Families arrive at the Dedza health centre to receive the measles-rubella vaccine in Malawi – the vaccine combinaation will remain a key component of Gavi support.

Gavi, the Vaccine Alliance has pared down its staff in its Geneva headquarters, Washington DC and New York by 33% – from 643 to 440 people, the agency confirmed today, following a June replenishment drive that fell about $2 billion short of a $11.9 billion fundraising goal for 2026-2030.

Beginning in 2026, the agency will also roll back support to partner agencies, The World Health Organization (WHO) and UNICEF for their vaccine initiatives. “As part of the package of trade-offs agreed by Gavi’s Board, WHO and UNICEF will see approximately a 30% reduction in funding,” a Gavi spokesperson confirmed of plans for the next five-year period, 2026-2030.

The new Gavi strategy, approved by its board on Thursday, also vests greater power in countries to determine their own vaccine priorities – beyond the most essential child and youth regimens – and within a pared-down budget of $10 billion for the next five years.

“In a major strategic shift that further centers country ownership, nearly 90% of the budget available to Gavi for vaccine procurement in its next strategic period will be allocated directly to countries through ‘country vaccine budgets’,” said the organization in a press statement after the four-day board meeting.

“In a time of financial constraints, countries will have full control of how to optimise and prioritise immunisation programmes per their national strategies and context,” Gavi said. The new budget will also increase its support for fragile and conflict settings by 15% –  alongside cuts in support to lower-middle-income countries. 

Gavi Leap

 

Gavi Leap offers most assistance in form of cash grants – with countries in charge of how it is used in vaccine programmes.

The changes are part of the new Gavi Leap  strategic plan for 2026-2030.

“As a result, more than a third of Gavi’s overall funding for countries will be focused on the 25% most vulnerable children. Allocations for country vaccine budgets will also prioritise the lowest-income countries with the highest number of deaths amongst children under five. A new agile funding mechanism, called the Gavi Resilience Mechanism, will provide flexible support to countries and partners in fragile and humanitarian settings around the world,” the organization said.  

In low-income countries, the budget cuts should not lead to the roll-back of existing vaccine schedules, a Gavi spokesperson emphasized in response to queries by Health Policy Watch. But new schedules and campaigns will be added more slowly.  And in the case of some lower-middle-income countries, Gavi will pare back some support in favor of domestic sources.  At the same time, new and more efficient procurement should also increase cost-saving efficiencies.

Since the June pledging event, Gavi has now raised $9.5 billion. And with other new commitments still pending, that Gavi officials expressed confidence that they could meet the $10 billion target for 2026-30 with ease.

The organization also will shift away from “rolling applications” so that all countries compete for funding on a more equal playing field.

“This also ensures countries that apply more quickly do not have an advantage in terms of access to Gavi financing and that all countries have an advance view of resources available for the next five years – and can clearly identify in advance areas to supplement with domestic financing,” the Gavi statement said.

Basic vaccine coverage assured

Vaccine priorities in new Gavi Leap strategic plan.

Sources in Gavi explained that support will work through country vaccine budgets to allow countries to:  

  • Maintain funding for key routine programmes: including polio vaccination (IPV and hexavalent); the pentavalent vaccine (diptheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b); pneumococcal conjugate vaccine (PCV);  routine measles/measles-rubella vaccination, as well as catch-up and follow-up campaigns;  Human Papillomavirus (HPV) campaigns among young teens and young women;  rotavirus and yellow fever.
  • Decide on other priority vaccines at national level –  meaning countries can choose/tailor which ones to implement based on their priorities, context, and available funding.

“Through the Gavi Leap, we are putting in place an ambitious programme of reforms that will enable countries to have increased agency and ownership over use of resources and decreased administrative burden, which will help our Alliance achieve its programmatic objectives. These changes are well on their way to implementation, with grant management reform – a key pillar of the Gavi Leap – already in place and a year-long Secretariat review that will see our headcount reduce by 33% now complete,” said Sania Nishtar, CEO of Gavi.

Gavi CEO Sonia Nishtar visits Solomon Islands health centre in November 2024

The new strategy includes provision for hepatitis B vaccine dose at birth – continuing with longstanding expert advice for the jabs estimated to have prevented some 200 million cases of hepatitis B between 2001-2020. A 2020 Lancet study estimated the vaccines will prevent some 38 million deaths among people born betweeen 2000 and 2030 in 98 low- and middle-income countries.

Despite the evidence, a newly reformed US vaccine advisory committee stacked with vaccine skeptics on Friday recommended to delay the birth dose by at least a month, a decision that critics say will reverse decades of progress against chronic liver disease. See related story.

CDC Committee Delays Hepatitis B Vaccine for Newborns in Critical Guidelines Shift

Building on the post pandemic ‘Big Catch-Up Campaign’

During its fifth strategy period from 2021 to 2025, Gavi exceeded the target of achieving a 10% reduction in under-five mortality in supported countries, the organization said. 

In 2024 alone, Gavi-supported vaccination programmes saved at least 1.7 million lives in 2024, the highest number recorded in a single year. Critical new efforts to introduce malaria vaccines and revitalise HPV vaccination programmes against cervical cancer also achieved their targets.

While delivering on these goals, the Alliance also helped the world respond to infectious disease emergencies – supporting an unprecedented number of outbreak response efforts, delivering 2 billion COVID-19 vaccines to 146 countries via COVAX, and enabling recovery of routine immunisation coverage after the pandemic through “the Big Catch-Up” campaign.   

Despite those successes, the broader crisis in global health finance was reflected in Gavi’s June replenishment drive – which saw the United States, traditionally a major donor, withhold any new pledges altogether for the upcoming period.  The event featured a blistering attack by US Secretary of Health and Human Services, Robert F. Kennedy around alleged vaccine safety issues – which both Gavi and other top experts repudiated.  See related story.

GAVI Vaccine Alliance Secures More than $9 Billion from Donors – Despite US Ambush at Pledging Event

 

Image Credits: Gavi/2017/Karel Prinsloo, Gavi , Gavi Leap .

Clinical trials
The African continent only accounts for 4% of clinical trials globally, jeopardizing the development of new medicines, and demonstrating the chronic underinvestment in the continent’s healthcare ecosystem.

In Kenya, toxicologists and epidemiologists face a difficult choice: to pursue better-paid work to support their families, or volunteer as reviewers for vaccine clinical trials, often without the compensation needed to cover even their children’s school fees.

Their dilemma underscores a broader challenge in Africa’s clinical research ecosystem. Slow, duplicative approval processes and limited regulatory capacity continue to deter sponsors from bringing trials to the continent. The continent accounts for 25% of the global disease burden, but just 4% of clinical trials. 

This “stark disparity” means that access to vaccines, diagnostics, and medicines is “not always guaranteed,” said Caxton Murira, a clinical research expert with the Science for Africa Foundation. 

Yet the continent also represents “enormous untapped potential” for the creation of effective and ethical medicines and vaccines, said Angelika Joos, science and regulatory policy executive at  Merck, and a panelist at the fourth and final event in a series at the annual Africa Regulatory Conference. 

“Africa is critical for advancing science and for ensuring that medicines work for everyone,” she said, addressing the recent webinar, hosted by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). The four-part online conference focused on patient and community engagement, under-represented populations, innovative designs, and lastly, streamlining regulatory processes. 

Creating incentives for reviewers is one of the many ways experts have proposed to improve the continent’s regulatory system for clinical trials. To draw more clinical trials to Africa, panelists urged countries to  harmonize, simplify, and accelerate approvals for regulatory and ethics approvals across the continent. 

A ‘mismatch’ in the R&D pipeline

Africa continent clinical trials
Capacity fragmentation, poor visibility of resources, and a time-consuming regulatory process all hinder Africa’s clinical trial capabilities.

At the heart of the problem is chronic underinvestment. Funding for clinical research and development does not reflect Africa’s burden of disease, Murira noted. This gap spans both infectious diseases, such as malaria and tuberculosis, and noncommunicable diseases (NCDs) like diabetes and heart disease, which are rising as Africa’s population ages.

And while many countries have made significant progress in reducing infectious diseases, NCDs are often neglected in clinical research and trials, Murira argued. 

Globally, clinical trials exceeded $84 billion in market size in 2024, with every dollar invested in clinical research yielding a $405 return. Yet only 4% of the roughly 25,000 trials that occur each year take place on the African continent. 

This mismatch, driven by global market and industry strategies rather than local disease burden, jeopardizes the future of new medicines and demonstrates the chronic underinvestment in the continent’s healthcare ecosystem.  

Experts pointed to capacity fragmentation, poor visibility of resources, and a time-consuming regulatory process as worsening Africa’s clinical trial under-representation. Many countries can host clinical trials – beyond the usual hubs where funding is typically concentrated to such as South Africa, Egypt, Nigeria, Kenya, Ghana, and Tanzania. However, lesser-known sites struggle to compete with established centers.

Networks for collaboration

Clinical trial research Africa
Researchers across the continent, like those at Cape Town’s H3D Foundation, benefit from online platforms that raise the visibility of potential clinical trial sites.

To enhance this visibility, the South African-based start-up, nuvoteQ, has set up an interactive online platform called the Clinical Trials Community (CTC) Africa. 

CTC aims to attract investment in African clinical trials by showcasing the continent’s clinical trialists and research sites, said CEO Adriaan Kruger. 

It is an “interactive platform” that provides a registry of sites, data on site feasibility, and access to country-specific regulatory and ethics information to make it easier for sponsors to find and partner with African research locations. 

“We actively work on providing and building a financially sustainable model so that we can keep these platforms running in the long term,” said Kruger, noting that past initiatives have failed to gain traction.

Efforts to enhance visibility and partnerships are already underway regionally. The Science for Africa Foundation, headquartered in Nairobi, has mapped over 3,500 clinical trial centers, regulatory boards in 55 countries, and 196 ethics committees. The goal, Murira said, is to improve visibility while highlighting gaps that need investment.

“We’ve shifted from asking, ‘What’s your research capacity?’ to ‘How can we use what you have to position you to be a leader on the African continent?’” said Murira, who heads the foundation’s clinical trials and research portfolio. 

Standardizing the process 

Clinical trials IFPMA regulatory conference
Panelists at the final Africa Regulatory Conference discuss potential solutions to optimize clinical trial approvals.

Aside from finding suitable sites for trials, researchers or pharmaceutical companies looking to recruit patients into clinical trials find that the approval process can be duplicative, ineffective, and expensive, said Joos. 

These delays hinder patient access to innovative treatments, and deter researchers from attempting more trials.

Bioethicist Keymanthri Moodley, an emeritus professor at Stellenbosch University, highlighted the lack of standardization – and trust – between research approval boards as impeding the process. 

“One research committee does not trust the competency of another,” Moodley argued. So if malaria vaccine researchers wanted to recruit participants across a national border, they could run into months-long delays for approvals from both countries. Furthermore, both researchers and reviewers are in need of training. 

“We have the tools but we need standardization,” said Moodley, pointing to World Health Organization’s (WHO) Global Benchmarking Tool (GBT) as a helpful metric for evaluating national regulatory authorities (NRAs). 

“There has been so much development at the theoretical level. But the area where we experience challenges is implementation. The continent is heterogeneous. Every country is different, but in general, very few resources are allocated to regulatory authorities and research ethics committees. And so we were always complaining about delays in regulatory approval,” said Moodley, who also served as founding director of a WHO Collaborating Centre in Bioethics.

David Mukanga, deputy director for Africa regulatory systems at the Gates Foundation, echoed these concerns, saying that as research ethics committee members are not paid to review trials, they are placed in a difficult position. 

“If you review 30 protocols in five years, it doesn’t count towards your promotion,” he said. But supervising a PhD student does.” 

This leaves academics juggling teaching loads, exams, and financial pressures while trying to support essential ethical reviews. 

“There needs to be creative incentives for people to be able to commit time and be recognized for their good work in supporting reviews,” he said.

Reducing duplication through regulatory reliance

One solution gaining attention is regulatory reliance – the concept that one country’s drug regulator uses the scientific assessments of another trusted authority. This, in turn, could reduce redundant reviews and shorten approval timelines.

“Leveraging trusted national regulatory assessments reduces duplication, speeds approvals, and fosters collaboration,” said Lada Leyens, a senior director at the pharmaceutical company Takeda. 

The UK’s medicines regulator recently introduced a clinical trial reliance pathway allowing approvals within two weeks when a trusted authority has already assessed the application, Leyens noted. For under-resourced African regulators facing staff shortages and high turnover, reliance could significantly shorten timelines.

Africa’s future

For those working to improve the clinical research and trials ecosystem in Africa, enhancing the visibility of capacity, fostering trust between researchers, regulators, sponsors, and the community, and increasing investments in ethical clinical trials in Africa all remain critical goals. 

“We need to build the capabilities now and the capacities now to position Africa as a key player in the next decade of this global health innovation. It’s about equity, it’s about scientific progress, and it’s about preparing Africa for the future,” remarked Joos. 

 

The webinar, Streamlining regulatory and ethics approvals, was the fourth of a four-part online African Regulatory Conference hosted by IFPMA. All four sessions were recorded and available for viewing.

Image Credits: Eugene Kabambi/ WHO, IFPMA.

San Francisco City Attorney David Chiu briefs the media about the case on Tuesday.

The City of San Francisco has filed a historic lawsuit against 10 ultra-processed food (UPF) manufacturers, seeking “restitution and civil penalties” to help local governments to “offset astronomical health care costs associated with UPF consumption”.

The 10 companies are Kraft Heinz Company, Mondelez International, Post Holdings, The Coca-Cola Company, PepsiCo, General Mills, Nestle USA, Kellogg, Mars Incorporated, and ConAgra Brands, which make the bulk of UPF in the US.

The first-of-its-kind lawsuit, filed on Tuesday on behalf of the people of the State of California, alleges that the companies used “unfair and deceptive acts” to sell and market their products, violating California’s Unfair Competition Law and public nuisance statute. 

Aside from restitution, the City wants the companies to stop using “deceptive marketing” and “take action to correct or lessen the effects of their behavior”. 

“This case is about food products whose ingredients and manufacturing processes interrupt our bodies’ abilities to function. It is about the Defendants – gigantic food conglomerates, all – who designed, manufactured, marketed, and sold these foods knowing they were dangerous for human consumption,” the City argues.

San Francisco City Attorney David Chiu told a media briefing: “They took food and made it unrecognisable and harmful to the human body.”

Comparing the UPF companies’ tactics to those used by tobacco companies, Chui said: “We must be clear that this is not about consumers making better choices. Recent surveys show Americans want to avoid ultra-processed foods, but we are inundated by them. These companies engineered a public health crisis, they profited handsomely, and now they need to take responsibility for the harm they have caused.”

Some of the UPF targeted by the City of San Francisco.

UPF stimulates cravings

San Francisco Mayor Daniel Lurie added: “San Francisco families deserve to know what’s in their food. We’re not going to let our residents be misled about the products in our grocery stores. We are going to stand up for public health and give parents the information they need to keep themselves and their kids safe and healthy.”

The court papers define UPF as “former whole foods that have been broken down, chemically modified, combined with additives, and then reassembled using industrial techniques such as molding, extrusion, and pressurization. 

Some contain additives unique to UPF, including “colors, flavor enhancers, emulsifiers, artificial sweeteners, thickeners, and foaming, anti-foaming, bulking, and gelling agents”. 

These foods are a “combination of chemicals designed to stimulate cravings and encourage overconsumption”. UPF makes up some 70% of food consumed in the US.

The consumption of UPF has been linked to Type 2 diabetes, fatty liver disease, cardiovascular disease, colorectal cancer, and depression.

Protecting communities

“This lawsuit is a critical step toward protecting the health of our communities,” said San Francisco Director of Health Daniel Tsai. “For decades, ultra-processed foods have reshaped our diets. 

“These products are not just unhealthy, they are engineered to be addictive, disproportionately harm low-income communities and communities of color, and contribute to rising rates of chronic illness like diabetes, heart disease, and cancer,”  said San Francisco Director of Health Daniel Tsai.

The City’s court papers also argue that UPF marketing campaigns “disproportionately targeted Black and Latino children, who have been targeted with 70% more ads for ultra-processed foods than their white counterparts”.

The prevalence of diabetes among Black Americans has quadrupled in the past 30 years, and Black Americans are 70% more likely to develop diabetes than White Americans, according to the court papers.

Largest review of UPF

The aggressive marketing of ultra-processed food is one of the drivers of children’s rising obesity.

The court case, the first such action by a municipality, comes a few weeks after the world’s largest review of UPF was published in The Lancet.

The three-part review argues that the rise in UPF “is driven by powerful global corporations who employ sophisticated political tactics to protect and maximise profits”. 

The review stresses that education aimed at individual behaviour change is not enough: “Deteriorating diets are an urgent public health threat that requires coordinated policies and advocacy to regulate and reduce ultra-processed foods and improve access to fresh and minimally processed foods.”

The series provides hundreds of studies to prove its thesis that UPF is displacing long-established dietary patterns centred on whole foods, and this is “a key driver of the escalating global burden of multiple diet-related chronic diseases”.

Using evidence from national food intake surveys, large cohorts, and interventional studies, the review highlights global patterns of “gross nutrient imbalances”. It shows that overeating is driven by the “high energy density, hyper-palatability, soft texture, and disrupted food matrices” of UPFs, and the rise of UPF has led to the consumption of “toxic compounds, endocrine disruptors, and potentially harmful classes and mixtures of food additives”.

The Lancet editorial published alongside the review notes that “the rise of UPFs in human diets is damaging public health, fuelling chronic diseases worldwide, and deepening health inequalities”.

“Addressing this challenge requires a unified global response that confronts corporate power and transforms food systems to promote healthier, more sustainable diets.”

The series advocates for a food system based on local food producers, preserving cultural foods and ensuring economic benefits for communities.

Image Credits: City of San Francisco.

Healthworkers wash hands before a vaccination campapign in Somalia, October 2020.  WASH practices, reinforced by the COVID pandemic, have since lapsed, increasing risks of infection and along with that, drug-resistant pathogens (AMR).

The post-pandemic decline in infection-prevention practices, along with the broader crash in global health finance, are undermining progress against antimicrobial resistance –  one of the planet’s most urgent health threats. At a recent panel discussion co-hosted by the Geneva Health Forum (GHF), leading experts from WHO, academia, biotech, and patient advocacy warned that national AMR plans are stalling in the absence of  funding. And pipelines for new drug development remain desperately under-financed. 

Governance and finance: ‘domestic investment is missing link’

Sarah Paulin-Deschenaux (second right) with Tomasso Cai, Melissa Mead, Ingrid Wanninger, and Mariam Zaidi (moderator) at the GHF symposium.

For Dr. Sarah Paulin-Deschenaux, a technical officer in WHO’s AMR department, the most troubling trend is how quickly hard-won gains from the COVID-19 era have faded.

During the pandemic, “there was political willingness, there was financing for infection prevention and control (IPC), WASH and hand hygiene,” she said. “But priorities shifted, financing shifted —and many behaviours we had begun to institutionalize were not sustained.”

Speaking at an event convened by the Geneva Health Forum (GHF)  and OM Pharma during World AMR Awareness week, in late November, she noted that most countries still lack the institutional structures required to implement AMR strategies at scale. Recent WHO analysis reveals:

  • Only 34% of countries have nationwide infection prevention and control (IPC) programmes;
  • Nearly 60 countries report no IPC systems in place;
  • IPC, public awareness, and antimicrobial-use monitoring consistently score as the weakest indicators in national action plan implementation.

On top of that, only one in four healthcare healthcare facilities globally have access to clean running water. And only two in five healthcare facilities have access to hand hygiene facilities at the point of care.

“How are you supposed to have effective infection prevention when you don’t have the enabling environment? So then you wind up using antibiotics as a substitute for good infection prevention and WASH,” Paulin-Deschenaux said.

The structural problem, she stressed, is that AMR commitments sit too low in government hierarchies. “Ministries of Health in developing and lower-middle income countries are not putting any domestic financing towards the actual implementation of their national action plans on AMR.

In contrast,  governance on antimicrobial resistance needs to be “embedded in the highest political office—in the president’s office. That’s where we need the political commitment. Only then will we have tangible results.”

Meeting the UN target of reducing AMR deaths by 10% by 2030

Deaths (all ages) attributable to and associated with bacterial antimicrobial resistance by
region, 2019

Post-pandemic, that sense of urgency hardly registers among politicians – even though AMR is the third leading cause of mortality in the world. 

In 2024, over 1 million deaths are directly linked to bacterial AMR, and 5 million deaths indirectly, according to the first major landmark study on the disease burden, published last year in The Lancet.  

In a business as usual scenario, AMR will cause 39 million deaths worldwide over the next 25 years, equivalent to over 3 deaths every minute, WHO projects. 

At the UN High Level Meeting on AMR in 2024, countries agreed to set a target for reducing  AMR deaths by 10% by 2030. 

Following on from the High Level Declaration on AMR, Nigeria will host a ministerial-level review in June 2026 of progress. But momentum has stagnated at a critical moment, Deschenaux and other experts at the panel warned. 

Lax regulatory measures in many developing countries continue to make antibiotics far too available over-the-counter, inviting overuse that breeds pathogen resistance – or ‘superbugs’. Public awareness of AMR is low – with the term difficult to even translate from English. The R&D pipeline for new antibiotics is “broken”. And along with human misuse, animal overuse of the life-saving drugs remains the elephant in the room – far greater quantities of antibiotics than human health globally.   

AI and diagnostics: can LMICs benefit from the potential?

Colombian doctor remotely evaluates patient’s respiratory symptoms using digital diagnostics.

Against that gloomy landscape, can new technology be one solution? Indeed, AI driven tools offer huge potential to improve diagnostic capacity for clinicians who often struggle to determine if a fever or other symptoms of illness are viral or bacterial in origin. Accurate diagnosis, in turn, can lead to much faster as well as better decisions about treatment in situations where the right choice of drugs may be the difference between life and death. 

New technologies, however, remain challenging to adapt to resource-limited settings that need them most.

Paulin-Deschenaux noted a promising Colombian pilot that uses AI to support clinical decisions in an environment where diagnostic tools are limited.  

“But [too] often these types of innovations stay within the high income country setting,” she said, expressing hopes that new public-private partnerships can help move the needle for other developing countries. 

On the front lines of sepsis prevention, Melissa Mead, UK Sepsis Trust Ambassador, described how NHS England is testing AI tools to help emergency departments distinguish patients at risk of sepsis—those “in that grey area, that cusp” where timely antibiotic decisions are crucial.

Can AI help detect drug-resistant bacteria more rapidly? Portrayed here, an electron micrograph of methicillin-resistant Staphylococcus aureus (MRSA, brown), a deadly bacteria resistant to many antibiotics, surrounded by cellular debris.

Italian urologist Prof. Tommaso Cai, meanwhile, noted that AI-assisted prescription models have already demonstrated clinical promise in more precise diagnosis and treatment of drug-resistant urinary tract infections – integrating individual patient histories and local resistance data.

“The system can suggest the correct antibiotic,” he said—offering clinicians a lifeline in an era where common bacteria are increasingly resistant to some drugs – but not others. 

However, technological innovation must be coupled with clinician training, behaviour change frameworks, and policy safeguards to prevent algorithm-driven misuse or overuse, the experts stressed. 

Innovation crisis: a broken market for new antibiotics

New drug resistant bacterial strains are emerging more and more rapidly after the introduction of new antibiotics.

While AI developments generate optimism, the innovation ecosystem behind new antimicrobials and infection-prevention technologies remains fragile.

Dr. Ingrid Wanninger, board member of the BEAM Alliance a European AMR innovation hub for Biotech, noted that small and medium-sized firms are leading the way in R&D. But they face a gauntlet of challenges to bring new drugs to market. 

“SMEs produce the majority of innovation, yet they operate with one to two years of financial runway,” she said. 

“We are really lost here. If you go to private investors and say you are working in infectious diseases, they have no interest. In AMR, business models are lacking. Big pharma has left the field.

 “Private investors won’t touch infectious diseases, and the AMR space is seen as too risky,” she added, describing the current landscape as “a broken market.”

Create sustainable market incentives for antimicrobial and prevention-focused innovation;

Traditionally, the existing public-private innovation engines like —CARB-X  and GARDP— have primarily supported R&D on new diagnostics or antibiotic treatments – leaving preventive therapies as a kind of outlier. 

“Prevention will not solve the whole AMR topic, but we need to have it as well,” said Wanninger, citing promising approaches such as bacteriophages (viruses that kill bacteria); and bacteriophage-derived endolysins (enzymes that have powerful antimicrobial properties). Other cutting edge mechanisms include immune stimulants (such as bacterial lysates or other bacterial-derived products, vaccines and immunotherapies.

In the past year alone, two BEAM member companies working on novel antimicrobials and bacteriophage-based interventions declared bankruptcy despite having viable technologies, she noted.

Along with more specific R&D calls for such methods, there is a continuing need for more integrated “push” mechanisms to de-risk early R&D; along with government and market-driven “pull incentives” to secure predictable uptake and revenue streams once products are put on the market. 

Without both, she warned, “You can have the innovation and the patents, but if financing isn’t there, companies disappear—and the expertise disappears with them.”

Public awareness and trust

Public trust is critical: Melissa Mead, center, Sepsis Trust, England.

While the pandemic also saw a huge acceleration in the R&D timeline for drugs and vaccines, the clock has slowed once more in the post-pandemic era. “We’ve gone back to six-or ten-years to develop an antibiotic, to get through the political rhetoric,” Mead said.

Paradoxically, the speed and way in which new COVID treatments were developed and rolled out may have also contributed to a crisis of public trust.  That, along with the current political climate has led to falling vaccination rates in many developed countries, including the UK.  And fewer vaccinations also leads to more antibiotic use amongst people who do actually fall ill, Mead noted. 

In many low and middle income countries, meanwhile, antibiotics can still be purchased widely over the counter – while in higher income countries they are generally impossible to obtain without a prescription – incentivizing diverse forms of misuse and hoarding. 

“In high-income countries, accessing an antibiotic when appropriate can be complex and expensive. That’s why households keep full courses of broad-spectrum antibiotics at home,” noted Raj Kumar, a physician and former UN medical officer, speaking from the floor of the GHF event.

Altogether, the AMR threat is poorly understood not only by politicians but by the public at large.  Even the language used by scientists doesn’t resonate.  

Multiple drivers and impacts of drug resistance (AMR) are difficult to communicate and poorly understood by the public.

Overall there is a need to reframe AMR communication to focus on infection, behaviour change, and relatable human impact.

“People understand infections, not AMR,” said Mead. “If a leaflet says antimicrobial resistance, they won’t pick it up. If it says infection, they will.”

In some countries, including Malawi, there is no direct translation for “AMR,” noted Paulin Deschanaux, complicating public-health messaging.

She described how WHO is working with patient survivors’ groups to shift communication strategies toward relatable human stories, rather than technical terminology. 

But conversely, celebrity-led stories and campaigns can backfire, Mead warned, raising questions about motivation and remuneration. “People relate to ordinary families. Real stories drive behaviour change far more effectively than professional endorsements.”  

Animal health oft-ignored factor 

Regional trends in volumes of animal antimicrobial sales largely correspond with growing AMR hotspots.

AMR issues and solutions also must be integrated into agriculture practices, from veterinary care to fisheries and plant production, panelists acknowledged.  

Under pressure from industry, proposed targets for reducing by 30% antibiotics use in agri-food systems by 2030 were dropped from the 2024 UN High Level Declaration – even though livestock and other food production in fact uses far larager volumes of the drugs than human health systems.  

But even if human health systems use fewer drugs, that doesn’t obviate the need for more robust infection prevention and control in clinical settings, Cai stressed: “Lower proportional use is not an excuse to relax standards.” 

And while the window for action is narrowing, it’s not too late yet to rebuild IPC systems with lessons learned from the pandemic; unlock more domestic finance; and create sustainable market incentives for innovation.

“We’re still in our [post-pandemic] learning phase,” Paulin-Deschenaux said. “It’s such a multifaceted approach. You need the education, the awareness, behavior change. It has to start in schools. It has to go all the way through to healthcare professionals’ in-service training. It’s really a continuous process. But I think the core of it, unfortunately, is priorities. Priorities change, financing shifts. And that is unfortunate.”

Image Credits: WHO/Sarah Pabst, UNICEF , HP Watch , The Lancet, CC BY-SA 4.0, via Wikimedia Commons, NIAID, Yvan Hutin/WHO, WHO , Van Boeckel et al, ETH Zurich.

Thousands of people claim that exposure to Roundup has given them cancer. Now the scientific paper exonerating the product has been retracted.

A scientific paper written 25 years ago, claiming that the herbicide glyphosate posed little risk to people, has finally been withdrawn after it was found that the authors relied solely on Monsanto studies and did not acknowledge that Monsanto staff had assisted in writing the paper.

Monsanto makes the glyphosate-based Roundup, used as a weedkiller throughout the world. Bayer, which bought Monsanto in 2018, is currently facing thousands of lawsuits, primarily from farmers, who claim that they have developed cancer as a result of exposure to Roundup.

The study by Gary Williams, Robert Kroes and Ian Munro was published in 2000 in the journal, Regulatory Toxicology and Pharmacology, but only retracted last Friday.

Making the announcement, journal co-editor Martin van den Berg cited several problems, including the “authorship of this paper, validity of the research findings in the context of misrepresentation of the contributions by the authors and the study sponsor and potential conflicts of interest of the authors”.

After 25 years, a scientific paper claiming that Monsanto’s Roundup was not harmful to people and animals, was retracted last week.

According to the paper: “The use of Roundup herbicide does not result in adverse effects on development, reproduction, or endocrine systems” in people or animals. 

“It was concluded that, under present and expected conditions of use, Roundup herbicide does not pose a health risk to humans.”

This paper has been used to justify the use of Roundup around the world.

“The conclusions about the non-carcinogenicity of glyphosate or Roundup in this article are limited to the Monsanto studies alone and hamper a general conclusion as suggested by the authors,” said Van den Berg.

This was despite other studies being available at the time that flagged the potential carcinogenicity of glyphosate, based on studies in mice, he added.

Meanwhile, a 2015 study by the World Health Organization (WHO) linked glyphosate to non-Hodgkin lymphoma.

What took so long?

Not only that, it “appears from correspondence that employees of Monsanto may have contributed to the writing of the article without proper acknowledgement as co-authors”.

The correspondence was obtained back in 2017 through litigation by lawyers “representing thousands of cancer victims who are suing Monsanto, alleging their exposure to the company’s glyphosate-based herbicides caused them to develop non-Hodgkin lymphoma,” according to the US-based organisation, Right to Know.

“In one email from 2001, Monsanto scientist Katherine Carr asked if the ‘team of people’ at Monsanto who worked on the Williams paper ‘could receive Roundup polo shirts as a token of appreciation for a job well done’,” according to Right to Know.

Right to Know and several researchers have questioned why it has taken the journal so long to retract the paper. Van den Berg, who is based in the Netherlands, told Right to Know via email: “It simply never ended (up) on my desk being at first primarily a U.S. situation with litigation”.

However, the organisation quoted various researchers claiming that the journal has a bias towards industry.

Bayer appeals to Trump

Bayer, which bought Monsanto in 2018, appealed to US President Donald Trump for assistance to avoid liability. In court papers, Bayer says it faces claims from “more than 100,000 plaintiffs across the country that … seek to hold Monsanto liable for not warning users that glyphosate, the active ingredient in Roundup, causes cancer”. 

Bayer argues that the responsibility for cancer warnings lies with the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) and the Environmental Protection Agency (EPA).

The US government heeded their appeal this week, and Solicitor General D. John Sauer urged the Supreme Court to review the company’s immunity plea.

“The Trump administration filed a brief with the Supreme Court arguing that lawsuits alleging that Monsanto failed to warn consumers of the health impacts of its Roundup weedkiller are preempted by federal law,” The Hill reported on Tuesday.

Monsanto wants the Supreme Court to overturn a lower court’s ruling that it has to pay damages for failing to warn about its product’s health impacts.

However, the Trump administration’s intervention has angered “Make America Healthy Again” (MAHA) supporters.

“President Trump specifically promised to address the harms from pesticides. This move to support the Supreme Court in hearing Bayer’s case for federal preemption of state laws that protect our safety could not stray further from that promise he made to American citizens,”  said Kelly Ryerson, co-executive director of American Regeneration and a MAHA leader.

Image Credits: Pesticide Action Network.

Ozempic injection obesity
The widely popular weight loss drugs were recommended for obesity treatment by the WHO, a first for the global agency.

First-ever WHO guidelines recommending the use of glucagon-like peptide-1 (GLP-1) therapies for the treatment of obesity in adults has been issued by the World Health Organization – in what the global health agency said is a “conditional” sign of approval for the cutting edge medications that have become widely popular. 

The new WHO recommendations go well beyond those of its Essential Medicines List (EML) issued in September, which recommended the drugs only for diabetes. 

And the guidelines should have widespread ramifications for policy decisions in countries where the drugs have not yet been approved. Worldwide, more than one billion people are obese, leaving individuals susceptible to a host of health conditions like diabetes, heart disease, and some cancers. 

The highly-sought after drugs, sold under brand names like Wegovy®, Ozempic®, and Zepbound® in the United States, were initially only recommended by WHO for the treatment of Type II diabetes in the EML. In September, the active ingredients of these drugs – not the brand names – were added to the WHO’s Essential Medicines List – which guides national health systems in making medicine procurement decisions. 

Recognizes obesity is a chronic disease

 “The new guidance recognizes that obesity is a chronic disease that can be treated with comprehensive and lifelong care,” said WHO Director General Dr Tedros Adhanom Ghebreyesus, in a statement. “While medication alone won’t solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms.”

The WHO did qualify its recommendations, saying endorsement “is conditional due to limited data on their long-term efficacy and safety, maintenance and discontinuation, their current costs, inadequate health-system preparedness, and potential equity implications.”

The drugs should not be used by pregnant women, and should be paired with evidence-based interventions like healthy diets and physical activity, the guidelines also stress. 

Need to assure equitable access

Obesity GLP-1 drugs US
The US comprises the lionshare of GLP-1 drug consumption, with states debating whether to shoulder the costs for Medicare recipients.

With US consumers comprising nearly 75% of current GLP-1 demand worldwide, the “greatest concern is equitable access” to the new treatments, said Tedros, speaking with journalists earlier this week. 

“Without concerted action, these medicines could contribute to widening the gap between the rich and poor, both between and within countries,” he added. 

And even with ramped up production, these drugs would likely only reach 10% of adults who could benefit from GLP medications in the next five years, the WHO said in a press release. Their guidelines recommended that countries and pharma companies implement several strategies to try to expand access, such as pooled procurement, tiered pricing, and voluntary licensing of what are now patented formulations to local manufacturers. 

Writing in the Journal of the American Medical Association (JAMA), this week, a team of WHO directors and advisors argued that “the availability of GLP-1 therapies should galvanize the global community to build a fair, integrated, and sustainable obesity ecosystem.”

Nearly one in five Americans have used a GLP-1 therapy at least once. And nearly one in eight are currently on the medication. Thirteen states already cover the drugs under Medicaid programmes, despite the enormous up-front cost – with others considering coverage.

While the US currently dominates GLP-1 sales, EU countries, China, and India are expected to make up more of the demand for these drugs in the coming years.

So the question remains whether lower-and-middle income countries, which are facing their own accelerating obesity rates, will have the same level of access. These countries still face barriers to basic diabetes care, the initial intent of use of GLP-1 drugs. 

‘Medication alone won’t solve the obesity crisis’

UNICEF and other international agencies singled out the aggressive marketing of ultra-processed food as a driver of rising obesity, especially in children.

Despite the excitement and potential of these drugs, the WHO cautioned that obesity treatment still must be paired with healthy diets and physical activity. 

“Medication alone will not solve the obesity crisis,” said Tedros. “Obesity is a complex disease that requires comprehensive, lifelong care. And it has many social, commercial and environmental determinants, requiring action in many sectors – not only in the clinic.”

These other determinants of obesity, such as a food environment rich in high sugar, fat, and salt foods, mean that the global overweight or obese population is expected to reach 60% by 2050.

Countries in Sub-Saharan Africa, the Middle East, and Latin America will be particularly affected by this surge. 

“Obesity is largely preventable,” said the WHO’s assistant director-general for health promotion and disease prevention, Jeremy Farr. “Yet millions of people around the world face environments that make it easier to gain weight and harder to stay healthy.”

Image Credits: David Trinks, KFF.

Dr.-Daniel WHO
Dr Daniel Ngamije outlines major updates from the latest malaria report during a press conference

Global malaria programmes have helped to save an estimated 14 million lives between 2000 and 2024, but growing drug resistance is threatening to undermine years of hard-won gains, a new World Health Organization (WHO) report has shown.

Last year, the world recorded 282 million malaria cases and more than 600,000 deaths, with Africa accounting for 95% of the total burden. 

Nearly two-thirds of all infections and deaths occurred in just 11 African countries, underscoring the concentration of the disease in the world’s most vulnerable regions.

At a WHO press briefing on Tuesday, officials stressed that malaria elimination remains achievable even as the path narrows.

“It is good to recall that malaria can be eliminated,” said Dr Daniel Ngamije, director of malaria and neglected tropical diseases at WHO. “To date, 47 countries and one territory have been certified malaria-free.” 

But he warned that global momentum is slowing as multiple crises converge. Once-steady progress has stalled, driven by drug resistance, climate change, conflict, inequity and weakening health systems, according to the report.

Drug resistance intensifying

Dr.-Arnaud-Le-Menach
Dr Arnaud Le Menach presents new findings on drug resistance patterns across Africa.

One of the most serious threats highlighted in the report is rising drug resistance, particularly to artemisinin, the backbone of first-line malaria treatment. Eight African countries have either confirmed or suspected partial artemisinin resistance, echoing earlier treatment failures, including the collapse of chloroquine’s efficacy in the late 20th century, said Dr Arnaud Le Menach, WHO’s unit head for strategic information for impact and lead author of the report.

Artemisinin partial resistance refers to a delay in clearing malaria parasites from the bloodstream following treatment with an artemisinin-based combination therapy (ACT). As a result, the artemisinin compound becomes less effective in eliminating all parasites within the expected three-day period among patients infected with partially resistant strains.

This resistance affects only one stage of the parasite cycle in humans, known as the ring stage. For this reason, WHO describes the phenomenon as “partial resistance,” reflecting its time-limited and cycle-specific nature. 

It remains unknown whether this resistance could evolve further, eventually affecting other parasite stages. Full artemisinin resistance has not been reported. Le Menach added that WHO is also detecting possible signals of declining efficacy in the partner drugs used alongside artemisinin.

Outside Africa, however, there are signs of progress. Countries such as Laos and Cambodia, once global centres of drug resistance, are now nearing malaria elimination. 

“So there is hope,” he said, noting that sustaining gains will require stronger community engagement, reliable diagnostics and tighter regulation to prevent the circulation of substandard malaria medicines.

Dr Martin Fitchet,
Dr Martin Fitchet, CEO of Medicines for Malaria Venture, briefs the press on the first non-artemisinin malaria therapy developed in 25 years.

“We have seen this story before,” said Dr Martin Fitchet, chief executive officer of Medicines for Malaria Venture (MMV). “The collapse of chloroquine in the 1980s and 1990s was not a medical issue it was a humanitarian disaster. We lost millions of lives, especially children. In fact, this was the reason MMV was founded in 1999, to ensure that through a public-private partnership, this should never happen again.”

“Today, we can see the red lights flashing again,” he said. “With resistant mutations rising in the African region, we need to prolong the resilience and effectiveness of malaria medicines.” He stressed the importance of taking the pressure off artemisinin-containing drugs and the partner drugs that support and protect them. 

“However, history and biology tell us that these measures will eventually be insufficient to prevent outright drug failure. At the end of the day, that is an evolutionary certainty,” Fitchet added. He added that long-term victory over malaria depends on developing the next generation of antimalarials. 

Progress is underway: Phase 3 data were recently presented on the first non-artemisinin therapy in 25 years, ganaplacide, combined with lumefantrine. 

Developed by Novartis in partnership with MMV, global research teams and donors, the combination known as GanLum has shown efficacy comparable to the current standard of care. Early evidence also suggests it may be able to kill drug-resistant parasites and block transmission, offering a critical new option at a time of growing resistance.

Funding shortfalls threaten progress

Funding shortfalls remain one of the biggest threats to malaria control. In 2024, an estimated $3.9 billion was invested in malaria prevention, less than half of what is required under WHO’s Global Technical Strategy for 2025.

This underfunding, combined with reductions in official development assistance, disruptions to health services, stockouts and delays in routine surveillance, poses “a severe risk” of increased outbreaks this year and next. “The main risk with the funding cuts is affected surveillance,” said Le Menach. “

This year, a lot of our surveillance and surveys have been affected, and there is a risk that information provided through surveillance will not be as accurate as it should be.”He added that initiatives are underway to ensure that key country-level surveillance functions can be maintained so data quality is not compromised.

Ngamije stressed that surveillance is central to malaria response. Member states have recommended it as a “co-intervention,” he said, because data-driven decision-making depends on tracking mortality, detecting outbreaks and measuring the impact of interventions.“

We cannot fight an enemy we do not know,” he said. “We cannot track the impact of our investment without surveillance. Investment in surveillance is part of the co-intervention to fight malaria.”Ngamije noted that when funding shrinks, countries often prioritise commodities such as medicines and diagnostic kits. “This makes sense,” he said. “But there should always still be resources to keep investing in surveillance.

Vaccine rollout

Dr Rafiq Okine
Dr Rafiq Okine, WHO technical officer for malaria vaccines, briefs the press on emerging vaccine trends.

The vaccine rollout is another area where progress and pressure now collide. “We have seen a rapid uptake of vaccines,” said Dr Rafiq Okine, technical officer for malaria vaccines at WHO. “At the end of 2024, there were 17 countries that had introduced malaria vaccines.”

But he warned that the biggest challenge in 2025 will be navigating shrinking funding. Countries need sustained support to expand vaccination to all areas where it is needed most, he added. Without stable financing, vaccine introduction risks slowing just as demand is rising.

 

Image Credits: WHO.

Clement Nchabaleng dispensing medicines at a central depot that services millions of patients.

JOHANNESBURG – Over 3.7 million South Africans on monthly chronic medication can now get their medicine faster and closer to home, thanks to a vast network involving government officials, private companies and couriers – some on bicycles.

But cuts to aid for global health will leave a hole in the programme that will be hard to fill.

In the past, these patients, most of whom are living with HIV, would have waited for around four hours at government clinics every month to fetch their medicine.

Many skipped collection dates as they could not manage the long monthly waits and the often costly transport to health facilities.

Meanwhile, pharmacy staff at the government health facilities spent around 70% of their time preparing repeat prescriptions, and there were also significant stock losses in places with poor security.

Almost 10 years ago, the South African government recognised that it needed to develop a more efficient system to get medication to stable patients to stem the defaulter rate and cut congestion in clinics.

South Africa has one of the biggest HIV positive populations in the world – over eight million people – and a growing burden of non-communicable diseases (NCD), particularly hypertension and diabetes.

The government established the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme in 2016 with seed money from the Global Fund. Later, it received support from the US President’s Emergency Plan for AIDS Relief (PEPFAR) and Project Last Mile.

Convenient pick-ups

National Programme Manager Merlin Pillay and Janus Prinsloo, senior operations manager, in the central warehouse in Johannesburg that houses up to four months’ supply of chronic medication for over three million South Africans.

The key focus of CCMDD – rebranded recently as Dablapmeds (“dablap” is local slang for shortcut) – was to establish convenient pick-up points for patients and improve the dispensing and distribution of chronic medicine.

Merlin Pillay, the national programme manager, says that the programme has “improved access to medicine, allowed more control over supply chains, reduced waiting times and reduced stigma” (for HIV positive patients).

Some 3,76 million patients in eight of the country’s nine provinces are using Dablapmeds, collecting medication from 3,500 facilities. The vast majority of these pick-up points are private facilities – almost 3000 – and most are private pharmacies.

But medical practices and NGOs also pick-up points in places where pharmacies are scarce. Some rural patients get home deliveries, including from couriers on bicycles.

Around 60% of patients using the system are living with HIV, 23% have NCDs, and the remainder have both HIV and an NCD, says Pillay.

Patients usually get three months’ supply of medicine. From April 2026, stable patients in the system for three months will get six months’ supply, which will enable a significant saving to the project.

Less than $5 per patient

The cost per patient to pack, dispense and deliver their medicines is less than $5 per year, while pick-up points get paid around 60 US cents per patient, says Pillay.

The terms of use are strict: if they fail to collect their medicine within seven days, it is returned to the clinic where they were enrolled for the programme, and they will need to go back and start from scratch.

So far, only 5% have defaulted in comparison to at least 15% in the government clinics.

“The system is highly efficient, and enables tight control of medicines,” says Pillay, who was speaking to Health Policy Watch at the Johannesburg headquarters of Pharmacy Direct, the private company that packs and dispenses most of the scripts, which get sent to it from the different health facilities.

Pharmacy Direct’s chief pharmacist, Doreen Nchabaleng, explains that most clinics use handwritten scripts. These are collected by courier from health facilities and delivered to her company’s headquarters, where they are entered into the central database. 

Some 800 Pharmacy Direct staff pack the medicine in the company’s vast storerooms. Controls are strict. All bags are left outside to prevent theft. Each packer’s output is tracked in real-time. Speedy workers can earn up to 30% more if they exceed certain targets.

Around 6,000 scripts are packed every day at the facility, which stores 250 different medicines and up to four months’ supply of each. Two-thirds of the medicine is the most common antiretroviral medicine.

Pharmacy Direct’s Doreen Nchabaleng with some of the thousands of scripts that the company deals with daily.

Substantial dangers

But Donald Demana, the Department of Health’s chief director for the Global Fund, says that the funding cuts to global health pose “substantial dangers” to South Africa’s HIV and tuberculosis response.

South Africa appears to be the only African PEPFAR recipient not to have been asked by the US to discuss terms for a new grant for 2026 amid a political row between the two countries.

“The government is mindful of the possibility of a PEPFAR pause and it will take a little while for the Treasury to be able to cover the gap,” said Demana. “Overall, development aid is shrinking and sustainability is difficult amid the reduced budget.”

While the South African government covers the cost of antiretiroviral medicine from its national budget, it has relied on donors like PEPFAR for assistance to reach groups where HIV is flourishing – “key populations” including young women, sex workers, gay men and people who inject drugs.

An estimated 1.1 million people in these groups are living with HIV and are not on treatment, but all community outreach funding for these groups has stopped.

While the Global Fund has committed to assisting all countries based on evidence of their need, US President Donald Trump recently cancelled all development assistance to South Africa. The US remains the largest donor to the Global Fund with its recent pledge of $4.6 billion.

Donald Demana, the health department’s chief director for the Global Fund, says that funding cuts pose substantial challenges to the country’s HIV response.

Image Credits: Kerry Cullinan, Kerry Cullinan .

The IQ of Indian children exposed to high levels of air pollution was lower than children in areas with low air pollution.

Air pollution not only affects lung health but also brain development in children, according to two studies presented at the World Conference on Lung Health (WCLH) held in Denmark recently.

One study from India found that children living in highly polluted areas scored nearly 20 points lower on the intelligence quotient (IQ) than their peers in cleaner environments, immediately limiting their educational potential and life opportunities.

These findings highlight air pollution as not merely an environmental issue but a global health emergency that threatens children’s futures and severely worsens existing lung disease.

Air quality lowers IQ in children

Zeroing in on the link between airborne particulate matter and cognitive ability, new findings from the Kalinga Institute of Industrial Technology (KIIT) in India suggest a significant and close association between children’s IQ development and long-term exposure to ambient air pollution.

The KIIT study, published in the WCLH abstract book, examined the impact of particulate matter PM2.5 and PM10 (particulate matter with a diameter of 2.5 and 10 micrometres) on the cognitive development of children aged 6-8 in the state of Odisha in India. While the effects of air pollution on lung and cardiovascular health are well documented, this research represents a pioneeringl look into its potential to disrupt cognitive development in children.

Setting up a comparative analytical study, researchers assessed two sites between July and December 2022: one with high pollution levels (PM10 above 60 micrograms per cubic metre and PM2.5 above 40 micrograms) and one with low pollution. Children who had lived within a 1.5 km radius of air quality monitoring stations for six years were tested, using Malin’s Intelligence Scale for Indian Children, which measures full-scale, verbal, and performance IQ.

The results were stark. Mean Full-Scale IQ in high-pollution areas was 80.33 compared to 98.12 in low-pollution areas. Children from high-pollution areas had a verbal IQ of 81.60 compared to 99.68 in low-pollution areas, and a performance IQ of 79.02 compared to 96.55 in cleaner areas.

The authors conclude that long-term exposure to air pollution is closely linked to poorer cognitive development in children. The report further suggested that the child’s age and weight, poor kitchen ventilation, maternal education, and family income also made an impact on full-scale IQ, painting a picture of multiple interacting risk factors.

Air pollution affects the poorest the most

“The burden of air pollution and climate change on health is one which sadly continues to grow. And, as with many other determinants of health, it is the world’s poorest who are the most affected,” said Professor Guy Marks, president of the International Union Against Tuberculosis and Lung Disease (The Union).

“New strategies are urgently needed globally to ensure no one’s future is limited simply because of the air they breathe.”

The Union was established in 1920 as the world’s first global health organisation and works towards a world free of tuberculosis and lung disease. Its members, staff, and consultants work in more than 140 countries globally. 

Asthma attacks increase in West Africa

Separately, a direct link between air pollution and the severity of asthmatic conditions in adolescents has been reported in a new study by the Centre Hospitalier et Universitaire de Pneumo-Phtisiologie (CNHUPPC) in Cotonou, Benin, in West Africa.

In Cotonou, where air pollution systematically exceeds World Health Organisation (WHO) thresholds for all pollutants, researchers followed a cohort of 730 asthmatic adolescents over 36 months. The study reported that over one-third 37% of the adolescents experienced at least one respiratory event or asthma attack.

Measuring individual exposure via portable air quality sensors carried in backpacks and fixed sensors in schools and homes, the researchers determined that the adolescents with frequent respiratory events had higher levels of exposure to several pollutants, including nitrogen dioxide, PM1, PM2.5 and PM10. 

The study also noted that asthma symptoms occurred 2.5 times more during the seasonal harmattan period when a cool, dry and dusty wind blows, usually between December and March. This highlights the compounding effect of climate-related atmospheric changes. 

“Fine particulate air pollution remains very high in West Africa and poses a serious risk to the respiratory health of adolescents with asthma who are chronically exposed,” said Dr Attannon Arnauld Fiogbé, chest physician and clinical researcher at CNHUPPC. He suggested that strengthening responses by combining air quality alerts with therapeutic education could significantly improve respiratory health.

Air purifiers in schools 

Proposing a tangible solution to mitigate some of the exposure, Professor Anant Sudarshan from the University of Warwick in the UK, advocates for targeted intervention in schools, especially for low-income communities. 

“Introducing appropriately sized air purifiers in all government schools may be a good policy. Children spend a significant share of their day in classrooms, and any reduction in pollution exposure can have large health benefits,” Sudarshan told Health Policy Watch. 

“This is most important for the poor who cannot afford to purify air at home or who live close to traffic or industry,” Sudarshan added.

Sudarshan explained that children spend roughly one-third of their day at school for two-thirds of the year – around 17% of their lives – so cleaning up the air just in schools could cut a child’s annual pollution exposure by approximately 17%.

This reduction is considered vital because PM2.5 has been shown to have similar effects on cognitive behaviour and productivity as CO2 buildup, impacting both short-term alertness and long-term development. 

For policymakers grappling with this crisis, the evidence is now clear: the fight for lung health must integrate immediate, robust action to protect the cognitive and life-long potential of the world’s children.

Image Credits: Akshar Dave/ Unsplash.

A technician at the Biomedical Research Institute in South Africa, which is training African scientists. Investing in regional health systems is essential to ensure global development.

As the world navigates a pivotal moment in global health and development, one of the most critical pathways to sustainable development is through regional public health. Investing in regional health systems and production capacity of public health goods isn’t just a moral responsibility; it is an economic imperative. 

A 2020 McKinsey & Company report revealed that every $1 spent on health in developing countries can yield a return of $2 to $4, underlining the impact of strategic investments in health. 

When the COVID-19 pandemic brought the world to a standstill, it not only revealed critical failures and fragilities in the global response to public health crises but also highlighted the inextricable link between health and development. 

It caused the first rise in global poverty in a generation, triggered the deepest global recession since the end of World War II, and widened inequalities within and across countries, particularly for the most vulnerable. 

The unequal access and distribution of medical countermeasures between wealthy nations and low- and middle-income countries left millions around the world without life-saving vaccines, overwhelmed healthcare systems, and led to the loss of lives. 

Over-centralized, top-down response

Beyond the human and economic costs, the pandemic exposed a troubling reality: An overly centralized, top-down global response is inadequate when crises arise. The failure of initiatives like the COVID-19 Vaccines Global Access (COVAX) to ensure equitable vaccine access for poorer nations exemplified these weaknesses. 

In response, regional institutions stepped up. The Caribbean Public Health Agency (CARPHA) mobilized resources to support member states in their COVAX participation. Similarly, the Association of Southeast Asian Nations (ASEAN) launched the Vaccine Security and Self-Reliance initiative to boost regional procurement and stockpiling. 

In Africa, the African Union (AU) and the Africa Centres for Disease Control and Prevention (Africa CDC) created the African Vaccine Acquisition Task Team, securing enough doses to cover a third of the continent’s population. 

Historically, public health outbreaks like HIV, TB, malaria, Ebola, SARS, dengue, Zika, mpox, and COVID-19 have demonstrated that public health threats do not respect borders. When a nation or region cannot adequately prepare for, prevent, or respond to these threats, it poses significant risks for the rest of the global community. 

Around the world, regional agencies like the Africa CDC, CARPHA, the European Centre for Disease Prevention and Control (ECDC), the Gulf CDC and the, yet to be established, ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED), are emerging as powerful models for tackling cross-border health challenges and fostering regional countries’ cooperation and a platform for future south-south collaboration – through shared responsibilities, knowledge exchange, data-sharing, and pooled resources. 

In the face of recent disruptions, regional bodies continue to show their indispensable role in shaping a more resilient and coordinated global response. 

The Africa CDC’s declaration of the 2024 mpox outbreak as a Public Health Emergency of Continental Security before the World Health Organisation (WHO) – making it the first of its kind in the agency’s history – illustrates the power of regional leadership. 

This catalyzed the rapid mobilization of resources, collective will, and interventions to contain the outbreak and protect vulnerable populations.

 Likewise, ASEAN convened and activated regional action quickly during its 2024 mpox outbreak, while in 2021, the European Union (EU) established the Health Emergency Preparedness and Response Authority, bolstering regional capacity to respond to health emergencies and ensuring access to vaccines, diagnostics, and therapeutics. 

Together, these highlight the transformative potential of regionally anchored strategies, and the crucial need for them as central players – not just in crisis response, but in ongoing efforts to coordinate, respond, and sustain recovery – not as mere beneficiaries but as essential actors. 

Equity and resilience

Strong regional public health mechanisms should be the key engines for equity and resilience. Although the world has taken a significant step forward with the adoption of the Pandemic Agreement to improve coordination, transparency, and equity, it is not enough. 

Challenges persist, especially the power dynamics that favor wealthier countries in decision-making and in controlling vaccine rights and distribution. By contrast, empowering regional health systems to produce vaccines, therapeutics, and diagnostics locally can help address these inequities. Such efforts can create ripple effects – enhancing human capital, creating jobs, and stimulating economic growth.

The African Vaccine Manufacturing Accelerator (AVMA) financing initiative, designed to unlock up to $1.2 billion over the next decade, reinforces this shift toward self-reliance. 

Moreover, regional institutions are vital for advancing equity by increasing the negotiating leverage of marginalized or less powerful states in global health governance. 

For instance, the Pandemic Agreement’s provision and voting rights for regional organisations such as ASEAN, the AU and the EU illustrate the importance of regional voices. 

The Africa CDC’s role in galvanizing a unified African position during the negotiations emphasizes how regional bodies strengthen collective influence. 

The lesson is clear: Robust regional public health systems not only promote equitable representation on the global stage but also serve as mediums for self-sufficiency and health sovereignty. 

These qualities are key to building resilient health systems capable of weathering overlapping global shocks and shifting geopolitical priorities. Given these promising developments, there is a compelling argument for establishing a Latin American CDC to enhance the region’s capacity to coordinate and respond to outbreaks effectively – a proposal worth exploring. 

Public health is a public good, and it must be viewed not as charity but as a strategic investment in our shared future. Building resilient, equitable, and well-resourced regional health systems, backed by strong political will, is essential for stability and shared prosperity. 

By prioritizing this approach, we take a step toward transforming the global health architecture and creating a more equitable and healthier future.  

Michael Weinstein is the president and co-founder of the AIDS Healthcare Foundation (AHF), the largest AIDS health organization in the world, whose mission is to provide cutting-edge medicine and advocacy regardless of ability to pay.

Mehdi Jomaa is the former Prime Minister of Tunisia (2014-2015) and a member of Club de Madrid, a forum of former democratic presidents and prime ministers who leverage their experience and global reach to strengthen inclusive democratic practice and improve the well-being of people around the world.

Image Credits: Kerry Cullinan.