Self-care (illustrative)

Self-care can be a key strategy in tackling the global crisis of non-communicable diseases that are responsible for three-quarters of premature deaths globally and 86 percent of early deaths (before age 70) in low- and middle-income countries (LMICs). Moreover, dentists, pharmacists and community health workers are trained professionals who can provide innovative forms of self-care advice and guidance – reaching communities and individuals that are often beyond the reach of mainstream medicine, noted experts at a recent Global Self-Care Federation (GSCF) webinar held in the leadup to September’s High-Level meeting on NCDs.

Through these groups, countries are finding innovative ways to deliver informed self-care knowledge and tools to individuals and commnunities, which could help prevent many NCDs related to unhealthy diets and lifestyles – as well as making other disease conditions easier to diagnose and treat.

“I think it is important that society understands that the healthcare profession consists of physicians, pharmacists, dentists, and the nursing sector. It’s not just a focus on one of those four groups,” explained Greg Perry, GSCF director general. He added that it is important to look at how community health workers and other skilled health professionals can work together with individuals to expand access to self-care tools and encourage their use.

Stimulating such innovation around self-care is critical as the global health community prepares for the 2025 Fourth High-level Meeting on NCDs in New York this September, said experts from Africa CDC, patients organisations and the private sector at the recent GSCF webinar.

Inconsistent progress on self-care issues

Progress on integrating self-care into broader global strategies on NCDs has so far been inconsistent. The World Health Organization (WHO) has published a series of guidance on self-care strategies in various domains.  But so far, neither the WHO Global NCD Action Plan (2013–2030), nor the NCD and Universal Health Coverage aims of the UN Sustainable Development Goals, have sufficient emphasis on self-care strategies, critics say. At the same time, the world remains far from reaching the goals for reducing NCDs set forth in the UN SDGs or WHO action plans, and health systems, particularly in LMICs, are struggling to meet the growing demand for NCD care. GSCF has highlighted that a siloed approach to healthcare has failed in many regions.

In a new policy paper, GSCF makes the case for prioritizing self-care as a central pillar of the global NCD response. In that context, it calls for three key actions: Member states need to recognise self-care as a vital tool for easing the global burden of NCDs and reduce pressure on healthcare systems, including formally integrating certain self-care tools and tactics into national health coverage plans. Secondly, the 2025 High Level Political Declaration on NCDs should explicitly highlight the role of self-care in reducing NCD risks and improving prevention and management. And thirdly, self-care should be acknowledged as essential to empowering individuals and improving health outcomes.

According to Orajitt Bumrungskulswat, a board member of the International Alliance of Patients’ Organisations, several barriers hinder the greater integration of self-care into NCDs management. These include a lack of knowledge and skills about NCDs and self-care practices. Financial constraints also play a role, limiting access to affordable, high-quality self-care products and services. In addition, many communities face insufficient health education and a lack of supportive environments, networks, and peer groups.

Thailand’s campaign for healthier habits

In Thailand, there are 6.5 million people living with diabetes, 40 million with high blood pressure, approximately 1 million with kidney disease at various stages, 140,000 cancer cases per year, and up to 10 million people dealing with mental health issues, Bumrungskulswat said, citing Ministry of Health estimates.

“This is mainly because of individual behaviours and because people are not really aware of how to practice self-care,” Bumrungskulswat said.

To change this trajectory, the ministry launched a campaign aimed at encouraging healthier habits—such as reducing salty, oily, and sugary foods and increasing physical activity – particularly in southern Thailand’s more urbanised regions, where unhealthy diets and sedentary lifestyles are more prevalent. The campaign includes distributing prevention guidelines on social media and in communities and strengthening support networks and patient groups. These groups now collaborate closely with professionals and local healthcare centres to promote prevention and self-care education. Thailand is already beginning to see the impact of these efforts, Bumrungskulswat said.

Ireland’s dentists take the lead

In Ireland, dentists have been empowered to innovative forms of self-care guidance on topics like vaccination as well as smoking cessation.

Expanding the network of care providers is also proving to be a key strategy in the fight against non-communicable diseases. Dr Dympna Kavanagh, chair of the Platform for Better Oral Health, shared how Ireland has leveraged its dental professionals to support this goal.

“Embedding oral health into wider self-care and prevention frameworks, we can achieve better outcomes, not just for individuals, but for healthcare systems, populations and societies as a whole,” Kavanagh said.

In Ireland, Kavanagh’s program has redefined the free dental examination for lower-income patients to include oral check-ups, risk assessments, and lifestyle advice. Payments for delivering these services were increased by more than 25% to reflect dentists’ expanded role.

“We do see that there has been an increase of over 8,000 patients attending per month seeking treatment since introducing this change,” Kavanagh said.

Advice on smoking cessation and vaccination in oral health exams

And the same oral health checkups also support other preventative health measures, he noted, pointing out that:  “Dentists remain amongst the top three healthcare professionals providing tobacco cessation advice in Ireland.”

According to Ireland’s “Healthy Ireland” surveys, smoking rates have plateaued at 17%.

In recent years, oral health professionals have also been empowered to take on a role in advocacy around vaccinations.

Vaccination, a critical component of self-care, became a focal point during the COVID-19 pandemic. Ireland achieved high vaccine uptake in part by passing emergency legislation that authorised dentists and hygienists to administer vaccines. This policy has since been made permanent.

Today, Irish dentists are also supporting HPV vaccination efforts, which play a crucial role in preventing oral – as well as cervical – cancers.

“In our population campaigns, we are fortunate to see an uptake of 80% in girls and 76% in boys,” Kavanagh said.

She emphasised the need to keep oral health front and center in discussions about NCDs: “We must continue to amplify oral health as part of the global NCD agenda. We must remind policymakers and governments that prevention doesn’t begin with policy alone and doesn’t end with policy alone. It begins with empowered individuals who are supported to care for their own health by reducing tobacco and alcohol use, improving their diets, accessing vaccination and maintaining consistent oral hygiene.”

Expanding access through pharmacies

Purchasing drugs at a pharmacy in Johannesburg, South Africa.

Pharmacists are another group of caregivers who can play a vital role in guiding self-care strategies and choices, according to Mfonobong Timothy, Disease Prevention and Self-Care program coordinator for the International Pharmaceutical Federation (FIP). She explained that pharmacies are widely recognised as first-line healthcare providers—personal healthcare professionals who are knowledgeable and highly accessible.

“Pharmacists are also playing a crucial role in promoting the role of vaccination in good health and wellbeing,” Timothy said. “In 56 countries and territories, we now have pharmacy-based vaccination, and we continue to advocate for this to ensure policymakers know that this is a form of self-care that we can provide to individuals towards having good health and wellbeing.”

In addition to their role in vaccination, Timothy emphasised that pharmacists provide essential hands-on guidance for using medical devices—a key part of supporting patients in their daily self-care routines.

“Without the strong support system, individuals may not feel motivated,” Timothy noted.

Community Health Workers can support shift from treatment to prevention of NCDs

Community Health Workers attend a training session on HIV prevention in Kirehe, Rwanda.

In some low and middle-income countries, there has been a shift away from the traditional medical model toward a community- or society-based model of care, often led by Community Health Workers. This shift is helping societies move from treatment toward prevention – and along with that, more informed self-care practices, explained GSCF’s Perry.

“In high-income countries, we have the drugs, we have the guidelines, we have the digital tools, yet we still see that healthcare-associated costs are increasing along with life expectancy,” said Dr Adelard Kakunze, lead for the NCDs, Injuries and Mental Health Program at the Africa CDC. “The question is why? Why, if we have all the knowledge and tools, are we not able to really control these conditions?”

Kakunze believes the answer lies in the lack of personal engagement with self-care. In most countries, he said, health systems have failed to encourage citizens to practice the daily discipline required for self-care—what he describes as the “invisible work” that begins after the clinic door closes. This can include checking one’s blood pressure, adjusting one’s diet, or going for a walk – before resorting to drug-based treatments.

In Africa, however, this approach is gaining traction, he maintains. With limited access to specialists and resources, countries on the continent have been forced to innovate. At the core of this innovation is community. Kakunze noting that many African countries have strong networks of community health workers (CHWs), embedded in nearly every neighbourhood.

“We have learned that those specialized services are too expensive, so we need to rely on communities,” he said.

“We also now have a political commitment to deploy and equip 2 million community health workers on the continent, and what we’ve been seeing in many countries [is] that they have really embraced this with a contextualized, adapted training curriculum now that integrates NCDs,” he said. “Now, those community health workers can screen, counsel, and follow thousands of patients at home.”

Examples in mental health

A lay counsellor sits with a community member on the Friendship Bench in Zimbabwe.

In the mental health arena, one example is the Friendship Bench project, developed in Zimbabwe and cited by recent WHO guidance as a global model of community-based mental health support.

Using a cognitive behavioural therapy-based approach, trained community volunteers—affectionately called “grandmothers”—deliver structured problem-solving therapy to people suffering from common mental health conditions like anxiety and depression. Patients meet with the grandmothers for six 45-minute sessions on discreet wooden benches at local clinics, creating a safe and welcoming space for healing.

Since its launch, the Friendship Bench has shown impressive results. A 2016 study published in JAMA found a significant reduction in depressive symptoms amongst participants. The model’s success has inspired adaptations beyond Zimbabwe, including in Malawi, Zanzibar, and even New York City—showing how solutions developed in low-income countries can transform mental health care around the world.

More recently, community health workers have been paired with primary healthcare centres or general practitioners who can provide supervision and standardised health checklists.

“We have seen the impact of those community health workers when they are supervised; the impact is really increasing a lot,” Kakunze said.

Looking ahead, the Africa CDC is now exploring the use of advanced technologies and tools to support community health workers and enhance their effectiveness.

Kavanagh echoed similar sentiments. She noted that Europe has taken a “very siloed, very narrow” approach to the healthcare workforce, defining it strictly as doctors, dentists, pharmacists, and nurses. She suggested countries should also consider tapping into their ageing populations to broaden that workforce.

“Talented people retire, and then the country loses their wealth of knowledge,” she said.

Kavanagh also proposed that older medical professionals could be engaged to play a meaningful role in community healthcare, helping fill workforce gaps while contributing valuable experience.

Private-sector partnerships

Six out of ten smokers, or 750 million people globally want to quit tobacco use.

Finally, experts say the private sector also has a vital role to play in advancing self-care.

Dr Vinayak Mohan Prasad, head of the No Tobacco Unit at WHO, noted that there are 1.25 billion tobacco users worldwide—and more than 60% of them want to quit. To address this, WHO established a consortium that brings together private companies, non-state actors, and state actors to collaborate on tobacco cessation.

“We have a pharma pillar, so all the pharma companies can come in. We have a digital tech pillar, and we have a couple of very powerful tech companies already in the consortium,” he said. “We also have a health system group. We have the research group because there are a lot of research gaps still existing.”

This collaborative model is being applied beyond tobacco control. Tamara Rogers, chief marketing officer for Haleon, highlighted how private and public actors can also partner to improve access to healthcare.

She explained that while private industry can drive innovation and develop affordable health products and solutions, non-governmental organisations can play a key role in ensuring these tools reach the people who need them most.

“I think building trustful, stable, multi-year partnerships is really pivotal in making sure that we can best maximize all of the collective resources, expertise and innovation,” Rogers said.

–Part of a supported series in collaboration with the Global Self-Care Federation

Image Credits: Caroline LM/ Unsplash, Wikimedia Commons, Cecille Joan Avila / Partners In Health, Sarah Johnson.

MSF Nurse Gatwech Tuoch immunizes a child against measles at the MSF Mobile Clinic in Bulukat, Upper Nile State South Sudan.

During this World Immunization Week (24-30 April), Médecins Sans Frontières (MSF), shares recommendations for how Gavi – which is developing its new five-year strategy amidst looming funding cuts – can strengthen collaboration between governments and humanitarian organisations to ensure that more children up until the age of at least five, especially those living in fragile and humanitarian settings, get their routine vaccinations.

On 10 January 2024, South Sudan declared a measles outbreak in its Western Equatoria state. With an alarming number of people in Western Equatoria never having been vaccinated against measles, there was an urgent need to start a large-scale measles vaccination to curb the spread of the disease in the area and its surroundings, protect people from contracting measles and, ultimately, save as many lives as possible.

However, obstacles around getting and using the measles vaccine in-country meant that it took almost four months for any measles vaccinations to begin in Western Equatoria. In the interim, thousands of people fell ill and at least thirteen people died, seven of whom were children under five years old.

For over five decades, MSF (Doctors without Borders), a medical humanitarian organization working in over 70 countries has been vaccinating people through routine vaccination, preventive vaccination campaigns, and in response to disease outbreaks in some of the world’s most challenging settings. Sometimes, we – and other humanitarian, non-governmental organisations – are the only providers of vaccination for people who are not reached by government-led vaccination activities. This can happen for various reasons, including security constraints, geographic and infrastructural challenges, and sometimes, deliberate exclusion.

Our years of experience have taught us invaluable lessons about vaccinating in humanitarian settings, and it’s because of this that we know the delay in South Sudan was not exceptional. Often, getting access to vaccine supplies requires months of negotiations around how and when they can be accessed – negotiations which often start anew each time there is a need. Such slow-moving coordination wastes valuable time and risks lives.

Delays don’t have to be the norm

But we don’t think it has to be this way.

Right now, Gavi, The Vaccine Alliance – an organisation which supports governments of the world’s poorest countries vaccinate children against some of the world’s deadliest diseases – is preparing its strategy for the next five years. As part of this, Gavi is designing a “Fragility and Humanitarian Approach” to reach communities that consistently miss out on immunization.

In fragile and humanitarian settings, such as war zones, refugee camps, and hard-to-reach areas cut off from health care, it is often more difficult for people to access routine vaccination services, and ‘zero-dose’* children are disproportionately found in these environments. For example, as of July 2024, 31 World Health Organization member countries with fragile, conflict-affected settings accounted for 55% of unvaccinated children.

Gavi’s effort to address this is therefore much welcomed. However, it must include the recommendations of non-governmental, humanitarian organisations – like us – that have spent years working in and understand these settings.

Returning to South Sudan’s Western Equatoria, a flexible system allowing for rapid access to vaccines could enable faster and smoother emergency vaccination responses. One way to make this happen, would be for Gavi to work with governments and humanitarian organisations together, to ensure a closer collaboration: we don’t operate in a void, and effective cooperation with country governments allows us to better support them and work where they are not.

Developing standing agreements

The MSF Mobile Clinic in Bulukat Transit Centre, Upper Nile State in South Sudan. Bulukat hosts over 5,000 people who fled the conflict in Sudan.

Specifically, instead of having to negotiate with governments on a case-by-case basis, Gavi should help develop standing agreements to allow humanitarian organisations rapid access to existing in-country vaccine stockpiles in order to complement national immunisation efforts by vaccinating the children that fall outside of national immunisation programmes.

We’ve seen how this can work. In South Sudan’s Upper Nile State, MSF set up mobile clinics to screen and vaccinate displaced people, preventing outbreaks. This relatively simple intervention allowed people outside of national immunisation programmes to receive healthcare, and was successful because of sufficient vaccine supplies and space to work.

There is another critical part to getting vaccines to as many children as possible in hard-to-reach places, which is making sure that when we do vaccinate, including in targeted campaigns, we reach all children who previously missed out on their basic childhood vaccines, regardless of their age. Unfortunately, due to national policies, age-limited Gavi support and – therefore – limited vaccine supplies, children over the age of two often are left out of  vaccination drives. This leaves older children who are still at an increased risk of falling ill from vaccine preventable diseases unprotected and makes any future response to an outbreak even tougher.

In our experience, missing out on vaccinations can have devastating impacts. In last year’s response to the measles outbreak in Western Equatoria, 20 per cent of children treated for measles at MSF-supported facilities were over five. While the Big Catch Up – an initiative by Gavi, UNICEF and WHO – aims to reach zero-dose children up to the age of five with vaccination, this effort will come to a close at the end of this year. Going forward, we urgently need country policies that allow for vaccination until at least the age of five matched with dedicated financial support from an ambitiously funded Gavi.

Of course, sustainable funding for immunisation is essential. And due to logistical and geographic challenges that often exist in fragile and humanitarian settings, the delivery of vaccines can be more expensive than in “stable” settings. That’s why it’s especially critical for all institutional and government donors to ensure the effort to reach children in humanitarian settings with immunisation is ambitiously supported, both financially and politically.

It’s abundantly clear that we in global health must work better together to reach every child in a fragile or humanitarian setting with lifesaving childhood, routine, or emergency vaccination. Health systems need to be strengthened so that country-led responses remain at the core of immunisation efforts, with humanitarian partners able to support where children are not reached.

This means the learnings and recommendations of humanitarian organisations must be reflected in the policies and practices that aim to reach children in humanitarian settings with vaccination. Actively dismantling the barriers in getting timely access to and using vaccine supplies is a particularly key part of ensuring that children up until at least age five will have a better chance of being protected from vaccine preventable diseases, and getting a real shot at life.

Victorine de Milliano is a vaccine policy and advocacy advisor for Médecins Sans Frontières/Doctors Without Borders (MSF).

 

 Pamela Onango is medical coordinator in South Sudan for Médecins Sans Frontières/Doctors Without Borders (MSF).

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*’Zero-dose’ children are defined as children who haven’t received a single dose of diphtheria, tetanus and pertussis-containing vaccine (DTP3).

Read MSF’s full recommendations on how Gavi can do more to reach people outside of government vaccination activities here, and for more information on Vaccination Barriers in complex settings, see here.

Image Credits: Gale Julius Dada/MSF, Gale Julius Dada/MSF.

Africa CDC headquarters, Addis Ababa, Ethiopia.

Uganda is set to declare an end to its Ebola outbreak on April 26 if no new cases emerge, Africa’s top public health agency announced Thursday. The country’s 83% recovery rate among confirmed cases significantly exceeds the typical 30-40% survival rate for Ebola outbreaks, with Uganda managing to contain the disease while simultaneously responding to mpox cases.

“We really keep our fingers crossed,” said Professor Yap Boum, Executive Director of the Institut Pasteur of Bangui, during the weekly Africa Centers for Disease Control and Prevention briefing. “The country will declare the end of Ebola.”

Boum, who delivered the briefing on behalf of Africa CDC Director John Kaseya, who was attending IMF-World Bank Spring meetings in Washington, also reported “promising news” on mpox, citing declining cases in several countries despite the disease’s continued spread.

“We can see a decrease in the decline in number of suspected cases, but also the confirmed cases,” Boum said. “This is due partly to Burundi, but also to some other countries.”

However, Malawi reported its first four cases of mpox on April 16, including a 2-year-old child. None of the patients had a recent travel history, indicating local transmission. The child’s case highlights what Boum called an “important opportunity” for countries to approve mpox vaccination for children between the ages of one and 12.

The Democratic Republic of Congo remains “the epicenter” of the continent’s mpox outbreak, though intensified community surveillance shows some positive trends, Boum said. Contact tracing has increased from an average of 1.7 to 7 contacts per case in recent weeks, indicating authorities’ surveillance of the outbreak is improving. 

“The Kivus are the place that carries the highest burden in internal number of cases,” Boum noted, adding that implementation of vaccination and other measures in this conflict-affected region of the Democratic Republic of Congo – where mpox has been endemic since at least the 1970s – would be “the turning point to the response in DRC and therefore in the continent.”

Boum also highlighted progress on a rapid diagnostic test for mpox that could deliver results in 15 minutes without requiring electricity, potentially replacing the current system that can take up to 30 days for results to reach patients, nullifying their efficacy to contain outbreaks. Africa CDC expects to receive updates on the performance of the rapid diagnostic tests in the second week of May, and anticipates improvement from the previous 23% sensitivity rate for accurate diagnosis, Boum said. 

As the continent slowly gets mpox under control, Africa CDC’s Emergency Committee will meet on May 17 to evaluate whether to maintain the Public Health Emergency of Continental Security declaration for mpox that was issued in August 2024.

The updates came as Africa CDC leadership attended IMF-World Bank Spring Meetings in Washington to discuss health financing amid funding cuts. Boum emphasized the need to increase domestic health financing, noting that only three of 44 African member states currently meet the Abuja Declaration target of allocating 15% of GDP to health.

Angola’s recent $5 million pledge to Africa CDC was cited as an example of “championing the Africa-led financing strategy,” particularly amid what Boum described as “an era where we need to do more with less” amid vast funding cuts from the largest supporter of the continent’s health systems – the United States – during Donald Trump’s first 100 days in office.

“This is an opportunity for our countries to follow the example of Angola, to increase the expenditure on health, especially considering the new era that we are in,” Boum said, adding Africa CDC leadership’s conversation in Washington will center on “how we should navigate considering the cuts that are happening.”

“Next week, when the Director-General will be back, we’ll have more outcomes on how Africa CDC, and the continent will benefit from this challenging environment,” Boum said.

Image Credits: Africa CDC.

A teacher at a school in Mozambique teaches local students about the health benefits of contraception.

The World Health Organization (WHO) has issued its first update in 13 years to guidelines aimed at preventing adolescent pregnancies, identifying child marriage as a primary driver behind millions of early pregnancies that endanger girls’ lives and futures.

The document published Thursday by the UN health agency pinpoints uptake and access to safe contraception, barriers to girls’ right to education, child marriage laws and access to sexual and reproductive health services broadly as fundamental to reducing early pregnancies, which endanger adolescents around the world.

“Early pregnancies can have serious physical and psychological consequences for girls and young women, and often reflect fundamental inequalities that affect their ability to shape their relationships and their lives,” said Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO.

The global crisis affects millions of girls, with devastating health consequences rippling across generations, particularly in regions torn by conflict and instability. Pregnancy and childbirth complications rank among the leading killers of girls aged 15-19 worldwide.

Over 21 million girls between 15 and 19 become pregnant annually in low and middle-income countries, the WHO review found. Half of those pregnancies are unintended, while 55% lead to abortions—often performed in unsafe conditions, carrying life-threatening risks.

Maternal conditions are among the top causes of disability-affected life years and mortality globally, according to UNICEF.

Health dangers from pregnancy are intensified for mothers aged 10-19, who face significantly higher risks than women in their twenties, including dangerous high blood pressure conditions like eclampsia, post-childbirth uterine infections and systemic infections.

The health consequences extend to their infants as well. Babies born to adolescent mothers have higher rates of low birth weight, premature birth and serious neonatal conditions compared to those born to older mothers. 

“Adolescents who give birth face higher risks of maternal and infant mortality compared with older women, while early pregnancies can restrict adolescents’ choices, limiting their educational and economic prospects,” Allotey said. “These limitations often perpetuate cycles of poverty and inequality.”

“Tackling this issue means creating conditions where girls and young women can thrive—by ensuring they can stay in school, be protected from violence and coercion, access sexual and reproductive health services that uphold their rights, and have real choices about their futures,” Allotey added. 

Child brides: one every three seconds

One in five young women worldwide were married before their 18th birthday. Levels are highest in sub-Saharan Africa.

An estimated 12 million girls marry before age 18 annually — approximately one every three seconds — according to Girls Not Brides, a coalition of over 14,000 international and human rights organizations. In low- and middle-income countries, nine out of ten adolescent births occur among girls married before turning 18.

“Early marriage denies girls their childhood and has severe consequences for their health,” said Dr Sheri Bastien, Scientist for Adolescent Sexual and Reproductive Health at WHO.

Though child marriage rates declined from 25% in 2010 to 19% in 2020, progress remains slow and is reversing in conflict zones. The prevalence has increased by 20% in Yemen and South Sudan amid ongoing conflicts.

About 650 million women alive today were married as children, with one in 20 girls worldwide wed before age 15.

The situation is most dire in fragile states, where Save the Children reported last year that a girl is married every 30 seconds. Global humanitarian crises from Sudan to Yemen, Gaza and Myanmar have only accelerated since that report, leaving millions of girls at heightened risk of dangerous pregnancies.

Child marriage not only leads to early pregnancies before girls’ bodies are fully developed, but also often restricts their access to adequate healthcare. Girls who marry before 15 are 50% more likely to experience intimate partner violence than those who marry later, creating additional health complications.

The issue forms part of a broader pattern of gender inequality. In regions where both female genital mutilation and child marriage are common practices, girls face compounded health risks. Countries including Sudan, Somaliland, Sierra Leone, Burkina Faso and Ethiopia report the highest rates of girls subjected to both practices.

Stark global divide in adolescent pregnancy crisis 

Girls living in rural areas are more likely to marry in childhood than girls in urban areas.

Progress region to region remains starkly uneven. Sub-Saharan Africa has far and away the highest prevalence of births to girls aged 15-19, with over six million occurring in 2021 alone, in addition to 332,000 births for girls between 10 and 14 years old. The best-performing region, Central Asia, saw just 68,000 adolescent births that same year.

This divide is also reflected in maternal death rates. Seventy percent of global maternal deaths in 2020 — over 200,000 — occurred in sub-Saharan Africa, where girls who reach age 15 face a one in 40 chance of dying from pregnancy-related complications in their lifetimes. In Chad, the country with the highest rate of maternal mortality, a 15-year-old girl has a one in 15 chance of dying of maternal causes.

Divides by income, culture and class can also occur within countries, undermining the representativeness of national-level statistics. The WHO cites examples of Zambia, where adolescent pregnancy rates vary from 14.9% in the capital region of Lusaka, to 42.5% in its Southern Province.

According to Save the Children’s 2024 Global Girlhood Report, the ten countries with the highest child marriage rates are either fragile or extremely fragile states. Eight of the top ten “fragility-child marriage hotspots” are in Africa, with Central African Republic, Chad, and South Sudan facing the most severe crises. In extremely fragile countries, almost 558,000 girls give birth before their 18th birthday, often without access to skilled birth attendants who could save their lives if complications arose. 

While worldwide adolescent birth rates have declined, the overall birth rate remains high. In 2021, an estimated 12.1 million girls aged 15–19 years and 499,000 girls aged 10–14 years gave birth globally, according to WHO.

“Ensuring that adolescents have the information, resources and support to exercise their sexual and reproductive health rights is not only a matter of health – it is a matter of justice,” concluded Allotey. “All adolescents need to be empowered to make choices that lead to healthier, more fulfilling lives.” 

Despite the heightened risks for girls worldwide, only 0.12% of all humanitarian funding between 2016 and 2018 was directed toward addressing gender-based violence, according to Save the Children.

Education as a shield

The WHO identifies education as a crucial human right and shield against adolescent pregnancies.

Among the WHO’s strongest recommendations is removing gender barriers to education, with evidence showing each additional year of secondary education reduces a girl’s likelihood of marrying as a child by six percentage points. 

Multiple randomized controlled trials from Kenya, India and Zimbabwe reviewed by WHO present strong evidence that that life skills curricula and support to remain in school effectively reduce child marriage rates.

“Quality education represents our strongest defense against early marriage and pregnancy,” WHO researchers noted in the guidelines. 

“These limitations often perpetuate cycles of poverty and inequality,” said Allotey. “In many parts of the world, adolescents – whether married or unmarried – lack access to the information and resources necessary to make informed decisions about their sexual and reproductive health. This leaves them vulnerable to early pregnancies and unprepared to navigate the physical, emotional and social changes that follow.”

While 50 million more girls enrolled in school between 2015 and 2023, completion rates for secondary education lag significantly behind primary education, with only 61% of girls finishing upper secondary school worldwide compared to 89% completing primary education.

Economic interventions also show promise according to the WHO guidelines. Programs focused on improving livelihood skills, financial literacy and economic autonomy demonstrated significant impact on reducing child marriage while increasing girls’ employment and control over resources.

“Education is critical to change the future for young girls, while empowering adolescents – both boys and girls – to understand consent, take charge of their health, and challenge the major gender inequalities that continue to drive high rates of child marriage and early pregnancy in many parts of the world,” Bastien said.

Beyond Legal Solutions

Child marriage–fragility hotspots where girls face high rates of child marriage and the challenges associated with fragility. / Save the Children 2024

The WHO also conditionally recommends implementing laws restricting marriage before age 18, though with important caveats. Criminalizing child marriage can produce unintended consequences, potentially driving the practice underground, which can make reporting more difficult for the child brides who are victims of sexual assaults, the guidance suggests. 

The evidence reviewed by WHO on worldwide child marriage laws suggests that legal restrictions show inconsistent results in reducing marriage rates without addressing underlying social factors.

“Laws alone are insufficient without addressing root causes,” concludes the report, citing the need for comprehensive frameworks tackling gender inequality.

Both the UN Convention on the Elimination of All Forms of Discrimination Against Women and the Convention on the Rights of the Child call for eliminating harmful practices affecting children’s health, but organizations like Girls Not Brides warn that punitive approaches without corresponding social support can harm the very girls they aim to protect.

“Progress is uneven,” Allotay said. “We must sustain efforts to ensure that the most vulnerable groups of adolescent girls are not left behind.” 

Image Credits: The Hepatitis Fund.

A rollout of the malaria vaccine in Western African countries with a special focus on immunising children is an important step towards eliminating the disease.

After the World Malaria Report 2024 was published, the global community confronted an undeniable and uncomfortable truth: while malaria affects entire communities, its burden is not equally distributed.

Women, particularly in malaria-endemic regions, are disproportionately impacted. Their physical, social and economic health suffers more than others’ as they bear the brunt of caregiving responsibilities, suffer barriers to accessing healthcare, and face the compounding effects of climate change on disease transmission.

Malaria is a preventable and treatable disease, yet the global tally of malaria deaths has risen in recent years. In 2023, the death count reached 597,000, up from 574,000 in 2018, in part due to antimalarial drug resistance, health systems weakening during COVID-19, and funding shortfalls.

But the hardship that malaria causes goes beyond countries grappling with staggering death counts. The disease leaves profound and lasting indirect impacts on communities –  falling disproportionately on women and girls.

The hidden costs of malaria on women and girls

Pregnancy weakens malaria immunity, increasing infection risk. For expectant mothers, malaria can cause severe anemia, pregnancy loss, premature birth, underweight newborns, or maternal death. / World Malaria Report 2024.

The fight against malaria is hindered by deeply rooted gender inequalities.

Women spend four times as many days on caregiving compared to men – a stark reality exacerbated by recurring malaria infections within families as poverty traps women in cycles of economic dependency and limits opportunities for education and employment.

Women’s contributions to the global health system are estimated to be around 5% of global GDP. But around 50% of this work is unrecognised and unpaid. In malaria-endemic regions, this labour often takes the form of informal caregiving, as women provide care in up to 83% of malaria cases.

For community health workers, 70% of whom are women, the imbalance is even larger. Female health workers spend significantly more unpaid hours than their male counterparts, despite forming the backbone of malaria detection, treatment, and prevention efforts in rural areas.

Women and girls often lack decision-making power in their households, preventing them from accessing life-saving interventions like insecticide-treated nets or seeking timely healthcare. Cultural norms can dictate who uses a bed net or who receives care first, often leaving women and girls at greater risk.

Malaria is a leading cause of death amongst adolescent girls in malaria-endemic countries. Many are forced to leave school to care for sick family members or themselves, disrupting their education and increasing their vulnerability to early marriage or exploitation. Without targeted interventions, these gendered gaps will continue to undermine global malaria eradication efforts.

Climate change is catalysing inequality and disease

Number of internally displaced people by endemic malaria region. Women and children face higher vulnerability during conflicts, natural disasters, and humanitarian crises. / World Malaria Report 2024

The accelerating effects of climate change are making the fight against malaria even harder.

Rising temperatures and shifting rainfall patterns are expanding the habitats of malaria-transmitting mosquitoes, bringing the disease to new regions and intensifying its prevalence in existing hotspots. These environmental changes disproportionately harm women, who already face barriers to health information and services.

Pregnant women are particularly vulnerable. In 2023, in 33 moderate-to-high transmission countries in the WHO African Region, there were an estimated 36 million pregnancies, of which 12.4 million (34%) were infected with malaria.

Malaria during pregnancy exponentially increases risks to both mother and child, including anaemia, stunted growth, and severe illness. The consequences ripple across generations, perpetuating cycles of poor health and poverty.

A gendered approach to malaria elimination

Four-year-old Aitano Valentina of Guatemala City proudly holds her health booklet after receiving DPT and Polio vaccination. For the first time in history, the number of under-five deaths has fallen below 5 million.

To accelerate progress against malaria and address these inequities, we must adopt a gender-responsive strategy that empowers women and girls as agents of change. Investing in women has far-reaching benefits – not just for malaria elimination but for broader health, economic, and societal outcomes.

When women are empowered with resources, time and decision-making agency, malaria outcomes improve. Research shows that households where women have greater bargaining power are 16 times more likely to use mosquito nets effectively, reducing malaria transmission.

It is equally important to address the structural barriers limiting women’s participation in the health workforce. Only 25% of women in the global health sector hold senior roles, despite making up 70% of the workforce. Providing pathways for professional advancement and fair compensation is essential to sustaining their contributions and ensuring a resilient healthcare system.

Change won’t happen by itself

WHO-recommended malaria vaccines are in the process of being rolled out across Africa, with over 10 million doses delivered in the first year of routine immunisation programmes in 2024.

Addressing the impact of malaria on women and girls can contribute to both malaria eradication efforts and gender equality progress. Action is overdue.

But if we commit now to putting economic resources in the hands of women, challenging gender norms, power imbalances and discriminatory laws, we can achieve a double dividend.

This should see us increase women’s economic ability to take charge of their health, the representation of women in leadership roles within malaria programs, research, and policymaking, ensuring interventions reflect the realities faced by women and girls.

Fair wages, adequate training, and professional development opportunities for female health workers are equally critical to building a robust and sustainable health workforce.

Malaria interventions must also account for gender dynamics, ensuring equitable access to tools such as insecticide-treated nets and addressing the unique barriers faced by pregnant women and adolescent girls. Closing the gender data gaps is another essential step to enable a deeper understanding of malaria’s full impact on women and girls, and to facilitate more effective and targeted solutions.

The fight against malaria is at a crossroads. With intentional investment in gender-focused strategies, we can eliminate this disease within a generation while empowering women and girls to lead healthier, more prosperous lives.

The World Malaria Report 2024 leaves no room for doubt; achieving this vision will require bold leadership, innovative solutions, and an unwavering commitment to leaving no one behind.

By placing women and girls at the centre of the malaria response, we can create a ripple effect of positive change that extends far beyond health, building stronger, more equitable communities worldwide.

About the authors

Dr. Jemimah Njuki is the Chief of Economic Empowerment at UN Women.

Lizz Ntonjira is the co-chair of the Zero Malaria Campaign Coalition & Author, #YouthCan. 

Image Credits: WHO, UNICEF 2024 , WHO.

Dr Monika Kosinka, WHO lead on the economic and commercial determinants of health.

KUALA LUMPUR, Malaysia – The healthcare sector in India produced 32 billionaires in 2022 – more than any other sector in an extraordinary demonstration of corporatisation, according to Abhay Shukla, co-convenor of Jan Swasthya Abhinyan, the People’s Health Movement in India.

Massive investment in healthcare by private companies since the 1990s, particularly in “corporate, profit-driven hospitals”, has sent non-essential procedures and treatments skyrocketing. 

For example, 48% of births in private hospitals are now Caesarian sections, in comparison to 14% in public health in India, said Shukla. The World Health Organization (WHO) recommends a rate of 10-15%.

“Two out of three Caesareans taking place in India are medically unnecessary. This is huge. We’re talking about hundreds of millions of women,” said Shukla, addressing a symposium on the growing influence of powerful private actors (PPAs) on global health, convened by the United Nations University International Institute for Global Health (UNU-IIGH) and Third World Network in Kuala Lumpur.

Unnecessary thrombolysis for stroke patients, additional cancer treatments and getting higher-paid consultants to perform basic procedures that could be done by frontline ER physicians to enable higher billing, are other examples of what the corporatisation of health has done to Indian healthcare.

Private equity and venture capital (PEVC) investment in Indian healthcare (as a percentage of PEVC total investment in India) doubled from 5% during 2017-2019 (pre-Covid years) to almost 10% during 2020-2023, with a record 18% in 2023.

Initially focused on pharmaceutical investment, investment in healthcare services has boomed since 2006, when the government made it easier for foreign direct investment in Indian companies. Healthcare investment boomed during COVID-19, rising to $413 million in 2021 (vs $160 million in 2019/20).

Private equity and venture capital (PEVC) investment in India’s health sector.

“The treating doctors are like spare parts in a big machine. They can be replaced at will by the corporate management. If they fulfil targets and if they are generating profits, they stay. If they are not generating profits, they go,” said Shukla.

Deaths driven by four industries

While India provides a jarring example of how corporate interests are subverting health services, the negative impact of a range of industries on health is better known.

One-third of global mortality is caused by four industries: tobacco, fossil fuel (air pollution) alcohol, and big food, said Dr Monika Kosinka, WHO lead on the economic and commercial determinants of health.

“For the region that we are in, the Western Pacific, the figure goes up to 48% mortality  attributable to these four interests,” she added.

“While businesses and private markets play a key role in producing and supplying the goods and services we consume every day, powerful corporations with commercial interests have also played a key role in driving consumption of health-harming products, blocking regulations to protect health or the environment and aggravating health inequalities between and within countries,” said Kosinka.

WHO Malaysia Representative Dr Rabi Abeyasinghe added that many corporate interests wanted the WHO to focus narrowly on medical concerns rather than taking a holistic view of health.

“They want us to be the World Medical Organization not the World Health Organization,” said Abeyasinghe.

Concentrated power and health

Prof Sharon Friel of the Australian National University mapping the influence of the fossil fuel industry.

“Looking at powerful private actors in global health governance and accountability is both important and necessary,” stressed conference co-convenor Dr David McCoy of UNU-IIGH. 

“Many people working in global health will perhaps find it odd that we’re looking at powerful private actors and accountability. They’re more used to having conferences that talk about HIV or universal health coverage, or global health financing. 

“But what you’ll be hearing throughout this symposium is the evidence that demonstrates the link between concentrated power and wealth and its impacts on health and health governance,” stressed McCoy 

“Whether it’s about the unethical and deceitful marketing of commercial milk formula or challenging the abuse of intellectual property rights to keep essential medicines out of the reach of millions of people with HIV, or the truth around the causal relationship between fossil fuels and global warming, there is a long history of public health having to engage with the politics of the world,” said McCoy.

The growing influence of private actors, including big philanthropy, on the UN and its organisations was also raised.

Barbara Adams pointed to how the increase in voluntary contributions by countries and donors, rather than member states’ assessed contributions, has slanted financial allocations to earmarked issues rather than core funding.

UNU-IIGH director Dr Revati Phalkey emphasized the urgency of the situation: “This symposium comes at a critical juncture. While painful budget cuts are being made to the WHO and many vital health programmes, private entities with commercial interests appear to be gaining more influence in the health sector. This raises urgent questions about accountability.”

‘Tax the rich’

Oxfam mapping of the increase in billionaires’ wealth.

“The extreme concentration of wealth in the hands of so few in today’s global economy is itself an existential threat to good global health governance,” said Oxfam’s Anna Marriott.

She pointed out that taxing the ultra-wealthy appropriately would provide enough money to address global health and poverty needs.

“In 2022, the 10 richest men in the world doubled their fortunes during the pandemic while the incomes of 99% of humanity fell,” said Marriott.

“In 2023, the richest 1% grabbed nearly twice as much new wealth as rest of the world put together, while poverty increased for the first time in 25 years,” she said. This year, billionaire wealth has “surged three times faster in 2024”.

“This much wealth and power in the hands of so few is intolerable,” Marriott stressed, urging participants to support “global movements’ and multilateral efforts from the global South to tax extreme wealth to raise urgently needed revenue for health”.

The symposium concluded with a powerful call for accountability in the system of global health governance, demanding that systems be established to prioritise public interest and hold powerful private actors responsible for their impact on health. 

Suggestions include greater transparency, stronger regulatory frameworks, more monitoring of private actors and greater collaboration between governments, civil society, and international organisations. 

Dr Jean Kaseya, Director General of Africa CDC.

New weekly cases of mpox across Africa have dropped to around 2,000 for the first time this year giving hope that the outbreak may be waning, according to Dr Jean Kaseya, Director-General of Africa Centres for Disease Control and Prevention (Africa CDC).

In the mpox epicentre of the Democratic Republic of Congo (DRC), new cases dropped to 1,453 – the first time this year that this has been below 2,000 – despite an increase in testing. 

Mpox in DRC, 17 April 2025

There has also been a decrease in confirmed cases in the DRC and a significant increase in contact tracing.

Mpox in health workers – a priority in the continental vaccination efforts – has almost halved since November when over 100 health workers were infected.

Seven countries are currently vaccinating against mpox, with over 595,000 people vaccinated so far.

However, mpox cases in Uganda continue to rise, with 271 cases confirmed over 247 the previous week.

China, Switzerland and the UK have all reported mpox cases in the past few weeks.

“I’m calling the emergency consultative group meeting on the 17 May. Our experts will analyse all data and all evidence, and they will tell us if we still need to continue with the public health emergency of continental security (PHECS) for mpox,” said Kaseya.

One human case of anthrax

One person has been identified with anthrax in Uganda. 

Meanwhile, in the eastern DRC – a hotspot for various disease outbreaks – anthrax has only been identified in animals, including hippos in Virunga Park in north Kivu.

Around 50 hippos as well as buffalo have died from the disease in the park, according to earlier reports from the park’s director, Emmanuel De Merode.

However, recent animal deaths in South Sudan and Uganda indicate the disease may have spread across the borders.

“We don’t have any evidence today that humans are affected, but will continue to follow what’s happening,” said Kaseya.

Anthrax is caused by bacteria in soil and animals can become infected when they inhale the spores in soil, plants or water.

Health financing

Over the past two weeks, Kaseya has been traveling internationally to try to drum up more funding for health on the continent to fill the huge hole left by departing aid – particularly from the United States.

The continent has lost 70% of its official development aid since 2023, down from $81 billion to $25 billion this year – and some countries are on the brink of running out of essential medicines including antiretroviral medicine to treat HIV.

“There are reports of people migrating to other countries just to get ARVs,” Kaseya disclosed.

He has met the CEO of Ethiopian Airlines Mesfin Tasew to explore the possibility of a levy on airline tickets that could be used for health programmes.

In addition, a meeting with the government of the United Arab Emirates (UAE) is likely to result in investment in local manufacturing, and the digital agenda, supply chain management and the health work force, Kaseya said.

“Emirates is one of the countries making huge progress in the health system by using AI, and we are moving toward a strong programme with this country for Africa,” he added, saying that details of this collaboration would be announced soon.

Latest report released by the International Council of Nurses highlights the challenges faced by those in the nursing profession.

Nearly half of national nursing associations (48.4%) report a significant increase in nurses’ migration or exodus from the profession altogether since 2021 – against stagnant salaries, poor health system performance, and growing violence directed at nurses along with a continually increasing workload.

These are among the key findings in a new report by the International Council of Nurses (ICN), warning of a deepening crisis in the global nursing workforce.

The report is backed by surveys showing that around 72.1% of National Nursing Associations (NNAs) reported little or no increase in nursing salaries since 2021, including in more affluent OECD countries. When accounting for inflation, over one-third, or 36.4%, of NNAs indicated that nurses have effectively experienced a decrease in salary in real terms.

Increased violence against health care workers, poor pay, and exhaustion are driving many nurses to leave the profession altogether.

“A shocking 86.2% of nurses’ associations reported experiences of violence from patients or the public, yet a third of countries had no policies in place to protect nurses from workplace violence,” said ICN’s President Pamela Cipriano, in launching the new findings.

Compensation has stagnated in OECD countries.

Growing demands on nurses’ time

These findings come against a background of growing demands on nurses in their day-to-day duties since the height of the pandemic in 2021 – as reported by some 61.7% of nursing associations.

The report, Our Nurses. Our Future. Caring for Nurses Strengthens Economies, is complemented by a survey of 68 NNAs between 2021–2024. The ICN is a federation of over 130 national nurses’ associations representing millions of nurses worldwide.

“The publications we are launching today show that many of the world’s nurses are at breaking point, pushed into burnout and facing enormous physical, mental, and emotional pressures. Unacceptable working conditions, inadequate compensation, and a failure to protect nurses from workplace violence and occupational hazards or provide opportunities to advance and practice at full scope are driving this crisis, which affects not only nurses but the health of entire populations,” said Cipriano.

Some 38% of national nursing associations rate their country’s capacity to meet current healthcare needs as “poor” or “very poor”, the survey of NNAs also found – partly as a result of the cumulative pressures on the nursing workforce and their exodus.

Threats to safety and low pay are major threats

Pamela Cipriano, president of the International Council of Nurses (ICN)

Along with low pay, various threats to safety while at work are among the key issues nurses face, she added.

“The survey results also underscore a failure to protect nurses’ safety,” Cipriano said.

“Our report highlights how direct attacks on nurses and healthcare workers in conflict settings have also dramatically increased.”

Outside of conflict settings, however, violence directed against nurses is often a result of the frustration patients and their caregivers have towards the health systems, as many nurses work in resource-poor settings. In India, for instance, violence against healthcare professionals is a huge issue, often linked to the over-extended public healthcare system.

Violence against nurses is a global issue.

Report’s recommendations

The report flags a range of solutions for policymakers and governments. Investment in the right resources and equipment, safe and decent working conditions, and training support are among the top three “asks.”

It also suggests improving work culture so that nurses can thrive in a supportive environment.

Another one is to improve access to healthcare for healthcare professionals themselves.

Poor health among health care workers accounts for approximately 2% of national health care expenditure on average, draining valuable resources, according to the findings.

“Remove barriers to health care access for nurses by streamlining pathways to ensure easy, timely access to preventive care, treatment and support services. Ensure these services are readily available and designed to meet nurses’ unique needs,” it states.

And finally, there is a need to pay nurses fair and competitive compensation.

Investing in nurses’ well-being would boost health sector productivity by 20%

Global shortage of nurses reaching record numbers.

Despite mounting evidence of the nursing workforce crisis, many leaders and decision makers continue to prioritize short-term solutions over the sustainable investments that are needed to address the root causes of the health workforce emergency, ICN’s CEO, Howard Catton noted. Fundamental to that is the growing nurses shortage.

International Council of Nurses CEO Howard Catton
Howard Catton, CEO of the International Council of Nurses

The report makes an economic case for investing in more nurses, as well as increasing their well-being. “For nurses, improving their health and resource allocation could boost health workforce productivity by as much as 20%, which directly translates into cost savings and improved health care delivery,” it states.

“We have clear evidence that supporting and caring for nurses is not a cost: it is a smart and strategic investment in the health and prosperity of all people, with the total potential value of initiatives to improve nurses’ wellbeing is estimated at $100-300 billion based on capturing lost workforce productivity alone,” Catton said. He said the estimates are based on the World Economic Forum & McKinsey’s 2025 Thriving Workplaces report, which estimated that investing in workers’ health, more broadly, could unlock some $11.7 trillion in global economic returns.

“Extrapolating those figures to the proportional size of the nursing workforce, we get a possible opportunity value of $100-$300 billion, in increased economic returns,” Catton said, framing those as reduced sick leave and attrition, absenteeism, etc.

Savings obtained from investments outweigh the costs

Numerous case studies show that investments in nurses’ health can yield clear economic returns.

“There is no concrete number put on the amount of investment required to bring about these benefits, however we do know that there is a strong return on investment on investing in nursing and in health: studies show that every dollar invested in health systems can generate a $2-$4 return (McKinsey Global Health Institute/Remes et al., 2020),” Catton added.

ICN has said that it will continue to push for increased protections for nurses at the upcoming World Health Assembly, 19-27 May, where WHA member states will consider the extension of a global strategy on Nursing and Midwifery, currently scheduled to expire this year.

“ICN is strongly advocating for this to be extended and prioritized, amidst grave risks to global health funding and a historic and chronic lack of investment in the health and care workforce,” said Richard Elliott, ICN spokesperson.

“The WHA has to decide to extend the current global nursing strategy,” Catton added.  “We obviously want a positive decision and are lobbying hard for that. However we are concerned that health workforce budgets at WHO and in countries are at risk and could be seen as a soft target for cuts. WHO in our view, has for a long time not invested proportionately in the health workforce – and given that it is so central to delivering so much, we are therefore very alert to risks of cuts.”

WHA will also include discussions on the Global Strategy on Human Resources for Health: Workforce 2030 and the most recent results of country compliance with the WHO Global Code of Practice on the International Recruitment of Health Personnel, which was released and reviewed at the WHO Executive Board in February.

“A strong, well-supported nursing workforce is more critical than ever to address global health challenges and support healthy, productive populations. It is now time for action to move nurses from being invisible to invaluable across all regions,” Cipriano said.

Image Credits: Unsplash, International Council of Nurses , International Council of Nurses, 2025, Studioregard.ch.

The final green text of the pandemic agreement, alongside INB co-chair Anne-Claire Amprou.

At around 3am Wednesday, after three years of often intense negotiations, World Health Organization (WHO) member states agreed on a draft Pandemic Agreement, which sets out basic terms of engagement to prepare for, prevent and respond to pandemics.

Bleary-eyed negotiators and co-chairs Precious Matsoso and Anne-Claire Amprou welcomed the final greening of the entire text after another tough, long day of talks.

“Now the real work begins to make this agreement a reality,” said Matsoso, with the draft due to be presented to the World Health Assembly (WHA) next month. Once adopted, it will become a legally binding document.

Amprou, admitting that she addressed the Intergovernmental Negotiating Body (INB) with great emotion, said: “Together, we have achieved an impressive work that has led to a massive step forward for global health, health security, equity and international solidarity. The world is watching us, and you can be very proud of what you have just achieved.”

For an hour after the entire agreement was finally “greened” at the WHO headquarters in Geneva, negotiators expressed their support – and often relief.

Tanzania, speaking for 77 African states, described the agreement as a “significant, and challenging step forward in our collective commitment to enhancing global health security. 

“While the process may not have yielded all the outcomes we aspired for, it has opened an important avenue for future collaboration and growth in our efforts to be better prepared to face potential pandemics,” said Tanzania.

Tanzania on behalf of Africa.

“We have not achieved all our objectives in the negotiation, but we believe that the new agreement, if effectively implemented, will make the world more resilient and better equipped to face the global health security challenges of the future,” said the European Union (EU).

“The COVID 19 pandemic was suffering on a worldwide scale and tested public health system to the limit. Our collective achievement today shows that international solidarity, enhanced collaboration and decisive action are the way forward.”

Germany stressed that, “once adopted, the pandemic agreement will serve as a new collective tool to jointly address the risks of future pandemics across the full spectrum of necessary action”.

Germany also warned that countries would need to ensure its practical implementation.

“This why we have also advocated strongly for transfer of technology to be voluntary for technology holders, and this is how we understand the current provisions in the text,” stressed Germany, highlighting one of the most contested aspects of the talks.

Germany addresses the final session of the INB.

At around 4am, WHO Director-General Dt Tedros Adhanom Ghebreyessus got his turn to address the INB, saying that the agreement “reflects your resilience, unity and unwavering commitment to the health and well being of people everywhere.

“In the face of enormous challenges, you have come together, rising above borders and differences, united by a common goal, the protection of humanity,” said Tedros.

“By reaching this milestone together, you have made history and shown how powerful collaboration can be,” added Tedros, who paid special tribute to “my African compatriots who saved the day with your flexibility”.

A WHO statement issued after the close of the meeting stressed that the agreement: “affirms the sovereignty of countries to address public health matters within their borders, and provides that nothing in the draft agreement shall be interpreted as providing WHO any authority to direct, order, alter or prescribe national laws or policies, or mandate States to take specific actions, such as ban or accept travellers, impose vaccination mandates or therapeutic or diagnostic measures or implement lockdowns.”

An extensive and damaging misinformation campaign incorrectly asserted that the agreement is a “power grab” by the WHO aimed at imposing various demands on countries.

A group of protestors against the WHO and the pandemic agreement, representing a wide range of interests, march in the streets of Geneva outside last year’s World Health Assembly in June 2024

Sharing pandemic products

The INB was set up in December 2021 to negotiate an agreement to ensure more equitable access to vaccines, therapeutics and diagnostics (VTDs) in the next pandemic. 

Over time, much of the agreement has been watered down – but it has retained one of the important stipulations: that the WHO will get 20% of the real-time production of vaccines, therapeutics, and diagnostics (VTDs) for the pathogen causing the pandemic, with 10% as a donation.

The WHO will then distribute these vaccines, medicines and tests to low- and middle-income countries according to need – partly righting the inequitable access to vaccines during COVID-19 when wealthy countries hoarded scarce vaccines.

All manufacturers who want to be part of a Pathogen Access and Benefit-Sharing (PABS) system will need to agree to this 20% allocation – although the details of the PABS system still need to be agreed on.

“My initial mandate was for 45% of VTDs to be made available for the WHO because you can be effective with that. But negotiations are negotiations, give and take. You have to be flexible,” Dr Aquina Thulare, who heads the South African negotiations, told Health Policy Watch. 

Further tough negotiations lie ahead to bring this PABS system into existence, something that has been deferred to the Conference of the Parties that will bring the agreement into being.

Dr David Reddy, Director General of  the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), said  that the industry has “made proactive commitments to deliver equitable access, pledging to reserve an allocation of real-time production of vaccines, treatments and diagnostics for priority populations in lower income countries and take measures to make them available and affordable”.

 But Reddy stressed that “intellectual property protection and legal certainty are essential for the innovative-based pharmaceutical industry to invest in high-risk R&D and enable voluntary partnerships that we will need in the next pandemic.

“We hope that in subsequent negotiations Member States maintain the conditions for the private sector to continue innovating against pathogens of pandemic potential.”

Recognition of human-animal connection

The agreement also sets out countries’ obligations to prevent disease outbreaks from becoming pandemics – including a “One Health” approach to prevent zoonotic diseases – those that spread from animals to humans.

“By embedding One Health and prevention at source into the pandemic agreement, member states are finally acknowledging what science has long confirmed: we cannot prevent future pandemics without improving how we treat animals and our environment in the present. This is a paradigm shift in the scope of global health policy and a victory for animals, for people, and for the planet,” says Nina Jamal, from the animal rights group Four Paws.

“For the first time, an international binding agreement has enshrined One Health principles and collaborative surveillance,” noted Wildlife Conservation Society’s Dr Chris Walzer.

Research and development

Medecins sans Frontieres (MSF) and DNDi, which develops new treatments for neglected tropical diseases, expressed support for the “groundbreaking research and development (R&D) access requirements”.

“Countries have recognised that when they finance research and development for new treatments, diagnostics, or vaccines through public funding, they need to attach conditions to that funding that ensure public benefit,” said Michelle Childs, Director of Policy Advocacy at DNDi.

Other positive issues highlighted by MSF include the commitment to ensuring frontline healthcare workers get priority access to medical products during emergencies, building a global supply chain and logistics network, and more transparency in government purchasing agreements.

Impact on young people

Katja Čič, a member of the WHO Youth Council based in Slovenia, said that the COVID-19 pandemic “cancelled the world in a few weeks… Schools were closed. Work happened over Zoom, socialising got uprooted. Stress was through the roof. Lots of people as their loved ones.

“Young people will live with the long-term consequences of today’s decisions the longest and be the most impacted. Everyone deserves to grow up in a world that can handle a health crisis, whether that means we will get a faster warning when something’s wrong, equal access to vaccines and tests and treatments, or our education is not disrupted.”

Success of multilateralism

“The pandemic agreement is a beacon of unified multilateral cooperation at a critical time, and we salute the member states for their tenacity and commitment in getting to this point.” said Helen Clark, Co-Chair of The Independent Panel for Pandemic Preparedness and Response, the Pandemic Action Network, Panel for a Global Public Health Convention and Spark Street Advisors.

Clark, and her co-chair Ellen Johnson Sirleaf, urged leaders to take action today to build the platforms which will stop an outbreak from becoming a pandemic.

“We need to invest in regional resilience today because it will take time,” said Sirleaf. “Don’t wait. Start now to build regional capacities for research, development, and manufacturing of pandemic countermeasures. ”

“Recently announced cutbacks to global health funding have devastating implications for global health security,” added Clark. “Currently, countries will need to scramble for the funds required in the event of another pandemic emergency. Leaders should be investing now in pandemic preparedness and emergency response – domestically, regionally, and internationally. We can’t afford another pandemic, but we can afford to prevent one.”

Dame Barbara Stocking, chair of the Panel for a Global Public Health Convention, described the agreement as “a breakthrough in global collaboration – helping countries better prevent, detect, and respond to future pandemics” but highlighted that “there’s still work to do on surveillance for both humans and animals, and on government preparedness”.

Thulare also sees the agreement as a triumph for multilateralism in the face of the rise of “very conservative governments, not just in the US, but also in Europe and elsewhere”.

“We have to make sure that we save this multilateral space, and we also save the WHO, which is the most neutral arbiter – especially in pandemics,” Thulare added.

Germany noted that the pandemic agreement “has the potential to become a milestone for multilateralism and global solidarity”, and pledged that it “has been and will remain, a committed and reliable partner for the World Health Organisation and an advocate of pandemic prevention, preparedness and response”.

United States President Donald Trump removed the US from the WHO – and explicitly from the negotiations upon assuming office in January, while Argentina also dissociated itself from both the WHO and the agreement.

However, 191 countries remained in the process – including those at war with one another, making consensus even more commendable.

Image Credits: Kerry Cullinan.

Europe is the world’s fastest warming continent and the year 2024 was its warmest on record.

Europe is the world’s fastest-warming continent and 2024 was the warmest year on record, with record temperatures in the central, eastern and southeastern regions, according to the latest European State of the Climate 2024 report published jointly by the World Meteorological Organization (WMO) and Copernicus Climate Change Service (C3S).

Severe storms and flooding claimed 335 lives last year and affected around 413,000 people. Scientists also reported that the east was extremely dry, while the west witnessed warm and wet conditions.

“This report highlights that Europe is the fastest-warming continent and is experiencing serious impacts from extreme weather and climate change. Every additional fraction of a degree of temperature rise matters because it accentuates the risks to our lives, to economies and to the planet. Adaptation is a must,” WMO Secretary-General Celeste Saulo said in a press statement.

The report has a silver lining. The proportion of electricity generation by renewables in Europe reached a record high in 2024, and now stands at 45%.

This is the eighth annual report, released in April every year, and the second that has been published jointly with Copernicus, the European Union’s earth observation program.

Climate change hotspots

In 2024 Europe saw climate impacts ranging from heatwaves to wildfires.

Europe experienced the most widespread flooding since 2013. Almost one-third of the continent’s river network experienced flooding that exceeded the ‘high’ flood threshold.

The continent saw both hot and cold extremes. The numbers of days with ‘strong’, ‘very strong’ and ‘extreme heat stress’ were all the second highest on record.

Nearly 60% of Europe saw more days than average with at least ‘strong heat stress’. But there was a record low number of days with at least ‘strong cold stress’ too.

“These extreme events led to an estimated 18 billion euros of damages, 85% of which is attributed to flooding,” said Samantha Burgess, deputy Director of C3S during a press conference to discuss the report’s key findings.

Last year was the warmest ever for Europe with record-high annual temperatures in almost half of the continent.

All European regions saw a loss of ice due to record temperatures. Glaciers in Scandinavia and Svalbard saw their highest rates of mass loss on record. In September, fires in Portugal burned around 110,000 ha (1100 km2) in one week, representing around a quarter of Europe’s total annual burnt area. An estimated 42,000 people were affected by wildfires in Europe.

“We observed the longest heatwave in southeastern Europe and record glacier mass loss in Scandinavia and Svalbard, an archipelago between Norway and the North Pole. But 2024 was also a year of marked climate contrasts between eastern and western Europe,” Carlo Buontempo, C3S director said during the press conference.

While the entire continent is not a climate change hotspot, experts said that some areas within Europe do fit those criteria.

“A good example of this is the Mediterranean region, which is widely recognized as a climate change hotspot with above average warming, a projected decrease in precipitation, rising drought, risk wildfires and strong socio economic and ecological vulnerabilities. Similarly, the alpine region in Europe is also experiencing above average warming and sensitive changes in the cryosphere,” Burgess said.

Impact of funding cuts to NOAA now visible

In recent months the United States government has cut funding to the country’s climate monitoring system, the National Oceanic and Atmospheric Administration (NOAA).

This has affected scientists who have been laid off from their jobs and has also limited the number of observations NOAA makes around the world. Scientists acknowledged that this has affected the quality of the report that uses data from multiple data sources.

“Observations are absolutely fundamental to monitor what we’re doing, and NOAA is providing a lot of observations. What we’ve seen since March is that there has been a drop in the number of observations delivered by NOAA due to funding cuts,” said Florence Rabier, Director-General of European Centre for Medium-Range Weather Forecasts or ECMWF.

“Any observation loss is a loss for climate monitoring, for calibration of satellite, for verification of forecasts. So, in terms of both science and observations for weather and climate, I think it would indeed have an impact on the whole community,” she told the press conference.

Progress on some fronts

Cities across Europe have been focusing on initiatives to respond to climate change.

The report spotlighted some progress that was made by cities and countries. In 2024, Europe generated 45% of its electricity needs from renewables, up from 43% in 2023.

The number of EU countries where renewables generate more electricity than fossil fuels has nearly doubled since 2019, rising from 12 to 20, according to reports.

In addition, around 51% of European cities have adopted climate adaptation plans, which is almost double the 26% in 2018. Urban areas are responsible for 70% of all carbon emissions globally and the United Nations has pushed for cities to take action as they can play a big role in our response to the climate crisis.

Around 100 scientists in Europe and around the world worked on this report, and WMO head Saulo emphasized the need for continued action: “Every fraction of a degree matters. Climate adaptation is not the future option. It’s a very real necessity now, today, not tomorrow.”

Image Credits: Unsplash, European State of the Climate 2024 report.