Huge Risk of Drug-Resistant Tuberculosis in Wake of Abrupt US Funding Cuts 06/03/2025 Kerry Cullinan In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis. Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday. As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB. “Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey. Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. Impact of US ‘stop work’ orders on TB projects surveyed Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff. CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub. As a result of the collapse of funding for CHW, almost half the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment. USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. ‘We won’t walk away without a fight’ “[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”. “Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat. “Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.” No support for ‘most vulnerable’ In Thailand, a patient with multi-drug resistant TB receives his daily treatment. Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”. “Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde. Impact of US stop work orders on projects surveyed “In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA). “In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.” Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. “Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. “Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.” ‘Devastating impact’ Dr Tereza Kasaeva, WHO’s Global TB Programme director, The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia. US Supreme Court Clears Path for District Judge to Rule on Aid Freeze 05/03/2025 Kerry Cullinan USAID staff offload emergency supplies. The United States Supreme Court has declined to intervene in the Trump administration’s freeze on foreign aid, referring the matter back to a District Court Judge who had earlier issued a temporary restraining order against the freeze. Judge Amir Ali issued the order on 13 February ordering the US administration to resume payments for work already done on Congress-approved contracts that were in place before Trump took office. Ali ruled that Trump and his officials were “temporarily enjoined” from “suspending, pausing, or otherwise preventing the obligation or disbursement of appropriated foreign-assistance funds in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025”. He also prevented them from “issuing, implementing, enforcing, or otherwise giving effect to terminations, suspensions, or stop-work orders” related to these financial awards. However, hours before the order was due to go into effect on 26 February, Trump’s legal team turned to the Supreme Court, claiming that Ali lacked the authority to make such a ruling. Chief Justice John Roberts then issued an administrative stay of the order to enable the Supreme Court to consider the matter. Wednesday’s Supreme Court ruling – with five judges in favour and four against – simply directs Ali to “clarify what obligations the government must fulfill to ensure compliance with the temporary restraining order, with due regard for the feasibility of any compliance timelines”. Ali’s ruling was made in response to court action by three civil society organisations – the AIDS Vaccine Advocacy Coalition (AVAC), Journalism Development Network and the Global Health Council – challenging Trump’s Executive Order (14169), which immediately stopped all congressionally appropriated foreign assistance funding pending future review. Return to court The plaintiffs return to court on Thursday (6 March) where they will argue for a temporary injunction against the aid freeze. A spokesperson on behalf of the plaintiffs told Health Policy Watch that they are encouraged by the Supreme Court’s ruling today. “But each passing day that we are not compensated for work already performed causes additional harm to American workers and suppliers across the country,” added the spokesperson. “Thousands of jobs all over the US have already been lost, with more likely to come. Hundreds of businesses – primarily small businesses, the backbone of our economy – face an existential crisis and the possibility of financial ruin. Meanwhile, every passing second denies millions around the world the essential care they desperately need, putting countless lives at even greater risk.” The plaintiffs’ lead counsel, Lauren Bateman, an attorney with Public Citizen Litigation Group, stated on Wednesday that the Supreme Court ruling “confirms that the administration cannot ignore the law. To stop needless suffering and death, the government must now comply with the order issued three weeks ago to lift its unlawful termination of federal assistance.” During the earlier court hearing, the plaintiffs detailed some of the effects of the freeze on foreign aid dispensed by the US Agency for International Development (USAID) and the State Department. It has disrupted critical health programmes including maternal and child health programs; infectious disease prevention including against malaria and HIV, and clinical trials. Plaintiffs were also forced to lay off staff in response to the freeze. In its defence, Trump’s legal team claimed that life-saving health programmes had been given waivers. But this is no longer the case as the majority of USAID has been dismantled and life-saving projects were issued with permanent termination letters last week. AVAC executive director Mitchell Warren AVAC executive director Mitchell Warren appealed for support for the case: “These are immensely challenging times for all of us, and it is easy to be paralysed, overwhelmed and depressed. But we’ve all come too far for that to be the new normal. Lives, economies and democracies depend on our collective ability to stand up and fight back.” Earlier, Warren described the funding freeze as harmful to global health and security: “In the name of economic efficiency, they are destabilizing public health, diplomatic relationships, communities, and economies.” Devastating setback for tuberculosis The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, approximately one-quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of Global Programme on TB and Lung Healt, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID Press Office. RFK Affirms Measles Vaccine But Says Decision to Vaccinate is ‘Personal’ 04/03/2025 Kerry Cullinan Robert F Kennedy Jr, Trump’s pick for US Health Secretary. Amid the worst measles outbreak in the United States in a decade, vaccine sceptic Robert F Kennedy Jr, the Trump administration’s Health and Human Services (HHS) Secretary, has affirmed that vaccines protect children. “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons,” Kennedy wrote in an opinion piece published by Fox News on Monday. He declared that “the decision to vaccinate is a personal one” rather than advising parents to ensure that their children are vaccinated against measles. He also asserted that “good nutrition remains a best defense against most chronic and infectious illnesses”. The Texas Department of State Health Services has confirmed 146 measles cases since late January and one death of an unvaccinated child, the first measles-related death of a US child in over a decade. Seventy nine of the confirmed cases were unvaccinated while the vaccine status of 62 others is unknown. “Prior to the introduction of the vaccine in the 1960s, virtually every child in the United States contracted measles. For example, in the United States, from 1953 to 1962, on average there were 530,217 confirmed cases and 440 deaths,” wrote Kennedy. While affirming that HHS would ensure vaccines are “readily accessible for all those who want them”, Kennedy noted that the US Centers for Disease Control and Prevention (CDC) “has recently updated their recommendation supporting administration of vitamin A under the supervision of a physician for those with mild, moderate, and severe infection”. The CDC noted in a statement last month that “supportive care, including vitamin A administration under the direction of a physician, may be appropriate”. Vitamin A has been shown to reduce the risk of death from measles by 87% in children younger than two years old, and reduce the length of time the child suffers from diarrhea and fever, according to the Cochrane Review. In his first address to HHS staff on 18 February, Kennedy said the he would investigate the childhood vaccine schedule as part of the Make America Healthy Again Commission set up by Trump that Kennedy is chairing. “Nothing is going to be off limits,” Kennedy said, adding that the commission would investigate the health impacts of pesticides, food additives, microplastics, antidepressants and the electromagnetic waves emitted by cellphones and microwaves. Last week, the Food and Drug Administration cancelled an advisory committee meeting to discuss the composition of annual flu shots, which then have to be cultured. The $40 Question: Can Africa Close the Health Financing Gap? 04/03/2025 Edith Magak Safiya Shuaibu (Nigeria Health Watch), Professor Mamadou Samba, Côte d’Ivoire’s Director General of Public Health and Hygiene, Aminata Wurie (Resilience Action Network Africa) and Roche’s Johnpaul Omollo. KIGALI, Rwanda – On average, African Health Ministers only have $40 per capita for health expenditure in comparison to $4,000 that ministers in many high-income countries have. How the continent can provide the maximum level of healthcare with such limited resources is one of the key questions that delegates to the Sixth Africa Health Agenda International Conference (AHAIC) in Kigali are trying to answer. There is consensus that aid is no longer a reliable solution in light of overnight funding cuts by the United States, and more incremental cuts from Europe. South-South solidarity and drawing more effectively on domestic resources are emerging as likely solutions. ’“To be honest, we cannot afford healthcare for everyone, but we can afford health, which will reduce our overall healthcare costs,” admitted Amref Health Group CEO, Dr Githinji Gitahi. Prevention Over Treatment The first short-term solution to manage the $40 well is by focusing on the basics and prioritizing prevention over treatment. “The foundation of health is clean water for everyone. It is sanitation for everyone. It is access to nutritious food to reduce the risk of non-communicable diseases. It is a strong emphasis on immunization. If we prioritize these, we will save significantly on future healthcare costs,” Gitahi explained. More investment in community health workers than expensive medical equipment like PET scans and MRI machines is also prudent. “Health is built at home – hospitals are there to repair,” he added. “We need to redesign our health systems to make prevention, primary care, and community health the core pillars.” Increasing the $40 However, even with careful management and efficiency, stakeholders agree that $40 is simply not enough. “We need political action now. Within our national budgets, health is not at the forefront. How many countries have actually reached the commitment of allocating 15% of their national budget to health? Just two – South Africa and Cape Verde,” said Aminata Wurie, project manager at Resilience Action Network Africa (RANA). This year, only one out of the 55 African countries allocated more than 5% of GDP to health while only two out of 55 countries have met the 15% Abuja Declaration commitment. Last month, Rwandan President Paul Kagame, the African Union’s (AU) Champion on Domestic Health Financing, hosted a High-Level Health Financing Conference in Addis Ababa to discuss alternative domestic sources of health funding. One of the key outcomes was a mandate for the Africa Centre for Disease Control and Prevention (Africa CDC) to develop a framework for domestic health financing. Africa CDC’s Dr Claudia Shilumani confirmed that efforts are already underway: “We are working with the African Medicines Agency and other partners to create a framework that will outline tangible actions governments can take to increase health sector funding. This will be presented to heads of state in the coming months for a decision.” Meanwhile, Rwanda is already setting an example by integrating existing health financing mechanisms to support long-term goals. In response to health system funding cuts, they have reassessed spending priorities to ensure critical programs remain operational. For example, instead of discontinuing workforce training, they have shifted many in-person trainings to online platforms and redirected the funds to essential programs. Public-private partnerships More attention is also being paid to public-private partnerships (PPPs) and innovative financing models to ensure the long-term sustainability of health programs. The pharmaceutical company Roche has committed to significantly increasing access to diagnostic testing across Africa, aiming to conduct over 3.4 billion tests by 2031 and reach more than 500 million people with quality diagnostics. “Reaching these ambitious goals, especially as Africa’s population continues to grow exponentially, cannot be done alone. Public-private collaboration is key,” said Johnpaul Omollo, Roche’s head of policy and government affairs. “First, we must ensure decentralisation – this is where localization plays a crucial role. As we expand local production, we must also understand what the market truly needs and identify the most essential products we can manufacture locally,” he added. South-South vaccine partnerships Another area where increased partnerships and collaboration will be essential is in vaccine distribution. The US withdrawal from the World Health Organization (WHO) might mean disruptions to vaccine distribution, which could delay availability and hinder efforts to achieve widespread immunity. However, vaccine manufacturers like Serum Institute of India (SII) – the biggest generic producer in the world – are stepping up their efforts to ensure the continued supply of life-saving vaccines. Speaking with Health Policy Watch on the sidelines of the conference, the company highlighted its partnerships with African manufacturers to promote local vaccine production. “We are collaborating with South Africa’s Aspen and Egypt’s Vacsera to establish fill-and-finish vaccine facilities within the continent,” said Anil Kulkarni, SII’s Senior Manager of International Business and Product Management. “In the coming years, we plan to expand these partnerships to more African countries.” SII has also committed to maintaining affordable vaccine prices to ensure that African countries can continue to get vaccines despite global funding challenges. But health experts stress that, for local pharmaceutical production to succeed, it will require a coordinated effort across multiple sectors. “The success of local production will require all hands-on deck. This means the private sector must be involved in understanding community needs, governments must create an enabling policy environment, and supply chains must be strengthened to ensure medicine accessibility,” said Omollo. Charles Okeahalam, president of Amref’s Board, described the current challenges facing Africa’s health systems as a wake-up call for the continent. “If we improve ourselves and systems by just 20%, we could see an 80% improvement in healthcare outcomes. The challenge is real but not as difficult as it might appear.” Image Credits: Edith Magak. Juggernaut of Overweight and Obesity is ‘Monumental Societal Failure’ 04/03/2025 Kerry Cullinan A mother and son in Usolanga, Tanzania. Childhood fat is traditionally seen as a sign of abundance, but it can lead to obesity and related diseases later in life. More than half of all adults and a third of children and adolescents will be overweight or obese by 2050 unless urgent action is taken, according to the most comprehensive global analysis to date, published by The Lancet to coincide with World Obesity Day on Tuesday. This poses an “unparalleled threat of premature disease and death at local, national, and global levels”, according to the Global Burden of Disease Study BMI Collaborators. Overweight and obesity rates in adults (25 or older) and children and adolescents (5-24 years) have more than doubled between 1990 and 2021, affecting 2.1 billion adults (up from 731 million) and 493 million young people (from 198 million). “The unprecedented global epidemic of overweight and obesity is a profound tragedy and a monumental societal failure,” said lead author Professor Emmanuela Gakidou from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the US. In 2019, the estimated total costs associated with obesity, including both direct and indirect costs, ranged from $3·19 billion in low-income countries to $1·33 trillion in high-income countries. Forecasts suggest that, by 2035, the obesity epidemic could lead to a 2·9% reduction in global gross domestic product, equating to a loss of $4 trillion. “Especially high levels have already been reached in Oceania and North Africa and the Middle East, with over 62% of adult males in Nauru, Cook Islands, and American Samoa, and over 71% of adult females in Tonga and Nauru living with obesity in 2021,” according to a media release from The Lancet. China, India, the US, Brazil, Russia, Mexico, Indonesia and Egypt accounted for more than half of the global population living with overweight and obesity in 2021. The US had the highest rates of obesity among high-income countries, with around 42% of males and 46% of females affected by obesity in 2021. In Latin America, 15 of the 17 countries had a prevalence of obesity among females of more than 30%. However, the largest future increases are projected in Asia and sub-Saharan Africa, driven by growing populations. No country has curbed adult obesity No country to date has successfully curbed the rising rates of adult overweight and obesity Among males, the prevalence of overweight and obesity was above 87% in Nauru, American Samoa, Northern Mariana Islands, Cook Islands, and Kuwait. In future, the highest levels for men are predicted in the United Arab Emirates and Nauru, where more than 80% of males are expected to have obesity in 2050. Estimated age-standardised prevalence of overweight and obesity among adult males aged 25 years and older, Among females, the prevalence has reached 88% and above in Tonga, Kuwait, Cook Islands, Nauru, and Samoa. In future, Tonga and Egypt are predicted to dominate with at least 87% of females being overweight or obese by 2050. Estimated age-standardised prevalence of overweight and obesity among female adults aged 25 years and older. “Obesity rates are skyrocketing across sub-Saharan Africa, with 522 million adults and more than 200 million young people expected to be living with overweight or obesity by 2050,” said co-author Awoke Temesgen, Associate Professor at IHME. In Nigeria, the number of overweight and obese adults is projected to more than triple from 36.6 million in 2021 to 141 million in 2050. “Action is urgently needed to implement preventative initiatives such as policies on the marketing of unhealthy foods and planning to include facilities for exercise and playing fields in schools,” added Temesgen. Obesity trends in young people The study predicts a 121% rise in obesity among young people globally by 2050, with the total number of children and adolescents with obesity predicted to reach 360 million. The most rapid increases in obesity in young are forecast for North Africa, the Middle East, Latin America and the Caribbean, where one-third of all the world’s children and adolescents with obesity (130 million) are expected to live in 2050. The transition to obesity predominance (versus overweight) is also expected to be overwhelming for several Oceanic countries, including the Cook Islands, Nauru, Tonga where levels of obesity are expected to reach 60-70% by 2050, as well as for heavily populated countries such as Nigeria (18.1 million), India (26.4 million), Brazil (17.8 million), China (35.2 million), and the US (22.1 million). The authors also note that more recent generations are gaining weight faster than previous ones and obesity is occurring earlier, increasing the risk of complications such as type 2 diabetes, high blood pressure, cardiovascular diseases, and multiple cancers occurring at younger ages. “Our estimates identify children and adolescents in much of Europe and south Asia living with overweight who should be targeted with obesity prevention strategies,” said co-lead author Dr Jessica Kerr from Murdoch Children’s Research Institute in Australia. “We have also identified large populations, particularly adolescent girls, in North America, Australasia, Oceania, north Africa and the Middle East, and Latin America that are expected to tip over to obesity predominance and require urgent, multifaceted intervention and treatment.” Action plans The authors stress that five-year action plans (2025-2030) are urgently required to curb the rise in obesity and help inform new goals and targets post-2030, when the Sustainable Development Goals end. “Preventing obesity must be at the forefront of policies in low- and middle-income countries,” said Kerr. “Policy action in these regions must balance the challenges of overnutrition with undernutrition and stunting, with interventions ranging from support for nutritional diets and regulating ultra-processed foods to promoting maternal and child health programmes that encourage pregnant women to follow a healthy diet and breastfeed. Kerr warned that many countries “only have a short window of opportunity to stop much greater numbers shifting from overweight to obesity”. She called for “much stronger political commitment” to “transform diets within sustainable global food systems and to support comprehensive strategies that improve people’s nutrition, physical activity and living environments, whether it’s too much processed food or not enough parks.” Image Credits: Jen Wen Luoh. COP16 Deal Commits Nations to Raise $200 Billion Annually for Biodiversity; But Funding A Big Lift 03/03/2025 Sophia Samantaroy Coral reefs are a vital breeding ground for fish, a major protein source for 3 billion people. But some 14% of coral reefs died between 2009 and 2018, according to the UN Environment Programme. Countries agreed to raise $200 billion a year by 2030 to help developing countries conserve biodiversity at the resumed Conference of Party (COP16) of the UN Convention on Biodiversity (CBD) in Rome last week. The deal marks a major breakthrough after negotiations over a finance package were suspended last November in the closing hours of COP16 in Cali, Colombia, over funding disagreements. In Rome, more than 140 nations who are parties to the Convention also pledged to raise $20 billion a year from international donors for the new effort, by 2025, and $30 billion by 2030 to support developing nations’ conservation efforts. Although actually reaching those financial goals poses a huge challenge, the commitment marks a major milestone in implementing the landmark 2022 Kunming-Montreal Global Biodiversity Framework (KMGBF). The Framework aims to ensure the conservation or restoration of at least 30% of the planet’s lands, freshwater, and ocean resources by 2030. Currently, only 17% and 10% of the world’s terrestrial and marine surfaces are protected, respectively. The first ever multilateral nature agreement, the Kunming-Montreal framework’s overarching goal is development in “harmony” with nature by 2050. “Montreal was about the ‘what’ — what are we all working towards together?” Georgina Chandler, of the Zoological Society London,was quoted as saying to the Independent. “Cali was supposed to focus on the ‘how’ — putting the plans and the financing in place to ensure we can actually implement this framework.” Before talks in Colombia broke down, countries did manage to reach agreement on a voluntary “Cali Fund” for sharing the genetic benefits derived from genetic resources. And they approved a groundbreaking “health and biodiversity action plan” – as a voluntary mechanism for countries to incorporate health considerations into nature protection plans. But sharp disagreements between developed and developing countries over funding support for other conservation efforts in developing countries emerged in the final hours of the two-week session. As the meeting ran into overtime, the departure of delegates left the COP without a quorum to reach a decision. Resources for reaching key CBD goals Now, last week in Rome, the parties to the CBD finally managed to agree on a way forward for mobilizing significant resource flows to developing countries, whose action is critical to realizing the big aims of the Kunming-Montreal framework. It provides for a structured mechanism to raise funds through a mix of public and private financing, and establishes a permanent arrangement for financing biodiversity conservation in developing nations beyond 2030. Finally, the Rome agreement includes other provisions for planning, monitoring, reporting, and review required to implement the Kunming-Montreal framework – the Paris Accord equivalent for nature. The accord was reached despite the relatively poor showing of delegates – around 40 of the 196 nations that are party to the convention failed to show up. The agreement also comes despite the fact that the United States, historically the world’s largest donor to biodiversity, recently halted most such funding as part of the Trump Administration’s broader foreign aid freeze. The US has never been a formal party to the CBD but had previously played a behind-the-scenes role in advancing the its goals. But while many hailed it as a diplomatic victory, concerns linger over implementation, accountability, and the absence of key nations and specific financial commitments from leading donor states in a time of turbulent global rhetoric around conservation. “We live in a very different world now, and only a handful of countries have sent ministers,” said Arthur Wyns, a climate research fellow based in Melbourne, on a social media post. All in all, the Rome talks boasted only a fraction of attendance of November’s Cali conference, which saw 1,000 delegates in attendance, compared to the 23,000 in Cali. Financing details pushed to 2028 African oil and gas projects are set to quadruple; 90% of projects overlap with sensitive ecosystems, such as the Congo Basin, the world´s second largest rainforest. However, the final agreement deferred a key decision on whether the Global Environment Facility (GEF) would remain the CBD’s primary biodiversity finance mechanism or if a new fund would be created. African and Latin American nations had pushed for a dedicated biodiversity fund, but the decision on that was postponed until at least 2028. The GEF is already managing finances for several other global environmental conventions, such as the Stockholm Convention on persistent organic pollutants, and the UN Framework Convention on Climate Change. And it manages the CBD’s Global Biodiversity Framework Fund (GBFF), dedicated to implementing the Kunming-Montreal targets. The Fund has issued over $3 billion in biodiversity finance since its creation in 2022. Meeting ambitious targets With the Trump administration freezing most nature-related foreign aid and European nations cutting their aid budgets, doubts persist over how the ambitious financial targets for this new fund will be met. More than 75% of nations have yet to submit their national biodiversity plans, as per the 2022 Kunming-Montreal agreement, despite the October deadline passing four months ago. Even among those that have submitted plans, over half fail to include the KMGBF’s headline goal of protecting 30% of land and oceans by 2030. Additionally, nations with biodiversity hotspots, notably Brazil and those in the Congo Basin, failed to adopt at least one national CBD target. Cali Fund for profit-sharing of profits made from genetic resources launched The Rome COP also saw the launch of the Cali Fund, a new voluntary initiative to facilitate voluntary corporate profit-sharing of revenues generated from the use and development of indigenous genetic resources, or genetic Digital Sequence Information (DSI), into new foods, cosmetics or pharma products. Big food, cosmetics and pharmaceutical companies worldwide now harness and use genetic resources, captured as DSI, across far-flung borders, to create new products worth billions of dollars annually. Developing countries have long maintained that they are left out of the loop of benefits that come from the harvesting of new genetic resources in their regions. The new plan marks the first global attempt to address the imbalance. The initiative, agreed to last November in Colombia targets companies meeting two of three thresholds: annual sales exceeding $50 million, profits over $5 million, or assets above $20 million. These firms “should” contribute either 1% of revenue or 0.1% of profits generated from the use of indigenous genetic material to the new “Cali Fund” to support developing country biodiversity preservation and restoration. The rates remain “indicative” and the arrangement “voluntary”, according to the agreement – whose details still need to be worked out. “Success of the Cali Fund will be critical for providing finance to people on the ground who are custodians for species and genetic diversity. We are proud to be a founding partner for this groundbreaking Fund,” said Marcos Neto, Director of UNDP’s Sustainable Finance Hub, in a press statement, upon the launch of the new scheme. ‘Not Charity’ COP16 President, Susana Muhamed of Colombia, confers with the Secretariat at COP16’s second edition in Rome. The Cali Fund is not for “charity from companies,” but “fair payment for use of global biodiversity,” as Susana Muhamad, CBD president and former Colombian Minister of Environment and Sustainable Development said in a press conference. Furthermore, “at least 50% of the Cali Fund resources will be allocated to indigenous peoples and local communities, recognizing their role as custodians of biodiversity,” the UN said in a statement, building upon agreements in Cali that gave Indigenous peoples and local communities a stronger voice in conservation matters. Pharmaceutical companies have also warned that the initiatives such as the Cali Fund also risks taking the world down a slippery slope that “stifles” easy access to genetic material and to medical innovation – particularly if something now framed as a voluntary measure eventually becomes mandatory. “The pharmaceutical industry has long supported the Convention on Biological Diversity’s objective to protect our natural world,” said David Reddy, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a statement following November’s Cali round. But “[t]he ability to rapidly use scientific data known as “digital sequence information” (DSI) is essential for developing new medicines and vaccines,” he warned. “Any new system should not introduce further conditions on how scientists access such data and add to a complex web of regulation, taxation and other obligations for the whole R&D ecosystem – including on academia and biotech companies. “Ahead of COP17, it is critical that governments work to ensure the implementation of any new mechanism on digital sequence information does not stifle medical research and innovation that can bring the next wave of medical progress to people around the world.” Biodiversity continues to declines Heavy deforestation in hotspots, such as the Amazon and Congo river basins, threatens biodiversity as well as increasing the risks to human communities of zoonotic diseases transmitted by displaced animal species. The new financial agreements come at a critical time in which biodiversity loss continues to accelerate. Global wildlife populations have declined by 73% since 1970, with more than one million species at risk of extinction, according to the World Wildlife Fund’s Living Planet Report. This means that a quarter of species are threatened – and only the ones researchers were able to study. Along with the conservation and/or restoration of 30% of the world’s degraded ecosystems (Target 2), the Kunming-Montreal accord’s 23 targets also include: Target 6 – reduction of invasive species by 50%; Target 12 – enhancement of urban greenspaces; Target 13 – increasing the sharing of benefits from genetic resources, digital sequence information and traditional knowledge. “The results of this meeting show that multilateralism works and is the vehicle to build the partnerships needed to protect biodiversity and move us towards Peace with Nature,” said Astrid Schomaker, Executive Secretary of the CBD. “As we do this and implement the other supporting elements for resource mobilization, the world will have given itself the means to close the biodiversity finance gap. Meanwhile, the decision reached in Cali on a health and biodiversity framework also gives countries a clear framework for integrating health more squarely into biodiversity planning. The framework calls for health impact assessments in land-use planning, disease surveillance where habitat loss is rapid, and stricter wildlife trade rules vital to preventing pathogens spreading from wild animals to human communities and food markets. But that still doesn’t go far enough to protect people from the risk of spill-over events, critics say. “Our health cannot be separated from the health of the planet and its many species,” UN Environment chief Inger Andersen told delegates in Cali last November. “We must adopt this action plan and implement it with a holistic, systemic approach that unifies action across health, environment, finance, industry and agriculture.” Nations are set to reconvene next year in Yerevan, Armenia, for COP17. See more Health Policy Watch coverage of Cali and biodiversity here. Image Credits: Oleksandr Sushko, Rainforest Foundation and Earth Insights, 2022, IISD/ENB | Mike Muzurakis, Earth.org. Common US Infant Formulas Are Laden with High Levels of Added Sugars 03/03/2025 Sophia Samantaroy The WHO and the American Academy of Pediatrics “support the unequivocal evidence that breastfeeding protects against a variety of diseases and conditions.” Most infant formulas in the United States contain a high percentage of added sugars instead of natural lactose, “jeopardizing” infant health and development, says researchers at the University of Kansas in a new analysis of commonly marketed formulas. “Infants may consume upwards of 60 grams of added sugars per day, or the equivalent of two soft drinks per day if they are entirely formula-fed,” researchers say in the study, published last week in the Journal of Food Composition and Analysis. The publication came as the Food and Drug Administration (FDA) delayed implementation of a rule that tightens what foods manufacturers are allowed to label as “healthy.” The study, which analyzed 73 infant formulas available in 2022, found that “gentle” and lactose-free formulas contained the highest proportion of added sugar, with median levels reaching 85% and 90% of total sugars, respectively. On average, formula-fed infants consume 7-8 grams of added sugar per serving – a quick form of energy, but lacking in nutritional value. Health experts warn that high sugar consumption in infancy, in the form of sucrose, glucose, and high-corn fructose, may contribute to rapid weight gain and early obesity, increasing the risk of chronic conditions such as diabetes later in life. 20% of US children have obesity – a figure that is only expected to rise in the coming decades. Babies exposed to sugary foods also develop a strong preference for more sugar, says the authors. But “lax” federal guidelines make it difficult for parents and caregivers to avoid added sugars in infant formula because of the “staggering extent” to which US formula contradicts federal healthy diet recommendations. The FDA does not require manufacturers to report sugars in US formulas, in “sharp contrast” to adult food regulations, which must display a breakdown of total carbohydrates and added sugars, despite federal dietary guidelines recommending zero added sugars for infants under two years old. “As a result, parents and guardians may unknowingly feed their infants formula that contains substantial quantities of added sugars… which likely present a substantial risk to their infant’s health and development.” A systemic issue It was only after the Affordable Care Act that employers were mandated to provide space for nursing mothers other than a bathroom. But state laws are still patchwork protection, and do not require compensation for time spent breastfeeding. Even though the researchers build upon a body of evidence showing the risks to formula feeding – including an increased risk of gastroenteritis, diarrhea, ear infections, and chronic illnesses – they acknowledge that larger, systemic issues bar families from breastfeeding. The World Health Organization (WHO) recommends that parents exclusively breastfeed for the first six months. But in the US, “extremely” limited social support, no paid maternity leave, and the lack of affordable early childcare means that reliance on formula is a “necessity” for most parents, the authors say. Those from low socioeconomic status backgrounds are the most disadvantaged. “[T]he structure of the US system and environment often leaves parents and caregivers with little choice but to use formula in some capacity,” write study authors Audrey Rips-Goodwin, Daiil Jun, Adrianne Griebel-Thompson, Kai Ling Kong, and Tera Fazzino. “[W]e reason that the focus on an individual-level solution (breastfeeding promotion to women and caregivers) is not well matched to addressing the systemic nature of the problem and places an unfair burden on women and families who are expected to navigate this systemic issue. “Ideally, the US labor system should support breastfeeding, and healthcare professionals should be properly trained and incentivized to promote it.” “At the federal level there is no requirement for paid maternity/paternity leave and very little structural support to promote breastfeeding. Given the vast limitations in systemic support of new mothers and parents, most turn to using formula out of necessity. US parents deserve an infant formula supply that does not jeopardize infant health due to the presence of added sugars,” said Dr Tera Fazzino, study author and associate professor of psychology and associate director of the Cofrin Logan Center for Addiction Research and Treatment at the University of Kansas. Formulas with lactose could be safer, if made available Lactose, which is naturally found in breast milk and cow and goat milk, is sometimes used as a base for formula. Infants digest the more complex form of sugar slower, boosting their nutrition and metabolism, and engaging in hunger satiation hormones. Unlike the added sugars in most formulas – high fructose corn syrup, glucose, sucrose – lactose does not cause the same blood sugar spike. “These non-lactose sugars also typically garner more pronounced neurochemical reward responses and glycemic responses relative to lactose. Therefore it is really important for infants to consume lactose and avoid consumption of other types of added sugars, which is in line with US Dietary Guidelines,” said Fazzino. Only 8% of US formulas contained primarily naturally lactose, but the type is no longer available in the US. And it is unknown whether any other formulas use the safer sugar. “When people have free choice, the choices should include options that promote infants’ health and development. In the case of the US formula supply, our findings indicate that parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Fazzino. The researchers argue that lactose-containing formulas are safer for infants, and that efforts should focus on “requiring formula companies to produce products that primarily contain naturally occurring lactose and are designed to minimize risks to healthy infant development.” Unclear if FDA will improve labelling after delay ‘Parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Dr Fazzino. Even with increased rhetoric around chronic diseases in the US, notably HHS Secretary Robert F Kennedy’s push to “Make America Healthy Again,” the role of infant formulas to early-life infant weight gain is largely overlooked. The FDA has delayed implementing a rule that would redefine which foods can be labeled as “healthy.” The regulation, which aims to prevent manufacturers from marketing sugary juices, processed sweets, and certain meats as “healthy” options, was initially set to take effect on 25 February but has now been pushed back to 28 April, according to HHS. The delay stems from a broader freeze on new rule proposals across the Trump administration, and an upheaval of firings in the past weeks. The department lost several thousand employees, including those working in food safety. Currently, infant formula labels do not disclose added sugar content, allowing products with high levels of sucrose, glucose, and corn syrup solids to be sold without clear warning. During the first Trump administration, US officials tried to derail a resolution at the 2018 World Health Assembly to promote breastfeeding, attempting to remove language urging governments to “protect, promote and support breast-feeding” and restrictions on the promotion of food unhealthy food products to children. The original sponsor of the resolution, Ecuador, withdrew after US threatened it with trade sanctions. “We need much clearer labeling requirements for formulas in the US, specifically regarding the reporting of added sugars,” Fazzino told Health Policy Watch. “Support from the federal government and associated entities is really needed to improve infant formula labeling requirements.” But Fazzino acknowledged that labelling reform is “not on their radar;” rather, the FDA is more concerned about shoring up the formula supply chain after shortages in 2022 rocked the US market. The FDA declined to respond to Health Policy Watch’s request for comment. Formula companies deploy “same tactics” as tobacco industry A Nestle advertisement from 1911 undermines breastfeeding. Formula companies were among those identified in a 2023 Lancet series on the mechanisms and scope of commercial determinants of health, examining how the private sector influences health through activities like product design, packaging, supply chains, lobbying, research funding, and marketing. These companies “are escalating avoidable levels of ill health, planetary damage, and inequity.” These include formula milk companies’ extensive lobbying networks and “predatory” marketing tactics that derailed progress on breastfeeding education. In response, just last month the WHO at its Executive Board meeting proposed a resolution to regulate digital marketing of breastmilk substitutes, after the WHO’s findings that the formula industry uses “exploitative” marketing strategies. The resolution focuses on the fact that digitial marketing – through influencers and paid content – rely on personalized data to “innapropriately” promote infant formula, and undermine recommendations from healthcare providers and national authorities. The threat of targeted misinformation led the WHO to issue guidance on “regulatory measures aimed at restricting digital marketing of breast-milk substitutes” in November 2022, following its report that “the global formula milk industry, valued at some $55 billion, is targeting new mothers with personalized social media content that is often not recognizable as advertising.” The study also follows investigations into how formula companies promoted their product as “healthy” in lower-and middle-income countries, despite high levels of added sugar. But as the authors note, hidden added sugars also plague US infant formulas. “Ultimately, caregivers and infants in the US deserve a formula market that promotes healthy infant development and does not promote early obesity risk.” Image Credits: FDA, University of Minnesota , Enfamil. ‘The Centre Must Hold’: Africa’s Health Leaders Rally for Bold Action 03/03/2025 Edith Magak Africa CDC’s Dr Claudia Shilumani, Rwandan Health Minister Dr Sabin Nsanzimana, Dr Githinji Gitahi, CEO of Amref Health Africa and Dr Chikwe Ihekweazu, acting WHO Regional Director for Africa KIGALI, Rwanda – “Sad”, “Worried” and “The centre is shaking”, were some of the reactions of African health leaders to the termination of US aid at a media briefing on Sunday (2 March) ahead of the 6th Africa Health Agenda International Conference (AHAIC). But speakers also stressed the need for resilience and swift action at the briefing ahead of the conference, which is hosted by Amref Health Africa in collaboration with Rwanda’s Ministry of Health, the World Health Organization (WHO) Africa Office for Africa, and the Africa Centres for Disease Control and Prevention (Africa CDC). “The centre of our health system on the continent must hold,” stressed Rwandan Minister of Health Dr Sabin Nsanzimana. “Even as financing declines, we must find ways to increase it – whether through domestic sources or partnerships with those who see health as an investment in humanity.” Nsanzimana believes Africa can find alternative funding sources to fill many of the gaps left by the massive cuts to US Agency for International Development (USAID) funding. “There’s always money somewhere,” he explained. “When some of our medical students in surgery and midwifery were at risk of pausing their long-term training because they were supported by financing that was stopped overnight, we reassessed our priorities. we looked at cross-sector health projects and found over 5 billion Rwandan francs [over $5 million] tied up in short-term training and workshops. “We asked ourselves: ‘Do we keep funding weekly training that people can read online, or do we invest in long-term workforce programs?’,” he said. Rwanda has now redirected those funds to keep students enrolled, shifting the current workshops to online platforms. Africa must “think beyond traditional funding models and use what we have to meet our most urgent needs”, he stressed. This will be one of the pressing question considered by the over 1,800 delegates from 56 countries attending the conference. Significant risks “This year’s conference comes at a time of significant risks to African communities and health systems,” said Dr Githinji Gitahi, CEO of Amref Health Africa, who called for Africa’s health systems to be redesigned to address the dual burden of infectious and non-communicable diseases (NCD). Many African countries bear high burdens of infectious diseases while also facing a surge in non-communicable diseases. NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. “The health system we have today is not the one we’ll need tomorrow,” said Gitahi. “[But] we have minimal fiscal space. With population growth, economic shifts, and tax inefficiencies, how do we mobilize resources to fight both infectious and non-communicable diseases with limited funds?” “Many of us didn’t anticipate the scale of change – cuts in government assistance from not only the US government but also Germany, the UK, and others. Our current health systems have relied heavily on external support. We must rethink how to sustain them in the future,” Gitahi added. Speakers also emphasized that ,while communities are aware of diseases like malaria and HIV, many are unaware of the risk factors driving NCDs such as cancer, cardiovascular diseases, and strokes. Artifical intelligence and climate change Beyond the urgent discussions on funding, the AHAIC conference is also focusing on topics including climate-resilient health policies, the growing burden of both infectious and non-communicable diseases, artificial intelligence in healthcare, and strengthening local pharmaceutical manufacturing. Dr Claudia Shilumani, Africa CDC director of external relations and strategic management, warned of increasing health threats linked to climate change. Africa CDC is currently monitoring 243 health threats across the continent, with 84 significant events recorded in the first few weeks of 2025. Artificial intelligence is also a major focus, with discussions on how technology can be leveraged to improve diagnostics, treatment, and hospital management. Delegates acknowledged that while Africa needs thousands of trained professionals to meet healthcare demands, AI-driven solutions could help bridge the gap by enhancing efficiency in service delivery. Efforts to align policies across Africa are also gaining traction. The Africa CDC is working closely with the African Medicines Agency to streamline drug approvals and distribution across the continent. There is also a push to fast-track the qualification process for local manufacturers, ensuring national health strategies align with continental frameworks like the Africa Safety Strategic Plan. Health resilience Dr Matshidiso Moeti, outgoing WHO Africa Regional Director, highlighted the remarkable progress Africa’s health systems have made over the years. She noted that the continent has confronted pandemics, eliminated once-deadly viruses, and turned death sentences into manageable conditions. Despite these achievements, Moeti emphasized that significant challenges remain. She pointed to the deepening link between health, economic stability, and the environment, warning that widening economic disparities, climate change, and conflict continue to threaten healthcare systems. “One constant has been our collective commitment to building a healthier, stronger Africa.” Image Credits: Edith Magak, WHO/NCD Portal. DRC Identifies New Mpox Variant and Investigates New Febrile Disease Outbreak 28/02/2025 Kerry Cullinan Dr Ngashi Ngongo A new and potentially more infectious variant of mpox Clade 1A has been identified in the Democratic Republic of the Congo (DRC) according to Dr Ngashi Ngongo, head of the mpox incident management team at the Africa Centre for Disease Control and Prevention (Africa CDC). The termination of USAID funding and violence in eastern DRC are hampering mpox testing and reporting, with test results being reduced to a trickle. Only 35% of mpox cases are currently being tested in DRC, both because of conflict and the ending of USAID funds to transport mpox tests to laboratories. The DRC finally started to vaccinate people in Kinshasa this week, and uptake was swift with over 24,800 people vaccinated over four days, said Ngongo. Mpox is continuing to spread in Uganda, which has seen case increases for three weeks in a row – 278 new cases in the past week. Mpox cases are overwhelming health facilities. For example, a treatment centre in Entebbe with 80-bed capacity currently has 102 patients. “Because of this, the leadership in the [Ugandan] Ministry of Health has now opted also to introduce home-based care for non-severe cases,” said Ngongo. Meanwhile, South Africa reported three mpox cases after being free of the disease for over 90 days. The World Health Organization resolved this week to keep mpox as a public health outbreak of international concern “based on the continuing rise in numbers and geographic spread, the violence in the eastern DRC, which hampers the response, as well as a lack of funding to implement the response plan”, according to the WHO. Febrile disease in DRC DRC health authorities are investigating a febrile disease outbreak in five villages in the Basankusu and Bolomba health zones in Equateur province. This has tripled deaths over the past three weeks, according to WHO. A total of 943 cases and, 52 deaths have been reported, with symptoms including fever, chills, sweating, headache and muscle pain.\, said Ngongo. There are no haemorrhagic symptoms and Ebola and Marburg tests are negative, making malaria the most likely cause, he added. “Children below five years make about 18% of cases with a case fatality of 5.3%. Children ages five to 15 years make up 20% of all cases, with a case fatality of 6.4%,” said Ngongo. “The diagnostic is pointing towards malaria. Rapid tests that were conducted on over 500 samples gave a positivity rate of 55% but there are also blood smears that were also conducted, around 70 samples, that also gave a positivity rate of almost 78%,” said Ngongo. “Further tests are to be carried out for meningitis. Food, water and environmental samples will also be analysed, to determine if there might be contamination,” according to the WHO. “Basankusu and Bolomba are about 180 kilometres apart and more than 300 kilometres from the provincial capital, Mbandaka. The two localities are reachable by road or via the Congo River from Mbandaka. This remoteness limits access to health care, including testing and treatment. Poor road and telecommunication infrastructure are also major challenges,” saif the WHO in a statement. US Terminates Thousands of Life-Saving Global Health Grants Including For HIV, TB and Malaria 27/02/2025 Kerry Cullinan Protestors gathered outside USAID headquarters in Washington D.C. after employees were informed via email to not come in to work. The Trump administration has terminated the contracts of nearly 10,000 global health projects funded by the US Agency for International Development (USAID) or the US State Department – including projects to provide vital diagnosis and treatment for HIV, tuberculosis, and malaria, as well as humanitarian aid projects providing nutrition and water and sanitation services. Grants to hundreds of African HIV organisations providing life-saving services have been terminated with immediate effect via letters received on Thursday morning. Globally, the terminated awards include 5,800 grants administered by the USAID and 4,100 grants for projects managed directly by the State Department. Some of the terminated programmes had previously been granted temporary waivers, due to their roles in providing lifesaving health or humanitarian aid. The Trump administration also announced Thursday that it was halting US funding to the Joint UN Programme on HIV/AIDS (UNAIDS), which is headquartered in Geneva, just across from the World Health Organization. “All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated,” said Dr Atul Gawande, USAID’s former assistant administrator under the Biden administration. Terminated, too, are all global tuberculosis programmes, all US-made food aid programmes, which manufacture specially enriched foods aimed at malnourished women and children, and around 1000 food kitchens serving displaced people in countries such as war-torn Sudan. “This is one of the worst days of my professional life,” said Dr Kate Rees of Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups. “Tomorrow, we are letting go 2,800 people who are mainly peer educators and data capturers.” Prof Linda-Gail Bekker, CEO of the South African Desmond Tutu HIV Foundation, said that the US termination would cost 500,000 South African lives over the next 10 years and result in around half a million new HIV infections, according to recent modelling. “As an activist, as a person living openly with HIV, I’m very hurt,” said Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “How am I going to survive? Will the public health care system be able to cater for us? Will be able to cover all the gaps that we are facing with all the challenges that the public healthcare system has?” South Africa has the highest burden of HIV in the world with eight million people living with the virus (over 16% of the adult population). All 44 South African HIV programmes that receive money from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID have seen their aid terminated. Projects affected range from mother-to-child transmission programmes and hospices to research groups. Many focus on “key populations”, groups that are the most vulnerable to HIV but often shun health centres in fear of discrimination. “I’ve been having a sleepless night trying to think how best we can save our communities because we know that some of the government healthy facilities are very discriminatory,” said Kholi Buthelezi, national coordinator of the sex worker organisation, Sisonke. HIV activist Sibongile Tshabalala, who lives with the virus, is fearful for her future. HIV programmes devastated across Africa HIV programmes across the continent have also been devastated. The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children. Late yesterday, we received award termination notices for three of our primary USAID agreements. Read our full statement. https://t.co/VpBNduu036 pic.twitter.com/0hAP17JqxG — Elizabeth Glaser Pediatric AIDS Foundation (@EGPAF) February 27, 2025 In Uganda, for example, the Baylor College of Medicine Children’s Foundation’s HIV and TB programmes, that strengthens district health systems to better deliver HIV, TB and maternal and child services, has been terminated. The termination letters all state that US Secretary of State Marco Rubio, in his capacity as acting administrator for USAID and Peter Marocco, USAID acting deputy administrator, “have determined your award is not aligned with agency priorities and made a determination that continuing this program is not in the national interest”. ‘Chaos and disaster’ The terminations have caused “chaos” and “disaster”, said emotional South African leaders of the HIV sector who urged their government to step in to save their programmes. Fatima Hassan, head of the Health Justice Initiative, urged the South African government to issue compulsory licenses to reduce the price of antiretroviral medicine as the US has already “done the worst to us”. “US Congress approved the funds, and that is what has been stopped. So we do believe that it’s an illegal grab. It’s an illegal halt of services and programs. It’s not following due process,” Hassan added. The terminations will decimate South Africa’s HIV testing, data collection and HIV and TB literacy, said public health expert Dr Lynne Wilkinson, who added that USAID funds also assisted groups combating gender-based violence. However, South Africa is luckier than many other African countries as it derives around 17% of its HIV budget from PEPFAR. The Democratic Republic of Congo (DRC) gets 89% of its HIV budget from PEPFAR, while Mozambique and Tanzania get 60% of their HIV budget from the US. USAID: Countries most reliant on US aid for HIV ‘Blanket freeze is illegal’ Mitchell Warren, head of the US-based HIV programme AVAC, described the blanket termination of USAID grants as “unlawful”. “The US government’s in a very strong position with any cooperative agreement or grant or contract. They’re allowed to cancel agreements or amend them. They’re in a very strong position generally, but the blanket freeze is illegal,” said Warren, whose organisation has resorted to the courts to prevent the cutting of lifesaving aid. AVAC’s Mitchell Warren “We have been now in a federal court for several weeks, and a temporary restraining order was provided two weeks ago by the Court that said that things had to go back. The tap had to be put back on until this 90 day review actually took place in a comprehensive way,” he added. “We now have evidence entered into the public record in the courts that show the intentionality at USAID and the State Department to dismantle everything but the government has simply thrown up additional legal delays, as is their want,” said Warren. A federal judge had set Wednesday at midnight as the deadline for USAID to release some $1,5 billion funds for the foreign aid work already completed, but the US Supreme Court granted the government a stay on the release of funds until the court could apply itself more thoroughly to the issue. “We expect a hearing next week in Washington,” said Warren. “This is not about PEPFAR. This is not about the HIV response. This is not about USAID. This is about the rule of law. The United States Congress has the power of the purse. They decide what gets spent. The executive branch is there to execute, and that’s the basis of this legal argument. “But as of [Wednesday] night, they began to basically massacre every possible implementing agency to deliver on this work. This court case, as important as it is, is not going to change that overnight. That’s why working in partnership with each other and with national governments is essential because the United States is not a partner that is trustworthy right now,” Warren concluded. Image Credits: Reuters Youtube, Gandhi A, et al, Annals of Internal Medicine, 11 Feb. 2025, UNAIDS. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
US Supreme Court Clears Path for District Judge to Rule on Aid Freeze 05/03/2025 Kerry Cullinan USAID staff offload emergency supplies. The United States Supreme Court has declined to intervene in the Trump administration’s freeze on foreign aid, referring the matter back to a District Court Judge who had earlier issued a temporary restraining order against the freeze. Judge Amir Ali issued the order on 13 February ordering the US administration to resume payments for work already done on Congress-approved contracts that were in place before Trump took office. Ali ruled that Trump and his officials were “temporarily enjoined” from “suspending, pausing, or otherwise preventing the obligation or disbursement of appropriated foreign-assistance funds in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025”. He also prevented them from “issuing, implementing, enforcing, or otherwise giving effect to terminations, suspensions, or stop-work orders” related to these financial awards. However, hours before the order was due to go into effect on 26 February, Trump’s legal team turned to the Supreme Court, claiming that Ali lacked the authority to make such a ruling. Chief Justice John Roberts then issued an administrative stay of the order to enable the Supreme Court to consider the matter. Wednesday’s Supreme Court ruling – with five judges in favour and four against – simply directs Ali to “clarify what obligations the government must fulfill to ensure compliance with the temporary restraining order, with due regard for the feasibility of any compliance timelines”. Ali’s ruling was made in response to court action by three civil society organisations – the AIDS Vaccine Advocacy Coalition (AVAC), Journalism Development Network and the Global Health Council – challenging Trump’s Executive Order (14169), which immediately stopped all congressionally appropriated foreign assistance funding pending future review. Return to court The plaintiffs return to court on Thursday (6 March) where they will argue for a temporary injunction against the aid freeze. A spokesperson on behalf of the plaintiffs told Health Policy Watch that they are encouraged by the Supreme Court’s ruling today. “But each passing day that we are not compensated for work already performed causes additional harm to American workers and suppliers across the country,” added the spokesperson. “Thousands of jobs all over the US have already been lost, with more likely to come. Hundreds of businesses – primarily small businesses, the backbone of our economy – face an existential crisis and the possibility of financial ruin. Meanwhile, every passing second denies millions around the world the essential care they desperately need, putting countless lives at even greater risk.” The plaintiffs’ lead counsel, Lauren Bateman, an attorney with Public Citizen Litigation Group, stated on Wednesday that the Supreme Court ruling “confirms that the administration cannot ignore the law. To stop needless suffering and death, the government must now comply with the order issued three weeks ago to lift its unlawful termination of federal assistance.” During the earlier court hearing, the plaintiffs detailed some of the effects of the freeze on foreign aid dispensed by the US Agency for International Development (USAID) and the State Department. It has disrupted critical health programmes including maternal and child health programs; infectious disease prevention including against malaria and HIV, and clinical trials. Plaintiffs were also forced to lay off staff in response to the freeze. In its defence, Trump’s legal team claimed that life-saving health programmes had been given waivers. But this is no longer the case as the majority of USAID has been dismantled and life-saving projects were issued with permanent termination letters last week. AVAC executive director Mitchell Warren AVAC executive director Mitchell Warren appealed for support for the case: “These are immensely challenging times for all of us, and it is easy to be paralysed, overwhelmed and depressed. But we’ve all come too far for that to be the new normal. Lives, economies and democracies depend on our collective ability to stand up and fight back.” Earlier, Warren described the funding freeze as harmful to global health and security: “In the name of economic efficiency, they are destabilizing public health, diplomatic relationships, communities, and economies.” Devastating setback for tuberculosis The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, approximately one-quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of Global Programme on TB and Lung Healt, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID Press Office. RFK Affirms Measles Vaccine But Says Decision to Vaccinate is ‘Personal’ 04/03/2025 Kerry Cullinan Robert F Kennedy Jr, Trump’s pick for US Health Secretary. Amid the worst measles outbreak in the United States in a decade, vaccine sceptic Robert F Kennedy Jr, the Trump administration’s Health and Human Services (HHS) Secretary, has affirmed that vaccines protect children. “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons,” Kennedy wrote in an opinion piece published by Fox News on Monday. He declared that “the decision to vaccinate is a personal one” rather than advising parents to ensure that their children are vaccinated against measles. He also asserted that “good nutrition remains a best defense against most chronic and infectious illnesses”. The Texas Department of State Health Services has confirmed 146 measles cases since late January and one death of an unvaccinated child, the first measles-related death of a US child in over a decade. Seventy nine of the confirmed cases were unvaccinated while the vaccine status of 62 others is unknown. “Prior to the introduction of the vaccine in the 1960s, virtually every child in the United States contracted measles. For example, in the United States, from 1953 to 1962, on average there were 530,217 confirmed cases and 440 deaths,” wrote Kennedy. While affirming that HHS would ensure vaccines are “readily accessible for all those who want them”, Kennedy noted that the US Centers for Disease Control and Prevention (CDC) “has recently updated their recommendation supporting administration of vitamin A under the supervision of a physician for those with mild, moderate, and severe infection”. The CDC noted in a statement last month that “supportive care, including vitamin A administration under the direction of a physician, may be appropriate”. Vitamin A has been shown to reduce the risk of death from measles by 87% in children younger than two years old, and reduce the length of time the child suffers from diarrhea and fever, according to the Cochrane Review. In his first address to HHS staff on 18 February, Kennedy said the he would investigate the childhood vaccine schedule as part of the Make America Healthy Again Commission set up by Trump that Kennedy is chairing. “Nothing is going to be off limits,” Kennedy said, adding that the commission would investigate the health impacts of pesticides, food additives, microplastics, antidepressants and the electromagnetic waves emitted by cellphones and microwaves. Last week, the Food and Drug Administration cancelled an advisory committee meeting to discuss the composition of annual flu shots, which then have to be cultured. The $40 Question: Can Africa Close the Health Financing Gap? 04/03/2025 Edith Magak Safiya Shuaibu (Nigeria Health Watch), Professor Mamadou Samba, Côte d’Ivoire’s Director General of Public Health and Hygiene, Aminata Wurie (Resilience Action Network Africa) and Roche’s Johnpaul Omollo. KIGALI, Rwanda – On average, African Health Ministers only have $40 per capita for health expenditure in comparison to $4,000 that ministers in many high-income countries have. How the continent can provide the maximum level of healthcare with such limited resources is one of the key questions that delegates to the Sixth Africa Health Agenda International Conference (AHAIC) in Kigali are trying to answer. There is consensus that aid is no longer a reliable solution in light of overnight funding cuts by the United States, and more incremental cuts from Europe. South-South solidarity and drawing more effectively on domestic resources are emerging as likely solutions. ’“To be honest, we cannot afford healthcare for everyone, but we can afford health, which will reduce our overall healthcare costs,” admitted Amref Health Group CEO, Dr Githinji Gitahi. Prevention Over Treatment The first short-term solution to manage the $40 well is by focusing on the basics and prioritizing prevention over treatment. “The foundation of health is clean water for everyone. It is sanitation for everyone. It is access to nutritious food to reduce the risk of non-communicable diseases. It is a strong emphasis on immunization. If we prioritize these, we will save significantly on future healthcare costs,” Gitahi explained. More investment in community health workers than expensive medical equipment like PET scans and MRI machines is also prudent. “Health is built at home – hospitals are there to repair,” he added. “We need to redesign our health systems to make prevention, primary care, and community health the core pillars.” Increasing the $40 However, even with careful management and efficiency, stakeholders agree that $40 is simply not enough. “We need political action now. Within our national budgets, health is not at the forefront. How many countries have actually reached the commitment of allocating 15% of their national budget to health? Just two – South Africa and Cape Verde,” said Aminata Wurie, project manager at Resilience Action Network Africa (RANA). This year, only one out of the 55 African countries allocated more than 5% of GDP to health while only two out of 55 countries have met the 15% Abuja Declaration commitment. Last month, Rwandan President Paul Kagame, the African Union’s (AU) Champion on Domestic Health Financing, hosted a High-Level Health Financing Conference in Addis Ababa to discuss alternative domestic sources of health funding. One of the key outcomes was a mandate for the Africa Centre for Disease Control and Prevention (Africa CDC) to develop a framework for domestic health financing. Africa CDC’s Dr Claudia Shilumani confirmed that efforts are already underway: “We are working with the African Medicines Agency and other partners to create a framework that will outline tangible actions governments can take to increase health sector funding. This will be presented to heads of state in the coming months for a decision.” Meanwhile, Rwanda is already setting an example by integrating existing health financing mechanisms to support long-term goals. In response to health system funding cuts, they have reassessed spending priorities to ensure critical programs remain operational. For example, instead of discontinuing workforce training, they have shifted many in-person trainings to online platforms and redirected the funds to essential programs. Public-private partnerships More attention is also being paid to public-private partnerships (PPPs) and innovative financing models to ensure the long-term sustainability of health programs. The pharmaceutical company Roche has committed to significantly increasing access to diagnostic testing across Africa, aiming to conduct over 3.4 billion tests by 2031 and reach more than 500 million people with quality diagnostics. “Reaching these ambitious goals, especially as Africa’s population continues to grow exponentially, cannot be done alone. Public-private collaboration is key,” said Johnpaul Omollo, Roche’s head of policy and government affairs. “First, we must ensure decentralisation – this is where localization plays a crucial role. As we expand local production, we must also understand what the market truly needs and identify the most essential products we can manufacture locally,” he added. South-South vaccine partnerships Another area where increased partnerships and collaboration will be essential is in vaccine distribution. The US withdrawal from the World Health Organization (WHO) might mean disruptions to vaccine distribution, which could delay availability and hinder efforts to achieve widespread immunity. However, vaccine manufacturers like Serum Institute of India (SII) – the biggest generic producer in the world – are stepping up their efforts to ensure the continued supply of life-saving vaccines. Speaking with Health Policy Watch on the sidelines of the conference, the company highlighted its partnerships with African manufacturers to promote local vaccine production. “We are collaborating with South Africa’s Aspen and Egypt’s Vacsera to establish fill-and-finish vaccine facilities within the continent,” said Anil Kulkarni, SII’s Senior Manager of International Business and Product Management. “In the coming years, we plan to expand these partnerships to more African countries.” SII has also committed to maintaining affordable vaccine prices to ensure that African countries can continue to get vaccines despite global funding challenges. But health experts stress that, for local pharmaceutical production to succeed, it will require a coordinated effort across multiple sectors. “The success of local production will require all hands-on deck. This means the private sector must be involved in understanding community needs, governments must create an enabling policy environment, and supply chains must be strengthened to ensure medicine accessibility,” said Omollo. Charles Okeahalam, president of Amref’s Board, described the current challenges facing Africa’s health systems as a wake-up call for the continent. “If we improve ourselves and systems by just 20%, we could see an 80% improvement in healthcare outcomes. The challenge is real but not as difficult as it might appear.” Image Credits: Edith Magak. Juggernaut of Overweight and Obesity is ‘Monumental Societal Failure’ 04/03/2025 Kerry Cullinan A mother and son in Usolanga, Tanzania. Childhood fat is traditionally seen as a sign of abundance, but it can lead to obesity and related diseases later in life. More than half of all adults and a third of children and adolescents will be overweight or obese by 2050 unless urgent action is taken, according to the most comprehensive global analysis to date, published by The Lancet to coincide with World Obesity Day on Tuesday. This poses an “unparalleled threat of premature disease and death at local, national, and global levels”, according to the Global Burden of Disease Study BMI Collaborators. Overweight and obesity rates in adults (25 or older) and children and adolescents (5-24 years) have more than doubled between 1990 and 2021, affecting 2.1 billion adults (up from 731 million) and 493 million young people (from 198 million). “The unprecedented global epidemic of overweight and obesity is a profound tragedy and a monumental societal failure,” said lead author Professor Emmanuela Gakidou from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the US. In 2019, the estimated total costs associated with obesity, including both direct and indirect costs, ranged from $3·19 billion in low-income countries to $1·33 trillion in high-income countries. Forecasts suggest that, by 2035, the obesity epidemic could lead to a 2·9% reduction in global gross domestic product, equating to a loss of $4 trillion. “Especially high levels have already been reached in Oceania and North Africa and the Middle East, with over 62% of adult males in Nauru, Cook Islands, and American Samoa, and over 71% of adult females in Tonga and Nauru living with obesity in 2021,” according to a media release from The Lancet. China, India, the US, Brazil, Russia, Mexico, Indonesia and Egypt accounted for more than half of the global population living with overweight and obesity in 2021. The US had the highest rates of obesity among high-income countries, with around 42% of males and 46% of females affected by obesity in 2021. In Latin America, 15 of the 17 countries had a prevalence of obesity among females of more than 30%. However, the largest future increases are projected in Asia and sub-Saharan Africa, driven by growing populations. No country has curbed adult obesity No country to date has successfully curbed the rising rates of adult overweight and obesity Among males, the prevalence of overweight and obesity was above 87% in Nauru, American Samoa, Northern Mariana Islands, Cook Islands, and Kuwait. In future, the highest levels for men are predicted in the United Arab Emirates and Nauru, where more than 80% of males are expected to have obesity in 2050. Estimated age-standardised prevalence of overweight and obesity among adult males aged 25 years and older, Among females, the prevalence has reached 88% and above in Tonga, Kuwait, Cook Islands, Nauru, and Samoa. In future, Tonga and Egypt are predicted to dominate with at least 87% of females being overweight or obese by 2050. Estimated age-standardised prevalence of overweight and obesity among female adults aged 25 years and older. “Obesity rates are skyrocketing across sub-Saharan Africa, with 522 million adults and more than 200 million young people expected to be living with overweight or obesity by 2050,” said co-author Awoke Temesgen, Associate Professor at IHME. In Nigeria, the number of overweight and obese adults is projected to more than triple from 36.6 million in 2021 to 141 million in 2050. “Action is urgently needed to implement preventative initiatives such as policies on the marketing of unhealthy foods and planning to include facilities for exercise and playing fields in schools,” added Temesgen. Obesity trends in young people The study predicts a 121% rise in obesity among young people globally by 2050, with the total number of children and adolescents with obesity predicted to reach 360 million. The most rapid increases in obesity in young are forecast for North Africa, the Middle East, Latin America and the Caribbean, where one-third of all the world’s children and adolescents with obesity (130 million) are expected to live in 2050. The transition to obesity predominance (versus overweight) is also expected to be overwhelming for several Oceanic countries, including the Cook Islands, Nauru, Tonga where levels of obesity are expected to reach 60-70% by 2050, as well as for heavily populated countries such as Nigeria (18.1 million), India (26.4 million), Brazil (17.8 million), China (35.2 million), and the US (22.1 million). The authors also note that more recent generations are gaining weight faster than previous ones and obesity is occurring earlier, increasing the risk of complications such as type 2 diabetes, high blood pressure, cardiovascular diseases, and multiple cancers occurring at younger ages. “Our estimates identify children and adolescents in much of Europe and south Asia living with overweight who should be targeted with obesity prevention strategies,” said co-lead author Dr Jessica Kerr from Murdoch Children’s Research Institute in Australia. “We have also identified large populations, particularly adolescent girls, in North America, Australasia, Oceania, north Africa and the Middle East, and Latin America that are expected to tip over to obesity predominance and require urgent, multifaceted intervention and treatment.” Action plans The authors stress that five-year action plans (2025-2030) are urgently required to curb the rise in obesity and help inform new goals and targets post-2030, when the Sustainable Development Goals end. “Preventing obesity must be at the forefront of policies in low- and middle-income countries,” said Kerr. “Policy action in these regions must balance the challenges of overnutrition with undernutrition and stunting, with interventions ranging from support for nutritional diets and regulating ultra-processed foods to promoting maternal and child health programmes that encourage pregnant women to follow a healthy diet and breastfeed. Kerr warned that many countries “only have a short window of opportunity to stop much greater numbers shifting from overweight to obesity”. She called for “much stronger political commitment” to “transform diets within sustainable global food systems and to support comprehensive strategies that improve people’s nutrition, physical activity and living environments, whether it’s too much processed food or not enough parks.” Image Credits: Jen Wen Luoh. COP16 Deal Commits Nations to Raise $200 Billion Annually for Biodiversity; But Funding A Big Lift 03/03/2025 Sophia Samantaroy Coral reefs are a vital breeding ground for fish, a major protein source for 3 billion people. But some 14% of coral reefs died between 2009 and 2018, according to the UN Environment Programme. Countries agreed to raise $200 billion a year by 2030 to help developing countries conserve biodiversity at the resumed Conference of Party (COP16) of the UN Convention on Biodiversity (CBD) in Rome last week. The deal marks a major breakthrough after negotiations over a finance package were suspended last November in the closing hours of COP16 in Cali, Colombia, over funding disagreements. In Rome, more than 140 nations who are parties to the Convention also pledged to raise $20 billion a year from international donors for the new effort, by 2025, and $30 billion by 2030 to support developing nations’ conservation efforts. Although actually reaching those financial goals poses a huge challenge, the commitment marks a major milestone in implementing the landmark 2022 Kunming-Montreal Global Biodiversity Framework (KMGBF). The Framework aims to ensure the conservation or restoration of at least 30% of the planet’s lands, freshwater, and ocean resources by 2030. Currently, only 17% and 10% of the world’s terrestrial and marine surfaces are protected, respectively. The first ever multilateral nature agreement, the Kunming-Montreal framework’s overarching goal is development in “harmony” with nature by 2050. “Montreal was about the ‘what’ — what are we all working towards together?” Georgina Chandler, of the Zoological Society London,was quoted as saying to the Independent. “Cali was supposed to focus on the ‘how’ — putting the plans and the financing in place to ensure we can actually implement this framework.” Before talks in Colombia broke down, countries did manage to reach agreement on a voluntary “Cali Fund” for sharing the genetic benefits derived from genetic resources. And they approved a groundbreaking “health and biodiversity action plan” – as a voluntary mechanism for countries to incorporate health considerations into nature protection plans. But sharp disagreements between developed and developing countries over funding support for other conservation efforts in developing countries emerged in the final hours of the two-week session. As the meeting ran into overtime, the departure of delegates left the COP without a quorum to reach a decision. Resources for reaching key CBD goals Now, last week in Rome, the parties to the CBD finally managed to agree on a way forward for mobilizing significant resource flows to developing countries, whose action is critical to realizing the big aims of the Kunming-Montreal framework. It provides for a structured mechanism to raise funds through a mix of public and private financing, and establishes a permanent arrangement for financing biodiversity conservation in developing nations beyond 2030. Finally, the Rome agreement includes other provisions for planning, monitoring, reporting, and review required to implement the Kunming-Montreal framework – the Paris Accord equivalent for nature. The accord was reached despite the relatively poor showing of delegates – around 40 of the 196 nations that are party to the convention failed to show up. The agreement also comes despite the fact that the United States, historically the world’s largest donor to biodiversity, recently halted most such funding as part of the Trump Administration’s broader foreign aid freeze. The US has never been a formal party to the CBD but had previously played a behind-the-scenes role in advancing the its goals. But while many hailed it as a diplomatic victory, concerns linger over implementation, accountability, and the absence of key nations and specific financial commitments from leading donor states in a time of turbulent global rhetoric around conservation. “We live in a very different world now, and only a handful of countries have sent ministers,” said Arthur Wyns, a climate research fellow based in Melbourne, on a social media post. All in all, the Rome talks boasted only a fraction of attendance of November’s Cali conference, which saw 1,000 delegates in attendance, compared to the 23,000 in Cali. Financing details pushed to 2028 African oil and gas projects are set to quadruple; 90% of projects overlap with sensitive ecosystems, such as the Congo Basin, the world´s second largest rainforest. However, the final agreement deferred a key decision on whether the Global Environment Facility (GEF) would remain the CBD’s primary biodiversity finance mechanism or if a new fund would be created. African and Latin American nations had pushed for a dedicated biodiversity fund, but the decision on that was postponed until at least 2028. The GEF is already managing finances for several other global environmental conventions, such as the Stockholm Convention on persistent organic pollutants, and the UN Framework Convention on Climate Change. And it manages the CBD’s Global Biodiversity Framework Fund (GBFF), dedicated to implementing the Kunming-Montreal targets. The Fund has issued over $3 billion in biodiversity finance since its creation in 2022. Meeting ambitious targets With the Trump administration freezing most nature-related foreign aid and European nations cutting their aid budgets, doubts persist over how the ambitious financial targets for this new fund will be met. More than 75% of nations have yet to submit their national biodiversity plans, as per the 2022 Kunming-Montreal agreement, despite the October deadline passing four months ago. Even among those that have submitted plans, over half fail to include the KMGBF’s headline goal of protecting 30% of land and oceans by 2030. Additionally, nations with biodiversity hotspots, notably Brazil and those in the Congo Basin, failed to adopt at least one national CBD target. Cali Fund for profit-sharing of profits made from genetic resources launched The Rome COP also saw the launch of the Cali Fund, a new voluntary initiative to facilitate voluntary corporate profit-sharing of revenues generated from the use and development of indigenous genetic resources, or genetic Digital Sequence Information (DSI), into new foods, cosmetics or pharma products. Big food, cosmetics and pharmaceutical companies worldwide now harness and use genetic resources, captured as DSI, across far-flung borders, to create new products worth billions of dollars annually. Developing countries have long maintained that they are left out of the loop of benefits that come from the harvesting of new genetic resources in their regions. The new plan marks the first global attempt to address the imbalance. The initiative, agreed to last November in Colombia targets companies meeting two of three thresholds: annual sales exceeding $50 million, profits over $5 million, or assets above $20 million. These firms “should” contribute either 1% of revenue or 0.1% of profits generated from the use of indigenous genetic material to the new “Cali Fund” to support developing country biodiversity preservation and restoration. The rates remain “indicative” and the arrangement “voluntary”, according to the agreement – whose details still need to be worked out. “Success of the Cali Fund will be critical for providing finance to people on the ground who are custodians for species and genetic diversity. We are proud to be a founding partner for this groundbreaking Fund,” said Marcos Neto, Director of UNDP’s Sustainable Finance Hub, in a press statement, upon the launch of the new scheme. ‘Not Charity’ COP16 President, Susana Muhamed of Colombia, confers with the Secretariat at COP16’s second edition in Rome. The Cali Fund is not for “charity from companies,” but “fair payment for use of global biodiversity,” as Susana Muhamad, CBD president and former Colombian Minister of Environment and Sustainable Development said in a press conference. Furthermore, “at least 50% of the Cali Fund resources will be allocated to indigenous peoples and local communities, recognizing their role as custodians of biodiversity,” the UN said in a statement, building upon agreements in Cali that gave Indigenous peoples and local communities a stronger voice in conservation matters. Pharmaceutical companies have also warned that the initiatives such as the Cali Fund also risks taking the world down a slippery slope that “stifles” easy access to genetic material and to medical innovation – particularly if something now framed as a voluntary measure eventually becomes mandatory. “The pharmaceutical industry has long supported the Convention on Biological Diversity’s objective to protect our natural world,” said David Reddy, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a statement following November’s Cali round. But “[t]he ability to rapidly use scientific data known as “digital sequence information” (DSI) is essential for developing new medicines and vaccines,” he warned. “Any new system should not introduce further conditions on how scientists access such data and add to a complex web of regulation, taxation and other obligations for the whole R&D ecosystem – including on academia and biotech companies. “Ahead of COP17, it is critical that governments work to ensure the implementation of any new mechanism on digital sequence information does not stifle medical research and innovation that can bring the next wave of medical progress to people around the world.” Biodiversity continues to declines Heavy deforestation in hotspots, such as the Amazon and Congo river basins, threatens biodiversity as well as increasing the risks to human communities of zoonotic diseases transmitted by displaced animal species. The new financial agreements come at a critical time in which biodiversity loss continues to accelerate. Global wildlife populations have declined by 73% since 1970, with more than one million species at risk of extinction, according to the World Wildlife Fund’s Living Planet Report. This means that a quarter of species are threatened – and only the ones researchers were able to study. Along with the conservation and/or restoration of 30% of the world’s degraded ecosystems (Target 2), the Kunming-Montreal accord’s 23 targets also include: Target 6 – reduction of invasive species by 50%; Target 12 – enhancement of urban greenspaces; Target 13 – increasing the sharing of benefits from genetic resources, digital sequence information and traditional knowledge. “The results of this meeting show that multilateralism works and is the vehicle to build the partnerships needed to protect biodiversity and move us towards Peace with Nature,” said Astrid Schomaker, Executive Secretary of the CBD. “As we do this and implement the other supporting elements for resource mobilization, the world will have given itself the means to close the biodiversity finance gap. Meanwhile, the decision reached in Cali on a health and biodiversity framework also gives countries a clear framework for integrating health more squarely into biodiversity planning. The framework calls for health impact assessments in land-use planning, disease surveillance where habitat loss is rapid, and stricter wildlife trade rules vital to preventing pathogens spreading from wild animals to human communities and food markets. But that still doesn’t go far enough to protect people from the risk of spill-over events, critics say. “Our health cannot be separated from the health of the planet and its many species,” UN Environment chief Inger Andersen told delegates in Cali last November. “We must adopt this action plan and implement it with a holistic, systemic approach that unifies action across health, environment, finance, industry and agriculture.” Nations are set to reconvene next year in Yerevan, Armenia, for COP17. See more Health Policy Watch coverage of Cali and biodiversity here. Image Credits: Oleksandr Sushko, Rainforest Foundation and Earth Insights, 2022, IISD/ENB | Mike Muzurakis, Earth.org. Common US Infant Formulas Are Laden with High Levels of Added Sugars 03/03/2025 Sophia Samantaroy The WHO and the American Academy of Pediatrics “support the unequivocal evidence that breastfeeding protects against a variety of diseases and conditions.” Most infant formulas in the United States contain a high percentage of added sugars instead of natural lactose, “jeopardizing” infant health and development, says researchers at the University of Kansas in a new analysis of commonly marketed formulas. “Infants may consume upwards of 60 grams of added sugars per day, or the equivalent of two soft drinks per day if they are entirely formula-fed,” researchers say in the study, published last week in the Journal of Food Composition and Analysis. The publication came as the Food and Drug Administration (FDA) delayed implementation of a rule that tightens what foods manufacturers are allowed to label as “healthy.” The study, which analyzed 73 infant formulas available in 2022, found that “gentle” and lactose-free formulas contained the highest proportion of added sugar, with median levels reaching 85% and 90% of total sugars, respectively. On average, formula-fed infants consume 7-8 grams of added sugar per serving – a quick form of energy, but lacking in nutritional value. Health experts warn that high sugar consumption in infancy, in the form of sucrose, glucose, and high-corn fructose, may contribute to rapid weight gain and early obesity, increasing the risk of chronic conditions such as diabetes later in life. 20% of US children have obesity – a figure that is only expected to rise in the coming decades. Babies exposed to sugary foods also develop a strong preference for more sugar, says the authors. But “lax” federal guidelines make it difficult for parents and caregivers to avoid added sugars in infant formula because of the “staggering extent” to which US formula contradicts federal healthy diet recommendations. The FDA does not require manufacturers to report sugars in US formulas, in “sharp contrast” to adult food regulations, which must display a breakdown of total carbohydrates and added sugars, despite federal dietary guidelines recommending zero added sugars for infants under two years old. “As a result, parents and guardians may unknowingly feed their infants formula that contains substantial quantities of added sugars… which likely present a substantial risk to their infant’s health and development.” A systemic issue It was only after the Affordable Care Act that employers were mandated to provide space for nursing mothers other than a bathroom. But state laws are still patchwork protection, and do not require compensation for time spent breastfeeding. Even though the researchers build upon a body of evidence showing the risks to formula feeding – including an increased risk of gastroenteritis, diarrhea, ear infections, and chronic illnesses – they acknowledge that larger, systemic issues bar families from breastfeeding. The World Health Organization (WHO) recommends that parents exclusively breastfeed for the first six months. But in the US, “extremely” limited social support, no paid maternity leave, and the lack of affordable early childcare means that reliance on formula is a “necessity” for most parents, the authors say. Those from low socioeconomic status backgrounds are the most disadvantaged. “[T]he structure of the US system and environment often leaves parents and caregivers with little choice but to use formula in some capacity,” write study authors Audrey Rips-Goodwin, Daiil Jun, Adrianne Griebel-Thompson, Kai Ling Kong, and Tera Fazzino. “[W]e reason that the focus on an individual-level solution (breastfeeding promotion to women and caregivers) is not well matched to addressing the systemic nature of the problem and places an unfair burden on women and families who are expected to navigate this systemic issue. “Ideally, the US labor system should support breastfeeding, and healthcare professionals should be properly trained and incentivized to promote it.” “At the federal level there is no requirement for paid maternity/paternity leave and very little structural support to promote breastfeeding. Given the vast limitations in systemic support of new mothers and parents, most turn to using formula out of necessity. US parents deserve an infant formula supply that does not jeopardize infant health due to the presence of added sugars,” said Dr Tera Fazzino, study author and associate professor of psychology and associate director of the Cofrin Logan Center for Addiction Research and Treatment at the University of Kansas. Formulas with lactose could be safer, if made available Lactose, which is naturally found in breast milk and cow and goat milk, is sometimes used as a base for formula. Infants digest the more complex form of sugar slower, boosting their nutrition and metabolism, and engaging in hunger satiation hormones. Unlike the added sugars in most formulas – high fructose corn syrup, glucose, sucrose – lactose does not cause the same blood sugar spike. “These non-lactose sugars also typically garner more pronounced neurochemical reward responses and glycemic responses relative to lactose. Therefore it is really important for infants to consume lactose and avoid consumption of other types of added sugars, which is in line with US Dietary Guidelines,” said Fazzino. Only 8% of US formulas contained primarily naturally lactose, but the type is no longer available in the US. And it is unknown whether any other formulas use the safer sugar. “When people have free choice, the choices should include options that promote infants’ health and development. In the case of the US formula supply, our findings indicate that parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Fazzino. The researchers argue that lactose-containing formulas are safer for infants, and that efforts should focus on “requiring formula companies to produce products that primarily contain naturally occurring lactose and are designed to minimize risks to healthy infant development.” Unclear if FDA will improve labelling after delay ‘Parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Dr Fazzino. Even with increased rhetoric around chronic diseases in the US, notably HHS Secretary Robert F Kennedy’s push to “Make America Healthy Again,” the role of infant formulas to early-life infant weight gain is largely overlooked. The FDA has delayed implementing a rule that would redefine which foods can be labeled as “healthy.” The regulation, which aims to prevent manufacturers from marketing sugary juices, processed sweets, and certain meats as “healthy” options, was initially set to take effect on 25 February but has now been pushed back to 28 April, according to HHS. The delay stems from a broader freeze on new rule proposals across the Trump administration, and an upheaval of firings in the past weeks. The department lost several thousand employees, including those working in food safety. Currently, infant formula labels do not disclose added sugar content, allowing products with high levels of sucrose, glucose, and corn syrup solids to be sold without clear warning. During the first Trump administration, US officials tried to derail a resolution at the 2018 World Health Assembly to promote breastfeeding, attempting to remove language urging governments to “protect, promote and support breast-feeding” and restrictions on the promotion of food unhealthy food products to children. The original sponsor of the resolution, Ecuador, withdrew after US threatened it with trade sanctions. “We need much clearer labeling requirements for formulas in the US, specifically regarding the reporting of added sugars,” Fazzino told Health Policy Watch. “Support from the federal government and associated entities is really needed to improve infant formula labeling requirements.” But Fazzino acknowledged that labelling reform is “not on their radar;” rather, the FDA is more concerned about shoring up the formula supply chain after shortages in 2022 rocked the US market. The FDA declined to respond to Health Policy Watch’s request for comment. Formula companies deploy “same tactics” as tobacco industry A Nestle advertisement from 1911 undermines breastfeeding. Formula companies were among those identified in a 2023 Lancet series on the mechanisms and scope of commercial determinants of health, examining how the private sector influences health through activities like product design, packaging, supply chains, lobbying, research funding, and marketing. These companies “are escalating avoidable levels of ill health, planetary damage, and inequity.” These include formula milk companies’ extensive lobbying networks and “predatory” marketing tactics that derailed progress on breastfeeding education. In response, just last month the WHO at its Executive Board meeting proposed a resolution to regulate digital marketing of breastmilk substitutes, after the WHO’s findings that the formula industry uses “exploitative” marketing strategies. The resolution focuses on the fact that digitial marketing – through influencers and paid content – rely on personalized data to “innapropriately” promote infant formula, and undermine recommendations from healthcare providers and national authorities. The threat of targeted misinformation led the WHO to issue guidance on “regulatory measures aimed at restricting digital marketing of breast-milk substitutes” in November 2022, following its report that “the global formula milk industry, valued at some $55 billion, is targeting new mothers with personalized social media content that is often not recognizable as advertising.” The study also follows investigations into how formula companies promoted their product as “healthy” in lower-and middle-income countries, despite high levels of added sugar. But as the authors note, hidden added sugars also plague US infant formulas. “Ultimately, caregivers and infants in the US deserve a formula market that promotes healthy infant development and does not promote early obesity risk.” Image Credits: FDA, University of Minnesota , Enfamil. ‘The Centre Must Hold’: Africa’s Health Leaders Rally for Bold Action 03/03/2025 Edith Magak Africa CDC’s Dr Claudia Shilumani, Rwandan Health Minister Dr Sabin Nsanzimana, Dr Githinji Gitahi, CEO of Amref Health Africa and Dr Chikwe Ihekweazu, acting WHO Regional Director for Africa KIGALI, Rwanda – “Sad”, “Worried” and “The centre is shaking”, were some of the reactions of African health leaders to the termination of US aid at a media briefing on Sunday (2 March) ahead of the 6th Africa Health Agenda International Conference (AHAIC). But speakers also stressed the need for resilience and swift action at the briefing ahead of the conference, which is hosted by Amref Health Africa in collaboration with Rwanda’s Ministry of Health, the World Health Organization (WHO) Africa Office for Africa, and the Africa Centres for Disease Control and Prevention (Africa CDC). “The centre of our health system on the continent must hold,” stressed Rwandan Minister of Health Dr Sabin Nsanzimana. “Even as financing declines, we must find ways to increase it – whether through domestic sources or partnerships with those who see health as an investment in humanity.” Nsanzimana believes Africa can find alternative funding sources to fill many of the gaps left by the massive cuts to US Agency for International Development (USAID) funding. “There’s always money somewhere,” he explained. “When some of our medical students in surgery and midwifery were at risk of pausing their long-term training because they were supported by financing that was stopped overnight, we reassessed our priorities. we looked at cross-sector health projects and found over 5 billion Rwandan francs [over $5 million] tied up in short-term training and workshops. “We asked ourselves: ‘Do we keep funding weekly training that people can read online, or do we invest in long-term workforce programs?’,” he said. Rwanda has now redirected those funds to keep students enrolled, shifting the current workshops to online platforms. Africa must “think beyond traditional funding models and use what we have to meet our most urgent needs”, he stressed. This will be one of the pressing question considered by the over 1,800 delegates from 56 countries attending the conference. Significant risks “This year’s conference comes at a time of significant risks to African communities and health systems,” said Dr Githinji Gitahi, CEO of Amref Health Africa, who called for Africa’s health systems to be redesigned to address the dual burden of infectious and non-communicable diseases (NCD). Many African countries bear high burdens of infectious diseases while also facing a surge in non-communicable diseases. NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. “The health system we have today is not the one we’ll need tomorrow,” said Gitahi. “[But] we have minimal fiscal space. With population growth, economic shifts, and tax inefficiencies, how do we mobilize resources to fight both infectious and non-communicable diseases with limited funds?” “Many of us didn’t anticipate the scale of change – cuts in government assistance from not only the US government but also Germany, the UK, and others. Our current health systems have relied heavily on external support. We must rethink how to sustain them in the future,” Gitahi added. Speakers also emphasized that ,while communities are aware of diseases like malaria and HIV, many are unaware of the risk factors driving NCDs such as cancer, cardiovascular diseases, and strokes. Artifical intelligence and climate change Beyond the urgent discussions on funding, the AHAIC conference is also focusing on topics including climate-resilient health policies, the growing burden of both infectious and non-communicable diseases, artificial intelligence in healthcare, and strengthening local pharmaceutical manufacturing. Dr Claudia Shilumani, Africa CDC director of external relations and strategic management, warned of increasing health threats linked to climate change. Africa CDC is currently monitoring 243 health threats across the continent, with 84 significant events recorded in the first few weeks of 2025. Artificial intelligence is also a major focus, with discussions on how technology can be leveraged to improve diagnostics, treatment, and hospital management. Delegates acknowledged that while Africa needs thousands of trained professionals to meet healthcare demands, AI-driven solutions could help bridge the gap by enhancing efficiency in service delivery. Efforts to align policies across Africa are also gaining traction. The Africa CDC is working closely with the African Medicines Agency to streamline drug approvals and distribution across the continent. There is also a push to fast-track the qualification process for local manufacturers, ensuring national health strategies align with continental frameworks like the Africa Safety Strategic Plan. Health resilience Dr Matshidiso Moeti, outgoing WHO Africa Regional Director, highlighted the remarkable progress Africa’s health systems have made over the years. She noted that the continent has confronted pandemics, eliminated once-deadly viruses, and turned death sentences into manageable conditions. Despite these achievements, Moeti emphasized that significant challenges remain. She pointed to the deepening link between health, economic stability, and the environment, warning that widening economic disparities, climate change, and conflict continue to threaten healthcare systems. “One constant has been our collective commitment to building a healthier, stronger Africa.” Image Credits: Edith Magak, WHO/NCD Portal. DRC Identifies New Mpox Variant and Investigates New Febrile Disease Outbreak 28/02/2025 Kerry Cullinan Dr Ngashi Ngongo A new and potentially more infectious variant of mpox Clade 1A has been identified in the Democratic Republic of the Congo (DRC) according to Dr Ngashi Ngongo, head of the mpox incident management team at the Africa Centre for Disease Control and Prevention (Africa CDC). The termination of USAID funding and violence in eastern DRC are hampering mpox testing and reporting, with test results being reduced to a trickle. Only 35% of mpox cases are currently being tested in DRC, both because of conflict and the ending of USAID funds to transport mpox tests to laboratories. The DRC finally started to vaccinate people in Kinshasa this week, and uptake was swift with over 24,800 people vaccinated over four days, said Ngongo. Mpox is continuing to spread in Uganda, which has seen case increases for three weeks in a row – 278 new cases in the past week. Mpox cases are overwhelming health facilities. For example, a treatment centre in Entebbe with 80-bed capacity currently has 102 patients. “Because of this, the leadership in the [Ugandan] Ministry of Health has now opted also to introduce home-based care for non-severe cases,” said Ngongo. Meanwhile, South Africa reported three mpox cases after being free of the disease for over 90 days. The World Health Organization resolved this week to keep mpox as a public health outbreak of international concern “based on the continuing rise in numbers and geographic spread, the violence in the eastern DRC, which hampers the response, as well as a lack of funding to implement the response plan”, according to the WHO. Febrile disease in DRC DRC health authorities are investigating a febrile disease outbreak in five villages in the Basankusu and Bolomba health zones in Equateur province. This has tripled deaths over the past three weeks, according to WHO. A total of 943 cases and, 52 deaths have been reported, with symptoms including fever, chills, sweating, headache and muscle pain.\, said Ngongo. There are no haemorrhagic symptoms and Ebola and Marburg tests are negative, making malaria the most likely cause, he added. “Children below five years make about 18% of cases with a case fatality of 5.3%. Children ages five to 15 years make up 20% of all cases, with a case fatality of 6.4%,” said Ngongo. “The diagnostic is pointing towards malaria. Rapid tests that were conducted on over 500 samples gave a positivity rate of 55% but there are also blood smears that were also conducted, around 70 samples, that also gave a positivity rate of almost 78%,” said Ngongo. “Further tests are to be carried out for meningitis. Food, water and environmental samples will also be analysed, to determine if there might be contamination,” according to the WHO. “Basankusu and Bolomba are about 180 kilometres apart and more than 300 kilometres from the provincial capital, Mbandaka. The two localities are reachable by road or via the Congo River from Mbandaka. This remoteness limits access to health care, including testing and treatment. Poor road and telecommunication infrastructure are also major challenges,” saif the WHO in a statement. US Terminates Thousands of Life-Saving Global Health Grants Including For HIV, TB and Malaria 27/02/2025 Kerry Cullinan Protestors gathered outside USAID headquarters in Washington D.C. after employees were informed via email to not come in to work. The Trump administration has terminated the contracts of nearly 10,000 global health projects funded by the US Agency for International Development (USAID) or the US State Department – including projects to provide vital diagnosis and treatment for HIV, tuberculosis, and malaria, as well as humanitarian aid projects providing nutrition and water and sanitation services. Grants to hundreds of African HIV organisations providing life-saving services have been terminated with immediate effect via letters received on Thursday morning. Globally, the terminated awards include 5,800 grants administered by the USAID and 4,100 grants for projects managed directly by the State Department. Some of the terminated programmes had previously been granted temporary waivers, due to their roles in providing lifesaving health or humanitarian aid. The Trump administration also announced Thursday that it was halting US funding to the Joint UN Programme on HIV/AIDS (UNAIDS), which is headquartered in Geneva, just across from the World Health Organization. “All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated,” said Dr Atul Gawande, USAID’s former assistant administrator under the Biden administration. Terminated, too, are all global tuberculosis programmes, all US-made food aid programmes, which manufacture specially enriched foods aimed at malnourished women and children, and around 1000 food kitchens serving displaced people in countries such as war-torn Sudan. “This is one of the worst days of my professional life,” said Dr Kate Rees of Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups. “Tomorrow, we are letting go 2,800 people who are mainly peer educators and data capturers.” Prof Linda-Gail Bekker, CEO of the South African Desmond Tutu HIV Foundation, said that the US termination would cost 500,000 South African lives over the next 10 years and result in around half a million new HIV infections, according to recent modelling. “As an activist, as a person living openly with HIV, I’m very hurt,” said Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “How am I going to survive? Will the public health care system be able to cater for us? Will be able to cover all the gaps that we are facing with all the challenges that the public healthcare system has?” South Africa has the highest burden of HIV in the world with eight million people living with the virus (over 16% of the adult population). All 44 South African HIV programmes that receive money from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID have seen their aid terminated. Projects affected range from mother-to-child transmission programmes and hospices to research groups. Many focus on “key populations”, groups that are the most vulnerable to HIV but often shun health centres in fear of discrimination. “I’ve been having a sleepless night trying to think how best we can save our communities because we know that some of the government healthy facilities are very discriminatory,” said Kholi Buthelezi, national coordinator of the sex worker organisation, Sisonke. HIV activist Sibongile Tshabalala, who lives with the virus, is fearful for her future. HIV programmes devastated across Africa HIV programmes across the continent have also been devastated. The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children. Late yesterday, we received award termination notices for three of our primary USAID agreements. Read our full statement. https://t.co/VpBNduu036 pic.twitter.com/0hAP17JqxG — Elizabeth Glaser Pediatric AIDS Foundation (@EGPAF) February 27, 2025 In Uganda, for example, the Baylor College of Medicine Children’s Foundation’s HIV and TB programmes, that strengthens district health systems to better deliver HIV, TB and maternal and child services, has been terminated. The termination letters all state that US Secretary of State Marco Rubio, in his capacity as acting administrator for USAID and Peter Marocco, USAID acting deputy administrator, “have determined your award is not aligned with agency priorities and made a determination that continuing this program is not in the national interest”. ‘Chaos and disaster’ The terminations have caused “chaos” and “disaster”, said emotional South African leaders of the HIV sector who urged their government to step in to save their programmes. Fatima Hassan, head of the Health Justice Initiative, urged the South African government to issue compulsory licenses to reduce the price of antiretroviral medicine as the US has already “done the worst to us”. “US Congress approved the funds, and that is what has been stopped. So we do believe that it’s an illegal grab. It’s an illegal halt of services and programs. It’s not following due process,” Hassan added. The terminations will decimate South Africa’s HIV testing, data collection and HIV and TB literacy, said public health expert Dr Lynne Wilkinson, who added that USAID funds also assisted groups combating gender-based violence. However, South Africa is luckier than many other African countries as it derives around 17% of its HIV budget from PEPFAR. The Democratic Republic of Congo (DRC) gets 89% of its HIV budget from PEPFAR, while Mozambique and Tanzania get 60% of their HIV budget from the US. USAID: Countries most reliant on US aid for HIV ‘Blanket freeze is illegal’ Mitchell Warren, head of the US-based HIV programme AVAC, described the blanket termination of USAID grants as “unlawful”. “The US government’s in a very strong position with any cooperative agreement or grant or contract. They’re allowed to cancel agreements or amend them. They’re in a very strong position generally, but the blanket freeze is illegal,” said Warren, whose organisation has resorted to the courts to prevent the cutting of lifesaving aid. AVAC’s Mitchell Warren “We have been now in a federal court for several weeks, and a temporary restraining order was provided two weeks ago by the Court that said that things had to go back. The tap had to be put back on until this 90 day review actually took place in a comprehensive way,” he added. “We now have evidence entered into the public record in the courts that show the intentionality at USAID and the State Department to dismantle everything but the government has simply thrown up additional legal delays, as is their want,” said Warren. A federal judge had set Wednesday at midnight as the deadline for USAID to release some $1,5 billion funds for the foreign aid work already completed, but the US Supreme Court granted the government a stay on the release of funds until the court could apply itself more thoroughly to the issue. “We expect a hearing next week in Washington,” said Warren. “This is not about PEPFAR. This is not about the HIV response. This is not about USAID. This is about the rule of law. The United States Congress has the power of the purse. They decide what gets spent. The executive branch is there to execute, and that’s the basis of this legal argument. “But as of [Wednesday] night, they began to basically massacre every possible implementing agency to deliver on this work. This court case, as important as it is, is not going to change that overnight. That’s why working in partnership with each other and with national governments is essential because the United States is not a partner that is trustworthy right now,” Warren concluded. Image Credits: Reuters Youtube, Gandhi A, et al, Annals of Internal Medicine, 11 Feb. 2025, UNAIDS. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
RFK Affirms Measles Vaccine But Says Decision to Vaccinate is ‘Personal’ 04/03/2025 Kerry Cullinan Robert F Kennedy Jr, Trump’s pick for US Health Secretary. Amid the worst measles outbreak in the United States in a decade, vaccine sceptic Robert F Kennedy Jr, the Trump administration’s Health and Human Services (HHS) Secretary, has affirmed that vaccines protect children. “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons,” Kennedy wrote in an opinion piece published by Fox News on Monday. He declared that “the decision to vaccinate is a personal one” rather than advising parents to ensure that their children are vaccinated against measles. He also asserted that “good nutrition remains a best defense against most chronic and infectious illnesses”. The Texas Department of State Health Services has confirmed 146 measles cases since late January and one death of an unvaccinated child, the first measles-related death of a US child in over a decade. Seventy nine of the confirmed cases were unvaccinated while the vaccine status of 62 others is unknown. “Prior to the introduction of the vaccine in the 1960s, virtually every child in the United States contracted measles. For example, in the United States, from 1953 to 1962, on average there were 530,217 confirmed cases and 440 deaths,” wrote Kennedy. While affirming that HHS would ensure vaccines are “readily accessible for all those who want them”, Kennedy noted that the US Centers for Disease Control and Prevention (CDC) “has recently updated their recommendation supporting administration of vitamin A under the supervision of a physician for those with mild, moderate, and severe infection”. The CDC noted in a statement last month that “supportive care, including vitamin A administration under the direction of a physician, may be appropriate”. Vitamin A has been shown to reduce the risk of death from measles by 87% in children younger than two years old, and reduce the length of time the child suffers from diarrhea and fever, according to the Cochrane Review. In his first address to HHS staff on 18 February, Kennedy said the he would investigate the childhood vaccine schedule as part of the Make America Healthy Again Commission set up by Trump that Kennedy is chairing. “Nothing is going to be off limits,” Kennedy said, adding that the commission would investigate the health impacts of pesticides, food additives, microplastics, antidepressants and the electromagnetic waves emitted by cellphones and microwaves. Last week, the Food and Drug Administration cancelled an advisory committee meeting to discuss the composition of annual flu shots, which then have to be cultured. The $40 Question: Can Africa Close the Health Financing Gap? 04/03/2025 Edith Magak Safiya Shuaibu (Nigeria Health Watch), Professor Mamadou Samba, Côte d’Ivoire’s Director General of Public Health and Hygiene, Aminata Wurie (Resilience Action Network Africa) and Roche’s Johnpaul Omollo. KIGALI, Rwanda – On average, African Health Ministers only have $40 per capita for health expenditure in comparison to $4,000 that ministers in many high-income countries have. How the continent can provide the maximum level of healthcare with such limited resources is one of the key questions that delegates to the Sixth Africa Health Agenda International Conference (AHAIC) in Kigali are trying to answer. There is consensus that aid is no longer a reliable solution in light of overnight funding cuts by the United States, and more incremental cuts from Europe. South-South solidarity and drawing more effectively on domestic resources are emerging as likely solutions. ’“To be honest, we cannot afford healthcare for everyone, but we can afford health, which will reduce our overall healthcare costs,” admitted Amref Health Group CEO, Dr Githinji Gitahi. Prevention Over Treatment The first short-term solution to manage the $40 well is by focusing on the basics and prioritizing prevention over treatment. “The foundation of health is clean water for everyone. It is sanitation for everyone. It is access to nutritious food to reduce the risk of non-communicable diseases. It is a strong emphasis on immunization. If we prioritize these, we will save significantly on future healthcare costs,” Gitahi explained. More investment in community health workers than expensive medical equipment like PET scans and MRI machines is also prudent. “Health is built at home – hospitals are there to repair,” he added. “We need to redesign our health systems to make prevention, primary care, and community health the core pillars.” Increasing the $40 However, even with careful management and efficiency, stakeholders agree that $40 is simply not enough. “We need political action now. Within our national budgets, health is not at the forefront. How many countries have actually reached the commitment of allocating 15% of their national budget to health? Just two – South Africa and Cape Verde,” said Aminata Wurie, project manager at Resilience Action Network Africa (RANA). This year, only one out of the 55 African countries allocated more than 5% of GDP to health while only two out of 55 countries have met the 15% Abuja Declaration commitment. Last month, Rwandan President Paul Kagame, the African Union’s (AU) Champion on Domestic Health Financing, hosted a High-Level Health Financing Conference in Addis Ababa to discuss alternative domestic sources of health funding. One of the key outcomes was a mandate for the Africa Centre for Disease Control and Prevention (Africa CDC) to develop a framework for domestic health financing. Africa CDC’s Dr Claudia Shilumani confirmed that efforts are already underway: “We are working with the African Medicines Agency and other partners to create a framework that will outline tangible actions governments can take to increase health sector funding. This will be presented to heads of state in the coming months for a decision.” Meanwhile, Rwanda is already setting an example by integrating existing health financing mechanisms to support long-term goals. In response to health system funding cuts, they have reassessed spending priorities to ensure critical programs remain operational. For example, instead of discontinuing workforce training, they have shifted many in-person trainings to online platforms and redirected the funds to essential programs. Public-private partnerships More attention is also being paid to public-private partnerships (PPPs) and innovative financing models to ensure the long-term sustainability of health programs. The pharmaceutical company Roche has committed to significantly increasing access to diagnostic testing across Africa, aiming to conduct over 3.4 billion tests by 2031 and reach more than 500 million people with quality diagnostics. “Reaching these ambitious goals, especially as Africa’s population continues to grow exponentially, cannot be done alone. Public-private collaboration is key,” said Johnpaul Omollo, Roche’s head of policy and government affairs. “First, we must ensure decentralisation – this is where localization plays a crucial role. As we expand local production, we must also understand what the market truly needs and identify the most essential products we can manufacture locally,” he added. South-South vaccine partnerships Another area where increased partnerships and collaboration will be essential is in vaccine distribution. The US withdrawal from the World Health Organization (WHO) might mean disruptions to vaccine distribution, which could delay availability and hinder efforts to achieve widespread immunity. However, vaccine manufacturers like Serum Institute of India (SII) – the biggest generic producer in the world – are stepping up their efforts to ensure the continued supply of life-saving vaccines. Speaking with Health Policy Watch on the sidelines of the conference, the company highlighted its partnerships with African manufacturers to promote local vaccine production. “We are collaborating with South Africa’s Aspen and Egypt’s Vacsera to establish fill-and-finish vaccine facilities within the continent,” said Anil Kulkarni, SII’s Senior Manager of International Business and Product Management. “In the coming years, we plan to expand these partnerships to more African countries.” SII has also committed to maintaining affordable vaccine prices to ensure that African countries can continue to get vaccines despite global funding challenges. But health experts stress that, for local pharmaceutical production to succeed, it will require a coordinated effort across multiple sectors. “The success of local production will require all hands-on deck. This means the private sector must be involved in understanding community needs, governments must create an enabling policy environment, and supply chains must be strengthened to ensure medicine accessibility,” said Omollo. Charles Okeahalam, president of Amref’s Board, described the current challenges facing Africa’s health systems as a wake-up call for the continent. “If we improve ourselves and systems by just 20%, we could see an 80% improvement in healthcare outcomes. The challenge is real but not as difficult as it might appear.” Image Credits: Edith Magak. Juggernaut of Overweight and Obesity is ‘Monumental Societal Failure’ 04/03/2025 Kerry Cullinan A mother and son in Usolanga, Tanzania. Childhood fat is traditionally seen as a sign of abundance, but it can lead to obesity and related diseases later in life. More than half of all adults and a third of children and adolescents will be overweight or obese by 2050 unless urgent action is taken, according to the most comprehensive global analysis to date, published by The Lancet to coincide with World Obesity Day on Tuesday. This poses an “unparalleled threat of premature disease and death at local, national, and global levels”, according to the Global Burden of Disease Study BMI Collaborators. Overweight and obesity rates in adults (25 or older) and children and adolescents (5-24 years) have more than doubled between 1990 and 2021, affecting 2.1 billion adults (up from 731 million) and 493 million young people (from 198 million). “The unprecedented global epidemic of overweight and obesity is a profound tragedy and a monumental societal failure,” said lead author Professor Emmanuela Gakidou from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the US. In 2019, the estimated total costs associated with obesity, including both direct and indirect costs, ranged from $3·19 billion in low-income countries to $1·33 trillion in high-income countries. Forecasts suggest that, by 2035, the obesity epidemic could lead to a 2·9% reduction in global gross domestic product, equating to a loss of $4 trillion. “Especially high levels have already been reached in Oceania and North Africa and the Middle East, with over 62% of adult males in Nauru, Cook Islands, and American Samoa, and over 71% of adult females in Tonga and Nauru living with obesity in 2021,” according to a media release from The Lancet. China, India, the US, Brazil, Russia, Mexico, Indonesia and Egypt accounted for more than half of the global population living with overweight and obesity in 2021. The US had the highest rates of obesity among high-income countries, with around 42% of males and 46% of females affected by obesity in 2021. In Latin America, 15 of the 17 countries had a prevalence of obesity among females of more than 30%. However, the largest future increases are projected in Asia and sub-Saharan Africa, driven by growing populations. No country has curbed adult obesity No country to date has successfully curbed the rising rates of adult overweight and obesity Among males, the prevalence of overweight and obesity was above 87% in Nauru, American Samoa, Northern Mariana Islands, Cook Islands, and Kuwait. In future, the highest levels for men are predicted in the United Arab Emirates and Nauru, where more than 80% of males are expected to have obesity in 2050. Estimated age-standardised prevalence of overweight and obesity among adult males aged 25 years and older, Among females, the prevalence has reached 88% and above in Tonga, Kuwait, Cook Islands, Nauru, and Samoa. In future, Tonga and Egypt are predicted to dominate with at least 87% of females being overweight or obese by 2050. Estimated age-standardised prevalence of overweight and obesity among female adults aged 25 years and older. “Obesity rates are skyrocketing across sub-Saharan Africa, with 522 million adults and more than 200 million young people expected to be living with overweight or obesity by 2050,” said co-author Awoke Temesgen, Associate Professor at IHME. In Nigeria, the number of overweight and obese adults is projected to more than triple from 36.6 million in 2021 to 141 million in 2050. “Action is urgently needed to implement preventative initiatives such as policies on the marketing of unhealthy foods and planning to include facilities for exercise and playing fields in schools,” added Temesgen. Obesity trends in young people The study predicts a 121% rise in obesity among young people globally by 2050, with the total number of children and adolescents with obesity predicted to reach 360 million. The most rapid increases in obesity in young are forecast for North Africa, the Middle East, Latin America and the Caribbean, where one-third of all the world’s children and adolescents with obesity (130 million) are expected to live in 2050. The transition to obesity predominance (versus overweight) is also expected to be overwhelming for several Oceanic countries, including the Cook Islands, Nauru, Tonga where levels of obesity are expected to reach 60-70% by 2050, as well as for heavily populated countries such as Nigeria (18.1 million), India (26.4 million), Brazil (17.8 million), China (35.2 million), and the US (22.1 million). The authors also note that more recent generations are gaining weight faster than previous ones and obesity is occurring earlier, increasing the risk of complications such as type 2 diabetes, high blood pressure, cardiovascular diseases, and multiple cancers occurring at younger ages. “Our estimates identify children and adolescents in much of Europe and south Asia living with overweight who should be targeted with obesity prevention strategies,” said co-lead author Dr Jessica Kerr from Murdoch Children’s Research Institute in Australia. “We have also identified large populations, particularly adolescent girls, in North America, Australasia, Oceania, north Africa and the Middle East, and Latin America that are expected to tip over to obesity predominance and require urgent, multifaceted intervention and treatment.” Action plans The authors stress that five-year action plans (2025-2030) are urgently required to curb the rise in obesity and help inform new goals and targets post-2030, when the Sustainable Development Goals end. “Preventing obesity must be at the forefront of policies in low- and middle-income countries,” said Kerr. “Policy action in these regions must balance the challenges of overnutrition with undernutrition and stunting, with interventions ranging from support for nutritional diets and regulating ultra-processed foods to promoting maternal and child health programmes that encourage pregnant women to follow a healthy diet and breastfeed. Kerr warned that many countries “only have a short window of opportunity to stop much greater numbers shifting from overweight to obesity”. She called for “much stronger political commitment” to “transform diets within sustainable global food systems and to support comprehensive strategies that improve people’s nutrition, physical activity and living environments, whether it’s too much processed food or not enough parks.” Image Credits: Jen Wen Luoh. COP16 Deal Commits Nations to Raise $200 Billion Annually for Biodiversity; But Funding A Big Lift 03/03/2025 Sophia Samantaroy Coral reefs are a vital breeding ground for fish, a major protein source for 3 billion people. But some 14% of coral reefs died between 2009 and 2018, according to the UN Environment Programme. Countries agreed to raise $200 billion a year by 2030 to help developing countries conserve biodiversity at the resumed Conference of Party (COP16) of the UN Convention on Biodiversity (CBD) in Rome last week. The deal marks a major breakthrough after negotiations over a finance package were suspended last November in the closing hours of COP16 in Cali, Colombia, over funding disagreements. In Rome, more than 140 nations who are parties to the Convention also pledged to raise $20 billion a year from international donors for the new effort, by 2025, and $30 billion by 2030 to support developing nations’ conservation efforts. Although actually reaching those financial goals poses a huge challenge, the commitment marks a major milestone in implementing the landmark 2022 Kunming-Montreal Global Biodiversity Framework (KMGBF). The Framework aims to ensure the conservation or restoration of at least 30% of the planet’s lands, freshwater, and ocean resources by 2030. Currently, only 17% and 10% of the world’s terrestrial and marine surfaces are protected, respectively. The first ever multilateral nature agreement, the Kunming-Montreal framework’s overarching goal is development in “harmony” with nature by 2050. “Montreal was about the ‘what’ — what are we all working towards together?” Georgina Chandler, of the Zoological Society London,was quoted as saying to the Independent. “Cali was supposed to focus on the ‘how’ — putting the plans and the financing in place to ensure we can actually implement this framework.” Before talks in Colombia broke down, countries did manage to reach agreement on a voluntary “Cali Fund” for sharing the genetic benefits derived from genetic resources. And they approved a groundbreaking “health and biodiversity action plan” – as a voluntary mechanism for countries to incorporate health considerations into nature protection plans. But sharp disagreements between developed and developing countries over funding support for other conservation efforts in developing countries emerged in the final hours of the two-week session. As the meeting ran into overtime, the departure of delegates left the COP without a quorum to reach a decision. Resources for reaching key CBD goals Now, last week in Rome, the parties to the CBD finally managed to agree on a way forward for mobilizing significant resource flows to developing countries, whose action is critical to realizing the big aims of the Kunming-Montreal framework. It provides for a structured mechanism to raise funds through a mix of public and private financing, and establishes a permanent arrangement for financing biodiversity conservation in developing nations beyond 2030. Finally, the Rome agreement includes other provisions for planning, monitoring, reporting, and review required to implement the Kunming-Montreal framework – the Paris Accord equivalent for nature. The accord was reached despite the relatively poor showing of delegates – around 40 of the 196 nations that are party to the convention failed to show up. The agreement also comes despite the fact that the United States, historically the world’s largest donor to biodiversity, recently halted most such funding as part of the Trump Administration’s broader foreign aid freeze. The US has never been a formal party to the CBD but had previously played a behind-the-scenes role in advancing the its goals. But while many hailed it as a diplomatic victory, concerns linger over implementation, accountability, and the absence of key nations and specific financial commitments from leading donor states in a time of turbulent global rhetoric around conservation. “We live in a very different world now, and only a handful of countries have sent ministers,” said Arthur Wyns, a climate research fellow based in Melbourne, on a social media post. All in all, the Rome talks boasted only a fraction of attendance of November’s Cali conference, which saw 1,000 delegates in attendance, compared to the 23,000 in Cali. Financing details pushed to 2028 African oil and gas projects are set to quadruple; 90% of projects overlap with sensitive ecosystems, such as the Congo Basin, the world´s second largest rainforest. However, the final agreement deferred a key decision on whether the Global Environment Facility (GEF) would remain the CBD’s primary biodiversity finance mechanism or if a new fund would be created. African and Latin American nations had pushed for a dedicated biodiversity fund, but the decision on that was postponed until at least 2028. The GEF is already managing finances for several other global environmental conventions, such as the Stockholm Convention on persistent organic pollutants, and the UN Framework Convention on Climate Change. And it manages the CBD’s Global Biodiversity Framework Fund (GBFF), dedicated to implementing the Kunming-Montreal targets. The Fund has issued over $3 billion in biodiversity finance since its creation in 2022. Meeting ambitious targets With the Trump administration freezing most nature-related foreign aid and European nations cutting their aid budgets, doubts persist over how the ambitious financial targets for this new fund will be met. More than 75% of nations have yet to submit their national biodiversity plans, as per the 2022 Kunming-Montreal agreement, despite the October deadline passing four months ago. Even among those that have submitted plans, over half fail to include the KMGBF’s headline goal of protecting 30% of land and oceans by 2030. Additionally, nations with biodiversity hotspots, notably Brazil and those in the Congo Basin, failed to adopt at least one national CBD target. Cali Fund for profit-sharing of profits made from genetic resources launched The Rome COP also saw the launch of the Cali Fund, a new voluntary initiative to facilitate voluntary corporate profit-sharing of revenues generated from the use and development of indigenous genetic resources, or genetic Digital Sequence Information (DSI), into new foods, cosmetics or pharma products. Big food, cosmetics and pharmaceutical companies worldwide now harness and use genetic resources, captured as DSI, across far-flung borders, to create new products worth billions of dollars annually. Developing countries have long maintained that they are left out of the loop of benefits that come from the harvesting of new genetic resources in their regions. The new plan marks the first global attempt to address the imbalance. The initiative, agreed to last November in Colombia targets companies meeting two of three thresholds: annual sales exceeding $50 million, profits over $5 million, or assets above $20 million. These firms “should” contribute either 1% of revenue or 0.1% of profits generated from the use of indigenous genetic material to the new “Cali Fund” to support developing country biodiversity preservation and restoration. The rates remain “indicative” and the arrangement “voluntary”, according to the agreement – whose details still need to be worked out. “Success of the Cali Fund will be critical for providing finance to people on the ground who are custodians for species and genetic diversity. We are proud to be a founding partner for this groundbreaking Fund,” said Marcos Neto, Director of UNDP’s Sustainable Finance Hub, in a press statement, upon the launch of the new scheme. ‘Not Charity’ COP16 President, Susana Muhamed of Colombia, confers with the Secretariat at COP16’s second edition in Rome. The Cali Fund is not for “charity from companies,” but “fair payment for use of global biodiversity,” as Susana Muhamad, CBD president and former Colombian Minister of Environment and Sustainable Development said in a press conference. Furthermore, “at least 50% of the Cali Fund resources will be allocated to indigenous peoples and local communities, recognizing their role as custodians of biodiversity,” the UN said in a statement, building upon agreements in Cali that gave Indigenous peoples and local communities a stronger voice in conservation matters. Pharmaceutical companies have also warned that the initiatives such as the Cali Fund also risks taking the world down a slippery slope that “stifles” easy access to genetic material and to medical innovation – particularly if something now framed as a voluntary measure eventually becomes mandatory. “The pharmaceutical industry has long supported the Convention on Biological Diversity’s objective to protect our natural world,” said David Reddy, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a statement following November’s Cali round. But “[t]he ability to rapidly use scientific data known as “digital sequence information” (DSI) is essential for developing new medicines and vaccines,” he warned. “Any new system should not introduce further conditions on how scientists access such data and add to a complex web of regulation, taxation and other obligations for the whole R&D ecosystem – including on academia and biotech companies. “Ahead of COP17, it is critical that governments work to ensure the implementation of any new mechanism on digital sequence information does not stifle medical research and innovation that can bring the next wave of medical progress to people around the world.” Biodiversity continues to declines Heavy deforestation in hotspots, such as the Amazon and Congo river basins, threatens biodiversity as well as increasing the risks to human communities of zoonotic diseases transmitted by displaced animal species. The new financial agreements come at a critical time in which biodiversity loss continues to accelerate. Global wildlife populations have declined by 73% since 1970, with more than one million species at risk of extinction, according to the World Wildlife Fund’s Living Planet Report. This means that a quarter of species are threatened – and only the ones researchers were able to study. Along with the conservation and/or restoration of 30% of the world’s degraded ecosystems (Target 2), the Kunming-Montreal accord’s 23 targets also include: Target 6 – reduction of invasive species by 50%; Target 12 – enhancement of urban greenspaces; Target 13 – increasing the sharing of benefits from genetic resources, digital sequence information and traditional knowledge. “The results of this meeting show that multilateralism works and is the vehicle to build the partnerships needed to protect biodiversity and move us towards Peace with Nature,” said Astrid Schomaker, Executive Secretary of the CBD. “As we do this and implement the other supporting elements for resource mobilization, the world will have given itself the means to close the biodiversity finance gap. Meanwhile, the decision reached in Cali on a health and biodiversity framework also gives countries a clear framework for integrating health more squarely into biodiversity planning. The framework calls for health impact assessments in land-use planning, disease surveillance where habitat loss is rapid, and stricter wildlife trade rules vital to preventing pathogens spreading from wild animals to human communities and food markets. But that still doesn’t go far enough to protect people from the risk of spill-over events, critics say. “Our health cannot be separated from the health of the planet and its many species,” UN Environment chief Inger Andersen told delegates in Cali last November. “We must adopt this action plan and implement it with a holistic, systemic approach that unifies action across health, environment, finance, industry and agriculture.” Nations are set to reconvene next year in Yerevan, Armenia, for COP17. See more Health Policy Watch coverage of Cali and biodiversity here. Image Credits: Oleksandr Sushko, Rainforest Foundation and Earth Insights, 2022, IISD/ENB | Mike Muzurakis, Earth.org. Common US Infant Formulas Are Laden with High Levels of Added Sugars 03/03/2025 Sophia Samantaroy The WHO and the American Academy of Pediatrics “support the unequivocal evidence that breastfeeding protects against a variety of diseases and conditions.” Most infant formulas in the United States contain a high percentage of added sugars instead of natural lactose, “jeopardizing” infant health and development, says researchers at the University of Kansas in a new analysis of commonly marketed formulas. “Infants may consume upwards of 60 grams of added sugars per day, or the equivalent of two soft drinks per day if they are entirely formula-fed,” researchers say in the study, published last week in the Journal of Food Composition and Analysis. The publication came as the Food and Drug Administration (FDA) delayed implementation of a rule that tightens what foods manufacturers are allowed to label as “healthy.” The study, which analyzed 73 infant formulas available in 2022, found that “gentle” and lactose-free formulas contained the highest proportion of added sugar, with median levels reaching 85% and 90% of total sugars, respectively. On average, formula-fed infants consume 7-8 grams of added sugar per serving – a quick form of energy, but lacking in nutritional value. Health experts warn that high sugar consumption in infancy, in the form of sucrose, glucose, and high-corn fructose, may contribute to rapid weight gain and early obesity, increasing the risk of chronic conditions such as diabetes later in life. 20% of US children have obesity – a figure that is only expected to rise in the coming decades. Babies exposed to sugary foods also develop a strong preference for more sugar, says the authors. But “lax” federal guidelines make it difficult for parents and caregivers to avoid added sugars in infant formula because of the “staggering extent” to which US formula contradicts federal healthy diet recommendations. The FDA does not require manufacturers to report sugars in US formulas, in “sharp contrast” to adult food regulations, which must display a breakdown of total carbohydrates and added sugars, despite federal dietary guidelines recommending zero added sugars for infants under two years old. “As a result, parents and guardians may unknowingly feed their infants formula that contains substantial quantities of added sugars… which likely present a substantial risk to their infant’s health and development.” A systemic issue It was only after the Affordable Care Act that employers were mandated to provide space for nursing mothers other than a bathroom. But state laws are still patchwork protection, and do not require compensation for time spent breastfeeding. Even though the researchers build upon a body of evidence showing the risks to formula feeding – including an increased risk of gastroenteritis, diarrhea, ear infections, and chronic illnesses – they acknowledge that larger, systemic issues bar families from breastfeeding. The World Health Organization (WHO) recommends that parents exclusively breastfeed for the first six months. But in the US, “extremely” limited social support, no paid maternity leave, and the lack of affordable early childcare means that reliance on formula is a “necessity” for most parents, the authors say. Those from low socioeconomic status backgrounds are the most disadvantaged. “[T]he structure of the US system and environment often leaves parents and caregivers with little choice but to use formula in some capacity,” write study authors Audrey Rips-Goodwin, Daiil Jun, Adrianne Griebel-Thompson, Kai Ling Kong, and Tera Fazzino. “[W]e reason that the focus on an individual-level solution (breastfeeding promotion to women and caregivers) is not well matched to addressing the systemic nature of the problem and places an unfair burden on women and families who are expected to navigate this systemic issue. “Ideally, the US labor system should support breastfeeding, and healthcare professionals should be properly trained and incentivized to promote it.” “At the federal level there is no requirement for paid maternity/paternity leave and very little structural support to promote breastfeeding. Given the vast limitations in systemic support of new mothers and parents, most turn to using formula out of necessity. US parents deserve an infant formula supply that does not jeopardize infant health due to the presence of added sugars,” said Dr Tera Fazzino, study author and associate professor of psychology and associate director of the Cofrin Logan Center for Addiction Research and Treatment at the University of Kansas. Formulas with lactose could be safer, if made available Lactose, which is naturally found in breast milk and cow and goat milk, is sometimes used as a base for formula. Infants digest the more complex form of sugar slower, boosting their nutrition and metabolism, and engaging in hunger satiation hormones. Unlike the added sugars in most formulas – high fructose corn syrup, glucose, sucrose – lactose does not cause the same blood sugar spike. “These non-lactose sugars also typically garner more pronounced neurochemical reward responses and glycemic responses relative to lactose. Therefore it is really important for infants to consume lactose and avoid consumption of other types of added sugars, which is in line with US Dietary Guidelines,” said Fazzino. Only 8% of US formulas contained primarily naturally lactose, but the type is no longer available in the US. And it is unknown whether any other formulas use the safer sugar. “When people have free choice, the choices should include options that promote infants’ health and development. In the case of the US formula supply, our findings indicate that parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Fazzino. The researchers argue that lactose-containing formulas are safer for infants, and that efforts should focus on “requiring formula companies to produce products that primarily contain naturally occurring lactose and are designed to minimize risks to healthy infant development.” Unclear if FDA will improve labelling after delay ‘Parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Dr Fazzino. Even with increased rhetoric around chronic diseases in the US, notably HHS Secretary Robert F Kennedy’s push to “Make America Healthy Again,” the role of infant formulas to early-life infant weight gain is largely overlooked. The FDA has delayed implementing a rule that would redefine which foods can be labeled as “healthy.” The regulation, which aims to prevent manufacturers from marketing sugary juices, processed sweets, and certain meats as “healthy” options, was initially set to take effect on 25 February but has now been pushed back to 28 April, according to HHS. The delay stems from a broader freeze on new rule proposals across the Trump administration, and an upheaval of firings in the past weeks. The department lost several thousand employees, including those working in food safety. Currently, infant formula labels do not disclose added sugar content, allowing products with high levels of sucrose, glucose, and corn syrup solids to be sold without clear warning. During the first Trump administration, US officials tried to derail a resolution at the 2018 World Health Assembly to promote breastfeeding, attempting to remove language urging governments to “protect, promote and support breast-feeding” and restrictions on the promotion of food unhealthy food products to children. The original sponsor of the resolution, Ecuador, withdrew after US threatened it with trade sanctions. “We need much clearer labeling requirements for formulas in the US, specifically regarding the reporting of added sugars,” Fazzino told Health Policy Watch. “Support from the federal government and associated entities is really needed to improve infant formula labeling requirements.” But Fazzino acknowledged that labelling reform is “not on their radar;” rather, the FDA is more concerned about shoring up the formula supply chain after shortages in 2022 rocked the US market. The FDA declined to respond to Health Policy Watch’s request for comment. Formula companies deploy “same tactics” as tobacco industry A Nestle advertisement from 1911 undermines breastfeeding. Formula companies were among those identified in a 2023 Lancet series on the mechanisms and scope of commercial determinants of health, examining how the private sector influences health through activities like product design, packaging, supply chains, lobbying, research funding, and marketing. These companies “are escalating avoidable levels of ill health, planetary damage, and inequity.” These include formula milk companies’ extensive lobbying networks and “predatory” marketing tactics that derailed progress on breastfeeding education. In response, just last month the WHO at its Executive Board meeting proposed a resolution to regulate digital marketing of breastmilk substitutes, after the WHO’s findings that the formula industry uses “exploitative” marketing strategies. The resolution focuses on the fact that digitial marketing – through influencers and paid content – rely on personalized data to “innapropriately” promote infant formula, and undermine recommendations from healthcare providers and national authorities. The threat of targeted misinformation led the WHO to issue guidance on “regulatory measures aimed at restricting digital marketing of breast-milk substitutes” in November 2022, following its report that “the global formula milk industry, valued at some $55 billion, is targeting new mothers with personalized social media content that is often not recognizable as advertising.” The study also follows investigations into how formula companies promoted their product as “healthy” in lower-and middle-income countries, despite high levels of added sugar. But as the authors note, hidden added sugars also plague US infant formulas. “Ultimately, caregivers and infants in the US deserve a formula market that promotes healthy infant development and does not promote early obesity risk.” Image Credits: FDA, University of Minnesota , Enfamil. ‘The Centre Must Hold’: Africa’s Health Leaders Rally for Bold Action 03/03/2025 Edith Magak Africa CDC’s Dr Claudia Shilumani, Rwandan Health Minister Dr Sabin Nsanzimana, Dr Githinji Gitahi, CEO of Amref Health Africa and Dr Chikwe Ihekweazu, acting WHO Regional Director for Africa KIGALI, Rwanda – “Sad”, “Worried” and “The centre is shaking”, were some of the reactions of African health leaders to the termination of US aid at a media briefing on Sunday (2 March) ahead of the 6th Africa Health Agenda International Conference (AHAIC). But speakers also stressed the need for resilience and swift action at the briefing ahead of the conference, which is hosted by Amref Health Africa in collaboration with Rwanda’s Ministry of Health, the World Health Organization (WHO) Africa Office for Africa, and the Africa Centres for Disease Control and Prevention (Africa CDC). “The centre of our health system on the continent must hold,” stressed Rwandan Minister of Health Dr Sabin Nsanzimana. “Even as financing declines, we must find ways to increase it – whether through domestic sources or partnerships with those who see health as an investment in humanity.” Nsanzimana believes Africa can find alternative funding sources to fill many of the gaps left by the massive cuts to US Agency for International Development (USAID) funding. “There’s always money somewhere,” he explained. “When some of our medical students in surgery and midwifery were at risk of pausing their long-term training because they were supported by financing that was stopped overnight, we reassessed our priorities. we looked at cross-sector health projects and found over 5 billion Rwandan francs [over $5 million] tied up in short-term training and workshops. “We asked ourselves: ‘Do we keep funding weekly training that people can read online, or do we invest in long-term workforce programs?’,” he said. Rwanda has now redirected those funds to keep students enrolled, shifting the current workshops to online platforms. Africa must “think beyond traditional funding models and use what we have to meet our most urgent needs”, he stressed. This will be one of the pressing question considered by the over 1,800 delegates from 56 countries attending the conference. Significant risks “This year’s conference comes at a time of significant risks to African communities and health systems,” said Dr Githinji Gitahi, CEO of Amref Health Africa, who called for Africa’s health systems to be redesigned to address the dual burden of infectious and non-communicable diseases (NCD). Many African countries bear high burdens of infectious diseases while also facing a surge in non-communicable diseases. NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. “The health system we have today is not the one we’ll need tomorrow,” said Gitahi. “[But] we have minimal fiscal space. With population growth, economic shifts, and tax inefficiencies, how do we mobilize resources to fight both infectious and non-communicable diseases with limited funds?” “Many of us didn’t anticipate the scale of change – cuts in government assistance from not only the US government but also Germany, the UK, and others. Our current health systems have relied heavily on external support. We must rethink how to sustain them in the future,” Gitahi added. Speakers also emphasized that ,while communities are aware of diseases like malaria and HIV, many are unaware of the risk factors driving NCDs such as cancer, cardiovascular diseases, and strokes. Artifical intelligence and climate change Beyond the urgent discussions on funding, the AHAIC conference is also focusing on topics including climate-resilient health policies, the growing burden of both infectious and non-communicable diseases, artificial intelligence in healthcare, and strengthening local pharmaceutical manufacturing. Dr Claudia Shilumani, Africa CDC director of external relations and strategic management, warned of increasing health threats linked to climate change. Africa CDC is currently monitoring 243 health threats across the continent, with 84 significant events recorded in the first few weeks of 2025. Artificial intelligence is also a major focus, with discussions on how technology can be leveraged to improve diagnostics, treatment, and hospital management. Delegates acknowledged that while Africa needs thousands of trained professionals to meet healthcare demands, AI-driven solutions could help bridge the gap by enhancing efficiency in service delivery. Efforts to align policies across Africa are also gaining traction. The Africa CDC is working closely with the African Medicines Agency to streamline drug approvals and distribution across the continent. There is also a push to fast-track the qualification process for local manufacturers, ensuring national health strategies align with continental frameworks like the Africa Safety Strategic Plan. Health resilience Dr Matshidiso Moeti, outgoing WHO Africa Regional Director, highlighted the remarkable progress Africa’s health systems have made over the years. She noted that the continent has confronted pandemics, eliminated once-deadly viruses, and turned death sentences into manageable conditions. Despite these achievements, Moeti emphasized that significant challenges remain. She pointed to the deepening link between health, economic stability, and the environment, warning that widening economic disparities, climate change, and conflict continue to threaten healthcare systems. “One constant has been our collective commitment to building a healthier, stronger Africa.” Image Credits: Edith Magak, WHO/NCD Portal. DRC Identifies New Mpox Variant and Investigates New Febrile Disease Outbreak 28/02/2025 Kerry Cullinan Dr Ngashi Ngongo A new and potentially more infectious variant of mpox Clade 1A has been identified in the Democratic Republic of the Congo (DRC) according to Dr Ngashi Ngongo, head of the mpox incident management team at the Africa Centre for Disease Control and Prevention (Africa CDC). The termination of USAID funding and violence in eastern DRC are hampering mpox testing and reporting, with test results being reduced to a trickle. Only 35% of mpox cases are currently being tested in DRC, both because of conflict and the ending of USAID funds to transport mpox tests to laboratories. The DRC finally started to vaccinate people in Kinshasa this week, and uptake was swift with over 24,800 people vaccinated over four days, said Ngongo. Mpox is continuing to spread in Uganda, which has seen case increases for three weeks in a row – 278 new cases in the past week. Mpox cases are overwhelming health facilities. For example, a treatment centre in Entebbe with 80-bed capacity currently has 102 patients. “Because of this, the leadership in the [Ugandan] Ministry of Health has now opted also to introduce home-based care for non-severe cases,” said Ngongo. Meanwhile, South Africa reported three mpox cases after being free of the disease for over 90 days. The World Health Organization resolved this week to keep mpox as a public health outbreak of international concern “based on the continuing rise in numbers and geographic spread, the violence in the eastern DRC, which hampers the response, as well as a lack of funding to implement the response plan”, according to the WHO. Febrile disease in DRC DRC health authorities are investigating a febrile disease outbreak in five villages in the Basankusu and Bolomba health zones in Equateur province. This has tripled deaths over the past three weeks, according to WHO. A total of 943 cases and, 52 deaths have been reported, with symptoms including fever, chills, sweating, headache and muscle pain.\, said Ngongo. There are no haemorrhagic symptoms and Ebola and Marburg tests are negative, making malaria the most likely cause, he added. “Children below five years make about 18% of cases with a case fatality of 5.3%. Children ages five to 15 years make up 20% of all cases, with a case fatality of 6.4%,” said Ngongo. “The diagnostic is pointing towards malaria. Rapid tests that were conducted on over 500 samples gave a positivity rate of 55% but there are also blood smears that were also conducted, around 70 samples, that also gave a positivity rate of almost 78%,” said Ngongo. “Further tests are to be carried out for meningitis. Food, water and environmental samples will also be analysed, to determine if there might be contamination,” according to the WHO. “Basankusu and Bolomba are about 180 kilometres apart and more than 300 kilometres from the provincial capital, Mbandaka. The two localities are reachable by road or via the Congo River from Mbandaka. This remoteness limits access to health care, including testing and treatment. Poor road and telecommunication infrastructure are also major challenges,” saif the WHO in a statement. US Terminates Thousands of Life-Saving Global Health Grants Including For HIV, TB and Malaria 27/02/2025 Kerry Cullinan Protestors gathered outside USAID headquarters in Washington D.C. after employees were informed via email to not come in to work. The Trump administration has terminated the contracts of nearly 10,000 global health projects funded by the US Agency for International Development (USAID) or the US State Department – including projects to provide vital diagnosis and treatment for HIV, tuberculosis, and malaria, as well as humanitarian aid projects providing nutrition and water and sanitation services. Grants to hundreds of African HIV organisations providing life-saving services have been terminated with immediate effect via letters received on Thursday morning. Globally, the terminated awards include 5,800 grants administered by the USAID and 4,100 grants for projects managed directly by the State Department. Some of the terminated programmes had previously been granted temporary waivers, due to their roles in providing lifesaving health or humanitarian aid. The Trump administration also announced Thursday that it was halting US funding to the Joint UN Programme on HIV/AIDS (UNAIDS), which is headquartered in Geneva, just across from the World Health Organization. “All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated,” said Dr Atul Gawande, USAID’s former assistant administrator under the Biden administration. Terminated, too, are all global tuberculosis programmes, all US-made food aid programmes, which manufacture specially enriched foods aimed at malnourished women and children, and around 1000 food kitchens serving displaced people in countries such as war-torn Sudan. “This is one of the worst days of my professional life,” said Dr Kate Rees of Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups. “Tomorrow, we are letting go 2,800 people who are mainly peer educators and data capturers.” Prof Linda-Gail Bekker, CEO of the South African Desmond Tutu HIV Foundation, said that the US termination would cost 500,000 South African lives over the next 10 years and result in around half a million new HIV infections, according to recent modelling. “As an activist, as a person living openly with HIV, I’m very hurt,” said Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “How am I going to survive? Will the public health care system be able to cater for us? Will be able to cover all the gaps that we are facing with all the challenges that the public healthcare system has?” South Africa has the highest burden of HIV in the world with eight million people living with the virus (over 16% of the adult population). All 44 South African HIV programmes that receive money from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID have seen their aid terminated. Projects affected range from mother-to-child transmission programmes and hospices to research groups. Many focus on “key populations”, groups that are the most vulnerable to HIV but often shun health centres in fear of discrimination. “I’ve been having a sleepless night trying to think how best we can save our communities because we know that some of the government healthy facilities are very discriminatory,” said Kholi Buthelezi, national coordinator of the sex worker organisation, Sisonke. HIV activist Sibongile Tshabalala, who lives with the virus, is fearful for her future. HIV programmes devastated across Africa HIV programmes across the continent have also been devastated. The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children. Late yesterday, we received award termination notices for three of our primary USAID agreements. Read our full statement. https://t.co/VpBNduu036 pic.twitter.com/0hAP17JqxG — Elizabeth Glaser Pediatric AIDS Foundation (@EGPAF) February 27, 2025 In Uganda, for example, the Baylor College of Medicine Children’s Foundation’s HIV and TB programmes, that strengthens district health systems to better deliver HIV, TB and maternal and child services, has been terminated. The termination letters all state that US Secretary of State Marco Rubio, in his capacity as acting administrator for USAID and Peter Marocco, USAID acting deputy administrator, “have determined your award is not aligned with agency priorities and made a determination that continuing this program is not in the national interest”. ‘Chaos and disaster’ The terminations have caused “chaos” and “disaster”, said emotional South African leaders of the HIV sector who urged their government to step in to save their programmes. Fatima Hassan, head of the Health Justice Initiative, urged the South African government to issue compulsory licenses to reduce the price of antiretroviral medicine as the US has already “done the worst to us”. “US Congress approved the funds, and that is what has been stopped. So we do believe that it’s an illegal grab. It’s an illegal halt of services and programs. It’s not following due process,” Hassan added. The terminations will decimate South Africa’s HIV testing, data collection and HIV and TB literacy, said public health expert Dr Lynne Wilkinson, who added that USAID funds also assisted groups combating gender-based violence. However, South Africa is luckier than many other African countries as it derives around 17% of its HIV budget from PEPFAR. The Democratic Republic of Congo (DRC) gets 89% of its HIV budget from PEPFAR, while Mozambique and Tanzania get 60% of their HIV budget from the US. USAID: Countries most reliant on US aid for HIV ‘Blanket freeze is illegal’ Mitchell Warren, head of the US-based HIV programme AVAC, described the blanket termination of USAID grants as “unlawful”. “The US government’s in a very strong position with any cooperative agreement or grant or contract. They’re allowed to cancel agreements or amend them. They’re in a very strong position generally, but the blanket freeze is illegal,” said Warren, whose organisation has resorted to the courts to prevent the cutting of lifesaving aid. AVAC’s Mitchell Warren “We have been now in a federal court for several weeks, and a temporary restraining order was provided two weeks ago by the Court that said that things had to go back. The tap had to be put back on until this 90 day review actually took place in a comprehensive way,” he added. “We now have evidence entered into the public record in the courts that show the intentionality at USAID and the State Department to dismantle everything but the government has simply thrown up additional legal delays, as is their want,” said Warren. A federal judge had set Wednesday at midnight as the deadline for USAID to release some $1,5 billion funds for the foreign aid work already completed, but the US Supreme Court granted the government a stay on the release of funds until the court could apply itself more thoroughly to the issue. “We expect a hearing next week in Washington,” said Warren. “This is not about PEPFAR. This is not about the HIV response. This is not about USAID. This is about the rule of law. The United States Congress has the power of the purse. They decide what gets spent. The executive branch is there to execute, and that’s the basis of this legal argument. “But as of [Wednesday] night, they began to basically massacre every possible implementing agency to deliver on this work. This court case, as important as it is, is not going to change that overnight. That’s why working in partnership with each other and with national governments is essential because the United States is not a partner that is trustworthy right now,” Warren concluded. Image Credits: Reuters Youtube, Gandhi A, et al, Annals of Internal Medicine, 11 Feb. 2025, UNAIDS. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
The $40 Question: Can Africa Close the Health Financing Gap? 04/03/2025 Edith Magak Safiya Shuaibu (Nigeria Health Watch), Professor Mamadou Samba, Côte d’Ivoire’s Director General of Public Health and Hygiene, Aminata Wurie (Resilience Action Network Africa) and Roche’s Johnpaul Omollo. KIGALI, Rwanda – On average, African Health Ministers only have $40 per capita for health expenditure in comparison to $4,000 that ministers in many high-income countries have. How the continent can provide the maximum level of healthcare with such limited resources is one of the key questions that delegates to the Sixth Africa Health Agenda International Conference (AHAIC) in Kigali are trying to answer. There is consensus that aid is no longer a reliable solution in light of overnight funding cuts by the United States, and more incremental cuts from Europe. South-South solidarity and drawing more effectively on domestic resources are emerging as likely solutions. ’“To be honest, we cannot afford healthcare for everyone, but we can afford health, which will reduce our overall healthcare costs,” admitted Amref Health Group CEO, Dr Githinji Gitahi. Prevention Over Treatment The first short-term solution to manage the $40 well is by focusing on the basics and prioritizing prevention over treatment. “The foundation of health is clean water for everyone. It is sanitation for everyone. It is access to nutritious food to reduce the risk of non-communicable diseases. It is a strong emphasis on immunization. If we prioritize these, we will save significantly on future healthcare costs,” Gitahi explained. More investment in community health workers than expensive medical equipment like PET scans and MRI machines is also prudent. “Health is built at home – hospitals are there to repair,” he added. “We need to redesign our health systems to make prevention, primary care, and community health the core pillars.” Increasing the $40 However, even with careful management and efficiency, stakeholders agree that $40 is simply not enough. “We need political action now. Within our national budgets, health is not at the forefront. How many countries have actually reached the commitment of allocating 15% of their national budget to health? Just two – South Africa and Cape Verde,” said Aminata Wurie, project manager at Resilience Action Network Africa (RANA). This year, only one out of the 55 African countries allocated more than 5% of GDP to health while only two out of 55 countries have met the 15% Abuja Declaration commitment. Last month, Rwandan President Paul Kagame, the African Union’s (AU) Champion on Domestic Health Financing, hosted a High-Level Health Financing Conference in Addis Ababa to discuss alternative domestic sources of health funding. One of the key outcomes was a mandate for the Africa Centre for Disease Control and Prevention (Africa CDC) to develop a framework for domestic health financing. Africa CDC’s Dr Claudia Shilumani confirmed that efforts are already underway: “We are working with the African Medicines Agency and other partners to create a framework that will outline tangible actions governments can take to increase health sector funding. This will be presented to heads of state in the coming months for a decision.” Meanwhile, Rwanda is already setting an example by integrating existing health financing mechanisms to support long-term goals. In response to health system funding cuts, they have reassessed spending priorities to ensure critical programs remain operational. For example, instead of discontinuing workforce training, they have shifted many in-person trainings to online platforms and redirected the funds to essential programs. Public-private partnerships More attention is also being paid to public-private partnerships (PPPs) and innovative financing models to ensure the long-term sustainability of health programs. The pharmaceutical company Roche has committed to significantly increasing access to diagnostic testing across Africa, aiming to conduct over 3.4 billion tests by 2031 and reach more than 500 million people with quality diagnostics. “Reaching these ambitious goals, especially as Africa’s population continues to grow exponentially, cannot be done alone. Public-private collaboration is key,” said Johnpaul Omollo, Roche’s head of policy and government affairs. “First, we must ensure decentralisation – this is where localization plays a crucial role. As we expand local production, we must also understand what the market truly needs and identify the most essential products we can manufacture locally,” he added. South-South vaccine partnerships Another area where increased partnerships and collaboration will be essential is in vaccine distribution. The US withdrawal from the World Health Organization (WHO) might mean disruptions to vaccine distribution, which could delay availability and hinder efforts to achieve widespread immunity. However, vaccine manufacturers like Serum Institute of India (SII) – the biggest generic producer in the world – are stepping up their efforts to ensure the continued supply of life-saving vaccines. Speaking with Health Policy Watch on the sidelines of the conference, the company highlighted its partnerships with African manufacturers to promote local vaccine production. “We are collaborating with South Africa’s Aspen and Egypt’s Vacsera to establish fill-and-finish vaccine facilities within the continent,” said Anil Kulkarni, SII’s Senior Manager of International Business and Product Management. “In the coming years, we plan to expand these partnerships to more African countries.” SII has also committed to maintaining affordable vaccine prices to ensure that African countries can continue to get vaccines despite global funding challenges. But health experts stress that, for local pharmaceutical production to succeed, it will require a coordinated effort across multiple sectors. “The success of local production will require all hands-on deck. This means the private sector must be involved in understanding community needs, governments must create an enabling policy environment, and supply chains must be strengthened to ensure medicine accessibility,” said Omollo. Charles Okeahalam, president of Amref’s Board, described the current challenges facing Africa’s health systems as a wake-up call for the continent. “If we improve ourselves and systems by just 20%, we could see an 80% improvement in healthcare outcomes. The challenge is real but not as difficult as it might appear.” Image Credits: Edith Magak. Juggernaut of Overweight and Obesity is ‘Monumental Societal Failure’ 04/03/2025 Kerry Cullinan A mother and son in Usolanga, Tanzania. Childhood fat is traditionally seen as a sign of abundance, but it can lead to obesity and related diseases later in life. More than half of all adults and a third of children and adolescents will be overweight or obese by 2050 unless urgent action is taken, according to the most comprehensive global analysis to date, published by The Lancet to coincide with World Obesity Day on Tuesday. This poses an “unparalleled threat of premature disease and death at local, national, and global levels”, according to the Global Burden of Disease Study BMI Collaborators. Overweight and obesity rates in adults (25 or older) and children and adolescents (5-24 years) have more than doubled between 1990 and 2021, affecting 2.1 billion adults (up from 731 million) and 493 million young people (from 198 million). “The unprecedented global epidemic of overweight and obesity is a profound tragedy and a monumental societal failure,” said lead author Professor Emmanuela Gakidou from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the US. In 2019, the estimated total costs associated with obesity, including both direct and indirect costs, ranged from $3·19 billion in low-income countries to $1·33 trillion in high-income countries. Forecasts suggest that, by 2035, the obesity epidemic could lead to a 2·9% reduction in global gross domestic product, equating to a loss of $4 trillion. “Especially high levels have already been reached in Oceania and North Africa and the Middle East, with over 62% of adult males in Nauru, Cook Islands, and American Samoa, and over 71% of adult females in Tonga and Nauru living with obesity in 2021,” according to a media release from The Lancet. China, India, the US, Brazil, Russia, Mexico, Indonesia and Egypt accounted for more than half of the global population living with overweight and obesity in 2021. The US had the highest rates of obesity among high-income countries, with around 42% of males and 46% of females affected by obesity in 2021. In Latin America, 15 of the 17 countries had a prevalence of obesity among females of more than 30%. However, the largest future increases are projected in Asia and sub-Saharan Africa, driven by growing populations. No country has curbed adult obesity No country to date has successfully curbed the rising rates of adult overweight and obesity Among males, the prevalence of overweight and obesity was above 87% in Nauru, American Samoa, Northern Mariana Islands, Cook Islands, and Kuwait. In future, the highest levels for men are predicted in the United Arab Emirates and Nauru, where more than 80% of males are expected to have obesity in 2050. Estimated age-standardised prevalence of overweight and obesity among adult males aged 25 years and older, Among females, the prevalence has reached 88% and above in Tonga, Kuwait, Cook Islands, Nauru, and Samoa. In future, Tonga and Egypt are predicted to dominate with at least 87% of females being overweight or obese by 2050. Estimated age-standardised prevalence of overweight and obesity among female adults aged 25 years and older. “Obesity rates are skyrocketing across sub-Saharan Africa, with 522 million adults and more than 200 million young people expected to be living with overweight or obesity by 2050,” said co-author Awoke Temesgen, Associate Professor at IHME. In Nigeria, the number of overweight and obese adults is projected to more than triple from 36.6 million in 2021 to 141 million in 2050. “Action is urgently needed to implement preventative initiatives such as policies on the marketing of unhealthy foods and planning to include facilities for exercise and playing fields in schools,” added Temesgen. Obesity trends in young people The study predicts a 121% rise in obesity among young people globally by 2050, with the total number of children and adolescents with obesity predicted to reach 360 million. The most rapid increases in obesity in young are forecast for North Africa, the Middle East, Latin America and the Caribbean, where one-third of all the world’s children and adolescents with obesity (130 million) are expected to live in 2050. The transition to obesity predominance (versus overweight) is also expected to be overwhelming for several Oceanic countries, including the Cook Islands, Nauru, Tonga where levels of obesity are expected to reach 60-70% by 2050, as well as for heavily populated countries such as Nigeria (18.1 million), India (26.4 million), Brazil (17.8 million), China (35.2 million), and the US (22.1 million). The authors also note that more recent generations are gaining weight faster than previous ones and obesity is occurring earlier, increasing the risk of complications such as type 2 diabetes, high blood pressure, cardiovascular diseases, and multiple cancers occurring at younger ages. “Our estimates identify children and adolescents in much of Europe and south Asia living with overweight who should be targeted with obesity prevention strategies,” said co-lead author Dr Jessica Kerr from Murdoch Children’s Research Institute in Australia. “We have also identified large populations, particularly adolescent girls, in North America, Australasia, Oceania, north Africa and the Middle East, and Latin America that are expected to tip over to obesity predominance and require urgent, multifaceted intervention and treatment.” Action plans The authors stress that five-year action plans (2025-2030) are urgently required to curb the rise in obesity and help inform new goals and targets post-2030, when the Sustainable Development Goals end. “Preventing obesity must be at the forefront of policies in low- and middle-income countries,” said Kerr. “Policy action in these regions must balance the challenges of overnutrition with undernutrition and stunting, with interventions ranging from support for nutritional diets and regulating ultra-processed foods to promoting maternal and child health programmes that encourage pregnant women to follow a healthy diet and breastfeed. Kerr warned that many countries “only have a short window of opportunity to stop much greater numbers shifting from overweight to obesity”. She called for “much stronger political commitment” to “transform diets within sustainable global food systems and to support comprehensive strategies that improve people’s nutrition, physical activity and living environments, whether it’s too much processed food or not enough parks.” Image Credits: Jen Wen Luoh. COP16 Deal Commits Nations to Raise $200 Billion Annually for Biodiversity; But Funding A Big Lift 03/03/2025 Sophia Samantaroy Coral reefs are a vital breeding ground for fish, a major protein source for 3 billion people. But some 14% of coral reefs died between 2009 and 2018, according to the UN Environment Programme. Countries agreed to raise $200 billion a year by 2030 to help developing countries conserve biodiversity at the resumed Conference of Party (COP16) of the UN Convention on Biodiversity (CBD) in Rome last week. The deal marks a major breakthrough after negotiations over a finance package were suspended last November in the closing hours of COP16 in Cali, Colombia, over funding disagreements. In Rome, more than 140 nations who are parties to the Convention also pledged to raise $20 billion a year from international donors for the new effort, by 2025, and $30 billion by 2030 to support developing nations’ conservation efforts. Although actually reaching those financial goals poses a huge challenge, the commitment marks a major milestone in implementing the landmark 2022 Kunming-Montreal Global Biodiversity Framework (KMGBF). The Framework aims to ensure the conservation or restoration of at least 30% of the planet’s lands, freshwater, and ocean resources by 2030. Currently, only 17% and 10% of the world’s terrestrial and marine surfaces are protected, respectively. The first ever multilateral nature agreement, the Kunming-Montreal framework’s overarching goal is development in “harmony” with nature by 2050. “Montreal was about the ‘what’ — what are we all working towards together?” Georgina Chandler, of the Zoological Society London,was quoted as saying to the Independent. “Cali was supposed to focus on the ‘how’ — putting the plans and the financing in place to ensure we can actually implement this framework.” Before talks in Colombia broke down, countries did manage to reach agreement on a voluntary “Cali Fund” for sharing the genetic benefits derived from genetic resources. And they approved a groundbreaking “health and biodiversity action plan” – as a voluntary mechanism for countries to incorporate health considerations into nature protection plans. But sharp disagreements between developed and developing countries over funding support for other conservation efforts in developing countries emerged in the final hours of the two-week session. As the meeting ran into overtime, the departure of delegates left the COP without a quorum to reach a decision. Resources for reaching key CBD goals Now, last week in Rome, the parties to the CBD finally managed to agree on a way forward for mobilizing significant resource flows to developing countries, whose action is critical to realizing the big aims of the Kunming-Montreal framework. It provides for a structured mechanism to raise funds through a mix of public and private financing, and establishes a permanent arrangement for financing biodiversity conservation in developing nations beyond 2030. Finally, the Rome agreement includes other provisions for planning, monitoring, reporting, and review required to implement the Kunming-Montreal framework – the Paris Accord equivalent for nature. The accord was reached despite the relatively poor showing of delegates – around 40 of the 196 nations that are party to the convention failed to show up. The agreement also comes despite the fact that the United States, historically the world’s largest donor to biodiversity, recently halted most such funding as part of the Trump Administration’s broader foreign aid freeze. The US has never been a formal party to the CBD but had previously played a behind-the-scenes role in advancing the its goals. But while many hailed it as a diplomatic victory, concerns linger over implementation, accountability, and the absence of key nations and specific financial commitments from leading donor states in a time of turbulent global rhetoric around conservation. “We live in a very different world now, and only a handful of countries have sent ministers,” said Arthur Wyns, a climate research fellow based in Melbourne, on a social media post. All in all, the Rome talks boasted only a fraction of attendance of November’s Cali conference, which saw 1,000 delegates in attendance, compared to the 23,000 in Cali. Financing details pushed to 2028 African oil and gas projects are set to quadruple; 90% of projects overlap with sensitive ecosystems, such as the Congo Basin, the world´s second largest rainforest. However, the final agreement deferred a key decision on whether the Global Environment Facility (GEF) would remain the CBD’s primary biodiversity finance mechanism or if a new fund would be created. African and Latin American nations had pushed for a dedicated biodiversity fund, but the decision on that was postponed until at least 2028. The GEF is already managing finances for several other global environmental conventions, such as the Stockholm Convention on persistent organic pollutants, and the UN Framework Convention on Climate Change. And it manages the CBD’s Global Biodiversity Framework Fund (GBFF), dedicated to implementing the Kunming-Montreal targets. The Fund has issued over $3 billion in biodiversity finance since its creation in 2022. Meeting ambitious targets With the Trump administration freezing most nature-related foreign aid and European nations cutting their aid budgets, doubts persist over how the ambitious financial targets for this new fund will be met. More than 75% of nations have yet to submit their national biodiversity plans, as per the 2022 Kunming-Montreal agreement, despite the October deadline passing four months ago. Even among those that have submitted plans, over half fail to include the KMGBF’s headline goal of protecting 30% of land and oceans by 2030. Additionally, nations with biodiversity hotspots, notably Brazil and those in the Congo Basin, failed to adopt at least one national CBD target. Cali Fund for profit-sharing of profits made from genetic resources launched The Rome COP also saw the launch of the Cali Fund, a new voluntary initiative to facilitate voluntary corporate profit-sharing of revenues generated from the use and development of indigenous genetic resources, or genetic Digital Sequence Information (DSI), into new foods, cosmetics or pharma products. Big food, cosmetics and pharmaceutical companies worldwide now harness and use genetic resources, captured as DSI, across far-flung borders, to create new products worth billions of dollars annually. Developing countries have long maintained that they are left out of the loop of benefits that come from the harvesting of new genetic resources in their regions. The new plan marks the first global attempt to address the imbalance. The initiative, agreed to last November in Colombia targets companies meeting two of three thresholds: annual sales exceeding $50 million, profits over $5 million, or assets above $20 million. These firms “should” contribute either 1% of revenue or 0.1% of profits generated from the use of indigenous genetic material to the new “Cali Fund” to support developing country biodiversity preservation and restoration. The rates remain “indicative” and the arrangement “voluntary”, according to the agreement – whose details still need to be worked out. “Success of the Cali Fund will be critical for providing finance to people on the ground who are custodians for species and genetic diversity. We are proud to be a founding partner for this groundbreaking Fund,” said Marcos Neto, Director of UNDP’s Sustainable Finance Hub, in a press statement, upon the launch of the new scheme. ‘Not Charity’ COP16 President, Susana Muhamed of Colombia, confers with the Secretariat at COP16’s second edition in Rome. The Cali Fund is not for “charity from companies,” but “fair payment for use of global biodiversity,” as Susana Muhamad, CBD president and former Colombian Minister of Environment and Sustainable Development said in a press conference. Furthermore, “at least 50% of the Cali Fund resources will be allocated to indigenous peoples and local communities, recognizing their role as custodians of biodiversity,” the UN said in a statement, building upon agreements in Cali that gave Indigenous peoples and local communities a stronger voice in conservation matters. Pharmaceutical companies have also warned that the initiatives such as the Cali Fund also risks taking the world down a slippery slope that “stifles” easy access to genetic material and to medical innovation – particularly if something now framed as a voluntary measure eventually becomes mandatory. “The pharmaceutical industry has long supported the Convention on Biological Diversity’s objective to protect our natural world,” said David Reddy, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a statement following November’s Cali round. But “[t]he ability to rapidly use scientific data known as “digital sequence information” (DSI) is essential for developing new medicines and vaccines,” he warned. “Any new system should not introduce further conditions on how scientists access such data and add to a complex web of regulation, taxation and other obligations for the whole R&D ecosystem – including on academia and biotech companies. “Ahead of COP17, it is critical that governments work to ensure the implementation of any new mechanism on digital sequence information does not stifle medical research and innovation that can bring the next wave of medical progress to people around the world.” Biodiversity continues to declines Heavy deforestation in hotspots, such as the Amazon and Congo river basins, threatens biodiversity as well as increasing the risks to human communities of zoonotic diseases transmitted by displaced animal species. The new financial agreements come at a critical time in which biodiversity loss continues to accelerate. Global wildlife populations have declined by 73% since 1970, with more than one million species at risk of extinction, according to the World Wildlife Fund’s Living Planet Report. This means that a quarter of species are threatened – and only the ones researchers were able to study. Along with the conservation and/or restoration of 30% of the world’s degraded ecosystems (Target 2), the Kunming-Montreal accord’s 23 targets also include: Target 6 – reduction of invasive species by 50%; Target 12 – enhancement of urban greenspaces; Target 13 – increasing the sharing of benefits from genetic resources, digital sequence information and traditional knowledge. “The results of this meeting show that multilateralism works and is the vehicle to build the partnerships needed to protect biodiversity and move us towards Peace with Nature,” said Astrid Schomaker, Executive Secretary of the CBD. “As we do this and implement the other supporting elements for resource mobilization, the world will have given itself the means to close the biodiversity finance gap. Meanwhile, the decision reached in Cali on a health and biodiversity framework also gives countries a clear framework for integrating health more squarely into biodiversity planning. The framework calls for health impact assessments in land-use planning, disease surveillance where habitat loss is rapid, and stricter wildlife trade rules vital to preventing pathogens spreading from wild animals to human communities and food markets. But that still doesn’t go far enough to protect people from the risk of spill-over events, critics say. “Our health cannot be separated from the health of the planet and its many species,” UN Environment chief Inger Andersen told delegates in Cali last November. “We must adopt this action plan and implement it with a holistic, systemic approach that unifies action across health, environment, finance, industry and agriculture.” Nations are set to reconvene next year in Yerevan, Armenia, for COP17. See more Health Policy Watch coverage of Cali and biodiversity here. Image Credits: Oleksandr Sushko, Rainforest Foundation and Earth Insights, 2022, IISD/ENB | Mike Muzurakis, Earth.org. Common US Infant Formulas Are Laden with High Levels of Added Sugars 03/03/2025 Sophia Samantaroy The WHO and the American Academy of Pediatrics “support the unequivocal evidence that breastfeeding protects against a variety of diseases and conditions.” Most infant formulas in the United States contain a high percentage of added sugars instead of natural lactose, “jeopardizing” infant health and development, says researchers at the University of Kansas in a new analysis of commonly marketed formulas. “Infants may consume upwards of 60 grams of added sugars per day, or the equivalent of two soft drinks per day if they are entirely formula-fed,” researchers say in the study, published last week in the Journal of Food Composition and Analysis. The publication came as the Food and Drug Administration (FDA) delayed implementation of a rule that tightens what foods manufacturers are allowed to label as “healthy.” The study, which analyzed 73 infant formulas available in 2022, found that “gentle” and lactose-free formulas contained the highest proportion of added sugar, with median levels reaching 85% and 90% of total sugars, respectively. On average, formula-fed infants consume 7-8 grams of added sugar per serving – a quick form of energy, but lacking in nutritional value. Health experts warn that high sugar consumption in infancy, in the form of sucrose, glucose, and high-corn fructose, may contribute to rapid weight gain and early obesity, increasing the risk of chronic conditions such as diabetes later in life. 20% of US children have obesity – a figure that is only expected to rise in the coming decades. Babies exposed to sugary foods also develop a strong preference for more sugar, says the authors. But “lax” federal guidelines make it difficult for parents and caregivers to avoid added sugars in infant formula because of the “staggering extent” to which US formula contradicts federal healthy diet recommendations. The FDA does not require manufacturers to report sugars in US formulas, in “sharp contrast” to adult food regulations, which must display a breakdown of total carbohydrates and added sugars, despite federal dietary guidelines recommending zero added sugars for infants under two years old. “As a result, parents and guardians may unknowingly feed their infants formula that contains substantial quantities of added sugars… which likely present a substantial risk to their infant’s health and development.” A systemic issue It was only after the Affordable Care Act that employers were mandated to provide space for nursing mothers other than a bathroom. But state laws are still patchwork protection, and do not require compensation for time spent breastfeeding. Even though the researchers build upon a body of evidence showing the risks to formula feeding – including an increased risk of gastroenteritis, diarrhea, ear infections, and chronic illnesses – they acknowledge that larger, systemic issues bar families from breastfeeding. The World Health Organization (WHO) recommends that parents exclusively breastfeed for the first six months. But in the US, “extremely” limited social support, no paid maternity leave, and the lack of affordable early childcare means that reliance on formula is a “necessity” for most parents, the authors say. Those from low socioeconomic status backgrounds are the most disadvantaged. “[T]he structure of the US system and environment often leaves parents and caregivers with little choice but to use formula in some capacity,” write study authors Audrey Rips-Goodwin, Daiil Jun, Adrianne Griebel-Thompson, Kai Ling Kong, and Tera Fazzino. “[W]e reason that the focus on an individual-level solution (breastfeeding promotion to women and caregivers) is not well matched to addressing the systemic nature of the problem and places an unfair burden on women and families who are expected to navigate this systemic issue. “Ideally, the US labor system should support breastfeeding, and healthcare professionals should be properly trained and incentivized to promote it.” “At the federal level there is no requirement for paid maternity/paternity leave and very little structural support to promote breastfeeding. Given the vast limitations in systemic support of new mothers and parents, most turn to using formula out of necessity. US parents deserve an infant formula supply that does not jeopardize infant health due to the presence of added sugars,” said Dr Tera Fazzino, study author and associate professor of psychology and associate director of the Cofrin Logan Center for Addiction Research and Treatment at the University of Kansas. Formulas with lactose could be safer, if made available Lactose, which is naturally found in breast milk and cow and goat milk, is sometimes used as a base for formula. Infants digest the more complex form of sugar slower, boosting their nutrition and metabolism, and engaging in hunger satiation hormones. Unlike the added sugars in most formulas – high fructose corn syrup, glucose, sucrose – lactose does not cause the same blood sugar spike. “These non-lactose sugars also typically garner more pronounced neurochemical reward responses and glycemic responses relative to lactose. Therefore it is really important for infants to consume lactose and avoid consumption of other types of added sugars, which is in line with US Dietary Guidelines,” said Fazzino. Only 8% of US formulas contained primarily naturally lactose, but the type is no longer available in the US. And it is unknown whether any other formulas use the safer sugar. “When people have free choice, the choices should include options that promote infants’ health and development. In the case of the US formula supply, our findings indicate that parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Fazzino. The researchers argue that lactose-containing formulas are safer for infants, and that efforts should focus on “requiring formula companies to produce products that primarily contain naturally occurring lactose and are designed to minimize risks to healthy infant development.” Unclear if FDA will improve labelling after delay ‘Parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Dr Fazzino. Even with increased rhetoric around chronic diseases in the US, notably HHS Secretary Robert F Kennedy’s push to “Make America Healthy Again,” the role of infant formulas to early-life infant weight gain is largely overlooked. The FDA has delayed implementing a rule that would redefine which foods can be labeled as “healthy.” The regulation, which aims to prevent manufacturers from marketing sugary juices, processed sweets, and certain meats as “healthy” options, was initially set to take effect on 25 February but has now been pushed back to 28 April, according to HHS. The delay stems from a broader freeze on new rule proposals across the Trump administration, and an upheaval of firings in the past weeks. The department lost several thousand employees, including those working in food safety. Currently, infant formula labels do not disclose added sugar content, allowing products with high levels of sucrose, glucose, and corn syrup solids to be sold without clear warning. During the first Trump administration, US officials tried to derail a resolution at the 2018 World Health Assembly to promote breastfeeding, attempting to remove language urging governments to “protect, promote and support breast-feeding” and restrictions on the promotion of food unhealthy food products to children. The original sponsor of the resolution, Ecuador, withdrew after US threatened it with trade sanctions. “We need much clearer labeling requirements for formulas in the US, specifically regarding the reporting of added sugars,” Fazzino told Health Policy Watch. “Support from the federal government and associated entities is really needed to improve infant formula labeling requirements.” But Fazzino acknowledged that labelling reform is “not on their radar;” rather, the FDA is more concerned about shoring up the formula supply chain after shortages in 2022 rocked the US market. The FDA declined to respond to Health Policy Watch’s request for comment. Formula companies deploy “same tactics” as tobacco industry A Nestle advertisement from 1911 undermines breastfeeding. Formula companies were among those identified in a 2023 Lancet series on the mechanisms and scope of commercial determinants of health, examining how the private sector influences health through activities like product design, packaging, supply chains, lobbying, research funding, and marketing. These companies “are escalating avoidable levels of ill health, planetary damage, and inequity.” These include formula milk companies’ extensive lobbying networks and “predatory” marketing tactics that derailed progress on breastfeeding education. In response, just last month the WHO at its Executive Board meeting proposed a resolution to regulate digital marketing of breastmilk substitutes, after the WHO’s findings that the formula industry uses “exploitative” marketing strategies. The resolution focuses on the fact that digitial marketing – through influencers and paid content – rely on personalized data to “innapropriately” promote infant formula, and undermine recommendations from healthcare providers and national authorities. The threat of targeted misinformation led the WHO to issue guidance on “regulatory measures aimed at restricting digital marketing of breast-milk substitutes” in November 2022, following its report that “the global formula milk industry, valued at some $55 billion, is targeting new mothers with personalized social media content that is often not recognizable as advertising.” The study also follows investigations into how formula companies promoted their product as “healthy” in lower-and middle-income countries, despite high levels of added sugar. But as the authors note, hidden added sugars also plague US infant formulas. “Ultimately, caregivers and infants in the US deserve a formula market that promotes healthy infant development and does not promote early obesity risk.” Image Credits: FDA, University of Minnesota , Enfamil. ‘The Centre Must Hold’: Africa’s Health Leaders Rally for Bold Action 03/03/2025 Edith Magak Africa CDC’s Dr Claudia Shilumani, Rwandan Health Minister Dr Sabin Nsanzimana, Dr Githinji Gitahi, CEO of Amref Health Africa and Dr Chikwe Ihekweazu, acting WHO Regional Director for Africa KIGALI, Rwanda – “Sad”, “Worried” and “The centre is shaking”, were some of the reactions of African health leaders to the termination of US aid at a media briefing on Sunday (2 March) ahead of the 6th Africa Health Agenda International Conference (AHAIC). But speakers also stressed the need for resilience and swift action at the briefing ahead of the conference, which is hosted by Amref Health Africa in collaboration with Rwanda’s Ministry of Health, the World Health Organization (WHO) Africa Office for Africa, and the Africa Centres for Disease Control and Prevention (Africa CDC). “The centre of our health system on the continent must hold,” stressed Rwandan Minister of Health Dr Sabin Nsanzimana. “Even as financing declines, we must find ways to increase it – whether through domestic sources or partnerships with those who see health as an investment in humanity.” Nsanzimana believes Africa can find alternative funding sources to fill many of the gaps left by the massive cuts to US Agency for International Development (USAID) funding. “There’s always money somewhere,” he explained. “When some of our medical students in surgery and midwifery were at risk of pausing their long-term training because they were supported by financing that was stopped overnight, we reassessed our priorities. we looked at cross-sector health projects and found over 5 billion Rwandan francs [over $5 million] tied up in short-term training and workshops. “We asked ourselves: ‘Do we keep funding weekly training that people can read online, or do we invest in long-term workforce programs?’,” he said. Rwanda has now redirected those funds to keep students enrolled, shifting the current workshops to online platforms. Africa must “think beyond traditional funding models and use what we have to meet our most urgent needs”, he stressed. This will be one of the pressing question considered by the over 1,800 delegates from 56 countries attending the conference. Significant risks “This year’s conference comes at a time of significant risks to African communities and health systems,” said Dr Githinji Gitahi, CEO of Amref Health Africa, who called for Africa’s health systems to be redesigned to address the dual burden of infectious and non-communicable diseases (NCD). Many African countries bear high burdens of infectious diseases while also facing a surge in non-communicable diseases. NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. “The health system we have today is not the one we’ll need tomorrow,” said Gitahi. “[But] we have minimal fiscal space. With population growth, economic shifts, and tax inefficiencies, how do we mobilize resources to fight both infectious and non-communicable diseases with limited funds?” “Many of us didn’t anticipate the scale of change – cuts in government assistance from not only the US government but also Germany, the UK, and others. Our current health systems have relied heavily on external support. We must rethink how to sustain them in the future,” Gitahi added. Speakers also emphasized that ,while communities are aware of diseases like malaria and HIV, many are unaware of the risk factors driving NCDs such as cancer, cardiovascular diseases, and strokes. Artifical intelligence and climate change Beyond the urgent discussions on funding, the AHAIC conference is also focusing on topics including climate-resilient health policies, the growing burden of both infectious and non-communicable diseases, artificial intelligence in healthcare, and strengthening local pharmaceutical manufacturing. Dr Claudia Shilumani, Africa CDC director of external relations and strategic management, warned of increasing health threats linked to climate change. Africa CDC is currently monitoring 243 health threats across the continent, with 84 significant events recorded in the first few weeks of 2025. Artificial intelligence is also a major focus, with discussions on how technology can be leveraged to improve diagnostics, treatment, and hospital management. Delegates acknowledged that while Africa needs thousands of trained professionals to meet healthcare demands, AI-driven solutions could help bridge the gap by enhancing efficiency in service delivery. Efforts to align policies across Africa are also gaining traction. The Africa CDC is working closely with the African Medicines Agency to streamline drug approvals and distribution across the continent. There is also a push to fast-track the qualification process for local manufacturers, ensuring national health strategies align with continental frameworks like the Africa Safety Strategic Plan. Health resilience Dr Matshidiso Moeti, outgoing WHO Africa Regional Director, highlighted the remarkable progress Africa’s health systems have made over the years. She noted that the continent has confronted pandemics, eliminated once-deadly viruses, and turned death sentences into manageable conditions. Despite these achievements, Moeti emphasized that significant challenges remain. She pointed to the deepening link between health, economic stability, and the environment, warning that widening economic disparities, climate change, and conflict continue to threaten healthcare systems. “One constant has been our collective commitment to building a healthier, stronger Africa.” Image Credits: Edith Magak, WHO/NCD Portal. DRC Identifies New Mpox Variant and Investigates New Febrile Disease Outbreak 28/02/2025 Kerry Cullinan Dr Ngashi Ngongo A new and potentially more infectious variant of mpox Clade 1A has been identified in the Democratic Republic of the Congo (DRC) according to Dr Ngashi Ngongo, head of the mpox incident management team at the Africa Centre for Disease Control and Prevention (Africa CDC). The termination of USAID funding and violence in eastern DRC are hampering mpox testing and reporting, with test results being reduced to a trickle. Only 35% of mpox cases are currently being tested in DRC, both because of conflict and the ending of USAID funds to transport mpox tests to laboratories. The DRC finally started to vaccinate people in Kinshasa this week, and uptake was swift with over 24,800 people vaccinated over four days, said Ngongo. Mpox is continuing to spread in Uganda, which has seen case increases for three weeks in a row – 278 new cases in the past week. Mpox cases are overwhelming health facilities. For example, a treatment centre in Entebbe with 80-bed capacity currently has 102 patients. “Because of this, the leadership in the [Ugandan] Ministry of Health has now opted also to introduce home-based care for non-severe cases,” said Ngongo. Meanwhile, South Africa reported three mpox cases after being free of the disease for over 90 days. The World Health Organization resolved this week to keep mpox as a public health outbreak of international concern “based on the continuing rise in numbers and geographic spread, the violence in the eastern DRC, which hampers the response, as well as a lack of funding to implement the response plan”, according to the WHO. Febrile disease in DRC DRC health authorities are investigating a febrile disease outbreak in five villages in the Basankusu and Bolomba health zones in Equateur province. This has tripled deaths over the past three weeks, according to WHO. A total of 943 cases and, 52 deaths have been reported, with symptoms including fever, chills, sweating, headache and muscle pain.\, said Ngongo. There are no haemorrhagic symptoms and Ebola and Marburg tests are negative, making malaria the most likely cause, he added. “Children below five years make about 18% of cases with a case fatality of 5.3%. Children ages five to 15 years make up 20% of all cases, with a case fatality of 6.4%,” said Ngongo. “The diagnostic is pointing towards malaria. Rapid tests that were conducted on over 500 samples gave a positivity rate of 55% but there are also blood smears that were also conducted, around 70 samples, that also gave a positivity rate of almost 78%,” said Ngongo. “Further tests are to be carried out for meningitis. Food, water and environmental samples will also be analysed, to determine if there might be contamination,” according to the WHO. “Basankusu and Bolomba are about 180 kilometres apart and more than 300 kilometres from the provincial capital, Mbandaka. The two localities are reachable by road or via the Congo River from Mbandaka. This remoteness limits access to health care, including testing and treatment. Poor road and telecommunication infrastructure are also major challenges,” saif the WHO in a statement. US Terminates Thousands of Life-Saving Global Health Grants Including For HIV, TB and Malaria 27/02/2025 Kerry Cullinan Protestors gathered outside USAID headquarters in Washington D.C. after employees were informed via email to not come in to work. The Trump administration has terminated the contracts of nearly 10,000 global health projects funded by the US Agency for International Development (USAID) or the US State Department – including projects to provide vital diagnosis and treatment for HIV, tuberculosis, and malaria, as well as humanitarian aid projects providing nutrition and water and sanitation services. Grants to hundreds of African HIV organisations providing life-saving services have been terminated with immediate effect via letters received on Thursday morning. Globally, the terminated awards include 5,800 grants administered by the USAID and 4,100 grants for projects managed directly by the State Department. Some of the terminated programmes had previously been granted temporary waivers, due to their roles in providing lifesaving health or humanitarian aid. The Trump administration also announced Thursday that it was halting US funding to the Joint UN Programme on HIV/AIDS (UNAIDS), which is headquartered in Geneva, just across from the World Health Organization. “All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated,” said Dr Atul Gawande, USAID’s former assistant administrator under the Biden administration. Terminated, too, are all global tuberculosis programmes, all US-made food aid programmes, which manufacture specially enriched foods aimed at malnourished women and children, and around 1000 food kitchens serving displaced people in countries such as war-torn Sudan. “This is one of the worst days of my professional life,” said Dr Kate Rees of Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups. “Tomorrow, we are letting go 2,800 people who are mainly peer educators and data capturers.” Prof Linda-Gail Bekker, CEO of the South African Desmond Tutu HIV Foundation, said that the US termination would cost 500,000 South African lives over the next 10 years and result in around half a million new HIV infections, according to recent modelling. “As an activist, as a person living openly with HIV, I’m very hurt,” said Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “How am I going to survive? Will the public health care system be able to cater for us? Will be able to cover all the gaps that we are facing with all the challenges that the public healthcare system has?” South Africa has the highest burden of HIV in the world with eight million people living with the virus (over 16% of the adult population). All 44 South African HIV programmes that receive money from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID have seen their aid terminated. Projects affected range from mother-to-child transmission programmes and hospices to research groups. Many focus on “key populations”, groups that are the most vulnerable to HIV but often shun health centres in fear of discrimination. “I’ve been having a sleepless night trying to think how best we can save our communities because we know that some of the government healthy facilities are very discriminatory,” said Kholi Buthelezi, national coordinator of the sex worker organisation, Sisonke. HIV activist Sibongile Tshabalala, who lives with the virus, is fearful for her future. HIV programmes devastated across Africa HIV programmes across the continent have also been devastated. The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children. Late yesterday, we received award termination notices for three of our primary USAID agreements. Read our full statement. https://t.co/VpBNduu036 pic.twitter.com/0hAP17JqxG — Elizabeth Glaser Pediatric AIDS Foundation (@EGPAF) February 27, 2025 In Uganda, for example, the Baylor College of Medicine Children’s Foundation’s HIV and TB programmes, that strengthens district health systems to better deliver HIV, TB and maternal and child services, has been terminated. The termination letters all state that US Secretary of State Marco Rubio, in his capacity as acting administrator for USAID and Peter Marocco, USAID acting deputy administrator, “have determined your award is not aligned with agency priorities and made a determination that continuing this program is not in the national interest”. ‘Chaos and disaster’ The terminations have caused “chaos” and “disaster”, said emotional South African leaders of the HIV sector who urged their government to step in to save their programmes. Fatima Hassan, head of the Health Justice Initiative, urged the South African government to issue compulsory licenses to reduce the price of antiretroviral medicine as the US has already “done the worst to us”. “US Congress approved the funds, and that is what has been stopped. So we do believe that it’s an illegal grab. It’s an illegal halt of services and programs. It’s not following due process,” Hassan added. The terminations will decimate South Africa’s HIV testing, data collection and HIV and TB literacy, said public health expert Dr Lynne Wilkinson, who added that USAID funds also assisted groups combating gender-based violence. However, South Africa is luckier than many other African countries as it derives around 17% of its HIV budget from PEPFAR. The Democratic Republic of Congo (DRC) gets 89% of its HIV budget from PEPFAR, while Mozambique and Tanzania get 60% of their HIV budget from the US. USAID: Countries most reliant on US aid for HIV ‘Blanket freeze is illegal’ Mitchell Warren, head of the US-based HIV programme AVAC, described the blanket termination of USAID grants as “unlawful”. “The US government’s in a very strong position with any cooperative agreement or grant or contract. They’re allowed to cancel agreements or amend them. They’re in a very strong position generally, but the blanket freeze is illegal,” said Warren, whose organisation has resorted to the courts to prevent the cutting of lifesaving aid. AVAC’s Mitchell Warren “We have been now in a federal court for several weeks, and a temporary restraining order was provided two weeks ago by the Court that said that things had to go back. The tap had to be put back on until this 90 day review actually took place in a comprehensive way,” he added. “We now have evidence entered into the public record in the courts that show the intentionality at USAID and the State Department to dismantle everything but the government has simply thrown up additional legal delays, as is their want,” said Warren. A federal judge had set Wednesday at midnight as the deadline for USAID to release some $1,5 billion funds for the foreign aid work already completed, but the US Supreme Court granted the government a stay on the release of funds until the court could apply itself more thoroughly to the issue. “We expect a hearing next week in Washington,” said Warren. “This is not about PEPFAR. This is not about the HIV response. This is not about USAID. This is about the rule of law. The United States Congress has the power of the purse. They decide what gets spent. The executive branch is there to execute, and that’s the basis of this legal argument. “But as of [Wednesday] night, they began to basically massacre every possible implementing agency to deliver on this work. This court case, as important as it is, is not going to change that overnight. That’s why working in partnership with each other and with national governments is essential because the United States is not a partner that is trustworthy right now,” Warren concluded. Image Credits: Reuters Youtube, Gandhi A, et al, Annals of Internal Medicine, 11 Feb. 2025, UNAIDS. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Juggernaut of Overweight and Obesity is ‘Monumental Societal Failure’ 04/03/2025 Kerry Cullinan A mother and son in Usolanga, Tanzania. Childhood fat is traditionally seen as a sign of abundance, but it can lead to obesity and related diseases later in life. More than half of all adults and a third of children and adolescents will be overweight or obese by 2050 unless urgent action is taken, according to the most comprehensive global analysis to date, published by The Lancet to coincide with World Obesity Day on Tuesday. This poses an “unparalleled threat of premature disease and death at local, national, and global levels”, according to the Global Burden of Disease Study BMI Collaborators. Overweight and obesity rates in adults (25 or older) and children and adolescents (5-24 years) have more than doubled between 1990 and 2021, affecting 2.1 billion adults (up from 731 million) and 493 million young people (from 198 million). “The unprecedented global epidemic of overweight and obesity is a profound tragedy and a monumental societal failure,” said lead author Professor Emmanuela Gakidou from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the US. In 2019, the estimated total costs associated with obesity, including both direct and indirect costs, ranged from $3·19 billion in low-income countries to $1·33 trillion in high-income countries. Forecasts suggest that, by 2035, the obesity epidemic could lead to a 2·9% reduction in global gross domestic product, equating to a loss of $4 trillion. “Especially high levels have already been reached in Oceania and North Africa and the Middle East, with over 62% of adult males in Nauru, Cook Islands, and American Samoa, and over 71% of adult females in Tonga and Nauru living with obesity in 2021,” according to a media release from The Lancet. China, India, the US, Brazil, Russia, Mexico, Indonesia and Egypt accounted for more than half of the global population living with overweight and obesity in 2021. The US had the highest rates of obesity among high-income countries, with around 42% of males and 46% of females affected by obesity in 2021. In Latin America, 15 of the 17 countries had a prevalence of obesity among females of more than 30%. However, the largest future increases are projected in Asia and sub-Saharan Africa, driven by growing populations. No country has curbed adult obesity No country to date has successfully curbed the rising rates of adult overweight and obesity Among males, the prevalence of overweight and obesity was above 87% in Nauru, American Samoa, Northern Mariana Islands, Cook Islands, and Kuwait. In future, the highest levels for men are predicted in the United Arab Emirates and Nauru, where more than 80% of males are expected to have obesity in 2050. Estimated age-standardised prevalence of overweight and obesity among adult males aged 25 years and older, Among females, the prevalence has reached 88% and above in Tonga, Kuwait, Cook Islands, Nauru, and Samoa. In future, Tonga and Egypt are predicted to dominate with at least 87% of females being overweight or obese by 2050. Estimated age-standardised prevalence of overweight and obesity among female adults aged 25 years and older. “Obesity rates are skyrocketing across sub-Saharan Africa, with 522 million adults and more than 200 million young people expected to be living with overweight or obesity by 2050,” said co-author Awoke Temesgen, Associate Professor at IHME. In Nigeria, the number of overweight and obese adults is projected to more than triple from 36.6 million in 2021 to 141 million in 2050. “Action is urgently needed to implement preventative initiatives such as policies on the marketing of unhealthy foods and planning to include facilities for exercise and playing fields in schools,” added Temesgen. Obesity trends in young people The study predicts a 121% rise in obesity among young people globally by 2050, with the total number of children and adolescents with obesity predicted to reach 360 million. The most rapid increases in obesity in young are forecast for North Africa, the Middle East, Latin America and the Caribbean, where one-third of all the world’s children and adolescents with obesity (130 million) are expected to live in 2050. The transition to obesity predominance (versus overweight) is also expected to be overwhelming for several Oceanic countries, including the Cook Islands, Nauru, Tonga where levels of obesity are expected to reach 60-70% by 2050, as well as for heavily populated countries such as Nigeria (18.1 million), India (26.4 million), Brazil (17.8 million), China (35.2 million), and the US (22.1 million). The authors also note that more recent generations are gaining weight faster than previous ones and obesity is occurring earlier, increasing the risk of complications such as type 2 diabetes, high blood pressure, cardiovascular diseases, and multiple cancers occurring at younger ages. “Our estimates identify children and adolescents in much of Europe and south Asia living with overweight who should be targeted with obesity prevention strategies,” said co-lead author Dr Jessica Kerr from Murdoch Children’s Research Institute in Australia. “We have also identified large populations, particularly adolescent girls, in North America, Australasia, Oceania, north Africa and the Middle East, and Latin America that are expected to tip over to obesity predominance and require urgent, multifaceted intervention and treatment.” Action plans The authors stress that five-year action plans (2025-2030) are urgently required to curb the rise in obesity and help inform new goals and targets post-2030, when the Sustainable Development Goals end. “Preventing obesity must be at the forefront of policies in low- and middle-income countries,” said Kerr. “Policy action in these regions must balance the challenges of overnutrition with undernutrition and stunting, with interventions ranging from support for nutritional diets and regulating ultra-processed foods to promoting maternal and child health programmes that encourage pregnant women to follow a healthy diet and breastfeed. Kerr warned that many countries “only have a short window of opportunity to stop much greater numbers shifting from overweight to obesity”. She called for “much stronger political commitment” to “transform diets within sustainable global food systems and to support comprehensive strategies that improve people’s nutrition, physical activity and living environments, whether it’s too much processed food or not enough parks.” Image Credits: Jen Wen Luoh. COP16 Deal Commits Nations to Raise $200 Billion Annually for Biodiversity; But Funding A Big Lift 03/03/2025 Sophia Samantaroy Coral reefs are a vital breeding ground for fish, a major protein source for 3 billion people. But some 14% of coral reefs died between 2009 and 2018, according to the UN Environment Programme. Countries agreed to raise $200 billion a year by 2030 to help developing countries conserve biodiversity at the resumed Conference of Party (COP16) of the UN Convention on Biodiversity (CBD) in Rome last week. The deal marks a major breakthrough after negotiations over a finance package were suspended last November in the closing hours of COP16 in Cali, Colombia, over funding disagreements. In Rome, more than 140 nations who are parties to the Convention also pledged to raise $20 billion a year from international donors for the new effort, by 2025, and $30 billion by 2030 to support developing nations’ conservation efforts. Although actually reaching those financial goals poses a huge challenge, the commitment marks a major milestone in implementing the landmark 2022 Kunming-Montreal Global Biodiversity Framework (KMGBF). The Framework aims to ensure the conservation or restoration of at least 30% of the planet’s lands, freshwater, and ocean resources by 2030. Currently, only 17% and 10% of the world’s terrestrial and marine surfaces are protected, respectively. The first ever multilateral nature agreement, the Kunming-Montreal framework’s overarching goal is development in “harmony” with nature by 2050. “Montreal was about the ‘what’ — what are we all working towards together?” Georgina Chandler, of the Zoological Society London,was quoted as saying to the Independent. “Cali was supposed to focus on the ‘how’ — putting the plans and the financing in place to ensure we can actually implement this framework.” Before talks in Colombia broke down, countries did manage to reach agreement on a voluntary “Cali Fund” for sharing the genetic benefits derived from genetic resources. And they approved a groundbreaking “health and biodiversity action plan” – as a voluntary mechanism for countries to incorporate health considerations into nature protection plans. But sharp disagreements between developed and developing countries over funding support for other conservation efforts in developing countries emerged in the final hours of the two-week session. As the meeting ran into overtime, the departure of delegates left the COP without a quorum to reach a decision. Resources for reaching key CBD goals Now, last week in Rome, the parties to the CBD finally managed to agree on a way forward for mobilizing significant resource flows to developing countries, whose action is critical to realizing the big aims of the Kunming-Montreal framework. It provides for a structured mechanism to raise funds through a mix of public and private financing, and establishes a permanent arrangement for financing biodiversity conservation in developing nations beyond 2030. Finally, the Rome agreement includes other provisions for planning, monitoring, reporting, and review required to implement the Kunming-Montreal framework – the Paris Accord equivalent for nature. The accord was reached despite the relatively poor showing of delegates – around 40 of the 196 nations that are party to the convention failed to show up. The agreement also comes despite the fact that the United States, historically the world’s largest donor to biodiversity, recently halted most such funding as part of the Trump Administration’s broader foreign aid freeze. The US has never been a formal party to the CBD but had previously played a behind-the-scenes role in advancing the its goals. But while many hailed it as a diplomatic victory, concerns linger over implementation, accountability, and the absence of key nations and specific financial commitments from leading donor states in a time of turbulent global rhetoric around conservation. “We live in a very different world now, and only a handful of countries have sent ministers,” said Arthur Wyns, a climate research fellow based in Melbourne, on a social media post. All in all, the Rome talks boasted only a fraction of attendance of November’s Cali conference, which saw 1,000 delegates in attendance, compared to the 23,000 in Cali. Financing details pushed to 2028 African oil and gas projects are set to quadruple; 90% of projects overlap with sensitive ecosystems, such as the Congo Basin, the world´s second largest rainforest. However, the final agreement deferred a key decision on whether the Global Environment Facility (GEF) would remain the CBD’s primary biodiversity finance mechanism or if a new fund would be created. African and Latin American nations had pushed for a dedicated biodiversity fund, but the decision on that was postponed until at least 2028. The GEF is already managing finances for several other global environmental conventions, such as the Stockholm Convention on persistent organic pollutants, and the UN Framework Convention on Climate Change. And it manages the CBD’s Global Biodiversity Framework Fund (GBFF), dedicated to implementing the Kunming-Montreal targets. The Fund has issued over $3 billion in biodiversity finance since its creation in 2022. Meeting ambitious targets With the Trump administration freezing most nature-related foreign aid and European nations cutting their aid budgets, doubts persist over how the ambitious financial targets for this new fund will be met. More than 75% of nations have yet to submit their national biodiversity plans, as per the 2022 Kunming-Montreal agreement, despite the October deadline passing four months ago. Even among those that have submitted plans, over half fail to include the KMGBF’s headline goal of protecting 30% of land and oceans by 2030. Additionally, nations with biodiversity hotspots, notably Brazil and those in the Congo Basin, failed to adopt at least one national CBD target. Cali Fund for profit-sharing of profits made from genetic resources launched The Rome COP also saw the launch of the Cali Fund, a new voluntary initiative to facilitate voluntary corporate profit-sharing of revenues generated from the use and development of indigenous genetic resources, or genetic Digital Sequence Information (DSI), into new foods, cosmetics or pharma products. Big food, cosmetics and pharmaceutical companies worldwide now harness and use genetic resources, captured as DSI, across far-flung borders, to create new products worth billions of dollars annually. Developing countries have long maintained that they are left out of the loop of benefits that come from the harvesting of new genetic resources in their regions. The new plan marks the first global attempt to address the imbalance. The initiative, agreed to last November in Colombia targets companies meeting two of three thresholds: annual sales exceeding $50 million, profits over $5 million, or assets above $20 million. These firms “should” contribute either 1% of revenue or 0.1% of profits generated from the use of indigenous genetic material to the new “Cali Fund” to support developing country biodiversity preservation and restoration. The rates remain “indicative” and the arrangement “voluntary”, according to the agreement – whose details still need to be worked out. “Success of the Cali Fund will be critical for providing finance to people on the ground who are custodians for species and genetic diversity. We are proud to be a founding partner for this groundbreaking Fund,” said Marcos Neto, Director of UNDP’s Sustainable Finance Hub, in a press statement, upon the launch of the new scheme. ‘Not Charity’ COP16 President, Susana Muhamed of Colombia, confers with the Secretariat at COP16’s second edition in Rome. The Cali Fund is not for “charity from companies,” but “fair payment for use of global biodiversity,” as Susana Muhamad, CBD president and former Colombian Minister of Environment and Sustainable Development said in a press conference. Furthermore, “at least 50% of the Cali Fund resources will be allocated to indigenous peoples and local communities, recognizing their role as custodians of biodiversity,” the UN said in a statement, building upon agreements in Cali that gave Indigenous peoples and local communities a stronger voice in conservation matters. Pharmaceutical companies have also warned that the initiatives such as the Cali Fund also risks taking the world down a slippery slope that “stifles” easy access to genetic material and to medical innovation – particularly if something now framed as a voluntary measure eventually becomes mandatory. “The pharmaceutical industry has long supported the Convention on Biological Diversity’s objective to protect our natural world,” said David Reddy, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a statement following November’s Cali round. But “[t]he ability to rapidly use scientific data known as “digital sequence information” (DSI) is essential for developing new medicines and vaccines,” he warned. “Any new system should not introduce further conditions on how scientists access such data and add to a complex web of regulation, taxation and other obligations for the whole R&D ecosystem – including on academia and biotech companies. “Ahead of COP17, it is critical that governments work to ensure the implementation of any new mechanism on digital sequence information does not stifle medical research and innovation that can bring the next wave of medical progress to people around the world.” Biodiversity continues to declines Heavy deforestation in hotspots, such as the Amazon and Congo river basins, threatens biodiversity as well as increasing the risks to human communities of zoonotic diseases transmitted by displaced animal species. The new financial agreements come at a critical time in which biodiversity loss continues to accelerate. Global wildlife populations have declined by 73% since 1970, with more than one million species at risk of extinction, according to the World Wildlife Fund’s Living Planet Report. This means that a quarter of species are threatened – and only the ones researchers were able to study. Along with the conservation and/or restoration of 30% of the world’s degraded ecosystems (Target 2), the Kunming-Montreal accord’s 23 targets also include: Target 6 – reduction of invasive species by 50%; Target 12 – enhancement of urban greenspaces; Target 13 – increasing the sharing of benefits from genetic resources, digital sequence information and traditional knowledge. “The results of this meeting show that multilateralism works and is the vehicle to build the partnerships needed to protect biodiversity and move us towards Peace with Nature,” said Astrid Schomaker, Executive Secretary of the CBD. “As we do this and implement the other supporting elements for resource mobilization, the world will have given itself the means to close the biodiversity finance gap. Meanwhile, the decision reached in Cali on a health and biodiversity framework also gives countries a clear framework for integrating health more squarely into biodiversity planning. The framework calls for health impact assessments in land-use planning, disease surveillance where habitat loss is rapid, and stricter wildlife trade rules vital to preventing pathogens spreading from wild animals to human communities and food markets. But that still doesn’t go far enough to protect people from the risk of spill-over events, critics say. “Our health cannot be separated from the health of the planet and its many species,” UN Environment chief Inger Andersen told delegates in Cali last November. “We must adopt this action plan and implement it with a holistic, systemic approach that unifies action across health, environment, finance, industry and agriculture.” Nations are set to reconvene next year in Yerevan, Armenia, for COP17. See more Health Policy Watch coverage of Cali and biodiversity here. Image Credits: Oleksandr Sushko, Rainforest Foundation and Earth Insights, 2022, IISD/ENB | Mike Muzurakis, Earth.org. Common US Infant Formulas Are Laden with High Levels of Added Sugars 03/03/2025 Sophia Samantaroy The WHO and the American Academy of Pediatrics “support the unequivocal evidence that breastfeeding protects against a variety of diseases and conditions.” Most infant formulas in the United States contain a high percentage of added sugars instead of natural lactose, “jeopardizing” infant health and development, says researchers at the University of Kansas in a new analysis of commonly marketed formulas. “Infants may consume upwards of 60 grams of added sugars per day, or the equivalent of two soft drinks per day if they are entirely formula-fed,” researchers say in the study, published last week in the Journal of Food Composition and Analysis. The publication came as the Food and Drug Administration (FDA) delayed implementation of a rule that tightens what foods manufacturers are allowed to label as “healthy.” The study, which analyzed 73 infant formulas available in 2022, found that “gentle” and lactose-free formulas contained the highest proportion of added sugar, with median levels reaching 85% and 90% of total sugars, respectively. On average, formula-fed infants consume 7-8 grams of added sugar per serving – a quick form of energy, but lacking in nutritional value. Health experts warn that high sugar consumption in infancy, in the form of sucrose, glucose, and high-corn fructose, may contribute to rapid weight gain and early obesity, increasing the risk of chronic conditions such as diabetes later in life. 20% of US children have obesity – a figure that is only expected to rise in the coming decades. Babies exposed to sugary foods also develop a strong preference for more sugar, says the authors. But “lax” federal guidelines make it difficult for parents and caregivers to avoid added sugars in infant formula because of the “staggering extent” to which US formula contradicts federal healthy diet recommendations. The FDA does not require manufacturers to report sugars in US formulas, in “sharp contrast” to adult food regulations, which must display a breakdown of total carbohydrates and added sugars, despite federal dietary guidelines recommending zero added sugars for infants under two years old. “As a result, parents and guardians may unknowingly feed their infants formula that contains substantial quantities of added sugars… which likely present a substantial risk to their infant’s health and development.” A systemic issue It was only after the Affordable Care Act that employers were mandated to provide space for nursing mothers other than a bathroom. But state laws are still patchwork protection, and do not require compensation for time spent breastfeeding. Even though the researchers build upon a body of evidence showing the risks to formula feeding – including an increased risk of gastroenteritis, diarrhea, ear infections, and chronic illnesses – they acknowledge that larger, systemic issues bar families from breastfeeding. The World Health Organization (WHO) recommends that parents exclusively breastfeed for the first six months. But in the US, “extremely” limited social support, no paid maternity leave, and the lack of affordable early childcare means that reliance on formula is a “necessity” for most parents, the authors say. Those from low socioeconomic status backgrounds are the most disadvantaged. “[T]he structure of the US system and environment often leaves parents and caregivers with little choice but to use formula in some capacity,” write study authors Audrey Rips-Goodwin, Daiil Jun, Adrianne Griebel-Thompson, Kai Ling Kong, and Tera Fazzino. “[W]e reason that the focus on an individual-level solution (breastfeeding promotion to women and caregivers) is not well matched to addressing the systemic nature of the problem and places an unfair burden on women and families who are expected to navigate this systemic issue. “Ideally, the US labor system should support breastfeeding, and healthcare professionals should be properly trained and incentivized to promote it.” “At the federal level there is no requirement for paid maternity/paternity leave and very little structural support to promote breastfeeding. Given the vast limitations in systemic support of new mothers and parents, most turn to using formula out of necessity. US parents deserve an infant formula supply that does not jeopardize infant health due to the presence of added sugars,” said Dr Tera Fazzino, study author and associate professor of psychology and associate director of the Cofrin Logan Center for Addiction Research and Treatment at the University of Kansas. Formulas with lactose could be safer, if made available Lactose, which is naturally found in breast milk and cow and goat milk, is sometimes used as a base for formula. Infants digest the more complex form of sugar slower, boosting their nutrition and metabolism, and engaging in hunger satiation hormones. Unlike the added sugars in most formulas – high fructose corn syrup, glucose, sucrose – lactose does not cause the same blood sugar spike. “These non-lactose sugars also typically garner more pronounced neurochemical reward responses and glycemic responses relative to lactose. Therefore it is really important for infants to consume lactose and avoid consumption of other types of added sugars, which is in line with US Dietary Guidelines,” said Fazzino. Only 8% of US formulas contained primarily naturally lactose, but the type is no longer available in the US. And it is unknown whether any other formulas use the safer sugar. “When people have free choice, the choices should include options that promote infants’ health and development. In the case of the US formula supply, our findings indicate that parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Fazzino. The researchers argue that lactose-containing formulas are safer for infants, and that efforts should focus on “requiring formula companies to produce products that primarily contain naturally occurring lactose and are designed to minimize risks to healthy infant development.” Unclear if FDA will improve labelling after delay ‘Parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Dr Fazzino. Even with increased rhetoric around chronic diseases in the US, notably HHS Secretary Robert F Kennedy’s push to “Make America Healthy Again,” the role of infant formulas to early-life infant weight gain is largely overlooked. The FDA has delayed implementing a rule that would redefine which foods can be labeled as “healthy.” The regulation, which aims to prevent manufacturers from marketing sugary juices, processed sweets, and certain meats as “healthy” options, was initially set to take effect on 25 February but has now been pushed back to 28 April, according to HHS. The delay stems from a broader freeze on new rule proposals across the Trump administration, and an upheaval of firings in the past weeks. The department lost several thousand employees, including those working in food safety. Currently, infant formula labels do not disclose added sugar content, allowing products with high levels of sucrose, glucose, and corn syrup solids to be sold without clear warning. During the first Trump administration, US officials tried to derail a resolution at the 2018 World Health Assembly to promote breastfeeding, attempting to remove language urging governments to “protect, promote and support breast-feeding” and restrictions on the promotion of food unhealthy food products to children. The original sponsor of the resolution, Ecuador, withdrew after US threatened it with trade sanctions. “We need much clearer labeling requirements for formulas in the US, specifically regarding the reporting of added sugars,” Fazzino told Health Policy Watch. “Support from the federal government and associated entities is really needed to improve infant formula labeling requirements.” But Fazzino acknowledged that labelling reform is “not on their radar;” rather, the FDA is more concerned about shoring up the formula supply chain after shortages in 2022 rocked the US market. The FDA declined to respond to Health Policy Watch’s request for comment. Formula companies deploy “same tactics” as tobacco industry A Nestle advertisement from 1911 undermines breastfeeding. Formula companies were among those identified in a 2023 Lancet series on the mechanisms and scope of commercial determinants of health, examining how the private sector influences health through activities like product design, packaging, supply chains, lobbying, research funding, and marketing. These companies “are escalating avoidable levels of ill health, planetary damage, and inequity.” These include formula milk companies’ extensive lobbying networks and “predatory” marketing tactics that derailed progress on breastfeeding education. In response, just last month the WHO at its Executive Board meeting proposed a resolution to regulate digital marketing of breastmilk substitutes, after the WHO’s findings that the formula industry uses “exploitative” marketing strategies. The resolution focuses on the fact that digitial marketing – through influencers and paid content – rely on personalized data to “innapropriately” promote infant formula, and undermine recommendations from healthcare providers and national authorities. The threat of targeted misinformation led the WHO to issue guidance on “regulatory measures aimed at restricting digital marketing of breast-milk substitutes” in November 2022, following its report that “the global formula milk industry, valued at some $55 billion, is targeting new mothers with personalized social media content that is often not recognizable as advertising.” The study also follows investigations into how formula companies promoted their product as “healthy” in lower-and middle-income countries, despite high levels of added sugar. But as the authors note, hidden added sugars also plague US infant formulas. “Ultimately, caregivers and infants in the US deserve a formula market that promotes healthy infant development and does not promote early obesity risk.” Image Credits: FDA, University of Minnesota , Enfamil. ‘The Centre Must Hold’: Africa’s Health Leaders Rally for Bold Action 03/03/2025 Edith Magak Africa CDC’s Dr Claudia Shilumani, Rwandan Health Minister Dr Sabin Nsanzimana, Dr Githinji Gitahi, CEO of Amref Health Africa and Dr Chikwe Ihekweazu, acting WHO Regional Director for Africa KIGALI, Rwanda – “Sad”, “Worried” and “The centre is shaking”, were some of the reactions of African health leaders to the termination of US aid at a media briefing on Sunday (2 March) ahead of the 6th Africa Health Agenda International Conference (AHAIC). But speakers also stressed the need for resilience and swift action at the briefing ahead of the conference, which is hosted by Amref Health Africa in collaboration with Rwanda’s Ministry of Health, the World Health Organization (WHO) Africa Office for Africa, and the Africa Centres for Disease Control and Prevention (Africa CDC). “The centre of our health system on the continent must hold,” stressed Rwandan Minister of Health Dr Sabin Nsanzimana. “Even as financing declines, we must find ways to increase it – whether through domestic sources or partnerships with those who see health as an investment in humanity.” Nsanzimana believes Africa can find alternative funding sources to fill many of the gaps left by the massive cuts to US Agency for International Development (USAID) funding. “There’s always money somewhere,” he explained. “When some of our medical students in surgery and midwifery were at risk of pausing their long-term training because they were supported by financing that was stopped overnight, we reassessed our priorities. we looked at cross-sector health projects and found over 5 billion Rwandan francs [over $5 million] tied up in short-term training and workshops. “We asked ourselves: ‘Do we keep funding weekly training that people can read online, or do we invest in long-term workforce programs?’,” he said. Rwanda has now redirected those funds to keep students enrolled, shifting the current workshops to online platforms. Africa must “think beyond traditional funding models and use what we have to meet our most urgent needs”, he stressed. This will be one of the pressing question considered by the over 1,800 delegates from 56 countries attending the conference. Significant risks “This year’s conference comes at a time of significant risks to African communities and health systems,” said Dr Githinji Gitahi, CEO of Amref Health Africa, who called for Africa’s health systems to be redesigned to address the dual burden of infectious and non-communicable diseases (NCD). Many African countries bear high burdens of infectious diseases while also facing a surge in non-communicable diseases. NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. “The health system we have today is not the one we’ll need tomorrow,” said Gitahi. “[But] we have minimal fiscal space. With population growth, economic shifts, and tax inefficiencies, how do we mobilize resources to fight both infectious and non-communicable diseases with limited funds?” “Many of us didn’t anticipate the scale of change – cuts in government assistance from not only the US government but also Germany, the UK, and others. Our current health systems have relied heavily on external support. We must rethink how to sustain them in the future,” Gitahi added. Speakers also emphasized that ,while communities are aware of diseases like malaria and HIV, many are unaware of the risk factors driving NCDs such as cancer, cardiovascular diseases, and strokes. Artifical intelligence and climate change Beyond the urgent discussions on funding, the AHAIC conference is also focusing on topics including climate-resilient health policies, the growing burden of both infectious and non-communicable diseases, artificial intelligence in healthcare, and strengthening local pharmaceutical manufacturing. Dr Claudia Shilumani, Africa CDC director of external relations and strategic management, warned of increasing health threats linked to climate change. Africa CDC is currently monitoring 243 health threats across the continent, with 84 significant events recorded in the first few weeks of 2025. Artificial intelligence is also a major focus, with discussions on how technology can be leveraged to improve diagnostics, treatment, and hospital management. Delegates acknowledged that while Africa needs thousands of trained professionals to meet healthcare demands, AI-driven solutions could help bridge the gap by enhancing efficiency in service delivery. Efforts to align policies across Africa are also gaining traction. The Africa CDC is working closely with the African Medicines Agency to streamline drug approvals and distribution across the continent. There is also a push to fast-track the qualification process for local manufacturers, ensuring national health strategies align with continental frameworks like the Africa Safety Strategic Plan. Health resilience Dr Matshidiso Moeti, outgoing WHO Africa Regional Director, highlighted the remarkable progress Africa’s health systems have made over the years. She noted that the continent has confronted pandemics, eliminated once-deadly viruses, and turned death sentences into manageable conditions. Despite these achievements, Moeti emphasized that significant challenges remain. She pointed to the deepening link between health, economic stability, and the environment, warning that widening economic disparities, climate change, and conflict continue to threaten healthcare systems. “One constant has been our collective commitment to building a healthier, stronger Africa.” Image Credits: Edith Magak, WHO/NCD Portal. DRC Identifies New Mpox Variant and Investigates New Febrile Disease Outbreak 28/02/2025 Kerry Cullinan Dr Ngashi Ngongo A new and potentially more infectious variant of mpox Clade 1A has been identified in the Democratic Republic of the Congo (DRC) according to Dr Ngashi Ngongo, head of the mpox incident management team at the Africa Centre for Disease Control and Prevention (Africa CDC). The termination of USAID funding and violence in eastern DRC are hampering mpox testing and reporting, with test results being reduced to a trickle. Only 35% of mpox cases are currently being tested in DRC, both because of conflict and the ending of USAID funds to transport mpox tests to laboratories. The DRC finally started to vaccinate people in Kinshasa this week, and uptake was swift with over 24,800 people vaccinated over four days, said Ngongo. Mpox is continuing to spread in Uganda, which has seen case increases for three weeks in a row – 278 new cases in the past week. Mpox cases are overwhelming health facilities. For example, a treatment centre in Entebbe with 80-bed capacity currently has 102 patients. “Because of this, the leadership in the [Ugandan] Ministry of Health has now opted also to introduce home-based care for non-severe cases,” said Ngongo. Meanwhile, South Africa reported three mpox cases after being free of the disease for over 90 days. The World Health Organization resolved this week to keep mpox as a public health outbreak of international concern “based on the continuing rise in numbers and geographic spread, the violence in the eastern DRC, which hampers the response, as well as a lack of funding to implement the response plan”, according to the WHO. Febrile disease in DRC DRC health authorities are investigating a febrile disease outbreak in five villages in the Basankusu and Bolomba health zones in Equateur province. This has tripled deaths over the past three weeks, according to WHO. A total of 943 cases and, 52 deaths have been reported, with symptoms including fever, chills, sweating, headache and muscle pain.\, said Ngongo. There are no haemorrhagic symptoms and Ebola and Marburg tests are negative, making malaria the most likely cause, he added. “Children below five years make about 18% of cases with a case fatality of 5.3%. Children ages five to 15 years make up 20% of all cases, with a case fatality of 6.4%,” said Ngongo. “The diagnostic is pointing towards malaria. Rapid tests that were conducted on over 500 samples gave a positivity rate of 55% but there are also blood smears that were also conducted, around 70 samples, that also gave a positivity rate of almost 78%,” said Ngongo. “Further tests are to be carried out for meningitis. Food, water and environmental samples will also be analysed, to determine if there might be contamination,” according to the WHO. “Basankusu and Bolomba are about 180 kilometres apart and more than 300 kilometres from the provincial capital, Mbandaka. The two localities are reachable by road or via the Congo River from Mbandaka. This remoteness limits access to health care, including testing and treatment. Poor road and telecommunication infrastructure are also major challenges,” saif the WHO in a statement. US Terminates Thousands of Life-Saving Global Health Grants Including For HIV, TB and Malaria 27/02/2025 Kerry Cullinan Protestors gathered outside USAID headquarters in Washington D.C. after employees were informed via email to not come in to work. The Trump administration has terminated the contracts of nearly 10,000 global health projects funded by the US Agency for International Development (USAID) or the US State Department – including projects to provide vital diagnosis and treatment for HIV, tuberculosis, and malaria, as well as humanitarian aid projects providing nutrition and water and sanitation services. Grants to hundreds of African HIV organisations providing life-saving services have been terminated with immediate effect via letters received on Thursday morning. Globally, the terminated awards include 5,800 grants administered by the USAID and 4,100 grants for projects managed directly by the State Department. Some of the terminated programmes had previously been granted temporary waivers, due to their roles in providing lifesaving health or humanitarian aid. The Trump administration also announced Thursday that it was halting US funding to the Joint UN Programme on HIV/AIDS (UNAIDS), which is headquartered in Geneva, just across from the World Health Organization. “All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated,” said Dr Atul Gawande, USAID’s former assistant administrator under the Biden administration. Terminated, too, are all global tuberculosis programmes, all US-made food aid programmes, which manufacture specially enriched foods aimed at malnourished women and children, and around 1000 food kitchens serving displaced people in countries such as war-torn Sudan. “This is one of the worst days of my professional life,” said Dr Kate Rees of Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups. “Tomorrow, we are letting go 2,800 people who are mainly peer educators and data capturers.” Prof Linda-Gail Bekker, CEO of the South African Desmond Tutu HIV Foundation, said that the US termination would cost 500,000 South African lives over the next 10 years and result in around half a million new HIV infections, according to recent modelling. “As an activist, as a person living openly with HIV, I’m very hurt,” said Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “How am I going to survive? Will the public health care system be able to cater for us? Will be able to cover all the gaps that we are facing with all the challenges that the public healthcare system has?” South Africa has the highest burden of HIV in the world with eight million people living with the virus (over 16% of the adult population). All 44 South African HIV programmes that receive money from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID have seen their aid terminated. Projects affected range from mother-to-child transmission programmes and hospices to research groups. Many focus on “key populations”, groups that are the most vulnerable to HIV but often shun health centres in fear of discrimination. “I’ve been having a sleepless night trying to think how best we can save our communities because we know that some of the government healthy facilities are very discriminatory,” said Kholi Buthelezi, national coordinator of the sex worker organisation, Sisonke. HIV activist Sibongile Tshabalala, who lives with the virus, is fearful for her future. HIV programmes devastated across Africa HIV programmes across the continent have also been devastated. The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children. Late yesterday, we received award termination notices for three of our primary USAID agreements. Read our full statement. https://t.co/VpBNduu036 pic.twitter.com/0hAP17JqxG — Elizabeth Glaser Pediatric AIDS Foundation (@EGPAF) February 27, 2025 In Uganda, for example, the Baylor College of Medicine Children’s Foundation’s HIV and TB programmes, that strengthens district health systems to better deliver HIV, TB and maternal and child services, has been terminated. The termination letters all state that US Secretary of State Marco Rubio, in his capacity as acting administrator for USAID and Peter Marocco, USAID acting deputy administrator, “have determined your award is not aligned with agency priorities and made a determination that continuing this program is not in the national interest”. ‘Chaos and disaster’ The terminations have caused “chaos” and “disaster”, said emotional South African leaders of the HIV sector who urged their government to step in to save their programmes. Fatima Hassan, head of the Health Justice Initiative, urged the South African government to issue compulsory licenses to reduce the price of antiretroviral medicine as the US has already “done the worst to us”. “US Congress approved the funds, and that is what has been stopped. So we do believe that it’s an illegal grab. It’s an illegal halt of services and programs. It’s not following due process,” Hassan added. The terminations will decimate South Africa’s HIV testing, data collection and HIV and TB literacy, said public health expert Dr Lynne Wilkinson, who added that USAID funds also assisted groups combating gender-based violence. However, South Africa is luckier than many other African countries as it derives around 17% of its HIV budget from PEPFAR. The Democratic Republic of Congo (DRC) gets 89% of its HIV budget from PEPFAR, while Mozambique and Tanzania get 60% of their HIV budget from the US. USAID: Countries most reliant on US aid for HIV ‘Blanket freeze is illegal’ Mitchell Warren, head of the US-based HIV programme AVAC, described the blanket termination of USAID grants as “unlawful”. “The US government’s in a very strong position with any cooperative agreement or grant or contract. They’re allowed to cancel agreements or amend them. They’re in a very strong position generally, but the blanket freeze is illegal,” said Warren, whose organisation has resorted to the courts to prevent the cutting of lifesaving aid. AVAC’s Mitchell Warren “We have been now in a federal court for several weeks, and a temporary restraining order was provided two weeks ago by the Court that said that things had to go back. The tap had to be put back on until this 90 day review actually took place in a comprehensive way,” he added. “We now have evidence entered into the public record in the courts that show the intentionality at USAID and the State Department to dismantle everything but the government has simply thrown up additional legal delays, as is their want,” said Warren. A federal judge had set Wednesday at midnight as the deadline for USAID to release some $1,5 billion funds for the foreign aid work already completed, but the US Supreme Court granted the government a stay on the release of funds until the court could apply itself more thoroughly to the issue. “We expect a hearing next week in Washington,” said Warren. “This is not about PEPFAR. This is not about the HIV response. This is not about USAID. This is about the rule of law. The United States Congress has the power of the purse. They decide what gets spent. The executive branch is there to execute, and that’s the basis of this legal argument. “But as of [Wednesday] night, they began to basically massacre every possible implementing agency to deliver on this work. This court case, as important as it is, is not going to change that overnight. That’s why working in partnership with each other and with national governments is essential because the United States is not a partner that is trustworthy right now,” Warren concluded. Image Credits: Reuters Youtube, Gandhi A, et al, Annals of Internal Medicine, 11 Feb. 2025, UNAIDS. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
COP16 Deal Commits Nations to Raise $200 Billion Annually for Biodiversity; But Funding A Big Lift 03/03/2025 Sophia Samantaroy Coral reefs are a vital breeding ground for fish, a major protein source for 3 billion people. But some 14% of coral reefs died between 2009 and 2018, according to the UN Environment Programme. Countries agreed to raise $200 billion a year by 2030 to help developing countries conserve biodiversity at the resumed Conference of Party (COP16) of the UN Convention on Biodiversity (CBD) in Rome last week. The deal marks a major breakthrough after negotiations over a finance package were suspended last November in the closing hours of COP16 in Cali, Colombia, over funding disagreements. In Rome, more than 140 nations who are parties to the Convention also pledged to raise $20 billion a year from international donors for the new effort, by 2025, and $30 billion by 2030 to support developing nations’ conservation efforts. Although actually reaching those financial goals poses a huge challenge, the commitment marks a major milestone in implementing the landmark 2022 Kunming-Montreal Global Biodiversity Framework (KMGBF). The Framework aims to ensure the conservation or restoration of at least 30% of the planet’s lands, freshwater, and ocean resources by 2030. Currently, only 17% and 10% of the world’s terrestrial and marine surfaces are protected, respectively. The first ever multilateral nature agreement, the Kunming-Montreal framework’s overarching goal is development in “harmony” with nature by 2050. “Montreal was about the ‘what’ — what are we all working towards together?” Georgina Chandler, of the Zoological Society London,was quoted as saying to the Independent. “Cali was supposed to focus on the ‘how’ — putting the plans and the financing in place to ensure we can actually implement this framework.” Before talks in Colombia broke down, countries did manage to reach agreement on a voluntary “Cali Fund” for sharing the genetic benefits derived from genetic resources. And they approved a groundbreaking “health and biodiversity action plan” – as a voluntary mechanism for countries to incorporate health considerations into nature protection plans. But sharp disagreements between developed and developing countries over funding support for other conservation efforts in developing countries emerged in the final hours of the two-week session. As the meeting ran into overtime, the departure of delegates left the COP without a quorum to reach a decision. Resources for reaching key CBD goals Now, last week in Rome, the parties to the CBD finally managed to agree on a way forward for mobilizing significant resource flows to developing countries, whose action is critical to realizing the big aims of the Kunming-Montreal framework. It provides for a structured mechanism to raise funds through a mix of public and private financing, and establishes a permanent arrangement for financing biodiversity conservation in developing nations beyond 2030. Finally, the Rome agreement includes other provisions for planning, monitoring, reporting, and review required to implement the Kunming-Montreal framework – the Paris Accord equivalent for nature. The accord was reached despite the relatively poor showing of delegates – around 40 of the 196 nations that are party to the convention failed to show up. The agreement also comes despite the fact that the United States, historically the world’s largest donor to biodiversity, recently halted most such funding as part of the Trump Administration’s broader foreign aid freeze. The US has never been a formal party to the CBD but had previously played a behind-the-scenes role in advancing the its goals. But while many hailed it as a diplomatic victory, concerns linger over implementation, accountability, and the absence of key nations and specific financial commitments from leading donor states in a time of turbulent global rhetoric around conservation. “We live in a very different world now, and only a handful of countries have sent ministers,” said Arthur Wyns, a climate research fellow based in Melbourne, on a social media post. All in all, the Rome talks boasted only a fraction of attendance of November’s Cali conference, which saw 1,000 delegates in attendance, compared to the 23,000 in Cali. Financing details pushed to 2028 African oil and gas projects are set to quadruple; 90% of projects overlap with sensitive ecosystems, such as the Congo Basin, the world´s second largest rainforest. However, the final agreement deferred a key decision on whether the Global Environment Facility (GEF) would remain the CBD’s primary biodiversity finance mechanism or if a new fund would be created. African and Latin American nations had pushed for a dedicated biodiversity fund, but the decision on that was postponed until at least 2028. The GEF is already managing finances for several other global environmental conventions, such as the Stockholm Convention on persistent organic pollutants, and the UN Framework Convention on Climate Change. And it manages the CBD’s Global Biodiversity Framework Fund (GBFF), dedicated to implementing the Kunming-Montreal targets. The Fund has issued over $3 billion in biodiversity finance since its creation in 2022. Meeting ambitious targets With the Trump administration freezing most nature-related foreign aid and European nations cutting their aid budgets, doubts persist over how the ambitious financial targets for this new fund will be met. More than 75% of nations have yet to submit their national biodiversity plans, as per the 2022 Kunming-Montreal agreement, despite the October deadline passing four months ago. Even among those that have submitted plans, over half fail to include the KMGBF’s headline goal of protecting 30% of land and oceans by 2030. Additionally, nations with biodiversity hotspots, notably Brazil and those in the Congo Basin, failed to adopt at least one national CBD target. Cali Fund for profit-sharing of profits made from genetic resources launched The Rome COP also saw the launch of the Cali Fund, a new voluntary initiative to facilitate voluntary corporate profit-sharing of revenues generated from the use and development of indigenous genetic resources, or genetic Digital Sequence Information (DSI), into new foods, cosmetics or pharma products. Big food, cosmetics and pharmaceutical companies worldwide now harness and use genetic resources, captured as DSI, across far-flung borders, to create new products worth billions of dollars annually. Developing countries have long maintained that they are left out of the loop of benefits that come from the harvesting of new genetic resources in their regions. The new plan marks the first global attempt to address the imbalance. The initiative, agreed to last November in Colombia targets companies meeting two of three thresholds: annual sales exceeding $50 million, profits over $5 million, or assets above $20 million. These firms “should” contribute either 1% of revenue or 0.1% of profits generated from the use of indigenous genetic material to the new “Cali Fund” to support developing country biodiversity preservation and restoration. The rates remain “indicative” and the arrangement “voluntary”, according to the agreement – whose details still need to be worked out. “Success of the Cali Fund will be critical for providing finance to people on the ground who are custodians for species and genetic diversity. We are proud to be a founding partner for this groundbreaking Fund,” said Marcos Neto, Director of UNDP’s Sustainable Finance Hub, in a press statement, upon the launch of the new scheme. ‘Not Charity’ COP16 President, Susana Muhamed of Colombia, confers with the Secretariat at COP16’s second edition in Rome. The Cali Fund is not for “charity from companies,” but “fair payment for use of global biodiversity,” as Susana Muhamad, CBD president and former Colombian Minister of Environment and Sustainable Development said in a press conference. Furthermore, “at least 50% of the Cali Fund resources will be allocated to indigenous peoples and local communities, recognizing their role as custodians of biodiversity,” the UN said in a statement, building upon agreements in Cali that gave Indigenous peoples and local communities a stronger voice in conservation matters. Pharmaceutical companies have also warned that the initiatives such as the Cali Fund also risks taking the world down a slippery slope that “stifles” easy access to genetic material and to medical innovation – particularly if something now framed as a voluntary measure eventually becomes mandatory. “The pharmaceutical industry has long supported the Convention on Biological Diversity’s objective to protect our natural world,” said David Reddy, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a statement following November’s Cali round. But “[t]he ability to rapidly use scientific data known as “digital sequence information” (DSI) is essential for developing new medicines and vaccines,” he warned. “Any new system should not introduce further conditions on how scientists access such data and add to a complex web of regulation, taxation and other obligations for the whole R&D ecosystem – including on academia and biotech companies. “Ahead of COP17, it is critical that governments work to ensure the implementation of any new mechanism on digital sequence information does not stifle medical research and innovation that can bring the next wave of medical progress to people around the world.” Biodiversity continues to declines Heavy deforestation in hotspots, such as the Amazon and Congo river basins, threatens biodiversity as well as increasing the risks to human communities of zoonotic diseases transmitted by displaced animal species. The new financial agreements come at a critical time in which biodiversity loss continues to accelerate. Global wildlife populations have declined by 73% since 1970, with more than one million species at risk of extinction, according to the World Wildlife Fund’s Living Planet Report. This means that a quarter of species are threatened – and only the ones researchers were able to study. Along with the conservation and/or restoration of 30% of the world’s degraded ecosystems (Target 2), the Kunming-Montreal accord’s 23 targets also include: Target 6 – reduction of invasive species by 50%; Target 12 – enhancement of urban greenspaces; Target 13 – increasing the sharing of benefits from genetic resources, digital sequence information and traditional knowledge. “The results of this meeting show that multilateralism works and is the vehicle to build the partnerships needed to protect biodiversity and move us towards Peace with Nature,” said Astrid Schomaker, Executive Secretary of the CBD. “As we do this and implement the other supporting elements for resource mobilization, the world will have given itself the means to close the biodiversity finance gap. Meanwhile, the decision reached in Cali on a health and biodiversity framework also gives countries a clear framework for integrating health more squarely into biodiversity planning. The framework calls for health impact assessments in land-use planning, disease surveillance where habitat loss is rapid, and stricter wildlife trade rules vital to preventing pathogens spreading from wild animals to human communities and food markets. But that still doesn’t go far enough to protect people from the risk of spill-over events, critics say. “Our health cannot be separated from the health of the planet and its many species,” UN Environment chief Inger Andersen told delegates in Cali last November. “We must adopt this action plan and implement it with a holistic, systemic approach that unifies action across health, environment, finance, industry and agriculture.” Nations are set to reconvene next year in Yerevan, Armenia, for COP17. See more Health Policy Watch coverage of Cali and biodiversity here. Image Credits: Oleksandr Sushko, Rainforest Foundation and Earth Insights, 2022, IISD/ENB | Mike Muzurakis, Earth.org. Common US Infant Formulas Are Laden with High Levels of Added Sugars 03/03/2025 Sophia Samantaroy The WHO and the American Academy of Pediatrics “support the unequivocal evidence that breastfeeding protects against a variety of diseases and conditions.” Most infant formulas in the United States contain a high percentage of added sugars instead of natural lactose, “jeopardizing” infant health and development, says researchers at the University of Kansas in a new analysis of commonly marketed formulas. “Infants may consume upwards of 60 grams of added sugars per day, or the equivalent of two soft drinks per day if they are entirely formula-fed,” researchers say in the study, published last week in the Journal of Food Composition and Analysis. The publication came as the Food and Drug Administration (FDA) delayed implementation of a rule that tightens what foods manufacturers are allowed to label as “healthy.” The study, which analyzed 73 infant formulas available in 2022, found that “gentle” and lactose-free formulas contained the highest proportion of added sugar, with median levels reaching 85% and 90% of total sugars, respectively. On average, formula-fed infants consume 7-8 grams of added sugar per serving – a quick form of energy, but lacking in nutritional value. Health experts warn that high sugar consumption in infancy, in the form of sucrose, glucose, and high-corn fructose, may contribute to rapid weight gain and early obesity, increasing the risk of chronic conditions such as diabetes later in life. 20% of US children have obesity – a figure that is only expected to rise in the coming decades. Babies exposed to sugary foods also develop a strong preference for more sugar, says the authors. But “lax” federal guidelines make it difficult for parents and caregivers to avoid added sugars in infant formula because of the “staggering extent” to which US formula contradicts federal healthy diet recommendations. The FDA does not require manufacturers to report sugars in US formulas, in “sharp contrast” to adult food regulations, which must display a breakdown of total carbohydrates and added sugars, despite federal dietary guidelines recommending zero added sugars for infants under two years old. “As a result, parents and guardians may unknowingly feed their infants formula that contains substantial quantities of added sugars… which likely present a substantial risk to their infant’s health and development.” A systemic issue It was only after the Affordable Care Act that employers were mandated to provide space for nursing mothers other than a bathroom. But state laws are still patchwork protection, and do not require compensation for time spent breastfeeding. Even though the researchers build upon a body of evidence showing the risks to formula feeding – including an increased risk of gastroenteritis, diarrhea, ear infections, and chronic illnesses – they acknowledge that larger, systemic issues bar families from breastfeeding. The World Health Organization (WHO) recommends that parents exclusively breastfeed for the first six months. But in the US, “extremely” limited social support, no paid maternity leave, and the lack of affordable early childcare means that reliance on formula is a “necessity” for most parents, the authors say. Those from low socioeconomic status backgrounds are the most disadvantaged. “[T]he structure of the US system and environment often leaves parents and caregivers with little choice but to use formula in some capacity,” write study authors Audrey Rips-Goodwin, Daiil Jun, Adrianne Griebel-Thompson, Kai Ling Kong, and Tera Fazzino. “[W]e reason that the focus on an individual-level solution (breastfeeding promotion to women and caregivers) is not well matched to addressing the systemic nature of the problem and places an unfair burden on women and families who are expected to navigate this systemic issue. “Ideally, the US labor system should support breastfeeding, and healthcare professionals should be properly trained and incentivized to promote it.” “At the federal level there is no requirement for paid maternity/paternity leave and very little structural support to promote breastfeeding. Given the vast limitations in systemic support of new mothers and parents, most turn to using formula out of necessity. US parents deserve an infant formula supply that does not jeopardize infant health due to the presence of added sugars,” said Dr Tera Fazzino, study author and associate professor of psychology and associate director of the Cofrin Logan Center for Addiction Research and Treatment at the University of Kansas. Formulas with lactose could be safer, if made available Lactose, which is naturally found in breast milk and cow and goat milk, is sometimes used as a base for formula. Infants digest the more complex form of sugar slower, boosting their nutrition and metabolism, and engaging in hunger satiation hormones. Unlike the added sugars in most formulas – high fructose corn syrup, glucose, sucrose – lactose does not cause the same blood sugar spike. “These non-lactose sugars also typically garner more pronounced neurochemical reward responses and glycemic responses relative to lactose. Therefore it is really important for infants to consume lactose and avoid consumption of other types of added sugars, which is in line with US Dietary Guidelines,” said Fazzino. Only 8% of US formulas contained primarily naturally lactose, but the type is no longer available in the US. And it is unknown whether any other formulas use the safer sugar. “When people have free choice, the choices should include options that promote infants’ health and development. In the case of the US formula supply, our findings indicate that parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Fazzino. The researchers argue that lactose-containing formulas are safer for infants, and that efforts should focus on “requiring formula companies to produce products that primarily contain naturally occurring lactose and are designed to minimize risks to healthy infant development.” Unclear if FDA will improve labelling after delay ‘Parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Dr Fazzino. Even with increased rhetoric around chronic diseases in the US, notably HHS Secretary Robert F Kennedy’s push to “Make America Healthy Again,” the role of infant formulas to early-life infant weight gain is largely overlooked. The FDA has delayed implementing a rule that would redefine which foods can be labeled as “healthy.” The regulation, which aims to prevent manufacturers from marketing sugary juices, processed sweets, and certain meats as “healthy” options, was initially set to take effect on 25 February but has now been pushed back to 28 April, according to HHS. The delay stems from a broader freeze on new rule proposals across the Trump administration, and an upheaval of firings in the past weeks. The department lost several thousand employees, including those working in food safety. Currently, infant formula labels do not disclose added sugar content, allowing products with high levels of sucrose, glucose, and corn syrup solids to be sold without clear warning. During the first Trump administration, US officials tried to derail a resolution at the 2018 World Health Assembly to promote breastfeeding, attempting to remove language urging governments to “protect, promote and support breast-feeding” and restrictions on the promotion of food unhealthy food products to children. The original sponsor of the resolution, Ecuador, withdrew after US threatened it with trade sanctions. “We need much clearer labeling requirements for formulas in the US, specifically regarding the reporting of added sugars,” Fazzino told Health Policy Watch. “Support from the federal government and associated entities is really needed to improve infant formula labeling requirements.” But Fazzino acknowledged that labelling reform is “not on their radar;” rather, the FDA is more concerned about shoring up the formula supply chain after shortages in 2022 rocked the US market. The FDA declined to respond to Health Policy Watch’s request for comment. Formula companies deploy “same tactics” as tobacco industry A Nestle advertisement from 1911 undermines breastfeeding. Formula companies were among those identified in a 2023 Lancet series on the mechanisms and scope of commercial determinants of health, examining how the private sector influences health through activities like product design, packaging, supply chains, lobbying, research funding, and marketing. These companies “are escalating avoidable levels of ill health, planetary damage, and inequity.” These include formula milk companies’ extensive lobbying networks and “predatory” marketing tactics that derailed progress on breastfeeding education. In response, just last month the WHO at its Executive Board meeting proposed a resolution to regulate digital marketing of breastmilk substitutes, after the WHO’s findings that the formula industry uses “exploitative” marketing strategies. The resolution focuses on the fact that digitial marketing – through influencers and paid content – rely on personalized data to “innapropriately” promote infant formula, and undermine recommendations from healthcare providers and national authorities. The threat of targeted misinformation led the WHO to issue guidance on “regulatory measures aimed at restricting digital marketing of breast-milk substitutes” in November 2022, following its report that “the global formula milk industry, valued at some $55 billion, is targeting new mothers with personalized social media content that is often not recognizable as advertising.” The study also follows investigations into how formula companies promoted their product as “healthy” in lower-and middle-income countries, despite high levels of added sugar. But as the authors note, hidden added sugars also plague US infant formulas. “Ultimately, caregivers and infants in the US deserve a formula market that promotes healthy infant development and does not promote early obesity risk.” Image Credits: FDA, University of Minnesota , Enfamil. ‘The Centre Must Hold’: Africa’s Health Leaders Rally for Bold Action 03/03/2025 Edith Magak Africa CDC’s Dr Claudia Shilumani, Rwandan Health Minister Dr Sabin Nsanzimana, Dr Githinji Gitahi, CEO of Amref Health Africa and Dr Chikwe Ihekweazu, acting WHO Regional Director for Africa KIGALI, Rwanda – “Sad”, “Worried” and “The centre is shaking”, were some of the reactions of African health leaders to the termination of US aid at a media briefing on Sunday (2 March) ahead of the 6th Africa Health Agenda International Conference (AHAIC). But speakers also stressed the need for resilience and swift action at the briefing ahead of the conference, which is hosted by Amref Health Africa in collaboration with Rwanda’s Ministry of Health, the World Health Organization (WHO) Africa Office for Africa, and the Africa Centres for Disease Control and Prevention (Africa CDC). “The centre of our health system on the continent must hold,” stressed Rwandan Minister of Health Dr Sabin Nsanzimana. “Even as financing declines, we must find ways to increase it – whether through domestic sources or partnerships with those who see health as an investment in humanity.” Nsanzimana believes Africa can find alternative funding sources to fill many of the gaps left by the massive cuts to US Agency for International Development (USAID) funding. “There’s always money somewhere,” he explained. “When some of our medical students in surgery and midwifery were at risk of pausing their long-term training because they were supported by financing that was stopped overnight, we reassessed our priorities. we looked at cross-sector health projects and found over 5 billion Rwandan francs [over $5 million] tied up in short-term training and workshops. “We asked ourselves: ‘Do we keep funding weekly training that people can read online, or do we invest in long-term workforce programs?’,” he said. Rwanda has now redirected those funds to keep students enrolled, shifting the current workshops to online platforms. Africa must “think beyond traditional funding models and use what we have to meet our most urgent needs”, he stressed. This will be one of the pressing question considered by the over 1,800 delegates from 56 countries attending the conference. Significant risks “This year’s conference comes at a time of significant risks to African communities and health systems,” said Dr Githinji Gitahi, CEO of Amref Health Africa, who called for Africa’s health systems to be redesigned to address the dual burden of infectious and non-communicable diseases (NCD). Many African countries bear high burdens of infectious diseases while also facing a surge in non-communicable diseases. NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. “The health system we have today is not the one we’ll need tomorrow,” said Gitahi. “[But] we have minimal fiscal space. With population growth, economic shifts, and tax inefficiencies, how do we mobilize resources to fight both infectious and non-communicable diseases with limited funds?” “Many of us didn’t anticipate the scale of change – cuts in government assistance from not only the US government but also Germany, the UK, and others. Our current health systems have relied heavily on external support. We must rethink how to sustain them in the future,” Gitahi added. Speakers also emphasized that ,while communities are aware of diseases like malaria and HIV, many are unaware of the risk factors driving NCDs such as cancer, cardiovascular diseases, and strokes. Artifical intelligence and climate change Beyond the urgent discussions on funding, the AHAIC conference is also focusing on topics including climate-resilient health policies, the growing burden of both infectious and non-communicable diseases, artificial intelligence in healthcare, and strengthening local pharmaceutical manufacturing. Dr Claudia Shilumani, Africa CDC director of external relations and strategic management, warned of increasing health threats linked to climate change. Africa CDC is currently monitoring 243 health threats across the continent, with 84 significant events recorded in the first few weeks of 2025. Artificial intelligence is also a major focus, with discussions on how technology can be leveraged to improve diagnostics, treatment, and hospital management. Delegates acknowledged that while Africa needs thousands of trained professionals to meet healthcare demands, AI-driven solutions could help bridge the gap by enhancing efficiency in service delivery. Efforts to align policies across Africa are also gaining traction. The Africa CDC is working closely with the African Medicines Agency to streamline drug approvals and distribution across the continent. There is also a push to fast-track the qualification process for local manufacturers, ensuring national health strategies align with continental frameworks like the Africa Safety Strategic Plan. Health resilience Dr Matshidiso Moeti, outgoing WHO Africa Regional Director, highlighted the remarkable progress Africa’s health systems have made over the years. She noted that the continent has confronted pandemics, eliminated once-deadly viruses, and turned death sentences into manageable conditions. Despite these achievements, Moeti emphasized that significant challenges remain. She pointed to the deepening link between health, economic stability, and the environment, warning that widening economic disparities, climate change, and conflict continue to threaten healthcare systems. “One constant has been our collective commitment to building a healthier, stronger Africa.” Image Credits: Edith Magak, WHO/NCD Portal. DRC Identifies New Mpox Variant and Investigates New Febrile Disease Outbreak 28/02/2025 Kerry Cullinan Dr Ngashi Ngongo A new and potentially more infectious variant of mpox Clade 1A has been identified in the Democratic Republic of the Congo (DRC) according to Dr Ngashi Ngongo, head of the mpox incident management team at the Africa Centre for Disease Control and Prevention (Africa CDC). The termination of USAID funding and violence in eastern DRC are hampering mpox testing and reporting, with test results being reduced to a trickle. Only 35% of mpox cases are currently being tested in DRC, both because of conflict and the ending of USAID funds to transport mpox tests to laboratories. The DRC finally started to vaccinate people in Kinshasa this week, and uptake was swift with over 24,800 people vaccinated over four days, said Ngongo. Mpox is continuing to spread in Uganda, which has seen case increases for three weeks in a row – 278 new cases in the past week. Mpox cases are overwhelming health facilities. For example, a treatment centre in Entebbe with 80-bed capacity currently has 102 patients. “Because of this, the leadership in the [Ugandan] Ministry of Health has now opted also to introduce home-based care for non-severe cases,” said Ngongo. Meanwhile, South Africa reported three mpox cases after being free of the disease for over 90 days. The World Health Organization resolved this week to keep mpox as a public health outbreak of international concern “based on the continuing rise in numbers and geographic spread, the violence in the eastern DRC, which hampers the response, as well as a lack of funding to implement the response plan”, according to the WHO. Febrile disease in DRC DRC health authorities are investigating a febrile disease outbreak in five villages in the Basankusu and Bolomba health zones in Equateur province. This has tripled deaths over the past three weeks, according to WHO. A total of 943 cases and, 52 deaths have been reported, with symptoms including fever, chills, sweating, headache and muscle pain.\, said Ngongo. There are no haemorrhagic symptoms and Ebola and Marburg tests are negative, making malaria the most likely cause, he added. “Children below five years make about 18% of cases with a case fatality of 5.3%. Children ages five to 15 years make up 20% of all cases, with a case fatality of 6.4%,” said Ngongo. “The diagnostic is pointing towards malaria. Rapid tests that were conducted on over 500 samples gave a positivity rate of 55% but there are also blood smears that were also conducted, around 70 samples, that also gave a positivity rate of almost 78%,” said Ngongo. “Further tests are to be carried out for meningitis. Food, water and environmental samples will also be analysed, to determine if there might be contamination,” according to the WHO. “Basankusu and Bolomba are about 180 kilometres apart and more than 300 kilometres from the provincial capital, Mbandaka. The two localities are reachable by road or via the Congo River from Mbandaka. This remoteness limits access to health care, including testing and treatment. Poor road and telecommunication infrastructure are also major challenges,” saif the WHO in a statement. US Terminates Thousands of Life-Saving Global Health Grants Including For HIV, TB and Malaria 27/02/2025 Kerry Cullinan Protestors gathered outside USAID headquarters in Washington D.C. after employees were informed via email to not come in to work. The Trump administration has terminated the contracts of nearly 10,000 global health projects funded by the US Agency for International Development (USAID) or the US State Department – including projects to provide vital diagnosis and treatment for HIV, tuberculosis, and malaria, as well as humanitarian aid projects providing nutrition and water and sanitation services. Grants to hundreds of African HIV organisations providing life-saving services have been terminated with immediate effect via letters received on Thursday morning. Globally, the terminated awards include 5,800 grants administered by the USAID and 4,100 grants for projects managed directly by the State Department. Some of the terminated programmes had previously been granted temporary waivers, due to their roles in providing lifesaving health or humanitarian aid. The Trump administration also announced Thursday that it was halting US funding to the Joint UN Programme on HIV/AIDS (UNAIDS), which is headquartered in Geneva, just across from the World Health Organization. “All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated,” said Dr Atul Gawande, USAID’s former assistant administrator under the Biden administration. Terminated, too, are all global tuberculosis programmes, all US-made food aid programmes, which manufacture specially enriched foods aimed at malnourished women and children, and around 1000 food kitchens serving displaced people in countries such as war-torn Sudan. “This is one of the worst days of my professional life,” said Dr Kate Rees of Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups. “Tomorrow, we are letting go 2,800 people who are mainly peer educators and data capturers.” Prof Linda-Gail Bekker, CEO of the South African Desmond Tutu HIV Foundation, said that the US termination would cost 500,000 South African lives over the next 10 years and result in around half a million new HIV infections, according to recent modelling. “As an activist, as a person living openly with HIV, I’m very hurt,” said Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “How am I going to survive? Will the public health care system be able to cater for us? Will be able to cover all the gaps that we are facing with all the challenges that the public healthcare system has?” South Africa has the highest burden of HIV in the world with eight million people living with the virus (over 16% of the adult population). All 44 South African HIV programmes that receive money from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID have seen their aid terminated. Projects affected range from mother-to-child transmission programmes and hospices to research groups. Many focus on “key populations”, groups that are the most vulnerable to HIV but often shun health centres in fear of discrimination. “I’ve been having a sleepless night trying to think how best we can save our communities because we know that some of the government healthy facilities are very discriminatory,” said Kholi Buthelezi, national coordinator of the sex worker organisation, Sisonke. HIV activist Sibongile Tshabalala, who lives with the virus, is fearful for her future. HIV programmes devastated across Africa HIV programmes across the continent have also been devastated. The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children. Late yesterday, we received award termination notices for three of our primary USAID agreements. Read our full statement. https://t.co/VpBNduu036 pic.twitter.com/0hAP17JqxG — Elizabeth Glaser Pediatric AIDS Foundation (@EGPAF) February 27, 2025 In Uganda, for example, the Baylor College of Medicine Children’s Foundation’s HIV and TB programmes, that strengthens district health systems to better deliver HIV, TB and maternal and child services, has been terminated. The termination letters all state that US Secretary of State Marco Rubio, in his capacity as acting administrator for USAID and Peter Marocco, USAID acting deputy administrator, “have determined your award is not aligned with agency priorities and made a determination that continuing this program is not in the national interest”. ‘Chaos and disaster’ The terminations have caused “chaos” and “disaster”, said emotional South African leaders of the HIV sector who urged their government to step in to save their programmes. Fatima Hassan, head of the Health Justice Initiative, urged the South African government to issue compulsory licenses to reduce the price of antiretroviral medicine as the US has already “done the worst to us”. “US Congress approved the funds, and that is what has been stopped. So we do believe that it’s an illegal grab. It’s an illegal halt of services and programs. It’s not following due process,” Hassan added. The terminations will decimate South Africa’s HIV testing, data collection and HIV and TB literacy, said public health expert Dr Lynne Wilkinson, who added that USAID funds also assisted groups combating gender-based violence. However, South Africa is luckier than many other African countries as it derives around 17% of its HIV budget from PEPFAR. The Democratic Republic of Congo (DRC) gets 89% of its HIV budget from PEPFAR, while Mozambique and Tanzania get 60% of their HIV budget from the US. USAID: Countries most reliant on US aid for HIV ‘Blanket freeze is illegal’ Mitchell Warren, head of the US-based HIV programme AVAC, described the blanket termination of USAID grants as “unlawful”. “The US government’s in a very strong position with any cooperative agreement or grant or contract. They’re allowed to cancel agreements or amend them. They’re in a very strong position generally, but the blanket freeze is illegal,” said Warren, whose organisation has resorted to the courts to prevent the cutting of lifesaving aid. AVAC’s Mitchell Warren “We have been now in a federal court for several weeks, and a temporary restraining order was provided two weeks ago by the Court that said that things had to go back. The tap had to be put back on until this 90 day review actually took place in a comprehensive way,” he added. “We now have evidence entered into the public record in the courts that show the intentionality at USAID and the State Department to dismantle everything but the government has simply thrown up additional legal delays, as is their want,” said Warren. A federal judge had set Wednesday at midnight as the deadline for USAID to release some $1,5 billion funds for the foreign aid work already completed, but the US Supreme Court granted the government a stay on the release of funds until the court could apply itself more thoroughly to the issue. “We expect a hearing next week in Washington,” said Warren. “This is not about PEPFAR. This is not about the HIV response. This is not about USAID. This is about the rule of law. The United States Congress has the power of the purse. They decide what gets spent. The executive branch is there to execute, and that’s the basis of this legal argument. “But as of [Wednesday] night, they began to basically massacre every possible implementing agency to deliver on this work. This court case, as important as it is, is not going to change that overnight. That’s why working in partnership with each other and with national governments is essential because the United States is not a partner that is trustworthy right now,” Warren concluded. Image Credits: Reuters Youtube, Gandhi A, et al, Annals of Internal Medicine, 11 Feb. 2025, UNAIDS. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Common US Infant Formulas Are Laden with High Levels of Added Sugars 03/03/2025 Sophia Samantaroy The WHO and the American Academy of Pediatrics “support the unequivocal evidence that breastfeeding protects against a variety of diseases and conditions.” Most infant formulas in the United States contain a high percentage of added sugars instead of natural lactose, “jeopardizing” infant health and development, says researchers at the University of Kansas in a new analysis of commonly marketed formulas. “Infants may consume upwards of 60 grams of added sugars per day, or the equivalent of two soft drinks per day if they are entirely formula-fed,” researchers say in the study, published last week in the Journal of Food Composition and Analysis. The publication came as the Food and Drug Administration (FDA) delayed implementation of a rule that tightens what foods manufacturers are allowed to label as “healthy.” The study, which analyzed 73 infant formulas available in 2022, found that “gentle” and lactose-free formulas contained the highest proportion of added sugar, with median levels reaching 85% and 90% of total sugars, respectively. On average, formula-fed infants consume 7-8 grams of added sugar per serving – a quick form of energy, but lacking in nutritional value. Health experts warn that high sugar consumption in infancy, in the form of sucrose, glucose, and high-corn fructose, may contribute to rapid weight gain and early obesity, increasing the risk of chronic conditions such as diabetes later in life. 20% of US children have obesity – a figure that is only expected to rise in the coming decades. Babies exposed to sugary foods also develop a strong preference for more sugar, says the authors. But “lax” federal guidelines make it difficult for parents and caregivers to avoid added sugars in infant formula because of the “staggering extent” to which US formula contradicts federal healthy diet recommendations. The FDA does not require manufacturers to report sugars in US formulas, in “sharp contrast” to adult food regulations, which must display a breakdown of total carbohydrates and added sugars, despite federal dietary guidelines recommending zero added sugars for infants under two years old. “As a result, parents and guardians may unknowingly feed their infants formula that contains substantial quantities of added sugars… which likely present a substantial risk to their infant’s health and development.” A systemic issue It was only after the Affordable Care Act that employers were mandated to provide space for nursing mothers other than a bathroom. But state laws are still patchwork protection, and do not require compensation for time spent breastfeeding. Even though the researchers build upon a body of evidence showing the risks to formula feeding – including an increased risk of gastroenteritis, diarrhea, ear infections, and chronic illnesses – they acknowledge that larger, systemic issues bar families from breastfeeding. The World Health Organization (WHO) recommends that parents exclusively breastfeed for the first six months. But in the US, “extremely” limited social support, no paid maternity leave, and the lack of affordable early childcare means that reliance on formula is a “necessity” for most parents, the authors say. Those from low socioeconomic status backgrounds are the most disadvantaged. “[T]he structure of the US system and environment often leaves parents and caregivers with little choice but to use formula in some capacity,” write study authors Audrey Rips-Goodwin, Daiil Jun, Adrianne Griebel-Thompson, Kai Ling Kong, and Tera Fazzino. “[W]e reason that the focus on an individual-level solution (breastfeeding promotion to women and caregivers) is not well matched to addressing the systemic nature of the problem and places an unfair burden on women and families who are expected to navigate this systemic issue. “Ideally, the US labor system should support breastfeeding, and healthcare professionals should be properly trained and incentivized to promote it.” “At the federal level there is no requirement for paid maternity/paternity leave and very little structural support to promote breastfeeding. Given the vast limitations in systemic support of new mothers and parents, most turn to using formula out of necessity. US parents deserve an infant formula supply that does not jeopardize infant health due to the presence of added sugars,” said Dr Tera Fazzino, study author and associate professor of psychology and associate director of the Cofrin Logan Center for Addiction Research and Treatment at the University of Kansas. Formulas with lactose could be safer, if made available Lactose, which is naturally found in breast milk and cow and goat milk, is sometimes used as a base for formula. Infants digest the more complex form of sugar slower, boosting their nutrition and metabolism, and engaging in hunger satiation hormones. Unlike the added sugars in most formulas – high fructose corn syrup, glucose, sucrose – lactose does not cause the same blood sugar spike. “These non-lactose sugars also typically garner more pronounced neurochemical reward responses and glycemic responses relative to lactose. Therefore it is really important for infants to consume lactose and avoid consumption of other types of added sugars, which is in line with US Dietary Guidelines,” said Fazzino. Only 8% of US formulas contained primarily naturally lactose, but the type is no longer available in the US. And it is unknown whether any other formulas use the safer sugar. “When people have free choice, the choices should include options that promote infants’ health and development. In the case of the US formula supply, our findings indicate that parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Fazzino. The researchers argue that lactose-containing formulas are safer for infants, and that efforts should focus on “requiring formula companies to produce products that primarily contain naturally occurring lactose and are designed to minimize risks to healthy infant development.” Unclear if FDA will improve labelling after delay ‘Parents and caregivers in the US largely do not have a choice with the formula supply; most of the supply has substantial added sugars that may jeopardize healthy infant development,” said Dr Fazzino. Even with increased rhetoric around chronic diseases in the US, notably HHS Secretary Robert F Kennedy’s push to “Make America Healthy Again,” the role of infant formulas to early-life infant weight gain is largely overlooked. The FDA has delayed implementing a rule that would redefine which foods can be labeled as “healthy.” The regulation, which aims to prevent manufacturers from marketing sugary juices, processed sweets, and certain meats as “healthy” options, was initially set to take effect on 25 February but has now been pushed back to 28 April, according to HHS. The delay stems from a broader freeze on new rule proposals across the Trump administration, and an upheaval of firings in the past weeks. The department lost several thousand employees, including those working in food safety. Currently, infant formula labels do not disclose added sugar content, allowing products with high levels of sucrose, glucose, and corn syrup solids to be sold without clear warning. During the first Trump administration, US officials tried to derail a resolution at the 2018 World Health Assembly to promote breastfeeding, attempting to remove language urging governments to “protect, promote and support breast-feeding” and restrictions on the promotion of food unhealthy food products to children. The original sponsor of the resolution, Ecuador, withdrew after US threatened it with trade sanctions. “We need much clearer labeling requirements for formulas in the US, specifically regarding the reporting of added sugars,” Fazzino told Health Policy Watch. “Support from the federal government and associated entities is really needed to improve infant formula labeling requirements.” But Fazzino acknowledged that labelling reform is “not on their radar;” rather, the FDA is more concerned about shoring up the formula supply chain after shortages in 2022 rocked the US market. The FDA declined to respond to Health Policy Watch’s request for comment. Formula companies deploy “same tactics” as tobacco industry A Nestle advertisement from 1911 undermines breastfeeding. Formula companies were among those identified in a 2023 Lancet series on the mechanisms and scope of commercial determinants of health, examining how the private sector influences health through activities like product design, packaging, supply chains, lobbying, research funding, and marketing. These companies “are escalating avoidable levels of ill health, planetary damage, and inequity.” These include formula milk companies’ extensive lobbying networks and “predatory” marketing tactics that derailed progress on breastfeeding education. In response, just last month the WHO at its Executive Board meeting proposed a resolution to regulate digital marketing of breastmilk substitutes, after the WHO’s findings that the formula industry uses “exploitative” marketing strategies. The resolution focuses on the fact that digitial marketing – through influencers and paid content – rely on personalized data to “innapropriately” promote infant formula, and undermine recommendations from healthcare providers and national authorities. The threat of targeted misinformation led the WHO to issue guidance on “regulatory measures aimed at restricting digital marketing of breast-milk substitutes” in November 2022, following its report that “the global formula milk industry, valued at some $55 billion, is targeting new mothers with personalized social media content that is often not recognizable as advertising.” The study also follows investigations into how formula companies promoted their product as “healthy” in lower-and middle-income countries, despite high levels of added sugar. But as the authors note, hidden added sugars also plague US infant formulas. “Ultimately, caregivers and infants in the US deserve a formula market that promotes healthy infant development and does not promote early obesity risk.” Image Credits: FDA, University of Minnesota , Enfamil. ‘The Centre Must Hold’: Africa’s Health Leaders Rally for Bold Action 03/03/2025 Edith Magak Africa CDC’s Dr Claudia Shilumani, Rwandan Health Minister Dr Sabin Nsanzimana, Dr Githinji Gitahi, CEO of Amref Health Africa and Dr Chikwe Ihekweazu, acting WHO Regional Director for Africa KIGALI, Rwanda – “Sad”, “Worried” and “The centre is shaking”, were some of the reactions of African health leaders to the termination of US aid at a media briefing on Sunday (2 March) ahead of the 6th Africa Health Agenda International Conference (AHAIC). But speakers also stressed the need for resilience and swift action at the briefing ahead of the conference, which is hosted by Amref Health Africa in collaboration with Rwanda’s Ministry of Health, the World Health Organization (WHO) Africa Office for Africa, and the Africa Centres for Disease Control and Prevention (Africa CDC). “The centre of our health system on the continent must hold,” stressed Rwandan Minister of Health Dr Sabin Nsanzimana. “Even as financing declines, we must find ways to increase it – whether through domestic sources or partnerships with those who see health as an investment in humanity.” Nsanzimana believes Africa can find alternative funding sources to fill many of the gaps left by the massive cuts to US Agency for International Development (USAID) funding. “There’s always money somewhere,” he explained. “When some of our medical students in surgery and midwifery were at risk of pausing their long-term training because they were supported by financing that was stopped overnight, we reassessed our priorities. we looked at cross-sector health projects and found over 5 billion Rwandan francs [over $5 million] tied up in short-term training and workshops. “We asked ourselves: ‘Do we keep funding weekly training that people can read online, or do we invest in long-term workforce programs?’,” he said. Rwanda has now redirected those funds to keep students enrolled, shifting the current workshops to online platforms. Africa must “think beyond traditional funding models and use what we have to meet our most urgent needs”, he stressed. This will be one of the pressing question considered by the over 1,800 delegates from 56 countries attending the conference. Significant risks “This year’s conference comes at a time of significant risks to African communities and health systems,” said Dr Githinji Gitahi, CEO of Amref Health Africa, who called for Africa’s health systems to be redesigned to address the dual burden of infectious and non-communicable diseases (NCD). Many African countries bear high burdens of infectious diseases while also facing a surge in non-communicable diseases. NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. “The health system we have today is not the one we’ll need tomorrow,” said Gitahi. “[But] we have minimal fiscal space. With population growth, economic shifts, and tax inefficiencies, how do we mobilize resources to fight both infectious and non-communicable diseases with limited funds?” “Many of us didn’t anticipate the scale of change – cuts in government assistance from not only the US government but also Germany, the UK, and others. Our current health systems have relied heavily on external support. We must rethink how to sustain them in the future,” Gitahi added. Speakers also emphasized that ,while communities are aware of diseases like malaria and HIV, many are unaware of the risk factors driving NCDs such as cancer, cardiovascular diseases, and strokes. Artifical intelligence and climate change Beyond the urgent discussions on funding, the AHAIC conference is also focusing on topics including climate-resilient health policies, the growing burden of both infectious and non-communicable diseases, artificial intelligence in healthcare, and strengthening local pharmaceutical manufacturing. Dr Claudia Shilumani, Africa CDC director of external relations and strategic management, warned of increasing health threats linked to climate change. Africa CDC is currently monitoring 243 health threats across the continent, with 84 significant events recorded in the first few weeks of 2025. Artificial intelligence is also a major focus, with discussions on how technology can be leveraged to improve diagnostics, treatment, and hospital management. Delegates acknowledged that while Africa needs thousands of trained professionals to meet healthcare demands, AI-driven solutions could help bridge the gap by enhancing efficiency in service delivery. Efforts to align policies across Africa are also gaining traction. The Africa CDC is working closely with the African Medicines Agency to streamline drug approvals and distribution across the continent. There is also a push to fast-track the qualification process for local manufacturers, ensuring national health strategies align with continental frameworks like the Africa Safety Strategic Plan. Health resilience Dr Matshidiso Moeti, outgoing WHO Africa Regional Director, highlighted the remarkable progress Africa’s health systems have made over the years. She noted that the continent has confronted pandemics, eliminated once-deadly viruses, and turned death sentences into manageable conditions. Despite these achievements, Moeti emphasized that significant challenges remain. She pointed to the deepening link between health, economic stability, and the environment, warning that widening economic disparities, climate change, and conflict continue to threaten healthcare systems. “One constant has been our collective commitment to building a healthier, stronger Africa.” Image Credits: Edith Magak, WHO/NCD Portal. DRC Identifies New Mpox Variant and Investigates New Febrile Disease Outbreak 28/02/2025 Kerry Cullinan Dr Ngashi Ngongo A new and potentially more infectious variant of mpox Clade 1A has been identified in the Democratic Republic of the Congo (DRC) according to Dr Ngashi Ngongo, head of the mpox incident management team at the Africa Centre for Disease Control and Prevention (Africa CDC). The termination of USAID funding and violence in eastern DRC are hampering mpox testing and reporting, with test results being reduced to a trickle. Only 35% of mpox cases are currently being tested in DRC, both because of conflict and the ending of USAID funds to transport mpox tests to laboratories. The DRC finally started to vaccinate people in Kinshasa this week, and uptake was swift with over 24,800 people vaccinated over four days, said Ngongo. Mpox is continuing to spread in Uganda, which has seen case increases for three weeks in a row – 278 new cases in the past week. Mpox cases are overwhelming health facilities. For example, a treatment centre in Entebbe with 80-bed capacity currently has 102 patients. “Because of this, the leadership in the [Ugandan] Ministry of Health has now opted also to introduce home-based care for non-severe cases,” said Ngongo. Meanwhile, South Africa reported three mpox cases after being free of the disease for over 90 days. The World Health Organization resolved this week to keep mpox as a public health outbreak of international concern “based on the continuing rise in numbers and geographic spread, the violence in the eastern DRC, which hampers the response, as well as a lack of funding to implement the response plan”, according to the WHO. Febrile disease in DRC DRC health authorities are investigating a febrile disease outbreak in five villages in the Basankusu and Bolomba health zones in Equateur province. This has tripled deaths over the past three weeks, according to WHO. A total of 943 cases and, 52 deaths have been reported, with symptoms including fever, chills, sweating, headache and muscle pain.\, said Ngongo. There are no haemorrhagic symptoms and Ebola and Marburg tests are negative, making malaria the most likely cause, he added. “Children below five years make about 18% of cases with a case fatality of 5.3%. Children ages five to 15 years make up 20% of all cases, with a case fatality of 6.4%,” said Ngongo. “The diagnostic is pointing towards malaria. Rapid tests that were conducted on over 500 samples gave a positivity rate of 55% but there are also blood smears that were also conducted, around 70 samples, that also gave a positivity rate of almost 78%,” said Ngongo. “Further tests are to be carried out for meningitis. Food, water and environmental samples will also be analysed, to determine if there might be contamination,” according to the WHO. “Basankusu and Bolomba are about 180 kilometres apart and more than 300 kilometres from the provincial capital, Mbandaka. The two localities are reachable by road or via the Congo River from Mbandaka. This remoteness limits access to health care, including testing and treatment. Poor road and telecommunication infrastructure are also major challenges,” saif the WHO in a statement. US Terminates Thousands of Life-Saving Global Health Grants Including For HIV, TB and Malaria 27/02/2025 Kerry Cullinan Protestors gathered outside USAID headquarters in Washington D.C. after employees were informed via email to not come in to work. The Trump administration has terminated the contracts of nearly 10,000 global health projects funded by the US Agency for International Development (USAID) or the US State Department – including projects to provide vital diagnosis and treatment for HIV, tuberculosis, and malaria, as well as humanitarian aid projects providing nutrition and water and sanitation services. Grants to hundreds of African HIV organisations providing life-saving services have been terminated with immediate effect via letters received on Thursday morning. Globally, the terminated awards include 5,800 grants administered by the USAID and 4,100 grants for projects managed directly by the State Department. Some of the terminated programmes had previously been granted temporary waivers, due to their roles in providing lifesaving health or humanitarian aid. The Trump administration also announced Thursday that it was halting US funding to the Joint UN Programme on HIV/AIDS (UNAIDS), which is headquartered in Geneva, just across from the World Health Organization. “All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated,” said Dr Atul Gawande, USAID’s former assistant administrator under the Biden administration. Terminated, too, are all global tuberculosis programmes, all US-made food aid programmes, which manufacture specially enriched foods aimed at malnourished women and children, and around 1000 food kitchens serving displaced people in countries such as war-torn Sudan. “This is one of the worst days of my professional life,” said Dr Kate Rees of Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups. “Tomorrow, we are letting go 2,800 people who are mainly peer educators and data capturers.” Prof Linda-Gail Bekker, CEO of the South African Desmond Tutu HIV Foundation, said that the US termination would cost 500,000 South African lives over the next 10 years and result in around half a million new HIV infections, according to recent modelling. “As an activist, as a person living openly with HIV, I’m very hurt,” said Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “How am I going to survive? Will the public health care system be able to cater for us? Will be able to cover all the gaps that we are facing with all the challenges that the public healthcare system has?” South Africa has the highest burden of HIV in the world with eight million people living with the virus (over 16% of the adult population). All 44 South African HIV programmes that receive money from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID have seen their aid terminated. Projects affected range from mother-to-child transmission programmes and hospices to research groups. Many focus on “key populations”, groups that are the most vulnerable to HIV but often shun health centres in fear of discrimination. “I’ve been having a sleepless night trying to think how best we can save our communities because we know that some of the government healthy facilities are very discriminatory,” said Kholi Buthelezi, national coordinator of the sex worker organisation, Sisonke. HIV activist Sibongile Tshabalala, who lives with the virus, is fearful for her future. HIV programmes devastated across Africa HIV programmes across the continent have also been devastated. The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children. Late yesterday, we received award termination notices for three of our primary USAID agreements. Read our full statement. https://t.co/VpBNduu036 pic.twitter.com/0hAP17JqxG — Elizabeth Glaser Pediatric AIDS Foundation (@EGPAF) February 27, 2025 In Uganda, for example, the Baylor College of Medicine Children’s Foundation’s HIV and TB programmes, that strengthens district health systems to better deliver HIV, TB and maternal and child services, has been terminated. The termination letters all state that US Secretary of State Marco Rubio, in his capacity as acting administrator for USAID and Peter Marocco, USAID acting deputy administrator, “have determined your award is not aligned with agency priorities and made a determination that continuing this program is not in the national interest”. ‘Chaos and disaster’ The terminations have caused “chaos” and “disaster”, said emotional South African leaders of the HIV sector who urged their government to step in to save their programmes. Fatima Hassan, head of the Health Justice Initiative, urged the South African government to issue compulsory licenses to reduce the price of antiretroviral medicine as the US has already “done the worst to us”. “US Congress approved the funds, and that is what has been stopped. So we do believe that it’s an illegal grab. It’s an illegal halt of services and programs. It’s not following due process,” Hassan added. The terminations will decimate South Africa’s HIV testing, data collection and HIV and TB literacy, said public health expert Dr Lynne Wilkinson, who added that USAID funds also assisted groups combating gender-based violence. However, South Africa is luckier than many other African countries as it derives around 17% of its HIV budget from PEPFAR. The Democratic Republic of Congo (DRC) gets 89% of its HIV budget from PEPFAR, while Mozambique and Tanzania get 60% of their HIV budget from the US. USAID: Countries most reliant on US aid for HIV ‘Blanket freeze is illegal’ Mitchell Warren, head of the US-based HIV programme AVAC, described the blanket termination of USAID grants as “unlawful”. “The US government’s in a very strong position with any cooperative agreement or grant or contract. They’re allowed to cancel agreements or amend them. They’re in a very strong position generally, but the blanket freeze is illegal,” said Warren, whose organisation has resorted to the courts to prevent the cutting of lifesaving aid. AVAC’s Mitchell Warren “We have been now in a federal court for several weeks, and a temporary restraining order was provided two weeks ago by the Court that said that things had to go back. The tap had to be put back on until this 90 day review actually took place in a comprehensive way,” he added. “We now have evidence entered into the public record in the courts that show the intentionality at USAID and the State Department to dismantle everything but the government has simply thrown up additional legal delays, as is their want,” said Warren. A federal judge had set Wednesday at midnight as the deadline for USAID to release some $1,5 billion funds for the foreign aid work already completed, but the US Supreme Court granted the government a stay on the release of funds until the court could apply itself more thoroughly to the issue. “We expect a hearing next week in Washington,” said Warren. “This is not about PEPFAR. This is not about the HIV response. This is not about USAID. This is about the rule of law. The United States Congress has the power of the purse. They decide what gets spent. The executive branch is there to execute, and that’s the basis of this legal argument. “But as of [Wednesday] night, they began to basically massacre every possible implementing agency to deliver on this work. This court case, as important as it is, is not going to change that overnight. That’s why working in partnership with each other and with national governments is essential because the United States is not a partner that is trustworthy right now,” Warren concluded. Image Credits: Reuters Youtube, Gandhi A, et al, Annals of Internal Medicine, 11 Feb. 2025, UNAIDS. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
‘The Centre Must Hold’: Africa’s Health Leaders Rally for Bold Action 03/03/2025 Edith Magak Africa CDC’s Dr Claudia Shilumani, Rwandan Health Minister Dr Sabin Nsanzimana, Dr Githinji Gitahi, CEO of Amref Health Africa and Dr Chikwe Ihekweazu, acting WHO Regional Director for Africa KIGALI, Rwanda – “Sad”, “Worried” and “The centre is shaking”, were some of the reactions of African health leaders to the termination of US aid at a media briefing on Sunday (2 March) ahead of the 6th Africa Health Agenda International Conference (AHAIC). But speakers also stressed the need for resilience and swift action at the briefing ahead of the conference, which is hosted by Amref Health Africa in collaboration with Rwanda’s Ministry of Health, the World Health Organization (WHO) Africa Office for Africa, and the Africa Centres for Disease Control and Prevention (Africa CDC). “The centre of our health system on the continent must hold,” stressed Rwandan Minister of Health Dr Sabin Nsanzimana. “Even as financing declines, we must find ways to increase it – whether through domestic sources or partnerships with those who see health as an investment in humanity.” Nsanzimana believes Africa can find alternative funding sources to fill many of the gaps left by the massive cuts to US Agency for International Development (USAID) funding. “There’s always money somewhere,” he explained. “When some of our medical students in surgery and midwifery were at risk of pausing their long-term training because they were supported by financing that was stopped overnight, we reassessed our priorities. we looked at cross-sector health projects and found over 5 billion Rwandan francs [over $5 million] tied up in short-term training and workshops. “We asked ourselves: ‘Do we keep funding weekly training that people can read online, or do we invest in long-term workforce programs?’,” he said. Rwanda has now redirected those funds to keep students enrolled, shifting the current workshops to online platforms. Africa must “think beyond traditional funding models and use what we have to meet our most urgent needs”, he stressed. This will be one of the pressing question considered by the over 1,800 delegates from 56 countries attending the conference. Significant risks “This year’s conference comes at a time of significant risks to African communities and health systems,” said Dr Githinji Gitahi, CEO of Amref Health Africa, who called for Africa’s health systems to be redesigned to address the dual burden of infectious and non-communicable diseases (NCD). Many African countries bear high burdens of infectious diseases while also facing a surge in non-communicable diseases. NCDs, still perceived as largely a problem of rich countries, are now a leading cause of premature deaths in Africa and Asia. “The health system we have today is not the one we’ll need tomorrow,” said Gitahi. “[But] we have minimal fiscal space. With population growth, economic shifts, and tax inefficiencies, how do we mobilize resources to fight both infectious and non-communicable diseases with limited funds?” “Many of us didn’t anticipate the scale of change – cuts in government assistance from not only the US government but also Germany, the UK, and others. Our current health systems have relied heavily on external support. We must rethink how to sustain them in the future,” Gitahi added. Speakers also emphasized that ,while communities are aware of diseases like malaria and HIV, many are unaware of the risk factors driving NCDs such as cancer, cardiovascular diseases, and strokes. Artifical intelligence and climate change Beyond the urgent discussions on funding, the AHAIC conference is also focusing on topics including climate-resilient health policies, the growing burden of both infectious and non-communicable diseases, artificial intelligence in healthcare, and strengthening local pharmaceutical manufacturing. Dr Claudia Shilumani, Africa CDC director of external relations and strategic management, warned of increasing health threats linked to climate change. Africa CDC is currently monitoring 243 health threats across the continent, with 84 significant events recorded in the first few weeks of 2025. Artificial intelligence is also a major focus, with discussions on how technology can be leveraged to improve diagnostics, treatment, and hospital management. Delegates acknowledged that while Africa needs thousands of trained professionals to meet healthcare demands, AI-driven solutions could help bridge the gap by enhancing efficiency in service delivery. Efforts to align policies across Africa are also gaining traction. The Africa CDC is working closely with the African Medicines Agency to streamline drug approvals and distribution across the continent. There is also a push to fast-track the qualification process for local manufacturers, ensuring national health strategies align with continental frameworks like the Africa Safety Strategic Plan. Health resilience Dr Matshidiso Moeti, outgoing WHO Africa Regional Director, highlighted the remarkable progress Africa’s health systems have made over the years. She noted that the continent has confronted pandemics, eliminated once-deadly viruses, and turned death sentences into manageable conditions. Despite these achievements, Moeti emphasized that significant challenges remain. She pointed to the deepening link between health, economic stability, and the environment, warning that widening economic disparities, climate change, and conflict continue to threaten healthcare systems. “One constant has been our collective commitment to building a healthier, stronger Africa.” Image Credits: Edith Magak, WHO/NCD Portal. DRC Identifies New Mpox Variant and Investigates New Febrile Disease Outbreak 28/02/2025 Kerry Cullinan Dr Ngashi Ngongo A new and potentially more infectious variant of mpox Clade 1A has been identified in the Democratic Republic of the Congo (DRC) according to Dr Ngashi Ngongo, head of the mpox incident management team at the Africa Centre for Disease Control and Prevention (Africa CDC). The termination of USAID funding and violence in eastern DRC are hampering mpox testing and reporting, with test results being reduced to a trickle. Only 35% of mpox cases are currently being tested in DRC, both because of conflict and the ending of USAID funds to transport mpox tests to laboratories. The DRC finally started to vaccinate people in Kinshasa this week, and uptake was swift with over 24,800 people vaccinated over four days, said Ngongo. Mpox is continuing to spread in Uganda, which has seen case increases for three weeks in a row – 278 new cases in the past week. Mpox cases are overwhelming health facilities. For example, a treatment centre in Entebbe with 80-bed capacity currently has 102 patients. “Because of this, the leadership in the [Ugandan] Ministry of Health has now opted also to introduce home-based care for non-severe cases,” said Ngongo. Meanwhile, South Africa reported three mpox cases after being free of the disease for over 90 days. The World Health Organization resolved this week to keep mpox as a public health outbreak of international concern “based on the continuing rise in numbers and geographic spread, the violence in the eastern DRC, which hampers the response, as well as a lack of funding to implement the response plan”, according to the WHO. Febrile disease in DRC DRC health authorities are investigating a febrile disease outbreak in five villages in the Basankusu and Bolomba health zones in Equateur province. This has tripled deaths over the past three weeks, according to WHO. A total of 943 cases and, 52 deaths have been reported, with symptoms including fever, chills, sweating, headache and muscle pain.\, said Ngongo. There are no haemorrhagic symptoms and Ebola and Marburg tests are negative, making malaria the most likely cause, he added. “Children below five years make about 18% of cases with a case fatality of 5.3%. Children ages five to 15 years make up 20% of all cases, with a case fatality of 6.4%,” said Ngongo. “The diagnostic is pointing towards malaria. Rapid tests that were conducted on over 500 samples gave a positivity rate of 55% but there are also blood smears that were also conducted, around 70 samples, that also gave a positivity rate of almost 78%,” said Ngongo. “Further tests are to be carried out for meningitis. Food, water and environmental samples will also be analysed, to determine if there might be contamination,” according to the WHO. “Basankusu and Bolomba are about 180 kilometres apart and more than 300 kilometres from the provincial capital, Mbandaka. The two localities are reachable by road or via the Congo River from Mbandaka. This remoteness limits access to health care, including testing and treatment. Poor road and telecommunication infrastructure are also major challenges,” saif the WHO in a statement. US Terminates Thousands of Life-Saving Global Health Grants Including For HIV, TB and Malaria 27/02/2025 Kerry Cullinan Protestors gathered outside USAID headquarters in Washington D.C. after employees were informed via email to not come in to work. The Trump administration has terminated the contracts of nearly 10,000 global health projects funded by the US Agency for International Development (USAID) or the US State Department – including projects to provide vital diagnosis and treatment for HIV, tuberculosis, and malaria, as well as humanitarian aid projects providing nutrition and water and sanitation services. Grants to hundreds of African HIV organisations providing life-saving services have been terminated with immediate effect via letters received on Thursday morning. Globally, the terminated awards include 5,800 grants administered by the USAID and 4,100 grants for projects managed directly by the State Department. Some of the terminated programmes had previously been granted temporary waivers, due to their roles in providing lifesaving health or humanitarian aid. The Trump administration also announced Thursday that it was halting US funding to the Joint UN Programme on HIV/AIDS (UNAIDS), which is headquartered in Geneva, just across from the World Health Organization. “All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated,” said Dr Atul Gawande, USAID’s former assistant administrator under the Biden administration. Terminated, too, are all global tuberculosis programmes, all US-made food aid programmes, which manufacture specially enriched foods aimed at malnourished women and children, and around 1000 food kitchens serving displaced people in countries such as war-torn Sudan. “This is one of the worst days of my professional life,” said Dr Kate Rees of Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups. “Tomorrow, we are letting go 2,800 people who are mainly peer educators and data capturers.” Prof Linda-Gail Bekker, CEO of the South African Desmond Tutu HIV Foundation, said that the US termination would cost 500,000 South African lives over the next 10 years and result in around half a million new HIV infections, according to recent modelling. “As an activist, as a person living openly with HIV, I’m very hurt,” said Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “How am I going to survive? Will the public health care system be able to cater for us? Will be able to cover all the gaps that we are facing with all the challenges that the public healthcare system has?” South Africa has the highest burden of HIV in the world with eight million people living with the virus (over 16% of the adult population). All 44 South African HIV programmes that receive money from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID have seen their aid terminated. Projects affected range from mother-to-child transmission programmes and hospices to research groups. Many focus on “key populations”, groups that are the most vulnerable to HIV but often shun health centres in fear of discrimination. “I’ve been having a sleepless night trying to think how best we can save our communities because we know that some of the government healthy facilities are very discriminatory,” said Kholi Buthelezi, national coordinator of the sex worker organisation, Sisonke. HIV activist Sibongile Tshabalala, who lives with the virus, is fearful for her future. HIV programmes devastated across Africa HIV programmes across the continent have also been devastated. The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children. Late yesterday, we received award termination notices for three of our primary USAID agreements. Read our full statement. https://t.co/VpBNduu036 pic.twitter.com/0hAP17JqxG — Elizabeth Glaser Pediatric AIDS Foundation (@EGPAF) February 27, 2025 In Uganda, for example, the Baylor College of Medicine Children’s Foundation’s HIV and TB programmes, that strengthens district health systems to better deliver HIV, TB and maternal and child services, has been terminated. The termination letters all state that US Secretary of State Marco Rubio, in his capacity as acting administrator for USAID and Peter Marocco, USAID acting deputy administrator, “have determined your award is not aligned with agency priorities and made a determination that continuing this program is not in the national interest”. ‘Chaos and disaster’ The terminations have caused “chaos” and “disaster”, said emotional South African leaders of the HIV sector who urged their government to step in to save their programmes. Fatima Hassan, head of the Health Justice Initiative, urged the South African government to issue compulsory licenses to reduce the price of antiretroviral medicine as the US has already “done the worst to us”. “US Congress approved the funds, and that is what has been stopped. So we do believe that it’s an illegal grab. It’s an illegal halt of services and programs. It’s not following due process,” Hassan added. The terminations will decimate South Africa’s HIV testing, data collection and HIV and TB literacy, said public health expert Dr Lynne Wilkinson, who added that USAID funds also assisted groups combating gender-based violence. However, South Africa is luckier than many other African countries as it derives around 17% of its HIV budget from PEPFAR. The Democratic Republic of Congo (DRC) gets 89% of its HIV budget from PEPFAR, while Mozambique and Tanzania get 60% of their HIV budget from the US. USAID: Countries most reliant on US aid for HIV ‘Blanket freeze is illegal’ Mitchell Warren, head of the US-based HIV programme AVAC, described the blanket termination of USAID grants as “unlawful”. “The US government’s in a very strong position with any cooperative agreement or grant or contract. They’re allowed to cancel agreements or amend them. They’re in a very strong position generally, but the blanket freeze is illegal,” said Warren, whose organisation has resorted to the courts to prevent the cutting of lifesaving aid. AVAC’s Mitchell Warren “We have been now in a federal court for several weeks, and a temporary restraining order was provided two weeks ago by the Court that said that things had to go back. The tap had to be put back on until this 90 day review actually took place in a comprehensive way,” he added. “We now have evidence entered into the public record in the courts that show the intentionality at USAID and the State Department to dismantle everything but the government has simply thrown up additional legal delays, as is their want,” said Warren. A federal judge had set Wednesday at midnight as the deadline for USAID to release some $1,5 billion funds for the foreign aid work already completed, but the US Supreme Court granted the government a stay on the release of funds until the court could apply itself more thoroughly to the issue. “We expect a hearing next week in Washington,” said Warren. “This is not about PEPFAR. This is not about the HIV response. This is not about USAID. This is about the rule of law. The United States Congress has the power of the purse. They decide what gets spent. The executive branch is there to execute, and that’s the basis of this legal argument. “But as of [Wednesday] night, they began to basically massacre every possible implementing agency to deliver on this work. This court case, as important as it is, is not going to change that overnight. That’s why working in partnership with each other and with national governments is essential because the United States is not a partner that is trustworthy right now,” Warren concluded. Image Credits: Reuters Youtube, Gandhi A, et al, Annals of Internal Medicine, 11 Feb. 2025, UNAIDS. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
DRC Identifies New Mpox Variant and Investigates New Febrile Disease Outbreak 28/02/2025 Kerry Cullinan Dr Ngashi Ngongo A new and potentially more infectious variant of mpox Clade 1A has been identified in the Democratic Republic of the Congo (DRC) according to Dr Ngashi Ngongo, head of the mpox incident management team at the Africa Centre for Disease Control and Prevention (Africa CDC). The termination of USAID funding and violence in eastern DRC are hampering mpox testing and reporting, with test results being reduced to a trickle. Only 35% of mpox cases are currently being tested in DRC, both because of conflict and the ending of USAID funds to transport mpox tests to laboratories. The DRC finally started to vaccinate people in Kinshasa this week, and uptake was swift with over 24,800 people vaccinated over four days, said Ngongo. Mpox is continuing to spread in Uganda, which has seen case increases for three weeks in a row – 278 new cases in the past week. Mpox cases are overwhelming health facilities. For example, a treatment centre in Entebbe with 80-bed capacity currently has 102 patients. “Because of this, the leadership in the [Ugandan] Ministry of Health has now opted also to introduce home-based care for non-severe cases,” said Ngongo. Meanwhile, South Africa reported three mpox cases after being free of the disease for over 90 days. The World Health Organization resolved this week to keep mpox as a public health outbreak of international concern “based on the continuing rise in numbers and geographic spread, the violence in the eastern DRC, which hampers the response, as well as a lack of funding to implement the response plan”, according to the WHO. Febrile disease in DRC DRC health authorities are investigating a febrile disease outbreak in five villages in the Basankusu and Bolomba health zones in Equateur province. This has tripled deaths over the past three weeks, according to WHO. A total of 943 cases and, 52 deaths have been reported, with symptoms including fever, chills, sweating, headache and muscle pain.\, said Ngongo. There are no haemorrhagic symptoms and Ebola and Marburg tests are negative, making malaria the most likely cause, he added. “Children below five years make about 18% of cases with a case fatality of 5.3%. Children ages five to 15 years make up 20% of all cases, with a case fatality of 6.4%,” said Ngongo. “The diagnostic is pointing towards malaria. Rapid tests that were conducted on over 500 samples gave a positivity rate of 55% but there are also blood smears that were also conducted, around 70 samples, that also gave a positivity rate of almost 78%,” said Ngongo. “Further tests are to be carried out for meningitis. Food, water and environmental samples will also be analysed, to determine if there might be contamination,” according to the WHO. “Basankusu and Bolomba are about 180 kilometres apart and more than 300 kilometres from the provincial capital, Mbandaka. The two localities are reachable by road or via the Congo River from Mbandaka. This remoteness limits access to health care, including testing and treatment. Poor road and telecommunication infrastructure are also major challenges,” saif the WHO in a statement. US Terminates Thousands of Life-Saving Global Health Grants Including For HIV, TB and Malaria 27/02/2025 Kerry Cullinan Protestors gathered outside USAID headquarters in Washington D.C. after employees were informed via email to not come in to work. The Trump administration has terminated the contracts of nearly 10,000 global health projects funded by the US Agency for International Development (USAID) or the US State Department – including projects to provide vital diagnosis and treatment for HIV, tuberculosis, and malaria, as well as humanitarian aid projects providing nutrition and water and sanitation services. Grants to hundreds of African HIV organisations providing life-saving services have been terminated with immediate effect via letters received on Thursday morning. Globally, the terminated awards include 5,800 grants administered by the USAID and 4,100 grants for projects managed directly by the State Department. Some of the terminated programmes had previously been granted temporary waivers, due to their roles in providing lifesaving health or humanitarian aid. The Trump administration also announced Thursday that it was halting US funding to the Joint UN Programme on HIV/AIDS (UNAIDS), which is headquartered in Geneva, just across from the World Health Organization. “All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated,” said Dr Atul Gawande, USAID’s former assistant administrator under the Biden administration. Terminated, too, are all global tuberculosis programmes, all US-made food aid programmes, which manufacture specially enriched foods aimed at malnourished women and children, and around 1000 food kitchens serving displaced people in countries such as war-torn Sudan. “This is one of the worst days of my professional life,” said Dr Kate Rees of Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups. “Tomorrow, we are letting go 2,800 people who are mainly peer educators and data capturers.” Prof Linda-Gail Bekker, CEO of the South African Desmond Tutu HIV Foundation, said that the US termination would cost 500,000 South African lives over the next 10 years and result in around half a million new HIV infections, according to recent modelling. “As an activist, as a person living openly with HIV, I’m very hurt,” said Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “How am I going to survive? Will the public health care system be able to cater for us? Will be able to cover all the gaps that we are facing with all the challenges that the public healthcare system has?” South Africa has the highest burden of HIV in the world with eight million people living with the virus (over 16% of the adult population). All 44 South African HIV programmes that receive money from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID have seen their aid terminated. Projects affected range from mother-to-child transmission programmes and hospices to research groups. Many focus on “key populations”, groups that are the most vulnerable to HIV but often shun health centres in fear of discrimination. “I’ve been having a sleepless night trying to think how best we can save our communities because we know that some of the government healthy facilities are very discriminatory,” said Kholi Buthelezi, national coordinator of the sex worker organisation, Sisonke. HIV activist Sibongile Tshabalala, who lives with the virus, is fearful for her future. HIV programmes devastated across Africa HIV programmes across the continent have also been devastated. The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children. Late yesterday, we received award termination notices for three of our primary USAID agreements. Read our full statement. https://t.co/VpBNduu036 pic.twitter.com/0hAP17JqxG — Elizabeth Glaser Pediatric AIDS Foundation (@EGPAF) February 27, 2025 In Uganda, for example, the Baylor College of Medicine Children’s Foundation’s HIV and TB programmes, that strengthens district health systems to better deliver HIV, TB and maternal and child services, has been terminated. The termination letters all state that US Secretary of State Marco Rubio, in his capacity as acting administrator for USAID and Peter Marocco, USAID acting deputy administrator, “have determined your award is not aligned with agency priorities and made a determination that continuing this program is not in the national interest”. ‘Chaos and disaster’ The terminations have caused “chaos” and “disaster”, said emotional South African leaders of the HIV sector who urged their government to step in to save their programmes. Fatima Hassan, head of the Health Justice Initiative, urged the South African government to issue compulsory licenses to reduce the price of antiretroviral medicine as the US has already “done the worst to us”. “US Congress approved the funds, and that is what has been stopped. So we do believe that it’s an illegal grab. It’s an illegal halt of services and programs. It’s not following due process,” Hassan added. The terminations will decimate South Africa’s HIV testing, data collection and HIV and TB literacy, said public health expert Dr Lynne Wilkinson, who added that USAID funds also assisted groups combating gender-based violence. However, South Africa is luckier than many other African countries as it derives around 17% of its HIV budget from PEPFAR. The Democratic Republic of Congo (DRC) gets 89% of its HIV budget from PEPFAR, while Mozambique and Tanzania get 60% of their HIV budget from the US. USAID: Countries most reliant on US aid for HIV ‘Blanket freeze is illegal’ Mitchell Warren, head of the US-based HIV programme AVAC, described the blanket termination of USAID grants as “unlawful”. “The US government’s in a very strong position with any cooperative agreement or grant or contract. They’re allowed to cancel agreements or amend them. They’re in a very strong position generally, but the blanket freeze is illegal,” said Warren, whose organisation has resorted to the courts to prevent the cutting of lifesaving aid. AVAC’s Mitchell Warren “We have been now in a federal court for several weeks, and a temporary restraining order was provided two weeks ago by the Court that said that things had to go back. The tap had to be put back on until this 90 day review actually took place in a comprehensive way,” he added. “We now have evidence entered into the public record in the courts that show the intentionality at USAID and the State Department to dismantle everything but the government has simply thrown up additional legal delays, as is their want,” said Warren. A federal judge had set Wednesday at midnight as the deadline for USAID to release some $1,5 billion funds for the foreign aid work already completed, but the US Supreme Court granted the government a stay on the release of funds until the court could apply itself more thoroughly to the issue. “We expect a hearing next week in Washington,” said Warren. “This is not about PEPFAR. This is not about the HIV response. This is not about USAID. This is about the rule of law. The United States Congress has the power of the purse. They decide what gets spent. The executive branch is there to execute, and that’s the basis of this legal argument. “But as of [Wednesday] night, they began to basically massacre every possible implementing agency to deliver on this work. This court case, as important as it is, is not going to change that overnight. That’s why working in partnership with each other and with national governments is essential because the United States is not a partner that is trustworthy right now,” Warren concluded. Image Credits: Reuters Youtube, Gandhi A, et al, Annals of Internal Medicine, 11 Feb. 2025, UNAIDS. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
US Terminates Thousands of Life-Saving Global Health Grants Including For HIV, TB and Malaria 27/02/2025 Kerry Cullinan Protestors gathered outside USAID headquarters in Washington D.C. after employees were informed via email to not come in to work. The Trump administration has terminated the contracts of nearly 10,000 global health projects funded by the US Agency for International Development (USAID) or the US State Department – including projects to provide vital diagnosis and treatment for HIV, tuberculosis, and malaria, as well as humanitarian aid projects providing nutrition and water and sanitation services. Grants to hundreds of African HIV organisations providing life-saving services have been terminated with immediate effect via letters received on Thursday morning. Globally, the terminated awards include 5,800 grants administered by the USAID and 4,100 grants for projects managed directly by the State Department. Some of the terminated programmes had previously been granted temporary waivers, due to their roles in providing lifesaving health or humanitarian aid. The Trump administration also announced Thursday that it was halting US funding to the Joint UN Programme on HIV/AIDS (UNAIDS), which is headquartered in Geneva, just across from the World Health Organization. “All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated,” said Dr Atul Gawande, USAID’s former assistant administrator under the Biden administration. Terminated, too, are all global tuberculosis programmes, all US-made food aid programmes, which manufacture specially enriched foods aimed at malnourished women and children, and around 1000 food kitchens serving displaced people in countries such as war-torn Sudan. “This is one of the worst days of my professional life,” said Dr Kate Rees of Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups. “Tomorrow, we are letting go 2,800 people who are mainly peer educators and data capturers.” Prof Linda-Gail Bekker, CEO of the South African Desmond Tutu HIV Foundation, said that the US termination would cost 500,000 South African lives over the next 10 years and result in around half a million new HIV infections, according to recent modelling. “As an activist, as a person living openly with HIV, I’m very hurt,” said Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “How am I going to survive? Will the public health care system be able to cater for us? Will be able to cover all the gaps that we are facing with all the challenges that the public healthcare system has?” South Africa has the highest burden of HIV in the world with eight million people living with the virus (over 16% of the adult population). All 44 South African HIV programmes that receive money from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID have seen their aid terminated. Projects affected range from mother-to-child transmission programmes and hospices to research groups. Many focus on “key populations”, groups that are the most vulnerable to HIV but often shun health centres in fear of discrimination. “I’ve been having a sleepless night trying to think how best we can save our communities because we know that some of the government healthy facilities are very discriminatory,” said Kholi Buthelezi, national coordinator of the sex worker organisation, Sisonke. HIV activist Sibongile Tshabalala, who lives with the virus, is fearful for her future. HIV programmes devastated across Africa HIV programmes across the continent have also been devastated. The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children. Late yesterday, we received award termination notices for three of our primary USAID agreements. Read our full statement. https://t.co/VpBNduu036 pic.twitter.com/0hAP17JqxG — Elizabeth Glaser Pediatric AIDS Foundation (@EGPAF) February 27, 2025 In Uganda, for example, the Baylor College of Medicine Children’s Foundation’s HIV and TB programmes, that strengthens district health systems to better deliver HIV, TB and maternal and child services, has been terminated. The termination letters all state that US Secretary of State Marco Rubio, in his capacity as acting administrator for USAID and Peter Marocco, USAID acting deputy administrator, “have determined your award is not aligned with agency priorities and made a determination that continuing this program is not in the national interest”. ‘Chaos and disaster’ The terminations have caused “chaos” and “disaster”, said emotional South African leaders of the HIV sector who urged their government to step in to save their programmes. Fatima Hassan, head of the Health Justice Initiative, urged the South African government to issue compulsory licenses to reduce the price of antiretroviral medicine as the US has already “done the worst to us”. “US Congress approved the funds, and that is what has been stopped. So we do believe that it’s an illegal grab. It’s an illegal halt of services and programs. It’s not following due process,” Hassan added. The terminations will decimate South Africa’s HIV testing, data collection and HIV and TB literacy, said public health expert Dr Lynne Wilkinson, who added that USAID funds also assisted groups combating gender-based violence. However, South Africa is luckier than many other African countries as it derives around 17% of its HIV budget from PEPFAR. The Democratic Republic of Congo (DRC) gets 89% of its HIV budget from PEPFAR, while Mozambique and Tanzania get 60% of their HIV budget from the US. USAID: Countries most reliant on US aid for HIV ‘Blanket freeze is illegal’ Mitchell Warren, head of the US-based HIV programme AVAC, described the blanket termination of USAID grants as “unlawful”. “The US government’s in a very strong position with any cooperative agreement or grant or contract. They’re allowed to cancel agreements or amend them. They’re in a very strong position generally, but the blanket freeze is illegal,” said Warren, whose organisation has resorted to the courts to prevent the cutting of lifesaving aid. AVAC’s Mitchell Warren “We have been now in a federal court for several weeks, and a temporary restraining order was provided two weeks ago by the Court that said that things had to go back. The tap had to be put back on until this 90 day review actually took place in a comprehensive way,” he added. “We now have evidence entered into the public record in the courts that show the intentionality at USAID and the State Department to dismantle everything but the government has simply thrown up additional legal delays, as is their want,” said Warren. A federal judge had set Wednesday at midnight as the deadline for USAID to release some $1,5 billion funds for the foreign aid work already completed, but the US Supreme Court granted the government a stay on the release of funds until the court could apply itself more thoroughly to the issue. “We expect a hearing next week in Washington,” said Warren. “This is not about PEPFAR. This is not about the HIV response. This is not about USAID. This is about the rule of law. The United States Congress has the power of the purse. They decide what gets spent. The executive branch is there to execute, and that’s the basis of this legal argument. “But as of [Wednesday] night, they began to basically massacre every possible implementing agency to deliver on this work. This court case, as important as it is, is not going to change that overnight. That’s why working in partnership with each other and with national governments is essential because the United States is not a partner that is trustworthy right now,” Warren concluded. Image Credits: Reuters Youtube, Gandhi A, et al, Annals of Internal Medicine, 11 Feb. 2025, UNAIDS. Posts navigation Older postsNewer posts