A new generation of obesity drugs has reached sky-high popularity and costs. Can WHO’s recommendation for wider use help lower prices and increase access?

WHO’s 2025 Essential Medicines Lists (EML), published Friday, has included the active ingredients in popular weight loss drugs like Ozempic and Wegovy –  semaglutide or other comparable  GLP-1 receptor agonists – in a recommendation that recognizes the growing importance of the drugs in clinical treatment of diabetes worldwide. 

These drugs, as well as new PD-1/PD-L1 cancer therapies, notably pembrolizumab and two other therapeutic alternatives, were also among the 20 new medicines added to the 2025 WHO EML. 

The EML also includes rapid acting insulin analogues to the list for the first time.  Longer-acting synthetic insulin formulas were first included in the list in 2021, as an alternative to human-derived insulin products.

WHO EML additions for adults (2025)

Another 15 drugs were added to a separate Essential Medicines List for children (EMLc) in this year’s listing, which is published every two years. The new list includes new drugs for cystic fibrosis and haemophilia, as well as recently approved vaccines for malaria and mpox. Also on Friday, WHO removed its declaration of an mpox Public Health Emergency of International Concern (PHEIC), noting that cases in Africa, which had been most affected by the recent emergency, had stabilized.  

The EML lists are used by over 150 countries, as well as insurance and health care providers, to guide decisions about procurement and provision of critical medicines for virtually every infectious and non-communicable disease condition. 

The 24th edition of the EML includes  about critical medicines for 563 drugs, on the adult list, and 361 treatments on the children’s listing.  

WHO EML additions for children (2025).

Short-acting insulin completes the package

This latest insulin addition rounds out the package of recommended insulin treatments, said WHO’s Deus Mubangizi.

“These are complementary; there those conditions where it’s more appropriate to use long-acting but also we need have conditions where we need short acting,” he said at a Friday press briefing.   

The inclusion of pembrolizumab and its counterparts follows on evidence demonstrating that the drugs, used in treatment of metastatic cervical, colorectal and lung cancer, prolong survival by at least four to six months, added WHO’s Lorenzo Moja, also at the briefing.

In comparison, trials in some of the newer, and also pricier, breast cancer drugs submitted for inclusion in the list, “are still maturing so the follow up of these patients is not yet consolidated,” Moja said, adding:  “The expert committee had a preference for those results in which we had long term follow up data and we are sure about the effect on overall survival and quality of life.” 

Short-acting insulin rounds out the balance of WHO recommendations: WHO’s Deus Mubangizi, at Friday’s briefing

Inclusion of new insulin analogues and GLP-1 agonist drugs welcomed by access advocates

Elizabeth Jarman, of Médecins Sans Frontières ACCESS initiative welcomed the WHO’s inclusion of the insulin analogues and GLP-1 agonists as a “critical milestone” – but called upon countries to make the treatments more affordable as well. 

“We welcome the inclusion of rapid-acting insulin analogues and GLP-1 agonists to the World Health Organization’s (WHO) Model List of Essential Medicines (EML) as a critical milestone on the path towards increasing access to diabetes treatment,” said Jarman.  

“In our experience of providing diabetes care in low-resource settings and humanitarian emergencies, rapid-acting insulins and GLP-1s are unaffordable and often unavailable. Current prices are unacceptably high, with rapid-acting insulin analogues priced as much as 75 times and GLP-1 agonists 400 times higher than what they can be profitably produced for, according to a recent MSF study. 

“We call on countries to take urgent steps to update their national EMLs, begin procurement planning, and – alongside the WHO – demand pharmaceutical corporations make these key diabetes treatments available in-country by immediately registering them and – critically – making them affordable.” ​ 

While gaining greater fame for obesity control, WHO has in fact recommended GLP-1 agonists as glucose-lowering therapy for adults with type 2 diabetes mellitus  “with established cardiovascular disease or chronic kidney disease, as well as obesity, defined as body mass index (BMI) ≥ 30kg/m2,” according to the EML.

The EML did not explicitly recommend the drugs for weight loss per se, but it contains guidance on “who can most benefit from the new drugs”, WHO said. 

GLP-1 agonists work by mimicking the body’s natural GLP-1 hormone to regulate blood sugar. They stimulate the pancreas to release insulin, reduce the liver’s sugar production, and slow down digestion. The medications also act on the brain to suppress appetite and have been shown to yield other benefits for heart and kidney health.

Exclusion of drug for spinal muscular atrophy decried

However, another medicines access group, Knowledge Ecology International (KEI) decried the exclusion, for the second time, of risdiplam, a drug that can significantly reduce the symptoms of spinal muscular atrophy, a rare genetic condition.

“The second rejection of risdiplam is appalling,” said director Jamie Love, of the drug, which is currently produced by the Swiss-based Roche.

Risdiplam, produced by Roche, was rejected by the EML expert group.

“This is exactly the type of drug for a rare disease the EML should embrace. It works and it’s easy and cheap to make and distribute generic versions. The consequences of no access are terrible for many children.”

The proposal for including the drug was apparently discarded by the EML expert group, Love said, because results of an ongoing trial on pre-symptomatic infants had not yet been published in a peer-reviewed journal at the time the group made its decisions. A study published in mid-August in the New England Journal of Medicine showed a very high rate of infants reaching key milestones for sitting, walking and other motorskills after 12 months of treatment, in comparison to untreated infants.

New cystic fibrosis drug addition hailed as a breakthrough 

Meanwhile, a leading cystic fibrosis patient advocate group hailed the inclusion of the new drug ivacaftor and its therapeutic alternatives, as a “historic breakthrough in the fight for global access to lifesaving cystic fibrosis treatment.”

The elexacaftor/tezacaftor/ivacaftor (ETI) trio –  better known as Trikafta/Kaftrio, was included in the EML for both adults and children.  

“This decision is a turning point. For the first time, a medicine specifically aimed at treating CF has been included on the EML and the world’s leading health authority has recognised that Trikafta is not a luxury drug, but an essential medicine – and that every child and adult living with CF should have the right to access it,” stated the group Right to Breathe.

“This is a powerful statement from the WHO: not only is Trikafta recognised as essential, but its inclusion is about breaking down barriers to access and ensuring patients everywhere – not just in the richest countries – can benefit from its lifesaving impact.” 

David Reddy, director-general of the International Federation of Pharmaceutical Manufacturers and Associations, hailed the addition of multiple new, cutting-edge treatments on the updated EML, saying their inclusion,”highlights how scientific advances are transforming how we prevent, treat and cure disease, and reinforces the importance of ensuring patients everywhere can benefit from them.”

While the EML expert group that vets new drugs has also held back, at times, on recommending cutting edge treatments specifically because of their high costs, “tiered pricing, voluntary licensing and value-based healthcare models” can help expand access, Reddy stressed.

Healthcare system strengthening is also a critical, and often overlooked, part of the equation, he added, noting “healthcare systems need to be strengthened with the right infrastructure, diagnostics and trained professionals in place, alongside effective regulatory pathways and sustainable procurement, to help ensure these innovations can achieve greatest impact for patients. “

Image Credits: Chemist4u.

Carrying drinking water supplies in Srinagar where supplies have been contaminated by heavy flooding across Jammu and Kashmir, India.

SRINAGAR, INDIA – When record-breaking rains, landslides and cloudbursts lashed northern India in late August — across Jammu and Kashmir, Punjab and Himachal Pradesh — highways turned into rivers, homes collapsed and death tolls mounted. But beneath the visible destruction lies a quieter emergency: public health systems buckling under the strain.

In Kashmir, the Jhelum River, a lifeline for the region, swelled dangerously after days of relentless downpours. By the night of Aug. 26–27, its waters entered neighbourhoods in Srinagar, the largest city in Jammu and Kashmir, and a popular summer tourism destination known for its stunning lake and riverfront visages and houseboats.  Earlier in the month, on Aug. 14, a devastating cloudburst near Chisoti — the last motorable village en route to the Machail Mata temple in Jammu — had already triggered flash floods that killed at least 64 people.

Health experts warn these floods are not isolated disasters but part of a worsening cycle of extreme weather events that India remains ill-prepared to handle. From Kashmir to Punjab to Himachal, disrupted medical care, contaminated water, and surges in mosquito-borne disease are exposing how fragile India’s public health safety nets are in the face of weather extremes driven by climate change. Unless resilience is built into the health system, each new flood risks compounding existing crises — from mental health to infectious disease.

Life cut off, treatment interrupted

Maliha Zehra – her medicines were inaccessible due to flooding.

In Srinagar’s flooded Rajbagh neighborhood, 22-year-old student Maliha Zehra from Baramulla faced a harrowing wait for her psychiatric medication after landslides blocked the Srinagar–Jammu National Highway, delaying essential supplies from reaching the Valley.

“My mental health medicines were delayed,” she told Health Policy Watch. “Without them, the flooding felt even more suffocating.”

Normally, winter highway closures meant she could at least call her doctor or request an ambulance. But this time, there was no lifeline. For three days, mobile networks and internet services across much of Kashmir were down after flood damage, severing communication between patients and providers.

“I tried to go to a nearby hospital, but it was overcrowded, and without a phone I couldn’t contact the private clinic where my psychiatrist sees me,” Zehra said. “At least in the snow you can call for help. With the floods, there was nothing.”

Mental health needs in Kashmir are staggering. As Health Policy Watch reported earlier this year, a 2015 survey by Médecins Sans Frontières (MSF) found that 1.8 million adults in the Kashmir Valley — about 45% of the population — experience significant mental distress. Almost one in five showed symptoms of post-traumatic stress disorder. Meanwhile, 41% of women and 26% of men showed signs of depression.

Yet the system is woefully underprepared to cope with chronic disease conditions during a disaster. According to the 2011 Census, there were just 41 psychiatrists for Jammu and Kashmir’s 12.5 million people. Experts say that number has only modestly increased since, leaving much of the population without specialized care. Flood-related disruption, even for a few days, becomes catastrophic in this context.

Contaminated waters, sick communities

Aadil Dar a community science educator: flooding brought illness in its wake.

The health toll was not limited to delayed prescriptions. Aadil Dar, a science educator at a community education centre in southern Kashmir’s Anantnag district, said the flooding brought illness in its wake.

“After these floods, many people in my area fell sick with diarrhoea because of contaminated drinking water,” he said.

Such outbreaks are common.  Epidemiologist Dr. Shailesh told The Tribune that “stagnant and contaminated water becomes the primary source of infections in flood-affected areas.” He warned that diseases like cholera, diarrhoea, typhoid, hepatitis A and gastroenteritis are “very common after floods,” while stagnant pools also fuel malaria, dengue and chikungunya outbreaks. 

Flood-linked disease is not hypothetical. In the aftermath of the 2014 Kashmir floods, clusters of jaundice and diarrheal illness were documented within days of the waters rising 

This year, Punjab is already seeing a surge in dengue cases since 2023 ,  in  2023 11,000 infections were reported by mid-november). Flooding has only worsened mosquito breeding conditions.

Arshdeep Singh, 22, from central Kashmir, said his family has resorted to buying bottled water after past illnesses. “My elder sister and I both developed jaundice earlier. It took me months to recover, so now we don’t take risks,” he said. “But packaged water is expensive. Not everyone can afford it.”

Collapsing infrastructure

Srinagar is a popular summer tourism area due to its lake and river visages – but extreme weather is making the area more flood prone during monsoon season.

Health facilities themselves were not spared. Landslides cut off access to several district hospitals in Jammu and Kashmir. In Punjab’s flood prone  24  districts, floodwaters inundated primary health centres, forcing patients to travel long distances. Himachal Pradesh, already battered by landslides, reported damaged subcentres and stockouts of critical drugs.

According to the Indian Meteorological Department Jammu and Kashmir registered 612 mm of rain  in the last week of August. That is 726% above normal rainfall in the region during for this time of the year. 

“It is the highest rainfall in the region since 1950,” Mukhtar Ahmad, Director at the India Meteorological Department in Srinagar, told Reuters. 

Roads, bridges and power lines collapsed under the onslaught, crippling emergency services. Ambulances struggled to reach rural patients, especially pregnant women and children. Telemedicine, which proved vital during the COVID-19 pandemic, was rendered useless in Kashmir due to the communications blackout.

A broader and recurring pattern

Satellite derived map shows scale and intensity of 2025 monsoon floods in neighbouring Pakistan.

Across the wider Himalayan arc and Gangetic plain, severe monsoon flooding has hammered neighboring countries this year too. In Pakistan, hundreds of deaths and mass displacement have been reported this season, with national  and UN flash updates detailing widespread damage along the Indus River basin. Regional weather and climate agencies  warn the Hindu Kush mountain range west of the Himalayas, which extends from Afghanistan into northwestern Pakistan, is also facing increasingly frequent, intense rain events that heighten risks of floods and landslides across borders. Afghanistan has thus also seen repeated flash floods across its northern and eastern provinces.

In Afghanistan, this season’s floods were compounded by another disaster. On Aug. 31, a 6.0-magnitude earthquake struck Afghanistan’s eastern region, killing more than 1,457 people and injuring over 3,394, according to the World Health Organization (WHO). 

Afghanistan is dealing with the combined impacts of a recent earthquake as well as heavy seasonal Monsoon flooding.

More than 6,700 homes were destroyed, leaving thousands homeless and exposed to harsh conditions just as monsoon floods were already battering the country. Hospitals in Kunar, Nangarhar, Laghman and Nuristan provinces have been overwhelmed by trauma cases, while overcrowded shelters and limited sanitation are raising fears of cholera, diarrhoea and other post-disaster outbreaks.

“When we speak of casualties, we are speaking of families and communities in crisis,” said Dr. Mukta Sharma, deputy representative in  Afghanistan, which has launched a flash emergency aid appeal for $4 million. “Our teams are working around the clock to deliver lifesaving care in areas devastated by the earthquake. The needs are immense. We urgently require more resources to sustain our operations and prevent further losses.”

Kashmir’s 2014 floods were a historic benchmark 

Flooded homestead in some of the worst flooding seen since 2014.

In 2014, India-administered Jammu and Kashmir saw its worst flooding in sixty years: more than 500 lives were lost and tens of thousands displaced. Hospitals, water and power infrastructure, and communications were crippled, leaving health systems paralyzed. Outbreaks of diarrhoeal disease, jaundice and other waterborne illnesses were reported within days of the waters rising, compounding the humanitarian emergency.

A spatial analysis of the 2014 floods found that the provincial capital of Srinagar, which has nearly 1.7 million residents, also had one of the highest “Relief Deprivation Index” scores — showing that access to timely rescue and aid was uneven, and the poorest households were often last in line for assistance.

A decade later, the pattern is repeating in Jammu Kashmir and beyond, with increasing frequency.  Almost every year in the past ten years has seen significant flood events. The neighbouring State of Himachal Pradesh also has endured successive monsoon-triggered landslides and floods over the past five years. Punjab continues to battle back-to-back dengue waves, related to more rainfall.

Climate scientists link this to a warming atmosphere fueling increased rainfall, more intense rainfall and sudden cloudburst events.  A Srinagar based climate scientist told Health Policy Watch  that the Himalayan region recorded a 33% increase in extreme weather events compared to the previous decade. In addition, glacial lakes are expanding as glaciers shrink. Rapid urbanization and deforestation have undermined natural watershed drainage, while urban flood drainage is often deficient or non-existent.

Public health experts say that while disaster relief often focuses on food and shelter, health systems remain the weakest link.

Building resilience – what needs to change

WHO has repeatedly warned that health crises following floods can cause more deaths than the flooding itself if not addressed promptly.

Flood preparedness in India still centers on evacuation and rescue, but public health preparedness continues to lag.

“Health is always the weakest link in disaster planning,” said a senior official from a Srinagar-based NGO who asked not to be named. “We have evacuation drills, but no real disease surveillance system to catch cholera, hepatitis or dengue outbreaks early.”

Another challenge is ensuring medicines don’t run out. “We need emergency stockpiles of essential drugs — psychiatric medicines, insulin, oral rehydration salts, antibiotics,” said the official. “When the highway closes or communication lines are down, the delay becomes life-threatening.”

Health workers also stressed the need to strengthen facilities themselves. “Flood-proofing primary health centers and keeping backup power and communications should be non-negotiable,” said Shazia Bhat, a community volunteer in Anantnag. “Right now, one storm can knock out the only health unit for an entire district.”

Clean water remains an urgent priority. “Mobile water treatment units should be deployed within hours, not weeks,” said Arshdeep Singh, the young resident from central Kashmir who earlier described his family’s struggle with jaundice. “Boiling water is not enough when sewage has already entered the supply.”

“We Can’t Afford to Wait”

As floodwaters recede in parts of Jammu and Kashmir, Punjab and Himachal Pradesh, communities are left to confront not just destroyed homes, but the lingering health fallout.

“The government talks about roads and bridges,” said Aadil Dar from Anantnag. “But people are falling sick. We can’t afford to wait for medicines and clean water next time.”

For Maliha Zehra in Srinagar, the disruption felt deeply personal. “Even after the water goes,” she said, “the anxiety stays.”

Image Credits: Arshdeep Singh, Al Jazeera/Creative Commons Licensing, European Commission .

Patients undergoing chemotherapy for cancer.

ISLAMABAD – Cancer cases in Pakistan are on the increase, but patients and health advocates are caught in a struggle for access to life-saving treatment amid concerns about the quality of generic drugs and the rising cost of medicine.

Tahmeena Kausar Parveen, a 45-year-old resident of Islamabad, was shocked by the news that she needs to see an oncologist about a lump in her breast after a screening at the Breast Cancer Hospital at Pakistan Institute of Medical Sciences.

Although she knows that early diagnosis makes this disease treatable, she has many anxieties. She is wrestling with the challenges of finding a reliable oncologist, covering the cost of treatment, and accessing quality medicines.

“I have the courage to fight this disease, but I fear that the difficult journey to get treatment may wear me down,” said Parveen.

The shadow of substandard drugs

Pakistan faces an estimated burden of 185,748 new cancer cases annually, according to the latest data from the World Health Organization (WHO).

But the fight against this disease extends far beyond the hospital ward – it is a battle fought on the supply chain, in regulatory offices, and in the courts, where the integrity and affordability of essential drugs hang in the balance.

The country’s cancer crisis is multifaceted, with access to cancer medication being one of the most complex problems.

There are fears about the quality of generic drugs, particularly following a report on failures in generic chemotherapy drugs published in The Lancet in late July.

The report, which involved testing various generic versions of seven key cancer drugs distributed in four African countries, found that around 20% failed various tests, most commonly over their active pharmaceutical ingredients (API). 

Many of these generic drugs are distributed worldwide, including in Pakistan.

Dr Maqbool Ahmed, an oncologist at Deaconess Hospital in Evansville in Indiana in the United States, says that the stakes could not be higher.

“Patients may not get the correct dose in a timely fashion, allowing their cancer to progress,” he warned. Medicines with lower APIs may be ineffective, while those with too high doses could have “toxic side effects”, said Ahmed.

Ahmed said that Pakistan “does not apparently have the know-how to test the drugs and no political desire to open this can of worms.”

Regulation of medicine

There are fears that sub-standard generic cancer medicine may be being distributed in the country.

However, Dr Akhtar Abbas, a representative from the  Drug Regulatory Authority of Pakistan (DRAP) disputes this.

While DRAP has not had any specific complaints about failed generic cancer treatments, Abbas confirmed that, in the wake of the report on failed generics elsewhere, the authority has initiated “proactive sampling and laboratory testing of suspect products already in the market.”

Initial tests on samples of Doxorubicin and Methotrexate performed successfully, said Abbas, adding that DRAP’s mandate is to ensure quality through strict regulatory mechanisms, including a detailed evaluation of safety, efficacy, and quality before a drug can be registered.

The authority also regulates the storage and distribution of anti-cancer medicines at the manufacturer and importers level and this includes mandatory adherence to Good Distribution Practices (GDP).

He said cold chain compliance, storage conditions, batch tracking, and recall procedures are routinely checked through inspections and audits.

DRAP is also scaling up its post-marketing surveillance activities including risk-based sampling, increased coordination with provincial drug control units, digital pharmacovigilance platforms, and a National Quality Control Surveillance Plan, added Abbas.

“DRAP also works with WHO and other global partners to track international alerts and trace counterfeit or substandard drugs entering the supply chain and is also going to introduce a bar code reader app in near future for detection of Spurious and counterfeit medicines,” said Abbas.

Underlying anxiety

However, the assurances from the regulator have done little to end the underlying anxiety.

For institutions like the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), which treat a significant portion of Pakistan’s cancer patients, the reliance on a national regulatory body is not enough.

“We, at SKMCH, have strong institutional mechanisms to ensure the quality of the products we get,” said CEO Dr Faisal Sultan.

He detailed the hospital’s own rigorous process of comprehensive pre-qualification assessments, review of quality documentation, and, when necessary, chemical equivalency tests and facility inspections.

According to Sultan, breast cancer is the most common cancer in Pakistani women, accounting for 31.3% of all new cases. Ovarian cancer ranks third with 4,987 new cases and 3,492 deaths annually.

Manufacturing success, pricing failure

Alongside concerns over drug quality and regulation, a significant success story has been unfolding in Pakistan’s pharmaceutical landscape: the rise of local anti-cancer drug manufacturing.

Noor Mahar, a pharmacist and president Pakistan Pharmacist Lawyers Forum (PPLF), points out that companies like Pharmasol, Oncogen Pharma, and BF Biosciences are now producing a range of essential oncology medications locally.

These include drugs to treat breast and ovarian cancer, as well as leukemia, said Mahar, marking a “major milestone for public health” by reducing the nation’s reliance on foreign imports, mitigating supply chain risks, and potentially lowering costs.

It is also a testament to the country’s growing industrial capabilities and represents a critical step towards achieving self-sufficiency in a highly specialized field.

However, Mahar warned that this progress is being undermined by an unwelcome policy called “price decontrol”.

In 2024, the country’s caretaker government enacted a policy to remove the maximum retail price (MRP) cap on non-essential medicines, allowing pharmaceutical companies to set their own prices. This has resulted in huge price hikes for certain medicines.

This decision is currently being challenged in the Lahore High Court.

Mahar argued that decontrol is a “clear violation of the Drug Act 1976,” which mandates strict regulation of life-saving medicines. 

He described the government’s stance as one of deep insensitivity towards patients and warns that the unchecked increase in drug prices will render essential cancer treatments “unaffordable for the common man”.

However, DRAP’s Abbas said that “the prices of the anti-cancer drugs included in Essential Medicine List are fixed and regulated”.

System under strain

The struggle with drug quality and pricing is compounded by a larger, systemic problem, namely the lack of a cohesive national framework for cancer care.

While the number of women presenting with breast cancer in early stages has increased at Shaukat Khanum Hospital, CEO Sultan notes that many women still present late and there is not enough understanding about why this is.

A functional national cancer registry would provide the data necessary for informed policy and resource allocation.

The supply chain is also under significant stress with several essential cancer medications not locally registered, making timely procurement a challenge, added Sultan.

Several multinational pharmaceutical companies have scaled down activities in Pakistan, which has contributed to the scarcity of essential cancer medications, creating additional challenges in ensuring consistent and timely patient care.

“This precarious environment puts immense pressure on healthcare providers,” said Sultan.

His hospital procures drugs from approved sources that comply with international standards.

“However, institutions like SKMCH&RC can only do so much. The core problems – the lack of political will, the absence of comprehensive data, and the recent dismantling of price controls – require a national-level solution,” he said.

Image Credits: Roche, WHO.

Delegates at World Health Assembly’s Committee A after it adopted the pandemic agreement by vote in May.

Regulating pharmaceutical companies that manufacture essential health products during a public health emergency is a key flashpoint between developed and developing countries ahead of the final round of talks on the pandemic agreement.

This is evident in some of the 17 submissions made to the Intergovernmental Negotiating Working Group (IGWG), which is coordinating the final phase of the talks. These talks begin on 15 September and focus on an annex to the pandemic agreement adopted at the World Health Assembly (WHA) in May. 

The annex deals with a pathogen access and benefit-sharing (PABS) system. It will outline how information about pathogens with pandemic potential is shared in a safe, transparent, and accountable manner, and how those who share information will benefit from products that are developed as a result.

Many countries in the global South want any sharing that they do to be on condition that they get benefits from products made as a result. It stems from the bitter experience of these countries during the COVID-19 pandemic, when countries like South Africa shared details of the Omicron variant only to face travel sanctions rather than access to vaccines.

Hours and hours of negotiations failed to secure agreement on PABS, which was then kicked down the road in an annex, enabling the WHA to adopt the deal. However, with less than nine months until the next WHA, it remains unclear whether member states will be able to reach a compromise.

The IGWG only has about seven months of negotiating time as the PABS annex has to be completed by 17 April 2026 to meet the deadline of submission to the World Health Assembly in May 2026, according to WHO legal officer Steven Solomon.

Group of Equity submission

The recent submission by the Group for Equity, a powerhouse interest group of 33 developing countries, wants manufacturers that are part of the PABS system to grant the World Health Organization (WHO) “non-exclusive licenses that can be sub-licensed to manufacturers in developing countries” during a public health emergency of international concern (PHEIC) and a pandemic. This would enable them to make vaccines, diagnostics and therapeutic products.

The Group believes that manufacturers in developing countries that provide pathogen materials and sequencing information should be the primary beneficiaries of such licenses.

They also want such a license to “include provision of the full regulatory dossier, technical know-how, and any necessary materials”. 

Two diseases – polio and mpox – are currently designated as PHEICs by the World Health Organization (WHO). 

If the Group’s proposal were adopted, it would mean that manufacturers in mpox hotspot countries that share information – such as the sequencing of the new mpox clades – could obtain licenses to produce any vaccines and therapeutics that develop as a result.

The Group of Equity includes countries with significant capacity to produce pharmaceutical products, including Bangladesh, Brazil, China, India, Indonesia, Malaysia, Thailand, Mexico, South Africa, Ethiopia and Egypt.

Voluntary contracts

Wealthier countries, primarily in Europe, now that the US is no longer part of the WHO, have sought to protect the intellectual property rights of their pharmaceutical companies and provide wide access to affordable medical products.

However, the European Union’s submission to the IGWG, a mere three pages, mainly summarises what the annex should cover, rather than proposals. But it does state that the key instrument for benefit-sharing should be “contracts with participating manufacturers (which are both legally-binding and voluntarily concluded)”.

Meanwhile, China has suggested that the access pharmaceutical manufacturers get to the PABS system should be “contingent” on their home country being a party to the Pandemic Agreement, as previously reported by Health Policy Watch. 

This would exclude US manufacturers, as the US withdrew from the WHO when the Trump administration assumed office on 20 January.

According to China,  the annex should “specify qualification criteria, boundaries of liability, and both financial and technical benchmarks” for manufacturers, and “make these contingent on whether their home state is a party to the Pandemic Agreement”.

Aside from deciding on PABS, the IGWG will prepare the ground for the Conference of the Parties that will govern the pandemic agreement, and the terms of reference for a coordinating financial mechanism, which will help defend countries against outbreaks and pandemics.

Image Credits: WHO.

The number of people living with mental health disorders around the world is on the rise, according to the World Health Organization (WHO).

Over a billion people across the world are living with mental health disorders, a slight but significant increase over the numbers from the last time the data was collected in 2000, with anxiety and depression being the most prevalent conditions.

In low-income countries, fewer than 10% of affected individuals receive care, compared to over 50% in higher-income nations, according to the latest data released Tuesday by the World Health Organization (WHO).

These key findings are contained in two WHO reports, ‘World Mental Health Today’ and ‘Mental Health Atlas 2024’.

Mental health disorders are prevalent across all countries and communities, affecting people across age and income groups, the reports found. The prevalence of mental health disorders is also rising. While there are some signs of progress, greater investment and action is needed globally to scale up mental health services, experts said during the report’s release.

“Transforming mental health services is one of the most pressing public health challenges,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Investing in mental health means investing in people, communities, and economies — an investment no country can afford to neglect. Every government and every leader has a responsibility to act with urgency and to ensure that mental health care is treated not as a privilege, but as a basic right for all.”

Globally, one in every seven people lives with a mental health disorder.

Apart from being the second biggest cause of long-term disability, after back pain, and contributing to loss of healthy life, mental health disorders are also driving up healthcare costs for affected people and families.

Women are disproportionately affected

Mental health disorders are more common among women than they are among men, according to the latest data.

While the prevalence of mental health disorders can vary by sex, women are disproportionately impacted.

“Since depression and anxiety are by far the most common mental health conditions, and since these are more common among women, the overall picture is that women have more mental health conditions,” said Dr Mark Van Ommeren, head of WHO’s Department of NCDs and Mental Health.

Anxiety, depression and eating disorders are the most common mental health disorders among women. ADHD and substance use is more common among men.

One extreme outcome of mental health disorders is death by suicide. There were an estimated 727,000 deaths by suicide in 2021 alone, making it a leading cause of death in young people across all countries and socioeconomic contexts.

Reduction in suicide rates is still far from the target.

While the United Nations Sustainable Development Goals (SDGs) aimed to cut down these deaths by a third before 2030, on the current trajectory, only a 12% reduction is likely to be achieved by that deadline.

The number one billion too has made an appearance for the first time. Ommeren said that the last time the data was reported was in 2000 when the number of people affected by mental health disorders was less than a billion.

“One would expect an increase, but there’s actually a bigger increase than the increase in the world population,” Ommeren said.

The reports also made it clear that the economic impacts of mental health disorders are staggering. Much of this is indirect cost in the form of lost productivity. For instance, depression and anxiety alone cost the global economy an estimated US$1 trillion each year, according to WHO data.

Investment continues to lag, workforce gap remains

WHO wants countries to focus on community-based models of care though that is not yet widespread.

While many countries did improve their mental health services post-pandemic, including taking actions like strengthening their mental health policies, laws and planning, it has not been not enough.

Investment has also stagnated. Median government spending on mental health remains at only  2% of total health budgets — unchanged since 2017. There is a huge spending of disparity between low-income countries and high-income countries.

While high-income countries spend up to $65 per person on mental health, low-income countries spend as little as $0.04.

“We see, for example, high-income countries spending a little less than 5% of their health budgets on mental health, whereas in low lower-income countries, it’s more like 1% so a threefold difference. And if you start looking at the actual dollar amounts, then the differences become much starker,” said Dr Daniel Chisholm, mental health specialist at WHO’s Department of NCDs and Mental Health.

There is no ideal amount to spend, experts said, but if low-income countries too spend about 5% of their overall health budget on mental health disorders, that is likely to go a long way.

Reform in how mental health services are being provided is also progressing very slowly.

Less than 10% of countries have fully transitioned to community-based care models recommended by WHO and other experts, with most countries still in the early stages of transition. Most of the inpatient care continues to rely heavily on psychiatric hospitals, with nearly half of admissions occurring involuntarily and over 20% lasting longer than a year.

Silver lining

WHO has called for an equitable financing of mental health resources.

WHO has been pushing countries to expand primary healthcare and integrate mental health services into primary care. Latest data suggests that 71% of countries are now meeting at least three of the five WHO criteria for doing so. However, data gaps remain; only 22 countries provided sufficient data to estimate service coverage for psychosis.

Most of the countries now report having functional mental health promotion initiatives such as early childhood development, school-based mental health and suicide prevention programmes. Over 80% of countries offer mental health and psychosocial support as part of emergency responses, up from 39% in 2020.

Outpatient mental health services and telehealth are also becoming more available, though access remains uneven.

While there is an extreme shortage of mental health workforce in low-and middle-income countries with the global median number of mental health workers at 13 per 100 000 people, small improvements have been registered.

“We see pretty modest but definitely some positive signs of increased availability of specialized mental health workers, like psychiatrists, of course, psychologists, nurses who work in mental health space, social workers,” Chisholm said. “So that’s a slightly more encouraging sign, rather than the stagnation in the estimated expenditure levels,” he added.

Dr Daniel Chisholm, mental health specialist at WHO’s Department of NCDs and Mental Health speaking at a press conference to mark the release of the two reports.

The latest data thus shows that countries remain far off track to achieve the targets set in WHO’s Comprehensive Mental Health Action Plan for the years 2013-2030.

“We need urgent systemic transformation of mental health systems worldwide, and this includes sustained investment in mental health workforce and services, a decisive shift toward community-based, person-centered care as part of universal health coverage, legal and policy reforms that uphold rights and dignity,” said Dr Dévora Kestel, director at WHO’s Department of NCDs and Mental Health.

The reports include data from 144 countries, are an attempt to provide policy makers with the most up-to-date global data on the prevalence, burden, and economic cost of mental health conditions. They are meant to inform national strategies and shape global dialogue ahead of the United Nations High-Level meeting on NCDs and promotion of mental health set to take place in New York on 25 September.

Image Credits: Joice Kelly/ Unsplash, WHO.

Oropouche mosquito monitoring
WHO staff in the Americas region (PAHO) explain mosquito sampling methodology to better understand the distribution of disease-carrying species.

A new White House “pocket rescission package” threatens to throw the Pan American Health Organization (PAHO), the Americas branch of the World Health Organization, into a financial crisis – if it is not stopped by the US Congress before the end of September.   

The White House order, announced on the eve of the long US Labor Day weekend, cancels some $4.9 billion more in US international aid already allocated by Congress in its last funding bill – striking another deep blow at initiatives in fair trade, workers health and safety, and clean energy as well as global health.

The targets of the cuts in “woke, wasteful and weaponized spending” include shards of programmes previously administered by the now-defunct USAID,  along with the International Labor Organization, the World Trade Organization, the Organization for Economic Co-Operation and Development (OECD), the Green Climate Fund, and UN-backed peacekeeping operations – as well as PAHO. 

US Senator Susan Collins (Rep, Maine), described the White House maneuver as “unlawful” because it was announced within 45 days of the 30 September end of the fiscal year – giving Congress almost no time to respond. 

“Given that this package was sent to Congress very close to the end of the fiscal year when the funds are scheduled to expire, this is an apparent attempt to rescind appropriated funds without congressional approval,” Collins said in a statement. 

“Article I of the Constitution makes clear that Congress has the responsibility for the power of the purse.  Any effort to rescind appropriated funds without congressional approval is a clear violation of the law,” she said. 

The White House initiative also threatens to sabotage bipartisan efforts to negotiate a new funding bill that would avoid a federal government shutdown on 1 October.  Leading Democrats in Congress have already threatened to reject a compromise on a funding bill if the pocket rescissions package isn’t  somehow halted. 

In July, Trump successfully clawed back some $9 billion in previously allocated Congressional funding for foreign aid and public broadcasting, after Republicans in both chambers approved the cuts — but that package of cuts was submitted to Congress with sufficient time for them to react. 

US alleges PAHO complicity in “trafficking of Cuban doctors” 

Cuban doctors first arrive in Brazil in 2013 as part of the Mais Medicos (More Doctors) initiative – now in the gunsights of the White House.

Last week’s announcement targeting $45 million in Congressional appropriations to PAHO as part of the new “pocket rescissions” package, was based on White House allegations that the regional health body faces “credible allegations of forced labor and human trafficking of Cuban doctors.”

The White House reference is to a longstanding Brazilian programme known as Mais Medicos (More Doctors), which aimed to increase the number of doctors serving in remote and indigenous Brazilian regions. The programme relied heavily upon Cuban medical teams in its start-up phase beginning in 2013 – although by 2025 Cubans represented no more than about 10% of the Mais Medicos medical teams.

In that initial phase, from 2013-2018, PAHO helped facilitate the dispatch of thousands of Cuban doctors, who typically earned only about $40 a month in their home country, to work in Brazil – where they earned roughly $500 monthly, Brazilian sources told Health Policy Watch. 

Most doctors returned home from Brazil satisfied with the scheme, which yielded a far higher income than they could have otherwise earned. However, the pay was only about one-quarter of the salary Brazilian doctors typically receive – with most of the balance going to the Cuban government, and about 5% paid to PAHO, for its work in facilitating the exchange. 

In 2018, some Cuban medical team members who did not return home, began looking for ways to take legal action over their employment conditions in Brazil. They claimed that they were subject to human trafficking due to the salary differentials, and the fund collected by the Cuban government as well as PAHO from the arrangement.  

Last week, a prominent Cuban member of Congress, Rep. Carlos Gimenez,  sent a letter to US President Donald Trump urging him to revoke PAHO’s traditional UN immunity to allow the doctors to file suit against the health agency in US courts.  

He charged that PAHO received about $129 million for facilitating the programme between 2013-2018 while Cuba reaped more than $2.3 billion from the salaries of the roughly 10,000 Cuban doctors who participated in the programme during those years. 

“I am not calling for a blanket revocation of PAHO’s immunity,” Gimenez wrote in an X post,  “Rather I am urging a targeted executive order revoking PAHO’s immunity solely for its activities related to the Mais Medicos programme.”

PAHO’s role ended in 2018 

A Cuban doctor treats a child from from an Afro-Brazilian community – which historically had less access to medical care.

In 2018, the exchange programme was halted by Brazil’s new president, Jair Bolsonaro, who accused Cuba of using it for human trafficking. 

Since the return of  President Lula da Silva to power in 2022, Cuban doctors are again serving in the Mais Medicos programme, but under private contracts that give them salaries equivalent to Brazilian doctors – and without any PAHO involvement. In 2025, Cuban doctors only represented about 10% of Mais Medicos participants.  A much higher priority has meanwhile been placed on the recruitment of Brazilian doctors as well as doctors from other Latin American countries. 

Cuba has a long tradition of sending its doctors abroad to work – with various bilateral arrangements put in place. In 2024, Cuban doctors were sent to Rwanda with much fanfare to help the country jumpstart its 4×4 initiative that aims to quadruple its health workforce.  Meabwhile, citizens of some Caribbean countries can attend medical school in Cuba for free. 

Cuban medical team welcomed by Rwanda at the start of its 4×4 initiative.

So at the time, the Cuban-Brazilian arrangement was not seen as so exceptional, sources told Health Policy Watch.  

“Cuba exports doctors and has been exporting for ages to more than 100 countries, including, in some cases, high income countries such as Portugal, Spain, and the Ukraine,” one source said. 

“Today, there is something like 25,000 Cuban doctors working abroad…Cuba is also under a US  economic embargo.  And medical know-how is one of its few assets.  It’s true that in some cases, the Cuban government may earn income from these exchanges, while some goes to pay the doctors themselves. But if the US is angry with this business, they should probably talk to all of these other countries that engage Cuban doctors as well.”

US support for PAHO in jeopardy

PAHO budget and sources for 2022-23 – during the COVID pandemic.

Meanwhile, if the White House rescission order holds, at least $45 million in US payments already appropriate by Congress to PAHO is at risk.

In fact, the US government assessed payment to PAHO for the 2024-25 biennium was $55.6 million a year. And of that amount, it still has some $78.5 million oustanding. That represents the lion’s share of  $116.9 million in unpaid assessed contributions from member states for 2024-2025.

The US is the single larger donor to PAHO, so a sustained cutoff in US funds would have lasting consequences on the organization, which has already shrunk down its budget from over $1.14 billion for 2022-23 in the wake of the COVID pandemic to a planned budget of  $762 million for 2026-2027, including $662 million for base programs and $100 million for special programs and emergencies.

Since PAHO is 75% self-funded by WHO member states that belong to the Americas region, the agency had comparatively been less affected by the global budget crisis hitting WHO headquarters and its five other regional offices in Asia, Europe and Africa, due to the US withdrawal from WHO in January.

In fact, last week’s White House rescissions represent the first direct attack by the Trump administration on PAHO, a storied regional health organization that the United States helped found over a century ago, as the Pan American Sanitary Bureau.  

Due to the long US history of involvement with PAHO, whose headquarters is also based in Washington, DC, PAHO staff had been hoping that the Trump administration might avoid targeting the agency in the massive assault launched on US foreign health, development and climate aid since January. 

Now all of that has changed.

But with the White House announcement issued at the start of a long holiday weekend in the United States, neither PAHO nor the WHO office in Geneva have yet offered any kind of official reaction. 

Said one senior PAHO officer, who requested anonymity, “Of course we are worried and we planning with different scenarios but that’s all I know for now.”

Image Credits: PAHO/WHO, @MaisMedicos, @Maismedicos , Rwanda New Times , Andre Medici/LinkedIn.

A healthworker takes a sample from a person suspected of having mpox.

Ghana has seen an “exponential” increase in mpox cases over the past week, while there have been smaller increases in the Democratic Republic of the Congo (DRC), Guinea, Burundi, and Kenya, according to the Africa Centres for Disease Control and Prevention (Africa CDC).

Ghana now has 313 confirmed cases, an 87% increase over the previous week when it had 167 cases, said Professor Yap Boum, the institution’s deputy lead on mpox at a media briefing on Thursday. Ghana and Guinea have both applied for vaccines to Africa CDC.

The DRC, Uganda, Sierra Leone, Burundi, Guinea, Liberia account for 86% of cases on the continent. While there was a small 7% uptick in cases over the past week, overall cases are down 76% since the peak of the epidemic.

Increase in Western Pacific

Globally, 47 countries in five of the six World Health Organization (WHO) regions had reported mpox cases by the end of July, according to the latest WHO surveillance report.

The Western Pacific reported a 160% increase in cases between June and July driven by the increase in cases in Philippines (from zero cases to 126 confirmed cases in July) and China (from 108 to 152 confirmed cases), according to the WHO report.

China, Germany, Türkiye, and the United Kingdom reported additional mpox cases last month of clade Ib MPXV linked to travel. Community transmission of this more serious clade is only happening in central and eastern Africa.

Overall, however, mpox cases are decreasing – particularly in African countries with a 28% reduction in cases between June and July, although 21 still have active cases.

Cases in the WHO regions of the Americas and Europe both reported a 31% reduction in cases. The Eastern Mediterranean Region did not report any mpox case in July 2025 .

Global mpox cases, 31 July 2025

Cholera task force

​​Cholera cases are also declining in Africa, aside from in the DRC and Chad.

African leaders have resolved to establish a Continental Task Force on Cholera Control and a Presidential Task Forces in the 23 affected countries, which is largely caused by inadequate access to clean water and sanitation.

Africa has already recorded 231,738 cholera cases so far this year – which is close to the total number of cases for 2024.

Image Credits: Katson Maliro/ WHO, Africa CDC , WHO.

CDC officials accuse US Health Secretary Robert F Kennedy Jr of politicising science.

Details from the resignation letters of top officials from the United States’ Centers for Disease Control and Prevention (CDC) show that the government’s top health experts have been ignored and sidelined by Health and Human Services (HHS) Secretary Robert F Kennedy Jr.

Kennedy has never been briefed by any experts from the CDC’s National Center for Immunization and Respiratory Diseases (NCIRP), which deals with immunisation, viral and bacterial diseases, influenza and coronaviruses, according to Dr Demetre Daskalakis, NCIRP director until his resignation on Wednesday.

“We are seven months into the new administration, and no CDC subject matter expert from my Center has ever briefed the Secretary. I am not sure who the Secretary is listening to, but it is quite certainly not to us,” said Daskalakis in his letter, which he published on X.

“Unvetted and conflicted outside organisations seem to be the sources HHS use over the gold standard science of CDC and other reputable sources,” he added.

The resignations came during a day of chaos at the CDC as Kennedy sought to remove director Dr Susan Monarez, the Republican pick for the post confirmed by the US Senate a month ago. 

Reports indicate that Kennedy attempted to pressure Monarez into supporting new restrictions on COVID-19 vaccines and instructed her to dismiss senior staff. Late Wednesday, Monarez’s legal counsel said that she refused to resign, but her appointment was later “terminated” by the White House.

During the COVID-19 pandemic, Kennedy was one of the foremost spreaders of anti-vaccine misinformation and conspiracies, while the organisation he founded, Children’s Health Defense, has campaigned against several vaccines for years.

Surging measles cases

Former CDC Chief Medical Officer Dr Debra Houry

Chief Medical Officer Dr Debra Houry, the institution’s most senior career leader, resigned on Wednesday after 10 years at the CDC, serving under both Republican and Democratic administrations.

“The science at CDC should never be censored or subject to political pauses or interpretations,” Houry wrote in her letter, published by Inside Medicine.

Asserting that vaccines save lives, Houry said that, while it is important to question research, this should be done “by experts with the right skills and experience, without bias, and considering the full weight of scientific evidence”. 

“Recently, the overstating of risks and the rise of misinformation have cost lives, as demonstrated by the highest number of US measles cases in 30 years and the violent attack on our agency,” she added.

Dr Daniel Jernigan, director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, has worked at the CDC since 1994.

“I believe strongly in the mission of public health and the leadership that CDC has given for almost 80 years; however, given the current context in the department, I feel it is best for me to offer my resignation,” said Jerigan.

CDC data manipulation?

Dr Jennifer Layden, director of the CDC’s Office of Public Health Data, Surveillance, and Technology, has also resigned, although her reasons have not been made public. 

There have been indications for months that the CDC’s database is under political pressure.

The CDC has removed 146 datasets since March, according to Stat. Meanwhile, on numerous datasets, the word “gender” was replaced by “sex”, according to a study published in The Lancet in July.

Axios reported on 8 August that the CDC had changed the wastewater viral activity for COVID-19 from “low” to “moderate”. However, when Health Policy Watch checked the CDC site, it indicated that wastewater data for COVID-19 has not been updated since 9 August due to a “technical issue”, but the COVID risk was now classified as “low”. This suggests it had been downgraded since the Axios report – despite no new data being available.

CDC database on wastewater and COVID-19, accessed on 27 August 2025.

The CDC apparently also took down its public database showing that Republican-governed states have higher homicide rates than Democratic states.

‘Eugenics’ at play?

Daskalakis makes several damaging allegations in his letter, one being that “eugenics plays prominently in the rhetoric being generated” about vaccines.

“The intentional eroding of trust in low-risk vaccines, favoring natural infection and unproven remedies, will bring us to a pre-vaccine era where only the strong will survive and many, if not all, will suffer,” he argues.

“The nation’s health security is at risk and is in the hands of people focusing on ideological self-interest,” he says, adding that he has “never experienced such radical non-transparency, nor have I seen such unskilled manipulation of data to achieve a political end rather than the good of the American people”.

Daskalakis also says that recent restrictions on access to COVID-19 vaccines threaten the lives of young children and pregnant women, and criticises Kennedy’s preference for communicating via social media rather than office channels.

“I must also cite the recklessness of the administration in their efforts to erase transgender populations, cease critical domestic and international HIV programming, and terminate key research to support equity as part of my decision. Public health is not merely about the health of the individual, but it is about the health of the community, the nation, the world,” he concludes.

Kennedy’s response

Kennedy was dismissive of the resignations during an interview on Fox News, suggesting the institution is “in trouble” and that “some people should not be working there anymore”.

Republican Senator Bill Cassidy, chair of the Senate health committee, simply said on X that the CDC’s “high-profile departures will require oversight” by his committee.

However, Senator Patty Murray (D-Wash.), the top Democrat on the Senate health committee, called for Kennedy to be fired: “We cannot let RFK Jr. burn what’s left of the CDC and our other critical health agencies to the ground – he must be fired. I hope my Republican colleagues who have come to regret their vote to confirm RFK Jr. will join me in calling for his immediate termination from office.”

Image Credits: HHS.

Wildfires in Canada and the US have substantially worsened their air pollution levels.

The eighth AQLI report released on Thursday, establishes a global warming link to air pollution – surprisingly in the United States and Canada. However, the global air pollution hotspot remains in South Asia. 

NEW DELHI – The latest data is out on how much air pollution is estimated to shorten lives, and New Delhi tops the global list for the eighth year running. 

The Indian megacity’s pollution level in 2023 was high enough to shave off 8.2 years of a person breathing its polluted air over the long term.

South Asia remains the most polluted region in the world. In countries here, the impact of particulate pollution on life expectancy is nearly twice that of childhood and maternal malnutrition and more than five times that of unsafe water, sanitation and handwashing. The report has been produced by the Energy Policy Institute at the University of Chicago (EPIC).

The 2025 Air Quality Life Index report shows South Asia to have the highest air pollution.

Within South Asia, Bangladesh is more polluted than India, averaging 60.8 micrograms/cubic metre (µg/m³) of the fine pollutant, PM 2.5, compared to 41 µg/m³ of it’s larger neighbour. But its capital Dhaka (76.4 µg/m³) is less polluted than Delhi, which – with 88.4 micrograms – is the highest of the global cities analysed. 

Air pollution poses the greatest threat to life expectancy in South Asian countries, in comparison to other major risks.

While India’s capital has topped the AQLI list for each of the eight reports so far, the data shared with Health Policy Watch shows a declining trend. It’s down from almost 10 years of life expectancy potentially lost in the 2018 report to 8.2 years in the latest report. 

Explaining what the declining numbers mean for a Delhi resident’s life span, Tanushree Ganguly, AQLI’s Director, told HPW, that, “our annual reports do not estimate the number of years of life already lost. Instead, they estimate the number of years that could be lost on average if people were exposed to the pollution levels of a given year over the long term.”

Government action in last eight years

While India and its cities continue to dominate rankings such as AQLI and those by IQAir, the government points to a series of measures it has implemented in the past decade, which it says are paying off.

It informed Parliament last month that the National Clean Air Programme (NCAP)  launched in January 2019, has shown “positive results” with pollution reducing in 103 cities. As many as 22 cities have met the national standards, which aren’t as stringent as WHO’s recommendations.

The government’s Delhi-centred action includes the creation of an empowered agency, CAQM, and an emergency response plan, GRAP, to shut down sources of pollution on days when air pollution spikes. 

Across India, a network of real-time, high-quality monitors has been installed, from a handful in 2014 to almost 600 now. It ‘leap-frogged’ fuel standards, jumping from Bharat Stage 4 to BS 6 (BS being at par with Euro standards). The most significant programme was NCAP which aimed to cut pollution in about a hundred cities. Since then it expanded the cities covered to about 130, and the raised the target to cut pollution levels by 40% by 2026.

Is air quality action reducing pollution?

AQLI’s data, too, shows a decline for both Delhi and India. However, Ganguly says it is “difficult to conclusively determine” with current evidence if these changes are due to meteorological changes or on-ground action. The year-to-year differences in these estimates reflect actual measured changes in pollution levels. To a lesser extent, they may also be influenced by improvements in the underlying satellite-derived models.  

AQLI Report Year AQLI India (years) AQLI Delhi (years)
2018 4.2 9.75
2019 4.07 9.23
2020 4.09 9.24
2021 3.73 7.89
2022 3.87 8.6
2023 3.92 8.61
2024 3.5 7.81
2025 3.5 8.2

Source: AQLI, EPIC, New Delhi. 

Each report is based on data from two years prior; so 2025’s report is based on 2023 data, and 2018’s report on 2016’s data.

Despite the progress in government policy there have been gaps, some literally. Obstacles include a 46% vacancy rate in pollution control agencies, government’s inability to enforce a ban on burning crop residue and fireworks, recent setbacks over targeting sources of high pollution from old vehicles and coal-fired power plants, and the fact that the NCAP prioritises PM 10 pollution (large particles like dust) rather than PM 2.5, which is far deadlier for human health and harder to contain. 

Huge jump in US, Canada air pollution

Globally, the United States and Canada sprang a surprise. Wildfires in Canada significantly worsened air quality in 2023, with PM2.5 levels rising by over 50% in Canada. Air quality in the US, which has recorded huge wildfires in California and is also affected by the Canadian fires, worsened by 20% compared to 2022. Both countries recorded their largest year-on-year increases in PM2.5 concentrations since 1998. 

Canada’s wildfire season was the worst in its history. The AQLI report points to growing evidence of a link between climate change and air pollution. Canada’s most polluted provinces were Northwest Territories, British Columbia, and Alberta. Here, particulate pollution levels in 2023 were comparable to polluted Latin American countries like Bolivia and Honduras, cutting people’s lives short by more than two years. 

The AQLI team wants the ‘life index’ to resonate with people by communicating the health consequences of air pollution shortening their lifespans. They reason that when communities have access to data on the air they breathe – and

understand its impact on their health – they are more likely to take protective action and push governments toward accountability.

Image Credits: Mike Newbry/ Unsplash, AQLI 2025 Report.

The headquarters of the US Centers for Disease Control and Prevention.

The White House “terminated” Dr Susan Monarez as director of the Centers for Disease Control and Prevention (CDC) late Wednesday night after she refused to resign.

On Wednesday evening, Monarez’s legal counsel said that she would not resign as CDC director despite an earlier announcement on X  by the US Department of Health and Human Services (HHS) that she was no longer in her post.

“When CDC Director Susan Monarez refused to rubber-stamp unscientific, reckless directives and fire dedicated health experts, she chose protecting the public over serving an agenda,” said her legal counsel, Mark Zaid, in a statement.

Zaid also accused Kennedy and HHS of “[setting] their sites on weaponising public health for political gain”, adding that his client had not been informed of her dismissal, which comes barely a month after she was confirmed in her position by the US Senate.

However, four top CDC officials did resign on Wednesday. They are CDC chief medical officer Dr Debra Houry; Dr Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases; Dr Daniel Jernigan from the National Center for Emerging and Zoonotic Infectious Disease, and Dr Jennifer Layden, head of the office public health data.

Daskalis said in a statement on X that he was resigning because he is “unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health”.

Daskalis added that the recent change in the adult and children’s immunization schedule “threaten the lives of the youngest Americans and pregnant people” and that “the data analyses that supported this decision have never been shared with CDC despite my respectful requests to HHS and other leadership”.

FDA restricts access to vaccines

The CDC turmoil comes a day after the US Food and Drug Administration (FDA) restricted  COVID-19 vaccines to Americans aged over 64. Access to younger people is restricted to those with at least one underlying medical condition that exposes them to severe risk. Children may only receive the vaccine if they consult a medical provider. 

The FDA has also removed the emergency use listing for vaccines for children. This means that the BioNTech-Pfizer COVID-19 vaccine, Comirnaty, is only available for children over the age of five, according to Pfizer. 

The Novavax vaccine has been licensed for those aged 12 and over. Moderna’s COVID-19 vaccine, Spikevax, is now the only vaccine available to children from the age of six months – but only if they have underlying conditions.

Newer COVID-19 formulations from Pfizer, Moderna and Novavax to address the latest variants have only been approved for those over the age of 11 years who have at least one underlying condition.

In reaction, the Infectious Diseases Society of America (IDSA) has urged physicians to continue to recommend COVID-19 vaccines based on “the best available science” after the US Food and Drug Administration (FDA) restricted  COVID-19 vaccines to Americans aged over 64.

“By narrowing its approval, FDA has made a decision that completely contradicts the evidence base, severely undermines trust in science-driven policy and dangerously limits vaccine access, removing millions of Americans’ choice to be protected and increasing the risk of severe outcomes from COVID,” said IDSA president Dr Tina Tan in a statement.

Off-label use

Tan added that “scientific evidence continues to strongly support broad vaccination far beyond the limited populations outlined in the FDA’s new label”.

“Physicians can still provide COVID vaccines off-label, and IDSA strongly urges doctors to continue recommending and administering vaccination to their patients based on the best available science,” said Tan.

She warned that “pharmacists’ ability to provide off-label vaccines may be severely constrained, underscoring the vital role of physicians and other clinicians in maintaining access”. 

IDSA also called on insurers to “continue covering COVID vaccines consistent with multiple medical society recommendations and scientific evidence”, and urged the US Congress to “conduct strong oversight of the administration’s decision to restrict Americans’ freedom to choose vaccination as we approach the upcoming respiratory virus season”. 

Dr Tom Frieden, CEO of Resolve to Save Lives and a former CDC director, said that “the change to the vaccine label, which has been driven by falsehoods, may put vaccines out of reach of many Americans who want to protect themselves and their loved ones from illness”.

Earlier this month, the American Academy of Pediatrics recommended COVID-19 vaccines for children between the ages of six months and two years, who are most vulnerable to severe disease.

Research shows that long COVID may have affected up to six million children in the US. 

Although Axios reported on 8 August that the CDC had changed the wastewater viral activity for COVID-19 from “low” to “moderate”, data from the CDC has not been available since 9 August due to a “technical issue” and the risk is now classified as “low”.

CDC advisory committee still to weigh in

Meanwhile, Health Secretary Robert F Kennedy Jr welcomed the FDA’s decisions on X, saying that he has delivered on his promises to “end covid vaccine mandates; keep vaccines available to people who want them, especially the vulnerable; demand placebo-controlled trials from companies, and end the emergency”.  

The CDC has yet to make its recommendations about this year’s COVID-19 vaccines. However, in June Kennedy Jr fired all 17 members of the CDC’s Advisory Committee for Immunization Practices (ACIP). At least half of the eight people he replaced them with have spoken out against the handling of COVID-19 and vaccines.

The new appointees are Dr Joseph Hibbeln, Martin Kulldorff, Retsef Levi, Dr Robert Malone, Dr Cody Meissner, Dr Michael Ross, Dr James Pagano and Vicky Pebsworth.

Malone has promoted several false and alarmist claims about COVID-19 vaccines, and said they did not work. 

Pebsworth is a director and board member at the National Vaccine Information Center, which has questioned the safety of COVID-19 vaccines and encouraged people to seek alternatives.

Kulldorff was co-author of the Great Barrington Declaration with Dr Jay Battacharya, new director of the National Institutes of Health, which favoured herd immunity to address COVID-19 for all but the most vulnerable.

Meissner, is in favour of children and pregnant children being excluded from the COVID-19 vaccine schedule.

Levi, who has questioned the safety of COVID-19 vaccines, has also been appointed to chair a new review committee to review COVID-19 science.

In his resignation statement, the CDC’s Daskalakis said that the “recent term of reference for the COVID vaccine work group created by this ACIP puts people of dubious intent and more dubious scientific rigor in charge of recommending vaccine policy to a director hamstrung and sidelined by an authoritarian leader.   Their desire to please a political base will result in death and disability of vulnerable children and adults.  Their base should be the people they serve not a political voting bloc.”

This story was updated with news of the disruptions in the CDC leadership.

Image Credits: Photo by Mat Napo on Unsplash.