Climate change EPA

Hailed as the “single largest deregulatory action in US history,” the Environmental Protection Agency repealed a 2009 scientific decision that gave the agency the authority to regulate climate change pollutants, also known as the Endangerment Finding.

The US Environmental Protection Agency (EPA) has eliminated the scientific finding that determined planet warming gases also harm human health. 

For the last 15 years, that finding has served as the legal basis for EPA’s regulation of greenhouse gas emissions by power plants, vehicles, and other sources. 

Reversal of the finding effectively pulls the legs out from the framework that underpins virtually all of the climate rules enacted since by the EPA – whose mandate is to regulate pollutants once it’s found that they damage public health and the environment. 

In a White House announcement, EPA administrator Lee Zeldin derided the Endangerment Finding as the “‘Holy Grail’ of the ‘climate change religion.’

Critics in the US and worldwide slammed the US reversal as a politically-charged policy decision that would lead to more ill health as well as putting “millions” of lives at risk in the US and worldwide, if the new finding survives the court challenges that are expected to follow, in the words of former EPA administrator Gina McCarthy. 

EPA following ‘letter of the law’

EPA trump Zeldin Climate change
EPA Administrator Lee Zeldin at a White House press conference, announcing the repeal of the Endangerment Finding, alongside President Trump.

“The Trump EPA is strictly following the letter of the law, returning common sense to policy, delivering consumer choice to Americans and advancing the American Dream,” Zeldin countered at a press conference at the White House on Thursday. He was joined by President Trump, who called the rule the legal foundation for the “Green New Scam.”

The 2009 finding issued after a technical assessment by EPA staff scientists determined that current and projected concentrations of six key greenhouse gases, including methane, carbon dioxide, and hydrofluorocarbons, threaten public health in current and future generations. 

The ruling, which directly connected greenhouse gases to human health impacts for the first time, followed a 2007 Supreme Court decision that greenhouse gases are also air pollutants covered by the 1970 Clean Air Act. But the Court also ordered the EPA to determine “whether or not emissions of greenhouse gases from new motor vehicles cause or contribute to air pollution that may reasonably be anticipated to endanger public health or welfare, or whether the science is too uncertain to make a reasoned decision.”

The White House announcement marked the culmination of years of backstage work by climate skeptics and conservatives aligned with President Donald Trump to undo the finding following his election to a second term. 

Speaking at a press conference alongside Zeldin yesterday at the White House, the President blamed the rule for costing “trillions of dollars in regulation” and for “driving up the cost of vehicles for American families and small businesses.” 

No longer a matter of debate 

The Administration statements also attacked the scientists who issued the findings for taking “novel mental leaps” and being part of an “ideological crusade” to connect greenhouse gases to human health harms, also describing the  2009 ruling as “legal fiction.”

Yet the evidence linking climate change and health is “no longer a matter of debate,” said Maria Neira, former World Health Organization Director of the Department of Climate, Environment and Health, told Health Policy Watch. 

“Evidence has grown exponentially since 2009. Today, it is no longer a matter of debate; it is a matter of record,” Neira said. “Research shows that heat extremes, air pollution, the spread of infectious diseases, and food insecurity driven by climate change are intensifying — and already costing millions of lives each year worldwide.”  

Furthermore, the Finding has led to changes in vehicle design that have reduced other harmful tailpipe pollution emissions, as well as making them more fuel efficient. So while the Administration claims that the repeal will save Americans $2400 per vehicle, critics pointed to the millions of dollars in long-term climate and pollution-related health costs that the reversal will entail – if tailpipe and power plant emissions indeed rise once more. And that’s regardless of new tariff policies that have also raised vehicle costs by thousands of dollars.

Tentative evidence is now resolved 

“Much of the understanding of climate change that was uncertain or tentative in 2009 is now resolved – and new threats have been identified,” said the National Academy of Sciences, Engineering, and Medicine in a 2025 report.

The EPA’s repeal of the endangerment finding “disregards decades of unequivocal scientific evidence on the severe health threats posed by climate change and fossil fuel–related emissions, and on the associated harms to the broader economy,” said Dr Marina Romanello, executive director of the Lancet Countdown on Climate and Health, in a statement to Health Policy Watch. “It is a direct attack on the health and survival of people in the US and beyond,” she said. 

Her group recently published the first estimates of heat-related deaths – over half a million in the past decade – or one heat-related death per minute.

“Together with the promotion of coal burning, it shows the US administration is prioritizing the economic interests of a wealthy few to the detriment of people’s health and wellbeing. 

“As the US loses its scientific leadership, other countries have the opportunity to lead the way forward, ensuring a safe environment, and reaping the major benefits that the transition away from dirty fuels can deliver.”

Win for industry, deregulatory champions

In this latest finding, the Administration argued that the 1970 Clean Air Act applies only to localized pollutants like smog and particulate matter – and not to the greenhouse gases, which disperse across the globe. 

That ignores, however, the fact that other polluting gases and particles also travel tens or hundreds of miles – and across borders, wreaking health damage on neighboring cities, rural areas, and countries. 

Other conservatives have argued that Congress should pass a new law to regulate greenhouse gases if it wishes to do so, instead of relying on the Clean Air Act. 

The debate over the economic cost of cleaner air regulations played a central part in the repeal, despite evidence that such regulations save millions in healthcare and disaster-related costs. 

“The final rule will save Americans over $1.3 trillion by removing the regulatory requirements to measure, report, certify, and comply with federal GHG emission standards for motor vehicles, and repeals associated compliance programs, credit provisions, and reporting obligations that exist solely to support the vehicle GHG regulatory regime,” said the EPA statement. “Americans will have certainty, flexibility and regulatory relief, allowing companies to plan appropriately, and empowering American families.”

Yet many emissions savings that followed the Endangerment Finding, such as start-stop ignitions in idling cars, also saved drivers some 7-26% in fuel economy savings. 

Wildfires and extreme weather 

Drought, wildfire, and other extreme weather events have and are expected to increase in frequency and intensity.

While Administration officials touted the immediate economic benefits around the ruling, they were silent about the costs of extreme weather – even though there is increasing recognition in American communities that climate is one of the drivers. 

“Repealing the Endangerment Finding will shape our clinical reality for years to come,” argued Lisa Patel, a pediatric hospitalist and executive director of the Medical Society Consortium on Climate and Health, in an opinion piece.

“Clinically, the implications are straightforward. Increased greenhouse gas emissions mean more days of unhealthy air, higher concentrations of ground-level ozone, and more frequent and intense wildfires,” Patel explained. “For pediatricians, this translates into more asthma exacerbations, more emergency department visits, and more hospitalizations. 

“For obstetricians and neonatologists, it means higher risks of preterm birth, low birthweight, and hypertensive disorders of pregnancy. For internists and cardiologists, it means higher rates of myocardial infarction, stroke, and heart failure exacerbations during heat waves and pollution events,” she said.

Heatwaves and natural disasters costing more 

EPA climate change cost
Cost of extreme weather-related events over the past several decades.

Already, the intensity of heatwaves and natural disasters is costing mounting damage, according to the University of Chicago’s Energy Policy Institute, which stated in a recent policy brief: 

“The average American experiences 20 percent more extremely hot days than they did two decades ago, and the last decade was the warmest on record. 

“Hurricanes of all intensity categories have become more frequent, and the most extreme, Category 5, have doubled in frequency. 

“If planet-warming emissions continue to rise at the same rate they have over the last few decades, by the end of this century there may be seven times more extremely hot days compared to today. 

“In that scenario, nearly half of U.S. states could experience summer temperatures hotter than today’s summers in India or Egypt,” the Institute stated. “Going forward, the combined effects on labor productivity, health, and energy systems “could cost roughly 0.7 percent of GDP for every 1°F increase in temperature on average.” 

Environmental groups gear up for court fights

“The repeal will likely face strong legal challenges,” said Arthur Wyns, Assistant Director of the Australia’s Center for Disease Control, in a social media post. 

Several US environmental groups have already vowed to challenge the Administration’s decision.

These groups still do have the 2007 Supreme Court ruling, determining that climate pollutants  can potentially harm health, although a more conservative bench may be sympathetic to the Administration’s arguments that short of new Congressional Legislation, the 2009 Endangerment Finding represented overreach of the EPA’s authority under the Clean Air Act.  

“This move is part of a growing pattern of hostility toward the American public: stripping protections and making people less safe, all while billionaires profit,” said Natural Resource Defense Council CEO Manish Bapna.

“NRDC will not let this stand. We will see them in court — and we will win.”

The Environmental Defense Fund echoed this sentiment. “This decision is now endangering all of it — and all of us.

“We need to know the truth about the challenges we face, not fake science. We need investment in our communities to promote health, support families, lower costs and power the economy. EDF will challenge this decision in court, where evidence matters, and keep working with everyone who wants to build a better, safer and more prosperous future.”

Looking at the opportunity – rather than costs 

Adds Neira: “This is not abstract science. It reflects Americans’ lived reality. Anyone who has fallen ill during a heatwave, struggled to breathe through wildfire smoke, or faced the aftermath of a devastating hurricane understands that climate change is not a distant environmental issue — it is an immediate and escalating threat to human health.

“But that is only half the story,” she added.

“When governments act to reduce the drivers of climate change, they also address some of the most pressing health challenges of our time. Cleaner vehicles and cleaner sources of electricity mean cleaner air — and fewer deaths from heart and lung disease. Designing cities around safe sidewalks and protected bike lanes encourages walking and cycling, increasing physical activity and lowering the risk of chronic illness.

“The benefits multiply across sectors. Climate action is not a sacrifice; it is a public health opportunity. By confronting climate change, we do not just protect the planet — we advance healthier, longer, and more equitable lives.”

Image Credits: White House, Matt Howard/ Unslash, WMO, Enel North America.

The US flag being removed from outside the WHO headquarters in Geneva last month, signalling the country’s exit from the global body. Since then, three US states and one city have opted to join the WHO’s outbreaks network.

The World Health Organization (WHO) has welcomed the decision of the US states of California, Illinois, New York and New York City to join its Global Outbreak Alert and Response Network (GOARN).

GOARN is a global network of public health institutions, governments, academic bodies and laboratories that helps to detect and control infectious disease outbreaks and public health emergencies throughout the world.

Dr Maria van Kerkhove, WHO Director of Epidemic and Pandemic Threat Management, said that GOARN is an “asset to the world” that currently has over 360 members.

Established 20 years ago, members include national and sub-national institutions with public health and field experience in outbreak response and preparedness, she explained.

“We welcome anyone who wants to be part of GOARN to see our website and fill in the application. It’s an incredible network of national and sub-national institutes, student and academic organisations that meet regularly and share information. They are sometimes deployed to outbreaks around the world,” Van Kerkhove told a media briefing on Wednesday.

Trump’s ‘reckless decision’

California Governor Gavin Newsom at the World Economic Summit in Davos recently, where he met WHO officials.

On 23 January, the day after the Trump administration completed its withdrawal from the WHO, California Governor Gavin Newsom announced that his state would join GOARN.

“The Trump administration’s withdrawal from WHO is a reckless decision that will hurt all Californians and Americans,” said Newsom in a statement. 

“California will not bear witness to the chaos this decision will bring. We will continue to foster partnerships across the globe and remain at the forefront of public health preparedness, including through our membership as the only state in WHO’s Global Outbreak Alert and Response Network.”

Illinois Governor JB Pritzker followed suit on 2 February, stating that US President Donald Trump’s withdrawal of the country from the WHO “has undermined science and weakened our nation’s ability to detect and respond to global health threats”.

By joining GOARN, “we are ensuring that our public health leaders – and the public – have the information, expertise, and partnerships they need to protect the people of our state”, Pritzker added. 

Safety during FIFA World Cup

Last week (5 February), the New York City Health Department also announced that it was joining GOARN, and on 10 February, New York State also reported that it would be joining GOARN.

“To best prevent disease outbreaks and public health emergencies and to protect New Yorkers and visitors from them, the NYC Health Department is joining hundreds of public health institutions worldwide that share critical public health information to support life-saving prevention and response efforts,” said Dr Michelle Morse, NYC’s Acting Health Commissioner.

“Infectious diseases know no boundaries, and nor should the information and resources that help us protect New Yorkers,” she said, adding that GOARN membership would give the city direct access to information and partners during “major events with high levels of international travel, such as the 2026 FIFA World Cup”.

Kathy Hochul, Governor of New York State, also announced her state’s membership: “By joining GOARN, we’re sharing our expertise, laboratories and highly skilled workforce to detect and respond to outbreaks worldwide while helping prevent global health threats from reaching New York State and the United States.”

GOARN members hold weekly meetings, exchange reports on international global health issues, provide support, technical assistance and even send people to assist during outbreaks, if requested to do so.

MOUs in place of multilateralism?

WHO Director General Dr Tedros Adhanom Ghebreyesus is “not worried” that US bilateral health deals with various countries will replace multilateral bodies.

The Trump administration has tried to ameliorate its withdrawal from the WHO by signing health Memorandums of Understanding (MOUs) with former health aid recipients, trading ongoing health support for immediate access to all information about pathogen outbreaks.

This is in keeping with its America First Global Health Strategy, published last September by the US State Department, which aims to “make America safer” by “continuing to support a global surveillance system that can detect an outbreak within seven days”.

“We will accomplish this through bilateral relationships with countries,” according to the strategy.

But the US has only signed health MOUs with 16 countries, and it has not yet translated any of these into bilateral agreements. In addition, the 16 countries are all based in Africa and do not appear to have been targeted because of their disease outbreak profiles.

SARS-CoV2, the virus that caused the COVID-19 pandemic, originated in China – an unlikely candidate for an MOU. Meanwhile, a recent European Commission Joint Research Centre report identifies Latin America as the region at highest risk of outbreaks of the diseases identified by the WHO as the most likely to cause epidemics and pandemics. Oceania is the second most likely area. The most risky countries are Papua New Guinea and the Republic of the Congo.

In contrast to the bilaterals that will be time-consuming to manage, the WHO’s 193 member states are bound by the International Health Regulations (IHR), a legal framework that defines their rights and obligations in managing public health risks, events and emergencies that have the potential to cross borders.

In addition, negotiations between WHO member states are at an advanced level about a global pathogen access and benefit-sharing (PABS) system, the final piece of the Pandemic Agreement adopted by the WHO last May.

WHO Director-General Dr Tedros Adhanom Ghebreyesus reiterated this week that bilateral agreements between countries are “not a new phenomenon”, and he did not think that the US-driven MOUs can replace the multilateral system.

“Any member state can have any MOU with any country it wants. This is between sovereign countries, and they know best for their respective countries,” said Tedros.

Tedros also shrugged off concerns that these MOUs will undermine the PABS system being negotiated as part of the WHO’s Pandemic Agreement.

“I don’t see that there will be any impact on the PABS negotiations. We’re not really worried… There can be bilateral agreements, and there can also be multilateral agreements. It’s not one or the other. Both can exist without any problem.”

A child in a camp in Tawila, North Darfur, for people displaced from Al Fasher.

Famine indicators are worsening in the most vulnerable areas of Sudan, where “a situation that is already awful continues to deteriorate”, World Health Organization (WHO) Director-General Dr Tedros Adhanon Ghebreyesus told a media briefing on Wednesday.

Last week, acute malnutrition surpassing famine thresholds was identified in two areas of North Darfur, by the Integrated Food Security Phase Classification (IPC).

Thousands of people fled to these areas, Um Baru and Kernoi, last last year to avoid violent attacks on civilians in the town of El Fasher.

“Famine conditions were confirmed in two other cities in November last year, and we know that where hunger goes, disease follows,” said Tedros, adding that an estimated 4.2 million cases of acute malnutrition are expected across Sudan this year – a 14% increase from 2025.

Violence is ongoing, including attacks on healthcare facilities. In the past three years of the war, the WHO has verified 205 attacks on health facilities, which have led to 1,924 deaths and 529 injuries.

WHO’s Sudan Country Representative, Dr Shible Sahbani,

WHO’s Sudan Country Representative, Dr Shible Sahbani, told the media briefing that, aside from famine and violence, Sudan is battling major outbreaks of cholera, malaria, dengue and measles.

Over 2.9 million malaria cases have been recorded, 124,000 cholera cases and more than 3,500 deaths, and over 63,000 dengue cases.

“Water, hygiene, sanitation and health conditions are very bad in many, many states,” said Sahbani, adding that continued fighting made it impossible for humanitarian efforts to reach those who need help.

No support for rape survivors

Widespread rape and gender-based violence have been hallmarks of the conflict, and Sakhani said that there was little access to services such as emergency obstetric care, and clinical management of rape.

Meanwhile, Dr Teresa Zakaria, WHO head of Humanitarian and Disaster Action, told the briefing that “70% of women in crisis are subjected to gender based violence”. 

However, “over 60% of organisations that in the past have provided clinical care, social protection, and social assistance to survivors of sexual violence have had to scale back or stop services because of funding cuts”, added Zakaria.

“Humanitarian aid cuts to the gender based violence sector amount to over $110 million. In 2025, what this represented is that three million people, mostly women and girls, but also boys and men in humanitarian crisis are deprived of access to services,” she said, adding that the situation this year “is only going to become much worse”.

Guinea-Bissau trial is ‘unethical’

When asked about a controversial trial to examine various impacts of the hepatitis B vaccine on newborn babies in Guinea-Bissau, Tedros declared bluntly that it is not ethical.

“Guinea-Bissau is one of the countries with a high prevalence of hepatitis B, and withholding a birth dose could actually expose infants to a high chance of infection,” said Tedros.

“This violates basic protocol. When you have an effective medicine, denying half of the population of children access to a vaccine that has been there for more than 40 years, which is safe and effective, is not ethical.”

A day after the press conference, the WHO issued a statement outlining in more detail why the study is “inconsistent with established ethical and scientific principles”.

It listed five reasons, namely:

  • withholding the vaccine from some study participants exposes newborns to serious and potentially irreversible harm, including chronic infection, cirrhosis, and liver cancer.
  • A placebo or no‑treatment vaccine trial is only acceptable when no proven intervention exists or when such a design is indispensable to answer a critical question of efficacy or safety. Neither condition appears to be met based on publicly available descriptions of the study.
  • The protocol does not question the established efficacy and impact of the birth dose; instead, it posits hypothetical safety outcomes without sufficient credible evidence of a safety signal that would warrant exposing participants to risk.
  • The single‑blind, no‑treatment‑controlled design raises a significant likelihood of substantial risk of bias, limiting interpretability of the study results and their policy relevance.
  • Exploiting scarcity is not ethical: Resource constraints cannot be used to justify withholding proven care in a research study involving people. Ethical obligations require minimizing risk and ensuring a prospect of benefit for participants.

There has been global outrage over the ethics of the trial, which would only give half the 14,000 babies it aims to enroll a hepatitis B vaccination shortly after birth – despite clinical evidence that early vaccination is highly effective at preventing mother-to-child transmission of the virus, which is the leading global cause of liver disease. 

A Danish research group, Bandim Health Project, headed by Dr Christine Stabell Benn, an ally of US Health Secretary Robert F Kennedy Jr, has been given a $1,6 million, five-year grant by the US Centers for Disease Control and Prevention (CDC) to “assess the effects of neonatal Hepatitis B vaccination on early-life mortality, morbidity, and long-term developmental outcomes”.

Stabell Benn is an adviser to the US Advisory Committee on Immunization Practices (ACIP), which recently resolved to stop recommending hepatitis B vaccines to US newborns. 

“Of course, a sovereign country can decide whatever it wants. But as far as WHO is concerned, it’s unethical to proceed with this study,” Tedros stressed.

In a statement, WHO listed glaring ethical violations for witholding the vaccine: the proven benefit of the vaccine, foreseeable harm of the disease, no scientific necessity for the no-treatment arm, insufficient scientific justification, biased and low-utility design, and that exploiting scarcity is not ethical.

WHO’s head of immunisation and vaccines, Dr Kate O’Brien, questioned purpose of the trial, adding that WHO’s representative in Guinea-Bissau had been in regular contact with the country’s Health Ministry about the trial.

“It’s a safe and extremely effective vaccine,” she said, adding that over 150 countries currently use the hepatitis B vaccine.

WHO’s head of immunisation and vaccines, Dr Kate O’Brien, questioned the reason for the trial.

“Whenever research is proposed, there has to be some foundation for proposing it, especially when it is asking a question about an authorised vaccine that has a very long-standing safety profile,” said O’Brien.

“There has to be some basis for expecting that there is an issue or a question that needs to be asked. And, to our knowledge, there is no underpinning evidence that would suggest that there is any concern with respect to hepatitis B vaccine.”

She added that, aside from policy relevance, the research needed to “protect the interests of the participants”.

“There are some very concerning aspects of the study that have been proposed, and these are some of the questions that we were asking of the investigators when we had a very good opportunity to discuss it with them.”

Two weeks ago, Guinea-Bissau Health Minister, Quinhim Nanthote, told a media briefing that the trial had been “suspended or cancelled”.

This is despite recent assertions by the US Health and Human Services (HHS) Department that it was going ahead.

‘Non-specific effects’ of vaccines

Nanthote initially told the briefing that his country’s ethics committee had not yet held a meeting about the trial, but later said that it “did not have the required technical resources” to approve the trial.

Nanthote, who addressed the briefing in military fatigues, was only appointed health minister on 29 November 2025, following a military coup three days earlier, and was not part of the discussions about the trial.

For years, Stabell Benn, co-principal investigator of the trial, has researched the “non-specific effects” (NSE) of vaccines. She and colleagues have conducted trials involving thousands of children in Guinea-Bissau and Denmark, and assert that all vaccines should also be tested for NSEs.

One of the research aims of their Guinea-Bissau trial is to investigate the effect of the vaccination “on neuro-development by five years of age”. This dovetails with Kennedy’s belief that the rise of autism is linked to childhood vaccinations.

“RFK Jr. has manipulated the [Guinea-Bissau] study to support his unsupportable, science-resistant beliefs about harms caused by the hepatitis B vaccine,” observed US paediatrician Dr Paul Offit, co-inventor of a rotavirus vaccine, on his Substack platform.

Story updated to include the WHO statement on the Guinea-Bissau trial.

Image Credits: UNICEF.

The Trump administration has abolished the US Agency for International Development (USAID) and slashed its global health funding, exposing the vulnerability of many African countries’ health systems.

On the eve of the African Union’s annual meeting, leaders need to secure their countries by increasing spending on health.

The year 2025 will go down in history as the moment the traditional model of global health financing ruptured. Sudden, sweeping aid cuts exposed a reality African policymakers have warned about for decades: while foreign aid can save lives, it cannot sustainably build strong health systems. 

In a split second, the shock reverberated through HIV clinics, vaccination campaigns, maternal health services, mental health and health information systems – critical infrastructure largely financed by resources beyond national control.  

For Africa, the lesson is unmistakable. Health security cannot rest on external priorities or volatile funding cycles. It must be anchored in Africa’s sovereignty and predictable domestic financing.

Months following the aid cuts, African leaders and policymakers have been exploring  permanent solutions that can protect lives and livelihoods today while laying the foundation for resilient health systems in a post-2030 development era.

Stronger domestic financing

President Paul Kagame of Rwanda has led continental efforts to increase domestic spending on health.

One such solution has been with us for years. In 2019, African Heads of State, led by Rwanda’s President Paul Kagame, convened the first-ever African Leadership Meeting (ALM) on Investing in Health in Addis Ababa. 

It was a defining moment of collective introspection where leaders acknowledged that Africa could not build strong health systems dependent on donor priorities or external timelines. They affirmed that health is not merely a development issue but a strategic investment foundational to economic, human security and long-term development.

The ALM Declaration, adopted unanimously, called for stronger domestic financing, enhanced mutual accountability and a new partnership between Ministries of Health and Ministries of Finance – two institutions that had too often approached healthcare challenges from opposing perspectives.

That foundation is now bearing fruit and should be among the first frameworks policymakers turn to as they confront the current financing crises and seek durable solutions for the years ahead.

To date, 12 African Union Member States including Burundi, Kenya, Malawi, Mauritius, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe have convened national health financing dialogues under the ALM framework in alignment with African Health Strategy (2016–2030). 

These dialogues, co-led by Finance and Health Ministries, are breaking long standing silos and developing more coherent approaches to mobilising domestic and blended finances, prioritising pandemic preparedness and increasing local manufacturing and innovation. Critically, they are translating political commitments into concrete budget reforms, parliamentary oversight and fiscal accountability.

Health is a pillar of national security

The US President’s Emergency Plan for AIDS Relief (PEPFAR) funded 80% of the costs of Luyengo Clinic in Eswatini, putting the HIV treatment of 3,000 clients in jeopardy when President Trump paused aid.

Anchored in the African Union’s Agenda 2063 and its vision of self-determination, the ALM takes a long-term view of Africa’s health agenda. It positions health spending not as a humanitarian cost vulnerable to shifting geopolitical shifts but as a pillar of economic resilience and national security.   

The tools now emerging from the ALM process are already reshaping decision-making across the continent. Regional health financing hubs, a continent-wide ALM tracker, the AU scorecard and new digital platforms for financing data are introducing levels of transparency, coordination and evidence-based planning that were once unimaginable. These mechanisms enable governments to track progress, monitor reforms and gaps that have long been obscured by fragmented systems.

Early results are beginning to emerge, with several countries – including Ghana, Nigeria and Rwanda – registering increases in domestic health spending and improved efficiency in allocation.

Yet the central vulnerability remains. External financing and out-of-pocket payments by patients account for most of Africa’s health financing. 

In the case of HIV, foreign aid makes up roughly 70% of financing — a figure that leaves households and national programs dangerously exposed to global political and economic shocks. Achieving universal health coverage will require confronting this structural risk directly, not tiptoeing around it.

Increased and smarter spending

The ALM offers one of the clearest paths forward. It calls for increased and smarter spending, with primary health care at its core. It embeds accountability in the flow of public funds and reframes domestic health financing as a high-return investment in productivity, stability and social cohesion.

The decade ahead will test Africa’s resilience more severely than the last. Climate shocks, emerging pathogens and demographic change will continue to strain already fragile systems. As the world approaches the final years of the SDGs, Africa must define its post-2030 agenda in its own terms. ALM shall become the backbone of that vision.

Success will require more than technical reforms or political goodwill. The ALM implementation must be people-centred. 

Citizens must have a meaningful voice in shaping, monitoring and scrutinising health budgets. Communities should become the active drivers of the process, holding governments accountable and ensuring that commitments translate into improvements in quality care.

Africa stands at a pivotal crossroad. The era of donor-driven health investment is ending. In its place, the continent must build systems capable of withstanding political transitions, economic volatility and shifting alliances.

Through the ALM, Africa has begun constructing that foundation — a continental pathway from vulnerability to sovereignty, from dependency to sustainability.

What remains is to strengthen it, scale it and ensure it delivers results for every African.

Ambassador Amma Adomaa Twum-Amoah is the African Union’s Commissioner for Health, Humanitarian Affairs and Social Development.

 

Image Credits: USAID Press Office, UNAIDS.

The US and Burundi signed a health MOU on 6 February.

Burundi has become the 16th African country to sign a five-year bilateral health Memorandum of Understanding (MOU) with the United States.

The US “intends to provide more than $129 million of health assistance in Burundi for HIV/AIDS, malaria, and infectious disease surveillance, response, and preparation”, according to a statement from the US State Department.  

In return, Burundi has pledged to increase domestic health expenditures by $26 million, to assume greater financial responsibility for its citizens’ healthcare.

US support will include support for “surveillance and outbreak responses, laboratory commodities, frontline health care workers, and data systems”. 

It will also “continue to improve access to malaria prevention, diagnostic tests and treatments, as well as HIV rapid diagnostic tests and antiretroviral HIV treatment regimens”.

As with the other 15 MOUs, Burundi has agreed to share “information and data” about infectious disease outbreaks with epidemic or pandemic potential, according to the US State Department.

The pace of signings has slowed after a flurry of MOUs the US signed late last year under its “America First Global Health Strategy”.

However, the health MOUs have given way to a flurry of US trade agreements, focusing on critical and rare earth minerals – with at least 21 MOUs related to minerals being signed in the past five months, including 11 signed last week alone alongside a Ministerial meeting on critical minerals, according to the US State Department.

The US has also chosen Hungary as its partner in advancing religious freedom in sub-Saharan Africa and the Middle East.

An MOU between the two countries was signed last week between US Deputy Secretary for Management and Resources Michael Rigas and Hungary’s Tristan Azbej, State Secretary for the Aid of Persecuted Christians and the Hungary Helps Program. It aims to “facilitate cooperation in supporting Christians and people of faith facing persecution, particularly in the Middle East and sub-Saharan Africa.”

A child getting a measles vaccination. 

Measles cases in Europe and Central Asia dropped by three-quarters in 2025 compared to the previous year – but the decline is partly due to the virus running out of people to infect after spreading rapidly through under-vaccinated communities.

Preliminary data from 53 countries in the World Health Organization (WHO) European Region reported 33,998 measles cases in 2025 and 127,412 in 2024, according to the WHO and UNICEF.

“While cases have reduced, the conditions that led to the resurgence of this deadly disease in recent years remain and must be addressed,” warned Regina De Dominicis, UNICEF Regional Director for Europe and Central Asia.

“Until all children are reached with vaccination, and hesitancy fuelled by the spread of misinformation is addressed, children will remain at risk of death or serious illness from measles and other vaccine-preventable diseases.”

In 2024, 19 countries had ongoing measles cases – up from 12 the previous year, according to the European Regional Verification Commission for Measles and Rubella Elimination.

“This represents the most significant setback in measles elimination in the region in recent years,” according to the two UN bodies.

WHO Regional Director for Europe, Dr Hans Henri Kluge, warned that over 200,000 people in our region have contracted measles in the past three years. 

“Unless every community reaches 95% vaccination coverage, closes immunity gaps across all ages, strengthens disease surveillance and ensures timely outbreak response, this highly contagious virus will keep spreading,” Kluge warned.

“In today’s environment of rampant fake news, it’s also crucial that people rely on verified health information from reliable sources such as WHO, UNICEF and national health agencies. Eliminating measles is essential for national and regional health security.”

Two doses of the measles vaccine provide up to 97% life-long protection against the virus and a vaccination rate of 95% with both doses in every community each year is needed to prevent measles outbreaks and achieve herd immunity. 

This protects infants too young for measles vaccination and other people for whom it is not recommended due to medical conditions, like those who are immunocompromised.

Measles is one of the most contagious viruses with every infected person able to infect up to 18 unvaccinated people.

It can cause serious illness, death and damage to the immune system, including by “erasing” its memory of how to fight infections, leaving measles survivors vulnerable to other diseases and death.

Image Credits: WHO.

While the total EU Commission commitments would remain near €700 million, the shift from a three-year cycle to a four-year period means that they reduce their support.
While the total EU commitments would remain near €700 million, the shift to a four-year period means that they reduce their support compared to previous cycles.

The European Commission intends to significantly cut its contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, ending a decades-long trend of increasing contributions to the multilateral health organisation.

According to research by Health Policy Watch, the Commission plans to pledge €700 million over a four-year span from 2026 to 2029 at the Global Fund Board meeting starting on Wednesday (11 February).

As the overall sum stretches a smaller amount of money over a longer period of time compared to previous commitments, this would mean a reduction of roughly €60 million per year  – a cut of 26.5%.

During the previous replenishment cycle, the Commission pledged €715 million over three years from 2023 to 2025, which at the time marked a 30% increase over the prior commitment.

The Commission did not respond to a query by Health Policy Watch before publication of the article.

Asked for a comment, a Global Fund spokesperson confirmed that several donors who are not yet in a position to make public announcements have provided “strong assurances of their continued support”. The Global Fund is still in “active discussions” with several partners, including the European Commission, to finalise their commitments.

However, they refrained from sharing any further details of the negotiations.

Cuts in step with broader global funding pull-back

Following the pledging conference in November 2025, the Global Fund faced a $6.6 billion shortfall against its $18 billion target. The 8th Replenishment total is projected to land significantly below previous cycles, mirroring the European Commission's move toward reduced annual support.
Following the pledging conference in November 2025, the Global Fund faced a $6.6 billion shortfall against its $18 billion target.

This drastic pull-back would line up with a broader retreat by major Western donors. At the Global Fund’s pledging conference in November 2025 – at which the Commission failed to submit a commitment due to ongoing internal negotiations – the United States reduced its contribution by $1.4 billion under its “America First” strategy. Germany cut its funding from €1.2 billion to €1 billion amidst a broader shift in budgetary priorities.

As a result, the Global Fund had only raised $11.4 billion in November, $6.6 billion short of its $18 billion target for the next three years with key countries and groups, including France and Japan, still missing at that time. The 8th Replenishment total amounts are likely to land well over $12 billion for 2026 to 2028, short over $2 billion compared to the previous cycle, sources confirmed.

Emergency money for foreseeable expenditures

Barry Andrews, Chair of the Committee on Development, raised concerns regarding the Commission's decision to use emergency reserve funds for predictable expenditures like the Global Fund.
Barry Andrews, chair of the Committee on Development in the European Parliament, raised concerns about the Commission’s decision to use emergency reserve funds for predictable expenditures like the Global Fund.

With its annual budget for 2026 already spread thin, the EU Commission is mobilising €150 million from a reserve fund designated for unforeseen crises to cover this year’s contribution to the Global Fund.

But this use of an “emergency cushion” within the Neighbourhood, Development, and International Cooperation Instrument (NDICI) to fund a predictable replenishment cycle is concerning, said Barry Andrews, chair of the Committee on Development, at a budget hearing on 5 February.

He reminded the Commission that the cushion is legally reserved “to respond to unforeseen circumstances, new needs, or emerging challenges.”

With the €150 million now allocated to the Global Fund and other money attributed to developments in Greenland and Syria, the cushion is already “nearly depleted,” as Myriam Ferran, Deputy Director-General at the Directorate-General for International Partnerships, admitted. It leaves only €159 million for the next two years to handle any genuine unexpected global crises.

Remaining funds not yet approved

In a hearing last week, Miriam Ferran, Deputy Director-General for International Partnerships, announced that the Commission intends to pledge €700 million to the Global Fund for the 2026–2029 period.
In a hearing last week, Miriam Ferran, Deputy Director-General for International Partnerships, declared that the Commission plans to commit €700 million to the Global Fund for the 2026–2029 period.

The remaining €550 million until 2029 “will be factored in the new Multiannual Financial Framework (MFF),” said Ferran at the European Parliament’s Budget Committee meeting last week.

The MFF is the EU’s long-term budget that sets the limits on spending over a seven-year period. The current MFF ends in 2027, and the next one (2028 to 2034) has not yet been adopted.

This approach drew sharp rebukes during committee oversight. Right-wing parliamentarians characterised the move as “budgetary madness,” noting that for 2026, the Commission is creating debt and pushing it into future years as it is “spending money that you don’t have”.

No long-term budget for global health

The Berlaymont building in Brussels, Belgium, serves as the official headquarters of the European Commission.
The Berlaymont building in Brussels, Belgium, serves as the official headquarters of the European Commission.

With the MFF already under pressure, European global health funding is facing a precarious future, raising fears among health advocates that it will be stripped of priority in the EU’s long-term strategy.

In its proposal for the next MFF, the Commission confirmed there will be “no dedicated health window”, making sure that budget appropriations are ringfenced.

Instead, it is to be split between a “global” pillar and “geographic” pillars – essentially regional accounts assigned to specific areas like sub-Saharan Africa, the Middle East, or Asia – sparking concerns over a shift away from multilateralism.

The Commission argues that this allows funding to be more flexible and better linked with the EU’s strategic goals. A Commission spokesperson stated that while there is no health window in Global Europe, there will be a health budget in the new European Competitiveness Fund dedicated to increasing economic growth.

Critics warn that contributions to global health initiatives will have to keep pace with infrastructure, digitalisation, and security projects. In the “sub-Saharan Africa” pillar, for example, a proposal to fund community health workers would have to compete directly for the same Euros against a project to build a highway or equip border guards, an EU official close to the negotiations told Health Policy Watch.

Editorial note: The article has been updated to reflect that Germany’s funding for the seventh replenishment was €1.2 billion (not €1.4 billion).

 

Image Credits: Felix Sassmannshausen, European Union/Christophe Licoppe.

The WHO has failed to recognise the health harms caused by firearms.

For nearly three decades, the World Health Organization (WHO) has recognised violence as a major public health concern. Since the landmark World Health Assembly (WHA) resolution of 1996, violence has been framed not only as a cause of injury and death, but as a driver of long-term physical, psychological, and social harm, as well as a significant burden on public-health systems. 

Over this period, WHO has issued technical guidance, developed prevention frameworks, and supported countries to strengthen health-system responses to violence against women and children, youth violence, and other forms of interpersonal harm.

Yet one of the most lethal drivers of violence globally, firearms, remains largely absent from the WHO’s governance architecture.

A multi-method analysis, Tracking WHO Attention to Firearm Violence, 2000–2025, co-published on Tuesday (10 February) by a consortium of Global North and Global South academic institutions and NGOs working on public health and violence prevention, examined WHA resolutions, WHO violence-prevention frameworks, and key institutional trends over 25 years. 

The finding is straightforward. Violence appears repeatedly in WHO resolutions, strategies, and technical documents. Firearm-related harms do not.

This absence shows up across WHA resolutions, flagship prevention frameworks, and the national policies that rely on them. It is a governance blind spot with practical consequences.

Silence at the World Health Assembly

Since the WHA first met in 1948, more than 3,200 resolutions have been adopted. Only a small fraction address violence and none explicitly mention firearms, small arms, or gun violence.

Yet firearm-related harm has accounted for over a million deaths over the past five years, with millions more injuries, many leaving permanent disabilities, each year, most of them occurring outside armed conflict.

The downstream effects of this omission extend well beyond injury and death. Exposure to firearm violence, whether direct or indirect, is associated with anxiety, depression, post-traumatic stress, and substance use, particularly among children and adolescents. 

In high-violence settings, the effects are cumulative. Teachers, caregivers, and health workers absorb the strain. Schools struggle with attendance and concentration. Academic performance suffers, and dropout rates rise. These impacts shape life chances long after the violence itself.

Because firearm-related harm is largely absent from WHO’s violence-prevention frameworks, these mental-health, substance-use, and educational harms are weakly integrated into prevention strategies, if they appear at all.

This is not because the evidence is missing. WHO produced substantial work in the early 2000s explicitly addressing small arms as a public-health concern, including analysis of firearm injury, disability, and trauma.

Tracking WHO Attention to Firearm Violence shows how that early engagement steadily narrowed, with firearms increasingly folded into broader violence agendas or dropped altogether.

Interviews with global-health experts point to familiar constraints. Firearm-related harm is politically sensitive. Some member states resist explicit attention. WHO is donor-dependent. New resolutions carry costs. In that environment, firearm violence repeatedly falls below the line of what is considered feasible.

Global policy omission

Firearm harm is not mentioned in key WHO resolutions and policies.

INSPIRE, the WHO-led framework guiding global action to end violence against children, is widely used by governments, UN agencies, and donors.

RESPECT, developed to prevent violence against women, plays a similar role in the gender-based violence (GBV) field. Both focus on social norms, family-level interventions, and service responses.

But neither meaningfully addresses firearm-related harms.

In INSPIRE, guns appear only in passing, despite being a leading cause of death among adolescents in many countries. 

RESPECT does not engage with firearm access as a risk factor in intimate-partner homicide, even though the link between gun availability and lethality in domestic violence is well established.

These omissions matter. INSPIRE and RESPECT shape donor priorities, technical assistance, indicators, and national action plans.

The pattern was visible at the 2024 Interministerial Meeting on Ending Violence Against Children in Bogota. Nearly 100 governments made pledges aligned with INSPIRE to address violence against children.

None mentioned firearms or firearm-related harm. This was not because gun violence is irrelevant to children and adolescents in those countries. It reflects how global frameworks define what counts as legitimate prevention policy.

Men at risk

A similar narrowing appears in the growing number of national men’s health strategies.

In many regions, men, particularly young and marginalised men, account for the majority of firearm homicide victims and survivors. 

Gun violence drives premature mortality, disability, and long-term psychological harm. Yet emerging national men’s health policies tend to emphasise non-communicable diseases, mental health, encouraging norms’ changes to increase health-seeking behaviour, while neglecting firearm violence entirely.

Most international NGOs working on men’s health mirror this framing. The focus is on norms, behaviours and services, not on structural drivers of injury, death and chronic mental health challenges. This reflects prevailing policy architectures rather than intent. Nonetheless, the result is men’s health policies and programmes that do not correspond to epidemiological realities in high-violence contexts.

Taken together, these patterns point to a broader governance problem. Firearm violence sits in a policy no-go-zone, too political for violence-prevention frameworks, too securitised for health, and too structural for the prevailing approach to men’s health.

Commercial determinants contradiction

This fragmentation stands out given WHO’s expanding work on the commercial determinants of health.

WHO has been explicit about the role of tobacco, alcohol, ultra-processed foods, and other industries in driving ill-health. It has documented how corporate practices shape exposure, risk, and inequity. It has also excluded both the tobacco and arms industries from engagement under its Framework of Engagement with Non-State Actors.

Yet firearms remain largely absent from the commercial-determinants agenda.

Guns are plainly commercial products. They are manufactured, marketed, and distributed by powerful global industries. Marketing, increasingly online and often gender-exploitative, shapes norms around risk and protection. Availability is shaped by regulation, trade, and enforcement choices.

WHO’s leadership on tobacco did not emerge because the issue was politically easy. It emerged because the health burden was undeniable and the commercial drivers clear. Firearms and the ammunition they carry, present a similarly preventable source of injury and death.

Beyond agenda-setting, the WHO has a well-established role in generating and consolidating the types of health data that inform national regulatory decision-making.

Evidence from international reviews of firearm legislation consistently indicates that more comprehensive and effectively implemented firearm regulations are associated with lower firearm mortality, while permissive regulatory environments correlate with higher rates of lethal violence. 

WHO leadership in improving surveillance, harmonising indicators, and translating this evidence into technical guidance could strengthen member states’ capacity to assess where and how firearms contribute to preventable death and injury.

Such an approach would also support more informed policy responses in contexts such as intimate-partner and gender-based violence, where the presence of a firearm markedly increases lethality.

Why this matters now

WHO is under acute financial pressure following funding withdrawals and delayed contributions. At the same time, it is reasserting its role on social and commercial determinants of health and revisiting questions of mandate and prioritisation.

A growing group of research institutions, public-health bodies, and civil-society organisations has responded by forming the Global Coalition for WHO Action on Firearm Violence. WHO Action, as its name suggests, is calling on the WHO to recognise firearm violence as a preventable public-health harm that warrants clearer better data, clearer technical guidelines to health ministries and coordinated prevention strategies.

At this point, the continued exclusion of firearms from WHO’s core health frameworks is hard to justify. Addressing firearm violence as a public-health issue would not expand WHO’s mandate. It would clarify it by bringing violence prevention, gender-based violence, child protection, men’s health, and commercial determinants into closer alignment.

The WHO has done this before with other health issues. The question now is whether the organisation can afford to keep treating one of the world’s leading drivers of violent death and disability and one of the most disruptive and costly health matters as though it isn’t a public health problem.

Dean Peacock is affiliated with the School of Public Health at the University of Cape Town and the Gender Centre at the Geneva Graduate Institute. 

Dr Stephen Hargarten is Professor of Emergency Medicine at the Medical College of Wisconsin, (MCW) and the Founding Director of the Comprehensive Injury Center at MCW, where he currently serves as the senior injury and policy advisor. 

They are Co-Commissioners of the Lancet Commission on Global Gun Violence and Health and serve as Founding Directors of the Global Coalition for WHO Action on Firearm Violence

 

Image Credits: Maria Lysenko/ Unsplash, Max Kleinen/ Unsplash.

Indonesia delivering a statement at IGWG5 on behalf of the Group of Equity.

Powerful member state blocs at the World Health Organization (WHO) stressed on Monday that they will not compromise on the final outstanding piece of the Pandemic Agreement simply to meet the May deadline.

The Group of Equity and the WHO’s Africa, Eastern Mediterranean and South-East Asia regions stated that they wanted a Pathogen Access and Benefit-Sharing (PABS) system with legal certainty at the second-to-last meeting of the Intergovernmental Working Group (IGWG).

“PABS is the heart of the Pandemic Agreement. If the heart is weak, the body cannot function, and the agreement will not deliver equity,” said Indonesia on behalf of the Group of Equity, and the three regions – collectively representing over 80% of the world’s population.

The PABS system aims to set out how countries can share information about pathogens and their genetic sequence data and ensure that those sharing this information get access to the benefits developed as a result, such as vaccines, diagnostics and therapeutics.

But the current PABS draft contains “major loopholes” that will prevent the system – an annex to the Pandemic Agreement – from functioning effectively, Indonesia added.

“The annex must articulate the operational details of the PABS System, and provide legal clarity on the rights and obligations of the providers of PABS material and sequence information, as well as various users of the system. We also question how any terms and conditions can be enforced when users are permitted to remain anonymous,” stressed Indonesia.

“We understand the pressure of timelines. But we should be clear about the choices and decisions in front of us: We are aiming for an annex by [the World Health Assembly in] May, that can actually deliver a functioning PABS System in totality. But if we cut too many corners now, we will pay for it later in credibility and implementation.”

Zimbabwe – speaking for the Africa Group – stated that “a system that safeguards some while leaving others exposed is not only unjust, it is ineffective”.

“For the Africa Group, equity and benefit-sharing must be operational, enforceable and central to Pandemic Agreement, including the PABS annex. These elements cannot be aspirational, deferred or left to voluntary implementation. Past experiences has shown the consequences of such approaches.”

Pragmatism and speed

The EU representative and France’s Anne-Claire Amprou.

However, the European Union, backed by G7 leader France, called for pragmatism and speed.

“We remain deeply committed to work towards an effective, workable and implementable PABS system in the remaining 12 Days of negotiations that we have at our disposal,” said the EU representative.

“We hope that a sense of pragmatism and common sense will help to guide us towards convergence on the key remaining outstanding areas for the purpose of bringing this process to a successful conclusion within the timeframe.”

Speaking for France, Anne-Claire Amprou, a former co-chair of the Pandemic Agreement negotiations, urged “quick progress” to adopt the annex by the World Health Assembly in May. 

“Given the time remaining, we need to be reasonable in terms of the amendments we make to the text,” said Amprou. “We invite member states not to reopen subjects or provisions which were already adopted as part of the Pandemic Agreement.”

The Pandemic Agreement cannot be endorsed or operationalised without the PABS annex, which means there is no global agreement on how to approach the next pandemic – which can strike at any time.

Benefit-sharing demands

India warned against adopting an ambiguous annex.

But for many low- and middle-income countries (LMICs), the bitter memory of being unable to get access to vaccines during the COVID-19 pandemic – even for health workers and their most vulnerable citizens – was a sobering lesson.

Some indicated that they would be prepared to miss the May deadline rather than budge on their demand for a legally binding PABS system that balances access and benefit-sharing.

India, speaking for the South-East Asia region, stated that “it is essential that quality is not compromised by the pressure of timelines”. 

“Our priority must be an annex that provides clear legal certainty with minimum room for interpretive ambiguity. Such clarity is critical for effective implementation and long-term trust in multilateralism, “ said India.

“Benefit-sharing obligation must be proportionate to access and cannot be voluntary, aspirational or based on ‘best endeavours’. 

Non-monetary benefits

Some LMICs also stressed – as India did – that benefit-sharing must extend “beyond monetary contributions and donations of vaccines, diagnostics and therapeutics”. 

“Non-monetary benefits, including timely capacity development, technical assistance and non-exclusive manufacturing licences for developing countries, must be clearly specified and applied both during pandemics and during the inter-pandemic period,” said India, for the South-East Asia region.

Indonesia said that, while equitable access to vaccines, therapeutics and diagnostics (VTDs) is essential, “we should also be serious about benefits that support timely diversified regional and local production, including non-exclusive licensing to manufacturers in developing countries, transfer of technology, and meaningful collaboration in R&D.”

“Benefit sharing cannot depend on purchasing power, ad hoc arrangements or discretionary decisions taken during emergencies,” said Namibia.

“It must be triggered by access, governed by multilateral rules and delivered when it matters most. Namibia also places strong emphasis on technology transfer and regional manufacturing capacity. Strengthening local and regional production is essential to reducing dependency and building real resilience.”

Way forward

The IGWG meeting – the fifth of six – ends on Saturday, and while it plans four evening sessions, co-chair Tovar da Silva Nunes reminded delegates that the meeting’s access to interpreters is limited, a casualty of WHO budget cuts.

There are 100 days to the deadline, and by the end of this week’s talks, it should be clear whether the annex is on track for adoption in May.

Mexico, meanwhile, indicated that it is available to facilitate “dialogue between blocs of countries”.

“We are convinced that, with political will and pragmatism, we can reach the necessary consensus so that we can allow this process to conclude successfully and strengthen our multilateral stance for future pandemics.” said Mexico.

Egypt leads the charge Friday against renewing WHO relations with NGOs working in the sexual and reproductive health rights space.

After fits, starts, hours of back room negotiations and hesitations, the closing day of WHO’s Executive Board session Friday saw agreement on a number of small – but potentially meaningful – efficiency measures aimed at saving booth member states and the financially-strapped agency a time and money in preparing for and responding to member state mandates.  

The changes come amidst mounting geopolitical and social tensions amongst member states, with an increasing share of discussion time consumed by a handful of highly politicized items, including the wars in Ukraine and Gaza, as well as sexual and reproductive health rights. 

At the same time, the Executive Board and the annual World Health Assembly (WHA) have become overloaded with a growing volume of draft decisions and resolutions – many costly to implement and not always aligned with established strategic plans.

Among the key reforms is an initiative to streamline timelines and criteria for the submission of proposed draft resolutions and decisions by member states. This could curb the proliferation of proposals seen over the past several years.

Streamlining discussion on Palestine and de-escalating flashpoints

WHO Director General Dr Tedros Adhanom Ghebreyesus Friday evening in emotional appeals for streamlining debates around divisive issues such as reproductive health rights and Palestine.

Another small efficiency steps for the upcoming WHA include a compromise on language, which enabled the approval of  WHO’s continued engagement with five NGOs working on sexual and reproductive health rights.

In addition, a plan to consolidate discussion around two overlapping reports on the thorny question of health conditions in the “Occupied Palestine Territory (OPT)’’ into a single WHA agenda item avoids duplications that have consumed hours of WHA time since 2024. That is when the Israel-Hamas war led to the development of a second WHO report on health conditions in the OPT, in addition to the annual report that has been a perennial feature on the WHA every year since Israel occupied the territories in 1967. 

Addressing the Executive Board on Friday, WHO Director-General Dr Tedros Adhanom Ghebreyesus framed the latter consolidation as both an efficiency gain and a confidence-building measure.

“As you know, the UN Security Council welcomed the comprehensive plan to end the Gaza conflict last November through Resolution 2803. This holds the real promise for advancing peace and …in a region with such urgent needs, peace is built one brave step at a time. It’s a commitment we renew every day. Peace endures only when we carry it forward together. Each of us can contribute through our decisions in the EB and the WHA,” Tedros said.

“Today, I propose one concrete step combining the two WHA agenda items… into a single discussion. …By taking this step together, we not only foster a more constructive environment for our governance deliberations, but also contribute, in a small way, to the success of the peace initiative.” 

More efficient process for advancing WHA resolutions  

Administratively, the Board also backed proposals to enforce stricter timelines for submitting draft resolutions and decisions, along with closer WHO Secretariat supervision to ensure their alignment with agency priorities and budgets, and manageable meeting agendas.

While current rules hold that zero drafts should be submitted several months before a session – and final drafts no later than 15 days ahead – in practice, many proposals have arrived late, leaving little time for review by the WHO Secretariat or member states.

In a draft decision Friday, Board members also agreed to advance a proposed rule change whereby three WHO member states from at least two regions must agree to co-sponsor any new decision or resolution. The innovation aims to curb member states’ debate on measures with little real backing. 

But the provision remains bracketed  in the draft text, which also refers to the  “piloting” of the reform measures, signalling the long road that remains to actual approval.  

Opposition to WHO’s engagement with reproductive health NGOs 

Norway’s EB representative, Cathrine Lofthus, Ministry of Health Director General, led negotiations with the Egyptian-led bloc on WHO collaborations with reproductive health NGOs.

The Executive Board also reached a time-saving agreement on another topic of frequent WHA conflict – WHO engagements with non-state actors that work on sexual and reproductive health rights (SRHR). 

Egypt, where abortion is illegal unless a woman’s life is at risk and is even subject to a jail sentence,  has long been a leader in opposing WHO’s engagements with NGOs working in this space. 

This year, that included opposition to WHO collaborations with five groups whose terms of engagement with WHO are due to be renewed this year, as part of a routine, triennial review process.

The groups are the International Planned Parenthood Federation, American Society for Reproductive Medicine, Family Health International, the Population Council and the World Association for Sexual Health. 

Speaking for the Organization of Islamic Cooperation (OIC), which includes states from WHO’s Eastern Mediterranean Region as well as countries in North Africa and Asia, Egypt’s delegate declared that continued engagement with the five NGOs is “contrary” to WHO’s Framework of Engagement with Non-State Actors (FENSA), which aims to ensure the agency’s “integrity, independence and credibility is not compromised” and that non-state actors do not wield undue “influence” in setting “policies, norms and standards.”

Norway, leading the EU and other supportive member states, spent several hours negotiating an addendum that effectively renews collaboration while taking “note” of reservations and affirms that “member states have full sovereign rights over which non-state actors operate within their national territories,” in line with their “national context and legislation.”

Addendum to EB decision renewing WHO’s collaboration’s with reproductive health NGOs de-escalated potential controversy at the upcoming World Health Assembly.

Here too, Tedros added his own support, recalling how parliamentary reforms liberalizing Ethiopia’s abortion laws during his tenure as health minister helped cut maternal mortality fivefold, as many deaths were linked to unsafe abortions.

“I myself invited not only WHO, but other international organizations for help, and it’s during that time, our Parliament passed a bill on how to handle unsafe abortion, because nobody wanted for our mothers to die, our sisters to die,” Tedros said.  

“We don’t allow our norms and standards to be influenced by anyone. We take sides with science,” Tedros affirmed. “Any country has sovereignty, either to invite us or not invite us [to support them]. But whatever relationship we have, it will not be forced on any country.” 

The EB negotiations and word-smithing, while tortuous and time-consuming, may help avert an even larger debate at the WHA.

Temporary fixes? 

Palestinian EB representative Ryad Awaja: consolidated discussion on health conditions in the Occupied Palestinian Territory is an “exceptional” move.

Despite the budget pressure that helped push member states toward incremental reforms, most changes remain tentative—preliminary or applicable only to the upcoming WHA.

Agreeing to combine discussions on the two overlapping WHO reports on “health conditions in the Occupied Palestine Territory (OPT)” into one dedicated discussion on the WHA agenda, Palestine’s EB representative Ryad Awaja stressed that the arrangement was temporary. 

He attributed it to logistical constraints facing this year’s WHA, with some meetings shifting to WHO headquarters during renovations at Geneva’s UN Offices in the Palais des Nations.

“To know this is exceptional,” Awaja said of the consolidated discussion. “It’s not …forever. It’s just an exception from Palestine to help for this time.”