A mother and newborn at a health center in the Patna district of Bihar, India. International aid cuts threaten progress on maternal health.

Maternal mortality rates have dropped by 40% since 2000, largely due to improved access to essential health services. But WHO officials warn that the recent, deep cuts to international aid could be as disruptive as the COVID-19 pandemic, if not more so, to a woman’s chances of surviving pregnancy and childbirth.

And in 2023, more than a quarter million women still died from pregnancy and childbirth complications, according to a report on global maternal mortality released on Monday, World Health Day, which focused on maternal and newborn health.

That’s a death every two minutes. 

“This is not just a medical failure,” said Dr Pascale Allotey, director of the WHO Department of Sexual and Reproductive Health and Research, at the report’s launch. “It’s a failure of society.”

The report by UNICEF, WHO and the UN Population Fund (UNFPA) comes as the dismantling of most of USAID’s international health programmes, and other cuts to health and humanitarian aid send shockwaves through global health, forcing countries to roll back vital services for maternal, newborn and child health, the WHO said. 

Without urgent action, fading attention, funding cuts, and humanitarian crises will jeopardize pregnant women in conflict settings – and make the persistent tragedy of maternal mortality “alarmingly high,” warned WHO officials convened at a press conference last week. 

International aid cuts could mirror COVID-19 chaos

Maternal mortality ratios 2000-2023 by SDG region.
Maternal mortality ratios by region. The COVID-19 pandemic caused an upsurge in deaths, particularly in 2021.

This year’s report is also the first to delve into how the pandemic affected deaths from pregnancy-related conditions.

“I hate to use the term ‘surviving’ pregnancy,” said Dr Bruce Aylward, WHO assistant director general for Universal Health Coverage and life course at a press conference. “But that’s what our reality is.”

The pandemic “shocked” health systems, said Aylward, meaning that many women could not access needed care for their pregnancies and deliveries.

As a result, more than 40,000 more women died in pregnancy and childbirth in 2021 (322,000) as compared to 2020 (282,000), the report concludes, as the pandemic was gathering steam in low-income regions such as Africa and South Asia.  

The upsurge in deaths was partly linked to direct complications caused by COVID-19 during pregnancy, but not only that. There were also widespread interruptions to maternity services – due to the competing demands of the pandemic on hospital beds and healthcare workers, limitations on travel, and other factors limiting access to hospitals and primary healthcare services. 

Severe bleeding, infections, preeclampsia and eclampsia, delivery complications, and unsafe abortions are the largest drivers of maternal mortality. 

Yet the spike in deaths during the pandemic was temporary. In 2022, the global MMR and number of maternal deaths were lower than they had been in the three years immediately prior to the COVID-19 pandemic, the report notes. 

Whether the disruptions now being experienced as a result of the broad funding cutbacks in international health assistance led by the United Strates, but also including the United Kingdom, will be as short-lived, remains to be seen.  

Aid crisis threatens to reverse decades of progress

To date, aid cuts have already led to facility closures and loss of health workers, while also disrupting supply chains for supplies and medicines for the pregnancy complications, WHO said in a joint statement with UNICEF. 

“Global funding cuts to health services are putting more pregnant women at risk, especially in the most fragile settings, by limiting their access to essential care during pregnancy and the support they need when giving birth. The world must urgently invest in midwives, nurses, and community health workers to ensure every mother and baby has a chance to survive and thrive,” UNICEF Executive Director Catherine Russell, said in the press statement. 

She added, “When a mother dies in pregnancy or childbirth, her baby’s life is also at risk. Too often, both are lost to causes we know how to prevent.”

Lead author Dr Jenny Cresswell also predicted a rise in unsafe abortions as one consequence of the recent funding cuts – which target reproductive health services, in particular.

“Any sudden disruptions will eventually lead to adverse outcomes,” she said.

US international assistance also “underpins” WHO’s ability to collect and analyse country data, and more importantly, support the “basic ability of a woman to survive during pregnancy,” Aylward noted at last week’s briefing. 

“The American people have been incredibly generous in the past 25 years – and share in the credit for progress so far. It makes a real difference” Aylward. This progress is now “at risk of disappearing.” 

And the most economically fragile countries are also the ones with the least ability to rapidly adjust to the abrupt funding halt, and are consequently at highest risk, he concluded.

Huge global disparities – particularly in conflict zones

The report gathers data from 195 countries and territories, with a third of all countries having “very low” maternal mortality ratios (MMR). No country was rated as having an “extremely high” ratio for the first time, defined as the number of deaths per 100,000 live births. 

In 2000, nearly a million women died from pregnancy-related conditions. In 2023, maternal morality had declined to 260,000.  That represents a 40% decline in the rate of maternal deaths, as compared to live births per 100,000 population. 

And while the WHO pointed to these significant improvements since 2000,  “there is a huge unfinished agenda in which a quarter million women die trying to give life,” said Aylward. 

The burden is not equal. Lower and middle income countries and countries caught in conflict are the places where the vast majority of maternal deaths occur – nine in ten in fact.  

Sub Saharan Africa did see the largest improvements over the past two decades. Even so, some 70% of maternal deaths still occur in that region, noted Cresswell. Globally, Chad, the Central African Republic (CAR), Nigeria, and Somalia face the highest burden of maternal mortality – along with Afghanistan. 

Conflict zones are especially vulnerable to high rates of maternal mortality. Countries in conflict – such as Afghanistan, Somalia, and CAR – accounted for three in ten deaths. 

The maternal mortality ratio is “significantly higher” in conflict-affected areas (504 deaths per 100,000 live births) compared to non-conflict of non fragile settings (99 per 100,000 live births), the report notes. 

Persistent social and economic inequalities underline uneven progress between regions. Post-2015, progress stalled in five regions: North Africa and Western Asia, Eastern and South-Eastern Asia, Oceania (excluding Australia and New Zealand), Europe and North America, and Latin America and the Caribbean.

“We cannot be complacent,” said Cresswell. 

Skilled health workers at the center of solutions

“This is not just a medical failure – it is a failure of society,” said Dr Pascale Allotey of the WHO, referring to maternal mortality. A child is tested for malnutrition by a WHO healthcare provider.

The most important factor in healthy pregnancy outcomes is having a skilled attendant at the time of childbirth – most deaths occur around the time of delivery. 

Part of the remarkable progress seen in the past two decades is attributable to the upsurge in midwifery programs, as well as in programmes targeted at reducing unsafe abortions, a major cause of complications. 

“Having a skilled health worker in place is key, and we have seen positive progress, particularly in Sub Saharan Africa,” said Cresswell. “There is still work to be done. There are still too many women who are delivering without a skilled health provider.”

Also imperative is improved access to family planning services, and preventing underlying health conditions like anaemias, malaria and noncommunicable diseases that increase pregnancy risks, the report notes. 

Allotey, from the department of sexual and reproductive health, also emphasized the role of access to comprehensive information throughout pregnancy. This means generally making sure girls stay in school and receive the knowledge and resources to protect their health.

“There are a whole range of preventive measures to make sure that women are safe,” she said. These include making sure the pregnancies are wanted, and therefore mothers are able to access better care, as well as political commitments.

In recent years, increased political support from African nations has begun to “move the needle” on maternal and child health. 

This year’s World Health Day theme “Healthy beginnings, hopeful futures,” aims to raise awareness on maternal and child health because “it is not okay for a woman to die trying to give birth,” said Aylward. 

“While this report shows glimmers of hope, the data also highlights how dangerous pregnancy still is in much of the world today – despite the fact that solutions exist to prevent and treat the complications that cause the vast majority of maternal deaths,” said Dr Tedros Adhanom Ghebreyesus, Director General of WHO. 

Image Credits: BMGF, WHO, Twitter.

Wearing green for go: INB co-chair Precious Matsoso, WHO’s Dr Tedros Adhanom Ghebreyessus and Mike Ryan at the INB opening.

Countries keep increasing their military budgets yet seem unwilling to prepare for an “invisible enemy” – a pandemic-causing pathogen that can be more damaging than a war, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyessus warned at the start of the final negotiations for a pandemic agreement on Monday.

The COVID-19 pandemic killed up to 20 million people and wiped $10 trillion from the global economy, while the 1918 influenza epidemic killed up to 50 million people – and First World War killed 15-22 million people, Tedros pointed out. 

WHO member states have a mere five days to reach consensus on the pandemic agreement if they are to present it to the World Health Assembly (WHA) next month – yet three ‘big ticket’ items and a myriad of process questions are still on the table.

Articles on how to share information about dangerous pathogens – the Pathogen Access and Benefit-Sharing (PABS) system; technology transfer (purely voluntary or not) and the pandemic preparedness responsibilities of member states (including ‘One Health’ measures) are still lacking agreement.

READ: What’s New in the Pandemic Agreement

Waning political will

The opening day coincided with International Health Day and the WHO’s 77th anniversary, and WHO and INB staff wore green to signify all systems go for the talks.

Tedros, hastily tying his green tie, urged all countries to “find a balance in protecting their people from both bombs and bugs” as the next pandemic is an “epidemiological certainty”.

While the talks at the Intergovernmental Negotiating Body (INB) could continue beyond this week and after the WHA, there is widespread consensus that member states’ already-waning political will to nail down a treaty will simply fizzle out.

The pandemic agreement has also been the target of a systematic misinformation campaign based on the incorrect claim that it will enable the WHO to undermine countries’ sovereignty. 

Right-wing parties and organisations, including a significant portion of US President Donald Trump’s Republican Party, have bought into various anti-WHO conspiracies as they have sought to blame the WHO for everything that went wrong during the COVID-19 pandemic.

Several influential countries have swung to the right, including Germany, the Netherlands and France, and this has also undermined support for the agreement as these right-wing parties typically opposed COVID-19 lockdowns and vaccine mandates, and have seen the pandemic agreement as an attempt to enforce these.

Growing health threats

The talks come amid serious and growing health threats. Disease outbreaks in Africa have increased by 41% between 2022 and 2024. Yet the continent has experienced a 70% loss in official development assistance (ODA), from $81 billion in 2021 plummeting to $25 billion in 2025 – largely as a result of US funding cuts – and ODA covers 30% of the continent’s health spending.

Dr Jean Kaseya, head of the Africa Centres for Disease Control and Prevention (Africa CDC), warned last week that the continent no longer has the means to adequately monitor outbreaks – including the mpox outbreak in central Africa.

The reduction in aid means fewer trained health workers, less equipment and medical countermeasures – vaccine, medicines and diagnostics, said Kaseya.

“It means we are, all of us, at risk. Our message to our colleagues from Western countries is:  ‘You are not protected, because if there is a pandemic coming from Africa, you will be affected’,” he added.

Ironically, however, the US also poses a risk to the rest of the world as it has dismantled vast areas of its health system, including cutting 2,400 posts at the Centers for Disease Control and Prevention (CDC), which monitors disease outbreaks – amid a serious and ongoing outbreak of H5N1 in cattle and a measles outbreak. In addition, the US’s radical aid cuts have also weakened global disease surveillance and response – including or mpox and Ebola.

Stakeholders’ pleas

IFPMA’s Grega Kumer.

Various stakeholders spoke in support of the pandemic agreement – with some caveats – on Monday, with several underlining that enough progress has been made to close the deal.

Grega Kumer, representing the International Federation of Pharmaceutucal Manufacturers and Associations (IFPMA), stressed the need for entrenched intellectual property rights and the voluntary transfer of technology and know-how during a pandemic (Article 11). 

“The significance of including both ‘voluntary’ and ‘on mutually agreed terms’ for tech transfer is paramount as it facilitates the sharing of technologies and expertise in a manner that respects the interests and agreements of all parties involved,” said Kumer.

Various other parties have pointed out that even the US and Germany have laws that allow their governments to enforce compulsory tech transfer during crises such as wars and pandemics.

Oxfam’s Mogha Kamal-Yanni told the INB that “technology transfer cannot be left to the whim of pharmaceutical companies”. 

“We see the clear evidence of the failure of voluntary action in the fact that, four years since the establishment of the mRNA hub in South Africa and despite several attempts to get companies to share the mRNA technology, not a single one agreed,” she said.

“Let’s hope that on Friday, we celebrate your hard work resulting in an agreement that is fair and that protects all people everywhere, and proves that the multilateral system works,” said Kamal-Yanni.

Spark Street Advisors CEO Nina Scwalbe

Spark Street Advisors CEO Nina Schwalbe said: “As currently drafted, the pandemic agreement secures important gains, including on research and development, equitable access to pandemic countermeasures and a One Health approach to pandemic threats. 

“While not all policy goals have been achieved, this potentially historic agreement lays essential groundwork for equitable, collective preparedness and response now and can be strengthened through additional protocols in the future,” said Schwalbe, also speaking for the Pandemic Action Network, the Panel for a Global Public Health Convention, Helen Clark, the co chair of the Independent Panel for Pandemic Preparedness and Response, and various members of the Global Preparedness Monitoring Board.

“We urge you, member states, to stay laser focused on the end goal and find room to give and take to reach agreement… We are counting on you to pull together and get this agreement.”

On 1 April 2025, locals pass by a collapsed building in the aftermath of the 7.7-magnitude earthquake that struck central Myanmar last week, killing and injuring thousands.

Myanmar’s health system was collapsing. Then the earthquake hit.

“The houses, which were all built on the water, were gone — all flattened,” 15-year-old Myat Nyein from Inle Lake in Shan State, recalled in testimony to Save the Children. His mother died in the disaster, her body found covered in bruises with stitches on her head. He survived by jumping into the lake with his brother.

“I will never forget the moment I pulled my younger brother into the water, the sight of our fallen village, or my mother’s broken body,” Nyein said. “These memories will stay with me forever.”

Myat Nyein’s story is just one of thousands that have unfolded across Myanmar since the 7.7-magnitude earthquake struck a week ago. The earthquake shook six regions across the country, home to approximately 28 million people, including 6.7 million children.

The disaster has killed at least 3,838 people and injured over 4,000, with another 500 still missing, according to the latest UN estimates. The United States Geological Survey warns the death toll could potentially exceed 10,000 as search and rescue operations continue in remote regions.

Aid officials describe the situation as a humanitarian catastrophe of historic proportions.

“The needs are beyond words,” said Nadia Khoury, head of the International Federation of Red Cross and Red Crescent Societies (IFRC) in Myanmar. “Our response must match the sheer scale of the disaster – now and for the longer term.”

The disaster has devastated a health system already crippled by years of civil war. The earthquake destroyed three hospitals and partially damaged 22 others, according to the World Health Organization, severely limiting healthcare capacity when it is most needed. Around 40% of hospitals in Myanmar are located in territories contested in the civil war, making them inaccessible to many seeking urgent medical care.

“The earthquake has taken a heavy toll. Thousands of lives are lost. Families displaced. Health facilities have been damaged or overwhelmed in the hardest hit areas,” said Hyon Chol Pak, administrative officer at WHO’s Myanmar office.

Even before the earthquake – the largest to hit Myanmar in over a century – the country faced a dire humanitarian crisis. In its December 2024 assessment, the UN had already declared that “the health system is in collapse,” with 12.9 million people requiring humanitarian health interventions. Due to severe underfunding, only 2.4 million were targeted for assistance, UN figures show. 

This deterioration follows years of political and economic instability after the February 2021 military coup in the country, which had already shuttered hospitals, disrupted medical supply chains, and internally displaced millions of people. 

“Myanmar is shattered,” the UN Refugee Agency said Thursday. “Millions urgently need shelter, safety, and aid.”

Disease threats mount amid a health system in ruins

Poe Kyal Sin Lin, 6, stands in front of a collapsed wall of the Aye Thukha Community Hall in the Mahar Aung Myay Ward of Mandalay, several days after the devastating earthquake.

Health officials warn that disease outbreaks now pose an imminent threat to earthquake survivors, many of whom are sleeping outdoors in temperatures exceeding 40 degrees Celsius. An estimated 100 people, mostly children and the elderly, died in a similar heatwave last year as power outages left civilians with no recourse to escape the scorching heat. 

Medical staff, many themselves affected by the earthquake, are struggling to provide care in impossible conditions. In many areas, patients are being treated outdoors in unseasonal heat as buildings remain unsafe, with healthcare workers attempting to manage thousands of traumatic injuries without adequate supplies or facilities. 

Water and sanitation infrastructure has been destroyed in numerous communities, leaving many without safe access to drinking water. The contaminated water is causing rising illness rates among populations in Myanmar’s regions impacted by the earthquake, according to Malteser International. The WHO has already detected cases of acute watery diarrhea in displacement sites, with 47 cases reported across Mandalay and Sagaing regions.

“Especially for young children and older people, watery diarrhea combined with dehydration can quickly lead to death,” said Arno Coerver, Malteser International’s Global WASH advisor. “Additionally, contaminated water used to clean wounds significantly increases the risk of infections for injured individuals.”

Myanmar was battling multiple disease outbreaks before the historic seismic shocks hit the nation this week. Elena Vuolo, the deputy head of WHO’s Myanmar office, told Reuters that “cholera remains a particular concern for all of us,” pointing to an outbreak last year in Mandalay, one of the regions hardest hit by the earthquake.

Malaria and tuberculosis cases spiked sevenfold since the coup in 2021, while HIV infections have grown by 10%, according to WHO data.

“Due to the ongoing shortage of malaria supplies, malaria cases are resurging in several regions and states of Myanmar,” the WHO reported. “Dengue remains a major public health concern, affecting an increasing number of people, mostly children under 15 years of age.”

Vaccination coverage for childhood illnesses was already “persistently low” before the disaster. “An estimated 1.5 million children under-five have missed basic vaccinations since 2018, posing a serious threat to the risk of measles and diphtheria outbreaks and possible re-emergence of polio,” according to WHO assessments.

Now the earthquake has created conditions that could accelerate disease spread. 

“Earthquake-related displacement, limited access to safe water and food, overcrowded displaced populations, poor sanitation, inadequate disease prevention measures and potential movement of rodents into urban areas increase the likelihood of water-borne, vector-borne, and airborne disease transmission and risk of plague re-emergence,” WHO warned.

“Widespread displacement caused by armed conflict, climatic disasters, and ethnic tensions has put IDPs and migrant populations at increased risk of public health threats due to overcrowding, poor overall living standards, and limited health care infrastructure,” the UN health agency added. 

Aid organizations identify clean drinking water, sanitation, medical care, shelter, and access to basic necessities as the most critical immediate needs.

The Red Cross reports operating mobile health clinics, water purification units, and ambulances in Mandalay and Sagaing. WHO has transported essential medical supplies, including trauma kits and essential medicines, to hospitals and first responders in affected regions.

Beyond physical injuries and infectious diseases, the earthquake has inflicted severe psychological trauma on survivors.

“The scars of the earthquake are not all physical,” the Red Cross reported, noting the critical need for mental health and trauma support following the disaster. “The coming days, weeks and months will be critical for the people of Myanmar.”

“Mental health challenges are also a major concern,” WHO confirmed, explaining that the earthquake “exacerbates the mental health challenges because of its sudden and traumatic nature, leading to widespread disruption and amplifying feelings of fragility in an already vulnerable setting.”

Cascading crises

The earthquake struck a country already grappling with multiple humanitarian challenges. Before the disaster, approximately 19.9 million people—over a third of Myanmar’s population—required humanitarian assistance.

“In the INFORM Risk for 2025, Myanmar ranks 11th out of 191 countries, with a ‘very high’ risk classification driven by extremely high scores for hazards and conflict intensity,” the UN assessed months before the earthquake struck. “If the current trajectory is not reversed, the humanitarian situation in Myanmar is expected to remain extremely dire and further deteriorate in 2025.”

The epicenter was near Sagaing Township, a region that was already hosting one-third of the country’s internally displaced persons due to the ongoing civil war. Nationwide, an estimated 3.5 million people had been displaced since the military overthrew the democratically elected government of Aung San Suu Kyi in 2021, all before the earthquake struck.

Myanmar’s civil war, now in its fourth year, has become the world’s most violent conflict, killing at least 50,000 people, including at least 8,000 civilians, according to the Armed Conflict Location and Event Data Project.

The 7.7 magnitude quake reverberated as far as Thailand from its epicenter in Mandalay, Myanmar.

The situation is set to worsen in the coming days, with weather forecasts predicting heavy rains from Sunday through April 11 in the earthquake-affected regions. 

“The monsoon season is right around the corner, it’s arriving in a couple weeks,” said Tommaso Della Longa, spokesperson at IFRC. “Of course, we cannot say the severity of the monsoon season, the severity of the rains, but by experience, we know that this kind of makeshift tent and temporary shelter are not enough to keep people safe. 

“There is a kind of domino effect where there is no proper shelter, where there is no proper water sanitation, where there is no proper health support, then you can have health issues,” Della Longa said. 

Regions hit by the earthquake were still recovering from the devastating floods caused by Typhoon Yagi, which swept across Myanmar and Thailand last year, raising concerns that another severe weather season could be even more catastrophic given the compounded crises of war and seismic damage.

“Imagine a disaster is a hammer,” said Unni Krishnan, global humanitarian director at Plan International. “One disaster has already struck which is the earthquake, then you bring another one called rains, then you bring the cyclone, and the floods and the storm surge. So, you’re talking about a bunch of hammers hitting the same spot again and again.”

Military operations hampering aid

The catastrophic health situation has been compounded by ongoing military operations and restricted humanitarian access. UN High Commissioner for Human Rights Volker Türk reported that the Myanmar military has continued operations and attacks in the aftermath of the earthquake, including airstrikes – some launched shortly after tremors subsided.

“The Office has received reports that the military has carried out at least 53 attacks, including strikes by aircraft and drones, artillery and paramotors in areas affected by the earthquake. At least 14 attacks by the military have been reported since they announced a temporary ceasefire taking effect on 2 April,” Türk stated.

While both the military junta and the opposition National Unity Government have announced ceasefires to facilitate aid operations, the continuing violence has severely restricted humanitarian access.

The humanitarian response faces additional challenges from an information blackout imposed by the military, making it extremely difficult to contact affected communities and assess the situation. Internet and telecommunication shutdowns have severely hampered coordination efforts.

“Sources from the ground describe a catastrophic humanitarian situation in earthquake-hit areas, especially those outside the military’s control, an absence of relief efforts, and a lack of clean water, food, and medicines,” Türk reported. “Fear and shock have augmented the suffering of a civilian population already subjected to four years of military violence since the coup.”

“I urge a halt to all military operations, and for the focus to be on assisting those impacted by the quake, as well as ensuring unhindered access to humanitarian organizations that are ready to support,” Türk said.

For Myanmar’s population, already suffering through years of conflict and inadequate healthcare, the earthquake has turned an ongoing crisis into a catastrophe of historic proportions—one that could have health implications extending far beyond the country’s borders.

“The people of Myanmar have suffered enough,” Türk concluded. “The response to this horrendous disaster must open pathways towards a comprehensive solution that upholds democracy and human rights.”

Image Credits: UNICEF.

A Gobi desert dust storm hits a village in the Qinghai province in China.

CARTAGENA, Colombia — “When I met with taxi drivers in Abu Dhabi about the pollution from their cars, they told me to talk to the desert,” recalled Dr George Thurston, director of New York University’s research program on the health impacts of ambient and occupational air pollution.

The taxi drivers’ retort points to a global challenge in the fight for clean air: while human-caused pollution can be regulated, natural sources — like sand storms, wildfires and dust — cannot be legislated away.

In cities across the Middle East, North Africa and Central Asia, sand and desert dust storms regularly buffet buildings, cars and neighbourhoods. These natural phenomena generate millions of tons of particulate matter annually that can travel thousands of miles, with well-documented health consequences for millions.

Yet dust from desert sandstorms is only part of the picture, according to experts convened at the second World Health Organization Air Pollution and Health conference in Cartagena, Colombia, last week. 

Rapid urbanisation in regions like the Middle East is adding new pollutants to the mix — sulfur dioxide, black carbon and nitrogen dioxide from factories, vehicles and shipping — all with well-established links to health conditions. This toxic blend makes the region an emerging pollution hotspot, affecting millions in Cairo, Tripoli, and Abu Dhabi daily.

But how to protect human health, and where more research is needed on long-term exposure impacts in arid countries, remains up for debate. Progress has been complicated by the misconception — shared by Abu Dhabi’s taxi drivers — that poor air quality in desert regions is an unavoidable “natural” fact of desert life.

Protecting health from ‘natural’ emissions

Sand and dust storms force road and airport closures, dramatically reduce visibility, deteriorate buildings and halt solar energy production, leading concerns to typically center around visibility, said Dr Kenza Khomsi, Morocco’s coordinator at the UN Industrial Development Organization.

Yet sand and dust storms hurl tonnes of loose sediment into the air, creating a whirlwind of health effects for livestock, agriculture and people alike. These microscopic particles pick up toxic, man-made chemicals and allergens, worsen coughs, trigger wheezing, exacerbate respiratory infections, and contribute to serious lung and cardiovascular diseases.

“We know particulate matter is harmful,” Khomsi said. “Dust is never just dust.” 

Morocco sits at the nexus of atmospheric currents — the Sahara, Atlantic Ocean and Mediterranean Sea all converge around the country, making it especially vulnerable to sandstorms. Khomsi, who previously served as head of the climate and climate change department for Morocco’s meteorological administration, said the country has increased its number of air monitoring stations, but “the health part is not aligned.”

Though severe sandstorms occur only about 10% of the year in the Middle East, dust is continuously re-suspended and natural desert particles mix with human-made pollutants year-round, creating air quality challenges that persist even when sandstorms aren’t occurring.

Region-specific research

Satellite image shows a Saharan dust plume crossing the Atlantic from Africa’s coast towards Europe, reaching capitals from Berlin to London.

Dust from sandstorms can travel thousands of miles. In 2020, an abnormally strong Saharan dust storm crossed the Atlantic Ocean to deposit 182 million tons of dust across the US and the Caribbean. The resulting air quality was hazardous in Puerto Rico and other Caribbean islands.

Just last year, plumes of Saharan dust sailed over the Atlantic from Africa’s coast over Europe, turning the skies of cities like London orange in a weather phenomenon observed by millions.

Though experts convened in Colombia emphasized that air pollution from sand and dust storms, especially fine particulate matter, has been extensively researched, the Middle East and North Africa lacked region-specific studies.

Most of the research on sand and dust health impacts comes from “receptor” regions in Southern Europe, North America, and other places where Sahara and desert sand settles. Sand traveling thousands of miles is diluted, and the chemical composition can change as well, said Rami Alfarra, principal scientist at the Qatar Environment and Energy Research Institute.

But in “source” regions — where the sand and dust originate — “we’re just starting this research,” said Alfarra, whose home country of Qatar, alongside the rest of the Middle East and North Africa, has emerged as an air pollution “hotspot,” according to University of Chicago research.

No representatives from the Middle East or North Africa were present at the WHO conference. 

University of Chicago research estimates reducing fine particulate matter pollution in Qatar would increase life expectancy by over three years.

“Particulate matter in the Middle East is different from the Amazon which is different from Europe.” This distinction means that for regions with huge exceedances from dust storms, perhaps the WHO guidelines are not specific enough, according to Alfarra. “Those [guidelines] are based on particulate mass, instead of region, decomposition, and source. There’s no definitive answer yet if [particle] toxicity is from the mass or chemical composition.”

Alfarra proposed region-specific air quality guidelines “where we have weighted factors for source-specific emissions”- differentiating between dust and combustion, for example – to account for natural sources.

But the composition of the particles shouldn’t matter, argued Dr Jonathan Samet, an American pulmonary physician and epidemiologist who served as dean of the Colorado School of Public Health. For Samet, whose career has spanned decades of air pollution research, the threat of air pollution requires action.

“In this case, the precautionary principle can be applied,” Samet said, noting the scientific literature is robust enough on the harms of particles that can travel deep into the lungs, implicated in cardiovascular and respiratory diseases, along with lung cancer, asthma, and allergies. He argues that the lack of full scientific certainty about the specifics of air pollutants should not be used as a justification to postpone action. 

“There’s been discussion for decades about what aspects of particles make them toxic,” Samet said. “There are many things that make particles toxic – the size, shape, charge, nature of their surface – but in the end they’re all going to go down the airway.”

“To try to pin down exactly what makes it toxic is a spurious question now.” 

Sufficient evidence to decarbonize 

Sandstorm arrives in Nyala, Sudan.

Air quality in arid regions like the Middle East has continued to deteriorate in the past two decades, fueled by population growth and energy usage. Particulate matter pollution jumped 13% from 2021 to 2022, making the region’s air nearly four times more polluted than WHO guidelines recommend. 

Much of this increase comes from fossil fuel burning, not sand and dust storms. Nitrogen dioxide emissions – from transportation and industry in Egypt, Lebanon, Iraq, and Qatar have all increased since 2005, according to NASA satellite analysis.

If pollution levels were reduced to meet the WHO guideline, the 466.5 million residents of this region stand to gain 1.3 years in life expectancy, according to a report from the Air Quality Life Index from the University of Chicago.

And for a region producing 31% of global oil production, there is a clear leadership opportunity for energy-rich countries to drive decarbonization, asserts the Clean Air Task Force, a climate technology organization.

In Qatar, whose air ranks as one of the worst polluted in the world, “we don’t need any more research to regulate anthropogenic sources,” said Alfarra.

When nature fights back

Pollution from wildfire smoke has been linked to a significant increase in dementia risk.

Like desert regions contending with sandstorms, forest ecosystems face their own form of uncontrollable natural air pollution — wildfires.

Canada exemplifies this struggle against nature’s fury as the escalating impacts of the climate crisis raze forests around the world. While wildfires are a natural part of forest regeneration, their frequency and intensity have increased due to climate change.

Globally, wildfires have progressively burned larger portions of the world’s forests. These fires account for 33% of tree loss cover, compared to 20% in 2001, according to a World Resources Institute analysis.

Canada now battles approximately 8,000 wildfires annually, which consume more than 2.5 million hectares of forest. In 2023 alone, fires scorched an area equivalent to the size of England — representing 65% of global tree loss due to fires and releasing carbon dioxide equivalent to India’s annual fossil fuel emissions. The resulting smoke plumes, like desert dust, can travel thousands of miles to contaminate air in distant population centers.

“Seventeen percent of fine particulate matter in Canada — which can penetrate deep into the lungs and cause a host of health issues — is from wildfires,” said Dr Kathleen Buset, director of water and air quality at Health Canada. “That’s on par with emissions from cars, buses and trucks [combined].”

Unlike urban pollution sources that can be regulated, these forest fires often rage beyond human control. With finite sources to fight fires, many are left to burn in remote areas, she said. Canada cannot feasibly mobilize resources to extinguish all fires in its forests 15 times the size of the Great Lakes. Instead, the country has resorted to initiatives like satellite systems to monitor burns. 

“It’s an adaptation issue,” Buset added, highlighting a parallel to desert regions’ approach. When nature itself is the polluter, traditional regulatory tools become ineffective — cars, buses and factories can all be regulated, but the desert or a remote wildfire cannot.

For communities in both fire-prone and arid regions, adaptation takes similar forms: implementing better early warning systems to alert residents of poor air quality, mitigating re-suspension of dust after storms, and most critically, protecting indoor air quality.

“Eighty to 90 percent of our time is spent indoors,” noted Alfarra, adding that in the Middle East, that percentage can be even higher during the brutally hot summers.

This reality makes improved filtration systems, indoor air quality monitoring and public awareness campaigns essential components of any realistic solution. Buset emphasized the importance of “layered communication” — ensuring people check outdoor air quality conditions, limit time outdoors during hazardous periods and actively protect their indoor air environments.

Regulators can differentiate between car emissions and wildfire smoke, but really, “we breathe in everything,” said Alfarra.

Image Credits: WMO, Marc Szeglat/ Unsplash.

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

Public health experts and labour unions are seeking to overturn the mass cancellation of research grants by appointees of United States President Donald Trump at the US National Institutes of Health (NIH).

In legal papers filed on Wednesday, the complainants describe an “ ideological purge of hundreds of critical research projects” – supposedly because they have “some connection to ‘gender identity’ or ‘Diversity, Equity, and Inclusion’ (“DEI”) or other vague, now-forbidden language.”

But, they add, the action of the defendants – NIH Director Jay Bhattacharya and Health and Human Services Secretary Robert F Kennedy – against “peer-reviewed science has not stopped at topics deemed to be related to gender or DEI.” 

“The defendants’ ideological purity directives also seek to cancel research deemed related to ‘vaccine hesitancy,’ ‘COVID,’ and studies involving entities located in South Africa and China, among other things,” they note.

They also object to the NIH’s cancellation of initiatives “designed to diversify the backgrounds of those in tenure-track positions at research universities.”

Impact on complainants

The court action has been brought by the American Public Health Association, Ibis Reproductive Health, United Automobile, Aerospace and Agricultural Implement Workers (UAW), which all represent members who have lost grants and jobs.

 Researchers Brittany Charlton, Katie Edwards, Dr Peter Lurie and Nicole Maphis are also complainants.

Charlton, a professor at Harvard Medical School, is the founding Director of the university’s LGBTQ Health Center of Excellence. She has lost five NIH grants worth over $9 million, had to lay off 18 staff and lost most of her salary.

Edwards, a professor at the University of Michigan School of Social Work, has lost $11.9 million of grant money for research on preventing sexual and related forms of violence amongst minority communities. She has to retrench 50 staff.

Lurie, executive director of the Center for Science in the Public Interest, has lost funding for research on HIV prevention.

Maphis, a postdoctoral fellow at the University of New Mexico’s School of Medicine, had her research grant on the link between alcohol and Alzheimer’s disease cancelled solely because it was aimed at diversifying the science profession. She is the first person in her family to attend college.

The NIH is the largest funder of biomedical research in the world, with an operating budget of $48 billion as allocated by the US Congress. It provides almost 50,000 competitive grants to more than 300,000 researchers at more than 2,500 universities, medical schools, and other research institutions in every state.

‘Unlawful and unconstitutional’

The complainants argue that the NIH’s action violates the Administrative Procedure Act in five different ways, including that it is arbitrary and capricious and exceeds its statutory authority as well as violating the separation of powers.

It wants the court to declare the NIH’s directives on grant terminations from 28 February to be “unlawful and unconstitutional”, and for the grants to be restored.


Aside from the grant cancellations, the directors of four of the NIH’s 27 institutes have been removed, including the country’s top infectious diseases official, reports Nature.

Jeanne Marrazzo of the National Institute of Allergy and Infectious Diseases (NIAID), Diana Bianchi of the National Institute of Child Health and Human Development (NICHD), Eliseo Pérez-Stable of the National Institute on Minority Health and Health Disparities (NIMHD) and Shannon Zenk of the National Institute of Nursing Research (NINR) were placed on administrative leave on 31 March. 

Only the NIH head is usually removed by an incoming president. Pérez-Stable, for example, has served three different presidents over his tenure.

“This will go down as one of the darkest days in modern scientific history in my 50 years in the business,” says Dr Michael Osterholm, an infectious-diseases epidemiologist at the University of Minnesota. “These are going to be huge losses to the research community.”

The gutting of the NIH follows mass firings of HHS staff last month, with around 10,000 people losing their jobs.

Image Credits: NIH.

INB co-chairs Anne-Claire Amprou and Precious Matsoso

On the eve of the final round of pandemic agreement negotiations ahead of the World Health Assembly (WHA), 30 legal experts have cautioned against using “voluntary” to describe technology transfer.

The latest draft of the pandemic agreement (text agreed by end of 21 February) states that technology transfer for the production of pandemic-related health products shall be on “mutually agreed terms” in a yet-to-be-agreed  footnote in Article 11. 

This inherently implies that it is voluntary, the experts state in a letter sent to the co-chairs of the World Health Organization (WHO) Intergovernmental Negotiating Body (INB) on Wednesday.

But if the agreement also describes tech transfer as “voluntary”, this will undermine member states’ “sovereign right … to implement legislation within their jurisdiction, and equity in pandemic preparedness and response”, according to the experts, who hail mostly from law departments of global universities.

“By insisting on manufacturers only coming to the negotiating table voluntarily, States Parties are limiting their options for facilitating or otherwise incentivising technology transfer, and for taking non-voluntary measures even where their domestic laws do or would provide for them,” they note.

Domestic non-voluntary measures

Several countries have laws allowing non-voluntary measures under exceptional circumstances, including the United States Defense Production Act, and Germany’s 2020 Act on the Protection of the Population in Case of an Epidemic Situation of National Significance, passed during COVID-19.

Insisting solely on voluntary measures will “defeat two principles that guide the Pandemic Agreement’s core objective: respect for the sovereign right of States to implement legislation within their jurisdiction, and equity in pandemic preparedness and response”, they note.

“The challenge during the COVID-19 pandemic was that manufacturers had little incentive to do transfer technology. By enshrining technology transfer as ‘voluntary,’ the pandemic agreement would codify an approach that has failed,” they note.

Article 11 is one of the few clauses where substantial disagreement exists, with Germany in particularly digging its heels in about the use of “voluntary tech transfer”.

“Among the European Union countries, it seems that Germany is taking a hard line and continues to insist on adding the term ‘voluntary’ in addition to ‘mutually agreed terms and conditions’,” according to Ellen ‘t Hoen, one of the signatories. 

“This raises eyebrows because Germany recognised, early in the Covid-19 pandemic, that it needed to amend its legislation to enable effective use of compulsory measures,” added ‘t Hoen, who heads Medicines Law & Policy based in Europe.

Another signatory, Nina Schwalbe from the O’Neill Institute for National & Global Health Law at Georgetown University in the US, notes that United Nations agreements on global health challenges “define tech transfer as occurring on mutually agreed terms—without specifying that it must be voluntary”.

‘The bottom line is that adding ‘voluntary’ is unnecessary and could weaken governments’ ability to act in future pandemics. Keeping the language as is ensures flexibility while upholding sovereign rights and equity in pandemic response,” says Schwalbe.

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has stated several times to the INB that “respect of intellectual property in pandemic times, support for tech transfer on voluntary and mutually agreed terms, the strengthening of regulatory agility and harmonization, and the removal of trade restrictions” are key to “to harness and leverage industry’s expertise”.

Article 12 on Pathogen Access and Benefit-Sharing System (PABS) is the other key area lacking in agreement. This article covers one of the most substantial parts of the agreement: that each manufacturer that is part of the PABS system will make 20% of their pandemic-related vaccines, therapeutics and diagnostics available to the WHO, with at least 10% as a donation.

‘Get it done’

The INB convenes from 7-11 April – next Monday to Friday – for the last time before the May WHA.  There is widespread acknowledgement that momentum and political will is likely to trickle rapidly away should negotiators fail to conclude an agreement to present to the Assembly.

The Pandemic Action Network and allies urged negotiators to “get it done” in a statement on Tuesday.

“New and resurging infectious diseases with pandemic potential threaten our collective health as our world becomes more fractured,” they note

“As currently drafted, the pandemic agreement secures important gains, including on research and development, equitable access to pandemic countermeasures, and a One Health approach to pandemic threats.

“While not all policy goals have been achieved, this potentially historic agreement lays essential groundwork for equitable, collective preparedness and response now and can be strengthened through additional protocols in the future. We urge Member States to stay laser focused on the end-goal, and find room to give-and-take to reach agreement.”

Candida auris is a multi-drug-resistant fungus

There is a “critical lack” of medicines and diagnostic tools for invasive fungal diseases, according to the World Health Organization (WHO), which released its first analysis of antifungals on Tuesday.

Invasive fungal diseases are on the rise, particularly in immune-compromised people – yet they get little attention or resources, asserts the global body.

Common infections such as candida (which causes oral and vaginal thrush) are growing increasingly resistant to treatment, but there are not enough medicines in the pipeline to combat this.

Several current anti-fungal treatments cause serious side effects, frequent drug-drug interactions, and treatment requires prolonged hospital stays. 

“Invasive fungal infections threaten the lives of the most vulnerable but countries lack the treatments needed to save lives,” said Dr Yukiko Nakatani, WHO interim Assistant Director-General for Antimicrobial Resistance. 

“Not only is the pipeline of new antifungal drugs and diagnostics insufficient, but there is a void in fungal testing in low- and middle-income countries, even in district hospitals,” added Nakatani.

“This diagnostic gap means the cause of people’s suffering remains unknown, making it difficult to get them the right treatments.”

Only four new drugs in a decade

In the past decade, only four new antifungal drugs have been approved by regulatory authorities across the United States, the European Union and China. 

Nine antifungal medicines are in clinical development against the most health-threatening fungi identified in the WHO’s fungal priority pathogens list (FPPL), according to the WHO analysis, which conducted a rigorous evaluation of antifungal agents in clinical and preclinical development with the assistance of an expert advisory group on the R&D of novel antifungal treatments.

Only three of the nine are in phase 3 trials, which means “few approvals are expected within the next decade”, according to the WHO. 

“Children are particularly underserved with few clinical trials exploring paediatric dosing and age-appropriate formulations,” the global body notes.

Critical priority pathogens

Many of the fungi in the critical priority pathogen (CPP) category of the WHO’s FPPL are deadly, with mortality rates reaching as high as 88%.

This critical group includes Cryptococcus neoformans (which causes cryptococcal meningitis); Candida auris (causes infections, including in wounds and blood); Aspergillus fumigatus (causes aspergillosis, a lung infection) and Candida albicans (thrush). 

These infections disproportionately affect those with weakened immune systems, including people undergoing cancer chemotherapy, living with HIV, and who have had organ transplants.

Candida auris is particularly drug-resistant and often acquired by vulnerable people in hospitals.

The nine new antifungals all target the critical group – and most target more than one of these fungal infections. 

Aspergillus fumigatus is targeted by the highest number of antifungal candidates, followed by Candida albicans and Candida auris. Cryptococcus neoformans gets the least attention.

There are 22 drugs in pre-clinical development, but this is “insufficient” given the dropout rates, risks and challenges associated with earlier development stages, says the WHO.

Antifungal drugs preclinical pipeline

Diagnostic challenges

Current tests for fungal priority pathogens “rely on well-equipped laboratories and trained staff, which means that most people in low- and middle-income countries (LMICs) do not benefit from them”, according to the WHO’s diagnostics analysis. 

In addition, these tests “work only for a limited range of fungi, are insufficiently accurate and take a long time to obtain results”. Health workers often lack knowledge about fungal infections.

WHO recommends investing in global surveillance, expanding financial incentives for drug discovery and development, funding basic research to help identify new and unexploited targets on fungi for medicines, and investigating treatments that work by enhancing patients’ immune responses.

It also urges the development of “faster, more accurate, cheaper and easier” tests for a broad range of fungal priority pathogens.

Image Credits: Science Media Centre, WHO.

air pollution quilt
Air pollution impacts the most vulnerable, including children showcased in a quilt from the Indian advocacy group Warrior Moms.

From Warsaw to Mexicali, a group of mothers from six cities worldwide came together to create and present a quilt highlighting the threat of dirty air to their children at the World Health Organization (WHO) Conference on Air Pollution and Health held in Cartagena, Colombia last week.

Each block of the quilt tells the story of a child suffering from the harmful effects of poor air quality, highlighting the devastating impact of pollution on children’s health in Warsaw (Poland), Quito (Ecuador), Jharia (India), Akim Wenchi (Ghana), Mpumalanga (South Africa) and Mexicali (Mexico).

The idea of a quilt surfaced a couple of months before the 2021 climate change conference, COP26, within the Indian movement, Warrior Moms. They wanted it to carry the faces of children from across India and intertwine their stories of pollution, representing at least one city from each state. 

Logistical challenges prevented the project from taking off in time for COP26, but  a few months ago, as a new global delegation of mothers called ‘The Clean Circle’ was taking shape, the idea resurfaced.

Warrior Moms, founded by Bhavreen Kandhari, reignited the project weeks ahead of WHO’s Air Pollution and Health conference. 

After meetings that lasted until midnight meetings, a proposal was put to WHO, which enthusiastically embraced and encouraged the initiative.

Kandhari, the mother of twins, has been at the forefront of the fight for clean air to ensure a better life for future generations.

“Air pollution is a child killer, accounting for one in five deaths of children under five. The ‘Quilt of Hope’ is a living testimony to the urgency of the air pollution crisis, calling on political leaders to safeguard our children’s future,” Kandhari said.

Six regions, one health challenge

This time, the logistics were meticulously planned. Sustainability remained at the heart of the project, with upcycled fabrics forming the quilt’s foundation. 

Small fabric samples were exchanged, tested, and reworked. But beyond materials and design, the real challenge for these mothers was to find artisans who would stitch this powerful symbol with the care and reverence it deserved. 

That’s when the craftswomen ‘Shades of India’, stepped in and pieced together – not just fabric, but stories, hope and resilience with skills and unwavering dedication. 

The process of gathering these images faced numerous challenges. The resolution of photos varied, making it difficult to ensure uniformity in print. 

In Jharia, where pollution from coal fires darkens the skies, finding high-quality images was especially tough. But photographer Vishal Singh captured striking images of the children, ensuring that their stories were not just seen but felt by every individual.

While the quilt features stories from six different regions, the health consequences of air pollution remain tragically similar: bronchitis, asthma, and other respiratory illnesses.

Ana Badillo, the mother of a five-year-old child, said that she put her child’s image on the quilt to show that the air pollution crisis is real, personal, and urgent.

“As a mother, I watch my child breathing toxic air in a city that should be full of life, not smog. Quito’s air is stealing our children’s health and their futures. Clean air is not a privilege, it is their right. We want leaders to feel this concern of mothers across the globe,” Badillo said. 

Asthma and developmental delays

The top left section of the quilt depicts a mother with her two children, one of whom is wearing an oxygen mask in Mpumalanga in South Africa, a region where coal-fired power plants release some of the highest levels of sulphur dioxide in the world, contributing to rising cases of asthma and developmental delays in children.

The story of a 12-year-old boy, Suresh, from Jharia, India, is highlighted in the top left corner. Suffering from chronic bronchitis since childhood due to underground coal fires in his region, Suresh’s experience is a stark reminder of the long-term health effects of air pollution.

The centre of the quilt showcases narratives from Mexico and Ghana, representing worsening asthma attacks and limited access to healthcare.

In Warsaw, Poland, smog from vehicle emissions and coal heating during winter fills the air, forcing children like Maciek, whose image appears in the bottom right corner, to carry an inhaler just to get through the school day. The seven-year-old has been struggling with bronchial hyperreactivity for the past year.

The last image from Quito, Ecuador, shows a five-year-old child wearing a mask and holding a banner.

 A call to action

Each panel in the ‘Quilt of Hope’ is not just fabric, it holds the emotions, struggles, and resilience of mothers who, despite living continents apart, are united by the same fight for their children’s right to breathe clean air. It is a testament to sustainability, craftsmanship, and resilience.

According to the delegation of mothers, the Quilt for Hope was not just a display at the WHO Conference in Cartagena, it was a call to action.

“As policymakers, scientists, and health professionals gathered to discuss the urgent need for cleaner air, the quilt serves as a tangible reminder that, behind every statistic, there is a child struggling to breathe,” the mothers said.

 

Image Credits: A. Bose/ HPW.

Over 2,600 people are now reported to have died in the two powerful earthquakes that devastated central Myanmar last Friday, while thousands have been injured or are missing, trapped under the rubble.

The 7.7- and 6.4 strength quakes hit regions of Mandalay, Nay Pyi Taw, Sagaing, Bago, and Shan regions, which are also where most of the almost 20 million people displaced by conflict have been living.

Thailand’s capital, Bangkok, was also affected with 17 people reported dead, while in Ruili city, in China’s southeastern Yunnan province, 2,840 people have also been affected and 847 houses have been damaged.

The World Health Organization (WHO) is “responding at its highest level of emergency activation”, but the cash-strapped global body has appealed for donations, as it needs $8 million to “deliver life-saving trauma care, prevent disease outbreaks, and restore essential health services over the next 30 days”.

Three hospitals have been destroyed and 22 have been partially damaged in the country, according to the WHO.

“Hospitals are overwhelmed with thousands of injured in need of medical care. There is a huge need for trauma and surgical care, blood transfusion supplies, anaesthetics, essential medicines, management of mass causality, safe water and sanitation, mental health and psychosocial support among others,” reported WHO.

UNICEF has also called for “urgent funding to scale up the delivery of life-saving support to children and families affected by the earthquake, including clean water, medical care, protection, psychosocial support, and emergency education”.

Myanmar has been controlled by a military junta since 2021, and foreign media are not allowed into the country. 

Meanwhile, China, Russia, India, Thailand, Malaysia and Vietnam have sent aid to the country – but the United States, which has dismantled its Agency for International Development (USAID) has not yet responded, according to the New York Times.

Some staff were preparing a response on Friday rwhen the received layoff notices, the newspaper added.

Myanmar, which has been controlled by a military junta since 2021, has reportedly refused to allow foreign media into the country to cover the earthquake.

However, Myanmar miliary leader Min Aung Hlaing issued a rare “open invitation to any organizations and nations willing to come and help the people in need within our country,” after the quakes – an indication of the severity of the disaster.

Image Credits: UNICEF.

As the World Health Organization (WHO) grapples with an estimated $600 million funding gap for 2025, it is planning to slash its biennial 2026-27 budget by 21% from $5.3 billion to $4.2 billion, according to an email Friday from Director General Dr Tedros Adhanom Ghebreyesus, obtained by Health Policy Watch.

But despite the DG’s promises that the WHO “Staff Association will play an active role”, critical decisions about workforce reductions, budget allocations, and organizational restructuring are being made behind closed doors so far.

The Staff Association, representing WHO’s 9,473 staff members worldwide including 2,666 in headquarters, has had no real access to the data underpinning critical choices that must be made over how and where to cut the budget. 

“This is not just about numbers – it’s about trust,” said one senior staff member. “We were promised transformation with people at the center. What we’re seeing now feels like a rollback of everything we fought for.”

In his recent message to staff, Tedros promised that the restructuring, however tough, will also be conducted “with fairness, transparency, and humanity.”

 “Despite our best efforts, we are now at the point where we have no choice but to reduce the scale of our work and workforce,” he said. “This reduction will begin at headquarters, starting with senior leadership, but will affect all levels and regions.”

Key information about costs, organigram remain unpublished  

According to an internal briefing presented to member states last week, and seen by Health Policy Watch, WHO is weighing a series of measures to cope with the financial shock that include:

  • A 20% average budget cut across all base programmes
  • The elimination of over 40% of current outputs – eg. products that are typically part of the World Health Assembly 
  • A 25% reduction in staff positions
  • The merging of entire divisions, departments, and units
  • Relocation of functions away from Geneva to regional and country offices.
Budget projection from the internal briefing presented to member states.

These are hard, necessary decisions. But without access to information about current costs and staff positions, it ia almost impossible for either member states or staff members to play an active role in reviewing priorities or plans. The most glaring omissions include items such as:  

  • A current organigram of staff and management distribution: the most recent one is from 2019 when WHO’s initial “transformation” process, intended to make the organization more efficient and fit-for-purpose, was launched by Tedros shortly after he first assumed office.  Despite multiple ad hoc changes since, the only organisational mapping current to 2025 is of divisions and their department heads at headquarters. 
  • Costs of staff positions by grade and region: real costs vary wildly from published salaries due to multiple layers of post adjustments, entitlements and agency contributions to pension and insurance funds.
  • Costs of consultancies along with more granular data about the number of full-time-equivalent consultants per region.

Also critical to consider are the savings that could be gained from other big-ticket items such as moving key tasks and staff to regional or country offices, 

But along with the resistance to “mobility plans” by staff at headquarters, there is also fierce debate within the organization about what tasks could be most effectively relocated, and what core functions (eg WHO standards and guidelines development) would best be retained at headquarters. Irrespective of which way the debate ends, keeping key HQ normative functions can still be retained if relevant staff are moved to less expensive duty stations, 

Certain technical support functions, such as IT support, could feasibly also be moved to much cheaper European locations, such as Lyon and Istanbul. More digitized administrative processes could also save administrative costs and staff. 

Directors without portfolios?

Sources: Appendix 1 to WHO staff rules 2024, effective as of January 2023, EB 2023 Salaries of Ungraded Positions and 31 July 2024 HR update: Estimates are based on costs of a D2 at Step VI and a D1/P6 at Step X of the published salary scale.

In an exclusive, Health Policy Watch documented the top-heavy structure of WHO’s senior leadership that has evolved, unbeknownst to most since 2017. Over the past eight years, the number of senior directors (D2) has nearly doubled, and the total cost of directors at both D1 and D2 grades, plus WHO’s senior leadership (ADGs and Regional Directors) are now costing the organization close to $100 million annually.

In terms of a top-heavy senior management, WHO insiders also point to the uneven distribution of tasks between different directors and the large teams associated with every Assistant Director General as potential areas for efficiencies.

While some directors manage large departments of dozens of people, others manage teams that include only a handful of staff or may not actively manage teams or departments at all, insiders report.  

“When we began looking at the directors in our region, we found that two D2s had been appointed for six-month contracts without any clarity about their roles,” said one senior scientist working in a regional office. 

Another issue emerging is the entourage of staff around each of the 10 Assistant Director Generals serving on Tedros’ leadership team in headquarters, not to mention the Deputy Director General and the office of the Director General. 

It is estimated that each ADG is managing a team of 6-7 people – which together with the ADG’s own post. But even an ADG plus a team of just 4-5 people, will  cost the organization an estimated $1.5 million, as a conservative figure, considering an average cost of $250,ooo per position for a team including senior advisors and professionals along with administrative staff.  Again, since no organigram or published costs of staff posts exists, only estimates can be made.   

The March Health Policy Watch investigation also revealed that consultants now make up over half of WHO’s workforce – 7,579 posts in comparison to the 9,473 staff. That is a precarious and costly staffing model in light of the administrative management requirements of consultancy contracts.  

Can’t continue to operate like a think tank

Sources: WHO bi-annual HR reports, and UN salary scales, in comparison to proportion of costs attributable to entitlements and benefits. Note: Costs of P6 positions, while comparable to D1, are included in the P- category, not D category.

“WHO cannot continue to operate as if it were a luxury think tank,” one anonymous official told Health Policy Watch. “We need boots on the ground not bloated bureaucracy in headquarters.”

The situation has led many to ask: If WHO is indeed undergoing a prioritization process, why are all divisions still fighting to preserve their full portfolios? Why have no clear de-prioritizations been communicated? 

In a climate where transparency is a necessity, the apparent sidelining of frontline voices adds to a growing anxiety about how this restructuring will unfold.

A WHO Global Town Hall is scheduled for Tuesday, April 1, where senior leadership is expected to provide further clarity to staff. But for now, trust is fraying and WHO stands at a crossroads: either double down on the values of its 2019 transformation—or risk losing the confidence of the very people it relies on to carry out its mission.

 

Image Credits: US Mission in Geneva / Eric Bridiers via Flickr, WHO, WHO HR and EB records, 2023-2024.