NIH research building
The NIH is the world’s leading public funder of biomedical research, spending some $48 billion annually on universities, hospitals, labs, and other institutions.

WASHINGTON, DC – The abrupt decision by the United States National Institutes of Health to slash funding for overheads to the nation’s research centers and universities has provoked a fresh outcry among leading US researchers, global health experts and even some Republican politicians  – with leading one expert saying this latest move could “seriously jeopardize” the US’s global dominance in biomedical research and innovation.

“If the Trump administration goes ahead with its plan to slash NIH research funding, it would seriously jeopardize the standing of the US worldwide,” said Lawrence Gostin, Distinguished University Professor in Global Health Law at Georgetown University, in a statement to Health Policy Watch. 

Similar reactions echoed across the research world after NIH’s Friday announcement cutting grants to research institutions for their “indirect costs” – which include expensive laboratory equipment and technologies vital to cutting edge research.  The cuts to biomedical research investments followed a shock list of recent Trump measures to drastically curtail the public health watchdog activities of the US Centers for Disease Control, as well as dismantle USAID and related global health programs. 

Susan Collins, a Republican  from Maine, who chairs the powerful Senate Appropriatiations commitee, also expressed opposition to what she called “the poorly conceived directive imposing an arbitrary cap on the indirect costs,” adding that the Congressional act under which the NIH allocations are made, also forbids arbitrary alterations. But even so, she posted a statement saying that she would vote to approve PresidentDonald Trump’s nominee Robert F Kennedy Jr, a vaccine skeptic who has also questioned the solidity of research underpinning recent vaccines, as Secretary of Health and Human Services, when the issue comes before the Senate, presumably later this week. 

Judge temporarily freezes NIH funding cuts 

Researcher
A researcher tests the efficacy of a generic drug. 80% of the NIH’s budget goes to universities, hospitals, or other research institutions.

On Monday, a Massachusetts judge  issued a nationwide order, temporarily halted the directive to slash the NIH grants from the Office of the Director, just before it was due to take effect. The suspension came as 22 state attorney generals sued the federal government for violating the 2018 Congressional appropriations law, which prohibits the NIH from altering its indirect cost rates “without proper authorization,” according to the filing. US District Judge Angel Kelley scheduled a hearing for 21 February for further arguments. 

Another lawsuit was filed on Monday on behalf of private and public universities and hospital systems, which stand to lose millions in federal dollars. The American Association of Universties, American Council on Education, Brandeis, Brown, George Washington, Cornell, Johns Hopkins, University of Rochester, Massachusetts Institute of Technology, and the University of California, among others, joined in filing suit against HHS, NIH, and the acting heads of these two agenices. These also argue that the funding cuts violate the Congressional appropriations law, and breaks prior negotiated indirect costs rates.

Across the country, from Birmingham to Buffalo, NIH research dollars fuels economic growth, medical innovation, and offers jobs to millions of Americans. In 24 states, hospital or university systems are the single largest employers, and leading the US’s global dominance in cancer, cardiovascular, and public health research. 

The storm unfurled Friday, after the Office of the Director of the National Institutes of Health, under an order by the Trump administration, issued a notice limiting the indirect costs biomedical research relies on to fund laboratories, equipment, facilities, new faculty, and software, to a standard 15% across all grants and institutions receiving them. 

The move was widely condemned by universities, research institutions, and medical centers who said that the one-size-fits all payment fails to reflect the real costs of research, in terms of investments in laboratories, technology and other hardware. 

Chipping away at the NIH’s status as the ‘envy of the world’

NIH funding impacts graphic
24 US states have hospital or university systems as their largest single employer.

At stake, critics say, is the National Institutes of Health (NIH) and the US biomedical research operation’s preeminence as the leading research innovator in the world, at the forefront of cancer therapies, personalized medicine, and brain health, to name a few domains. The administration’s moves have deeply rattled the NIH, with  the number two official, Dr. Lawrence Tabak to resigning 12 February. 

“The NIH is the envy of the world and sets the gold standard for scientific research and innovation. NIH funding has led to breakthroughs, ranging from treatments for cancer and cardiovascular diseases to vaccines for infectious diseases, and so much more,” said Gostin. 

The economic and scientific impacts could reverberate across the country – and in cancer clinical trials and drug-development labs. 

“NIH does incredible work, and this seems like it’s an obscure overhead issue. It is not,” said Senator Mark Warner (D-Virginia) in a town hall for residents.

“If these cuts, without any congressional review go through, we will have less research, less cures.” The senator pointed out that institutions have already negotiated and signed contracts at existing indirect cost rates. “You cannot arbitrarily change the reimbursement level for existing contracts by executive order.” Warner alluded to the multitude of Trump-issued executive orders that violate the law.

Ttop universities and medical centers stand to lose “$100 million a year or more” if the sweeping changes to how the National Institutes of Health reimburses research costs takes effect, according to an analysis from STAT news. 

White House claims moves allows ‘more money and resources available for legitimate scientific research’

In a post on X, the NIH framed its decision as a cost-cutting move, given that elite universities have tens of billions of dollars in endowment funds. Even so, research institutions at Harvard University, Yale University, and Johns Hopkins University all receive indirect rates over 60%, the NIH said. The post highlights that the 15% cap would save $4 billion per year. About $9 billion of the $35 billion awarded to researchers through grants in 2023 was in the form of indirect costs.

“Contrary to the hysteria, redirecting billions of allocated NIH spending away from administrative bloat means there will be more money and resources available for legitimate scientific research, not less,” said White House spokesperson Kush Desai in a statement to Fox News Digital. The comment implies that the administration does not believe that current scientific research is not “legitimate.”

And on X, Elon Musk, the un-elected billionaire who leads Donald Trump’s Department of Government Efficiency (DOGE), echoed this sentiment, saying over the weekend “Can you believe that universities with tens of billions in endowments were siphoning off 60% of research award money for ‘overhead’? What a ripoff!”

But most universities are not Harvard, Gostin countered, saying, “Most small to medium sized universities actually take a loss in taking NIH dollars even with indirect payments,” he said in a statement to Health Policy Watch. 

“Research costs an enormous amount, including paying researchers, running laboratories, and conducting large clinical trials. Many universities could not afford to take NIH research grants with such low indirect costs. That means the pipeline of research innovation could dry up.”

“What administrative bloat?” he asked. 

Collins, Britt, say cuts could harm Republican states 

 

The NIH distributes about 80% of its $48 billion budget to research institutions in the US – in Republican as well as Democratic-majority states. As a result, lawmakers from both parties have scrambled to the defense of universities, hospitals, and institutions that rely on NIH funding.

“I oppose the poorly conceived directive imposing an arbitrary cap on the indirect costs that are part of NIH grants and negotiated between the grant recipient and NIH,” said Senator Susan Collins (R-Maine) in her statement, saying she’s heard from laboratories and research institutions and other schools in Maine about the cuts, which “would be devastating, stopping vital biomedical research and leading to the loss of jobs.”

Collins, who chairs the Senate Appropriations Committee, and noted that the fiscal 2024 appropriations law, which funds the federal government, “includes language that prohibits the use of funds to modify NIH indirect costs,” indicating that the NIH is not allowed to arbitrarily change its funding policies.

Still supporting Kennedy for Secretary of HHS

Despite her opposition to the NIH’s cap, Collins said she would support Robert F Kennedy Jr, Trump’s nominee for Secretary of Health and Human Services. Kennedy’s record of support for biomedical research has been uneven, at best, expressing skepticism over vaccine studies, in particular. Even so, Collins said she had contacted Kennedy about the cuts, and said he pledged to “reexamine” the issue.

During his Senate confirmation hearings, Kennedy repeatedly dodged questions as to whether he would continue NIH’s funding for vaccines, including the cutting-edge mRNA technology developed for the COVID-19 vaccines. And in the months following his nomination, Kennedy said he would cut 600 NIH jobs. 

Kennedy could afford three “no” votes from Republicans and still be confirmed. 

Alabama Senator also expresses misgivings over NIH cuts

Another Republican senator and Trump ally, Katie Britt of Alabama, also expressed misgivings over the funding cuts.

“While the administration works to achieve this goal at NIH, a smart, targeted approach is needed in order to not hinder life-saving, groundbreaking research at high-achieving institutions like those in Alabama,” Britt told AL.com, an Alabama-based news agency. Alabama is home to several research universities who receive billions in NIH funding.

The University of Alabama is the single largest employer in the state. 

The University is an example of how universities and hospitals often support entire towns, cities, or even states. 

In Western New York, the University of Rochester is the largest private employer in the region, generating approximately 56,000 jobs across Upstate New York. And in Pennsylvania, the University of Pittsburgh Medical Center system creates nearly a million jobs, and is the largest employer in the state.

In their filings against the NIH, leading US universities disclosed they received up to $1 billion dollars in NIH funding, in the case of Johns Hopkins. The University of Rochester disclosed receiving $188 million in fiscal year 2024, and with the current indirect cost rate at 15%, it stands to lose $40 million. The filing also revealed that universities in conservative states would lose tens of millions – the University of Florida would lose $70 million in funding.   

Department of Defense, philanthropies, and private companies unable to fill funding void

NIH Research
Scientist conducting coronavirus vaccine research at NIAID’s Vaccine Research Center, Moderna’s original collaborator on the SARS-CoV-2 vaccine.

With the rationale of government efficiency, DOGE has singled out the NIH’s funding structure as the leading public funder of biomedical research. Some observers hope that the Department of Defense (DOD), a frequent partner, could pick up some of the slack with its $800 billion budget. The DOD spent $1.5 billion on such biomedical research in fiscal year 2021.

But Trump has instructed DOGE to turn its attention to Defense spending next, saying in an interview on Friday “And I’ve instructed him [Musk] to go check out Education, to check out the Pentagon, which is the military. And you know, sadly, you’ll find some things that are pretty bad.”  Others have suggested that the private sector might step into NIH’s shoes. But historically,  private sector investors have not been eager to fund the kind of basic research that NIH supports – which often then lead to the breakthroughs, such as mRNA vaccine technology, that the private sector later develops.  

As for the DOD, Gostin notes that “it is possible that the DOD would expand its research portfolio but Musk will probably also cut Defense spending. But the main point is there is no substitute for the NIH. Many scientists want peer-to-peer relationships with NIH scientists and may be leary in getting too close to military applications of their research.”

The US has been the world’s leader in research and biomedical innovation for over 80 years. 

In a letter to the university community, Harvard president Alan M. Garber expressed the widespread sentiment: “At a time of rapid strides in quantum computing, artificial intelligence, brain science, biological imaging, and regenerative biology, and when other nations are expanding their investment in science, America should not drop knowingly and willingly from her lead position on the endless frontier.” 

Last updated 12 February.

Image Credits: NIH, FDA/Michael Ermarth, Kristy Ainslie, NIAID.

South African programmes like this one, to encourage people living with HIV to adhere to treatment, face an uncertain future following US President Donald Trump’s latest Executive order cutting off aid to the country.

CAPE TOWN – A coalition of South African civil society groups have urged South Africa’s President Cyril Ramaphosa to “step up” and lead a coordinated national and regional response to prevent “mass healthcare disruptions, preventable deaths, and surges in new HIV infections and drug resistance,” in the wake of the US President Donald Trump’s cut off of aid to the country. 

Trump last week issued an Executive Order halting all aid to South Africa, citing “unjust racial discrimination” against the country’s Afrikaner farmers as well as the country’s case against Israel at the International Criminal Court, alleging genocide in Gaza. The Trump order was referring to a new South African government law that makes it easier to expropriate unused land from white landowners without compensation – when it’s deemed to be in the “public interest“. The new law is being challenged in court.

“Action is critical, particularly in his role as the African Union (AU) Champion on Pandemic Prevention, Preparedness and Response (PPPR) and as South Africa takes on the G20 Presidency,” said the coalition, Community Health and HIV Advocate Navigating Global Emergencies (CHANGE), in a statement on Saturday.

A few organisations have received waivers, but many haven’t

South African schoolgirls campaign on World AIDS Day.

While a few South African organisations delivering HIV and tuberculosis services through the US President’s Emergency Plan for AIDS Relief (PEPFAR) confirmed to Health Policy Watch that they had received PEPFAR waiver letters on Saturday exempting them from the 90-day freeze on PEPFAR activities, originally announced in late January, many others have seen activities cut or curtailed.

However, in light of the most recent Trump order, there is uncertainty about the fate of all PEPFAR-supported South African programmes beyond the 90 days exemption period. Meanwhile, the US Agency for International Development (USAID), which disburses a significant portion of the PEPFAR funding, is being dismantled and PEPFAR’s long-term future is in doubt as its budget comes up for consideration before the US Congress in late March.

Adding to the confusion, several other organisations have not received waivers, while forcing them to cut certain activities. 

For example, at least 9,000 people have lost access to needle exchange and opioid substitution therapy (OST), according to the South African National AIDS Council’s (SANAC) civil society forum.

Funding for HIV clinics catering for those most vulnerable to HIV – “key populations” including sex workers, men who have sex with men and trans people – is likely to be cut permanently.

Funding for a game-changing intervention for groups vulnerable to HIV – twice-yearly injections of lenacapivir that are 100% effective in preventing HIV infection or pre-exposure prophylaxis (PREP) has also been cancelled, according to various reports.

Witkoppen Clinic’s HIV services in Gauteng are among many South African clinics receiving PEPFAR funds via USAID.

Calling on Ramaphosa to “personally intervene” 

CHANGE has urged President Ramaphosa to “personally intervene before the situation worsens and to ensure a whole-of-government and civil society response.”

Sibongile Tshabalala, TAC chairperson.

“The reckless freezing of US foreign aid is nothing short of a death sentence for thousands of people in South Africa,” warned Sibongile Tshabalala, chairperson of the Treatment Action Campaign (TAC) which advocates for people living with HIV.

“Critical healthcare infrastructure is being dismantled, clinics forced to close, frontline workers without support, all while lives hang in the balance. We are watching decades of progress on HIV being decimated.” 

Historically, South Africa has had one of the highest rates of HIV infection in Africa and in the World.  However, rates of new infections have declined sharply thanks to aggressive campaigns to get those infected on anti-retroviral drugs.  Overall HIV prevalence is about 14% in South Africa, and nearly 20% amongst people aged 15-49 years.

No idea what is happening – people are going to start dying soon

“Health workers and people have no idea what is happening across the region. People are going to start dying soon. Can you imagine being dependent on treatment to save your life, and having it snatched away from you like this, with no alternative?” warned HIV clinician Dr Francois Venter, who directs the Ezintsha research centre in Johannesburg.

New HIV infections have declined sharply as ARV uptake increased.

Fatima Hassan, head of Health Justice Initiative (HJI), confirmed that while some projects had been given waivers “the issue is still the concern about key populations and what the waiver seeks to cruelly limit”.

“The loss of US government funding has left sex workers without life-saving healthcare, HIV prevention, and critical support. Without these services, they face higher risks of violence, stigma, and disease—pushing them further into isolation and vulnerability,” said Kholi Buthelezi of Sisonke, the National Sex Worker Movement of South Africa.

Grassroots organisations that fund outreach workers, peer educators, and service providers have been “left destitute”. “While the communities they serve face even greater barriers to safety and healthcare. Without urgent funding, these lifelines will disappear, leaving sex workers more isolated and at risk than ever,” said Buthelezi.

In light of the additional orders directed at South Africa, communities are also calling on Ramaphosa to use “all available domestic, as well as compulsory measures,” to ensure that life-saving tools and medicines reach all who need them.

Image Credits: UNAIDS, AIDS Healthcare Foundation, Witkoppen Clinic, TAC, UNAIDS.

The United States conducts a nuclear test, code-named Seminole, at Enewetak Atoll in the Marshall Islands in 1956.

Russia has rejected a World Health Organization initiative to update its assessment of the health effects of nuclear weapons use, breaking with nations still grappling with the devastating legacy of Cold War-era explosions. The opposition comes as Russia has threatened to resume nuclear testing amid its war in Ukraine.

In regions known as “sacrifice zones,” where thousands of nuclear tests have left the soil poisoned and communities ravaged, residents continue to face elevated rates of cancer and birth defects decades after the last Soviet-era detonations.

“The Russian delegation is not in favour of discussing this topic,” Russia’s representative told the WHO Executive Board on Saturday, arguing that “the negative impact of the destructive factors of nuclear explosions on humans and the environment, on which we have sufficient scientific data, is already obvious.”

The proposed initiative, which needs to be approved by the EB in order to go before the entire World Health Assembly in May, would update WHO’s guidance on the “Health effects of nuclear weapons and nuclear war on health and health services”, last revised in 1993. It is co-sponsored by the Marshall Islands, Micronesia and three other Pacific island states, as well as Iraq and Kazakhstan – regions where fall out from nuclear testing continues to have devastating health consequences generations after test explosions by either Russia or the United States.

“Nuclear weapons do not discriminate and have catastrophic consequences on health and the environment,” Samoa’s delegate said. “In the interest of health and in the interest of humanity, we need to ensure that nuclear weapons and nuclear war are fully understood.”

The expert study would cost $540,000, according to a cost assessment submitted to the EB. Kazakhstan called the cost a “modest but necessary investment in global health security.”

“The Pacific region has a painful nuclear legacy,” the Marshall Islands’ representative said. After taking control from Japan in 1944, the United States conducted 67 nuclear tests there. The delegate noted that “many other countries with similar nuclear legacies” would benefit from the resolution.

The initiative was dismissed by North Korea, which joined Russia in opposition. North Korea’s foreign policy relies heavily on its nuclear threat, and it has threatened nuclear strikes against targets like Guam. “Sufficient research and analysis in this regard has already been conducted,” its delegate said.

The last nuclear test was conducted in 2017 by North Korea. The U.N. Treaty on the Prohibition of Nuclear Weapons bans all forms of nuclear testing.

Nuclear threats 

Vladimir Putin has threatened to restart nuclear testing throughout his invasion of Ukraine.

The two nations opposing the WHO health study — Russia and North Korea — come as both face international scrutiny over their nuclear threats.

Russian President Vladimir Putin has repeatedly threatened nuclear weapon use during his invasion of Ukraine. Russia has lowered its threshold for nuclear weapon use, placed its arsenal on heightened alert, and deployed tactical nuclear weapons to Belarus – the first time since the Soviet Union’s collapse in 1991.

Putin’s threats to resume nuclear testing carry particular weight for nations like Kazakhstan that still bear the scars of Soviet-era explosions. These threats followed Russia’s withdrawal from the New START treaty — the last remaining agreement limiting nuclear weapons between the United States and Russia.

North Korea, meanwhile, has deepened ties with Russia throughout the Ukraine war, providing millions of artillery shells and ballistic missiles in exchange for economic support and military technology that experts warn could enhance its nuclear capabilities.

“The additional research proposed by a number of countries as regards the consequences of using nuclear weapons, are not capable of introducing radically new elements to international discourse on nuclear weapons,” Russia’s delegate said. Russia will “once again raise the issue of counterproductiveness of adopting this draft resolution” at the World Health Assembly in May, he said. 

The WHO’s EB moved to suspend debate on the initiative until the end of the session next week.  The Board has taken the same move on every draft decision and resolution to come before it so far  – with the exception of aid to Gaza – due to the WHO budget crisis triggered by the US announcement last month that it is withdrawing from the global health agency, to which it is the largest single contributor.

Haunting health legacy of nuclear testing

Craters dot the former Soviet Union nuclear test site Semipalatinsk, Kazakhstan.

Since the invention of the atomic bomb, Russia has conducted hundreds of nuclear weapons tests among more than 2,000 detonations worldwide. The United States is responsible for the largest share – nearly half – followed by France, the United Kingdom and China.

Five hundred of these tests were conducted in the atmosphere rather than underground, releasing radiation equivalent to 29,000 Hiroshima bombs. The radioactive particles dispersed remain in the soil, air and water around test sites decades later. “The legacy of nuclear testing is nothing but destruction,” U.N. Secretary-General António Guterres said in 2019.

Health impacts persist across generations

The health impacts persist across generations. Hereditary cancers, chronic health conditions and birth defects — from missing limbs to infants born with cancer — continue to afflict indigenous populations living near the more than 60 sites where nuclear explosions were conducted since 1945.

In the Kazakh steppes, where Russia detonated hundreds of nuclear bombs throughout the Cold War, populations in nearby cities like Semipalatinsk, home to 120,000 people just 75 miles from the testing site, were blanketed in radioactive ash. Doctors were forbidden by the government from diagnosing cancers, while authorities maintained the tests had no adverse health effects.

“Local people began to get sick and die young. Women suffered through miscarriages, complicated pregnancies, and stillbirths. Babies were born with missing limbs, Down syndrome, and other disabilities linked to radiation exposure,” according to the Carnegie Endowment for Peace.

Kurchatov city, East Kazakhstan Province, Kazakhstan – the center of the Semipalatinsk nuclear test site.

A series of studies by Kazakhstan’s Institute of Radiation Medicine and Ecology found significantly higher mortality rates amongst those exposed to radiation, with elevated risks of serious illness continuing through their children and grandchildren. The data on the fourth generation remains under study, but ongoing birth defects and elevated cancer rates in the region suggest the fallout will affect their health too.

“If you travel to the villages near the former testing site, you’ll meet small children born without limbs or sick with cancer, suggesting that the damage from the site continues to this day,” the Carnegie Endowment reported.

While Russia’s nuclear legacy haunts Kazakhstan, the United States left its own trail of devastation. Hundreds of nuclear tests were conducted on Native American land in Arizona, Nevada and Utah, yet the U.S. government has never studied or investigated the health effects on these communities. More than 900 tests were conducted on the land of the Shoshone nation, earning them the moniker of “the most bombed people on earth.” 

Similar patterns of official neglect persist in Pacific island nations, where the United States has refused to fully compensate populations for widespread damage to their health and ecosystems from nuclear testing.

“WHO must speak with the authority bestowed to it by its constitution to provide the most recent science and research to support the call for peace,” Samoa’s delegate said. “We need to ensure the negative consequences of nuclear weapons and nuclear war are fully understood for all people and the world.”

Image Credits: Comprehensive Nuclear-Test-Ban Treaty Organization, RIA Novosti archive.

Bird flu in USA. Outbreaks in Ohio and NY
Bird flu is circulating across the US, affecting over 25 million poultry. Complicating outbreak efforts is the hampered health communication from the federal government, and the efforts to reduce the federal workforce by 10%.

The US Centers for Disease Control has not updated its bi-weekly bird flu (H5N1) situation summary since 17 January – even if it finally published a limited edition of its Mortality and Morbidity Weekly Report (MMWR) on Thursday, 6 February. In the wake of the CDC information flow shutdown and the US withdrawal from WHO, Dr Lynn Goldman, Dean of the Milken Institute School of Public Health, spoke with Health Policy Watch about how public health communications and global health collaboration remains all the more critical.

The highly pathogenic avian influenza has affected millions of US poultry birds since December 2024, with Ohio accounting for 10 million of these birds where infections were detected, according to the US Department of Agriculture (USDA). The pathogen, which has sickened 68 people and caused one death, led global experts to criticize the US response as inadequate and “inept” – long before the Trump administration began to curtail reporting operations of the US Centers for Disease Control.  

Politicizing the federal workforce

Now, educating the public and the agricultural workforce about the risks of bird flu, and how to combat them, has only become more complicated by the ongoing communications pause imposed by the Department of Health and Human Services, says Goldman, who also served in the US Environmental Protection Agency (EPA) during the administration of former US President Bill Clinton (1993-2001).

But Goldman expressed hopes that specialised US government agencies will remain anchored by civil service professionals, where “people are really just serving the public…They’re not serving a politician. They’re serving the public. They are experts, and we’re proud that they’re there for merit, not loyalty.”

However, that civil service workforce is shrinking rapidly. 

About 65,000 of 2.3 million federal employees – including those who work at key public health agencies such as US CDC, the US Department of Health and Human Services – have taken up the Trump administration’s offer to resign now, with pay until September. And on Friday, the new US administration was poised to lay off nearly 95% of the US Aid and International Development agency’s (USAID) workforce, following a freeze on operations announced earlier this week. Only 294 of the more than 10,000 employees worldwide appear set to remain. 

The implications for public health range from impeded infectious disease communication, slowed research, and hampered global collaboration, according to Goldman. 

Bird flu response jeopardized

CDC bird flu website Feb 2025
The CDC’s bird flu website displays a message saying the page is “being modified to comply with President Trump’s Executive Orders.”

Since last year’s ongoing avian flu outbreak, the US has seen 67 human cases and one death – and countless poultry, dairy cows, and wildlife sickened. Most of these cases originated in dairy herds or poultry farms. And on 31 January, a new variant of H1N5 was reported in a dairy herd in Nevada, according to the US Department of Agriculture (USDA). Egg farmers must cull or depopulate their flocks if the virus is detected. New York state shut down live poultry markets 7 February after bird flu was detected.

“As this flu spreads around, it is affecting the price of eggs and eventually will increase the price of milk as well,” said Goldman.

In fact, over the past month, eggs prices in the US soared to an average of $5.30 per dozen, up from $3.50 the same time last year. The situation is complex, and the communications “need to be very finely tuned,” argued Goldman.

“It’s very complicated to communicate to the public the risks around food products,” Goldman added, referring to issues such as risks of virus transmission through raw milk consumption. “It’s very complicated because you don’t want to create untoward concern because of the way you communicate it. 

“Stopping the communications means you’re not controlling the public health threat, because a good part of doing your job in public health, especially with regard to infectious diseases, like bird flu, is that you communicate.”

Communicating with the public is not the only aspect that worries Goldman. For physicians, the recent tumult in the transition has meant the relative lack of messaging from the federal government on bird flu can impact medical practice.

“As a pediatrician, I want to always have up to date information about what’s going on with bird flu. I need to know what’s going on if I’m in the clinic seeing people. Is this something I should be looking for? Has it been identified in my part of the country? That’s important for doctors to know.”

Halting NIH grant reviews – ‘highly unusual’ with a severe ‘financial downside’

The NIH is the world’s leading public funder of biomedical research, spending some $48 billion on universities, hospitals, labs, and other institutions.

While the Trump administration’s decision to freeze health communications and grants processes for a short transition period might be “fairly normal,” the halt to routine NIH grant review meetings is “highly unusual,” Goldman observed.

“I don’t know why you want to throw a wrench into that work,” said Goldman, adding, that new staff may simply be uninformed about research – although that is worrisome as well. “Maybe they’re just coming from a very negative point of view about the government and don’t understand those things.” 

The grant review meetings, also known as study sections, are often scheduled far in advance and they focus on the peer review of new scientific proposals on biomedical topics, such as cancer therapeutics. Although some reviews were reportedly resumed this week, NIH advisory panels across several research areas remained in hiatus. The National Science Foundation (NSF) pause of grant review panels also was ongoing as of this publication. 

“We are so dependent on the NIH to develop the science that we need for protecting the health of the public. No corporation does what they do. No one else will do it, including philanthropy.” The NIH is the largest single public funder of biomedical research in the US, with a $48 billion budget. Everything from the discovery of hundreds of new drugs, gene therapy and vaccines can trace its funding back to the NIH. Every $1 investment in this biomedical research yields a $2.46 return, according to the Office of Budget. 

With almost an entire month’s pause on the grant process, there could be a serious “financial downside,” noted Goldman. “This one month halt on meetings could result in a reduction in NIH expenditures for the year, unless they can play catch up. 

“And it’s important, as expenditures are what support scientists to do the research we need.”

Censoring diversity criteria in clinical trial research – a particularly acute impact

In addition to the CDC pages on urgent outbreaks like bird flu, the main page of the Food and Drug Administration’s “Diversity Action Plan” guidelines to pharmaceutical companies for including diverse populations in clinical trials of new new medicines and vaccines also has been taken down. That’s despite the fact that decades of research shows that considering ethnicity, gender, age and other similar factors is essential for assessing a vaccine or medicine’s overal efficacy.  

Helping to oversee the entire Department of Health and Human Services’ management is the HHS Office of the Inspector General (OIG), an independent watchdog responsible for fighting waste, fraud, and abuse in the department. On 31 January, the Trump administration fired 17 Inspector Generals, including the HHS IG. The two-sentence termination emails took the IG community by surprise, as the role is intended to be independent and non-partisan. 

“It’s not just the NIH, but it’s an effort across the federal government to politicize all the personnel in the government,” said Goldman. She noted that “it is part of our process” for certain but not largescale to occur during administration transitions. 

Goldman hopes the nominee to head the NIH, Dr Jay Battacharya, will outline his vision for the agency during his hearing process, which is not yet scheduled. “That is something all of us – the American public, the scientific community, and the public health community – need to hear from him.”

WHO withdrawal, USAID shutdown means US is ‘lagging behind’

The Trump administration’s decision to begin pulling the US out of the World Health Organization, the specialized United Agency which enjoys support from 194 member states since its founding in 1948, sent reverberations through the global health community. The administration also ordered CDC to cease communicating with the WHO. Similarly, the recent moves to dismantle the US foreign aid agency, USAID, which has saved tens of  millions of lives through work targeting maternal and newborn health, malnutrition, malaria, tuberculosis and HIV, threatens to leave a “vacuum” for geopolitical adversaries.

“Russia and China are cheering the work of DOGE [Department of Government Efficiency]. It’s not efficient to destroy capacity. We’re talking about world class expertise. It’s not an overhaul, it’s a destruction,” said Dr Atul Gawande, former global health head at USAID, in a CBS interview about the agency. He also noted that the fallout means monitoring for bird flu has been cut off in 49 countries, and that the malaria program has been shut down. 

“Health provides an entryway for us to engage with countries, many of whom we may not agree with, and to have diplomatic conversations and other conversations. If that is lost, it will have tremendous consequences for the U.S.’s security and long-term economic and political outlook,” Dr Judd Walson, chair of International Health at Johns Hopkins, said in an interview 28 January. 

“If we actually have an approaching bird flu pandemic, [withdrawing from WHO] would make that doubly worse, because we need global collaboration when epidemics are erupting globally,” said Goldman.

When it’s not just a local problem, we need to be able to share the data from across the world.”

 

Image Credits: Julio Reynaldo, CDC, NIH.

Displaced Gazans living amongst garbage and ruins in January as the Israeli-Hamas ceasefire went into effect.

The WHO Executive Board voted to advance a resolution on aid to war-torn Gaza to May’s World Health Assembly, the first to be greenlighted while several dozen other initiatives remain on hold due to budget constraints. Meanwhile, WHO Director General Dr Tedros Adhanom Ghebreyesus appealed to Israel to allow thousands of desperately sick and injured Palestinians to evacuate via its borders, and to reconsider the shuttering of UNRWA, the massive UN relief agency for Palestinians.

The Gaza aid resolution likely holds the steepest price tag of any new measure being considered by the Executive Board (EB) this week – some $648 million for the delivery of emergency aid and the initial rehabilitation of Gaza’s shattered hospitals and health clinics.

Those costs would be covered by the department’s “emergency appeals budget segment” according to a financial analysis accompanying the report. Even so, it was unclear how the huge price tag could be squared with a projected 25% cut in WHO’s budget for its emergency operations, under new austerity measures being imposed at the global health agency as a result of the United States withdrawal from the organisation.

See related story:

Crucial WHO Health Emergency Response Faces Budget Cut of 25%

The Wednesday evening vote on the Gaza measure came after an emotional five-hour debate and a prolonged back and forth on the technicalities of voting procedures. That came after Israel, which currently holds a seat on the EB, proposed that the resolution be “noted” by the EB without an explicit endorsement due to it’s failure to call out Hamas role in the conflict and ensuing humanitarian crisis.  

Brazil and others objected. And several hours later, the new EB resolution, identical to a Gaza measure approved at the May 2024 World Health Assembly, was approved by a vote of 26 to two. Amongst the 34-member EB, five member states also abstained and one country was absent. 

At the time of the vote, WHO swivelled its live video stream away from the EB assembly, so that no one outside of the EB room could witness the vote by show of hands in one of this session’s most charged moments of decision-making.  

While the United States, Israel’s staunchest ally, was at the table for the vote, it did not speak on behalf of Israel’s claims that both the resolution, as well as a WHO report accompanying it, were  “biased” because they targeted only one party to the conflict, Israel, and not Hamas.

Hamas is the “foremost” cause of civilian suffering: Israel’s Waleed Gadban, at the EB Thursday.

“Hamas is and remains the first and foremost cause of civilian sufferings in Gaza,” contended Waleed Gadban, Israeli delegate to the EB. 

“Yet the report in front of us keeps referring to effects in healthcare without acknowledging that hospitals in Gaza are used outside of their humanitarian function to store arms and ammunition, hide innocent [Israeli] hostages and commit acts on Israel and its citizens. Israel does not launch attacks in those facilities, but on Hamas personnel and on targets hiding in healthcare facilities.

“Even when, immediately after the announcement of the cease-fire, Hamas emerged from the Al Nassar Hospital complex, carrying their arms and weapons stored there, UN agencies still failed to condemn the blatant abuse,” Gadban said.     

Palestine and Arab states fiercely dispute contentions 

Ryad Awaja, counselor in Palestine’s Mission to the UN: “A shame we need to vote to say that killing health workers is wrong.”

The EB’s delegate from Palestine fiercely disputed Israel’s contentions regarding Hamas’ role in the conflict or its militarisation of health facilities, laying the blame for the 15 month-long destruction of the enclave solely on Israel.  

“Let Palestine remind you that the Gaza Strip’s 364 square kilometres has turned from an open air prison to an open air prison to an open air graveyard for Palestinians, stripped of basic rights and hope,” said Ryad Awaja, a counsellor in Palestine’s UN Mission to Geneva, referring to Israel’s decades-long blockade of Gaza, imposed when Hamas first took control in 2007. 

“The people in the Gaza Strip enclave were stripped of their basic human rights and access to health and most importantly, and were stripped of hope of a better life and future,” he said.

 “It’s a shame that we need a UN vote to say killing civilians is wrong.  

“It’s a shame that we need to vote to say that killing health workers is wrong. It is a shame that we need a vote to say bombing hospitals and health facilities are wrong. It’s a shame that we need a vote to say starving the whole population is wrong.”

Added Egypt: “We plead for the EB not to be compromised or intimidated by some member states and their groundless and twisted allegations against health workers. Those WHO staff, who have lost their lives while fulfilling their responsibilities didn’t belong to any factions. They didn’t carry weapons, and they’re certainly not terrorists.”

Concerns about Trump’s recent statements and UNRWA’s fate

Egypt protests recent US proposals to relocate Gaza Palestinians to neighboring states.

A long list of European, African and Asian states meanwhile expressed hopes that the current Hamas-Israel cease-fire would hold despite its fragility, leaving space for the daunting task of rebuilding the 365-km2 enclave, and a more lasting peace arrangement. 

Many delegates also denounced recent statements by US President Donald Trump describing how he wants to relocate Palestinians away from Gaza in order to expedite the rebuilding process and even take control of Gaza himself, something that has been staunchly opposed by countries across the region and beyond.    

“All attempts to displace the Gaza population outside is against international law,” said Spain. 

“Malaysia strongly opposes any proposal that could lead to the false displacements or movement of Palestinians that will constitute ethnic cleansing and a violation of international law,” said the country’s delegate. “Any attempt, whether direct or indirect, to unilaterally and forcefully impose solutions that disregard the Palestinians people’s right to self determination and infringe on their freedom is unacceptable, undesired, unjustifiable, and will only further deepen one of the longest conflicts in the region.” 

Norway, meanwhile, said it was “deeply concerned about the consequences of the Israeli laws seeking to prevent UNRWA from delivering services in Palestine, the implementation could have catastrophic consequences on the lives of Palestinians, including on their access to health services.” 

Will Hamas remain in control in Gaza?

Hamas forces have been visibly in control again in Gaza, since the ceasefire begin. Portrayed here, the moment on 17 January when the first three Israeli hostages, of 33 included in the ceasefire deal, are turned over to the Red Cross in Gaza City.

On the other side of the fence, several member states, including Australia, emphasised that Hamas, which has become much more visible in Gaza again since the cease-fire came into effect on 17 January, should not be allowed to retain control of the enclave in a final settlement. 

Two conservative member states, Argentina and Hungary, echoed Israel’s concerns regarding WHO bias in its reporting on the conflict, saying that the WHO report on Gaza’s humanitarian crisis, which accompanied the resolution, ignores evidence that Hamas frequently used health facilities to hide fighters, munitions as well as Israeli captives. 

Said Hungary: “We must make sure that Hamas and other terrorist organisations are no longer in position to gain power and military Gaza through coordinated attacks and misuse of civilian infrastructure, including hospitals and other medical facilities.”

And Argentina also complained about bias in the WHO reporting on Gaza saying “It does not mention in any way the use of hospitals by armed groups as cover.. It’s a completely biased report, with a warped view of reality.” On Wednesday, the country’s president Javier Milai announced that he intends to withdraw from WHO, following in the footsteps of the United States. 

Suffering in Gaza is beyond comprehension

Hanan Al-Balkhy, Eastern Mediterranean Regional Director at the EB meeting.

While the price tag of the aid to Gaza that would be delivered as part of the resolution approved Thursday is steep, it’s only the beginning. WHO has estimated that it will cost some $3 billion over the next 18 months to begin rebuilding Gaza’s shattered health system. Costs could be as high as $1o billion over several years.

To date, only 18 out of 35 hospitals are functioning, only partially, along with about one-third of primary health care centres and 11 field hospitals, Altaf Musani, WHO’s director of Health Emergencies interventions, told the EB assembly. 

“Some 12,000 to 14,000 critically ill patients, including 2500 children, require immediate medical evacuation”, he added, noting that WHO continued to encounter “significant access challenges” to medical evacuations – even after the opening of Gaza’s Rafah crossing into Egypt. 

“Some 12,000 to 14,000 critically ill patients, including 2500 children require immediate medical evacuation despite significant access challenges since the opening of Rafah.

“The suffering in the strip is beyond comprehension,” Hanan Al-Balkhy, director of the Eastern Mediterranean Regional office, told the EB. “Tens of thousands of people have died, and around 30,000 have life changing injuries. The health system is in ruins. Malnutrition is rising, the risk of famine persists. Families are returning to devastated neighborhoods, although no health facilities remain intact despite unimaginable challenges,” she added.  An estimated 85% of Gaza’s two million people have been displaced by the conflict.

“We urgently need systematic and sustained access to the population across Gaza, and we need an end to restrictions on the entry of essential supplies,” Balkhy said. “Equally critical is protecting civilians and healthcare workers, expediting the evacuation of patients in urgent need of specialised care and strengthening the referral system to [hospitals in] East Jerusalem and the West Bank.”

Tedros appeals for faster pace of medical evacuations

Sick and injured Palestinians leave Gaza for an airlift to the United Arab Emirates via Israel’s Ramon airfield in July 2024 – but Israel has allowed only a few hundred people to evacuate the enclave via it’s land borders or airports.

Meanwhile, the WHO DG appealed to Israel to enable a faster pace of medical evacuations to third countries through Israeli, as well as Egypt’s crossing points.

Between 1 and 3 February, only 105 sick and injured patients were evacuated via Egypt, a drop in the bucket of the need.  Israeli approval of transfers over its land borders have meanwhile moved at snails’ pace, even for infants with deadly genetic conditions.

In his remarks, Tedros also urged a reconsideration of Israel’s decision to shutter the Jerusalem operations of the UN Relief Works Agency (UNRWA), which has provided specialised health and education services to Palestinians since 1948. 

Israel took the move following reports that UNRWA employees had been involved in the bloody Hamas attacks on Israeli communities on 7 October. An UNRWA investigation subsequently determined that nine UNRWA workers, out of the thousands employed by the organisation, may have been involved in the attacks.   

“All of the UN agencies combined cannot replace UNRWA,” Tedros declares, and anyone who says so, it’s not true.   

Tedros also rebutted some of the member state comments about bias in the WHO report on the situation in Gaza – although he did not refer to the allegations about Hamas militarisation of health facilities. 

But Tedros noted that the number of Israeli deaths during the war, (about 1,539) had been cited alongside the death toll for Gaza Palestinians, reported at more than 45,000 casualties. 

And the report makes reference to the 251 hostages originally taken by Hamas, of which there were still 107 in Hamas captivity as of 31 August when the report was drafted, he said.  Following the hostage releases seen during the cease-fire, some 76 Israelis and foreigners remain in Hamas captivity, although only about 42 are still believed to be alive. 

“So I just wanted to remind the representatives that this is a balanced report,” he said.

Image Credits: @nabilajamal, WHO.

Dr Yap Boum, Africa CDC’s deputy incident manager.

Parties embroiled in the conflict around Goma in the eastern Democratic Republic of the Congo (DRC) are discussing a humanitarian corridor to enable supplies and staff to address the mpox outbreak, according to Dr Yap Boum, Africa CDC’s deputy incident manager for Africa.  Last week, the M-23 militia, reportedly supported by Rwanda, took over the strategically positioned city on the shores of Lake Kivu from DRC government forces, overwhelming hospitals with injuries, and sending hundreds of thousands of displaced people living in the vicinity into flight once again.  

Boum told the Africa CDC’s weekly briefing that 128 mpox patients had fled from health facilities in Goma during fighting and could be spreading the infectious disease in the community. Africa CDC is also concerned that incorrect handing of dead bodies may also result in disease.

Discussion is ongoing with the government and partners, on how to implement a humanitarian corridor so that the medical countermeasures can be sent to North Kivu, as well as the human resources to ensure doctors, infection control specialists and laboratory technicians are on site.

The DRC this week reported a decrease in the number of cases, but this may “because we no longer have data and testing being done in North Kivu”, said Boum. The National Institute for Biomedical Research (INRB) laboratory in Goma has stopped processing tests since the conflict began.

In the past week, there were 2,635 new cases (878 confirmed), and mpox 28 deaths. 

“The DRC, Uganda and Zambia are the countries where we still see an increased number of cases, and they currently represent 97.5% of all cases. “

In Burundi, we are now seeing a decrease in the number of suspected case, but also in the number of confirmed cases, which is a good news, knowing that the testing coverage is quite high.

Tanzania continues to battle with a Marburg outbreak, with one more person confirmed with the disease.

Meanwhile, Uganda continues to battle an Ebola outbreak with 10 suspected cases (only two confirmed).

Uganda's Ministry of Health, WHO and partners launch the first ever vaccine trial for Ebola from the Sudan species of the virus.
Uganda’s Ministry of Health, WHO and partners launched a first ever vaccine trial for Ebola from the Sudan species of the virus this week.

Responding to health emergencies is at the heart of the work of the World Health Organization (WHO), which assisted almost 90 million people with humanitarian health support in the first nine months of 2024.

But the loss of United States funding, which has included the immediate freezing of funds already committed, means that this essential work will need to be cut back by as much as 25%.

There were 45 graded emergencies affecting 87 countries, and 18 required major support, according to the WHO Director General’s report on health emergencies to the Executive Board.

Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme, joined the EB on Zoom from Uganda where he is assisting the country to respond to an outbreak of Ebola.

“The immediate response here in WHO was to use our Emergency Response Framework, to realign the functions at the country office to deploy an incident manager and core staff from the Afro rapid response mechanism, to send specialist expertise in from both the regional and from the HQ level,” explained Ryan.

“Dr Tedros immediately issued contingency funds of $1 million to support the response, and that allowed that response to start up very quickly,” added Ryan, who explained that the WHO has worked with the Ugandan government for the past year to prepare for such an emergency.

“It took less than one day to sequence the virus, and it was immediately published for the global community. An incredible achievement by public health laboratories here in Uganda,” added Ryan.

Uganda’s Ministry of Health, WHO and other partners also launched the first-ever clinical efficacy trial for a vaccine for Ebola Sudan virus in that country this week.

Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme, joined the EB on Zoom from Uganda

Immediate impact of US aid cut

But the US funds around 20% of the WHO’s emergency appeal and acute response side, and about 25% of its core programme, Scott Pendergast, Director for Strategy, Financing, and Partnerships for the WHO Health Emergencies Programme, told the EB.

“We’re also having to deal with the immediate withdrawal, the instruction of the US to stop any spending against the existing awards we have. This is putting a major challenge on our teams on the ground in terms of how to reduce operations or meet the obligations that we have now that we no longer have access to that financing,” Pendergast added.

The WHO’s health emergency appeal is only 65% funded for 2025, while there is only $22 million in the contingency fund for rapid action in health emergencies, he explained.

“More than 80% of the financing for the emergency programme is going to the country level,” said Pendergast. But the department was working with regions on the “new reality” of potentially having to cut a quarter of its budget and a report on how this will be done will be available next month.

Scott Pendergast (left), Director for Strategy, Financing, and Partnerships for the WHO Health Emergencies Programme

Switzerland noted that some emergency relief programmes “are currently under immediate operational risk”. 

“For example, numerous CDC deployments from the United States no longer appeared at work since last Monday. These are specialized experts who played key roles in functions such as immunization, surveillance and the preparation against the pandemics in many countries. Contracts for contractors and suppliers are frozen. Therefore expertise is already starting to leave the organization and offices are starting to cut back on staff.” 

Budget cut comes amid growing need

The loss of US funding comes at a time of increased health emergencies, fuelled by rising conflict and climate-related health emergencies. In the African Region alone, 56% of all public health emergencies between 2001 and 2021 were climate-related.

Over several hours on Wednesday, member states at the EB expressed gratitude to WHO teams for assistance in a wide variety of situations.

Lebanon, speaking for the Eastern Mediterranean region, described 2024 as being “marked by violence, death, disease, destruction and displacement”. 

“It is sobering to note that over one-third of all health emergencies responded to by WHO last year occurred in our region. Outbreaks of measles, cholera, dengue and other diseases escalated, fueled by conflict, fragility, disrupted surveillance and control systems and effects of climate change,” Lebanon noted.

“The most devastating humanitarian crisis unfolded in the occupied Palestinian territory,  Sudan and Lebanon.

“Wars and armed conflicts do not only shatter buildings and destroy lives. They can leave people mentally and emotionally scarred, sometimes for a lifetime.”

Togo, speaking for the Africa region, described how the WHO African region has “actively intervened in 17 emergencies, with 14 extreme emergencies, four of which were at level three, requiring the highest level of support, and three prolonged emergencies”.

WHO assistance included training health workers, establishing health emergency operations centres, and providing medicines, vaccines and diagnostics “in considerable quantities to help countries in crisis”.

Attacks on health workers

WHO officials survey the destruction around Northern Gaza hospitals in mission over weekend of 2-3 March 2024.

“By 30 September 2024, 1080 attacks on healthcare workers and facilities had been reported through the WHO surveillance system, in 13 countries/ territories – resulting in 554 deaths and 923 injuries among staff and patients,” according to the DG’s report.

The occupied Palestinian territory, including east Jerusalem, accounted for the highest number of incidents (505), followed by Ukraine (320).

 “Attacks on health care have become an unacceptable norm in these conflicts,” Lebanon noted.

“These assaults undermine the very essence of humanity. In Gaza, aid workers describe the war as the most brutal and severe crisis they have ever faced. In Sudan, violence has displaced more people than any recent emergency. Over half of the population now needs urgent humanitarian assistance.”

Questions for Secretariat

Switzerland asked how the WHO Secretariat can “protect the critical work in all these areas, as well as other essential work”, but pledged to support the WHO,

Meanwhile, Germany urged WHO and member states to “do whatever it takes to secure flexible and sustainable funding for these now severely underfunded functions”.

“We would also appreciate more information by the Secretariat on the immediate measures taken by who to address this gap,” said Germany.

“Let us not forget that it is in our collective and national interest to maintain and prioritize work and health emergencies. Filling funding gaps and funding the initial response is particularly crucial, and the contingency fund for emergencies has an important role to play,” added Germany, urging all countries to increase their commitments to the fund. 

While Brazil acknowledged the WHO’s efforts in strengthening surveillance preparedness and response, it urged the WHO to “fulfil the estimated $55.5 million needed to bolster global response capabilities”.

Meanwhile, Namibia urged the WHO Secretariat “to collaborate with relevant stakeholders, including the World Bank and IMF, to support developing countries in addressing their international debt burdens, which have colonial underpinnings.

“Facilitating debt restructuring reforms is crucial for improving the fiscal space of African nations, enabling them to allocate more resources toward domestic health investments. 

By doing so, we believe the Secretariat can help build a more robust financial foundation for member states, facilitating improved health outcomes and stronger resilience against future health emergencies.”

Dr Tedros addresses the EB

In response, Director General Dr Tedros Adhanom Ghebreyesus told member states that the WHO’s operational arm, “will stay and will be very important”.

“There is no way that we can leave the community behind and go, and in some places, our colleagues paid the ultimate sacrifice. So I hope you will understand that, when we talk about financing, prioritization and balancing, it’s not just norms and standards. We have the operational arm that we develop, and that cannot be starved because the people we serve need it.”

“We need to continue to mobilize resources, and we need to also be careful about expenditure, meaning we need to do efficiency gains, meaning, tighten our belts,” added Tedros.

He appealed to member states: “We have the assessed contribution. If you agree on that 20% that means a lot. We have the investment round. For countries who haven’t contributed to that, if you can contribute, that will help us in balancing.

“And we have the WHO Foundation. If your private sectors could be convinced, if you can convince them, and then we have some resources through that. I think that will really keep the balance.”

Image Credits: WHO, WHO .

Ailan Li, WHO’s Assistant Director-General for Universal Health Coverage and Healthier Populations
Ailan Li, WHO’s Assistant Director-General for Universal Health Coverage and Healthier Populations

Social isolation as a driver of poor mental health was discussed for the first time at the World Health Organization’s (WHO) executive board meeting (EB) on Wednesday.

Several member states called for WHO guidance on addressing loneliness and social isolation, and for measures to combat these to be included in the body’s Comprehensive Mental Health Action Plan.

“This is a historical discussion as a social connection is being addressed at this executive board for the first time,” said Ailan Li, WHO’s Assistant Director-General for Universal Health Coverage and Healthier Populations.

“We are working to strengthen data and metrics on social isolation. The available evidence already shows the impacts on health and also the economy,” said Li, adding that more evidence was still needed.

“We are continuing to work together to expand the evidence base. This will allow us to develop metrics to monitor our progress while exercising our financial wisdom and efficiency as required by the current difficult situation.”

The WHO Commission and technical advisory group on social connection will launch its report later in the year.

This “will provide more evidence and recommendations for action, including developing evidence-based policy, implementing tailored country support based on the culture and social context and promoting partnerships,” said Li.

The WHO Director-General’s report on mental health and social connection maps the extent of the problem, noting that a quarter of older people and at least one in six adolescents are socially isolated or lonely.

“Lack of social connection poses serious health risks, and is associated with a 14–32% higher risk of mortality, akin to other known risk factors such as smoking, excessive alcohol consumption, physical inactivity, obesity and air pollution,” notes the report.

“It has a serious impact on physical health, increasing the risk of stroke by 32% and cardiovascular disease by 29%… and is linked to higher rates of anxiety, depression and suicide. Moreover, 5% of global dementia risk is attributable to social isolation.”

NCD High-Level Meeting

Much of the discussion at the EB on Wednesday focused on non-communicable diseases (NCDs) in preparation for the United Nations High-Level Meeting (HLM) on NCDs in September.

This is the fourth HLM on the issue yet “underinvestment in health services has created a significant gap in care and support for people affected by NCDs and mental health conditions,” according to a report from the WHO Director-General to the EB.

“Targeted investments are needed to reorient health systems towards primary health care as the foundation for universal health coverage and health security, with a focus on NCDs and mental health,” it adds.

The WHO has “launched multistakeholder engagement activities, including global and regional consultations, briefings and other processes” to encourage input from stakeholders in preparation for the HLM.

“The fourth high-level meeting of the General Assembly on the prevention and control of NCDs provides an opportunity to adopt a new, ambitious and achievable political declaration on NCDs, based on evidence and grounded in human rights, to accelerate the global NCD response beyond 2025,” the report notes.

During the discussion, there was significant support for resolutions on a dedicated cervical cancer elimination day (proposed by South Africa) and kidney health (from Guatemala).

However, in view of the funding crunch caused by the withdrawal of the United States, the EB is considering pausing new resolutions pending their costing. A report from the WHO to the EB notes on Tuesday notes that the board is discussing 19 new resolutions that all have funding implications.

Germany has been particularly insistent the financial implications of every new action needs to be worked out but several member states have not let that dampen their enthusiasm for new activities.

WHO Executive Board in session on Wednesday just as Argentina’s decision to withdraw was announced.

Argentina’s maverick President, Javier Milei, declared Wednesday that he would follow the United States in withdrawing from the World Health Organization,citing “profound differences in health management, especially due to the pandemic, which led us to the longest confinement in the history of humanity.”

The announcement came as another blow to the morale of the Geneva-based specialised UN agency, which has enjoyed broad support from member states of all political shades since its founding in 1948. It has, however, less financial consequences insofar as Argentina’s assessed contribution to WHO is comparatively small, amounting to only $8 million as for the 2024-25 biennium, as compared to some nearly $1 billion paid by the US, including over $260 million in assessed contributions.

The announcement came as WHO’s Executive Board was meeting in Geneva to debate the agenda for the May World Health Assembly. 

Total USA contributions to WHO for the 2024-25 two year period.
Argentina’s total contribution to WHO for the two-year 2024-25 budget period.

Cost impacts slow approval of new WHO initiatives

The financial fallout of the US withdrawal was evident in the proceedings where decisions to move forward with several new member state initiatives – addressing issues ranging from rare diseases to strengthening health finance – were paused until their costs could be more fully assessed. 

WHO’s leadership, meanwhile, laid out three options that it said the EB could consider in advancing new member state resolutions and decisions to the WHA: 

“According to the option chosen,” stated an administration memo, “the Board could mandate the Programme, Budget and Administration Committee to recommend that Health Assembly:

(1) adopt the resolutions as proposed and ask the Secretariat to de-prioritize other

activities to allow for implementation of resolutions within the defined budget envelope;

(2) postpone adoption of all resolutions by one year to 2026; or (3) approve the resolutions but with a provision that their implementation, other than

advocacy for the topic at minimal costs, should be postponed until the review of the programme budget proposed for 2026”.

The memo included a massive table of cost implications for every new decision being considered by the EB – more than two dozen in all. 

That includes projected costs as low as $9 million for stepped up advocacy and action on rare diseases to costs of $79.6 million for implementing a draft decision on strengthening global health financing by working with countries to help them devise better public health financial and insurance schemes.  

Other big ticket items, not yet debated, include a new draft global strategy on climate change and health ($161 million); an action plan for the global health care workforce ($125 million); and traditional medicines strategy ($119 million). More modest investments would be required for items like new WHO guidelines to governments on combating loneliness in mental health care ($38.77);  accelerating guinea worm eradication ($35 million); and a road map for air pollution response ($34 million); as well as much more modest initiatives on prevention and care of sensory impairments ($18 million); and child nutrition planning ($3.38 million). 

Germany urges caution

German delegate urges caution in green-lighting any new resolutions until priorities can be aligned with a shrinking budget.

Against the gloomy financial outlook, member states such as Germany urged “caution” in the EB’s decisions to advance new WHA resolutions for which the budget might not exist to cover the promised work. 

“We would caution against deciding on resolutions before the budgetary implications and the process of prioritisation has been clarified and decided,” said Germany, during a discussion on Universal Health Coverage (UHC) that dominated the morning EB session.

She added that Germany regards four priorities as central to achieving UHC.

“First, essential health services must be accessible to all, especially the most vulnerable; a well- functioning primary health care system is the foundation of UHC. Second, we must make universal access to sexual and reproductive health and rights a reality,” she said.

“We must expand health financing and social protection systems based on solidarity and equity. This is key to reducing out of pocket payments and ensuring access to health services. Fourth, we must establish efficient and sustainable financing mechanisms for UHC and social protection, primarily through domestic resources.”

Rare diseases resolution gets widespread endorsement 

Luxembourg, one of the co-sponsors of the rare diseases resolution considered at Wednesdays Executive Board meeting

Despite the cost concerns, a new resolution aimed at promoting greater inclusion of rare diseases in health care services received widespread endorsement, with some 21 countries co-sponsoring the initiative, ranging from France, Spain and Luxembourg to China, Brazil, Somalia and island states like Vanuatu.  

“Somalia faces challenges in addressing rare diseases, which includes limited awareness and diagnostic capacity with no specialised centres for rare diseases,” said the nation’s EB delegate “Out of pocket expenditures place a disproportionate burden on affected families. Workforce shortages hinder the integration of her disease services into primary health care.

“But there is opportunity to overcome these challenges, notably the growing political commitment to universal health coverage and health system strengthening and the potential for partnering with international organisations and research institutions to get the capacity and share knowledge. 

“Somalia is committed to integrate rare disease screening and management into essential package of health services, leveraging existing maternal and child health programs, training health workers to recognise rare diseases and refer cases to higher level facilities.”

Resolution calls for WHO Global Action Plan

Along with urging efforts by countries, the draft resolution would commit WHO to map existing policies and develop a draft plan of action on diseases that range from rare forms of cancer to genetic disabilities, and affect millions of people collectively – but too few individually to receive the kind of private sector investments and public sector attention that other leading infectious diseases and NCDs receive. 

In fact, some 300 million people worldwide are living with a rare disease, noted Rare Diseases International, the leading civil society advocacy group, along with the International Alliance of Patients Organizations and other NGOs.

“Yet despite the growing recognition of their importance, millions of families continue to face barriers to timely diagnosis, treatment and care, hindering their ability to lead dignified and fulfilling lives. The WHO estimates that there are more than 7000 rare diseases defined and this number is steadily increasing. More than 80% of rare diseases are of genetic origin. 70% start in childhood, and about 95% lack treatments.  The average time for an accurate diagnosis is four to eight years,” she added, “and about 30% of the affected children died before five years of age.” 

A WHO global action plan would provide member states with a strategic framework to integrate rare diseases into their national health priorities, she added, as well as fostering collaborations; supporting more innovation in diagnostics and therapies; and strengthening data collection.

While the associated costs are only about $9 million, one civil society group, Knowledge Ecology International, said that one affordable solution “in a time of severe fiscal challenges” could include low-cost surveys of member states, regarding the publication of “prices, sales revenue, costs of trials and subsidies related to R&D” for medical products related to rare diseases. 

Taiwan also surfaces as issue

US delegate makes a rare statement on Taiwan at the WHO Executive, on Wednesday.

Throughout the day, the issue of Taiwan’s exclusion from the WHA and EB debates surfaced intermittently with China, Pakistan and Belarus, amongst others, punctuating their comments on universal health coverage with political references to the “One China” policy that should, they argued, exclude Taiwan.

“With reference to the participation of Taiwan, that is to say, the Republic of China, in WHO and its bodies as an observer, we strongly abide by the one China principle. This issue is one that we think should guide all that we do. We should act in accordance with relevant WHO and resolutions that make it clear that the People’s Republic of China has the right to determine the membership.”  

Meanwhile, in a rare statement Wednesday afternoon, a member of the US delegation, which had been silently observing proceedings until then, spoke on behalf of re-admitting Taiwan to the assembly as an observer, the status it held until 2016.  

“We need the engagement of all members of the global community to help reach this shared aim,” said the US delegate to the EB, during a discussion of mental health strategies.  “To that end, we urge WHO member states to support Taiwan’s meaningful participation in WHO and its work, and to call for the resumption of Taiwan’s participation as an observer to the WHO.”

Image Credits: WHO Budget portal, WHO Budget Portal , Thiru Balasubramaniam .

WHO's New Leadership Team

China has signalled it could oppose a planned increase in national membership fees to the World Health Organization (WHO) aimed at increasing the reliability of its funding, threatening to deepen the financial crisis at the UN health agency as it faces the loss of its largest donor, the United States.

The proposed 20% increase in assessed fees for the budget year 2026-27 was debated at WHO’s Executive Board meeting on Tuesday – despite being agreed too, in principle, by member states in 2022 when the World Health Assembly (WHA) passed a resolution to increase the agency’s funding that comes from member states to half by 2030. 

The proposed  increase in member states’ national contributions is not an increase to WHO’s budget as an agency. But the shift would give WHO greater predicability in budget planning and control over its priorities. Right now, only about 22% of WHO’s budget is financed by fixed, member state fees, while the rest is reliant upon voluntary donations from member states and large charities.  

“China does not have clear information on the specific amount of assessed contribution increase or how it will be calculated for the coming year,” China’s representative told the EB, expressing the country’s unease with the plan, which was the focus of extensive debate in 2022 and 2023 before being passed by the WHA.

“It is difficult for any country to agree to such a plan under such opacity.”

The WHO aims to gradually ramp up fixed state contributions as a proportion of its overall budget, to reach the 50% mark for 2030-2031. While states in 2023 approved the first 20% increase for 2024-2025, the next stepwise hike, of another 20%, would require WHA approval this May to kick in for the next 2026-27  budget biennium.

The Chinese delegation also questioned whether the proposed 20% increase in national contributions was necessary, pressing for additional options as low as 5%.

“China believes that the secretariat, as of now, should further study the feasibility of the 20% increase in assessed contributions and avoid rushing into any decisions,” China said. “Member states need more time to discuss and China hopes the secretariat will present multiple scenarios with varying levels of increase, allowing member states to discuss and make a decision.”

The calculations underlying the step-wise increase still include the US share, as Washington remains a legal WHO member until its withdrawal takes effect in early 2026. This means that the true impact of the US exit has yet to be factored in, and without the US, an even higher step wise increase would likely be required to reach the 50% mark by 2030.

Proposal to slash next biennial budget

WHO on Monday revised down its upcoming biennial budget by $400 million in the wake of the US exit.

Chinese opposition to the plan comes at a time of unprecedented budget crunch at WHO.

In line with the current budget uncertainty, WHO’s administration also has proposed to cut its 2026-2028 budget to $4.9 billion, slashing $400 million from its planned spending and acknowledging it could not be “business as usual” following the US exit.  That proposal is contained in the budget documents before the EB, and will presumably be approved by the board later this week. 

The agency has also imposed an immediate hiring freeze and shifted to virtual meetings while limiting technical support to only the most critical missions. Behind closed doors, WHO finance director George Kyriacou warned the organization would face “a hand-to-mouth type situation” in early 2026 at current spending rates, according to recordings obtained by The Associated Press.

The US, WHO’s largest donor, has yet to pay its full fees for 2024-2025, WHO has also said. WHO’s attempts to reclaim these dues have been largely rejected, pushing the agency into deficit even before the formal withdrawal takes effect. The US was set to provide $900 million in total funding for 2024-2025, including both assessed fees and voluntary funding.

Under budget, behind schedule

WHO Director General Dr Tedros Adhanom Ghebreyesus addresses the opening day of the WHO Executive Board’s 156th session.

The drive to boost assessed member state contributions aims to free WHO from its current constraints, where over 80% of its funding is earmarked for specific programs dictated by donor countries and organizations.

“When it is within the purview of the Secretariat, we do the right thing to make sure that funding is equitably allocated across the organization. However, when it is highly earmarked, we are actually handcuffed,” Raul Thomas, WHO Assistant Director General of Business, told the board.

But WHO Director-General Dr Tedros Adhanom Ghebreyesus warned the board that the plan to ensure that the agency can meet 50% of its budget goals by 2030-31 with assessed member state contributions is already faltering. At the current pace – assuming that the contested 20% 2026-27 increase is finally approved – the target won’t be met until 2032-33, he said.

Proposed member state fee increase timeline published by WHO on Monday.

“That [timeline] was what was agreed by our member states, by you,” Tedros told the board. “If the 2026-2027 20% is not agreed, that will push further the target to be reached by 2034-2035, almost 12 years after the agreement. Compared to the earliest target you set, it will be delayed by six years.”

The flexibility crisis is acute – just 4.1% of voluntary donations in 2022-2023, worth $320 million, came without strings attached. Tedros suggested the organization might need to seek short-term solutions, including renegotiating with existing donors to loosen restrictions on their funding.

His warnings came as several middle-income nations joined China in expressing reservations about the planned increases, despite supporting the principle of sustainable financing for WHO.

“We do need to express our concern about the burden of time in which this contribution increases going ahead that countries are facing economic difficulties, inflationary pressures and the domestic context mean that we need to take into we will struggle to deal with this increase,” Chile’s representative said.

Peru, while backing the broader goal of increasing membership fees to 50% of WHO’s budget, emphasized that the plan must “take into account the economic reality and the fiscal reality in our countries.”

China will not fill US vacuum

China donated 239 million vaccines during the COVID-19 pandemic. Just seven million went through the WHO-led COVAX financing facility.

China’s resistance to increased WHO funding indicates it won’t fill the financial vacuum left by the U.S. withdrawal, countering, at least initially, some of the speculation that the US departure would boost Chinese influence over the global health body.

Instead, China’s approach reflects its preferred model of health diplomacy: direct bilateral engagement rather than working through multilateral institutions. This pattern became evident during the COVID-19 pandemic when China largely bypassed COVAX, the global vaccine-sharing initiative designed to ensure equitable distribution of COVID-19 vaccines, especially to lower-income countries.

Of the 239 million vaccine doses China provided globally, only about seven million – roughly 3% – went through COVAX. China instead favoured country-to-country arrangements, a stark contrast to the US and European Union, which donated 682 million and 265 million doses respectively through the COVAX mechanism.

EU stands alone 

Top donors during the WHO’s recent investment round.

As the world’s two largest economies step back from WHO, the financial burden is shifting to European states – and philanthropies.

WHO’s recent investment rounds have so far secured $1.7 billion in new commitments toward its $11.15 billion budget for 2025-2028 – less than half its target. European nations provided the overwhelming majority of new funding, accounting for 77.3% ($1.27 billion) raised in the blitz. 

Brazil and Saudi Arabia, despite co-hosting two different fundraising efforts, made no pledges themselves, while China contributed just $20 million. The US, constrained by Trump’s executive order, made no new commitments. Qatar made the only contribution from the Middle East region, providing $4 million – 0.2% of the total.

“We remain strongly concerned about structural funding challenges, in particular the unhealthy dependency on a very few donors,” Germany’s representative said at the board meeting. “The announced withdrawal of the United States raises serious financial concerns and will affect core and emergency response funding.”

“We wonder why one region did not contribute financially,” he added, in an apparent reference to the complete absence of wealthy Gulf states from the funding commitments. 

WHO’s revised budget of $2.45 billion a year, or $4.9 billion for the entire 2026-2028 ‘biennium’, divided among its 194 member states, would amount to approximately $12.6 million per country – a fraction of what major economies spend on healthcare.

“The EU wants to stress the relevance of continuing efforts to broaden the funding base of WHO now more than ever,” the EU representative told the board – a diplomatic call for greater contributions from China, Middle Eastern oil-producing states, emerging economies like Brazil, India and other wealthy nations.

“Now more than ever, we should be aware of the vulnerability for the work of who to be dependent on the small number of donors.”

Image Credits: Guilhem Vellut, AidData.