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

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

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

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

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

Streamlining discussion on Palestine and de-escalating flashpoints

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

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

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

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

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

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

More efficient process for advancing WHA resolutions  

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

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

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

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

Opposition to WHO’s engagement with reproductive health NGOs 

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

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

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

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

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

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

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

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

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

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

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

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

Temporary fixes? 

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

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

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

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

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

An infographic titled Global Maternal and Child Health Targets “Off Track” showing six key nutrition indicators. From left to right: Anaemia in women (rising from 27.6% to 30.7%), Childhood overweight (stagnating/rising at 5.5%), Low birth weight (stagnating at 14.7%), stunting (improving but off track at estimated 136.3 million by 2030), wasting (off track at 6.6%), and Exclusive breastfeeding (improving but off track at 47.4%).
The current status of six global maternal and child health targets as of 2023.

The World Health Organization (WHO) Executive Board faced a grim reckoning on Thursday in a report detailing how global progress on maternal, infant and child nutrition has largely stalled or even regressed.  Notably, six critical nutrition targets remain “off track,” with rising rates of anaemia and childhood obesity sliding back, threatening to reverse years of development gains, according to a report reviewed by the EB.

“Malnutrition is really a silent epidemic today in Africa,” stated the representative of Cameroon. “Despite all that has been done, we still see stunting, anaemia, and lack of certain nutrients.”

International commitments aim to halve the prevalence of anaemia in women of reproductive age by 2030, as part of Sustainable Development Goal 2 (Zero Hunger). However, rates have climbed from 27.6% in 2012 to 30.7% in 2023. Driven by factors ranging from food insecurity and infectious diseases to poverty, this leaves millions of women without enough healthy red blood cells.

Global targets for tackling the double burden of malnutrition, which includes both undernutrition and overweight, are similarly off-track.

The global prevalence of childhood overweight has crept up to 5.5%, as food systems struggle to provide healthy options, the WHO report notes. Stunting, a measure of undernutrition, still affects 150.2 million children under five, with an estimated 136.3 million more children likely to face stunting by 2030. And low birth weight rates have barely improved, inching down just 0.3% to 14.7% of newborns between 2012 and 2023. Meanwhile, childhood wasting remains stubbornly high at 6.6% of children under the age of five years of age – well above the 5% threshold required to ensure child survival.

Maternal and child health is crisis of inequality 

Delegates from Cameroon, Cabo Verde, and Algeria seated at a World Health Organization Executive Board meeting, discussing the global crisis in maternal and child health.
The delegation from Cameroon highlighted the ‘silent epidemic’ of malnutrition and the urgent need to prioritise maternal and child health amidst stalling global progress.

In the first comprehensive debate since member states pledged to extend and accelerate action on maternal, infant and young child nutrition in a 2025 World Health Assembly resolution, delegates called out the stagnation as a systemic crisis of inequality deepened by conflict and climate change.

Speaking on behalf of the 47 Member States of the African Region, the delegation from Lesotho warned that the continent bears the highest global burden of stunting and anaemia, a situation that persists, despite ongoing interventions, delegates from Cameroon added.

Somalia, speaking for the Eastern Mediterranean Region, highlighted the devastating impact of climate and conflict-driven instability, noting a “complex nutrition burden driven by conflict, displacement, and climate shocks.”

The delegation reported that 24.3 million children under five in the Africa region are currently stunted, urging prioritised support for fragile and conflict-affected settings.

Outrage over ‘savage marketing’ of formula

A medium shot of a female delegate with long brown hair and glasses, wearing a white blazer. She sits behind a laptop and microphone.
The Norwegian delegation joined the European Union and African nations in calling for stricter regulations on the formula industry’s digital marketing following recent safety recalls.

A major point of contention during the session was the aggressive commercialisation of infant nutrition. In a sharp rebuke of the formula industry, the Central African Republic condemned “savage marketing for breast milk substitutes.”

The delegate noted that these practices are “undermining breastfeeding and taking advantage of communities that are already poor and fragile”, putting industry interests over public health.

This concern bridged the divide between the Global South and wealthy donor nations. Norway joined African nations in demanding stricter regulation, specifically targeting the digital sphere. The Norwegian delegation raised alarm over “recent large-scale recalls of breast milk substitutes,” arguing that food safety and robust monitoring must be paramount.

Advocacy groups demand industry accountability

In the foreground, a man representing the Central African Republic speaks into a microphone while holding a document. To his left sits a woman representing Chile working on a laptop, and to his right is a man representing Cameroon. The table features official nameplates and microphones for each delegate.
The delegate from the Central African Republic condemned ‘aggressive’ and ‘savage marketing for breast milk substitutes.’

The tension between public health priorities and commercial interests was palpable in statements from non-state actors.

The International Baby Food Action Network (IBFAN) hit back at the formula industry. The advocacy group warned that recent contamination cases exposed “systemic failures” in formula production. IBFAN argued that cross-border social media marketing exacerbates food safety risks by allowing unregistered products to enter countries, demanding that governments take the lead in verifying safety rather than trusting manufacturers.

Meanwhile, the Global Self-Care Federation, representing the consumer health industry, argued that policymakers also “must prioritise the provision of micronutrient supplements”  to women. A statement by the group noted that iron, folate, iodine, and calcium supplementation can help reduce anaemia prevalence, and therefore maternal mortality and pre-term birth, as well as some “life-long NCD risks.” Such supplementation is thus a “cost-effective public health investment”, the group stated.

Rising stakes in a climate of receding aid

A wide-angle view of the World Health Organization (WHO) Executive Board meeting in a circular assembly hall, where delegates are gathered to debate global progress on maternal and child health.
The WHO Executive Board convenes in Geneva to address a critical report revealing that most global maternal and child health targets are currently off track.

The United Kingdom called the report “sobering,” noting that “no country is on track to meet the targets” and flagging worsening trends in minimum dietary diversity even within its borders. Canada emphasised the need to “step up nutritional interventions” that are based on evidence and take gender into account.

Speaking for the 27-member European Union, Bulgaria admitted the world is “far off track.” However, the bloc reiterated its financial commitment, noting that Europe has pledged €6.5 billion to fight malnutrition up to 2029. The EU called for increased coordination on data collection to better target the most vulnerable populations.

While officials figures are yet to be finalised, international development assistance for nutrition declined by an estimated 9% to 17% in 2025. In light of this, the Board faces the difficult task of reversing these trends in a constrained financial environment.

Such reductions in donor aid threaten to “reverse hard work and increase preventable child deaths,” warned Nigeria, saying that nutrition needs to be considered an “essential” organising principle of primary health care.

Image Credits: Felix Sassmannshausen, HPW/Felix Sassmannshausen.

Argentina’s Ambassador to the UN in Geneva, Carlos Mario Foradori, affirms his country will remain involved with WHO’s regional arm, PAHO,

Although Argentina is withdrawing from the World Health Organization’s global body, it intends to remain an active member in WHO’s regional affiliate, the Pan American Health Organization (PAHO),  the country’s representative told the WHO Executive Board on Friday. 

His comments came in the course of a discussion on the legal and policy impacts of Argentina’s declaration in February 2025 that it would leave WHO, following that of the United States last January. Argentina’s official notice, made in March, is due to be discussed at the May World Health Assembly along with the United States withdrawal. 

But the two countries are in somewhat different legal positions vis a vis any WHA response.  In terms of Argentina, there is no explicit provision in WHO’s  Constitution for member states to withdraw, with the exception of the United States, which reserved that right explicitly when it joined in 1948. As for the United States, the US also owes WHO some $260.6 million in unpaid dues for 2024-2025, on which WHA member states could feasibly demand payment before its withdrawal is legally “accepted.”   See related story.

Stars and Stripes No Longer Flying at WHO – But US Can’t Really Leave Until Dues are Paid, Agency Says

Argentina will continue to abide by International Health Regulations on Emergencies

Regardless of the formalities, Argentina’s Ambassador to the UN in Geneva, Carlos Mario Foradori, affirmed that the country would continue to abide by International Health Regulations whereby WHO must be notified of an infectious disease outbreak of epidemic potential. 

“We will not be isolated from the world. We will continue to respect all the rules that exist. We cooperate very closely with the Pan American Health Organization, and we will strengthen this even further,” Foradori said, adding that PAHO’s Director Jarbas Barbosa, is in fact visiting Argentina next week. 

“And it should be clear to the whole membership that we’re not leaving this world. To be very clear, as was mentioned, the pandemic knows no borders, and as a Western civilized country, we understand that we need to respect rules, and work with the whole world.”  Some WHO observers called out Foradori’s reference to a “western civilized country” was as a slight on non-western regions of the world.

So far, the US also has remained in PAHO, of which it was a founding member, and whose existence predates the 1948 formation of WHO by nearly half a century. Historically, the US is also PAHO’s largest funder. 

However, currently the US owes PAHO some 78.5 million in unpaid dues for the 2024-25 fiscal year, and a total of $136.5 million including 2026 dues. In August, meanwhile, the White House ordered cuts in some $45 million to already approved PAHO allocations in protest over a now-discontinued PAHO programme supporting the deployment of Cuban doctors to rural areas of Brazil at sub-market wages and with Cuba’s government reaping financial benefits.  See related story: 

Pan American Health Organization Targeted in New Round of US Funding Cuts

This week’s Congressional passage of a $9.42 billion global health appropriations bill , meanwhile, contained no explicit mention of funding to PAHO. And so it remains to be seen the cutbacks previously ordered by the White House are indeed implemented – as well as how PAHO will be funded for 2026. 

Legally, PAHO is an anomaly amongst WHO’s six regional offices insofar as it operates with its own budget and decision-making structure as a semi-autonomous entity – even though it also serves as a WHO Regional Office. This anomaly, in turn, opens up the unique possibility for nations in the Americas to retain their affiliation with PAHO as a regional organization, whilst disassociating themselves from WHO as a global body.  

No clear way forward on response to member states that withdraw 

Costa Rica’s delegate at the EB was one of several member states that expressed regret at Argentina’s withdrawal from WHO.

The EB discussion did not yield a unanimous recommendation on whether the World Health Assembly should actively ‘accept’ Argentina’s withdrawal – or how to respond to the US withdrawal at a time when Washington stills owe WHO some $360 million in past dues. 

While many WHO member states at the EB meeting stressed that countries had the sovereign right to determine whether they remain in an international organization – others stressed the legal complexities around the issue and the need for further consideration before the WHA must take a position in May.    

Ultimately, the EB agreed to pass onto the WHA a draft resolution co-sponsored by Argentina and Israel, calling on WHO member states to formally acknowledge Argentina’s withdrawal. But some leading member states reserved their final position, asking for further legal analysis and clarification. 

“Argentina’s notification of withdrawal raises numerous issues that do require careful consideration,” said Australia’’s delegate.

Said Switzerland, “We hear that there are still different legal, political, technical questions on the conditions and the implication in this context, on this agenda. ..We would all benefit from additional clarity for the WHA to be able to take an informed decision.”

A report submitted to this Executive Board meeting has already has laid out the key issues relateld to the withdrawal of both Argentina and the US. Effectively, there is no legal provision in the WHO Constitution for a member state to withdraw  – with the exception of the United States, which made that right an explicit condition of its joining in 1948, WHO’s paper notes. 

At the same time, Argentina and other member states argued that broader international legal principles guarantee a country the sovereign right to determine its affiliations in multilateral organizations like WHO.

Australia, Costa Rica, Zimbabwe and other member states also expressed regret over Argentina’s departure from the global body, asking for continued dialogue over its decision and describing Argentina as a valued partner in global health. 

“We request them to reconsider in view of global health security,” said Zimbabwe. 

China says US withdrawal shows lack of ‘leadership’

China’s EB delegate describes US withdrawal from WHO as a lack of leadership.

No such regrets were expressed at Friday’s meeting regarding the US departure. But China described the US move as a lack of leadership, saying:  

“As the most representative and authoritative intergovernmental, international health organization, the WHO bears a significant responsibility in global health governance….Major countries in particular, should lead by example. They should not treat the WHO as something to be used as it fits and abandoned when it does not. Nor should they bypass the WHO and set up alternative mechanisms,” China’s delegate said. 

“Countries should adhere to the rule of law and should not selectively fulfill their international obligations and commitments, and should not place [their] domestic political agenda above international law and governments.”

At the same time, China called for a re-evaluation of WHO rules around the entry and exit of member states from the organization, for which WHO’s 1948 constitution made few provisions, saying: 

“The issue of withdrawal is complex and sensitive. Members cannot enter or exit at their will. At present, there are certain gaps and ambiguity in the WHO’s rule regarding membership changes based on fairness and transparency, necessary adjustments and improvements should be made to better respond to the new circumstances and requirements on global health governance.” 

Israel, meanwhile, said that WHA members should accept the US notice of withdrawal without hinging it to other issues – an indirect reference to the unpaid US dues for 2024-2025.

Said Israel, “Any attempt to compel states against the national decisions is an infringement of their sovereign rights. There is no valid reason to further discuss this matter in any WHO forum. Further discussions only consume the limited resources this organization has without carrying any actual impact on the ground. Other issues of dispute between a member state and the organization do not affect the right of withdrawal in the context of the WHO,” Israel’s delegate said, an apparent reference to the outstanding, unpaid WHO dues still owed by the US.

At Monday’s Executive Board opening, Israel’s EB Representative, Asher Salmon, warned that his country, a close ally of the US, is also under pressure to withdraw from WHO, saying, “in Israel, there are also, unfortunately, strong public voices calling for us to leave the organisation.” 

Claiming that the WHO had become “too politicised,” he called for a “brave conceptual overhaul” of the organization. See related story: 

Days After US Leaves WHO, Israel Warns it Faces Pressure to Withdraw

 

Image Credits: DavidRockDesign/Pixabay.

Spanish Prime Minister Pedro Sanchez at the World Governments Summit in Dubai

Spain announced this week that it would tighten its social media laws, aiming to ban access for children under the age of 16 as part of a global tide against electronic platforms.

Last year, Australia became the first country to restrict social media for children, while French lawmakers voted to follow suit last month. So far, the UK, Denmark, Norway, Greece and India are considering similar moves, while German lawmakers are considering a digital law to contain the anti-competitive behaviour of global digital platforms.

There is growing evidence of the harmful effects of social media on children, including depression, anxiety, stress and cyberbullying – alongside evidence that digital platforms such as X are influencing political outcomes by manipulating content and algorithms.

“First, we will change the law in Spain to hold platform executives legally accountable for many infringements taking place on their sites,” Spanish Prime Minister Pedro Sanchez told the World Governments Summit in Dubai on Tuesday.

“This means that CEOs of these techno platforms will face criminal liability for failing to remove illegal or hateful content,” said Sanchez.

“Second, we will turn algorithmic manipulation and amplification of illegal content into a new criminal offence,” he added. “No more hiding behind code. No more pretending technology is neutral.

“Third, we will implement a hate and polarization footprint system to track, quantify, and expose how digital platforms fuel division and amplify hate. For too long, hate has been treated as invisible and untraceable, but we will change that.”

Sanchez added that Spain “will ban access to social media for minors under the age of 16” and platforms“will be required to implement effective age verification systems”.

“Today, our children are exposed to a space they were never meant to navigate alone. A space of addiction, abuse, pornography, manipulation… we will protect them from a digital wild west.”

“Fifth and last, my government will work with our public prosecutor to investigate and pursue the infringement committed by Grok, TikTok, and Instagram. We will have zero tolerance and protect our digital sovereignty against foreign coercion.”

Elon Musk, the owner of social media platform X, responded by describing Sanchez as “dirty” and a “tyrant and traitor to the people of Spain”.

 

However, X faces global probes after it emerged that the platform’s AI chatbot, Grok, is generating deepfake pornography, including involving children.

Australia provides global example

Australia’s ban on social media for children aged 15 and under came into effect on 10 December last year. It affects platforms including Tiktok, X, Facebook, Instagram, YouTube, Snapchat and Threads.

While children and their parents are not sanctioned for breaking the ban, the Australian government will impose heavy fines on companies that allow children to have accounts.

Days before the ban came into effect, Meta – owner of Facebook, Instagram and Threads – said it had deleted about 550,000 accounts.

A representative survey of children aged 10-15 commissioned by the Australian government in 2024/5 found that 96% used social media, and that 71% had experienced harmful content.

“This included exposure to misogynistic or hateful material, dangerous online challenges, violent fight videos, and content promoting disordered eating and suicide,” according to a media release on the survey.

One in seven children reported experiencing online “grooming” from adults or children at least four years older, which included being asked questions about their private parts or to share nude images.

Growing evidence of harms to children

Meanwhile, global evidence keeps growing of the negative effects of social media use – particularly on the developing brains of children.

A scoping review of multiple studies published last year in PubMed linked social media to bullying, and prolonged use to depression, anxiety, and stress.

The review notes the “alarming” increase in mental health disorders among youth and adolescents, particularly “anxiety, depression, attention deficit hyper-reactivity disorder, autism spectrum disorder, and body dysmorphic disorder”.

“One contributing factor that has received growing attention is the role of social media and technology in shaping adolescent brain development, behaviour, and emotional well-being,” the researchers note.

“While digital platforms provide opportunities for social connection, self-expression, and mental health support, they also introduce significant risks, including compulsive social media use, cyberbullying, unrealistic beauty standards, and exposure to substance-related content.”

A meta-analysis of 143 studies involving over one million adolescents, published in JAMA Pediatrics in 2024, found “a positive and significant meta-correlation between time spent on social media and mental health symptoms”, particularly depression and anxiety.

Image Credits: Unsplash.

WHO Regional Director for Europe Dr Hans Henri P. Kluge addresses the Executive Board.
Hans Kluge, WHO Regional Director for Europe, warns that digital tools and AI may widen health gaps without proper governance and trust.

A stark debate over who owns the data in the future of AI and digital health emerged at the World Health Organization (WHO) Executive Board on Wednesday.

Low and middle-income countries warned that the rapid deployment of new technologies risks accelerating data extraction and increasing inequality, cautioning that – without strict AI governance, sustainable financing and equitable guardrails – the implementation of AI in health systems would compromise “data sovereignty”.

The debate centred on a WHO report outlining the framework for a digital transformation strategy spanning 2028 to 2033. Highlighting the profound shifts driven by AI and genomics, the report notes that many member states remain paralysed by “fragmented systems with limited interoperability.” And it warns that without reliable, representative data, AI risks amplifying biases and inefficiencies.

“Innovation alone is not enough,” stated Hans Kluge, WHO Regional Director for Europe. “Without skills, governance and trust, digital tools widen gaps instead of closing them.”

Kluge also warned that “the risk of a new digital divide is real”.

Based on the deliberations, the Secretariat will continue its technical work on the strategy. To this end, the WHO has established a tripartite collaboration with the International Telecommunication Union and the World Intellectual Property Organization.

The board also decided to move forward on consultations to strengthen the global health workforce code, while the fight against substandard medicines moves to a new operational phase under an approved work plan. 

Closing the rift in AI regulation

A male delegate representing Cameroon speaks into a microphone at a World Health Organization Executive Board meeting.
The representative from Cameroon, speaking for the African Region, shifted the focus from technical standards to ownership at the WHO Executive Board session on Wednesday.

Regarding AI and digital health, a regulatory rift is opening as high-income regions press forward. While the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) have established guiding principles on AI, a formal global standard remains elusive.

The European Union, represented by Bulgaria, argued that health data and information systems are the “essential foundation”, calling for the WHO to lead harmonisation efforts. These ought to focus on autonomy, safety, well-being of patients and health care professionals. Israel supported this, proposing “regulatory sandboxes” to test technologies safely while integrating economic considerations.

However, the African Region and other LMICs shifted the focus from technical standards to ownership. Cameroon, speaking for the region, called for rigorous ethical governance. The prevailing fear is that international companies will harvest data from the Global South to train AI models or develop products that are then sold back for profit.

Barbados reinforced this, rejecting the model of “donor-funded surveys”. The delegate argued that health data must be treated as a “national asset” under local control.

Positioning the country as a “living laboratory” for digital innovation, Barbados demanded sustainable financing models to advance universal health coverage rather than short-term extraction.

Rich nations urged to ‘pay up’ for imported health talent

The representative for Zimbabwe sits at a WHO conference table behind his country's nameplate, speaking into a microphone to demand co-investment from wealthy nations.
Zimbabwe’s representative calls for co-investment from rich nations to address the crisis of health worker migration.

The board also confronted the escalating crisis of health worker migration, reviewing new data confirming that active recruitment from nations with fragile health systems is intensifying ‘brain drain’ to plug staffing gaps in the Global North.

Zimbabwe, speaking for the African Region, issued a sharp rebuke of current practices. “Targeted recruitment continues to strain our fragile health systems,” the delegate warned. The region demanded that development banks and donor agencies move beyond rhetoric to “co-invest” in the education and retention of the workforce in source countries.

Pakistan amplified this, arguing that while the principle of co-investment is recognised, there is currently a lack of “binding commitment to deliver it”.

The United Kingdom, a major destination country, maintained that the Global Code of Practice remains “central to ethical international recruitment.” However, the UK acknowledged the need for clearer guidance on safeguards and supported a process to refine the Code’s application.

To bridge this divide, the Secretariat, and member states agreed to launch informal consultations to draft a decision for the World Health Assembly in May. The talks will focus on specific additions to the Code, such as co-investment mechanisms and protections for care workers.

Debate on ‘scourge’ of substandard medicines ongoing

A clear plastic bottle containing orange liquid medicine stands in sharp focus in the foreground, with several amber glass medicine bottles blurred in the background.
The WHO is intensifying surveillance of medical products following a deadly spike in contaminated products containing toxic chemicals like cough syrups.

On a last item, the board confronted the lethal proliferation of substandard and falsified medical products, a crisis described by delegates as a critical threat to both public health and economic security. The WHO’s surveillance system has recorded over 10,000 suspect products since 2013, with the Secretariat highlighting a recent, deadly spike in contaminated medical products containing diethylene glycol, like cough syrups.

Togo, speaking for the African Region, characterised the issue as a “scourge,” exacerbated by open borders and informal markets. The region called for “innovative financing” to support regulatory authorities in resource-poor settings, where the risk of infiltration into public supply chains remains high.

Ukraine shifted the focus to modern distribution channels, warning of the specific threat posed by “unregulated online sales.” The delegate urged the WHO to help secure supply chains for high-risk excipients – inactive ingredients often implicated in contamination cases.

The International Pharmaceutical Federation backed these concerns, emphasising that the workforce must be trained to detect fakes before they reach patients. “Protecting patients requires safeguarding the quality of medicines,” the Federation argued.

To close the detection gap, the Board noted the urgent need to roll out market surveillance technologies, specifically the Epione reporting tool, to track suspect products in real-time.

The Secretariat will now develop the draft global strategy for 2028 to 2033, which is scheduled for submission to the board at its 160th session in January 2027 before final consideration by the 80th World Health Assembly.

Image Credits: Felix Sassmannshausen, WHO/Christopher Black , Pexels/Towfiqu barbhuiya.

WHO Diector-General Dr Tedros and IGWG co-chair Matthew Harpur (right)

World Health Organization (WHO) Director General expressed confidence that member states would agree on the last outstanding part of the Pandemic Agreement by the “absolute deadline” of May at the body’s Executive Board meeting on Wednesday.

“This year’s World Health Assembly [in May] must receive a text that member states can consider and act upon. There is no scope for delay because the next pandemic will not wait,” Tedros urged.

But questions by Pakistan, part of the Group for Equity negotiating bloc in the negotiations, indicated a lack of agreement on several key issues relating to how pathogens should be shared.

Member states only have two more weeks of formal negotiations before the deadline – with the next round starting on Monday. However, the talks are also affected by WHO budget cuts which have limited their access to translators.

Countries are hammering out a Pathogen Access and Benefit-Sharing (PABS) system, deciding on how materials and sequence information from pathogens with pandemic potential can be shared fast and fairly – and how countries sharing this information can also benefit from any products that are developed as a result.

The Group for Equity and Africa Region want draft contracts to be included as part of the deal to set out the terms for those who want access to pathogen information – for example, pharmaceutical companies in order to make vaccines, therapeutics and diagnostic tests.

The Pakistan delegate said that the two groups – representing 80% of the world’s population – had come up with a standard material transfer agreement based on other international agreements, and a draft contract for digital sequence information.

“We have had only one informal discussion on the draft contracts,” said Pakistan, urging those in charge of the process to organise more consultation on the contracts.

“In order to complete the exercise, to have full legal clarity and certainty we would like to have a pandemic agreement with draft contracts.”

Three key areas for talks

Matthew Harpur, co-chair of the Intergovernmental Working Group (IGWG) overseeing the negotiations, outlined the three key areas for the talks.

“Firstly, we have the scope and objectives and the use of terms,” said Harpur, who added that by last meeting, “it was really good to see some progress”. 

“Secondly, we have the implementation and the operation of the PABS system,” he added. This includes the issue of “equal footing” – namely, that rapid access to pathogens information and how the benefits deriving from this sharing are of equal importance.

“How do we how do we swiftly share that information that keeps us all safer and but how do we also ensure equity,” said Harpur, adding that issues such as monetary contributions had to be agreed on to ensure equity. 

The third part is “governance and enforcement”. 

“You can have the best words on paper, but if they’re not enforceable, if they don’t work in practice, it is meaningless,” said Harpur.

“So how do we ensure an effective governance system, with the advisory group, the role of the [Conference of the Parties] and, of course, the role of the Secretariat.”

The next IGWG meeting runs from 9-14 February.

Polio
Polio cases are falling, but persistent transmission in Afghanistan and Pakistan, vaccine-derived outbreaks elsewhere, and funding gaps keep global eradication at risk.

Polio remains a public health emergency of international concern despite a continued decline in case numbers, according to the World Health Organization’s (WHO) Director-General report presented to the Executive Board.

The report warns that progress toward eradication remains fragile. Some 38 cases of wild poliovirus type 1 had been reported globally by 22 October 2025, down from 62 during the same period in 2024. All cases occurred in Afghanistan and Pakistan, the only two countries where wild poliovirus remains endemic.

Environmental sampling has continued to detect the virus beyond core transmission areas, including during the low-transmission season, suggesting silent spread even where no clinical cases are immediately visible.

Transmission concentrated in endemic reservoirs

WPV1 cases in Pakistan and Afghanistan

Wild poliovirus type 1 persists in a small number of reservoirs, particularly in southern Afghanistan, and the southern area of Khyber Pakhtunkhwa in Pakistan, the report notes. 

In Afghanistan, operational and communication strategies are being adjusted to improve coverage. Supplementary immunization improved markedly in the eastern region in early 2025, contributing to reductions in transmission. Vaccination teams continue to use site-to-site approaches in the south, supported by transit posts and advocacy for house-to-house vaccination to reach missed children.

Pakistan is implementing the Polio National Emergency Action Plan 2024–2025 with a phased strategy aimed at restoring an emergency posture, closing operational gaps and sustaining high immunity. While high-level political commitment and intensified supervision have improved performance, subprovincial variation persists in parts of Khyber Pakhtunkhwa, Quetta and Karachi.

Both countries are applying risk-categorization models to identify and reach migrants, mobile groups and other missed children, while strengthening coordination along virus corridors and addressing surveillance gaps. Microplanning, targeted campaigns, fractional-dose inactivated poliovirus vaccine and expanded subnational surveillance are part of these efforts.

The Global Polio Eradication Initiative (GPEI), which leads implementation with national authorities, says its 2026 Action Plan will prioritize the low-transmission season to interrupt remaining chains of spread and close immunity gaps among persistently under-immunized populations.

Vaccine-derived poliovirus outbreaks in low-coverage areas

polio vaccine
Vaccine-derived polio persists in low-coverage regions, with cases across 13 countries and new detections signalling ongoing cross-border spread.

Beyond the two endemic countries, circulating vaccine-derived poliovirus remains a persistent challenge where routine immunization coverage is weak.

WHO reported 151 cases of circulating vaccine-derived poliovirus type 2 across 13 countries as of late October 2025, compared with 182 cases across 16 countries a year earlier. Despite the decline, transmission continues in northern Nigeria, the Lake Chad Basin, the Horn of Africa, particularly south and central Somalia, Ethiopia and Yemen.

Health experts say these outbreaks occur when weakened strains of the oral polio vaccine circulate for prolonged periods among under-immunized children, allowing the virus to mutate and spread.

Some countries have recorded progress. Madagascar’s outbreak of circulating vaccine-derived poliovirus type 1 was declared closed in May 2025. In the Democratic Republic of the Congo, cases have fallen sharply in recent years following targeted responses, dropping to a single case in 2025. 

Limited detections of circulating vaccine-derived poliovirus type 3 were reported in Guinea, Cameroon and Chad, with outbreak responses underway.

New environmental detections, including in Papua New Guinea and several European countries, underscore the risk of international spread through travel, population movement and surveillance gaps.

Vaccination tools and integration expand

Polio efforts are shifting toward new vaccines and integrated routine immunization to reach zero-dose children and strengthen health systems.

While the standard oral polio vaccine remains the primary tool in eradication efforts, new products include the expanded use of the novel oral polio vaccine type 2 and combination formulations.

With support from Gavi, the vaccine alliance, Senegal and Mauritania became the first countries to introduce the hexavalent vaccine into routine immunization schedules this year.

WHO partners are also emphasising the integration of polio activities into broader health services. Coordination between GPEI, the Essential Programme on Immunization and Gavi has been strengthened to reach zero-dose children with multiple vaccines and to align polio assets with routine immunization systems.

Addressing the Executive Board, a Gavi representative urged countries to promote integrated approaches to reaching zero-dose and under-vaccinated children with life-saving vaccination and primary health care, particularly in humanitarian and complex emergency settings, and to accelerate the transition of polio programme infrastructure into national systems to ensure long-term resilience.

Humanitarian pressures complicate delivery

In the Eastern Mediterranean Region, which includes both the endemic countries, ongoing crises continue to strain health services. 

Regional Director Hanan Balkhi told the board that the region carries nearly half of the world’s humanitarian burden and accounted for 40% of attacks on health care last year.

She said WHO responded to 62 outbreaks in 2025 and delivered supplies to crisis settings, including Gaza and Sudan, but funding cuts have reduced the regional health emergency workforce by about half. 

Millions of treatments are now at risk, while clinic closures in Afghanistan and disruptions in Sudan have limited access to essential services.

Cross-border collaboration between Pakistan and Afghanistan continues, supported by regional oversight and diplomatic engagement, to sustain polio eradication activities.

Although the Polio Eradication Strategy has been extended through 2029, financing remains a constraint. Donors have pledged $ 4.7 billion of the $ 6.9 billion required, leaving a $ 2.2 billion shortfall.

The Director-General’s report cautions that sustained political commitment, stronger routine immunization systems and adequate resources will be essential to interrupt remaining transmission and secure a lasting polio-free world.

 








 



































Image Credits: GPEI, RAJA IMRAN BAHADR / Unsplash..

A baby is being weighed, measured and vaccinated in the health center of Gonzagueville, a suburban of Abidjan, in the South of Côte d’Ivoire. The US is the largest single contributor to global health funding.

The US House of Representatives passed a more than $1 trillion spending package, bringing an end to a five-day partial government shutdown over Department of Homeland Security funding.

Among the allocations is a $9.42 billion package for global health programs – signaling strong bipartisan support and maintaining significant global health aid. 

The Fiscal Year 2026 (FY26) National Security-State Department Appropriations Bill maintains funding for global health at a substantially higher level than envisaged by the Trump administration, in an apparent bipartisan rejection of the administration’s proposed cuts. 

The $9.42 billion package agreed to by the US House and Senate, and signed into law by the President, is lower than the $12.4 billion allocation in 2024 and 2025 – but it is still $5.7 billion more than requested last September by US President Donald Trump in his America First Global Health Strategy.

Although the administration requested major cuts to foreign aid, Congress’s version of the bill preserves flagship global health programs like President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight TB, AIDS and Malaria, and HIV/AIDS programs previously administered through USAID – and reasserts Congress’s role in government spending. 

The global health allocations are part of a larger $51.4 billion foreign aid spending package for the 2026 fiscal year. That foreign aid bill, while a 16% cut from 2024, is nearly $20 billion more than what the Trump Administration initially requested.

The broader bill also includes $5.4 billion in funding for humanitarian assistance and comes as the Trump administration moves forward on a $11 billion plan for direct bilateral assistance to developing country governments – some of which would also be dedicated to health. 

Funding for HIV/AIDS, malaria, TB, family planning

US Senate 2026 global health bill
Of the $9.4 billion, some $5.88 billion is dedicated to fighting HIV/AIDS – with about $4.5 billion allocated to PEPFAR (not named here), and the rest to Global Fund, UNAIDS, and related activities. (This chart is from the Jan 2026 Senate version of the Act.)

Of the $9.42 billion earmarked in the bill specifically for global health programs, some $5.9 billion would be allocated to HIV/AIDS – with $1.25 billion channeled through the Global Fund, $45 million for UN AIDS, and $4.6 billion through PEPFAR, the flagship US program founded in 2003. This represents $200 million more for PEPFAR, and a $400 million decrease (24%) for the Global Fund from FY25 levels. 

And while less than the $7.1 billion level of support to these organizations under the Biden administration in FY24, it’s a major increase from the $2.9 billion for HIV/AIDS requested by Trump. At the same time, the Bill also calls for PEPFAR, founded by former US President George Bush, to transition to a largely self-reliant program of national governments over the coming years. 

Other global health priorities still see strong funding: $795 million is dedicated to malaria, and $379 million for tuberculosis; $85 million is earmarked for polio.

Some $575 million for family planning and reproductive health services are also included in the funding package – despite the historic reticence of some conservatives to fund such programs, and the fact that the Administration requested no funds for these programs.  

And although the administration has ordered a US withdrawal from the UN Population Fund (UNFPA), Congress allocated $32.5 million for the organization, as part of the family planning funds. The bill does stipulate that the agency cannot spend these funds on China – and that if the Trump administration makes good on its plan to withdraw from UNFPA, the money should then be transferred to other global health programs. 

Allocations earmarked for “Global Health Security,” are $615.6 million for organizations like Pandemic Fund and the Coalition for Epidemic Preparedness Innovations (CEPI). While global health security overall was cut by about 12% from FY25, these funds could also be used in the event of a public health emergency.

Funds will also go to neglected tropical diseases (NTDs; $109 million) and nutrition ($165 million).

US to continue funding Gavi despite federal anti-vaccine rhetoric

Over 1.7 million COVID-19 vaccine doses arrived in Ghana during the pandemic as part of the Gavi-organized Covax program.

In late January the US froze all funds to Gavi, the Vaccine Alliance, over concerns that the organization, which procures and delivers life-saving vaccines, provides vaccines with the preservative thimerosal. 

And while the US FDA has stated that the preservative “has a long record of safe and effective use preventing bacterial and fungal contamination of vaccines,” the US plans to withhold the $300 million already allocated by the Biden administration but not yet paid, as well as any new funds. 

Despite this, the newly passed FY26 bill does include another $300 million for a US contribution to Gavi. The Administration had requested Gavi funds be eliminated. 

New ‘National Security Fund’ also includes health components

In another twist, support for family planning, reproductive health and countering child marriage is also supported through a new National Security Fund of $6.77 billion that Congress aims to create – to “combat China’s influence” among other things. 

The fund, which also includes monies for clean cook stoves, a Young African Leaders Initiative, peace process monitoring, trade capacity building, and assorted other priorities, specifies that at least 15% of the fund should go to the African continent. 

This story is a follow up to a 15 January piece, which can be found here:

US Congressional Leaders Agree to $9.4 Billion for Global Health – Countering Trump Proposal for Deeper Cuts

Image Credits: UNICEF, Senate Appropriations.

Ongoing conflicts combined with vaccine hesitancy are derailing global immunization efforts, in turn worsening the spread of communicable diseases.

Ongoing conflicts and vaccine hesitancy are undermining efforts to immunize all children, according to a report tabled at the World Health Organization’s Executive Board meeting.

Over 120 million people were displaced by conflicts in 2024 alone, according to the WHO. Countries will have to put in significant efforts to achieve the 2030 target of averting 50 million vaccine-preventable deaths between 2021 and 2030.

“Over the next five years, Gavi will invest nearly 3 billion US dollars in fragile countries, about 35% of our programmatic resources,” a representative from the vaccine alliance Gavi told the EB. “We urge member states to continue investing in routine immunization, reach zero-dose children, and strengthen outbreak preparedness and response,” the representative said.

There has been some progress in addressing Neglected Tropical Disease (NTDs) and Tuberculosis (TB), though the gains are precarious, the WHO warned.

Between 2015 and 2021, the disease burden due to NTDs decreased from 17.2 to 14.1 million disability-adjusted life years, according to another report tabled.

The global number of people falling ill with TB declined for the first time since the COVID-19 pandemic in 2024 and stood at 10.7 million. Around 8.3 million people accessed care that year, the highest number since WHO began monitoring, a report on TB noted.

Globally, the net reduction in incidence rate between 2015 and 2024 was around 12.3%.

Anti-vaccine narratives

Immunization strategies are often poorly tailored to conflict settings.

Apart from the worsening humanitarian crisis, particularly in Ukraine, Gaza, and Sudan, there is growing vaccine hesitancy.

The anti-science sentiment and politicization of science and public health risk are undermining trust in immunization and threatening progress, the WHO’s report said.

“Misinformation has become a major constraint, and we note with concern that some anti-vaccine narratives are amplified through coordinated influence operations, even by state actors,” a representative from Ukraine said.

“To regain momentum, Ukraine emphasizes strengthening primary health care and making continuous catch-ups a permanent, everyday function of the health system, rather than just a periodic campaign,” the representative added.

Immunization strategies are often poorly tailored to conflict settings, with coverage declining sharply during crises, WHO said.

Despite the COVID-19 pandemic, vaccinations averted over four million deaths annually between 2021 and 2024.

Immunization to control NTDs

In 2024, 1.4 billion people required interventions against NTDs, a 36% decrease from 2010. The estimated mortality from NTDs between 2015 and 2021 dropped from 139,000 to 119,000.

Immunization and eradication drives against NTDs have met with success. In 2024, over 880 million people were treated for at least one neglected tropical disease, 99% through mass drug administration interventions.

WHO acknowledged nine countries for eliminating at least one neglected tropical disease in 2023.

“The implementation context has changed radically, with the COVID-19 pandemic, humanitarian crises, climate change, and the fact that financing has dwindled. All of these things have made our health systems more fragile. It is important that we recommit the whole world to this agenda, and that Africa be placed at the heart of vaccine equity,” said Cameroon on behalf of the African Union.

TB’s precarious gains

WHO’s ongoing Executive Board session in Geneva.

TB remains one of the leading causes of death from an infectious agent. With funding cuts from the Trump administration and a drop in overall development assistance for health, the risk that hard-won gains may be reversed is high.

Russia advocated for a flexible and adaptable strategy to end TB. “We have to look at what, in fact, works in countries. We need to have separate strategies that include tailor-made approaches and that promote efforts to achieve those goals that have been set for high burden TB countries where there are few resources and where there are emergency situations,” the representative from Russia said.

Africa (25%) had the highest TB burden, followed by South-East Asia (34%) and Western Pacific (27%), the WHO’s report found, noting the high cost of treatment remains a huge area of concern.

Globally, the net reduction in incidence rate between 2015 and 2024 was only 12.3%, well below the End TB Strategy milestone of a 50% reduction by 2025.

Push for more funding, collaboration

Routine immunization is often disrupted in conflict zones, threatening the resurgence of communicable diseases.

Member states expressed the need for greater international collaboration and for countries to take responsibility for their citizens in the changing funding landscape.

“There is also a change of the global health architecture, which means that we need to have more coordinated efforts between countries, and we need to make sure that we have more technical support and financial support,” a representative of Cuba said.

Canada expressed similar sentiments. “Strengthening country ownership and accountability is crucial, particularly in the context of funding constraints. Recognizing that immunization is a cornerstone of resilient health systems, we call on all partners to align investments with country-led priorities,” the Canadian representative said.

Countries also urged using data more effectively for targeted immunization, sharing data across borders for better coordination, and integrating immunization in maternal and post-natal care programmes.

Image Credits: WHO/X, WHO/X, WHO/X, WHO/X.

Image Credits: Center for Reproductive Rights, Gayatri Malhotra/ Unsplash.