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

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

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

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

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

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

A break from quantifying health benefits

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

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

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

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

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

EPA calls past methods ‘erroneous’ 

EPA

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

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

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

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

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

Slippery slope to looser standards

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

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

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

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

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

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

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

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

Dangerous global precedent 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Huge wins since 1970 Clean Air Act under threat?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Chetan Bhattacharji and Elaine Ruth Fletcher contributed to this report.

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

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

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

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

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

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

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

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

Sugary drink taxes are ‘too low’

WHO economist Anne-Marie Perucic

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

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

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

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

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

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

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

No tax on wine in 25 countries

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

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

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

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

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

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

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

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

Taxes are a win-win

Dr Jeremy Farrar, WHO Assistant Director-General

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Listen to the full episode:

Image Credits: Global Health Matters Podcast.

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

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

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

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

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

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

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

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

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

What’s happening with the DRC?

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

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

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

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

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

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

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

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

Kenya recognised as key ally

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

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

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

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

Extract from the Kenya MOU dealing with pathogen access.

Nigerian air strikes

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

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

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

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

Digitisation, disease surveillance

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

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

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

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

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

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

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

Eswatini will increase domestic health expenditures by $37 million.

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

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

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

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

Ownership of HIV service delivery

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

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

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

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

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

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

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

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

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

The United Nations headquarters in New York.

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

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

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

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

Second-largest emitter

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

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

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

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

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

The UN had not responded at the time of publication.

Image Credits: Giorgia Galletoni , Wikimedia Commons.

US Health and Human Services Secretary Robert F Kennedy Jr.

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

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

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

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

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

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

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

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

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

Controversial Danish researchers

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

Stabell Benn is an adviser to the US Advisory Committee on Immunization Practices (ACIP), which recently resolved to stop recommending hepatitis B vaccines to US newborns. ACIP has advised that it is up to parents to decide on the vaccination. US newborns have been vaccinated against hepatitis B since 1991, and this policy has reduced infections in children by 99%. 

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

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

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

Enrolment before new policy rollout

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

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

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

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

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

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

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

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

Among the core vaccines no longer recommended for all children are those that protect against rotavirus, RSV, influenza, meningococcal disease, hepatitis A, and hepatitis B. 

HHS Secretary Robert F Kennedy Jr makes good on promise to reduce the number of recommended vaccines.

US health officials announced Monday an overhauled version of the vaccines recommended to infants and adolescents, shrinking the number of diseases for which vaccines should be administered from 17 to 11. 

The decision follows a December 5, 2025 directive from President Donald Trump to the US Centers for Disease Control and Prevention (CDC) to review the US childhood vaccine schedule in comparison to those of wealthy, peer-nations, citing Denmark, Germany and Japan in particular.

The revisions now mean that the US will go from being one of the developed nations with the highest number of diseases covered – to one of the lowest – according to HHS’s own analysis.

In fact, only Denmark recommends fewer jabs – for just 10 diseases in total. Greece and Ireland recommend immunization for 16 diseases and five countries recommend immunization against 15 diseases, including Australia, Canada, Denmark, Ireland, Spain and the United Kingdom.  Japan recommends childhood immunization against 14 different diseases.

New jan 2026 CDC vaccine guidance country comparison
A table from HHS’s assessment of the US vaccine schedule in comparison to other wealthy nations. The table shows the number of doses for each type of vaccine recommended. The “# Mandated” row uses the example of New York state. The “18-19” number in the bottom right reflects the number of shots a child could receive if they take a yearly COVID-19 and flu shot. Some vaccines are duplicated, such as the measles, mumps, rubella combined vaccine (MMR). “A” reflects the new CDC guidance that these shots be only for high-rish patients or at the bequest of caregivers. The US has no childhood federal vaccine mandate – these vary by state.

Among the core vaccines CDC will no longer recommend for all children are those that protect against rotavirus, influenza, meningococcal disease, hepatitis A, and hepatitis B (HBV). 

The CDC also dropped a relatively new recommendation for newborns to be vaccinated against  Respiratory Syncytial Virus (RSV) – if their mothers had not been previously vaccinated.  

RSV is the single largest cause of childhood hospitalizations in the US today, burdening the healthcare system with 80,000 hospitalizations a year. 

And the new CDC policy reduces the number of recommended doses against HPV – a key cause of cervical cancer – from two to one. This is contrary to the two-dose advice of most other developed nations and the World Health Organization. WHO’s cervical cancer elimination strategy calls for a dramatic reduction in cases by 2030, largely through mass immunization programs. 

Another key point of concern for US public health experts is the removal of any broad recommendation for vaccination against hepatitis B – a leading cause of liver disease and a vaccine that almost every other developed country includes for newborns or infants. Instead, the updated recommendation urges caregivers to consult with their physicians if their child falls into a “high risk” category. 

Already in December 2025, the CDC in recommended to delay  administration of the hepatitis B (HBV) vaccine for infants by six months. 

The Department of Health and Human Services Secretary Robert F Kennedy Jr’s longtime skepticism about the HBV vaccine played a central part of his Senate confirmation hearing where Senator Bill Cassidy (R-LA), a medical doctor and liver specialist, credited the vaccine with saving some 90,000 children’s lives in the US since 1991. 

Despite the reassurances that Kennedy provided at that time to the Senate Confirmation Committee to follow well-established evidence on immunization’s benefits, the HHS Secretary, who built his career around vaccine hesitancy, has now made good on his previous record as a vaccine skeptic.    

Changes announced Monday following a brief review

cdc acting director jim o'neill vaccines
U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. conducts the swearing-in ceremony of Jim O’Neill as the Department’s Deputy Secretary Monday, June 9, 2025 at the Hubert H. Humphrey Building in Washington, D.C. (Source: HHS by Amy Rossetti)

The changes were announced abruptly Monday by acting Centers for Disease Control and Prevention Director Jim O’Neill.  He directed the public health agency to move forward immediately on the new CDC recommendations. 

The Trump Administration’s health leadership has argued that the change will increase transparency and rebuild trust in health institutions. 

“After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent. This decision protects children, respects families, and rebuilds trust in public health,” Kennedy said in the statement. 

But the overhaul also is an unprecedented departure from the evidence-based process the US previously used to decide its vaccine schedule.

Normally an independent federal advisory panel of experts would review studies and data for each vaccine before publishing recommendations. 

In this instance, CDC director O’Neill issued the changes in a memorandum responding to a request by Trump for such a review only a month ago – and with the underlying analysis based on a comparison of schedules in other nations.  

The comparisons between the seemingly high number of actual shots, or  jabs, US children previously received as compared to those of other nations is also somewhat misleading – insofar as annual flu and COVID-19 vaccines up until the age of 18 are included in the US count of previous recommendations – totaling about 35 or 36 more shots across 18 years. 

But in November, the CDC last year already stated that COVID vaccination for children, while recommended, should be a matter of “individual decision-making.”  And WHO’s own recommendations for COVID-19 vaccination of children were already reversed  post-pandemic, advising only one dose for never-vaccinated children with co-morbidities. 

In 2010, the CDC did adopt a universal recommendation for annual childhood sesasonal flu vaccination. That went further than the current WHO recommendation which recommends prioritizing seasonal flu vaccine for “health workers, individuals with comorbidities and underlying conditions, older adults and pregnant women,” adding only that “Depending on national disease goals, capacity and resources, epidemiology, national policies and priorities, and disease burden, countries may consider additional (sub)populations for vaccination, such as children.”

Concerns that hospitalizations, deaths may increase

“Fewer vaccinations (specifically for rotavirus, COVID-19, influenza, RSV, meningococcal disease, hepatitis A and hepatitis B) will result in an increase in disease, disability, and death, wrote epidemiologist and infectious disease specialist Jessica Malaty Rivera in a post. 

“Please ignore this unscientific nonsense and follow the @ameracadpeds schedule alongside your pediatrician.” 

Prior to the vaccines and therapeutics that prevent RSV, for instance, the virus accounted for over one in four hospitalizations among young children in the US. 

Other physicians and health experts criticized the shift for causing confusion and for ignoring decades of vaccine studies demonstrating safety and efficacy. 

“Know this: Even as our government shifts its recommendation language, I would never forgo the RSV, hepatitis A & B, or meningitis vaccines for my own kids,” said Dr Scott Hadland, a pediatrician and chief of adolescent medicine at Harvard.

“This is health policy malpractice at the highest level and must be reversed before children and families suffer,” said Dr George C Benjamin, executive director of the American Public Health Association.

Attempt to bring US “in-line” with other wealthy countries

The 33-page CDC policy document argues that in light of falling vaccination rates across the US and the lack of trust in public health institutions, the US should therefore cut back on the number of recommended vaccines.

“Bringing the U.S. pediatric immunization schedule in line with the consensus of peer nations while keeping non-consensus vaccines available for high-risk groups and populations and/orthrough shared clinical decision-making is a balanced approach to reform and restore trust in public health,” the document says.

Traditionally, the US has recommended slightly more vaccines, on average, than “peer” nations. However, the US also continues to face surges of measles, hepatitis A, RSV, and other infectious diseases. 

The other problem with policy decisions based on comparisons with other high income countries experts say, is that the US has a far larger, and more sickly, population that often lacks access to primary healthcare. 

“Many high-income countries have universal coverage and paid family leave that make it easier to get care and stay safe when kids get sick,” said Dr Uché Blackstock, a physician and health equity advocate in a social media post. 

“You cannot copy the [vaccine] list without copying the supports,” Blackstock said. 

Denmark and Japan’s healthier population, more robust healthcare systems, surveillance, testing, and social support mean there is less of a reliance on vaccines. 

“We have fragmented insurance, we’ve got millions uninsured, we don’t have a national health registry and we’ve got enormous gaps in the continuity of care,” said Dr. Jake Scott, an infectious disease specialist at Stanford University School of Medicine. “And we use broader vaccine recommendations because our system can’t reliably identify and follow up with every person at risk.”

Assessment downplays risk of rotavirus, meningococcal disease, HPV

Rotavirus vaccines
A screen capture of the CDC website with the burden of rotavirus on the US

Of the vaccines being cut from the list, RSV and rotavirus pose a significant burden to the healthcare system. Prior to the RSV maternal vaccine and monoclonal antibodies, up to 80,000 children were hospitalized with the virus. Nearly all children were infected with rotavirus prior to the vaccine. It caused 20-60 deaths each year, according to the CDC.

“Reasonable people can reach different conclusions about recommending the rotavirus vaccine for all children,” says the assessment. 

The assessment also argued that low rates of meningococcal disease warranted an end of recommendations. “Considering the low incidence of meningococcal disease in the U.S., the meningococcal vaccine should not be part of the consensus recommended vaccine schedule.” These low rates are due in large part to vaccinations.

Still covered by health insurers? 

The vaccines dropped from the CDC’s recommendations should still be covered by health insurance systems  – the new CDC policy also states. 

But it is unclear whether health insurers in the US’s fragmented public health system will in fact guarantee continued access for all of those who would like to get a shot – once the actual CDC recommendation has been removed. 

The authors of the new CDC policy are Dr Tracy Beth Høeg, a Danish-American physician and Food and Drug Administration director of the Center for Drug Research and Evaluation, and Martin Kulldorff.  

They are self-described in the assessment as “one of the most pro-vaccine scientists in the country” – however, they garnered significant attention during the COVID pandemic for their anti-COVID-19 vaccine stances. 

Kulldorff’s bio continues in the assessment: “In early 2021, he was one of the first public health scientists to publicly oppose Covid vaccine mandates and it is hard to imagine a policy doing more harm to the trust in vaccines and public health.”

Image Credits: European Union, Quinn Dombrowski, HHS , Amy Rossetti, CDC.

EPA atrazine corn fields
Over 70 million tons of atrazine is applied to US soil each year. The chemical is now deemed a ‘probable’ carcinogen to humans.

The US Environmental Protection Agency has dismissed a recent finding that atrazine, the second most widely-used herbicide in the United States, is “probably carcinogenic to humans” by the World Health Organization’s cancer review agency. 

Atrazine is used extensively in the US on crops like corn, sorghum, and sugarcane. However, over 60 countries have banned the chemical due to its endocrine-disrupting properties and tendency to contaminate groundwater. 

In a new classification, published in the January, 2026 issue of The Lancet Oncology, the International Agency for Research on Cancer (IARC) ranked atrazine as probably carcinogenic to humans based on what it described as “limited evidence” for cancer in humans and “sufficient evidence for cancer in experimental animals.”

The agency’s findings are independent assessments that guide national regulatory authorities worldwide in the promulgation of rules around chemicals used in agriculture, food systems and occupational settings.  

The IARC assessment was the first in nearly three decades. In 1998 the organization said the compound was not classifiable as to its carcinogenicity to humans. 

Since the IARC findings were initially released in late November, the US Environmental Protection Agency (EPA), as well as chemical producers in China and elsewhere, have pushed back against the new classification. Both used almost identical terms in describing the determination as “flawed” and “inconsistent with scientific consensus.”

Hormone disruptor, cancer risk of atrazine  

Farm workers atrazine EPA
Atrazine has been linked to non-Hodgkin’s lymphoma

Atrazine’s cancer links include evidence of oxidative stress, hormone disruption, immune suppression, and actual tumor growth, IARC found in its abbreviated evaluation of atrazine and two other compounds.

In particular, IARC pointed to animal studies that showed tumor growth in the mammary glands and uterus of female rats, reduced estrogen and testosterone in both male and female rats, and induced cell death and division. The most recent study IARC cites, from 2024, also concluded that male rats also experience oxidative stress and severe hormone disruption.

In humans, only a handful of studies have been published so far. However, IARC noted that two case-control studies that reported “strong positive associations between exposure to atrazine…and translocation-positive NHL [non-Hodgkin’s Lymphoma]” among exposed farm workers. Links to other human cancers did not show “consistent positive findings.” 

Beyond its cancer inks, atrazine exposure is also associated with birth defects, reproductive harm, and hormone disruption, in papers not cited by IARC – an agency that focuses almost exclusively on cancer risks. 

US regulators and manufacturers push back  

EPA
The US EPA said IARC’s findings used a “deeply flawed approach to its cancer assessments”

In a 21 November statement, Syngenta, the agrochemical company that produces most of the US’s atrazine, said:  “[c]urrent scientific evidence clearly demonstrate[s] that atrazine is safe when applied in accordance with registered label instructions.” Syngenta is owned by the Chinese state-operated company Sinochem.

Speaking to Health Policy Watch just a few days after the Syngenta statement, EPA used identical terms, arguing that IARC’s findings “stir up fear” by also including “very hot beverages, red meat, working the night shift and hairdressing in the same classification.” 

“This announcement on atrazine is just another example of the World Health Organization International Agency for Research on Cancer (IARC) using a deeply flawed approach to its cancer assessments on multiple levels,” the EPA added. 

The EPA spokesperson complained, in particular, that the two-page article published so far is just a brief summary of the full review, which is only due to be published later this year, according to IARC.

“[F]or IARC to roll out these “findings” and unnecessarily stir up fear when IARC has said it will not be publishing any of its detailed science until late 2026 or 2027 is irresponsible and lacks transparency. Currently, there is no opportunity for anyone to meaningfully review how IARC has reached its conclusions,” said the EPA’s press office. 

“In contrast, atrazine has been extensively studied by EPA across multiple administrations, including having five meetings of independent Scientific Advisory Panels peer review the cancer potential of atrazine between 2009-2011,” EPA said. 

“As a reminder, IARC also has a long history of being severely misguided in its findings,” the EPA spokesperson said, citing past IARC findings on red meat and night shift work, among other factors, as possible or probable causes of cancer. 

In 2015 IARC concluded that red meat was a possible cause of cancer and processed meat is a probable cause. Those findings have since been echoed by the American Institute for Cancer Research, which in 2021 concluded “there is strong evidence that eating high amounts of red meat increases the risk of colorectal cancer.” 

The US Department of Agriculture’s most recent dietary guidelines also suggest reducing red meat consumption. The US CDC concluded in a 2021 report that there is “high confidence” that persistent night shift work that results in circadian disruption can cause human cancer.

Environmental groups welcome IARC re-evaluation 

EPA USGS atrazine map usage
Latest estimates of atrazine use from the US Geological Survey, 2019

Separate EPA reviews in 2003 and 2018 concluded that available evidence does not support a relationship between atrazine exposure and human cancers. IARC cites one new animal study from 2024, while re-evaluating older data in a new light.

For pesticide experts like Dr Jennifer Sass, a senior scientist at the Natural Resources Defense Council (NRDC), IARC’s re-evaluation was welcome – correcting industry bias in previous evaluations. . 

“With atrazine, there’s hormone disruption, there’s oxidative stress, there is indication of tumors in human and animal studies,” said Sass. “IARC gathered a solid expert array of people from different disciplines, including industry people. They didn’t second-guess or overinterpret the data. 

“The EPA needs to take another look at their assessment to account for the carcinogenicity,” said Sass. 

Canada, Australia and Brazil also use atrazine extensively

Atrazine, also known under brand names such as Aatrex®, Aatram®, Atratol®, and Gesaprim®  is the second most widely-used pesticide in the US after glyphosate – also known as Roundup®. Glyphosate also was designated as a probable carcinogen in humans by IARC in 2015, in a ruling that continues to trigger controversy between the US and trading partners that have banned the chemical.  

Across the US’s corn belt, up to 60 million pounds of atrazine is applied to treat US crops each year. 

Atrazine also is flushed from soil into streams or groundwater aquifers where it can contaminate drinking water supplies, according to the US Centers for Disease Control and Prevention. 

A 2017 analysis of EPA tap water data found that nearly 30 million Americans across 28 states have tap water that contains atrazine. Drinking water in these areas had atrazine levels three to seven times higher than the federal limit of three parts per billion during spikes due to run-off in spring and summer, according to another major research and advocacy non-profit, Environmental Working Group. 

“Because the EPA has been sweeping the evidence on cancer under the rug for the time it has been on the market for 50 years, they’re not monitoring for atrazine in the water. The drinking water standard should be zero, because it’s a carcinogen,” said Sass. 

But the US is not alone in its reliance on the chemical, which is typically applied to unplanted fields so as to kill any other weeds or plants before crops are planted. 

Canada, Australia, Brazil and China also use atrazine to increase crop yields. 

In the decades prior to IARC’s classification, 60 countries banned the use of atrazine. These include 27 European Union countries, most Middle Eastern countries, and even many African countries. However, in many lower-and-middle income countries where atrazine is banned, the chemical is often smuggled in illegally. 

The European Union banned atrazine in 2004 and most EU countries have since banned glyphosate as well. Mexico, which exports tens of billions of dollars of agricultural products to the US, had attempted to ban glyphosate.  But in 2024 it postponed the ban indefinitely  following pressure from industry and the US, citing the lack of an effective alternative.

As international assessments increasingly flag risks associated with such chemicals, the US remains an outlier among high-income countries in continued widespread use. 

“We were all told for a long time that weed killers aren’t harmful to people because their mechanism of toxicity targets photosynthesis. We all believed them,” said Sass.

“Because of that, we didn’t have proper food monitoring. We didn’t have proper drinking water monitoring. The people exposed to atrazine occupationally, whether by mixing it, loading it, applying it, manufacturing it, need to take the proper precautions because of how toxic it is.

EPA stance contrasts sharply with MAHA rhetoric about healthier foods 

EPA’s pro-pesticide stance under the new US administration of President Donald Trump contrasts sharply with the healthy foods rhetoric of the “Make America Healthy Again” (MAHA) movement, critics also said.   

“Despite the rhetoric of MAHA, there will be no robust review of the dangers of pesticides by the Trump Administration,” said Sylvia Wu, of the Washington DC-based Center for Food Safety.  “Instead, a toxic poison like atrazine will continue to contaminate our lands and waters, making our children sick for decades to come,” said Wu.

Wu was responding, in particular, to another recent US Fish and Wildlife’s (FWS) statement that atrazine does not pose an extinction risk to any US endangered species. 

The Center for Food Safety sued the EPA in 2020 when the agency moved to reapprove atrazine, along with a host of other pesticides and herbicides, as part of a routine evaluation. 

“The public trust has been steamrolled by agrochemical interests,” said Sass of the Natural Resources Defence Council. “The EPA has fast-tracked the approval of their poisons, which is not only a violation of the public’s trust, but also of the mission of the EPA.”

“Using modern farming methods, we do not need weed killers like atrazine. We simply don’t have to kill every weed to grow our crops. It. We don’t have to be so scorched earth in our farm practices,” Sass argued. 

“I look forward to the day that the US catches up to other countries in keeping American families safe from chemicals.”

Image Credits: Akshat Jhingran , Waldemar Brandt , AP/Sierra Club, USGS.

Air pollution
Delhi air pollution during peak days in mid-November 2025 – an annual public health crisis that remains unresolved.

The latest ten-year data shows almost no change. Can the momentum of outrage finally push officials to take high-impact measures to lower pollution this year?

It’s Delhi 2026.

Since 2016, there’s been near-zero improvement in the city’s air pollution during the annual peak pollution period of October to December, a new analysis by the Center for Research on Energy and Clean Air (CREA) reveals. This period also usually sees peak coverage and public outrage about the crisis.

In 2025, average levels for those peak months even inched up a notch over the year before to 177 micrograms/cubic meter (µg/m³) of PM2.5 – despite a slight decline in the annual average levels in 2025 as compared to 2024 (96 µg/m³ in 2025 versus 105 in 2024).

This means average levels in the peak pollution months were over 35 times the WHO’s annual average guideline of 5 µg/m³ and 11 times the peak 24 guideline limit of 15 µg/m³. And that’s if questions over the robustness of the latest government monitoring data are ignored for the moment.

For nine of these last 10 years, opposition-led the Aam Aadmi Party was in power in Delhi, while Narendra Modi’s BJP party has been in power at the national level during the entire time.

Delhi air pollution graph
Near-zero improvement in Delhi’s peak pollution months since 2016.

In 2025, Delhi also elected a BJP-led state government, which means the BJP is now in power at the national, state and municipality level – a ‘triple engine sarkar’, as the Hindustan Times framed it, referring to the Hindi term for “government.” Indeed, the BJP not only controls Delhi, but also the governments of two key bordering states, Haryana and Uttar Pradesh – which generate smoke from crop waste burning that contributes to the capital’s autumn smog crisis.

That’s also why the new Delhi government, led by Chief Minister Ms Rekha Gupta, was expected to be uniquely placed to reduce pollution when she assumed office. Yet, as the peak season began, there was little indication of a significant shift in strategy.

Unprecedented outrage against air pollution

Public outrage against air pollution in Delhi and northern India has escalated to a level not seen in many years. It’s been characterised by a mix of anger and cutting humour – reels, memes and so on – against the government and the crisis.

There were other aspects. Multiple protests, including the one on 9th November where police detained several demonstrators, including parents, among others, demanding clean air for their children.

Multiple groups have been created on various social media and messaging apps.

Some TV anchors and journalists, seen to be close to the ruling establishment since 2014, took many by surprise by pivoting and questioning official inaction and apathy.

 

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India’s air pollution is “a metaphor for the challenges facing the nation more broadly.… if India cannot solve a problem that manifestly and acutely affects its elite, the prospects for solving the larger challenges confronting the country remain slim,” observed Arvind Subramanian and Devesh Kapur, in their book, A Sixth of Humanity, published last October.

India’s environment minister Bhupender Yadav held a series of meetings on Delhi’s pollution, including one where he directed officials to “ensure visible improvement” in the air quality across Delhi and its neighbourhood “within one week.” That was mid-December. By the end of the month, there was no improvement. In fact, this December saw the worst pollution since 2018.

Delhi’s environment minister and chief minister held several meetings, extensively posted policy action and photo ops on social media.

There have been some positive steps, like distributing electric heaters to gatekeepers at various residential areas, curbs on categories of polluting vehicles, and stricter enforcement of OCEMS, online continuous emissions monitoring systems, at thousands of factories.

Gaps in pollution control

Along with the global “embarrassment” mentioned in A Sixth of Humanity, critical technical gaps remain.

Firstly, misplaced focus on PM10:

The government’s focus remains on spraying water to control dust because it continues to prioritise controlling PM10 particulate matter pollutants rather than the finer PM2.5 ones. PM2.5 is dangerous because it is small enough to enter the bloodstream and, so, is more lethal, whereas the body’s defenses can often stop the larger PM10 particles.

In theory, watering down dust may help, but in practice, there hasn’t been much improvement. As this clip shows there’s simply too much pollution. And this water mist barely tackles PM2.5.

Secondly, lack of political will:

At a national level, there’s a lack of political will to stop the practice of farmers burning the residue of the paddy harvest in the three states north of Delhi and upwind of the city – Punjab, Haryana and Uttar Pradesh. This contributes almost 10% of the pollution in October and November in Delhi and the neighbourhood, according to a government (IITM) study, but on certain days and hours, it can be much higher.

Thirdly, pseudo-science over evidence:

There has been a reluctance among decision-makers to fully embrace scientifically evidence-based action. So a lot of time, taxpayers’ money, and effort over the years have gone into what may be described as pseudo-science, like smog towers, or action taken against scientific advice, like cloud-seeding trials.

Fourthly, flawed monitoring of vehicular pollution:

The Delhi government has, in a well-intentioned move, made pollution-under-control (PUC) certificates mandatory for all vehicles. However, the old PUC regime is flawed, and it needs to be replaced as it doesn’t check for key pollutants like PM2.5 and nitrogen oxides, which are major contributors to Delhi’s pollution.

But to give credit where credit is due: a new panel has been formed by the national government with external experts on curbing vehicular pollution, which contributes more than a third of the capital’s air pollution levels.

Many vehicles in Delhi are highly polluting, contributing more than a third to ambient air pollution levels.

Battle against air pollution, 2026

There have been political missteps, too.

One example: In early July, after public protests pressured the Delhi government to quickly roll back stricter enforcement of limits on old, polluting vehicles, the same government also successfully petitioned the Supreme Court to reverse a previous ban on firecrackers during the annual Diwali festival of lights, arguing that certain brands of so-called “green firecrackers” would not pollute. They were wrong. And the ensuing smoke was a factor in 2025’s post-Diwali pollution being the worst in years; and the chief minister repeatedly came in for criticism for comments she made on pollution.

In 2026, can the public’s pressure, and even the government’s momentum, for clean air action be sustained or will it, as in the past, fizzle out when Delhi’s peak pollution season tapers off?

Republished, with slight adaptation, from the original ‘What Am I Breathing’ Substack by Chetan Bhattacharji, a senior correspondent for Health Policy Watch from Delhi. 

 

Image Credits: Chetan Bhattacharji, Centre for Research on Energy and Clean Air.

Hans Henri Kluge, the WHO/Europe Regional Director, emphasised that vaccines save lives in the midst of a new flu strain surging early.

Sudden fever, a severe cough and acute respiratory distress are the familiar onset symptoms of seasonal flu, which has affected WHO’s European Region with unusual intensity and speed this year. As the Northern Hemisphere enters winter, health systems are struggling to manage an epidemic driven by an aggressive, genetically mutated influenza strain A(H3N2) subclade K.

But a new report by the European Centre for Disease Prevention and Control (ECDC), published on Friday, concluded that current seasonal influenza vaccines remain effective against this new strain of the virus. Health experts urge vulnerable groups to get vaccinated.

The current influenza outbreak is dominated almost entirely by the A(H3N2) subclade K, which now accounts for up to 90 per cent of all confirmed cases in the region, according to data from WHO’s European Regional Office (EURO). Subclade K marks a “notable evolution in influenza A(H3N2) viruses,” having undergone genetic drift and displaying several amino acid changes in the hemagglutinin protein (the “key” the virus uses to unlock and enter human cells). Due to these slight changes, antibodies acquired from previous infections or older vaccines may not recognise the virus as effectively.

“Flu comes around every winter, but this year is a little different,” stated Hans Kluge, WHO Regional Director for Europe, in a press release on Wednesday. Although there is no evidence that it causes more severe disease, Kluge explained that the small genetic variation in the virus places “enormous pressure on our health systems because people don’t have built-up immunity against it.”

Flu season gains early momentum

Map of the Influenza cases in the WHO/Europe region.
A(H3N2) subclade K is fuelling a flu surge across the WHO/Europe region, with protection stalling as most countries fail to meet critical vaccination targets.

With the new strain spreading quickly, the current influenza season began approximately four weeks earlier than in previous years. High or very high activity is now being reported in at least 27 of the 38 countries being monitored by the WHO European Region. These countries range from EU Member States such as Ireland and Slovenia to Kyrgyzstan and Montenegro.

“This is expected to cause a significant burden in terms of morbidity and mortality, as observed in past years, and target groups should be vaccinated rapidly,” said Bruno Ciancio, an ECDC senior expert, in response to a query from Health Policy Watch.

WHO data shows that the strain has been detected in more than 34 countries globally over the last six months. While it is most prevalent in the European and Western Pacific regions, its expansion has also been confirmed in the WHO South-East Asia region. Since October, A(H3N2) subclade K sequences have been reported in Nepal, India and Thailand, as well as in the WHO African and Eastern Mediterranean Regions.

Vaccines remain primary shield against severe illness

Vaccinations remain the key protection against the new strain.
Vaccinations remain effective and a key protection against the new strain, experts emphasize, based on preliminary findings.

With cases expected to continue rising, likely peaking in late December or early January, protecting the most vulnerable is paramount. Public health authorities are emphasising urgently that vaccination is the most important protective measure for vulnerable groups, including adults aged 65 and over, pregnant women, people with chronic conditions and healthcare workers.

Although recent reports suggest that subclade K shows “reduced reactivity” to current vaccines, it remains effective in preventing severe health outcomes, the ECDC concluded. “The current influenza vaccine is not perfectly matched to circulating strains, including H3N2. However, the primary aim of vaccination is to prevent severe disease, and effectiveness against severe outcomes is expected to be preserved,” explained ECDC expert Ciancio.

According to the preliminary data published by the ECDC for this flu season, vaccine effectiveness in preventing influenza cases that require medical attention at the primary care level ranges from 52% in children (ages 0–17) and 57% in adults (ages 18–64). For the critical group of individuals aged 65 and older, it was not possible to estimate vaccine effectiveness separately, due to the low number of influenza cases so far considered in the study. ECDC experts emphasized, moreover, that the findings rely on small sample sizes from nine participating countries and have low statistical precision (e.g. wide confidence intervals). Efficacy could fluctuate as the season progresses.

According to a ECDC analysis released only this week, vaccines significantly cut hospital admission rates in the last 2024-25 flu season. The modeling study found that seasonal vaccines were 70-75% effective at preventing hospital admissions among children aged 2-17 years and 30-40% effective in adults. Using computer simulations, the analysis estimated that vaccination programmes prevented 26-41% of flu-related hospitalisations among adults aged 65 and over across European Union (EU) countries between August 2024 and June 2025.

Low vaccination rates remain public health concern

To protect the vulnerable and to reduce transmission, a multilayered approach following the WHO playbook is essential.

Within the EU, only Denmark, Portugal, and Ireland met the 75 percent target for older adults during the reporting period. The ECDC projects that a 75% vaccination rate can prevent up to three-quarters of flu-related hospitalisations, significantly reducing the strain on public health systems.

Influenza vaccination rates for high-risk groups in other EU countries remained below WHO targets in the past seasons, as ECDC data from the most recent available season (2021-2022) shows. The overall median influenza vaccine coverage for adults aged 65 years and older was only 43 percent.

The scale of the challenge is huge. Recent interim data from Germany’s Robert Koch Institute (RKI) for the 2024-25 season found that flu vaccination coverage among German adults aged 60+ declined from 39.7-34.5% since 2020-21, the first year of the COVID pandemic, reaching its lowest level in over 17 years. And at the same time, a severe flu season can strain hospital staff and capacity in already overburdened health systems.

Combating the flu requires a multi-layered approach, experts underline. Slowing transmission requires proactive public health and social measures alongside vaccination, says WHO. These steps, proven effective during the COVID-19 pandemic, include staying home if unwell, wearing a mask in public if symptomatic, maintaining regular hand hygiene, and improving indoor ventilation.

European health systems have “decades of experience managing influenza,” said Kluge, striking a note of optimism alongside the WHO warning. “We have safe vaccines that are updated annually, and we have a clear playbook of protective measures that work.”

Image Credits: European Union, WHO/Europe , World Health Organization, European Union.