In Sierra Leone, students receive the HPV vaccine to protect them against cervical cancer.

Almost 40% of global cancer cases could be prevented, according to a new global study from the World Health Organization (WHO) and its International Agency for Research on Cancer (IARC), published in Nature Medicine on Tuesday.

The study attributed some 7.1 million cancer cases in 2022 to 30 “modifiable risk factors”.

Tobacco was the leading preventable cause of cancer, globally responsible for 15% of all new cases, followed by infections (10%) and alcohol consumption (3%).

Three cancer types – lung, stomach and cervical cancer – accounted for nearly half of all preventable cancer cases in both men and women, globally.

Lung cancer was primarily linked to smoking and air pollution, stomach cancer was largely attributable to Helicobacter pylori infection, and cervical cancer was overwhelmingly caused by human papillomavirus (HPV).

Gender and regional differences

Around 45% of new cancer cases in men could be prevented in comparison to 30% in women, according to the study, which draws on data from 185 countries and 36 cancer types.

In men, smoking accounted for an estimated 23% of all new cancer cases, followed by infections at 9% and alcohol at 4%. Among women globally, infections accounted for 11% of all new cancer cases, followed by smoking at 6% and high body mass index at 3%.

There were also geographical differences. Preventable cancers for women ranged from 24% in North Africa and West Asia to 38% in sub-Saharan Africa. 

Among men, 57% of cancers in East Asia were preventable, while only 26% were in Latin America and the Caribbean at 28%

“This is the first global analysis to show how much cancer risk comes from causes we can prevent,” said Dr Andre Ilbawi, WHO Team Lead for Cancer Control, and author of the study. “By examining patterns across countries and population groups, we can provide governments and individuals with more specific information to help prevent many cancer cases before they start.”

The WHO urged countries to develop “context-specific prevention strategies that include strong tobacco control measures, alcohol regulation, vaccination against cancer-causing infections such as human papillomavirus (HPV) and hepatitis B, improved air quality, safer workplaces, and healthier food and physical activity environments”.

Europe recognises air pollution as cancer agent

Meanwhile, air pollution will be added to the European Code Against Cancer for the first time.

“Air pollution raises our overall cancer risk by 11% and risk of death from cancer by 12%. Poor air quality is the largest environmental threat to human health, killing more people than tobacco, so it’s significant progress that air pollution is now recognised in the latest European Code Against Cancer,” said Nina Renshaw, head of health at the Clean Air Fund.

“This vital change means that institutions and governments across the EU and the World Health Organization’s wider European region now have an even clearer mandate to reduce dangerous air pollution, and in doing so, protect people’s health.

“With 99% of people worldwide currently breathing harmful air – contributing to respiratory diseases, strokes, heart attacks, and dementia, as well as stillbirths and miscarriages – it’s essential to address the interconnections between air quality and urgent health challenges.

“Clean air measures positively impact public health almost immediately, resulting in reduced hospitalisations – and ultimately in fewer people developing chronic health conditions such as lung cancer.”

Image Credits: Gavi.

Dr Jeremy Farrar, WHO Assistant Director-General.

Proposals to include steatotic liver disease and haemophilia, and other inherited bleeding disorders, into the definition of non-communicable diseases (NCDs) will be tabled at the World Health Assembly in May, the World Health Organization (WHO) Executive Board (EB) resolved on Tuesday.

Egypt, which sponsored the resolution on steatotic liver disease (formerly known as fatty liver disease), told the EB that it affects more than 1.7 billion people worldwide, “driven by metabolic risk factors, unhealthy diets and physical inactivity”.

The resolution calls for the formal recognition and systematic integration of the liver disease into the global NCD response, “including surveillance systems, prevention strategies, primary healthcare-based management and national NCD plans”.

Introducing the resolution on haemophilia and other inherited bleeding disorders, Armenia said it aimed to address “the systematic under-diagnosis and historical lack of prioritisation” afforded to these disorders and “bridge the gap in access to essential treatment and care”.

Dr Jeremy Farrar, WHO Assistant Director General, said that NCDs will be one of the “defining concerns” of the 21st century, after a mammoth session on NCDs that was addressed by almost every member state.

NCDs already account for over 80% of deaths in the Western Pacific region, the EB heard from a representative from the Solomon Islands.

Several countries appealed for support and guidance to address their growing burdens of key NCDs, including diabetes, heart disease and hypertension – driven mainly by unhealthy diets and lack of exercise.

The majority of countries have been unable to reach NCD-related targets set out in the Sustainable Development Goals (SDGs), and Farrar warned that the world’s ageing population would make matters worse.

Farrar also cautioned against an “over-reliance in many parts of the world on treatment, as opposed to prevention and promotion of health”.

During the WHO’s reforms, it has combined into one division health promotion, disease prevention and care, and this would encourage a “holistic approach to treatment beyond just drugs”. 

UN Declaration on NCDs

NCD Alliance representative Mina Pécot-Demiaux addresses the EB.

Much of the discussion focused on how to implement the Political Declaration on NCDs and mental health, adopted by the United Nations last December after last year’s High-Level Meeting (HLM).

The declaration was expected to be adopted by consensus at HLM last September, but the US refused at the last minute. It was then referred to the UN General Assembly for a vote, where only the US and Argentina opposed it.

Farrar said that, during the current time where there are “questions on multilateralism”, it was reassuring that “the vast, overwhelming number of countries could come together and agree on a political declaration”.

The declaration sets three global targets for 2030: 150 million fewer tobacco users; 150 million more people with hypertension under control; and 150 million more people with access to mental health care.

It also commits to at least 80% of countries with policy, legislative, regulatory and fiscal measures in place to address NCDs and mental health; at least 80% of primary health care facilities stocking essential medicines and basic technologies; and at least 60% of countries with measures to cover or limit the cost of essential NCD and mental health services.

However, the NCD Alliance told the EB it was concerned about “the significant influence of health-harming industries, which weakened the [Political Declaration], including less ambitious commitments on NCD prevention, the removal of the health tax targets [on tobacco, alcohol and sugary drinks] and the omission of any reference to fossil fuels as key drivers of NCDs”.

Meanwhile, Farrar said that while “political declarations have a critical role to play, in the end, they’re not the way that things get implemented,” pledging WHO support to countries to make a difference to people’s lives. 

Resources allocated to mental health services have not increased since 2020, according to the WHO Director General’s latest report on mental health.

Countries are significantly off track in meeting global targets set to transform mental health systems, according to the latest Director-General report tabled at the World Health Organization’s (WHO) Executive Board meeting.

Around 1.1 billion people were estimated to be living with a mental health disorder, according to the latest WHO data available for 2021.

Financial and human resources available for mental health services have not increased since 2020, with budgets remaining at a median of 2% of government health spending, the report found.

On average, there is only one government mental health worker for every 10,000 people with stark variations between lower- and higher-income countries, the Director General’s (DG) report noted.

Countries discussed a range of responses.

“It is absolutely essential to advance towards true inclusion of mental health and all policies tackling related inequalities to do with housing, the socio-economic level, work and climate change, as well as discrimination and violence,” the representative from Spain said.

“We want to make sure that we focus ourselves on non-pharmaceutical tools, the fewer prescriptions of psychotropic drugs and the prescription of social measures and community action,” the Spanish representative added.

The WHO has a ‘Comprehensive Mental Health Action Plan 2013-2030’ in place, and the DG’s report was meant to highlight the ways in which this action plan can be implemented or enhanced.

New pressures on mental health disorders

WHO wants mental health to be managed in a community set-up and is pushing countries to do so.

Mental health disorders are worsening with the added pressure of the recent COVID-19 pandemic and increasing climate change impacts. The pandemic has worsened all the factors that expose young people to mental health problems – indebtedness, economic insecurity and inequalities, migration and conflict, the report found.

Death by suicide is now the third leading cause of death among 15 to 29-year-olds, with an estimated 727,000 deaths by suicide in 2021, according to WHO data.

Digital pressures are exacerbating poor mental health, and the WHO has already recognized that the time spent online is associated with depression, anxiety, and psychological distress in adolescents.

“We request WHO to urgently address the impact of social media and extensive use of technology among adolescents and young people by ensuring that the recently published guidance on mental health for children and young people is fully implemented by member states,” a representative of Zambia said during the discussion. Belgium echoed similar sentiments.

One of the key components of WHO’s plan is to integrate mental health and social care services in community-based settings. Currently, most countries are at an early stage of this transition to community-based service delivery, despite it being a key priority area for the WHO, according to the DG report.

Millions of alcohol and drug-use deaths 

WHO Director General Tedros Adhanom Ghebreyesus addressing the 158th session of WHO’s Executive Board in Geneva.

In 2019, an estimated 2.5 billion people consumed alcohol and 400 million people were living with alcohol use disorders. Alcohol consumption and psychoactive drug use was responsible for 2.6 million and 0.6 million deaths in 2019, according to the WHO.

The world health body estimates that 316 million people used psychoactive drugs in 2023, and 64 million people were living with drug use disorders.

Both alcohol use and drug use disorders are problems that in recent years have been categorized as a mental health issue that require help.

“Little progress has been made in implementing the high-impact policy interventions proven to reduce alcohol-related harm,” the DG’s report read. “…and quality and ethical treatment for substance use disorders is still largely inaccessible for those most in need.”

Members of the European Union raised concern over tobacco products being aggressively marketed to children online.

“Children should be protected from aggressive online marketing of unhealthy food and drinks, alcohol, tobacco and similar products or prohibited substances. We call upon WHO to advance research and develop effective guidance to protect and promote mental health online and offline, while recognizing the responsibility of digital platforms and industries,” said Bulgaria on behalf of the European Union.

Growing recognition of the impact of mental health

WHO EB’s ongoing 158th session in Geneva

While the action on the ground is still limited, it is clear that there is a growing recognition among countries of the kinds of mental health disorders affect health. Discussions on the non-communicable diseases (NCDs) too saw extensive mention of mental health disorders.

Germany drew attention to the impact of climate change on all NCDs, including mental health.

Several non-state actors raised concerns about the mental health impacts on healthcare providers themselves due to a combination of excessive working hours, job insecurity, violence and psychosocial workplace risk.

“Studies show that health workers face mental health crises in several countries, reflected in a suicide risk that is 24% higher than in other sectors. We urge member states to ramp up efforts at strengthening mental health and psychosocial support for the populations of their countries and with dedicated programs for health workers,” said a representative of Public Services International, a global union that represents millions of workers.

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

George Vredenburg and Rajinder Dhamija
George Vredenburg and Rajinder Dhamija

“You start with, as in my case, with the loss of three generations of my family to various forms of Alzheimer’s or dementia.”

Those were the words of George Vradenburg. For him, brain health is not an abstract policy issue. It is a lived reality that mirrors a fast-growing global crisis.

This issue was the focus of a recent episode of the Global Health Matters podcast, hosted by Dr. Garry Aslanyan.

An estimated 57 million people worldwide are living with dementia, Vradenburg said, but that figure captures only those with symptoms. The scale is far larger. Disease processes often begin decades earlier, placing hundreds of millions more at risk.

“The problem is by and large, now two thirds to three quarters of the people with dementia are in the global south, and that number and percentage is going to increase in the next 25 years,” Vradenburg said.

The economic and social toll is enormous, already exceeding trillions of dollars globally. Families shoulder much of the burden, facing years of emotional strain and financial loss.

Read related article: Unlocking ‘Brain Capital’ in the Brain Economy – Davos Initiative Aims to Make Brain Health a Development Indicator 

In India, neurologist Rajinder Dhamija sees brain health as a challenge that spans generations.

“One of three of us will develop a brain disorder at one point of our life,” he said.

Children face neurodevelopmental conditions and infections. Young adults confront rising rates of stroke and mental illness. Older adults are living longer, often with multiple chronic brain-related conditions.

India’s numbers are stark. More than 330 million people are expected to be over the age of 60 within two decades. Dementia alone costs the country billions each year. Yet specialist care remains scarce.

“We have less than one neurologist per million population in India, around 3,000 neurologists at present,” according to Dhamija.

Both experts argued that brain health must be reframed beyond hospitals and clinics. Prevention, education, nutrition, and primary care deliver far greater returns than crisis response.

“Prevention at the primary level yields much more results than the investing in terms of a large infrastructure,” Dhamija said.

India has begun piloting district brain health clinics that combine screening, treatment, rehabilitation, and data collection to inform national policy. Globally, new tools may further expand access. Vaccines for Alzheimer’s are now in clinical trials. Low-cost screening using mobile phones and artificial intelligence could bring early detection to underserved communities.

The stakes are high. As Dhamija put it, “brain health… is very essential, not only for the healthy societies and healthy countries, but also for a smooth economic development and the social development of any nation.”

See more Global Health Matters episodes on Health Policy Watch.

Image Credits: Global Health Matters Podcast.

In the latest episode of Trailblazers with Garry, Garry Aslanyan visits Accra, Ghana, to speak with Professor John Owusu Gyapong, Secretary General of the African Research Universities Alliance.

Gyapong took on the role in 2024, leading efforts to strengthen research collaboration across African universities. His work focusses on building capacity within the continent and supporting locally driven research agendas.

Earlier in his career, when much of global health funding and attention centred on malaria, Gyapong chose to study neglected tropical diseases. These illnesses, he explains, had major social and economic consequences but received far less attention.

Now, as a researcher and educator, Gyapong continues to emphasise the importance of African-led solutions and long-term investment in young scientists. The conversation touches on leadership, research priorities, and why universities play a critical role in shaping Africa’s health future.

Watch the full episode:

Trailblazers with Garry is part of Global Health Matters. Listen to more Global Health Matters shows on Health Policy Watch.

Image Credits: Global Health Matters Podcast.

Kenyan women at a family planning clinic.

Global health organisations have reacted with anger to the new US foreign aid policy, which prohibits all aid recipients, bar military, from performing or promoting abortion, “gender ideology”, or “diversity, equity and inclusion” (DEI).

“Catastrophic”, “bullying”, “draconian” and “ideologically driven” – are some of their reactions to the Promoting Human Flourishing in Foreign Assistance (PHFFA) policy, announced by US Vice-President JD Vance at an anti-abortion event last Friday evening.

The policy’s three parts were published in the Federal Register on Tuesday as Protecting Life in Foreign Assistance, Combating Gender Ideology in Foreign Assistance and Combating Discriminatory Equity Ideology in Foreign Assistance Rules.

The new rules apply to all foreign and US NGOs and “international organisations”, including multilateral UN agencies still funded by the US and bodies such as the Global Fund to Fight AIDS, TB and Malaria.

However, in countries that allow abortion, governments and parastatals (government agencies) will need to place any US funds in “a segregated account” to ensure they’re not used for abortions and related activities.

Governments and parastatals “may” also be required to agree that they won’t use US funds to promote or engage in “gender ideology” or DEI.

The US State Department defines “gender ideology” activities as those that provide or promote “sex rejecting procedures” (defined broadly to include puberty blockers, hormones, surgeries); promote or counsel social transition; use materials that discuss changing one’s sex or pronoun usage not aligned with biological sex; lobby foreign governments on gender identity issues; and support drag queen workshops, performances, or similar activities”.

Aid recipients are also compelled to agree to US officials visiting their offices unannounced to inspect their documents and activities, and to speak to people receiving their services. This is potentially a violation of patient confidentiality.

Imposing ‘extremist ideology’

Since 1984, successive Republican governments have imposed a “Global Gag Rule” (also known as the Mexico City Policy) on foreign NGOs receiving global health aid, barring them from using this money – or even money they have raised from other sources – for any abortion-related activities, including referrals.

However, the second Trump administration is the first to extend this to all non-military foreign assistance, including humanitarian assistance, and to widen the scope to include US NGOs, international organisations and – potentially – governments.

“Bullying countries into complying with anti-rights and extremist ideology is despicable and unacceptable. The imperialist goals of this administration are on full display in these conditions to foreign assistance,” Anu Kumar, CEO of the global reproductive justice organisation, Ipas, told a media briefing this week.

In 2024, $39.8 billion in US foreign aid was dispensed over 160 countries, with the largest share (41%) going to multilateral agencies, according to KFF.

“This is tens of billions more than the amount of global health assistance subject to the policy under the first Trump administration’s previously expanded policy ($7.3 billion in 2020),” notes KFF.

This “catastrophic expansion” is going to be especially harmful to “women, young people, girls and LGBTQI+ people”, added Ipas senior researcher Jamie Vernaelde.

“There is an agenda here from the US government to push these ideologies across to other countries, both through direct government-to-government funding, but also forcing multilateral organisations to be subject to the ideology of one specific country.”

Impact on Kenya

The bilateral Memorandums of Understanding (MOU) that the US has signed with 15 African countries as part of its “America First Global Health Strategy” all contain a clause compelling countries to comply with the Global Gag Rule.

“What we’ve realised is this inclusion of the Global Gag Rule in the MOUs was basically a Trojan horse, in the sense that now the governments have signed, they are obligated to implement these expanded conditions, for example, on gender ideology,” said Ipas’s Kenya director, Dr Musoba Kitui.

Kitui said that 40,000 health workers had already lost their jobs in his country since the closure of the US Agency for International Development (USAID), leading to the “weakening of the health system”.

Many African governments “are very, very desperate” to inject resources into their health systems since the closure of USAID, and were willing to sign bilateral MOUs with the US, despite some of the unfavourable conditions, said Kitui.

Kenya’s MOU would be complex to implement, and there is “no way the US can monitor compliance without seeing patient records,” added Kitui, highlighting a concern about patient privacy which has resulted in the MOU being challenged in court.

However, “this MOU grants US personnel diplomatic immunity, insulating them from any local courts against judicial processes for any violations of data privacy, or even crippling the health system for that matter”, he added.

“Sexual and reproductive health is not a diplomatic bargaining chip. It’s a fundamental human right. Essential health care services must be separate from political agendas. What is really important is to protect the progress that we have made over the years, including in countries like Kenya,” Kitui stressed.

Impact on humanitarian aid

South Sudanese women survivors of violence shared their stories with a visiting UN delegation. The narrow redefinition of US global aid will affect survivors of gender-based violence who need access to rape kits and emergency contraception.

Dr Jean-Claude Mulunda, who heads Ipas work in the Democratic Republic of Congo (DRC), said that his organisation assisted displaced people in camps with family planning services, abortion care and also supports survivors of gender-based violence (GBV). 

With the demise of USAID, “rape kits” for GBV survivors containing medicine to protect women and girls against sexually transmitted infections and pregnancy are no longer available.

“Ipas is trying, with our limited funds, to buy unit-by-unit, the different medicines in these kits,” said Mulunda. “Many women who are victims of rape can’t access abortion care, even though the country has signed the Maputo Protocol which allows access to abortion in case of rape.” 

The more onerous aid conditions are going to make it even harder for displaced women to access sexual and reproductive services.

“The risk of unsafe abortion is elevated in humanitarian settings where it’s even harder for people to access medical services,” warned Médecins Sans Frontières (MSF) in its reaction to the new policy.

“In 2023, MSF provided more than 31,000 consultations for post-abortion care, most of which were due to complications related to unsafe abortion. With the reinstatement of the Global Gag Rule, MSF expects these already troubling numbers to increase.”

The new policy, PHFFA, “escalates a pattern established across both Trump administrations: the systematic subordination of scientific evidence and patient needs to ideological and political objectives,” added MSF. 

“Versions of the Global Gag Rule have been introduced by Republican administrations since 1984, and extensive research has repeatedly documented that the policy disrupts health services and causes cascading adverse health outcomes in low- and middle-income countries, with the chilling impact enduring even when the policy has been rescinded,” MSF noted.

MSF added that the State Department’s definitions of “gender ideology” and “discriminatory equity ideology” are so broad “that it is likely to result in barring or limiting access to essential health services for LGBTQIA+ individuals, women and girls, racial and ethnic minorities, and other marginalized groups”. 

‘Abdication of decency’

US Vice President JD Vance addressing the March for Life last Friday, where he announced the new policy.

“President Trump and his anti-abortion administration would rather let people starve to death in the wake of famine and war than let anyone in the world get an abortion – or even receive information about it,” said Rachana Desai Martin, chief US program officer at the Center for Reproductive Rights. 

“People are already dying because of this administration’s slashing of foreign assistance. Now, they’re making it harder for doctors and aid workers to provide food, water, and lifesaving medical care. This isn’t about saving lives – it’s a stunning abdication of basic human decency,” Martin added.

“Trump’s expansion [of the Global Gag Rule] continues on a path of instrumentalising those most marginalised. It marks increasing attempts to capture global health and human rights with a deeply regressive act of imperialism masquerading as foreign policy,” said Mina Barling, International Planned Parenthood Federation’s global director of external relations. 

“This is yet another attack on national sovereignty and colonial intervention through the curtailing of sexual and reproductive rights.”

“The dismantling of USAID has already caused widespread harm: more than 45 million women and girls have lost access to contraceptive care and clinics around the world have been forced to close,” said Marieke van der Plas, executive director of the Dutch reproductive rights organisation, Rutgers.

“Now, the Trump administration is further reshaping global health policy through new government agreements that embed ideological conditions and deepen political control.”

The Senate Foreign Relations Democrats said in a statement: “By blocking US funding to any entity that does not conform to his extreme ideological agenda, the administration is exporting MAGA culture wars overseas and turning lifesaving aid into a political tool

“This order goes far beyond anything we’ve seen before. It will shrink global resources to fight disease, respond to humanitarian crises and protect women and girls from violence, while forcing many of our trusted partners to shut their doors or betray their missions. In doing so, it also leaves Americans more vulnerable to infectious diseases and health threats that do not respect borders.”

Image Credits: saac Billy/ UN Photo, KFF.

Flagship UN report finds irreversible damage to global water systems affects three-quarters of the global population, threatens food security and thrusts the world into a new era of the water crisis.

The world has entered the era of “global water bankruptcy” as water systems relied on by six billion people, and half of the world’s food production, are pushed beyond the point of recovery, a United Nations (UN) report has found.

The report marks the first time UN scientists have declared water systems “bankrupt” rather than “stressed or “in crisis”, a distinction that denotes irreversible damage to natural water systems, as opposed to acute, time-limited shortages due to factors like weather, high demand or economic shocks.

“This report tells an uncomfortable truth: many regions are living beyond their hydrological means, and many critical water systems are already bankrupt,” said Kaveh Madani, director of the UN University’s Institute for Water, Environment and Health and lead author of the report.

“If we continue to manage these failures as temporary crises with short-term fixes, we will only deepen the ecological damage and fuel social conflicts,” Madani said. “We must act because water bankruptcy is a justice and security issue. The cost of the hydrological overshoot that the world is facing falls disproportionately on those who can least afford it.”

The UN report arrived ahead of high-level meetings in Dakar, Senegal, this week to prepare the agenda for the 2026 UN Water Conference, set for December in the UAE. It calls on member states to formally recognise water bankruptcy, establish global monitoring frameworks and position water investments as fundamental to achieving climate, biodiversity and food security targets.

This year’s summit is only the second major international meeting on water governance this century, following a 2023 summit at UN headquarters in New York. The only other global water conference in history was held in Mar del Plata, Argentina, in 1977.

“Declaring bankruptcy is not about giving up, it is about starting fresh. By acknowledging the reality of water bankruptcy, we can finally make the hard choices that will protect people, economies, and ecosystems,” Madani said. “The longer we delay, the deeper the deficit grows.”

‘Day Zero’ threatens major cities

The world’s third largest lake, the Aral Sea, lying between Kazakhstan and Uzbekistan in 1989 (left) and in 2025 (right).

The UN report draws on satellite data, hydrological modelling and over 300 case studies to document the scale of water loss.

More than half of the world’s large lakes have lost water since the early 1990s, over 30% of glacier mass since 1970 has disappeared in certain regions, while about 410 million hectares of natural wetlands—a land mass nearly equal to that of the European Union—have been destroyed over the past five decades.

“Surface waters are shrinking. Those are our checking accounts that get renewed every year, that nature is kind enough and generous enough to deposit some budget, give us some income,” Madani explained. “It is normal to go to the savings account and buy resilience for the dry years. But what we are seeing around the world is that the savings accounts are also draining – we are exhausting them.”

The Middle East, North Africa, South Asian and parts of the American Southwest face the most severe threat as high water stress collides with extreme vulnerability to climate change. Over 1.42 billion people, including 450 million children, already live in conditions of high or extremely high water vulnerability, according to UN Water data.

Water scarcity has been a major driver of public outrage at Iran’s regime throughout the recent wave of protests. After six years of drought, reservoirs around its capital, Tehran, are on the brink of the next “Day Zero” event. / Satellite image: Institute for the Study of War.

For some of the world’s largest cities, the crisis has already arrived. Metropolises around the globe, from Cape Town to Sao Paolo and Tehran, have already faced their first “Day Zero” emergencies – events where water supplies for a city are near complete depletion. Kabul, meanwhile, is on the brink of becoming the first major city globally to run out of water.

While cities survived, these first “Day Zero” events are warning shots, and many – particularly the urban poor – continue to live with the consequences, the UN warned.

“Emergency measures—severe restrictions, tariff changes, rapid drilling of new wells, reliance on tanker supplies, and behavioural campaigns—helped some cities narrowly avoid a complete shutdown of taps,” the report found.

“Yet in many of these places, the underlying aquifers, reservoirs and catchments remain degraded, and poorer neighbourhoods continue to live with intermittent service, tanker dependence, and high water costs long after the media attention has moved on.” 

Half the world’s 100 largest cities experience high water stress, while 38 – including Beijing, New York, Delhi, Los Angeles and Rio de Janeiro – face “extremely high stress” levels, according to a separate analysis published by Watershed Investigations this week.

Another study published this year by the University of Utrecht, analysing 21 global water scarcity hot spots, found that hydroclimatic change – long-term changes in water cycles driven by climate change – was cited in 49% of case studies, but typically was not the sole driver of scarcity, operating alongside population growth (31% of cases), agricultural overuse (77%), industrial demand (30%) and municipal consumption (46%).

Disease and displacement

Water access is a fundamental determinant of health, yet nearly 2.2 billion people lack safely managed drinking water, while 3.5 billion lack safely managed sanitation, according to WHO figures. 

These gaps expose populations to cholera, typhoid, polio, dysentery, hepatitis A and diarrhoea. Waterborne diseases and inadequate water supplies kill an estimated 3.5 million people annually, according to UN Water. WHO research estimates that 900 children under five per day die from diarrheal diseases caused by unsafe water.  That is one child every two minutes, adding up to 328,500 deaths every year.

About four billion people—nearly two-thirds of the global population—face severe water scarcity for at least one month every year, forcing communities to use water contaminated with agricultural runoff, industrial waste and untreated sewage for basic health activities such as handwashing and bathing. This amplifies the breeding grounds for infectious waterborne disease spread and raises risks of poisoning from chemicals like lead or arsenic.

Water scarcity also drives displacement, which cascades into health crises as populations move into areas with inadequate sanitation, limited healthcare and overcrowded conditions that accelerate health risks. Over 700 million people are projected to be displaced by water scarcity by 2030, according to UNICEF.

“Bankruptcy management requires honesty, courage, and political will,” Madani said. “We cannot rebuild vanished glaciers or reinflate acutely compacted aquifers. But we can prevent further loss of our remaining natural capital, and redesign institutions to live within new hydrological limits.”

Water-driven conflicts rise

Water-related violence has nearly doubled since 2022, rising from 235 incidents to 419 in 2024, according to Water Conflict Chronology, a database updated this week by the Pacific Institute that tracks water-driven violence throughout history.

The dataset contains 2,757 conflicts dating back to a dispute in ancient Sumeria over water and irrigation that led to nearly a century of war in 2500BC. The latest incident added documents of residents punching and beating firefighters in Manila, Philippines, blaming them for a lack of water.

Water has increasingly been a target in major wars, despite Article 54 of the Geneva Convention classifying attacks or destruction of water infrastructure or supplies necessary for civilian survival as a war crime.

Recent examples include Israel’s systematic destruction of Gaza’s water systems and desalination plants, Russia targeting hydropower dams in Ukraine, and tensions over the Indus River treaty between India and Pakistan, the report found.

Water Conflict Chronology’s tracker lists nearly 3,000 wars over water since 2500BC.

Oxfam’s water security lead, Joanna Trevor, told the Guardian that her team has observed “an increase in localised conflicts over water due to climate change and water insecurity” as competition for dwindling reserves intensifies.

“In East Africa and the Sahel, water is becoming increasingly insecure, and people are moving into new areas to access water, which in itself can trigger competition and conflict with the host population,” Trevor said.

UNICEF estimates that by 2040, roughly one in four children—about 450 million—will live in areas of extremely high water stress.

“Water bankruptcy is becoming a driver of fragility, displacement and conflict,” said Tshilidzi Marwala, UN Under-Secretary-General. “Managing it fairly is now central to maintaining peace, stability and social cohesion.”

Food systems dry up

Total freshwater withdrawals for agriculture, industry and domestic uses across the globe from 1900 to 2010.

Three billion people and more than half of global food production are concentrated in areas where total water storage is already declining or unstable, according to the report.

With agriculture accounting for an estimated 72% of global freshwater withdrawals, the report’s concern is echoed by recent research by the World Resources Institute (WRI), which found 25% of the world’s crops are grown in areas where water supply is highly stressed or unreliable.

“One out of every 11 people in the world grapples with hunger,” WRI found. “A hidden and growing driver is lack of water.”

As water stress soars, the world will need to produce 56% more food calories in 2050 than it did in 2010 to feed a projected population boom to 10 billion people.

Yet current production is already under threat: one-third of rice, wheat and corn produced globally—which provide more than half of global food calories—is grown in water-stressed regions, while irrigation water demand is forecast to increase 16% over the next two decades due to warming temperatures, according to WRI.

“We need to decouple growth from water,” Madani said. “We need to move away from the asumption that economic prosperit requires ever-increasing water withdrawals – the problem that has got us in this situation.”

Just 10 countries produce 72% of the world’s irrigated crops, with two-thirds of that production facing high to extremely high water stress. India, the world’s largest rice exporter, is losing up to 30 centimeters of groundwater per year in some regions, with depletion rates projected to triple by 2080.

Over 170 million hectares of irrigated cropland—equivalent to the combined land area of France, Spain, Germany and Italy—are under high or very high water stress. An additional 106 million hectares have been degraded by salinisation, the UN report found.

“Millions of farmers are trying to grow more food from shrinking, polluted or disappearing water sources,” Madani said. “Without rapid transitions toward water-smart agriculture, water bankruptcy will spread rapidly.”

“Despite its warnings, the report is not a statement of hopelessness,” he concluded. “It is a call for honesty, realism, and transformation.”

Image Credits: Art Poskanzer, Institute for the Study of War , Pacific Institute.

WHO flags
The US accused the WHO of “holding hostage” the American flag that once flew outside the Organization’s Geneva headquarters (seen here in 2025).

A dispute over an American flag has become symbolic of the bitter public dispute between the US and the World Health Organization (WHO) after the US withdrew from the organization on 22 January.

In a joint statement by Secretary of State Marco Rubio and Secretary of Health and Human Services Robert F Kennedy Jr on the termination of US membership of the WHO, they accused the organization of keeping the American flag that hung outside its Geneva headquarters captive.

“Even on our way out of the organization, the WHO tarnished and trashed everything that America has done for it. The WHO refuses to hand over the American flag that hung in front of it, arguing it has not approved our withdrawal and, in fact, claims that we owe it compensation. From our days as its primary founder, primary financial backer, and primary champion until now, our final day, the insults to America continue.

“We will get our flag back for the Americans who died alone in nursing homes, the small businesses devastated by WHO-driven restrictions, and the American lives shattered by this organization’s inactivity,” the statement said.

A day after the official withdrawal, the State Department declared victory, posting: “Under @POTUS leadership, the @StateDept and @HHSGov have secured its return, now safely held by U.S. Marines @usmissiongeneva, and on its way back to USA.”

The dispute over the flag underscores broader and long-simmering tensions between the Trump administration and the WHO, particularly over the Organization’s handling of the COVID-19 pandemic.

US still owes WHO $260.6 million

The US’s highest-ranking health officials, including National Institutes of Health director Dr Jay Bhattacharya, rose to prominence during the pandemic for their criticism of COVID-19 policies, tapping into widespread public anger over restrictions, school closures, and vaccine mandates.

In the view of current US leadership, the WHO is an organization “beyond repair.”

Instead, the Trump administration has begun pursuing a series of bilateral agreements with 14 sub-Saharan African countries, aiming to recreate aspects of the WHO’s multilateral system for pooling scientific and public health data.

But according to global health policy experts at Georgetown University, Sam Halabi and Lawrence O Gostin, this “transactional alternative” assumes that the US could strike comparable agreements with nearly every country in the world – “which of course it cannot,” they wrote in a commentary published in the Washington Post.

The WHO is expected to discuss how to address the US withdrawal at its upcoming Executive Board meetings on 2 February and again at the annual World Health Assembly in May. The organization also maintains that the US owes $260.6 million in unpaid membership dues.

WHO says withdrawal makes US and world ‘less safe’

WHO Director General Dr Tedros Adhanom Ghebreyesus at a press briefing in Geneva. Tedros defended the Organization’s COVID-19 response.

The WHO responded to the US’s accusations on Saturday, saying that “[w]hile no organization or government got everything right, WHO stands by its response to this unprecedented global health crisis. Throughout the pandemic, WHO acted quickly, shared all information it had rapidly and transparently with the world, and advised Member States on the basis of the best available evidence.”

WHO Director General Dr Tedros Adhanom Ghebreyesus echoed the sentiment, saying: “While WHO recommended the use of masks, physical distancing and vaccines, WHO did not recommend governments to mandate the use of masks or vaccines and never recommended lockdowns. 

“WHO supported sovereign governments with technical advice and guidance that was developed on the basis of evolving evidence on COVID-19 for them to make policy decisions in the best interests of their citizens. Each government made their own decisions, based on their needs and circumstances.”

The WHO pointed to the US’s global participation in some of the world’s greatest public health achievements, despite the fact that the US promises to continue “leading the world in public health” without collaborating with the UN organization. 

“As a founding member of the World Health Organization, the United States of America has contributed significantly to many of WHO’s greatest achievements, including the eradication of smallpox, and progress against many other public health threats including polio, HIV, Ebola, influenza, tuberculosis, malaria, neglected tropical diseases, antimicrobial resistance, food safety and more.

“WHO therefore regrets the United States’ notification of withdrawal from WHO – a decision that makes both the United States and the world less safe.”

This story is a continuation of Health Policy Watch’s coverage of the US-WHO withdrawal. See related stories here:

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

America First is Not America Absent

 

Image Credits: Arkansas Advocate , E. Fletcher/Health Policy Watch.

Healthcare workers
The mission to ensure safe, effective and affordable diagnostics, therapeutics and vaccines (DTVs) within 100 days of a pandemic threat being identified is not possible in many regions, according to the International Pandemic Preparedness Secretariat.

Global pandemic preparedness is becoming “increasingly fragile at a time of growing biosecurity and geopolitical risk”, according to the International Pandemic Preparedness Secretariat (IPPS), which launched its Fifth Implementation Report of the 100 Days Mission on Tuesday.

IPPS is an independent entity that promotes the “100 Days Mission”, the global ambition to develop safe, effective and affordable diagnostics, therapeutics and vaccines (DTVs) within 100 days of a pandemic threat being identified. 

But pressure on global R&D pipelines, declining investment in pandemic countermeasures, and heavy reliance on a small number of funders mean that the 100-day target is not possible in many areas, according to the report.

“Major reductions in global health and research budgets in 2025 have exposed structural vulnerabilities, disrupted development pipelines, and weakened preparedness,” the IPPS notes in a media release.

“Investment in pandemic countermeasure R&D continued to decline through 2024, with the steepest impacts seen in therapeutics. Pipelines across diagnostics, therapeutics and vaccines remain uneven and clustered in early stages, with limited progression into mid-stage and late-stage development. 

“Progress on enabling systems, including regulatory preparedness, clinical trial readiness, data-sharing frameworks and manufacturing coordination, remains slow,” the media release notes.

Outbreaks of mpox,  a continental health emergency in Africa until last week; the zoonotic spillover risk of H5N1; and outbreaks of Ebola, Marburg, Rift Valley Fever and Chikungunya “have highlighted persistent challenges in early detection, coordination and equitable access to countermeasures”, according to the IPPS, which is funded by the Wellcome Trust and Gates Foundation

“The science needed to respond faster to pandemics continues to advance, but this report makes clear that progress in applying these advances to delivering effective tools is insufficient,” said Dr Mona Nemer, chair of the IPPS Steering Group and Chief Science Adviser of Canada.

“Today, despite the landmark WHO Pandemic Agreement, the world remains vulnerable to funding shocks, uncoordinated R&D efforts and fragile development pipelines – particularly for therapeutics.”

Priorities for 2026

For the first time, the 100-day scorecard includes an assessment of pandemic preparedness and response (PPR) capacity in Africa. 

This evaluates the continent’s capabilities in clinical trials, laboratory systems, regulatory frameworks and manufacturing.

“Advances in platform technologies, including mRNA, monoclonal antibodies and artificial intelligence, continue to offer opportunities to accelerate development,” according to the report, which also identifies “significant pressures”.

However, it notes that Africa shows “growing regulatory maturity and manufacturing capability”. It highlights Rwanda’s integration of the 100 Days Mission framework and scorecard into national preparedness planning as an example of how the mission can be operationalised at the country level.

The report, launched in Paris, identifies 2026 as a decisive year as France begins its G7 presidency.

It  identifies four priority action areas for 2026:

  • Operationalising the Therapeutics Development Coalition to address persistent gaps in antiviral R&D.
  • Enhancing coordination across the diagnostics ecosystem and implementing recommendations from the Global Diagnostics Gap Assessment.
  • Sustaining vaccine investment and strengthening alignment across diagnostics, therapeutics and vaccines.
  • Agreeing on a sustainable mechanism for pandemic preparedness monitoring, including a long-term path for the 100 Days Mission Scorecard beyond the IPPS mandate(which ends in 2027).

 

 

Image Credits: PREZODE , Photo by Carlos Magno on Unsplash.

WHO member states at an Intergovernmental Working Group meeting, negotiating a pathogen access and benefit-sharing (PABS) system.

Only 12 more negotiating days remain until WHO member states hit the May 2026 deadline for an agreement on a Pathogen Access and Benefit Sharing (PABS) system, as part of the new Pandemic Agreement adopted at last year’s World Health Assembly (WHA). 

The gap between developed and developing blocs of countries remains large, and progress has been slow in bridging the divide. A bloc of approximately 100 low-and middle-income countries (LMICs) continues to call for mandatory benefit sharing, including guaranteed LMIC access to vaccines, therapeutics, and diagnostics (VTDs) as the price of their rapid sharing of information on novel pathogens that might pose a pandemic risk.  

High-income countries, on the other hand, remain focused on protecting the pharma innovation ecosystem and ensuring open pharma access to pathogen sequence data. In terms of benefit-sharing, they tend to favor more flexible and voluntary commitments by manufacturers and research institutions to share products and manufacturing know-how with LMICs. 

While some elements of the PABS might actually be settled in time for adoption at  this year’s 79th WHA (18-23 May), other issues are likely to be kicked further down the road, potentially to a future Pandemic Agreement Conference of Parties (COP).  

In the seventh issue of the Governing Pandemics Snapshot, Daniela Morich dissects the choices facing member states.

Longstanding tension between rapid pathogen sharing and access to benefits

Cheers among the lead negotiators as the World Health Assembly adopts the Pandemic Agreement, 20 May 2025

On 20 May 2025, the global health community welcomed the adoption of the Pandemic Agreement (PA) as a much-needed triumph of multilateralism in a year marked by significant challenges and strains on global cooperation.

Although adopted, the Agreement will not be opened for signature until a supplementary Annex on the Pathogen Access and Benefit Sharing (PABS) system is completed—an uncommon feature in international law that temporarily halts the Agreement’s progress toward entry into force until the details of the Annex are agreed.

At the core of the Annex lies a longstanding tension: how to ensure rapid and reliable sharing of pathogens and their genetic sequence data – crucial for managing health emergencies and for the development of health products – while also guaranteeing fair and meaningful access to the benefits derived from their use, such as vaccines and therapeutics.  

Article 12 of the PA sets out the foundational principles of the PABS system. But the specifics – such as the recognition of obligations for countries and manufacturers, benefit-sharing arrangements, and implementation mechanisms – remain to be negotiated. An ad hoc Intergovernmental Working Group (IGWG), open to all WHO member states, has been tasked with translating these principles into operational rules.

Wide divide from the start

Ethiopia representing the position of the Africa group during pandemic agreement negotiations in March 2024.

The IGWG officially began its work in mid-2025. In August, WHO Member States submitted 17 textual proposals reflecting the views of approximately 100 countries. These proposals revealed, from the outset, deep divergences in how countries imagine the PABS System, and those differences have continued to shape the negotiations ever since.  

Developing countries advocate for strong equity provisions, including mandatory benefit-sharing and guaranteed access to vaccines, therapeutics, and diagnostics (VTDs). Their approach relies on transparency and traceability, with a strong role for WHO in administering the system and oversight by a future Conference of the Parties (COP).

Developing country blocs also have placed a greater emphasis  on technology transfer, and as part of that, licensing of medicines and vaccines as core benefits they should reap from the PABS agreement. As such, their proposals prioritize binding obligations operationalized through contractual mechanisms to ensure traceability and enforceability of commitments and to support the development of regional production capacity.

Consistent with this approach, the leading LMIC negotiating blocs, known as the Africa Group and the Group for Equity, as well as Egypt, Libya, Somalia and Sudan jointly submitted an ad hoc proposal for draft contractual agreements for negotiation (see Adam Strobeyko’s piece Avoiding Contract Fatalism.).

High-income countries, by contrast, focus on protecting the innovation ecosystem, maintaining open access to pathogen sequence data, and preserving incentives for private-sector research and development, which is still mainly happening in the Global North.

With regards to benefit-sharing obligations, they tend to favor voluntary and flexible commitments for manufacturers and research institutions. Their concern is that overly rigid obligations could undermine scientific collaboration or discourage investment in pandemic-related technologies.

First draft text does not bridge divides

IGWG3 gets underway on 4 November 2025.

In October 2025, the IGWG’s Bureau, a six-person panel steering the negotiations, released the first Draft Text of the Annex ahead of the Group’s third meeting. Although the text drew significant criticism from many delegations, it nonetheless became the basis for negotiations during the two subsequent meetings in November and December.

Progress was extraordinarily slow. Delegations used the sessions not to narrow differences but to reinsert the language they considered had been omitted from the Bureau’s proposal. As a result, the document expanded from seven pages to 37, producing a dense and unwieldy “rolling text” in which every proposal reappeared.

The only areas where common ground emerged were a few preliminary words on governance elements, notably that the COP would oversee the PABS System and that a PABS Advisory Group would be created.

Following calls for more transparency in the proceedings, the second IGWG meeting marked a surprising shift by deciding, on a pilot basis, to invite stakeholders to observe discussions starting at IGWG3 in November 2025. 

However, this openness was quickly revoked at the beginning of IGWG3, with no access to the negotiating room granted to observers. Further constraints on meaningful participation were introduced in January 2026, when participation was limited to virtual attendance. It is hoped that greater transparency will be allowed as the process moves forward.

Revising the Draft: Gains Limited to Pathogen Definition

The fourth session of the IGWG made some progress in clarifying the definition of a pathogen with pandemic potential. Here, a microscopic view of  SARS-COV-2. 

In the fourth resumed session of the IGWG (20–22 January 2026), progress remained slow. The Bureau, following regular intersessional informal meetings, released a revised draft text.

Some advancement was seen in clarifying language on the definition of “pathogen with pandemic potential,” an important step in defining the system’s scope, but little progress was made elsewhere in the text. Despite a generally positive mood in the room, the ticking clock reinforced a sense of urgency. Progress in bridging the divides continues to be painfully slow.

A small but highly engaged group of relevant stakeholders continues to follow the process closely, although it remains state-led and conducted behind closed doors. Interaction with delegates is limited to short briefings led by the Bureau and is restricted to stakeholders duly accredited to the process.

Are we nearing the finish line?

With the May 2026 deadline approaching – and only 12 actual negotiation days remaining – clear divergences between blocs of countries remain a significant obstacle. 

Additionally, while some issues—such as laboratory networks, databases, and traceability—have been discussed, other critical topics, including financing, have yet to be meaningfully addressed, as highlighted by Suerie Moon in her companion article Could money grease the wheels of compromise on PABS?”

Against the ticking clock, an overarching  question now looms: which elements of the PABS  parties might be willing to settle now –  and which they might further kick down the road to a future Pandemic Agreement’s COP.

Problematically, these negotiations also unfold against the backdrop of a spate of US  bilateral agreements with  developing countries – so far 15 in all. In these arrangements, seen as a cornerstone of the new US global health policy, aid and commercial deals are offered in exchange for access to pathogen samples and data about disease outbreaks. 

Some experts worry that these deals will negatively affect the negotiations in Geneva, and the future PABS systems, as they could create structural dependency that constrains a country’s ability to share data independently with regional or WHO-coordinated networks.

With only a few months remaining, parties will need to be realistic about what can be achieved. Successfully concluding this work would consolidate years of effort and strengthen the foundations of a more equitable global pandemic preparedness and response system.

Daniela Morich is head of policy engagement and Global Health Platform at the Geneva Graduate Institute’s Global Health Centre.

Explore the three other articles available in the seventh issue of the Governing Pandemics Snapshot:

In  “Avoiding Contractual Fatalism: Lessons from PIP Framework for Standardising PABS contracts” Adam Strobeyko looks at how the experience of the Pandemic Influence Preparedness (PIP) Framework could help inform the PABS process. He examines WHO contracts that enable pharma access to a global network of influenza samples in exchange for benefit-sharing commitments channelled through WHO.

In PABS laboratory networks: building a new system or using what we have? Gian Luca Burci examines whether existing WHO-managed networks, such as the Global Influenza Surveillance and Response System (GISRS), could take on the additional role of a PABS laboratory network, presuming an agreement is reached.

Finally, in her piece, Could money grease the wheels of compromise on PABS? Suerie Moon explores how finance for Access and Benefit Sharing (ABS) could be generated in “interpandemic” times when the absence of a clear pandemic threat provides limited incentive to pharma companies to invest in related products. 

Image Credits: NIAID-RML .