The new US EPA ruling on power plant emissions noted the health benefits of stricter regulations, but failed to assign monetary value for those benefits.

While the US Environmental Protection Agency (EPA) will still consider the health benefits of emissions regulations, it will no longer publish estimates of the economic costs of deaths, illness and disability from unsafe air pollution levels.

The US EPA, whose path-finding work on air pollution’s health impacts helped set standards internationally, will no longer put dollar amounts to the human health toll of the most hazardous air pollutants, PM 2.5 and ozone, in the course of setting new regulations or assessing the health harms of potentially polluting energy projects, the agency signalled on Monday. 

The sea change in four decades of policy was included in a new economic assessment of new emissions standards for gas turbines, which fine-tunes and strengthens slightly regulations on nitrogen oxide (NOx) emissions, but avoids setting explicit limits for emissions of fine particles, PM2.5, widely considered the most health-hazardous air pollutant.  

The costs to industry of the updated rule will amount to roughly $22.6 million annually, the assessment states. But it refrains from making any monetary estimate of health costs and benefits, stating:  

 “The EPA is no longer monetizing benefits from PM2.5 and ozone but will continue to quantify the emissions until the Agency is confident enough in the modeling to properly monetize those impacts.” 

A break from quantifying health benefits

Dr Maria Neira, former WHO director for Public Health, Environment and Social Determinants of Health highlights the $8.1 trillion is the current cost of air pollution to global GDP at a 2025 conference.

Since the 1990s, the EPA included detailed health-related benefit estimates – such as the costs saved from avoiding hospitalizations from asthma attacks, fewer lost workdays and school absences, as well as assigning a monetized value to avoided premature deaths. 

Quantifying the health benefits in dollar terms allowed for a comparison between the costs and benefits of pollution mitigation and compliance with air quality regulations on an even playing ground, advocates have long maintained. 

Estimating savings in medical costs, productivity and avoided deaths – made clear that many air rules delivered billions in net benefits over a period of a decade or more, even when industry costs were substantial. 

The new policy falls into line with industry complaints that current economic models, used by scientists and health economists around the world, overstate the benefits of air pollution mitigation – while underestimating the costs to business.   

EPA calls past methods ‘erroneous’ 

EPA

The new EPA rule, which was first reported on by the New York Times Monday,  defended its change, describing its mission to “rectify this error.”

Dropping  the monetary benefit analysis, is meant to clarify “uncertainties” in past EPA assessments, according to the agency. 

Buried in the technical jargon of the agency’s newly released power plant emissions analysis and regulation is a shift from precedent in how the EPA will approach cost-benefit analysis. 

 “Historically, however, the EPA’s analytical practices often provided the public with a false sense of precision and more confidence regarding the monetized impacts of fine particulate matter (PM2.5) and ozone than the underlying science could fully support, especially as overall emissions have significantly decreased, and impacts have become more uncertain.”

It goes on to say: “Therefore, to rectify this error, the EPA is no longer monetizing benefits from PM2.5 and ozone but will continue to quantify the emissions until the Agency is confident enough in the modeling to properly monetize those impacts.”

Slippery slope to looser standards

In a post on X that followed on the New York Times story, EPA administrator Lee Zeldin said that the agency will continue to calculate health costs of air pollution – even if it doesn’t attach a dollar sign to those costs. 

“EPA will still be considering lives saved when setting pollution limits,” said Zeldin in his post. 

The turbine policy rule change, however, includes no analysis of health benefits or costs from alternative emissions strategies. 

However nuanced the arguments may be, critics also argue that dropping the economic assessment of the health costs and benefits of air pollution mitigation from the EPA toolkit ultimately weakens the policy case for stricter standards in an agency that has long been regarded as the gold standard. 

“By foregoing the opportunity to monetize the health impacts of air pollution, the EPA will lose insight which is key to inform sound financial and health-promoting decision making,” said Dr Marina Romanello, executive director of the Lancet Countdown commission on climate and health, in a statement to Health Policy Watch. “The quantification of health impacts alone is not sufficient – translating this into monetary terms is the key step to incorporate these impacts into decision making.”

This makes some in the field worry that the EPA could drop accounting for broader health impacts next.

“The adverse health impacts of soot and smog pollution are well documented and for decades, the EPA has accounted for them when setting safeguards,” said Amanda Leland, executive director of the Environmental Defense Fund in a social media post. “Now, the agency is set to stop factoring in those enormous health benefits while still counting costs to corporations.

“At a time when climate change is driving more of the pollution that makes us sick, this decision to ignore the data doesn’t make the problem go away—it only makes it harder to address.”

Dangerous global precedent 

And in the international space, clean air experts in Asia and elsewhere worry this shift could undermine emission standards in the Global South. 

“This sets a dangerous global precedent that could weaken the adoption of stronger environmental protections. It is crucial that this shift does not influence or undermine the air quality and emission standards currently taking shape across the Global South,” Anumita Roychowdhury, executive director, at the Centre for Science and Environment in New Delhi, told Health Policy Watch.

“It removes the primary justification for essential environmental standards. By focusing solely on industrial compliance costs, the EPA has created a regulatory environment where significant public health harms are ignored in favour of corporate profits.

“This decision to stop calculating the health impacts of air pollution and the associated life-saving benefits in the rule making process by the EPA places millions of Americans at risk,” Rowchowdhury said.

Former World Health Organization Chief Scientist Soumya Swaminathan echoed the sentiment, telling Health Policy Watch: “The EPA was a fine example of a science based agency, that led in environmental health regulations globally.”

Swaminathan is currently chair of the M S Swaminathan Research Foundation, as well as a Co-Chair of the Our Common Air, a global initiative. 

Air pollution costs US over $790 billion annually – previous EPA data  

Infographic: More Americans Exposed to Spikes in Air Pollution | Statista You will find more infographics at Statista

Ground level ozone and particulate matter (PM2.5), the two leading air pollutants that cause health harms, together account for the majority of the 135,000 air pollution-related premature  deaths in the United States, according to the US State Department website.

As of the time of this publication, the State Department website still cited  previous EPA estimates of air pollution’s health costs and monetary benefits of cleanup, stating “The EPA estimates that for every dollar invested in cleaning the air, 30-90 dollars are returned in improved health and economic productivity. Reducing air pollution is an economic accelerant.”

“The World Bank found that air pollution costs the U.S. economy over $790 billion per year or approximately 5% of our GDP in economic welfare losses. Air pollution costs the world economy over $8.1 trillion per year, or 6.1% of global GDP,” the State Department website adds.  

PM2.5, typically emitted by power plants and car exhaust, travels deep into a person’s lungs and into the bloodstream. 

In the short-term, breathing polluted air can trigger asthma, coughing, and respiratory distress.  Chronic exposures lead to the build up of plaque on arterial walls, more blood clots, constricted blood vessels and higher blood pressure – all contributing to a heightened risk of heart attack and stroke as well as cancers. 

PM 2.5 pollution is also linked to a host of conditions starting from birth: pre-term birth and low birth weight, reproductive stress, heart disease and lung cancer, and even dementia and cognitive decline. 

“Air pollution is a silent killer,” said Romanello who also researchers climate change and health researcher at University College London. “This not only affects people’s health, but also the economy, making people sick, reducing their capacity to work, increasing health bills, and affecting the economy as a whole.”

Huge wins since 1970 Clean Air Act under threat?

The US saw huge wins in cleaning up its air following the passage of the landmark 1970 Clean Air Act.

While PM2.5 levels have declined sharply in past decades, hot spots remain. Ground-level ozone (O3), which forms when nitrogen oxide (NOx) emissions and other volatile organic compounds are exposed to sunlight, has remained a major problem – associated with asthma and other chronic respiratory issues, as well as reduced crop production.

Meanwhile, under the new administration of President Donald Trump, tensions between government and environmental groups escalated – including with the appointment of Zeldin as EPA administrator.  

In March 2025, the EPA unleashed the first in a series of sweeping regulatory changes on pollution emissions with Zeldin saying “[t]oday is the greatest day of deregulation our nation has seen. We are driving a dagger straight into the heart of the climate change religion to drive down cost of living for American families, unleash American energy, bring auto jobs back to the US and more.” 

Some take a wait-and-see attitude on EPA policy change

Some experts noted that dropping the monetary value on the health benefits of air pollution regulation may not be as dramatic as advocacy groups warn.

“I’m not convinced yet that this will make a big difference – but it will likely mean more court cases with less complete information,” Michael Brauer, a Canadian expert affiliated with the University of Washington-based Institute for Health Metrics and Evaluation (IHME). IHME’s Global Burden of Disease assessments have regularly ranked air pollution as one of the world’s leading risks to health.  

“The Clean Air Act (CAA) still requires only consideration of public health, not cost, in setting national ambient air quality standards,” said Brauer. 

“Now, it looks like they will still do cost analyses, but just not quantify any benefits – still, none of this changes the basic CAA requirements.

“This does not preclude them from assessing health impacts and in the setting of standards for criteria air pollutants, public health protection and not cost is the requirement under the law.  Perhaps EPA will also raise questions about the mortality estimates themselves, but for now this is just about the costs assigned to health impacts which has always been somewhat controversial.

“Bottom line – more court cases  (and in at least some of these I’d expect that judges will want to know about costs and benefits and the EPA will not have the benefits part accounted for which may, in the end, work against changes in regulation),” said Brauer. 

Several US-based environmental health groups declined to comment publicly on the changes. The Trump administration has punished health advocacy and research institutions in the past with retaliatory funding cuts in response to criticism. In one of the most recent examples, the American Academy of Pediatrics was informed that some $12 million in federal research funds would be rescinded after it criticized HHS’s vaccine policy changes. Early in January, a federal judge ordered the funding be restored, deeming the cuts to be retaliatory. 

For Dr Maria Neira, former director of the Department of Public Health and Environment at the World Health Organization, the fact that the EPA still acknowledges its mandate to monitor the health effects of air pollution is a positive. “Protecting the health of people is one of the biggest, most beautiful and incredible missions for all of us to come together around,” said Neira, in a statement to Health Policy Watch. “Of course, we need to protect the economy, but the two things can be done together.”

This story was updated 14 January to inlcude additional expert reaction.

Chetan Bhattacharji and Elaine Ruth Fletcher contributed to this report.

Image Credits: Ella Ivanescu/ Unsplash, AP/Sierra Club.

Sugary drinks have become popular in Africa, and are driving NCDs including obesity and diabetes.

Governments should “significantly strengthen” taxes on alcoholic and sugary drinks as these products are getting cheaper, fueling obesity, diabetes, heart disease, cancers and injuries.

This is according to the World Health Organization (WHO), which issued two reports on taxing sugary drinks and alcohol on Tuesday, including how countries are implementing these.

“In most countries, these taxes are too low to be effective, poorly designed, not adjusted regularly, and rarely aligned with public health objectives,” WHO Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Tuesday.

“As a result, alcohol and sugary drinks have become more affordable, even as diseases and injuries associated with their consumption continue to place growing strain on health systems, families and budgets.”

Only 14% of countries adjust taxes according to inflation, allowing health-harming products to become steadily more affordable. 

Tedros also warned that health taxes “are not a silver bullet” or simple to introduce: “They can be politically unpopular, and they attract opposition from powerful industries with deep pockets and a lot to lose. But many countries have shown that when they’re done right, they’re a powerful tool for help.”

Sugary drink taxes are ‘too low’

WHO economist Anne-Marie Perucic

In the case of sugary drinks, at least 116 countries tax these, but there are several weaknesses, the biggest being that taxes are too low, according to the WHO report on sugary drinks taxes.

WHO economist Anne-Marie Perucic said that the average tax is around 9%. The average tax on a 330ml can of soda is merely 2,4%, according to the report.

“That’s very low, because if we compare it with [the tax on] tobacco products, on average it’s about 50% to 60%.”

Some countries only tax sodas, meaning that fruit juices, sweetened milk drinks, and ready-to-drink coffees and teas high in sugar escape taxation. Sweetened milk products are the least likely to be taxed.

Since 2013, consumption of sugary drinks has increased globally by 14%, and the most popular brands have become cheaper over the last three decades in most countries, according to WHO.

But several countries have had successes. Tedros reported that a sugary drinks tax introduced in the United Kingdom in 2018 “reduced sugar consumption, generated £338 million in revenue in 2024 alone, and has been associated with lower obesity rates in girls aged 10 to 11, especially in the most deprived areas.”

Meanwhile, Mauritius recently doubled their tax on sugar-sweetened beverages, said Perucic.

No tax on wine in 25 countries

Alcohol abuse has a serious impact on both the drinkers and communities.

“Alcohol consumption is one of the leading risk factors for noncommunicable diseases (NCDs) worldwide. It is also a risk factor for poor mental health, injury and poisoning,” according to the WHO report on alcohol taxes.

At least 167 countries levy taxes on alcoholic beverages, and 12 ban alcohol entirely. 

Most countries use volume-based excise taxes for beer and wine, and excise taxes for spirits based on their alcohol content.

“The global median excise tax shares are low for both beer (20.9% of retail price)and spirits (28.4% of retail price),” according to the WHO.

Wine is untaxed in at least 25 countries, mostly in Europe, despite clear health risks. WHO recommends that alcohol taxes should apply to all alcoholic beverages “to avoid incentivising undesirable substitutions “.

Meanwhile, “alcohol has become more affordable or remained unchanged in price in most countries since 2022, as taxes fail to keep pace with inflation and income growth,” according to WHO.

One of the few success stories for alcohol taxes is Lithuania, where “a major tax increase on alcohol in 2017 was associated with an almost 5% reduction in all-cause mortality the following year,” according to Tedros.

Taxes are a win-win

Dr Jeremy Farrar, WHO Assistant Director-General

WHO Assistant Director-General Dr Jeremy Farrar added that “the evidence from tobacco is obviously extremely strong that if taxation is increased, consumption reduces” and that “we can anticipate from the existing evidence that this will be true for alcohol and sugary drinks as well”.

Farrar described high taxes on unhealthy products as “a win-win on every aspect”, encouraging people to lower their consumption of these products, preventing non-communicable diseases (NCDs) and enabling governments to raise revenue.

Alison Cox, the NCD Alliance’s director of policy and advocacy, described well-designed health taxes as a “triple win”, bringing about “better health outcomes, stronger public finances, and reduced long-term costs”. 

However, she said that the pushback against including tax targets in the United Nations (UN) Political Declaration on NCDs and mental health, which was recently adopted by the UN General Assembly, “reflects the continued influence of health-harming industries like producers of tobacco, alcohol and sugar-sweetened beverages”. 

Cox added that some governments framed health taxes as external interference in their national sovereignty.

“These sovereignty arguments can act as dog-whistle language obscuring the reality: health taxes can support national autonomy by increasing capacity to respond to domestic health and fiscal challenges on their own terms,” said Cox.

“They protect population health while internalizing the social and economic costs of harmful products to the industries who create them – costs that would otherwise be externalized onto individuals, families, and overstretched public systems.”

Last July, WHO launched its 3 by 35 Initiative to increase the real prices of any or all of three health-harming products – tobacco, alcohol, and sugary drinks – by at least 50% by 2035 through tax increases, while taking into account each country’s unique context.

Image Credits: Heala_SA/Twitter, Artem Labunsky/ Unsplash.

Thick forests once contained rainfall and mudslides in northern Pakistan, but the hillsides have been stripped of trees.

ISLAMABAD, Pakistan – Along the winding road to Babusar Top, a favourite summer tourist spot in northern Pakistan, there was once a thick forest that shielded the slopes and cooled the air. 

Today, these hillsides are bare, stripped of trees that took a century to mature. So when torrential rains arrived in August, torrents of water roared down the unclothed slopes, sweeping away homes and roads in catastrophic flash floods.

The monsoon rains triggered the floods that submerged villages, killing more than 300 people and displacing hundreds. In Khyber Pakhtunkhwa’s Buner and Mansehra districts, whole villages were washed away in hours. Around 1.6 million people in the province were affected, and a further 356,000 people in neighbouring Gilgit-Baltistan

“Deforestation is the main reason that the cloudbursts at Babusar caused so much destruction,” said Muhammad Hanif, a community development officer at the Khyber Pakhtunkhwa Forest Department. 

“What was once forest is now just barren land. Not a single tree is left,” he said.

Hanif explained to Health Policy Watch that forest cutting has accelerated since 2017, often justified by policies allowing logging on private property. Combined with rising demand for fuelwood in mountain areas, weak law enforcement, and powerful timber “mafias”, the result is a landscape more vulnerable than ever to extreme weather.

Forests lost, futures at risk

Pakistan has one of the world’s lowest levels of forest cover — only about 5.4% of its total land area. Each year, roughly 11,000 hectares are lost to fire, land conversion, and logging. 

The consequences are immediate in northern regions such as Khyber Pakhtunkhwa and Gilgit-Baltistan, where deforestation has removed the natural barriers that absorb rainfall and prevent soil erosion.

“When trees are cut, climate change becomes not just a global issue but a very local one,” Hanif said. 

“Flash floods, landslides, and even rising temperatures are all connected. But enforcement against illegal logging is nearly impossible unless the local community is part of the solution,” he said.

The lack of alternative energy sources only deepens the crisis. Many mountain households rely on wood for heating and cooking, further depleting precious forests. 

“An alternative like LPG must be given to people, otherwise the forests will continue to disappear,” said Hanif.

Crushing mountains, crushing ecosystems

Across Khyber Pakhtunkhwa and Gilgit-Baltistan, mountains are being blasted and ground into gravel to fuel Pakistan’s construction boom.

Deforestation is only one part of the story. Across Khyber Pakhtunkhwa and Gilgit-Baltistan, mountains themselves are being blasted and ground into gravel to fuel Pakistan’s construction boom.

“Mountain and hill crushing devastates landscapes,” warned Aisha Khan, a climate activist and the chief executive officer of the Mountain and Glacier Protection Organization. 

“It removes the vegetation and topsoil that protect slopes, accelerating soil erosion and making floods and landslides more likely.”

Pakistan is home to over 13,000 glaciers – more than anywhere outside the polar regions. Yet unchecked stone crushing and quarrying destabilize fragile ecosystems, threatening both biodiversity and the glaciers that provide water to millions.

“There are more than 3,000 glacial lakes in Pakistan, with at least 33 classified as highly volatile,” Khan noted. “Crushing activities worsen these risks, increasing vulnerability for seven million people living downstream,” she said. 

Air pollution adds another layer of harm. Dust from crushers worsens respiratory health and may even disrupt regional climate patterns. Nationwide, air pollution contributes to an estimated 128,000 premature deaths annually.

Post-traumatic stress after the floods

Dr Ahsan Naveed, a clinical psychiatrist, set up mental health camps in the region after the floods.

Environmental devastation in Pakistan is often discussed in terms of economic loss and infrastructure damage. But the mental health toll is harder to quantify, just as devastating, and rarely addressed in national climate policies. 

“Climate change in the Khyber Pakhtunkhwa region is absolutely creating mental health issues,” said Dr Ahsan Naveed, a clinical psychiatrist who set up mental health camps in the region after the floods. 

“Come visit Beshonai in Buner or Neelmand in Mansehra — you’ll see the grave impact yourself.”

For survivors of last August’s floods, the scars are not just physical.

“After the floods, hundreds died, and the survivors experienced acute stress reactions,” recalled Naveed. “Within weeks, many developed post-traumatic stress disorder (PTSD).”

Naveed described children haunted by flashbacks, mothers numbed by grief, and families unable to sleep for fear of the next storm. Symptoms ranged from irritability and insomnia to emotional detachment.

For many flood survivors, every dark cloud brings fear. Repeated disasters erode community resilience, leaving people trapped in cycles of trauma. Children grow up in uncertainty, women face compounded stress as caregivers, and displaced families struggle to rebuild their lives.

After the floods, Naveed’s team offered crisis interventions, from psychological first aid to art therapy for children. 

“We even created a space called Ijtimai Duwa Hujra, where communities could gather, share their trauma, and heal together,” he explained.

At first, villagers resisted mental health treatment, but psycho-education and the involvement of local leaders broke down the stigma. 

“Now people call us for help themselves,” Naveed said. “It shows how deep the need is.”

Air pollution challenges

Pakistan and other countries in blue have experienced the biggest increases in air pollution over the past decade, while China and France saw the biggest declines. (State of Global Air report 2025.)

Air pollution has also become a critical environmental and public health issue in Pakistan, particularly in major cities like Lahore, Faisalabad, Gujranwala and Karachi. 

According to global air quality rankings, several Pakistani cities now rank among the most polluted in the world.

The rising pollution levels to a combination of factors, including emissions from heavy traffic, smoke from factories and brick kilns, agricultural residue burning and the broader impacts of climate change.

In response, the government has taken a series of national initiatives, including implementing and enforcing environmental regulations, establishing air quality monitoring stations and developing a smog management policy. 

The Punjab government has even introduced modern anti-smog guns across key urban areas of the province. Speaking at the launch event in Lahore, Chief Minister Maryam Nawaz stated that the technology has been tested internationally and is now being deployed in Lahore and other smog-affected cities. 

The anti-smog machines are designed to spray water into the air to suppress harmful airborne particulate matter (PM2.5 and PM10).

Punjab’s Senior Provincial Minister, Marriyum Aurangzeb, acknowledged that “smog has now become a public health emergency.” 

She said, as part of the new measures, an AI-powered air quality monitoring and forecasting system is also being introduced. This system will provide real-time data and predictive insights on air quality, allowing for timely interventions.

Laws on paper, loopholes in practice

Pakistan is not without environmental laws. The Forest Act of 1927, the Pakistan Environmental Protection Act of 1997, and provincial mining concession rules all regulate forest management and quarrying. The National Climate Change Policy of 2021 also emphasizes conservation.

But Bina Shahid, a lawyer working for environmental justice in Pakistan, points out that these laws are poorly enforced. “Illegal logging and mountain quarrying continue unchecked due to weak institutions, corruption, and political interference,” she said. 

“Local mafias often operate with impunity because of political patronage,” said Shahid. 

She highlighted multiple governance gaps: minimal fines that fail to deter violators, lack of public participation in decision-making, and Environmental Impact Assessments (EIAs) that are bypassed or poorly conducted. 

“Decentralization after the 18th Amendment gave provinces responsibility, but without capacity-building,” she noted. “Many simply lack the expertise to monitor effectively.”

The result is a legal framework that looks strong on paper but is weak in practice, leaving forests and mountains defenseless against both logging mafias and stone-crushing companies.

Stripping away natural defenses

The gravel mines have removed all the vegetation that can hold rain, making landslides inevitable, particularly during heavy rami/

The consequences of weak enforcement are stark. Without trees, hillsides cannot absorb rainwater. Without glaciers, rivers run dry.

“Deforestation and mountain crushing directly strip away Pakistan’s natural defenses,” Shahid warned. 

She said they remove buffers that regulate ecosystems, leaving communities exposed to floods, landslides, and rising temperatures.

This ecological imbalance has cascading effects — from food insecurity and biodiversity loss to increased displacement and migration. And as each disaster compounds the next, the mental health burden on communities grows heavier.

In the northern valleys of Khyber Pakhtunkhwa and Gilgit-Baltistan, communities live with the knowledge that the next flood or landslide could come at any season. Bare hills and crushed mountains stand as silent warnings of what is lost — and what is still at risk.

Court orders and future action

Last June, Khyber Pakhtunkhwa’s top court ordered the provincial government, particularly its Environmental Protection Agency, to enforce environmental protection laws and take strict action against violators. The court made it clear that no activity with adverse environmental impacts could proceed without a valid approval.

Meanwhile, appearing before the parliamentary committee on climate change earlier this month, Khyber Pakhtunkhwa’s Environment Secretary Shahid Zaman reported that the forest coverage in the province has improved, a claim verified through third-party assessments. 

He told lawmakers that monitoring of harvesting operations was ongoing, with seizures of 2.3 million cubic feet of timber and more than 360 vehicles as part of the government’s forest protection policy.

Zaman added that a comprehensive plan was in place to address environmental challenges and was showing “positive results.”

Gilgit-Baltistan officials also briefed the committee, stating that while forest land remained largely protected, extensive degradation had occurred in the 1980s due to sectarian violence and weaknesses in law and order. They urged constitutional protection for forests and sought federal technical support, particularly in digital monitoring systems.

Possible solutions

Despite the grim picture, experts agree that solutions exist. Aisha Khan advocates for strict enforcement of zoning laws, mandatory environmental impact assessments, and investment in sustainable alternatives like recycled construction materials and green building techniques.

Shahid called for harmonizing forestry and mining laws across provinces, raising penalties, and using technology like satellite monitoring to track illegal activities. She also urged greater citizen participation and independent oversight bodies to hold both government and private companies accountable.

Hanif, from the Forest Department, emphasized community involvement. “Without locals, enforcement is impossible,” he insisted. 

“We need to provide them alternatives energy for cooking, livelihoods that don’t depend on timber, and a sense of ownership in protecting forests.”

And for Naveed, mental health must become integral to climate policy. “Every disaster is not just physical — it is psychological,” he said, stressing that communities cannot be rebuilt without healing the minds of those affected by climate change.

The intertwined crises of environmental degradation and mental health demand urgent attention. As forests vanish and mountains disappear, Pakistan is not only losing its natural heritage but also the resilience of its people.

Without decisive action, the country faces a future where disasters come faster, hit harder, and leave deeper scars — both on the land and on the human spirit.

Image Credits: Rahul Basharat Rajput, HEI/State of Global Air .

Dr. Garry Aslanyan (left) with with Alex Brewis
Dr. Garry Aslanyan (left) with with Alex Brewis

Stigma remains one of the most under-examined yet damaging forces shaping global health policy and practice, according to anthropologist Alex Brewis, who argues that shame-based approaches often undermine the very outcomes health interventions aim to achieve.

In a recent episode of Dialogues, a special program of the Global Health Matters Podcast hosted by Dr. Garry Aslanyan, Brewis said stigma should be removed entirely from the public health toolkit.

“The most effective way to undo the damage of stigma within public health is to prevent it from happening in the first place,” Brewis said. “Stigma should not be used in any way for any reason to promote public health.”

Brewis, Regents and Presidents Professor at Arizona State University, co-authored Lazy, Crazy, and Disgusting: Stigma and the Undoing of Global Health, which examines how moral judgments attached to traits such as body size, mental illness, or sanitation practices strip individuals and communities of power and opportunity.

“Stigma is really about applying moral meanings to an otherwise arbitrary trait and using that as a way to devalue some people relative to others,” she said, noting that stigma produces humiliation and shame and is “physiologically stressful,” with emerging evidence of intergenerational effects through epigenetics.

Drawing on fieldwork in Mozambique and Micronesia, Brewis highlighted how sanitation interventions can backfire when they ignore local realities. In Pemba, Mozambique, open defecation was viewed as “social and practical,” while latrines were seen as burdensome or unsafe. In Kiribati, imported toilet blocks were rejected as unhygienic, ultimately left unused.

Brewis also addressed global obesity campaigns, arguing that decades of individual-blame messaging in countries such as Samoa have plateaued health outcomes while intensifying stigma.

“It’s been a cacophony of anti-fat messages for decades,” she said.

The solution, Brewis emphasised, lies in structural awareness and empathy.

“The solution to stigma is empathy,” she said. “Just about sums the book up.”

Listen to the full episode:

Image Credits: Global Health Matters Podcast.

Youth people are facing a mental health crisis, compounded by the stresses of poverty, social pressures and bullying.

As the magnitude of the global crisis surrounding youth mental health continues to unfold, increased attention has been placed on developing strategies to prevent young people’s mental health from deteriorating and promote mental wellbeing at scale. With global stressors accelerating and services failing to keep pace, the need for system-level solutions has never been more urgent.

While governments must play a primary role, strategic philanthropic investments have the opportunity to work in a complementary and collaborative way to strengthen the social determinants of youth mental health and drive change.  

Urgent public health priority

Around 75% of mental disorders emerge before the age of 25, with one in five young people experiencing a mental health condition each year, and one in seven adolescents (aged 10-19) living with a diagnosed disorder. 

One of the more prominent neurodevelopmental mechanisms associated with youth mental health outcomes is exposure to stress – including poverty and food scarcity, academic and social pressures, bullying and online bullying. 

Further, an extensive body of research continues to highlight the impact of resource insecurity, particularly climate change, as a prominent stressor on youth mental health. Together, these global-scale stressors amplify distress and fuel fear about the future, which can lead to an increase in conditions such as depression and anxiety. 

In recent years, awareness of mental health issues has grown, partly driven by the United Nations Sustainable Development Goals (SDGs), which include two key targets (SDG 3.4 and 3.5) which focus on mental health and substance abuse. 

The UN High-Level Meeting on Noncommunicable Diseases (NCDs) and Mental Health last September was the first time in history that mental health made it to the top of the global agenda, with countries making strong commitments to addressing the shared drivers and determinants of NCDs and mental health conditions. Yet, whilst mental health has gained more visibility, many experts agree that progress remains insufficient – particularly for young people.

There are very few mental health services geared towards young people, despite the global crisis in youth mental health. In India, for example, suicide is the leading cause of death for the 15-29 age group.

Key barriers facing young people include limited mental health services tailored to youth and persistent stigma around mental illness and emotional expression. Prevention and promotion remain under-prioritised globally, with countries only spending 2% of national budgets on mental health (and less than 1% in low- and middle-income countries). 

Notably, less than 1% of philanthropic funding is allocated to mental health, with even less on prevention and promotion efforts.

Addressing the root causes of youth mental health requires comprehensive, multisectoral approaches that acknowledge the systems young people navigate – schools, families, community environments, and health and social services. 

Several global initiatives are already seeking to support this shift, including the Being initiative, the Helping Adolescents Thrive Initiative and UNICEF and the Z Zurich Foundations’ Global Coalition for Youth Mental Health.

Swiss Foundations Symposium 

The Swiss Foundations Symposium 2025 – an annual event dedicated to fostering dialogue within the Swiss foundation sector – explored how philanthropy can accelerate systemic change. 

Themed “Mission Possible”, last year’s forum emphasised that by joining forces, we can make the impossible possible. Our session at the symposium focused on youth mental health and issued the following calls to action:

  • Recognise that we cannot meaningfully address the system-level changes required for youth mental health alone and therefore must engage in partnerships across sectors.
  • Identify like-minded partners in terms of mission and values to work coherently and complement each other.
  • Invest in building the capacity of each partner to address different angles of systemic changes as they relate to youth mental health.
  • Allow for flexibility in scope and timelines and build trusted collaboration through time and perseverance.
  • Build and reinforce networks and learning communities.
  • Combine implementation, research, communication, stakeholder engagement and policy work.
  • Engage with governments from the outset, while also supporting context-appropriate work at the community level.
  • Engage with young people to co-develop, drive and communicate progress and solutions.

This conversation underscored a growing consensus: youth mental health cannot be addressed in isolation. It requires coordinated efforts across disciplines and sectors.

Cross-national approach: The ‘Being Initiative’

 The Being Initiative, hosted by Grand Challenges Canada and co-developed with Fondation Botnar and global partners, including the Science for Africa Foundation, which leads the longitudinal research strategy, represents a significant evolution in philanthropic practice. 

Operating in 12 countries across Latin America, Africa, Europe, and Asia, it unites research, innovation, and ecosystem strengthening under one framework to improve the conditions that help prevent the onset of mental health conditions among young people.

Being’s model leverages learning, investment and mobilisation to address key stressors such as bullying, family functioning, and academic pressures. 

Each country begins by identifying priority drivers through collaborative, multi-stakeholder consultations. The initiative then supports ideas from youth-led organisations to see how they can improve mental health prevention and promotion, while engaging policymakers, practitioners, and young people to refine strategies and embed new solutions into national systems. 

This is underpinned by implementation research, which produces evidence to inform policy, and long-term fundamental research, which deepens understanding of emerging stressors. These components are coordinated through country-level ecosystem funding to strengthen structures and enable sustainable uptake, while also informing and contributing to global advocacy.

Philanthropy and systems change: Z Zurich Foundation

Established in 1973, the Z Zurich Foundation’s purpose is to create brighter futures for vulnerable people by supporting social impact through its four strategic pillars: climate change, mental wellbeing, social equity, and crisis response. 

Its “Thriving Together” program with UNICEF focuses on systems change, aiming to prevent mental health conditions and support 11 million people across 15 countries by 2027.

The Foundation’s approach emphasises collaboration, drawing on complementary resources, expertise and networks to scale impact sustainably across contexts. As of November 2025, the Z Zurich Foundation’s youth mental wellbeing portfolio is in 29 countries, working through 30 different programs.

The path forward

As a global community, we are in an unprecedented moment of change. The rising burden of mental disorders among young people requires immediate and targeted action. 

Strategic philanthropy can play a pivotal role by supporting system approaches that integrate research, community engagement, innovation, policy and cross-sector partnerships. Such efforts can help curb the long-term effects associated with youth mental health issues, and in turn, deliver essential benefits to our societies and economies globally.

This mission is possible – but only if we act together, and act now.

Dr Byron Bitanihirwe is the programme manager in Mental Health Research and Development at the Science for Africa Foundation and a former University of Manchester lecturer in global health. He holds a PhD in Neurobiology from ETH Zürich.

Gabriel Brumariu is the executive director of SECS Romania, where he draws on 14 years of youth-focused, community-based work in education, health, wellbeing, and advocacy.

Dr Nicole Bardikoff is the mental health lead at Grand Challenges Canada, overseeing strategy and partnerships to advance community-led youth mental health innovations across low-resource settings.

Dr Aline Cossy-Gantner is the mental health portfolio manager at Fondation Botnar and co-lead of the Being Initiative, with extensive experience developing youth wellbeing programmes globally.

Sofyen Khalfaoui is head of the Improving Mental Wellbeing pillar at the Z Zurich Foundation, leading a global portfolio of programmes informed by prior humanitarian and child protection work with Save the Children, NGOs and the UN.

 

Image Credits: Joice Kelly/ Unsplash, The Lancet.

Kenya’s President William Ruto applauds Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio.

Over December, the United States signed bilateral health co-operation agreements with 14 African countries, setting out the parameters for aid in exchange for speedy information about new disease outbreaks – and, in some instances, clinched alongside trade deals profitable to US companies.

The fourteen countries, in order of when the agreements were signed, are: Kenya, Rwanda, Liberia, Uganda, Lesotho, Eswatini, Mozambique, Cameroon, Nigeria, Madagascar, Sierra Leone, Botswana, Ethiopia and Cote d’Ivoire.

Grant agreements still need to be crafted from the memorandums of understanding (MOU), which are characterised by vague disease targets and tight pathogen-sharing terms.

Notable absences are South Africa, Tanzania and the Democratic Republic of Congo (DRC) – all with high disease burdens that previously received significant grants from the US President’s Emergency Plan for AIDS Relief (PEPFAR). 

As previously reported, a US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”.

Several political spats between the US and South Africa – over Israel’s conduct in Palestine, the fate of white Afrikaans-speaking South Africans and the G20 –  have put any bilateral agreements on the back burner.

In early December, the US stated that it is “reconsidering ties” with Tanzania in light of the government’s “ongoing repression of religious freedom and free speech, the presence of persistent obstacles to US investment, and disturbing violence against civilians in the days leading up to and following Tanzania’s October 29 elections”.

This follows the shooting of hundreds of people protesting the outcome of the Tanzanian elections.

What’s happening with the DRC?

It remains unclear why the DRC has not yet clinched a deal with the US, as Rwanda did on 5 December, the day after it signed a peace accord with the DRC in the presence of US President Donald Trump in Washington.

Instead, the US and the DRC signed a “strategic partnership agreement” that will, amongst other things, “promote secure, reliable, and mutually beneficial critical mineral flows for commercial and defense purposes”. The DRC is one of the world’s most important sources of rare earth minerals, but China currently dominates the purchase and processing of the DRC’s minerals.

The US may be holding out on health aid to the DRC as it seeks better access to the country’s minerals. 

A similar scenario unfolded in Zambia, where the US announced on 8 December that two countries had committed to a plan to unlock “a substantial grant package of US support in exchange for collaboration in the mining sector and clear business sector reforms that will drive economic growth and commercial investment that benefit both the United States and Zambia”.

“We want to leverage US assistance to bring about reforms that will unleash business investment that enhances US access to critical supply chains and creates great jobs for the Zambian people,” said Caleb Orr, US Assistant Secretary of State  for Economic, Energy, and Business Affairs.

Until then, Zambia and the US had been set to sign their health MOU on 11 December, author Emily Bass reported.

“Access to the region’s natural resources and markets is central to America’s geopolitical ambitions and strategy, and supercedes every other consideration that has historically motivated health foreign aid including winning hearts and minds, saving lives and shoring up global health security,” argues Bass.

“The [State] Department’s public statement about the Zambia terms is a warning and an object lesson to anyone who thinks the way things were is the way they are going to be.”

Kenya recognised as key ally

By choosing Kenya as the first country to sign an MOU, the US was anointing it as its most-favoured state, and the official announcement reflects this. 

The US will provide up to $1.6 billion over the next five years for “HIV/AIDS, tuberculosis (TB), malaria, maternal and child health, polio eradication, disease surveillance, and infectious disease outbreak response and preparedness”. Kenya pledges to increase domestic health expenditures by $850 million.

However, Kenya’s High Court has frozen implementation of the MOU after two separate court challenges by the Consumer Federation of Kenya (COFEK) and local Senator Okiya Omtatah over concerns about patients’ data privacy and the bypassing of Parliament. The government has until 16 January to file its response, and the case will return to court on 12 February.

While Oluga Ouma, Principal Secretary of Medical Services, assured the media that the MOU contained no pathogen-sharing clauses, but clause 3 of the MOU commits the country to pathogen-sharing. 

Extract from the Kenya MOU dealing with pathogen access.

Nigerian air strikes

In early December, Nigeria’s relationship with the US was on shaky ground after the US announced it would take “decisive action” against the “mass killings and violence against Christians by radical Islamic terrorists, Fulani ethnic militias, and other violent actors in Nigeria and beyond”.

However, on 20 December, the two countries signed an MOU committing the US to giving Africa’s most populous state nearly $2.1 billion, while Nigeria committed to increasing domestic health expenditures by almost $3 billion.

“The MOU was negotiated in connection with reforms the Nigerian government has made to prioritize protecting Christian populations from violence and includes significant dedicated funding to support Christian health care facilities with a focus on expanding access to integrated HIV, TB, malaria, and maternal and child health services,” according to the US State Department announcement about the MOU.

Five days later, the US launched air strikes against Islamic militants’ bases in northern Nigeria with the buy-in of the Nigerian government.

Digitisation, disease surveillance

Rwanda’s Health Minister Dr Sabin Nsanzimana met with Dr Mamadi Yilla, US Deputy Assistant Secretary for Global Health Policy and Diplomacy, to discuss the terms of the MOU before it was signed in Washington.

The US will give Rwanda $158 million over the next five years, while its government will increase domestic health investment by $70 million.

Liberia will get up to $125 million and will increase domestic health expenditures by almost $51 million.

Almost $2.3 billion in US aid is heading to Uganda and the Ugandan government has  “pledged to co-invest over $500 million” in health.

 “The agreement will further Uganda’s national health digitalization effort, as well as provide support for faith-based health care providers and for health care services to the Ugandan military, which is assisting with a number of key operations in the region,” according to the US State Department.

Lesotho, the tiny southern African state that declared an emergency after its economy was shattered by Trump tariffs last year, will get up to $232 million and it has undertaken to invest $132 million in its HIV/AIDS response. 

Eswatini, which has the highest HIV rate in the world, will get $205 million to “improve public health data systems, modernize disease surveillance and outbreak response technology, provide access to HIV antiretroviral medications, and scale up access to highly effective HIV prevention interventions”, according to the US State Department.

Eswatini will increase domestic health expenditures by $37 million.

Mozambique stands to get $1.8 billion to “expand cutting-edge solutions such as the HIV/AIDS prevention drug lenacapavir and drive advancements in malaria prevention efforts”. Mozambique commits to increasing its domestic expenditure on healthcare by nearly 30% over the next five years to “improve maternal, newborn, and child health” including the elimination of mother-to-child HIV transmission of HIV. 

According to the MOU with Cameroon, the US will provide nearly $400 million in health assistance while Cameroon has committed to increase its own health expenditures by $450 million. The focus of the agreement is on “global health cooperation, including funding frontline health commodities and health care workers, strengthening laboratory networks, and modernizing data systems with secure, interoperable digital tools that enhance disease surveillance and outbreak preparedness”.

Agreements with Madagascar, Sierra Leone, Botswana, and Ethiopia were signed over two days shortly before Christmas.

In Ethiopia, the US will invest $1.016 billion and that country $450 million, for  HIV/AIDS, tuberculosis, malaria, polio eradication, maternal and child health, and infectious disease preparedness and response, including ongoing support for the Marburg response. 

Ownership of HIV service delivery

Botswana’s MOU focuses on that country taking more “ownership of HIV clinical and community service delivery”, with $106 million from the US and $380 million from Botswana.

“The MOU will modernize electronic medical records and disease surveillance systems, including US supported networking infrastructure that may leverage American satellite-based technologies to strengthen outbreak preparedness while advancing U.S. technological leadership,” according to the US State Department.

In Sierra Leone, the United States will “front-load more than $30 million in 2026 to rapidly strengthen disease surveillance, laboratory capacity, health workforce, and data systems”.

“By 2030, Sierra Leone will assume responsibility for most commodity costs, workforce, and laboratory expenses, significantly reducing long-term US burden,” according to the US State Department.

The US aid for Madagascar focused on “malaria, maternal and child health, and global health security, while transitioning the infectious disease-focused community health workforce to national ownership”.  The US has committed more than $134 million in and Madagascar,  $41 million.

On 30 December, the last agreement for the year was signed between the US and Cote d’Ivoire. It involves up to $487 million from the US with a $450 million buy-in from the country.

“This assistance is focused on stopping outbreaks early – before they spread across borders.  It strengthens epidemic surveillance and laboratory systems, modernizes health supply chains and data systems, and reinforces frontline health systems so outbreaks are detected faster and contained sooner,” according to the State Department.

All agreements are over five years and provide opportunities for US companies to provide logistics, data, and supply-chain support. They are also all geared towards ensuring that individual governments assume responsibility for the health service delivery to citizens with a rapid weaning off US funds from the second year of the five-year agreements.

The MOUs have been concluded in haste as countries’ PEPFAR bridging finance runs out on 31 March, and the new MOUs are supposed to kick in on 1 April. However, MOUs still need to be reached with many countries previously part of PEPFAR, while the 14 signed MOUs need to be translated into concrete contracts.

Then German Chancellor Angela Merkel and WHO Director General Dr Tedros Adhanom Ghebreyessus open the WHO's Pandemic Surveillance Hub in Berlin in 2021.
Then German Chancellor Angela Merkel and WHO Director General Dr Tedros Adhanom Ghebreyesus open the WHO’s Pandemic Surveillance Hub in Berlin in 2021.

The German government is set to halve its funding for the Berlin-based WHO Hub for Pandemic and Epidemic Intelligence this year as part of a broader retreat from global health and aid financing under Chancellor Friedrich Merz.

Funding for the pandemic surveillance hub will be reduced from €30 million yearly to €15 million, with only one year of funds committed, according to research conducted by Health Policy Watch.

The cuts represent a major setback for the global data ecosystem required to detect future health threats, as the pandemic surveillance hub is the world’s premier “radar system” for emerging pathogens.

“The proposed cuts to the WHO Pandemic Surveillance Hub in Berlin send the wrong signal at the wrong time,” Ralph Achenbach, executive director at Amref Health Africa Deutschland, the German representative of Africa’s leading health NGO, told Health Policy Watch. “Viruses know no borders, and neither should our investments in global health security,” he emphasised.

The WHO Pandemic Surveillance Hub was launched as a flagship project in the midst of the COVID-19 pandemic in 2021 by then-Chancellor Angela Merkel and WHO Director-General Dr Tedros Adhanom Ghebreyesus. The mission of the Berlin-based hub is to provide decision-makers with real-time insights to stop outbreaks of infectious diseases before they escalate into pandemics.

Cuts will hit Global South collaborations

The budget cuts to the Pandemic Hub pose significant risks, according to Chikwe Ihekweazu, Executive Director, WHO Health Emergencies Preparedness and Response Programme.
The budget cuts pose significant risks, according to Chikwe Ihekweazu, executive director of the WHO Health Emergencies Preparedness and Response Programme.

The cuts’ initial effects are already becoming apparent. “While we don’t foresee cutting staff positions in the short term, we have cut back on certain activities,” said Dr Chikwe Ihekweazu, executive director of the WHO Health Emergencies Preparedness and Response Programme, in response to a query by Health Policy Watch.

“With global health financing under pressure, sustaining our work is crucial,” added Ihekweazu, who led the hub at its inception.

Among these cutbacks are projects with the Robert Koch Institute (RKI), Germany’s central federal institution for public health, and the Charité in Berlin, one of Europe’s largest university hospitals. They were intended to be the scientific pillars of the hub’s Berlin ecosystem, providing technical expertise for genomic surveillance and disease modelling.

“Charité regrets the planned cuts to the WHO Hub for Pandemic and Epidemic Intelligence and does not rule out that these will affect joint research projects,” a spokesperson confirmed in a statement to Health Policy Watch. Research into the development and validation of rapid tests for pandemic pathogens and the modelling expertise of the Charité Centre for Global Health could be negatively impacted, the spokesperson pointed out.

Project expansions have been halted, and the number of fellowships supported by the hub for researchers from lower and middle-income countries will be reduced, according to the WHO.

“By weakening ties with experts from the Global South, Germany undermines exactly the kind of global collaboration that effective pandemic preparedness depends on,” Achenbach lamented.

Future of global epidemic AI-monitoring tool uncertain

German Health Minister Nina Warken (left) maintains that the Pandemic Hub remains a strategic priority (here at a meeting with WHO Director-General Dr Tedros (right) in May 2025).
German Health Minister Nina Warken (left) maintains that the Pandemic Hub remains a strategic priority, pictured here with WHO Director-General Dr Tedros. Germany remains one of the biggest donors to the WHO.

The reduction comes at a critical juncture: only in October 2025, the pandemic surveillance hub celebrated the launch of an AI-powered upgrade to its Epidemic Intelligence from Open Sources system (EIOS) that now supports over 150 countries worldwide. EIOS 2.0 functions like a global digital radar system for health that constantly scans the internet, listening to “chatter” from social media, news, and even regional radio waves to detect the first signs of public health threats.

Despite the cuts, WHO is confident that the project will continue to be rolled out as it is supported by “a number of financial and technical partners”, including the European Commission.

However, “under the current funding constraints, EIOS can only operate at a minimal viable level in 2026”, WHO’s Ihekweazu said.

The hub’s Health Security Partnership to support disease surveillance in Africa (HSPA) is not affected due to financing from Canada, supplemented by the United Kingdom. HSPA is part of a broader “collaborative intelligence” ecosystem and aims to provide African WHO Member States with data analytics and tools to identify the earliest signals of an outbreak.

In a statement to Health Policy Watch, the German Federal Ministry of Health (BMG) maintains that the WHO pandemic surveillance hub in Berlin remains a strategic priority despite the cuts, and expressed confidence that the hub will remain “fully functional” and continue to serve as a centre for “co-creation” within the planned 2026 budget.

According to the Ministry, the flagship project has been working to diversify its financial base by engaging other member states and philanthropic organisations.

Pivot from international health to defence

Germany is cutting its budget for international health, cooperation, and development amidst a broader shift in priorities.
Germany is cutting its budget for international health, cooperation, and development amidst a broader shift in priorities.

The financial overhaul at the pandemic surveillance hub is part of a broader shift in German priorities under Merz towards defence, as well as national innovation and infrastructure spending.

“This reflects the prioritisation of military budgets over social programmes, which also include health programmes,” Felix Litschauer, Global Health Advocate at the NGO Medico International, said in an interview with Health Policy Watch.

The Health Ministry’s overall budget for “International Health” (chapter 1505) is set to decrease from €132.35 million in 2025 to €114.89 million in 2026, a drop of 13.2%, continuing the downward trend since 2024 and falling below the pre-pandemic levels of 2020.

Additionally, the Federal Ministry for Economic Cooperation and Development (BMZ) is pulling back: the budget for international cooperation and development (chapters 2301 and 2303) for 2026 will fall by 5% to around €6.42 billion, from €6.76 billion in 2025. Funding for the Global Fund to Fight AIDS, Tuberculosis, and Malaria is set to be reduced by €82 million to €288 million.

The cuts will most severely impact the economically precarious and marginalised groups in the Global South, Medico Health Advocate Litschauer argues. “By cutting these programs, the German government is evading its international responsibility,” he criticises, asserting that its economic model “profits from the poverty in the Global South.”

‘Weakening health security increases risks of future crises’

Ralph Achenbach, Executive Director at Amref Health Africa Deutschland, criticises that Germany's cuts undermine global collaboration and pandemic preparedness.
Ralph Achenbach, executive director at Amref Health Africa Deutschland, says that Germany’s cuts undermine global collaboration and pandemic preparedness.

From a macroeconomic perspective, the planned cuts at the WHO hub in Berlin may seem marginal, as saving €15 million looks more like a rounding error in a multibillion-euro wallet. The entire “International Health” budget represents a mere 0.02% of the total German federal budget.

Yet, the risks are exponential. It weakens the very system designed to protect society and the economy from a repeat of the COVID-19 shock.

“Germany scores an own goal by saving relatively small amounts at the expense of global and national health security,” Amref Germany’s executive director Achenbach warns. “These investments are not charity; they are essential to global equity and stability.”

Health financing worldwide under pressure

Cutting funding in the global health sector jeopardises preparations for the next pandemic, warned Axel R. Pries, President of the World Health Summit.
Cutting funding in the global health sector jeopardises preparations for the next pandemic, warned Axel R. Pries, president of the World Health Summit.

The timing of Germany’s retreat is particularly perilous. In a recent statement, WHO Director-General Dr Tedros warned that the world is facing “steep cuts in development assistance” that are causing “severe disruptions to health services.”

The withdrawal of major donor countries like the United States initially left the WHO facing a $1.7 billion shortfall for the upcoming 2026-27 budget period. The deficit has recently been narrowed to approximately $1.05 billion following a significant reduction in the organisation’s global workforce.

The German government’s cuts to the WHO pandemic surveillance hub reflect “a global trend towards cutting funding in the global health sector and, in particular, jeopardise preparations for the next pandemic, which will come sooner or later,” warns Axel R. Pries, president of the World Health Summit, a subsidiary of Charité.

“Investments in pandemic prevention and preparedness pay off in the long term for Germany and the world, as they strengthen the resilience of society, the economy, and stability.”

Is Germany relinquishing its leading global health efforts?

Image of the WHO pandemic surveillance hub in Berlin.
Image of the WHO pandemic surveillance hub in Berlin.

With its “whole-of-government investment” strategy, Germany ranked as the second-largest donor-country to the WHO by funnelling funds through various ministries and government agencies to global health initiatives.

“Germany has been, and remains, a strong supporter of WHO and the WHO Hub for Pandemic and Epidemic Intelligence,” WHO’s Emergency Response Programme Director Ihekweazu emphasised.

However, there is serious concern among global health experts that Germany might be relinquishing its leading role championing global health initiatives. “Such cuts weaken Germany’s position in important multilateral and UN organisations, including the WHO,” explained Pries.

While Germany’s push to increase mandatory countries’ “assessed contributions” (membership fees) to the WHO, which remain stable at €37.1 million in this year’s Federal budget, is considered positive, these efforts don’t solve the WHO’s underlying dependency on voluntary contributions, critics argue.

“The World Health Organization remains dependent upon donors who use their resources to push for their health priorities,” Medico Health Advocate Litschauer clarifies.

Voluntary funds are often channelled into high-profile initiatives at the expense of strengthening general health systems, he criticises, calling for a fundamental reform of WHO financing to sustain flagship initiatives like the pandemic surveillance hub in Berlin.

Image Credits: WHO/Christopher Black, WHO/Christopher Black, WHO/Christopher Black , Felix Sassmannshausen, Amref Health Africa Deutschland, World Health Summit, WHO/Marcio Schimming.

The United Nations headquarters in New York.

The Trump administration has withdrawn the United States from 66 multilateral organisations that it describes as “wasteful, ineffective, and harmful” – including the UN Framework Convention on Climate Change (UNFCCC), which coordinates the world’s response to climate change and has the buy-in of every other country in the world.

The UN Population Fund (UNFPA), UN Women, UN Oceans, UN Water, UN Conference on Trade and Development and the Peacebuilding Commission are some of the 31 UN organisations that the US has withdrawn from.

Included in the 35 non-UN bodies are a host of groups dealing with issues such as climate, peace and trade. These include the Intergovernmental Panel on Climate Change (IPCC), which is the global scientific body studying climate change; the International Renewable Energy Agency, the Global Counterterrorism Forum, and the International Institute for Democracy and Electoral Assistance.

According to US Secretary of State Marco Rubio, who President Trump credited for identifying the 66 groups, the organisations are “redundant in their scope, mismanaged, unnecessary, wasteful, poorly run, captured by the interests of actors advancing their own agendas contrary to our own, or a threat to our nation’s sovereignty, freedoms, and general prosperity”.

Second-largest emitter

“The UNFCCC underpins global climate action. It brings countries together to support climate action, reduce emissions, adapt to climate change, and track progress.  The decision by the world’s largest economy and second-largest emitter [of greenhouse gas] to retreat from it is regrettable and unfortunate,” said European Union (EU) Climate Commissioner Wopke Hoekstra 

Dr Rachel Cleetus of the Union of Concerned Scientists (UCS) described the US withdrawal from the “bedrock global treaty to tackle climate change” as “a new low and yet another sign that this authoritarian, anti-science administration is determined to sacrifice people’s well-being and destabilize global cooperation”.

Her colleague, Dr Delta Merner, added: “Walking away doesn’t make the science disappear; it only leaves people across the United States, policymakers, and businesses flying in the dark at the very moment when credible climate information is most urgently needed”.

Democratic leaders of the House Sustainable Energy and Environment Coalition (SEEC) said that Trump “is abandoning America’s international leadership and allowing competitors and adversaries to step into the void we leave behind”. 

They added: “At a time when climate change impacts are accelerating – whether it’s ever-worsening fire seasons, more intense hurricanes, or prolonged droughts – choosing withdrawal over leadership is shortsighted and profoundly irresponsible. Climate change does not respect borders, and we cannot address this crisis alone.

The UN had not responded at the time of publication.

Image Credits: Giorgia Galletoni , Wikimedia Commons.

US Health and Human Services Secretary Robert F Kennedy Jr.

A US government-funded trial on the timing of hepatitis B vaccinations, which will delay vaccination for up to 7,000 newborns in Guinea-Bissau, is due to start this week.

The US Centers for Disease Control and Prevention (CDC) has awarded a controversial Danish research group a $1,6 million five-year grant to study the “optimal timing and delivery of monovalent hepatitis B vaccinations on newborns in Guinea-Bissau”, according to the US Health and Human Services’ (HHS) federal register.

The trial aims to enrol 14,000 newborns in a “randomized controlled trial to assess the effects of neonatal Hepatitis B vaccination on early-life mortality, morbidity, and long-term developmental outcomes”, according to HHS register.

Half of the babies will get vaccinated at birth, while the other half will get vaccinated six weeks later. 

However, the World Health Organisation (WHO) has recommended hepatitis B vaccinations since 1992, and universal birth vaccinations from 2009. The vaccination is usually given as a series of three or four injections, and several clinical trials have already established the best intervals for the vaccinations.

“[Robert F Kennedy Jr], the Secretary of Health and Human Services, will soon conduct his own Tuskegee experiment,” US paediatrician Dr Paul Offit, co-inventor of a rotavirus vaccine, wrote this week on his Substack platform.

“He has chosen the resource-poor nation of Guinea-Bissau, West Africa, to do it. Guinea-Bissau is currently overwhelmed by hepatitis B virus. About 18% of the population is infected. The World Health Organization (WHO) strongly recommends that all children in all countries receive a birth dose of hepatitis B vaccine to prevent mother-to-child transmission,” added Offit, director of the Vaccine Education Center and an attending physician at Children’s Hospital of Philadelphia and a professor of both Paediatrics and Vaccinology at the University of Pennsylvania.

Tuskegee refers to a 40-year US study that withheld syphilis treatment from 399 African Americans between 1932 and 1972 to observe the effects of the disease when untreated.

Hepatitis B virus is an extremely contagious virus that infects the liver. It is transmitted through blood and bodily fluids and can be transmitted sexually, through contaminated needles, and – most commonly – to babies during birth from an infected mother. It is the leading cause of liver cancer worldwide.

Controversial Danish researchers

The CDC grant has been awarded to the Bandim Health Project at the University of Southern Denmark, which is led by controversial married couple Dr Christine Stabell Benn and Dr Peter Aaby.

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. ACIP has advised that it is up to parents to decide on the vaccination. US newborns have been vaccinated against hepatitis B since 1991, and this policy has reduced infections in children by 99%. 

Stabell Benn and Aaby’s research has focused on the “non-specific effects” (NSE) of vaccines. They have conducted trials involving thousands of children in Guinea-Bissau and Denmark, and assert that all vaccines should also be tested for NSEs.

However, the journal Vaccine recently published a comprehensive review of 13 trials conducted by their research group, Bandim, which showed that their trials have been unable to show non-specific effects for measles, tuberculosis, diphtheria, tetanus, and whooping cough vaccines.

“We were surprised to find several instances of questionable research practices, such as unpublished primary outcomes, outcome switching, reinterpretation of trials based on statistically fragile subgroup analyses, and frequent promotion of cherry-picked secondary findings as causal, even when primary outcomes yielded null results,” according to the review, which was headed by Dr Henrik Støvring of the Department of Biomedicine, at Aarhus University in Denmark.

Enrolment before new policy rollout

Currently, babies in Guinea-Bissau only receive the hepatitis B vaccination from six weeks’ old. But some 11% of children in the country are already infected with hepatitis B by the age of 18 months, so the government has resolved to introduce vaccination at birth from 2027, as recommended by the WHO.

The hepatitis B vaccine is delivered in a series of three or four injections. When given within 24 hours of birth, the vaccine is up to 90% effective in preventing mother-to-child infection.

Bandim says its trial will stop enrolling participants when the government rollout of the hepatitis B vaccine to newborns starts. They will follow their cohort for five years, primarily to compare “overall mortality and hospitalisations,” and “secondary outcomes”, looking at “atopic dermatitis and neurodevelopment”, according to a Bandim media release.

“The hepatitis B vaccine at birth has never been tested on a large scale for its overall health effects, so it is unknown whether the vaccine has non-specific health effects,” added Bandim. 

But Professor Gavin Yamey, director of the Center for Policy Impact in Global Health at Duke University, argues that “it is unethical to do a randomized controlled trial in which you withhold a proven, life-saving vaccine from newborn babies”.

Meanwhile, Offit contends that “RFK Jr. has manipulated the study to support his unsupportable, science-resistant beliefs about harms caused by the hepatitis B vaccine”.

He also notes that the study is single-blinded, which means that researchers will know which children received a birth dose of the vaccine.

“This allows for investigator bias, where the investigator might find vague neurodevelopmental problems in the birth-dose group but not the six-week group,” he added.

Health workers demand a phase out of fossil fuel at COP30 in Belem, Brazil.

The last 12 months have been an unpredictable rollercoaster for those of us working in global health, climate change and development: trade wars, real wars, job and finance cuts, cost of living pressures, attacks on science, the rise of far-right extremism, and the increasingly deadly impacts of climate change, to name but a few of the challenges we currently face.

Only a fool would have the confidence to predict what happens next. This author will try, nevertheless. Here are some of the key moments in global health and climate change that we can expect in 2026.

January: High Seas Treaty becomes international law

Two-thirds of the world’s oceans are unregulated and subjected to overfishing and pollution. The High Seas Treaty offers leagl protection for marine biodiversity in international waters.

The High Seas Treaty officially enters into force on 17 January. The treaty – formally known as the UN Agreement on Biodiversity Beyond National Jurisdiction (BBNJ) – was adopted by UN Member States in June 2023 after nearly two decades of negotiations. It has now been ratified by over 60 countries and will enter into force in January.

The treaty offers new legal protections for marine biodiversity in international waters, which cover nearly half the planet’s surface. By enabling the establishment of marine protected areas and strengthening international rules, the treaty can help achieve the global biodiversity goals of protecting 30% of the planet’s land and ocean by 2030.

Welcoming the development, UN Secretary-General António Guterres said “the ocean’s health is humanity’s health”.

February: Negotiations on the global plastics treaty 

Protestors gather outside UN plastics treaty talks at the Palais des Nations in Geneva, Switzerland, in 2024.

Global talks on a treaty to end plastic pollution collapsed in August 2025 after six rounds of negotiations. A coalition of over 100 countries wants the agreement to reduce plastic production, to ban the most dangerous chemicals used in plastic products and to protect human health. Oil-producing countries, on the other hand, have resisted a limit on plastic production in the treaty, arguing that it should only focus on demand-side measures like recycling.

On 7 February, a short session of the Intergovernmental Negotiating Committee (INC) will appoint a new chair to facilitate the discussions between countries, with a series of negotiations likely to follow throughout 2026.

April: International conference on fossil fuel transition 

Climate activists call for a transition away from fossil fuel at COP30

The governments of Colombia and the Netherlands will co-host the first-ever International Conference on the Just Transition Away from Fossil Fuels. This follows calls by over 80 countries at COP30 to develop a global roadmap to transition away from fossil fuels.

The convening will take place on 28-29 April in the Colombian port city of Santa Marta, which is the country’s major port for coal exports. Pacific nations have also committed to convening a follow-up meeting to advance the outcomes.

It remains to be seen how the Colombia conference and efforts to develop a global fossil fuel reduction roadmap can be introduced into the formal climate negotiations. The roadmap currently sits outside of the formal UN regime, with the Brazilian COP30 presidency holding the pen. Some creative diplomatic manoeuvring by the countries supporting the roadmap might be needed to anchor it to COP31 at the end of the year.

May: World Health Assembly 

The  2025  World Health Assembly (WHA) adopted the pandemic agreement, and WHA 2026 is due to finalise the last portion of this agreement.

The 79th World Health Assembly is scheduled for 18–23 May in the Swiss capital of Geneva. The gathering of the world’s health ministers is expected to finalise the Pathogen Access and Benefit-Sharing (PABS) system as part of the new WHO Pandemic Agreement. Discussions on wider global health reform will also gather pace.

Following the adoption of WHO’s Global Action Plan on Climate and Health last year, we can expect continued pressure from countries to strengthen the global response to the health impacts of climate change.

The health harms of fossil fuels will likely receive renewed attention at this year’s WHA. Even though WHO’s climate plans omitted a focus on fossil fuels, many countries and partners are pushing for stronger action to transition away from polluting energy sources.

June: UN climate talks in Bonn 

Following a mixed outcome at the COP30 UN Climate Change Conference in Belém, Brazil, governments will have to pick up the pieces at the climate negotiations from 8 to 18 June in the German city of Bonn.

Key areas of work will include the implementation of a set of indicators — including health indicators – to track global progress on climate adaptation. Following a push by Island Countries, negotiators will also discuss how to respond to the persistent gap in ambition to reduce temperatures to 1.5°. A first-of-its-kind dialogue on the role of trade and international cooperation in taking climate action will also take place.

June: Elections in Ethiopia 

The Ethiopian delegation at COP30. The country hosts COP32.

The country hosting the COP32 climate conference in 2028 will go to the polls mid-year. Elections in Africa’s second-most populous country may give local and international observers an initial sense of the political difficulties that Ethiopia will have to navigate while hosting the world’s most important climate conference in 2028.

The ruling Prosperity Party, led by Prime Minister Abiy Ahmed, is expected to win following the jailing or expulsion of most opposition leaders. A new draft law prepared by Abiy’s government will grant authorities far-reaching powers to restrict civil society groups on “national security” grounds.

August: Pacific Island Forum 

A WHO field staff member talks to a woman fetching water in Kiribati, one of the Pacific Island nations threatened by climate change and sea level rise.

The Republic of Palau will host the 55th Pacific Islands Forum (PIF) in August. The forum will bring together the heads of state from the Pacific Islands, Australia and New Zealand, alongside regional organisations and civil society.

The PIF plays an important role in developing a common position across Pacific Island countries. Among the key topics will be the role of oceans in securing health and climate goals, as well as a push for a just transition to a Fossil Fuel Free Pacific. This year’s forum might host follow-up discussions on a global roadmap to transition away from fossil fuels, and will function as a stepping stone to a Pacific pre-COP two months later.

October: European mayors’ summit on climate and health 

The mayor of Cork has invited mayors from across Europe to attend a major summit on climate and health. During the summit, city leaders will explore city-led solutions that reduce emissions, strengthen resilience, and enhance the well-being of populations. This will come at a time when Ireland holds the Presidency of the Council of the European Union.

October: Pre-COP in the Pacific

About a month before the COP31 climate conference kicks off in Türkiye, ministers and lead climate negotiators will be invited to the Pacific for a pre-COP meeting. A pre-COP is a preparatory meeting for key decision makers, which provides a key forcing moment to align on priorities, build coalitions, and settle early disagreements before the formal climate negotiations commence.

By hosting the pre-COP, Pacific island countries (the host island has yet to be decided) can ensure their priorities remain at the centre of the climate talks and raise the bar for success at COP. The Pacific has long prioritised climate and health, including with a special initiative to address the health impacts of climate change in Small Island Developing States at COP23 in 2019, which was presided over by Fiji.

October: Global conference on tipping points 

Global mean temperatures are set to breach the Paris agreement target of 1.5°C, at least temporarily.

Malaysia will host a Global Tipping Points Conference in October, following successful events in 2022 and 2025. The conference will provide the latest scientific updates on global climate tipping points and risks with a focus on Asia and the Pacific. It will also share opportunities and initiatives to drive accelerated climate action through positive tipping.

The conference, hosted by the Sunway Centre for Planetary Health in Kuala Lumpur, will have a particular focus on tipping points at the climate-health-equity nexus in Asia-Pacific.

November: COP31 UN climate conference 

COP31 will take place in the Turkish resort town of Antalya this year from 10-21 November. Türkiye will physically host the talks, be in charge of the action agenda, and appoint the COP31 president, while Australia will lead the formal negotiations. 

If Australia, Türkiye and the Pacific can combine their diplomatic assets, they might be able to meaningfully improve climate diplomacy and international collaboration between countries. However, the COP31 power-sharing between Türkiye and Australia is an unprecedented and potentially risky arrangement, given the current geopolitical environment.

Despite not being formally on the agenda for COP31, fossil fuels will likely be one of the main areas of focus. The case for a rapid shift away from fossil fuels is getting stronger by the day. Expect the economic, energy security, and health arguments against fossil fuels to gather pace in 2026. However, whether the UN climate negotiations themselves can actually yield a more detailed commitment on fossil fuel phaseout before the end of the year remains to be seen.

All we can say for certain is that 2026 promises to be an interesting year for climate and health diplomacy.

Arthur Wyns is a former senior advisor to the United Arab Emirates COP28 Presidency and the secretariat lead for Friends of Climate and Health, an informal group of countries exploring opportunities to integrate health and well-being into UN climate negotiations. He is also a research fellow at the University of Melbourne, an editor of the Journal of Climate and Health and the governance co-lead of the climate-migration-health network.

Image Credits: Mike Muzurakis IISD/ENB , Julia Goralski/ Unsplash, UNEP, Mike Muzurakis IISD/ENB , Mike Muzurakis/ IISD ENB , WHO / Yoshi Shimizu, WMO.