No More UK. “Cutting funding risks the deadliest resurgence we’ve ever seen.” 

The findings highlight a critical juncture in the centuries-long battle against a disease that currently claims 597,000 lives annually, with 95% of malaria deaths occurring in Africa and three-quarters of victims being children under five, according to WHO data.

“If we fail to act, malaria could steal Africa’s children, and $83 billion of our future GDP,” President Advocate Duma Gideon Boko, President of the Republic of Botswana, said of the findings.

As the Global Fund prepares for its November replenishment summit in South Africa, the analysis models different funding scenarios ahead of the event, where donors will determine contributions for 2027 to 2029. The Fund channels 59% of all international financing for malaria control, such as mosquito nets, treatment drugs, and vaccines, to low-and middle-income countries.

“We are really at a very momentous time in human history,” said Joy Phumaphi, executive secretary of ALMA. “There are tools that are available that can actually facilitate the elimination of malaria. One of our biggest challenges at the moment is financing.”

Yet the current trajectory suggests the opposite of elimination, the Global Fund chief warned.

“At the moment, what we’re doing with malaria is we’re making malaria sustainable,” Sands said. “We’re spending enough to reduce the number of lives that are being lost, but we’re not actually breaking the transmission cycle.”

“If anything,” Sands added, “it’s going the wrong way.”

‘Pandemic preparedness hats’

Global Fund Executive Director Peter Sands (center) accepts a $1 billion pledge from Germany on the opening night of WHS 2025.

At a pandemic preparedness meeting during the summit focused on potential future disease threats, Sands said he was struck by how much attention novel pathogens receive compared to malaria, which is killing hundreds of thousands each year.

“In many African countries, the biggest health emergency right now is the upsurge in malaria,” he said. “And you’ve got all these people wearing pandemic preparedness hats who are sort of worrying about Marburg and Ebola and all that stuff – which is fine, those are legitimate threats – none of them, if you take a country like DRC, are going to kill remotely as many people as malaria.”

The data on Malaria’s resurgence bear out his assessment. Cases rose to 263 million in 2023, the latest year for which data is available, an increase of 11 million from the previous year, according to the World Health Organization’s 2024 World Malaria Report. 

“The WHO African region still accounts for over 95% of global malaria cases and deaths,” Maru Aregawi Weldedawit, unit head of WHO’s Global Malaria Programme, told the summit by video link. “Even in the region, 11 countries account for over 70% of the global burden. Progress has stalled and in some settings reversed, with significant setbacks placing the 2030 global technical strategy targets at serious risk.”

“In 2023 alone, Africa recorded 249 million cases and 569,000 deaths, more than the combined deaths from all multiplying diseases such as cholera, measles, yellow fever, meningitis and viral hemorrhagic fevers,” Weldedawit added. “Yet malaria is still managed as a routine illness despite being the leading infectious killer on the continent today.”

Working toolkit, missing money 

The funding crisis runs deep across the global health world, but is particularly severe for malaria. Only $4 billion was mobilized for malaria in 2023 against a needed $8.3 billion, according to WHO data.

Germany’s pledge last week of €1 billion to the Global Fund represents a 23% cut from its previous commitment. The UK, another leading funder of the fight against malaria, is reportedly considering a similar 20% reduction.

“The thing with a disease like malaria is we don’t have to drop by very much in terms of investments in order for cases to spiral out of control,” Phumaphi warned. “If we don’t sustain the same level of coverage, we are going to have a crisis.”

The Trump administration’s gutting of USAID has deepened that threat. Internal USAID memos warned that permanently halting the President’s Malaria Initiative could cause an additional 12.5 to 17.9 million cases and 71,000 to 166,000 deaths annually, a 39.1% increase from current levels.

“We need some of that same sense of urgency around what the risks are with malaria right now, as we have whenever we have an outbreak of one of these other new threats,” Sands said. “The current toolkit works, but you need to get a critical level of funding. Crudely speaking, my view is you need roughly twice as much funding per capita.”

Drug resistance and climate converge

A young girl reads under a malaria bednet. Photo: UNDP

As funding falters, new biological threats are emerging. Professor Isabella Oyier, head of the Biosciences Department at Kenya’s KEMRI-Wellcome Trust Research Program, is tracking the spread of drug-resistant malaria parasites across East Africa through genomic surveillance.

“We’re seeing these variants that are allowing the parasite to escape treatment,” Oyier explained at a side event focused on African scientific leadership. “When an individual comes to a health facility, they will be given an anti-malarial drug, but they will not clear their fever, and they’ll still, two to three days after treatment, have parasites in their bloodstream.”

“The treatment is failing because the parasite has developed mechanisms to escape,” she said.

Partial resistance to artemisinin, the backbone of current malaria treatment, has been confirmed in Rwanda, Uganda, Tanzania, and Eritrea, with signals detected in Ethiopia and Zambia, according to WHO data.

The spread of resistance echoes the chloroquine resistance crisis that emerged decades ago, when the malaria parasite’s ability to evade that once-effective drug forced the development of entirely new treatment approaches, including the artemisinin-based therapies now facing their own resistance challenges.

“That issue of resistance and the need for new tools is something that’s extremely important for us to talk about,” Dr Ngashi Ngongo, Chief of Staff at Africa CDC, told the summit, adding that with current low coverage rates, “if you have an intervention that is 50% effective, you can’t be satisfied with 59% of children sleeping underneath nets.”

“Take 59% of 50%, what does it give you? It’s about 30% of children that are protected,” he said. “No wonder every year we are seeing increasing numbers of cases.”

Oyier’s genomic surveillance work with national malaria control programs has led to the introduction of multiple first-line treatments in East Africa, a strategy designed to outmanoeuvre the parasite by rotating different drug combinations and sequencing the malaria parasite’s genome to identify resistance markers before they become widespread.

“Part of the work I do is using genomic surveillance, working with the National Malaria Control Programme to set up an early warning system so that we can identify these variants,” Oyier explained.

“So that they can then have a response plan and figure out what policy changes they need to make,” she said, noting that generating data locally allows for faster integration with health ministries and more agile national responses.

At the beginning of this month, East African countries began rolling out multiple first-line treatment protocols based on this surveillance data, she said.

“At the beginning of September, they are looking at introducing what we call multiple first-line treatments, which means you want to confuse the parasite. This year I’ll give you drug A. Next year, I’ll give you a different combination, and that messes the parasite up.”

“This is a historical challenge for us,” she said. “We know since chloroquine days, the parasite is going to change. So we need to stay a step ahead and be clever.”

Mosquitos on the move  

An infant and mother under an insecticide-treated mosquito net in Ghana. Such nets remain a key prevention technique.

Climate change is further exacerbating these challenges by expanding the habitats of mosquitoes. Historical data analysis published in The Lancet Planetary Health shows malaria mosquitoes in Africa have moved away from the equator by 4.7 kilometers per year over the past century and climbed 6.5 meters annually in altitude.

“You have a vector that is really widespread, quite resilient, now complicated with the challenges of global warming and climate change that is actually expanding the habitat of the vector,” Ngongo said.

The Lancet research projects that by 2070, an additional 4.7 billion people could be at risk of malaria or dengue as warming temperatures extend transmission seasons.

“Then you have the partial effectiveness of the interventions themselves,” Ngongo added. “We’ve been pushing ITNs [insecticide-treated nets] for many years, but the effectiveness was just around 50% reduction of cases. Now, when you bring in the issues of resistance, you are further reducing the effectiveness of those interventions.”

MMV: the urgency of developing next-generation treatments

The funding challenges are not just for existing tools.  In view of the growing resistance to existing drugs, the urgency of developing next-generation treatments is even greater, Dr Martin Fitchet, CEO of Medicines for Malaria Venture, emphasised at a plenary WHS session on the issue.

“We were formed 26 years ago because the child mortality rate went up,” he told the summit. “Mortality rate, of which 75% were children under five, doubled to 1.2 million on the world’s watch when it wasn’t really looking, and we’re never going to let that happen again, I hope.”

MMV is now developing next-generation antimalarials designed to overcome resistance and prevent another crisis in which the world is unprepared for new mutations in malaria parasites, including potential single-dose cures and long-acting injectable prevention that could protect children for an entire malaria season.

“The new drugs we discover now are five to eight years from the [arriving to] market,” Fitchet explained. “These drugs have to have a high barrier of resistance, they have to be new mechanisms, brand new ways of working, the next generation after artemisinin.”

“Imagine if you can give a single injection of a medicine supervised to a child or school-age child at the beginning of the season, and they’re completely protected,” Fitchet said. “Complementary to vaccines, complementary to nets. I think we need multiple tools in the toolbox.”

Vaccine breakthrough – but is it enough?

P vivax malaria is the most widespread form of malaria disease, with victims extending from South-East Asia to North Africa and Latin America (MMV/Damien Schumann)

The rollout of malaria vaccines represents a genuine breakthrough. By early 2025, 19 African countries had introduced WHO-recommended vaccines into routine childhood immunisation programs, reaching more than 3 million children, according to WHO data.

The RTS,S vaccine, developed over three decades by GSK and the PATH Malaria Vaccine Initiative, was first recommended by WHO in 2021. Pilot programs in Ghana, Kenya, and Malawi demonstrated a 13% drop in all-cause child mortality among vaccine-eligible children.

The newer R21/Matrix-M vaccine, developed by Oxford University and prequalified by WHO in December 2023, achieved 78% efficacy in initial trials. Both vaccines reduce clinical malaria by more than 50% in the first year after vaccination.

However, Sands expressed frustration that the vaccine breakthrough alone has failed to galvanise donors in the way other recent innovations have. The challenge, he explained, is that simply telling donors “we have the tools but need more money” no longer works as a fundraising message.

“The trouble is, the narrative that says actually we’ve got the tools but we need more money doesn’t really work, because donors don’t want to hear that,” Sands said. “We need to find ways of injecting something new or different or urgent or hopeful, particularly positive, hopeful stuff that changes the narrative.”

The first two girls ever vaccinated with the malaria vaccine RTS,S in Ghana.

He also warned that vaccines will not be sufficient to reverse the surge in malaria cases because they primarily reduce mortality rather than stopping transmission of the disease.

“For some of the donors, they think that the vaccines are the story,” he said. “Personally, I don’t think they’re powerful enough, and not least because they don’t really change the transmission. Yes, they will help us reduce mortality, but they’re not going to really help transmission.”

He drew a contrast with lenacapavir, a long-acting injectable HIV prevention drug that requires just two injections per year and has shown near-perfect efficacy in clinical trials. The breakthrough has reinvigorated donor enthusiasm for HIV prevention in a way malaria vaccines have not.

“If I could change the conversation to talk about lenacapavir in HIV, what we have is a long-acting injectable. It’s the most exciting thing to happen in HIV prevention for at least a decade,” Sands said.

“It’s completely changed the conversation,” he added. “It’s allowed us to talk really differently and excite donors about being part of ending HIV. It has both medical impact and donor mobilisation impact.”

Local solutions

African public health leaders used the World Health Summit in Berlin to call for increased investment in national health systems and research capacity across the continent.

African scientists and policymakers are increasingly demanding ownership of the malaria response. Oyier emphasised the importance of building research capacity across the continent. 

“For me to break that down, you’re all aware that in COVID, everyone knew the COVID language, the Greek alphabet. These are the same across all pathogens,” she said, explaining her genomic surveillance work.

“Part of the work I do is using genomic surveillance, working with the National Malaria Control Programme to set up an early warning system so that we can identify these variants, and so that they can then have a response plan and figure out what policy changes they need to make,” Oyier said.

MMV is establishing five manufacturing hubs across Africa in partnership with Africa CDC. The organization is also making an AI-powered drug discovery tool available as open access to researchers globally.

“We’re working with DeepMind, the Google arm of AI, with our database of 10 million compounds,” Fitchet explained. “We’re building a machine learning tool that is going to accelerate the medicinal chemistry, the design, the invention of new anti-malarials.”

“And here’s the kicker: we’re going to make it available open access for any researcher anywhere in the world, particularly if you’re in malaria-endemic countries,” he said.

A health worker examines a child with suspected malaria.

Fitchet noted that only one clinical candidate for an anti-malarial drug has come from an African research institution to reach clinical trials in recent years – something he says has to change.

“We’ve only had one clinical candidate for an anti-malarial drug going to the clinic from an African research group in Cape Town, in 2014,” he said, referring to work at the University of Cape Town’s Drug Discovery and Development Centre.

“I think it’s time to have more of those coming out of African research groups and having our first approved and accessible African-invented anti-malarial,” Fitchet said.

While African governments have increased their spending on health in recent years, the continent faces severe fiscal constraints. Low-income countries, on average, depend on foreign aid for one-third of their national health spending, and more than 60 countries worldwide now spend more on debt service than on their health systems, according to World Bank data.

“I think we need to appreciate the enormity of the challenge,” Phumaphi concluded, “and exactly how much is required in funding in order for countries to be able to catch up.”

Image Credits: Yoshi Shimizu, World Health Summit, UNDP, WHO, MMV/Damien Schumann, WHO/Fanjan Combrink, Damien Schumann / MMV.

The World Bank, Japan, and the WHO launched the Health Works Leaders Coalition. to promote investments in health systems as a strategy for economic growth, job creation, and improved resilience.

How to find more money has dominated discussions at global health gatherings this year as the precipitous 21% fall in development assistance over the past year threatens to unravel years of hard-won gains.

There is near-universal agreement that aid-dependent countries need to pay more for their citizens’ health, and that the donors need to become more collaborative and efficient.

Many also posit the idea that the financial crisis presents an opportunity to rearrange the global health “architecture” to ensure that low and middle-income countries (LMICs) drive their own destinies rather than their donors.

But exactly how to achieve all of this is less clear.

One new vehicle is the Health Works Leaders Coalition, launched last Friday by the World Bank, Japan, and the World Health Organization (WHO). It brings together health and finance ministers, donors, business, global health agencies and civil society to promote “investments in health systems as a strategy for economic growth, job creation, and improved resilience”, according to a media release.

The coalition stresses that it is “not a funding mechanism, but rather a coordinated effort to drive bold, high-impact action on health reform globally”. It is part of the World Bank’s Health Works initiative launched earlier this year, which aims to help countries transform their health systems to provide quality, affordable health services by 2030.

“Our goal is ambitious: to help countries deliver quality, affordable health services to 1.5 billion people by 2030. No single institution, government, or philanthropist can achieve that alone,” said Ajay Banga, World Bank president. 

“But with aligned purpose and shared effort, it is possible. If we get this right, we can make real impact – improving health, transforming lives, strengthening economies – and creating jobs. This effort is as much an ingredient of our jobs agenda as it is a health initiative.”

The countries that make up the coalition are Egypt, Ethiopia, Indonesia, Kenya, Nigeria, Philippines, Sierra Leone, Saint Lucia and the United Kingdom.

Health Works is linked to three World Bank backed funds: the Health System Transformation & Resilience Fund (HSTRF), the Global Financing Facility, which focuses on strengthening primary health care to reduce deaths of women, children, and adolescents, and The Pandemic Fund, which provides financing for pandemic prevention, preparedness, and response. 

However, at last week’s World Health Summit in Berlin several global health actors acknowledged that there needed to be fewer agencies and funds.

“I do think we’re actually going to have to reduce the number of entities,” Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, told participants. “The system is too fragmented. There are too many underfunded institutions. There’s too much duplication. It’s too complex. That diagnosis, I think, is pretty straightforward.”

Expanding tax revenue

World Bank vice-president Mamta Murthi

According to World Bank vice-president Mamta Murthi, countries need to spend $50 to $60 per person per year for a basic health package, but low-income countries (LIC) spend about $20, and for many, around half of this comes from donors.

Countries need to expand tax revenues and engage in domestic resource mobilisation, “including through better tax policy and better tax administration, and that includes health taxes”, Murthi told a discussion hosted by the Center for Global Development (CGD) at which key development leaders discussed sustainable solutions to the health financing crisis.

“The second thing that they can do is make health more of a priority in their budgets,” she said, adding that around a third of low and low-middle-income countries could allocate more to health with the fiscal conditions that they have. 

“And I don’t think they should just look at health taxes. There are lots of other things that they spend on, which don’t deliver a bang for the buck, and some of them are harmful to health. Let’s think of fossil fuel subsidies.”

In addition, it is also “shocking that, on average, about 10 to 15% of resources that are allocated for health spending don’t get spent,” she added.

However, she said the Bank is encouraged by countries presenting “compacts”– country vision statements with “asks” to the donor community, setting out what they need from development agencies to reach their goals and targets.

“I feel very encouraged by the leadership that the countries are showing… they have goals and targets in terms of accessibility, affordability, job creation that ensue from the full implementation of these compacts.”

The end of ODA?

Gavi CEO Sania Nishtar.

Sania Nishtar, CEO of the vaccine alliance, Gavi, declared: “We are seeing the beginning of the end of overseas development aid (ODA).”

Gavi Leap, the platform’s reform plan, is “preparing for this future” by ensuring that countries have greater ownership and agency, and are more effective in this resource-constrained environment, said Nishtar.

Gavi is accommodating countries’ requests for more decision-making agency, quicker turnaround, less administration and vaccine sovereignty, she added.

“End-to-end digitising” will simplify and speed up the grant process, while Gavi’s support for , the African Vaccine Manufacturing Accelerator aims to “catalyse sustainable vaccine manufacturing on the continent”.

“We are speaking to our colleagues at the World Bank and other international multilateral development banks, and we have put in place what is called the MDB [multilateral development bank] Multiplier” to “unlock concessional lending for countries”.

Catalysing investment

 

Hitoshi Hirata, vice-president of the Japan International Cooperation Agency.

Hitoshi Hirata, vice-president of the Japan International Cooperation Agency, said that at the Financing for Development (FfD4) meeting in Sevilla in July, partner countries had committed to expanding domestic revenue for health, particularly through health taxes.

“We would like to support health financing, and also link with existing public finance management efforts and tap domestic and private resources,” said Hirata.

The resulting Sevilla Commitment proposes concrete steps to catalyse investment in sustainable development, address the debt crisis affecting the world’s poorest countries  (three billion people live in countries that spend more on interest payments than on health),  and give developing countries a stronger voice in the international financing architecture.

The Japanese government is hosting a Universal Health Coverage (UHC) High-Level Forum in Tokyo in December, at which various countries will launch their National Health Compacts.

These are “government-led agreements that will lay out bold reforms, investment priorities, shared accountability and unlock resources for expanding access to quality, affordable health care”, according to a media release.

Strong country leadership

Wellcome Trust CEO John-Arne Røttingen.

Wellcome Trust CEO John-Arne Røttingen warned that the “abrupt changes to the international financing environment” will result in many lives lost and worsen the global burden of disease.

But he is “optimistic” that the loss in financing will result in “stronger country leadership, supported by multilateral development banks and major bilateral donors”.

“Countries are demanding that they need to be in charge – with a one country, one plan, one budget, one monitoring approach,” said Røttingen.

“And I’m hearing commitment now from almost all big external financing agencies – the dedicated GHIs, the Global Fund, the World Bank, and the other multilateral development banks and the major bilateral donors – that signals a global moving towards empowering and also making countries responsible for delivering.”

Wellcome Trust is also supporting global and regional discussions on “reimagining the global health architecture”, which kicked off with papers on the subject written by five thought leaders.

Its motivation is to find long-term solutions to the crisis in global health that involve “more regional and national accountability and less dependence on the priorities of donors from high-income countries”. 

But Røttingen cautioned that devolving too much to country governments might reinforce the priorities and norms of undemocratic governments that could be contrary to human rights.

“There needs to be very strong transparency and the voice from civil society and different groups”, he noted, adding that positive lessons from different regions where things are working