While babies and children are being vaccinated againts malaria, few options exist for pregnant women.

The first pregnant woman infected with malaria has been recruited into a Phase 3 trial in Mali that is evaluating the efficacy and safety of antimalarial drugs during the first trimester of pregnancy.

Pregnant women are more susceptible to malaria as they have reduced immunity, and malaria poses serious risks to both mothers and babies.

Malaria in pregnancy is responsible for 20% of all stillbirths and 11% of all newborn deaths in sub‑Saharan Africa, as well as 10,000 maternal deaths globally each year. It can also cause severe maternal anaemia, miscarriage, stillbirth, preterm delivery and low birthweight. 

Some 12.4 million pregnant women in sub-Saharan Africa were exposed to malaria in in 2023, according to the World Health Organization (WHO), yet treatment options for pregnant women, particularly in the first trimester, are extremely limited.

The SAFIRE consortium aims to address this research gap through this trial, which will also be run in Burkina Faso and Kenya.

“To advance the malaria elimination agenda in a meaningful and sustainable manner, properly tolerated and effective options must be made available to everyone at risk of malaria, including pregnant women,” says Myriam El Gaaloul, SAFIRE co-principal investigator. 

‘More equitable’

“Enrolling the first patient into the SAFIRE trial is a decisive step forward that will help pave the way towards a more just and equitable future in the fight against this disease,” added El Gaaloul, who heads the Malaria in Mothers and Babies (MiMBa) strategy at Medicines for Malaria Venture (MMV).

The trial is recruiting women in the first trimester of pregnancy with a malaria who will be treated with one of the three artemisinin-based combination therapies (ACTs).

The trial aims to compare the safety and efficacy of pyronaridine-artesunate (PA) and dihydroartemisinin-piperaquine (DP), both approved for the general population but not yet in early pregnancy, to artemether-lumefantrine (AL), which is approved By the WHO for use in the first trimester.

The women will receive follow-up care throughout their pregnancy until delivery, while their newborns will be followed for up to six months after birth.

Fill ethical gap

“The SAFIRE trial will, on one hand, fill the ethical gap of excluding pregnant women from clinical trials, and on the other hand, provide the necessary information to increase therapeutic options in the guidelines for the management of malaria in all stages of pregnancy, thus contributing to reducing the unacceptable burden of malaria among pregnant women,” says Prof Kassoum Kayentao of The Université des Sciences, des Techniques et des Technologies de Bamako in Mali, SAFIRE’s co-principal investigator.

Before recruiting the women, the consortium conducted formative research to ensure recruitment strategies and participant materials were culturally appropriate and reflected the realities of local communities. 

“The formative research we conducted as part of community engagement was key in understanding socio-cultural beliefs and barriers that could hinder the recruitment and retention of participants,” said Dr Innocent Valea, SAFIRE co-principal investigator from The Institut de Recherche en Sciences de la Santé Burkina Faso.

“It allows us to leverage facilitators and co-design appropriate messages targeted at pregnant women and communities. Moving forward, we remain committed to maintaining this engagement to foster trust and successful collaboration.”

Image Credits: WHO.

A pregnant woman gets examined by a nurse.

Women who lose 300ml of blood after giving birth should be diagnosed with postpartum haemorrhage (PPH) according to new guidelines published by the World Health Organization (WHO), the International Federation of Gynaecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM).

In the past, PPH has only been diagnosed if a woman loses 500ml of blood, but this has often meant that the diagnosis is too late for adequate interventions.

Doctors and midwives are now advised to monitor women closely after birth using a calibrated drape, a simple device that collects and accurately quantifies lost blood.

As soon as PPH is diagnosed, the guidelines recommend the immediate deployment of the MOTIVE bundle. This stands for: Massage of the uterus; Oxytocic drugs to stimulate contractions; Tranexamic acid (TXA) to reduce bleeding; Intravenous fluids; Vaginal and genital tract examination; and Escalation of care if the bleeding persists.

PPH affects millions of women annually and is one of the leading causes of maternal mortality, causing nearly 45,000 deaths. 

Even when not fatal, it can cause lifelong physical and mental health impacts, from major organ damage to hysterectomies, anxiety and trauma.  

“Postpartum haemorrhage is the most dangerous childbirth complication since it can escalate with such alarming speed. While it is not always predictable, deaths are preventable with the right care,” said Dr Jeremy Farrar, WHO Assistant Director-General. 

“These guidelines are designed to maximise impact where the burden is highest and resources are most limited – helping ensure more women survive childbirth and can return home safely to their families.”

Fast, feasible and effective

Motivation for the change comes from a large study published in The Lancet last week, which analysed 12 datasets involving 312,151 women.

The study found that blood loss of 300ml offered the “preferred sensitivity threshold”, particularly when combined with “any abnormal haemodynamic sign”, such as increased pulse rate or a drop in blood pressure.

In rare cases where bleeding continues, the guidelines also recommend surgery or blood transfusions to safely stabilise the woman.

“Women affected by PPH need care that is fast, feasible, effective and drives progress towards eliminating PPH-related deaths,” said FIGO President Professor Anne-Beatrice Kihara.

The guidelines were launched at the president’s session at FIGO’s world congress in Cape Town, South Africa, on Sunday 5 October, which was also declared as the first World Postpartum Haemorrage Day.

“These guidelines take a proactive approach of readiness, recognition and response. They are designed to ensure real-world impact – empowering health workers to deliver the right care, at the right time, and in a wide range of contexts.”

The guidelines also stress good antenatal and postnatal care to mitigate critical risk factors such as anaemia, which increases the likelihood of PPH and worsens outcomes if it occurs. Recommendations for anaemic mothers include daily oral iron and folate during pregnancy and intravenous iron transfusions when rapid correction is needed, including after PPH, or, if oral therapy fails.

The guidance also discourages routine episiotomies to reduce the likelihood of trauma and severe bleeding after birth.

During the third stage of labour, the guidelines recommend administering medicine to support uterine contraction, particularly oxytocin or carbetocin. 

If intravenous options are not available and the cold chain is unreliable, misoprostol may be used as a last resort.

More evidence and protocols

“Midwives know first-hand how quickly postpartum haemorrhage can escalate and cost lives,” said Professor Jacqueline Dunkley-Bent, ICM’s Chief Midwife. 

“These guidelines are a game-changer. But to end preventable deaths from PPH, we need more than evidence and protocols. We call on governments, health systems, donors, and partners to step up, adopt these recommendations, adopt them quickly, and invest in midwives and maternal care so that postpartum haemorrhage becomes a tragedy of the past.”

According to a commentary in The Lancet, the new guidelines are “an equity intervention” and they align “the prevention–detection–treatment continuum with enablers (eg, supportive infrastructure)” and also state “what not to do when skills or supplies are scarce”.

“The guidelines recognise where women give birth, who is present, and what commodities are reliably available, and they reduce ambiguity that so often paralyses action in the first minutes of a dire emergency.”

Image Credits: Elizabeth Poll/MMV.

From climate shocks to protracted conflicts and shrinking budgets, today’s “metacrisis” is reshaping the future of child health.

In this recent episode of Global Health Matters, host Garry Aslanyan speaks with Landry Dongmo Tsague, director of the Centre for Primary Health Care at Africa CDC, and Debra Jackson, Takeda Chair in Global Child Health at the London School of Hygiene & Tropical Medicine, about what it will take for children not just to survive, but to thrive.

Both guests note the real gains of the last three decades.

Aslanyan points to under-five mortality falling by over 60% since 1990, while Tsague stresses that “we recorded unprecedented gains over the past two decades,” driven by investments in community-based primary care and immunisation reaching underserved populations. But those advances are fragile.

“Since COVID-19 … there’s now serious concern that these gains will be lost,” Jackson says, citing rising temperatures, conflict and the fact that “as of last year, 2024, we reached or exceeded the 1.5-degree target.”

Conflict zones, from the Sahel to Sudan, put children at immediate risk of malnutrition, disease and interrupted services.

“Without peace, there is no health,” Tsague underscores.

He also flags steep funding declines and outlines emerging solutions endorsed by African leaders: boosting domestic budgets, tapping innovative financing such as levies and diaspora remittances, and mobilising blended finance for primary care infrastructure and local manufacturing.

What works on the ground?

Jackson argues for integrated services and better data: “Information systems are going to be critical if we’re going to address this.”

Community engagement is central; in Zimbabwe, mothers co-created a heat early-warning approach and became local advocates.

Looking ahead, Tsague points to youth as a game-changer: “I can’t be optimistic without highlighting the strength that the continent has in its young people,” including plans for 2 million community health workers by 2030.

Watch the full episode: 

Image Credits: Global Health Matters.

In the latest episode of Trailblazers with Garry, host Dr. Garry Aslanyan sits down with Professor Adalsteinn (Steini) Brown, dean of the Dalla Lana School of Public Health at the University of Toronto.

Together, they explore how public health education must evolve to meet the challenges of a rapidly changing world. From integrating data and evidence into policymaking to designing learning health systems that continuously improve, Brown shares insights from his career spanning academia, government, and industry.

He also reflects on the skills and values the next generation of leaders will need to drive meaningful impact in global health.

Listen to the full episode:

 

Image Credits: "Trailblazers with Garry".

An infant surrounded by malaria bednets. Malaria bed nets are still not accessible enough in Africa’s most endemic countries, leading to the needless deaths of hundreds of thousands of people, mainly children and pregnant women, from the parasitic disease.

The President of the Republic of Botswana and Chair of the African Leaders Malaria Alliance (ALMA), writes about the urgency of mobilising funding to defend the gains and further progress in the fight against malaria. 

Despite decades of progress, we are not on track to defeat malaria in Africa. Without more resolve, innovation, financing, and partnerships, we risk sliding back to the days when malaria killed over a million children each year. 

Malaria remains one of Africa’s leading killers of children. This cannot be our legacy. 

The fight against this disease is threatened by a perfect storm: insufficient funding, extreme weather events linked to climate change expanding mosquito habitats, rising drug and insecticide resistance, and humanitarian crises exposing millions to infection. 

Science has done its part. It has given us the tools: new dual-insecticide mosquito nets, effective medicines, and the world’s first malaria vaccines. Unless we act decisively, malaria will continue to claim lives that should have been saved. 

We know what is needed: strong global commitment, effective financing, and shared responsibility. We must achieve a successful Global Fund replenishment to ensure the effective tools reach everyone who needs them.

The Global Fund replenishment is decisive

People with access to an insecticide-treated mosquito nets In sub-Saharan African countries where the Global Fund invests.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria provides over 60% of all international financing for the fight against malaria.  

Since 2002, the Global Fund has helped cut malaria deaths by nearly a third, distributing hundreds of millions of mosquito nets, treatments, and diagnostic tests. That progress cannot be taken for granted – without a fully funded replenishment, millions of children’s lives hang in the balance. The 2025 replenishment will determine whether we advance or retreat. 

Expert economists calculate that every dollar invested in malaria yields four times that in economic growth. It is also an investment in pandemic preparedness, because the systems strengthened to fight malaria are the same ones that detect and respond to new threats. 

These investments strengthen primary healthcare systems by training community health workers, improving diagnostic capabilities, and enhancing supply chain management. They create a foundation for comprehensive healthcare delivery that extends far beyond malaria treatment.

Strengthening domestic resource mobilisation

Twenty African nations rank among the world’s most dependent on U.S. health aid, with several receiving American assistance that exceeds their own government health spending, leaving the continent acutely vulnerable to potential funding cuts.

Africa’s health financing is entering a new era. We must face the reality that official development assistance for health in Africa has fallen by 70% in just four years. Without decisive action, Africa CDC warns that declining aid and rising debt repayments could cost the continent up to four million additional preventable deaths each year by 2030.  

First, we must strengthen domestic resource mobilisation by allocating an increasing proportion of our national budgets to health. We must also tap into public–private partnerships. It makes economic sense for the private sector to operate in a healthy environment. 

We already have proof of concept through innovative platforms such as national End Malaria Councils and Funds, which bring public and private actors together in coordinated action across 11 countries. To date, they have raised more than $166 million in domestic resource commitments to support national malaria strategies. 

These efforts must now be scaled across the continent. We should embrace innovative financing, for example, through solidarity levies on airline tickets, tobacco, or alcohol; diaspora bonds; and community health insurance. We see how possible this is in Rwanda’s Mutuelles de Santé, which covers over 90% of its population.

Next, we need to expand blended finance. This means using public funds to reduce risk and attract private investment, unlocking billions for health infrastructure, supply chains, and local pharmaceutical production. 

The Global Health Investment Fund has used blended finance to bring private investors into funding new vaccines and treatments. With the African health market projected to reach $259 billion by 2030, these investments can build resilience and sovereignty if governed well.

Leveraging World Bank financing 

The International Development Association (IDA) of the World Bank has long supported health system strengthening, be it training community health workers in Senegal or upgrading surveillance systems and strengthening supply chains. 

These investments make a real difference. When health workers can diagnose and treat malaria in the community, through integrated community case management, it also significantly improves maternal and child health.

The IDA’s Booster Program for Malaria from 2005 to 2010 showed that front-loading investment can rapidly cut malaria cases and strengthen the primary health care system. We urgently need to bring back this approach through a second Malaria Booster Program, aligned with national plans, which would help Africa close financing gaps while strengthening systems for the long term.

Where should UN focus?

Global malaria incidence, which accounts for population changes, ticked up last year, translating to 11 million more cases, most of which occurred in the African continent.

In the short term, we must place our emphasis on securing additional financing. 

The Global Fund replenishment, domestic mobilisation, including through the private sector, and World Bank International Development Association financing are not competing choices. They offer a path to close the funding gap, putting Africa back on track to end malaria, and building health systems strong enough to withstand the next pandemic.

But time is not on our side. Donor retrenchment, rising debt, and climate shocks mean that the cost of inaction grows by the day. 

I urge world leaders gathering in New York to see the fight against malaria for what it is: a measure of how committed we are to safeguarding health and human dignity worldwide.

If we fail to finance the fight, history will judge us harshly. If we succeed, millions of children will live, communities will thrive, and Africa will stand stronger against tomorrow’s threats. The choice is ours.

Duma Gideon Boko is the President of the Republic of Botswana and Chair of the African Leaders Malaria Alliance (ALMA). 

Image Credits: Peter Mgongo, Arne Hoel/World Bank.

EHFG President Clemens Marten Auer warned Europe’s health systems face an existential threat from artificial intelligence.

BAD HOFGASTEIN, Austria — Artificial intelligence poses an “existential” threat to Europe’s health and social security systems through its potential to “completely replace” human work and eliminate the income tax funding base on which they depend, a leading health policy figure has warned.

Clemens Marten Auer, president of the European Health Forum Gastein, used the opening of the summit’s 28th edition in Austria’s Tauren mountains to sound the alarm that AI automation could hollow out the tax revenues that underpin Europe’s postwar welfare systems.

“AI will drastically change, even obliterate, the very foundations of the social contract as we know it today,” Auer said, arguing that the tax base funding Europe’s social provisions requires “total reformation” to preempt the coming transformation of the labour force and collapse of tax revenue.

“AI will transform societies, but may also devalue human labour, deepening inequality and creating instability,” Auer said. “The sustainability of solidarity systems is threatened at its core by this development and cannot be rendered future-proof unless the basis for funding of these systems changes.”

Europe’s social contract—the postwar consensus guaranteeing health, housing and education funded through employment-based taxation—is under attack from all sides as stagnating economic growth and ageing populations collide with budgets strained by war, climate change and digitalisation.

Demographics lead the assault. The EU’s active workforce is projected to shrink by 2 million by 2040, pushing the ratio of workers to pensioners from 3:1 to 2:1 as medical advances extend life expectancy and healthcare costs. Fewer workers mean less tax revenue even as spending on an ageing population rises.

“Society is changing in a positive way. We have lots of technological changes, new drugs, we can treat more diseases,” said Slovenia’s health minister Valentina Prevolnik Rupel. “In developed countries, the number of citizens does not really grow—what grows is the life expectancy. All this is positive, but it brings changes in demand, and needs are growing.”

Those same trends are pushing Europe’s medical workforce to the limit with a projected shortage of 4 million staff by 2030, despite increasing the import of foreign nurses by 67% and doctors by 54% over the last decade, according to WHO figures.

“If we keep the social contributions or the funding unchanged, and on the other hand, we see that the needs are increasing, we have some discrepancies that cause issues in trust,” she said.

‘Learn to speak Russian’

NATO Secretary-General Mark Rutte warned in July that nations face a choice between welfare system spending and defence.

Geopolitical tensions on European borders have intensified competition for scarce funds. Russia’s four-year full-scale invasion of Ukraine has forced a fundamental rethink of EU defence budgets, which stalled in a holding pattern around 2% of GDP in recent decades.

Nato allies are now pushing for member states to reach 5% of GDP in defence spending. The EU has already relaxed budget rules to allow member states to boost defence output, driving a 19% increase in defence spending across the bloc last year.

“If you do not do this, if you would not go to the 5%, including the 3.5% core defence spending, you could still have the National Health Service…the pension system, etc.,” Nato secretary-general Mark Rutte said ahead of a summit in The Hague in June. “But you’d better learn to speak Russian.”

“Sounds a little cynical,” Auer quipped, “but he said it.”

The landmark Draghi report on European competitiveness, released last month, estimates that investment in decarbonisation, defence, economic independence and digitalisation will require an additional 5% of GDP to keep pace with global powers in the US and China, a daunting figure given the bloc’s minimal economic growth and correspondingly stagnant government revenues.

“It’s high time to wake up and to start reflecting these political developments for our sector,” Auer continued. “All these developments will have a massive impact on how we finance, how we organise the level of and the access to health services.”

The 5% calculation in the Draghi report does not include health or pensions, which are largely absent from the document that charts the EU’s growth roadmap and investment priorities. Health and welfare budgets will have to compete for what’s left.

“You need additional money for the investment in infrastructure, that’s the fact. Through social contributions, we just fund the [social] programs,” Prevolnik Rupel said, noting that Slovenia has spent more in the last two years on health than in the previous decade combined to meet rising demand.

“That’s investments in the infrastructure—they are needed because the technological events are so fast,” she explained. “We need new equipment, we need new buildings, we need new spaces, because the protocols of how the patient travels through the systems change.”

Steam engine or hot air? 

The financial pressures on European welfare systems from demographic ageing, geopolitical instability and climate change are clear, as is the looming crisis in health worker shortages. The apocalyptic impact of AI that Auer outlined, however, remains far less certain.

In an essay accompanying his opening remarks, Auer compared AI’s potential to automate work processes to “the invention of the steam engine…and the First Industrial Revolution” in transformative power.

He cited Sam Altman, OpenAI’s chief executive, who predicted ChatGPT “will soon be more powerful than any person who has ever lived,” and Eric Schmidt, Google’s former chief executive, who forecast AI will reach 80 to 90% of top expert skills in mathematics, law, science and programming by 2033. Schmidt maintains one of the largest private AI investment portfolios worth billions of dollars.

Yet nearly all predictions of AI’s looming takeover come from inside the industry itself, where executives and investors have substantial financial stakes in the technology’s success. A significant decline in AI’s perceived value would cost companies like OpenAI hundreds of billions in valuation, and industry figures personally many billions of dollars.

The optimistic industry narrative has fuelled historic valuations despite record cash burn. The AI industry’s leading companies—Google, Meta, Microsoft, OpenAI, Amazon and Tesla—have spent a combined $560bn on capital expenditure since 2024 and generated just $35bn in return, netting $525bn in combined losses.

Despite the losses, OpenAI reached a $500bn valuation on Thursday, cementing its place as the world’s most valuable start-up.

The lack of profitability has contributed to growing concerns that the AI market might be a bubble, potentially undercutting its perceived revolutionary potential—and threat to solidarity systems in Europe.

AI’s capacity to “completely replace human work,” as Auer wrote, echoing warnings from other AI industry figures such as Anthropic’s Dario Amodei, has scarcely materialised.

A Yale University study published on Thursday found that US labour market metrics show “the broader labour market has not experienced a discernible disruption since ChatGPT’s release 33 months ago, undercutting fears that AI automation is currently eroding the demand for cognitive labour across the economy.”

Meanwhile, AI advancement has stalled as models hit walls in processing power, energy infrastructure, compute capacity and diminishing returns, all while companies have yet to identify profitable use cases for the technology.

A Massachusetts Institute of Technology report in August found that 95% of companies experimenting with AI are not making money from it, despite widespread promises from corporate leaders about efficiency gains.

Large language model technology is currently built on burning cash and the environment. Data centres consume more energy annually than all but 16 of the world’s 192 nations, with consumption set to double by 2030.

Global AI demand for water to cool servers and microchips is projected to require a supply equal to the total annual water withdrawal of countries like Denmark by 2027.

Continuing AI scaling and power-hungry data centres are eating into gains from green energy sources such as solar and wind, forcing gas, oil and coal plants back online to meet demand as air, noise and environmental pollution from digital waste threaten the health of nearby communities.

AI leaders including Altman have acknowledged that an energy breakthrough, likely from nuclear fusion, will be required if AI is to continue scaling. Google and Microsoft have started investing in nuclear technology, but a scalable breakthrough in the field is still a long way off.

“Naturally, historic predictions are difficult, especially when it comes to developments and employment in the labour market,” Auer acknowledged. “I do not want to oversimplify the issue here.”

AI’s healthcare promise 

If AI does fulfil its transformative potential, healthcare is seen as one of the most promising frontiers. Yet here too, the gap between promise and reality remains wide.

Nearly two-thirds of physicians surveyed in the United States reported using AI in 2024, a jump to 78% from 38% the previous year, according to a study by the American Medical Association. The usage, however, was primarily for administrative tasks such as documentation of billing codes, medical charts, visit notes, discharge instructions and translation services rather than medical or scientific breakthroughs.

Slovenia’s experience illustrates the challenge facing health systems. The government issued an open call for AI healthcare proposals and received 52 potential solutions for a country of just 2 million people.

“It’s like a flood of artificial intelligence applications, and we have to decide which ones to take on—and it’s very difficult because we don’t know,” Prevolnik Rupel said. “We don’t have enough evidence yet on which solutions work and which don’t.”

The government decided to pilot the most promising submission, an artificial intelligence program for scheduling healthcare workers’ shifts. Like the administrative applications in the AMA survey, the use case was organizational rather than medical, as doctors remain wary of trusting AI with decisions that could impact patients.

“Because it was an artificial intelligence, a logical program, it was more fair than when it was a nurse who would say, you do this,” she said. “Everybody was happy, and the level of satisfaction increased, and actually, the absenteeism among the healthcare workers fell in that hospital.”

The proliferation of untested AI applications has raised questions about how to regulate the technology safely. But experts say existing regulatory frameworks can be adapted rather than reinvented.

“When we started regulating medicines, 70 years ago more or less in the European Union, it was one of the first success stories,” said Natasha Azopardi-Muscat, division lead for WHO’s Europe office.

“We said medicines have to meet certain criteria: quality, safety, efficacy. And then we went further. We said that they have to be better than the alternative,” Azopardi-Muscat explained. “We can use the same [standards] for AI… We need to have a very clear system of evaluation.”

Despite the gap between AI predictions and current reality, Auer argued that political leaders are ceding crucial decisions about society’s future to private investors.

“If the automation stimulated by AI leads to a broad reduction of costs, meaning labour costs, meaning a significant loss of jobs,” he said, decisions about “how much capital to invest in development are made by financial investors, and not in parliaments or cabinet tables of governance.”

“The political call of the economic elites to strengthen Europe’s innovative power as forcefully as possible will come to nothing if at the same time we ignore the political concerns that innovations of the tech industry have the potential to dehumanize economic activity and weaken human labour,” he said.

“We must discuss and politically initiate steps to protect the solidarity systems in the long term and ensure the social and economic participation of as many segments of the population as possible.”

Image Credits: CC.

In April 2024, the Israeli Defence Force bombed Al Shifa Hospital, the largest hospital in Gaza.

All attacks on hospitals should be banned and the exceptions in international humanitarian law (IHL) that enable aggressors to justify bombing hospitals – by, for example, claiming that they are shielding combatants – should be removed.

Professor Neve Gordon, professor of international law at Queen Mary University in London, made this argument at a recent seminar hosted by the Geneva Graduate Institute’s Global Health Centre  and the International Geneva Global Health Platform. Queen Mary University, Médecins Sans Frontières (MSF) and the Graduate Institute’s Center on Conflict, Development & Peacebuilding co-hosted the event.

According to IHL, hospitals are protected from attack unless they are being used to “commit acts harmful to the enemy”, including shielding combatants and weapons.

But, said Gordon, this exception has now become the law, particularly in Gaza where “shielding has become a tool of genocide”.

The Israeli government claims that there are “hundreds of kilometres of tunnels under the Gaza Strip, and these tunnels are legitimate military targets, so anything above the target can be interpreted as a shield to the target”, said Gordon.

“Israel has targeted [hundreds] of medical units in the Gaza Strip, and each time it has claimed that these hospitals shielded something that belongs to Hamas,” he added.

“The vast majority of these claims are fabrications…. what you can see is how the law is being deployed by Israel, through the shielding argument, to defend and protect genocide,” he added.

“Anyone can decide what is proportional and what is not. Today, you kill two civilians for a soldier. Tomorrow, you kill 100 civilians for a soldier. And who can argue that that is not an adequate interpretation?” Gordon asked.

 “Part of the problem is the law. Let’s say there’s evidence of 10 combatants in a hospital. I say:” So what? We do not attack the hospital full stop. Wait till they come out, and you attack them.”

Massive increase in state attacks on hospitals

There has been a massive increase in attacks on health facilities, particularly by states.

Maarten van der Heijden, Global Health Centre research fellow,  showed that states were responsible for the majority of attacks on hospitals between 2016 and 2024, according  to the the Epidemic of Violence Report 2024 produced by the Safeguarding Health in Conflict Coalition.

There has also been a 1,000% increase in attacks on hospitals by states during this time.

“Attacks on healthcare are becoming part of the scorched-earth tactic, where you make a place unlivable,” said van der Heijden. 

After an Israeli attack on Nasser Hospital in August, the government of Prime Minister Benjamin Netanyahu used “multiple arguments” to justify the attack, based on denial, deflection and justification, he said.

“Netanyahu said it was a mistake. The military claimed that there was a [Hamas] camera. And then later, … they published a picture of six Hamas fighters that were attacked,” he said, adding that there was no clarity about how the Israeli military had assessed that the hospital was a legitimate target.

Deciding whether a hospital is a legitimate target requires a “complex analysis”, he added. “During a conflict, as we see right now in Myanmar, in Gaza, in Sudan, it is impossible to assess whether these attacks are actually legitimate or not.”

Lack of compliance

Professor Esperanza Martinez, head of Health and Human Security at the Australian National University’s law college, argued there was not an absence of legal frameworks but rather “an absence of compliance.”

“In 2024, there were more than 1,000 incidents directly targeting health facilities, hospitals primarily, and more than 80% of the attacks were committed by states,” said Martinez.

“So what we do have really here is a situation of widespread violations, impunity or lack of compliance and very limited enforcement.”

Professor Gloria Gaggioli, Vice-Dean for Research at the University of Geneva’s Law Faculty, agreed that IHL is sufficient and that exceptions to hospital attacks are important.

“Is the exception the problem? I don’t think so, because imagine a situation where we would say all attacks on hospitals are prohibited, and it’s a crime. What would be the result? The result would be that the enemy would have an incentive to use hospitals for military purposes,” said Gaggioli.

Moderator Ellen Rosskam with panellists Neve Gordon, Gloria Gaggioli and Tarak Bach-Baouab, with Esperanza Martinez on screen.

Plea from the field

“IHL doesn’t work,” said MSF’s Tarak Bach-Baouab. “We have the lives of our patients, the lives of our staff in our hands, and we have to have an environment where all the rules are well understood by all the players, and in which we can continue to operate.

“We have a larger problem than compliance. The law is actually used to justify attacks on health care, and the onus today is put on practitioners like ourselves, working in hospitals in conflict zones, to prove that the hospital is not used for a military purpose, or is not used as a shield,” added Bach-Baouab, who heads advocacy for MSF’s Operations Management Team.

“It used to be that the military contemplating attacking a hospital needed to go through almost a checklist before being able to attack. Today, the onus of proof has been turned on its head, and I think this is a major problem we are facing as humanitarians in conflict zones.”

He called for mobilisation by medical associations across the globe against these attacks and in support of the implementation of resolutions such as Resolution 2286 on the protection of health care, which was passed almost 10 years ago.

He also challenged the Swiss government, as the host of the Geneva Convention adopted at the end of the Second World War, to step up as guardians of IHL and push for “stronger uptake of these rules”.

How many civilians is it acceptable to kill in pursuit of a military target, Bach-Baouab concluded? 

MSF’s health facility in Al Shifa Hospital compound was severely damaged in the attack on the hospital in April 2024.

A complete recording of the event is available at the GHC You Tube Channel. 

Image Credits: Olga Cherevko/ OCHA, MSF, Safeguarding Health in Conflict Coalition.

Dr Kate O’Brien, WHO director of Immunisation, Vaccines and Biologicals

Vaccinations have saved the lives of an estimated 17 million people between 2021 and 2024 – but global immunisation programmes face several challenges, according to an assessment by the World Health Organization’s (WHO) Strategic Advisory Group of Experts (SAGE) on Immunisation.

Dr Kate O’Brien, WHO director of Immunisation, Vaccines and Biologicals, acknowledged the “deep commitment of countries and communities around the world to vaccination” at a media briefing on Tuesday following SAGE’s biannual meeting. 

While vaccination coverage has largely rebounded to pre-pandemic levels, “backsliding in Gavi-ineligible middle-income countries, and an increasing number of people living in fragile and conflict settings, threaten the global gains”, according to the WHO.

Immunisation programmes are being tested by “geopolitical instability”, constrained global and national budgets, and “shifting health architectures”.

In addition, “the information and trust crisis threatens vaccine confidence and uptake”, WHO noted.

However, O’Brien stressed that “the vast majority of parents are strongly supportive of vaccines”. 

“The rollout of malaria vaccine on the African continent, one of the fastest rollouts that we’ve seen, is a testament to the impact of vaccines, and the deep desire for people to protect their children to family members from infectious diseases that are otherwise a daily occurrence,” she said.

Four malaria vaccine doses affirmed as ‘optimal’

Harvard Professor Dyann Wirth, chair of the Malaria Policy Advisory Group (MPAG)

SAGE confirmed that four doses of the malaria vaccine, known as RTS,S/AS01, provide optimal protection over three doses in preventing the rebound of severe malaria.

This decision was informed by a four-year study, which included children under five years of age, conducted in Ghana, Kenya and Malawi, where the vaccine is being rolled out as part of the routine childhood immunisation programmes.

“The fourth dose reduced severe malaria by 54%, with a 30% incremental effectiveness, above that provided by three doses,” said Harvard Professor Dyann Wirth, chair of the Malaria Policy Advisory Group (MPAG).

“The cumulative effectiveness of the four doses in reducing cerebral malaria, one of the most severe and deadly manifestations, was 74%,” added Wirth. In comparison, three doses reduced cerebral malaria by 48%.

“While three doses provide safe and effective protection against clinical malaria and severe disease, the incremental effectiveness of the fourth dose against severe disease was substantial,” she added.

SAGE chair Dr Hanna Nohynek

SAGE chair Dr Hanna Nohynek said at least 20 countries were using or considering the malaria vaccine, and SAGE recommends aligning the vaccines with other childhood vaccinations where possible.

SAGE “supported the expanded use of the novel oral poliovirus vaccine (OPV) to reduce vaccine-derived polio virus transmission in select geographies with persistent transmission of this particular virus”, said Nohynek.

It also recommended the use of “fractional doses of Sabin-based inactivated poliovirus vaccines (IPV)”.

Dr Joachim Hombach, SAGE’s executive secretary, highlighted the importance of countries “establishing programmes to support trust in vaccines, the safety of vaccines and the impact that they have, as they are “one of the most cost-effective health interventions”.

Hombach stressed that SAGE is an independent group of experts that base their decision on scientific evidence not politics.

Dr Joachim Hombach, SAGE’s executive secretary

O’Brien stressed that “the economic return on investment of vaccines is probably one of the highest available”.

Over the past 50 years, vaccines have saved approximately 154 million lives – and the measles vaccine is responsible for saving around 60% of these deaths, she noted.

US vaccine decision

The US recently decided to recommend two separate vaccinations for children – a combined one for measles, mumps and rubella (MMR), and another for varicella (chicken pox) – instead of a combined MMRV vaccine for all four conditions.

O’Brien said there were a range of vaccines available for the four common childhood infections, and that clinical trials have been done to assess the safety and the performance of the vaccines when they’re put together in a combination.

“Combination vaccines have a lot of benefits to them, especially from the perspective of the child, as it’s fewer injections, and  fewer number of visits to the healthcare provider,” said O’Brien.

“It’s well known that the measles, mumps, rubella and varicella (MMRV) combination vaccine does have a higher risk of fevers following the vaccine than when the varicella vaccine is given separately,” she added, and that these fevers could result in “febrile seizures”.

“A number of different countries constrain the recommendation for use of that combination vaccine to those kids who are older,” she said, but stressed that the MMR vaccine is “very safe”.

As measles and rubella have “significant health risks”, the WHO recommends that countries vaccinate against these two illnesses and this is using given in a combination vacine, she added.

SAGE also reported a decline in reported COVID-19 cases and deaths in the past year, along with low annual vaccination uptake “mainly limited to high-income countries in the WHO regions of Europe, the Americas and the Western Pacific in 2024”.

Variant-adapted COVID-19 vaccines show “moderate” effectiveness in preventing COVID-19 cases and hospitalizations, though protection wanes by six months, said SAGE.

“SAGE recommended an updated review of the evidence on the effectiveness of COVID-19 vaccines during the Omicron period, with a focus on the effect of vaccination in pregnancy on birth outcomes and infant COVID-19 to reassess the validity of recommendation on vaccination during pregnancy, in the current epidemiological context,” said the body.

SAGE also noted that there are 16 candidate tuberculosis vaccines in clinical development, five of which are in phase 3 trials. One, known as M72/ASO1E, could be licenced as early as 2028, depending on trial results.

China’s Ambassador to Nigeria, Yu Dunhai, announcing the deal.

A deal with China will enable Nigeria to join Egypt and South Africa as a producer of insulin, the drug that is essential to control diabetes.

Diabetes is increasing exponentially on the continent, and is projected to affect almost 60 million people by 2050 – a massive increase from the 2.5 million estimated cases in 2000.

The memorandum of understanding between Nigeria’s National Biotechnology Research and Development Agency (NBRDA) and Shanghai Haiqi Industrial Company Limited of China was announced last week.

“Chinese companies are in talks with Nigeria to build Africa’s first local insulin production facility, potentially ending Nigeria’s reliance on imported insulin and positioning it as a hub for African biotechnology,” Chinese Ambassador to Nigeria Yu Dunhai said.

However, two other African countries are already making insulin. Egypt’s EVA Pharma began producing insulin in 2024 in partnership with Eli Lilly, which supplied the active pharmaceutical ingredients (API) at reduced cost alongside free technology transfer. 

This has enabled EVA Pharma to formulate, fill and finish insulin vials and cartridges aimed at low- and middle income countries (LMICs).  

The local insulin, called glargine, received regulatory approval from the Egyptian Drug Authority in December 2024.

“Less than two years after the initial announcement, EVA Pharma has completed a new biologics manufacturing facility, finalized insulin formulations and stability testing processes, engaged with the local regulatory authorities to obtain approval of the insulin glargine injection, and released the first batch of the locally manufactured insulin drug product,” the company announced at the time. 

Meanwhile, the South African generic company Aspen signed a deal with Danish company Novo Nordisk to fill-and-finish insulin vials, although details of the deal are not public.

However, Novo Nordisk and Sanofi are facing investigation in South Africa after the for anti-competitive activity in the insulin pen market. This follows the refusal of Novo Nordisk, Sanofi and Eli Lily, which produce 90% of insulin pens on the continent, to tender to supply the South African government with insulin pens. 

 

WHO Headquarters in Geneva where planned staff cuts are the focus of significant unrest.

Staff unrest at the World Health Organization’s Geneva headquarters reached a new milestone this week, as the WHO Staff Association (HQSA) adopted three resolutions challenging the fairness and legitimacy of the Organization’s ongoing restructuring process, which has already led to post abolitions, reassignments, and widespread anxiety.

In two meetings, Monday and Friday, attended by some 800 members of Geneva’s WHO staff, members expressed a vote of “no confidence” in the downsizing process, endorsing demands for greater transparency.  Key components of the demands call upon WHO senior management to:

  • Disclose all criteria and decision-making logic used in departmental staff cuts, including pre- and post department structures;
  • Freeze abolitions and recruitments tied to the restructuring pending independent review;
  • Launch an independent review within four weeks with meaningful staff participation; 
  • Issue a savings and impact statement showing what has been cut, what has been protected, and where further efficiencies are expected.
  • Report corrective actions not just to staff but also to Member States.

WHO is in the process of eliminating some 600 jobs at its Geneva headquarters, where nearly  2,800 people were employed as of June 2025, as part of a restructuring triggered by the withdrawal of United States funding for the global health agency in January. The withdrawal of the US, WHO’s largest donor, has left a massive $1.7 billion hole in the upcoming 2026-2027 budget cycle. WHO’s worldwide workforce is set to be trimmed by about  20% down to 7,525 staff from 9,463 as of December 2024.

Vote of No Confidence

The Friday meeting of the “Extraordinary General Assembly” (EGA) carried a motion of no confidence in the prioritization exercise and review process (ARC) of the cutbacks, citing widespread reports from staff, HR insiders, and even some directors that the process was “fundamentally unfair and flawed,” with evidence of both of inconsistencies as well as allegations that the abolition of posts, in some cases, was used as a retaliatory measure against staff who had previously acted as whistleblowers. 

The final text  sidestepped criticism of elected Staff Association representatives themselves, who have also come under fire for allegedly failing to defend staff interests more assertively throughout the restructuring process, which began at staff level in June.  

Freeze on Abolitions and Recruitment

Another measure approved called on the WHO administration to temporarily freeze further post abolitions/discontinuations and new recruitments directly linked to the prioritization exercise “until completion of an independent review” within four weeks time. Supporters argued this measure was essential to prevent further damage before an independent review could be conducted, overriding concerns by some critics that freezing action indefinitely could worsen WHO’s financial crisis and obstruct urgent recruitment.

Independent Review

Finally, the Staff Association called upon WHO management to urgently establish an independent review of the process and its outcomes, with direct engagement of staff, to document issues of concern and present proposed corrective actions to staff, administration and Member States.

The resolution calls for a tight, four-week deadline for  the review, which could be conducted by an external body such as the International Labour Organization, which maintains a judicial process for individual staff-administration disputes, or  by an internal panel with staff-elected members, insiders suggested.

A fourth resolution, which would have authorized collective legal action challenging the restructuring, was deferred due to the fact that collective staff appeals have limited standing before the ILO Administrative Tribunal, whose purview mainly involves the review of individual staff-management disputes. 

Broader Implications

Together, the Assembly resolutions have poised  the Staff Association to play a more assertive role in the WHO downsizing process.  However,  it remains to be seen how WHO’s senior management might respond to demands by the group, which has never gone on strike and typically remained in the shadows of major WHO management moves.  Health Policy Watch could not reach a WHO spokesperson by the time of publication.  

For WHO, already facing a US$1.7 billion budget shortfall after the withdrawal of major donor funding, the challenge is acute. Leadership must balance cost-cutting imperatives with credibility, fairness, and staff morale. Headquartered in Geneva, WHO’s staff there is in the eye of the storm. 

A Call for Deeper Reform

Speaking to Health Policy Watch on condition of anonymity, staff members stressed that the criticism over the downsizing goes beyond budgetary pressures.

The process has exposed patterns of favoritism that risk creating an opaque, top-heavy structure that sacrifices more vulnerable junior and temporary staff disproportionately.

The process has also exposed structural gaps in WHO’s internal justice system and the absence of a truly independent mechanism to hold senior leadership accountable. 

“Moving forward, real accountability requires strengthening the internal justice system, with clear protections against retaliation for staff who speak out,” one staff member said. “This is not just an HR quarrel—it is a governance crisis,” echoed another staff member.

 “WHO staff are international civil servants, bound by an oath to act solely in the Organization’s interest, and management is bound to transparent, rule-based administration confirmed by the Executive Board. 

“When prioritization and realignment sever core public health functions without clear criteria; when decision review files, organigrams, and rationales are withheld; when decisions are perceived to be personalized rather than principled, the problem isn’t morale—it’s legality and legitimacy.”

Said another: “By adopting these resolutions, staff have sent a unified signal: austerity cannot override fairness, transparency, and due process. For an organization tasked with setting global standards, staff reminded management that those standards must begin at home.

“The coming four weeks will be decisive. If leadership implements the freeze, commissions a credible independent review, and engages staff meaningfully, trust may be restored. If not, the Organization risks deepening mistrust — with consequences not just for staff morale, but for the credibility of WHO’s governance itself.”

Image Credits: WHO .