Lancet editor Richard Horton (left) moderates a panel with Helen Clark, Precious Matsoso and Raj Panjabi at the Geneva Graduate Institute.

There are tensions between World Health Organization (WHO) member states about how to approach the final negotiations on the pandemic agreement – an annex on Pathogen Access and Benefit Sharing system (PABS), according to Precious Matsoso, who co-chaired the negotiations.

“There’s an argument about whether you invite experts to start working on a technical document and then invite member states to discuss the details and negotiate amongst themselves, or get member states to submit their inputs and discuss and only then would you invite experts,” Matsoso told on event at the Global Health Centre at the Geneva Graduate Institute on Tuesday.

The Intergovernmental Negotiating Body (INB), co-chaired by Matsoso of South Africa and French Global Health Ambassador Anne-Claire Amprou, hands the PABS talks to an  Intergovernmental Working Group (IGWG). 

The working group is supposed to conclude talks on annex by next year’s WHA and, once adopted, the pandemic agreement will then be open for signature and ratification. Once 60 countries have ratified it, the agreement will enter into force.

The IGWG will also begin to set up a Coordinating Financial Mechanism for pandemic prevention, preparedness and response, and the Global Supply Chain and Logistics Network (GSCL).

Helen Clark, co-chair of The Independent Panel for Pandemic Preparedness and Response, said the IGWG was expected to start work in September.

She flagged the 2026 United Nations High-Level Meeting on pandemic prevention, preparedness and response as an opportunity to “push for rapid ratification” – or agreement on the annex if it has not yet been passed.

“The message we could send out to countries is: start looking at your national procedures and doing your national tests, and be ready to run on ratification when the annex is actually agreed,” Clark told the Graduate School audience.

Clark added that while South Africa, as chair of the G20, was supportive of pandemic prevention, preparedness and response, the US was due to assume the chair in 2026.

“Will they take the chair next year, or will it pass to someone else? If they take the chair, what hope is there for any of this? That’s an open question. I’m not a diplomat, so I can put this question on the on the table. If they take the chair, it could be treading water for a year, for with G20,” said Clark, who is a former Prime Minister of New Zealand.

Role of EU in talks

Speaking shortly after the World Health Assembly (WHA) plenary adopted the pandemic agreement, Matsoso said that the “Slovakia drama” raised questions about how regional blocs operated during negotiations.

Slovakia, whose Prime Minister Robert Fico is opposed to mRNA vaccines, demanded a vote on the pandemic agreement resolution during a committee discussion on Monday night. The resolution was passed by 124 votes in favour, zero objections, and 11 abstentions.

But Matsoso said Slovakia was part of the European Union (EU), which had negotiated as a bloc, so it should have been party to the regional position.

Matsoso added that some of the countries that had abstained had explained they “were still going through their own internal processes, and had not been given a mandate to vote” as they had expected the agreement would be adopted by consensus.

Dr Raj Panjabi, former White House official under Joe Biden, said there were three things to watch to ensure the pandemic agreement was implemented: independent monitoring and clear accountability; adequate financing, and “increasing regional self reliance”.

“Ensuring that financing is stepped up [is] very hard in this moment when overseas development assistance is being pulled back, not just by my country, the United States, but by several others,” said Panjabi.

“The WHO is more strained than ever, and that’s why ensuring that assessed contributions are increased is going to be critical, as is harmonising and leveraging other funds in the system,” said Panjabi.

Regional self-reliance

Panjabi defined regional self reliance as “an entire end-to-end focus, from research and development, investment and innovation to enhancing manufacturing and ensuring that the delivery of counter-measures in the next pandemic occurs,” said Panjabi.

Swedish global health expert Anders Nordström (left) moderates a panel with Diah Saminarsih, Eloise Todd, Michel Kazatchkine and Mariangelo Simao.
Swedish global health expert Anders Nordström (left) moderates a panel with Diah Saminarsih, Eloise Todd, Michel Kazatchkine and Mariangelo Simao.

However, Brazil’s deputy minister of health, Mariângela Simão, warned that, while there is a G20 coalition on local and regional production, “there’s so much that you can do at country level”. 

“Research and Development is one of the things that I’m more worried about – the capacity to copy what’s already developed and make safe and quality-assured products. We don’t need reinventing the wheel everywhere. We need to recognise what are global public goods and then make sure they are available at country level… you can’t have everyone producing everything.”

UNAIDS special adviser Michel Kazatchkine said that he could not see a world “that is just a juxtaposition of regions without any glue, without any coordination, without any compass”. This,  he added, is the role of the WHO, providing “vaccine blueprints, pre-qualification, its normative role”. 

In the future, global health “will not look like a top-down construction that it has been with money flowing from Geneva to various places”, Kazatchkine stressed. “The international money will be there to complement the national and the regional efforts, because global health is also about global solidarity.”

But Eloise Todd, who leads the Pandemic Action Network (PAN), noted that one of the biggest learnings from the COVID pandemic is “definitely no country, and certainly no region that can do it all themselves”. 

“We’re in a very uncomfortable place in which we know that there are modernisations and ways in which we need to reform to support the regionalisation agenda and the country agenda, but we certainly shouldn’t be doing it at the pace and with the disregard being done at present.

“We’re in this tension between the excellent work that some global entities do to fill a gap. And so what do you do about that? You can’t cut it away and risk lives, but we have to have, like, a 10 ,15, 20-year conversation about powering that down and getting towards proper national and regional level intersectionality.”

Delegates gathered on Tuesday at the World Health Assembly agreed a new WHO budget for the 2026–2027 period which included a rise in membership fees. Photo WHO/Pierre Albouy.

Nations at the 78th World Health Assembly approved a new budget and a 20% increase in annual membership fees for the World Health Organisation (WHO), handing the embattled UN health agency a crucial lifeline as it grapples with the financial bomb dropped on Geneva by the United States’ withdrawal from international institutions.

The vote marks the second consecutive 20% hike in membership dues in as many budgets, which the agency’s member states approve on a biennial basis, the last coming in 2024.

The move is part of a long-term plan to boost mandatory contributions from 16% of WHO’s core budget at the start of the decade to 50% by 2030 to reduce its dependence on the whims of major donors like the now-departed US.

These membership fees provide the organization with flexible funding it can allocate according to its own priorities, unlike the voluntary contributions that typically come strictly earmarked by donors for specific programmes that have historically made up the vast majority of the WHO’s budget.

Under the new budget, assessed contributions will make up 40% of the WHO’s base program budget of $4.2 billion for the 2026-27 period. The core budget does not include emergency humanitarian appeals or polio programmes, which bring the total budget target up to $6.2 billion.

The fee increase, initially mandated in a 2022 resolution at the WHO’s executive assembly, faced an uncertain path to approval on Tuesday, with member nations engaging in tense pre-vote debates over the fairness of regional funding cuts in the new budget – which will run for two years starting in 2026 – and demands for greater transparency in expenditure tracking.

Projected financing for the base programmes segment of the budget for 2026–2027, compared to previous bienniums, in US$ million.

A battle of buzzwords played out during the proceedings: supporters of the fee increase championed “flexible, predictable, sustainable and agile” funding, while skeptics countered with demands for “efficiency,” “transparency,” elimination of “redundancy” and “cost-effectiveness” – signaling clearly that the WHO’s financial reprieve comes with strings and expectations attached.

WHO officials had acknowledged in the budget document they were “cognizant that such an increase will not be automatically granted” amid overlapping global crises straining national budgets worldwide.

In the end, a collective recognition of the existential financial threat facing the agency carried the budget over the line. The chamber fell silent during the vote, with no objections raised. 

“There is a crisis,” WHO Director-General Dr Tedros Adhanom Ghebreyesus declared following the vote. “But we will use this crisis as an opportunity and make sure our organisation emerges sharper and more empowered.”

Germany’s delegation, the WHO’s most important financial backer since the American departure, hailed the decision as “historic” — but not before voicing their support in song.

“I tell you what I want, what I really, really want,” the German representative sang in an awkward rendition of the Spice Girls hit befitting the oft-lively proceedings of Committee A, “and that is that we all indeed are serious about functioning and effective multilateralism.”

“The increase is the best vaccination against the highest financial risk that WHO faces,” he added, “its dependency on a very few donors, and the discrepancy between the expectations we all put on the organisation and its ability to fulfil them.”

Financial triage

Imre Hollo, director of strategic planning and budget at WHO.

The agency has been in financial triage mode since the US exit announcement in November, implementing drastic budget reductions to secure votes that earned praise from member states for its “budgetary realism.” 

Before the US departure, the 2026-27 budget required to fulfill WHO’s core mission was projected at $5.3 billion over the two year period. Following Tuesday’s vote, the target plummeted to $4.2 billion, a 22% cut that will impact the agency’s operations worldwide. 

The revised budget represents a $700 million decrease from projections presented at WHO’s January executive board meeting, but even this diminished figure approved in Geneva remains aspirational. 

Level of projected financing for the base programmes segment of the Proposed programme budget 2026–2027, US$ million.

While WHO secured an additional $170 million toward its 2026-27 budget Tuesday evening following major commitments of $50 million a year from China and first-time donors Mongolia and Cambodia, among others, the agency still faces a $1.5 billion funding shortfall on top of the $1.1 billion decrease from previous budget projections.

The two new donor nations join 42 additional first-time voluntary contributors to WHO, including seven low-income and 28 lower-middle and upper-middle income countries. 

“With the exception of the headquarters and the European region, the allocated or proposed budget for every regional office is currently higher, even after the reduction, than the projected implementation,” explained Imre Hollo, director of strategic planning and budget at WHO.

Without additional contributions, further life-threatening program cuts loom. All of the WHO’s six regions face significant cuts heading into the 2026-27 period covered by the budget. Regional office budgets are set to fall by 14%, with the African region facing the largest total cut of $153 million year-on-year. The agency’s Geneva headquarters will lose nearly a quarter of its annual funding.

China announced it will contribute $500 million to the WHO over the next five-year period, though it was unclear whether this includes the 20% increase in its fee contributions. This will make China, for the first time, the largest fee payer in the WHO, supplanting the US as it exits.

“We can only implement the budget if we have the financing,” Hollo said, noting the “personal sacrifice” that member states will need to make should the funding target remain unmet.

More freedom, less money

WHO Director-General Dr Tedros Adhanom Ghebreyesus and Raul Thomas, the Assistant Director-General for Business Operations at WHO address the committee following the successful vote.

The WHO’s budget victory comes amid a zero-sum competition for international aid dollars, with UN agencies and humanitarian organisations worldwide scrambling to fill gaps left by America’s retreat from global commitments.

Since January, the White House has systematically dismantled the US Agency for International Development (USAID) – historically the world’s largest humanitarian donor – while slashing support for the United Nations and WHO’s sister agencies. By March, over 80% of USAID programs had been shuttered, punching a $60 billion hole in global aid budgets.

This broader retreat from international commitments has left organisations like the UN Refugee Agency and Office for Humanitarian Affairs and non-governental humanitarian organisations scrambling for resources just as the WHO does the same, creating unprecedented competition for a dwindling pool of donor funds that no single government appears willing or able to replenish.

In the latest sign of distress, top UN officials told staff at a town hall in New York City Tuesday that the organization is considering a 20% reduction across every secretariat under the UN umbrella for 2026 — from humanitarian affairs, to human rights, peacekeeping operations, and development programs — heightening the financial crisis in the world of international institutions and those who depend on them.

Several major financial contributors to WHO, including Germany, France, and the EU delegation, pressed the agency to develop contingency plans for potential fundraising shortfalls as the UN system creaks under the weight of the US withdrawal. 

“Should the resources, the $1.65 billion, not materialise, the idea is that we will be in a position to actually scale back or ramp up,” said Raul Thomas, WHO’s Assistant Director-General for business operations who led the budget consultations with member states. “We never know – I’m the eternal optimist. Maybe we’ll get much more money than the 1.65 million. That’s the gap right now.”

Image Credits: WHO/Pierre Albouy.

WHO officials including the co-chairs of the Intergovernmental Negotiating Body (INB) Ambassador Anne-Claire Amprou and Precious Matsoso (right) celebrate the World Health Assembly’s adoption of the pandemic agreement.

Presidents, prime ministers and even opera singers, celebrated the unanimous adoption of the world’s first Pandemic Agreement by consensus at the World Health Assembly (WHA) plenary on Tuesday morning.

Despite the 11th-hour insistence of Slovakia on a vote on the agreement in Committee A on Monday night, none of the World Health Organization (WHO) member states obstructed the agreement’s adoption at the plenary.

Instead, it was presented as a rare example of successful multilateral engagement in a world of heightened conflict.

Head of the African Union and Angolan President João Lourenço commended the WHO’s resilience in the face of “unfair and unjust criticism”, and pledged an additional $8 million from his country to the WHO.

Head of the African Union and Angolan President João Lourenço

Speaking on behalf of the 55 AU member states, Lourenço said the continent is “united in supporting the proposal to increase assessed contributions” [membership fees] as “the WHO is the only institution with a universal mandate to protect global health and promote equity”.

China’s Vice-Premier Liu Guozhong pledged an “additional quota of $500 million over five years” to the WHO, at the plenary, and urged all countries to “support the WHO to play a central coordinating role in global health governance” and enable it “to perform its duty in an independent, professional and science-based manner”.

Croatian Prime Minister Andrej Plenković, also in the room, described the WHO as “a beacon of hope and a guardian of humanity’s right to health”. 

Plenković described sustainable financing of the WHO as “a strategic imperative” to enable “timely responses to emergencies and meaningful support where it is needed most”. 

Egyptian opera singer Farrah El-Dibany and soprano singers Elaine Vidal and Eunice Miller of the Philippines also performed for the assembly.

Macron appeals to US scientists

Emmanuel Macron addresses the WHA plenary in a recorded message.

“Our first line of defence is the WHO,” said French President Emmanuel Macron in a recorded message. He then appealed to “all those researchers who want to freely continue to do their work” – a veiled reference to US scientists dismissed during US President Donald Trump’s massive budget cuts – to move to Europe.

“We will be happy to welcome you in Europe, because that will be good for Europe, for medical research, for you and for everyone. It’s not a question of ‘if’ we will have a new pandemic. It’s a question of ‘when’ we’ll have it,” said Macron.

South African and G20 President Cyril Ramaphosa, and the leaders of the Philippines, Peru, Mongolia and Senegal also sent recorded messages of support.

The UN Secretary-General Antonio Guterres called for a coherent global health architecture and described the pandemic agreement as “historic”.

As one leader after another defended the WHO and multilateralism, Trump’s withdrawal from the WHO loomed as the elephant in the room – and the target of unspoken rebuke. So it was timely – but also surprising – that US Health and Human Services Secretary Robert F Kennedy Jr also sent a recorded message to the plenary.

Unlike the other messages, however, Kennedy claimed that the WHO “has become mired in bureaucratic bloat, entrenched paradigms, conflicts of interest and international power politics”.

“The WHO has not even come to terms with its failures during COVID, let alone made significant reforms. Instead, it has doubled down with the pandemic agreement, which will lock in all of the dysfunctions of the WHO pandemic response,” he added, without articulating any specific US objections to the agreement.  

‘Eyes on the prize’

Namibian Health Minister and chair of Committee A, Dr Esperance Luvindao, Dr Tedros and Dr Mike Ryan applauding the vote on the pandemic agreement in Committee A on Monday night.

Addressing the plenary after the leaders’ messages, WHO Director General Dr Tedros Adhanom Ghebreysus paid tribute to those who negotiated the pandemic agreement.

“You have engaged in very tough negotiations. Sometimes the disagreements were sharp, the discussions heated and the frustration evident. Sometimes it seemed the distance between you might be too great to overcome. But you kept your eyes on the prize, and did not stop until you had achieved it,” said Tedros, adding that sometimes delegates had talked all night in the windowless basement room of the WHO headquarters where the Intergovernmental Negotiating Body (INB) met.

“The pandemic agreement has been negotiated by countries for countries, and will be implemented in countries in accordance with their own national laws,” stressed Tedros, referring to the “torrent of mis- and disinformation” that claimed the agreement will “infringe on national sovereignty” and  give the WHO Secretariat “power to impose mask or vaccine mandates or lockdowns.

“Today, you have sent a loud message that multilateralism not only works, but is the only way to find shared solutions to shared threats. Let’s not understate what you have achieved. You have made the world a safer place,” stressed Tedros.

Pathogens ‘won’t wait’

The agreement was welcomed by the co-chairs of The Independent Panel for Pandemic Preparedness and Response, Ellen Johnson Sirleaf, former President of Liberia, and Helen Clark, former Prime Minister of New Zealand.

“Consider this agreement a foundation from which to build, starting today,” said Clark. “Many gaps remain in finance, equitable access to medical countermeasures and in understanding evolving risks. Don’t wait to get started. Dangerous pathogens are looming, and they certainly will not wait.

The Third World Network said that the “next phases of negotiations, beginning with the Pathogen Access and Benefit-Sharing System (PABS), will determine whether this agreement becomes a meaningful tool for equity or if it remains merely symbolic”.
“At stake is the ability of developing countries to access affordable vaccines, treatments, and diagnostics swiftly and fairly during health emergencies and to realize the ambition of a fairer and more effective global health architecture that can equitably prevent, prepare for and respond to pandemics,” said TWN.

Dr David Reddy, director-general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), said that, as the next level of detail of the agreement is worked through, it is essential that the experience of  pharmaceutical companies is drawn upon “so that their expertise can be mobilized when needed”.

This includes how the PABS will work “where we must make sure that companies are able to access the pathogens and sequence information as quickly as possible to undertake scientific research and avoid unnecessary conditions that make it harder for companies to do so”, Reddy stressed.

He added that “intellectual property protections that are essential for pharmaceutical companies to invest in high-risk R&D, must not be eroded and instead should enable partnerships on voluntary and mutually agreed terms, in a way that draws on the expertise and networks of each company.”

‘US is not indispensible’

Public Citizen Access to Medicines Director Peter Maybarduk said that “WHO member states chose health and justice today, despite RFK’s cheap insult, the reckless US withdrawal and Trump’s deadly neglect of infectious disease threats.

“The world moved forward without the US today. Trump’s devastating cuts cast a shadow on the talks, and are on course to cost millions of lives, including the lives of Americans made more vulnerable to infectious disease,” said Maybarduk. “Still, countries came together amidst scarcity to commit themselves to a more just and healthy world, and that is worth celebrating.”

Matthew Kavanagh, director of Georgetown University’s Center for Global Health Policy and Politics, said that the US “did not show up for the final negotiations but it turns out the US is not indispensable and, in fact, perhaps not having the US engaged is what enabled more cooperation.”
“With the current administration seemingly intent on dismantling global public health efforts, it may be the best case scenario if the rest of the world can come together. In that way, this new agreement is a spot of light in and otherwise dark geopolitical environment for fighting pandemics,” Kavanagh told Health Policy Watch.

Image Credits: WHO.

Digital blood pressure monitoring devices have now become widely available

The pace of technological change today is nothing short of revolutionary, according to Dr Douglas Bettcher, Senior Advisor in the Director-General’s Office at the World Health Organization (WHO).

“I think we find ourselves very strangely in the last couple of years, in what seems to be a really brave new world, brave new reality,” he told attendees at Monday’s Global Self-Care Federation (GSCF) event, which focused on how digital innovations could help prevent and manage noncommunicable diseases (NCDs).

“A case can be made that this communications revolution is even greater and more mind-boggling than what we’ve seen in the past,” Bettcher continued. “Even some pundits in the know compare this to the 19th-century industrial revolution. And what must be clear to us, being confronted with these very, very rapid changes, is that we in the public health community cannot be left standing during this digital innovation, this mass revolution.”

Bettcher, who discussed WHO’s Be He@lthy, Be Mobile (BHBM) program, stressed that the train has already left the station. Industries that harm health are already leveraging artificial intelligence and related technologies. Now, he said, it’s time for those working to improve health to use them too.

The Monday event—hosted as a side event of the 78th World Health Assembly—was a collaboration between GSCF, WHO, and the International Telecommunication Union (ITU). Titled “Empowering Self-Care: Digital Innovations for NCD Prevention and Management,” it highlighted the vital role of self-care and digital technology in tackling NCDs, emphasizing cross-sector collaboration.

Keynote addresses were given by H.E. Honourable Tuafafa Latasi, a member of the Tuvalu parliament, and Dr Dympna Kavanagh, the Chief Dental Officer of Ireland’s Department of Health.

“Digital innovation has the power to transform healthcare and how we look after ourselves,” said moderator Shiulie Ghosh. “That is the role of digital innovation in preventing and managing some of the biggest causes of death across the globe.”

She emphasized that digital tools can improve access to self-care and empower individuals living with NCDs to monitor and manage their conditions effectively.

GSCF Director-General Greg Perry added, “We are at a pivotal moment in NCDs,” referring to WHO’s release last week of the zero draft of the political declaration on NCDs and mental health. The draft was published in preparation for the upcoming High-Level Meeting on September 25.

Greg Perry (center)
Greg Perry (center)

The declaration outlines proposed global targets for 2030:

  • 150 million fewer people using tobacco
  • 150 million more people managing their hypertension
  • 150 million more people gaining access to mental health care

The 10-page draft includes a set of five sub-targets, offering a roadmap for reaching these ambitious goals.

“Digital tools can play a very, very important part,” Perry told the audience. “When we talk about self-care, we’re not just about keeping fit, eating correctly, or even brushing our teeth. We’re talking about the necessary tools for people to self-care.”

These tools may include medicines and digital applications from the industry’s perspective.

“If you add AI and digital applications together with the current and future self-care tools that are available and will be available, we are on the verge of almost a self-care revolution,” Perry said. “These [tools] will be accessible, they’ll be self-managed, and they will have a very high impact.”

Making digital self-care tools useful and trusted

One key challenge with emerging digital self-care tools is the lack of guidance on how to incorporate them into people’s daily lives.

Luis Lourenço of the International Pharmaceutical Federation noted that pharmacists are often the first point of contact when individuals seek advice or support related to digital tools.

“When you talk about the impact of digital tools on primary health care, you can focus on four major areas: prevention, health literacy, diagnosis, and the management of a chronic disease,” Lourenço said.

He added that health literacy is often one of the most complicated aspects.

While having access to information is essential, Lourenço emphasized that it’s not enough. People also need to understand the information and apply it in their routines.

“What’s the point of having information about your blood pressure if you don’t understand what it means or when to incorporate it?” he asked. “What we have today is a lot of access to information, but people rely a lot, mostly on their healthcare partners, healthcare professionals, and pharmacists.”

Without that support, he said, people may have information but not know how to use it effectively.

Lourenço also pointed out that people want to be sure the tools they use are evidence-based and trustworthy.

However, Debbie Rogers, CEO of Reach Digital Health, offered a slightly different perspective, suggesting that if digital tools provide enough value, people will ultimately trust them.

Addressing accessibility, accountability, and inclusion

Another key challenge is user hesitation, particularly among specific populations, about whether they want to use digital tools at all.

“On one hand, we have developed countries. We have higher literacy levels. We have digital-savvy sort of people,” explained Hussain Jafri of the World Patient Alliance. “They are using [digital tools] and giving us very good results. But then you look at the other populations—at the lower- and middle-income countries and the elderly population, the people who are not tech-savvy. They are not really using them.”

Jafri shared that he once downloaded an app designed for people with pre-diabetes but found it too complicated and deleted it after only a few days.

Experts said encouraging adoption also depends on better integration of these tools into healthcare systems, where people feel accountable for the data they enter.

Lourenço noted that if patients knew their doctors were reviewing the data collected in an app, it would likely motivate them to use the tool more consistently.

Jafri stressed that companies developing digital health technologies must involve users, patients, and providers early in the design process, rather than waiting until products are already on the market.

“I think they also need to take into account our input—the input of the people who are going to use [the tools] should also be there while they’re developing these products, so that, you know, once it is out there, people are happy using it,” he said.

Language accessibility is another barrier. Jafri emphasized the importance of localization.

“These [tools] need to be in multiple languages, not just English,” he said, adding that companies should also provide training for providers and patients to ensure successful adoption.

Empowering mothers through technology: South African case study

A pregnant woman in Africa (illustrative)

There are already promising examples of how digital health tools are making a difference, as illustrated by Rogers of Reach Digital Health. She shared a case from South Africa, where hypertension during pregnancy is one of the leading causes of maternal mortality.

“We have a program called MomConnect, where every mother who comes into the clinic can sign up to receive messaging throughout her pregnancy and until her baby is two years old,” Rogers explained. The mothers receive both information and behavior-change tips. They can also ask questions and provide feedback to the system.

Because hypertension is such a critical issue, the National Department of Health wanted to better understand the root causes. They started by asking mothers about their experience during their first antenatal visit: Did they have their blood pressure taken? Were they told what the results were? If so, were they prescribed the appropriate medication?

“It was important to understand that patient journey, understand where the challenges were, and to do this at a national scale,” Rogers said.

Based on the insights gathered, the department introduced targeted training for healthcare workers. This effort helped drive increased demand for quality care from the patients themselves.

“We got mothers to go back to their clinic and say, ‘You didn’t take my blood pressure last time. I want you to take my blood pressure,’ or ‘you didn’t put me on the right medication.'”

Rogers concluded that this initiative “shows the power of being able to empower people, both with information and behavior change, communication knowledge, so they knew what they had to ask for and what they were looking out for.”

Carl Massonneau, Technical Officer for Sexual and Reproductive Health and Research for the WHO, speaking from the audience, explained that another tool recently released by the World Health Organization is the Digital Adaptation Kit for Antenatal Care. The kit translates WHO recommendations into machine-readable formats, making integrating them into digital health systems easier.

Carl Masano of the WHO
Carl Massonneau of the WHO

One specific feature of the kit is a tool for self-monitoring blood pressure among pregnant women diagnosed with hypertensive disorders. That tool will be released next week.

“It’s the first time we’re putting a step in this world and trying to provide standards to improve the quality of digital health interventions we have,” Massonneau said.

He acknowledged that although a growing number of digital technologies are available, there are still major challenges in ensuring they are evidence-based, equitable, and accessible.

Integrating Digital Tools Into Broader NCD Strategies

As the conversation around digital health tools evolves, experts caution that no single solution will address the full complexity of noncommunicable diseases.

Lourenço noted that while some aspects of NCDs fall under primary prevention, where individuals can be empowered to make healthier choices, others require more structured support. He said that strategic outreach, including digital media, can help move people from “pre-contemplation to contemplation,” encouraging them to recognize risks, develop motivation, and ultimately commit to change.

However, he emphasized that many behaviors tied to NCDs cannot be addressed through self-care alone. These require ongoing guidance and system-level support. Effective management, Lourenço said, demands full integration within a broader framework—” at the policy level, at the health system level, [and] at the community level.”

In this context, digital innovation is not a silver bullet but a key part of a larger ecosystem—one that must be built with intentional design, inclusive access, and cross-sector collaboration to truly transform outcomes in global health.

Image Credits: Marco Verch/Flickr , Provided by Global Self-Care Foundation, Elizabeth Poll/MMV, Elaine Fletcher.

 

Countries indicating their wish to speak about the pandemic agreement in Committee A

An enormous list of World Health Organization (WHO) member states, 173 in all, lined up to speak in favour of the pandemic agreement at the World Health Assembly (WHA) on Monday – an extraordinary demonstration of the breadth of support for the document.

By the end yesterday’s meeting of Committee A, member states passed the pandemic agreement resolution by vote not consensus – at the insistence of Slovakia – with 124 in favour, zero objections, and 11 abstentions. The WHA plenary is due to consider the resolution on Tuesday.

But between the cheers were reminders that the talks are not yet done. An annex still needs to be negotiated to establish the mechanisms for a pathogen access and benefit-sharing (PABS) system – the most controversial aspect of the three-year talks.

The PABS system will develop a mechanism for how countries that share information about pathogens with pandemic potential may benefit if pharmaceutical products are developed as a result.

“As a country that has shared its pathogens, often without equitable returns, the PABS system is paramount in rectifying these imbalances and ensuring the realisation of genuine equity and equitable access,” said South African Health Minister Aaron Motsoaledi, speaking for the Africa region in Committee A, where the document was being discussed.

The Africa region sees the target of 20% of pandemic products being reserved for the WHO for distribution to low- and middle-income countries (LMICs) by manufacturers participating in PABS, with at least 10% as a donation, during future pandemics, as a “positive first step”, added Motsoaledi.

Speaker after speaker urged countries to maintain their political commitment to the PABS negotiations and reach an agreement on the annex before next year’s WHA.

Even Hungary, a staunch ally of United States President Donald Trump, welcomed the agreement – and stressed that it did not infringe on countries’ sovereignty, a key claim of disinformation about the pandemic.

Trump distanced the US from the pandemic agreement at the outset of his presidency in January, and many of his MAGA supporters claim it is a “power grab” by the WHO.

Iran and Paraguay said they could not support the current pandemic agreement draft – reserving support until after the PABS negotiations. Meanwhile, Slovakia, which is led by Prime Minister Robert Fico who has spoken out against COVID-19 vaccines, demanded that the agreement be put to a vote during the committee session.

Delegates at WHA’s Committee A after it adopted the pandemic agreeemnt by vote

First ‘One Health’ agreement

Germany said it “would have welcomed stronger provisions, particularly regarding prevention,” but “recognise this agreement as a critical and timely step toward global solidarity and multilateralism”. 

“We urge all member states to engage in the upcoming annex negotiations with the same political will and unity that have brought us this far. Let us continue to invest in international cooperation and global solidarity, not only to protect our citizens, but also to lay the groundwork that future generations can benefit from,” said Germany.

Switzerland, which has sought to protect its pharmaceutical sector during talks, said it supports “a pragmatic, voluntary approach within existing frameworks, that take into account the advice and contributions from experts”. 

The European Union said that the agreement “marks an important accomplishment for global health security and cooperation” and “can bolster country capacities to prevent and prepare for pandemics using the One Health approach”.

Ireland added that “the commitment to [pandemic] prevention through a One Health approach is the first of its kind to recognise the interconnectedness of human, animal and environmental health in our response to emerging health trends”. 

“The establishment of a global supply chain and logistics network and a pathogen access and benefit sharing system will ensure that the response to future health threats will be faster, more effective and more equitable,” it added. 

China said the agreement “will contribute to the fair distribution of health products, relevant technologies and resources to help developing countries enhance their capacities for prevention, preparedness and response” – but that it needed “some follow-up mechanisms, as well as sustained investment and capacity building efforts from all countries” to be effective. 

Kazakhstan said that “this is not just a global legal document. It is our collective response to a future where everybody will be protected, regardless of their economic position or status. We must underscore that the success outcome will be defined not only by its content, but also by its ability the state’s ability to implement it.”

Jamaica, speaking for 22 countries in the Americas and Caribbean (excluding the USA), said the region was ready to do the work to finish the pandemic agreement.

“We remember too vividly the oxygen shortages, the overwhelmed hospitals and healthcare workers, and over seven million lives lost during the COVID-19 pandemic,” said Jamaica. “For the Americas,  this agreement means stronger commitments to regional manufacturing capacity, coordinated surveillance, research and development and transfer of technology, especially for developing countries.”

‘The worst of times’

INB co-chairs Anne-Claire Amprou and Precious Matsoso

Co-chairs of the Intergovernmental Negotiating Body (INB), South Africa’s Precious Matsoso and French Ambassador for Global Health Anne-Claire Amprou, also addressed the session, expressing appreciation to member states for their commitment.

Matsoso reminded the WHA that the special assembly called to establish the INB was convened “at a time when we all wore masks, we practised social distancing, and we had face-to-face meetings that were highly restricted”. 

“It was the worst of times, the season of despair, of tragic losses, immeasurable devastation – all associated with COVID-19,” said Matsoso.

She praised delegates for working through “13 formal rounds of negotiations, many of them extended, producing various iterations of draft pandemic agreement and proposals that have culminated into what we have before us as a consensus draft”.

Amprou, who took over as co-chair from Roland Driece of the Netherlands in July 2024, said that the process involved “three years of dialogue, of compromise, of debates, of sleepless nights, but above all, three years guided by a common conviction that health is a common good”.

“The COVID-19 pandemic was a shock for us all. It was a brutal reminder of the fact that viruses know no borders. No country, however powerful, can address a global health crisis on its own,” said Amprou.

Meanwhile, former co-chair Driece spoke for the Netherlands, expressed his appreciation that the long process had resulted in an agreement.

 

Image Credits: WHO.

Dr Tedros addresses the 78th WHA

The World Health Organization (WHO) faces “significant challenges” amid “significant achievements”, characterised by a 21% budget cut alongside the imminent adoption of a pandemic agreement, Director-General Dr Tedros Adhanom Ghebreyesus told the opening of the World Health Assembly on Monday.

Tedros appealed to member states to support its “extremely modest” budget, reduced from $5.3 billion to $4.2 billion for the 2026-2027 biennium as a result of the United States’ withdrawal from the global body.

But this modest amount isn’t even in the bank yet.  It relies on member states agreeing to increase membership fees and receiving more donations via the WHO’s next Investment Round to be held in Geneva on Tuesday.

“Assuming you approve the increased assessed contributions [membership fees], and thanks to the investment round, we’re confident that we have already secured more than $2.6 billion of the funding for the next biennium. That leaves an anticipated budget gap of more than $1.7 billion,” said Tedros.

He added that raising that amount in the current landscape would be a challenge but described the figure – $2.1 billion a year – as “extremely modest” for an organisation “working on the ground in 150 countries with the vast mission and mandate that member states have given us”.

“$2.1 billion is the equivalent of global military expenditure every eight hours,” said Tedros, and “a quarter of what the tobacco industry spends on advertising and promotion every single year”. 

The 78th WHA opened in Geneva on Monday.

Reducing costs has led to a reformulation of the organisation and with significant staff layoffs ahead.

The WHA gave a round of applause to outgoing executive team members Dr Mike Ryan, Dr Samira Asma, Dr Bruce Aylward, Dr Catharina Boehme, Dr Li Ailan and Dr Jerome Salomon, who will be leaving the WHO as part of this process.

“A reduced workforce means a reduced scope of work. The organisation simply cannot do everything member states have asked it to do with the resources available,” he added.

Steep bilateral aid cuts

However, the dismantling of the US Agency for International Development (USAID) and deep cuts to the US President’s Emergency Plan for AIDS Relief (PEPFAR) have strained the finances of many member states, some of which may not be in a position to increase their contributions to WHO.

“Many Ministers have told me that sudden and steep cuts to bilateral aid are causing severe disruption in their countries and imperilling the health of millions of people,” Teros acknowledged.

“In at least 70 countries, patients are missing out on treatments. Health facilities have closed, health workers have lost their jobs, and people face increased out-of-pocket health spending.

“Although this is a challenge, many countries also see this as an opportunity to leave behind an era of aid dependency and accelerate the transition to sustainable self-reliance based on domestic resources.”

But at the same time, several countries were doubling and tripling their defence spending, spending “vast sums protecting themselves against attacks from other countries, but relatively little on protecting themselves from an invisible enemy that can cause far more havoc and damage,” said Tedros, pointing out that COVID-19 killed an estimated 20 million people.

Key achievements

Tedros described the pandemic agreement as a “historic moment” amid “significant opposition”.

In the past year, the WHO coordinated the response to 51 graded emergencies in 89 countries including “outbreaks, natural disasters, conflicts and more”.

It delivered urgently needed specialist medical supplies worth $196 million to 80 countries, supporting countries to address cholera, Marburg and Ebola.

WHO is poised to resume aid to Gaza as soon as Israel lifts its blockade, said Tedros, who  appealed to member states to assist the more than 10,000 patients who need medical evacuation out of Gaza. 

“War is not the solution. Peace and political solutions are the solution,” he stressed.

Tedros stressed that the WHO’s “increased focus on science, data and digital health” is “the future of the organisation”.

“WHO’s normative standard-setting work is its bread and butter, and we have streamlined processes to give member states the highest quality, evidence-based advice as fast as possible,” said Tedros. “Last year, there were 65 million downloads of WHO publications, guidance and other materials.”

Swiss support

Welcoming delegates to Geneva, Swiss Federal Council member Élisabeth Baume-Schneider stressed that her country was committed to supporting the WHO, and would contribute $80 million to the organisation over the next four years.

“The WHO is the only real global platform for cooperation on health matters which has legitimacy, respect and can do the job,” said Schneider.

“It is the only international organisation dealing with health which is run by its member states, and that means shared responsibility… We, as her member states, need to demonstrate that we are ready to reconsider our relationship with the organisation and ensure that we offer our full support.”

WHA president, Dr Teodoro Herbosa of Philippines, urged the assembly to be focused on “unity not unilateralism, solidarity not isolation”.

Newly-elected African Regional Director, Dr Mohamed Yakub Janabi.

Dr Mohamed Yakub Janabi, of Tanzania, was elected as the new African Region nominee for Regional Director, in a special meeting of the WHO African Regional Committee on Sunday – replacing fellow Tanzanian, RD-elect Dr Faustine Ndugulile, who died suddenly in November, 2024.

The WHO Executive Board will be asked to approve Janabi’s nomination at their meeting immediately after the World Health Assembly, clearing the way for his formal appointment by WHO Director General Dr Tedros Adhanom Ghebreyesus.

Janabi beat out three other candidates in secret voting by the committee, which followed a series of presentations and interviews of the four candidates at Sunday’s meeting. They included candidates proposed by ​​​​Côte d’Ivoire, Togo, and Guinea.

A senior health advisor to Tanzania’s late president and its present head of state, Samia Hassan, Janabi is a cardiologist by training and the former executive director of Tanzania’s largest hospital.

Born in 1962, his career spans over three decades of work in clinical and policy settings, from the early days of the HIV epidemic to his role today as presidential advisor, he noted, in his presentation before the African Regional Committee.

Hardships caused by out-of-pocket expenses

Janabi said his first priority as Regional Director would be achieving Universal Health Coverage for the African Region, reducing catastrophic health expenses that cause financial hardship.

“During the course of my duties, I have witnessed, first hand, patients being denied access to health care due to financial constraints, families parting ways with their position, their very means of living just to pay hospital bills,” he told the Regional Committee.

“Yet, despite making these heartbreaking sacrifices, many still find themselves trapped in debt and still in poor health conditions. For me, this is a harrowing experience out of pocket, costs have pushed countless families into the depths of poverty, thereby recycling poverty.”

He also noted his  involvement in HIV vaccine trials in Tanzania and Mozambique in the early 2000s, and later, public health advocacy that convinced Tanzania’s then-president to get a public HIV test, “encouraging 5 million Tanzanians to get tested that year.”

In 2021, he supported Tanzania’s new president, Samia Hassan, in devising a new, COVID-19 vaccination strategy, “which played a key role in countering misinformation and boosting vaccine uptake,” he noted. Hassan took over following the death in March 2021 of then-President John Magufuli, a COVID vaccine skeptic, who ultimately succumbed to the virus himself, according to some reports.

Janabi also is the founder of the Jakaya Kikwete Heart Institute in 2014, which he claimed achieved a “95% reduction in overseas heart disease referrals” within five years of its founding.

Building health systems on primary health care

Other priorities he cited would include supporting larger fixed contributions to WHO from member states “for more predictable, flexible and sustainable investment” along with stepped up domestic financing for health systems – through blended financing, private-public partnerships and solidarity levies.”

Building emergency preparedness, including through cross border collaborations, as well as advancing maternal and child health, along with nutrition, are other high priority items he said, noting that 70% of maternal deaths and 56% of deaths of children under the age of 5 still occur on the continent.

Janabi also pledged to tackle infectious diseases as well as non-communicable diseases through a “One Health” approach that  “acknowledges the interconnectedness of humans, animals and the environment” – as well as tackling antimicrobial resistance, through better surveillance systems, as well as strengthening local production of diagnostic, therapeutics and vaccines “by leveraging the pandemic agreement” – the new accord expected to be approved at this year’s WHA.

He added that primary health care and Community Health Worker networks need more investment as the backbone of health systems – noting that in high-income countries nurse practitioners carry out many functions that doctors used to perform.

“You have to build on your community health workers, because these are the people who have the trust. They are the people who are communicating with your general population every day,” he said, adding, “There’s other thing, which unfortunately is not very prominent in Africa. They are called nurse practitioners… So if they get training on basic things like immunization, maternal and child health, education, these efforts will improve access.”

Janabi, once confirmed by WHO’s Executive Board and formally appointed by the DG, will step into the shoes of the late RD-elect, Nduguilile, who died on November 27, 2024, at the age of 55, while receiving medical treatment in India.

Ndugulile, a former Tanzanian Deputy Health Minister and member of parliament had been elected as the WHO Africa Regional Director in August of 2024 and was scheduled to begin his term in February 2025. His death led to a special session of the WHO Regional Committee for Africa in January 2025 to decide on a new election process. Dr Matshidiso Moeti had been the WHO Africa Director for two terms before Ndugulile’s election.

A child with HIV takes a paediatric dose of antiretroviral medication. Many paediatric HIV trials were conducted in South Africa over the past 20 years.

Essential research on tuberculosis and HIV cancelled. Clinical trial participants in limbo. Young researchers’ careers halted  – and billions of dollars invested and expertise developed over 30 years potentially down the drain.

These are some of the impacts on South Africa of the decision by the National Institutes of Health (NIH) barely a week ago to prohibit United States scientists from working with foreign researchers via “subawards”, leading to the immediate and mass cancellation of such grants with South African institutions.

At least 39 TB and HIV clinical research sites in South Africa are under threat due to NIH funding cuts, jeopardising at least 27 HIV trials and 20 TB trials, according to an analysis by the Treatment Action Group (TAG) and Médecins Sans Frontières (MSF) drawn mostly from the NIH’s Division of AIDS (DAIDS) presented at a media briefing on Thursday.

Impact of NIH cuts on TB and HIV research in South Africa

TB trials at risk include testing potential vaccines and new drugs; shorter, safer regimens, and the best treatment for TB meningitis. 

The HIV trials at risk include cure-related treatments involving broadly neutralising antibodies (bNAbs); vaccines designed to prime the body to make bNAbs; the impact of hormone treatment on women with HIV and treatment options for pre-exposure prophylaxis to prevent HIV.

Many of these trials are global, with South Africans making up 30-50% of global trial participants and 50-90% of trials on interventions for children and pregnant women, said Lindsay McKenna, TAG’s TB project co-director.

She estimates that the average investment in each trial participant is $12,000 – potentially all wasted if the trials are discontinued, and some have been going for several years already.

For some 30 years, South African clinical studies have provided global guidance on issues including prevention of mother-to-child HIV infection, when to start children on antiretroviral treatment, how to simultaneously treat TB and HIV, as well as the safety of HIV and TB treatments. Meanwhile, operational research, such task-shifting from HIV doctors to nurses, has led to more efficiency and cost-cutting.

“NIH funding is not aid. It’s competitive funding that researchers here competed for that went through stringent NIH processes and committees,” stresses Marcus Low, an epidemiologist and editor.

The NIH cuts come on top of the cancellation of grants from the US Agency for International Development (USAID) and US Centers for Disease Control (CDC) – primarily for HIV and TB programmes.

Impact on institutions

“South African academic and research institutes could lose about 30% of their annual income and may be forced to lay off hundreds of staff as a result of US funding cuts,” the analysis notes.

It warns of “the potential collapse of TB and HIV research and development capacity” in the country, with global impact in light of “ the substantial contributions of South African research centres to advancements in TB and HIV prevention, treatment, and care worldwide.”

(From Top L-R) Lindsay McKenna, Ian Sanne, Tom Ellman, (Bottom L-R) Marcus Low, Ntobeko Ntusi and Linda-Gail Bekker
(Top L-R) Lindsay McKenna, Ian Sanne, Tom Ellman, (Bottom L-R) Marcus Low, Ntobeko Ntusi and Linda-Gail Bekker

Professor Ntobeko Ntusi, head of the South African Medical Research Council (SAMRC), told the media briefing that the country had been disproportionately affected both because of its high burden of HIV and TB and the excellence of its scientific community – making it a preferred site for research.

“Universities are now beginning retrenchments at scale,” said Ntusi, adding that affected scientists also provide postgraduate training.

“Hundreds of master’s, doctoral and post-doctoral fellows, whose stipends and research costs are dependent on these grants, find themselves in a position of inordinate precarity,” said Ntusi.

‘Ethical nightmare’

Prof Ian Sanne, co-principal investigator of the Wits HIV Research Group Clinical Trials Unit, describes navigating the US funding cuts as a “major regulatory and ethics nightmare”.

NIH investment in South African HIV and TB research “amounts to almost $2 billion over 20 years”, according to Sanne. His institution alone, Wits University in Johannesburg, stands to lose $150 million to $180 million in NIH funding.

As co-chair of Wits University’s ethics committee, Sanne has had to work with units on contingency plans for both staff and trial participants – despite US funds being terminated with immediate effect with nothing left over to wind down processes.

“In one of the studies in KwaZulu-Natal, the sponsor, USAID, stopped funding overnight and the microbicide rings that were under research with the participants were terminated without their knowledge,” said Sanne, leading to “a real ethical problem”.

Microbicide rings impregnated with ARVs are inserted vaginally to prevent HIV and studies often involve women at high risk of HIV infection.

Sanne’s unit lost US funding with immediate effect on 21 March – but it then had to embark on retrenchment procedures in terms of South African law, draining the reserves of the unit.

Expertise and infrastructure lost

Prof Linda-Gail Bekker, director of the Desmond Tutu HIV Centre at the University of Cape Town, says her centre will lose $6.9 million out of $10 million in NIH funds.

Earlier in the year, the centre lost a HIV vaccine grant worth $45 million over five years from USAID that would have seen five trials in eight southern African countries “contributing to the global quest to find an effective HIV vaccine”, she added.

The centre employs 400 people and will have to retrench “one-third to half our workforce”, said Bekker, whose groundbreaking research on a twice-yearly injection to prevent HIV infection earned her a standing ovation at the International AIDS Conference in Munch last year.

Professor Linda-Gail Bekker presenting the results of the PURPOSE 1 trial at the Munich AIDS conference, which found a twice-a-year injectable ARV prevented all women in the trial from contracting HIV.

“We have an incredible critical mass of very experienced and very well-established research organisations in the country, and the infrastructure that has been built over the last 30 years has established an extraordinary clinical trial infrastructure,” said Bekker.

South Africa was able to use this expertise and infrastructure during the COVID-19 pandemic to “pivot to test at great speed, new COVID-related vaccines”.

“Throughout the years, we have contributed to creating new knowledge that is often [Investigational New Drug] related studies… that feeds into important guidance, such as the WHO guidance.”

Impact on other African countries

Dr Tom Ellman, director of MSF’s Southern Africa Medical Unit, said that MSF has applied the “pragmatic” HIV and TB research generated in South Africa in resource-poor settings throughout the continent.

Recently back from the Democratic Republic of Congo (DRC), Ellman said it was able to draw on the “self-managed, fixed-combination antiretroviral treatment regimen” developed in South Africa for people living with HIV in the conflict zone in South Kivu.

MSF’s large HIV programme in Kinshasa relies on dolutegravir – “a basic, simple, effective drug enabled by South African research”, said Ellman, who listed several other drugs that had been trialled in South Africa before hitting the global market.

“The best science leads to impact in the most difficult settings. There’s no question that South African science has transformed access to HIV, TB and other disease responses across Africa and across the world.”

Ellman said the funds cut is “particularly awful”  as “we are closer than ever to finding ways out of the HIV, TB and malaria pandemics”.

Appeal for support

TAG, MSF and the SAMRC have appealed for “alternative funds to sustain TB and HIV research in South Africa”.

Ntusi says numerous donors and governments have offered support and solidarity – but most wish to remain anonymous at present.

The researchers all agreed that the most urgent need is to provide immediate support to clinical research sites to ensure continuity of care and follow-up for study participants. 

“South African trial participants must be supported to complete treatments safely and, in cases of treatment failure, be offered appropriate alternatives, and research sites must be supported to complete data collection and analysis,” said TAG and MSF.

Image Credits: Paul Kamau/ DNDi, IAS.

A billboard in South Africa in support of a tax on sugary drinks as part of a campaign in 2017.

Significant portions of health care budgets across Africa have vanished. Countries across the continent are grappling with the unprecedented scale and speed of recent reductions in development assistance for health.

In 2021, external financing supported more than a third of health expenditures in half of the countries in sub-Saharan Africa. While multilateral and bilateral development assistance for health, which have historically supported about 30% of health care spending, were expected to decline by 2050, the region was not prepared for a staggering drop from $80 billion in 2021 to $24 billion in 2025. 

The question is this: How will governments address these unplanned deficits, fulfill essential health care needs, and meet new demands created by demographic transitions, climate change, and the non-communicable disease (NCD) epidemic?

Solution in plain sight

There is a solution hiding in plain sight. Taxing harmful commodities to increase government revenue and reduce societal costs is a tool that has been around for centuries, dating back to the 17th century when sin taxes were imposed in England on tobacco.

More recently, the Task Force on Fiscal Policy for Health estimates that raising the price of tobacco, sugary beverages, and alcohol by 50% worldwide through excise taxes could prevent 50 million premature deaths over 50 years. Over five years, this solution would produce an additional $3.7 trillion in tax revenue worldwide, with more than half of that generated in low- and middle-income countries, enough to cover 40% of health budgets.

Over five years, this solution would produce an additional $3.7 trillion in tax revenue worldwide, with more than half of that generated in low- and middle-income countries, which is enough to cover 40% of health budgets. 

With crisis comes opportunity. Despite industry opposition and interference, conflicts of interests, and implementation challenges, now is the time to mobilize action around this solution.

Health taxes have the potential to boost budgets and save lives, particularly in the current funding crisis.

How to mobilise around health taxes – lessons learnt

At Vital Strategies, our partnerships with governments and civil society across more than 35 countries to help implement tobacco, alcohol, and sugary beverages taxes has provided some perspectives on how to overcome these barriers.

Our key message: We can apply lessons from multiple successful efforts to advance health taxes to tackle these barriers. Health taxes are achievable and deliver immense returns for population and financial health. Here are some important steps to success.

Rapid modelling

First, rapid modeling and assessment can create country-specific guidance on projected revenue gains and health benefits — data needed by decision-makers and legislators across health, finance, trade, and other ministries. Painting a picture of how these taxes yield tangible benefits  to make the case to policymakers and the public for action, or to document benefits of a new policy recently undertaken, should be part of this exercise.

In the Philippines, for example, taxes on tobacco and alcohol are helping to fund universal health care, while in Guatemala, revenue from alcohol taxes supports family planning programs. In Philadelphia, a sugary drink excise tax introduced in 2017 had generated more than $500 million by early 2024, helping to fund universal pre-kindergarten education for children across the city.

Prepare for pushback from industry

Secondly, anticipate and prepare for opposition from industry actors, who will inevitably work to block policies that threaten their profits.

Their tactics often include exaggerating claims of economic harm, denying the health harms of their products, and spreading disinformation on taxes’ impact on the economy, jobs, illicit trade, and the well-being of lower-income people.

But in country after country, smart tax policies demonstrate that these claims don’t hold up. When the prices of harmful products increase, worker productivity improves, and people shift their spending to other sectors, resulting in a net impact on employment and economic growth that is neutral or positive.

And taxes are not the primary drivers of illicit trade. Non-price factors, such as governance status, a weak regulatory framework, and the availability of informal distribution networks appear to be far more critical.

Effective dialogue with the public 

When Mexico launched it’s one-peso soda tax, it also launched a campaign explaining that a single 600ml soda had an average of 12 teaspoons of sugar. Sales of sugary drinks decreased 6.3% in the first year.

The final step is to build broad public support by highlighting how these measures benefit children, families, and communities, creating the momentum needed to overcome industry resistance and drive political buy-in.

We know that public support for health taxes is strong when benefits are clearly communicated. A Gallup study across India, Colombia, and Tanzania found up to 74% of adults supported higher taxes on alcohol, tobacco, and sugary drinks. Effective dialogue with the public fosters trust and aligns fiscal policies with community priorities.

In the Philippines, for instance, a concerted public campaign reframed ‘sin’ taxes as a means to help fund universal health care.

Guatemala’s experience offers a similar lesson. After a law was enacted allocating 15% of alcohol tax revenues to family planning programs, communication campaigns were launched to inform citizens about the benefits of this allocation. 

The introduction of a tax on sugary drinks was strategically communicated as a means to fund universal pre-kindergarten education in Philadelphia. This framing resonated with the public, leading to the tax’s approval and the generation of over $500 million by early 2024, with a portion allocated to early childhood education programs. ​

In December 2024, Brazil’s National Congress approved a tax on tobacco, soft drinks and alcohol. Health taxes in Brazil were framed as a mechanism to address deep-rooted health inequities, designed to shift the burden of harm from society back to the industries profiting from it, and using policy to reduce disease burden where it’s most concentrated: low-income and underserved communities. 

When there are clear benefits to be gained, such as better health and better social services, the public supports taxation on unhealthy products. 

Few African countries tax tobacco, alcohol and ultraprocessed food effectively, in part due to massive industry pushback.

Altering the trajectory of health inequities 

Non-communicable diseases such as cancer, heart disease, and diabetes, once mostly occurring in wealthy nations, is shifting to emerging markets.

Africa is witnessing some of the fastest growth rates in the consumption of unhealthy commodities; this increase is concentrated in lower-income households and among youth. Currently, consumption of these commodities is linked to 3 million deaths a year. NCDs account for an estimated  29% of all deaths in Nigeria, 38.5% in Kenya, and 51% in South Africa. If we allow the status quo to continue, low- and middle-income countries will see about a 50% increase in NCD deaths by 2030, with Africa a major contributor, resulting in $500 billion to $1 trillion in economic losses by 2030.

This does not have to be our future. Young people and lower-income households are especially sensitive to price.

After the implementation of the Health Promotion Levy in 2018, South Africa saw the sugar content of beverage purchases fall by 32%, with greater reductions seen in lower-income households. In Mexico, after the introduction of a soda tax, sales of sugary drinks fell by 6.3% in the first year. Within two years, rates of overweight and obesity among adolescent girls dropped by 3%. With an average population age of 19, price increases on unhealthy commodities can have an outsized impact on Africa’s development trajectory.

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

In the case of Brazil’s new tax on tobacco, soft drinks and alcohol, rather than taking a piecemeal approach, Brazil’s reform adopted a comprehensive reform grouping  tobacco, alcohol and sugary drinks with other harms like coal and betting. 

The reform established an equity-driven National Basic Food Basket (CBNA) exempt from taxation to promote healthier consumption, including meat, poultry, fish and minimally processed foods. 

The legislation also includes annual tax adjustments tied to inflation to maintain the effectiveness of these taxes over time, and this year, lawmakers will determine the specific tax rates on harmful products. The tax rates it adopts and the resulting changes in consumption, health outcomes and health disparities will be something to watch, as Brazil must establish those rates at levels that significantly reduce consumption to generate real public health benefits.

What are we waiting for?

Health taxes remain an undervalued and underutilized solution to address the triple shocks of contracting donor funding, domestic fiscal tightening, and the growing health care burden, providing governments with a unique opportunity to improve both long-term population and fiscal health. Now, when there is political and economic pressure to establish more stable and sustainable sources of domestic revenue for health, is the time to come together across sectors and mobilize for health taxes. Future generations will thank us.

What are we waiting for?

Dr Mary-Ann Etiebet is the President and CEO of the New York City-based Vital Strategies, a global health non-profit working in more than 80 countries to advance  equitable public health systems, including through stronger action on the drivers of non-communicable diseases. 

Image Credits: Kerry Cullinan, Bllomberg Philanthropies, Alianza por la Salud Alimentaria, Leo Zhuang/ Unsplash, Heala_SA/Twitter.

A nurse tests a patient for hypertension. Two-thirds of Africans with high blood pressure are unaware of their condition.

Three key issues feature in the United Nations zero draft of the political declaration on non-communicable diseases (NCDs) and mental health, published on Thursday in preparation for the High-Level Meeting on 25 September.

Tobacco control, hypertension and improving mental health care are the cornerstones of proposed action to contain NCDs. The draft proposes 2030 global targets of 150 million fewer people using tobacco, 150 million more people controlling their hypertension and 150 million more people having access to mental health care.

Five sub-targets are included in the 10-page draft as the pathway to achieving the three “150 million” targets by 2030.

The first focuses on at least 80% member states countries implementing excise taxes on tobacco, alcohol, and sugar-sweetened beverages at levels recommended by the World Health Organization (WHO).

The second is for 80% of public primary health care facilities in all countries to have “uninterrupted availability” of at least 80% of World Health Organization-recommended essential medicines and basic technologies for NCDs and  mental health conditions at affordable prices by 2030.

Other targets relate to limiting the cost of essential NCD and mental health “services, diagnostics, and medicines”, integrated country-based frameworks and surveillance and monitoring.

Member states have a tight window – until 27 May – to submit written comments on the draft ahead of the first round of negotiations on 5 June. 

No mention of fossil fuel

The NCD Alliance (NCDA), which has been leading civil society mobilisation ahead of the HLM, told Health Policy Watch that it is currently studying the draft and will formulate its response early next week, and will share its analysis at a public webinar on 20 May.

However, an NCDA advocacy briefing outlines its key asks, including universal health coverage (UHC) and achieving the Sustainable Development Goal (SDG) target on NCDs. 

Seventy percent of deaths are caused by NCDs, as unhealthy diets, lack of exercise, smoking, air pollution, and poor mental health take their toll globally. Yet only 19 countries are on track to achieve SDG 3.4 to reduce premature mortality from NCDs by one-third by 2030.

Several of the NCDA asks are in the draft, but perhaps not as strongly stated as it would like.

For instance, while the draft identifies the need to reduce air pollution – the second biggest driver of NCD deaths after tobacco –  there is no mention of the cutting back on fossil fuel use.

The draft proposes that a reduction in air pollution can be achieved through clean urban transport, reducing burning of agricultural residue, and access to “affordable and less polluting fuels for cooking, heating and lighting”.

The NCDA wants interventions to “reduce air pollution and fossil fuel use” – and for government policies to be protected from the influence of the fossil fuel industry. 

The draft’s only reference to climate change is its acknowledgement that countries’ resources are strained by several emergencies including “climate crises” – whereas the NCDA wants policies to cost health and climate, reduce fossil fuel use, and ensure funding for vulnerable countries, particularly Small Island Developing States (SIDS). (The draft does acknowledge the “unique vulnerabilities” for people living in SIDS.)

Increased funding

“The last decade has been coined as a policy success, but an implementation failure. This HLM has to change this, renewing commitments to cost-effective policies that we know work to reduce the risk factors and improve access to care,” Katie Dain, NCDA CEO, told a recent multi-stakeholder hearing called by the UN Secretary General ahead of the HLM.

Dain added that the HLM “must address the glaring mismatch between the scale of the burden of NCDs and the level of funding”.

“We urge governments to increase sustainable financing for NCDs by adopting specific and measurable financing targets for NCDs and improving financing data and tracking, as well as committing to health taxes that have a triple win of raising revenue, improving health outcomes and reducing long-term healthcare costs.”

The draft devotes five points to increased budgets, which call for increased domestic resources (helped by funding from the excise taxes), more donor resources and strategies such as pooled procurement for medicines.

It also calls on countries to “urgently scale up the percentage of public health budgets dedicated to mental health with the aim to increase the current global average of 2% to at least 5% by 2030”.

Human rights approach

Importantly, the draft stresses the importance of adopting a human rights-based approach, acknowledging that people living with NCDs and mental health issues are “routinely and unjustly deprived of such access and discriminated against”.

It also calls for measures to decriminalise suicide, which was a key demand made by civil society groups at the recent multi-stakeholder hearing.

Image Credits: Hush Naidoo Jade Photography/ Unsplash.